Microbial etiology of community-acquired pneumonia*

	United States^[1]	United Kingdom^[2]	Spain^[3]	Sweden^[4]	Asia^[5]
Total patients evaluated	2259	323	3524	184	955
Patients in whom a pathogen was identified	853 (37.8)	280 (86.7)	1463 (41.5)	124 (67.4)^¶	428 (44.8)
Patients in whom no pathogen was identified	1406 (62.2)	43 (13.3)	2061 (58.5)	60 (32.6)	527 (55.2)
Pathogen^Δ
Bacteria
Streptococcus pneumoniae	115 (5.1)	115 (35.6)	613 (17.4)	70 (38)	114 (11.9)
Klebsiella pneumoniae	0	13 (4.0)	0	0	60 (6.3)
Haemophilus influenzae	13 (0.6)	130 (40.2)	70 (2)	9 (4.9)	59 (6.2)
Pseudomonas aeruginosa	8 (0.3)	9 (2.8)	50 (1.4)	0	26 (2.7)
Staphylococcus aureus	37 (1.6)	33 (10.2)	25 (0.7)	4 (2.2)	19 (2)
Mycobacterium tuberculosis	8 (0.3)		0	2 (1.1)	13 (1.4)
Moraxella catarrhalis	0	44 (13.6)	5 (0.1)	7 (3.8)	12 (1.3)
Mycoplasma pneumoniae	43 (1.9)	6 (1.9)	65 (1.8)^◊	15 (8.2)^◊	61/556 (11)^◊
Chlamydia pneumoniae	9 (0.4)	0	50 (1.4)^◊	0^◊	55/411 (13.4)^◊
Chlamydia psittaci		2 (0.6)
Legionella pneumophila	32 (1.4)	3 (0.9)	118 (3.3)^◊	3 (1.6)	7/648 (1.1)
Non-pneumophila Legionella spp		3 (0.9)
Coxiella burnetii	0	0	30 (0.8)^◊	0	0
Gram-negative enteric bacilli	31 (1.4)	37 (11.5)	27 (0.8)	0	0
Acinetobacter baumannii	0	3 (0.9)	0	0	0
Viruses					§
Respiratory viruses^¥			148 (4.2)^◊
Influenza viruses	132 (5.8)	23 (7.1)		14 (7.6)^◊
Rhinovirus	194 (8.6)	41 (12.7)		12 (6.5)
Respiratory syncytial virus	68 (3.0)	4 (1.2)		7 (3.8)^◊
Parainfluenza viruses	67 (3.0)	11 (3.4)		7 (3.8)^◊
Coronaviruses	53 (2.3)	9 (2.8)		4 (2.2)
Human metapneumovirus	88 (3.9)	3 (0.9)		4 (2.2)
Adenovirus	32 (1.4)	7 (2.2)		3 (1.6)^◊
Other pathogen	36 (1.6)		54 (1.5)	5 (2.7)	77 (8)
Polymicrobial (>1 pathogen identified)	115 (5.1)	‡	208 (5.9)^◊	46 (25)^◊	60 (6.3)^◊
Diagnostic methods
	Cultures (blood, endotracheal aspirates, quantitative BAL fluid specimens, pleural fluid), PCR from nasopharyngeal and oropharyngeal swabs (for adenovirus; C. pneumoniae; coronaviruses 229E, HKU1, NL63, and OC43; human metapneumovirus; rhinovirus; influenza A and B; M. pneumoniae; parainfluenza viruses 1-3; respiratory syncytial virus), real-time PCR from sputum (for L. pneumophila), PCR from pleural fluid (for Enterobacteriaceae, H. influenzae, Pseudomonas, S. aureus, S. anginosus, S. mitis, S. pneumoniae, S. pyogenes), urinary antigen testing (for L. pneumophila and S. pneumoniae), serologic testing (for adenovirus, human metapneumovirus, influenza A and B, parainfluenza viruses, respiratory syncytial virus)	Fast multiplex real-time PCR of lower respiratory tract specimens (for S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, E. coli, K. pneumoniae, P. aeruginosa, A. baumannii, M. pneumoniae, C. pneumoniae, C. psittaci, L. pneumophila, non-pneumophila Legionella spp, influenza A, influenza B, RSV, parainfluenza viruses 1-3, adenovirus, human coronaviruses [229E, HKU1, NL63, and OC43], human metapneumovirus, rhinovirus)^†	Cultures (sputum, blood, transthoracic needle aspirate, transbronchial aspirates, BAL fluid, protected specimen brush respiratory samples, pleural fluid), serologic testing (for M. pneumoniae, C. pneumoniae, L. pneumophila, C. burnetti, influenza A and B, parainfluenza viruses 1-3, respiratory syncytial virus, adenovirus), urinary antigen testing (for S. pneumoniae or L. pneumophila), immunofluorescence assay plus virus isolation or reverse transcriptase PCR for influenza A and B, parainfluenza viruses 1-3, respiratory syncytial virus, adenovirus	Cultures (sputum, blood, nasopharyngeal secretions), real-time PCR on sputum (for S. pneumoniae, H. influenzae, M. catarrhalis), PCR from nasopharyngeal secretions (for M. pneumoniae), serologic testing (for M. pneumoniae, C. pneumoniae, influenza A and B, parainfluenza viruses 1-3, respiratory syncytial virus, adenovirus), urinary antigen testing (for S. pneumoniae, L. pneumophila), virus isolation and real-time PCR (for influenza A and B, parainfluenza viruses 1-3, respiratory syncytial virus, adenovirus, human metapneumovirus, rhinovirus) on nasopharyngeal secretions	Cultures (sputum, blood, BAL fluid, pleural fluid, transthoracic needle aspiration), serologic testing (for M. pneumoniae, C. pneumoniae), urinary antigen testing (for L. pneumophila)
Site of care
	Inpatient	Inpatient	1302 inpatient, 161 outpatient	Inpatient	593 inpatient, 362 outpatient

