Tuberc Respir Dis.  2009 May;66(5):358-364. 10.4046/trd.2009.66.5.358.

The Etiologic Agents and Clinical Outcomes of Adult Community-acquired Pneumonia in Jeju

• Jeon BH
• Kim M
• Kim JH
• Shin SY
• Lee J

• KMID: 1846398
• DOI: http://doi.org/10.4046/trd.2009.66.5.358

Abstract

BACKGROUND: The appropriate empirical antimicrobial choice in the treatment of community-acquired pneumonia (CAP) should be advocated by community-based information on the etiologic pathogens, their susceptibility to antimicrobials, clinical characteristics and outcomes. Jeju is a geographically isolated and identical region in Korea. However, there is no regional reference on adult CAP available. This study investigated the etiologic agents and clinical outcomes of adult patients diagnosed with CAP in Jeju, Korea, to help guide the empirical antimicrobial choice.
METHODS
A prospective observational study for one year in a referral hospital in Jeju, Korea. Patients diagnosed with CAP were enrolled with their clinical characteristics. Microbiological evaluations to identify the etiologic agents in the adult patients with CAP were performed with blood culture, expectorated sputum smear and culture, antibody tests for mycoplasma, chlamydophila, and antigen tests for legionella and pneumococcus. The clinical outcomes of the initial empirical treatment were analyzed.
RESULTS
Two hundred and three patients with mean age of 64 and 79 females were enrolled. Ten microbials from 90 cases (44.3%) were isolated and multiple isolates were confirmed in 30. Among the microbial isolates, S. pneumoniae (36.3%) was the most common, followed by M. pneumoniae (23.0%), C. pneumoniae (17.0%), S. aureus (9.6%) and P. aeruginosa (5.9%). The initial treatment failure (23.8%) was related to the isolation of polymicrobial pathogens, elevated inflammatory markers, and the presence of pleural effusion. Among the 30 isolates of S. pneumoniae, 16 (53.3%) were not susceptible to penicillin, and 19 isolates (63.3%) to erythromycin and clarithromycin. However, 29 isolates (96.7%) were susceptible to levofloxacin and ceftriaxone.
CONCLUSION
S. pneumoniae, M. pneumoniae, S. aureus, and P. aeruginosa are frequent etiologic agents of adult CAP in Jeju, Korea. The clinical characteristics and antibiotic resistance should be considered when determining the initial empirical antimicrobial choice. Respiratory quinolone or ceftriaxone is recommended as an empirical antimicrobiotic in the treatment of adult CAP in Jeju, Korea.

Keyword

Pneumonia; Drug resistance; Community-acquired infections

MeSH Terms

Adult
Ceftriaxone
Chlamydophila
Clarithromycin
Community-Acquired Infections
Drug Resistance
Drug Resistance, Microbial
Erythromycin
Female
Humans
Korea
Legionella
Mycoplasma
Ofloxacin
Penicillins
Pleural Effusion
Pneumonia
Prospective Studies
Referral and Consultation
Sputum
Streptococcus pneumoniae
Treatment Failure
Ceftriaxone
Clarithromycin
Erythromycin
Ofloxacin
Penicillins

Reference

1. Chung MH, Shin WS, Kim YR, Kang MW, Kim MJ, Jung HJ, et al. Etiology of community-acquired pneumonia surveyed by 7 university hospitals. Korean J Infect Dis. 1997. 29:339–359.

2. Woo JH, Kang JM, Kim YS, Shin WS, Ryu JH, Choi JH, et al. A prospective multicenter study of community-acquired pneumonia in adults with emphasis on bacterial etiology. Korean J Infect Dis. 2001. 33:1–7.

3. Yoon JH, Lee DC, Lee HS, Lee CH, Kim BH, Kim JW. A clinical investigation of community-acquired pneumonia in Mokpo area. Tuberc Respir Dis. 2001. 51:17–24.

4. Song JH, Oh WS, Kang CI, Chung DR, Peck KR, Ko KS, et al. Epidemiology and clinical outcomes of community-acquired pneumonia in adult patients in Asian countries: a prospective study by the Asian network for surveillance of resistant pathogens. Int J Antimicrob Agents. 2008. 31:107–114.

5. Sohn JW, Park SC, Choi YH, Woo HJ, Cho YK, Lee JS, et al. Atypical pathogens as etiologic agents in hospitalized patients with community-acquired pneumonia in Korea: a prospective multi-center study. J Korean Med Sci. 2006. 21:602–607.

6. Lionel AM, Richard W. Anthony SF, Eugene B, Dennis LK, Stephen LH, Dan LL, Larry J, Joseph L, editors. Chapter 251. Pneumonia. Harrison's principles of internal medicine. 2007. 17th ed. New York: McGraw-Hill Co, Inc.;1620.

7. Hyun JC, Yoon HJ, Nam JH, Moon MS, Cho YK, Woo JH, et al. A prospective multicenter study on the etiological analysis of community-acquired pneumonia in adult patients in Korea: detection of Mycoplasma pneumoniae and Chlamydia pneumoniae Infections. Korean J Infect Dis. 2001. 33:15–24.

8. Lee SJ, Lee MG, Jeon MJ, Jung KS, Lee HK, Kishimoto T. Atypical pathogens in adult patients admitted with community-acquired pneumonia in Korea. Jpn J Infect Dis. 2002. 55:157–159.

9. Kim JH, Kwak YH, Na BK, Lee JY, Shin GC, Jung HS, et al. Viral etiology of community-acquired pneumonia in Korean adults. Korean J Infect Dis. 2001. 33:8–14.

10. Kim MJ, Cheong HJ, Sohn JW, Shim HS, Park DW, Park SC, et al. A prospective multicenter study of the etiological analysis in adults with community-acquired pneumonia: Legionella, Leptospira, Hantaan virus and Orientia tsutsugamushi. Korean J Infect Dis. 2001. 33:24–31.

11. Porath A, Schlaeffer F, Lieberman D. The epidemiology of community-acquired pneumonia among hospitalized adults. J Infect. 1997. 34:41–48.

12. Falguera M, Nogues A, Ruiz-Gonzalez A, Garcia M, Puig T. Detection of Mycoplasma pneumoniae by polymerase chain reaction in lung aspirates from patients with community-acquired pneumonia. Chest. 1996. 110:972–976.

13. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of AmericaAmerican Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007. 44:Suppl 2. S27–S72.