Abstract
Background: Non cystic fibrosis-bronchiectasis (NCFBE) are characterised by frequent pneumonia (CAP). Nonetheless, the knowledge on clinical characteristics of CAP in NCFBE is poor and no specific recommendations are currently available.
Objectives: to investigate clinical and microbiological characterisation of NCFBE patients with CAP.
Methods: prospective, observational study of 3719 CAP patients (2000-2011).
Results: we found 130(3.5%) CAP patients with NCFBE that, compared with non-bronchiectatic CAP showed: older age(CAP-NCFBE: 71yrs vs CAP: 65yrs), less male gender (43% vs. 62%), more vaccinations (pneumococcal:40% vs 15%; influenza:61% vs 42%), comorbidities(n≥2: 43% vs 26%), previous antibiotics (37% vs 22%) and inhaled steroids(51% vs 17%)(p<0.05 each). S.pneumoniae was the most frequent isolate (CAP-NCFBE 39%, CAP 42%; p=0.64), followed by mixed aetiology (27.3% vs 12.6%; p<0.01), viruses (7.6% vs 15.4%;p=0.08), atypicals (4.5% vs 8%,NS), E.coli (3% vs 0.9%,NS), Legionella (1.5% vs 6.9%,NS). P aeruginosa was more prevalent among CAP-NCFBE (18.2% vs. 3.0%,p<0.01) especially in mixed aetiology, such as H. influenzae (10.6% vs. CAP 2.7%, p<0.01) while S. aureus (6.1% vs 3.5%, NS) was infrequent. Despite similar mortality (CAP-NCFBE, 3.8% vs CAP 7.2%, NS), and length of hospitalization (median, 6 vs. 7days,p=0.13), NCFBE patients needed more hospitalization (97% vs 84%, p<0.01) and ICU (23.8% vs 16.2%,p<0.03). The presence of NCFBE was a risk factor for ICU (OR:2.9) in CAP (multivariate analysis).
Conclusions: CAP-NCFBE patients are usually older and have more comorbidities, present an increased prevalence of mixed aetiology with P. aeruginosa or H. influenzae and an increased risk of hospitalization and ICU.
- © 2013 ERS