title: Significance of atypical pathogens among community-acquired pneumonia adult patients admitted to hospital in Kuwait.
abstract: OBJECTIVE
  The aim of this study is to determine the microbial etiology and severity of community-acquired pneumonia (CAP) in Kuwait.
  
  
  METHODS
  The severity of consecutive adult CAP cases admitted to 3 hospitals over a 1-year period was classified according to the Pneumonia Outcome Research Team (PORT) severity index. The microbial etiology was determined using standard methods for bacteria and serological tests for atypical and viral pathogens.
  
  
  RESULTS
  The study population was 124 of the 135 admissions; 63 female, 61 male; mean age 41.3+/-18 years. The severity class distribution was: class I 31%, class II 37%, class III 17%, class IV 13%, and class V 2%. Etiological agents were identified from 44 patients (35%), with one pathogen in 31 (25%), two in 9 (7%), and three or more in 4 (3%). The most common pathogens identified were: Mycoplasma pneumoniae in 14 patients (11%), Legionella pneumophila in 10 (8%), Chlamydia pneumoniae in 8 (6%), influenza B virus in 8 (6%), influenza A virus in 5 (4%), Haemophilus influenzae in 4 (3%), Streptococcus pneumoniae in 3 (2%), Staphylococcus aureus in 3 (2%), gram-negative enterobacteria in 5 (4%), Moraxellacatarrhalis in 2 (2%), and viruses in 4 (3%). The yields from laboratory tests were 48% for paired serology, 20% from adequate sputum sample, and 3% from blood culture.
  
  
  CONCLUSIONS
  Our study shows that a large percentage of mild CAP cases are admitted to hospitals in Kuwait. Atypical pathogens have a significant role in the etiology of CAP. There is overtreatment of CAP with a combination treatment consisting mainly of third-generation chephalosporins and macrolides.
authors.affiliation: Department of Medicine, Kuwait University, Kuwait. nasser_beh@hsc.edu.kw
authors.forename: N
authors.initials: N
authors.lastname: Behbehani
authors.forename: A
authors.initials: A
authors.lastname: Mahmood
authors.forename: E M
authors.initials: EM
authors.lastname: Mokaddas
authors.forename: Z
authors.initials: Z
authors.lastname: Bittar
authors.forename: B
authors.initials: B
authors.lastname: Jayakrishnan
authors.forename: M
authors.initials: M
authors.lastname: Khadadah
authors.forename: A S
authors.initials: AS
authors.lastname: Pacsa
authors.forename: R
authors.initials: R
authors.lastname: Dhar
authors.forename: T D
authors.initials: TD
authors.lastname: Chugh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D017714:Community-Acquired Infections / Q000382:microbiology*; D015897:Comorbidity; D004267:DNA Viruses / Q000302:isolation & purification; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006760:Hospitalization; D006801:Humans; D007124:Immunoenzyme Techniques; D007730:Kuwait / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D011024:Pneumonia, Viral / Q000188:drug therapy / Q000401:mortality / Q000821:virology*; D012328:RNA Viruses / Q000302:isolation & purification; D012720:Severity of Illness Index; D013183:Sputum / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents