A 3-Year Retrospective Study of Community-Acquired Pneumonia in Kuwait with Emphasis on Microbial Aetiology

Abstract

Background: There has not been any published study on community-acquired pneumonia (CAP) in Kuwait. The aim of this study is to determine the clinical characteristics of adult patients with CAP as well as the microbial aetiology and the treatment of CAP. Methods: A retrospective study of all CAP cases admitted to the three acute care hospitals in Kuwait over a 3-year period, 1993–1995, was done. Results: There were 290 patients identified, mean age 41 ± 19 years, of which 57% were males. The patients were divided into three groups (mild, moderate and severe) according to standard published criteria: mild 27.5%, moderate 61%, and severe 11.5%. The microbial aetiology was identified for only 15% of the total cases, 11.5% of the mild group, 14% of the moderate, and 22.5% of the severe. The most common organisms identified were Streptococcus pneumoniae 32%, Mycoplasma pneumoniae 20%, Haemophilus influenzae 14%, Mycobacterium tuberculosis 11%, gram-negative organisms other than Haemophilus species 11% and others 12%. There were 243 (84%) patients who received a single antibiotic as initial therapy while the rest received a combination of antibiotics. The most common antibiotics used were macrolide 28%, ampicillin 24%, a combination of antibiotic 17%, third-generation cephalosporin 12% and others 19%. Conclusion: The rate of identification of microbial aetiology in CAP is poor in Kuwait. There are 27.5% of the patients who can be classified as mild and probably the majority of them can be treated as out-patients. Based on these results, we have started a prospective study to better evaluate the microbial aetiology of CAP in Kuwait.

Significance of Atypical Pathogens among Community-Acquired Pneumonia Adult Patients Admitted to Hospital in Kuwait

“…The overall rate of identifi cation of the microbial etiology, 35%, was much better than the rate of 14% obtained in our previous retrospective study [4] from 1993 to 1995, but it is still considered low. However, other published studies on the etiology of CAP fail to identify a microbial organism in 40-50% of ambulatory patients and in 20-70% of hospitalized patients [5] .…”

“…However, other published studies on the etiology of CAP fail to identify a microbial organism in 40-50% of ambulatory patients and in 20-70% of hospitalized patients [5] . A somewhat surprising fi nding in this study was that there were only 3 cases of proven S. pneumoniae, which is widely regarded as the most common organism causing CAP among adult patients admitted to hospital [11] , as it was also the predominant organism found in the retrospective study [4] . There are several possible explanations for this fi nding.…”

“…There is a signifi cant change in the antibiotics used in our study compared to the ones used during the retrospective study [4] . In the retrospective study, 80% of the patients received a single antibiotic -either ampicillin or a macrolide -as initial empirical therapy, while in the current study 79% received a combination of two antibiotics as initial therapy.…”