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2016 ; 62
(8
): 957-61
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Postobstructive Pneumonia: An Underdescribed Syndrome
#MMPMID26908806
Abers MS
; Sandvall BP
; Sampath R
; Zuno C
; Uy N
; Yu VL
; Stager CE
; Musher DM
Clin Infect Dis
2016[Apr]; 62
(8
): 957-61
PMID26908806
show ga
BACKGROUND: Postobstructive community-acquired pneumonia (PO-CAP) is relatively
common in clinical practice. The clinical syndrome is poorly defined, and the
role of infection as a cause of the infiltrate is uncertain. We prospectively
studied patients with PO-CAP and compared them to a cohort of patients with
bacterial community-acquired pneumonia (B-CAP). METHODS: We prospectively studied
patients hospitalized for CAP; 5.4% had PO-CAP, defined as a pulmonary infiltrate
occurring distal to an obstructed bronchus. Sputum and blood cultures, viral
polymerase chain reaction, urinary antigen tests, and serum procalcitonin (PCT)
were done in nearly all cases. Clinical and laboratory characteristics of
patients with PO-CAP were compared to those of patients with B-CAP. RESULTS: In a
2-year period, we identified 30 patients with PO-CAP. Compared to patients with
B-CAP, patients with PO-CAP had longer duration of symptoms (median, 14 vs 5
days;P< .001). Weight loss and cavitary lesions were more common (P< .01 for both
comparisons) and leukocytosis was less common (P< .01) in patients with PO-CAP. A
bacterial pathogen was implicated in only 3 (10%) PO-CAP cases. PCT was <0.25
ng/mL in 19 (63.3%) patients. Although no differences were observed in disease
severity or rates of intensive care unit admissions, 30-day mortality was
significantly higher in PO-CAP vs B-CAP (40.0% vs 11.7%;P< .01). CONCLUSIONS:
Although there is substantial overlap, PO-CAP is a clinical entity distinct from
B-CAP; a bacterial cause was identified in only 10% of patients. Our study has
important implications for the clinical recognition of patients with PO-CAP, the
role of microorganisms as etiologic agents, and the use of antibiotic therapy.
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