title: The aetiology of community-acquired pneumonia and implications for patient management.
abstract: OBJECTIVE
  Understanding which pathogens are associated with clinical manifestation of community-acquired pneumonia (CAP) is important to optimise treatment. We performed a study on the aetiology of CAP and assessed possible implications for patient management in the Netherlands.
  
  
  METHODS
  Patients with CAP attending the emergency department of a general hospital were invited to participate in the study. We used an extensive combination of microbiological techniques to determine recent infection with respiratory pathogens. Furthermore, we collected data on clinical parameters and potential risk factors.
  
  
  RESULTS
  From November 2007 through January 2010, 339 patients were included. Single bacterial infection was found in 39% of these patients, single viral infection in 12%, and mixed bacterial-viral infection in 11%. Streptococcus pneumoniae was the most frequently identified pathogen (22%; n=74). Infection with atypical bacteria was detected in 69 (20%) of the patients.
  
  
  CONCLUSIONS
  Initial empirical antibiotics should be effective against S. pneumoniae, the most common pathogen identified in CAP patients. The large proportion of patients with infection with atypical bacteria points to the need for improved diagnostic algorithms including atypical bacteria, especially since these atypical bacteria are not covered by the first-choice antibiotic treatment according to the recently revised Dutch guidelines on the management of CAP.
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: A B
authors.initials: AB
authors.lastname: van Gageldonk-Lafeber
authors.forename: P C
authors.initials: PC
authors.lastname: Wever
authors.forename: I M
authors.initials: IM
authors.lastname: van der Lubben
authors.forename: C P C
authors.initials: CP
authors.lastname: de Jager
authors.forename: A
authors.initials: A
authors.lastname: Meijer
authors.forename: M C
authors.initials: MC
authors.lastname: de Vries
authors.forename: K
authors.initials: K
authors.lastname: Elberse
authors.forename: M A B
authors.initials: MA
authors.lastname: van der Sande
authors.forename: W
authors.initials: W
authors.lastname: van der Hoek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology / Q000821:virology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D011024:Pneumonia, Viral / Q000188:drug therapy / Q000821:virology*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents