Clinical Investigation|Articles in Press

Clinical relevance of bronchiectasis in patients with community-acquired pneumonia



      Data regarding the clinical characteristics and treatment outcomes of patients with community-acquired pneumonia (CAP) and bronchiectasis (BE) are rare. This study aims to elucidate the clinical relevance of BE in patients with CAP.


      Patients hospitalized with CAP in a single center were retrospectively analyzed and divided into significant BE (BE with ≥ 3 lobes or cystic BE on computed tomography) and control groups. Clinical and microbiological characteristics were compared between the two groups.


      In the final analysis, 2112 patients were included, and 104 (4.9%) had significant BE. The significant BE group exhibited a higher prevalence of sputum production, dyspnea, and complicated parapneumonic effusion or empyema than the control group. Pseudomonas aeruginosa was more frequently isolated in the significant BE group than in the control group, whereas Mycoplasma pneumoniae was less commonly identified. Length of hospital stay (LOS) was significantly longer in the significant BE group than the control group (12 [8–17] days vs. 9 [6–13] days, p < 0.001). In contrast, 30-day and in-hospital mortality rates did not significantly differ between the two groups. Furthermore, significant BE was an independent predictor of prolonged hospitalization in two models based on CURB-65 and pneumonia severity index.


      Significant BE occurred in approximately 5% of patients with CAP and was more likely to be associated with sputum, dyspnea, complicated parapneumonic effusion or empyema, and isolation of P. aeruginosa. Significant BE was an independent predictor of LOS in patients with CAP.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Polverino E.
        • Goeminne P.C.
        • McDonnell M.J.
        • et al.
        European respiratory society guidelines for the management of adult bronchiectasis.
        Eur Respir J. 2017; 501700629
        • Chalmers J.D.
        • Goeminne P.
        • Aliberti S.
        • et al.
        The bronchiectasis severity index. An international derivation and validation study.
        Am J Respir Crit Care Med. 2014; 189: 576-585
        • Hill A.T.
        • Sullivan A.L.
        • Chalmers J.D.
        • et al.
        British thoracic society guideline for bronchiectasis in adults.
        Thorax. 2019; 74: 1-69
        • Chalmers J.D.
        • Aliberti S.
        • Filonenko A.
        • et al.
        Characterization of the “frequent exacerbator phenotype” in bronchiectasis.
        Am J Respir Crit Care Med. 2018; 197: 1410-1420
        • Martínez-García M.A.
        • Soler-Cataluña J.-.J.
        • Perpiñá-Tordera M.
        • et al.
        Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis.
        Chest. 2017; 132: 1565-1572
        • Menendez R.
        • Mendez R.
        • Polverino E.
        • et al.
        Factors associated with hospitalization in bronchiectasis exacerbations: a one-year follow-up study.
        Respir Res. 2017; 18: 176
        • Seitz A.E.
        • Olivier K.N.
        • Steiner C.A.
        • et al.
        Trends and burden of bronchiectasis-associated hospitalizations in the United States, 1993-2006.
        Chest. 2010; 138: 944-949
        • Ringshausen F.C.
        • de Roux A.
        • Pletz M.W.
        • et al.
        Bronchiectasis-associated hospitalizations in Germany, 2005-2011: a population-based study of disease burden and trends.
        PLoS One. 2013; 8: e71109
        • Polverino E.
        • Rosales-Mayor E.
        • Benegas M.
        • et al.
        Pneumonic and non-pneumonic exacerbations in bronchiectasis: clinical and microbiological differences.
        J Infect. 2018; 77: 99-106
        • Polverino E.
        • Cilloniz C.
        • Menendez R.
        • et al.
        Microbiology and outcomes of community acquired pneumonia in non cystic-fibrosis bronchiectasis patients.
        J Infect. 2015; 71: 28-36
        • Martinez-Garcia M.A.
        • de Gracia J.
        • Vendrell Relat M.
        • et al.
        Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED score.
        Eur Respir J. 2014; 43: 1357-1367
        • Seo H.
        • Cha S.I.
        • Shin K.M.
        • et al.
        Clinical relevance of emphysema in patients hospitalized with community-acquired pneumonia: clinical features and prognosis.
        Clin Respir J. 2021; 15: 826-834
        • Kalil A.C.
        • Metersky M.L.
        • Klompas M.
        • et al.
        Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the infectious diseases society of America and the American thoracic society.
        Clin Infect Dis. 2016; 63: e61-e111
        • Ramirez J.A.
        • Musher D.M.
        • Evans S.E.
        • et al.
        Treatment of community-acquired pneumonia in immunocompromised adults: a consensus statement regarding initial strategies.
        Chest. 2020; 158: 1896-1911
        • Oken M.M.
        • Creech R.H.
        • Tormey D.C.
        • et al.
        Toxicity and response criteria of the eastern cooperative oncology group.
        Am J Clin Oncol. 1982; 5: 649-656
        • Lim W.
        • Van der Eerden M.
        • Laing R.
        • et al.
        Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study.
        Thorax. 2003; 58: 377-382
        • Fine M.J.
        • Auble T.E.
        • Yealy D.M.
        • et al.
        A prediction rule to identify low-risk patients with community-acquired pneumonia.
        N Engl J Med. 1997; 336: 243-250
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • et al.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Teixeira P.J.Z.
        • Seligman R.
        • Hertz F.
        • et al.
        Inadequate treatment of ventilator-associated pneumonia: risk factors and impact on outcomes.
        J Hosp Infect. 2007; 65: 361-367
        • Magiorakos A.-.P.
        • Srinivasan A.
        • Carey R.B.
        • et al.
        Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance.
        Clin Microbiol Infect. 2012; 18: 268-281
        • Sanchez-Munoz G.
        • Lopez-de-Andres A.
        • Hernandez-Barrera V.
        • et al.
        Hospitalizations for community-acquired and non-ventilator-associated hospital-acquired pneumonia in Spain: influence of the presence of bronchiectasis. A retrospective database study.
        J Clin Med. 2020; 9: 2339
        • Evans S.S.
        • Repasky E.A.
        • Fisher D.T.
        Fever and the thermal regulation of immunity: the immune system feels the heat.
        Nat Rev Immunol. 2015; 15: 335-349
        • Whitters D.
        • Stockley R.
        Immunity and bacterial colonisation in bronchiectasis.
        Thorax. 2012; 67: 1006-1013
        • Chalmers J.D.
        • Hill A.T.
        Mechanisms of immune dysfunction and bacterial persistence in non-cystic fibrosis bronchiectasis.
        Mol Immunol. 2013; 55: 27-34
        • Angrill J.
        • Agusti C.
        • De Celis R.
        • et al.
        Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors.
        Thorax. 2002; 57: 15-19
        • McDonnell M.J.
        • Jary H.R.
        • Perry A.
        • et al.
        Non cystic fibrosis bronchiectasis: a longitudinal retrospective observational cohort study of Pseudomonas persistence and resistance.
        Respir Med. 2015; 109: 716-726
        • Miszkiel K.A.
        • Wells A.U.
        • Rubens M.B.
        • et al.
        Effects of airway infection by Pseudomonas aeruginosa: a computed tomographic study.
        Thorax. 1997; 52: 260-264
        • Kwok W.C.
        • Ho J.C.M.
        • Tam T.C.C.
        • et al.
        Risk factors for Pseudomonas aeruginosa colonization in non-cystic fibrosis bronchiectasis and clinical implications.
        Respir Res. 2021; 22: 132
        • Restrepo M.I.
        • Babu B.L.
        • Reyes L.F.
        • et al.
        Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia: a multinational point prevalence study of hospitalised patients.
        Eur Respir J. 2018; 521701190
        • Sando E.
        • Suzuki M.
        • Ishida M.
        • et al.
        Definitive and indeterminate Pseudomonas aeruginosa infection in adults with community-acquired pneumonia: a prospective observational study.
        Ann Am Thorac Soc. 2021; 18: 1475-1481
        • Arancibia F.
        • Bauer T.T.
        • Ewig S.
        • et al.
        Community-acquired pneumonia due to gram-negative bacteria and Pseudomonas aeruginosa: incidence, risk, and prognosis.
        Arch Intern Med. 2002; 162: 1849-1858
        • Cilloniz C.
        • Gabarrus A.
        • Ferrer M.
        • et al.
        Community-acquired pneumonia due to multidrug- and non-multidrug-resistant Pseudomonas aeruginosa.
        Chest. 2016; 150: 415-425
        • Chen H.
        • Hara Y.
        • Horita N.
        • et al.
        Declined functional status prolonged hospital stay for community-acquired pneumonia in seniors.
        Clin Interv Aging. 2020; 15: 1513-1519
        • Kim J.
        • Park J.S.
        • Cho Y.J.
        • et al.
        Predictors of prolonged stay in patients with community-acquired pneumonia and complicated parapneumonic effusion.
        Respirology. 2016; 21: 164-171
        • Scioscia G.
        • Amaro R.
        • Alcaraz-Serrano V.
        • et al.
        Clinical factors associated with a shorter or longer course of antibiotic treatment in patients with exacerbations of bronchiectasis: a prospective cohort study.
        J Clin Med. 2019; 8: 1950