The Etiology of Community‐Acquired Pneumonia at an Urban Public Hospital: Influence of Human Immunodeficiency Virus Infection and Initial Severity of Illness

Abstract

In a prospective study, the etiology of community-acquired pneumonia (CAP) was investigated among consecutive patients admitted to an academic, urban public hospital in Seattle. The study population was uniquely young, was predominantly male, and had high rates of homelessness, cigarette smoking, alcoholism, injection drug use, and human immunodeficiency virus (HIV) infection. Leading causes of CAP among HIV-negative patients were aspiration, followed by Streptococcus pneumoniae, Legionella species, and Mycoplasma pneumoniae. Among HIV-positive patients, Pneumocystis carinii, Mycobacterium tuberculosis, S. pneumoniae, and M. pneumoniae were the most common etiologic agents. Severe CAP was associated with typical bacterial infections and aspiration pneumonia but not Legionella infection among HIV-negative patients and with Pseudomonas aeruginosa infections among HIV-positive patients. These findings emphasize the need to tailor empirical antibiotic therapy according to local patient populations and individual risk factors and highlight the importance of recognizing underlying HIV infection in patients who are hospitalized with CAP.

Pneumonia estafilocócica adquirida na comunidade

“…(14,15) The percentage found in this study sample is in accordance with the variation shown in other studies. (1)(2)(3)(4)(5)(6)(16)(17)(18)(19) The infection typically affects elderly individuals with preexisting chronic pathologies such as COPD, cardiovascular diseases, alcoholism and diabetes mellitus, as well as hemodialysis patients with chronic kidney disease. (2,4,6) Young or previously healthy individuals can also be affected, principally when they present predisposing factors such as skin infections (impetigo, abscess, cellulitis, furunculosis or infected wound) or infections of the genital tract associated with septic abortion, all of which represent hematogenous dissemination of the infection.…”

Community-acquired pneumonia in adult HIV-infected patients: course, treatment, and prevention

“…Самой частой этиологической причиной ВП у боль ных ВИЧ инфекцией является Streptococcus pneumo niae, реже -Haemophilus influenzae [25][26][27][28][29][30].…”

“…Замечено, что у больных ВИЧ инфек цией чаще, чем в общей популяции регистрируются MRSA штаммы S. aureus, особенно при низком со держании CD4 клеток [31,32] Pseudomonas aerugi nosa также значительно чаще, чем у лиц без ВИЧ, выступает патогеном тяжелой ВП. В свою очередь, роль таких атипичных возбудителей, как Legionella pneumophila, Mycoplasma pneumoniae и Chlamydophi la pneumoniae значительно скромнее в этиологии ВП у больных ВИЧ инфекцией, чем у лиц без ВИЧ [27][28][29][30][31].…”

Impact of macrolide therapy on mortality of HIV-infected patients with community-acquired pneumonia in a tertiary teaching hospital

“…1,2 Its incidence has decreased after the introduction of highly active antiretroviral therapy (HAART); 3,4 however, these patients still have a higher risk of acquiring this type of infection, when compared to the general population, 3 in addition to having higher rates of invasive pneumococcal disease 5 and mortality. 6,7 The etiology of community-acquired pneumonia (CAP) in HIV-infected patients is similar to that of immunocompetent patients, with the main agent being Streptococcus pneumoniae. Infections by Gram-negative bacteria (including Haemophilus influenzae, Pseudomonas aeruginosa and Legionella pneumophila, among others) are common, as well as by Staphylococcus aureus.…”

“…Infections by Gram-negative bacteria (including Haemophilus influenzae, Pseudomonas aeruginosa and Legionella pneumophila, among others) are common, as well as by Staphylococcus aureus. 1,2,3,6 The following are considered risk factors for CAP in HIV-infected patients: low socioeconomic level, smoking, alcohol consumption, use of intravenous (IV) drugs, comorbidities (including cardiovascular disease, kidney disease or liver cirrhosis), malnutrition, low CD4+ T-cell counts (CD4 < 200 cells/µL), HIV replication and lack of HAART. 2 Regarding prevention, the role of the antipneumococcal vaccine in HIV-infected patients is yet to be defined, as the studies have shown controversial results.…”