Tsai, Danny

Chiong, Fabian

Secombe, Paul

Hnin, Khin Moe

Stewart, Penny

Goud, Rajendra

Woodman, Richard

Lipman, Jeffrey

Roberts, Jason

Hewagama, Saliya

2020-12-20

BACKGROUND: Severe community-acquired pneumonia (SCAP) has high mortality and morbidity. AIMS: To describe the epidemiology and microbiology of SCAP in Central Australia. METHODS: A retrospective epidemiological study describing the characteristics, incidence rates (IR) and microbiological aetiology of SCAP in Central Australia. Adult patients admitted to Alice Springs Hospital Intensive Care Unit (ICU) between 2011-2014 that fitted the IDSA/ATS definition of SCAP were included. Medical records were reviewed and compared between Indigenous and non-Indigenous patients. Primary outcomes were incidence rate and microbiological aetiology of SCAP. Secondary outcomes were 30-day mortality, and ICU and hospital length of stay (LoS). RESULTS: A total of 185 patents were included (156 Indigenous, 29 non-Indigenous). The overall SCAP IR per 1000 person-years was 3.24 (3.75 Indigenous and 1.87 non-Indigenous) with an IR difference of 2.71 after adjustment (p<0.001). Those aged ≥50 had an IR 74.8% higher than those younger. Male IR was 50% higher than females. There was a significant difference between Indigenous and non-Indigenous groups for age (48 vs. 64 years), but not for 30-day mortality (7.7% vs. 10.3%), ICU LoS (4.8 vs. 4.6 days) and hospital LoS (10.9 vs. 15.1 days), respectively. Likely causative pathogen(s) were identified in 117 patients; Streptococcus pneumoniae was the most common pathogen (28.2%), followed by Haemophilus influenzae (19.7%), Influenza A/B (16.2%) and Staphylococcus aureus (14.5%). CONCLUSION: A high incidence of SCAP was observed in Central Australia, disproportionately affecting the Indigenous population. Prevention strategies are imperative, as well as early identification of SCAP and appropriate empiric antibiotic regimens. This article is protected by copyright. All rights reserved.

University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.

Centre for Remote Health, Flinders NT, Flinders University, Alice Springs, NT, Australia.

Pharmacy Department, Alice Springs Hospital, Alice Springs, NT, Australia.

Department of Medicine, Alice Springs Hospital, Alice Springs, NT, Australia.

Department of Infectious Diseases, University Hospital Geelong, Geelong, VIC, Australia.

Department of Intensive Care Medicine, Alice Springs Hospital, Alice Springs, NT, Australia.

Norwood Specialist Clinic, Adelaide, SA, Australia.

Department of Intensive Care Medicine, Cairns Base Hospital, Cairns, QLD, Australia.

School of Bioinformatics, Flinders University, Adelaide, SA, Australia.

Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.

Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, QLD, Australia.

Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.

Departments of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.

Department of Infectious Diseases, The Northern Hospital, Epping, Melbourne, VIC, Australia.

Intern Med J . 2022 Jun;52(6):1048-1056. doi: 10.1111/imj.15171. Epub 2022 May 31.

0000-0002-7059-8808

https://pubmed.ncbi.nlm.nih.gov/33342052/?otool=iaurydwlib

https://hdl.handle.net/10137/11618

Epidemiology and Microbiology of Severe Community-Acquired Pneumonia in Central Australia: A Retrospective Study.

Journal Article

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