New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases.

摘要: Three hundred fifty-nine consecutive patients with community-acquired pneumonia admitted to university, community, and VA hospitals underwent a standardized evaluation, including specialized tests for Legionella spp. Chlamydia pneumoniae (TWAR). The most common underlying illnesses were immunosuppression (36.3%), chronic obstructive pulmonary disease (32.4%), malignancy (28.4%). frequent etiologic agents Streptococcus (15.3%) Hemophilus influenzae (10.9%). Surprisingly, C. the third fourth etiologies at 6.7% 6.1%, respectively. Aerobic gram-negative pneumonias relatively uncommon causes of despite fact that empiric broad-spectrum combination antibiotic therapy is so often directed this subgroup. In 32.9%, etiology was undetermined. Antibiotic administration before admission significantly associated undetermined (p = 0.0003). There no distinctive clinical features found be diagnostic any agent, although high fever occurred more frequently in Legionnaires' disease. Clinical manifestations generally mild, 38% had mental status changes. Mortality highest Staphylococcus aureus (50%) lowest (4.5%) Mycoplasma (0%). We document laboratory testing should widely used rather than reserved cases not responding standard therapy. Furthermore, realization are affect prescription.