Community acquired pneumonia: Aetiology and usefulness of severity criteria on admission

被引:288
作者
Neill, AM
Martin, IR
Weir, R
Anderson, R
Chereshsky, A
Epton, MJ
Jackson, R
Schousboe, M
Frampton, C
Hutton, S
Chambers, ST
Town, GI
机构
[1] CHRISTCHURCH SCH MED,CANTERBURY RESP RES GRP,CHRISTCHURCH,NEW ZEALAND
[2] CANTERBURY HLTH LABS,MICROBIOL LAB,CANTERBURY,KENT,ENGLAND
[3] CANTERBURY HLTH,DEPT RADIOL,CANTERBURY,KENT,ENGLAND
[4] CHRISTCHURCH SCH MED,DEPT MED,CHRISTCHURCH,NEW ZEALAND
[5] CHRISTCHURCH SCH MED,DEPT PATHOL,CHRISTCHURCH,NEW ZEALAND
[6] MENZIES SCH HLTH RES,DARWIN,NT,AUSTRALIA
关键词
community acquired pneumonia; severity assessment; mortality; aetiology;
D O I
10.1136/thx.51.10.1010
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background - Community acquired pneumonia remains an important cause of hospital admission and carries an appreciable mortality, Criteria for the assessment of severity during admission have been developed by the British Thoracic Society (BTS). A study was performed to determine the sensitivity and specificity of a severity rule based on a modification of the BTS prognostic rules applied on admission, to compare severity as assessed by medical staff with the modified rule, and to determine the microbiological cause of community acquired pneumonia in Christchurch. Methods - A 12 month study of all adults admitted to Christchurch Hospital with community acquired pneumonia was undertaken. Three hundred and sixteen consecutive patients with suspected community acquired pneumonia were screened for inclusion, Variables obtained from the history, examination, investigations, and initial treatment were examined for association with mortality. Results - Two hundred and fifty five patients met the inclusion criteria. Their mean age was 58 years (range 18-97). A microbiological diagnosis was made in 181 cases (71%), Streptococcus pneumonia (39%), Mycoplasma pneumonia (16%), Legionella species (11%), and Haemophilus influenzae (11%) being the most commonly identified organisms. Patients had a 36-fold increased risk of death if any two of the following were present on admission: respiratory rate greater than or equal to 30/min, diastolic BP less than or equal to 60 mm Hg, urea >7 mmol/1, or confusion. The severity rule identified 19 of the 20 patients who died and six of eight patients admitted to the intensive care unit acquired pneumonia. The sensitivity of the modified rule for predicting death was 0.95 and the specificity 0.71. In 47 cases (21%) the clinical team appeared to underestimate the severity of the illness. Conclusions - The organisms responsible for community acquired pneumonia in Christchurch are similar to those reported from other centres except for Legionella. species which were more common than in most studies. The modification of the BTS prognostic rules applied as a severity indicator at admission performed well and could be incorporated into management guidelines.
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页码:1010 / 1016
页数:7
相关论文
共 23 条
[1]  
[Anonymous], BR J HOSP MED
[2]  
BOHRE R, 1995, THORAX, V50, P543
[3]   IS PNEUMONIA REALLY THE OLD MANS FRIEND - 2-YEAR PROGNOSIS AFTER COMMUNITY-ACQUIRED PNEUMONIA [J].
BRANCATI, FL ;
CHOW, JW ;
WAGENER, MM ;
VACARELLO, SJ ;
YU, VL .
LANCET, 1993, 342 (8862) :30-33
[4]   PROGNOSTIC ANALYSIS AND PREDICTIVE RULE FOR OUTCOME OF HOSPITAL-TREATED COMMUNITY-ACQUIRED PNEUMONIA [J].
EWIG, S ;
BAUER, T ;
HASPER, E ;
PIZZULLI, L ;
KUBINI, R ;
LUDERITZ, B .
EUROPEAN RESPIRATORY JOURNAL, 1995, 8 (03) :392-397
[5]   NEW AND EMERGING ETIOLOGIES FOR COMMUNITY-ACQUIRED PNEUMONIA WITH IMPLICATIONS FOR THERAPY - A PROSPECTIVE MULTICENTER STUDY OF 359 CASES [J].
FANG, GD ;
FINE, M ;
ORLOFF, J ;
ARISUMI, D ;
YU, VL ;
KAPOOR, W ;
GRAYSTON, JT ;
WANG, SP ;
KOHLER, R ;
MUDER, RR ;
YEE, YC ;
RIHS, JD ;
VICKERS, RM .
MEDICINE, 1990, 69 (05) :307-316
[6]   PREDICTING DEATH IN PATIENTS HOSPITALIZED FOR COMMUNITY-ACQUIRED PNEUMONIA [J].
FARR, BM ;
SLOMAN, AJ ;
FISCH, MJ .
ANNALS OF INTERNAL MEDICINE, 1991, 115 (06) :428-436
[7]   PREDICTION OF MICROBIAL ETIOLOGY AT ADMISSION TO HOSPITAL FOR PNEUMONIA FROM THE PRESENTING CLINICAL-FEATURES [J].
FARR, BM ;
KAISER, DL ;
HARRISON, BDW ;
CONNOLLY, CK .
THORAX, 1989, 44 (12) :1031-1035
[8]   SURVEILLANCE OF MYCOPLASMA-PNEUMONIAE INFECTIONS IN SCOTLAND 1986-1991 [J].
GHOSH, K ;
CLEMENTS, GB .
JOURNAL OF INFECTION, 1992, 25 (02) :221-227
[9]  
Hodkinson H M, 1973, J R Coll Physicians Lond, V7, P305
[10]   FAILURE OF INTENSIVE-CARE UNIT SUPPORT TO INFLUENCE MORTALITY FROM PNEUMOCOCCAL BACTEREMIA [J].
HOOK, EW ;
HORTON, CA ;
SCHABERG, DR .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1983, 249 (08) :1055-1057