community-acquired pneumonia (CAP)
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Introduction
Pneumonia acquired in the community. (also see pneumonia)
Etiology
- adults
- pathogen identified in 38% of cases[52]
- viruses in 23%
- bacteria in 11%
- both bacteria & virus in 3%
- fungus or mycobacterium in 1%
- most commonly detected pathogens (% of cases)
- rhinovirus (9%)
- influenza virus (6%)*
- S. pneumoniae (5%)
- human metapneumovirus (4%)
- respiratory syncytial virus (3%)
- common bacteria
- Streptococcus pneumoniae, most common in adults[52]
- Haemophilus influenzae (most commonly with chronic pulmonary disease)[16]
- Moraxella catarrhalis (most commonly with chronic pulmonary disease)[16]
- Staphylococcus aureus[16] (< 10%), < 1%[68]
- risk increases following influenza[16][48][49] & with hemodialysis
- MRSA more common with nosocomial pneumonia, or nursing home setting
- also see Staphylococcal pneumonia
- bacterial pathogens detected by multiplex PCR assay[99]
- Hemophilus influenzae in 33%
- Streptococcus pneumoniae in 20%
- Staphylococcus aureus in 20%
- gram-negative bacilli in 18%
- Moraxella catarrhalis in 12%
- atypical bacteria in 20-30%[12]
- Mycoplasma pneumoniae (12%) (most commonly age 20-40 years)[16]
- Chlamydophilq pneumoniae (7%) (most commonly age 20-40 years)[16]
- Legionella pneumophila (5%)
- other bacteria (aspiration pneumonia)[16]
- risk factors
- older age
- 25-fold more common among the elderly than younger adults[52]
- pulmonary disease: COPD, bronchietasis, smoking
- common variable immunodeficiency
- poor dentition
- aspiration due to GI or neurologic disease
- injection drug use
- antibiotic therapy within 3 months
- alcoholism
- older age
- pathogen identified in 38% of cases[52]
- children
- viral pneumonia (66%)[47]; 80%[52]
- respiratory syncytial virus (28%)
- rhinovirus (27%)
- adenovirus
- metapneumovirus
- influenza is not a common cause of pneumonia[48][49]
- bacterial pneumonia (8%)
- both (7%)
- viral pneumonia (66%)[47]; 80%[52]
- other pathogens (see see pathogens in community-acquired pneumonia)
- bacterial pneumonia
- pertussis
- pulmonary tuberculosis
- atypical Mycobacterium: Mycobacterium kansasii
- psittacosis (exposure to birds)
- Pseudomonoas aeruginosa
- Coxiella burnetti
- Burkholderia pseudomallei, Burkholderia cepacia
- inhalation anthrax (bioterrorism)
- plague (bioterrorism)
- tularemia (bioterrorism)
- Acinetobacter
- fungal pneumonia
- histoplasmosis (exposure to bat or bird droppings)
- coccidiodomycosis
- apspergillosis
- viral pneumonia
- bacterial pneumonia
- other causes
- idiopathic > 50%[100]
* the 10-15% estimate is at odds with the 90% of isolates largely because in most cases no pathogen is identified[52]
* ref[16] suggests influenza viruses most common viruses contributing to development of CAP
Epidemiology
- 60% of hospitalizations for community-acquired pneumonia are in patients > 65 years of age
- most children hospitalized with pneumonia are < 5 years of age with underlying conditions, such as asthma or premature birth[47]
History
- travel history
- southwestern USA (coccidioidomycosis, Hantavirus)
- southeast Asia or China (meliodosis, SARS)
- occupational history
- exposure to birds (psittacosis, cryptococcus), bats (SARS-like coronavirus), farm animals (anthrax), rabbits (tularemia)
Clinical manifestations
- typical CAP
- rapid onset
- high fever
- productive cough (sputum production)
- pleuritic chest pain
- dyspnea
- tachypnea (esp in elderly)[16]
- pulmonary crackles, consolidation
- atypical CAP
- low-grade fever
- non productive cough
- no chest pain[16]
- may present as delirium, confusion, & falls in the elderly[102]
- influenza-like syndrome that seems to be improving, suddenly becoming worse suggests Staphylococcus aureus[16]
- signs/symptoms of severe CAP
- confusion, disorientation
- hypothermia: core temperature < 36.0 C
- tachypnea: respiratory rate > 30/min
- hypotension[16]
Laboratory
- sputum gram stain & sputum culture
- may not be cost-effective for outpatient treatment[16]
- patients not responding to outpatient antibiotic therapy[16]
- all patients admitted to ICU
- patients with cavitary lung lesions[16]
- patients with structural lung disease
- consider lung abscess if sputum is foul smelling
- multiplex PCR assay may become the new standard
- may not be cost-effective for outpatient treatment[16]
- blood cultures prior to IV antibiotics[16]
- not cost-effective for outpatient treatment[7]
- all patients admitted to ICU
- patients treated empirically for MRSA or Pseudomonas aeruginosa
- culture may direct different specific antibiotic therapy
- sputum culture & blood culture are recommended for patients with severe CAP, all ICU patients & for inpatients receiving empirical treatment for MRSA or Pseudomonas aeruginosa.
