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Correspondence |

Identifying Pathogen in Culture-Negative Pneumonia FREE TO VIEW

Virginie Lemiale, MD; Jerôme Lambert, MD; Elie Azoulay, MD, PhD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

CORRESPONDENCE TO: Virginie Lemiale, MD, Saint-Louis Hospital, Medical Intensive Care Unit, 1 Ave Claude Vellefaux, Paris 75010, France


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(2):609-610. doi:10.1016/j.chest.2015.10.077
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In their article in the July 2015 issue of CHEST, Andruska et al reported that pathogen-related pneumonia was associated with an increased hospital readmission rate. In the Discussion section, the authors noted that hospitalization readmission could be related, in that setting, to inappropriate antibiotic therapy. Approximately 46% of patients had culture-negative pneumonia, and these patients had a lower readmission rate. The data are interesting and highlight the difficulty in making an accurate diagnosis of pneumonia by using microbiological methods.

From 1998 to 2008, we performed a retrospective study in 289 nonimmunocompromised patients admitted to the ICU with community-acquired pneumonia and analyzed their diagnosis made according to microbiological methods. At least one bacteriological analysis at admission was performed in all patients; however, no viral diagnosis was performed at that time. In this study, 56% of patients had culture-negative pneumonia, and all patients received antibiotics according to the French guidelines. Mortality was 34% at day 28 for patients with microbiologically documented pneumonia and 11% for patients with nondocumented pneumonia (NDCAP). ICU length of stay was shorter for patients with NDCAP (P = .01). In patients with documented pneumonia, we performed a multiple correspondence analysis between admission parameters and a microbiological diagnosis to determine the pathogen for patients with NDCAP (Fig 1). Unfortunately, bacterial etiology could not be easily determined with this method. Thus, it seems difficult to assess outcome and readmission rate when almost one-half of the population could not be diagnosed by using microbiological techniques.

Figure Jump LinkFigure 1 Multiple correspondance analysis between admission parameters to microbiologic diagnosis. Each point corresponds with one patient with nondocumented pneumonia. ERS = extra-pulmonary symptoms; GNB = gram negative pneumonia; GPC = gram positive pneumonia; MAP = mean arterial pressure; O2 Sat = oxygen saturation.Grahic Jump Location

References

Andruska A. .Micek S.T. .Shindo Y. .et al Pneumonia pathogen characterization is an independent determinant of hospital readmission. Chest. 2015;148:103-111 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1 Multiple correspondance analysis between admission parameters to microbiologic diagnosis. Each point corresponds with one patient with nondocumented pneumonia. ERS = extra-pulmonary symptoms; GNB = gram negative pneumonia; GPC = gram positive pneumonia; MAP = mean arterial pressure; O2 Sat = oxygen saturation.Grahic Jump Location

Tables

References

Andruska A. .Micek S.T. .Shindo Y. .et al Pneumonia pathogen characterization is an independent determinant of hospital readmission. Chest. 2015;148:103-111 [PubMed]journal. [CrossRef] [PubMed]
 
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