Global and Local Epidemiology of Community-Acquired Pneumonia: The Experience of the CAPNETZ Network

 

 Buy Article Permissions and Reprints

ABSTRACT

Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Young children and the elderly are disproportionately affected by CAP. Lower respiratory tract infections (LRTIs), including CAP, were ranked third in a list of the 30 leading causes of death worldwide in 1990. Mortality rates are low (< 2%) in CAP patients treated as outpatients, but are higher (5 to 20%) among patients hospitalized for CAP, and are highest (up to 50%) in patients admitted to the intensive care unit. Several risk factors are known to be associated with increases in mortality, the most important of which are age > 65 years, male gender, and comorbidities such as chronic heart failure, advanced chronic obstructive pulmonary disease, neurological diseases, and liver cirrhosis. Patients living in nursing homes may have a special risk for multiresistant bacterial infection. The incidence of CAP varies worldwide by country, age, and gender. Further, data about epidemiology, etiology, morbidity, mortality, and economical burden of diseases differ between countries. In this review, we present recent data regarding the incidence, etiology, and rate of antibiotic resistance among CAP patients from the German Network for Community Acquired Pneumonia (CAPNETZ) registry and review data from several European countries.

REFERENCES

• 1 Murray C JL, Lopez A D. Mortality by cause for eight regions of the world: Global Burden of Disease Study.  Lancet. 1997;  349 1269-1276
  CrossrefPubMedGoogle Scholar
• 2 Bundesgeschäftsstelle für Qualitätssicherung . Qualitätsreport BQS 2007 Hrg.  Düsseldorf. 2008;  28-34
  PubMedGoogle Scholar
• 3 Welte T, Suttorp N, Marre R. CAPNETZ–community-acquired pneumonia competence network.  Infection. 2004;  32 234-238
  PubMedGoogle Scholar
• 4 Trotter C L, Stuart J M, George R, Miller E. Increasing hospital admissions for pneumonia, England.  Emerg Infect Dis. 2008;  14 727-733
  CrossrefPubMedGoogle Scholar
• 5 European Respiratory Society/European Lung Foundation .Pneumonia. In: European Respiratory Society/European Lung Foundation. European Lung White Book. Sheffield, UK; 2003: 55-65
  Google Scholar
• 6 Schnoor M, Hedicke J, Dalhoff K, Raspe H, Schafer T. CAPNETZ study group: approaches to estimate the population-based incidence of community acquired pneumonia.  J Infect. 2007;  55 233-239
  CrossrefPubMedGoogle Scholar
• 7 Mandell L A. Spectrum of microbial etiology of community- acquired pneumonia in hospitalized patients: implications for selection of the population for enrollment in clinical trials.  Clin Infect Dis. 2008;  47 S189-S192
  CrossrefPubMedGoogle Scholar
• 8 Marston B J, Plouffe J F, File T M et al.. Incidence of community-acquired pneumonia requiring hospitalization: results of a population-based active surveillance study in Ohio. The Community-Based Pneumonia Incidence Study Group.  Arch Intern Med. 1997;  157 1709-1718
  CrossrefPubMedGoogle Scholar
• 9 Niederman M S, McCombs J S, Unger A N, Kumar A, Popovian R. The cost of treating community-acquired pneumonia.  Clin Ther. 1998;  20 820-837
  CrossrefPubMedGoogle Scholar
• 10 Monge V, San-Martin M, Gonzalez A. The burden of community-acquired pneumonia in Spain.  Eur J Public Health. 2001;  11 362-364
  CrossrefPubMedGoogle Scholar
