Aetiological agents of adult community-acquired pneumonia in Japan: systematic review and meta-analysis of published data

被引:12
作者
Fujikura, Yuji [1 ,2 ]
Somekawa, Kohei [3 ]
Manabe, Toshie [4 ,5 ]
Horita, Nobuyuki [6 ]
Takahashi, Hiroshi [7 ]
Higa, Futoshi [8 ]
Yatera, Kazuhiro [9 ]
Miyashita, Naoyuki [10 ]
Imamura, Yoshifumi [11 ]
Iwanaga, Naoki [12 ]
Mukae, Hiroshi [13 ]
Kawana, Akihiko [1 ]
机构
[1] Natl Def Med Coll, Dept Internal Med, Div Infect Dis & Resp Med, Tokorozawa, Saitama, Japan
[2] Natl Def Med Coll Hosp, Dept Med Risk Management & Infect Control, Tokorozawa, Saitama, Japan
[3] Yokohama City Univ, Dept Pulmonol, Grad Sch Med, Yokohama, Kanagawa, Japan
[4] Nagoya City Univ, Grad Sch Med Sci, Nagoya, Aichi, Japan
[5] Nagoya City Univ, West Med Ctr, Nagoya, Aichi, Japan
[6] Yokohama City Univ Med, Chemotherapy Ctr, Yokohama, Kanagawa, Japan
[7] Saka Gen Hosp, Dept Resp Med, Shiogama, Miyagi, Japan
[8] Okinawa Natl Hosp, Natl Hosp Org, Dept Resp Med, Ginowan, Okinawa, Japan
[9] Univ Occupat & Environm Hlth, Dept Resp Med, Kitakyushu, Fukuoka, Japan
[10] Kansai Med Univ, Dept Internal Med 1, Div Resp Med Infect Dis & Allergol, Hirakata, Osaka, Japan
[11] Nagasaki Univ Hosp, Med Educ Dev Ctr, Nagasaki, Nagasaki, Japan
[12] Nagasaki Univ Hosp, Dept Resp Med, Nagasaki, Nagasaki, Japan
[13] Nagasaki Univ, Grad Sch Biomed Sci, Dept Resp Med, Nagasaki, Nagasaki, Japan
关键词
respiratory infection; bacterial infection; viral infection; pneumonia; CARE-ASSOCIATED PNEUMONIA; SEMIQUANTITATIVE PROCALCITONIN TEST; INFECTIOUS-DISEASES-SOCIETY; RISK-FACTORS; PROSPECTIVE MULTICENTER; HOSPITALIZED-PATIENTS; ELDERLY-PATIENTS; ANTIMICROBIAL TREATMENT; MECHANICAL VENTILATION; RETROSPECTIVE ANALYSIS;
D O I
10.1136/bmjresp-2023-001800
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
ObjectiveEpidemiological information is essential in providing appropriate empiric antimicrobial therapy for pneumonia. This study aimed to clarify the epidemiology of community-acquired pneumonia (CAP) by conducting a systematic review of published studies in Japan.DesignSystematic review.Data sourcePubMed and Ichushi web database (January 1970 to October 2022).Eligibility criteriaClinical studies describing pathogenic micro-organisms in CAP written in English or Japanese, excluding studies on pneumonia other than adult CAP, investigations limited to specific pathogens and case reports.Data extraction and synthesisPatient setting (inpatient vs outpatient), number of patients, concordance with the CAP guidelines, diagnostic criteria and methods for diagnosing pneumonia pathogens as well as the numbers of each isolate. A meta-analysis of various situations was performed to measure the frequency of each aetiological agent.ResultsFifty-six studies were included and 17 095 cases of CAP were identified. Pathogens were undetectable in 44.1% (95% CI 39.7% to 48.5%). Streptococcus pneumoniae was the most common cause of CAP requiring hospitalisation or outpatient care (20.0% (95% CI 17.2% to 22.8%)), followed by Haemophilus influenzae (10.8% (95% CI 7.3% to 14.3%)) and Mycoplasma pneumoniae (7.5% (95% CI 4.6% to 10.4%)). However, when limited to CAP requiring hospitalisation, Staphylococcus aureus was the third most common at 4.9% (95% CI 3.9% to 5.8%). Pseudomonas aeruginosa was more frequent in hospitalised cases, while atypical pathogens were less common. Methicillin-resistant S. aureus accounted for 40.7% (95% CI 29.0% to 52.4%) of S. aureus cases. In studies that used PCR testing for pan-respiratory viral pathogens, human enterovirus/human rhinovirus (9.4% (95% CI 0% to 20.5%)) and several other respiratory pathogenic viruses were detected. The epidemiology varied depending on the methodology and situation.ConclusionThe epidemiology of CAP varies depending on the situation, such as in the hospital versus outpatient setting. Viruses are more frequently detected by exhaustive genetic searches, resulting in a significant variation in epidemiology.
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页数:9
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