Rémond, M G W; Ralph, Anna; Brady, Stephen; Martin, J; Tikoft, E; Maguire, G P

Author(s)

Rémond, M G W

Ralph, Anna

Brady, Stephen

Martin, J

Tikoft, E

Maguire, G P

Publication Date

2010-01-01

Abstract

Community-acquired pneumonia (CAP) results in significant morbidity in central and north-western Australia. However, the nature, management and outcome of CAP are poorly documented. The aim of the study was to describe CAP in the Kimberley and Central Desert regions of Australia.Prospective and retrospective cohort studies of inpatient management of adults with CAP at Alice Springs Hospital and six Kimberley hospitals were carried out. We documented demographic data, comorbidities, investigations, causes, CAP severity, outcome and concordance between prescribed and protocol-recommended antibiotics.Two hundred and ninety-three subjects were included. Aboriginal Australians were overrepresented (relative risk 8.1). Patients were notably younger (median age 44.5 years) and disease severity lower than in urban Australian settings. Two patients died within 30 days of admission compared with expected mortality based on Pneumonia Severity Index predictions of seven deaths (chi(2), P= 0.09). Disease severity and outcome did not differ between regions. Management differences were identified, including significantly more investigations, higher rates of critical care and broader antibiotic cover in Central Australia compared with the Kimberley. Sputum culture results showed Gram-negative organisms in both regions. However, Streptococcus pneumoniae was the most frequent organism isolated in the Kimberley and Haemophilus influenzae in Central Australia.CAP in this setting is an Aboriginal health issue. The low mortality observed and results of microbiology investigations support the use of existing antibiotic protocols. Larger studies investigating CAP aetiology are warranted. Addressing social and environmental disadvantage remains the key factors in dealing with the burden of CAP in this setting.

Affiliation

School of Medicine and Dentistry, Faculty of Medicine, Health and Molecular Sciences, James Cook University, Cairns, Queensland, Australia.

Citation

Intern Med J . 2010 Jan;40(1):37-44. doi: 10.1111/j.1445-5994.2008.01883.x.

ISSN

1445-5994

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/20561364/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/13945

MESH subject

Adult

Cohort Studies

Community-Acquired Infections

Desert Climate

Female

Haemophilus Infections

Haemophilus influenzae

Humans

Male

Middle Aged

Northern Territory

Pneumonia, Bacterial

Pneumonia, Pneumococcal

Prospective Studies

Retrospective Studies

Streptococcus pneumoniae

Western Australia

Title

Community-acquired pneumonia in the central desert and north-western tropics of Australia.

Type of document

Journal Article

Entity Type

Publication

Author(s)	Rémond, M G W Ralph, Anna Brady, Stephen Martin, J Tikoft, E Maguire, G P
Publication Date	2010-01-01
Abstract	Community-acquired pneumonia (CAP) results in significant morbidity in central and north-western Australia. However, the nature, management and outcome of CAP are poorly documented. The aim of the study was to describe CAP in the Kimberley and Central Desert regions of Australia.Prospective and retrospective cohort studies of inpatient management of adults with CAP at Alice Springs Hospital and six Kimberley hospitals were carried out. We documented demographic data, comorbidities, investigations, causes, CAP severity, outcome and concordance between prescribed and protocol-recommended antibiotics.Two hundred and ninety-three subjects were included. Aboriginal Australians were overrepresented (relative risk 8.1). Patients were notably younger (median age 44.5 years) and disease severity lower than in urban Australian settings. Two patients died within 30 days of admission compared with expected mortality based on Pneumonia Severity Index predictions of seven deaths (chi(2), P= 0.09). Disease severity and outcome did not differ between regions. Management differences were identified, including significantly more investigations, higher rates of critical care and broader antibiotic cover in Central Australia compared with the Kimberley. Sputum culture results showed Gram-negative organisms in both regions. However, Streptococcus pneumoniae was the most frequent organism isolated in the Kimberley and Haemophilus influenzae in Central Australia.CAP in this setting is an Aboriginal health issue. The low mortality observed and results of microbiology investigations support the use of existing antibiotic protocols. Larger studies investigating CAP aetiology are warranted. Addressing social and environmental disadvantage remains the key factors in dealing with the burden of CAP in this setting.
Affiliation	School of Medicine and Dentistry, Faculty of Medicine, Health and Molecular Sciences, James Cook University, Cairns, Queensland, Australia.
Citation	Intern Med J . 2010 Jan;40(1):37-44. doi: 10.1111/j.1445-5994.2008.01883.x.
ISSN	1445-5994
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/20561364/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/13945
MESH subject	Adult Cohort Studies Community-Acquired Infections Desert Climate Female Haemophilus Infections Haemophilus influenzae Humans Male Middle Aged Northern Territory Pneumonia, Bacterial Pneumonia, Pneumococcal Prospective Studies Retrospective Studies Streptococcus pneumoniae Western Australia
Title	Community-acquired pneumonia in the central desert and north-western tropics of Australia.
Type of document	Journal Article
Entity Type	Publication

Community-acquired pneumonia in the central desert and north-western tropics of Australia.

Files: