The aetiology of severe community-acquired pneumonia requiring intensive care unit admission in the Western Cape

Abstract

Background. Community-acquired pneumonia (CAP) is a common condition, with mortality increasing in patients who require intensive care unit (ICU) admission. A better understanding of the current aetiology of severe CAP will aid clinicians in requesting appropriate diagnostic tests and initiating appropriate empiric antimicrobials. Objective. To assess the comorbidities, aetiology and mortality associated with severe CAP in a tertiary ICU in Cape Town, South Africa. Methods. We retrospectively analysed a prospective registry of all adults admitted to the medical intensive care unit at Tygerberg Hospital with severe CAP over a 1-year period. Results. We identified 74 patients (mean (SD) age 40.0 (15.5) years; 44 females). The patients had a mean (SD) APACHE II score of 21.4 (7.9), and the mean ICU stay was 6.6 days. Of the 74 patients, 16 (21.6%) died in ICU. Non-survivors had a higher mean (SD) APACHE II score than survivors (28.3 (6.8) v. 19.4 (7.1); p<0.001). Mycobacterium tuberculosis (n=16; 21.6%) was the single most common agent identified, followed by Pseudomonas aeruginosa (n=9; 12.2%). All P. aeruginosa isolates were sensitive to first-line treatment. No organism was identified in 32 patients (43.2%). Conclusion. M. tuberculosis was the single most common agent identified in patients presenting with CAP. The mortality of CAP requiring invasive ventilation was relatively low, with a strong association between mortality and a higher APACHE II score.

Community acquired pneumonia: the need to broaden our diagnostic armamentarium

“…[3,[5][6][7] In this issue of the AJTCCM, researchers from Tygerberg Hospital (TBH), one of two large tertiary hospitals in the Western Cape Province, reviewed their admissions for CAP to the intensive care unit (ICU) over a 12-month period. [8] They found that patients with CAP accounted for 17.5% of the 423 admissions during that period, confirming the high burden of CAP in this setting.…”

“… [9] What is made clear by Mazaza et al . [8] is that unless we start looking, we may never know what we are up against, or how to tailor our response.…”

“…The challenge of developing a locally responsive empirical strategy is in balancing the risk of failure to treat, on the one hand, and the risks of overtreatment on the other. [9] What is made clear by Mazaza et al [8] is that unless we start looking, we may never know what we are up against, or how to tailor our response.…”

“…This confirms the increasing presentation of TB as an acute pneumonia. [10] Mazaza et al [8] argue, and rightly so, that we should actively confirm or exclude TB in every patient admitted to the ICU. The location of their study, in the global epicentre of TB, reminds us that we should always seek to 'know our epidemic, and know our response' -the global rallying call for intensified local responses to global epidemics based on unique local disease epidemiology.…”

Microbial Pattern and Antibiotic Resistance of Severe Pneumonia in A National Referral Hospital in Indonesia

“…In the United States, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterobacteriaceae were the most common isolated microorgamanisms in severe HAP/VAP [28], whereas Streptococcus pneumoniae, Staphylococcus aureus, and Enterobacteriaceae were commonly isolated in CAP patients admitted to ICU [29]. In Africa, Staphylococcus aureus (MRSA), and Klebsiella pneumoniae were the most common isolated microorganisms in severe HAP/VAP [30], whereas Mycobacterium tuberculosis and Pseudomonas aeruginosa were commonly isolated in CAP patients admitted to ICU [31]. Compared to other countries' microbial patterns, we do not report the presence of other possible pneumonia pathogens, such as Streptococcus pneumoniae, Legionella sp, and Staphylococcus aureus (MRSA).…”