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Aetiological agents of adult community-acquired pneumonia in Japan: systematic review and meta-analysis of published data

OBJECTIVE: Epidemiological information is essential in providing appropriate empiric antimicrobial therapy for pneumonia. This study aimed to clarify the epidemiology of community-acquired pneumonia (CAP) by conducting a systematic review of published studies in Japan. DESIGN: Systematic review. DAT...

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Autores principales: Fujikura, Yuji, Somekawa, Kohei, Manabe, Toshie, Horita, Nobuyuki, Takahashi, Hiroshi, Higa, Futoshi, Yatera, Kazuhiro, Miyashita, Naoyuki, Imamura, Yoshifumi, Iwanaga, Naoki, Mukae, Hiroshi, Kawana, Akihiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10533802/
https://www.ncbi.nlm.nih.gov/pubmed/37751988
http://dx.doi.org/10.1136/bmjresp-2023-001800
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author Fujikura, Yuji
Somekawa, Kohei
Manabe, Toshie
Horita, Nobuyuki
Takahashi, Hiroshi
Higa, Futoshi
Yatera, Kazuhiro
Miyashita, Naoyuki
Imamura, Yoshifumi
Iwanaga, Naoki
Mukae, Hiroshi
Kawana, Akihiko
author_facet Fujikura, Yuji
Somekawa, Kohei
Manabe, Toshie
Horita, Nobuyuki
Takahashi, Hiroshi
Higa, Futoshi
Yatera, Kazuhiro
Miyashita, Naoyuki
Imamura, Yoshifumi
Iwanaga, Naoki
Mukae, Hiroshi
Kawana, Akihiko
author_sort Fujikura, Yuji
collection PubMed
description OBJECTIVE: Epidemiological information is essential in providing appropriate empiric antimicrobial therapy for pneumonia. This study aimed to clarify the epidemiology of community-acquired pneumonia (CAP) by conducting a systematic review of published studies in Japan. DESIGN: Systematic review. DATA SOURCE: PubMed and Ichushi web database (January 1970 to October 2022). ELIGIBILITY CRITERIA: Clinical studies describing pathogenic micro-organisms in CAP written in English or Japanese, excluding studies on pneumonia other than adult CAP, investigations limited to specific pathogens and case reports. DATA EXTRACTION AND SYNTHESIS: Patient setting (inpatient vs outpatient), number of patients, concordance with the CAP guidelines, diagnostic criteria and methods for diagnosing pneumonia pathogens as well as the numbers of each isolate. A meta-analysis of various situations was performed to measure the frequency of each aetiological agent. RESULTS: Fifty-six studies were included and 17 095 cases of CAP were identified. Pathogens were undetectable in 44.1% (95% CI 39.7% to 48.5%). Streptococcus pneumoniae was the most common cause of CAP requiring hospitalisation or outpatient care (20.0% (95% CI 17.2% to 22.8%)), followed by Haemophilus influenzae (10.8% (95% CI 7.3% to 14.3%)) and Mycoplasma pneumoniae (7.5% (95% CI 4.6% to 10.4%)). However, when limited to CAP requiring hospitalisation, Staphylococcus aureus was the third most common at 4.9% (95% CI 3.9% to 5.8%). Pseudomonas aeruginosa was more frequent in hospitalised cases, while atypical pathogens were less common. Methicillin-resistant S. aureus accounted for 40.7% (95% CI 29.0% to 52.4%) of S. aureus cases. In studies that used PCR testing for pan-respiratory viral pathogens, human enterovirus/human rhinovirus (9.4% (95% CI 0% to 20.5%)) and several other respiratory pathogenic viruses were detected. The epidemiology varied depending on the methodology and situation. CONCLUSION: The epidemiology of CAP varies depending on the situation, such as in the hospital versus outpatient setting. Viruses are more frequently detected by exhaustive genetic searches, resulting in a significant variation in epidemiology.
