Role of ‘atypical pathogens’ among adult hospitalized patients with community‐acquired pneumonia
Identifieur interne : 002D09 ( Main/Exploration ); précédent : 002D08; suivant : 002D10Role of ‘atypical pathogens’ among adult hospitalized patients with community‐acquired pneumonia
Auteurs : Grace Lui ; Margaret Ip ; Nelson Lee [Hong Kong] ; Timothy H. Rainer ; Shin Y. Man ; Clive S. Cockram ; Gregory E. Antonio ; Margaret H. L. Ng ; Michael H. M. Chan [Hong Kong] ; Shirley S. L. Chau ; Paulina Mak ; Paul K. S. Chan ; Anil T. Ahuja ; Joseph J. Y. Sung ; David S. C. HuiSource :
- Respirology [ 1323-7799 ] ; 2009-11.
English descriptors
- Teeft :
- Acute infection, Acute infections, Admission mortality, Adult patients, Aetiology, Antibiotic, Antibody levels, Asian network, Asian society, Assay, Atypical, Atypical pathogen, Atypical pathogens, Atypical pathogens table, Atypical pneumonia, Authors journal compilation, Bacterial infection, Bacterial pneumonia, Blood sample, Causal organisms, Chlamydophila, Chlamydophila pneumoniae, Class score, Clin, Clinical characteristics, Clinical features, Clinical laboratory standards, Clinical outcomes, Clinical prediction rule, Commercial tests, Communityacquired, Communityacquired pneumonia, Comorbidity, Comorbidity comorbidity, Consecutive patients, Discriminatory ability, Disease severity, Elderly patients, Empirical antibiotic coverage, Empirical therapy, Female gender, Hong kong, Hospital authority, Important causes, Infection, Intensive care unit, Laboratory variables, Legionella pneumophila, Leucocyte count, Microbiol, Mycoplasma, Mycoplasma pneumoniae, Nasopharyngeal aspirates, National committee, Nursing home, Nursing home residents, Older adults, Other aetiologies, Other causes, Other studies, Oxygen therapy, Pathogen, Pneumonia, Pneumonia severity index, Pneumoniae, Pneumoniae infections, Pneumophila, Pneumophila serogroup, Positive result, Prediction rule, Prospective comparison, Prospective study, Pulse rate, Reasonable sensitivity, Respiratory rate, Respiratory syncytial virus, Respiratory viruses, Respirology, Respirology respirology, Serological assays, Serological diagnosis, Severe pneumonia, Sodium urea, Standard procedures, Supplemental oxygen therapy, Thorax, Urine specimens, Viral, Viral causes, Viral pneumonia, Virus types, Wales hospital.
Abstract
Background and objective: Agents such as Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila are recognized as important causes of community‐acquired pneumonia (CAP) worldwide. This study examined the role of these ‘atypical pathogens’ (AP) among adult hospitalized patients with CAP. Methods: A prospective, observational study of consecutive adult CAP (clinico‐radiological diagnosis) patients hospitalized during 2004–2005 was conducted. Causal organisms were determined using cultures, antigen testing and paired serology. Clinical/laboratory/radiological variables and outcomes were compared between different aetiologies, and a clinical prediction rule for AP was constructed. Results: There were 1193 patients studied (mean age 70.8 ± 18.0 years, men 59.3%). Causal organisms were identified in 468 (39.2%) patients: ‘bacterial’ (48.7%), ‘viral’ (26.9%), ‘AP’ (28.6%). The AP infections comprised Mycoplasma or Chlamydophila pneumoniae (97.8%) and co‐infection with bacteria/virus (30.6%). The majority of AP infections involved elderly patients (63.4%) with comorbidities (41.8%), and more than one‐third of patients were classified as ‘intermediate’ or ‘high’ risk CAP on presentation (pneumonia severity index IV–V (35.1%); CURB‐65 2–5 (42.5%)). Patients with AP infections had disease severities and outcomes similar to patients with CAP due to other organisms (oxygen therapy 29.1% vs 29.8%; non‐invasive ventilation 3.7% vs 3.3%; admission to the intensive care unit 4.5% vs 2.7%; length of hospitalization 6 day vs 7 day; 30‐day mortality: 2.2% vs 6.0%; overall P > 0.05). Age <65 years, female gender, fever ≥38.0°C, respiratory rate <25/min, pulse rate <100/min, serum sodium >130 mmol/L, leucocyte count <11 × 109/L and Hb < 11 g/dL were features associated with AP infection, but the derived prediction rule failed to reliably discriminate CAP caused by AP from bacterial CAP (area under the curve 0.75). Conclusions: M. pneumoniae and C. pneumoniae as single/co‐pathogens are important causes of severe pneumonia among older adults. No reliable clinical indicators exist, so empirical antibiotic coverage for hospitalized CAP patients may need to be considered.
Url:
DOI: 10.1111/j.1440-1843.2009.01637.x
Affiliations:
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Rainer</name><affiliation><wicri:noCountry code="subField">and</wicri:noCountry></affiliation></author><author><name sortKey="Man, Shin Y" sort="Man, Shin Y" uniqKey="Man S" first="Shin Y." last="Man">Shin Y. Man</name><affiliation><wicri:noCountry code="subField">and</wicri:noCountry></affiliation></author><author><name sortKey="Cockram, Clive S" sort="Cockram, Clive S" uniqKey="Cockram C" first="Clive S." last="Cockram">Clive S. Cockram</name><affiliation><wicri:noCountry code="subField">and</wicri:noCountry></affiliation></author><author><name sortKey="Antonio, Gregory E" sort="Antonio, Gregory E" uniqKey="Antonio G" first="Gregory E." last="Antonio">Gregory E. Antonio</name><affiliation><wicri:noCountry code="subField">and</wicri:noCountry></affiliation></author><author><name sortKey="Ng, Margaret H L" sort="Ng, Margaret H L" uniqKey="Ng M" first="Margaret H. L." last="Ng">Margaret H. L. 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Sung</name><affiliation><wicri:noCountry code="subField">and</wicri:noCountry></affiliation></author><author><name sortKey="Hui, David S C" sort="Hui, David S C" uniqKey="Hui D" first="David S. C." last="Hui">David S. C. Hui</name><affiliation><wicri:noCountry code="subField">and</wicri:noCountry></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Respirology</title><title level="j" type="alt">RESPIROLOGY</title><idno type="ISSN">1323-7799</idno><idno type="eISSN">1440-1843</idno><imprint><biblScope unit="vol">14</biblScope><biblScope unit="issue">8</biblScope><biblScope unit="page" from="1098">1098</biblScope><biblScope unit="page" to="1105">1105</biblScope><biblScope unit="page-count">8</biblScope><publisher>Blackwell Publishing Asia</publisher><pubPlace>Melbourne, Australia</pubPlace><date type="published" when="2009-11">2009-11</date></imprint><idno type="ISSN">1323-7799</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1323-7799</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Acute infection</term><term>Acute infections</term><term>Admission mortality</term><term>Adult patients</term><term>Aetiology</term><term>Antibiotic</term><term>Antibody levels</term><term>Asian network</term><term>Asian society</term><term>Assay</term><term>Atypical</term><term>Atypical pathogen</term><term>Atypical pathogens</term><term>Atypical pathogens table</term><term>Atypical pneumonia</term><term>Authors journal compilation</term><term>Bacterial infection</term><term>Bacterial pneumonia</term><term>Blood sample</term><term>Causal organisms</term><term>Chlamydophila</term><term>Chlamydophila pneumoniae</term><term>Class score</term><term>Clin</term><term>Clinical characteristics</term><term>Clinical features</term><term>Clinical laboratory standards</term><term>Clinical outcomes</term><term>Clinical prediction rule</term><term>Commercial tests</term><term>Communityacquired</term><term>Communityacquired pneumonia</term><term>Comorbidity</term><term>Comorbidity comorbidity</term><term>Consecutive patients</term><term>Discriminatory ability</term><term>Disease severity</term><term>Elderly patients</term><term>Empirical antibiotic coverage</term><term>Empirical therapy</term><term>Female gender</term><term>Hong kong</term><term>Hospital authority</term><term>Important causes</term><term>Infection</term><term>Intensive care unit</term><term>Laboratory variables</term><term>Legionella pneumophila</term><term>Leucocyte count</term><term>Microbiol</term><term>Mycoplasma</term><term>Mycoplasma pneumoniae</term><term>Nasopharyngeal aspirates</term><term>National committee</term><term>Nursing home</term><term>Nursing home residents</term><term>Older adults</term><term>Other aetiologies</term><term>Other causes</term><term>Other studies</term><term>Oxygen therapy</term><term>Pathogen</term><term>Pneumonia</term><term>Pneumonia severity index</term><term>Pneumoniae</term><term>Pneumoniae infections</term><term>Pneumophila</term><term>Pneumophila serogroup</term><term>Positive result</term><term>Prediction rule</term><term>Prospective comparison</term><term>Prospective study</term><term>Pulse rate</term><term>Reasonable sensitivity</term><term>Respiratory rate</term><term>Respiratory syncytial virus</term><term>Respiratory viruses</term><term>Respirology</term><term>Respirology respirology</term><term>Serological assays</term><term>Serological diagnosis</term><term>Severe pneumonia</term><term>Sodium urea</term><term>Standard procedures</term><term>Supplemental oxygen