Clinical and etiological characteristics of severe community-acquired pneumonia: A two-center retrospective analysis from Xi’an and Jiaxing in China
TL;DR
Severe community-acquired pneumonia, which is most often caused by K. pneumoniae in the authors' region, regularly complicates chronic obstructive pulmonary disease and other chronic pulmonary diseases, requires broad-spectrum antibiotics and life-support, and is associated with a relatively high mortality rate.
Abstract
Objective This study was conducted to evaluate the baseline clinical profile, causative pathogens, and treatment patterns of severe community-acquired pneumonia across two medical centers (Xi’an and Jiaxing) from January 2023 to August 2025. Methods We extracted data regarding medical profile, demographic characteristics, comorbidities, laboratory parameters, treatments during hospitalization, and outcomes for these patients from electronic records. Pathogens were detected using a combination of sputum culture/throat-swab polymerase chain reaction with metagenomic next-generation sequencing or targeted next-generation sequencing. Results Among the 204 severe community-acquired pneumonia patients, majority were men (72.55%, 95% confidence interval: 66.05%–78.21%); the age range of the population was 65–79 years (41.18%, 95% confidence interval: 34.65%–48.03%), and chronic obstructive pulmonary disease was the predominant chronic pulmonary condition, present in 28.92% of the study participants. Laboratory evaluations revealed high illness severity scores (Acute Physiology and Chronic Health Evaluation II score: 19.00 (14.00, 24.00) and Sequential Organ Failure Assessment score: 7.00 (6.00, 10.00)). Pathogens were identified using metagenomic next-generation sequencing or targeted next-generation sequencing of blood/sputum/bronchoalveolar lavage fluid and polymerase chain reaction of sputum culture/throat-swab in 117 and 85 cases, respectively. Klebsiella pneumoniae was the most common pathogen, present in 20.10% of the participants (95% confidence interval: 15.18%–26.13%), followed by coronavirus 2019 (16.18%, 95% confidence interval: 11.76%–21.85%), and influenza A virus (12.75%, 95% confidence interval: 8.85%–18.02%). Most frequently administered medicines were β-lactam/β-lactamase-inhibitor combinations (89.22%) and carbapenems (60.78%). All patients received respiratory support, with 15.69% undergoing continuous renal-replacement therapy and 5.39% receiving extracorporeal membrane oxygenation. The in-hospital mortality rate was 38.73% (79/204, 95% confidence interval: 32.31%–45.56%). Conclusion Severe community-acquired pneumonia, which is most often caused by K. pneumoniae in our region, regularly complicates chronic obstructive pulmonary disease and other chronic pulmonary diseases, requires broad-spectrum antibiotics and life-support, and is associated with a relatively high mortality rate.