- multiplex PCR assay may become the new standard
- rapid antigen testing for influenza A & influenza B
- all hospitalized patients with CAP during influenza season
- urine antigen testing in hospitalized patients
- Legionella pneumophila antigen in urine (positive for serotype 1)
- Streptococcus pneumoniae antigen in urine*
- all patients admitted to ICU & probably all hospitalized patients with CAP[16]
- complete blood count (CBC)
- leukopenia: WBC < 4000/uL suggests severe CAP[16]
- thrombocytopenia: platelet count < 100,000/uL suggests severe CAP[16]
- basic metabolic panel
- serum glucose
- patients without preexisting diabetes mellitus with hyperglycemia have increased risk of mortality
- serum urea nitrogen: BUN > 20 mg/dL suggests severe CAP[16]
- serum glucose
- arterial blood gas: pO2/FiO2 <= 250 suggests severe CAP[16]
- serum CRP, CRP Whole Blood,
- cut-point of 20 mg/L may be of value in ruling out a diagnosis of CAP if probability of CAP >10%, typically in emergency departments
- in primary care, CRP testing is unlikely to be of value[14]
- useful in primary care when used in combination with serum procalcitonin[36]
- low serum CRP helpful to rule out pneumonia[36]
- serum CRP > 150 mg/L at hospital admission may be indication for glucocorticoids[46]
- point of CRP reduces antibiotic use in primary care[90]
- serum procalcitonin > 0.1-0.25 ng/mL suggests bacterial pneumonia rather than heart failure[56][60]
- high levels (>10 ng/mL) associated with need for intensive care but clinical relevance uncertain[66]
- PCT Assay FDA-approved Feb 2017[71]
- reduces antibiotic use (26%) in primary care without safety concern[89]
- not recommended by the Infectious Diseases Society of America to guide initiation of antimicrobial therapy in community-acquired pneumonia
- no threshold for WBC, serum CRP or serum procalcitonin that reliably rules in or rules out community-acquired pneumonia[85]
- see ARUP consult[25]
* sensitivity 70% not affected by prior antibiotic administration[16]
Diagnostic procedures
- endotracheal aspirate for gram stain & culture for hospitalized patients[16][32]
- fiberoptic bronchoscopy with bronchoalveolar lavage &/or bronchoscopic biopsy is generally performed as indicated after CT[16]
- failure to improve after 3 days of initial empiric therapy[16]
- failure of 2 courses appropriate antibiotics[96]
* computed tomgraphy of the chest is the initial diagnostic test of choice[16]
Radiology
- chext X-ray
- pulmonary infiltrate required for diagnosis
- a negative chest X-ray does not rule out pneumonia esp. in elderly[16]
- cavities with air-fluid levels suggest pulmonary abscess
- abscesses may be due to Staphylococcus aureus, Klebsiella pneumoniae, Nocardia, Actinomyces, Rhodococcus, mycobacteria, fungi
- cavities without air-fluid levels suggest tuberculosis or pulmonary mycosis
- cavitary infiltrate can result from Staphylococcus aureus[16]
- enlargement of mediastinal or hilar lymph nodes suggest tuberculosis or pulmonary mycosis[16]
- lobar pneumonia suggests Streptococcus pneumoniae[16]
- right lower lobe pneumonia suggests aspiration pneumonia (anaerobes)
- interstitial infiltrate suggests virus vs atypical bacteria (Legionella, Chlamydiphila, Mycoplasma)
- bronchiolitis & bronchopneumonia suggest viral infection
- pleural effusion/empyema suggests oral anaerobes, Staphylococcus aureus, Streptococcus pneumoniae & other Streptococci
- multilobar infiltrates suggests severe CAP[16]
- pulmonary infiltrate required for diagnosis
- follow-up chest X-ray in 2-3 months[13]
- not necessary if symptoms have resolved in 5-7 days[16]
- routine follow-up chest X-ray not recommended because radiographic findings may linger after clinical improvement[16][83]
- if rapid resolution, 6 week follow-up[14]
- to show resolution & absence of underlying lung cancer
- may not be necessary in younger non-smokers[16][22]
- ultrasound may be appropriate for children & young adults[28][89]
- sensitivity 86%, specificity 89% relative to chest X-ray
- CT of thorax is gold standard
- improves diagnostic accuracy
- unknown whether routine use would improve outcomes[55]
- significant radiation exposure
- no direct comparison with ultrasound[55]
- initial diagnostic test of choice for treatment failure[16]
- no resolution of chest X-ray pathology
* cases of chest X-ray negative, but chest CT positive community acquired pneumonia with similar distribution of bacterial & viral pathogens, similar rates of requiring intensive care, & similar hospital stays[77]
Complications
- pulmonary
- lung abscess
- empyema
- ARDS
- underlying lung cancer ?[14]
- hematology
- cardiac
- acute coronary syndrome
- cardiac arrhythmias
- hospitalization for pneumonia in middle-aged & older adults is associated with increased risk for cardiovascular disease (RR=4.1, risk greatest within 30 days)[44]
- increased risk for heart failure (RR=1.6-1.7); 12% vs 7.4% within 10 years[72]
- other
- delirium
- acute renal failure
- adrenal insufficiency
- CAP due to Staphylococcus aureus is associated with higher mortality & prolonged hospitalizations than CAP due to Streptococcus pneumoniae[16]
- male sex & older age associated with higher risk for treatment failure[91]
- C difficile colitis:
- patients without history of C difficle colitis
- 30 day risk 0.7%, similar for azithromycin & doxycycline[101]
- patients with prior history of C difficle colitis
- 30 day risk 12%, greater for azithromycin than doxycycline (RR=1.8)[101]
- patients without history of C difficle colitis
Differential diagnosis
- influenza A or influenza B
- tuberculosis or other Mycobacterial pulmonary infection
- pulmonary mycosis
- cryptogenic organizing pneumonia (no response to antibiotics)
- whooping cough (Bordetella pertussis)
- pulmonary abscess (foul smelling sputum)
- psittacosis (Chlamydophilia psittaci)
- tularemia (Francisella tularensis)
- Hantavirus pulmonary syndrome
- Q fever (Coxiella burnetii)
- bronchiectasis
- cystic fibrosis (Burkholderia cepacia, Pseudomonas aeruginosa, Staphylococcus aureus)
- anthrax (Bacillus anthracis)
- pneumonic plague (Yersinia pestis)
- endobronchial obstruction
- heart failure
Management
also see pneumonia
general
- pneumonia severity index, CURB-65 criteria or other criteria for severe pneumonia should be used in assessment of need for hospitalization[16]
- diagnostic measures (sputum gram stain & culture) prior to empiric antibiotics[16]
- antibiotic initiation within 4-8 hours of hospital arrival associated with lower mortality[65]
- early mobilization[26]
- objective criteria for switching from intravenous to oral antibiotics[26]
- predefined criteria for deciding on hospital discharge[26]
- a clinical decision support embedded in the electronic medical record may reduce practice variation & improve care[93]
- if patients test positive for influenza, treat[16]
- see viral pneumonia &/or influenza
empiric antimicrobial therapy in adults
- outpatient community-acquired pneumonia in patients < 60 years of age without comorbidity
- etiology: most likely:
- empiric therapy:
- amoxicillin[83] (MKSAP19)
- doxycycline: efficacy equivalent to macrolide or fluoroquinolone[94]
- macrolide
- erythromycin
- clarithromycin or azithromycin in smokers because of their activity against Haemophilus influenzae
- azithromycin for patients without risk factors for drug-resistant Streptococcus pneumoniae (M-phenotype)[16][29]; older age, immunosuppression, alcoholism, beta-lactam within past 3 months, exposure to child in day care
