Aetiology and outcome of severe community-acquired pneumonia in Singapore

Abstract

The aim of this study was to determine the aetiology and outcome of severe community-acquired pneumonia, and to assess whether the existing guidelines for initial antimicrobial therapy are being applied. The records of 57 consecutive nonimmunocompromised patients admitted to the medical intensive care unit (ICU) between January 1989 and May 1993 with this diagnosis were reviewed. The microbiological data, chest radiographic changes and outcome were analysed. Nine (16%) of the 57 patients had pulmonary tuberculosis. When these patients were excluded from further analysis, a microbiological diagnosis was made in 41 (72%) cases. The most commonest pathogens were Burkholderia pseudomallei (n=10), Klebsiella spp. (n=5) and Staphylococcus aureus (n=5), Mycoplasma pneumoniae (n=4) and Streptococcus pneumoniae (n=2) were less common. This microbiological spectrum was quite different from that in the West, where the incidence of S. pneumoniae was higher. Also, when pulmonary tuberculosis was excluded, the mortality (67%) was much higher than that in other series. This was attributed to the high incidence of unrecognized B. pseudomallei infection, which is associated with a very high mortality in the region under study. In addition to applying published guidelines on severe community-acquired pneumonia, the endemicity of certain organisms such as Mycobacterium tuberculosis and Burkholderia pseudomallei in different geographical regions needs to be considered when choosing initial empirical antimicrobial therapy.

Severe Community-acquired Pneumonia in an Intensive Care Unit: Risk Factors for Mortality

“…This was higher than the overall mortality recently reported (7)(8)(9)(10)(11)(14)(15)(16)(17)(18), and only two previous reports had a higher rate than that of this study with regard to overall mortality (12,13). Such discrepancies may be explained by varying degrees of the criteria requiring ICU admittance, the severity of illness, underlying medical conditions, and deaths unrelated to pneumonia.…”

“…Therefore gramnegative rods might have been detected at higher rates than usual. Although M. tuberculosis was isolated in 2 patients (2.8%), the prevalence of tuberculosis is still high in Asian countries (13).…”

“…Severe communityacquired pneumonia (SCAP) is a condition where severely ill patients with pneumonia who have an especially high mortality rate, ranging from 18-61% (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), necessitates the use of a wider spectrum of microbial chemotherapy, with potential benefits resulting from early ICU admission (2,3). In 1993, the American Thoracic Society (ATS) defined a subset of CAP admission as being severe on the basis of specific risk factors (19), but this criteria for ICU admission is overly sensitive and non-specific (7,8).…”

Clinical and economic burden of community-acquired pneumonia amongst adults in the Asia-Pacific region

“…Aetiological pathogens associated with community-acquired pneumonia 3.3.1. Major community-acquired pneumonia bacterial pathogens Table 2 lists major aetiological pathogens associated with CAP amongst adults in the Asia-Pacific region [14,15,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. The multinational Asian Network for Surveillance of Resistant Pathogens (ANSORP) recently reported that Streptococcus pneumoniae accounted for 29.2% of isolates from adults with CAP in South Korea, China, Taiwan, Hong Kong, India, Singapore, Vietnam and the Philippines [43].…”

Atypical Pneumonia – An Uncommon Presentation of a Well-Known Disease

“…In a retrospective study from Singapore [15] looking at the aetiology of severe CAP in non-immunocompromised patients, there was a surprisingly high incidence of M. tuberculosis in the study population (9 of 57 patients).…”