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Cited by 500Pneumonia and Respiratory InfectionsMicrobial infections and disease researchBacterial Identification and Susceptibility Testing

Etiology of Community‐Acquired Pneumonia: Increased Microbiological Yield with New Diagnostic Methods

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Johansson, Niclas, Kalin, Mats, Tiveljung‐Lindell, Annika, Giske, Christian G., Hedlund, Jonas·2010·Clinical Infectious Diseases
DOI 10.1086/648678PMC PMC7107844
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Abstract

BACKGROUND: The microbial etiology of community-acquired pneumonia (CAP) is still not well characterized. During the past few years, polymerase chain reaction (PCR)-based methods have been developed for many pathogens causing respiratory tract infections. The aim of this study was to determine the etiology of CAP among adults-especially the occurrence of mixed infections among patients with CAP-by implementing a new diagnostic PCR platform combined with conventional methods. METHODS: Adults admitted to Karolinska University Hospital were studied prospectively during a 12-month period. Microbiological testing methods included culture from blood, sputum, and nasopharyngeal secretion samples; sputum samples analyzed by real-time quantitative PCR for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis; nasopharyngeal specimens analyzed by use of PCR; serological testing for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and viruses common in the respiratory tract; and urine antigen assays for detection of pneumococcal and Legionella pneumophila antigens. RESULTS: A microbial etiology could be identified for 67% of the patients (n = 124). For patients with complete sampling, a microbiological agent was identified for 89% of the cases. The most frequently detected pathogens were S. pneumoniae (70 patients [38%]) and respiratory virus (53 patients [29%]). Two or more pathogens were present in 43 (35%) of 124 cases with a determined etiology. CONCLUSIONS: By supplementing traditional diagnostic methods with new PCR-based methods, a high microbial yield was achieved. This was especially evident for patients with complete sampling. Mixed infections were frequent (most commonly S. pneumoniae together with a respiratory virus).

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  • An additional six studies reported that 12-50% of patients had preceding antibiotic treatment at enrollment.

    “An additional six studies reported on participant antibiotic use at the time of enrollment and found that 12–50% of patients had preceding antibiotic treatment which may have led to an underestimation of the true frequency of bacterial coinfection in their sample population.30, 33, 40, 45, 47, 52”

    From The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. (2016) · cites this paper as [40]

  • Preceding antibiotic treatment may have led to an underestimation of the true frequency of bacterial coinfection in the sample population.

    “An additional six studies reported on participant antibiotic use at the time of enrollment and found that 12–50% of patients had preceding antibiotic treatment which may have led to an underestimation of the true frequency of bacterial coinfection in their sample population.30, 33, 40, 45, 47, 52”

    From The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. (2016) · cites this paper as [40]

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Authors
Johansson, N., Kalin, M., Tiveljung‐Lindell, A., Giske, C. G., & Hedlund, J.
Affiliations
Karolinska University Hospital (SE)
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2010-01-15
Volume
50
Issue
2
Pages
202-209
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1086/648678
PMC
PMC7107844
OpenAlex
W2163593399
Cited by
500
References
38
Citations by year
2026: 7 · 2025: 19 · 2024: 19 · 2023: 33 · 2022: 28 · 2021: 29 · 2020: 47 · 2019: 33 · 2018: 24 · 2017: 30 · 2016: 37 · 2015: 30 · 2014: 41 · 2013: 46 · 2012: 37
FWCI
17.31
Type
journal article
Language
en
Open access
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Karolinska Institutet
Topics
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
  • Life Sciences › Immunology and Microbiology › Microbiology › Microbial infections and disease research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
Keywords
community-acquired pneumonia, microbial etiology, co-infection, Streptococcus pneumoniae, respiratory viruses, Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, pneumococcal antigen detection, PCR diagnosis, sputum culture, serological testing
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pneumonia, Prospective Studies, Virus Diseases, Community-Acquired Infections, Young Adult

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