TY - JOUR
T1 - Atypical pathogens in hospitalized patients with community-acquired pneumonia
T2 - a worldwide perspective
AU - Gramegna, Andrea
AU - Sotgiu, Giovanni
AU - Di Pasquale, Marta
AU - Radovanovic, Dejan
AU - Terraneo, Silvia
AU - Reyes, Luis F
AU - Vendrell, Ester
AU - Neves, Joao
AU - Menzella, Francesco
AU - Blasi, Francesco
AU - Aliberti, Stefano
AU - Restrepo, Marcos I
AU - GLIMP Study Group
A2 - Jacobsson, Marie-Laure Bouchy
A2 - Vestergaard Jensen, Andreas
A2 - Baunbæk Egelund, Gertrud
A2 - Trier Petersen, Pelle
A2 - Andersen, Stine
PY - 2018
Y1 - 2018
N2 - BACKGROUND: Empirical antibiotic coverage for atypical pathogens in community-acquired pneumonia (CAP) has long been debated, mainly because of a lack of epidemiological data. We aimed to assess both testing for atypical pathogens and their prevalence in hospitalized patients with CAP worldwide, especially in relation with disease severity.METHODS: A secondary analysis of the GLIMP database, an international, multicentre, point-prevalence study of adult patients admitted for CAP in 222 hospitals across 6 continents in 2015, was performed. The study evaluated frequency of testing for atypical pathogens, including L. pneumophila, M. pneumoniae, C. pneumoniae, and their prevalence. Risk factors for testing and prevalence for atypical pathogens were assessed through univariate analysis.RESULTS: Among 3702 CAP patients 1250 (33.8%) underwent at least one test for atypical pathogens. Testing varies greatly among countries and its frequency was higher in Europe than elsewhere (46.0% vs. 12.7%, respectively, p < 0.0001). Detection of L. pneumophila urinary antigen was the most common test performed worldwide (32.0%). Patients with severe CAP were less likely to be tested for both atypical pathogens considered together (30.5% vs. 35.0%, p = 0.009) and specifically for legionellosis (28.3% vs. 33.5%, p = 0.003) than the rest of the population. Similarly, L. pneumophila testing was lower in ICU patients. At least one atypical pathogen was isolated in 62 patients (4.7%), including M. pneumoniae (26/251 patients, 10.3%), L. pneumophila (30/1186 patients, 2.5%), and C. pneumoniae (8/228 patients, 3.5%). Patients with CAP due to atypical pathogens were significantly younger, showed less cardiovascular, renal, and metabolic comorbidities in comparison to adult patients hospitalized due to non-atypical pathogen CAP.CONCLUSIONS: Testing for atypical pathogens in patients admitted for CAP in poorly standardized in real life and does not mirror atypical prevalence in different settings. Further evidence on the impact of atypical pathogens, expecially in the low-income countries, is needed to guidelines implementation.
AB - BACKGROUND: Empirical antibiotic coverage for atypical pathogens in community-acquired pneumonia (CAP) has long been debated, mainly because of a lack of epidemiological data. We aimed to assess both testing for atypical pathogens and their prevalence in hospitalized patients with CAP worldwide, especially in relation with disease severity.METHODS: A secondary analysis of the GLIMP database, an international, multicentre, point-prevalence study of adult patients admitted for CAP in 222 hospitals across 6 continents in 2015, was performed. The study evaluated frequency of testing for atypical pathogens, including L. pneumophila, M. pneumoniae, C. pneumoniae, and their prevalence. Risk factors for testing and prevalence for atypical pathogens were assessed through univariate analysis.RESULTS: Among 3702 CAP patients 1250 (33.8%) underwent at least one test for atypical pathogens. Testing varies greatly among countries and its frequency was higher in Europe than elsewhere (46.0% vs. 12.7%, respectively, p < 0.0001). Detection of L. pneumophila urinary antigen was the most common test performed worldwide (32.0%). Patients with severe CAP were less likely to be tested for both atypical pathogens considered together (30.5% vs. 35.0%, p = 0.009) and specifically for legionellosis (28.3% vs. 33.5%, p = 0.003) than the rest of the population. Similarly, L. pneumophila testing was lower in ICU patients. At least one atypical pathogen was isolated in 62 patients (4.7%), including M. pneumoniae (26/251 patients, 10.3%), L. pneumophila (30/1186 patients, 2.5%), and C. pneumoniae (8/228 patients, 3.5%). Patients with CAP due to atypical pathogens were significantly younger, showed less cardiovascular, renal, and metabolic comorbidities in comparison to adult patients hospitalized due to non-atypical pathogen CAP.CONCLUSIONS: Testing for atypical pathogens in patients admitted for CAP in poorly standardized in real life and does not mirror atypical prevalence in different settings. Further evidence on the impact of atypical pathogens, expecially in the low-income countries, is needed to guidelines implementation.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Antibiotic Prophylaxis/statistics & numerical data
KW - Chlamydophila pneumoniae/isolation & purification
KW - Community-Acquired Infections/epidemiology
KW - Female
KW - Geography
KW - Global Health/statistics & numerical data
KW - Healthcare-Associated Pneumonia/epidemiology
KW - Hospitalization/statistics & numerical data
KW - Humans
KW - Legionella pneumophila/isolation & purification
KW - Legionellosis/epidemiology
KW - Male
KW - Middle Aged
KW - Mycoplasma pneumoniae/isolation & purification
KW - Prevalence
KW - Risk Factors
U2 - 10.1186/s12879-018-3565-z
DO - 10.1186/s12879-018-3565-z
M3 - Journal article
C2 - 30563504
SN - 1471-2334
VL - 18
SP - 677
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
IS - 1
ER -