- azithromycin provides coverage for atypical organisms; Chlamydia pneumoniae, Mycoplasma pneumoniae[16][29]
- solithromycin non-inferior to moxifloxacin[57]
- base on local resistance[83]
- NOT for patients recently treated with antibiotics (use fluoroquinolone)[1][16]
- respiratory fluoroquinolone*
- recent treatment with beta-lactam antibiotic[16]
- do not use same class of antibiotic patients has received within last 3 months[16]
- no follow-up necessary unless failure to improve within 3 days of a 5 day cours of antibiotics[16]
- outpatient community-acquired pneumonia in patients > 60 years of age or with comorbidity
- etiology: most likely:
- Streptococcus pneumoniae (30% PCN resistant)
- respiratory viruses
- Haemophilus influenzae
- aerobic gram negative bacilli
- Staphylococcus aureus (< 1%)[68] (also see Staphylococcal pneumonia)
- empiric therapy:
- oral 2nd generation cephalosporin
- amoxicillin or Augmentin
- add macrolide or doxycycline to cover:
- respiratory fluoroquinolone* (alone)
- add vancomycin if suspecting Staphylococcus aureus[16]
- Bactrim not recommended[14]
- increased Streptococcus pneumoniae resistance
- no coverage of Mycoplasma, Chlamydia
- do not use same class of antibiotic patients has received within last 3 months[16]
- etiology: most likely:
- patients with community-acquired pneumonia that require hospitalization (see pneumonia severity index)
- increased likelihood of polymicrobial infection
- risk factors
- age > 65 or < 2 years
- coexisting illnesses
- immunosuppression
- altered mental status
- aspiration
- malnutrition
- alcohol abuse
- tachypnea (respiratory rate > 30/min)
- systolic blood pressure < 90 mm Hg
- hypoxemia
- multilobular involvement
- exposure to a child in a day care center
- etiology: most likely:
- empiric therapy
- 3rd generation cephalosporin plus a macrolide or doxycycline[1]
- ceftriaxone, cefotaxime, or ceftizoxime
- erythromycin, azithromycin, or clarithromycin covers Legionella[5], Mycoplasma & Chlamydia frequently complicating bacterial pneumonia
- doxycycline alternative to macrolide - may be better choice if prior history of C difficile colitis - may be better choice if prolonged PR interval
- benefits of azithromycin in the elderly outweigh risks[41]
- beta-lactam antibiotic plus macrolide more effective than beta-lactam antibiotic alone[42]
- evidence favors empiric beta-lactam/macrolide vs empiric beta-lactam/fluoroquinolone[83]
- fluoroquinolone* (alone)
- oral fluoroquinolone as effective as IV[67]
- tigecycline (Tygacil) FDA-approved in 2009 for CAP
- Lefamulin FDA-approved in 2019 for CAP
- add vancomycin or linezolid if MRSA suspected[16]
- coverage with 2 effective antibiotics if Pseudomonas suspected (ex ceftazidime or cefepime + fluroquinolone)
- beta-lactam-macrolide combination or fluoroquinolone vs beta-lactam monotherapy
- macrolide resistance in pneumococcal pneumonia does not affect outcomes[51]
- 3rd generation cephalosporin plus a macrolide or doxycycline[1]
- switch from IV to oral antibiotics once symptoms improve & patients becomes afebrile[58]
- observation of patients for 24 hours in hospital after switch from IV to oral antibiotics unecessary[10][16][31]
- patients with community-acquired pneumonia that require hospitalization in an intensive care unit (ICU)
- indications
- heart rate > 125/min
- respiratory rate > 30/min
- diastolic blood pressure < 60 mm Hg
- systolic blood pressure < 90 mm Hg
- temperature < 35 C (95 F) or > 40 C (104 F)[16]
- sepsis syndrome
- empiric therapy
- vancomycin, ceftriaxone or ampicillin sulbactam or Zosyn or meropenem plus a macrolide or fluoroquinolone*[16]
- vancomycin if critically ill or risk factor for MRSA[16]
- increased nephrotoxicity when vancomycin used in combination with piperacillin tazobactam[79] - discontinue piperacillin tazobactam but continue vancomycin if evidence of nephrotoxicity[79]
- coverage for MRSA + dual coverage for Pseudomonas if hospitalized & treated with parenteral antibiotics in past 3 months[16]
- Cefepime, imipenem, meropenem, or Zosyn plus an aminoglycoside plus a fluoroquinolone (dual Pseudomonas coverage for COPD, smokers, bronchiectasis, cystic fibrosis, glucocorticoid use)[16]
- dual Pseudomonas coverage if growth from respiratory culture in past year - single agent appropriate if antibiotic sensitivity known[104]
- coverage for Legionella in patients with COPD (macrolide or fluroquinolone)
- treat aspiration pneumonia with Zosyn plus azithromycin for failed fluoroquinolone treatment in an alcoholic[16]
- older regimens
- erythromycin, azithromycin or a fluoroquinolone* plus cefotaxime, ceftriaxone or penicillin/beta-lactamase inhibitor**
- macrolide plus beta-lactamase inhibitor may confer advantage over fluoroquinolone[18]
- fluoroquinolone* plus clindamycin, vancomycin or aminoglycoside[2]
- fluoroquinolone* plus aztreonam
- corticosteroids
- patients with possible adrenal insufficiency[16]
- may shorten hospital stay (1 day) in patients with refractory septic shock[16][19]
- may reduce mortality in patients with severe disease if started early[98]
- indications
- presence of cavitary lesion(s) requires treatment for Staphylococcus aureus, including MRSA (also see Staphylococcal pneumonia)
- add vancomycin to initial empiric therapy[16][30]
- low-risk patients may be safely treated as outpatients[5]
- length of therapy (outpatient)
- 5 days of inpatient antibiotics if good response to treatment[16][69][73][87]
- afebrile for 48-72 hours
- no more than 1 sign of clinical instability
- pulse > 100/min
- respiratory rate > 24/min
- systolic blood pressure < 90 mm Hg
- arterial oxygen saturation < 90% or pO2 < 60 mm Hg on room air
- previously 7-10 days, 14 days if severe
- exceptions to 5 days of therapy
- cavitary lesion, lung abscess, empyema
- sepsis or other extrapulmonary infection
- instability (persistent fever, abnormal vital signs, or hypoxia)
failure to improve
- fiberoptic bronchoscopy with bronchoalveolar lavage &/or bronchoscopic biopsy is generally performed after CT*[16]
- failure to improve after 3 days of initial empiric therapy
- may be due to misdiagnosis, a resistant pathogen, lung abscess, empyema, pulmonary embolism, fungal infection, or aspiration pneumonia[16]
- aspiration pneumonia most common in right lower lobe in patients with reduced level of consciousness (alcoholism, drug abuse, seizures)
- piperacillin-tazobactam + azithromycin[16]
- anaerobic coverage for lung abscess or empyema[16]
- thoracentesis to determine need for chest tube drainage[16]
- failure to improve after 2 courses appropriate antibiotics[96]
- failure to improve after 3 days of initial empiric therapy
* computed tomgraphy of the chest is the initial diagnostic test of choice[16]
CAP in children
- parenteral penicillin or ampicillin works as well as ceftriaxone or cefotaxime[37]
- 5-day antibiotic strategy was superior to a 10-day strategy for outpatient treatment of children[92]
- 5 days of oral amoxicillin (80 mg/kg/day; divided TID) for outpatient therapy[38]
- for children discharged from the hospital with complicated pneumonia (pneumonia with pleural effusion), IV antibiotics offers no advantage over oral antibiotics[70]
- antibiotic therapy broader than ampicillin should be avoided in otherwise healthy, immunized, hospitalized patients with uncomplicated CAP[78]
* see refs[23][37][38][70][78][92]
glucocorticoid adjunct to antibiotics
