在社区获得的肺炎中比较病毒,细菌和共感染,这是一个回顾性队列研究
Frederike Waldeck1, Solveig Lemmel1, Marcus Panning2
1Infectious Diseases Clinic, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
经验性抗生素通常用于社区获得的肺炎 (CAP). 识别细菌或病毒病原体对于有针对性的治疗,改善结果和减少过度使用抗生素至关重要.
科学领域:
- 传染性疾病 传染性疾病
- 肺部病理学 肺部病理学
- 临床微生物学 临床微生物学
背景情况:
- 社区获得性肺炎 (CAP) 经常有病毒原因,但抗生素治疗是常见的.
- 当前的诊断方法往往无法识别特定的病原体,导致广泛的抗生素使用.
研究的目的:
- 根据已识别的致病原体 (细菌,病毒,共感染或没有检测到) 来比较临床表现,抗生素使用和CAP患者的结果.
主要方法:
- 对一个潜在的国际队列 (CAPNETZ,2007-2017年) 免疫能力强的CAP患者的分析.
- 多重聚合酶连锁反应 (PCR) 测试唾液以识别细菌和病毒病原体.
- 分层分为四组:细菌,病毒,共感染,没有发现病原体;多变量回归分析.
主要成果:
- 细菌CAP患者更年轻,CRB-65得分更高. 细菌CAP的180天死亡率更高,而病毒CAP的30天死亡率更高.
- 在入院时,在组之间没有观察到临床表现,并发症或停留时间的显著差异.
- 几乎所有患者 (98.4%) 接受了抗生素,无论已识别的病原体,表明广泛的经验治疗.
结论:
- 需要一种以病原体为中心的CAP治疗策略,以优化患者的治疗结果,并最大限度地减少与抗生素相关的副作用和耐药性.
- 目前的临床表现不足以区分CAP的病因原因.
- 开发有针对性的治疗算法可以减少不必要的抗生素暴露,并改善患者的长期健康.
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