COMMUNITY-ACQUIRED PNEUMONIA IN CHRONIC OBSTRUCTIVE PULMONARY-DISEASE- A SPANISH MULTICENTER STUDY

Community-acquired pneumonia (CAP) is an infectious illness that frequ ently motivates hospital admission when comorbid conditions are presen t. However, the epidemiology of CAP in relation to the underlying dise ase of the patients is not well known. We performed a prospective mult icenter study with the aim of assessing the clinical characteristics, etiology, and outcome of chronic obstructive pulmonary disease (COPD) patients with CAP. Between October 1992 and December 1994 we studied 1 24 COPD patients (mean FEV(1) 40 +/- 11% of predicted, mean FVC/FEV(1) 49 +/- 10) admitted because of CAP to one of the participating center s. An attempt to obtain an etiologic diagnosis was performed by means of blood cultures (n = 123), sputum cultures (n = 97), pleural fluid c ultures (n = 17), protected specimen brush samples (n = 41), percutane ous transthoracic needle aspiration (n = 41), and serology (n = 106). Etiologic diagnosis was achieved in 80 (64%) of cases, however, diagno sis based upon valid techniques was only possible in 73 (59%) cases. T he main causal microorganisms were the following: Streptococcus pneumo niae in 32 (43%), Chlamydia pneumoniae in 9 (12%), Hemophilus influenz ae in 7 (9%), Legionella pneumophila in 7 (9%), Streptococcus viridans in 3 (4%), Coxiello burnetii in 3 (4%), Mycoplasma pneumoniae in 2 (3 %), Nocardia osteroides 2, Aspergillus ssp. 1, and others 10. In three of these cases the etiology was polymicrobial. Bacteremia was present in 19 (15%) cases; S. pneumoniae was the most frequent isolate (13 ca ses). Antibiotic treatment was modified in 22 cases due to etiologic f indings, and in 9 due to therapeutic failure. Ten patients died (8%), and 22 needed mechanical ventilation, the mortality rate in the latter population being 23%. Total or partial resistance of S. pneumoniae to penicillin was observed in 10 of 32 (31%) isolations, and to erythrom ycin in 2 (6%). The results of this study are Important for the standa rdization of empiric antibiotic strategies in COPD patients with pneum onia.