Community-acquired pneumonia requiring hospitalization among U.S. adults

Sema Jain, W. H. Self, R. G. Wunderink, S. Fakhran, R. Balk, A. M. Bramley, C. Reed, C. G. Grijalva, E. J. Anderson, D. M. Courtney, J. D. Chappell, C. Qi, E. M. Hart, F. Carroll, Christopher Trabue, H. K. Donnelly, D. J. Williams, Y. Zhu, Sandra Arnold, K. Ampofo & 12 others G. W. Waterer, M. Levine, S. Lindstrom, J. M. Winchell, J. M. Katz, D. Erdman, E. Schneider, L. A. Hicks, Jonathan Mccullers, A. T. Pavia, K. M. Edwards, L. Finelli

Research output: Contribution to journalArticle

494 Citations (Scopus)

Abstract

BACKGROUND: Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radiographically and with the use of current laboratory diagnostic tests are needed. METHODS: We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among adults 18 years of age or older in five hospitals in Chicago and Nashville. Patients with recent hospitalization or severe immunosuppression were excluded. Blood, urine, and respiratory specimens were systematically collected for culture, serologic testing, antigen detection, and molecular diagnostic testing. Study radiologists independently reviewed chest radiographs. We calculated population-based incidence rates of community-acquired pneumonia requiring hospitalization according to age and pathogen. RESULTS: From January 2010 through June 2012, we enrolled 2488 of 3634 eligible adults (68%). Among 2320 adults with radiographic evidence of pneumonia (93%), the median age of the patients was 57 years (interquartile range, 46 to 71); 498 patients (21%) required intensive care, and 52 (2%) died. Among 2259 patients who had radiographic evidence of pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 853 (38%): one or more viruses in 530 (23%), bacteria in 247 (11%), bacterial and viral pathogens in 59 (3%), and a fungal or mycobacterial pathogen in 17 (1%). The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%). The annual incidence of pneumonia was 24.8 cases (95% confidence interval, 23.5 to 26.1) per 10,000 adults, with the highest rates among adults 65 to 79 years of age (63.0 cases per 10,000 adults) and those 80 years of age or older (164.3 cases per 10,000 adults). For each pathogen, the incidence increased with age. CONCLUSIONS: The incidence of community-acquired pneumonia requiring hospitalization was highest among the oldest adults. Despite current diagnostic tests, no pathogen was detected in the majority of patients. Respiratory viruses were detected more frequently than bacteria.

Original languageEnglish (US)
Pages (from-to)415-427
Number of pages13
JournalNew England Journal of Medicine
Volume373
Issue number5
DOIs
StatePublished - Jul 30 2015

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Pneumonia
Hospitalization
Incidence
Routine Diagnostic Tests
Molecular Diagnostic Techniques
Population Surveillance
Viruses
Bacteria
Rhinovirus
Critical Care
Streptococcus pneumoniae
Orthomyxoviridae
Immunosuppression
Cause of Death
Thorax
Urine
Confidence Intervals
Antigens
Population

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Jain, S., Self, W. H., Wunderink, R. G., Fakhran, S., Balk, R., Bramley, A. M., ... Finelli, L. (2015). Community-acquired pneumonia requiring hospitalization among U.S. adults. New England Journal of Medicine, 373(5), 415-427. https://doi.org/10.1056/NEJMoa1500245

Community-acquired pneumonia requiring hospitalization among U.S. adults. / Jain, Sema; Self, W. H.; Wunderink, R. G.; Fakhran, S.; Balk, R.; Bramley, A. M.; Reed, C.; Grijalva, C. G.; Anderson, E. J.; Courtney, D. M.; Chappell, J. D.; Qi, C.; Hart, E. M.; Carroll, F.; Trabue, Christopher; Donnelly, H. K.; Williams, D. J.; Zhu, Y.; Arnold, Sandra; Ampofo, K.; Waterer, G. W.; Levine, M.; Lindstrom, S.; Winchell, J. M.; Katz, J. M.; Erdman, D.; Schneider, E.; Hicks, L. A.; Mccullers, Jonathan; Pavia, A. T.; Edwards, K. M.; Finelli, L.

In: New England Journal of Medicine, Vol. 373, No. 5, 30.07.2015, p. 415-427.