• 11 United Nations Population Division .World population prospects: the 2006 revision population database. Available at http://esa.un.org/unpp/p2k0data.asp Accessed October 25, 2008
  Google Scholar
• 12 Bartolome M, Almirall J, Morera J Maresme Community-Acquired Pneumonia Study Group (GEMPAC) et al. A population-based study of the costs of care for community-acquired pneumonia.  Eur Respir J. 2004;  23 610-616
  CrossrefPubMedGoogle Scholar
• 13 Bauer T T, Welte T, Ernen C et al.. Cost analyses of community-acquired pneumonia from the hospital perspective.  Chest. 2005;  128 2238-2246
  CrossrefPubMedGoogle Scholar
• 14 Restrepo M I, Mortensen E M, Valez J A et al.. A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU.  Chest. 2008;  133 610-617
  CrossrefPubMedGoogle Scholar
• 15 Welte T, Marre R, Suttorp N. Kompetenznetzwerk “Ambulant Erworbene Pneumonie” (CAPNETZ) . What is new in the treatment of community-acquired pneumonia? [in German].  Med Klin (Munich). 2006;  101 313-320
  CrossrefPubMedGoogle Scholar
• 16 Koivula I, Stén M, Mäkelä P H. Prognosis after community-acquired pneumonia in the elderly: a population-based 12-year follow-up study.  Arch Intern Med. 1999;  159 1550-1555
  CrossrefPubMedGoogle Scholar
• 17 Yende S, D'Angelo G, Kellum J A GenIMS Investigators et al. Inflammatory markers at hospital discharge predict subsequent mortality after pneumonia and sepsis.  Am J Respir Crit Care Med. 2008;  177 1242-1247
  CrossrefPubMedGoogle Scholar
• 18 El Solh A, Pineda L, Bouquin P, Mankowski C. Determinants of short and long term functional recovery after hospitalization for community-acquired pneumonia in the elderly: role of inflammatory markers.  BMC Geriatr. 2006;  6 12
  CrossrefPubMedGoogle Scholar
• 19 Garbino J, Sommer R, Gerber A et al.. Prospective epidemiologic survey of patients with community-acquired pneumonia requiring hospitalization in Switzerland.  Int J Infect Dis. 2002;  6 288-293
  CrossrefPubMedGoogle Scholar
• 20 Giorgi Rossi P, Agabiti N, Faustini A et al.. The burden of hospitalised pneumonia in Lazio, Italy, 1997–1999.  Int J Tuberc Lung Dis. 2004;  8 528-536
  PubMedGoogle Scholar
• 21 Froes F. Pneumonia in the adult population in continental Portugal: incidence and mortality in hospitalized patients from 1998 to 2000 [in Spanish].  Rev Port Pneumol. 2003;  9 187-194
  PubMedGoogle Scholar
• 22 Falcó V, Almirante B, Jordano Q et al.. Influence of penicillin resistance on outcome in adult patients with invasive pneumococcal pneumonia: is penicillin useful against intermediately resistant strains?.  J Antimicrob Chemother. 2004;  54 481-488
  CrossrefPubMedGoogle Scholar
• 23 Aspa J, Rajas O, Rodríguez de Castro F Pneumococcal Pneumonia in Spain Study Group et al.. Drug-resistant pneumococcal pneumonia: clinical relevance and related factors.  Clin Infect Dis. 2004;  38 787-798
  CrossrefPubMedGoogle Scholar
• 24 Viegi G, Pistelli R, Cazzola M et al.. Epidemiological survey on incidence and treatment of community acquired pneumonia in Italy.  Respir Med. 2006;  100 46-55
  CrossrefPubMedGoogle Scholar
• 25 Foley S C, Kelly E M, O'Neill S J. Audit of the management of patients admitted with community acquired pneumonia.  Ir Med J. 2006;  99 138-140
  PubMedGoogle Scholar
• 26 Menéndez R, Torres A, Zalacain R Neumofail Group et al.. Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome.  Thorax. 2004;  59 960-965
  CrossrefPubMedGoogle Scholar
