Air pollution is associated with a distinct pathogen spectrum in community-acquired pneumonia: a prospective multicentre cohort study
12 affiliations
- 1Institute 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
- 2Department 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
- 3Department of Geography, University of Marburg, Marburg, Germany
- 4Institute of Medical Informatics, University of Münster, Münster, Germany
- 5CAPNETZ STIFTUNG, Hannover, Germany
- 6Infectious Diseases Clinic and Institute of Medical Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
- 7Department 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
- 8Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
- 9Department 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
- 10Institute for Infectious Diseases and Infection Control, and Center for Sepsis Care and Control, Jena University Hospital and Friedrich-Schiller-University Jena, Jena, Germany
- 11Pulmonology Süderelbe, Hamburg, Germany
- 12Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
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 (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.
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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s41479-026-00212-3.
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BibTeX
@article{kutzinski2026pollution,
title = {{Air pollution is associated with a distinct pathogen spectrum in community-acquired pneumonia: a prospective multicentre cohort study}},
author = {Max Kutzinski and Thomas Brenner and Saeed A. Khan and Hendrik Pott and Roman Martin and Barbara C. Weckler and Ann-Christine Link and Christoph Reudenbach and Jörg Bendix and Jan Rupp and Martin Witzenrath and Gernot Rohde and Mathias W. Pletz and Jessica Rademacher and Wilhelm Bertrams and Claus F. Vogelmeier and André Fuchs and André Fuchs and Maximilian Engelmann and Gregor Paul and Mousa Ayoub and Katharina Groehl and Katrin Riedl and Daiana Stolz and Wolfgang Bauer and Eva Corinna Diehl-Wiesenecker and Iris von Wunsch-Rolshoven Teruel and Noah Galtung and Norbert Suttorp and Martin Witzenrath and Christian Wildberg and Caitlin Pley and Enrico Zessin and Sibylle Schmager and Bernhard Schaaf and Julius Kremling and Daniela Nickoleit-Bitzenberger and Harun Azzaui and Martin Hower and Frederik Hempel and Katharina Prebeg and Kalina Popkirova and Martin Kolditz and Bernhard Schulte-Hubbert and Simona Langner and Gernot Rohde and Carla Bellinghausen and Achim Grünewaldt and Adrian Endres and Carlo Frigerio and Benno Fiedler and Marcus Panning and Tobias Welte and Isabell Pink and Nora Drick and Thomas Fühner and Mariet van ’t Klooster and Tabea Steinberg and Grit Barten-Neiner and Waldemar Kröner},
journal = {Pneumonia},
year = {2026},
month = nov,
doi = {10.1186/s41479-026-00212-3},
url = {https://doi.org/10.1186/s41479-026-00212-3},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Air pollution is associated with a distinct pathogen spectrum in community-acquired pneumonia: a prospective multicentre cohort study
AU - Max Kutzinski
AU - Thomas Brenner
AU - Saeed A. Khan
AU - Hendrik Pott
AU - Roman Martin
AU - Barbara C. Weckler
AU - Ann-Christine Link
AU - Christoph Reudenbach
AU - Jörg Bendix
AU - Jan Rupp
AU - Martin Witzenrath
AU - Gernot Rohde
AU - Mathias W. Pletz
AU - Jessica Rademacher
AU - Wilhelm Bertrams
AU - Claus F. Vogelmeier
AU - André Fuchs
AU - André Fuchs
AU - Maximilian Engelmann
AU - Gregor Paul
AU - Mousa Ayoub
AU - Katharina Groehl
AU - Katrin Riedl
AU - Daiana Stolz
AU - Wolfgang Bauer
AU - Eva Corinna Diehl-Wiesenecker
AU - Iris von Wunsch-Rolshoven Teruel
AU - Noah Galtung
AU - Norbert Suttorp
AU - Martin Witzenrath
AU - Christian Wildberg
AU - Caitlin Pley
AU - Enrico Zessin
AU - Sibylle Schmager
AU - Bernhard Schaaf
AU - Julius Kremling
AU - Daniela Nickoleit-Bitzenberger
AU - Harun Azzaui
AU - Martin Hower
AU - Frederik Hempel
AU - Katharina Prebeg
AU - Kalina Popkirova
AU - Martin Kolditz
AU - Bernhard Schulte-Hubbert
AU - Simona Langner
AU - Gernot Rohde
AU - Carla Bellinghausen
AU - Achim Grünewaldt
AU - Adrian Endres
AU - Carlo Frigerio
AU - Benno Fiedler
AU - Marcus Panning
AU - Tobias Welte
AU - Isabell Pink
AU - Nora Drick
AU - Thomas Fühner
AU - Mariet van ’t Klooster
AU - Tabea Steinberg
AU - Grit Barten-Neiner
AU - Waldemar Kröner
PY - 2026
DA - 2026/11/05
JO - Pneumonia
DO - 10.1186/s41479-026-00212-3
UR - https://doi.org/10.1186/s41479-026-00212-3
AB - 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 (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. 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s41479-026-00212-3.
SN - 2200-6133
ER -