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Mixed community-acquired pneumonia in hospitalised patients

¹ Servei de Pneumologia I Allergia respiratoria, Institut Clínic del Torax, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Facultad de Medicina, Universitat de Barcelona, and ³ Servei de Malalties Infeccioses, and ⁴ Servei de Microbiologia, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain. ² Augusta Kranken-Anstalt Bochum, Klinik für Pneumologie, Beatmungsmedizin und Infektiologie, Bochum, and ⁵ Lungenklinik Heckeshorn, Abteilung für Pneumologie I, Berlin, Germany.

CORRESPONDENCE: A. Torres, Pulmonology Dept, Hospital Clinic, Villarroel 170, Barcelona, E-08036, Spain. Fax: 34 932275454. E-mail: atorres{at}ub.edu

Keywords: Community-acquired pneumonia, hospitalisation, mixed pneumonia

Received: May 18, 2005
Accepted November 11, 2005

The role of mixed community-acquired pneumonia (CAP) is controversial. The aim of the present study was to determine the incidence, principal microbial patterns, clinical predictors and course of mixed CAP.

The current study included 1,511 consecutive hospitalised patients with CAP. Of these, 610 (40%) patients had an established aetiology. One pathogen was demonstrated in 528 patients and 82 (13%) patients had mixed pneumonia. Cases including CAP, by a pyogenic bacteria and a complete paired serology for "atypicals", revealed that 82 (13%) patients had definite single pyogenic pneumonia and 28 patients (5%) had mixed pyogenic pneumonia.

In patients with mixed CAP, Streptococcus pneumoniae was the most prevalent microorganism (44 out of 82; 54%). The most frequent combination was S. pneumoniae with Haemophilus influenzae (17 out of 82; 21%). Influenza virus A and S. pneumoniae (five out of 28; 18%) was the most frequent association in the mixed pyogenic pneumonia group. No clinical predictors for mixed pneumonias could be identified. Patients with mixed pyogenic pneumonia more frequently developed shock when compared with patients with single pyogenic pneumonia (18 versus 4%).

In conclusion, mixed pneumonia occurs in >10% of cases with community-acquired pneumonia requiring hospitalisation.

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