Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity.
Identifieur interne : 000680 ( Main/Exploration ); précédent : 000679; suivant : 000681Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity.
Auteurs : M. Ruiz [Espagne] ; S. Ewig ; M A Marcos ; J A Martinez ; F. Arancibia ; J. Mensa ; A. TorresSource :
- American journal of respiratory and critical care medicine [ 1073-449X ] ; 1999.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Comorbidité (MeSH), Consommation d'alcool (effets indésirables), Espagne (épidémiologie), Facteurs de risque (MeSH), Facteurs âges (MeSH), Femelle (MeSH), Fumer (effets indésirables), Humains (MeSH), Infections communautaires (microbiologie), Infections communautaires (épidémiologie), Infections communautaires (étiologie), Mâle (MeSH), Pneumopathie bactérienne (microbiologie), Pneumopathie bactérienne (épidémiologie), Pneumopathie bactérienne (étiologie), Sujet âgé (MeSH), Sujet âgé de 80 ans ou plus (MeSH), Techniques bactériologiques (MeSH), Études prospectives (MeSH).
- MESH :
- effets indésirables : Consommation d'alcool, Fumer.
- microbiologie : Infections communautaires, Pneumopathie bactérienne.
- épidémiologie : Espagne, Infections communautaires, Pneumopathie bactérienne.
- étiologie : Infections communautaires, Pneumopathie bactérienne.
- Adulte, Adulte d'âge moyen, Comorbidité, Facteurs de risque, Facteurs âges, Femelle, Humains, Mâle, Sujet âgé, Sujet âgé de 80 ans ou plus, Techniques bactériologiques, Études prospectives.
- Wicri :
- geographic : Espagne.
English descriptors
- KwdEn :
- Adult (MeSH), Age Factors (MeSH), Aged (MeSH), Aged, 80 and over (MeSH), Alcohol Drinking (adverse effects), Bacteriological Techniques (MeSH), Community-Acquired Infections (epidemiology), Community-Acquired Infections (etiology), Community-Acquired Infections (microbiology), Comorbidity (MeSH), Female (MeSH), Humans (MeSH), Male (MeSH), Middle Aged (MeSH), Pneumonia, Bacterial (epidemiology), Pneumonia, Bacterial (etiology), Pneumonia, Bacterial (microbiology), Prospective Studies (MeSH), Risk Factors (MeSH), Smoking (adverse effects), Spain (epidemiology).
- MESH :
- geographic , epidemiology : Spain.
- adverse effects : Alcohol Drinking, Smoking.
- epidemiology : Community-Acquired Infections, Pneumonia, Bacterial.
- etiology : Community-Acquired Infections, Pneumonia, Bacterial.
- microbiology : Community-Acquired Infections, Pneumonia, Bacterial.
- Adult, Age Factors, Aged, Aged, 80 and over, Bacteriological Techniques, Comorbidity, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors.
Abstract
The aim of this study was to determine the etiology of community-acquired pneumonia (CAP) and the impact of age, comorbidity, and severity on microbial etiologies of such pneumonia. Overall, 395 consecutive patients with CAP were studied prospectively during a 15-mo period. Regular microbial investigation included examination of sputum, blood culture, and serology. Sampling of pleural fluid, transthoracic puncture, tracheobronchial aspiration, and protected specimen brush (PSB) sampling were performed in selected patients. The microbial etiology was determined in 182 of 395 (46%) cases, and 227 pathogens were detected. The five most frequent pathogens were Streptococcus pneumoniae (65 patients [29%]), Haemophilus influenzae (25 patients [11%]), Influenza virus A and B (23 patients [10%]), Legionella sp. (17 patients [8%]), and Chlamydia pneumoniae (15 patients [7%]). Gram-negative enteric bacilli (GNEB) accounted for 13 cases (6%) and Pseudomonas aeruginosa for 12 cases of pneumonia (5%). Patients aged < 60 yr were at risk for an "atypical" bacterial etiology (odds ratio [OR]: 2.3; 95% confidence interval [CI]: 1.2 to 4.5), especially Mycoplasma pneumoniae (OR: 5.3; 95% CI: 1.7 to 16.8). Comorbid pulmonary, hepatic, and central nervous illnesses, as well as current cigarette smoking and alcohol abuse, were all associated with distinct etiologic patterns. Pneumonia requiring admission to the intensive care unit was independently associated with the pathogens S. pneumoniae (OR: 2.5; 95% CI: 1.3 to 4.7), gram-negative enteric bacilli, and P. aeruginosa (OR: 2.5; 95% CI: 0.99 to 6.5). Clinical and radiographic features of "typical" pneumonia were neither sensitive nor specific for the differentiation of pneumococcal and nonpneumococcal etiologies. These results support a management approach based on the associations between etiology and age, comorbidity, and severity, instead of the traditional syndromic approach to CAP.
