Etiology of severe community-acquired pneumonia in adults: Results of the first Russian multicenter study [Этиология тяжелой внебольничной пневмонии у взрослых: результаты первого российского многоцентрового исследования]

Aim: to study the etiology of severe community-acquired pneumonia (SCAP) in adults in Russian Federation. SCAP is distinguished by high mortality and socio-economic burden. Both etiology and antimicrobial resistance are essential for appropriate antibiotic choice. Materials and methods. A prospective cohort study recruited adults with confirmed diagnosis of SCAP admitted to multi-word hospitals of six Russian cities in 2014-2018. Etiology was confirmed by routine culture of blood, respiratory (sputum, endotracheal aspirate or bronchoalveolar lavage) and when appropriate, autopsy samples, urinary antigen tests (L. pneumophila serogroup 1, S. pneumoniae); real-time PCR for identification of “atypical” bacterial pathogens (M. pneumoniae, C. pneumoniae, L. pneumophila) and respiratory viruses (influenza viruses A and B, parainfluenza, human metapneumovirus, etc.) was applied. Results. Altogether 109 patients (60.6% male; mean age 50.8±18.0 years old) with SCAP were enrolled. Etiological agent was identified in 65.1% of patients, S. pneumoniae, rhinovirus, S. aureus and K. pneumoniae were the most commonly isolated pathogens (found in 43.7, 15.5, 14.1 and 11.3% of patients with positive results of microbiological investigations, respectively). Bacteriemia was seen in 14.6% of patients and most commonly associated with S. pneumoniae. Co-infection with 2 or more causative agents was revealed in 36.6% of cases. Combination of bacterial pathogens (mainly S. pneumoniae with S. aureus or/and Enterobacterales) prevailed - 57.7% of cases; associations of bacteria and viruses were identified in 38.5% of patients, different viruses - in one case. Conclusion. S. pneumoniae was the most common pathogen in adults with SCAP. A high rate of respiratory viruses (mainly rhinovirus and influenza viruses) identification both as mixt infection with bacteria and mono-infection should be taken into account. © 2020 Consilium Medikum. All rights reserved.

Zakharenkov I.A.1, 2 , Rachina S.A. 3 , Dekhnich N.N.4 , Kozlov R.S.2, 4 , Sinopalnikov A.I. 5 , Ivanchik N.V.4 , Yatsyshina S.B.6 , Elkina M.A.6 , Archipenko M.V.7 , Gordeeva S.A.8 , Lebedeva M.S.9 , Portnyagina U.S.10
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  • 1 Bryansk City Hospital №1, Bryansk, Russian Federation
  • 2 Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, Smolensk, Russian Federation
  • 3 RUDN University, Moscow, Russian Federation
  • 4 Smolensk State Medical University, Smolensk, Russian Federation
  • 5 Russian Medical Academy of Postgraduate Education, Moscow, Russian Federation
  • 6 Central Research Institute of Epidemiology, Moscow, Russian Federation
  • 7 Regional Clinical Hospital №1, Krasnodar, Russian Federation
  • 8 P.A. Bayandin Murmansk State Regional Clinical Hospital, Murmansk, Russian Federation
  • 9 State Budgetary Healthcare Institution «Saint-Petersburg Clinical Scientific and Practical Center for Specialised Types of Medical Care (oncological)», Saint-Petersburg, Russian Federation
  • 10 M.K. Ammosov Federal North-Eastern University, Yakutsk, Russian Federation
Etiology; Microbiological diagnostics; Severe community-acquired pneumonia
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Avdeev S.N., Aisanov Z.R., Belevsky A.S., Beeh K.M., Vizel A.A., Zyryanov S.K., Ignatova G.L., Kostikas K., Leshchenko I.V., Ovcharenko S.I., Sinopal'Nikov A.I., Titova O.N., Shmelev E.I.
Terapevticheskii Arkhiv. Vol. 92. 2020. P. 89-95