- considered in patients with refractory septic shock[83]
- dexamethasone 5 mg IV QD for 4 days; adjunct to antibiotics
- may shorten hospital stay[27]
- not ready for routine use[20][21][27]
- prednisone 20-60 mg QD for 3-7 days[45][54][76]
- shortens time to clinical stability & hospital discharge
- lowers risk of ARDS[100]
- lowers in-hospital mortality[54]; NNT = 38
- increase risk of in-hospital hyperglycemia requiring insulin
- methylprednisolone 0.5 mg/kg IV every 12 hours[46]
- serum CRP > 150 mg/L at hospital admission may be indication for glucocorticoids[46]
- may be beneficial for patients hospitalized with severe pneumonia[53][54][76]
- oral glucocorticoids of no benefit to adults without chronic obstructive pulmonary disease[74]
- a bundled protocol than included 50 mg of prednisolone for 7 days does not improve 90 day mortality, length of stay or hospital readmission but does increase gastrointestinal bleeding[82]
- no mortality benefit but does reduce need for mechanical ventilation[97]
follow-up
- evaluate for bronchiectasis with recurrent pneumonia
- immunodeficiency
- unusual pathogen
- routine follow-up chest X-ray not recommended because radiographic findings may linger after clinical improvement[16]
- transitional care programs for home care after hospitalization can reduce readmissions[1]
prevention
- influenza vaccine annually
- PCV13 & PPSV23[16]
- decline in pneumococcal pneumonia due to:
- widespread use of pneumovax in adults
- use of pneumococcal conjugate vaccine in children
- decreased rates of cigarette smoking[43]
- decline in pneumococcal pneumonia due to:
- effective & consistent oral hygiene may reduce incidence of pneumonia in nursing home residents[86]
Notes
* Most fluoroquinolones are not recommended for empiric antimicrobial activity in pneumonia because of unreliable activity against Streptococcus pneumoniae. Fluoroquinolones with enhanced activity against Streptococcus pneumonia include:
- levofloxacin (750 mg QD)[11]
- sparfloxacin
- trovafloxacin
- grepafloxacin
- moxifloxacin
- gatifloxacin
- gemifloxacin
* oral fluoroquinolones as effective as IV[67] ** penicillin/beta lactamase inhibitor:
More general terms
Additional terms
- criteria for hospitalization of patients with pneumonia
- CURB-65 criteria
- outpatient management of HIV related pneumonia
- pathogens in community-acquired pneumonia
- pneumonia severity index; PORT score (PSI)
References
- ↑ 1.0 1.1 1.2 1.3 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - ↑ 2.0 2.1 Journal Watch 25(1):10, 2005 Mortensen EM, Restrepo M, Anzueto A, Pugh J. Effects of guideline-concordant antimicrobial therapy on mortality among patients with community-acquired pneumonia. Am J Med. 2004 Nov 15;117(10):726-31. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15541321
- ↑ Selected Treatment Issues in the Updated Guidelines for Community-Acquired Pneumonia in Immunocompetent Adults and Bacterial Sinusitis Prescriber's Letter 11(2):12 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200209&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Journal Watch 25(6):48-49, 2005 Carratala J, Fernandez-Sabe N, Ortega L, Castellsague X, Roson B, Dorca J, Fernandez-Aguera A, Verdaguer R, Martinez J, Manresa F, Gudiol F. Outpatient care compared with hospitalization for community- acquired pneumonia: a randomized trial in low-risk patients. Ann Intern Med. 2005 Feb 1;142(3):165-72. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15684204
- ↑ 5.0 5.1 5.2 Journal Watch 25(9):71, 2005 Mills GD, Oehley MR, Arrol B. Effectiveness of beta lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis. BMJ. 2005 Feb 26;330(7489):456. Epub 2005 Jan 31. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15684024 <Internet> http://bmj.bmjjournals.com/cgi/content/full/330/7489/456
- ↑ Ramsdell J, Narsavage GL, Fink JB; American College of Chest Physicians' Home Care Network Working Group. Management of community-acquired pneumonia in the home: an American College of Chest Physicians clinical position statement. Chest. 2005 May;127(5):1752-63. Review. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15888856 <Internet> http://www.chestjournal.org/cgi/content/full/127/5/1752
- ↑ 7.0 7.1 Kennedy M, Bates DW, Wright SB, Ruiz R, Wolfe RE, Shapiro NI. Do emergency department blood cultures change practice in patients with pneumonia? Ann Emerg Med. 2005 Nov;46(5):393-400. Epub 2005 Jul 22. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16271664
Walls RM, Resnick J. The Joint Commission on Accreditation of Healthcare Organizations and Center for Medicare and Medicaid Services community-acquired pneumonia initiative: what went wrong? Ann Emerg Med. 2005 Nov;46(5):409-11. Epub 2005 Sep 1. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16271669
Ramanujam P, Rathlev NK. Blood cultures do not change management in hospitalized patients with community-acquired pneumonia. Acad Emerg Med. 2006 Jul;13(7):740-5. Epub 2006 Jun 9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16766742 - ↑ 8.0 8.1 et Moussaoui R et al, Effectiveness of discontinuing antibiotic treatment after 3 days vs eight days in mild to moderate-severity community- acquired pneumonia: Randomized, double blind study BMJ 2006; 332:1355 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16763247
Paul J, Commentary: What is the optimal duration of antibiotic therapy? BMJ 2006; 332:1355 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16763248 - ↑ Aspa J et al, Impact of initial antibiotic choice on mortality from pneumococcal pneumonia. Eur Respir J 2006; 27:1010 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16455824
- ↑ 10.0 10.1 Nathan RV et al, In hospital evaluation after antibiotic switch in pneumonia: A national evaluation. Am J Med 2006; 119:512.e1 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16750965
- ↑ 11.0 11.1 Prescriber's Letter 14(3): 2007 Empiric Antibiotic Treatment of Community-Acquired Pneumonia in Adults Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230302&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 12.0 12.1 Arnold FW, Summersgill JT, Lajoie AS, Peyrani P, Marrie TJ, Rossi P, Blasi F, Fernandez P, File TM Jr, Rello J, Menendez R, Marzoratti L, Luna CM, Ramirez JA. A Worldwide Perspective of Atypical Pathogens in Community-acquired Pneumonia. Am J Respir Crit Care Med. 2007 May 15;175(10):1086-93. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17332485
- ↑ 13.0 13.1 Bruns AH, Oosterheert JJ, Prokop M, Lammers JW, Hak E, Hoepelman AI. Patterns of resolution of chest radiograph abnormalities in adults hospitalized with severe community-acquired pneumonia. Clin Infect Dis. 2007 Oct 15;45(8):983-91. Epub 2007 Sep 12. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17879912
- ↑ 14.0 14.1 14.2 14.3 14.4 Cals JW et al, Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ 2009;338:b1374 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19416992
Falk G and Fahey T C-reactive protein and community-acquired pneumonia in ambulatory care: systematic review of diagnostic accuracy studies Family Practice 2009 26(1):10-21 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19074757 doi:10.1093/fampra/cmn095 - ↑ eMedicine: Pneumonia Resource Center http://www.emedicine.com/rc/rc/i50/pneumonia.htm
