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. 2021 Oct 6;8(11):ofab499.
doi: 10.1093/ofid/ofab499. eCollection 2021 Nov.

Incidence, Etiology, and Environmental Risk Factors of Community-Acquired Pneumonia Requiring Hospitalization in China: A 3-Year, Prospective, Age-Stratified, Multicenter Case-Control Study

Tian Qin  1 , Haijian Zhou  1 , Hongyu Ren  1 , Jiantong Meng  2 , Yinju Du  3 , Mahemut Mahemut  4 , Peng Wang  5 , Nana Luo  6 , Fei Tian  7 , Ming Li  2 , Pu Zhou  3 , Fang Li  4 , Pengyuan Duan  5 , Yinan Li  1 , Na Zhao  1 , Qiwu Yuan  2 , Jinzhong Zhang  3 , Lihong Cheng  3 , Longze Luo  8 , Ming Fang  9 , Xin Huang  10 , Changguo Gu  10 , Huifang Zhou  11 , Min Yang  12 , Shan Lu  1 , Xiangkun Jiang  3 , Hualiang Lin  7 , Huaiyu Tian  6 , Biao Kan  1 , Jianguo Xu  1
Affiliations

Incidence, Etiology, and Environmental Risk Factors of Community-Acquired Pneumonia Requiring Hospitalization in China: A 3-Year, Prospective, Age-Stratified, Multicenter Case-Control Study

Tian Qin et al. Open Forum Infect Dis. .

Abstract

Background: Community-acquired pneumonia (CAP) is a leading infectious cause of hospitalization and death worldwide. Knowledge about the incidence and etiology of CAP in China is fragmented.

Methods: A multicenter study performed at 4 hospitals in 4 regions in China and clinical samples from CAP patients were collected and used for pathogen identification from July 2016 to June 2019.

Results: A total of 1674 patients were enrolled and the average annual incidence of hospitalized CAP was 18.7 (95% confidence interval, 18.5-19.0) cases per 10000 people. The most common viral and bacterial agents found in patients were respiratory syncytial virus (19.2%) and Streptococcus pneumoniae (9.3%). The coinfections percentage was 13.8%. Pathogen distribution displayed variations within age groups as well as seasonal and regional differences. The severe acute respiratory syndrome coronavirus 2 was not detected. Respiratory virus detection was significantly positively correlated with air pollutants (including particulate matter ≤2.5 µm, particulate matter ≤10 µm, nitrogen dioxide, and sulfur dioxide) and significantly negatively correlated with ambient temperature and ozone content; bacteria detection was opposite.

Conclusions: The hospitalized CAP incidence in China was higher than previously known. CAP etiology showed that differences in age, seasons, regions, and respiratory viruses were detected at a higher rate than bacterial infection overall. Air pollutants and temperature have an influence on the detection of pathogens.

Keywords: bacterial pneumonia; community-acquired pneumonia; environmental factor; etiology; respiratory tract infection; viral pneumonia.

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Figures

Figure 1.
Figure 1.
Distribution of pathogens detected in 900 patients with community-acquired pneumonia from Chengdu, China, between July 2016 and June 2019. Abbreviations: ADV, adenovirus; BV, bocavirus; C, co-infection; CP, Chlamydia pneumoniae; CV, coronavirus; HI, Haemophilus influenzae; HMPV, human metapneumovirus; HRV, human rhinovirus; IV, influenza virus; KP, Klebsiella pneumoniae; LP, Legionella pneumophila; MC, Moraxella catarrhalis; MP, Mycoplasma pneumoniae; PA, Pseudomonas aeruginosa; PIV, parainfluenza virus; RSV, respiratory syncytial virus; S, single infection; SA, Staphylococcus aureus; SP, Streptococcus pneumoniae.
Figure 2.
Figure 2.
Pathogen distribution across different age groups among 900 patients with community-acquired pneumonia from Chengdu, China, between July 2016 and June 2019. Abbreviations: ADV, adenovirus; BV, bocavirus; CP, Chlamydia pneumoniae; CV, coronavirus; HI, Haemophilus influenzae; HMPV, human metapneumovirus; HRV, human rhinovirus; IV, influenza virus; KP, Klebsiella pneumoniae; LP, Legionella pneumophila; MC, Moraxella catarrhalis; MP, Mycoplasma pneumoniae; PA, Pseudomonas aeruginosa; PIV, parainfluenza virus; RSV, respiratory syncytial virus; SA, Staphylococcus aureus; SP, Streptococcus pneumoniae.
Figure 3.
Figure 3.
Comparison of positive rates of the different pathogens observed in patients with community-acquired pneumonia across 3 epidemic years based on year (A), quarter (B), and month (C). Abbreviations: ADV, adenovirus; BV, bocavirus; CP, Chlamydia pneumoniae; CV, coronavirus; HI, Haemophilus influenzae; HMPV, human metapneumovirus; HRV, human rhinovirus; IV, influenza virus; KP, Klebsiella pneumoniae; LP, Legionella pneumophila; MC, Moraxella catarrhalis; MP, Mycoplasma pneumoniae; PA, Pseudomonas aeruginosa; PIV, parainfluenza virus; RSV, respiratory syncytial virus; SA, Staphylococcus aureus; SP, Streptococcus pneumoniae.
Figure 4.
Figure 4.
Distribution of pathogens detected in patients aged 0–4 years (A) and ≥50 years (B) with community-acquired pneumonia in different cities in China. Abbreviations: ADV, adenovirus; BV, bocavirus; CP, Chlamydia pneumoniae; CV, coronavirus; HI, Haemophilus influenzae; HMPV, human metapneumovirus; HRV, human rhinovirus; IV, influenza virus; KP, Klebsiella pneumoniae; LP, Legionella pneumophila; MC, Moraxella catarrhalis; MP, Mycoplasma pneumoniae; PA, Pseudomonas aeruginosa; PIV, parainfluenza virus; RSV, respiratory syncytial virus; SA, Staphylococcus aureus; SP, Streptococcus pneumoniae.
Figure 5.
Figure 5.
Association between positive rates of bacterial and viral infection and environmental factors (air pollutants and weather variables) across 3 epidemic years in Chengdu, China. Abbreviations: NO2, nitrogen dioxide; O3, ozone; PM2.5, particulate matter ≤2.5 µm; PM10, particulate matter ≤10 µm; SO2, sulfur dioxide.
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