Ewig S, Bauer T, Hasper E, Marklein G, Kubini R, Lüderitz B
Department of Medicine, University of Bonn, Germany.
Respiration. 1996;63(3):164-9. doi: 10.1159/000196538.
The study was conducted at a tertiary care and teaching hospital with about 200 beds for internal medicine. The objective was to determine the diagnostic yield and value in directing antibiotic therapy of a routine microbial approach in patients with community-acquired pneumonia referred to a tertiary care center. We studied 93 episodes in a retrospective study. 69/93 (74%) cases were treated with at least one empirical antibiotic therapy prior to admission. Microbial investigation was performed in 83/93 cases (89%). An etiological agent was established in 19/83 (23%) cases including 7/50 (14%) by blood culture and 12/52 (23%) by serology. Bronchoscopy with 18 protected specimen brush and 20 bronchoalveolar lavage examinations was definitely diagnostic in only 1/25 (4%) cases, and this case was also identified by blood culture. 5/25 (20%) were probably diagnostic. Three pathogens, Streptococcus pneumoniae, Mycoplasma pneumoniae and Legionella pneumophila, accounted for 15/19 (79%) of the identified agents. The diagnostic results directed a change in antibiotic therapy in 6/19 (32%) of cases with definitely proven pathogens. 4/19 (21%) of cases would have been treated with an inappropriate regimen without diagnostic results. The diagnostic yield of routine microbial investigation in pretreated patients is low. The routine approach reveals its limited value especially in patients with severe courses. The role of bronchoscopy remains to be defined for patients with severe (and pretreated) community-acquired pneumonia.
该研究在一家拥有约200张内科床位的三级医疗教学医院进行。目的是确定在转诊至三级医疗中心的社区获得性肺炎患者中，常规微生物检测方法在指导抗生素治疗方面的诊断率和价值。我们通过一项回顾性研究对93例病例进行了研究。69/93（74%）的病例在入院前接受了至少一种经验性抗生素治疗。83/93（89%）的病例进行了微生物检测。19/83（23%）的病例确定了病原体，其中血培养确定7/50（14%），血清学确定12/52（23%）。25例患者进行了18次保护性标本刷检和20次支气管肺泡灌洗检查，只有1/25（4%）的病例通过支气管镜检查明确诊断，且该病例也通过血培养确诊。5/25（20%）的病例可能诊断。三种病原体，肺炎链球菌、肺炎支原体和嗜肺军团菌，占已确定病原体的15/19（79%）。确诊病原体的病例中，6/19（32%）的病例根据诊断结果改变了抗生素治疗方案。4/19（21%）的病例若没有诊断结果，将会接受不恰当的治疗方案。预处理患者常规微生物检测的诊断率较低。常规方法显示其价值有限，尤其是在病程严重的患者中。对于重症（且经过预处理）社区获得性肺炎患者，支气管镜检查的作用仍有待确定。
