Community-acquired pneumonia in northern Australia: low mortality in a tropical region using locally-developed treatment guidelines

J Elliott, Nicholas Anstey, S Jacups, D Fisher, Bart Currie

    Research output: Contribution to journalArticle

    Abstract

    To investigate the epidemiology and outcome of adult community-acquired pneumonia (CAP) in tropical Australia. A prospective study was performed of all adult patients with CAP admitted to the Royal Darwin Hospital, a major hospital in tropical northern Australia. A standard definition of CAP was used and data collected on demographics, risk factors, history, examination, investigations, treatment and outcome. Locally-developed treatment guidelines were used. One hundred and sixty-seven adults were included in the analysis. Aboriginal people were over-represented, younger and were more likely to have risk factors for CAP. The most frequent pathogens isolated were Streptococcus pneumoniae and Burkholderia pseudomallei. 'Atypical pneumonia' organisms were uncommon. Treatment guidelines included penicillin for mild pneumonia but emphasised coverage of Burkholderia pseudomallei in those with risk factors, especially during the monsoon season. The mortality rate from pneumonia was low with three deaths in 167 cases (1.8%). International guidelines for the management of CAP have been based on populations and organisms from temperate regions and may not necessarily be applicable to tropical regions. Guidelines based upon local epidemiology must therefore be developed. This study illustrates how mortality can be minimised using a process of determining local CAP etiology, developing treatment guidelines and auditing patient management. � 2005 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
    Original languageEnglish
    Pages (from-to)15-20
    Number of pages6
    JournalInternational Journal of Infectious Diseases
    Volume9
    Issue number1
    Publication statusPublished - 2005

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    Pneumonia
    Guidelines
    Mortality
    Burkholderia pseudomallei
    Therapeutics
    Epidemiology
    Streptococcus pneumoniae
    Penicillins
    History
    Demography
    Prospective Studies
    Population

    Cite this

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    title = "Community-acquired pneumonia in northern Australia: low mortality in a tropical region using locally-developed treatment guidelines",
    abstract = "To investigate the epidemiology and outcome of adult community-acquired pneumonia (CAP) in tropical Australia. A prospective study was performed of all adult patients with CAP admitted to the Royal Darwin Hospital, a major hospital in tropical northern Australia. A standard definition of CAP was used and data collected on demographics, risk factors, history, examination, investigations, treatment and outcome. Locally-developed treatment guidelines were used. One hundred and sixty-seven adults were included in the analysis. Aboriginal people were over-represented, younger and were more likely to have risk factors for CAP. The most frequent pathogens isolated were Streptococcus pneumoniae and Burkholderia pseudomallei. 'Atypical pneumonia' organisms were uncommon. Treatment guidelines included penicillin for mild pneumonia but emphasised coverage of Burkholderia pseudomallei in those with risk factors, especially during the monsoon season. The mortality rate from pneumonia was low with three deaths in 167 cases (1.8{\%}). International guidelines for the management of CAP have been based on populations and organisms from temperate regions and may not necessarily be applicable to tropical regions. Guidelines based upon local epidemiology must therefore be developed. This study illustrates how mortality can be minimised using a process of determining local CAP etiology, developing treatment guidelines and auditing patient management. � 2005 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.",
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    author = "J Elliott and Nicholas Anstey and S Jacups and D Fisher and Bart Currie",
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    N2 - To investigate the epidemiology and outcome of adult community-acquired pneumonia (CAP) in tropical Australia. A prospective study was performed of all adult patients with CAP admitted to the Royal Darwin Hospital, a major hospital in tropical northern Australia. A standard definition of CAP was used and data collected on demographics, risk factors, history, examination, investigations, treatment and outcome. Locally-developed treatment guidelines were used. One hundred and sixty-seven adults were included in the analysis. Aboriginal people were over-represented, younger and were more likely to have risk factors for CAP. The most frequent pathogens isolated were Streptococcus pneumoniae and Burkholderia pseudomallei. 'Atypical pneumonia' organisms were uncommon. Treatment guidelines included penicillin for mild pneumonia but emphasised coverage of Burkholderia pseudomallei in those with risk factors, especially during the monsoon season. The mortality rate from pneumonia was low with three deaths in 167 cases (1.8%). International guidelines for the management of CAP have been based on populations and organisms from temperate regions and may not necessarily be applicable to tropical regions. Guidelines based upon local epidemiology must therefore be developed. This study illustrates how mortality can be minimised using a process of determining local CAP etiology, developing treatment guidelines and auditing patient management. � 2005 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

    AB - To investigate the epidemiology and outcome of adult community-acquired pneumonia (CAP) in tropical Australia. A prospective study was performed of all adult patients with CAP admitted to the Royal Darwin Hospital, a major hospital in tropical northern Australia. A standard definition of CAP was used and data collected on demographics, risk factors, history, examination, investigations, treatment and outcome. Locally-developed treatment guidelines were used. One hundred and sixty-seven adults were included in the analysis. Aboriginal people were over-represented, younger and were more likely to have risk factors for CAP. The most frequent pathogens isolated were Streptococcus pneumoniae and Burkholderia pseudomallei. 'Atypical pneumonia' organisms were uncommon. Treatment guidelines included penicillin for mild pneumonia but emphasised coverage of Burkholderia pseudomallei in those with risk factors, especially during the monsoon season. The mortality rate from pneumonia was low with three deaths in 167 cases (1.8%). International guidelines for the management of CAP have been based on populations and organisms from temperate regions and may not necessarily be applicable to tropical regions. Guidelines based upon local epidemiology must therefore be developed. This study illustrates how mortality can be minimised using a process of determining local CAP etiology, developing treatment guidelines and auditing patient management. � 2005 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

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