Polymicrobial community‐acquired pneumonia: An emerging entity

Abstract

Polymicrobial aetiology in community-acquired pneumonia (CAP) is more common than previously recognized. This growing new entity can influence inflammation, host immunity and disease outcomes in CAP patients. However, the true incidence is complicated to determine and probably underestimated due mainly to many cases going undetected, particularly in the outpatient setting, as the diagnostic yield is restricted by the sensitivity of currently available microbiologic tests and the ability to get certain types of clinical specimens. The observed rate of polymicrobial cases may also lead to new antibiotic therapy considerations. In this review, we discuss the pathogenesis, microbial interactions in pneumonia, epidemiology, biomarkers and antibiotic therapy for polymicrobial CAP.

Mycoplasma pneumoniae and Streptococcus pneumoniae caused different microbial structure and correlation network in lung microbiota

“…However, Massilia will need more study to unravel its potential involvement in pneumonia inducement and progression, because there were just several reports about Massilia contribution to eye and skin illness (20). Previous reports indicated that S. pneumoniae, S. aureus, P. aeruginosa and H. influenzae were also the main pathogenic agents for and accumulated in children with respiratory diseases (2)(3)(4). In this study, Pseudomonas and Haemophilus showed no discrepancy among three groups.…”

“…Previous reports implicated that bacterial pathogens were the main contributors to pneumonia incidence and progression (2), and polymicrobial interaction was demonstrated, including Mycoplasma pneumoniae (M. pneumoniae), Chlamydophila pneumoniae (C. pneumoniae), Legionella pneumophila (L. pneumophila), Candida albicans (C. albicans), Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) (2).…”

Non-invasive ventilation in the treatment of severe polymicrobial community-acquired pneumonia

“…Patients with polymicrobial infections are more likely to have underlying medical conditions and have more severe outcome. 13,14 S. pneumoniae was the most frequent co-pathogen in polymicrobial infections as previously reported. 15,16 Our case series report the most frequent causative organisms in hospitalized patients: 17 it is not clear if the severity of the clinical picture is due to polymicrobial etiology or to causative organism in itself (e.g., L. pneumophila).…”

“…When a viral respiratory infection occurs, this destroys the respiratory epithelium, thus increases the adhesion of bacteria to the mucosa. 13 The same can happen for atypical bacteria. Mycoses and in particular C. albicans, increases the virulence of P. aeruginosa and allows S. aureus to evade phagocytosis.…”

“…Mycoses and in particular C. albicans, increases the virulence of P. aeruginosa and allows S. aureus to evade phagocytosis. 13 For clinicians, it is very important: combined-empirical antimicrobial therapy may reduce mortality: 18 International Guidelines have incorporated the idea that CAP could be due to polymicrobial agents in all patients. 10,[15][16][17] Rapid detection of Influenza may allow physician to use neuraminidase inhibitors effectively within 36 to 48 h from symptoms onset as well as rapid detection of L. pneumophila or S. pneumoniae via urinary test.…”