Adult Community-Acquired Pneumonia in Central London

Abstract

Summary: Strep. pneumoniae was diagnosed as the cause of pneumonia in 40 (50%) of 80 consecutive adults admitted to St Stephen's Hospital with community-acquired pneumonia. None of the patients had evidence of Mycoplasma pneumoniae infection, and Legionella pneumophila serology was positive on only one occasion. In 29 patients (36%) no causative organism was demonstrated. The diagnosis of pneumococcal infection was obtained in 15 cases by isolating Strep. pneumoniae from the sputum, in 13 further cases by demonstrating pneumococcal capsular antigen in sputum, and in 12 other cases by detecting pneumococcal antigen in serum only. Only 2 cases with pneumococcal pneumonia were bacteraemic and 3 patients (7%), all aged more than 75 years, died. The relatively low bacteraemic and mortality rates suggest that community-acquired pneumococcal pneumonia currently seen in patients admitted to hospital in central London may not be so severe as in some other areas.

A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit

“…The overall mortality of patients hospitalized for community-acquired pneumonia varies, according to the studies [13,16,18,19], between 5.7 and 21~ Mortality of patients with pneumonia treated in the ICU is often higher: 22~ reported by Torres and co-workers [5]; 25~ by Ortqwist and colleagues [20]; 28.5~ in our series and 5307o by Feldman and co-workers [21]. These differences in mortality may be explained by varying degrees in severity of illness and underlying medical conditions.…”

BTS guidelines for the management of community acquired pneumonia in adults: update 2009

“…Coincident influenza-type symptoms are reported in 39% (95% CI 27% to 53%) of cases 6 35 36 102 . [II] Evidence of coincident influenza virus infection is found in 39% (95% CI 17% to 64%) of those admitted to hospital,6 35 36 102 [II] and 50% (95% CI 25% to 75%) of those admitted to an ICU 33 34 42 103 . [II] …”

BTS Guidelines for the Management of Community Acquired Pneumonia in Adults

“…Coincident influenza type symptoms are reported in 39% (95% CI 27 to 53)11 12 14 15 [ II ]. Evidence of coincident influenza virus infection is found in 39% (95% CI 17 to 64) of those admitted to hospital11 12 14 15[ II ], and 50% (95% CI 25 to 75) of those admitted to an ICU21 22 66 73[ II ].…”

“…The literature review for the period 1981–99 provided only 16 acceptable articles relevant to the antibiotic management of CAP54 [ Ib ],221 [ II ],241 [ Ib ],242 [ Ib ],243 [ Ib ], 244 [ Ib ],245 [ Ib ],246 [ Ib ],247 [ Ib ],248 [ Ib ],249 [ Ib ], 250[ Ib ],251 [ Ib ],252 [ Ib ],253 [ Ib ],254 [ Ib ]. The remainder were rejected for the following reasons: inadequately powered studies or a retrospective design,15 255-272 antibiotic not available in the UK or withdrawn,27 273-306 study population or management unrepresentative of normal clinical practice in the UK,253 307-315 or they included mixed lower respiratory tract infections including CAP 253286 316 317 …”