title: The Challenging Diagnosis of Non-Community-Acquired Pneumonia in Non-Mechanically Ventilated Subjects: Value of Microbiological Investigation.
abstract: BACKGROUND
  Early recognition and an attempt at obtaining microbiological documentation are recommended in patients with non-community-acquired pneumonia (NCAP), whether hospital-acquired (HAP) or health care-associated (HCAP). We aimed to characterize the clinical features and microbial etiologies of NCAP to assess the impact of microbiological investigation on their management.
  
  
  METHODS
  This was a prospective 1-y study in a university hospital with 141 non-mechanically ventilated subjects suspected of having HAP (n = 110) or HCAP (n = 31).
  
  
  RESULTS
  Clinical criteria alone poorly identified pneumonia (misdiagnosis in 50% of cases). Microbiological confirmation was achievable in 80 subjects (57%). Among 79 microorganisms isolated, 28 were multidrug-resistant aerobic Gram-negative bacilli and group III Enterobacteriaceae and 6 were methicillin-resistant Staphylococcus aureus. Multidrug-resistant aerobic Gram-negative bacilli accounted for one third of the microorganisms in early-onset HAP and for 50% in late-onset HAP. Methicillin-resistant S. aureus was most often recovered from subjects with HCAP. Inappropriate empirical antibiotics were administered to 36% of subjects with confirmed pneumonia. Forty subjects were admitted to the ICU, 13 (33%) of whom died. Overall, 39 subjects (28%) died in the hospital.
  
  
  CONCLUSIONS
  Integrating the microbiological investigation in the complex clinical diagnostic workup of patients suspected of having NCAP is mandatory. Respiratory tract specimens should be obtained whenever possible for appropriate management.
authors.affiliation: Service de Réanimation Médico-Chirurgicale, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, AP-HP, Colombes, France, Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, Paris, France, and INSERM, IAME, U1137, Paris, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Messika
authors.affiliation: Service de Réanimation Médico-Chirurgicale, Hôpital Tenon, AP-HP, Paris, France.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Stoclin
authors.affiliation: Service de Médecine Interne, Hôpital Tenon, AP-HP, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Bouvard
authors.affiliation: Service de Réanimation Médico-Chirurgicale, Hôpital Tenon, AP-HP, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Fulgencio
authors.affiliation: Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, AP-HP, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Ridel
authors.affiliation: Service de Neurologie, Hôpital Tenon, AP-HP, Paris, France.
authors.forename: Ioan-Paul
authors.initials: IP
authors.lastname: Muresan
authors.affiliation: Service de Néphrologie et Dialyse, Hôpital Tenon, AP-HP, Paris, France and Sorbonne Universités, UPMC Univ Paris 06, Paris, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Boffa
authors.affiliation: Service de Médecine Interne, Hôpital Tenon, AP-HP, Paris, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Bachmeyer
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hôpital Tenon, AP-HP, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Denis
authors.affiliation: Service de Pneumologie, Hôpital Tenon, AP-HP, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Gounant
authors.affiliation: Service d'Oncologie Médicale, Hôpital Tenon, AP-HP, Paris, France.
authors.forename: Adoracion
authors.initials: A
authors.lastname: Esteso
authors.affiliation: Service de Chirurgie Digestive, AP-HP, Hôpital Tenon, Paris, France.
authors.forename: Valeria
authors.initials: V
authors.lastname: Loi
authors.affiliation: Laboratoire de Bactériologie, Hôpital Tenon, AP-HP, Paris, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Verdet
authors.affiliation: Service de Réanimation Médico-Chirurgicale, Hôpital Tenon, AP-HP, and Sorbonne Universités, UPMC Univ Paris 06, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Prigent
authors.affiliation: Service de Réanimation Médico-Chirurgicale, Hôpital Tenon, AP-HP, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Parrot
authors.affiliation: Service de Réanimation Médico-Chirurgicale, Hôpital Tenon, AP-HP, and Sorbonne Universités, UPMC Univ Paris 06, Paris, France. muriel.fartoukh@tnn.aphp.fr.
authors.forename: Muriel
authors.initials: M
authors.lastname: Fartoukh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015373:Bacterial Typing Techniques; D003428:Cross Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D003951:Diagnostic Errors; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000302:isolation & purification; D005260:Female; D005602:France; D006088:Gram-Negative Aerobic Bacteria / Q000302:isolation & purification; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D011446:Prospective Studies; D012137:Respiratory System / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics; diagnosis; hospital-acquired pneumonia; multidrug-resistant microorganisms; nosocomial infection