Aetiology and outcome of severe community-acquired pneumonia

Woodhead, Mark; Macfarlane, J T; Rodgers, Frank G.; Laverick, A; Pilkington, Ruth; Macrae, A.D.

doi:10.1016/s0163-4453(85)92463-6

Cited by 133 publications

(69 citation statements)

References 13 publications

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“…The reasons for this are not fully understood but one implication is that the in-hospital population covered in one study may be the same as, or overlap with, the community population covered in another study. Criteria for ICU admission vary from hospital to hospital and, for example, intubation rates are quite different in separate ICU studies of CAP, ranging from 50% [25] to 100% [26] even within the same country. Thus different populations of patients may be being studied.…”

Section: Methodological Issuesmentioning

confidence: 99%

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Community-acquired pneumonia in Europe: causative pathogens and resistance patterns

Woodhead¹

2002

Eur Respir J

183

117

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Community-acquired pneumonia (CAP) is a common condition affecting about 1/1,000 of the adult population per year. It occurs when bacteria enter the alveolar spaces of the lung initiating an inflammatory response which leads to the clinical features of cough, sputum production, breathlessness and sometimes chest pain and haemoptysis.At the end of the last century the causal relationship between bacteria and pneumonia was established and many of the early discoveries about the causes of CAP were made in Europe. Some 41 different prospective studies have established that ∼10 different microbial pathogens regularly cause CAP with occasional cases due to other rarer causes. The frequency of these organisms in Europe is similar in most countries, but there are some geographic differences. Differences in frequency are also apparent according to illness severity. It is generally recognised thatStreptococcus pneumoniaeis the most important causal bacterium in all countries.A relatively recent development has been the appearance and spread, in some of the common causative bacteria, of resistance to commonly used antibiotics to which they were once sensitive. The frequency of such resistance does vary markedly between European countries.However, published data is often difficult to interpret. The reasons for this are that the frequency of resistance varies according to the age of the patient, the site of the sample, the clinical diagnosis, the use of prior antibiotics and the influence of special groupse.g.those with cystic fibrosis. The impact ofin vitroantibiotic resistance on clinical outcome is still poorly understood, but recent studies are helping to clarify this issue and will be discussed.

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Section: Methodological Issuesmentioning

confidence: 99%

“…Some 41 prospective studies of the aetiology of CAP in European countries have been published and form the basis for this section of the paper [1,2,4,5,25,26,. As indicated above, CAP in the community is the most difficult to define and study, and is therefore the least known with only eight studies published.…”

Section: Causative Pathogensmentioning

confidence: 99%

Community-acquired pneumonia in Europe: causative pathogens and resistance patterns

Woodhead¹

2002

Eur Respir J

183

117

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“…Many studies have investigated CAP prognosis factors [1][2][3][4][5][6][7][8][9][10][11][12], and guidelines have been proposed by several medical societies to define the optimal management of patients with CAP [13][14][15][16][17].…”

mentioning

confidence: 99%

“…In many studies, the rate of microbial identification, even in the ICU, remains extremely low, ranging 10-30% [2][3][4][5][18][19][20].…”

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confidence: 99%

Severe community-acquired pneumonia: assessment of microbial aetiology as mortality factor

Paganin¹

2004

Eur Respir J

143

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Community-acquired pneumonia (CAP) remains a major cause of mortality. The aetiology of CAP has rarely been identified as a mortality risk factor. A prospective study was conducted to assess the prognostic factors of CAP patients admitted to the intensive care unit (Centre Hospitalier Departmental Félix Guyon, St Denis de la Réunion, France), with a special emphasis on microbial aetiology.All variables assessing severity were collected, with a special emphasis on microbial investigations. Among 112 immunocompetent patients (mean¡SD age 54.7¡15.1 yrs), 84% were male. Severity of CAP was demonstrated by mortality rate (43%), shock (48%), simplified acute physiology score (SAPS; 46.4¡21.6) and mechanical ventilation support (82%). Mean risk factor score was 2.2¡1.2. Microbiological identification was obtained in 78.6% of cases, with positive blood culture in 33%. Most frequently, microbial agents were Streptococcus pneumoniae and Klebsiella pneumoniae (42% and 22%, respectively).The univariate analysis recorded the usual mortality variables: age, alcohol consumption, SAPS, shock, mechanical ventilation, positive end expiratory pressure level, positive blood culture, multilobar infiltrates on chest radiograph, neutropenia, and acidosis, and found K. pneumoniae (versus S. pneumoniae, and all CAP) as a mortality factor. The multivariate analysis demonstrated that septic shock (relative risk (RR) 141), K. pneumoniae CAP (RR 27), SAPS (RR 10.7) and positive blood culture (RR 2.7) were independent factors related to death.In conclusion, the present study found that the microbial aetiology, Klebsiella pneumoniae, was an independent risk factor for mortality in severe community-acquired pneumonia.

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“…This accentuates the importance of prompt, accurate diagnosis and severity of illness which approaches to decisions regarding the extremity of management. [19,20] 200 patients with CAP were enrolled in this study. The current study asserts that B/A ratio with 97.1 % sensitivity and 100 % specificity with AUC of 0.999 is a better marker for the deciding severity, need of ICU and development of any complications during the course of CAP.…”

Section: Discussionmentioning

confidence: 99%

Study on the utilities of the role of biomarkers like albumin, CRP, PCT and blood urea nitrogen to serum albumin (B/A) ratio in the prediction of development of complications, prognosis, and need of ICU during the course of CAP

Patel¹,

Makadia²,

Patel³

et al. 2016

Int J of Biomed & Adv Res

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Context: Community-acquired pneumonia (CAP) is a serious illness. Early studies of community-acquired pneumonia reported that nonsurvivors had higher blood urea nitrogen levels and lower serum albumin levels than survivors. Therefore, elevation of the blood urea nitrogen to serum albumin (B/A) ratio may classify patients with community-acquired pneumonia who are becoming critically ill. Aim: To study the role of biomarkers in the prediction of development of complications, prognosis and need of ICU during the course of community-acquired pneumonia (CAP). Settings and Design: This is a retrospective study. Material and Method: The present study was conducted in the department of Biochemistry. 200 patient's data, required for the study was collected from the online LIS system, Chest-Medicine ward and medical ICU department. Statistical Analysis Used: Statistical analysis was performed by Pearson's correlation coefficient (r) and ROC plots. Results: B/A, PCT, and CRP are statistically significantly positively correlated with the severity of the CAP, decided on the base of PSI and CURB-65 scoring system. (Correlation coefficient r=0.7368, 0.6412 and 0.8064 respectively. P<0.0001). These biomarkers also have good sensitivity and specificity for deciding need of the ICU during the course of CAP. Conclusions: In our present study, we found an expressive and unaided positive correlation between B/A (BUN-Blood urea nitrogen/Albumin) ratio and severity of CAP. Both serum biochemical markers, blood urea nitrogen and albumin, are commonly used and can be measured promptly. Thus, our study suggests that the B/A ratio on admission can be a rapid, simple, cost-effective and predictable prognostic and severity indicator for CAP.

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Aetiology and outcome of severe community-acquired pneumonia

Cited by 133 publications

References 13 publications

Community-acquired pneumonia in Europe: causative pathogens and resistance patterns

Community-acquired pneumonia in Europe: causative pathogens and resistance patterns

Severe community-acquired pneumonia: assessment of microbial aetiology as mortality factor

Study on the utilities of the role of biomarkers like albumin, CRP, PCT and blood urea nitrogen to serum albumin (B/A) ratio in the prediction of development of complications, prognosis, and need of ICU during the course of CAP

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