The aetiology of community-acquired pneumonia and implications for patient management

A B van Gageldonk-Lafeber, P C Wever, I M van der Lubben, C P C de Jager, A Meijer, M C de Vries, K Elberse, Marianne van der Sande, W van der Hoek

Research output: Contribution to journalA1: Web of Science-articlepeer-review


PURPOSE: Understanding which pathogens are associated with clinical manifestation of community-acquired pneumonia (CAP) is important to optimise treatment. We performed a study on the aetiology of CAP and assessed possible implications for patient management in the Netherlands.

METHODS: Patients with CAP attending the emergency department of a general hospital were invited to participate in the study. We used an extensive combination of microbiological techniques to determine recent infection with respiratory pathogens. Furthermore, we collected data on clinical parameters and potential risk factors.

RESULTS: From November 2007 through January 2010, 339 patients were included. Single bacterial infection was found in 39% of these patients, single viral infection in 12%, and mixed bacterial-viral infection in 11%. Streptococcus pneumoniae was the most frequently identified pathogen (22%; n=74). Infection with atypical bacteria was detected in 69 (20%) of the patients.

CONCLUSION: Initial empirical antibiotics should be effective against S. pneumoniae, the most common pathogen identified in CAP patients. The large proportion of patients with infection with atypical bacteria points to the need for improved diagnostic algorithms including atypical bacteria, especially since these atypical bacteria are not covered by the first-choice antibiotic treatment according to the recently revised Dutch guidelines on the management of CAP.

Original languageEnglish
JournalNetherlands Journal of Medicine
Issue number8
Pages (from-to)418-425
Number of pages8
Publication statusPublished - 2013


  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents/therapeutic use
  • Community-Acquired Infections/drug therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Pneumonia, Bacterial/drug therapy
  • Pneumonia, Viral/drug therapy
  • Practice Guidelines as Topic
  • Prospective Studies
  • Young Adult


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