Microbial aetiology of community-acquired pneumonia and its relation to severity
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Open Access
- 21 January 2011
- Vol. 66 (4), 340-346
- https://doi.org/10.1136/thx.2010.143982
Abstract
Background The distribution of the microbial aetiology and mortality of community-acquired pneumonia (CAP) was investigated in relation to the clinical setting and severity scores (pneumonia severity index (PSI) and confusion, blood urea nitrogen, respiratory rate, blood pressure, age (CURB-65)). Methods 3523 patients with CAP were included (15% outpatients, 85% inpatients). The distribution of the microbial aetiology in relation to the clinical setting and severity scores (PSI, CURB-65) and the relative mortality of different aetiologies across the severity scores were analysed. Results The aetiology was established in 1463 patients (42%), of whom 257 died (7%). The ranking of aetiologies varied according to site of care, with increasing frequency of Streptococcus pneumoniae and mixed aetiologies and decreasing frequency of atypical pathogens in hospitalised patients and those in ICUs. The distribution of aetiologies according to severity scores showed corresponding patterns; however, the severity scores were more sensitive to Gram-negative enteric bacilli (GNEB) and Pseudomonas aeruginosa and less sensitive in identifying mixed aetiologies as moderate- and high-risk conditions. Mortality rates according to aetiology and severity scoring showed increasing mortality rates for all pathogens except atypical pathogens. S pneumoniae had the highest number of deaths while GNEB, P aeruginosa, Staphylococcus aureus and mixed aetiologies had the highest mortality rates. Legionella pneumophila was similarly distributed according to site of care and prognostic scores. Conclusions CAP due to atypical bacterial pathogens is recognised both clinically and by severity scoring as a low-risk condition. Severity scores are more sensitive in identifying patients with GNEB and P aeruginosa as moderate- and high-risk aetiologies whereas mixed aetiologies may be underestimated.Keywords
This publication has 24 references indexed in Scilit:
- BTS guidelines for the management of community acquired pneumonia in adults: update 2009Thorax, 2009
- Adherence to guidelines' empirical antibiotic recommendations and community-acquired pneumonia outcomeEuropean Respiratory Journal, 2008
- Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in AdultsClinical Infectious Diseases, 2007
- Guidelines for the management of adult lower respiratory tract infectionsEuropean Respiratory Journal, 2005
- Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation studyThorax, 2003
- Etiology, Reasons for Hospitalization, Risk Classes, and Outcomes of Community‐Acquired Pneumonia in Patients Hospitalized on the Basis of Conventional Admission CriteriaClinical Infectious Diseases, 2001
- Microbial Etiology of Community-Acquired Pneumonia in the Adult Population of 4 Municipalities in Eastern FinlandClinical Infectious Diseases, 2001
- Etiology of Community-Acquired Pneumonia:American Journal of Respiratory and Critical Care Medicine, 1999
- A Prediction Rule to Identify Low-Risk Patients with Community-Acquired PneumoniaThe New England Journal of Medicine, 1997
- Chlamydia pneumoniae as a Cause of Community-Acquired Pneumonia in Hospitalized Patients in BerlinClinical Infectious Diseases, 1996