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04 11, 2023;13 (4): e066721.

Prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis.

Sidan Wang, Jiaoqi Tang, Yurong Tan, Zhi Song, Ling Qin
Author Information
  1. Sidan Wang: The Second Department of Gastrointestinal Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China. ORCID
  2. Jiaoqi Tang: Emergency Department, Zhuzhou Central Hospital, Zhuzhou, Hunan, China.
  3. Yurong Tan: Department of Medical Microbiology, School of Basic Medical Sciences, Central South University, Changsha, Hunan, China.
  4. Zhi Song: The Second Department of Gastrointestinal Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China 13069778@qq.com.
  5. Ling Qin: Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
PMID: 37041056 DOI: 10.1136/bmjopen-2022-066721

Abstract

OBJECTIVES: We aimed to summarise the prevalence of atypical pathogens in patients with severe pneumonia to understand the prevalence of severe pneumonia caused by atypical pathogens, improve clinical decision-making and guide antibiotic use.
DESIGN: Systematic review and meta-analysis.
DATA SOURCES: PubMed, Embase, Web of Science and Cochrane Library were searched through November 2022.
ELIGIBILITY CRITERIA: English language studies enrolled consecutive cases of patients diagnosed with severe pneumonia, with complete aetiological analysis.
DATA EXTRACTION AND SYNTHESIS: We conducted literature retrieval on PubMed, Embase, Web of Science and The Cochrane Library to estimate the prevalence of , and in patients with severe pneumonia. After double arcsine transformation of the data, a random-effects model was used for meta-analyses to calculate the pooled prevalence of each pathogen. Meta-regression analysis was also used to explore whether the region, different diagnostic method, study population, pneumonia categories or sample size were potential sources of heterogeneity.
RESULTS: We included 75 eligible studies with 18 379 cases of severe pneumonia. The overall prevalence of atypical pneumonia is 8.1% (95% CI 6.3% to 10.1%) In patients with severe pneumonia, the pooled estimated prevalence of , and was 1.8% (95% CI 1.0% to 2.9%), 2.8% (95% CI 1.7% to 4.3%) and 4.0% (95% CI 2.8% to 5.3%), respectively. We noted significant heterogeneity in all pooled assessments. Meta-regression showed that the pneumonia category potentially influenced the prevalence rate of . The mean age and the diagnostic method of pathogens were likely moderators for the prevalence of and , and contribute to the heterogeneity of their prevalence.
CONCLUSIONS: In severe pneumonia, atypical pathogens are notable causes, especially . The diagnostic method, regional difference, sample size and other factors contribute to the heterogeneity of prevalence. The estimated prevalence and relative heterogeneity factors can help with microbiological screening, clinical treatment and future research planning.
PROSPERO REGISTRATION NUMBER: CRD42022373950.

Keywords

Epidemiology INTENSIVE & CRITICAL CARE Respiratory infections

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MeSH Term

Humans
Pneumonia, Bacterial
Prevalence
Mycoplasma pneumoniae
Pneumonia, Mycoplasma
Legionella
Chlamydia
Meta-Analysis Systematic Review Journal Article Research Support, Non-U.S. Gov't
Article has an altmetric score of 11

Word Cloud

Created with Highcharts 10.0.0prevalencepneumoniasevereatypicalpathogenspatientsheterogeneity95%CIpooleddiagnosticmethod3%18%2clinicalreviewmeta-analysisDATAPubMedEmbaseWebScienceCochraneLibrarystudiescasesanalysisusedMeta-regressionsamplesize1%estimated0%4contributefactorsOBJECTIVES:aimedsummariseunderstandcausedimprovedecision-makingguideantibioticuseDESIGN:SystematicSOURCES:searchedNovember2022ELIGIBILITYCRITERIA:EnglishlanguageenrolledconsecutivediagnosedcompleteaetiologicalEXTRACTIONANDSYNTHESIS:conductedliteratureretrievalestimatedoublearcsinetransformationdatarandom-effectsmodelmeta-analysescalculatepathogenalsoexplorewhetherregiondifferentstudypopulationcategoriespotentialsourcesRESULTS:included75eligible18 379overall86109%7%5respectivelynotedsignificantassessmentsshowedcategorypotentiallyinfluencedratemeanagelikelymoderatorsCONCLUSIONS:notablecausesespeciallyregionaldifferencerelativecanhelpmicrobiologicalscreeningtreatmentfutureresearchplanningPROSPEROREGISTRATIONNUMBER:CRD42022373950Prevalencepneumonia:systematicEpidemiologyINTENSIVE&CRITICALCARERespiratoryinfections

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