- ↑ 16.00 16.01 16.02 16.03 16.04 16.05 16.06 16.07 16.08 16.09 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30 16.31 16.32 16.33 16.34 16.35 16.36 16.37 16.38 16.39 16.40 16.41 16.42 16.43 16.44 16.45 16.46 16.47 16.48 16.49 16.50 16.51 16.52 16.53 16.54 16.55 16.56 16.57 16.58 16.59 16.60 16.61 16.62 16.63 16.64 16.65 16.66 16.67 16.68 16.69 Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Mortensen EM et al Diagnosis of pulmonary malignancy after hospitalization for pneumonia. Am J Med. 2010 Jan;123(1):66-71. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20102994
- ↑ 18.0 18.1 Martin-Loeches I et al. Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia. Intensive Care Med 2010 Apr; 36:612. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19953222
Waterer GW. Are macrolides now obligatory in severe community-acquired pneumonia? Intensive Care Med 2010 Apr; 36:562. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19953221 - ↑ 19.0 19.1 Meijvis SC et al Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial The Lancet, Early Online Publication, 1 June 2011 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21636122 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60607-7/fulltext
Confalonieri M and Meduri GU Glucocorticoid treatment in community-acquired pneumonia The Lancet, Early Online Publication, 1 June 2011 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21636121 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60777-0/fulltext - ↑ 20.0 20.1 Meijvis SCA et al. Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: A randomised, double-blind, placebo-controlled trial. Lancet 2011 Jun 11; 377:2023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21636122
Confalonieri M and Meduri GU. Glucocorticoid treatment in community-acquired pneumonia. Lancet 2011 Jun 11; 377:1982. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21636121 - ↑ 21.0 21.1 Prescriber's Letter 18(8): 2011 Corticosteroids for Community-Acquired Pneumonia Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=270813&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 22.0 22.1 Tang KL et al. Incidence, correlates, and chest radiographic yield of new lung cancer diagnosis in 3398 patients with pneumonia. Arch Intern Med 2011 Jul 11; 171:1193 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21518934
- ↑ 23.0 23.1 Bradley JS et al The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America Clin Infect Dis. published online August 30, 2011 http://cid.oxfordjournals.org/content/early/2011/08/30/cid.cir531.full
- ↑ Lepper PM et al Serum glucose levels for predicting death in patients admitted to hospital for community acquired pneumonia: prospective cohort study BMJ 2012;344:e3397 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22645184 <Internet> http://www.bmj.com/content/344/bmj.e3397
- ↑ 25.0 25.1 ARUP Consult: Community-Acquired Pneumonia - CAP The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/community-acquired-pneumonia
- ↑ 26.0 26.1 26.2 26.3 Carratala J et al. Effect of a 3-step critical pathway to reduce duration of intravenous antibiotic therapy and length of stay in community-acquired pneumonia: A randomized controlled trial. Arch Intern Med 2012 Jun 25; 172:922. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22732747
Sharpe BA. Putting a critical pathway into practice: The devil is in the implementation details. Arch Intern Med 2012 Jun 25; 172:928. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22732748 - ↑ 27.0 27.1 27.2 Journal Watch. Jan 30, 2012 Massachusetts Medical Society http://www.jwatch.org
Shafiq M et al. Adjuvant steroid therapy in community-acquired pneumonia: A systematic review and meta-analysis. J Hosp Med 2012 Nov 26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23184813 - ↑ 28.0 28.1 Shah VP et al. Prospective evaluation of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults. Arch Pediatr Adolesc Med 2012 Dec 10; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23229753 <Internet> http://archpedi.jamanetwork.com/article.aspx?articleid=1558168
Darge K and Chen A. Ultrasonography of the lungs and pleurae for the diagnosis of pneumonia in children: Prime time for routine use. Arch Pediatr Adolesc Med 2012 Dec 10 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23229804 <Internet> http://archpedi.jamanetwork.com/article.aspx?articleid=1476812
Nazerian P et al. Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography. Am J Emerg Med 2015 May; 33:620 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25758182 - ↑ 29.0 29.1 29.2 Mandell LA, Wunderink RG, Anzueto A et al Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17278083
- ↑ 30.0 30.1 Taneja C, Haque N, Oster G et al Clinical and economic outcomes in patients with community- acquired Staphylococcus aureus pneumonia. J Hosp Med. 2010 Nov-Dec;5(9):528-34 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20734457
- ↑ 31.0 31.1 Weinstein MP, Klugman KP, Jones RN. Rationale for revised penicillin susceptibility breakpoints versus Streptococcus pneumoniae: coping with antimicrobial susceptibility in an era of resistance. Clin Infect Dis. 2009 Jun 1;48(11):1596-600. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19400744
- ↑ 32.0 32.1 Niederman M. In the clinic. Community-acquired pneumonia. Ann Intern Med. 2009 Oct 6;151(7):ITC4-2-ITC4-14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19805767
- ↑ Chalmers JD, Singanayagam A, Akram AR et al Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis. Thorax. 2010 Oct;65(10):878-83. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20729231
- ↑ Jackson ML, Nelson JC, Jackson LA. Risk factors for community-acquired pneumonia in immunocompetent seniors. J Am Geriatr Soc. 2009 May;57(5):882-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19453307
- ↑ Waterer GW, Rello J, Wunderink RG. Management of community-acquired pneumonia in adults. Am J Respir Crit Care Med. 2011 Jan 15;183(2):157-64 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20693379
- ↑ 36.0 36.1 36.2 van Vugt SF et al. Use of serum C reactive protein and procalcitonin concentrations in addition to symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough: Diagnostic study. BMJ 2013 Apr 30; 346:f2450. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23633005
- ↑ 37.0 37.1 37.2 Williams DJ et al. Narrow vs broad-spectrum antimicrobial therapy for children hospitalized with pneumonia. Pediatrics 2013 Nov; 132:e1141 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24167170 <Internet> http://pediatrics.aappublications.org/content/132/5/e1141
- ↑ 38.0 38.1 38.2 38.3 Greenberg D et al. Short-course antibiotic treatment for community-acquired alveolar pneumonia in ambulatory children: A double-blind, randomized, placebo-controlled trial. Pediatr Infect Dis J 2014 Feb; 33:136 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23989106
Pernica JM et al. Short-course antimicrobial therapy for pediatric community-acquired pneumonia: The SAFER randomized clinical trial. JAMA Pediatr 2021 Mar 8; PMID: https://www.ncbi.nlm.nih.gov/pubmed/33683325 PMCID: PMC7941245 (available on 2022-03-08) https://jamanetwork.com/journals/jamapediatrics/article-abstract/2776976 - ↑ Frei CR, Attridge RT, Mortensen EM Guideline-concordant antibiotic use and survival among patients with community-acquired pneumonia admitted to the intensive care unit. Clin Ther. 2010 Feb;32(2):293-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20206787
- ↑ McCabe C, Kirchner C, Zhang H, Daley J, Fisman DN. Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules. Arch Intern Med. 2009 Sep 14;169(16):1525-31 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19752411
