title: Microbial pathogens of adult community-acquired pneumonia in Southern Estonia.
abstract: Prospective analysis of the etiology of community-acquired pneumonia in 209 inpatients (mean age 56.2+/-11.2 years) was performed at the Lung Hospital of Tartu University, Estonia. Majority of the patients (87.6%) had at least one significant modifying or risk factor and 30.6% had severe community-acquired pneumonia. Streptococcus pneumoniae, beta-hemolytic streptococci, Klebsiella pneumoniae, and Moraxella catarrhalis were the most frequent pathogens (22.0, 12.2, 11.4, and 10.2%, respectively). Combined etiology was detected in 17.2%. Gram-negative pathogens prevailed over gram-positives and were significantly more frequent in patients aged > or =60 years (p=0.002) as in those with underlying diseases (p=0.01). An age of > or =60 years and previous antibacterial therapy were significant risk factors for Klebsiella pneumoniae as a pathogen (p=0.005 and p=0.002, respectively). Susceptibility of Streptococcus pneumoniae to penicillin, erythromycin, and doxycycline was 79.5, 90.2, and 100%, respectively, whereas all penicillin-resistant isolates were cefuroxime- and ceftriaxone-susceptible. Klebsiella pneumoniae was 100, 88.5, 84.2, and 81.8% susceptible to ceftazidime, gentamicin, ampicillin-sulbactam, and ciprofloxacin, and Moraxella catarrhalis was 100, 100, 100, 93.8, and 93.3% susceptible to ampicillin-sulbactam, cephalexin, ceftriaxone, ciprofloxacin, and erythromycin, respectively. In conclusion, Streptococcus pneumoniae, Moraxella catarrhalis, and Klebsiella pneumoniae were the major pathogens of community-acquired pneumonia in Southern Estonia. Although gram-negatives were more prevalent, the major pathogens were favorably susceptible without a noticeable cross-resistance. Nevertheless, improved surveillance studies are needed because of a pressure for the rise in antibiotic resistance in the society.
authors.affiliation: Department of Pulmonary Medicine, University of Tartu, Tartu, Estonia.
authors.forename: Helle
authors.initials: H
authors.lastname: Leesik
authors.forename: Ulle
authors.initials: U
authors.lastname: Ani
authors.forename: Anneli
authors.initials: A
authors.lastname: Juhani
authors.forename: Alan
authors.initials: A
authors.lastname: Altraja
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001419:Bacteria / Q000187:drug effects*; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D003627:Data Interpretation, Statistical; D024881:Drug Resistance, Bacterial; D004957:Estonia; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D001936:Moraxella catarrhalis / Q000187:drug effects; D010403:Penicillin Resistance; D018410:Pneumonia, Bacterial / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology*; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents