Prospective study of epidemiology and prognostic factors in community-acquired pneumonia

Of 342 patients with community-acquired pneumonia, 100 were diagnosed etiologically. In these patients, disease epidemiology, prognostic factors, and influence of antibiotic treatment were analyzed prospectively. Fifty-two patients were treated with a broad-spectrum antibiotic (ceftriaxone), and 48 received a medium-spectrum antibiotic (cefuroxime); some patients in each group also received erythromycin. Streptococcus pneumoniae was the most frequently isolated microorganism (43%), followed by Chlamydia pneumoniae (21%), Haemophilus influenzae (19%), and Mycoplasma pneumoniae (11%). Factors significantly associated with increased mortality were initially critical or poor clinical condition, involvement of two or more lobules, and complications. Prior administration of antibiotics was predictive of penicillin and erythromycin resistance in Streptococcus pneumoniae, but had no effect on the course of the disease. Eight patients died, 89 were cured, and three had recurrences; there was no significant difference in outcome between treatment groups, regardless of whether patients also received erythromycin. Increased knowledge of epidemiological, predictive, and prognostic factors can significantly improve early diagnosis of community-acquired pneumonia and facilitate the choice of appropriate antibiotic treatment, thereby helping to reduce morbidity and mortality.