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Adult Pneumonia in a General Hospital: Etiology and Host Risk Factors

Adult Pneumonia in a General Hospital: Etiology and Host Risk Factors Abstract Adult patients admitted to the medical service of a city-county hospital for treatment of presumptive acute pneumonia were followed up in a prospective study of pneumonia etiology from July 1, 1967, to June 30, 1968. Laboratory specimens were tested for bacterial, mycoplasmal, and viral agents, and results, supported by serologic data, were evaluated. Of 292 cases of pneumonia, 167 (57%) could be attributed to specific bacterial pathogens. The pneumococcus was the most frequent etiologic agent (62%), gram-negative bacilli the second most frequent (20%), and Staphylococcus aureus the third (10%). Viral infections other than influenza appeared to be unrelated to adult pneumonias. Four fifths of the patients had one or more associated diseases. Overall mortality was 24%. An age of 40 years and over and gram-negative bacillus or staphylococcal etiology were identified as mortality risk factors. References 1. Bath JCJL, Boissard GPB, Calder MA, et al: Pneumonia in hospital practice in Edinburgh. Brit J Dis Chest 58:1-16, 1964.Crossref 2. Evans AS, Brobst M: Bronchitis, pneumonitis and pneumonia in University of Wisconsin students. New Eng J Med 265:401-409, 1961.Crossref 3. Fiala M: A study of the combined role of viruses, mycoplasmas, and bacteria in adult pneumonia. Amer J Med Sci 257:44-51, 1969.Crossref 4. Holland WW, Tanner EI, Pereira MS, et al: A study of the aetiology of respiratory disease in a general hospital. Brit Med J 1:1917-1922, 1960.Crossref 5. Loda FM, Clyde WA Jr, Glezen WP, et al: Studies on the role of viruses, bacteria, and M. pneumoniae as causes of lower respiratory tract infections in children. J Pediat 72:161-176, 1968.Crossref 6. Mufson MA, Chang V, Gill V, et al: The role of viruses, mycoplasmas, and bacteria in acute pneumonia in civilian adults. Amer J Epidem 86:526-544, 1967. 7. Provisional statistics, annual summary for the United States, 1968: Births, deaths, marriages, and divorces , in Monthly Vital Statistics , report 17, No. 13. National Center for Health Statistics, 1969. 8. Heffron R: Pneumonia: With Special Reference to Pneumococcus Lobar Pneumonia . New York, The Commonwealth Fund, 1939. 9. Forsyth BR, Bloom HH, Johnson KM, et al: Etiology of primary atypical pneumonia in military population. JAMA 191:364-368, 1965.Crossref 10. Miller LF, Rytel M, Pierce WE, et al: Epidemiology of nonbacterial pneumonia among naval recruits. JAMA 185:92-99, 1963.Crossref 11. Portnoy B, Eckert HL, Hanes B, et al: Multiple respiratory virus infections in hospitalized children. Amer J Epidem 82:262-272, 1965. 12. Lepow ML, Balassanian N, Emmerich J, et al: Interrelationships of viral, mycoplasmal, and bacterial agents in uncomplicated pneumonia. Amer Rev Resp Dis 97:533-545, 1968. 13. Kraybill WH, Crawford YE: A selective medium and color test for Mycoplasma pneumoniae. Proc Soc Exp Biol Med 118:965-970, 1965.Crossref 14. Standardized diagnostic complement fixation method and adaption to micro test. Public Health Service monograph 74, 1965. 15. Dowdle WR, Robinson RQ: An indirect hemagglutination test for diagnosis of Mycoplasma pneumoniae infection. Proc Soc Exp Biol Med 116:947-950, 1964.Crossref 16. Robinson RQ, Dowdle WR: Influenza viruses , in Lennette EH, Schmidt NJ (eds): Diagnostic Procedures for Viral and Rickettsial Infections . New York, APHA Inc, 1969, pp 414-433. 17. Hierholzer JC, Suggs MT, Hall EC: Standardized viral hemagglutination and hemagglutination-inhibition tests: II. Description and statistical evaluation. Appl Microbiol 18:824-833, 1969. 