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Article from ERJ

Community-acquired pneumonia in outpatients: aetiology and outcomes

Catia Cilloniz1,3, Santiago Ewig5, Eva Polverino1,3, Maria Angeles Marcos4, Elena Prina6, Jacobo Sellares1,3, Miquel Ferrer1,3, Mar Ortega2, Albert Gabarrus1,3, Josep Mensa2, Antoni Torres1,3
1. Dept. of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, 2. Dept. of Infectious Diseases, Hospital Clinic, IDIBAPS, 3. Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 4. Dept. of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain, 5. Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, EVK Herne und Augusta-Kranken-Anstalt, Bochum, Germany, 6. Dipartimento di Medicina d’Urgenza, Policlinico – Universitá degli Studi di Milano, Milan, Italy
The purpose of this study was to establish the microbial aetiology and outcomes of patients with communityacquired pneumonia (CAP) treated as outpatients after presenting to a hospital emergency care unit. A prospective observational study was carried out in the Hospital Clinic of Barcelona (Barcelona, Spain). All consecutive cases of CAP treated as outpatients were included. 568 adult outpatients with CAP were studied (mean±sd age 47,2±17,6 yrs; 110 (19,4%) were aged ≥65 yrs). Aetiological diagnoses were established in 188 (33.1%) cases. Streptococcus pneumoniae was the most frequent pathogen followed by Mycoplasma pneumoniae and respiratory viruses. Legionella was detected in 13 (2.3%) cases. More than one causative agent was found in 17 (9.0%) patients. Mortality was low (three patients died, 0.5%) and other adverse events were rare: 30 (5.2%) patients had complications, 13 (2.3%) were re-admitted and treatment failed in 13 (2.3%). Complications were mostly related to pleural effusion and empyema, and re-admissions and treatment failures to comorbidities. Outpatients with CAP have a characteristic microbial pattern. Regular antipneumococcal coverage remains mandatory. Treatment failures and re-admissions are rare and may be reduced by increased attention to patients requiring short-term observation in the emergency care unit and in the presence of pleural effusion and comorbidities.

Keywords: Community-acquired pneumonia, outpatients, respiratory infection