Aetiology of Community-acquired Pneumonia in Hospital Treated Patients

Holmberg, Hans

doi:10.3109/00365548709032413

Cited by 85 publications

(31 citation statements)

References 47 publications

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“…In Denmark, until very recently, pneumococcal vaccine was used only in asplenic patients. All studies of aetiology show that the majority of community acquired pneumonias are caused by pneumococci [2,6,7]. Recent studies suggest that the vaccines now available are effective in preventing this type of infection in elderly subjects with chronic diseases [26,27].…”

Section: Discussionmentioning

confidence: 99%

“…Although there are numerous papers dealing with causes of community acquired pneumonia [2,[5][6][7] and with the prognosis once the patients have been admitted to hospital, the literature concerning the identification of factors that make subjects prone to develop pneumonia is sparse. In fact, we are familiar with only one prospective study, where subjects from the general population have been followed with regard to pneumonia mortality and morbidity [8] and a few other studies that investigated cohorts of employees or ambulatory patients [9,10].…”

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confidence: 99%

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Risk factors for death and hospitalization from pneumonia. A prospective study of a general population

Lange¹,

Vestbo²,

Nyboe³

1995

Eur Respir J

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R Ri is sk k f fa ac ct to or rs s f fo or r d de ea at th h a an nd d h ho os sp pi it ta al li iz za at ti io on n f fr ro om m p pn ne eu um mo on ni ia a. .A A p pr ro os sp pe ec ct ti iv ve e s st tu ud dy y o of f a a g ge en ne er ra al l p po op pu ul la at ti io on n A total of 260 deaths with pneumonia as main or contributory death cause had occurred, and 405 subjects had been admitted to hospital at least once because of pneumonia. Mortality and hospitalization were analysed by multivariate Cox regression models.In addition to increasing age, forced expiratory volume in one second (FEV1) was strongly and consistently related to both pneumonia related mortality and hospitalization. Women with FEV1<60% predicted had a relative risk of 5.7 (95% confidence interval: 2.9-11) and 3.6 (2.1-6.4) for death and hospitalization, respectively, when compared with women with FEV1 ≥ 100% predicted. Similar, although lower, relative risks were observed in men. Other significant risk indicators for hospitalization were: self-reported asthma (women), mucus hypersecretion (women and men), history of stroke (men) and smoking (women).We conclude that, in addition to age, reduced FEV1 is the most important risk indicator for severe pneumonia.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Risk factors for death and hospitalization from pneumonia. A prospective study of a general population

Lange¹,

Vestbo²,

Nyboe³

1995

Eur Respir J

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“…The agents causing community-acquired pneumonia in patients treated in hospital have been shown to be Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia species, Legionella species, and viruses with geographical variations [1,2]. Since a definite etiological diagnosis is obtained in approximately 50% of patients with pneumonia in clinical studies and in fewer in the hospital routine, other and preferably rapid differential diagnostic tools are needed.…”

Section: Introductionmentioning

confidence: 99%

Cytokine Responses in Patients with Pneumonia Caused by <i>Chlamydia</i> or <i>Mycoplasma</i>

Kragsbjerg

Vikerfors²,

Holmberg³

1998

Respiration

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The serum concentrations of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ) were measured by enzyme immunoassays in 44 patients with Chlamydia (n = 13) or Mycoplasma (n = 14) pneumonia or influenza A infection (n = 17) and in 20 control subjects. The levels of IFN-γ were raised in 29/44 patients. The concentrations of IL-6 were raised in 32/44 patients. Raised levels of TNF-α were seen in 26/44 but there was no significant difference between the levels of the different groups of patients. All three cytokines indicated clinical recovery when acute and convalescent samples from 10 patients with Chlamydia pneumonia were analyzed. IFN-γ, IL6 and TNF-α are present in the circulation in the majority of patients with Chlamydia and Mycoplasma pneumonia and in influenza A infection. We suggest that repeated measurement of cytokines, such as IL-6, IFN-γ and TNF-α, may be useful in the management of lower respiratory tract infections but further studies are needed to define the value of cytokine measurements in acute pneumonia.

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“…Consequently, the spectrum of étio logie agents involved differs substantially between these two types of pneumonias leading to different treatment modalities in antibiotic therapy [7,8].…”

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confidence: 99%

Clinical Requirements in the Treatment of Today’s Respiratory Tract Infections

Höffken¹

1993

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Respiratory tract infections (RTIs) are among the most frequent infections in man and lower tract infections account substantially for the overall mortality in hospitals. Regarding the etiology of pneumonias, one has to consider different pathogenic mechanisms, age of the patients, underlying diseases, concomitant medications, symptomatologies, seasonal influences, and clinical conditions, e.g. intensive care environment and mechanical ventilation. To optimize the rational management of respiratory infections, identification of the etiologic agent would be desirable. The decision of how to treat is often based on epidemiologic, clinical, and radiological assessments. Epidemiologic studies have shown a pronounced difference in the etiologic spectrum between community- and hospital-acquired RTIs. In community-acquired pneumonias, pneumococci, Haemophilus influenzae, Legionella, Mycoplasma and viruses predominate, whereas in nosocomially acquired pneumonias, Enterobacteriaceae, e.g. Klebsiella, Proteus, Enterobacter as well as Pseudomonas and staphylococci comprise the most frequent isolates. Empirical therapy has to cover all possible etiologic pathogens which most likely cause the infection. In addition, an adequate kinetic profile, e.g. once or twice daily dosing, sufficient pulmonary tissue or fluid penetration, and acceptable tolerance and costs are prerequisites for optimal therapy. Drugs of choice for the treatment of community-acquired pneumonia are aminobenzylpenicillins or macrolides. Oral cephalosporins exhibit excellent activity against many bacterial pathogens of typical community-acquired pneumonia, and are active against β-lactamase-producing H. influenzae.

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Aetiology of Community-acquired Pneumonia in Hospital Treated Patients

Cited by 85 publications

References 47 publications

Risk factors for death and hospitalization from pneumonia. A prospective study of a general population

Risk factors for death and hospitalization from pneumonia. A prospective study of a general population

Cytokine Responses in Patients with Pneumonia Caused by <i>Chlamydia</i> or <i>Mycoplasma</i>

Clinical Requirements in the Treatment of Today’s Respiratory Tract Infections

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