{
  "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.\n\nMethods: 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.\n\nResults: 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 (SO2) (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 (NO2) (OR 2.75, p = 0.004) and higher temperature (OR 1.51, p = 0.03), whereas increased fine particulate matter (PM2.5) exposure (OR 0.37, p = 0.001) was linked to reduced detection. Furthermore, SO2 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.\n\nConclusion: 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.\n\nStudy registration: Registry: German Clinical Trials Register (DRKS), DRKS-ID: DRKS00005274, Registration date: 2013-09-11.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s41479-026-00212-3.",
  "abstract_shown": true,
  "affiliations": [
    "Institute for Lung Research, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), University of Marburg, Marburg, Germany",
    "Department of Respiratory, Intensive Care and Sleep Medicine, Clinic for Airway Infections, University Medical Centre Marburg, University of Marburg, Member of the German Center for Lung Research (DZL), Baldingerstraße, 35033 Marburg, Germany",
    "Department of Geography, University of Marburg, Marburg, Germany",
    "Institute of Medical Informatics, University of Münster, Münster, Germany",
    "CAPNETZ STIFTUNG, Hannover, Germany",
    "Infectious Diseases Clinic and Institute of Medical Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany",
    "Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité, Member of the German Center for Lung Research (DZL), Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany",
    "Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany",
    "Department of Respiratory, Intensive Care and Sleep Medicine, Faculty of Medicine, Marburg-University, Member of the German Center for Lung Research (DZL), Baldingerstraße, 35033 Marburg, Germany",
    "Institute for Infectious Diseases and Infection Control, and Center for Sepsis Care and Control, Jena University Hospital and Friedrich-Schiller-University Jena, Jena, Germany",
    "Pulmonology Süderelbe, Hamburg, Germany",
    "Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 98,
  "authors": [
    {
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        0,
        1
      ],
      "name": "Max Kutzinski",
      "orcid": "0009-0008-8751-603X"
    },
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      "affs": [
        2
      ],
      "name": "Thomas Brenner"
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        2
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      "name": "Saeed A. Khan"
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        1
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      "name": "Barbara C. Weckler"
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      "name": "Ann-Christine Link"
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        2
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      "name": "Christoph Reudenbach"
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      "affs": [
        2
      ],
      "name": "Jörg Bendix"
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    {
      "affs": [
        4,
        5
      ],
      "name": "Jan Rupp"
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    {
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        4,
        6
      ],
      "name": "Martin Witzenrath"
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    {
      "affs": [
        4,
        7,
        8
      ],
      "name": "Gernot Rohde"
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    {
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        4,
        9
      ],
      "name": "Mathias W. Pletz"
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    {
      "affs": [
        4,
        7,
        10,
        11
      ],
      "name": "Jessica Rademacher"
    },
    {
      "affs": [
        0
      ],
      "name": "Wilhelm Bertrams"
    },
    {
      "affs": [
        8
      ],
      "name": "Claus F. Vogelmeier"
    },
    {
      "name": "André Fuchs"
    },
    {
      "name": "André Fuchs"
    },
    {
      "name": "Maximilian Engelmann"
    },
    {
      "name": "Gregor Paul"
    },
    {
      "name": "Mousa Ayoub"
    },
    {
      "name": "Katharina Groehl"
    },
    {
      "name": "Katrin Riedl"
    },
    {
      "name": "Daiana Stolz"
    },
    {
      "name": "Wolfgang Bauer"
    },
    {
      "name": "Eva Corinna Diehl-Wiesenecker"
    },
    {
      "name": "Iris von Wunsch-Rolshoven Teruel"
    },
    {
      "name": "Noah Galtung"
    },
    {
      "name": "Norbert Suttorp"
    },
    {
      "name": "Martin Witzenrath"
    },
    {
      "name": "Christian Wildberg"
    },
    {
      "name": "Caitlin Pley"
    },
    {
      "name": "Enrico Zessin"
    },
    {
      "name": "Sibylle Schmager"
    },
    {
      "name": "Bernhard Schaaf"
    },
    {
      "name": "Julius Kremling"
    },
    {
      "name": "Daniela Nickoleit-Bitzenberger"
    },
    {
      "name": "Harun Azzaui"
    },
    {
      "name": "Martin Hower"
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    {
      "name": "Frederik Hempel"
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    {
      "name": "Katharina Prebeg"
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    {
      "name": "Kalina Popkirova"
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    {
      "name": "Martin Kolditz"
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    {
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    {
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    {
      "name": "Gernot Rohde"
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    {
      "name": "Carla Bellinghausen"
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    {
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    {
      "name": "Adrian Endres"
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    {
      "name": "Carlo Frigerio"
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    {
      "name": "Benno Fiedler"
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    {
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    {
      "name": "Tobias Welte"
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    {
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    {
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    {
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    {
      "name": "Mariet van ’t Klooster"
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    {
      "name": "Tabea Steinberg"
    },
    {
      "name": "Grit Barten-Neiner"
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    {
      "name": "Waldemar Kröner"
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  "bibtex": "https://research.draconitic.com/paper/7zcz4mav11qwg.bib",
  "cited_by": 0,
  "doi": "10.1186/s41479-026-00212-3",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13737847/",
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  "licence_label": "CC BY 4.0",
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  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
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      "heading",
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      "2307|Air Quality and Health Impacts"
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  "pdf_url": "https://link.springer.com/content/pdf/10.1186/s41479-026-00212-3.pdf",
  "pmcid": "PMC13737847",
  "pmid": "42983605",
  "published": "2026-11-05",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/7zcz4mav11qwg.ris",
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    {
      "first_seen": "2026-11-09T12:22:57Z",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2307|Air Quality and Health Impacts",
      "subfield": "pharmacology-toxicology"
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  "title": "Air pollution is associated with a distinct pathogen spectrum in community-acquired pneumonia: a prospective multicentre cohort study",
  "title_text": "Air pollution is associated with a distinct pathogen spectrum in community-acquired pneumonia: a prospective multicentre cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:22:57Z",
  "url": "https://research.draconitic.com/paper/7zcz4mav11qwg",
  "venue": "Pneumonia",
  "versions": []
}