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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