Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults

Details

• Alternative Title:
  N Engl J Med
• Personal Author:
  Jain, S. ; Self, W.H. ; Wunderink, R.G. ; Fakhran, S. ; Balk, R. ; Bramley, A.M. ; Reed, C. ; Grijalva, C.G. ; Anderson, E.J. ; Courtney, D.M. ; Chappell, J.D. ; Qi, C. ; Hart, E.M. ; Carroll, F. ; Trabue, C. ; Donnelly, H.K. ; Williams, D.J. ; Zhu, Y. ; Arnold, S.R. ; Ampofo, K. ; Waterer, G.W. ; Levine, M. ; Lindstrom, S. ; Winchell, J.M. ; Katz, J.M. ; Erdman, D. ; Schneider, E. ; Hicks, L.A. ; McCullers, J.A. ; Pavia, A.T. ; Edwards, K.M. ; Finelli, L.
• Description:
  BACKGROUND
  
  Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radio-graphically and with the use of current laboratory diagnostic tests are needed.
  
  METHODS
  
  We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among adults 18 years of age or older in five hospitals in Chicago and Nashville. Patients with recent hospitalization or severe immunosuppression were excluded. Blood, urine, and respiratory specimens were systematically collected for culture, serologic testing, antigen detection, and molecular diagnostic testing. Study radiologists independently reviewed chest radiographs. We calculated population-based incidence rates of community-acquired pneumonia requiring hospitalization according to age and pathogen.
  
  RESULTS
  
  From January 2010 through June 2012, we enrolled 2488 of 3634 eligible adults (68%). Among 2320 adults with radiographic evidence of pneumonia (93%), the median age of the patients was 57 years (interquartile range, 46 to 71); 498 patients (21%) required intensive care, and 52 (2%) died. Among 2259 patients who had radio-graphic evidence of pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 853 (38%): one or more viruses in 530 (23%), bacteria in 247 (11%), bacterial and viral pathogens in 59 (3%), and a fungal or mycobacterial pathogen in 17 (1%). The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%). The annual incidence of pneumonia was 24.8 cases (95% confidence interval, 23.5 to 26.1) per 10,000 adults, with the highest rates among adults 65 to 79 years of age (63.0 cases per 10,000 adults) and those 80 years of age or older (164.3 cases per 10,000 adults). For each pathogen, the incidence increased with age.
  
  CONCLUSIONS
  
  The incidence of community-acquired pneumonia requiring hospitalization was highest among the oldest adults. Despite current diagnostic tests, no pathogen was detected in the majority of patients. Respiratory viruses were detected more frequently than bacteria. (Funded by the Influenza Division of the National Center for Immunizations and Respiratory Diseases.)
  
  
• Subjects:
  Adolescent Adult Aged Aged, 80 And Over Age Distribution Chicago Community-Acquired Infections Female Hospitalization Humans Incidence Lung Male Middle Aged Pneumonia Population Surveillance Radiography Risk Factors Seasons Severity Of Illness Index Tennessee Young Adult

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• Source:
  N Engl J Med. 373(5):415-427
• Pubmed ID:
  26172429
• Pubmed Central ID:
  PMC4728150
• Document Type:
  Journal Article
• Funding:
  U18 IP000490/IP/NCIRD CDC HHSUnited States/ ; U18 IP000299/IP/NCIRD CDC HHSUnited States/ ; U18 IP000489/IP/NCIRD CDC HHSUnited States/ ; U18 IP000301/IP/NCIRD CDC HHSUnited States/ ; K23 AI104779/AI/NIAID NIH HHSUnited States/ ; U18 IP000488/IP/NCIRD CDC HHSUnited States/ ; K23 GM110469/GM/NIGMS NIH HHSUnited States/ ; CC999999/Intramural CDC HHSUnited States/ ; U18 IP000303/IP/NCIRD CDC HHSUnited States/ ; U18 IP000302/IP/NCIRD CDC HHSUnited States/ ; U18 IP000491/IP/NCIRD CDC HHSUnited States/
• Volume:
  373
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9db787dec095b6b58376b7bc748b5cfe35c0443cb250fc24d63c579a51189269
• Download URL:
  https://stacks.cdc.gov/view/cdc/37803/cdc_37803_DS1.pdf
• File Type:
  [PDF - 509.10 KB ]