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Etiology of Community‐Acquired Pneumonia: Increased Microbiological Yield with New Diagnostic Methods
Open accessAbstract
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 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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“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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Practice Guidelines for the Management of Community-Acquired Pneumonia in Adults
Bartlett, J. G., Dowell, S. F., Mandell, L. A., File, T. M., Musher, D. M., & Fine, M. J. (2000) · Clinical Infectious Diseases · doi:10.1086/313954 · Cited by 2,283
Etiology of Community-Acquired Pneumonia: Impact of Age, Comorbidity, and Severity
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PROSPECTIVE STUDY OF THE AETIOLOGY AND OUTCOME OF PNEUMONIA IN THE COMMUNITY
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Rhinoviruses infect the lower airways
Papadopoulos, N. G., Bates, P. J., Bardin, P. G., Papi, A., Leir, S. H., Fraenkel, D. J., Meyer, J., Lackie, P. M., Sanderson, G., Holgate, S. T., et al. (2000) · The Journal of Infectious Diseases · doi:10.1086/315513 · Cited by 535
Lim, W. S. (2001) · Thorax · doi:10.1136/thorax.56.4.296 · Cited by 527
File, T. M. (2003) · The Lancet · doi:10.1016/s0140-6736(03)15021-0 · Cited by 497
Templeton, K. E., Scheltinga, S. A., Beersma, M. F. C., Kroes, A. C. M., & Claas, E. C. J. (2004) · Journal of Clinical Microbiology · doi:10.1128/jcm.42.4.1564-1569.2004 · Cited by 468
BTS Guidelines for the Management of Community Acquired Pneumonia in Childhood
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Incidence and characteristics of viral community-acquired pneumonia in adults
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Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults
Jain, S., Self, W. H., Wunderink, R. G., Fakhran, S., Balk, R., Bramley, A. M., Reed, C., Grijalva, C. G., Anderson, E. J., Courtney, D. M., et al. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1500245 · Cited by 2,323
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Guidelines for the management of adult lower respiratory tract infections - Full version
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Torres, A., Cillóniz, C., Niederman, M. S., Menéndez, R., Chalmers, J. D., Wunderink, R. G., & van der Poll, T. (2021) · Nature Reviews Disease Primers · doi:10.1038/s41572-021-00259-0 · Cited by 904
Musher, D. M., & Thorner, A. R. (2014) · New England Journal of Medicine · doi:10.1056/nejmra1312885 · Cited by 647
Metadata
- Authors
- Johansson, N., Kalin, M., Tiveljung‐Lindell, A., Giske, C. G., & Hedlund, J.
- Affiliations
- Karolinska University Hospital (SE)
- 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
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
- Health Sciences › Medicine › Microbiology (medical) › 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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