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Community-Acquired Pneumonia in Southeast Asia^*

The Microbial Differences Between Ambulatory and Hospitalized Patients

^* From the Division of Pulmonary (Drs. Wattanathum, Chaoprasong, Jatakanon, and Chanthadisai), Department of Medicine, and Department of Microbiology (Ms. Chantaratchada), Phramongkutklao Hospital, Bangkok, Thailand; the Department of Microbiology (Ms. Nunthapisud), Chulalongkorn University, Bankok, Thailand; and the Division of Clinical Pathology (Mr. Limpairojn), Army Institute of Pathology, Bangkok, Thailand.

Correspondence to: Anan Wattanathum, MD, 706-1772 Comox St, Vancouver, BC, V6G 1P8 Canada; e-mail: wattanathum{at}hotmail.com

Study objectives: To determine microbial agents causing community-acquired pneumonia (CAP) in Southeast Asia.

Design: A prospective study.

Setting: Three general hospitals in Thailand.

Patients: Two hundred forty-five adult patients fulfilling the clinical criteria of CAP from September 1998 to April 2001.

Interventions: Investigations included sputum Gram stain and culture, blood culture, pleural fluid culture (if presented), urine antigen for Legionella pneumophila and Streptococcus pneumoniae, and serology for Mycoplasma pneumoniae, Chlamydia pneumoniae, and L pneumophila.

Results: There were 98 outpatients and 147 hospitalized patients included in the study, and an organism was identified in 74 of 98 outpatients (75.5%) and 105 of 147 of the hospitalized patients (71.4%). C pneumoniae (36.7%), M pneumoniae (29.6%), and S pneumoniae (13.3%) were the most frequent causative pathogens found in outpatients, while S pneumoniae (22.4%) and C pneumoniae (16.3%) were the most common in hospitalized patients. There was a significantly higher incidence of C pneumoniae (36.7% vs 16.3%, respectively; p < 0.001) and M pneumoniae (29.6% vs 6.8%; p < 0.001, respectively) in the outpatients than in the hospitalized patients. The incidence of S pneumoniae, L pneumophila, and mixed infections was not different between the groups. Mixed infections were presented in 13 of 98 outpatients (13.3%) and 9 of 147 hospitalized patients (6.1%), with C pneumoniae being the most frequent coinfecting pathogen.

Conclusions: The data indicate that the core organisms causing CAP in Southeast Asia are not different from those in the Western countries. The guidelines for the treatment of patients with CAP, therefore, should be the same.

Key Words: community-acquired pneumonia • etiology • pathogens • Southeast Asia • Thailand

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