• 27 Ochoa-Gondar O, Vila-Córcoles A, de Diego C EVAN-65 Study Group et al.. The burden of community-acquired pneumonia in the elderly: the Spanish EVAN-65 study.  BMC Public Health. 2008;  8 222
  CrossrefPubMedGoogle Scholar
• 28 Braun J J, de Graaff C S, de Goey J, Zwinderman A H, Petit P LC. Community-acquired pneumonia: pathogens and course in patients admitted to a general hospital [in Dutch].  Ned Tijdschr Geneeskd. 2004;  148 836-840
  PubMedGoogle Scholar
• 29 Paganin F, Lilienthal F, Bourdin A et al.. Severe community-acquired pneumonia: assessment of microbial aetiology as mortality factor.  Eur Respir J. 2004;  24 779-785
  CrossrefPubMedGoogle Scholar
• 30 Rello J, Bodi M, Mariscal D et al.. Microbiological testing and outcome of patients with severe community-acquired pneumonia.  Chest. 2003;  123 174-180
  CrossrefPubMedGoogle Scholar
• 31 Vallès X, Marcos A, Pinart M et al.. Hospitalized community-acquired pneumonia due to Streptococcus pneumoniae: has resistance to antibiotics decreased?.  Chest. 2006;  130 800-806
  CrossrefPubMedGoogle Scholar
• 32 Rosón B, Carratalà J, Fernández-Sabé N, Tubau F, Manresa F, Gudiol F. Causes and factors associated with early failure in hospitalized patients with community-acquired pneumonia.  Arch Intern Med. 2004;  164 502-508
  CrossrefPubMedGoogle Scholar
• 33 Bonnard P, Lescure F X, Douadi Y et al.. Community-acquired bacteraemic pneumococcal pneumonia in adults: effect of diminished penicillin susceptibility on clinical outcome.  J Infect. 2005;  51 69-76
  CrossrefPubMedGoogle Scholar
• 34 Melegaro A, Edmunds W J, Pebody R, Miller E, George R. The current burden of pneumococcal disease in England and Wales.  J Infect. 2006;  52 37-48
  CrossrefPubMedGoogle Scholar
• 35 Kothe H, Bauer T, Marre R, Suttorp N, Welte T, Dalhoff K. Competence Network for Community-Acquired Pneumonia Study Group . Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment.  Eur Respir J. 2008;  32 139-146
  CrossrefPubMedGoogle Scholar
• 36 Kollef M H, Shorr A, Tabak Y P et al.. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia.  Chest. 2005;  128 3854-3862
  CrossrefPubMedGoogle Scholar
• 37 Echols R M, Tillotson G S, Song J X, Tosiello R L. Clinical trial design for mild-to-moderate community-acquired pneumonia: an industry perspective.  Clin Infect Dis. 2008;  47(Suppl 3) S166-S175
  CrossrefPubMedGoogle Scholar
• 38 Nielsen S V, Poullsen K, Jørgensen L M, Rasmussen E, Sanders S, Henrichsen J. Incidence and diagnosis of cases of pneumonia caused by pneumococci that required hospitalization [in Danish].  Ugeskr Laeger. 1992;  154 412-415
  PubMedGoogle Scholar
• 39 Jokinen C, Heiskanen L, Juvonen H et al.. Microbial etiology of community-acquired pneumonia in the adult population of 4 municipalities in eastern Finland.  Clin Infect Dis. 2001;  32 1141-1154
  CrossrefPubMedGoogle Scholar
• 40 Lim W S, Macfarlane J T, Boswell T CJ et al.. Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines.  Thorax. 2001;  56 296-301
  CrossrefPubMedGoogle Scholar
• 41 Welte T. Treatment of hospitalized patients with community-acquired pneumonia: reply [letter].  Clin Infect Dis. 2006;  43 110
  CrossrefPubMedGoogle Scholar
• 42 Beović B, Bonac B, Kese D et al.. Aetiology and clinical presentation of mild community-acquired bacterial pneumonia.  Eur J Clin Microbiol Infect Dis. 2003;  22 584-591
  CrossrefPubMedGoogle Scholar
• 43 Fernandez Alvarez R, Suarez Toste I, Rubinos Cuadrado G et al.. Community-acquired pneumonia: aetiologic changes in a limited geographic area. An 11-year prospective study.  Eur J Clin Microbiol Infect Dis. 2007;  26 495-499
