Abstract
Pseudomonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aeruginosa-CAP are limited. We assessed the multinational burden and specific risk factors associated with P. aeruginosa-CAP.
We enrolled 3193 patients in 54 countries with confirmed diagnosis of CAP who underwent microbiological testing at admission. Prevalence was calculated according to the identification of P. aeruginosa. Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant P. aeruginosa-CAP.
The prevalence of P. aeruginosa and antibiotic-resistant P. aeruginosa-CAP was 4.2% and 2.0%, respectively. The rate of P. aeruginosa CAP in patients with prior infection/colonisation due to P. aeruginosa and at least one of the three independently associated chronic lung diseases (i.e. tracheostomy, bronchiectasis and/or very severe chronic obstructive pulmonary disease) was 67%. In contrast, the rate of P. aeruginosa-CAP was 2% in patients without prior P. aeruginosa infection/colonisation and none of the selected chronic lung diseases.
The multinational prevalence of P. aeruginosa-CAP is low. The risk factors identified in this study may guide healthcare professionals in deciding empirical antibiotic coverage for CAP patients.
Abstract
P. aeruginosa is infrequent in CAP patients. Specific risk factors should be assessed when choosing antibiotics for CAP. http://ow.ly/jpP130koSMX
Footnotes
This article has supplementary material available from erj.ersjournals.com
GLIMP investigators: We would like to thank the following study contributors for their valuable collaboration: Argentina: Patricia Karina Aruj, Department of Internal Medicine, University Hospital Alfredo Lanari, Buenos Aires, Argentina; Silvia Attorri, Hospital Luis Lago Maggiore, Mendoza, Argentina; Enrique Barimboim, Hospital Central de Mendoza, Argentina; Juan Pablo Caeiro and María I. Garzón, Hospital Privado Universitario, Córdoba, Argentina; Victor Hugo Cambursano, V.H. Dr Cazaux A. Servicio de Neumologia, Hospital Rawson, Córdoba, Argentina; Adrian Ceccato, Hospital Nacional Prof Alejandro Posadas, Argentina; Julio Chertcoff, Florencia Lascar and Fernando Di Tulio, Critical Care Unit and Respiratory Medicine, Buenos Aires British Hospital, Buenos Aires, Argentina; Ariel Cordon Díaz, Hospital General Alvear, Ciudad, Mendoza, Argentina; Lautaro de Vedia, Respiratory Intensive Care Unit, Hospital Muñiz, Buenos Aires, Argentina; Maria Cristina Ganaha, Infectious Diseases Ward, Hospital Interzonal General de Agudos “Vicente Lopez y Planes” from General Rodriguez, Buenos Aires, Argentina; Sandra Lambert, Hospital El Cruce – Alta Complejidad en Red, Argentina; Gustavo Lopardo, Hospital Bernardo Houssay, Vicente López, Argentina; Carlos M. Luna, Pulmonary Medicine Division, Department of Medicine, Hospital de Clínicas, Universidad de Buenos Aires, Argentina; Alessio Gerardo Malberti, Hospital Nuestra Señora del Carmen, Argentina; Nora Morcillo and Silvina Tartara, Hospital Zonal Especializado de Agudos y Crónicos Dr Antonio A. Cetrangolo, Argentina; Claudia Pensotti, Infectious Diseases and Infection Control Department, Buenos Aires, Clinica Privada Monte Grande, Argentina; Betiana Pereyra, Hospital San Roque, Córdoba, Argentina; Pablo Gustavo Scapellato, Infectious Diseases Department, Hospital D.F. Santojanni, Argentina; Juan Pablo Stagnaro, HZGA Mi Pueblo, Florencio Varela, Argentina. Australia: Sonali Shah, Department of General Medicine, Austin Hospital, Heidelberg, Australia. Austria: Felix Lötsch and Florian Thalhammer, Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Austria. Belgium: Kurt Anseeuw, ZNA Campus Stuivenberg, Antwerp, Belgium; Camille A. Francois, Anesthesia and Critical Care Department, Erasme University Hospital, Brussels, Belgium; Eva Van Braeckel, Department of Respiratory Medicine, Ghent University Hospital, Belgium; Jean Louis Vincent, Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. Benin: Marcel Zannou Djimon, Jules Bashi and Roger Dodo, Centre Hospitalier Universitaire HKM of Cotonou, Benin. Brazil: Simone Aranha Nouér, Federal University