Comparing viral, bacterial and co-infections in community- acquired pneumonia, a retrospective cohort study
Abstract
BACKGROUND
Despite substantial rates of viral aetiology of community-acquired pneumonia (CAP) empirical antibiotic therapy is regularly administered. This study compares the clinical presentation, antibiotic use, and outcomes of CAP patients based on the identified causative pathogens.
METHODS
Immunocompetent CAP patients from the international, multicentre prospective CAPNETZ cohort study from 2007-2017 with available multiplex PCR testing for bacterial / viral pathogens from sputum were included. Patients were divided into four groups, based on the detection of bacterial pathogens, viral pathogens, bacterial/viral co-infection and no pathogen detected. Differences were analysed using multivariate linear regression.
RESULTS
Patients with bacterial CAP were significantly younger (median age 60 years; aOR 0.96 [0.94-0.98]) and reported less smoking (aOR 0.98 [0.97-1.0]). Higher CRB-65 score was associated with bacterial CAP (aOR 1.69 [1.1-2.58]). bacterial CAP showed higher 180-day mortality (aOR 3.59 [1.09-11.8]) and viral CAP had higher 30-day mortality (aOR 15.79 [1.04-238.75]) in comparison with other groups. Upon admission, the four groups could not be discriminated based on clinical presentation and showed no differences in CAP-related complications, length of stay and application / duration of antibiotic treatment (98.4% received antibiotics).
CONCLUSIONS
A pathogen-centred treatment algorithm in CAP patients is required to avoid unnecessary antibiotic therapies, side…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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