Research output: Contribution to journalArticle

Jain, S, Self, WH, Wunderink, RG, Fakhran, S, Balk, R, Bramley, AM, Reed, C, Grijalva, CG, Anderson, EJ, Courtney, DM, Chappell, JD, Qi, C, Hart, EM, Carroll, F, Trabue, C, Donnelly, HK, Williams, DJ, Zhu, Y, Arnold, S, Ampofo, K, Waterer, GW, Levine, M, Lindstrom, S, Winchell, JM, Katz, JM, Erdman, D, Schneider, E, Hicks, LA, Mccullers, J, Pavia, AT, Edwards, KM & Finelli, L 2015, 'Community-acquired pneumonia requiring hospitalization among U.S. adults', New England Journal of Medicine, vol. 373, no. 5, pp. 415-427. https://doi.org/10.1056/NEJMoa1500245
Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. New England Journal of Medicine. 2015 Jul 30;373(5):415-427. https://doi.org/10.1056/NEJMoa1500245
Jain, Sema ; Self, W. H. ; Wunderink, R. G. ; Fakhran, S. ; Balk, R. ; Bramley, A. M. ; Reed, C. ; Grijalva, C. G. ; Anderson, E. J. ; Courtney, D. M. ; Chappell, J. D. ; Qi, C. ; Hart, E. M. ; Carroll, F. ; Trabue, Christopher ; Donnelly, H. K. ; Williams, D. J. ; Zhu, Y. ; Arnold, Sandra ; Ampofo, K. ; Waterer, G. W. ; Levine, M. ; Lindstrom, S. ; Winchell, J. M. ; Katz, J. M. ; Erdman, D. ; Schneider, E. ; Hicks, L. A. ; Mccullers, Jonathan ; Pavia, A. T. ; Edwards, K. M. ; Finelli, L. / Community-acquired pneumonia requiring hospitalization among U.S. adults. In: New England Journal of Medicine. 2015 ; Vol. 373, No. 5. pp. 415-427.
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abstract = "BACKGROUND: Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radiographically and with the use of current laboratory diagnostic tests are needed. METHODS: We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among adults 18 years of age or older in five hospitals in Chicago and Nashville. Patients with recent hospitalization or severe immunosuppression were excluded. Blood, urine, and respiratory specimens were systematically collected for culture, serologic testing, antigen detection, and molecular diagnostic testing. Study radiologists independently reviewed chest radiographs. We calculated population-based incidence rates of community-acquired pneumonia requiring hospitalization according to age and pathogen. RESULTS: From January 2010 through June 2012, we enrolled 2488 of 3634 eligible adults (68{\%}). Among 2320 adults with radiographic evidence of pneumonia (93{\%}), the median age of the patients was 57 years (interquartile range, 46 to 71); 498 patients (21{\%}) required intensive care, and 52 (2{\%}) died. Among 2259 patients who had radiographic evidence of pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 853 (38{\%}): one or more viruses in 530 (23{\%}), bacteria in 247 (11{\%}), bacterial and viral pathogens in 59 (3{\%}), and a fungal or mycobacterial pathogen in 17 (1{\%}). The most common pathogens were human rhinovirus (in 9{\%} of patients), influenza virus (in 6{\%}), and Streptococcus pneumoniae (in 5{\%}). The annual incidence of pneumonia was 24.8 cases (95{\%} confidence interval, 23.5 to 26.1) per 10,000 adults, with the highest rates among adults 65 to 79 years of age (63.0 cases per 10,000 adults) and those 80 years of age or older (164.3 cases per 10,000 adults). For each pathogen, the incidence increased with age. CONCLUSIONS: The incidence of community-acquired pneumonia requiring hospitalization was highest among the oldest adults. Despite current diagnostic tests, no pathogen was detected in the majority of patients. Respiratory viruses were detected more frequently than bacteria.",
author = "Sema Jain and Self, {W. H.} and Wunderink, {R. G.} and S. Fakhran and R. Balk and Bramley, {A. M.} and C. Reed and Grijalva, {C. G.} and Anderson, {E. J.} and Courtney, {D. M.} and Chappell, {J. D.} and C. Qi and Hart, {E. M.} and F. Carroll and Christopher Trabue and Donnelly, {H. K.} and Williams, {D. J.} and Y. Zhu and Sandra Arnold and K. Ampofo and Waterer, {G. W.} and M. Levine and S. Lindstrom and Winchell, {J. M.} and Katz, {J. M.} and D. Erdman and E. Schneider and Hicks, {L. A.} and Jonathan Mccullers and Pavia, {A. T.} and Edwards, {K. M.} and L. Finelli",
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T1 - Community-acquired pneumonia requiring hospitalization among U.S. adults

AU - Jain, Sema

AU - Self, W. H.

AU - Wunderink, R. G.

AU - Fakhran, S.

AU - Balk, R.

AU - Bramley, A. M.

AU - Reed, C.

AU - Grijalva, C. G.

AU - Anderson, E. J.

AU - Courtney, D. M.

AU - Chappell, J. D.

AU - Qi, C.

AU - Hart, E. M.

AU - Carroll, F.

AU - Trabue, Christopher

AU - Donnelly, H. K.

AU - Williams, D. J.

AU - Zhu, Y.

AU - Arnold, Sandra

AU - Ampofo, K.

AU - Waterer, G. W.

AU - Levine, M.

AU - Lindstrom, S.

AU - Winchell, J. M.

AU - Katz, J. M.

AU - Erdman, D.

AU - Schneider, E.

AU - Hicks, L. A.

AU - Mccullers, Jonathan

AU - Pavia, A. T.

AU - Edwards, K. M.

AU - Finelli, L.

PY - 2015/7/30

Y1 - 2015/7/30

N2 - BACKGROUND: Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radiographically and with the use of current laboratory diagnostic tests are needed. METHODS: We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among adults 18 years of age or older in five hospitals in Chicago and Nashville. Patients with recent hospitalization or severe immunosuppression were excluded. Blood, urine, and respiratory specimens were systematically collected for culture, serologic testing, antigen detection, and molecular diagnostic testing. Study radiologists independently reviewed chest radiographs. We calculated population-based incidence rates of community-acquired pneumonia requiring hospitalization according to age and pathogen. RESULTS: From January 2010 through June 2012, we enrolled 2488 of 3634 eligible adults (68%). Among 2320 adults with radiographic evidence of pneumonia (93%), the median age of the patients was 57 years (interquartile range, 46 to 71); 498 patients (21%) required intensive care, and 52 (2%) died. Among 2259 patients who had radiographic evidence of pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 853 (38%): one or more viruses in 530 (23%), bacteria in 247 (11%), bacterial and viral pathogens in 59 (3%), and a fungal or mycobacterial pathogen in 17 (1%). The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%). The annual incidence of pneumonia was 24.8 cases (95% confidence interval, 23.5 to 26.1) per 10,000 adults, with the highest rates among adults 65 to 79 years of age (63.0 cases per 10,000 adults) and those 80 years of age or older (164.3 cases per 10,000 adults). For each pathogen, the incidence increased with age. CONCLUSIONS: The incidence of community-acquired pneumonia requiring hospitalization was highest among the oldest adults. Despite current diagnostic tests, no pathogen was detected in the majority of patients. Respiratory viruses were detected more frequently than bacteria.

AB - BACKGROUND: Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radiographically and with the use of current laboratory diagnostic tests are needed. METHODS: We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among adults 18 years of age or older in five hospitals in Chicago and Nashville. Patients with recent hospitalization or severe immunosuppression were excluded. Blood, urine, and respiratory specimens were systematically collected for culture, serologic testing, antigen detection, and molecular diagnostic testing. Study radiologists independently reviewed chest radiographs. We calculated population-based incidence rates of community-acquired pneumonia requiring hospitalization according to age and pathogen. RESULTS: From January 2010 through June 2012, we enrolled 2488 of 3634 eligible adults (68%). Among 2320 adults with radiographic evidence of pneumonia (93%), the median age of the patients was 57 years (interquartile range, 46 to 71); 498 patients (21%) required intensive care, and 52 (2%) died. Among 2259 patients who had radiographic evidence of pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 853 (38%): one or more viruses in 530 (23%), bacteria in 247 (11%), bacterial and viral pathogens in 59 (3%), and a fungal or mycobacterial pathogen in 17 (1%). The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%). The annual incidence of pneumonia was 24.8 cases (95% confidence interval, 23.5 to 26.1) per 10,000 adults, with the highest rates among adults 65 to 79 years of age (63.0 cases per 10,000 adults) and those 80 years of age or older (164.3 cases per 10,000 adults). For each pathogen, the incidence increased with age. CONCLUSIONS: The incidence of community-acquired pneumonia requiring hospitalization was highest among the oldest adults. Despite current diagnostic tests, no pathogen was detected in the majority of patients. Respiratory viruses were detected more frequently than bacteria.

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DO - 10.1056/NEJMoa1500245

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