18. Bailey WR, Scott EG: Diagnostic Microbiology , ed 2. St. Louis, CV Mosby Co, 1966. 19. Bauer AW, Kirby WMM, Sherris JC, et al: Antibiotic susceptibility testing by a standardized single disk method. Amer J Clin Path 45:493-496, 1966. 20. Buddingh GJ: Bacterial dynamics in combined infection: A study of the population dynamics of strains of Hemophilus influenzae type B in combined infection with influenza C virus in embryonated eggs. Amer J Path 43:407-418, 1963. 21. Buddingh GJ, Al-Talib AM, Pipes FJ: Combined viral and bacterial infection: An in vitro analysis of the population dynamics and factors influencing the enhancement of virulence of Hemophilus influenzae in combined infection with influenza virus in embryonated eggs. Amer J Path 49:353-363, 1966. 22. Burnet FM: The pathogenesis of virus disease , in Principles of Animal Virology , ed 2. New York, Academic Press Inc, 1960, p 211. 23. Gerone PJ, Ward TG, Chappell WA: Combined infections in mice with influenza virus and Diplococcus pneumoniae. Amer J Hyg 66:331-341, 1957. 24. Glover RE: Spread of infection from the respiratory tract of the ferret: II. Association of influenza A virus and Streptococcus group C. Brit J Exp Path 22:98-107, 1941. 25. Harford CG, Leidler V, Hara M: Effect of the lesion due to influenza virus on the resistance of mice to inhaled pneumococci. J Exp Med 89:53-68, 1949.Crossref 26. Janssen RJ, Chappell WA, Gerone PJ: Synergistic activity between PR8 influenza virus and Staphylococcus aureus in the guinea pig. Amer J Hyg 78:275-284, 1963. 27. Kass EH, Green GM, Goldstein E: Mechanisms of antibacterial action in the respiratory system. Bact Rev 30:488-496, 1966. 28. Loosli CG: Synergism between respiratory viruses and bacteria. Yale J Biol Med 40:522-540, 1968. 29. Sellers TF Jr, Schulman J, Bouvier C, et al: The influence of influenza virus infection on exogenous staphylococcal and endogenous murine bacterial infection of the bronchopulmonary tissues of mice. J Exp Med 114:237-256, 1961.Crossref 30. Chanock RM, Mufson MA, Johnson KM: Comparative biology and ecology of human virus and mycoplasma respiratory pathogens. Progr Med Virol 7:208-252, 1965. 31. Chanock RM, Mufson MA, Bloom HH, et al: Eaton agent pneumonia. JAMA 175:213-220, 1961.Crossref 32. Hilleman MR, Hamparian VV, Ketler A, et al: Acute respiratory illnesses among children and adults: Field study of contemporary importance of several viruses and appraisal of the literature. JAMA 180:445-453, 1962.Crossref 33. Avery OT, Chickering HT, Cole R, et al: Acute lobar pneumonia: Prevention and serum treatment . New York, Rockefeller Institute for Medical Research, monograph 7, 1917. 34. Cecil RL, Baldwin HS, Larsen NP: Lobar pneumonia: A clinical and bacteriologic study of 2,000 typed cases. Arch Intern Med 40:253-280, 1927.Crossref 35. Sutliff WD, Finland M: The significance of the newly classified types of pneumococci in disease. JAMA 101:1289-1295, 1933.Crossref 36. Bullowa JGM, Wilcox C: Incidence of bacteremia in the pneumonias and its relation to mortality. Arch Intern Med 55:558-573, 1935.Crossref 37. Solomon S: Primary Friedlander pneumonia. JAMA 108:937-947, 1937.Crossref 38. Johanson WG, Pierce AK, Sanford JP: Changing pharyngeal bacterial flora of hospitalized patients: Emergence of gramnegative bacilli. New Eng J Med 281:1137-1140, 1969.Crossref 39. Green GM: Pulmonary clearance of infectious agents. Ann Rev Med 19:315-336, 1968.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Adult Pneumonia in a General Hospital: Etiology and Host Risk Factors

