Microbial etiology of community-acquired pneumonia by site of care*

	Outpatients		Ward patients		Intensive care unit patients
	Spain^[1^]	Canada^[2]	Spain^[1]	United States^[3]	Spain^[1]	United States^[3]
Total patients evaluated	514	507	2521	585	488	145
Patients in whom a pathogen was identified	161 (31.3)	244 (48.1)	1042 (41)	120 (21)	260 (53)	57 (39)
Patients in whom no pathogen was identified	353 (68.7)	263 (51.9)	1479 (59)	465 (79)	228 (47)	88 (61)
Pathogen^¶
Streptococcus pneumoniae	56 (10.9)	30 (5.9)	447 (17.7)	38 (6.5)	110 (22.5)	22 (15.2)
Other Streptococcus spp	0	5 (1.0)	0	0	0	0
Haemophilus influenzae	8 (1.6)	25 (4.9)	54 (2.1)	16 (2.7)	8 (1.6)	3 (2.1)
Haemophilus parainfluenzae	0	10 (2.0)	0	0	0	0
Moraxella catarrhalis	0	6 (1.2)	4 (0.2)	0	1 (0.2)	0
Legionella pneumophila	10 (1.9)	Δ	87 (3.5)	◊	21 (4.3)	◊
Mycoplasma pneumoniae	27 (5.3)^§	87 (17.2)^§	32 (1.3)^§	¥	6 (1.2)^§	¥
Chlamydia pneumoniae	10 (1.9)^§	72 (14.2)^§	32 (1.3)^§	¥	8 (1.6)^§	¥
Coxiella burnetii	11 (2.1)^§	Δ	17 (0.7)^§	¥	2 (0.4)^§	¥
Staphylococcus aureus	1 (0.2)	6 (1.2)	18 (0.7)	25 (4.3)	6 (1.2)	12 (8.3)
MSSA	1 (0.2)	NR	9 (0.4)	18 (3.1)	4 (0.8)	9 (6.2)
MRSA	0	NR	9 (0.4)	7 (1.2)	2 (0.4)	3 (2.1)
Gram-negative enteric bacilli	1 (0.2)	2 (0.4)	23 (0.9)	15 (2.6)	3 (0.6)	4 (2.8)
Pseudomonas aeruginosa	1 (0.2)	1 (0.2)	37 (1.5)	12 (2.1)	12 (2.5)	8 (5.5)
Respiratory viruses^‡	15 (2.9)^§	†	123 (4.9)^§	†	10 (2.0)^§	†
Other pathogen	6 (1.2)	14 (2.8)	33 (1.3)	8 (1.4)	15 (3.1)	3 (2.1)
>1 pathogen	15 (2.9)	**	135 (5.4)	6 (1.0)	58 (11.9)	7 (4.8)
Diagnostic methods
	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 to 3, respiratory syncytial virus, adenovirus), urinary antigen testing (for S. pneumoniae and L. pneumophila), immunofluorescence assay plus virus isolation or reverse transcriptase PCR for influenza A and B, parainfluenza viruses 1 to 3, respiratory syncytial virus, adenovirus	Cultures (sputum, blood), serologic testing (for M. pneumoniae, C. pneumoniae)	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 to 3, respiratory syncytial virus, adenovirus), urinary antigen testing (for S. pneumoniae and L. pneumophila), immunofluorescence assay plus virus isolation or reverse transcriptase PCR for influenza A and B, parainfluenza viruses 1 to 3, respiratory syncytial virus, adenovirus	Cultures (blood, endotracheal aspirates, protected specimen brush respiratory samples, BAL fluid, pleural fluid), urinary antigen (for L. pneumophila)	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 to 3, respiratory syncytial virus, adenovirus), urinary antigen testing (for S. pneumoniae and L. pneumophila), immunofluorescence assay plus virus isolation or reverse transcriptase PCR for influenza A and B, parainfluenza viruses 1 to 3, respiratory syncytial virus, adenovirus	Cultures (blood, endotracheal aspirates, protected specimen brush respiratory samples, BAL fluid, pleural fluid), urinary antigen testing (for L. pneumophila)

MSSA: methicillin-susceptible Staphylococcus aureus; MRSA: methicillin-resistant Staphylococcus aureus; NR: not reported; BAL: bronchoalveolar lavage; PCR: polymerase chain reaction.
* Results are reported as number of patients (percent). Different methods were used for diagnosis in each study, as described in the row on diagnostic methods.
¶ 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 30 of 507 patients in the study (5.9%). Among the 244 patients in whom a pathogen was identified, S. pneumoniae was detected in 12.3%.
Δ Testing for Legionella spp and C. burnetti was not performed.
◊ Legionella urinary antigen testing was performed in 35 ward patients and 26 intensive care unit patients, but all results were negative. Legionella culture was not performed.
§ Pathogens detected by serologic methods may represent recent infection rather than active infection.
¥ Testing for M. pneumoniae, C. pneumoniae, and C. burnetii was not performed.
‡ Influenza viruses A or B, parainfluenza viruses 1 to 3, respiratory syncytial virus, adenovirus.
† Testing for viruses was not performed.
** Some patients had >1 pathogen isolated, but the details were not reported.

References:

Cillóniz C, Ewig S, Polverino E, et al. Microbial aetiology of community-acquired pneumonia and its relation to severity. Thorax 2011; 66:340.
Marrie TJ, Poulin-Costello M, Beecroft MD, Herman-Bnjidic Z. Etiology of community-acquired pneumonia treated in an ambulatory setting. Resp Medicine 2005; 99:60.
Restrepo MI, Mortensen EM, Velez JA, et al. A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU. Chest 2008; 133:610.

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خرید پکیج

Microbial etiology of community-acquired pneumonia by site of care*