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Article: Role of 'atypical pathogens' among adult hospitalized patients with community-acquired pneumonia

TitleRole of 'atypical pathogens' among adult hospitalized patients with community-acquired pneumonia
Authors
KeywordsPneumonia
Outcome
Mycoplasma
Severity
Chlamydophila
Issue Date2009
Citation
Respirology, 2009, v. 14, n. 8, p. 1098-1105 How to Cite?
AbstractBackground 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. © 2009 Asian Pacific Society of Respirology.
Persistent Identifierhttp://hdl.handle.net/10722/291924
ISSN
2023 Impact Factor: 6.6
2023 SCImago Journal Rankings: 1.559
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLui, Grace-
dc.contributor.authorIp, Margaret-
dc.contributor.authorLee, Nelson-
dc.contributor.authorRainer, Timothy H.-
dc.contributor.authorMan, Shin Y.-
dc.contributor.authorCockram, Clive S.-
dc.contributor.authorAntonio, Gregory E.-
dc.contributor.authorNg, Margaret H.L.-
dc.contributor.authorChan, Michael H.M.-
dc.contributor.authorChau, Shirley S.L.-
dc.contributor.authorMak, Paulina-
dc.contributor.authorChan, Paul K.S.-
dc.contributor.authorAhuja, Anil T.-
dc.contributor.authorSung, Joseph J.Y.-
dc.contributor.authorHui, David S.C.-
dc.date.accessioned2020-11-17T14:55:24Z-
dc.date.available2020-11-17T14:55:24Z-
dc.date.issued2009-
dc.identifier.citationRespirology, 2009, v. 14, n. 8, p. 1098-1105-
dc.identifier.issn1323-7799-
dc.identifier.urihttp://hdl.handle.net/10722/291924-
dc.description.abstractBackground 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. © 2009 Asian Pacific Society of Respirology.-
dc.languageeng-
dc.relation.ispartofRespirology-
dc.subjectPneumonia-
dc.subjectOutcome-
dc.subjectMycoplasma-
dc.subjectSeverity-
dc.subjectChlamydophila-
dc.titleRole of 'atypical pathogens' among adult hospitalized patients with community-acquired pneumonia-
dc.typeArticle-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/j.1440-1843.2009.01637.x-
dc.identifier.pmid19818051-
dc.identifier.scopuseid_2-s2.0-70350441757-
dc.identifier.volume14-
dc.identifier.issue8-
dc.identifier.spage1098-
dc.identifier.epage1105-
dc.identifier.eissn1440-1843-
dc.identifier.isiWOS:000271064100005-
dc.identifier.issnl1323-7799-

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