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Publisher
American Medical Association
Copyright
Copyright © 1972 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1972.00320060083010
Publisher site
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Abstract

Abstract Adult patients admitted to the medical service of a city-county hospital for treatment of presumptive acute pneumonia were followed up in a prospective study of pneumonia etiology from July 1, 1967, to June 30, 1968. Laboratory specimens were tested for bacterial, mycoplasmal, and viral agents, and results, supported by serologic data, were evaluated. Of 292 cases of pneumonia, 167 (57%) could be attributed to specific bacterial pathogens. The pneumococcus was the most frequent etiologic agent (62%), gram-negative bacilli the second most frequent (20%), and Staphylococcus aureus the third (10%). Viral infections other than influenza appeared to be unrelated to adult pneumonias. Four fifths of the patients had one or more associated diseases. Overall mortality was 24%. An age of 40 years and over and gram-negative bacillus or staphylococcal etiology were identified as mortality risk factors. References 1. Bath JCJL, Boissard GPB, Calder MA, et al: Pneumonia in hospital practice in Edinburgh. Brit J Dis Chest 58:1-16, 1964.Crossref 2. Evans AS, Brobst M: Bronchitis, pneumonitis and pneumonia in University of Wisconsin students. New Eng J Med 265:401-409, 1961.Crossref 3. Fiala M: A study of the combined role of viruses, mycoplasmas, and bacteria in adult pneumonia. Amer J Med Sci 257:44-51, 1969.Crossref 4. Holland WW, Tanner EI, Pereira MS, et al: A study of the aetiology of respiratory disease in a general hospital. Brit Med J 1:1917-1922, 1960.Crossref 5. Loda FM, Clyde WA Jr, Glezen WP, et al: Studies on the role of viruses, bacteria, and M. pneumoniae as causes of lower respiratory tract infections in children. J Pediat 72:161-176, 1968.Crossref 6. Mufson MA, Chang V, Gill V, et al: The role of viruses, mycoplasmas, and bacteria in acute pneumonia in civilian adults. Amer J Epidem 86:526-544, 1967. 7. Provisional statistics, annual summary for the United States, 1968: Births, deaths, marriages, and divorces , in Monthly Vital Statistics , report 17, No. 13. National Center for Health Statistics, 1969. 8. Heffron R: Pneumonia: With Special Reference to Pneumococcus Lobar Pneumonia . New York, The Commonwealth Fund, 1939. 9. Forsyth BR, Bloom HH, Johnson KM, et al: Etiology of primary atypical pneumonia in military population. JAMA 191:364-368, 1965.Crossref 10. Miller LF, Rytel M, Pierce WE, et al: Epidemiology of nonbacterial pneumonia among naval recruits. JAMA 185:92-99, 1963.Crossref 11. Portnoy B, Eckert HL, Hanes B, et al: Multiple respiratory virus infections in hospitalized children. Amer J Epidem 82:262-272, 1965. 12. Lepow ML, Balassanian N, Emmerich J, et al: Interrelationships of viral, mycoplasmal, and bacterial agents in uncomplicated pneumonia. Amer Rev Resp Dis 97:533-545, 1968. 13. Kraybill WH, Crawford YE: A selective medium and color test for Mycoplasma pneumoniae. Proc Soc Exp Biol Med 118:965-970, 1965.Crossref 14. Standardized diagnostic complement fixation method and adaption to micro test. Public Health Service monograph 74, 1965. 15. Dowdle WR, Robinson RQ: An indirect hemagglutination test for diagnosis of Mycoplasma pneumoniae infection. Proc Soc Exp Biol Med 116:947-950, 1964.Crossref 16. Robinson RQ, Dowdle WR: Influenza viruses , in Lennette EH, Schmidt NJ (eds): Diagnostic Procedures for Viral and Rickettsial Infections . New York, APHA Inc, 1969, pp 414-433. 