Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi

Aston, Stephen J ORCID: 0000-0002-0701-8364, Ho, Antonia ORCID: 0000-0003-1465-3785, Jary, Hannah, Huwa, Jacqueline, Mitchell, Tamara, Ibitoye, Sarah, Greenwood, Simon, Joekes, Elizabeth, Daire, Arthur, Mallewa, Jane
et al (show 6 more authors) (2019) Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 200 (3). pp. 359-369.

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<b>Rationale:</b> In the context of rapid antiretroviral therapy rollout and an increasing burden of noncommunicable diseases, there are few contemporary data describing the etiology and outcome of community-acquired pneumonia (CAP) in sub-Saharan Africa.<b>Objectives:</b> To describe the current etiology of CAP in Malawi and identify risk factors for mortality.<b>Methods:</b> We conducted a prospective observational study of adults hospitalized with CAP to a teaching hospital in Blantyre, Malawi. Etiology was defined by blood culture, <i>Streptococcus pneumoniae</i> urinary antigen detection, sputum mycobacterial culture and Xpert MTB/RIF, and nasopharyngeal aspirate multiplex PCR.<b>Measurements and Main Results:</b> In 459 patients (285 [62.1%] males; median age, 34.7 [interquartile range, 29.4-41.9] yr), 30-day mortality was 14.6% (64/439) and associated with male sex (adjusted odds ratio, 2.60 [95% confidence interval, 1.17-5.78]), symptom duration greater than 7 days (2.78 [1.40-5.54]), tachycardia (2.99 [1.48-6.06]), hypoxemia (4.40 [2.03-9.51]), and inability to stand (3.59 [1.72-7.50]). HIV was common (355/453; 78.4%), frequently newly diagnosed (124/355; 34.9%), but not associated with mortality. <i>S. pneumoniae</i> (98/458; 21.4%) and <i>Mycobacterium tuberculosis</i> (75/326; 23.0%) were the most frequently identified pathogens. Viral infection occurred in 32.6% (148/454) with influenza (40/454; 8.8%) most common. Bacterial-viral coinfection occurred in 9.1% (28/307). Detection of <i>M. tuberculosis</i> was associated with mortality (adjusted odds ratio, 2.44 [1.19-5.01]).<b>Conclusions:</b> In the antiretroviral therapy era, CAP in Malawi remains predominantly HIV associated, with a large proportion attributable to potentially vaccine-preventable pathogens. Strategies to increase early detection and treatment of tuberculosis and improve supportive care, in particular the correction of hypoxemia, should be evaluated in clinical trials to address CAP-associated mortality.

Item Type: Article
Uncontrolled Keywords: community-acquired pneumonia, HIV, Africa south of the Sahara, Streptococcus pneumoniae, pulmonary tuberculosis
Depositing User: Symplectic Admin
Date Deposited: 06 Feb 2019 12:04
Last Modified: 15 Mar 2024 08:09
DOI: 10.1164/rccm.201807-1333OC
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