Seasonality of pathogens causing community-acquired pneumonia.
Identifieur interne : 000087 ( Main/Exploration ); précédent : 000086; suivant : 000088Seasonality of pathogens causing community-acquired pneumonia.
Auteurs : Catia Cilloniz [Espagne] ; Santiago Ewig [Allemagne] ; Albert Gabarrus [Espagne] ; Miquel Ferrer [Espagne] ; Jorge Puig De La Bella Casa [Espagne] ; Josep Mensa [Espagne] ; Antoni Torres [Espagne]Source :
- Respirology (Carlton, Vic.) [ 1440-1843 ] ; 2017.
Descripteurs français
- KwdFr :
- MESH :
- microbiologie : Infections communautaires.
- épidémiologie : Espagne, Infections communautaires.
- Adulte, Adulte d'âge moyen, Femelle, Humains, Incidence, Mâle, Saisons, Sujet âgé, Études prospectives.
English descriptors
- KwdEn :
- MESH :
- epidemiology : Community-Acquired Infections, Spain.
- microbiology : Community-Acquired Infections.
- Adult, Aged, Female, Humans, Incidence, Male, Middle Aged, Prospective Studies, Seasons.
Abstract
BACKGROUND AND OBJECTIVE
Seasonal distribution of microbial aetiology in patients with community-acquired pneumonia (CAP) may add important information both for epidemiologists and clinicians. We investigate the seasonal distribution of microbial aetiology in CAP.
METHODS
This prospective observational study was carried out in the Hospital Clinic of Barcelona, Spain (January 2003-December 2014).
RESULTS
We studied 4431 patients with CAP, of whom 2689 (61%) were males. Microbial aetiology was identified in 1756 patients (40%). CAP was most frequent in winter (34%) but two-third of patients with CAP presented in other seasons. Seasonal variations included Streptococcus pneumoniae (winter 21% vs spring 17% vs summer 14% vs autumn 13%, overall P < 0.001). Influenza viruses were most prevalent in autumn (6%) and winter (5%) compared with spring (3%) and summer (1%) (overall P < 0.001). Legionella pneumophila was most frequent in autumn (4%) and summer (4%) compared with spring (2%) and winter (1%) (overall P < 0.001). Incidence of polymicrobial pneumonia also differed between seasons (winter 7% vs spring 5% vs summer 3% vs autumn 6%, overall P = 0.001). We observed a significant correlation between the lowest seasonal average temperature and polymicrobial pneumonia, pneumococcal pneumonia, and influenza viruses; conversely, L. pneumophila was more common when temperatures were higher.
CONCLUSION
CAP should not be regarded as a seasonal disease but occurs throughout all seasons. However, S. pneumoniae, influenza viruses, polymicrobial pneumonia and L. pneumophila are clearly subject to seasonal variations.
DOI: 10.1111/resp.12978
PubMed: 28093834
Affiliations:
Links toward previous steps (curation, corpus...)
