Cosentini R, Blasi F, Raccanelli R, Rossi S, Arosio C, Tarsia P, Randazzo A, Allegra L
Department of Emergency Medicine, Ospedale Maggiore, Milano, Italy.
Respiration. 1996;63(2):61-5. doi: 10.1159/000196519.
Between July 1992 and June 1993, 61 patients with severe community-acquired pneumonia were admitted to our semi-intensive care unit. For all patients chest X-ray, blood gas analysis while breathing room air, Gram stain and culture of bronchoaspirate, determination of acute and convalescent anti-body titers for Legionella pneumophila, Mycoplasma pneumoniae and Chlamydia pneumoniae, blood culture when body temperature was greater than 38 degrees C, and pharyngeal swab for C. pneumoniae detection by means of an indirect immunofluorescence test were obtained. Among the patients enrolled, 15 suffered from chronic obstructive pulmonary disease, 18 had serious chronic diseases, 9 were immunodeficient and 15 had cardiovascular diseases, and only 4 had no underlying disease. Etiologic diagnosis was reached in 30 cases (49%). As expected, due to the high rate of seriously ill patients, gram-negative pathogens were identified most commonly (15%), followed by Streptococcus pneumoniae (10%) and, surprisingly, by C. pneumoniae (10%). These data, showing the possible emergence of Pseudomonas aeruginosa and C. pneumoniae, warrant further studies in order to verify whether the epidemiological pattern of severe community-acquired pneumonia is actually changing.
1992年7月至1993年6月期间，61例重症社区获得性肺炎患者入住我们的半重症监护病房。对所有患者均进行了胸部X光检查、呼吸室内空气时的血气分析、支气管吸出物的革兰氏染色和培养、嗜肺军团菌、肺炎支原体和肺炎衣原体急性期和恢复期抗体滴度的测定、体温高于38摄氏度时的血培养以及通过间接免疫荧光试验检测肺炎衣原体的咽拭子检查。在纳入的患者中，15例患有慢性阻塞性肺疾病，18例患有严重慢性病，9例免疫功能低下，15例患有心血管疾病，只有4例无基础疾病。30例（49%）患者获得了病因诊断。不出所料，由于重症患者比例较高，最常见的病原体为革兰氏阴性菌（15%），其次是肺炎链球菌（10%），令人惊讶的是，肺炎衣原体也占10%。这些数据显示了铜绿假单胞菌和肺炎衣原体可能出现，有必要进一步研究以验证重症社区获得性肺炎的流行病学模式是否真的在发生变化。
