军团菌病(LD)是由嗜肺军团菌引起的一种严重的,有时是致命的肺炎。LD的临床表现可能与肺炎链球菌引起的相似。因为这两种情况都可能是严重的疾病,但需要不同的抗菌疗法,有助于区分这些类型肺炎的因素有助于细菌性肺炎住院患者的临床治疗.本研究旨在比较肺炎支原体和肺炎链球菌引起的社区获得性肺炎住院患者的临床特征和疾病进展指标。
我们对LD或肺炎链球菌住院的成年患者进行了回顾性病例比较研究。收集的数据包括人口统计,临床特征,和合并症,和结果。使用SPSvs24.0分析数据。多变量分析使用逻辑回归和正向逐步算法进行。
共有106名患者符合研究标准。LD的发病率在夏季达到峰值,肺炎链球菌在冬季达到峰值。从多变量分析,LD的预测因素是男性(OR=21.6,p<0.001),腹泻(OR=4.5,p=0.04),体重指数(BMI)(OR=1.13,p=0.02),低钠血症(OR=5.6,p=0.03,Charlson合并症加权指数(CWIC)评分(OR=0.61,p=0.01)。肺炎链球菌患者机械通气率较高,感染性休克,和死亡比那些有LD的人。
我们的数据表明,可以区分LD和肺炎链球菌的变量包括男性,腹泻,低钠血症,入院时温度较高,更高的BMI和更少的合并症。与LD相比,肺炎链球菌与更差的结局相关,包括更高的脓毒性休克发生率。机械通气,入住ICU,和死亡。
Legionnaires\' disease (LD) is a serious sometimes fatal pneumonia caused by Legionella pneumophila. The clinical manifestations of LD may be similar to those by caused by Streptococcus pneumoniae. As both conditions can be serious illnesses but requiring different antimicrobial therapies, factors that can help differentiate these types of pneumonias can be helpful in the clinical management of hospitalized patients with bacterial pneumonia. This study aimed to compare clinical features and indicators of disease progression in hospitalized patients with community-acquired pneumonia caused by L. pneumophila and bacteremic S. pneumoniae.
We conducted a retrospective case comparison study of adult patients hospitalized with LD or S. pneumoniae. Data collected included demographic, clinical characteristics, and comorbidities, and outcomes. Data were analyzed using SPS vs 24.0. Multivariable analysis was done using logistic regression with a forward stepwise algorithm.
A total of 106 patients met study criteria. The incidence of LD peaked in summer months and S. pneumoniae peaked in the winter quarter. From multivariable analysis predictors of LD were male gender (OR=21.6, p < 0.001), diarrhea (OR=4.5, p = 0.04), body mass index (BMI) (OR=1.13, p = 0.02), hyponatremia (OR=5.6, p = 0.03 and Charlson weighted index of comorbidity (CWIC) score (OR=0.61, p = 0.01). Patients with S. pneumoniae had higher rates of mechanical ventilation, septic shock, and death than those with LD.
Our data suggests that variables that may distinguish LD from S. pneumoniae include male gender, diarrhea, hyponatremia, higher temperature on admission, higher BMI and fewer comorbidities. Bacteremic S. pneumoniae was associated with poorer outcomes than LD including higher rates of septic shock, mechanical ventilation, ICU admission, and death.