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spelling pubmed-105338022023-09-29 Aetiological agents of adult community-acquired pneumonia in Japan: systematic review and meta-analysis of published data Fujikura, Yuji Somekawa, Kohei Manabe, Toshie Horita, Nobuyuki Takahashi, Hiroshi Higa, Futoshi Yatera, Kazuhiro Miyashita, Naoyuki Imamura, Yoshifumi Iwanaga, Naoki Mukae, Hiroshi Kawana, Akihiko BMJ Open Respir Res Respiratory Infection OBJECTIVE: Epidemiological information is essential in providing appropriate empiric antimicrobial therapy for pneumonia. This study aimed to clarify the epidemiology of community-acquired pneumonia (CAP) by conducting a systematic review of published studies in Japan. DESIGN: Systematic review. DATA SOURCE: PubMed and Ichushi web database (January 1970 to October 2022). ELIGIBILITY CRITERIA: Clinical studies describing pathogenic micro-organisms in CAP written in English or Japanese, excluding studies on pneumonia other than adult CAP, investigations limited to specific pathogens and case reports. DATA EXTRACTION AND SYNTHESIS: Patient setting (inpatient vs outpatient), number of patients, concordance with the CAP guidelines, diagnostic criteria and methods for diagnosing pneumonia pathogens as well as the numbers of each isolate. A meta-analysis of various situations was performed to measure the frequency of each aetiological agent. RESULTS: Fifty-six studies were included and 17 095 cases of CAP were identified. Pathogens were undetectable in 44.1% (95% CI 39.7% to 48.5%). Streptococcus pneumoniae was the most common cause of CAP requiring hospitalisation or outpatient care (20.0% (95% CI 17.2% to 22.8%)), followed by Haemophilus influenzae (10.8% (95% CI 7.3% to 14.3%)) and Mycoplasma pneumoniae (7.5% (95% CI 4.6% to 10.4%)). However, when limited to CAP requiring hospitalisation, Staphylococcus aureus was the third most common at 4.9% (95% CI 3.9% to 5.8%). Pseudomonas aeruginosa was more frequent in hospitalised cases, while atypical pathogens were less common. Methicillin-resistant S. aureus accounted for 40.7% (95% CI 29.0% to 52.4%) of S. aureus cases. In studies that used PCR testing for pan-respiratory viral pathogens, human enterovirus/human rhinovirus (9.4% (95% CI 0% to 20.5%)) and several other respiratory pathogenic viruses were detected. The epidemiology varied depending on the methodology and situation. CONCLUSION: The epidemiology of CAP varies depending on the situation, such as in the hospital versus outpatient setting. Viruses are more frequently detected by exhaustive genetic searches, resulting in a significant variation in epidemiology. BMJ Publishing Group 2023-09-26 /pmc/articles/PMC10533802/ /pubmed/37751988 http://dx.doi.org/10.1136/bmjresp-2023-001800 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 Infection
Fujikura, Yuji
Somekawa, Kohei
Manabe, Toshie
Horita, Nobuyuki
Takahashi, Hiroshi
Higa, Futoshi
Yatera, Kazuhiro
Miyashita, Naoyuki
Imamura, Yoshifumi
Iwanaga, Naoki
Mukae, Hiroshi
Kawana, Akihiko
Aetiological agents of adult community-acquired pneumonia in Japan: systematic review and meta-analysis of published data
title Aetiological agents of adult community-acquired pneumonia in Japan: systematic review and meta-analysis of published data
title_full Aetiological agents of adult community-acquired pneumonia in Japan: systematic review and meta-analysis of published data
title_fullStr Aetiological agents of adult community-acquired pneumonia in Japan: systematic review and meta-analysis of published data
title_full_unstemmed Aetiological agents of adult community-acquired pneumonia in Japan: systematic review and meta-analysis of published data
title_short Aetiological agents of adult community-acquired pneumonia in Japan: systematic review and meta-analysis of published data
title_sort aetiological agents of adult community-acquired pneumonia in japan: systematic review and meta-analysis of published data
topic Respiratory Infection
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10533802/
https://www.ncbi.nlm.nih.gov/pubmed/37751988
http://dx.doi.org/10.1136/bmjresp-2023-001800
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