Marrie T J, Haldane E V, Faulkner R S, Durant H, Kwan C
J Am Geriatr Soc. 1985 Oct;33(10):671-80. doi: 10.1111/j.1532-5415.1985.tb01775.x.
The authors studied 138 patients, 57 of whom were younger than 65 years of age and 81 who were 65 years of age and older, with community-acquired pneumonia to determine whether or not such pneumonia is different in the elderly and to define how such patients are investigated and treated. Pneumonia in the elderly was characterized by a higher mortality, 30 v 10%; more likely to be of unknown etiology, 54 v 30%; and more likely to show radiographic progression after the patient had been admitted to the hospital, 48 v 11%. In addition, elderly patients were more likely to be afebrile when admitted, 57 v 26%. Twenty-seven etiologic categories were present in 77 patients in whom a cause for the pneumonia was established. Streptococcus pneumoniae accounted for 9.4% of the pneumonia overall and for 27% of the pneumonia among patients who had sputum cultures performed before antibiotic therapy. The diagnostic yield was 11.6% for blood cultures, 38.2% for sputum cultures, 2.3% for throat washing, and 22.1% for serological studies. Twenty-seven percent of patients were receiving antibiotics of the time of admission to the hospital. Most (79%) received more than one antibiotic after admission. This study indicates that community-acquired pneumonia is a serious illness and that an algorithm approach to diagnosis and treatment of such pneumonia is necessary.
作者对138例社区获得性肺炎患者进行了研究，其中57例年龄小于65岁，81例年龄在65岁及以上，以确定老年患者的此类肺炎是否有所不同，并明确对此类患者如何进行检查和治疗。老年肺炎的特点是死亡率较高，分别为30%和10%；病因不明的可能性更大，分别为54%和30%；患者入院后影像学进展的可能性更大，分别为48%和11%。此外，老年患者入院时无发热的可能性更大，分别为57%和26%。在77例确定了肺炎病因的患者中，存在27种病因分类。肺炎链球菌占总体肺炎的9.4%，在抗生素治疗前进行痰培养的患者中占肺炎的27%。血培养的诊断阳性率为11.6%，痰培养为38.2%，咽拭子培养为2.3%，血清学检查为22.1%。27%的患者在入院时正在接受抗生素治疗。大多数患者（79%）在入院后接受了不止一种抗生素治疗。这项研究表明，社区获得性肺炎是一种严重疾病，对这种肺炎采用算法方法进行诊断和治疗是必要的。
