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Prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis

OBJECTIVES: We aimed to summarise the prevalence of atypical pathogens in patients with severe pneumonia to understand the prevalence of severe pneumonia caused by atypical pathogens, improve clinical decision-making and guide antibiotic use. DESIGN: Systematic review and meta-analysis. DATA SOURCES...

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Autores principales: Wang, Sidan, Tang, Jiaoqi, Tan, Yurong, Song, Zhi, Qin, Ling
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10106036/
https://www.ncbi.nlm.nih.gov/pubmed/37041056
http://dx.doi.org/10.1136/bmjopen-2022-066721
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author Wang, Sidan
Tang, Jiaoqi
Tan, Yurong
Song, Zhi
Qin, Ling
author_facet Wang, Sidan
Tang, Jiaoqi
Tan, Yurong
Song, Zhi
Qin, Ling
author_sort Wang, Sidan
collection PubMed
description OBJECTIVES: We aimed to summarise the prevalence of atypical pathogens in patients with severe pneumonia to understand the prevalence of severe pneumonia caused by atypical pathogens, improve clinical decision-making and guide antibiotic use. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Embase, Web of Science and Cochrane Library were searched through November 2022. ELIGIBILITY CRITERIA: English language studies enrolled consecutive cases of patients diagnosed with severe pneumonia, with complete aetiological analysis. DATA EXTRACTION AND SYNTHESIS: We conducted literature retrieval on PubMed, Embase, Web of Science and The Cochrane Library to estimate the prevalence of Chlamydia, Mycoplasma and Legionella in patients with severe pneumonia. After double arcsine transformation of the data, a random-effects model was used for meta-analyses to calculate the pooled prevalence of each pathogen. Meta-regression analysis was also used to explore whether the region, different diagnostic method, study population, pneumonia categories or sample size were potential sources of heterogeneity. RESULTS: We included 75 eligible studies with 18 379 cases of severe pneumonia. The overall prevalence of atypical pneumonia is 8.1% (95% CI 6.3% to 10.1%) In patients with severe pneumonia, the pooled estimated prevalence of Chlamydia, Mycoplasma and Legionella was 1.8% (95% CI 1.0% to 2.9%), 2.8% (95% CI 1.7% to 4.3%) and 4.0% (95% CI 2.8% to 5.3%), respectively. We noted significant heterogeneity in all pooled assessments. Meta-regression showed that the pneumonia category potentially influenced the prevalence rate of Chlamydia. The mean age and the diagnostic method of pathogens were likely moderators for the prevalence of Mycoplasma and Legionella, and contribute to the heterogeneity of their prevalence. CONCLUSIONS: In severe pneumonia, atypical pathogens are notable causes, especially Legionella. The diagnostic method, regional difference, sample size and other factors contribute to the heterogeneity of prevalence. The estimated prevalence and relative heterogeneity factors can help with microbiological screening, clinical treatment and future research planning. PROSPERO REGISTRATION NUMBER: CRD42022373950.
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spelling pubmed-101060362023-04-17 Prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis Wang, Sidan Tang, Jiaoqi Tan, Yurong Song, Zhi Qin, Ling BMJ Open Respiratory Medicine OBJECTIVES: We aimed to summarise the prevalence of atypical pathogens in patients with severe pneumonia to understand the prevalence of severe pneumonia caused by atypical pathogens, improve clinical decision-making and guide antibiotic use. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Embase, Web of Science and Cochrane Library were searched through November 2022. ELIGIBILITY CRITERIA: English language studies enrolled consecutive cases of patients diagnosed with severe pneumonia, with complete aetiological analysis. DATA EXTRACTION AND SYNTHESIS: We conducted literature retrieval on PubMed, Embase, Web of Science and The Cochrane Library to estimate the prevalence of Chlamydia, Mycoplasma and Legionella in patients with severe pneumonia. After double arcsine transformation of the data, a random-effects model was used for meta-analyses to calculate the pooled prevalence of each pathogen. Meta-regression analysis was also used to explore whether the region, different diagnostic method, study population, pneumonia categories or sample size were potential sources of heterogeneity. RESULTS: We included 75 eligible studies with 18 379 cases of severe pneumonia. The overall prevalence of atypical pneumonia is 8.1% (95% CI 6.3% to 10.1%) In patients with severe pneumonia, the pooled estimated prevalence of Chlamydia, Mycoplasma and Legionella was 1.8% (95% CI 1.0% to 2.9%), 2.8% (95% CI 1.7% to 4.3%) and 4.0% (95% CI 2.8% to 5.3%), respectively. We noted significant heterogeneity in all pooled assessments. Meta-regression showed that the pneumonia category potentially influenced the prevalence rate of Chlamydia. The mean age and the diagnostic method of pathogens were likely moderators for the prevalence of Mycoplasma and Legionella, and contribute to the heterogeneity of their prevalence. CONCLUSIONS: In severe pneumonia, atypical pathogens are notable causes, especially Legionella. The diagnostic method, regional difference, sample size and other factors contribute to the heterogeneity of prevalence. The estimated prevalence and relative heterogeneity factors can help with microbiological screening, clinical treatment and future research planning. PROSPERO REGISTRATION NUMBER: CRD42022373950. BMJ Publishing Group 2023-04-11 /pmc/articles/PMC10106036/ /pubmed/37041056 http://dx.doi.org/10.1136/bmjopen-2022-066721 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Respiratory Medicine
Wang, Sidan
Tang, Jiaoqi
Tan, Yurong
Song, Zhi
Qin, Ling
Prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis
title Prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis
title_full Prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis
title_fullStr Prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis
title_full_unstemmed Prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis
title_short Prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis
title_sort prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis
topic Respiratory Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10106036/
https://www.ncbi.nlm.nih.gov/pubmed/37041056
http://dx.doi.org/10.1136/bmjopen-2022-066721
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