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xml:lang="fr">Espagne</country><wicri:regionArea>Department of Pneumology, Hospital Clinic of Barcelona, University of Barcelona (UB), Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Biomedical Research Institute "August Pi Sunyer" (IDIBAPS), Biomedical Research Networking Centres on Respiratory Diseases (CIBERES), Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Biomedical Research Institute "August Pi Sunyer" (IDIBAPS), Biomedical Research Networking Centres on Respiratory Diseases (CIBERES), Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Ewig, Santiago" sort="Ewig, Santiago" uniqKey="Ewig S" first="Santiago" last="Ewig">Santiago 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(UB), Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Biomedical Research Institute "August Pi Sunyer" (IDIBAPS), Biomedical Research Networking Centres on Respiratory Diseases (CIBERES), Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Biomedical Research Institute "August Pi Sunyer" (IDIBAPS), Biomedical Research Networking Centres on Respiratory Diseases (CIBERES), Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Ferrer, Miquel" sort="Ferrer, Miquel" uniqKey="Ferrer M" first="Miquel" last="Ferrer">Miquel Ferrer</name><affiliation wicri:level="3"><nlm:affiliation>Department of Pneumology, Hospital Clinic of Barcelona, University of Barcelona (UB), Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Pneumology, Hospital Clinic of Barcelona, University of Barcelona (UB), Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Biomedical Research Institute "August Pi Sunyer" (IDIBAPS), Biomedical Research Networking Centres on Respiratory Diseases (CIBERES), Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Biomedical Research Institute "August Pi Sunyer" (IDIBAPS), Biomedical Research Networking Centres on Respiratory Diseases (CIBERES), Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Puig De La Bella Casa, Jorge" sort="Puig De La Bella Casa, Jorge" uniqKey="Puig De La Bella Casa J" first="Jorge" last="Puig De La Bella Casa">Jorge Puig De La Bella Casa</name><affiliation wicri:level="3"><nlm:affiliation>Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Microbiology, Hospital Clinic of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Mensa, Josep" sort="Mensa, Josep" uniqKey="Mensa J" first="Josep" last="Mensa">Josep Mensa</name><affiliation wicri:level="3"><nlm:affiliation>Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Torres, Antoni" sort="Torres, Antoni" uniqKey="Torres A" first="Antoni" last="Torres">Antoni Torres</name><affiliation wicri:level="3"><nlm:affiliation>Department of Pneumology, Hospital Clinic of Barcelona, University of Barcelona (UB), Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Pneumology, Hospital Clinic of Barcelona, University of Barcelona (UB), Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Biomedical Research Institute "August Pi Sunyer" (IDIBAPS), Biomedical Research Networking Centres on Respiratory Diseases (CIBERES), Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Biomedical Research Institute "August Pi Sunyer" (IDIBAPS), Biomedical Research Networking Centres on Respiratory Diseases (CIBERES), Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author></analytic><series><title level="j">Respirology (Carlton, Vic.)</title><idno type="eISSN">1440-1843</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Aged (MeSH)</term><term>Community-Acquired Infections (epidemiology)</term><term>Community-Acquired Infections (microbiology)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Incidence (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Prospective Studies (MeSH)</term><term>Seasons (MeSH)</term><term>Spain (epidemiology)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Espagne (épidémiologie)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Incidence (MeSH)</term><term>Infections communautaires (microbiologie)</term><term>Infections communautaires (épidémiologie)</term><term>Mâle (MeSH)</term><term>Saisons (MeSH)</term><term>Sujet âgé (MeSH)</term><term>Études prospectives (MeSH)</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Community-Acquired Infections</term><term>Spain</term></keywords><keywords scheme="MESH" qualifier="microbiologie" xml:lang="fr"><term>Infections communautaires</term></keywords><keywords scheme="MESH" qualifier="microbiology" xml:lang="en"><term>Community-Acquired Infections</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Espagne</term><term>Infections communautaires</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Female</term><term>Humans</term><term>Incidence</term><term>Male</term><term>Middle Aged</term><term>Prospective Studies</term><term>Seasons</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Mâle</term><term>Saisons</term><term>Sujet âgé</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND AND OBJECTIVE</b></p><p>Seasonal distribution of microbial aetiology in patients with community-acquired pneumonia (CAP) may add important information both for epidemiologists and clinicians. We investigate the seasonal distribution of microbial aetiology in CAP.