Etiology of Community-Acquired Pneumonia: Increased Microbiological Yield with New Diagnostic Methods.
Johansson, Niclas 1,3,4; Kalin, Mats 1,3,4; Tiveljung-Lindell, Annika 2,5; Giske, Christian G. 2,5; Hedlund, Jonas 1,3,4
[Article]
Clinical Infectious Diseases.
50(2):202-209, January 15, 2010.
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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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