title: Causative agent distribution and antibiotic therapy assessment among adult patients with community acquired pneumonia in Chinese urban population.
abstract: BACKGROUND
  Knowledge of predominant microbial patterns in community-acquired pneumonia (CAP) constitutes the basis for initial decisions about empirical antimicrobial treatment, so a prospective study was performed during 2003-2004 among CAP of adult Chinese urban populations.
  
  
  METHODS
  Qualified patients were enrolled and screened for bacterial, atypical, and viral pathogens by sputum and/or blood culturing, and by antibody seroconversion test. Antibiotic treatment and patient outcome were also assessed.
  
  
  RESULTS
  Non-viral pathogens were found in 324/610 (53.1%) patients among whom M. pneumoniae was the most prevalent (126/610, 20.7%). Atypical pathogens were identified in 62/195 (31.8%) patients carrying bacterial pathogens. Respiratory viruses were identified in 35 (19%) of 184 randomly selected patients with adenovirus being the most common (16/184, 8.7%). The nonsusceptibility of S. pneumoniae to penicillin and azithromycin was 22.2% (Resistance (R): 3.2%, Intermediate (I): 19.0%) and 79.4% (R: 79.4%, I: 0%), respectively. Of patients (312) from whom causative pathogens were identified and antibiotic treatments were recorded, clinical cure rate with beta-lactam antibiotics alone and with combination of a beta-lactam plus a macrolide or with fluoroquinolones was 63.7% (79/124) and 67%(126/188), respectively. For patients having mixed M. pneumoniae and/or C. pneumoniae infections, a better cure rate was observed with regimens that are active against atypical pathogens (e.g. a beta-lactam plus a macrolide, or a fluoroquinolone) than with beta-lactam alone (75.8% vs. 42.9%, p = 0.045).
  
  
  CONCLUSIONS
  In Chinese adult CAP patients, M. pneumoniae was the most prevalent with mixed infections containing atypical pathogens being frequently observed. With S. pneumoniae, the prevalence of macrolide resistance was high and penicillin resistance low compared with data reported in other regions.
authors.affiliation: Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing, PR China. liuyn@301hospital.com.cn
authors.forename: Youning
authors.initials: Y
authors.lastname: Liu
authors.forename: Minjun
authors.initials: M
authors.lastname: Chen
authors.forename: Tiemei
authors.initials: T
authors.lastname: Zhao
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.forename: Baiqiang
authors.initials: B
authors.lastname: Cai
authors.forename: Bin
authors.initials: B
authors.lastname: Cao
authors.forename: Tieying
authors.initials: T
authors.lastname: Sun
authors.forename: Yunjian
authors.initials: Y
authors.lastname: Hu
authors.forename: Qingyu
authors.initials: Q
authors.lastname: Xiu
authors.forename: Xin
authors.initials: X
authors.lastname: Zhou
authors.forename: Xing
authors.initials: X
authors.lastname: Ding
authors.forename: Lan
authors.initials: L
authors.lastname: Yang
authors.forename: Jiansheng
authors.initials: J
authors.lastname: Zhuo
authors.forename: Yingchun
authors.initials: Y
authors.lastname: Tang
authors.forename: Kouxing
authors.initials: K
authors.lastname: Zhang
authors.forename: Derong
authors.initials: D
authors.lastname: Liang
authors.forename: Xiaoju
authors.initials: X
authors.lastname: Lv
authors.forename: Shengqi
authors.initials: S
authors.lastname: Li
authors.forename: Yong
authors.initials: Y
authors.lastname: Liu
authors.forename: Yunsong
authors.initials: Y
authors.lastname: Yu
authors.forename: Zeqing
authors.initials: Z
authors.lastname: Wei
authors.forename: Kejing
authors.initials: K
authors.lastname: Ying
authors.forename: Feng
authors.initials: F
authors.lastname: Zhao
authors.forename: Ping
authors.initials: P
authors.lastname: Chen
authors.forename: Xiaona
authors.initials: X
authors.lastname: Hou
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D002681:China / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000821:virology; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology* / Q000821:virology; D011446:Prospective Studies; D014505:Urban Population; D014780:Viruses / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents