Etiology and outcome of severe community acquired pneumonia in immunocompetent adults

Abstract

BackgroundCommunity Acquired Pneumonia (CAP) is a commonly encountered disease, one third of which is Severe Community Acquired Pneumonia (SCAP) that can be potentially fatal. There is a paucity of data on etiology and outcome of patients with SCAP in South Asian Population.MethodsA retrospective cross-sectional study was conducted from March 2002 till December 2008 on patients of 16 years and above who were admitted with the diagnosis of SCAP in accordance to the criteria of American Thoracic Society Guidelines (2001). The patients underwent clinical and diagnostic evaluations to detect the severity of illness as well as the etiology and other risk factors influencing the eventual outcome of SCAP.ResultsA total of 189 patients were included in the study. The mean age was 60 ± 18.0 years and 110 (58%) patients were males. The most common isolated pathogens were Staphylococcus aureus (15 patients), Streptococcus pneumoniae (14 patients) and Pseudomonas aeruginosa (9 patients). The highest mortality was seen in patients with Pseudomonas aeruginosa (89%) and Staphylococcus aureus (53%). Overall mortality rate was 51%. On univariate analysis, septic shock (p <0.001), prior antibiotic use (p = 0.04), blood urea nitrogen > 30 mg/dl (p = 0.03), hematocrit < 30% (p = 0.03) and Acute Physiology and Chronic Health Evaluation (APACHE) II score > 20 (p < 0.001) were significantly different between the patients who survived as compared to those who did not. On multivariate analysis, septic shock (p <0.001, OR: 4.70; 95% CI= 2.49-8.87) was found to be independently associated with mortality.ConclusionThe microbes causing SCAP in our study are different from the usual spectrum. Staphylococcus aureus and Pseudomonas aeruginosa were the common causative pathogens and associated with high mortality. It is important to establish clinical guidelines for managing SCAP according to the etiologic organisms in our setting.

Disruption of staphylococcal aggregation protects against lethal lung injury

“…We maintained pulmonary arterial and left atrial pressures of 10 and 3 cm H 2 O, respectively, and constant persibly, massive cytokine release that caused cardiovascular collapse. These findings are consistent with clinical reports of rapid-onset septic shock and death in the setting of severe lung infection (3,57,58). Notably, however, mortality due to PhnD-null infection was equally severe, if delayed, ruling out the possibility that the null bacteria were intrinsically less virulent.…”

Factors predicting in‐hospital mortality among patients admitted with community acquired pneumonia at a tertiary care hospital Karachi, Pakistan

“…In Pakistan, limited research has been conducted on CAP and this existing literature mostly focuses on microbiological etiology and drug susceptibility patterns. Studies reporting CAP mortality in our population suggest figures between 11% and 28% with mortality in severe community acquired pneumonia (S‐CAP) as high as 51% . Previous data from Pakistan suggests that on admission elevated blood urea, new onset of confusion, low serum albumin, abnormal liver function test, cardiomegaly and underlying malignancy were strongly associated with increased mortality .…”

Coronary calcium scoring: are the results comparable to computed tomography coronary angiography for screening coronary artery disease in a South Asian population?

“…With an operational strength of 650 beds, the facility serves over 42,000 inpatients and over 500,000 outpatients annually. Established since 1985, it is one of the few teaching hospitals in South Asia accredited by the Joint Commission for International Accreditation [12]. A retrospective study design was conducted in which the medical record numbers of patients who had undergone CTCA and CCS were obtained.…”