Community-acquired pneumonia. A prospective outpatient study.

Détails

ID Serval
serval:BIB_7F98E28769B6
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Community-acquired pneumonia. A prospective outpatient study.
Périodique
Medicine
Auteur(s)
Bochud P.Y., Moser F., Erard P., Verdon F., Studer J.P., Villard G., Cosendai A., Cotting M., Heim F., Tissot J., Strub Y., Pazeller M., Saghafi L., Wenger A., Germann D., Matter L., Bille J., Pfister L., Francioli P.
ISSN
0025-7974 (Print)
ISSN-L
0025-7974
Statut éditorial
Publié
Date de publication
03/2001
Volume
80
Numéro
2
Pages
75-87
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't ; Review WOS = article
Résumé
We initiated a prospective study with a group of practitioners to assess the etiology, clinical presentation, and outcome of community-acquired pneumonia in patients diagnosed in the outpatient setting. All patients with signs and symptoms suggestive of pneumonia and an infiltrate on chest X-ray underwent an extensive standard workup and were followed over 4 weeks. Over a 4-year period, 184 patients were eligible, of whom 170 (age range, 15-96 yr; median, 43 yr) were included and analyzed. In 78 (46%), no etiologic agent could be demonstrated. In the remaining 92 patients, 107 etiologic agents were implicated: 43 were due to "pyogenic" bacteria (39 Streptococcus pneumoniae, 3 Haemophilus spp., 1 Streptococcus spp.), 39 were due to "atypical" bacteria (24 Mycoplasma pneumoniae, 9 Chlamydia pneumoniae, 4 Coxiella burnetii, 2 Legionella spp.), and 25 were due to viruses (20 influenza viruses and 5 other respiratory viruses). There were only a few statistically significant clinical differences between the different etiologic categories (higher age and comorbidities in viral or in episodes of undetermined etiology, higher neutrophil counts in "pyogenic" episodes, more frequent bilateral and interstitial infiltrates in viral episodes). There were 2 deaths, both in patients with advanced age (83 and 86 years old), and several comorbidities. Only 14 patients (8.2%) required hospitalization. In 6 patients (3.4%), the pneumonia episode uncovered a local neoplasia. This study shows that most cases of community-acquired pneumonia have a favorable outcome and can be successfully managed in an outpatient setting. Moreover, in the absence of rapid and reliable clinical or laboratory tests to establish a definite etiologic diagnosis at presentation, the spectrum of the etiologic agents suggest that initial antibiotic therapy should cover both S. pneumoniae and atypical bacteria, as well as possible influenza viruses during the epidemic season.
Mots-clé
Adolescent, Adult, Aged, Aged, 80 and over, Analysis of Variance, Community-Acquired Infections, Comorbidity, Female, Humans, Male, Middle Aged, Pneumonia/diagnosis, Pneumonia/epidemiology, Pneumonia/</QualifierName> <QualifierName MajorTopicYN="N">, Prospective Studies, Seasons, Sensitivity and Specificity, Switzerland/epidemiology, Treatment Outcome
Pubmed
Web of science
Création de la notice
29/01/2008 10:58
Dernière modification de la notice
03/03/2018 18:43
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