CAPNETZ: Data on clinical efficacy of antibiotic therapy and mortality of CAP in Germany
Abstract number: P844
Welte T., Burkhardt O., Marre R., Suttorp N.
Objectives: Because of the medical and economic impact of community-acquired pneumonia (CAP), the Federal Ministry for Education and Research (BMBF) has, since 2001, been financing a network on CAP (CAPNETZ). CAPNETZ was founded to gain new insights into pathogenesis, particularly on pathogen-host interactions, to improve actual care in this area in Germany.
Methods: CAPNETZ integrates components of health research as well as clinical and basic research (horizontal network) on one hand and supports cooperation among general practitioners, community hospitals and universities (vertical network). The network partners report each suspected case of pneumonia to the local clinical centre of CAPNETZ. In case of CAP confirmation all clinical and microbiological data are documented.
Results: By the end of 2006, a total of 5,965 patients had been included in CAPNETZ of whom 1807 were out-patients and 4,158 were in-patients. The mean mortality was 8.2%. A further 5.8% of the patients died within the subsequent 5 months of observation after the cure of CAP. In spite of optimal conditions, an evaluable sputum sample could only be obtained from about half the patients. Usually a throat swab or nasal rinse was obtained for virus or mycoplasma diagnosis and urine was provided for antigen diagnosis (legionella and pneumococci). Even in most cases with sputum no causal pathogen could be found. S. pneumoniae was the most important pathogen, followed by H. influenzae and M. pneumoniae. With a prevalence of ca. 3%, legionella were rare. Nevertheless, they were linked to marked excessive mortality, emphasising the importance of performing a urine antigen test if there is a clinical suspicion of legionella. With a prevalence of about 3%, infections with Enterobacteriaceae were rare and primarily occurred in the risk group of very old and comorbid patients and patients from nursing homes. The mortality of these patients was 8-fold higher than in patients from a domestic environment. For the older patients (> 65 years), survival was highly dependent on the adequate primary antibiotic therapy. For this group (CRB-65 > 2), moxifloxacin was superior to b-lactam antibiotics. For patients with less severe disease (CRB-65 0 and 1), antibiotics like ampicillin were as effective as broad spectrum antibiotics.
Conclusion: The CAPNETZ data confirm the importance of pneumococci in CAP. The more severe cases benefit notably from an antibiotic therapy with moxifloxacin.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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