Table 2.
Studies of Etiology of NHAP Published since 2005
| Study Characteristics | Maruyama et al19 | Maruyama et al20 | Pulverino et al21 | Ma et al22 | Ewig et al23 | Putot et al24 | Kang et al25 |
|---|---|---|---|---|---|---|---|
| Study Years | 2004‒2005 | 2004‒2005 | 1997‒2007 | 2006‒2007 | 2002‒2009 | Jan‒Jun 2013 | 2008‒2014 |
| Country | Japan | Japan | Spain | Japan | Germany | France | Korea |
| Type of study | Prospective | Prospective | Prospective | Prospective | Prospective | Prospective | Retrospective |
| Number of NHAP cases | 75 | 54 | 150 | 108 | 518 | 56 | 105 |
| Number of (%) cases with etiology | 54 (72) | 37 (69) | 57 (38) | 74 (69) | 117 (23) | 6 (12) | 54 (51) |
| Methods to identify etiology | Sp, B, Ser, PUA, LUA | Sp, B, Ser, PUA, LUA | Sp, B, Ser, PUA, LUA | Sp, B, Ser, PUA, LUA, NPA cult and PCR | Sp, B, Ser, PUA, LUA, NPS | Sp, B, Ser, PUA, LUA, Ser, immunoflor-essence or PCR for viruses | Sp, B, Ser, PUA, LUA; viruses not evaluated |
| Organisms identified (% of cases with etiology identified) | |||||||
| S pneumoniae | 46% | 51% | 58% | 22% | 33% | 83% | 35% |
| S aureus | 6% | 5% | 5% | 4% | 10% | 24% | |
| Enterobacteriacea | 6% | 5% | 9% | 4% | 15% | 33% | |
| P aeruginosa | 2% | 0 | 4% | 9% | 3% | 13% | |
| H influenza | 0 | 0 | 4% | 7% | 1% | NS | |
| M catarrhalis | 4% | 5% | 0 | 0 | 1% | 4% | |
| C pneumoniae | 48% | 54% | 2% | 4% | 0 | ||
| C psittaci | 3% | ||||||
| M pneumoniae | 13% | 19% | 4% | 8% | 1% | 0 | |
| L pneumophila | 0 | 0 | 5% | 0 | 11% | 17% | 0 |
| Cytomegalovirus | 11% | 11% | 0 | No viruses identified | |||
| Influenza virus | 20% | 16% | 10% | 8% | |||
| RSV | 6% | 8% | 18% | ||||
| Parainfluenza | 6% | 8% | 20% | ||||
| Adenovirus | 0 | ||||||
| Metapneumovirus | 12% | ||||||
| Rhinovirus | 1% | ||||||
| Coronavirus | 3% | ||||||
| Enterovirus | 4% | ||||||
| Additional comments | 29% mixed infection; MDR in 7; 54% abx rx before admission | All ≥ 85 years old; 45% abx rx before admission; 62% mixed infection | Viruses isolated in only 3 cases | Rate of mixed infection not reported | Viruses that could be detected not reported; mixed infection rate not reported | Number with positive etiologic identification small | Polymicrobial infection 3 (6%); MDR organisms 23 (43%); 2/3 were bedridden or in wheelchair; 46% tube feeding |
| Treatment (denominator is all residents in study) | Only gave information about rx of those with atypical organisms isolated: 10/11 rx'd with abx that did not cover these organisms and all survived | ||||||
| Monotherapy: | 59% BL 30% Quin 17% Carb 4% |
58% | Amox 9% Am/clav 52% 3GC 30% Pip/taz 2% Quin 4% Mac 0 |
33 (31%) Quin 1 Aps pcn 30 Carb 2 |
|||
| Combination rx: | 41% BL + Quin 30% BL + Mac 11% |
42% | BL + Mac 4% | 72 (69% 3GC + Mac 9 3GC + Quin 1 Aps pcn + mac 9 Aps pcn + quin 50 |
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| % Hospital mortality | NS | 14.8% | NS | 10.7% | 11 (10.5%) | ||
| % 30-d mortality | 20% | NS | 27% | NS | NS |
Abx, antibiotic; Am/clav, amoxicillin/clavulanate; Amox, amoxicil; Aps pcn, antipseudomonal penicillin; B, blood culture; BL, betalactam; Carb, carbapenem; cult, culture; LUA, legionella urinary antigen; Mac, macrolide; MDR, multidrug resistant; NPA, nasopharyngeal aspirate; NPS, nasopharyngeal swab; NS, not stated; PCR, polymerase chain reaction; Pip/taz, piperacillin/tazobactam; PUA, pneumococcal urinary antigen; Quin, quinolone; RSV, respiratory syncytial virus; rx, treatment; Ser, serology; Sp, sputum culture; 3 GC, third generation cephalosporin.