Decline in Microbial Studies for Patients with Pulmonary Infections

This is the authors' abstract. We don't add key points for this paper.

There appears to be a substantial decline in the quality of microbiology done in the context of pulmonary infections during the current era, compared with 3 decades ago, and the question posed to the medical community is whether this change is acceptable or reversible. The decline seems to be well documented. In the prepenicillin era, for example, Bullowa [ 1 ] reported his own experience with >4000 cases of pneumonia, from 80% of which S. pneumoniae was recovered. In the 1950s, most reports had a yield of pneumococci in patients hospitalized with community-acquired pneumonia of 40%–70%. During the past 15 years, it has been a challenge to find any US-based study in which the yield of pneumococci was >18%. The experience at Johns Hopkins Hospital (Baltimore, MD) reflects these trends: the yield of S. pneumoniae from Gram staining and culture of sputum samples in cases of community-acquired pneumonia in 1970 was 60% [ 2 ]; in 1980, it was 40% [ 3 ]; and in 1991, it was 18% [ 4 ]. The conclusion from these reports is that either the pneumococcus is disappearing or microbiology is disappearing. Some would argue that other microbes have become far more prominent and thus fill the void, but this argument is weakened by the fact that few studies identify any likely pathogen in 50%–70% of cases.