Evaluation of severe community-acquired pneumonia at Charlotte Maxeke Johannesburg Academic Hospital, 2007-2019

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Severe Community Acquired Pneumonia (SCAP) is associated with significant morbidity and mortality worldwide, and there are a paucity of data relating to infections in South Africa, a country with a high prevalence of HIV co-infection. The aim of this study was to investigate a cohort of HIV-positive and HIV-negative patients with SCAP, who were admitted to ICU at a tertiary hospital in Johannesburg, South Africa. This was a retrospective single-centre observational study. Consecutive patients admitted to the Medical ICU at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between 1 July 2007 and 31 May 2019 with a diagnosis of community-acquired pneumonia were included in the study. Patients were identified by using the ICU admission books, electronic discharge summaries and/or clinical case notes. Pneumonia was considered to be community-acquired if there was no hospitalization in the 2 weeks prior to the current admission. After excluding 313 records, the cohort consisted of 931 patients with SCAP. The patients were young (median age 37 [IQR 30-48] years), and the predominant co-morbidity was HIV co-infection (77.1%). The median CURB-65 score was 3 (IQR 2-3), the median APACHE II score was 18 (IQR 14-23) and most patients had multilobar consolidation on chest X-ray. Overall Mycobacterium tuberculosis was the most common microbial aetiology identified amongst both HIV-positive and HIV-negative patients. Streptococcus pneumoniae was more common amongst the patients who lived, whereas infection with Pneumocystis jirovecii was more common amongst patients who died. Overall mortality was high (50.1%), and PLWH had a higher risk of mortality than their HIV-negative counterparts on univariable analysis (OR, 1.61; 95% CI 1.07-2.34; P=0.01). In conclusion, we describe a cohort of patients with SCAP in Johannesburg, an area with high HIV prevalence. To our knowledge, this is the largest ICU cohort of patients with SCAP reported in the literature.
A research report submitted in partial fulfilment of the requirement for the degree of Master of Medicine (MMed) in Internal Medicine to the Faculty of Health Sciences, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, 2023
Pneumonia, HIV-positive patients, HIV-negative patients, Intensive Care Unit