The Burden and Etiology of Community-Onset Pneumonia in the Aging Japanese Population: A Multicenter Prospective Study

Background: The increasing burden of pneumonia in adults is an emerging health issue in the era of global population aging. This study was conducted to elucidate the burden of community-onset pneumonia (COP) and its etiologic fractions in Japan, the world\u27s most aged society. Methods: A multicenter prospective surveillance for COP was conducted from September 2011 to January 2013 in Japan. All pneumonia patients aged ?15 years, including those with community-acquired pneumonia (CAP) and health care-associated pneumonia (HCAP), were enrolled at four community hospitals on four major islands. The COP burden was estimated based on the surveillance data and national statistics. Results: A total of 1,772 COP episodes out of 932,080 hospital visits were enrolled during the surveillance. The estimated overall incidence rates of adult COP, hospitalization, and in-hospital death were 16.9 (95% confidence interval, 13.6 to 20.9), 5.3 (4.5 to 6.2), and 0.7 (0.6 to 0.8) per 1,000 person-years (PY), respectively. The incidence rates sharply increased with age; the incidence in people aged ?85 years was 10-fold higher than that in people aged 15-64 years. The estimated annual number of adult COP cases in the entire Japanese population was 1,880,000, and 69.4% were aged ?65 years. Aspiration-associated pneumonia (630,000) was the leading etiologic category, followed by Streptococcus pneumoniae-associated pneumonia (530,000), Haemophilus influenzae-associated pneumonia (420,000), and respiratory virus-associated pneumonia (420,000), including influenza-associated pneumonia (30,000)

High Incidence of Community-Acquired Pneumonia among Rapidly Aging Population in Japan: A Prospective Hospital-Based Surveillance

The age-group-specific incidence and etiological patterns of community-acquired pneumonia (CAP) have not been fully established in Japan. A 2-year prospective surveillance was conducted in Kochi city, Western Japan. All CAP patients aged ?15 years who visited a community-based hospital were enrolled in the study. Clinical samples were examined by conventional bacterial culture and urinary antigen tests, and 6 bacterial pathogens and 16 respiratory viruses were identified from sputum samples by multiplex polymerase chain reaction assays. The age-group-specific incidence of CAP was estimated using a population-based data set of the total number of outpatients in the whole city. Ninety of the 131 enrolled patients, 68.7zwere positive for respiratory pathogens. Streptococcus pneumoniae was the leading bacterial pathogen identified (28.2z). Respiratory viruses were identified in 36 patients (27.5z), and human entero-rhinovirus was the most common (13.3z) among them. The estimated overall incidence of adult CAP in Kochi was 9.6 per 1,000 person-years (PY); the estimated age group-specific incidence was 3.4, 10.7, and 42.9 per 1,000 PY for those aged 15-64, 65-74, and ?75 years, respectively. The high incidence of CAP in these rural city of Japan, probably reflects the substantial aged population. S. pneumoniae and respiratory viruses play important roles in CAP in all age groups

Estimated annual incidence rates (per 1,000 people) of community-onset pneumonia (COP) in Japanese adults by clinical category, 2012.

<p>CAP = community-acquired pneumonia; CI = confidence interval; HCAP = health care-associated pneumonia; PDR = potentially drug-resistant; RV = respiratory virus.</p><p>*The WHO standardized population was used.</p><p>^†Positivity was defined when a sputum culture, sputum PCR, or urinary antigen test showed a positive result.</p><p>^‡Positivity was defined when a sputum culture or urinary antigen test showed a positive result.</p><p>^§Positivity was defined when a sputum culture or sputum PCR showed a positive result.</p><p>^¶Positivity was defined when a sputum culture showed a positive result.</p><p>^#PDR bacterial pathogens, including methicillin-resistant <i>Staphylococcus aureus</i>, extended spectrum beta lactamase-producing gram-negative bacilli, <i>Pseudomonas aeruginosa</i>, and <i>Stenotrophomonas maltophilia</i></p><p>Estimated annual incidence rates (per 1,000 people) of community-onset pneumonia (COP) in Japanese adults by clinical category, 2012.</p

Microbiological profiles of patients with community-onset pneumonia.

