Patterns of pneumonia in Singapore General Hospital

Abstract

Pneumonia remains a common and often serious problem in spite of the availability of potent antibiotics. Because of the difficulties of microbiological diagnosis, treatment is often empirical. This study was aimed at examining the clinical radiological and bacteriological characteristics of pneumonia as clues to specific diagnosis. 107 cases of pneumonia admitted over one year to a general medical service unit were studied retrospectively. The diagnosis of pneumonia was made on history, clinical findings and radiological evidence of consolidation. 62% of patients smoked tobacco and 21% smoked or swallowed opium. 56% of patients had some form of chronic lung disease. 38.3% of cases were classified as lobar pneumonia and 61.6% as bronchopneumonia. Half of the cases of lobar pneumonia and 79% of cases of bronchopneumonia had a predisposing factor. Cough and sputum production, fever and dyspnea were the most common complaints and fever the most common sign. Pleural effusion, lung abscess or septicemia complicated 12.1% of cases. Hypoxemia occurred in 46% of cases. Sputum specimens were bacteriologically examined in 69% of cases, blood cultures in 25%. 65% of patients had antibiotic treatment before sputum were obtained. There was no difference in the types or proportion of organisms isolated between the group who had prior antibiotic therapy and the group who did not. The overall mortality rate was 22.4%. This study emphasized the poor bacteriological yield of sputum cultures and suggested likely reasons for it. There is an obvious need for improved methods of sputum collection, frequent blood cultures and the detection of bacterial antigens in sputum and serum in a similar prospective study.