Marston B J, Plouffe J F, File T M, Hackman B A, Salstrom S J, Lipman H B, Kolczak M S, Breiman R F
Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC, Atlanta, Ga 30303, USA.
Arch Intern Med. 1997;157(15):1709-18.
Pneumonia is the leading cause of death due to infectious diseases in the United States; however, the incidence of most infections causing community-acquired pneumonia in adults is not well defined.
We evaluated all adults, residing in 2 counties in Ohio, who were hospitalized in 1991 because of community-acquired pneumonia. Information about risk factors, symptoms, and outcome was collected through interview and medical chart review. Serum samples were collected from consenting individuals during the acute and convalescent phases, and specific etiologic diagnoses were assigned based on results of bacteriologic and immunologic tests.
The incidence of community-acquired pneumonia requiring hospitalization in the study counties in 1991 was 266.8 per 100,000 population; the overall case-fatality rate was 8.8%. Pneumonia incidence was higher among blacks than whites (337.7/100,000 vs 253.9/ 100,000; P < .001), was higher among males than females (291.4 vs 244.8; P < .001), and increased with age (91.6/100,000 for persons aged < 45 years, 277.2/ 100,000 for persons aged 45-64 years, and 1012.3/ 100,000 for persons aged > or = 65 years; P < .001). Extrapolation from study incidence data showed the projected annual number of cases of community-acquired pneumonia requiring hospitalization in the United States to be 485,000. These data provide previously unavailable estimates of the annual number of cases that are due to Legionella species (8000-18,000), Mycoplasma pneumoniae (18,700-108,000), and Chlamydia pneumoniae (5890-49,700).
These data provide information about the importance of community-acquired pneumonia and the relative and overall impact of specific causes of pneumonia. The study provides a basis for choosing optimal empiric pneumonia therapy, and allows interventions for prevention of pneumonia to be targeted at groups at greatest risk for serious illness and death.
在美国，肺炎是感染性疾病导致死亡的首要原因；然而，大多数引起成人社区获得性肺炎的感染发病率尚不明确。
我们评估了1991年因社区获得性肺炎在俄亥俄州两个县住院的所有成年人。通过访谈和查阅病历收集有关危险因素、症状及转归的信息。在急性期和恢复期从同意参与的个体采集血清样本，并根据细菌学和免疫学检测结果做出特定的病因诊断。
1991年研究所在县需住院治疗的社区获得性肺炎发病率为每10万人266.8例；总体病死率为8.8%。黑人的肺炎发病率高于白人（337.7/10万对253.9/10万；P<.001），男性高于女性（291.4对244.8；P<.001），且随年龄增长而升高（<45岁者为91.6/10万，45 - 64岁者为277.2/10万，≥65岁者为1012.3/10万；P<.001）。根据研究发病率数据推断，美国每年需住院治疗的社区获得性肺炎病例数预计为48.5万例。这些数据提供了此前无法获得的关于每年因军团菌属（8000 - 18000例）、肺炎支原体（18700 - 108000例）和肺炎衣原体（5890 - 49700例）导致的病例数估计。
这些数据提供了有关社区获得性肺炎的重要性以及肺炎特定病因的相对和总体影响的信息。该研究为选择最佳经验性肺炎治疗方法提供依据，并使肺炎预防干预措施能够针对发生严重疾病和死亡风险最高的人群。
