Abstract
BackgroundCurrently, broad empiric antimicrobial treatment including atypical coverage is recommended for patients with mild to moderate community-acquired pneumonia (CAP). Therefore, the relative impact of each atypical pathogen, particularly Mycoplasma pneumoniae deserves renewed attention.MethodsBased on prospective data from 4532 patients with CAP included in the German CAP-Competence Network (CAPNETZ), we studied the incidence, clinical characteristics, and outcome of patients with Mycoplasma pneumoniae pneumonia (MPP). The diagnosis of MPP was based on a positive PCR from respiratory samples and/or a positive IgM-titer from an acute phase serum sample.Results307 patients (6.8%) had definite MPP (148 with positive PCR, 204 with positive IgM, 46 with positive PCR and IgM). Compared to patients with other definite and unknown etiologies, patients with MPP were significantly younger (41 ± 16 versus 62 ± 17 and 61 ± 18 years), had fewer co-morbidities, presented with a less severe disease, showed a lower inflammatory response in terms of leukocyte counts (median 8850 versus 13200 and 11000 μL) and CRP values (60 versus 173 and 73 mg/L), and had better outcomes, including a shorter length of hospitalization (9 ± 5 versus 14 ± 11 and 12 ± 9 days), fewer patients requiring mechanical ventilation (0.3 versus 4.5 and 2.1%), and a minimal mortality (0.7 versus 8.7 and 6.5%).ConclusionIn this large series of patients with definite MPP according to very strict criteria, MPP appears as a condition with a high incidence, quite specific clinical presentation, and a largely benign course. In view of a widely favorable clinical outcome, recent recommendations including regular coverage of atypical pathogens in patients with mild to moderate CAP might be reconsidered for patients in Germany as well as in other countries with comparable epidemiological settings.
Highlights
Broad empiric antimicrobial treatment including atypical coverage is recommended for patients with mild to moderate community-acquired pneumonia (CAP)
In several epidemiologic studies of CAP, largely relying on paired serology, Mycoplasma pneumoniae was identified in 5–15% of cases, resulting in a second or third rank pathogen causing CAP in most series [1,2]
Sixty-five percent (n = 2922) of the patients were hospitalized when first contacted for participation in CAPNETZ
Summary
Broad empiric antimicrobial treatment including atypical coverage is recommended for patients with mild to moderate community-acquired pneumonia (CAP). Mycoplasma pneumoniae as an important pathogen of community-acquired pneumonia (CAP) is only rarely diagnosed in routine practice. This is explained by the many limitations of paired serology which still is the applied diagnostic tool in most cases. Together with Legionella spp. and Chlamydophila pneumoniae, these three pathogens are usually addressed as "atypical bacterial pathogens", and considered as prominent targets for broad spectrum antimicrobial treatment including atypical coverage [3]. This approach is questionable for several reasons. Lumping together all three atypical pathogens throughout all pneumonia severities at admission may heavily bias the potential prognostic implications of the pathogens included in this group, and thereby lead to recommendations of initial empiric antimicrobial treatment implying frank overtreatment
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