PDF(Pubmed)
Abstract：
OBJECTIVE: Epidemiological information is essential in providing appropriate empiric antimicrobial therapy for pneumonia. This study aimed to clarify the epidemiology of community-acquired pneumonia (CAP) by conducting a systematic review of published studies in Japan.
METHODS: Systematic review.
METHODS: PubMed and Ichushi web database (January 1970 to October 2022).
METHODS: Clinical studies describing pathogenic micro-organisms in CAP written in English or Japanese, excluding studies on pneumonia other than adult CAP, investigations limited to specific pathogens and case reports.
METHODS: Patient setting (inpatient vs outpatient), number of patients, concordance with the CAP guidelines, diagnostic criteria and methods for diagnosing pneumonia pathogens as well as the numbers of each isolate. A meta-analysis of various situations was performed to measure the frequency of each aetiological agent.
RESULTS: Fifty-six studies were included and 17 095 cases of CAP were identified. Pathogens were undetectable in 44.1% (95% CI 39.7% to 48.5%). Streptococcus pneumoniae was the most common cause of CAP requiring hospitalisation or outpatient care (20.0% (95% CI 17.2% to 22.8%)), followed by Haemophilus influenzae (10.8% (95% CI 7.3% to 14.3%)) and Mycoplasma pneumoniae (7.5% (95% CI 4.6% to 10.4%)). However, when limited to CAP requiring hospitalisation, Staphylococcus aureus was the third most common at 4.9% (95% CI 3.9% to 5.8%). Pseudomonas aeruginosa was more frequent in hospitalised cases, while atypical pathogens were less common. Methicillin-resistant S. aureus accounted for 40.7% (95% CI 29.0% to 52.4%) of S. aureus cases. In studies that used PCR testing for pan-respiratory viral pathogens, human enterovirus/human rhinovirus (9.4% (95% CI 0% to 20.5%)) and several other respiratory pathogenic viruses were detected. The epidemiology varied depending on the methodology and situation.
CONCLUSIONS: The epidemiology of CAP varies depending on the situation, such as in the hospital versus outpatient setting. Viruses are more frequently detected by exhaustive genetic searches, resulting in a significant variation in epidemiology.
METHODS: Systematic review.
METHODS: PubMed and Ichushi web database (January 1970 to October 2022).
METHODS: Clinical studies describing pathogenic micro-organisms in CAP written in English or Japanese, excluding studies on pneumonia other than adult CAP, investigations limited to specific pathogens and case reports.
METHODS: Patient setting (inpatient vs outpatient), number of patients, concordance with the CAP guidelines, diagnostic criteria and methods for diagnosing pneumonia pathogens as well as the numbers of each isolate. A meta-analysis of various situations was performed to measure the frequency of each aetiological agent.
RESULTS: Fifty-six studies were included and 17 095 cases of CAP were identified. Pathogens were undetectable in 44.1% (95% CI 39.7% to 48.5%). Streptococcus pneumoniae was the most common cause of CAP requiring hospitalisation or outpatient care (20.0% (95% CI 17.2% to 22.8%)), followed by Haemophilus influenzae (10.8% (95% CI 7.3% to 14.3%)) and Mycoplasma pneumoniae (7.5% (95% CI 4.6% to 10.4%)). However, when limited to CAP requiring hospitalisation, Staphylococcus aureus was the third most common at 4.9% (95% CI 3.9% to 5.8%). Pseudomonas aeruginosa was more frequent in hospitalised cases, while atypical pathogens were less common. Methicillin-resistant S. aureus accounted for 40.7% (95% CI 29.0% to 52.4%) of S. aureus cases. In studies that used PCR testing for pan-respiratory viral pathogens, human enterovirus/human rhinovirus (9.4% (95% CI 0% to 20.5%)) and several other respiratory pathogenic viruses were detected. The epidemiology varied depending on the methodology and situation.
CONCLUSIONS: The epidemiology of CAP varies depending on the situation, such as in the hospital versus outpatient setting. Viruses are more frequently detected by exhaustive genetic searches, resulting in a significant variation in epidemiology.
摘要：
目的：流行病学信息对于为肺炎提供适当的经验性抗菌治疗至关重要。本研究旨在通过对日本已发表的研究进行系统回顾，阐明社区获得性肺炎（CAP）的流行病学。
方法：系统评价。
方法：PubMed和Ichushi网络数据库（1970年1月至2022年10月）。
方法：用英文或日文描述CAP致病微生物的临床研究，不包括成人CAP以外的肺炎研究，调查仅限于特定病原体和病例报告。
方法：患者设置（住院与门诊），患者数量,符合CAP指南，诊断肺炎病原体的诊断标准和方法以及每种分离株的数量。对各种情况进行了荟萃分析，以测量每种病因的频率。
结果：纳入56项研究，发现17095例CAP。在44.1%(95%CI39.7%至48.5%)中未检测到病原体。肺炎链球菌是需要住院治疗或门诊治疗的CAP的最常见原因（20.0%（95%CI17.2%至22.8%）），其次是流感嗜血杆菌(10.8%(95%CI7.3%~14.3%))和肺炎支原体(7.5%(95%CI4.6%~10.4%))。然而,当仅限于需要住院治疗的CAP时，金黄色葡萄球菌是第三常见的，为4.9%(95%CI3.9%至5.8%)。铜绿假单胞菌在住院病例中更为常见，而非典型病原体较不常见。耐甲氧西林金黄色葡萄球菌占金黄色葡萄球菌的40.7%（95%CI29.0%～52.4%）。在使用PCR检测泛呼吸道病毒病原体的研究中，检测到人肠道病毒/人鼻病毒(9.4%(95%CI0%~20.5%))和其他几种呼吸道病原病毒.流行病学因方法和情况而异。
结论：CAP的流行病学因情况而异，例如在医院和门诊设置。病毒更经常被详尽的基因搜索发现，导致流行病学的显著差异。
方法：系统评价。
方法：PubMed和Ichushi网络数据库（1970年1月至2022年10月）。
方法：用英文或日文描述CAP致病微生物的临床研究，不包括成人CAP以外的肺炎研究，调查仅限于特定病原体和病例报告。
方法：患者设置（住院与门诊），患者数量,符合CAP指南，诊断肺炎病原体的诊断标准和方法以及每种分离株的数量。对各种情况进行了荟萃分析，以测量每种病因的频率。
结果：纳入56项研究，发现17095例CAP。在44.1%(95%CI39.7%至48.5%)中未检测到病原体。肺炎链球菌是需要住院治疗或门诊治疗的CAP的最常见原因（20.0%（95%CI17.2%至22.8%）），其次是流感嗜血杆菌(10.8%(95%CI7.3%~14.3%))和肺炎支原体(7.5%(95%CI4.6%~10.4%))。然而,当仅限于需要住院治疗的CAP时，金黄色葡萄球菌是第三常见的，为4.9%(95%CI3.9%至5.8%)。铜绿假单胞菌在住院病例中更为常见，而非典型病原体较不常见。耐甲氧西林金黄色葡萄球菌占金黄色葡萄球菌的40.7%（95%CI29.0%～52.4%）。在使用PCR检测泛呼吸道病毒病原体的研究中，检测到人肠道病毒/人鼻病毒(9.4%(95%CI0%~20.5%))和其他几种呼吸道病原病毒.流行病学因方法和情况而异。
结论：CAP的流行病学因情况而异，例如在医院和门诊设置。病毒更经常被详尽的基因搜索发现，导致流行病学的显著差异。