DOI: 10.1164/ajrccm.160.2.9808045
PubMed: 10430704
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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Ewig</name></author><author><name sortKey="Marcos, M A" sort="Marcos, M A" uniqKey="Marcos M" first="M A" last="Marcos">M A Marcos</name></author><author><name sortKey="Martinez, J A" sort="Martinez, J A" uniqKey="Martinez J" first="J A" last="Martinez">J A Martinez</name></author><author><name sortKey="Arancibia, F" sort="Arancibia, F" uniqKey="Arancibia F" first="F" last="Arancibia">F. Arancibia</name></author><author><name sortKey="Mensa, J" sort="Mensa, J" uniqKey="Mensa J" first="J" last="Mensa">J. Mensa</name></author><author><name sortKey="Torres, A" sort="Torres, A" uniqKey="Torres A" first="A" last="Torres">A. 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Ruiz</name><affiliation wicri:level="3"><nlm:affiliation>Department of Medicine, University of Barcelona, Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Medicine, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Ewig, S" sort="Ewig, S" uniqKey="Ewig S" first="S" last="Ewig">S. Ewig</name></author><author><name sortKey="Marcos, M A" sort="Marcos, M A" uniqKey="Marcos M" first="M A" last="Marcos">M A Marcos</name></author><author><name sortKey="Martinez, J A" sort="Martinez, J A" uniqKey="Martinez J" first="J A" last="Martinez">J A Martinez</name></author><author><name sortKey="Arancibia, F" sort="Arancibia, F" uniqKey="Arancibia F" first="F" last="Arancibia">F. 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Overall, 395 consecutive patients with CAP were studied prospectively during a 15-mo period. Regular microbial investigation included examination of sputum, blood culture, and serology. Sampling of pleural fluid, transthoracic puncture, tracheobronchial aspiration, and protected specimen brush (PSB) sampling were performed in selected patients. The microbial etiology was determined in 182 of 395 (46%) cases, and 227 pathogens were detected. The five most frequent pathogens were Streptococcus pneumoniae (65 patients [29%]), Haemophilus influenzae (25 patients [11%]), Influenza virus A and B (23 patients [10%]), Legionella sp. (17 patients [8%]), and Chlamydia pneumoniae (15 patients [7%]). Gram-negative enteric bacilli (GNEB) accounted for 13 cases (6%) and Pseudomonas aeruginosa for 12 cases of pneumonia (5%). Patients aged < 60 yr were at risk for an "atypical" bacterial etiology (odds ratio [OR]: 2.3; 95% confidence interval [CI]: 1.2 to 4.5), especially Mycoplasma pneumoniae (OR: 5.3; 95% CI: 1.7 to 16.8). Comorbid pulmonary, hepatic, and central nervous illnesses, as well as current cigarette smoking and alcohol abuse, were all associated with distinct etiologic patterns. Pneumonia requiring admission to the intensive care unit was independently associated with the pathogens S. pneumoniae (OR: 2.5; 95% CI: 1.3 to 4.7), gram-negative enteric bacilli, and P. aeruginosa (OR: 2.5; 95% CI: 0.99 to 6.5). Clinical and radiographic features of "typical" pneumonia were neither sensitive nor specific for the differentiation of pneumococcal and nonpneumococcal etiologies. These results support a management approach based on the associations between etiology and age, comorbidity, and severity, instead of the traditional syndromic approach to CAP.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">10430704</PMID><DateCompleted><Year>1999</Year><Month>08</Month><Day>30</Day></DateCompleted><DateRevised><Year>2006</Year><Month>11</Month><Day>15</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">1073-449X</ISSN><JournalIssue CitedMedium="Print"><Volume>160</Volume><Issue>2</Issue><PubDate><Year>1999</Year><Month>Aug</Month></PubDate></JournalIssue><Title>American journal of respiratory and critical care medicine</Title><ISOAbbreviation>Am. J. Respir. Crit. Care Med.</ISOAbbreviation></Journal><ArticleTitle>Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity.</ArticleTitle><Pagination><MedlinePgn>397-405</MedlinePgn></Pagination><Abstract><AbstractText>The aim of this study was to determine the etiology of community-acquired pneumonia (CAP) and the impact of age, comorbidity, and severity on microbial etiologies of such pneumonia. Overall, 395 consecutive patients with CAP were studied prospectively during a 15-mo period. Regular microbial investigation included examination of sputum, blood culture, and serology. Sampling of pleural fluid, transthoracic puncture, tracheobronchial aspiration, and protected specimen brush (PSB) sampling were performed in selected patients. The microbial etiology was determined in 182 of 395 (46%) cases, and 227 pathogens were detected. The five