Epidemiology and microbiology of severe community-acquired pneumonia in Central Australia: a retrospective study.
indigenous health
intensive care
microbiology
pneumonia
severe community-acquired pneumonia
Journal
Internal medicine journal
ISSN: 1445-5994
Titre abrégé: Intern Med J
Pays: Australia
ID NLM: 101092952
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
revised:
13
11
2020
received:
04
08
2020
accepted:
04
12
2020
pubmed:
21
12
2020
medline:
22
6
2022
entrez:
20
12
2020
Statut:
ppublish
Résumé
Severe community-acquired pneumonia (SCAP) has high mortality and morbidity. To describe the epidemiology and microbiology of SCAP in Central Australia. 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). 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%). 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.
Sections du résumé
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.
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1048-1056Subventions
Organisme : National Health and Medical Research Council PhD Scholarship
ID : GNT1074523
Organisme : Douglas and Lola Douglas Scholarship
ID : GNT1074523
Organisme : National Health and Medical Research Council
ID : APP1048652
Informations de copyright
© 2020 Royal Australasian College of Physicians.
Références
Wilson PA, Ferguson J. Severe community-acquired pneumonia: an Australian perspective. Intern Med J 2005; 35: 699-705.
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.
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.
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.
Australian Bureau of Statistics (ABS) Census 2016. Indigenous Status by Age by Sex (LGA). Contract No.: ABS_C16_T04_LGA. Canberra: ABS; 2016.
Secombe P, Brown A, McAnulty G, Pilcher D. Aboriginal and Torres Strait Islander patients requiring critical care: characteristics, resource use, and outcomes. Crit Care Resusc 2019; 21: 200-11.
Davis JS, Cheng AC, McMillan M, Humphrey AB, Stephens DP, Anstey NM. Sepsis in the tropical Top End of Australia's Northern Territory: disease burden and impact on indigenous Australians. Med J Aust 2011; 194: 519-24.
Einsiedel LJ, Fernandes LA, Woodman RJ. Racial disparities in infection-related mortality at Alice Springs Hospital, Central Australia, 2000-2005. Med J Aust 2008; 188: 568-71.
Remond MG, Ralph AP, Brady SJ, Martin J, Tikoft E, Maguire GP. Community-acquired pneumonia in the central desert and north-western tropics of Australia. Intern Med J 2010; 40: 37-44.
Restrepo MI, Jorgensen JH, Mortensen EM, Anzueto A. Severe community-acquired pneumonia: current outcomes, epidemiology, etiology, and therapy. Curr Opin Infect Dis 2001; 14: 703-9.
Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200: e45-67.
National Prescribing Survey Report - Alice Springs Hospital. Northern Territory, Australia: Alice Springs Hospital; 2019.
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453-7.
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: S27-72.
Del Rio-Pertuz G, Gutierrez JF, Triana AJ, Molinares JL, Robledo-Solano AB, Meza JL et al. Usefulness of sputum gram stain for etiologic diagnosis in community-acquired pneumonia: a systematic review and meta-analysis. BMC Infect Dis 2019; 19: 403.
Torres A, Peetermans WE, Viegi G, Blasi F. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax 2013; 68: 1057-65.
Walden AP, Clarke GM, McKechnie S, Hutton P, Gordon AC, Rello J et al. Patients with community acquired pneumonia admitted to European intensive care units: an epidemiological survey of the GenOSept cohort. Crit Care 2014; 18: R58.
Einsiedel L, Fernandes L, Spelman T, Steinfort D, Gotuzzo E. Bronchiectasis is associated with human T-lymphotropic virus 1 infection in an indigenous Australian population. Clin Infect Dis 2012; 54: 43-50.
Australian Institute of Health and Welfare. The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2015. Canberra: AIHW; 2015.
Luna CM, Palma I, Niederman MS, Membriani E, Giovini V, Wiemken TL et al. The impact of age and comorbidities on the mortality of patients of different age groups admitted with community-acquired pneumonia. Ann Am Thorac Soc 2016; 13: 1519-26.
Ferrer M, Travierso C, Cilloniz C, Gabarrus A, Ranzani OT, Polverino E et al. Severe community-acquired pneumonia: characteristics and prognostic factors in ventilated and non-ventilated patients. PLoS One 2018; 13: e0191721.
Chalmers JD. Identifying severe community-acquired pneumonia: moving beyond mortality. Thorax 2015; 70: 515-6.
Elliott JH, Anstey NM, Jacups SP, Fisher DA, Currie BJ. Community-acquired pneumonia in northern Australia: low mortality in a tropical region using locally-developed treatment guidelines. Int J Infect Dis 2005; 9: 15-20.
Charles PG, Wolfe R, Whitby M, Fine MJ, Fuller AJ, Stirling R et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis 2008; 47: 375-84.
Hewagama S, Spelman T, Einsiedel LJ. Staphylococcus aureus bacteraemia at Alice Springs Hospital, Central Australia, 2003-2006. Intern Med J 2012; 42: 505-12.
Macmorran E, Harch S, Athan E, Lane S, Tong S, Crawford L et al. The rise of methicillin resistant Staphylococcus aureus: now the dominant cause of skin and soft tissue infection in Central Australia. Epidemiol Infect 2017; 145: 2817-26.
Kelly H, ed. Therapeutic Guidelines - Antibiotic, 16th edn. Melbourne: Therapeutic Guidelines Limited; 2019.
Jeremiah CJ, Hannan LM, Baird R, Phelps G, Knight B. Low utilisation of diagnostic microbiology for community acquired pneumonia in regional Victoria. Pathology 2013; 45: 162-6.