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>This prospective observational study was carried out in the Hospital Clinic of Barcelona, Spain (January 2003-December 2014).</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>We studied 4431 patients with CAP, of whom 2689 (61%) were males. Microbial aetiology was identified in 1756 patients (40%). CAP was most frequent in winter (34%) but two-third of patients with CAP presented in other seasons. Seasonal variations included Streptococcus pneumoniae (winter 21% vs spring 17% vs summer 14% vs autumn 13%, overall P < 0.001). Influenza viruses were most prevalent in autumn (6%) and winter (5%) compared with spring (3%) and summer (1%) (overall P < 0.001). Legionella pneumophila was most frequent in autumn (4%) and summer (4%) compared with spring (2%) and winter (1%) (overall P < 0.001). Incidence of polymicrobial pneumonia also differed between seasons (winter 7% vs spring 5% vs summer 3% vs autumn 6%, overall P = 0.001). We observed a significant correlation between the lowest seasonal average temperature and polymicrobial pneumonia, pneumococcal pneumonia, and influenza viruses; conversely, L. pneumophila was more common when temperatures were higher.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>CAP should not be regarded as a seasonal disease but occurs throughout all seasons. However, S. pneumoniae, influenza viruses, polymicrobial pneumonia and L. pneumophila are clearly subject to seasonal variations.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">28093834</PMID><DateCompleted><Year>2017</Year><Month>11</Month><Day>13</Day></DateCompleted><DateRevised><Year>2018</Year><Month>12</Month><Day>02</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1440-1843</ISSN><JournalIssue CitedMedium="Internet"><Volume>22</Volume><Issue>4</Issue><PubDate><Year>2017</Year><Month>05</Month></PubDate></JournalIssue><Title>Respirology (Carlton, Vic.)</Title><ISOAbbreviation>Respirology</ISOAbbreviation></Journal><ArticleTitle>Seasonality of pathogens causing community-acquired pneumonia.</ArticleTitle><Pagination><MedlinePgn>778-785</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1111/resp.12978</ELocationID><Abstract><AbstractText Label="BACKGROUND AND OBJECTIVE">Seasonal distribution of microbial aetiology in patients with community-acquired pneumonia (CAP) may add important information both for epidemiologists and clinicians. We investigate the seasonal distribution of microbial aetiology in CAP.</AbstractText><AbstractText Label="METHODS">This prospective observational study was carried out in the Hospital Clinic of Barcelona, Spain (January 2003-December 2014).</AbstractText><AbstractText Label="RESULTS">We studied 4431 patients with CAP, of whom 2689 (61%) were males. Microbial aetiology was identified in 1756 patients (40%). CAP was most frequent in winter (34%) but two-third of patients with CAP presented in other seasons. Seasonal variations included Streptococcus pneumoniae (winter 21% vs spring 17% vs summer 14% vs autumn 13%, overall P < 0.001). Influenza viruses were most prevalent in autumn (6%) and winter (5%) compared with spring (3%) and summer (1%) (overall P < 0.001). Legionella pneumophila was most frequent in autumn (4%) and summer (4%) compared with spring (2%) and winter (1%) (overall P < 0.001). Incidence of polymicrobial pneumonia also differed between seasons (winter 7% vs spring 5% vs summer 3% vs autumn 6%, overall P = 0.001). We observed a significant correlation between the lowest seasonal average temperature and polymicrobial pneumonia, pneumococcal pneumonia, and influenza viruses; conversely, L. pneumophila was more common when temperatures were higher.</AbstractText><AbstractText Label="CONCLUSION">CAP should not be regarded as a seasonal disease but occurs throughout all seasons. However, S. pneumoniae, influenza viruses, polymicrobial pneumonia and L. pneumophila are clearly subject to seasonal variations.</AbstractText><CopyrightInformation>© 2017 Asian Pacific Society of Respirology.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Cilloniz</LastName><ForeName>Catia</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Pneumology, Hospital Clinic of Barcelona, University of Barcelona (UB), Barcelona, Spain.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Biomedical Research Institute "August Pi Sunyer" (IDIBAPS), Biomedical Research Networking Centres on Respiratory Diseases (CIBERES), Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ewig</LastName><ForeName>Santiago</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Respiratory Medicine and Infectious Diseases, Evangelic Hospital in Herne and Augusta Hospital in Bochum, Bochum, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gabarrus</LastName><ForeName>Albert</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Pneumology, Hospital Clinic of Barcelona, University of Barcelona (UB), Barcelona, Spain.