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. 2018 Dec 18;18(1):677.
doi: 10.1186/s12879-018-3565-z.

Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective

Andrea Gramegna  1 , Giovanni Sotgiu  2 , Marta Di Pasquale  1 , Dejan Radovanovic  3 , Silvia Terraneo  4 , Luis F Reyes  5 , Ester Vendrell  6 , Joao Neves  7 , Francesco Menzella  8 , Francesco Blasi  1 , Stefano Aliberti  9 , Marcos I Restrepo  5 ; GLIMP Study Group
Affiliations

Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective

Andrea Gramegna et al. BMC Infect Dis. .

Erratum in

Abstract

Background: Empirical antibiotic coverage for atypical pathogens in community-acquired pneumonia (CAP) has long been debated, mainly because of a lack of epidemiological data. We aimed to assess both testing for atypical pathogens and their prevalence in hospitalized patients with CAP worldwide, especially in relation with disease severity.

Methods: A secondary analysis of the GLIMP database, an international, multicentre, point-prevalence study of adult patients admitted for CAP in 222 hospitals across 6 continents in 2015, was performed. The study evaluated frequency of testing for atypical pathogens, including L. pneumophila, M. pneumoniae, C. pneumoniae, and their prevalence. Risk factors for testing and prevalence for atypical pathogens were assessed through univariate analysis.

Results: Among 3702 CAP patients 1250 (33.8%) underwent at least one test for atypical pathogens. Testing varies greatly among countries and its frequency was higher in Europe than elsewhere (46.0% vs. 12.7%, respectively, p < 0.0001). Detection of L. pneumophila urinary antigen was the most common test performed worldwide (32.0%). Patients with severe CAP were less likely to be tested for both atypical pathogens considered together (30.5% vs. 35.0%, p = 0.009) and specifically for legionellosis (28.3% vs. 33.5%, p = 0.003) than the rest of the population. Similarly, L. pneumophila testing was lower in ICU patients. At least one atypical pathogen was isolated in 62 patients (4.7%), including M. pneumoniae (26/251 patients, 10.3%), L. pneumophila (30/1186 patients, 2.5%), and C. pneumoniae (8/228 patients, 3.5%). Patients with CAP due to atypical pathogens were significantly younger, showed less cardiovascular, renal, and metabolic comorbidities in comparison to adult patients hospitalized due to non-atypical pathogen CAP.

Conclusions: Testing for atypical pathogens in patients admitted for CAP in poorly standardized in real life and does not mirror atypical prevalence in different settings. Further evidence on the impact of atypical pathogens, expecially in the low-income countries, is needed to guidelines implementation.

Keywords: Atypical pathogens; CAP; Epidemiology.

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Conflict of interest statement

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests for this study.

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Figures

Fig. 1
Fig. 1
a) Worldwide map on testing for atypical pathogens in hospitalized patients with community-acquired pneumonia (CAP) by country. Denominator: all CAP for each country. b) Worldwide map on prevalence of atypical pathogens in community-acquired pneumonia (CAP) in hospitalized patients by country. Denominator: all CAP tested for atypical pathogens for each country. Figure 1 is original and it was created using Stat Planet software with the information created from the study
See this image and copyright information in PMC

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