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Etiology of community-acquired pneumonia varies with severity

הסקירה מתוך אתר medicontext.co.il

WESTPORT, CT (Reuters Health) – Among low-risk patients with community-acquired pneumonia, the etiologies of infection differ depending on the severity of the illness, according to a report in the August 13/27 issue of the Archives of Internal Medicine.

Effective empirical therapy of community-acquired pneumonia (CAP) requires a knowledge of the likely causative organisms, the authors explain, but little is known about the pathogens responsible for nonsevere CAP in previously healthy subjects and in patients with underlying disease.

Dr. Miquel Falguera and colleagues from Hospital Universitari Arnau de Vilanova in Lleida, Spain analyzed the causes of nonsevere CAP in 247 patients and sought to correlate these causes with the severity of illness (using the Pneumonia Patient Outcome Research Team (PORT) risk classification system) and the existence of underlying disease.

The researchers were able to make a microbial diagnosis in 162 (66%) of the patients. The most prevalent organisms overall were Streptococcus pneumoniae (69 patients), Mycoplasma pneumoniae (40) and Chlamydia pneumoniae (28).

The spectrum of organisms differed according to risk group. In prognostic group 1 (the lowest risk), M. pneumoniae was the most frequent organism, the results indicate, whereas in prognostic groups 2 and 3 (combined), S. pneumoniae was the most frequently isolated microorganism.

Atypical pathogens were also relatively more common in risk group 1, the authors report, occurring in 69% of cases where a cause was determined.

Bacteremia occurred more commonly in risk groups 2 (7%) and 3 (8%) than in risk group 1 (1%), the report indicates, but the difference did not reach statistical significance.

The etiology of CAP did not appear to differ between patients with and without underlying diseases, the researchers note. Of interest, all seven cases of Legionella pneumonia occurred in younger patients (under age 50 years) with no underlying disease.

"CAP constitutes, for Pneumonia PORT prognostic group 1 patients, an infection commonly caused by atypical microorganisms," the authors conclude. "In contrast, for patients in Pneumonia PORT groups 2 and 3, the microbial spectrum is more varied, including, in a similar proportion, either bacterial or atypical agents."

"We hope," the investigators add, "that our results provide valuable and practical implications in the management of low-risk patients with CAP, and, undoubtedly, the understanding of the pathogens most frequently involved is a key consideration in the choice of empirical antibiotic therapy."

Arch Intern Med 2001;161:1866-1872.

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