Watanakunakorn C, Bailey T A
Department of Internal Medicine, St Elizabeth Health Center, Youngstown, Ohio, USA.
Arch Intern Med. 1997 Sep 22;157(17):1965-71.
To review the clinical and laboratory findings of 108 adult patients with bacteremic pneumococcal pneumonia admitted to a community hospital and to determine the value of sputum Gram stains and cultures in the diagnosis of pneumococcal pneumonia in this setting.
Using the laboratory logbooks to identify adult inpatients with pneumococcal bacteremia from January 1, 1992, to June 30, 1996, were reviewed medical records.
We found 108 patients. There was an apparent increase in prevalence from 1995 to 1996 compared with 1992 to 1994. Patients included 44 men and 64 women. Ages ranged from 20 to 95 years (median, 70 years). The fatality rate was 24.1% and increased with advancing age (no patient younger than 45 years died, and 36.8% of patients aged 85-95 years died). Cigarette smoking, cardiovascular disease, chronic obstructive lung disease, malignant disease, and diabetes mellitus were major underlying conditions. Fever, dyspnea, and cough were the most common presenting symptoms. Sputum Gram stain was useful in the diagnosis when moderate to abundant Gram-positive diplococci were seen. Sputum culture was less useful. Factors associated with higher fatality rate were being 65 years of age or older, APACHE II (Acute Physiologic and Chronic Health Evaluation II) score greater than 15, intensive care unit admission, low or normal leukocyte count, thrombocytopenia, renal dysfunction, diffused infiltrates on chest radiography, bilateral pneumonia, and sputum culture positive for Streptococcus pneumoniae.
We found a recent increase in the prevalence of bacteremic pneumococcal pneumonia in adults. Gram stain of sputum is useful, but sputum culture is less sensitive in the diagnosis of pneumococcal pneumonia. The fatality rate remains high. More effort should be made at prevention using pneumococcal immunization.
回顾108例入住社区医院的成年菌血症性肺炎球菌肺炎患者的临床和实验室检查结果，并确定痰革兰氏染色和培养在该情况下肺炎球菌肺炎诊断中的价值。
利用实验室日志识别1992年1月1日至1996年6月30日期间患有肺炎球菌菌血症的成年住院患者，并查阅其病历。
我们共发现108例患者。与1992年至1994年相比，1995年至1996年患病率明显上升。患者包括44名男性和64名女性。年龄范围为20至95岁（中位数为70岁）。死亡率为24.1%，且随年龄增长而增加（45岁以下患者无死亡，85至95岁患者中有36.8%死亡）。吸烟、心血管疾病、慢性阻塞性肺疾病、恶性疾病和糖尿病是主要的基础疾病。发热、呼吸困难和咳嗽是最常见的首发症状。当看到中度至大量革兰氏阳性双球菌时，痰革兰氏染色对诊断有用。痰培养的作用较小。与较高死亡率相关的因素包括年龄在65岁及以上、急性生理与慢性健康状况评分II（APACHE II）大于15、入住重症监护病房、白细胞计数低或正常、血小板减少、肾功能不全、胸部X线弥漫性浸润、双侧肺炎以及痰培养肺炎链球菌阳性。
我们发现成年菌血症性肺炎球菌肺炎的患病率近期有所上升。痰革兰氏染色有用，但痰培养在肺炎球菌肺炎诊断中的敏感性较低。死亡率仍然很高。应加大使用肺炎球菌疫苗进行预防的力度。
