Viruses and Gram-negative bacilli dominate the etiology of community-acquired pneumonia in Indonesia, a cohort study

Farida, Helmia; Gasem, Muhammad Hussein; Suryanto, Agus; Keuter, Monique; Zulkarnain, Nasirun; Satoto, Bambang; Eijk, Annemiek A. van der; Djokomoeljanto, R.; Wahyono, Hendro; Verbrugh, Henri A.; Severin, Juliëtte A.; Broek, P.J. van den

doi:10.1016/j.ijid.2015.07.023

Cited by 25 publications

(28 citation statements)

References 22 publications

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“…We found that obesity and need for invasive mechanical ventilation were the only two risk factors associated with increased incidence of viral CAP; however, obesity was the only independent risk factor associated with influenza CAP. This is consistent with findings of animal models which suggested a role of leptin dysregulation in more severe disease [33,34], while a higher incidence and severity of viral CAP was found in obese patients [30,31,35,36]; on the other hand, several studies showed that severity of CAP and need for ICU admittance with invasive ventilation were not associated with etiology [10,17,21,[37][38][39]. Thus, we conclude that obesity is the only independent risk factor predisposing patients to influenza infection, although the association of obesity and viral CAP, and then, with influenza CAP, could be over-represented by the large proportion of patients with Influenza virus diagnosed in this cohort.…”

Section: Discussionsupporting

confidence: 89%

“…However, early diagnosis and treatment of viral CAP caused by Influenza virus is known to have notable clinical implications [20]. In this regard, several studies showed that prevalence of viral CAP varies from 15% to 35% [2,7,9,10,21-23]; however, these studies limit data analyses to only tested patients or all the patients enrolled were systematically tested for viral infection [2,7,9,10,[21][22][23]. In the present study, which was an attempt to assess real-life scenarios, < 15% of patients were tested for viruses with a prevalence of viral CAP of 28.4% among those tested, consistent with the recent results of a systematic review [7].…”

Section: Discussionmentioning

confidence: 99%

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An international perspective on hospitalized patients with viral community-acquired pneumonia

Radovanovic¹,

Sotgiu²,

Janković³

et al. 2019

European Journal of Internal Medicine

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

An international perspective on hospitalized patients with viral community-acquired pneumonia

Radovanovic¹,

Sotgiu²,

Janković³

et al. 2019

European Journal of Internal Medicine

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“…Gram negative bacteria predominated the organisms in this study, similar to the results of H. Farida et al [26]. Detection of mycobacterium tuberculosis was observed to be high.…”

Section: Discussionsupporting

confidence: 91%

Etiological Trends and Patterns of Antimicrobial Resistance in Respiratory Infections

et al. 2018

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Background:Respiratory infections are one of the commonest causes of morbidity and mortality related to infectious diseases worldwide. The emergence of antimicrobial resistance is a major global health problem which is well established in developing countries. Good clinical suspicion and correct laboratory identification of respiratory infection causing organisms followed by the appropriate management are needed to compact both community-acquired and nosocomial infection respiratory infections.Objectives:A retrospective study was carried out to elucidate the etiology of respiratory infections in Sudan, as well as to guide the physician to the best antimicrobial alternatives used in the treatment of respiratory infection.Method:Respiratory isolates that have been morphologically identified and biologically characterized were subjected to antibiotic susceptibility testing.Results:A total of 1481 respiratory specimens were examined, recovering 377 organisms from 350 culture positive samples [225(59.7%) sputum, 94(24.9%) broncho-alveolar lavage (BAL), 58(15.4%) Pleural fluid], the commonest organisms were Klebsiella ssp. (25.20%) and mycobacterium tuberculosis (25.20%), followed by Staphylococcus aureus(19.89%) and Pseudomonas aeruginosa(8.49%). High rate of resistance of bacterial isolates was observed to Co-trimoxazole (BA), Ampicillin sulbactam (AS), Cefotaxime (CF) and Tetracycline (TE), being 80%, 72.3%, 68.8% and 66.9% respectively; on the other hand, very low resistance rate was found to Amikacin (AK) and Levofloxacin (LE), being 4.6% and 8.5%, respectively.Conclusion:Guided prescription of antimicrobial agents must be implemented and controlled to limit further spread of antimicrobial resistance.

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“…In South Africa and some Asian countries, Klebsiella pneumoniae is a common cause of severe bacteraemic CAP, displacing S . pneumoniae as the most common bacterial cause in some cohorts . Acinetobacter baumannii —typically associated with nosocomial pneumonia in high‐income countries—has also been identified as a cause of severe CAP in tropical settings .…”

Section: Pneumonia Aetiologymentioning

confidence: 99%

“…The utility and cost‐effectiveness of different diagnostic modalities will also vary by region and context. Whilst blood cultures are an expensive and usually fairly insensitive diagnostic modality in CAP, in a Southeast Asian setting, for example, with high rates of bacteraemic Gram‐negative disease, the facility might be valuable . Diagnostic tests for use in community‐level facilities must require minimal staff training and laboratory infrastructure to perform .…”

Section: Diagnosis and Assessmentmentioning

confidence: 99%

Pneumonia in the developing world: Characteristic features and approach to management

Aston

2017

Respirology

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Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in adults worldwide, but its epidemiology varies markedly by region. Whilst in high-income countries, the predominant burden of CAP is in the elderly and those with chronic cardiovascular and pulmonary co-morbidity, CAP patients in low-income settings are often of working age and, in sub-Saharan Africa, frequently HIV-positive. Although region-specific aetiological data are limited, they are sufficient to highlight major trends: in high-burden settings, tuberculosis (TB) is a common cause of acute CAP; Gram-negative pathogens such as Klebsiella pneumoniae are regionally important; and HIV-associated opportunistic infections are common but difficult to diagnose. These differences in epidemiology and aetiological profile suggest that modified approaches to diagnosis, severity assessment and empirical antimicrobial therapy of CAP are necessary, but tailored individualized management approaches are constrained by limitations in the availability of radiological and laboratory diagnostic services, as well as medical expertise. The widespread introduction of the Xpert MTB/RIF platform represents a major advance for TB diagnosis, but innovations in rapid diagnostics for other opportunistic pathogens are urgently needed. Severity assessment tools (e.g. CURB65) that are used to guide early management decisions in CAP have not been widely validated in low-income settings and locally adapted tools are required. The optimal approach to initial antimicrobial therapy choices such as the need to provide early empirical cover for atypical bacteria and TB remain poorly defined. Improvements in supportive care such as correcting hypoxaemia and intravenous fluid management represent opportunities for substantial reductions in mortality.

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Viruses and Gram-negative bacilli dominate the etiology of community-acquired pneumonia in Indonesia, a cohort study

Abstract: Viruses and Gram-negative bacilli are dominant causes of CAP in this region, more so than S. pneumoniae. Most of the bacteria have wild type susceptibility to antimicrobial agents. Patients with severe disease and those with unknown etiology have a higher mortality risk.

Cited by 25 publications

References 22 publications

An international perspective on hospitalized patients with viral community-acquired pneumonia

An international perspective on hospitalized patients with viral community-acquired pneumonia

Etiological Trends and Patterns of Antimicrobial Resistance in Respiratory Infections

Pneumonia in the developing world: Characteristic features and approach to management

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