Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective

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URI: http://hdl.handle.net/10818/41343Visitar enlace: https://bmcinfectdis.biomedcen ...
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DOI: 10.1186/s12879-018-3565-z
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Gramegna, Andrea; Sotgiu, Giovanni; Pasquale, Marta Di; Radovanovic, Dejan; Terraneo, Silvia; Reyes, Luis F.; Vendrell, Ester; Neves, Joao; Menzella, Francesco; Blasi, Francesco; Aliberti, Stefano; Restrepo, Marcos I.Fecha
2018-12-18Resumen
Background: Empirical antibiotic coverage for atypical pathogens in community-acquired pneumonia (CAP) has
long been debated, mainly because of a lack of epidemiological data. We aimed to assess both testing for atypical
pathogens and their prevalence in hospitalized patients with CAP worldwide, especially in relation with disease
severity.
Methods: A secondary analysis of the GLIMP database, an international, multicentre, point-prevalence study of
adult patients admitted for CAP in 222 hospitals across 6 continents in 2015, was performed. The study evaluated
frequency of testing for atypical pathogens, including L. pneumophila, M. pneumoniae, C. pneumoniae, and their
prevalence. Risk factors for testing and prevalence for atypical pathogens were assessed through univariate analysis.
Results: Among 3702 CAP patients 1250 (33.8%) underwent at least one test for atypical pathogens. Testing varies
greatly among countries and its frequency was higher in Europe than elsewhere (46.0% vs. 12.7%, respectively, p < 0.
0001). Detection of L. pneumophila urinary antigen was the most common test performed worldwide (32.0%). Patients
with severe CAP were less likely to be tested for both atypical pathogens considered together (30.5% vs. 35.0%, p = 0.009)
and specifically for legionellosis (28.3% vs. 33.5%, p = 0.003) than the rest of the population. Similarly, L. pneumophila
testing was lower in ICU patients. At least one atypical pathogen was isolated in 62 patients (4.7%), including M.
pneumoniae (26/251 patients, 10.3%), L. pneumophila (30/1186 patients, 2.5%), and C. pneumoniae (8/228 patients, 3.5%).
Patients with CAP due to atypical pathogens were significantly younger, showed less cardiovascular, renal, and metabolic
comorbidities in comparison to adult patients hospitalized due to non-atypical pathogen CAP.
Conclusions: Testing for atypical pathogens in patients admitted for CAP in poorly standardized in real life and does not
mirror atypical prevalence in different settings. Further evidence on the impact of atypical pathogens, expecially in the
low-income countries, is needed to guidelines implementation.
Ubicación
BMC Infectious Diseases (2018) 18:677
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