Investigation of etiology of community-acquired pneumonia in hospitalized patients in a tertiary hospital of Sao Paulo City, Brazil
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article
Data de publicação
2023
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ELSEVIER BRAZIL
Citação
BRAZILIAN JOURNAL OF INFECTIOUS DISEASES, v.27, n.6, article ID 103690, 6p, 2023
Resumo
Background: Community-Acquired Pneumonia (CAP) is the primary cause of hospitalization in the United States and the third leading cause of death in Brazil. The gold standard for diagnosing the etiology of CAP includes blood culture, Gram-stained sputum, and sputum culture. However, these methods have low sensitivity. No studies investigating the etiology of CAP have been conducted in Brazil in the last 20-years, and the empirical choice of antimicrobials is mainly based on the IDSA guidelines. This is the first national study with this aim, and as a result, there's potential for the Brazilian consensus to be impacted and possibly modify its guidelines rather than adhering strictly to the IDSA's recommendations. Methods: The aim of this study is to identify the main microorganisms implicated in CAP by employing a multiplex Polymerase Chain Reaction (mPCR) at the foremost public hospital in Brazil. All patients who were admitted to the emergency department and diagnosed with severe CAP underwent an mPCR panel using nasopharyngeal and oropharyngeal swabs, with the aim of detecting 13 bacterial and 21 viral pathogens. Results: A total of 169 patients were enrolled in the study. The mPCR panel identified an etiological agent in 61.5% of patients, with viruses being the most common (42.01%), led by Rhinovirus, followed by Influenza and Coronavirus (non-SARS-CoV-2). Bacterial agents were identified in 34.91% of patients, with S. pneumoniae being the most common, followed by H. influenzae, M. catarrhalis, and S. aureus. Additionally, we found that the prescription for 92.3% of patients could be modified, with most changes involving de-escalation of antibiotics and antiviral therapy. Conclusion: Our study revealed different etiological causes of CAP than those suggested by the Brazilian guidelines. Using molecular diagnostic tests, we were able to optimize treatment by using fewer antibiotics. (c) 2023 Sociedade Brasileira de Infectologia.
Palavras-chave
Community-acquired pneumonia, Severe pneumonia, Brazil, Etiology, Multiplex polymerase chain reaction
Referências
- [Anonymous], 2022, GLOBAL HLTH ESTIMATE
- Campbell SG, 2003, CHEST, V123, P1142, DOI 10.1378/chest.123.4.1142
- Carugati M, 2018, ERJ OPEN RES, V4, DOI 10.1183/23120541.00096-2018
- CHALASANI NP, 1995, CHEST, V108, P932, DOI 10.1378/chest.108.4.932
- Corrêa RD, 2018, J BRAS PNEUMOL, V44, P405, DOI [10.1590/S1806-37562018000000130, 10.1590/s1806-37562018000000130]
- Correa RD, 2009, J BRAS PNEUMOL, V35, P574
- Del Rio-Pertuz G, 2019, BMC INFECT DIS, V19, DOI 10.1186/s12879-019-4048-6
- Di Pasquale MF, 2019, CLIN INFECT DIS, V68, P1482, DOI 10.1093/cid/ciy723
- Evans L, 2021, INTENS CARE MED, V47, P1181, DOI [10.1007/s00134-021-06506-y, 10.1097/CCM.0000000000005337]
- Fine MJ, 1997, NEW ENGL J MED, V336, P243, DOI 10.1056/NEJM199701233360402
- Gadsby NJ, 2016, CLIN INFECT DIS, V62, P817, DOI 10.1093/cid/civ1214
- Gilbert DN, 2022, The Sanford guide to antimicrobial therapy, V52th
- Huchon G, 1998, EUR RESPIR J, V11, P986, DOI 10.1183/09031936.98.11040986
- Infections IoMUFoE, 2003, RES PHEN MICR INF DI
- Jain S, 2015, NEW ENGL J MED, V373, P415, DOI 10.1056/NEJMoa1500245
- Lansbury L, 2020, J INFECTION, V81, P266, DOI 10.1016/j.jinf.2020.05.046
- Lidman C, 2002, SCAND J INFECT DIS, V34, P873, DOI 10.1080/0036554021000026967
- Lim WS, 2009, THORAX, V64, P1, DOI 10.1136/thx.2009.121434
- Mandell LA, 2007, CLIN INFECT DIS, V44, pS27, DOI 10.1086/511159
- Metlay JP, 2019, AM J RESP CRIT CARE, V200, pE45, DOI 10.1164/rccm.201908-1581ST
- Ministerio da Saude D SINAM, 2022, About us
- Musher DM, 2004, CLIN INFECT DIS, V39, P165, DOI 10.1086/421497
- Olson G, 2020, JAMA-J AM MED ASSOC, V323, P885, DOI 10.1001/jama.2019.21118
- Ramsey C, 2011, CURR OPIN CRIT CARE, V17, P64, DOI 10.1097/MCC.0b013e3283427259
- Rosón B, 2000, CLIN INFECT DIS, V31, P869, DOI 10.1086/318151
- Sollid JUE, 2014, INFECT GENET EVOL, V21, P531, DOI 10.1016/j.meegid.2013.03.020
- Templeton KE, 2005, CLIN INFECT DIS, V41, P345, DOI 10.1086/431588
- Wee Liang En, 2020, J Clin Virol, V128, P104436, DOI 10.1016/j.jcv.2020.104436
- Woodhead M, 2011, CLIN MICROBIOL INFEC, V17, P1, DOI 10.1111/j.1469-0691.2011.03602.x
- Youngs J, 2020, J INFECTION, V81, pE55, DOI 10.1016/j.jinf.2020.06.056