The increasing importance of Haemophilus influenzae in community-acquired pneumonia: results from a Danish cohort study

Abstract

Background

Numerous studies have shown that the aetiology of community-acquired pneumonia (CAP) varies considerably among different healthcare settings. Because empiric therapies for CAP should cover the major pathogens, reports examining CAP aetiology are considered crucial, particularly in Nordic countries that still rely on penicillin G or V treatments for most patients with CAP. The primary objective of our study was to report CAP aetiology. Secondary objectives included the estimation of positivity rates for different tests and the odds of a positive test for various subgroups.

Methods

In this cohort study, microbiological data were analysed for an overall cohort (variable degree of microbiological testing) and for a subgroup that was tested for both, bacteria, viruses and fungi, using routine methods (defined as extensive testing).

Results

The overall cohort comprised 2,264 patients, including 315 who were extensively tested. Bacterial and viral monoinfections were the most commonly identified infections. The dominant pathogen identified among extensively tested patients was Haemophilus influenzae (23.7%), followed by Streptococcus pneumoniae (20.6%). The tests with the highest positivity rates were sputum cultures (34.7%) and viral polymerase chain reaction (PCR, 24.4%). The odds of achieving a microbiological diagnosis increased significantly when extensive testing was performed compared with selective testing (OR 2.86, 95% CI 2.24–3.64).

Conclusion

Our study indicated that H. influenzae is the dominant responsible pathogen for bacterial CAP in Denmark. Thus, we believe that the current treatment recommendations that encourage the use of penicillin G or V for the majority of patients with CAP need to be revised.

Keywords:

• Community-acquired pneumonia
• CAP
• pneumonia aetiology
• microbiology
• microbiological testing

Acknowledgements

The authors acknowledge the rest of the optiCAP group: Lise Notander Clausen, Anne-Marie Blok Hellesøe, Line Molzen, Regitze Seerup, Emma Diernaes, Susanne Nielsen, Susanne Rasmussen, Gunhild Agnete Hansen, Lea Normand Nielsen, Magnus Søltoft Lindhardt and Malte Schmücker.

Disclosure statement

Dr Benfield reports grants from Pfizer, Novo Nordisk Foundation, Simonsen Foundation, Lundbeck Foundation, Kai Hansen Foundation outside the submitted work; grants and personal fees from GSK, Pfizer, Gilead outside the submitted work; personal fees from Boehringer Ingelheim, MSD outside the submitted work. Dr Ravn reports personal fees from Novartis Healthcare A/S, MSD Denmark ApS, CSL Behring GmbH, Takeda Pharma A/S outside the submitted work. The other authors do not report any conflicts of interest.

Additional information

Funding

The optiCAP study was funded by the Danish Ministry of Health under grant number [1608969] and by the participating hospitals.