of Rio de Janeiro, Brazil. Bulgaria: Peter Chipev and Milena Encheva, Clinic of Pulmonary Diseases, Military Medical Academy, Sofia, Bulgaria; Darina Miteva, UMHAT “St. Marina”, Varna, Bulgaria; Diana Petkova, University Hospital Varna, Bulgaria. Cameroon: Adamou Dodo Balkissou, Yaounde Jamot Hospital, Yaounde, Cameroon; Eric Walter Pefura Yone, Département de Médecine Interne, University of Yaounde, Yaoundé, Cameroon; Bertrand Hugo Mbatchou Ngahane, Douala General Hospital, Douala, Cameroon. China: Ning Shen, Respiratory Medicine, Peking University Third Hospital, Beijing, China; Jin-fu Xu, Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, China. Colombia: Carlos Andres Bustamante Rico and Ricardo Buitrago, Clinica Shaio, Bogota, Colombia; Fernando Jose Pereira Paternina, Las Americas Clinic, Medellin, Colombia. Congo: Jean-Marie Kayembe Ntumba, Cliniques Universitaires de Kinshasa, DR Congo. Croatia: Vesna Vladic Carevic, Interne Medicine, Dubrovnik, Croatia; Marko Jakopovic, Medical School, University of Zagreb, Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia; Mateja Jankovic, University Hospital Center Zagreb, Department for Respiratory Diseases, Zagreb, Croatia; Zinka Matkovic, University Hospital Dubrava, Zagreb, Croatia; Ivan Mitrecic, Karlovac General Hospital, Karlovac, Croatia. Denmark: Marie-Laure Bouchy Jacobsson, Emergency Department in North Zealand's Hospital, Hillerød, Denmark; Anette Bro Christensen, Department of Anaethesiology, Viborg Region Hospital, Denmark; Uffe Christian Heitmann Bødtger, Department of Pulmonology, Naestved Hospital, Denmark; Christian Niels Meyer, Department of Internal Medicine, Roskilde Hospital, Copenhagen University Hospital, Roskilde, Denmark; Andreas Vestergaard Jensen, Gertrud Baunbæk-Knudsen, Pelle Trier Petersen and Stine Andersen, Department of Lung- and Infectious Diseases, Nordsjællands Hospital-Hillerød, Denmark. Egypt: Ibrahim El-Said Abd El-Wahhab, Thoracic Medicine, Faculty of Medicine – Mansoura University, Egypt; Nesreen Elsayed Morsy, Pulmonary, Critical Care and Sleep Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Hanaa Shafiek, Chest Diseases Department, Faculty of Medicine, Alexandria University, Egypt; Eman Sobh, Chest Diseases Department, Al-Azhar University, Cairo, Egypt. Ethiopia: Kedir Abdella Abdulsemed, Department of Medical Laboratory Science and Pathology, College of Health Sciences, Mycobacteriology Research Centre, Institute of Biotechnology Research, Jimma University, Jimma, Ethiopia. France: Fabrice Bertrand, Critical Care Unit, Robert Ballanger Hospital, Aulnay sous Bois, France; Christian Brun-Buisson, Univ Hospital Henri Mondor, 94000 Créteil, France; Etienne de Montmollin, Intensive Care Unit, Hôpital Delafontaine, Centre hospitalier de Saint-Denis, Saint-Denis, France; Muriel Fartoukh, Unité de réanimation médico-chirurgicale, Pôle Thorax Voies aériennes, Hôpital Tenon, Groupe Hospitalier Est Parisien, France; Jonathan Messika, Publique-Hôpital de Paris, Service de Réanimation Médico-chirurgicale, Hôpital Louis Mourier, Colombes, France and Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; Pierre Tattevin, Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France; Abdo Khoury, Department of Emergency Medicine and Critical Care, University of Franche – Comté, Medical Center, France. Gambia: Bernard Ebruke, Medical Research Council Unit, Gambia. Germany: Michael Dreher, Department of Cardiology, Pneumology, Vascular Medicine and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany; Martin Kolditz, Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Matthias Meisinger, Klinikum Niederlausitz GmbH, Klinik für Innere Medizin und Intensivmedizin, Senftenberg, Germany; Mathias W. Pletz and Stefan Hagel, Center for Infectious Diseases and Infection Control, Jena University Hospital, Germany; Jan Rupp, Department of Molecular and Infectious Diseases, University of Lübeck, Lübeck, Germany; Tom Schaberg, Zentrum für Pneumologie, Agaplesion Diakonieklinikum Rotenburg, Germany; Marc Spielmanns, Internal Medicine