Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective

Andrea Gramegna; Giovanni Sotgiu; Marta Di Pasquale; Dejan Radovanovic; Silvia Terraneo; Luis F Reyes; Ester Vendrell; Joao Neves; Francesco Menzella; Francesco Blasi; Stefano Aliberti; Marcos I Restrepo; GLIMP Study Group; Marie-Laure Bouchy Jacobsson; Andreas Vestergaard Jensen; Gertrud  Baunbæk Egelund; Pelle Trier Petersen; Stine Andersen

doi:10.1186/s12879-018-3565-z

Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective

Andrea Gramegna, Giovanni Sotgiu, Marta Di Pasquale, Dejan Radovanovic, Silvia Terraneo, Luis F Reyes, Ester Vendrell, Joao Neves, Francesco Menzella, Francesco Blasi, Stefano Aliberti, Marcos I Restrepo, GLIMP Study Group, Marie-Laure Bouchy Jacobsson (Member of study group), Andreas Vestergaard Jensen (Member of study group), Gertrud Baunbæk Egelund (Member of study group), Pelle Trier Petersen (Member of study group), Stine Andersen (Member of study group)

Abstract

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.

Original language	English
Journal	BMC Infectious Diseases
Volume	18
Issue number	1
Pages (from-to)	677
ISSN	1471-2334
DOIs	https://doi.org/10.1186/s12879-018-3565-z
Publication status	Published - 2018

Keywords

Adult
Aged
Aged, 80 and over
Antibiotic Prophylaxis/statistics & numerical data
Chlamydophila pneumoniae/isolation & purification
Community-Acquired Infections/epidemiology
Female
Geography
Global Health/statistics & numerical data
Healthcare-Associated Pneumonia/epidemiology
Hospitalization/statistics & numerical data
Humans
Legionella pneumophila/isolation & purification
Legionellosis/epidemiology
Male
Middle Aged
Mycoplasma pneumoniae/isolation & purification
Prevalence
Risk Factors

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10.1186/s12879-018-3565-z

Cite this

Gramegna, A., Sotgiu, G., Di Pasquale, M., Radovanovic, D., Terraneo, S., Reyes, L. F., Vendrell, E., Neves, J., Menzella, F., Blasi, F., Aliberti, S., Restrepo, M. I., GLIMP Study Group, Jacobsson, M.-L. B., Vestergaard Jensen, A., Baunbæk Egelund, G., Trier Petersen, P., & Andersen, S. (2018). Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective. BMC Infectious Diseases, 18(1), 677. https://doi.org/10.1186/s12879-018-3565-z

Gramegna, A, Sotgiu, G, Di Pasquale, M, Radovanovic, D, Terraneo, S, Reyes, LF, Vendrell, E, Neves, J, Menzella, F, Blasi, F, Aliberti, S, Restrepo, MI, GLIMP Study Group, Jacobsson, M-LB, Vestergaard Jensen, A , Baunbæk Egelund, G , Trier Petersen, P & Andersen, S 2018, 'Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective', BMC Infectious Diseases, vol. 18, no. 1, pp. 677. https://doi.org/10.1186/s12879-018-3565-z

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title = "Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective",

abstract = "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.",

keywords = "Adult, Aged, Aged, 80 and over, Antibiotic Prophylaxis/statistics & numerical data, Chlamydophila pneumoniae/isolation & purification, Community-Acquired Infections/epidemiology, Female, Geography, Global Health/statistics & numerical data, Healthcare-Associated Pneumonia/epidemiology, Hospitalization/statistics & numerical data, Humans, Legionella pneumophila/isolation & purification, Legionellosis/epidemiology, Male, Middle Aged, Mycoplasma pneumoniae/isolation & purification, Prevalence, Risk Factors",

author = "Andrea Gramegna and Giovanni Sotgiu and {Di Pasquale}, Marta and Dejan Radovanovic and Silvia Terraneo and Reyes, {Luis F} and Ester Vendrell and Joao Neves and Francesco Menzella and Francesco Blasi and Stefano Aliberti and Restrepo, {Marcos I} and {GLIMP Study Group} and Jacobsson, {Marie-Laure Bouchy} and {Vestergaard Jensen}, Andreas and {Baunb{\ae}k Egelund}, Gertrud and {Trier Petersen}, Pelle and Stine Andersen",

year = "2018",

doi = "10.1186/s12879-018-3565-z",

language = "English",

volume = "18",

pages = "677",

journal = "BMC Infectious Diseases",

issn = "1471-2334",

publisher = "BioMed Central Ltd",

number = "1",

}

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 -

Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective

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Keywords

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