Medline ® Abstracts for References 34,35
of 'Treatment of community-acquired pneumonia in adults who require hospitalization'
A worldwide perspective of atypical pathogens in community-acquired pneumonia.
Arnold FW, Summersgill JT, Lajoie AS, Peyrani P, Marrie TJ, Rossi P, Blasi F, Fernandez P, File TM Jr, Rello J, Menendez R, Marzoratti L, Luna CM, Ramirez JA, Community-Acquired Pneumonia Organization (CAPO) Investigators
Am J Respir Crit Care Med. 2007;175(10):1086.
RATIONALE: Controversy still exists in the international literature regarding the need to use antimicrobials covering atypical pathogens when initially treating hospitalized patients with community-acquired pneumonia (CAP). In different regions of the world, monotherapy with a beta-lactam antimicrobial is common.
OBJECTIVES: We sought to correlate the incidence of CAP due to atypical pathogens in different regions of the world with the proportion of patients treated with an atypical regimen in those same regions. In addition, we sought to compare clinical outcomes of patients with CAP treated with and without atypical coverage.
METHODS: A secondary analysis was performed using two comprehensive international databases. World regions were defined as North America (I), Europe (II), Latin America (III), and Asia and Africa (IV). Time to reach clinical stability, length of hospital stay, and mortality were compared between patients treated with and without atypical coverage.
MEASUREMENTS AND MAIN RESULTS: The incidence of CAP due to atypical pathogens from 4,337 patients was 22, 28, 21, and 20% in regions I-IV, respectively. The proportion of patients treated with atypical coverage from 2,208 patients was 91, 74, 53, and 10% in regions I-IV, respectively. Patients treated with atypical coverage had decreased time to clinical stability (3.7 vs. 3.2 d, p<0.001), decreased length of stay (7.1 vs. 6.1 d, p<0.01), decreased total mortality (11.1 vs. 7%, p<0.01), and decreased CAP-related mortality (6.4 vs. 3.8%, p = 0.05).
CONCLUSIONS: The significant global presence of atypical pathogens and the better outcomes associated with antimicrobial regimens with atypical coverage support empiric therapy for all hospitalized patients with CAP with a regimen that covers atypical pathogens.
Division of Infectious Diseases, University of Louisville, Louisville, KY 40292, USA. email@example.com
Does empiric therapy for atypical pathogens improve outcomes for patients with CAP?
File TM Jr, Marrie TJ
Infect Dis Clin North Am. 2013 Mar;27(1):99-114.
The present controversy regarding the need to cover atypical pathogens in the empiric therapy of community-acquired pneumonia is related to several issues, including the relevance of terminology, imprecise diagnostic methods, and perceived contradictory results of published evidence. Studies evaluating the time to clinical recovery and the use of earlier endpoints for evaluation suggest that appropriate therapy provides a benefit if an atypical pathogen is a pathogen. Because recent surveillance studies suggest these pathogens are common and until there is the availability of accurate, cost-effective, and easily interpreted laboratory tests to provide the etiologic diagnosis at the time of point of care, empiric therapy of atypical pathogens is supported.
Infectious Disease Section, Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA. firstname.lastname@example.org