Microbial aetiology of community-acquired pneumonia in hospitalised patients.

Abstract

Adult patients hospitalised with community-acquired pneumonia were studied prospectively to determine the microbial aetiology of pneumonia. Between April 1996 and March 1997, blood and sputum samples were collected for culture. Throat swabs were obtained for isolation of viruses and for detection of antigens of Chlamydia pneumoniae, influenza viruses A and B, respiratory syncytial virus and parainfluenza virus. Antibodies against Legionella spp., Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, Coxiella burnetii, influenza viruses A and B, respiratory syncytial virus, adenovirus and parainfluenza virus were tested in serum samples. Two hundred eleven patients were included in the study; paired sera were available from 152 patients. Blood culture was positive in 23 (10.9%) patients, Streptococcus pneumoniae being the bacterium isolated most frequently. A fourfold or greater rise or fall in the Chlamydia pneumoniae IgG and/or IgM antibody titre was found in 20 (9.5%) patients and a high antibody titre (> or = 1:512) in the first and/or the second serum sample in 18 (18.5%) patients. Antibodies confirming acute Mycoplasma pneumoniae infection were found in 12 (5.7%) patients, Legionella spp. in six (2.8%), Chlamydia psittaci in two and Coxiella burnetii in one. Three patients had pulmonary tuberculosis. Only two patients had a virus present in the throat swab (adenovirus in one patient and echovirus in the other), and in nine patients, viral antigen was detected. Acute viral infection was confirmed in 51 (24.1%) patients. Bacterial pneumonia was diagnosed in 84 (39.8%) patients, 23 of whom had concurrent viral infection. Acute viral pneumonia without any other identified pathogen was diagnosed in 28 patients. Streptococcus pneumoniae and Chlamydia pneumoniae were the most frequently identified microorganisms.