Porath A, Schlaeffer F, Pick N, Leinonen M, Lieberman D
Department of Medicine F, Soroka Medical Center of Kupat Holim, Beer-Sheva, Israel.
Eur J Clin Microbiol Infect Dis. 1997 Dec;16(12):863-70. doi: 10.1007/BF01700551.
In a previous prospective study, Streptococcus pneumoniae was identified as the causative agent in 148 (42.8%) of 346 adult patients hospitalized over the course of one year with community-acquired pneumonia (CAP) in the Soroka Medical Center, Beer-Sheva, Israel. The present study characterizes those cases in which Streptococcus pneumoniae was the only pathogen and those in which additional etiological agents were identified. Pneumococcal CAP was diagnosed by standard blood cultures or positive serological tests by one of two laboratory methods. In 100 (67.6%) patients, at least one other etiological agent of CAP was identified in addition to Streptococcus pneumoniae. Compared with patients who were not infected by Streptococcus pneumoniae, patients with Streptococcus pneumoniae CAP were older and had a higher rate of comorbidity (39.5% vs. 29.8%). Streptococcus pneumoniae CAP had a more severe clinical course and a higher mortality rate, especially when Streptococcus pneumoniae was the only pathogen. Community-acquired pneumonia due to Streptococcus pneumoniae only was more similar in its clinical manifestations to classic typical pneumococcal pneumonia. When an additional etiological agent was identified, the clinical characteristics could not be distinguished from those of atypical pneumonia. It is concluded that Streptococcus pneumoniae remains the principal cause of CAP in this region. The frequency of additional etiological agents of CAP and the difficulty in differentiating clinically between cases due to Streptococcus pneumoniae only and those due to Streptococcus pneumoniae plus other organisms necessitates initial empirical treatment that covers Streptococcus pneumoniae as well as other causative agents of atypical pneumonia.
在之前的一项前瞻性研究中，以色列贝尔谢巴索罗卡医疗中心一年内收治的346例社区获得性肺炎（CAP）成年患者中，148例（42.8%）的致病原被鉴定为肺炎链球菌。本研究对那些肺炎链球菌是唯一病原体的病例以及鉴定出其他病原体的病例进行了特征描述。肺炎球菌性CAP通过标准血培养或两种实验室方法之一的阳性血清学检测来诊断。在100例（67.6%）患者中，除肺炎链球菌外，至少还鉴定出了一种其他CAP病原体。与未感染肺炎链球菌的患者相比，肺炎链球菌性CAP患者年龄更大，合并症发生率更高（39.5%对29.8%）。肺炎链球菌性CAP临床病程更严重，死亡率更高，尤其是当肺炎链球菌是唯一病原体时。仅由肺炎链球菌引起的社区获得性肺炎在临床表现上更类似于典型的典型肺炎球菌肺炎。当鉴定出其他病原体时，其临床特征与非典型肺炎无法区分。结论是肺炎链球菌仍然是该地区CAP的主要病因。CAP其他病原体的发生率以及仅由肺炎链球菌引起的病例与肺炎链球菌加其他病原体引起的病例在临床上难以区分，这使得初始经验性治疗有必要覆盖肺炎链球菌以及非典型肺炎的其他病原体。