Department, Pulmonary Rehabilitation and Department of Health, School of Medicine, University Witten-Herdecke, St. Remigius-Hospital, Leverkusen, Germany; Petra Creutz and Norton Suttorp, Department of Infectious Disease and Respiratory Medicine, Charité – University Medicine, Berlin, Germany. Ghana: Beatrice Siaw-Lartey, Komfo-Anokye Teaching Hospital, Kumasi, Ghana. Greece: Katerina Dimakou, 5th Respiratory Medicine Dpt, “SOTIRIA” Chest Hospital, Athens 11527, Greece; Dimosthenis Papapetrou, Medical Group of Athens (Paleo Faliro Clinic), Athens, Greece; Evdoxia Tsigou and Dimitrios Ampazis, Agioi Anargiroi Hospital, Kifissia, Athens, Greece; Evangelos Kaimakamis, Intensive Care Unit, “G. Papanikolaou” General Hospital of Thessaloniki, Greece. India: Mohit Bhatia, S.S. Hospital IMS BHU Varanasi, India; Raja Dhar, Fortis Hospitals, Kolkata, India; George D'Souza, Department of Pulmonary Medicine, St John's Medical College Hospital, Bangalore, India; Rajiv Garg, Department of Respiratory Medicine, King George's Medical University UP, Lucknow, India; Parvaiz A. Koul, Department of Internal and Pulmonary Medicine, SheriKashmir Institute of Medical Sciences, Srinagar, India; P.A. Mahesh and B.S. Jayaraj, Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore, India; Kiran Vishnu Narayan, Pulmonary Medicine, Government Medical College Kozhikode, Kerala, India; Hirennappa B. Udnur and Shashi Bhaskara Krishnamurthy, Columbia Asia Hospital, Hebbal, Bengaluru, Karnataka, India; Surya Kant, Department of Respiratory Medicine, King George's Medical University, Chowk, Lucknow, India; Rajesh Swarnakar, Getwell Hospital and Research Institute, Dhantoli, Nagpur, India; Sneha Limaye and Sundeep Salvi, on behalf of the Respiratory Research Network of India (RRNI) from the Chest Research Foundation in Pune, India. Iran: Keihan Golshani, Isfahan University of Medical Sciences, Iran. Ireland: Vera M. Keatings, Letterkenny General Hospital, Co. Donegal, Ireland; Ignacio Martin-Loeches, Multidisciplinary Intensive Care Research Organization (MICRO), St James's University Hospital, Trinity Centre for Health Sciences Dublin, Ireland. Israel: Yasmin Maor, Infectious Disease Unit, Affiliated to Tel Aviv University, Wolfson Medical Center, Holon, Israel; Jacob Strahilevitz, Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University, Jerusalem, Israel. Italy: Salvatore Battaglia, University of Palermo, Pneumologia DiBiMIS, Palermo, Italy; Maria Carrabba, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122, Milano, Italy; Piero Ceriana, Pulmonary Rehabilitation, IRCCS Fondazione Maugeri, 27100, Pavia, Italy; Marco Confalonieri, Department of Pulmunology, University Hospital, Trieste, Italy; Antonella d'Arminio Monforte, Department of Health Sciences, Clinic of Infectious Disease, San Paolo Hospital, University of Milan, Italy; Bruno Del Prato, Interventional Pneumology, Hospital Antonio Cardarelli, Naples, Italy; Marino De Rosa, UOC Pneumologia P.O. San Filippo Neri ASL RM E Roma, Italy; Riccardo Fantini, Respiratory Diseases clinic, Policlinico di Modena, 41124 Modena, Italy; Giuseppe Fiorentino, UOC Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli PO Monaldi, Italy; Maria Antonia Gammino, Pulmonary Medicine Unit, San Martino Hospital, ASL 5 Oristano, Sardegna, Italy; Francesco Menzella, Department of Cardiac-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; Giuseppe Milani, Azienda Ospedaliera Sant Anna di Como, Presidio Ospedale S. Anna Nuovo, Unità Operativa di Pneumologia, Como, Italy; Stefano Nava, Alma Mater University of Bologna, DIMES, Respiratory and Critical Care Unit Sant'Orsola Malpighi Hospital, Italy; Gerardo Palmiero, Respiratory Unit, Versilia Hospital, Azienda USL 12 Viareggio, Lido di Camaiore, Lucca, Italy; Roberta Petrino and Barbra Gabrielli, Emergency Medicine Unit, S. Andrea Hospital, Vercelli, Italy; Paolo Rossi, Internal Medicine Department, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy; Claudio Sorino, Pulmonology Unit, A.O. Sant'Anna di Como, Italy; Gundi Steinhilber, Spedali Civili Brescia, U.O. Pneumologia e Fisiopatologia Respiratoria, Brescia, Italy; Alessandro Zanforlin, ULSS 18 Rovigo, Ospedale San Luca, 45027 Trecenta (RO), Italy; Fabio Franzetti, Manuela Carugati, Manuela Morosi and Elisa Monge, Department of Biomedical and Clinical Sciences, Division of Infectious Diseases, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy; Mauro Carone, Fondazione Salvatore Maugeri, IRCCS, Cassano Murge, Italy; Vincenzo Patella, Allergology and Clinical Immunology Unit, Department of Medical Sciences, Battipaglia Hospital, Battipaglia, Salerno, Italy; Simone Scarlata, Geriatrics, Unit of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio Medico University and Teaching Hospital, Rome, Italy; Andrea Comel, UO Pneumologia, Ospedale Pederzoli, Peschiera del Garda, Italy. Japan: Kiyoyasu Kurahashi, Yokohama City University Medical Center, Japan. Lebanon: Zeina Aoun Bacha, Medicine School, St Joseph University, Beyrouth, Lebanon. Mexico: Daniel Barajas Ugalde, National Institute of Respiratory Diseases, Mexico; Omar Ceballos Zuñiga, Hospital General de Mexicali, Mexicali, Baja California, Mexico; José F. Villegas, Hospital Universitario Monterrey, n. l. México CP 64030. Montenegro: Milic Medenica, Hospital for Lung Diseases – Brezovik, Niksic, Montenegro. Nepal: Deebya Raj Mihsra, Internal Medicine, BP Koirala Institute of Health Sciences, Nepal; Poojan Shrestha, Oxford University Clinical Research Unit, Patan Hospital, Nepal. The Netherlands: E.M.W. van de Garde, Dept Clinical Pharmacy, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands. New Zealand: Elliott Ridgeon, Medical Research Institute of New Zealand. Nigeria: Babatunde Ishola Awokola, Department of Family Medicine and Primary Care, Lily Hospitals Limited, Warri, Nigeria; Ogonna N.O. Nwankwo, University of Calabar Teaching Hospital, Calabar, Nigeria; Adefuye Bolanle Olufunlola, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria; Segaolu Olumide, Department of Medicine (Pulmonary Unit), University College Hospital, Ibadan, Nigeria; Kingsley N. Ukwaja, Department of Medicine, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria. Pakistan: Muhammad Irfan, Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Karachi-74800, Pakistan. Poland: Lukasz Minarowski, Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Poland; Skoczyński Szymon, Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland. Portugal: Felipe Froes, Hospital Pulido Valente – CHLN, Lisboa, Portugal; Pedro Leuschner, Centro Hospitalar do Porto, Porto, Portugal; Mariana Meireles, Cláudia Ferrão, Pedro Leuschner and João Neves, Serviço de Medicina, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal; Sofia B Ravara, Faculty of Health Sciences, University of Beira Interior; Cova da Beira Hospital Center, 6200-251 Covilhã, Portugal. Republic of Moldova: Victoria Brocovschii, Department of Pneumology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu” Republic of Moldova; Chesov Ion, Clinic of Anesthesia and Intensive Care “Valeriu Ghrerg”, Institute of Emergency Medicine, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Republic of Moldova; Doina Rusu, SMFU “N. Testemitanu”, Chisinau, Republic of Moldova; Cristina Toma, Department of Pneumology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Republic of Moldova. Romania: Daniela Chirita, Hospital Sfantul Stefan, Bucharest, Romania; Carmen Mihaela Dorobat, Universitatea de Medicină şi Farmacie “Gr. T. Popa” Iaşi Facultatea de Medicină Stomatologică, Spitalul Clinic de Boli Infecţioase “Sfânta Parascheva”, Iaşi, Romania. Russia: Alexei Birkun, Department of Anesthesiology, Critical Care and Emergency Medicine, Medical Academy named after S. I. Georgievsky, Russian Federation; Anna Kaluzhenina, Volgograd State Medical University, Russia. Saudi Arabia: Abdullah Almotairi, King Fahad Medical City (KFMC), Riyadh, KSA; Zakeya Abdulbaqi Ali Bukhary, College of Medicine, Taibah University, Medina, KSA; Jameela Edathodu, Al Faisal University, King Faisal Specialist Hospital, Riyadh, KSA; Amal Fathy, Pulmonary and Respiratory Critical Care Medicine, Mansoura University Egypt, Affiliate at Taibah University, KSA; Abdullah Mushira Abdulaziz Enani and Nazik Eltayeb Mohamed, Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh, KSA; Jawed Ulhadi Memon, Pulmonology Division, Department of Internal Medicine, King Fahad Hospital, Hofuf, Al Ahasa, 31982, KSA; Abdelhaleem Bella, Dammam University-Saudi Arabia and King Fahad Hospital, KSA. Serbia: Nada Bogdanović, Pulmonary Department of KHC Dr. Dragiša Mišović, Belgrade, Serbia; Branislava Milenkovic, Clinic for Pulmonary Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Dragica Pesut, University of Belgrade School of Medicine, Teaching Hospital of Pulmonology, Clinical Centre of Serbia, Belgrade, Serbia. South Africa: Charles Feldman, Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. South Korea: Ho Kee Yum, Inje Univ. Seoul Paik Hospital, South Korea. Spain: Luis Borderìas, Respiratory and Sleep Unit, Hospital San Jorge, Huesca, Spain; Noel Manuel Bordon Garcia, Barcelona Policlínic and Moises Broggi Hospital at sant Joan Despí, Spain; Hugo Cabello Alarcón, Sant Hospital Seu de Urgell, Catalonia, Spain; Catia Cilloniz and Antoni Torres, Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Vicens Diaz-Brito and Xavier Casas, Infectious Diseases Unit and Pneumology Service, Parc Sanitari Sant Joan de Deu, Sant Boi, Barcelona, Spain; Alicia Encabo González, Hospital Complex of Pontevedra, Spain; Maria Luisa Fernández-Almira, Medicina Interna, Hospital Universitario Central de Asturias, Spain; Miguel Gallego, Department of Respiratory Medicine, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain; Inmaculada Gaspar-García, Department of Respiratory Medicine, Hospital Costa del Sol, Marbella, Málaga, Spain; Juan González del Castillo, Emergency Department, Hospital Universitario Clínico San Carlos, Madrid, Spain; Patricia Javaloyes Victoria, Hospital General Universitario de Alicante, Alicante, Spain; Elena Laserna Martínez, Hospital Mollet, Barcelona, Spain; Rosa Malo de Molina, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Pedro J. Marcos, Servicio de Neumología, Complejo Hospitalario Universitario de A Coruña (CHUAC), INIBIC, Sergas, Universidade de A Coruña (UDC), Spain; Rosario Menéndez, Pneumology Service, Universitary and Polytechnic Hospital La Fe, Valencia, Spain; Ana Pando-Sandoval, Hospital Universitario Central de Asturias. Area de Gestion Clinica de Pulmon. Servicio de Neumologia, Oviedo, Spain; Cristina Prat Aymerich, Alicia Lacoma de la Torre and Ignasi García-Olivé, Microbiology Department and Pneumology Department, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Spain; Jordi Rello and Silvia Moyano, Critical Care Department, Hospital Vall d'Hebron, Barcelona, Spain; Francisco Sanz, Servicio de Neumología, Consorci Hospital General Universitari de Valencia, Valencia, Spain; Oriol Sibila and Ana Rodrigo-Troyano, Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain; Jordi Solé-Violán, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain; Ane Uranga, Pulmology Department, Hospital of Galdakao-Usansolo, Spain; Job F.M. van Boven, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Ester Vendrell Torra and Jordi Almirall Pujol, Intensive Care Medicine, Hospital de Mataró, Spain. Togo: Arnauld Attannon Fiogbe, Pulmonology and Infectious Diseases Service/University Hospital of Sylvanus Olympio, Lomé, Togo. Tunisia: Ferdaous Yangui, Department of Pneumology, Hospital of Internal Forces Security (I.F.S), Marsa, Tunis, Tunisia. Turkey: Semra Bilaceroglu, Izmir Dr. Suat Seren Training and Research Hospital for Thoracic Medicine and Surgery, Izmir, Turkey; Levent Dalar, Pulmonary Medicine, Istanbul Bilim University, Istanbul, Turkey; Ufuk Yilmaz, Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey. Ukraine: Artemii Bogomolov, Vinnitsa National Pirogov Memorial Medical University, Vinnitsa Regional Antituberculosis Hospital, Vinnitsa, Ukraine. United Arab Emirates: Naheed Elahi, Dubai Hospital, UAE. UK: Devesh J. Dhasmana, Victoria Hospital, Kirkcaldy, NHS Fife, UK; Andrew Feneley, Rhiannon Ions, Julie Skeemer and Gerrit Woltmann, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK; Carole Hancock, Royal Respiratory Research Team, Royal Liverpool University Hospital, Liverpool, UK; Adam T. Hill, Royal Infirmary and University of Edinburgh, UK; Banu Rudran, The Royal London Hospital, Barts Health Trust, London, UK; Silvia Ruiz-Buitrago and Marion Campbell, Hairmyres Hospital, East Kilbride, UK; Paul Whitaker, Department of Respiratory Medicine, St James's Hospital, Leeds, UK; Alexander Youzguin, Southport and Ormskirk Hospitals NHS Trust, UK; Anika Singanayagam, Imperial College Healthcare NHS Trust, London, UK. USA: Karen S. Allen, University of Oklahoma Health Sciences Center, USA; Veronica Brito, Texas A&M Health Science Center, Division of Pulmonary, Critical Care and Sleep Medicine Baylor Scott and White Health, USA; Jessica Dietz, Fargo VA Health Care System, Fargo, North Dakota, USA; Claire E. Dysart and Susan M. Kellie, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA, Division of Infectious Diseases, University of New Mexico School of Medicine, Raymond G. Murphy VA Medical Center, Albuquerque, NM, USA; Ricardo A. Franco-Sadud and Garnet Meier, Division of Hospital Medicine, Cook County Hospital, Chicago, USA; Mina Gaga, 7th Resp. Med. Dept and Asthma Center, Athens Chest Hospital, USA; Thomas L. Holland and Stephen P. Bergin, Department of Medicine, Duke University Medical Center and School of Medicine, Duke Clinical Research Institute, USA; Fayez Kheir, Department of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA; Mark Landmeier, Division of Pulmonary and Critical Care Medicine, Northwestern Memorial Hospital, Chicago, IL, USA; Manuel Lois, John Peter Smith Hospital, Fort Worth, TX, USA; Girish B. Nair, Interstitial Lung Disease Program and Pulmonary Rehabilitation, SUNY Stony Brook Winthrop University Hospital, Mineola, NY, USA; Hemali Patel, Department of Medicine, Division of General Internal Medicine, Hospital Medicine Group, University of Colorado, USA; Katherine Reyes, Henry Ford Hospital, Detroit, IL, USA; William Rodriguez-Cintron, Pulmonary/Critical Care Medicine VA Caribbean Healthcare System, USA; Shigeki Saito, Tulane University, New Orleans, USA; Nilam J. Soni, Julio Noda, Cecilia I. Hinojosa, Stephanie M. Levine, Luis F. Angel and Antonio Anzueto, Divisions of Hospital Medicine and Pulmonary/Critical Care Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center San Antonio, San Antonio, TX, USA; K. Scott Whitlow, John Hipskind, Kunal Sukhija and Vicken Totten, Kaweah Delta Health Care District, Department of Emergency Medicine, Visalia, CA, USA; Richard G. Wunderink and Ray D. Shah, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Zambia: Kondwelani John Mateyo, Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia. Other investigators: Lorena Noriega; Ezequiel Alvarado; Mohamed Aman; Lucía Labra.
Conflict of interest: J.D. Chalmers has received research grants for COPD studies and personal fees from GlaxoSmithKline, Boehringer Ingelheim and Pfizer, research grants for COPD studies from AstraZeneca, research grants for bronchiectasis studies and personal fees from Bayer Healthcare and Grifols, and personal fees for consultancy from Napp, outside the submitted work. S. Aliberti reports grants and personal fees from Bayer Healthcare, Aradigm Corporation, Grifols, Chiesi and INSMED, and personal fees from AstraZeneca, Basilea, Zambon, Novartis, Raptor, Actavis UK Ltd and Horizon, outside the submitted work.
Support statement: This project was unfunded. However, Nilam Soni's time is partially funded by the Department of Veterans Affairs, Quality Enhancement Research Initiative (QUERI) Partnered Evaluation Initiative Grant (HX002263-01A1). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs, nor the United States Government.
- Received June 15, 2017.
- Accepted June 6, 2018.
- The content of this work is not subject to copyright. Design and branding are copyright ©ERS 2018