Epidemiology and microbiology of severe community-acquired pneumonia in Central Australia: a retrospective study

Danny Tsai^{1

2

3}, Fabian Chiong^{4

5}, Paul Secombe⁶, Khin Moe Hnin⁷, Penny Stewart⁶, Rajendra Goud⁸, Richard Woodman⁹, Jeffrey Lipman^{1

10

11}, Jason Roberts^{1

10

12

13}, Saliya Hewagama^{4

14}

Affiliations

¹ University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
² Centre for Remote Health, Flinders NT, Flinders University, Alice Springs, Northern Territory, Australia.
³ Pharmacy Department, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
⁴ Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
⁵ Department of Infectious Diseases, University Hospital Geelong, Geelong, Victoria, Australia.
⁶ Department of Intensive Care Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
⁷ Norwood Specialist Clinic, Adelaide, South Australia, Australia.
⁸ Department of Intensive Care Medicine, Cairns Base Hospital, Cairns, Queensland, Australia.
⁹ School of Bioinformatics, Flinders University, Adelaide, South Australia, Australia.
¹⁰ Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
¹¹ Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
¹² Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.
¹³ Departments of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
¹⁴ Department of Infectious Diseases, The Northern Hospital, Melbourne, Victoria, Australia.

PMID: 33342052
DOI: 10.1111/imj.15171

Epidemiology and microbiology of severe community-acquired pneumonia in Central Australia: a retrospective study

Danny Tsai et al. Intern Med J. 2022 Jun.

. 2022 Jun;52(6):1048-1056.

doi: 10.1111/imj.15171. Epub 2022 May 31.

Authors

Affiliations

¹ University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
² Centre for Remote Health, Flinders NT, Flinders University, Alice Springs, Northern Territory, Australia.
³ Pharmacy Department, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
⁴ Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
⁵ Department of Infectious Diseases, University Hospital Geelong, Geelong, Victoria, Australia.
⁶ Department of Intensive Care Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.
⁷ Norwood Specialist Clinic, Adelaide, South Australia, Australia.
⁸ Department of Intensive Care Medicine, Cairns Base Hospital, Cairns, Queensland, Australia.
⁹ School of Bioinformatics, Flinders University, Adelaide, South Australia, Australia.
¹⁰ Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
¹¹ Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
¹² Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.
¹³ Departments of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
¹⁴ Department of Infectious Diseases, The Northern Hospital, Melbourne, Victoria, Australia.

PMID: 33342052
DOI: 10.1111/imj.15171

Abstract

Background: Severe community-acquired pneumonia (SCAP) has high mortality and morbidity.

Aims: To describe the epidemiology and microbiology of SCAP in Central Australia.

Methods: A retrospective epidemiological study describing the characteristics, incidence rates (IR) and microbiological aetiology of SCAP in Central Australia. Adult patients admitted to Alice Springs Hospital Intensive Care Unit (ICU) between 2011 and 2014 that fitted the Infectious Diseases Society of America and American Thoracic Society definition of SCAP were included. Medical records were reviewed and compared between indigenous and non-indigenous patients. Primary outcomes were incidence rate and microbiological aetiology of SCAP. Secondary outcomes were 30-day mortality, and ICU and hospital length of stay (LoS).

Results: A total of 185 patents were included (156 indigenous; 29 non-indigenous). The overall SCAP IR per 1000 person-years was 3.24 (3.75 indigenous; 1.87 non-indigenous) with an IR difference of 2.71 after adjustment (P < 0.001). Those aged ≥50 years had an IR 74.8% higher than those younger. Male IR was 50% higher than females. There was a significant difference between indigenous and non-indigenous groups for age (48 vs 64 years), but not for 30-day mortality (7.7% vs 10.3%), ICU LoS (4.8 vs 4.6 days) and hospital LoS (10.9 vs 15.1 days) respectively. Likely causative pathogen(s) were identified in 117 patients; Streptococcus pneumoniae was the most common pathogen (28.2%), followed by Haemophilus influenzae (19.7%), Influenza A/B (16.2%) and Staphylococcus aureus (14.5%).

Conclusion: A high incidence of SCAP was observed in Central Australia, disproportionately affecting the indigenous population. Prevention strategies are imperative, as well as early identification of SCAP and appropriate empiric antibiotic regimens.

Keywords: indigenous health; intensive care; microbiology; pneumonia; severe community-acquired pneumonia.

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References

1. Wilson PA, Ferguson J. Severe community-acquired pneumonia: an Australian perspective. Intern Med J 2005; 35: 699-705.
1. Rello J, Diaz E, Manez R, Sole-Violan J, Valles J, Vidaur L et al. Improved survival among ICU-hospitalized patients with community-acquired pneumonia by unidentified organisms: a multicenter case-control study. Eur J Clin Microbiol Infect Dis 2017; 36: 123-30.
1. Tanzella G, Motos A, Battaglini D, Meli A, Torres A. Optimal approaches to preventing severe community-acquired pneumonia. Expert Rev Respir Med 2019;13: 1005-18.
1. Liapikou A, Ferrer M, Polverino E, Balasso V, Esperatti M, Piner R et al. Severe community-acquired pneumonia: validation of the Infectious Diseases Society of America/American Thoracic Society guidelines to predict an intensive care unit admission. Clin Infect Dis 2009; 48: 377-85.
1. Australian Bureau of Statistics (ABS) Census 2016. Indigenous Status by Age by Sex (LGA). Contract No.: ABS_C16_T04_LGA. Canberra: ABS; 2016.

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Epidemiology and microbiology of severe community-acquired pneumonia in Central Australia: a retrospective study

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Epidemiology and microbiology of severe community-acquired pneumonia in Central Australia: a retrospective study

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