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Thorax. 2001 Apr; 56(4): 296–301.
PMCID: PMC1746017

Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines


BACKGROUND—Since the last British study of the microbial aetiology of community acquired pneumonia (CAP) about 20 years ago, new organisms have been identified (for example, Chlamydia pneumoniae), new antibiotics introduced, and fresh advances made in microbiological techniques. Pathogens implicated in CAP in adults admitted to hospital in the UK using modern and traditional microbiological investigations are described.
METHODS—Adults aged 16 years and over admitted to a teaching hospital with CAP over a 12 month period from 4 October 1998 were prospectively studied. Samples of blood, sputum, and urine were collected for microbiological testing by standard culture techniques and new serological and urine antigen detection methods.
RESULTS—Of 309 patients admitted with CAP, 267 fulfilled the study criteria; 135 (50.6%) were men and the mean (SD) age was 65.4 (19.6) years. Aetiological agents were identified from 199 (75%) patients (one pathogen in 124 (46%), two in 53 (20%), and three or more in 22 (8%)): Streptococcus pneumoniae 129 (48%), influenza A virus 50 (19%), Chlamydia pneumoniae 35 (13%), Haemophilus influenzae 20 (7%), Mycoplasma pneumoniae 9 (3%), Legionella pneumophilia 9 (3%), other Chlamydia spp 7 (2%), Moraxella catarrhalis 5 (2%), Coxiella burnetii 2 (0.7%), others 8 (3%). Atypical pathogens were less common in patients aged 75 years and over than in younger patients (16% v 27%; OR 0.5, 95% CI 0.3 to 0.9). The 30 day mortality was 14.9%. Mortality risk could be stratified by the presence of four "core" adverse features. Three of 60 patients (5%) infected with an atypical pathogen died.
CONCLUSIONS pneumoniae remains the most important pathogen to cover by initial antibiotic therapy in adults of all ages admitted to hospital with CAP. Atypical pathogens are more common in younger patients. They should also be covered in all patients with severe pneumonia and younger patients with non-severe infection.

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Selected References

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  • Guest JF, Morris A. Community-acquired pneumonia: the annual cost to the National Health Service in the UK. Eur Respir J. 1997 Jul;10(7):1530–1534. [PubMed]
  • Macfarlane JT, Finch RG, Ward MJ, Macrae AD. Hospital study of adult community-acquired pneumonia. Lancet. 1982 Jul 31;2(8292):255–258. [PubMed]
  • White RJ, Blainey AD, Harrison KJ, Clarke SK. Causes of pneumonia presenting to a district general hospital. Thorax. 1981 Aug;36(8):566–570. [PMC free article] [PubMed]
  • Marrie TJ, Blanchard W. A comparison of nursing home-acquired pneumonia patients with patients with community-acquired pneumonia and nursing home patients without pneumonia. J Am Geriatr Soc. 1997 Jan;45(1):50–55. [PubMed]
  • Neill AM, Martin IR, Weir R, Anderson R, Chereshsky A, Epton MJ, Jackson R, Schousboe M, Frampton C, Hutton S, et al. Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax. 1996 Oct;51(10):1010–1016. [PMC free article] [PubMed]
  • Lieberman D, Schlaeffer F, Boldur I, Lieberman D, Horowitz S, Friedman MG, Leiononen M, Horovitz O, Manor E, Porath A. Multiple pathogens in adult patients admitted with community-acquired pneumonia: a one year prospective study of 346 consecutive patients. Thorax. 1996 Feb;51(2):179–184. [PMC free article] [PubMed]
  • Steinhoff D, Lode H, Ruckdeschel G, Heidrich B, Rolfs A, Fehrenbach FJ, Mauch H, Höffken G, Wagner J. Chlamydia pneumoniae as a cause of community-acquired pneumonia in hospitalized patients in Berlin. Clin Infect Dis. 1996 Jun;22(6):958–964. [PubMed]
  • Bartlett JG, Breiman RF, Mandell LA, File TM., Jr Community-acquired pneumonia in adults: guidelines for management. The Infectious Diseases Society of America. Clin Infect Dis. 1998 Apr;26(4):811–838. [PubMed]
  • Kauppinen MT, Herva E, Kujala P, Leinonen M, Saikku P, Syrjälä H. The etiology of community-acquired pneumonia among hospitalized patients during a Chlamydia pneumoniae epidemic in Finland. J Infect Dis. 1995 Nov;172(5):1330–1335. [PubMed]
  • Marrie TJ, Grayston JT, Wang SP, Kuo CC. Pneumonia associated with the TWAR strain of Chlamydia. Ann Intern Med. 1987 Apr;106(4):507–511. [PubMed]
  • Shemer-Avni Y, Lieberman D. Chlamydia pneumoniae-induced ciliostasis in ciliated bronchial epithelial cells. J Infect Dis. 1995 May;171(5):1274–1278. [PubMed]
  • Kauppinen MT, Saikku P, Kujala P, Herva E, Syrjälä H. Clinical picture of community-acquired Chlamydia pneumoniae pneumonia requiring hospital treatment: a comparison between chlamydial and pneumococcal pneumonia. Thorax. 1996 Feb;51(2):185–189. [PMC free article] [PubMed]
  • Troy CJ, Peeling RW, Ellis AG, Hockin JC, Bennett DA, Murphy MR, Spika JS. Chlamydia pneumoniae as a new source of infectious outbreaks in nursing homes. JAMA. 1997 Apr 16;277(15):1214–1218. [PubMed]
  • Ruiz M, Ewig S, Torres A, Arancibia F, Marco F, Mensa J, Sanchez M, Martinez JA. Severe community-acquired pneumonia. Risk factors and follow-up epidemiology. Am J Respir Crit Care Med. 1999 Sep;160(3):923–929. [PubMed]
  • Woodhead MA, Macfarlane JT, Macrae AD, Pugh SF. The rise and fall of Legionnaires' disease in Nottingham. J Infect. 1986 Nov;13(3):293–296. [PubMed]
  • Woodhead MA, Macfarlane JT, Rodgers FG, Laverick A, Pilkington R, Macrae AD. Aetiology and outcome of severe community-acquired pneumonia. J Infect. 1985 May;10(3):204–210. [PubMed]
  • Heath CH, Grove DI, Looke DF. Delay in appropriate therapy of Legionella pneumonia associated with increased mortality. Eur J Clin Microbiol Infect Dis. 1996 Apr;15(4):286–290. [PubMed]
  • Lim WS, Lewis S, Macfarlane JT. Severity prediction rules in community acquired pneumonia: a validation study. Thorax. 2000 Mar;55(3):219–223. [PMC free article] [PubMed]
  • Jalonen E, Paton JC, Koskela M, Kerttula Y, Leinonen M. Measurement of antibody responses to pneumolysin--a promising method for the presumptive aetiological diagnosis of pneumococcal pneumonia. J Infect. 1989 Sep;19(2):127–134. [PubMed]
  • Burman LA, Leinonen M, Trollfors B. Use of serology to diagnose pneumonia caused by nonencapsulated Haemophilus influenzae and Moraxella catarrhalis. J Infect Dis. 1994 Jul;170(1):220–222. [PubMed]
  • Domínguez J, Galí N, Matas L, Pedroso P, Hernández A, Padilla E, Ausina V. Evaluation of a rapid immunochromatographic assay for the detection of Legionella antigen in urine samples. Eur J Clin Microbiol Infect Dis. 1999 Dec;18(12):896–898. [PubMed]

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