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Prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis

Sidan Wang, Jiao Tang, Yurong Tan, Zhi Song, Ling Qin

BMJ Open, 2023

36 citations

Abstract

Objectives We aimed to summarise the prevalence of atypical pathogens in patients with severe pneumonia to understand the prevalence of severe pneumonia caused by atypical pathogens, improve clinical decision-making and guide antibiotic use. Design Systematic review and meta-analysis. Data sources PubMed, Embase, Web of Science and Cochrane Library were searched through November 2022. Eligibility criteria English language studies enrolled consecutive cases of patients diagnosed with severe pneumonia, with complete aetiological analysis. Data extraction and synthesis We conducted literature retrieval on PubMed, Embase, Web of Science and The Cochrane Library to estimate the prevalence of Chlamydia, Mycoplasma and Legionella in patients with severe pneumonia. After double arcsine transformation of the data, a random-effects model was used for meta-analyses to calculate the pooled prevalence of each pathogen. Meta-regression analysis was also used to explore whether the region, different diagnostic method, study population, pneumonia categories or sample size were potential sources of heterogeneity. Results We included 75 eligible studies with 18 379 cases of severe pneumonia. The overall prevalence of atypical pneumonia is 8.1% (95% CI 6.3% to 10.1%) In patients with severe pneumonia, the pooled estimated prevalence of Chlamydia, Mycoplasma and Legionella was 1.8% (95% CI 1.0% to 2.9%), 2.8% (95% CI 1.7% to 4.3%) and 4.0% (95% CI 2.8% to 5.3%), respectively. We noted…

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