<p>HRV = human rhinovirus; RSV <i>=</i> respiratory syncytial virus; HMPV = human metapneumovirus</p><p>* Positive rates were compared between outpatients and inpatients using chi-square tests unless otherwise indicated.</p><p>^† Fisher's exact test was performed.</p><p>^‡Other RVs included HPIV2 (n = 10), HPIV3 (n = 10), HPIV1 (n = 9), influenza B (n = 6), HCoV (human coronavirus) (n = 4), and HAdV (human adenovirus) (n = 4).</p><p>Microbiological profiles of patients with community-onset pneumonia.</p

Demographic and clinical characteristics of patients with community-onset pneumonia in Japan.

<p>* Characteristics were compared between outpatients and inpatients using chi-square tests unless otherwise indicated.</p><p>^† A score test for trend was performed.</p><p>^‡ Underlying diseases included diabetes mellitus, hypertension, hyperlipidemia, chronic heart disease, cerebrovascular disease, liver disease, renal disease, collagen vascular disease, chronic lung disease, neuromuscular disease, and malignant disease.</p><p>^§ The period from onset to hospital visit.</p><p>^¶ Fisher’s exact test was performed.</p><p>Demographic and clinical characteristics of patients with community-onset pneumonia in Japan.</p

Тагильский рабочий. 2018. № 050

Background: Various viruses are known to be associated with pneumonia. However, the impact of viral infections on adult pneumonia mortality remains unclear. This study aimed to clarify the effect of virus infection on pneumonia mortality among adults stratified by virus type and patient comorbidities. Methods: This multicentre prospective study enrolled pneumonia patients aged ≥15 years from September 2011 to August 2014. Sputum samples were tested by in-house multiplex polymerase chain reaction assays to identify 13 respiratory viruses. Viral infection status and its effect on in-hospital mortality were examined by age group and comorbidity status. Results: A total of 2617 patients were enrolled in the study and 77.8% was aged ≥65 years. 574 (21.9%) did not have comorbidities, 790 (30.2%) had chronic respiratory disease, and 1253 (47.9%) had other comorbidities. Viruses were detected in 605 (23.1%) patients. Human rhinovirus (9.8%) was the most frequently identified virus, followed by influenza A (3.9%) and respiratory syncytial virus (3.9%). Respiratory syncytial virus was more frequently identified in patients with chronic respiratory disease (4.7%) than those with other comorbidities (4.2%) and without comorbidities (2.1%) (p = 0.037). The frequencies of other viruses were almost identical between the three groups. Virus detection overall was not associated with increased mortality (adjusted risk ratio (ARR) 0.76, 95% CI 0.53-1.09). However, influenza virus A and B were associated with three-fold higher mortality in patients with chronic respiratory disease but not with other comorbidities (ARR 3.38, 95% CI 1.54-7.42). Intriguingly, paramyxoviruses were associated with dramatically lower mortality in patients with other comorbidities (ARR 0.10, 95% CI 0.01-0.70) but not with chronic respiratory disease. These effects were not affected by age group. Conclusions: The impact of virus infections on pneumonia mortality varies by virus type and comorbidity status in adults

Estimated annual burden of community-onset pneumonia in Japanese adults by clinical and etiological category, 2012.

<p>CAP = community-acquired pneumonia; CI = confidence interval; HCAP = health care-associated pneumonia; HI = <i>H</i>. <i>influenzae</i>; PDR = potentially drug-resistant; RV = respiratory virus; SP = <i>S</i>. <i>pneumoniae</i>. Maximum estimates are shown for SP- and HI-associated pneumonia.</p

Additional file 1: Table S1. of The impact of virus infections on pneumonia mortality is complex in adults: a prospective multicentre observational study

Proportion of patients with multiple symptoms (number of symptoms ≥3) by virus. Table S2. Viral and bacterial infection status and in-hospital mortality among pneumonia patients with and without aspiration risk factors. (DOCX 17 kb