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

Abstract

Appropriate antimicrobial treatment of community-acquired pneumonia (CAP) should be based on the distribution of aetiological pathogens, antimicrobial resistance of major pathogens, clinical characteristics and outcomes. We performed a prospective observational study of 955 cases of adult CAP in 14 hospitals in eight Asian countries. Microbiological evaluation to determine etiological pathogens as well as clinical evaluation was performed. Bronchopulmonary disease (29.9%) was the most frequent underlying disease, followed by cardiovascular diseases (19.9%), malignancy (11.7%) and neurological disorder (8.2%). Streptococcus pneumoniae (29.2%) was the most common isolate, followed by Klebsiella pneumoniae (15.4%) and Haemophilus influenzae (15.1%). Serological tests were positive for Mycoplasma pneumoniae (11.0%) and Chlamydia pneumoniae (13.4%). Only 1.1% was positive for Legionella pneumophila by urinary antigen test. Of the pneumococcal isolates, 56.1% were resistant to erythromycin and 52.6% were not susceptible to penicillin. Seventeen percent of CAP had mixed infection, especially S. pneumoniae with C. pneumoniae. The overall mortality rate was 7.3%, and nursing home residence, mechanical ventilation, malignancy, cardiovascular diseases, respiratory rate>30/min and hyponatraemia were significant independent risk factors for mortality by multivariate analysis (P<0.05). The current data provide relevant information about pathogen distribution and antimicrobial resistance of major pathogens of CAP as well as clinical outcomes of illness in Asian countries.

Viral and bacterial infection among hospitalized-suspected influenza A/H5N1 patients in Indonesia, 2008-2009

“…This finding was similar with previous study where Streptococcus pneumoniae is the prominent pathogen causing community acquired pneumonia in Asian countries while Klebsiella pneumoniae and Haemophillus influenzae were the commonest bacterial pathogens in South East Asia. 9,22,23 Co-infection of viral and bacterial pathogen cases were found within the present study although only minor cases. Co-infections between one of viral pathogen such as; influenza A, Coronavirus 229E/NL 63, Rhinovirus, Bocavirus, Adenovirus, Parainfluenza Virus, respiratory syncytial virus and bacterial, Klebsiella pneumoniae, Streptococcus pneumoniae and Haemophillus influenzae were detected.…”

Impact of hyponatremia and the syndrome of inappropriate antidiuresis on mortality in elderly patients with aspiration pneumonia

“…However, for 80% power, the calculated sample size was 100 non-SIAD patients with aspiration pneumonia versus 10 SIAD patients, given that the mortality rate of elderly patients with aspiration pneumonia was, at a moderate estimate, 15% according to the studies of both Stukenborg and colleagues and Oliver and colleagues, and the mortality rate of SIAD patients was increased by 400% compared with that of non-SIAD patients according to the study of Song and colleagues, with an alpha error of 0.05. 7,23,24 Our sample size was therefore greater than the required size.…”

“…2 Previous studies have suggested that the presence and degree of hyponatremia is associated with the severity of pneumonia in adults and children, although the results have differed among studies. [3][4][5][6][7] Hyponatremia is caused by various factors, including volume depletion, use of diuretics, hypothyroidism, adrenal insufficiency, heart failure, renal failure, and cirrhosis. Additionally, the syndrome of inappropriate antidiuresis (SIAD) is a frequent and heterogeneous disorder characterized by hyponatremia and impaired urinary dilution in the absence of any recognized stimulation of antidiuretic hormone secretion.…”

Fulminant Community-Acquired Hemorrhagic Pneumonia due to Pseudomonas aeruginosa in a Patient With Anorexia Nervosa

“…Firstly, anorexia nervosa can be a risk factor for CAP due to P. aeruginosa. P. aeruginosa is a rare pathogen that causes CAP [1][2][3][4]. Several risk factors have been reported for CAP due to P. aeruginosa such as probable aspiration, previous hospital admission, previous use of antibiotics, pulmonary comorbidity, male sex and pneumonia severity index risk class IV to V [2,5].…”

“…Pseudomonas aeruginosa is a rare pathogen of communityacquired pneumonia (CAP) [1][2][3][4]. CAP due to this pathogen is associated with higher cases of inappropriate initial therapy and mortality [2].…”