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      Incidence and case fatality rates of community-acquired pneumonia and pneumococcal diseases among Korean adults: Catchment population-based analysis

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          Abstract

          Background

          Pneumonia is a leading infectious cause of morbidity and mortality among adults. Pneumococcal pneumonia (PP) is the most common vaccine-preventable bacterial etiology of pneumonia. In this study, we estimated the incidence of community-acquired pneumonia (CAP) and pneumococcal diseases among Korean adults.

          Methods

          Clinical and microbiological databases from three hospitals were retrospectively reviewed to determine the incidence and case fatality rates of CAP and pneumococcal diseases in Korean adults aged ≥19 years from 2011 to 2014. Incidence and case fatality rates of CAP, PP and invasive pneumococcal diseases (IPD) were evaluated based on the catchment population. Catchment population was calculated using national health insurance data, estimating the proportion of patients with pneumonia that were medically attended at each hospital.

          Results

          Among 5,783 patients with medically attended CAP, 833 (14.4%) had PP. For IPD, a total of 91 culture-confirmed cases were identified. The overall incidence of CAP was 307.7 cases per 100,000 persons per year with an in-hospital mortality rate of 6.2%. The estimated annual incidence of pneumococcal pneumonia was 42.2–49.4 cases per 100,000 persons per year, increasing with age to >280 per 100,000 persons per year in older patients over 70 years. The annual incidence of IPD had a range of 4.1–6.5 cases per 100,000 persons per year. The overall case fatality rate for invasive pneumococcal diseases was 30.8% with the highest rate of 66.7% in patients over 80 years.

          Conclusion

          Over the study period, incidences of CAP, PP and IPD were consistently high, particularly in older people. These results provide baseline data to establish healthcare strategies and estimate their impact among Korean adults.

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          Most cited references26

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          Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis.

          To systematically review the medical literature on the prognosis and outcomes of patients with community-acquired pneumonia (CAP). A MEDLINE literature search of English-language articles involving human subjects and manual reviews of article bibliographies were used to identify studies of prognosis in CAP. Review of 4573 citations revealed 122 articles (127 unique study cohorts) that reported medical outcomes in adults with CAP. Qualitative assessments of studies' patient populations, designs, and patient outcomes were performed. Summary univariate odds ratios (ORs) and rate differences (RDs) and their associated 95% confidence intervals (CIs) were computed to estimate a summary effect size for the association of prognostic factors and mortality. The overall mortality for the 33,148 patients in all 127 study cohorts was 13.7%, ranging from 5.1% for the 2097 hospitalized and ambulatory patients (in six study cohorts) to 36.5% for the 788 intensive care unit patients (in 13 cohorts). Mortality varied by pneumonia etiology, ranging from less than 2% to greater than 30%. Eleven prognostic factors were significantly associated with mortality using both summary ORs and RDs: male sex (OR = 1.3; 95% CI, 1.2 to 1.4), pleuritic chest pain (OR = 0.5; 95% CI, 0.3 to 0.8), hypothermia (OR = 5.0; 95% CI, 2.4 to 10.4), systolic hypotension (OR = 4.8; 95% CI, 2.8 to 8.3), tachypnea (OR = 2.9; 95% CI, 1.7 to 4.9), diabetes mellitus (OR = 1.3; 95% CI, 1.1 to 1.5), neoplastic disease (OR = 2.8; 95% CI, 2.4 to 3.1), neurologic disease (OR = 4.6; 95% CI, 2.3 to 8.9), bacteremia (OR = 2.8; 95% CI, 2.3 to 3.6), leukopenia (OR = 2.5, 95% CI, 1.6 to 3.7), and multilobar radiographic pulmonary infiltrate (OR = 3.1; 95% CI, 1.9 to 5.1). Assessments of other clinically relevant medical outcomes such as morbid complications (41 cohorts), symptoms resolution (seven cohorts), return to work or usual activities (five cohorts), or functional status (one cohort) were infrequently performed. Mortality for patients hospitalized with CAP was high and was associated with characteristics of the study cohort, pneumonia etiology, and a variety of prognostic factors. Generalization of these findings to all patients with CAP should be made with caution because of insufficient published information on medical outcomes other than mortality in ambulatory patients.
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            Epidemiology of community-acquired pneumonia in adults: a population-based study.

            In this prospective study, the authors assessed the incidence, aetiology, and outcome of patients with community-acquired pneumonia in the general population. From December 1993 to November 1995, a study was performed in a mixed residential-industrial urban population of the "Maresme" region in Barcelona, Spain. All subjects > or =14 yrs of age (annual average population size 74,368 inhabitants) with clinically suspected community-acquired pneumonia were registered. All cases were re-evaluated by chest radiographs on the 5th day of illness and at monthly intervals until complete recovery. Urine and blood samples were obtained for culture and antigen detection. When lower respiratory tract secretions were obtained, these were also cultured. There were 241 patients with community-acquired pneumonia, with an annual incidence rate of 1.62 cases (95% confidence interval, 1.42-1.82) per 1,000 inhabitants. Incidence rates increased by age groups and were higher in males than in females. Of 232 patients with aetiological data, 104 had an identifiable aetiology. A total of 114 pathogens were found (single pathogen 94, two pathogens 10). There were 81 episodes of bacterial infection and 33 of viral infection. The most common pathogens were Streptococcus pneumoniae, Chlamydia pneumoniae, and influenza A and B viruses. No case of Hantavirus infection was found. The rate of hospital admission was 61.4% with a mean+/-SD length of 11.7+/-10.1 days, a mean period of 23.0+/-14.3 days inactivity, and an overall mortality rate of 5%. The high rate of hospital admission, prolonged stay in hospital, and long period of inactivity all continue to constitute a social and health care burden of community-acquired pneumonia.
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              Community-acquired pneumonia.

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                Author and article information

                Contributors
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: SoftwareRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                29 March 2018
                2018
                : 13
                : 3
                : e0194598
                Affiliations
                [1 ] Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
                [2 ] Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
                [3 ] Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
                [4 ] Asian Pacific Influenza Institute (APII), Korea University Guro Hospital, Seoul, Korea
                [5 ] Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
                [6 ] Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
                [7 ] Division of Infectious Diseases, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
                [8 ] Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
                Public Health England, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-0148-7194
                Article
                PONE-D-17-28796
                10.1371/journal.pone.0194598
                5875769
                29596444
                7f7b7d94-6738-48b7-825e-7973422e2eaf
                © 2018 Heo et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 2 August 2017
                : 20 February 2018
                Page count
                Figures: 0, Tables: 3, Pages: 10
                Funding
                We declare no funding to perform this research.
                Categories
                Research Article
                Medicine and Health Sciences
                Pulmonology
                Pneumonia
                Biology and Life Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Public and Occupational Health
                Preventive Medicine
                Vaccination and Immunization
                People and places
                Geographical locations
                Asia
                South Korea
                Biology and Life Sciences
                Population Biology
                Population Metrics
                Death Rates
                People and Places
                Population Groupings
                Ethnicities
                Korean People
                People and Places
                Population Groupings
                Age Groups
                Medicine and Health Sciences
                Epidemiology
                Medicine and Health Sciences
                Public and Occupational Health
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