• Naoto Ishimaru, Satoshi Suzuki, Toshio Shimokawa, Yusaku Akashi, Yuto Takeuchi, Atsuo Ueda, Saori Kinami, Hisashi Ohnishi, Hiromichi Suzuki, Yasuharu Tokuda, and Tetsuhiro Maeno.
• Department of General Internal Medicine, Akashi Medical Center, 743-33, Ohkubo-Cho Yagi, Akashi, Hyogo, 674-0063, Japan. maru-tkb@umin.ac.jp.
• Intern Emerg Med. 2021 Nov 1; 16 (8): 2129-2137.

AbstractCommunity-acquired pneumonia (CAP) is a common illness that can lead to mortality. β-lactams are ineffective against atypical pathogen including Mycoplasma pneumoniae. We used molecular examinations to develop a decision tree to predict atypical pathogens with CAP and to examine the prevalence of macrolide resistance in Mycoplasma pneumoniae. We conducted a prospective observational study of patients aged ≥ 18 years who had fever and respiratory symptoms and were diagnosed with CAP in one of two community hospitals between December 2016 and October 2018. We assessed combinations of clinical variables that best predicted atypical pathogens with CAP by classification and regression tree (CART) analysis. Pneumonia was defined as respiratory symptoms and new infiltration recognized on chest X-ray or chest computed tomography. We analyzed 47 patients (21 females, 44.7%, mean age: 47.6 years). Atypical pathogens were detected in 15 patients (31.9%; 12 Mycoplasma pneumoniae, 3 Chlamydophila pneumoniae). Ten patients carried macrolide resistant Mycoplasma pneumoniae (macrolide resistant rate 83.3%). CART analysis suggested that factors associated with presence of atypical pathogens were absence of crackles, age < 45 years, and LD ≥ 183 U/L (sensitivity 86.7% [59.5, 98.3], specificity 96.9% [83.8, 99.9]). ur simple clinical decision rules can be used to identify primary care patients with CAP that are at risk for atypical pathogens. Further research is needed to validate its usefulness in various populations.Trial registration Clinical Trial (UMIN trial ID: UMIN000035346).© 2021. Società Italiana di Medicina Interna (SIMI).

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