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Open Access Research article

Causative agent distribution and antibiotic therapy assessment among adult patients with community acquired pneumonia in Chinese urban population

Youning Liu1*, Minjun Chen2, Tiemei Zhao1, Hui Wang2, Rui Wang3, Baiqiang Cai4, Bin Cao4, Tieying Sun5, Yunjian Hu6, Qingyu Xiu7, Xin Zhou8, Xing Ding8, Lan Yang9, Jiansheng Zhuo9, Yingchun Tang10, Kouxing Zhang10, Derong Liang11, Xiaoju Lv11, Shengqi Li12, Yong Liu13, Yunsong Yu14, Zeqing Wei14, Kejing Ying15, Feng Zhao15, Ping Chen16 and Xiaona Hou17

Author Affiliations

1 Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing, PR China

2 Department of Clinical Laboratory, Beijing Union Medical College Hospital, Beijing, PR China

3 Clinical Pharmacological Laboratory, Chinese PLA General Hospital, Beijing, PR China

4 Department of Respiratory Diseases, Beijing Union Medical College Hospital, Beijing, PR China

5 Department of Respiratory Diseases, Beijing Hospital, Beijing, PR China

6 Department of Clinical Laboratory, Beijing Hospital, Beijing, PR China

7 Department of Respiratory Diseases, Changzheng Hospital, Second Military Medical College, Shanghai, PR China

8 Department of Respiratory Diseases, First People's Hospital of Shanghai, Shanghai, PR China

9 Department of Respiratory Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China

10 Department of Respiratory Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China

11 Clinical Pharmacological Institutes, West China Hospital of Sichuan University, Sichuan, PR China

12 Department of Respiratory Diseases, Second Affiliated University of China Medical University, Shenyang, PR China

13 Department of Clinical Laboratory, Second Affiliated University of China Medical University, Shenyang, PR China

14 Department of Infectious Diseases, First Affiliated Hospital of Zhejiang University, Zhejiang, PR China

15 Department of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang, PR China

16 Department of Respiratory Diseases, General Hospital of Shenyang Military Region, Shenyang, PR China

17 Department of Clinical Laboratory, General Hospital of Shenyang Military Region, Shenyang, PR China

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BMC Infectious Diseases 2009, 9:31  doi:10.1186/1471-2334-9-31

Published: 18 March 2009

Abstract

Background

Knowledge of predominant microbial patterns in community-acquired pneumonia (CAP) constitutes the basis for initial decisions about empirical antimicrobial treatment, so a prospective study was performed during 2003–2004 among CAP of adult Chinese urban populations.

Methods

Qualified patients were enrolled and screened for bacterial, atypical, and viral pathogens by sputum and/or blood culturing, and by antibody seroconversion test. Antibiotic treatment and patient outcome were also assessed.

Results

Non-viral pathogens were found in 324/610 (53.1%) patients among whom M. pneumoniae was the most prevalent (126/610, 20.7%). Atypical pathogens were identified in 62/195 (31.8%) patients carrying bacterial pathogens. Respiratory viruses were identified in 35 (19%) of 184 randomly selected patients with adenovirus being the most common (16/184, 8.7%). The nonsusceptibility of S. pneumoniae to penicillin and azithromycin was 22.2% (Resistance (R): 3.2%, Intermediate (I): 19.0%) and 79.4% (R: 79.4%, I: 0%), respectively. Of patients (312) from whom causative pathogens were identified and antibiotic treatments were recorded, clinical cure rate with β-lactam antibiotics alone and with combination of a β-lactam plus a macrolide or with fluoroquinolones was 63.7% (79/124) and 67%(126/188), respectively. For patients having mixed M. pneumoniae and/or C. pneumoniae infections, a better cure rate was observed with regimens that are active against atypical pathogens (e.g. a β-lactam plus a macrolide, or a fluoroquinolone) than with β-lactam alone (75.8% vs. 42.9%, p = 0.045).

Conclusion

In Chinese adult CAP patients, M. pneumoniae was the most prevalent with mixed infections containing atypical pathogens being frequently observed. With S. pneumoniae, the prevalence of macrolide resistance was high and penicillin resistance low compared with data reported in other regions.