机构：[1]Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China[2]Department of Respiratory Medicine, Shanghai Putuo District People’s Hospital, Shanghai 200060, China[3]Department of Respiratory Medicine,Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai 201700, China[4]Department of Respiratory Medicine, The FifthPeople’s Hospital of Shanghai, Fudan University, Shanghai 200240, China[5]Department of Respiratory Medicine, Tong Ren Hospital, Shanghai JiaoTong University, Shanghai 200050, China[6]Department of Respiratory Medicine, Shanghai Yangpu District Central Hospital, Tongji University,Shanghai 200090, China[7]Department of Respiratory Medicine, Shanghai Putuo District Central Hospital, Shanghai University of TraditionalChinese Medicine, Shanghai 200062, China[8]Department of Pulmonary and Critical Care Medicine, Changhai Hospital of Shanghai, Navy MedicalUniversity, Shanghai 200433, China[9]Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Pulmonary Medicine,Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
Background: Despite the release of a national guideline in 2016, the actual practices with respect to adult community-acquired pneumonia (CAP) remain unknown in China. We aimed to investigate CAP patient management practices in Shanghai to identify potential problems and provide evidence for policy making. Methods: A short-period, 5-day prospective cross-sectional study was performed with sampled pulmonologists from 36 hospitals, encompassing all the administrative districts of Shanghai, during January 8-12, 2018. The medical information was recorded and analyzed for the patients with the diagnosis of CAP who were cared for by 46 pulmonologists during the study period. Results: Overall, 435 patients were included in the final analysis, and 94.3% had a low risk of death in terms of CRB-65 criteria (C: disturbance of consciousness, R: respiratory rate, B: blood pressure, 65: age). When diagnosed with CAP, 70.1% of patients were not evaluated using the CURB-65 score (CRB-65 + U: urea nitrogen), but most patients (95.4%) were evaluated using CRB-65. Time to achieve clinical stability was longer in patients with hypoxemia than in those without hypoxemia (8.42 +/- 6.36 vs. 5.53 +/- 4.12 days, P=0.004). Overall, 84.4% of patients with a CRB-65 score of 0 were administered antibiotics intravenously, and 19.4% were still hospitalized after excluding hypoxemia and comorbidities. The average duration of antibiotic treatment was 10.4 +/- 4.9 days. Overall, 72.6% of patients received antibiotics covering atypical pathogens whose time to clinical stability was significantly shortened compared with those without coverage, but the antibiotic duration was similar and not correspondingly shortened. Conclusions: CRB-65 seems to be more practical than CURB-65 for the initial evaluation of CAP in the context of local practice, and oxygenation assessment should be included in the evaluation of severity. Overtreatment may be relatively common in patients at low risk of death, including unreasonable hospitalization, intravenous administration, and antibiotic duration.
基金：
Shanghai key discipline for respiratory diseases (Number 2017ZZ02014) and the National Innovative Research Team of High-level Local Universities in Shanghai.
第一作者机构：[1]Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
共同第一作者：
通讯作者：
通讯机构：[1]Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China[9]Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Pulmonary Medicine,Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China[*1]Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China.[*2]Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Pulmonary Medicine, Shanghai Jiao Tong University School of Medicine, 197 Ruijin No. 2 Road, Huangpu District, Shanghai 200020, China.
推荐引用方式(GB/T 7714)：
Hu Wei-Ping,Zhang Feng-Ying,Zhang Jing,et al.Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai[J].JOURNAL OF THORACIC DISEASE.2020,12(4):1417-1426.doi:10.21037/jtd.2020.03.02.
APA：
Hu, Wei-Ping,Zhang, Feng-Ying,Zhang, Jing,Hang, Jing-Qing,Zeng, Ying-Ying...&on behalf of Shanghai Primary Respiratory Care Union and Pulmonary Infection Assembly of Shanghai Respiratory Society.(2020).Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai.JOURNAL OF THORACIC DISEASE,12,(4)
MLA：
Hu, Wei-Ping,et al."Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai".JOURNAL OF THORACIC DISEASE 12..4(2020):1417-1426