  CrossrefPubMedGoogle Scholar
• 44 Guglielmo L, Leone R. Veneto Pneumonia Research Group . Aetiology and therapy of community-acquired pneumonia: a hospital study in northern Italy.  Eur J Clin Pharmacol. 1997;  51 437-443
  CrossrefPubMedGoogle Scholar
• 45 Ostergaard L, Andersen P L. Etiology of community-acquired pneumonia: evaluation by transtracheal aspiration, blood culture, or serology.  Chest. 1993;  104 1400-1407
  PubMedGoogle Scholar
• 46 Laurichesse H, Sotto A, Bonnet E Infectio-Sud Study Group et al.. Pre- and in-hospital management of community-acquired pneumonia in Southern France, 1998–99.  Eur J Clin Microbiol Infect Dis. 2001;  20 770-778
  CrossrefPubMedGoogle Scholar
• 47 Wellinghausen N, Straube E, Freidank H, von Baum H, Marre R, Essig A. Low prevalence of Chlamydia pneumoniae in adults with community-acquired pneumonia.  Int J Med Microbiol. 2006;  296 485-491
  CrossrefPubMedGoogle Scholar
• 48 von Baum H, Ewig S, Marre R Competence Network for Community Acquired Pneumonia Study Group et al. Community-acquired Legionella pneumonia: new insights from the German competence network for community acquired pneumonia.  Clin Infect Dis. 2008;  46 1356-1364
  CrossrefPubMedGoogle Scholar
• 49 De Roux A, Marcos M A, Garcia E et al.. Viral community-acquired pneumonia in nonimmunocompromised adults.  Chest. 2004;  125 1343-1351
  CrossrefPubMedGoogle Scholar
• 50 Apisarnthanarak A, Mundy L M. Etiology of community-acquired pneumonia.  Clin Chest Med. 2005;  26 47-55
  CrossrefPubMedGoogle Scholar
• 51 Vanderkooi O G, Low D E, Green K, Powis J E, McGeer A. for the Toronto Invasive Bacterial Disease Network . Predicting antimicrobial resistance in invasive pneumococcal infections.  Clin Infect Dis. 2005;  40 1288-1297
  CrossrefPubMedGoogle Scholar
• 52 Yu V L, Chiou C CC, Feldman C International Pneumococcal Study Group et al.. An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome.  Clin Infect Dis. 2003;  37 230-237
  CrossrefPubMedGoogle Scholar
• 53 Daneman N, McGeer A, Green K, Low D E. Toronto Invasive Bacterial Diseases Network . Macrolide resistance in bacteremic pneumococcal disease: implications for patient management.  Clin Infect Dis. 2006;  43 432-438
  CrossrefPubMedGoogle Scholar
• 54 Whitney C G, Farley M M, Hadler J et al.. Active bacterial core surveillance of the emerging infections program network: invasive pneumococcal disease after the introduction of protein–polysaccharide conjugate vaccine.  N Engl J Med. 2003;  348 1737-1746
  CrossrefPubMedGoogle Scholar
• 55 Stephens D S, Zughaier S M, Whitney C G Georgia Emerging Infections Program et al.. Incidence of macrolide resistance in Streptococcus pneumoniae after introduction of the pneumococcal conjugate vaccine: population-based assessment.  Lancet. 2005;  365 855-863
  CrossrefPubMedGoogle Scholar
• 56 Low D E. Quinolone resistance among pneumococci: therapeutic and diagnostic implications.  Clin Infect Dis. 2004;  38(Suppl 4) S357-S362
  CrossrefPubMedGoogle Scholar
• 57 Woodhead M, Blasi F, Ewig S et al.. Guidelines for the management of adult lower respiratory tract infections.  Eur Respir J. 2005;  26 1138-1180
  CrossrefPubMedGoogle Scholar

Tobias WelteM.D. 

Department of Pulmonary Medicine, Medizinische Hochschule Hannover

Carl Neuberg Strasse 1, D-30625 Hannover, Germany

Email: welte.tobias@mh-hannover.de