Janssens J P, Gauthey L, Herrmann F, Tkatch L, Michel J P
Institutions Universitaires de Geriatrie, Geneva, Switzerland.
J Am Geriatr Soc. 1996 May;44(5):539-44. doi: 10.1111/j.1532-5415.1996.tb01439.x.
To document the prevalence of Legionella sp., Mycoplasma Pneumoniae and Influenza A and B in older patients hospitalized for community-acquired pneumonia (CAP) of nursing-home acquired pneumonia (NHAP) and to determine risk factors associated with fatal outcome or prolonged hospital stay.
Prospective clinical and serological study.
All patients with CAP of NHAP--confirmed by chest roentgenogram--admitted to a 320-bed acute care geriatric university hospital from May 1, 1988 to August 31, 1989, were included. Serological testing was performed upon admission and after 2 and 4 weeks. Relevant data concerning medical history, clinical examination, and laboratory data were recorded upon admission. Ninety-nine patients (age: 85 +/- 6.3 years, 36 male, 63 female) met inclusion criteria; 20 came from nursing homes, 79 from their homes in the community.
Fourteen patients died during the month after admission. An etiological diagnosis could be established in 22 patients. No cases of Legionella pneumonia and one case of M. pneumoniae were detected. Seven patients had evidence of Influenza pneumonia. Nonsurvivors were more likely to have been admitted from a nursing home and to have a temperature less than 37.5 degrees C and elevated urea nitrogen (BUN). Cyanosis, involvement of upper lobes, elevated white blood cell counts, and higher percentage of band forms were associated statistically with longer treatment.
This study confirms the low prevalence of Legionella sp. and M. Pneumoniae infection in CAP and NHAP in this age group. Risk factors as to outcome and length of treatment may be used as points to identify high risk patients, with special attention to patients coming from nursing homes, and patients with high BUN.
记录因社区获得性肺炎（CAP）或养老院获得性肺炎（NHAP）住院的老年患者中军团菌属、肺炎支原体及甲型和乙型流感病毒的感染率，并确定与致命结局或延长住院时间相关的危险因素。
前瞻性临床和血清学研究。
纳入1988年5月1日至1989年8月31日入住一家拥有320张床位的急性护理老年大学医院、经胸部X线片确诊为CAP或NHAP的所有患者。入院时、入院后2周和4周进行血清学检测。入院时记录有关病史、临床检查和实验室数据的相关资料。99例患者（年龄：85±6.3岁，男性36例，女性63例）符合纳入标准；20例来自养老院，79例来自社区家中。
14例患者在入院后1个月内死亡。22例患者可明确病因诊断。未检测到军团菌肺炎病例，仅1例肺炎支原体感染病例。7例患者有流感肺炎证据。非幸存者更可能来自养老院，体温低于37.5℃且尿素氮（BUN）升高。发绀、上叶受累、白细胞计数升高及杆状核细胞百分比更高与治疗时间延长有统计学关联。
本研究证实该年龄组CAP和NHAP中军团菌属和肺炎支原体感染率较低。作为结局和治疗时长的危险因素可用于识别高危患者，尤其要关注来自养老院的患者及BUN升高的患者。
