title: Microbiological diagnosis and antibiotic therapy in patients with community-acquired pneumonia and acute COPD exacerbation in daily clinical practice: comparison to current guidelines.
abstract: BACKGROUND
  The aim of this secondary analysis was to evaluate current microbiological approaches, microbiology, and antibiotic therapy in patients with community-acquired pneumonia (CAP) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in clinical practice and to compare them with current international guidelines.
  
  
  METHODS
  A total of 362 patients with suspected CAP were enrolled in 14 European centers in a prospective multicenter study.
  
  
  RESULTS
  A total of 279 inpatients (CAP, n = 222; AECOPD, n = 57) were evaluated. A total of 83 (37 %) CAP patients and 25 (44 %) AECOPD patients did not undergo any microbiological tests. In patients with CAP/AECOPD, blood culture was performed in 109 (49 %)/16 (28.1 %), urinary antigen tests for Legionella pneumophila in 67 (30 %)/9 (16 %), and sputum investigation in 55 (25 %)/17 (30 %), respectively. The most frequent pathogens in CAP were Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, L. pneumophila, Staphylococcus aureus, and Enterobacter cloacae; in AECOPD they were Escherichia coli, Haemophilus haemolyticus, Haemophilus influenzae, and Moraxella catarrhalis. All CAP patients (mean = 11.1 days) and 35 (61.4 %) of AECOPD patients (mean = 8.9 days) received antibiotics. CAP patients were given mostly aminopenicillin with β-lactamase inhibitors and AECOPD patients were given mostly cephalosporins.
  
  
  CONCLUSIONS
  Pathogens isolated in CAP and AECOPD and the antibiotic therapy used are in good accordance with the guidelines. Blood culture, recommended for all CAP patients, was performed in only 50 % of the cases and antibiotic therapy lasted longer than the suggested 5-7 days. Therefore, international guidelines regarding performance of blood culture and duration of antibiotic therapy should be adopted more often. This duration was independent of the number of isolated pathogens and number of symptoms on admission. Therefore, the question arises as to whether microbiological data are necessary only for patients who are resistant to initial therapy.
authors.affiliation: Department of Internal Medicine I, Pneumology & Allergology, Jena University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07740 Jena, Germany. angelika.reissig@med.uni-jena.de
authors.forename: Angelika
authors.initials: A
authors.lastname: Reissig
authors.forename: Christine
authors.initials: C
authors.lastname: Mempel
authors.forename: Ulrike
authors.initials: U
authors.lastname: Schumacher
authors.forename: Roberto
authors.initials: R
authors.lastname: Copetti
authors.forename: Florian
authors.initials: F
authors.lastname: Gross
authors.forename: Stefano
authors.initials: S
authors.lastname: Aliberti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000592:standards; D001431:Bacteriological Techniques / Q000592:standards; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D018450:Disease Progression; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D005060:Europe; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
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