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Biomedical Research Institute "August Pi Sunyer" (IDIBAPS), Biomedical Research Networking Centres on Respiratory Diseases (CIBERES), Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ferrer</LastName><ForeName>Miquel</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Pneumology, Hospital Clinic of Barcelona, University of Barcelona (UB), Barcelona, Spain.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Biomedical Research Institute "August Pi Sunyer" (IDIBAPS), Biomedical Research Networking Centres on Respiratory Diseases (CIBERES), Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Puig de la Bella Casa</LastName><ForeName>Jorge</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mensa</LastName><ForeName>Josep</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Torres</LastName><ForeName>Antoni</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Pneumology, Hospital Clinic of Barcelona, University of Barcelona (UB), Barcelona, Spain.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Biomedical Research Institute "August Pi Sunyer" (IDIBAPS), Biomedical Research Networking Centres on Respiratory Diseases (CIBERES), Barcelona, Spain.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D064888">Observational Study</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2017</Year><Month>01</Month><Day>17</Day></ArticleDate></Article><MedlineJournalInfo><Country>Australia</Country><MedlineTA>Respirology</MedlineTA><NlmUniqueID>9616368</NlmUniqueID><ISSNLinking>1323-7799</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017714" MajorTopicYN="N">Community-Acquired Infections</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000382" MajorTopicYN="Y">microbiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015994" MajorTopicYN="N">Incidence</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012621" MajorTopicYN="Y">Seasons</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013030" MajorTopicYN="N">Spain</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">community-acquired pneumonia</Keyword><Keyword MajorTopicYN="Y">microbial aetiology</Keyword><Keyword MajorTopicYN="Y">season</Keyword><Keyword MajorTopicYN="Y">seasonality</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2016</Year><Month>09</Month><Day>08</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2016</Year><Month>11</Month><Day>04</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2016</Year><Month>11</Month><Day>04</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2017</Year><Month>1</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2017</Year><Month>11</Month><Day>14</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2017</Year><Month>1</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">28093834</ArticleId><ArticleId IdType="doi">10.1111/resp.12978</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Allemagne</li><li>Espagne</li></country><region><li>Catalogne</li></region><settlement><li>Barcelone</li></settlement></list><tree><country name="Espagne"><region name="Catalogne"><name sortKey="Cilloniz, Catia" sort="Cilloniz, Catia" uniqKey="Cilloniz C" first="Catia" last="Cilloniz">Catia Cilloniz</name></region><name sortKey="Cilloniz, Catia" sort="Cilloniz, Catia" uniqKey="Cilloniz C" first="Catia" last="Cilloniz">Catia Cilloniz</name><name sortKey="Ferrer, Miquel" sort="Ferrer, Miquel" uniqKey="Ferrer M" first="Miquel" last="Ferrer">Miquel Ferrer</name><name sortKey="Ferrer, Miquel" sort="Ferrer, Miquel" uniqKey="Ferrer M" first="Miquel" last="Ferrer">Miquel Ferrer</name><name sortKey="Gabarrus, Albert" sort="Gabarrus, Albert" uniqKey="Gabarrus A" first="Albert" last="Gabarrus">Albert Gabarrus</name><name sortKey="Gabarrus, Albert" sort="Gabarrus, Albert" uniqKey="Gabarrus A" first="Albert" last="Gabarrus">Albert Gabarrus</name><name sortKey="Mensa, Josep" sort="Mensa, Josep" uniqKey="Mensa J" first="Josep" last="Mensa">Josep Mensa</name><name sortKey="Puig De La Bella Casa, Jorge" sort="Puig De La Bella Casa, Jorge" uniqKey="Puig De La Bella Casa J" first="Jorge" last="Puig De La Bella Casa">Jorge Puig De La Bella Casa</name><name sortKey="Torres, Antoni" sort="Torres, Antoni" uniqKey="Torres A" first="Antoni" last="Torres">Antoni Torres</name><name sortKey="Torres, Antoni" sort="Torres, Antoni" uniqKey="Torres A" first="Antoni" last="Torres">Antoni Torres</name></country><country name="Allemagne"><noRegion><name sortKey="Ewig, Santiago" sort="Ewig, Santiago" uniqKey="Ewig S" first="Santiago" last="Ewig">Santiago Ewig</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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|wiki= Sante
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|clé= pubmed:28093834
|texte= Seasonality of pathogens causing community-acquired pneumonia.
}}
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