- ↑ 41.0 41.1 Mortensen EM et al Association of Azithromycin With Mortality and Cardiovascular Events Among Older Patients Hospitalized With Pneumonia. JAMA. 2014;311(21):2199-2208 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24893087 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1877208
- ↑ 42.0 42.1 Garin N et al beta-Lactam Monotherapy vs beta-Lactam Macrolide Combination Treatment in Moderately Severe Community-Acquired Pneumonia. A Randomized Noninferiority Trial. JAMA Intern Med. Published online October 06, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25286173 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1910547
Lee JS, Fine MJ The Debate on Antibiotic Therapy for Patients Hospitalized for Pneumonia. Where Should We Go From Here? JAMA Intern Med. Published online October 06, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25285980 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1910545 - ↑ 43.0 43.1 43.2 43.3 Musher DM, Thorner AR Community-Acquired Pneumonia. N Engl J Med 2014; 371:1619-1628October 23, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25337751 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1312885
- ↑ 44.0 44.1 Corrales-Medina VF et al Association Between Hospitalization for Pneumonia and Subsequent Risk of Cardiovascular Disease. JAMA. 2015;313(3):264-274. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25602997 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2091304
- ↑ 45.0 45.1 Blum CA et al. Adjunct prednisone therapy for patients with community- acquired pneumonia: A multicentre, double-blind, randomised, placebo-controlled trial. Lancet 2015 Jan 18 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25608756 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2962447-8/abstract
Annane D. Corticosteroids and pneumonia: Time to change practice. Lancet 2015 Jan 18 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25608755 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2962391-6/abstract - ↑ 46.0 46.1 46.2 46.3 Torres A, Sibila O, Ferrer M et al Effect of Corticosteroids on Treatment Failure Among Hospitalized Patients With Severe Community-Acquired Pneumonia and High Inflammatory Response: A Randomized Clinical Trial. JAMA. 2015 Feb 17;313(7):677-686 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25688779 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2110967
Wunderink RG Corticosteroids for Severe Community-Acquired Pneumonia: Not for Everyone. JAMA. 2015 Feb 17;313(7):673-674 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25688777 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2110952 - ↑ 47.0 47.1 47.2 Jain S, Williams DJ, Arnold SR et al Community-Acquired Pneumonia Requiring Hospitalization among U.S. Children. N Engl J Med 2015; 372:835-845. February 26, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25714161 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1405870
- ↑ 48.0 48.1 48.2 48.3 Rothberg MB et al. Complications of viral influenza. Am J Med 2008 Apr 1; 121:258 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18374680
- ↑ 49.0 49.1 49.2 49.3 Chertow DS and Memoli MJ. Bacterial coinfection in influenza: a grand rounds review. JAMA 2013 Jan 17; 309:275 JAMA 2013 Jan 17; 309:275
- ↑ 50.0 50.1 Postma DF et al Antibiotic Treatment Strategies for Community-Acquired Pneumonia in Adults. N Engl J Med 2015; 372:1312-1323. April 2, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25830421 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1406330
- ↑ 51.0 51.1 51.2 Ampel NM Should Macrolides Be Used for Community-Acquired Pneumonia? NEJM Journal Watch. June 16, 2015 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Cilloniz C et al. The effect of macrolide resistance on the presentation and outcome of patients hospitalized for Streptococcus pneumoniae pneumonia. Am J Respir Crit Care Med 2015 Jun 1; 191:1265. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25807239
Niederman MS. Macrolide-resistant pneumococcus in community-acquired pneumonia: Is there still a role for macrolide therapy? Am J Respir Crit Care Med 2015 Jun 1; 191:1216. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26029831 - ↑ 52.0 52.1 52.2 52.3 52.4 52.5 Jain S, Self WH, Wunderink RG et al Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med. July 14, 2015 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26172429
Jain S, Williams DJ, Arnold SR Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015 Feb 26;372(9):835-45 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25714161 - ↑ 53.0 53.1 Siemieniuk RAC et al Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Meta-analysis. Ann Intern Med. Published online 11 August 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26258555 <Internet> http://annals.org/article.aspx?articleid=2424872
Restrepo MI et al Corticosteroids for Severe Community-Acquired Pneumonia: Time to Change Clinical Practice. Ann Intern Med. Published online 11 August 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26258646 <Internet> http://annals.org/article.aspx?articleid=2424873 - ↑ 54.0 54.1 54.2 54.3 54.4 Siemieniuk RAC et al. Corticosteroid therapy for patients hospitalized with community-acquired pneumonia: A systematic review and meta-analysis. Ann Intern Med 2015 Oct 6; 163:519. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26258555
Restrepo MI et al. Corticosteroids for severe community-acquired pneumonia: Time to change clinical practice. Ann Intern Med 2015 Oct 6; 163:560 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26258646 - ↑ 55.0 55.1 55.2 Brett AS. Should Chest CT Be Routine in Patients with Suspected Community-Acquired Pneumonia? NEJM Journal Watch. Oct 29, 2015 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Claessens Y-E et al. Early chest computed tomography scan to assist diagnosis and guide treatment decision for suspected community- acquired pneumonia. Am J Respir Crit Care Med 2015 Oct 15; 192:974 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26168322 - ↑ 56.0 56.1 Alba GA, Truong QA, Gaggin HK et al Diagnostic and Prognostic Utility of Procalcitonin in Patients Presenting to the Emergency Department with Dyspnea. Am J Med. 2016 Jan;129(1):96-104.e7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26169892
- ↑ 57.0 57.1 Barrera CM et al Efficacy and safety of oral solithromycin versus oral moxifloxacin for treatment of community-acquired bacterial pneumonia: a global, double-blind, multicentre, randomised, active-controlled, non-inferiority trial (SOLITAIRE-ORAL). Lancet Infectious Diseases. Feb 4, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26852726 <Internet> http://thelancet.com/journals/laninf/article/PIIS1473-3099%2816%2900017-7/abstract
- ↑ 58.0 58.1 Aliberti S, Zanaboni AM, Wiemken T et al Criteria for clinical stability in hospitalised patients with community-acquired pneumonia. Eur Respir J. 2013 Sep;42(3):742-9. Epub 2012 Nov 8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23143544 Free Article
- ↑ Bartlett JG, Dowell SF, Mandell LA et al Practice guidelines for the management of community-acquired pneumonia in adults. Infectious , File Jr TM, Musher DM, Fine MJ. Clin Infect Dis. 2000 Aug;31(2):347-82. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10987697 Free Article
