马拉维成人社区获得性肺炎队列的病因学和死亡危险因素 [Am J Respir Crit Care Med]

点击上方蓝色小字关注Aetiology and Risk Factors for Mortality in an Adult Community-Acquired Pneumonia Cohort in MalawiAston SJ, Ho A, Jary H, Huwa J, Mitchell T, Ibitoye S, et al.Am J Respir Crit Care Med. Aug 1;200(3):359–69.DOI:10.1164/rccm.07-1333OCRationaleIn the context of rapid antiretroviral therapy (ART) rollout and an increasing burden of non-communicable diseases, there are few contemporary >基本原理在快速抗逆转录病毒疗法（ART）问世和非传染性疾病负担日益加重的情况下，很少有当代数据描述撒哈拉以南非洲地区社区获得性肺炎(CAP)的病因与结局。ObjectivesTo describe the current aetiology of CAP in Malawi and identify risk factors for mortality.目标描述马拉维目前社区获得性肺炎（CAP）的病因，并识别致死率的风险因素。MethodsWe conducted a prospective observational study of adults hospitalised with CAP to a teaching hospital in Blantyre, Malawi. Aetiology was defined by blood culture, Streptococcus pneumoniae urinary antigen detection, sputum mycobacterial culture and Xpert MTB/RIF, and nasopharyngeal aspirate multiplex PCR.方法我们对在马拉维布兰太尔的一家教学医院内患有CAP的成年住院患者进行了一项前瞻性的观察研究。通过血液培养，肺炎链球菌尿抗原检测、痰细菌培养及Xpert MTB/RIF，鼻咽吸入性多重PCR来共同确诊病因学。Measurements and Main ResultsIn 459 patients (285 [62.1%] males; median age 34.7 [IQR:29.4-41.9] years), 30-day mortality was 14.6% (64/439) and associated with male sex(adjusted odds ratio 2.60 [95% CI: 1.17-5.78]), symptom duration >7 days (2.78 [1.40-5.54]),tachycardia (2.99 [1.48-6.06]), hypoxaemia (4.40 [2.03-9.51]) and inability to stand (3.59[1.72-7.50]). HIV was common (355/453; 78.4%), frequently newly diagnosed (124/355; 34.9%), but not associated with mortality.S. pneumoniae(98/458 [21.4%]) andMycobacterium tuberculosis(75/326 [23.0%]) were the most frequently identified pathogens. Viral infection occurred in 32.6% (148/454) with influenza (40/454 [8.8%]) most common. Bacterial-viral co-infection occurred in 9.1% (28/307). Detection ofM. tuberculosiswas associated with mortality (aOR 2.44 [1.19-5.01]).测量和主要结果459名患者中（285名男性[62.1%]，；年龄中位数34.7岁[四分位间距：29.4-41.9岁]），30天死亡率是14.6%（64/439），且与男性（调整后优势比2.60[95% CI: 1.17-5.78]），症状持续时间>7天（2.78[1.40-5.54]），心动过速（2.99[1.48-6.06]，低氧血症（2.99[1.48-0.04]），无法站立（3.59[1.72-7.50]）相关。HIV很常见（355/453；78.4%），且常是新诊断（124/355；34.9%），但与死亡率无关。肺炎链球菌（98/458 [21.4%]）和结核分枝杆菌（75/326 [23.0%]）是最常见的病原体。病毒感染发生率是32.6%（148/454），其中流感病毒（40/454 [8.8%]）最普遍。细菌和病毒合并感染发生率是9.1%（28/307）。结核病的检出与死亡率相关（调整后优势比2.44 [1.19-5.01]）。

ConclusionsIn the ART era, CAP in Malawi remains predominantly HIV-associated with a CAP in Malawian adults large proportion attributable to potentially vaccine-preventable pathogens. Strategies to increase early detection and treatment of tuberculosis and improve supportive care, in particular the correction of hypoxaemia, should be evaluated in clinical trials to address CAP associated mortality.结论在ART时期，马拉维的CAP主要是与HIV相关，而马拉维成人CAP很大一部分归因于可通过接种疫苗预防的病原体。在临床试验中评估提高结核病的早期发现和治疗以及改善辅助性护理的策略，尤其是纠正低血氧血症，以解决CAP相关死亡率。首都医科大学北京市石景山教学医院吴世龙译欢迎大家点击右上“发送给朋友”或“分享到朋友圈”关注方式：长按下方二维码识别完成关注