Epidemiology of community-acquired pneumonia in adult patients at the dawn of the 21st century: a prospective study on the Mediterranean coast of Spain

Abstract

This study presents data from a prospective study of adult patients with community-acquired pneumonia (CAP). Of 493 patients included in the study, 223 (45.2%) were aged > or = 65 years, and 265 (53.7%) had one or more underlying diseases, mostly chronic obstructive pulmonary disease, diabetes mellitus or dementia. In total, 281 microorganisms were identified in 250 (50.7%) patients, with two or more pathogens detected in 28 (5.7%) cases. Microbial diagnosis varied according to age, severity, co-morbidity and site-of-care, but there was much overlap among groups. Streptococcus pneumoniae was the single most prevalent organism in outpatients, patients admitted to hospital, and patients who died, either as a single pathogen or combined with another organism. Infections caused by 'atypical' pathogens were seen across all groups, including the elderly and patients with co-morbidities. Mortality varied according to the pneumonia severity index (PSI) of the pneumonia patient outcomes research team. Shock (OR 34.48), an age of > 65 years (OR 25) and altered mental status (OR 9.92) were factors associated independently with 30-day mortality. Key findings from this study were the advanced age of the population with CAP, and the high prevalence of dementia as an underlying disease. The study also revealed that microbiological diagnosis of CAP remains problematic. Although certain epidemiological features may help to predict the microbial aetiology, the overlap among groups reduces the usefulness of this information in guiding therapeutic decisions. Greater effort should be made to improve identification methods for microbial pathogens causing CAP.

Midregional Pro-A-Type Natriuretic Peptide and Carboxy-Terminal Provasopressin May Predict Prognosis in Community-Acquired Pneumonia

“…A prospective population-based investigation of CAP was conducted at Hospital General Universitario de Elche, a 430-bed university-affiliated teaching hospital covering a population of about 275 000 people in Spain, as previously described (25,26 ). The study was approved by the local ethics committee.…”

“…No signs of degradation were observed. We also measured LBP, CRP, and PCT in serum as described (6,26 ).…”

Phenotypic and Molecular Analysis of Penicillin-Nonsusceptible Streptococcus pneumoniae Isolates in Poland

“…Four predominant serotypes, serotypes 6B, 9V, 14, and 23F, characterized 85.5% of the isolates. MLST Streptococcus pneumoniae (the pneumococcus) represents one of the leading bacterial infectious agents of respiratory tract infections (RTI) in humans, including acute otitis media, sinusitis, acute exacerbations of chronic bronchitis, and community-acquired pneumonia (5), and it is the main cause of mortality of patients affected by the latter disease (19). This pathogen is also frequently involved in life-threatening infections of the central nervous system; e.g., in Poland, it is responsible for 20.9% of the reported cases of bacterial meningitis (42).…”

Prognostic value of on admission arterial PCO2 in hospitalized patients with community-acquired pneumonia

“…Multiple factors have been shown to be associated with poor prognoses in patients with CAP which include higher Pneumonia Severity Index (PSI), age >65 years, shock, altered mental status on arrival, presence of comorbidities, tachypnea, hypoxemic respiratory failure (PaO 2 /FiO 2 <300), renal failure, bacteremia, aspiration pneumonia and inadequate or inappropriate antibiotic treatment (4)(5)(6)(7).…”