BAL: bronchoalveolar lavage; PCR: polymerase chain reaction.
* Results are reported as number of patients (percent).
¶ A pathogen was identified in 85% of the 38 patients who had all of the diagnostic studies performed, as described in "Diagnostic methods."
Δ Results are reported as the number of patients with a given pathogen, followed by the percentage of patients in whom the pathogen was identified out of all of the patients in the study. For example, in the first column,S. pneumoniae was detected in 115 of 2259 patients in the study (5.1%). Among the 853 patients in whom a pathogen was identified,S. pneumoniae was detected in 13.5%.
◊ Pathogens detected by serologic methods may represent recent infection rather than active infection.
§ Viral etiology was not evaluated.
¥ Influenza viruses A or B, parainfluenza viruses 1-3, respiratory syncytial virus, adenovirus.
‡ Some patients had >1 pathogen identified, but the total number was not reported.
† Lower respiratory tract cultures were also sent from patients included in this study, but they are not shown in this table because complete data (ie, total number of patients in whom a pathogen was detected by either molecular methods or by culture) were not reported in the study.

References:

Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med 2015; 373:415.
Gadsby NJ, Russell CD, McHugh MP, et al. Comprehensive molecular testing for respiratory pathogens in community-acquired pneumonia. Clin Infect Dis 2016; 62:817.
Cillóniz C, Ewig S, Polverino E, et al. Microbial aetiology of community-acquired pneumonia and its relation to severity. Thorax 2011; 66:340.
Johansson N, Kalin M, Tiveljung-Lindell A, et al. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis 2010; 50:202.
Song JH, Oh WS, Kang CI, et al. Epidemiology and clinical outcomes of community-acquired pneumonia in adult patients in Asian countries: a prospective study by the Asian network for surveillance of resistant pathogens. Int J Antimicrob Agents 2008; 31:107.

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خرید پکیج

Microbial etiology of community-acquired pneumonia*