Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia

Lee, Mi Suk; Oh, Jee Youn; Kang, Cheol-In; Kim, Eu Suk; Park, Sunghoon; Rhee, Chin Kook; Jung, Ji Ye; Jo, Kyung-Wook; Heo, Eun Young; Park, Dong-Ah; Suh, Gee Young; Kiem, Sungmin

Respiratory virus induces pneumonia in children, as well as community-acquired pneumonia in adults. Rapid antigen tests for influenzas and respiratory syncytial virus (RSV) have recently been introduced and used in clinical settings. Multi-plex reverse transcriptase polymerase chain reaction (RT-PCR) has also been used against various respiratory viruses. In a recent study involving 456 adults with community-acquired pneumonia, multiplex RT-PCR was performed for 327 patients. Respiratory viruses were detected in 60 patients (18.3%) [5] . Influenza virus was the most common (n = 23, 38%), followed by RSV (n = 9, 15%), rhinovirus (n = 7, 12%), coronavirus (n = 6, 10%), adenovirus (n = 6, 10%), metapneumovirus (n = 5, 8%), parainfluenza virus (n = 3, 5%) [6] . When a respiratory virus test was performed on patients with community-acquired pneumonia hospitalized in ICU, more than one type of respiratory virus was detected in 72 of 198 patients (36.4%) for whom RT-PCR was performed [14] . Rhinovirus was the most common (n = 17, 23.6%), followed by parainfluenza (n = 15, 20.8%), metapneumovirus (n = 13, 18.1%), influenza virus (n = 12, 16.7%), RSV (n = 10, 13.9%), coronavirus (n = 4, 5.6%), and adenovirus (n = 1, 1.4%) [14] . Other causative bacteria of atypical pneumonia in Korea include Mycobacterium tuberculosis, non-tuberculous mycobacteria, Orientia tsutsugamushi, Leptospira, Coxiella burnetii. Since the preva-167 lence of tuberculosis is still quite high, the possibility of tuberculosis being one of the causes of pneumonia must always be considered. When a patient shows delayed response to antibiotic treatment, or has underlying diseases such as diabetes, chronic obstructive respiratory disease, chronic kidney diseases, and long-term steroid use, tuberculosis must be considered as a possible cause of pneumonia. In addition, pneumonia caused by M. tuberculosis can occur as typical bacterial pneumonia or atypical pneumonia. Since tsutsugamushi disease and leptospirosis, which are febrile illnesses that usually occur in the fall, are sometimes accompanied by atypical pneumonia, when a patient has a febrile illness accompanied by pneumonia in the fall, pneumonia must be differentiated with the possibility of febrile illnesses in mind. Furthermore, as there have been reports of pneumonia caused by C. burnetii in Korea, it is necessary to differentiate C. burnetii, which may possibly be the causative bacteria of pneumonia in persons who come in close direct or indirect contact with livestock. Table 2 lists common causative bacteria of community-acquired pneumonia by epidemiological characteristics and risk factors [15] . Table 3 summarizes common clinical characteristics associated with certain causative bacteria [16] .