Epidemiology of Community-Acquired Pneumonia
المؤلف:
Longo, D., Fauci, A. S., Kasper, D. L., Hauser, S., Jameson, J. L., Loscalzo, J., Holland, S. M., & Langford, C. A.
المصدر:
Harrisons Principles of Internal Medicine (2025)
الجزء والصفحة:
22e , p1024
2025-08-12
428
It is estimated that 7 million or more CAP cases occur annually in the United States. The annual incidence in adults ranges from 16 to 23 per 1000 population. The incidence of hospitalization is 650/100,000 but rises dramatically to 2000/100,000 yearly in the elderly. Overall, approximately 30% of patients are hospitalized, resulting in 1.5 million admissions. Along with influenza, CAP is the eighth leading cause of death in the United States, resulting in >60,000 deaths annually. The mortality rate among outpatients is usually <5% but ranges from ~12 to 40% among hospitalized patients. The exact rate depends on whether treatment takes place in or outside the intensive care unit (ICU). In the United States, CAP is the leading cause of death from infection among patients >65 years of age. Moreover, 18% of hospitalized CAP patients are readmitted within 1 month of discharge. The overall yearly CAP cost is estimated at $17 billion.
Risk factors for CAP in general and pneumococcal pneumonia in particular have implications for treatment. They include alcoholism, asthma, immunosuppression, institutionalization, and age >70 years. In the elderly, decreased cough and gag reflexes and reduced antibody and Toll-like receptor responses increase the likelihood of pneumonia. Risk factors for pneumococcal pneumonia include dementia, seizure disorders, heart failure, cerebrovascular disease, alcoholism, tobacco smoking, chronic obstructive pulmonary disease (COPD), and HIV infection. CA-MRSA pneumonia is more likely in patients with skin colonization or infection with CA-MRSA at other sites, and after viral infection. Enterobacteriaceae tend to infect patients recently hospitalized, given antibiotics, or who have comorbidities such as alcoholism, heart failure, or renal failure. P. aeruginosa is a particular problem in patients with severe structural lung disease (e.g., bronchiectasis, cystic fibrosis, or severe COPD). Risk factors for Legionella infection include diabetes, hematologic malignancy, cancer, severe renal disease, HIV infection, smoking, male gender, and a recent hotel stay or cruise ship trip.
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