- ↑ 60.0 60.1 Christ-Crain M, Stolz D, Bingisser R et al Procalcitonin guidance of antibiotic therapy in community- acquired pneumonia: a randomized trial. Am J Respir Crit Care Med. 2006 Jul 1;174(1):84-93. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16603606
- ↑ Falguera M, Trujillano J, Caro S et al A prediction rule for estimating the risk of bacteremia in patients with community-acquired pneumonia. Clin Infect Dis. 2009 Aug 1;49(3):409-16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19555286 Free Article
- ↑ File TM Jr, Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgrad Med. 2010 Mar;122(2):130-41. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20203464
- ↑ Lim WS, Baudouin SV, George RC et al BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64 Suppl 3:iii1-55. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19783532
- ↑ Hage CA, Knox KS, Wheat LJ. Endemic mycoses: overlooked causes of community acquired pneumonia. Respir Med. 2012 Jun;106(6):769-76. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22386326 Free Article
- ↑ 65.0 65.1 Lee JS, Giesler DL, Gellad WF, Fine MJ. Antibiotic therapy for adults hospitalized with community- acquired pneumonia: A systematic review. JAMA 2016 Feb 9; 315:593 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26864413
- ↑ 66.0 66.1 Self WH et al. Procalcitonin as an early marker of the need for invasive respiratory or vasopressor support in adults with community- acquired pneumonia. Chest 2016 Apr 21 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27107491
- ↑ 67.0 67.1 67.2 Belforti RK, Lagu1 T, Haessler S et al. Association between initial route of fluoroquinolone administration and outcomes in patients hospitalized for community-acquired pneumonia. Clin Infect Dis 2016 Jul 1; 63:1 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27048748 <Internet> http://cid.oxfordjournals.org/content/63/1/1
- ↑ 68.0 68.1 68.2 68.3 Self WH et al. Staphylococcus aureus community-acquired pneumonia: Prevalence, clinical characteristics, and outcomes. Clin Infect Dis 2016 Aug 1; 63:300. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27161775 <Internet> http://cid.oxfordjournals.org/content/63/3/300
- ↑ 69.0 69.1 Uranga A, Espana PP, Bilbao A et al. Duration of antibiotic treatment in community-acquired pneumonia: A multicenter randomized clinical trial. JAMA Intern Med 2016 Jul 25; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27455166
- ↑ 70.0 70.1 70.2 Shah SS, Srivastava R, Wu S et al Intravenous Versus Oral Antibiotics for Postdischarge Treatment of Complicated Pneumonia Pediatrics Nov 2016, e20161692 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27940695
- ↑ 71.0 71.1 FDA News Release. February 23, 2017 FDA clears test to help manage antibiotic treatment for lower respiratory tract infections and sepsis. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm543160.htm
- ↑ 72.0 72.1 Eurich DT et al. Risk of heart failure after community acquired pneumonia: Prospective controlled study with 10 years of follow-up. BMJ 2017 Feb 13; 356:j413 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28193610 <Internet> http://www.bmj.com/content/356/bmj.j413
- ↑ 73.0 73.1 Madaras-Kelly KJ, Burk M, Caplinger C et al. Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: Results of a national medication utilization evaluation. J Hosp Med 2016 Dec; 11:832. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27527659
- ↑ 74.0 74.1 Hay AD, Little P, Harnden A et al Effect of Oral Prednisolone on Symptom Duration and Severity in Nonasthmatic Adults With Acute Lower Respiratory Tract Infection. A Randomized Clinical Trial. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28829884 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2649201
- ↑ 75.0 75.1 Williams DJ, Edwards KM, Self WH et al Effectiveness of beta-Lactam Monotherapy vs Macrolide Combination Therapy for Children Hospitalized With Pneumonia. JAMA Pediatr. 2017; Oct 30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29084336 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2659321
Smith MJ. Macrolides and Pediatric Community-Acquired Pneumonia - Time for a Paradigm Shift? JAMA Pediatr. 2017; Oct 30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29084314 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2659318 - ↑ 76.0 76.1 76.2 Stern A, Skalsky K, Avni T, Carrara E, Leibovici L, Paul M. Corticosteroids for pneumonia. Cochrane Database Syst Rev 2017 Dec 13; 12:CD007720. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29236286
Briel M, Spoorenberg SMC, Snijders D et al. Corticosteroids in patients hospitalized with community- acquired Pneumonia: Systematic review and individual patient data metaanalysis. Clin Infect Dis 2018 Feb 1; 66:346. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29020323 - ↑ 77.0 77.1 Upchurch CP, Grijalva CG, Wunderink RG et al. Community-acquired pneumonia visualized on CT scans but not chest radiographs: Pathogens, severity, and clinical outcomes. Chest 2018 Mar; 153:601. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28802696 <Internet> http://journal.chestnet.org/article/S0012-3692(17)31392-2/fulltext
Niederman MS. Imaging for the management of community-acquired pneumonia: What to do if the chest radiograph is clear. Chest 2018 Mar; 153:583. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29519296 <Internet> http://journal.chestnet.org/article/S0012-3692(17)32886-6/fulltext - ↑ 78.0 78.1 78.2 American Academy of Pediatrics - Committee on Infectious Diseases and the Pediatric Infectious Diseases Society. Choosing Wisely. November 12, 2018 http://www.choosingwisely.org/societies/american-academy-of-pediatrics-committee-on-infectious-diseases-and-the-pediatric-infectious-diseases-society/
- ↑ 79.0 79.1 79.2 Rutter WC et al. Acute kidney injury in patients treated with vancomycin and piperacillin-tazobactam: A retrospective cohort analysis. J Hosp Med 2017 Feb; 12:77 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28182801 <Internet> http://www.journalofhospitalmedicine.com/jhospmed/article/130044/hospital-medicine/acute-kidney-injury-patients-treated-vancomycin-and
Luther MK, Timbrook TT, Caffrey AR et al Vancomycin Plus Piperacillin-Tazobactam and Acute Kidney Injury in Adults: A Systematic Review and Meta-Analysis. Crit Care Med. 2018 Jan;46(1):12-20. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29088001
Miano TA, Hennessy S, Yang W et al Association of vancomycin plus piperacillin-tazobactam with early changes in creatinine versus cystatin C in critically ill adults: a prospective cohort study. Intensive Care Med. 2022 Sep;48(9):1144-1155 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35833959 PMCID: PMC9463324 Free PMC article - ↑ Cilloniz C, Gabarrus A, Ferrer M et al Community-Acquired Pneumonia Due to Multidrug- and Non-Multidrug- Resistant Pseudomonas aeruginosa. Chest. 2016 Aug;150(2):415-25. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27060725
- ↑ 81.0 81.1 Kutty PK, Jain S, Taylor TH et al. Mycoplasma pneumoniae among children hospitalized with community- acquired pneumonia. Clin Infect Dis 2019 Jan 1; 68:5-12. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29788037 https://academic.oup.com/cid/article/68/1/5/4996995
Shah SS. Mycoplasma pneumoniae as a cause of community-acquired pneumonia in children. Clin Infect Dis 2019 Jan 1; 68:13-14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29788200 https://academic.oup.com/cid/article-abstract/68/1/13/4996996 - ↑ 82.0 82.1 Lloyd M, Karahalios A, Janus E et al. Effectiveness of a bundled intervention including adjunctive corticosteroids on outcomes of hospitalized patients with community-acquired pneumonia: A stepped-wedge randomized clinical trial. JAMA Intern Med 2019 Jul 8; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31282921 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2737749