most frequent pathogens were Streptococcus pneumoniae (65 patients [29%]), Haemophilus influenzae (25 patients [11%]), Influenza virus A and B (23 patients [10%]), Legionella sp. (17 patients [8%]), and Chlamydia pneumoniae (15 patients [7%]). Gram-negative enteric bacilli (GNEB) accounted for 13 cases (6%) and Pseudomonas aeruginosa for 12 cases of pneumonia (5%). Patients aged < 60 yr were at risk for an "atypical" bacterial etiology (odds ratio [OR]: 2.3; 95% confidence interval [CI]: 1.2 to 4.5), especially Mycoplasma pneumoniae (OR: 5.3; 95% CI: 1.7 to 16.8). Comorbid pulmonary, hepatic, and central nervous illnesses, as well as current cigarette smoking and alcohol abuse, were all associated with distinct etiologic patterns. Pneumonia requiring admission to the intensive care unit was independently associated with the pathogens S. pneumoniae (OR: 2.5; 95% CI: 1.3 to 4.7), gram-negative enteric bacilli, and P. aeruginosa (OR: 2.5; 95% CI: 0.99 to 6.5). Clinical and radiographic features of "typical" pneumonia were neither sensitive nor specific for the differentiation of pneumococcal and nonpneumococcal etiologies. These results support a management approach based on the associations between etiology and age, comorbidity, and severity, instead of the traditional syndromic approach to CAP.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Ruiz</LastName><ForeName>M</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Medicine, University of Barcelona, Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ewig</LastName><ForeName>S</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Marcos</LastName><ForeName>M A</ForeName><Initials>MA</Initials></Author><Author ValidYN="Y"><LastName>Martinez</LastName><ForeName>J A</ForeName><Initials>JA</Initials></Author><Author ValidYN="Y"><LastName>Arancibia</LastName><ForeName>F</ForeName><Initials>F</Initials></Author><Author ValidYN="Y"><LastName>Mensa</LastName><ForeName>J</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Torres</LastName><ForeName>A</ForeName><Initials>A</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Am J Respir Crit Care Med</MedlineTA><NlmUniqueID>9421642</NlmUniqueID><ISSNLinking>1073-449X</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000367" MajorTopicYN="N">Age Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000428" MajorTopicYN="N">Alcohol Drinking</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001431" MajorTopicYN="N">Bacteriological Techniques</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017714" MajorTopicYN="N">Community-Acquired Infections</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000209" MajorTopicYN="Y">etiology</QualifierName><QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015897" MajorTopicYN="N">Comorbidity</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018410" MajorTopicYN="N">Pneumonia, Bacterial</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000209" MajorTopicYN="Y">etiology</QualifierName><QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012907" MajorTopicYN="N">Smoking</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013030" MajorTopicYN="N" Type="Geographic">Spain</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>1999</Year><Month>8</Month><Day>3</Day></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>1999</Year><Month>8</Month><Day>3</Day><Hour>0</Hour><Minute>1</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>1999</Year><Month>8</Month><Day>3</Day><Hour>0</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">10430704</ArticleId><ArticleId IdType="doi">10.1164/ajrccm.160.2.9808045</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Espagne</li></country><region><li>Catalogne</li></region><settlement><li>Barcelone</li></settlement></list><tree><noCountry><name sortKey="Arancibia, F" sort="Arancibia, F" uniqKey="Arancibia F" first="F" last="Arancibia">F. Arancibia</name><name sortKey="Ewig, S" sort="Ewig, S" uniqKey="Ewig S" first="S" last="Ewig">S. Ewig</name><name sortKey="Marcos, M A" sort="Marcos, M A" uniqKey="Marcos M" first="M A" last="Marcos">M A Marcos</name><name sortKey="Martinez, J A" sort="Martinez, J A" uniqKey="Martinez J" first="J A" last="Martinez">J A Martinez</name><name sortKey="Mensa, J" sort="Mensa, J" uniqKey="Mensa J" first="J" last="Mensa">J. Mensa</name><name sortKey="Torres, A" sort="Torres, A" uniqKey="Torres A" first="A" last="Torres">A. Torres</name></noCountry><country name="Espagne"><region name="Catalogne"><name sortKey="Ruiz, M" sort="Ruiz, M" uniqKey="Ruiz M" first="M" last="Ruiz">M. Ruiz</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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