Adults with symptoms of pneumonia : a prospective comparison of patients with and without infiltrates on chest radiography

• Published in: Clinical Microbiology and Infection
• Main Authors: Rögnvaldsson, Kristján Godsk, Bjarnason, Agnar, Ólafsdóttir, Inga Sif, Helgason, Kristján Orri, Guðmundsson, Aðalsteinn, Gottfreðsson, Magnús
• Other Authors: Faculty of Medicine, Other departments, University of Iceland
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2023
• Subjects: Smitsjúkdómalæknisfræði; Lungnalæknisfræði; Öldrunarlæknisfræði; Chest x-ray; Community-acquired pneumonia; Lower respiratory tract infections; Population-based; Prospective-study; Humans; Male; Viruses; Community-Acquired Infections/diagnostic imaging; Hospitalization; Streptococcus pneumoniae; Radiography; Adult; Female; Aged; Pneumonia/diagnostic imaging; Microbiology (medical); Infectious Diseases; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/4385; https://doi.org/10.1016/j.cmi.2022.07.013

Funding Information: The authors thank the staff at the emergency wards of Landspitali–The National University Hospital of Iceland for assistance with patient recruitment and Salvör Rafnsdóttir for her contribution in terms of patient recruitment. Funding Information: This work was supported by The Icelandic Centre for Research (Rannís) (grant number 217716-051), The Doctoral Grants of The University of Iceland Research Fund, The Scientific fund of Landspitali- The National University Hospital of Iceland, The Scandinavian Society for Antimicrobial Chemotherapy Foundation, and the Foundation of St. Josef's Hospital. The funding sources had no role in the study's design, conduct or reporting. Publisher Copyright: © 2022 The Author(s) OBJECTIVE: Most studies on patients hospitalized with community-acquired pneumonia (CAP) require confirmation of an infiltrate by chest radiography, but in practice admissions are common among patients with symptoms of pneumonia without an infiltrate (SPWI). The aim of this research was to compare clinical characteristics, microbial etiology, and outcomes among patients with CAP and SPWI. METHODS: Adults suspected of CAP were prospectively recruited at Landspitali University Hospital over a 1-year period, 2018 to 2019. The study was population based. Those admitted with two or more of the following symptoms were invited to participate: temperature ≥38°C or ≤36°C, sweating, shaking/chills, chest pain, a new cough, or new onset of dyspnea. Primary outcome was mortality at 30 days and one year. RESULTS: Six hundred twenty-five cases were included, 409 with CAP and 216 with SPWI; median age was 75 (interquartile range [IQR] 64-84) and 315 (50.4%) were females. Patients with CAP were more likely to have fever (≥38.0°C) (66.9% [273/408]) vs. 49.3% (106/215), p < 0.001), a higher CRP (median 103 [IQR 34-205] vs. 55 (IQR 17-103), p < 0.001), identification of Streptococcus pneumoniae (18.0% [64/355]) vs. 6.3% (10/159) of tested, p = 0.002) and to receive antibacterial treatment (99.5% ...