- ↑ 83.0 83.1 83.2 83.3 83.4 83.5 Metlay JP, Waterer GW, Long ACet al Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31573350 Free PMC article https://www.atsjournals.org/doi/full/10.1164/rccm.201908-1581ST
- ↑ Olson G, Davis AM Diagnosis and Treatment of Adults With Community-Acquired Pneumonia. JAMA. Published online Feb 6, 2020. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32027358 https://jamanetwork.com/journals/jama/fullarticle/2760882
Abramowicz M et al Corticosteroids in Community-Acquired Pneumonia. JAMA. Published online Feb 6, 2020. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32027338 https://jamanetwork.com/journals/jama/fullarticle/2760883
The Medical Letter on Drugs and Therapeutics. January 13, 2020;62(1589):7-8 - ↑ 85.0 85.1 Ebell MH, Bentivegna M, Cai X, Hulme C, Kearney M. Accuracy of biomarkers for the diagnosis of adult community-acquired pneumonia: A meta-analysis. Acad Emerg Med 2020 Mar; 27:195. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32100377 https://onlinelibrary.wiley.com/doi/abs/10.1111/acem.13889
- ↑ 86.0 86.1 Zimmerman S, Sloane PD, Ward K et al Effectiveness of a Mouth Care Program Provided by Nursing Home Staff vs Standard Care on Reducing Pneumonia Incidence. A Cluster Randomized Trial. JAMA Netw Open. 2020;3(6):e20432 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32558913 Free PMC article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767357
- ↑ 87.0 87.1 87.2 Lee RA, Centor RM, Humphrey LL et al. Appropriate use of short-course antibiotics in common infections: Best practice advice from the American College of Physicians. Ann Intern Med 2021 Apr 6; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33819054 https://www.acpjournals.org/doi/10.7326/M20-7355
- ↑ 88.0 88.1 Dinh A et al. Discontinuing beta-lactam treatment after 3 days for patients with community- acquired pneumonia in non-critical care wards (PTC): A double-blind, randomised, placebo-controlled, non-inferiority trial. Lancet 2021 Mar 27; 397:1195. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33773631 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00313-5/fulltext
- ↑ 89.0 89.1 89.2 Lhopitallier L, Kronenberg A, Meuwly JY et al. Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care: Pragmatic cluster randomised trial. BMJ 2021 Sep 21; 374:n2132 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34548312 Free article https://www.bmj.com/content/374/bmj.n2132
- ↑ 90.0 90.1 Boere TM, van Buul LW, Hopstaken RM et al. Effect of C reactive protein point-of-care testing on antibiotic prescribing for lower respiratory tract infections in nursing home residents: Cluster randomised controlled trial. BMJ 2021 Sep 21; 374:n2198. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34548288 PMCID: PMC8453309 Free PMC article
- ↑ 91.0 91.1 Dinh A, Duran C, Ropers J et al. Factors associated with treatment failure in moderately severe community-acquired pneumonia: A secondary analysis of a randomized clinical trial. JAMA Netw Open 2021 Oct 15; 4:e2129566 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34652445 PMCID: PMC8520128 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2785010
- ↑ 92.0 92.1 92.2 Williams DJ, Creech CB, Walter EB et al. Short- vs standard-course outpatient antibiotic therapy for community- acquired pneumonia in children: The SCOUT-CAP randomized clinical trial. JAMA Pediatr 2022 Jan 18; PMID: https://www.ncbi.nlm.nih.gov/pubmed/35040920 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2788071
- ↑ 93.0 93.1 Dean NC et al. A pragmatic, stepped-wedge, cluster-controlled clinical trial of real-time pneumonia clinical decision support. Am J Respir Crit Care Med 2022 Jun 1; 205:1330. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35258444 https://www.atsjournals.org/doi/10.1164/rccm.202109-2092OC
Waterer G, Donaldson G. Can electronic decision support tools really reduce mortality from community-acquired pneumonia? Am J Respir Crit Care Med 2022 Jun 1; 205:1267 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35320063 https://www.atsjournals.org/doi/10.1164/rccm.202202-0358ED - ↑ 94.0 94.1 Choi SH et al. Efficacy of doxycycline for mild-to-moderate community-acquired pneumonia in adults: A systematic review and meta-analysis of randomized controlled trials. Clin Infect Dis 2022 Jul 29; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/35903011 https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciac615/6651448
Musher DM. Doxycycline to treat community-acquired pneumonia. Clin Infect Dis 2022 Aug 4; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35926091 https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciac617/6655864 - ↑ Febbo J, Revels J, Ketai L. Viral Pneumonias. Radiol Clin North Am. 2022 May;60(3):383-397. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35534126 Review.
- ↑ 96.0 96.1 96.2 Alves dos Santos JW, Torres A, Michel GT et al Non-infectious and unusual infectious mimics of community-acquired pneumonia. Respir Med. 2004 Jun;98(6):488-94 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15191032 Free article
- ↑ 97.0 97.1 Saleem N et al. Effect of corticosteroids on mortality and clinical cure in community-acquired pneumonia. Chest 2023 Mar; 163:484 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36087797 https://journal.chestnet.org/article/S0012-3692(22)03705-9/fulltext
- ↑ 98.0 98.1 Dequin PF et al. Hydrocortisone in severe community-acquired pneumonia. N Engl J Med 2023 Mar 21; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36942789 https://www.nejm.org/doi/10.1056/NEJMoa2215145
- ↑ 99.0 99.1 Falsey AR et al. Real-life assessment of BioFire FilmArray pneumonia panel in adults hospitalized with respiratory illness. J Infect Dis 2023 Jun 27; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37369370 https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiad221/7209038
- ↑ 100.0 100.1 100.2 100.3 100.4 Bergmann F et al. Efficacy and safety of corticosteroid therapy for community-acquired pneumonia: A meta-analysis and meta-regression of randomized, controlled trials. Clin Infect Dis 2023 Oct 25; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37876267 https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciad496/7329349
- ↑ 101.0 101.1 101.2 O'Leary AL et al. Impact of doxycycline on Clostridioides difficile infection in patients hospitalized with community-acquired pneumonia. Am J Infect Control 2023 Nov 1; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/37921728 https://www.ajicjournal.org/article/S0196-6553(23)00628-4/fulltext
- ↑ 102.0 102.1 Marrie TJ. Community-acquired pneumonia in the elderly. Clin Infect Dis. 2000 Oct;31(4):1066-78. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11049791 Review.
- ↑ 103.0 103.1 Bai AD et al. Comparative effectiveness of first-line and alternative antibiotic regimens in hospitalized patients with nonsevere community-acquired pneumonia: A multicenter retrospective cohort study. Chest 2024 Jan; 165:68. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37574164 https://journal.chestnet.org/article/S0012-3692(23)05268-6/fulltext
- ↑ 104.0 104.1 NEJM Knowledge+