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

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          Abstract

          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’s 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).

          Conclusions

          A substantial portion of the COP burden occurs among elderly members of the Japanese adult population. In addition to the introduction of effective vaccines for S. pneumoniae and influenza, multidimensional approaches are needed to reduce the pneumonia burden in an aging society.

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          Most cited references32

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          BTS guidelines for the management of community acquired pneumonia in adults: update 2009.

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            Clinical and economic burden of community-acquired pneumonia among adults in Europe.

            It is difficult to determine the impact of community-acquired pneumonia (CAP) in Europe, because precise data are scarce. Mortality attributable to CAP varies widely between European countries and with the site of patient management. This review analysed the clinical and economic burden, aetiology and resistance patterns of CAP in European adults. All primary articles reporting studies in Europe published from January 1990 to December 2007 addressing the clinical and economic burden of CAP in adults were included. A total of 2606 records were used to identify primary studies. CAP incidence varied by country, age and gender, and was higher in individuals aged ≥65 years and in men. Streptococcus pneumoniae was the most common agent isolated. Mortality varied from <1% to 48% and was associated with advanced age, co-morbid conditions and CAP severity. Antibiotic resistance was seen in all pathogens associated with CAP. There was an increase in antibiotic-resistant strains, but resistance was not related to mortality. CAP was associated with high rates of hospitalisation and length of hospital stay. The review showed that the clinical and economic burden of CAP in Europe is high. CAP has considerable long-term effects on quality of life, and long-term prognosis is worse in patients with pneumococcal pneumonia.
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              Etiology of Community-Acquired Pneumonia: Increased Microbiological Yield with New Diagnostic Methods

              Abstract Background The microbial etiology of community-acquired pneumonia (CAP) is still not well characterized. During the past few years, polymerase chain reaction (PCR)-based methods have been developed for many pathogens causing respiratory tract infections. The aim of this study was to determine the etiology of CAP among adults—especially the occurrence of mixed infections among patients with CAP—by implementing a new diagnostic PCR platform combined with conventional methods. Methods Adults admitted to Karolinska University Hospital were studied prospectively during a 12-month period. Microbiological testing methods included culture from blood, sputum, and nasopharyngeal secretion samples; sputum samples analyzed by real-time quantitative PCR for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis; nasopharyngeal specimens analyzed by use of PCR; serological testing for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and viruses common in the respiratory tract; and urine antigen assays for detection of pneumococcal and Legionella pneumophila antigens. Results A microbial etiology could be identified for 67% of the patients (n = 124). For patients with complete sampling, a microbiological agent was identified for 89% of the cases. The most frequently detected pathogens were S. pneumoniae (70 patients [38]) and respiratory virus (53 patients [29]). Two or more pathogens were present in 43 (35%) of 124 cases with a determined etiology. Conclusions By supplementing traditional diagnostic methods with new PCR-based methods, a high microbial yield was achieved. This was especially evident for patients with complete sampling. Mixed infections were frequent (most commonly S. pneumoniae together with a respiratory virus).
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                30 March 2015
                2015
                : 10
                : 3
                : e0122247
                Affiliations
                [1 ]Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
                [2 ]Department of General Internal Medicine, Kameda Medical Center, Chiba, Japan
                [3 ]Department of Internal Medicine, Juzenkai Hospital, Nagasaki, Japan
                [4 ]Department of Internal Medicine, Chikamori Hospital, Kochi, Japan
                [5 ]Department of General Internal Medicine, Ebetsu City Hospital, Hokkaido, Japan
                [6 ]Department of Pulmonology, Kameda Medical Center, Chiba, Japan
                National Institutes of Health, UNITED STATES
                Author notes

                Competing Interests: Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University received financial support for this study from Pfizer. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. We do not have any other competing interests to disclose.

                Conceived and designed the experiments: KM MS KA. Performed the experiments: KM MS TI MY NA NH M. Abe M. Aoshima KA. Analyzed the data: KM MS KA. Contributed reagents/materials/analysis tools: MS. Wrote the paper: KM MS KA.

                ¶ Membership of the Adult Pneumonia Study Group—Japan (APSG-J) is listed in the Acknowledgments.

                Article
                PONE-D-14-41019
                10.1371/journal.pone.0122247
                4378946
                25822890
                ac0e51ff-928f-4223-8d88-7448b9434767
                Copyright @ 2015

                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
                : 12 September 2014
                : 10 February 2015
                Page count
                Figures: 2, Tables: 3, Pages: 18
                Funding
                This work was supported by JSPS KAKENHI Grant Number 25460761, Pfizer and Nagasaki University. Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University received financial support for this study from Pfizer. The funding source had no role in the design, data collection, analysis or interpretation of the study.
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