TY - JOUR
T1 - Community-acquired pneumonia
T2 - Impact of immune status
AU - Mundy, Linda M.
AU - Auwaerter, Paul G.
AU - Oldach, David
AU - Warner, Mary Laird
AU - Burton, Albert
AU - Vance, Estil
AU - Gaydos, Charlotte A.
AU - Joseph, J. Mehsen
AU - Gopalan, Ramana
AU - Moore, Richard D.
AU - Quinn, Thomas C
AU - Charache, Patricia
AU - Bartlett, John
PY - 1995/10
Y1 - 1995/10
N2 - This cross-sectional and prospective one year study evaluated adults admitted to an inner city hospital with community-acquired pneumonia. The study used extensive diagnostic methods to evaluate the etiologies of community-acquired pneumonia in hospitalized patients with differing immunologic status. Of 385 study patients, concurrent problems associated with immunosuppression were noted in 221 (57%) patients, 180 of whom were human immunodeficiency virus (HIV)-infected. The five most common causes of community-acquired pneumonia were: Streptococcus pneumoniae, Pneumocystis carinii, aspiration, Hemophilus influenzae, and gram-negative bacilli. Only 8.3% of patients had either Legionella, Chlamydia pneumoniae or Mycoplasma pneumoniae. Despite use of state-of-the-art diagnostic techniques, no diagnosis was made in 46 of 180 (25.6%) HIV-infected patients, 56 of 164 (34.1%) immunocompetent patients, and 20 of 41 (48.8%) non-HIV-infected immunosuppressed patients. The diagnostic yield of pre-antibiotic sputum culture for conventional bacteria was 99/155 (63.9%) compared to 52 of 169 patients (32.7%) with adequate post-antibiotic sputum culture (p < 0.0001). Although S. pneumonia continues to be the most commonly identified etiologic agent of commmunity-acquired pneumonia, it is surpassed by P. carinii in the HIV-infected patient population. The apparent decline in the frequency of S. pneumoniae in our series presumably reflects administration of antibiotics prior to procurement of sputum culture. The paucity of atypical agents in this study support the current American Thoracic Society guidelines for selective use of macrolide therapy in immunocompetent adults hospitalized with community-acquired pneumonia. The causes of community-acquired pneumonia in hospitalized adults in the 1990s reflects a changing patient population, in whom a majority may be immunosuppressed by HIV infection, transplantation, malignancy, or immunosuppressive drug regimens.
AB - This cross-sectional and prospective one year study evaluated adults admitted to an inner city hospital with community-acquired pneumonia. The study used extensive diagnostic methods to evaluate the etiologies of community-acquired pneumonia in hospitalized patients with differing immunologic status. Of 385 study patients, concurrent problems associated with immunosuppression were noted in 221 (57%) patients, 180 of whom were human immunodeficiency virus (HIV)-infected. The five most common causes of community-acquired pneumonia were: Streptococcus pneumoniae, Pneumocystis carinii, aspiration, Hemophilus influenzae, and gram-negative bacilli. Only 8.3% of patients had either Legionella, Chlamydia pneumoniae or Mycoplasma pneumoniae. Despite use of state-of-the-art diagnostic techniques, no diagnosis was made in 46 of 180 (25.6%) HIV-infected patients, 56 of 164 (34.1%) immunocompetent patients, and 20 of 41 (48.8%) non-HIV-infected immunosuppressed patients. The diagnostic yield of pre-antibiotic sputum culture for conventional bacteria was 99/155 (63.9%) compared to 52 of 169 patients (32.7%) with adequate post-antibiotic sputum culture (p < 0.0001). Although S. pneumonia continues to be the most commonly identified etiologic agent of commmunity-acquired pneumonia, it is surpassed by P. carinii in the HIV-infected patient population. The apparent decline in the frequency of S. pneumoniae in our series presumably reflects administration of antibiotics prior to procurement of sputum culture. The paucity of atypical agents in this study support the current American Thoracic Society guidelines for selective use of macrolide therapy in immunocompetent adults hospitalized with community-acquired pneumonia. The causes of community-acquired pneumonia in hospitalized adults in the 1990s reflects a changing patient population, in whom a majority may be immunosuppressed by HIV infection, transplantation, malignancy, or immunosuppressive drug regimens.
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U2 - 10.1164/ajrccm.152.4.7551387
DO - 10.1164/ajrccm.152.4.7551387
M3 - Article
C2 - 7551387
AN - SCOPUS:0029115663
SN - 1073-449X
VL - 152
SP - 1309
EP - 1315
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 4 I
ER -