therapy</term><term>Thorax</term><term>Urine specimens</term><term>Viral</term><term>Viral causes</term><term>Viral pneumonia</term><term>Virus types</term><term>Wales hospital</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background and objective: Agents such as Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila are recognized as important causes of community‐acquired pneumonia (CAP) worldwide. This study examined the role of these ‘atypical pathogens’ (AP) among adult hospitalized patients with CAP. Methods: A prospective, observational study of consecutive adult CAP (clinico‐radiological diagnosis) patients hospitalized during 2004–2005 was conducted. Causal organisms were determined using cultures, antigen testing and paired serology. Clinical/laboratory/radiological variables and outcomes were compared between different aetiologies, and a clinical prediction rule for AP was constructed. Results: There were 1193 patients studied (mean age 70.8 ± 18.0 years, men 59.3%). Causal organisms were identified in 468 (39.2%) patients: ‘bacterial’ (48.7%), ‘viral’ (26.9%), ‘AP’ (28.6%). The AP infections comprised Mycoplasma or Chlamydophila pneumoniae (97.8%) and co‐infection with bacteria/virus (30.6%). The majority of AP infections involved elderly patients (63.4%) with comorbidities (41.8%), and more than one‐third of patients were classified as ‘intermediate’ or ‘high’ risk CAP on presentation (pneumonia severity index IV–V (35.1%); CURB‐65 2–5 (42.5%)). Patients with AP infections had disease severities and outcomes similar to patients with CAP due to other organisms (oxygen therapy 29.1% vs 29.8%; non‐invasive ventilation 3.7% vs 3.3%; admission to the intensive care unit 4.5% vs 2.7%; length of hospitalization 6 day vs 7 day; 30‐day mortality: 2.2% vs 6.0%; overall P > 0.05). Age <65 years, female gender, fever ≥38.0°C, respiratory rate <25/min, pulse rate <100/min, serum sodium >130 mmol/L, leucocyte count <11 × 109/L and Hb < 11 g/dL were features associated with AP infection, but the derived prediction rule failed to reliably discriminate CAP caused by AP from bacterial CAP (area under the curve 0.75). Conclusions: M. pneumoniae and C. pneumoniae as single/co‐pathogens are important causes of severe pneumonia among older adults. No reliable clinical indicators exist, so empirical antibiotic coverage for hospitalized CAP patients may need to be considered.</div></front></TEI><affiliations><list><country><li>Hong Kong</li></country><settlement><li>Sha Tin</li></settlement><orgName><li>Université chinoise de Hong Kong</li></orgName></list><tree><noCountry><name sortKey="Ahuja, Anil T" sort="Ahuja, Anil T" uniqKey="Ahuja A" first="Anil T." last="Ahuja">Anil T. Ahuja</name><name sortKey="Antonio, Gregory E" sort="Antonio, Gregory E" uniqKey="Antonio G" first="Gregory E." last="Antonio">Gregory E. Antonio</name><name sortKey="Chan, Paul K S" sort="Chan, Paul K S" uniqKey="Chan P" first="Paul K. S." last="Chan">Paul K. S. Chan</name><name sortKey="Chau, Shirley S L" sort="Chau, Shirley S L" uniqKey="Chau S" first="Shirley S. L." last="Chau">Shirley S. L. Chau</name><name sortKey="Cockram, Clive S" sort="Cockram, Clive S" uniqKey="Cockram C" first="Clive S." last="Cockram">Clive S. Cockram</name><name sortKey="Hui, David S C" sort="Hui, David S C" uniqKey="Hui D" first="David S. C." last="Hui">David S. C. Hui</name><name sortKey="Ip, Margaret" sort="Ip, Margaret" uniqKey="Ip M" first="Margaret" last="Ip">Margaret Ip</name><name sortKey="Lui, Grace" sort="Lui, Grace" uniqKey="Lui G" first="Grace" last="Lui">Grace Lui</name><name sortKey="Mak, Paulina" sort="Mak, Paulina" uniqKey="Mak P" first="Paulina" last="Mak">Paulina Mak</name><name sortKey="Man, Shin Y" sort="Man, Shin Y" uniqKey="Man S" first="Shin Y." last="Man">Shin Y. Man</name><name sortKey="Ng, Margaret H L" sort="Ng, Margaret H L" uniqKey="Ng M" first="Margaret H. L." last="Ng">Margaret H. L. Ng</name><name sortKey="Rainer, Timothy H" sort="Rainer, Timothy H" uniqKey="Rainer T" first="Timothy H." last="Rainer">Timothy H. Rainer</name><name sortKey="Sung, Joseph J Y" sort="Sung, Joseph J Y" uniqKey="Sung J" first="Joseph J. Y." last="Sung">Joseph J. Y. Sung</name></noCountry><country name="Hong Kong"><noRegion><name sortKey="Lee, Nelson" sort="Lee, Nelson" uniqKey="Lee N" first="Nelson" last="Lee">Nelson Lee</name></noRegion><name sortKey="Chan, Michael H M" sort="Chan, Michael H M" uniqKey="Chan M" first="Michael H. M." last="Chan">Michael H. M. Chan</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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