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Microbiological Diagnosis and Antibiotic Therapy in Patients with Community-Acquired Pneumonia and Acute COPD Exacerbation in Daily Clinical Practice: Comparison to Current Guidelines

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Abstract

Background

The aim of this secondary analysis was to evaluate current microbiological approaches, microbiology, and antibiotic therapy in patients with community-acquired pneumonia (CAP) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in clinical practice and to compare them with current international guidelines.

Methods

A total of 362 patients with suspected CAP were enrolled in 14 European centers in a prospective multicenter study.

Results

A total of 279 inpatients (CAP, n = 222; AECOPD, n = 57) were evaluated. A total of 83 (37 %) CAP patients and 25 (44 %) AECOPD patients did not undergo any microbiological tests. In patients with CAP/AECOPD, blood culture was performed in 109 (49 %)/16 (28.1 %), urinary antigen tests for Legionella pneumophila in 67 (30 %)/9 (16 %), and sputum investigation in 55 (25 %)/17 (30 %), respectively. The most frequent pathogens in CAP were Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, L. pneumophila, Staphylococcus aureus, and Enterobacter cloacae; in AECOPD they were Escherichia coli, Haemophilus haemolyticus, Haemophilus influenzae, and Moraxella catarrhalis. All CAP patients (mean = 11.1 days) and 35 (61.4 %) of AECOPD patients (mean = 8.9 days) received antibiotics. CAP patients were given mostly aminopenicillin with β-lactamase inhibitors and AECOPD patients were given mostly cephalosporins.

Conclusions

Pathogens isolated in CAP and AECOPD and the antibiotic therapy used are in good accordance with the guidelines. Blood culture, recommended for all CAP patients, was performed in only 50 % of the cases and antibiotic therapy lasted longer than the suggested 5–7 days. Therefore, international guidelines regarding performance of blood culture and duration of antibiotic therapy should be adopted more often. This duration was independent of the number of isolated pathogens and number of symptoms on admission. Therefore, the question arises as to whether microbiological data are necessary only for patients who are resistant to initial therapy.

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Abbreviations

AECOPD:

Acute exacerbation of chronic obstructive pulmonary disease

ATS:

American thoracic society

BTS:

British thoracic society

CAP:

Community-acquired pneumonia

COPD:

Chronic obstructive pulmonary disease

CT:

Computed tomography

ERS:

European respiratory society

IDSA:

Infectious disease society of America

LRTI:

Lower respiratory tract infection

PCR:

Polymerase chain reaction

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Acknowledgments

The authors are indebted to the following: Claus Kroegel, Rotraud Neumann, Sylvia Fischer, Monika Möbius, Dr. Heike Hoyer, and Christine Dietrich (Friedrich-Schiller-University Jena, Germany); Maurizio Vergendo and Grazia Portale (Emergency Department Tolmezzo, Italy); Andreas Schuler and Gerhard Fenk (Helfenstein Clinic Geislingen, Germany); Peter Zechner, Fritz Flückiger, Herbert Wurzer, Susanne Rienmüller, and Gerald Geyer (Hospital Graz West, Austria); Roberto Cosentini and Andrea Gramegna (Emergency Department and Respiratory Department, University of Milan, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy); Gebhard Mathis and Thomas Amann (Medical practice Rankweil, Austria); Alexander Heinzmann, Wolfgang Blank, and Bernd Braun (Hospital Reutligen, Germany); Antonin Polach, Peter Schmidt, and Ernst Deu (Hospital Stolzalpe, Austria); Jörg Kämmer and Bernd Kissig (St. Hedwig Clinic Berlin, Germany); Hubert Bertolini and Markus Ammann (Medical practice Dornbirn, Austria); Martin Mauch (Hospital Sigmaringen, Germany); Harald Simader and Rudolg Kaiser (Diakonissen-Hospital Schladming, Austria); and Cornelia Schirpke and Kathrin Ludwig (Pulmonary Clinic Lostau gGmbH, Germany).

Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Internal Medicine I, Pneumology & Allergology, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07740, Jena, Germany

    Angelika Reissig

  2. Department of Geriatric Medicine, Helios Clinic, Erfurt, Germany

    Christine Mempel

  3. Centre for Clinical Studies, Friedrich-Schiller-University Jena, Jena, Germany

    Ulrike Schumacher

  4. Emergency Department, Latisana General Hospital, Latisana, Italy

    Roberto Copetti

  5. Department of Internal Medicine, Helfenstein Clinic, Geislingen, Germany

    Florian Gross

  6. Department of Health Science, University of Milan Bicocca, AO San Gerardo, Monza, Italy

    Stefano Aliberti

Authors
  1. Angelika Reissig
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  2. Christine Mempel
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  3. Ulrike Schumacher
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  4. Roberto Copetti
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  5. Florian Gross
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  6. Stefano Aliberti
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Correspondence to Angelika Reissig.

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Reissig, A., Mempel, C., Schumacher, U. et al. Microbiological Diagnosis and Antibiotic Therapy in Patients with Community-Acquired Pneumonia and Acute COPD Exacerbation in Daily Clinical Practice: Comparison to Current Guidelines. Lung 191, 239–246 (2013). https://doi.org/10.1007/s00408-013-9460-x

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  • DOI: https://doi.org/10.1007/s00408-013-9460-x

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