Bacterial etiology of community-acquired pneumonia in immunocompetent hospitalized patients and appropriateness of empirical treatment recommendations: an international point-prevalence study

Abstract

An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for selecting appropriate antimicrobial treatments. Very few etiological studies assessed the appropriateness of empiric guideline recommendations at a multinational level. This study aims at the following: (i) describing the bacterial etiologic distribution of CAP and (ii) assessing the appropriateness of the empirical treatment recommendations by clinical practice guidelines (CPGs) for CAP in light of the bacterial pathogens diagnosed as causative agents of CAP. Secondary analysis of the GLIMP, a point-prevalence international study which enrolled adults hospitalized with CAP in 2015. The analysis was limited to immunocompetent patients tested for bacterial CAP agents within 24 h of admission. The CAP CPGs evaluated included the following: the 2007 and 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA), the European Respiratory Society (ERS), and selected country-specific CPGs. Among 2564 patients enrolled, 35.3% had an identifiable pathogen. Streptococcus pneumoniae (8.2%) was the most frequently identified pathogen, followed by Pseudomonas aeruginosa (4.1%) and Klebsiella pneumoniae (3.4%).

BioFire® FilmArray® Pneumonia Panel for Severe Lower Respiratory Tract Infections: Subgroup Analysis of a Randomized Clinical Trial

“…A subsequent study using a novel serotype-specific urinary antigen detection assay in 1736 samples coming from the EPIC trial identified additional 76 (4.4%) cases of pneumococcal CAP [ 11 ]. Similar results were provided by the Global Initiative for Methicillin-resistant S. aureus Pneumonia (GLIMP) point-prevalence international study among 2564 patients hospitalized with CAP in 2015; S. pneumoniae was detected in 8.2% followed by P. aeruginosa (4.1%) and K. pneumoniae (3.45), whereas in 35.3% no pathogen was detected [ 12 ]. Many patients of the PROGRESS trial were found with bacterial and viral co-infection.…”

Simulated Adoption of 2019 Community-Acquired Pneumonia Guidelines Across 114 Veterans Affairs Medical Centers: Estimated Impact on Culturing and Antibiotic Selection in Hospitalized Patients

“…Our findings show that the expected effects are congruent with this intention.. Presumably more frequently culturing the "right" patients would increase the overall diagnostic yield [24][25][26]. However, we estimated that 370 (26%) of MRSA and 479 (36%) of P. aeruginosa cases would be "missed" by guideline recommended culturing on hospital wards, including 45 (11%) of cases of MRSA bacteremia.…”

Evaluation of semi-quantitative compared to quantitative cultures of tracheal aspirates for the yield of culturable respiratory pathogens – a cross-sectional study

“…Studies from our center have shown atypical pathogens are more common in the etiology of pneumonia [ 18 ], however, recently, amongst cultivable organisms, Staphylococcus aureus was the most common pathogen causing pneumonia, with S. pneumoniae and P. aeruginosa being close seconds [ 19 ]. Another study looking at bacterial etiology of pneumonia in immunocompetent hospitalized patients showed Pseudomonas aeruginosa to be the most common causative agent in Pakistan [ 20 ]. Only 2 samples were positive for Streptococcus pneumoniae, historically considered the most common etiologic agent of CAP worldwide.…”