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Published on: February 23, 2014
Etiology and management of community-acquired pneumonia in Asia
Toshiharu Matsushima1, Naoyuki Miyashita, Thomas M File
1Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Kurashiki, Japan. resp@med.kawasaki-m.ac.jp
Abstract:
The causative organisms of community-acquired pneumonia, especially in Japan and Korea, are essentially similar to those in Western countries. If there are any differences, these are due to the laboratory tests and criteria used to define pathogenicity. Overall, Streptococcus pneumoniae is the most frequently occurring pathogen and Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae and viruses follow. Legionella spp. look likely to be low frequency pathogens in Asian countries, but a reason for this might be limitations of the laboratory tests used. A high frequency of Gram-negative bacilli as pathogens of community-acquired pneumonia in some Asian countries may be due to different criteria used to identify disease-causing organisms. A small number of papers about antibiotic resistance have shown no large differences between Asian countries, but considerable differences to Western countries, such as frequency of macrolide-resistant S. pneumoniae. Some Asian countries have their own guidelines for community-acquired pneumonia, but these are written in their own languages.
Insights
Community-acquired pneumonia pathogens in Asia largely mirror Western countries, with Streptococcus pneumoniae being most common. Differences in identification methods and antibiotic resistance patterns, particularly macrolide resistance, warrant attention.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Community-acquired pneumonia (CAP) is a significant global health concern.
- Understanding causative pathogens and antibiotic resistance is crucial for effective treatment strategies.
- Regional variations in CAP etiology and resistance patterns necessitate localized research.
Purpose of the Study:
- To compare the causative organisms of community-acquired pneumonia (CAP) in Asian countries with those in Western nations.
- To investigate potential differences in pathogenicity criteria and laboratory diagnostic methods.
- To assess antibiotic resistance patterns, particularly for Streptococcus pneumoniae, in Asian populations.
Main Methods:
- Literature review and synthesis of existing studies on CAP pathogens in Japan, Korea, and other Asian countries.
- Comparative analysis of identified pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, viruses, Legionella spp., and Gram-negative bacilli.
- Examination of data on antibiotic resistance, focusing on macrolide resistance in S. pneumoniae.
Main Results:
- The primary causative agents of CAP in Japan and Korea are broadly similar to those in Western countries.
- Streptococcus pneumoniae is the most frequent pathogen, followed by Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, and viruses.
- Potential underestimation of Legionella spp. in Asia may stem from diagnostic limitations; differing criteria might explain higher Gram-negative bacilli frequencies in some Asian regions.
- Antibiotic resistance profiles show minimal variation within Asian countries but notable differences compared to Western countries, especially concerning macrolide-resistant S. pneumoniae.
Conclusions:
- Causative agents of CAP in East Asia largely align with Western patterns, though diagnostic and definitional variations exist.
- Significant differences in macrolide resistance among S. pneumoniae strains highlight the need for region-specific antibiotic stewardship.
- The development of CAP guidelines in local languages is important for clinical practice in various Asian countries.
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