Epidemiology and aetiology of severe community acquired pneumonia at Royal Darwin Hospital Intensive Care Unit

Ian Marr, Resy van Beek, Rob Baird, Anna Ralph

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    Abstract

    The aetiology of severe community acquired
    pneumonia (CAP) differs between tropical
    Australia and temperate parts of the country. We
    undertook an audit to describe the
    implementation of a new testing algorithm to
    determine the additional diagnostic yield, if any,
    of a newly-introduced rapid diagnostic test in
    severe CAP in an Intensive Care Unit (ICU) in a
    tertiary facility in Australia’s Northern Territory.
    All adult patients with severe CAP admitted
    during a 12-month period were included. A
    diagnostic algorithm was implemented whereby
    patients in whom the microbiological diagnosis
    remained uncertain at 48 hours of intubation
    were eligible to have an endotracheal tube
    aspirate tested using a multiplex real-time
    polymerase chain reaction (RT-PCR) (BioFire
    Diagnostics, Salt Lake City, UT). This detects
    Adenovirus, Coronaviruses, Human
    metapneumovirus, Rhinovirus, Enterovirus,
    Influenza A and B, Parainfluenza 1-4,
    Respiratory syncytial virus (RSV), Bordetella
    pertussis, Chlamydophila pneumoniae and
    Mycoplasma pneumoniae.
    There were 86 eligible CAP diagnoses during the
    study period. We found that a microbiological
    aetiology was detected using standard
    diagnostics in 50/86 (58%). Most common
    pathogens were: Streptococcus pneumoniae (10),
    Burkholderia pseudomallei (9), Influenza (9),
    Staphylococcus aureus (8), Acinetobacter
    baumannii (3), Pseudomonas aeruginosa (3),
    Myocbacterium tuberculosis (2) and Nocardia sp
    (1).
    Eight patients were eligible for testing using the
    RT-PCR according to the algorithm; 5 tests were
    performed showing Rhinovirus/ Enterovirus (1),
    Parainfluenza-3 (1) and Respiratory Syncytial
    Virus (1) or no pathogens (2). Therefore, the
    additional diagnostic yield using the algorithm in
    this patient subset was low.

    Multiplex testing for respiratory infections may
    have an important place, but few patients were
    eligible using a strict algorithm, and clinician
    uptake was low. Implementation of a new test
    requires careful consideration about strategies
    for targeted use and clinician education. Current
    local guidelines on empirical CAP antimicrobial
    therapy are appropriate for the range of
    pathogens which predominate in this tropical
    environment.
    Original languageEnglish
    Pages (from-to)14-19
    Number of pages6
    JournalThe Northern Territory Disease Control Bulletin
    Volume25
    Issue number2
    Publication statusPublished - Jun 2018

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