Lung

, Volume 191, Issue 3, pp 239–246 | Cite as

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

  • Angelika Reissig
  • Christine Mempel
  • Ulrike Schumacher
  • Roberto Copetti
  • Florian Gross
  • Stefano Aliberti
Article

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.

Keywords

Community-acquired pneumonia Microbiological diagnosis Antibiotic therapy Guidelines Acute exacerbation of chronic obstructive pulmonary disease 

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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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Angelika Reissig
    • 1
  • Christine Mempel
    • 2
  • Ulrike Schumacher
    • 3
  • Roberto Copetti
    • 4
  • Florian Gross
    • 5
  • Stefano Aliberti
    • 6
  1. 1.Department of Internal Medicine I, Pneumology & AllergologyJena University Hospital, Friedrich-Schiller-University JenaJenaGermany
  2. 2.Department of Geriatric MedicineHelios ClinicErfurtGermany
  3. 3.Centre for Clinical StudiesFriedrich-Schiller-University JenaJenaGermany
  4. 4.Emergency DepartmentLatisana General HospitalLatisanaItaly
  5. 5.Department of Internal MedicineHelfenstein ClinicGeislingenGermany
  6. 6.Department of Health ScienceUniversity of Milan BicoccaMonzaItaly

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