Etiology and antimicrobial resistance of community-acquired pneumonia in adult patients in China

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Author:
TAO Li-li(Department of Respiratory Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
DENG Wei-wu(Department of Respiratory Medicine,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
HU Bi-jie(Department of Respiratory Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
HE Li-xian(Department of Respiratory Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
WEI Li(Department of Respiratory Medicine,Taishan Medical University Affiliated Hospital,Taian,Shandong 271000,China)
XIE Hong-mei(Department of Respiratory Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
WANG Bao-qing(Department of Respiratory Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
LI Hua-ying(Department of Respiratory Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
CHEN Xue-hua(Department of Respiratory Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
ZHOU Chun-mei(Department of Respiratory Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
Journal Title:
Chinese Medical Journal
Issue:
Volume 125, Issue 17, 2012
DOI:
10.3760/cma.j.issn.0366-6999.2012.17.002
Key Word:
community-acquired infection; pneumonia; etiology; antimicrobial drug resistance; epidemiology

Abstract: Background Appropriate antimicrobial therapy of community-acquired pneumonia (CAP) is mainly based on the distribution of etiology and antimicrobial resistance of major pathogens.We performed a prospective observational study of adult with CAP in 36 hospitals in China.Methods Etiological pathogens were isolated in each of the centers,and all of the isolated pathogens were sent to Zhongshan Hospital for antimicrobial susceptibility tests using agar dilution.Results A total of 593 patients were enrolled in this study,and 242 strains of bacteria were isolated from 225 patients.Streptococcus pneumoniae (79/242,32.6%) was the most frequently isolated pathogen,followed by Haemophilus influenzae (55/242,22.7%) and Klebsiella pneumoniae (25/242,10.3%).Totally 527 patients underwent serological tests for atypical pathogens; Mycoplasma pneumoniae and Chlamydia pneumoniae infections were identified in 205 (38.9%)and 60 (11.4%) patients respectively.Legionella pneumophila infections were identified in 4.0% (13/324) of patients.The non-susceptibility rate of isolated Streptococcus pneumoniae to erythromycin and penicillin was 63.2% and 19.1%respectively.Six patients died from the disease,the 30-day mortality rate was 1.1% (6/533).Conclusions The top three bacteria responsible for CAP in Chinese adults were Streptococcus pneumonia,Haemophitus influenza and Klebsiella pneumonia.There was also a high prevalence of atypical pathogens and mixed pathogens.The resistance rates of the major isolated pathogens were relatively low except for the high prevalence of macrolide resistance in Streptococcus pneumoniae.