17. Hierholzer JC, Suggs MT, Hall EC: Standardized viral hemagglutination and hemagglutination-inhibition tests: II. Description and statistical evaluation. Appl Microbiol 18:824-833, 1969. 18. Bailey WR, Scott EG: Diagnostic Microbiology , ed 2. St. Louis, CV Mosby Co, 1966. 19. Bauer AW, Kirby WMM, Sherris JC, et al: Antibiotic susceptibility testing by a standardized single disk method. Amer J Clin Path 45:493-496, 1966. 20. Buddingh GJ: Bacterial dynamics in combined infection: A study of the population dynamics of strains of Hemophilus influenzae type B in combined infection with influenza C virus in embryonated eggs. Amer J Path 43:407-418, 1963. 21. Buddingh GJ, Al-Talib AM, Pipes FJ: Combined viral and bacterial infection: An in vitro analysis of the population dynamics and factors influencing the enhancement of virulence of Hemophilus influenzae in combined infection with influenza virus in embryonated eggs. Amer J Path 49:353-363, 1966. 22. Burnet FM: The pathogenesis of virus disease , in Principles of Animal Virology , ed 2. New York, Academic Press Inc, 1960, p 211. 23. Gerone PJ, Ward TG, Chappell WA: Combined infections in mice with influenza virus and Diplococcus pneumoniae. Amer J Hyg 66:331-341, 1957. 24. Glover RE: Spread of infection from the respiratory tract of the ferret: II. Association of influenza A virus and Streptococcus group C. Brit J Exp Path 22:98-107, 1941. 25. Harford CG, Leidler V, Hara M: Effect of the lesion due to influenza virus on the resistance of mice to inhaled pneumococci. J Exp Med 89:53-68, 1949.Crossref 26. Janssen RJ, Chappell WA, Gerone PJ: Synergistic activity between PR8 influenza virus and Staphylococcus aureus in the guinea pig. Amer J Hyg 78:275-284, 1963. 27. Kass EH, Green GM, Goldstein E: Mechanisms of antibacterial action in the respiratory system. Bact Rev 30:488-496, 1966. 28. Loosli CG: Synergism between respiratory viruses and bacteria. Yale J Biol Med 40:522-540, 1968. 29. Sellers TF Jr, Schulman J, Bouvier C, et al: The influence of influenza virus infection on exogenous staphylococcal and endogenous murine bacterial infection of the bronchopulmonary tissues of mice. J Exp Med 114:237-256, 1961.Crossref 30. Chanock RM, Mufson MA, Johnson KM: Comparative biology and ecology of human virus and mycoplasma respiratory pathogens. Progr Med Virol 7:208-252, 1965. 31. Chanock RM, Mufson MA, Bloom HH, et al: Eaton agent pneumonia. JAMA 175:213-220, 1961.Crossref 32. Hilleman MR, Hamparian VV, Ketler A, et al: Acute respiratory illnesses among children and adults: Field study of contemporary importance of several viruses and appraisal of the literature. JAMA 180:445-453, 1962.Crossref 33. Avery OT, Chickering HT, Cole R, et al: Acute lobar pneumonia: Prevention and serum treatment . New York, Rockefeller Institute for Medical Research, monograph 7, 1917. 34. Cecil RL, Baldwin HS, Larsen NP: Lobar pneumonia: A clinical and bacteriologic study of 2,000 typed cases. Arch Intern Med 40:253-280, 1927.Crossref 35. Sutliff WD, Finland M: The significance of the newly classified types of pneumococci in disease. JAMA 101:1289-1295, 1933.Crossref 36. Bullowa JGM, Wilcox C: Incidence of bacteremia in the pneumonias and its relation to mortality. Arch Intern Med 55:558-573, 1935.Crossref 37. Solomon S: Primary Friedlander pneumonia. JAMA 108:937-947, 1937.Crossref 38. Johanson WG, Pierce AK, Sanford JP: Changing pharyngeal bacterial flora of hospitalized patients: Emergence of gramnegative bacilli. New Eng J Med 281:1137-1140, 1969.Crossref 39. Green GM: Pulmonary clearance of infectious agents. Ann Rev Med 19:315-336, 1968.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 1, 1972

References