Abstract
BackgroundIn the Netherlands, an increased risk of community-acquired pneumonia (CAP) has been reported for adults living near goat and poultry farms. Previous results of respiratory microbiome studies in hospitalized CAP patients near poultry farms suggested a higher relative abundance of Streptococcus pneumoniae. This retrospective study, using routine laboratory data from hospitalized CAP patients, aims to explore possible aetiologic micro-organisms of CAP in relation to livestock exposure.MethodsPatient characteristics and PCR and urinary antigen test results were retrieved retrospectively from electronic medical records of CAP patients admitted to the Jeroen Bosch Hospital or Gelre Hospital in the Netherlands during 2016–2017. Distances between the patients’ home address and the nearest poultry and goat farm were calculated. Differences in laboratory test results between CAP patients with and without goat or poultry farms within 2 km of their home address were analyzed using Fisher’s exact test.ResultsIn total, 2230 CAP episodes with diagnostic results were included. In only 25% of the CAP episodes, a micro-organism was detected. A positive urinary antigen test for S. pneumoniae was found more often in patients living within two kilometers of goat (15.2% vs. 11.3%) and poultry farms (14.4% vs. 11.3%), however these differences were not statistically significant (p = 0.1047 and p = 0.1376).ConclusionOur retrospective analysis did not show statistically significant differences in the identified micro-organisms in hospitalized CAP patients related to livestock farming. The study was hampered by limited statistical power and limited laboratory results. Therefore, the potential increased CAP risk around goat and poultry farms will be further explored in a prospective study among CAP patients in primary care.
Highlights
In the Netherlands, large numbers of livestock animals are kept in close proximity to human residential areas
It has been proposed that exposure to particulate matter (PM) and its components may increase the susceptibility to community-acquired pneumonia (CAP). [9–11] Previous results suggested a shift in the respiratory microbiome composition in hospitalized pneumonia patients near poultry farms, with a higher relative abundance of Streptococcus pneumoniae. [3]While most CAP patients in the Netherlands are managed by the general practitioner (GP), yearly, around 40,000–50,000 pneumonia patients in the Netherlands require hospitalization
Of the total number of CAP episodes, 12.4% (JBH 19.1%, Gelre Hospital (Gelre) 3.6%) and 16.6% (JBH 18.2%, Gelre 14.5%) occurred in patients living within a two kilometer range of goat farms or poultry farms, respectively (Table 1)
Summary
In the Netherlands, large numbers of livestock animals are kept in close proximity to human residential areas. Even in hospitalized CAP patients, the causative organism is not specified in 85% of cases when routine diagnostics are applied [12] Despite this limitation, in preparation for a large prospective aetiological study, we still decided to analyze the laboratory management systems of two hospitals in livestock dense areas for relevant microbiological test data, especially for S. pneumoniae, to explore the identified micro-organisms in pneumonia patients in relation to livestock exposure. Previous results of respiratory microbiome studies in hospitalized CAP patients near poultry farms suggested a higher relative abundance of Streptococcus pneumoniae. This retrospective study, using routine laboratory data from hospitalized CAP patients, aims to explore possible aetiologic micro-organ‐ isms of CAP in relation to livestock exposure
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