  • 1.Polverino E, Torres Marti A.Community-acquired pneumonia.Minerva anestesiologica 2011; 77:196-211.
  • 2.Apisamthanarak A, Mundy LM.Etiology of community-acquired pneumonia.Clin Chest Med 2005; 26:47-55.
  • 3.Welte T,Torres A,Nathwani D.Clinical and economic burden of community-acquired pneumonia among adults in Europe.Thorax 2012; 67:71-79.
  • 4.Niederman MS,McCombs JS,Unger AN,Kumar A,Popovian R.The cost of treating community-acquired pneumonia.Clin Ther 1998; 20:820-837.
  • 5.Monte SV,Paolini NM,Slazak EM,Schentag JJ,Paladino JA.Costs of treating lower respiratory tract infections.Am J Manag Care 2008; 14:190-196.
  • 6.Carbonara S, Monno L, Longo B, Angarano G.Community-acquired pneumonia.Curr Opin Pulm Med 2009;15:261-273.
  • 7.Liu Y,Chert M,Zhao T,Wang H,Wang R,Cai B,et al.Causative agent distribution and antibiotic therapy assessment among adult patients with community acquired pneumonia in Chinese urban population.BMC Intect Dis 2009; 9:31.
  • 8.Huang HH,Zhang YY,Xiu QY,Zhou X,Huang SG,Lu Q,et al.Community-acquired pneumonia in Shanghai,China:microbial etiology and implications for empirical therapy in a prospective study of 389 patients.Eur J Clin Microbiol Infect Dis 2006; 25:369-374.
  • 9.Song JH,Oh WS,Kang CI,Chung DR,Peck KR,Ko KS,et al.Epidemiology and clinical outcomes of community-acquired pneumonia in adult patients in Asian countries:a prospective study by the Asian network for surveillance of resistant pathogens.Int J Antimicrob Agents 2008; 31:107-114.
  • 10.K(o)ksal I,Ozlü T,Bayraktar O,Yilmaz G,Bülbül Y,Oztuna F,et al.Etiological agents of community-acquired pneumonia in adult patients in Turkey; a muhicentric,cross-sectional study.Tuberk Toraks 2010; 58:119-127.
  • 11.Cillóniz C,Ewig S,Polverino E,Marcos MA,Esquinas C,Gabarrús A, et al.Microbial aetiology of community-acquired pneumonia and its relation to severity.Thorax 2011; 66:340-346.
  • 12.Lim WS,Macfarlane JT,Boswell TC,Harrison TG,Rose D,Leinonen M,et al.Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital:implications for management guidelines.Thorax 2001; 56:296-301.
  • 13.Lin YT,Jeng YY,Chert TL,Fung CP.Bacteremic community-acquired pneumonia due to Klebsiella pneumoniae:clinical and microbiological characteristics in Taiwan,2001-2008.BMC Infect Dis 2010; 10:307.
  • 14.Wattanathum A, Chaoprasong C, Nunthapisud P,Chantaratchada S,Limpairojn N,Jatakanon A,et al.Community-acquired pneumonia in southeast Asia:the microbial differences between ambulatory and hospitalized patients.Chest 2003; 123:1512-1519.
  • 15.Thibodeau KP,Viera AJ.Atypical pathogens and challenges in community-acquired pneumonia.Am Fam Physician 2004;69:1699-1706.
  • 16.Woodhead M.Community-acquired pneumonia in Europe:causative pathogens and resistance patterns.Eur Respir J Suppl 2002; 36:20s-27s.
  • 17.Kauppinen MT,Herva E,Kujala P,Leinonen M,Saikku P,Syrj(a)l(a) H.The etiology of community-acquired pneumonia among hospitalized patients during a Chlamydia pneumoniae epidemic in Finland.J Infect Dis 1995; 172:1330-1335.
  • 18.De Roux A,Ewig S,Garcia E,Marcos MA,Mensa J,Lode H, et al.Mixed community-acquired pneumonia in hospitalised patients.Eur Respir J 2006; 27:795-800.
  • 19.Shemer-Avni Y, Lieberman D.Chlamydia pneumoniae-induced ciliostasis in ciliated bronchial epithelial cells.J Infect Dis 1995; 171:1274-1278.
  • 20.Hoban DJ,Biedenbach DJ,Mutnick AH.Jones RN.Pathogen of occurrence and susceptibility patterns associated with pneumonia in hospitalized patients in North America:results of the SENTRY Antimicrobial Surveillance Study (2000).Diagn Microbiol Infect Dis 2003; 45:279-285.
  • 21.Yang F,Xu XG.Yang MJ,Zhang YY,Klugman KP,McGee L.Antimicrobial susceptibility and molecular epidemiology of Streptococcus pneumoniae isolated from Shanghai,China.Int J Antimicrob Agents 2008; 32:386-391.
  • 22.Sun HL,Wang H,Chen MJ,Liu YM,Hu ZD,Liao K,et al.An antimicrobial resistance surveillance of gram-positive cocci isolated from 12 teaching hospitals in China in 2009.Chin J Intern Med (Chin) 2010; 49:735-740.
  • 23.Mandell LA,Wunderink RG,Anzueto A,Bartlett JG,Campbell GD,Dean NC,et al.Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.Clin Infect Dis 2007; 44 Suppl 2:S27-S72.
  • 24.Lynch JP,Zhanel GG.Streptococcus pneumoniae:does antimicrobial resistance matter? Semin Respir Crit Care Med 2009; 30:210-238.
  • 25.Azoulay-Dupuis E,Rieux V,Muffat-Joly M,Bédos JP,Vallée E,Rivier C,et al.Relationship between capsular type,penicillin susceptibility, and virulence of human Streptococcus pneumoniae isolates in mice.Antimicrob Agents Chemother 2000; 44:1575-1577.
  • 26.Cap B,Zhao C J,Yin YD,Zhao F,Song SF,Bai L,et al.High prevalence of macrolide resistance in Mycoplasma pneumoniae isolates from adult and adolescent patients with respiratory tract infection in China.Clin Infect Dis 2010; 51:189-194.
  • 27.Miyashita N,Oka M,Group AP,Kawai Y,Yamaguchi T,Ouchi K.Macrolide-resistant Mycoplasma pneumoniae in adults with community-acquired pneumonia.Int J Antimicrob Agents 2010; 36:384-385.
  • 28.Morozumi M,Takahashi T,Ubukata K.Macrolide-resistant Mycoplasma pneumoniae:characteristics of isolates and clinical aspects of community-acquired pneumonia.J Infect Chemother 2010; 16:78-86.
  • 29.Xin D,Mi Z,Han X,Qin L,Li J,Wei T,et al.Molecular mechanisms of macrolide resistance in clinical isolates of Mycoplasma pneumoniae from China.Antimicrob Agents Chemother 2009; 53:2158-2159.
  • 30.British Thoracic Society Standards of Care Committee.BTS Guidelines for the Management of Community Acquired Pneumonia in Adults.Thorax 2001 ; 56 Suppl 4:Ⅳ1-Ⅳ64.
  • 31.Jinks MF,Kelly CA.The pattern and significance of abnormal liver function tests in community-acquired pneumonia.Eur J Intern Med 2004; 15:436-440.
  • 32.Lieberman D,Shimoni A,Shemer-Avni Y,Keren-Naos A,Shtainberg R,Lieberman D.Respiratory viruses in adults with community-acquired pneumonia.Chest 2010; 138:811-816.
  • 33.Cao B,Ren LL,Zhao F,Gonzalez R,Song SF,Bai L,et al.Viral and Mycoplasma pneumoniae community-acquired pneumonia and novel clinical outcome evaluation in ambulatory adult patients in China.Eur J Clin Microbiol Infect Dis 2010; 29:1443-1448.
  • 34.Dean N.Methicillin-resistant Staphylococcus aureus in community-acquired and health care-associated pneumonia:incidence,diagnosis,and treatment options.Hosp Pract (Minneap) 2010; 38:7-15.
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