Investigation of the causative agents for community-acquired pneumonia in adult patients
Community-acquired pneumonia (CAP) is a common condition in healthy people, causing morbidity and mortality worldwide despite latest advances in therapy and immunization procedures. Causative agents cannot be detected in approximately 50% of CAP episodes and therapy is initiated empirically. We aimed to determine the spectrum and frequency of the causative agents in patients with CAP in a university hospital. Materials and methods: Seventy seven adult patients hospitalized with CAP from November 2007 to March 2008 were included. CAP was diagnosed with clinical, radiological, and laboratory signs. Results: Sputum and blood cultures grew Streptococcus pneumoniae in 15 specimens; Haemophilus influenzae in 4, Klebsiella pneumoniae in 4, Staphylococcus aureus in 3, and Escherichia coli in 2. Mycoplasma pneumoniae DNA was detected in serum from 10 patients with RT-PCR. Legionella pneumophila urinary antigen was detected in 5 patients. Serological IgM antibodies to Chlamydia pneumoniae in 7 patients and Respiratory Syncytial Virus in 2 patients were observed. Etiology was not determined in 32.5% of patients. The most frequently identified pathogens causing CAP were S. pneumoniae, M. pneumoniae, and C. pneumoniae in descending order in our hospital. Conclusion: Although determination of causative agents in all CAP patients has not been accomplished, knowledge of the spectrum and frequency of local causative agents are valuable for targeted therapy.
Investigation of the causative agents for community-acquired pneumonia in adult patients
Community-acquired pneumonia (CAP) is a common condition in healthy people, causing morbidity and mortality worldwide despite latest advances in therapy and immunization procedures. Causative agents cannot be detected in approximately 50% of CAP episodes and therapy is initiated empirically. We aimed to determine the spectrum and frequency of the causative agents in patients with CAP in a university hospital. Materials and methods: Seventy seven adult patients hospitalized with CAP from November 2007 to March 2008 were included. CAP was diagnosed with clinical, radiological, and laboratory signs. Results: Sputum and blood cultures grew Streptococcus pneumoniae in 15 specimens; Haemophilus influenzae in 4, Klebsiella pneumoniae in 4, Staphylococcus aureus in 3, and Escherichia coli in 2. Mycoplasma pneumoniae DNA was detected in serum from 10 patients with RT-PCR. Legionella pneumophila urinary antigen was detected in 5 patients. Serological IgM antibodies to Chlamydia pneumoniae in 7 patients and Respiratory Syncytial Virus in 2 patients were observed. Etiology was not determined in 32.5% of patients. The most frequently identified pathogens causing CAP were S. pneumoniae, M. pneumoniae, and C. pneumoniae in descending order in our hospital. Conclusion: Although determination of causative agents in all CAP patients has not been accomplished, knowledge of the spectrum and frequency of local causative agents are valuable for targeted therapy.
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- Acar A, Öncül O. Toplum Kökenli Pnömoniler. Klimik Derg 2007; 20(1): 3-16.
- Mandell LA, Marrie TJ, Grossman RF, Chow AW, Hyland RH. Canadian guidelines for the initial management of community- acquired pneumonia: an evidence based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. Clin Infect Dis 2000; 31: 387-421.
- Restrepo MI, Anzueto A. Guidelines for the diagnoses and treatment of adult lower respiratory tract infections: a true “European cooperative effort”. Eur Respir J 2005; 26: 979-81.
- Ruiz M, Ewig S, Torres A, Arancibia F, Marco F, Mensa J, et al. Severe community-acquired pneumonia: risk factors and follow-up epidemiology. Am J Respir Crit Care Med 1999; 160: 923-9.
- Tabak F. Toplum kökenli pnömonilerde laboratuvar yöntemlerinin akılcı kullanımı. Ankem Derg 2005; 19(2): 24-7.
- Metlay JP, Fine MJ. Testing strategies in the initial management of patients with community-acquired pneumonia. Ann Intern Med 2003; 138: 109-18.
- Almirall, Bolibar I, Toran P, Pera G, Boquet X, Balanzo X, Sauca G. Contrubition of C-reaktive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest 2004; 125: 1335-42.
- Garcia-Vazquez E, Marcos MA, Mensa J, Roux de A, Puig J, Font C, et al. Assesment of the usefulness of sputum culture for diagnosis of community-acquired pneumonia using the PORT predictive scoring system. Arc Intern Med 2004; 164: 1807-11.
- Roson B, Carratala J, Verdaguer R, Dorca J, Manresa F, Gudiol F. Prospective study of the usefulness of sputum gram-stain in the initial approach to community-acquired pneumonia requiring hospitalization. Clin Infect Dis 2000; 31: 869-74.
- Küçükardalı Y, Öncül O, Nalbant S, Çankır Z, Top C, Ağdaş Ş, et al. Yaşlı popülasyonda toplum kökenli pnömoni olguları. Geriatri 2001; 4(2): 59-62.
- Kömürcüoğlu B, Büyükşirin M, Çıkırıkçıoğlu B, Öztuna I, Perim K. 60 yaş ve üzeri hastalarda toplum kökenli pnömonilerin genel özellikleri. Solunum Derg 2000; 2: 80-4.
- Fidan A, Kıral N, Erdem İ, Eren A, Saraç G, Çağlayan B. Toplum kökenli pnömonilerde hastane mortalitesi ve ulusal pnömoni tanı ve tedavi rehberlerine göre değerlendirme. Toraks Derg 2005; 6(2): 115-21.
- Yüce A, Yapar N. Mycoplasma türleri. In: Willke Topçu A, Söyletir G, Doğanay M. Editors. İnfeksiyon Hastalıkları ve Mikrobiyolojisi. 1st ed. İstanbul:Nobel Tıp Kitabevleri; 2002. p. 1453-9.
- Özlü T, Bülbül Y, Kaygusuz S, Öztuna F, Yıldırım Z, Köksal İ. Toplum Kökenli Pnömoni Olgularımızda M. pneumoniae, C. pneumoniae ve L. pneumophilia Sıklığı. Solunum Hastalıkları 2000; 11: 135-9.
- Esposito S, Blasi F, Bellini F, Allegra L, Principi N, Mowgli Study Group. Mycoplasma pneumoniae and Chlamydia pneumoniae infections in children with pneumonia. Eur Respir J 2001, 17: 241-5.
- Harris JS, Kolokathis A, Campbell M, Cassell GH, Hammerschlag MR. Safety and efficacy of azithromycin in the treatment of community-acquired pneumonia in children. Pediatr Infect Dis J 1998; 17: 865-71.
- Principi N, Esposito S. Comparative tolerability of erythromycin and newer macrolide antibacterials in paediatric patients. Drug Safety 1999; 20: 25-41.
- Cunha BA. Ambulatory community-acquired pneumonia: the predominance of atypical pathogens. Eur J Clin Microbiol Infect Dis 2003; 22: 579-83.
- Bohte R, Van Furth R, Van Der Broek PJ. Aetiology of community acquired pneumonia: a prospective study among adults requiring admission to hospital. Thorax 1995; 50: 543-7.
- Ruiz M, Ewing S, Marcos MA, Martinez JA, Arancibia F, Mensa J, et al. Etiology of community acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Crit Care Med 1999; 160: 397-405.
- Neill AM, Martin IR, Weir R, Anderson R, Chereshsky A, Epton MJ, et al. Community acquired pneumonia: Aetiology and usefulness of severity. Thorax 1996; 51: 1010-6.