Clinical profile and microbiological aetiology diagnosis in adult patients hospitalized with community-acquired pneumonia

Autor: Sofia R. Valdoleiros, Maria Inês Costa, Ana Flávia Machado, Miguel Abreu, Ana Cipriano, Helder Novais Bastos, Fábio Videira Santos, I. Furtado
Přispěvatelé: Instituto de Investigação e Inovação em Saúde
Rok vydání: 2022
Předmět:
Adult
Pulmonary and Respiratory Medicine
Staphylococcus aureus
medicine.medical_specialty
Community-acquired pneumonia
Etiology
medicine.drug_class
Pneumonia
Bacterial / microbiology
Antimicrobial treatment
Antibiotics
medicine.disease_cause
Microbiology
Comorbidities
Haemophilus influenzae
03 medical and health sciences
0302 clinical medicine
Internal medicine
Gram-Negative Bacteria
Streptococcus pneumoniae
Pneumonia
Bacterial
medicine
Humans
Prospective Studies
030212 general & internal medicine
Risk factor
Retrospective Studies
COPD
Pneumonia
Bacterial / therapy
business.industry
Community-Acquired Infections / diagnosis
Community-Acquired Infections / microbiology
medicine.disease
Community-Acquired Infections
Hospitalization
Pneumonia
Bacterial / diagnosis
030228 respiratory system
Sputum
medicine.symptom
business
Zdroj: Pulmonology. 28:358-367
ISSN: 2531-0437
Popis: Early introduction of appropriate antibiotherapy is one of the major prognostic-modifying factors in community acquired pneumonia (CAP). Despite established guidelines for empirical therapy, several factors may influence etiology and, consequently, antibiotic choices. The aims of this study were to analyze the etiology of CAP in adults admitted to a northern Portugal University Hospital and evaluate the yield of the different methods used to reach an etiological diagnosis, as well as analyze of the impact of patient demographic and clinical features on CAP etiology. We retrospectively analyzed 1901 cases of CAP with hospitalization. The diagnostic performance increased significantly when blood and sputum cultures were combined with urinary antigen tests. The most frequent etiological agent was Streptococcus pneumoniae (45.7%), except in August, when it was overtaken by gram-negative bacilli (GNB) and Legionella pneumophila infections. Viral infections were almost exclusive to winter and spring. A negative microbiological result was associated with increasing age, non-smoking and lack of both blood/sputum cultures. Younger age was a predictor for S. pneumoniae, Influenza and L. pneumophila infections. Active smoking without any previously known respiratory disease was a risk factor for legionellosis. COPD was associated with Haemophilus influenzae cases, while dementia was typical in GNB and S. aureus patients. Diabetes mellitus (DM) and heart disease were negative predictors of S. pneumoniae and H. influenzae, respectively. P. aeruginosa was an independent risk factor for mortality (OR 13.02, 95% CI 2.94–57.7). This study highlights the importance of a comprehensive microbiological diagnostic workup and provides clues to predicting the most probable CAP causative agents, based on a patient's clinical profile. These may be taken into account when establishing first line antibiotherapy.
Databáze: OpenAIRE
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