Abstract
The aim of this multicenter study was to identify the causative pathogens of community-acquired pneumonia (CAP) in Shanghai, China, and to determine their susceptibility to antimicrobial agents. Pathogens obtained from 389 patients with documented CAP during 2001–2003 were identified by multiple diagnostic tools that included bacterial culture, polymerase chain reaction (PCR), and specific immunological assays. Susceptibility of the bacterial isolates was tested by the broth microdilution method. A specific pathogen was identified in 39.8% (155/389) of the patients: Haemophilus influenzae (n=80), Klebsiella spp. (n=15), Streptococcus pneumoniae (n=12), Staphylococcus aureus (n=6), Moraxella catarrhalis (n=1), other gram-negative organisms (n=9), and atypical pathogens that comprised Mycoplasma pneumoniae (n=42), Chlamydia pneumoniae (n=17), and Legionella pneumophila (n=2). Most H. influenzae isolates were susceptible to ampicillin (88.3%), and all were susceptible to macrolides. Of the S. pneumoniae isolates, 75% (9/12) were susceptible to penicillin, while 25% (3/12) were intermediately susceptible. H. influenzae and atypical pathogens are among the most important pathogens of CAP. Ampicillin, cephalosporins, and the newer fluoroquinolones can be used as empirical therapy for CAP in the Shanghai area. The efficacy of monotherapy with newer macrolides for CAP caused by S. pneumoniae requires further evaluation.
Similar content being viewed by others
References
Marston BJ, Plouffe JF, File TM Jr, Hackman BA, Salstrom SJ, Lipman HB, Kolczak MS, Breiman RF (1997) Incidence of community-acquired pneumonia requiring hospitalization. Results of a population-based active surveillance study in Ohio. Arch Intern Med 157:1709–1718
Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS, Weissfeld LA, Kapoor WN (1996) Prognosis and outcomes of patients with community-acquired pneumonia. JAMA 275:134–141
National Committee for Clinical Laboratory Standards (2003) Approved standard M7-A6. NCCLS, Wayne, Pennsylvania
Dowell SF, Peeling RW, Boman J, Carlone GM, Fields BS, Guarner J, Hammerschlag MR, Jackson LA, Kuo CC, Maass M, Messmer TO, Talkington DF, Tondella ML, Zaki SR, and the C. pneumoniae Workshop Participants (2001) Standardizing Chlamydia pneumoniae assays: recommendations from the Centers for Disease Control and Prevention (USA) and the Laboratory Centre for Disease Control (Canada). Clin Infect Dis 33:492–503
Gaydos CA, Quinn TC, Eiden JJ (1992) Identification of Chlamydia pneumoniae by DNA amplification of the 16S rRNA gene. J Clin Microbiol 30:796–800
Daxboeck F, Krause R, Wenisch C (2003) Laboratory diagnosis of Mycoplasma pneumoniae infection. Clin Microbiol Infect 9:263–273
Ieven M, Ursi D, van Bever H, Quint W, Niesters HG, Goossens H (1996) Detection of Mycoplasma pneumoniae by two polymerase chain reactions and role of M. pneumoniae in acute respiratory tract infections in pediatric patients. J Infect Dis 173:1445–1452
Darelid J, Lofgren S, Malmvall BE, Olinder-Nielsen MA, Briheim G, Hallander H (2003) Legionella pneumophila serogroup 1 antibody kinetics in patients with Legionnaires’ disease: implications for serological diagnosis. Scand J Infect Dis 35:15–20
Hindiyeh M, Carroll KC (2000) Laboratory diagnosis of atypical pneumonia. Semin Respir Infect 15:101–113
Ngeow YF, Suwanjutha S, Chantarojanasriri T, Wang F, Saniel M, Alejandria M, Hsueh PR, Ping-Ing L, Park SC, Sohn JW, Aziah AM, Liu Y, Seto WH, Ngan CC, Hadiarto M, Hood A, Cheong YM (2005) An Asian study on the prevalence of atypical respiratory pathogens in community-acquired pneumonia. Int J Infect Dis 9:144–153
Gotfried MH (2001) Epidemiology of clinically diagnosed community-acquired pneumonia in the primary care setting: results from the 1999–2000 respiratory surveillance program. Am J Med 111:25–29
Jokinen C, Heiskanen L, Juvonen H, Kallinen S, Kleemola M, Koskela M, Leinonen M, Ronnberg PR, Saikku P, Sten M, Tarkiainen A, Tukiainen H, Pyorala K, Makela PH (2001) Microbial etiology of community-acquired pneumonia in the adult population of 4 municipalities in eastern Finland. CID 32:1141–1154
