Community-acquired pneumonia in outpatients: aetiology and outcomes

Cillóniz, Catia; Ewig, Santiago; Polverino, Eva; Marcos, María Ángeles; Prina, Elena; Sellarés, Jacobo; Ferrer, Miquel; Ortega, Mar; Gabarrús, Albert; Mensa, Josep

doi:10.1183/09031936.00168811

Cited by 65 publications

(64 citation statements)

References 29 publications

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“…However, there is little information regarding the prevalence and clinical impact of bacteraemia in CAP patients treated outside the hospital. Previous studies reported incidences of 2.1-7%, respectively [5][6][7][8]. However, few data exist regard predictive factors and the clinical outcomes associated with positive blood cultures in this population [8].…”

Section: Bacteraemia In Outpatients With Community-acquired Pneumoniamentioning

confidence: 86%

Bacteraemia in outpatients with community-acquired pneumonia

et al. 2015

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Section: Bacteraemia In Outpatients With Community-acquired Pneumoniamentioning

confidence: 86%

Bacteraemia in outpatients with community-acquired pneumonia

et al. 2015

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“…In a recent study of CAP aetiology in outpatients, Streptococcus pneumoniae was reported to be the most frequent pathogen [1]; unchanged from previous studies. The knowledge that S. pneumoniae is the commonest cause is sufficient to assist the choice of appropriate antibiotics; the most important management decision required for most patients.…”

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confidence: 81%

Pneumococcal serotypes and respiratory failure: soil or seed?

Woodhead¹

2014

European Respiratory Journal

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@ERSpublications Small differences in the capsule of causative bacteria may determine the exact pattern of clinical illness in pneumonia http://ow.ly/qlQbA When considering the microbial aetiology of community-acquired pneumonia (CAP) we seldom think beyond the name (genus and species) of the causative organism. In a recent study of CAP aetiology in outpatients, Streptococcus pneumoniae was reported to be the most frequent pathogen [1]; unchanged from previous studies. The knowledge that S. pneumoniae is the commonest cause is sufficient to assist the choice of appropriate antibiotics; the most important management decision required for most patients.However, there is a lot more to this bacterial species than the name might imply. In fact, there are now known to be .90 distinct pneumococcal serotypes, each characterised by a slightly different structure in the pneumococcal capsular polysaccharide. These small molecular differences are an important determinant of immune response; therefore, immunity is serotype specific. Studies in the pre-antibiotic era dealt in depth with serotype distributions, as at that time serotype specific serum was the only available therapy. With the advent of antibiotics, pneumococcal serotypes have received much less attention. Now with the development of pneumococcal vaccines, and the importance of matching vaccines to causative serotypes, this subject is having a renaissance. From this we are starting to understand that there is more to the different serotypes than just a difference in polysaccharide structure. Indeed, the serotype is increasingly being linked, not just with the immune response, but also with the clinical phenotype in individual patients.In this issue of the European Respiratory Journal, BURGOS et al.[2] describe an investigation into the risk factors for respiratory failure (defined as an oxygen saturation of ,90% on room air or an arterial oxygen tension/inspiratory oxygen fraction ratio ,250) in a prospectively collected cohort of 1258 adults admitted to hospital with invasive (i.e. blood culture positive) pneumococcal pneumonia. Patients with respiratory failure (present in 48.9% of cases) were perhaps not surprisingly older, were more likely to have had chronic heart or lung disease, were more severely ill (as judged by the presence of septic shock and pneumonia severity index score), had more extensive radiographic change, were more likely to have received assisted ventilation and intensive care unit admission, and were more likely to have died. After multivariate analysis, age, chronic heart or lung disease, and pneumococcal serotypes 3, 19A and 19F remained associated with respiratory failure, while type 1 remained associated with its absence. This is the first study to find an association between specific serotypes and the presence or absence of respiratory failure. Previous studies have found associations between patterns of serotypes and other clinical phenotypes including nasopharyngeal carriage [3], invasive disease [4], septic shock [5], empyema and pa...

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“…In the outpatient setting nonresponse was much lower, ranging from 2.3% [Cilloniz et al 2012] to 7.5% [Fantin et al 2001] or 8% [Minogue et al 1998]. In all these studies, mortality rate was below 5% and appeared to be mainly related to the patient's comorbidities and not to antibiotic selection or to pneumonia itself [Minogue et al 1998;Fantin et al 2001;Cilloniz et al 2012].…”

Section: Assessing Nonrespondersmentioning

confidence: 96%

“…In all these studies, mortality rate was below 5% and appeared to be mainly related to the patient's comorbidities and not to antibiotic selection or to pneumonia itself [Minogue et al 1998;Fantin et al 2001;Cilloniz et al 2012].…”

Section: Assessing Nonrespondersmentioning

confidence: 99%

“…Initial severe clinical presentation, multilobar pneumonia, empyema and bacteremia, but not chronic obstructive pulmonary disease, were also risk factors for slow CAP resolution [Menendez et al 2004;Roson et al 2004], even in immunocompetent patients. Splenectomy [Tajiri et al 2007], malignancy [Genne et al 2006], neurological disease [Genne et al 2006;Cilloniz et al 2012] and immunosuppression [Japanese Respiratory Society, 2009] have all been suggested to increase CAP severity and treatment failure rate.…”

Section: Therapeutic Advances In Infectious Disease 1 (1)mentioning

confidence: 99%

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Community-acquired pneumonia: identification and evaluation of nonresponders

Gonçalves-Pereira

Conceição

Póvoa

2013

Therapeutic Advances in Infection

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Community acquired pneumonia (CAP) is a relevant public health problem, constituting an important cause of morbidity and mortality. It accounts for a significant number of adult hospital admissions and a large number of those patients ultimately die, especially the population who needed mechanical ventilation or vasopressor support.Thus, early identification of CAP patients and its rapid and appropriate treatment are important features with impact on hospital resource consumption and overall mortality. Although CAP diagnosis may sometimes be straightforward, the diagnostic criteria commonly used are highly sensitive but largely unspecific. Biomarkers and microbiological documentation may be useful but have important limitations.Evaluation of clinical response is also critical especially to identify patients who fail to respond to initial treatment since these patients have a high risk of in-hospital death. However, the criteria of definition of non-response in CAP are largely empirical and frequently markedly diverse between different studies. In this review, we aim to identify criteria defining nonresponse in CAP and the pitfalls associated with this diagnosis. We also aim to overview the main causes of treatment failure especially in severe CAP and the possible strategies to identify and reassess non-responders trying to change the dismal prognosis associated with this condition.

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Community-acquired pneumonia in outpatients: aetiology and outcomes

Cited by 65 publications

References 29 publications

Bacteraemia in outpatients with community-acquired pneumonia

Bacteraemia in outpatients with community-acquired pneumonia

Pneumococcal serotypes and respiratory failure: soil or seed?

Community-acquired pneumonia: identification and evaluation of nonresponders

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