Virulent Gram-Negative Bacilli Isolated in Sputum Culture Predict Length of Hospital Stay in Patients with Community-Acquired Pneumonia

前言：根據文獻報告，痰液培養於社區型肺炎診斷和治療的角色極其有限。然而在臨床上痰液培養仍然被廣泛使用著。本研究的目的在於探討痰液培養對於社區型肺炎病人住院天數及死亡率的影響。方法：我們回溯性地納入西元2002年一年中住院於臺中榮民總醫院社區型肺炎的病患。依據痰液培養中出現克雷伯氏菌和綠膿桿菌是否，將病患分成高毒性格蘭式陰性桿菌及非高毒性格蘭式陰性桿菌兩組，藉此探討格蘭式陰性桿菌對住院天數及死亡率的影響。結果：共有一百四十八位病人收案。我們發現兩組病患並無住院死亡率的差別。然而相較於非高毒性格蘭式陰性桿菌組，高毒性格蘭式陰性桿菌組的病患住院天數較長(18.89±14.85天vs.12.74±11.35天；P=0.024)，特別是高危險群(27.24±15.67天vs.17.50±13.07天；P=0.019)及住進加護病房的病人。結論：於痰液培養中出現格蘭式陰性桿菌，特別是在高危險群的社區型肺炎病人，其住院天數會顯著延長。

關鍵字

格蘭式陰性桿菌；住院天數；痰液培養；社區型肺炎

並列摘要

Background: The role of sputum culture in identifying infectious pathogens and in guiding initial empiric antibiotic treatment for community-acquired pneumonia (CAP) is limited. However, sputum culture is still widely used clinically in Taiwan. The aim of this retrospective study was to examine the value of sputum culture in terms of the clinical outcome. Methods and patients: From January 1, 2002 to December 31, 2002, CAP patients who were admitted to our hospital and had a sputum culture on admission day were enrolled. Patients were divided into 2 groups: one, a Gram-negative bacilli (GNB) group, for those with a presence of Klebsiella pneumoniae and/or Pseudomonas aeruginosa, and the other, a non-GNB group. Both groups were stratified by means of the modified Fine's pneumonia severity index into low-and high-risk patients. We determined the impact of virulent GNB isolated in the sputum culture on in-hospital mortality and length of stay (LOS) in the hospital. Results: One hundred and forty-eight patients were enrolled. Thirty-eight patients (25.7%) were in the virulent GNB group. The demographic characteristics were similar in both groups. In terms of in-hospital mortality, there was no significant difference between the 2 groups. LOS was significantly longer in the virulent group (18.89±14.85 vs. 12.74±11.35 days; P=0.024), especially for high-risk patients (27.24±15.67 vs. 17.50±13.07 days; P=0.019). The possible explanation for this is that more patients were admitted to the ICU. Conclusion: We conclude that virulent GNB isolated in sputum culture, especially in a high- risk patient group, could result in a significant increase in LOS in the hospital.

並列關鍵字

Gram-negative bacilli ； length of hospital stay ； sputum culture ； community-acquired pneumonia

國際替代計量

Virulent Gram-Negative Bacilli Isolated in Sputum Culture Predict Length of Hospital Stay in Patients with Community-Acquired Pneumonia

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