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Correlation Between Cause and Severity or Comorbidity

Miquel Falguera, MD; Oscar Sacristán, MD; Antoni Nogués, MD; Agustín Ruiz-González, MD; Mercè García, MD; Anton Manonelles, MD; Manuel Rubio-Caballero, MD

Arch Intern Med. 2001;161:1866-1872.

Background  Community-acquired pneumonia frequently constitutes a nonsevere infection manageable at home. However, for these low-risk episodes, the epidemiological features have not been carefully analyzed.

Objectives  To determine the cause of nonsevere community-acquired pneumonia and to investigate if a correlation exists between cause and severity or comorbidity.

Methods  During a 3-year period, all patients with nonsevere community-acquired pneumonia, according to the Pneumonia Patient Outcome Research Team prognostic classification (patients in groups 1-3), were included in the study. Causes were investigated through the following procedures: cultures of blood, sputum, and pleural fluid; serologic tests; and polymerase chain reaction methods to detect Streptococcus pneumoniae DNA in whole blood or Mycoplasma pneumoniae and Chlamydia pneumoniae DNA in throat swab specimens.

Results  Of 317 initially included patients, 247 were eligible for the study. A microbial diagnosis was obtained in 162 patients (66%), and the main pathogens detected were S pneumoniae (69 patients [28%]), M pneumoniae (40 patients [16%]), and C pneumoniae (28 patients [11%]). For the 58 patients in prognostic group 1, M pneumoniae was the most prevalent cause, and atypical microorganisms constituted 40 (69%) of the isolated agents. In contrast, for patients in prognostic groups 2 and 3, S pneumoniae was the leading agent, and a significant reduction of M pneumoniae cases and a greater presence of other more uncommon pathogens were observed. The existence of comorbid conditions was not a determining factor for particular causes.

Conclusions  Among low-risk patients with community-acquired pneumonia, there was a certain correlation between severity and cause. In contrast, the existence of a comorbidity did not have a predictive causative value.

From the Departments of Internal Medicine (Drs Falguera, Sacristán, and Rubio-Caballero), Microbiology (Drs Nogués, García, and Manonelles), and Emergencies (Dr Ruiz-González), Hospital Universitari Arnau de Vilanova, Lleida, Spain.

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