title: Microbiology and outcomes of community acquired pneumonia in non cystic-fibrosis bronchiectasis patients.
abstract: BACKGROUND
  It is general belief that Non-cystic fibrosis bronchiectasis (NCFB) is characterized by frequent community-acquired pneumonia. Nonetheless, the knowledge on clinical characteristics of CAP in NCFBE is poor and no specific recommendations are available. We aim to investigate clinical and microbiological characteristics of NCFBE patients with CAP.
  
  
  METHODS
  Prospective observational study of 3495 CAP patients (2000-2011).
  
  
  RESULTS
  We found 90 (2.0%) NCFBE-CAP that in comparison with non-bronchiectatic CAP (n, 3405) showed older age (mean ± [SD], NCFBE-CAP 73 ± 14 vs. CAP 65 ± 19yrs), more vaccinations (pneumococcal: 35% vs. 14%; influenza: 60% vs. 42%), comorbidities (n ≥ 2: 43% vs. 25%), previous antibiotics (38% vs. 22%), and inhaled steroids (53% vs. 16%) (p < 0.05 each). Streptococcus pneumoniae was the most frequent isolate in both groups (NCFBE-CAP 44.4% vs. CAP 42.7%; p = 0.821) followed by respiratory virus, mixed infections and atypical bacteria. Considering overall frequencies of the main pathogens (including monomicrobial and mixed infections) Pseudomonas aeruginosa (15.5% vs. 2.9%; p < 0.001) and Enterobacteriaceae (8.8% vs. 2.4%; p = 0.025) were more prevalent in NCFBE-CAP patients than in CAP. Despite these clinical and microbiological differences, NCFBE-CAP showed similar outcomes to CAP patients (mortality, length of hospital stay, etc.).
  
  
  CONCLUSIONS
  NCFBE-CAP patients are usually older and have more comorbidities but similar outcomes than general CAP population. Usual CAP pathogens, such as S. pneumoniae, are also involved in NCFBE-CAP but P. aeruginosa and other Enterobacteriaceae were globally more frequent than in CAP. Therefore, a wide microbiological investigation should be recommended in all NCFBE-CAP cases as well as routine pneumococcal vaccination for prevention of pneumonia.
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Polverino
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Catia
authors.initials: C
authors.lastname: Cilloniz
authors.affiliation: Department of Pneumology, Hospital La Fe Valencia, Ciber de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Menendez
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Gabarrus
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Edmundo
authors.initials: E
authors.lastname: Rosales-Mayor
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Alcaraz
authors.affiliation: Respiratory Unit, San Paolo Hospital, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Terraneo
authors.affiliation: Department of Microbiology, Hospital Clinic of Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Puig de la Bella Casa
authors.affiliation: Department of Infectious Disease, Hospital Clinic of Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Spain. Electronic address: atorres@clinic.ub.es.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001987:Bronchiectasis / Q000150:complications*; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology / Q000821:virology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology / Q000821:virology; D011446:Prospective Studies
keywords: Community-acquired pneumonia; Etiology; Non-cystic fibrosis bronchiectasis