Air pollution is associated with a distinct pathogen spectrum in community-acquired pneumonia: a prospective multicentre cohort study

Abstract Background Community-acquired pneumonia (CAP) is the leading cause of death due to infection worldwide, with its incidence and disease course influenced by air pollution exposure. Little is known about how air pollution influences microbiological findings in patients with CAP. Methods Patients were recruited from a prospective, multicentre study of CAP (CAPNETZ). Air pollution data were collected at the city level considering data up to one month before inclusion. Associations with sputum pathogen detection and cell counts were tested using generalised linear mixed-effects logistic regression models adjusting for clinical confounders, centre-level heterogeneity and meteorological data. Internal validation was performed using an Ensemble Feature Selection (EFS) approach. Results Among 4,446 eligible patients with available sputum samples, a potential pathogen was detected in 1,581 patients, while complete sputum-cell-count data were available for 4,014 patients. Detection of Streptococcus pneumoniae was associated with previous higher exposure to sulphur dioxide (SO 2 ) (OR 1.75, p = 0.008) and carbon monoxide (CO) (OR 1.57, p = 0.02). Escherichia coli was more frequently detected in patients who were exposed to elevated levels of nitrogen dioxide (NO 2 ) (OR 2.75, p = 0.004) and higher temperature (OR 1.51, p = 0.03), whereas increased fine particulate matter (PM 2.5 ) exposure (OR 0.37, p = 0.001) was linked to reduced detection. Furthermore, SO 2 exposure influenced the likelihood of obtaining a diagnostically relevant sputum culture and was associated with higher odds of detecting a high leucocyte count (OR 1.18, p = 0.02). Results were largely corroborated by EFS, particularly for S. pneumoniae and E. coli detection. Conclusion Exposure to air pollution was associated with a distinct pathogen spectrum in patients with CAP. These findings may have implications for the interpretation of microbiological data in an epidemiological and clinical context and highlight the importance of considering air pollution exposure as a confounding factor. Further validation in cohorts with high-quality environmental, microbiological and antimicrobial resistance data is needed. Study registration Registry: German Clinical Trials Register (DRKS), DRKS-ID: DRKS00005274, Registration date: 2013-09-11.

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Publication Details

Journal
Pneumonia
Published
2026-11-05
DOI
https://doi.org/10.1186/s41479-026-00212-3
Primary Topic
Air Quality and Health Impacts
Type
article
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article

Air pollution is associated with a distinct pathogen spectrum in community-acquired pneumonia: a prospective multicentre cohort study

Gernot G. U. Rohde, Ludwig Traby, Wilhelm Bertrams, Katharina Prebeg et al.
Pneumonia
Air Quality and Health Impacts
article

Air pollution is associated with a distinct pathogen spectrum in community-acquired pneumonia: a prospective multicentre cohort study

Gernot G. U. Rohde, Ludwig Traby, Wilhelm Bertrams, Katharina Prebeg, Daiana Stolz, Julius Kremling, W. Kröner, Florian Voit, Johanna Erber, Nora Drick, Giusy Tiseo, Martin Kolditz, Olesya Unruh, Christoph Reudenbach, Juliane Ankert, Gregor Paul, Barbara Christine Weckler, Sibylle Schmager, Nadja Käding, Christina Julius, Daniela Nickoleit-Bitzenberger, Nina Adaskina, Norbert Suttorp, Achim Grünewaldt, Christoph D. Spinner, Steffen Stenger, Tobias Wintermantel, Heinz Burgmann, Frederik Hempel, Ann-Christine Link, Claus Franz Vogelmeier, Eva Diehl-Wiesenecker, Tobias Welte, Lorenz Schubert, Anne Moeser, Benjamin Thomas Schleenvoigt, Marcus Panning, Jan Rupp, Martin Hower, Bernhard Schulte-Hubbert, Isabell Pink, Patrick Parschke, Bernd Schmeck, Carla Bellinghausen, Christina Bahrs, Caitlin Pley, Urte Sommerwerck, Thomas Illig, Frederike Waldeck, Martin Witzenrath, Jessica Rademacher, M. Klooster, Tabea Steinberg, Grit Barten-Neiner, Hendrik Pott, Harun Azzaui, Kalina Popkirova, Katharina Groehl, Noah Galtung, Norman Klopp, Capnetz Study group, Andreas Essig, Iris Hering, Claus Neurohr, Simona Langner, Max Kutzinski, Klaas Franzen, Christian Wildberg, Werner Albrich, Mathias Pletz, Daniel Drömann, Bernhard Schaaf, David Heigener, Mathias W. Pletz, Frank Eberhardt, Carlo Frigerio, Marco Falcone, Mousa Ayoub, Enrico Zessin, Adrian Endres, Thomas Fühner, André Fuchs, Iris von Wunsch-Rolshoven Teruel, Michael Wallner, Benjamin Wirth, Benno Fiedler, Katrin Riedl, Thomas Brenner, Maximilian Engelmann, Frank Rassouli, Roman Martin, Jörg Bendix, Jochen Schneider, Wolfgang Bauer, Saeed A. Khan
article en

Abstract

Abstract Background Community-acquired pneumonia (CAP) is the leading cause of death due to infection worldwide, with its incidence and disease course influenced by air pollution exposure. Little is known about how air pollution influences microbiological findings in patients with CAP. Methods Patients were recruited from a prospective, multicentre study of CAP (CAPNETZ). Air pollution data were collected at the city level considering data up to one month before inclusion. Associations with sputum pathogen detection and cell counts were tested using generalised linear mixed-effects logistic regression models adjusting for clinical confounders, centre-level heterogeneity and meteorological data. Internal validation was performed using an Ensemble Feature Selection (EFS) approach. Results Among 4,446 eligible patients with available sputum samples, a potential pathogen was detected in 1,581 patients, while complete sputum-cell-count data were available for 4,014 patients. Detection of Streptococcus pneumoniae was associated with previous higher exposure to sulphur dioxide (SO 2 ) (OR 1.75, p = 0.008) and carbon monoxide (CO) (OR 1.57, p = 0.02). Escherichia coli was more frequently detected in patients who were exposed to elevated levels of nitrogen dioxide (NO 2 ) (OR 2.75, p = 0.004) and higher temperature (OR 1.51, p = 0.03), whereas increased fine particulate matter (PM 2.5 ) exposure (OR 0.37, p = 0.001) was linked to reduced detection. Furthermore, SO 2 exposure influenced the likelihood of obtaining a diagnostically relevant sputum culture and was associated with higher odds of detecting a high leucocyte count (OR 1.18, p = 0.02). Results were largely corroborated by EFS, particularly for S. pneumoniae and E. coli detection. Conclusion Exposure to air pollution was associated with a distinct pathogen spectrum in patients with CAP. These findings may have implications for the interpretation of microbiological data in an epidemiological and clinical context and highlight the importance of considering air pollution exposure as a confounding factor. Further validation in cohorts with high-quality environmental, microbiological and antimicrobial resistance data is needed. Study registration Registry: German Clinical Trials Register (DRKS), DRKS-ID: DRKS00005274, Registration date: 2013-09-11.

PneumoniaVol. 18(1)
Openalex Percentile: Top 20%
Air Quality and Health Impacts
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