Luna CM, Famiglietti A, Absi R, Videla AJ, Nogueira FJ, Fuenzalida AD, Gene RJ (2000) Community-acquired pneumonia: etiology, epidemiology, and outcome at a teaching hospital in Argentina. Chest 118:1344–1354
Gupta SK, Sarosi GA (2001) The role of atypical pathogens in community-acquired pneumonia. Med Clin North Am 85:1349–1365
Drummond P, Clark J, Wheeler J, Galloway A, Freeman R, Cant A (2000) Community-acquired pneumonia—a prospective UK study. Arch Dis Child 83:408–412
Wubbel L, Muniz L, Ahmed A, Trujillo M, Carubelli C, McCoig C, Abramo T, Leinonen M, McCracken GH Jr (1999) Etiology and treatment of CAP in ambulatory children. Peditr Infect Dis J 18:98–104
Mandell LA, Marrie TJ, Grossman RF, Chow AW, Hyland RH (2000) Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. Clin Infect Dis 31:383–426
Gordon KA, Biedonbach DJ (2003) Comparison of Streptococcus pneumoniae and Haemophilus influenzae susceptibilities from community-acquired respiratory tract infections and hospitalized patients with pneumonia: five-year results for the SENTRY Antimicrobial Surveillance. Diagn Microbiol Infect Dis 46:285–289
Zhu DM, Wang F, Zhang YY (2005) Surveillance of bacterial resistance from hospitals in Shanghai in 2003. Chin J Infect Chemother 1:4–12
Yang F, Zhang YY, McGee L (2001) Resistance of Streptococcus pneumoniae isolated from patients with respiratory tract infections. Chin J Infect Chemother 1:13–16
Zhang XZ, Liu Y, Chen DK (2002) A comparison of in vitro activity between cefprozil and other antimicrobial agents against pathogens in community-acquired respiratory tract infections. Chin J Infect Chemother 2:154–157
Jacobs MR, Felmingham D, Appelbaum PC (2003) The Alexander Project 1998–2000: susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents. J Antimicrob Chemother 52:229–246
Chen MJ, Xie XL, Zhang XZ (1998) The isolation and susceptibility of Haemophilus influenzae in Beijing, Shanghai and Guangzhou area. Clin J Infect Dis 16:238–239
Biedenbach DJ, Jones RN, Pfaller MA (2001) Activity of BMS284756 against 2,681 recent clinical isolates of Haemophilus influenzae and Moraxella catarrhalis: report from the SENTRY Antimicrobial Surveillance Program (2000) in Europe, Canada and the United States. Diagn Microbiol Infect Dis 39:245–250
Venkatesan P, Innes JA (1995) Antibiotic resistance in common acute respiratory pathogens. Thorax 50:481–483
Dubois J, St-Pierre C (1999) In vitro activity of gatifloxacin, compared with ciprofloxacin, clarithmycin, erythromycin, and rifampin, against Legionella species. Diagn Microbiol Infect Dis 33:261–265
Allegra L, Francesco B (2001) Problems and perspectives in the treatment of respiratory infections caused by atypical pathogens. Pulm Pharmacol Ther 14:21–27
Niederman MS (2004) Review of treatment guidelines for community-acquired pneumonia. Am J Med 117(Suppl 3A):51s–57s
File TM Jr, Garau J, Blasi F, Chidiac C, Klugman K, Lode H, Lonks JR, Mandell L, Ramirez J, Yu V (2004) Guidelines for empiric antimicrobial prescribing in community-acquired pneumonia. Chest 125:1888–1901
Ho PL, Yung RW, Tsang DN, Que TL, Ho M, Seto WH, Ng TK, Yam WC, Ng WW (2001) Increasing resistance of Streptococcus pneumoniae to fluoroquinolones: results of Hong Kong multicentre study in 2000. J Antimicrob Chemother 48:659–665
Zhu DM, Wang F, Zhang YY (2005) Surveillance of bacterial resistance from hospitals in Shanghai in 2003. Chin J Infect Chemother 5:4–12
Acknowledgements
We are indebted to the staff and residents of the various departments of infectious diseases, respiratory diseases, and diagnostic microbiology of the participating hospitals for their valuable cooperation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Huang, H.H., Zhang, Y.Y., Xiu, Q.Y. et al. Community-acquired pneumonia in Shanghai, China: microbial etiology and implications for empirical therapy in a prospective study of 389 patients. Eur J Clin Microbiol Infect Dis 25, 369–374 (2006). https://doi.org/10.1007/s10096-006-0146-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-006-0146-7