Atypical aetiology in patients hospitalised with community-acquired pneumonia is associated with age, gender and season; a data-analysis on four Dutch cohorts


Background:
Microorganisms causing community-acquired pneumonia (CAP) can be categorised into viral, typical and atypical (Legionella species, Coxiella burnetii, Mycoplasma pneumoniae, and Chlamydia species). Extensive microbiological testing to identify the causative microorganism is not standardly recommended, and empiric treatment does not always cover atypical pathogens. In order to optimize epidemiologic knowledge of CAP and to improve empiric antibiotic choice, we investigated whether atypical microorganisms are associated with a particular season or with the patient characteristics age, gender, or chronic obstructive pulmonary disease (COPD).

Methods:
A data-analysis was performed on databases from four prospective studies, which all included adult patients hospitalised with CAP in the Netherlands (N = 980). All studies performed extensive microbiological testing.

Results:
A main causative agent was identified in 565/980 (57.7 %) patients. Of these, 117 (20.7 %) were atypical microorganisms. This percentage was 40.4 % (57/141) during the non-respiratory season (week 20 to week 39, early May to early October), and 67.2 % (41/61) for patients under the age of 60 during this season. Factors that were associated with atypical causative agents were: CAP acquired in the non-respiratory season (odds ratio (OR) 4.3, 95 % CI 2.68–6.84), age <60 year (OR 2.9, 95 % CI 1.83–4.66), male gender (OR 1.7, 95 % CI 1.06–2.71) and absence of COPD (OR 0.2, 95 % CI 0.12–0.52).

Conclusions:
Atypical causative agents in CAP are associated with respectively non-respiratory season, age <60 years, male gender and absence of COPD. Therefore, to maximise its yield, extensive microbiological testing should be considered in patients <60 years old who are admitted with CAP from early May to early October.

Trial registration:
NCT00471640, NCT00170196 (numbers of original studies).

Keywords:
Aetiology, Atypical pathogens, Community-acquired pneumonia, Demography, Pneumonia


Autoři: Vivian M. Raeven† 1,7;  Simone M. C. Spoorenberg† 1*;  Wim G. Boersma 2;  Ewoudt M. W. Van De Garde 3,4;  Suzanne C. Cannegieter 5;  G. P. Paul Voorn 6;  Willem Jan W. Bos 1;  Jim E. Van Steenbergen 7,8;  On Behalf Of The Alkmaar Study Group;  On Behalf Of The Ovidius Study Group
Působiště autorů: Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands. 1;  Department of Pulmonary Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands. 2;  Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands. 3;  Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, The Netherlands. 4;  Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands. 5;  Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands. 6;  Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. 7;  Centre of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands. 8
Vyšlo v časopise: BMC Infectious diseases 2016, 16:299
Kategorie: Research article
prolekare.web.journal.doi_sk: 10.1186/s12879-016-1641-9

© 2016 The Author(s).
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-1641-9

Souhrn

Background:
Microorganisms causing community-acquired pneumonia (CAP) can be categorised into viral, typical and atypical (Legionella species, Coxiella burnetii, Mycoplasma pneumoniae, and Chlamydia species). Extensive microbiological testing to identify the causative microorganism is not standardly recommended, and empiric treatment does not always cover atypical pathogens. In order to optimize epidemiologic knowledge of CAP and to improve empiric antibiotic choice, we investigated whether atypical microorganisms are associated with a particular season or with the patient characteristics age, gender, or chronic obstructive pulmonary disease (COPD).

Methods:
A data-analysis was performed on databases from four prospective studies, which all included adult patients hospitalised with CAP in the Netherlands (N = 980). All studies performed extensive microbiological testing.

Results:
A main causative agent was identified in 565/980 (57.7 %) patients. Of these, 117 (20.7 %) were atypical microorganisms. This percentage was 40.4 % (57/141) during the non-respiratory season (week 20 to week 39, early May to early October), and 67.2 % (41/61) for patients under the age of 60 during this season. Factors that were associated with atypical causative agents were: CAP acquired in the non-respiratory season (odds ratio (OR) 4.3, 95 % CI 2.68–6.84), age <60 year (OR 2.9, 95 % CI 1.83–4.66), male gender (OR 1.7, 95 % CI 1.06–2.71) and absence of COPD (OR 0.2, 95 % CI 0.12–0.52).

Conclusions:
Atypical causative agents in CAP are associated with respectively non-respiratory season, age <60 years, male gender and absence of COPD. Therefore, to maximise its yield, extensive microbiological testing should be considered in patients <60 years old who are admitted with CAP from early May to early October.

Trial registration:
NCT00471640, NCT00170196 (numbers of original studies).

Keywords:
Aetiology, Atypical pathogens, Community-acquired pneumonia, Demography, Pneumonia


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