Spectrum Of Pneumonia Research Articles

HEALTHCARE-ASSOCIATED PNEUMONIA: THE STATE OF EVIDENCE TO DATE?A QUALITATIVE REVIEW

PURPOSE: The evolution of healthcare-associated infection as a concept attests to the need for clinicians to recognize the proliferation healthcare delivery, as many of the traditionally hospital-based interventions now transpire in the ambulatory arena. Healthcare-associated pneumonia (HCAP) is a separate entity in the spectrum of pneumonia. Because of its emerging importance and widely differing pathogen make-up and outcomes in some recent studies, we examined in detail the 5 cohort studies published to date in HCAP to identify the potential reasons for these disparate findings and to identify current knowledge gaps.

Spectrum of Pneumonia in the Current Era of Liver Transplantation and Its Effect on Survival

To examine the frequency and microbial pattern of pneumonia and its effect on survival in the current era of orthotopic liver transplantation (OLT). At the Mayo Clinic in Jacksonville, Fla, the medical records of consecutive patients who underwent their first OLT between February 1998 and January 2001 were retrospectively reviewed through the end of the first year posttransplantation. Of 401 study patients, 20 developed pneumonia; estimates of incidence with corresponding 95% confidence interval (CI) at 1 and 12 months were 3% (1%-5%) and 5% (3%-7%), respectively. Pseudomonas aeruginosa was the predominant microorganism identified (in 8 of 14 patients) during the first month after transplantation. Between the second and sixth months, 2 of the 4 cases of pneumonia were due to fungal infections of Aspergillus fumigatus. Cytomegalovirus was associated with Aspergillus in 1 patient. No other viral or Pneumocystis carnil pneumonia was diagnosed. There were only 2 cases of pneumonia between 7 months and 1 year after transplantation, neither of which was fungal. Approximately 40% (95% CI, 14%-58%) of patients with pneumonia died within 1 month after diagnosis. The relative risk of mortality in the first month after onset of pneumonia was estimated to be 24 (95% CI, 10-54), which is strong evidence of increased risk of mortality with pneumonia (P<0.001). Pneumonia appears to occur less often after OLT than previously reported but still has a substantial negative effect on survival. In the early period after OLT, P. aeruginosa continues to be the predominant organism causing pneumonia.

The spectrum of pneumonia in 1983 at the Riyadh Armed Forces Hospital.

The agents causing pneumonia have been assessed in 112 adult patients admitted to the Armed Forces Hospital in Riyadh during a period of one year: pathogens were identified in 78 patients (69.6%). Sputum culture produced a significant isolate in 60 patients (53.5%), and in 17 (15.2%) the causative agent was suggested by serological tests. Streptococcus pneumonia was the commonest infecting agent (21.4%). Pneumonia due to Mycobacterium tuberculosis was diagnosed in eight patients, to Mycoplasma pneumoniae in seven, to Chlamydia psittaci in two and to Legionella pneumophila in one. Three renal transplant patients had pneumonia caused by Staphylococcus aureus, cytomegalovirus and Pneumocystis carinii respectively, the latter diagnosed by lung biopsy. Two patients with acute Brucella melitensis infections developed pneumonia. In 34 patients (30.4%) the causative organism was not identified. Most of the epidemiological and aetiological factors studied in this survey are inconsistent with previous reports on pneumonia from western countries. For example, the commonest age group affected was younger than in western series. Tuberculous and brucella pneumonia, not commonly seen in western countries, are diagnoses to be considered in Saudi Arabia.