Community-acquired pneumonia (CAP) is the leading cause of death due to infection worldwide, with its incidence and disease course influenced by air pollution exposure. Little is known about how air pollution influences microbiological findings in patients with CAP. Patients were recruited from a prospective, multicentre study of CAP (CAPNETZ). Air pollution data were collected at the city level considering data up to one month before inclusion. Associations with sputum pathogen detection and cell counts were tested using generalised linear mixed-effects logistic regression models adjusting for clinical confounders, centre-level heterogeneity and meteorological data. Internal validation was performed using an Ensemble Feature Selection (EFS) approach. Among 4,446 eligible patients with available sputum samples, a potential pathogen was detected in 1,581 patients, while complete sputum-cell-count data were available for 4,014 patients. Detection of Streptococcus pneumoniae was associated with previous higher exposure to sulphur dioxide (SO2) (OR 1.75, p = 0.008) and carbon monoxide (CO) (OR 1.57, p = 0.02). Escherichia coli was more frequently detected in patients who were exposed to elevated levels of nitrogen dioxide (NO2) (OR 2.75, p = 0.004) and higher temperature (OR 1.51, p = 0.03), whereas increased fine particulate matter (PM2.5) exposure (OR 0.37, p = 0.001) was linked to reduced detection. Furthermore, SO2 exposure influenced the likelihood of obtaining a diagnostically relevant sputum culture and was associated with higher odds of detecting a high leucocyte count (OR 1.18, p = 0.02). Results were largely corroborated by EFS, particularly for S. pneumoniae and E. coli detection. Exposure to air pollution was associated with a distinct pathogen spectrum in patients with CAP. These findings may have implications for the interpretation of microbiological data in an epidemiological and clinical context and highlight the importance of considering air pollution exposure as a confounding factor. Further validation in cohorts with high-quality environmental, microbiological and antimicrobial resistance data is needed. Registry: German Clinical Trials Register (DRKS), DRKS-ID: DRKS00005274, Registration date: 2013-09-11.
Residents living near goat farms (< 2000 m) in the Netherlands have consistently shown an elevated risk of pneumonia, yet the pathogens underlying this association remain unknown. This study assessed the presence of 33 respiratory pathogens, including bacteria, viruses, and fungi, across rural populations with different goat farm exposures. This cross-sectional study included general practitioner (GP)-diagnosed pneumonia patients (PP; n = 108), non-farming rural residents without pneumonia (NFR; n = 200), and goat farm workers (GFW; n = 91). Oropharyngeal and nasopharyngeal swabs were collected and analyzed by a multiplex and two additional PCR test targeting in total 12 bacteria, 20 viruses and 1 fungus. Between-group differences in detection were assessed by Fisher’s exact tests. Logistic regression analyses were performed to assess associations between pathogen detection and residential proximity to goat farming and other covariates. Presence of any of the examined pathogens was highest in the PP group (94.5
The hospitalization rate for pneumonia among adults has decreased in the U.S. since the early 2000’s. The increasing prevalence of chronic conditions among adults, especially those associated with risk factors for pneumonia caused by Streptococcus pneumoniae, influenza and respiratory syncytial virus, may be contributing to a larger population susceptible to pneumonia. Existing estimates utilizing claims data may underestimate the true rates of disease due to how diagnostic coding fields are used to define outcomes. A retrospective descriptive study of adult (> 18 years) ACPI inpatient hospitalizations was conducted using US healthcare claims data from 2014 to 2023. Principal ACPI hospitalizations were defined as those with a principal field code for ACPI only. Expanded principal ACPI hospitalizations were those with a principal code for ACPI or a principal code for sepsis, meningitis, COPD, empyema, and acute respiratory failure in combination with a secondary code for ACPI. Prevalence of risk factors indicative for pneumococcal pneumonia, RSV, or severe influenza vaccination were assessed. Principal ACPI showed the largest decline in incidence and this decline was greatest among the younger age groups compared to the older adults. In contrast, the expanded principal definition of ACPI captured between 48.5 and 63.4
To compare the clinical characteristics, management, and outcomes of community-acquired pneumonia (CAP) caused by Haemophilus influenzae in people living with HIV (PWH) versus HIV-negative patients, and to evaluate whether HIV infection independently influences disease severity, intensive care unit (ICU) admission, or short- and long-term mortality. We conducted a retrospective observational study of prospectively collected data including all consecutive adults hospitalized with CAP at a tertiary teaching hospital in Spain between 1996 and 2025. Microbiological confirmation of H. influenzae was obtained using standard diagnostic methods. Clinical variables, treatments, and outcomes were compared between PWH and HIV-negative patients. Propensity score matching (1:3) was applied to adjust for baseline differences. Multivariable generalized linear and Cox regression models were used to assess the association between HIV status and ICU admission, 30-day, 90-day, and 1-year mortality. Among 202 patients, 18 (9
Abstract Background Pneumococcal disease (PD) is a leading cause of morbidity among US children, particularly those with chronic medical conditions (CMC) and immunocompromising conditions (IC), and the decline in PD incidence was less pronounced in the late pneumococcal conjugate vaccine (PCV) 13 period. This study quantified healthcare resource utilization (HCRU) and costs among commercially and Medicaid-insured children with PD. Methods This retrospective observational cohort study used Merative™ MarketScan® Commercial Database and Multi-State Medicaid Databases to identify children with invasive pneumococcal disease (IPD), all-cause pneumonia (ACP), and acute otitis media (AOM) episodes using inpatient and outpatient claims. HCRU and costs per PD episode were assessed in the commercially and Medicaid-insured populations, stratified by age (<2, 2-4, and 5-17 years) and risk group (CMC, IC, and no CMC/IC). Results Between 2018 and 2023, commercially insured children contributed 23.6 million person-years (PY) and Medicaid-insured children contributed 23.4 million PY; 423 and 664 children had IPD, 309,540 and 281,569 had ACP, and 2,721,354 and 2,596,201 had AOM in the commercial and Medicaid populations, respectively. In both databases, HCRU and cost was higher in children with CMC or IC, compared to no CMC/IC across age groups for all PD manifestations. For IPD and ACP, inpatient admissions were 1.4 to 2.2-fold longer for children with CMC or IC. For IPD, costs per episode were 2-to-3-fold higher in children with CMC or IC, compared with those without CMC/IC (Commercial: $76,278 and $72,130 vs. $22,371; Medicaid: $17,389 and $19,945 vs. $6,476, respectively). For ACP, costs were highest in children with IC, followed by CMC and no CMC/IC (Commercial: $7,343, $2,637, and $809; Medicaid: $3,257, $1,160, and $356, respectively). AOM showed a similar pattern, with highest costs in children with IC (Commercial: $608; Medicaid: $178), followed by CMC ($442; $141), and lowest in those without CMC/IC ($368; $123). Conclusions US children with underlying conditions that increase susceptibility to PD experience substantially higher HCRU and costs compared with those without such conditions, across all PD manifestations, regardless of insurance type and age group. These findings underscore the need for risk-based prevention strategies, including vaccination, beyond early childhood in high-risk pediatric populations.
