Abstract
Background: Community-Acquired Pneumonia (CAP) is a major cause of mortality worldwide. While COPD is a common co-morbidity in CAP, its impact remains relatively unknown.
Objectives: 1) To assess potential differences in microbial aetiology of CAP between subjects with and without COPD in a well-characterized cohort of CAP patients; 2) To study the association between microbiology, ICS use and mortality.
Methods: 1307 patients with CAP (57.0% males, age 59.0±18.5 y) were included and followed for 180 days. 264 of these (20.2%) fulfilled diagnostic criteria for COPD. Differences in microbial aetiology and ICS use were investigated by univariate analyses. Logistic regression analysis was performed to study the association between microbial aetiology and mortality.
Results: H. influenzae and S. pneumoniae were the most common pathogens in CAP-COPD, whereas S. pneumoniae was most frequently identified in CAP-only. Enterobacteriaceae significantly predicted mortality risk in all CAP-patients (p=0.045), while COPD was not identified as independent risk factor. ICS use of ≥1000μg Fluticason-equivalent was associated with 180-day mortality in COPD (p=0.043). ICS use was not associated with different microbial aetiology.
Conclusion: Microbial aetiology differs between CAP patients with and without COPD. Enterobacteriaceae impacts on mortality risk, highlighting the importance of microbiological sampling in CAP. The role of ICS use in CAP mortality requires further investigation, as there might be a dose-related association.
- © 2014 ERS