2,566
Views
30
CrossRef citations to date
0
Altmetric
Review Article

Management of community-acquired pneumonia in immunocompetent adults: updated Swedish guidelines 2017

ORCID Icon, , , , ORCID Icon, , & show all
Pages 247-272 | Received 22 Oct 2017, Accepted 25 Oct 2017, Published online: 09 Nov 2017

References

  • Hedlund J, Strålin K, Örtqvist Å, et al. Swedish guidelines for the management of community-acquired pneumonia in immunocompetent adults. Scand J Infect Dis. 2005;37:791–805.
  • Spindler C, Stralin K, Eriksson L, et al. Swedish guidelines on the management of community-acquired pneumonia in immunocompetent adults-Swedish society of infectious diseases 2012. Scand J Infect Dis. 2012;44: 885–902.
  • BTS Guidelines for the Management of Community Acquired Pneumonia in Adults. Thorax. 2001;56(Suppl 4): IV1–I64.
  • Torres A, Peetermans WE, Viegi G, et al. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax. 2013;68:1057–1065.
  • Jokinen C, Heiskanen L, Juvonen H, et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol. 1993;137:977–988.
  • Almirall J, Bolibar I, Vidal J, et al. Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Respir J. 2000;15:757–763.
  • Schnoor M, Hedicke J, Dalhoff K, et al. Approaches to estimate the population-based incidence of community acquired pneumonia. J Infect. 2007;55:233–239.
  • Guest JF, Morris A. Community-acquired pneumonia: the annual cost to the national health service in the UK. Eur Respir J. 1997;10:1530–1534.
  • Ewig S, Birkner N, Strauss R, et al. New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality. Thorax. 2009;64:1062–1069.
  • Lidman C, Burman LG, Lagergren A, et al. Limited value of routine microbiological diagnostics in patients hospitalized for community-acquired pneumonia. Scand J Infect Dis. 2002;34:873–879.
  • Hedlund JU, Örtqvist AB, Kalin ME, et al. Factors of importance for the long term prognosis after hospital treated pneumonia. Thorax. 1993;48:785–789.
  • Kaplan V, Clermont G, Griffin MF, et al. Pneumonia: still the old man's friend?. Arch Intern Med. 2003;163:317–323.
  • Mortensen EM, Kapoor WN, Chang CC, et al. Assessment of mortality after long-term follow-up of patients with community-acquired pneumonia. Clin Infect Dis. 2003;37:1617–1624.
  • Bruns AH, Oosterheert JJ, Cucciolillo MC, et al. Cause-specific long-term mortality rates in patients recovered from community-acquired pneumonia compared with the general Dutch population. Clin Microbiol Infect. 2011;17: 763–768.
  • Corrales-Medina VF, Suh KN, Rose G, et al. Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies. PLoS Med. 2011;8:e1001048.
  • Corrales-Medina VF, Taljaard M, Yende S, et al. Intermediate and long-term risk of new-onset heart failure after hospitalization for pneumonia in elderly adults. Am Heart J. 2015;170:306–312.
  • Pletz MW, von Baum H, van der Linden M, et al. The burden of pneumococcal pneumonia - experience of the German competence network CAPNETZ. Pneumologie. 2012;66:470–475.
  • Kaplan V, Angus DC, Griffin MF, et al. Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med. 2002;165:766–772.
  • Arnold FW, Wiemken TL, Peyrani P, et al. Outcomes in females hospitalised with community-acquired pneumonia are worse than in males. Eur Respir J. 2013;41:1135–1140.
  • Johansson N, Kalin M, Tiveljung-Lindell A, et al. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis. 2010;50:202–209.
  • Rhedin S, Galanis I, Granath F, et al. Narrow-spectrum ss-lactam monotherapy in hospital treatment of community-acquired pneumonia: a register-based cohort study. Clin Microbiol Infect. 2017;23:247–252.
  • Fransen H, Tunevall G. Bacteria and serologic reactions against bacteria in patients hospitalized with acute respiratory illness. Scand J Infect Dis. 1969;1:191–202.
  • Kalin M, Lindberg AA, Tunevall G. Etiological diagnosis of bacterial pneumonia by gram stain and quantitative culture of expectorates. Leukocytes or alveolar macrophages as indicators of sample representativity. Scand J Infect Dis. 1983;15:153–160.
  • Berntsson E, Blomberg J, Lagergard T, et al. Etiology of community-acquired pneumonia in patients requiring hospitalization. Eur J Clin Microbiol. 1985;4:268–272.
  • Holmberg H. Aetiology of community-acquired pneumonia in hospital treated patients. Scand J Infect Dis. 1987;19:491–501.
  • Örtqvist A, Hedlund J, Grillner L, et al. Aetiology, outcome and prognostic factors in community-acquired pneumonia requiring hospitalization. Eur Respir J. 1990;3:1105–1113.
  • Burman LA, Trollfors B, Andersson B, et al. Diagnosis of pneumonia by cultures, bacterial and viral antigen detection tests, and serology with special reference to antibodies against pneumococcal antigens. J Infect Dis. 1991;163:1087–1093.
  • Stralin K, Olcen P, Tornqvist E, et al. Definite, probable, and possible bacterial aetiologies of community-acquired pneumonia at different CRB-65 scores. Scand J Infect Dis. 2010;42:426–434.
  • Naucler P. Rapport från Pneumoniregistret 2012. Infektionsläkaren. 2013;17:33–38.
  • Walden AP, Clarke GM, McKechnie S, et al. Patients with community acquired pneumonia admitted to European intensive care units: an epidemiological survey of the GenOSept cohort. Crit Care. 2014;18:R58.
  • Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64(Suppl 3):iii1–ii55.
  • von Baum H, Welte T, Marre R, et al. Mycoplasma pneumoniae pneumonia revisited within the German competence network for community-acquired pneumonia (CAPNETZ). BMC Infect Dis. 2009;9:62.
  • Lind K, Benzon MW, Jensen JS, et al. A seroepidemiological study of mycoplasma pneumoniae infections in Denmark over the 50-year period 1946-1995. Eur J Epidemiol. 1997;13:581–586.
  • Lagerström F, Bader M, Foldevi M, et al. Microbiological etiology in clinically diagnosed community-acquired pneumonia in primary care in Örebro, Sweden. Clin Microbiol Infect. 2003;9:645–652.
  • Said MA, Johnson HL, Nonyane BA, et al. Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques. PLoS One. 2013;8:e60273.
  • Eldika N, Sethi S. Role of nontypeable Haemophilus influenzae in exacerbations and progression of chronic obstructive pulmonary disease. Curr Opin Pulm Med. 2006;12:118–124.
  • File TM, Jr., Monte SV, Schentag JJ, et al. A disease model descriptive of progression between chronic obstructive pulmonary disease exacerbations and community-acquired pneumonia: roles for underlying lung disease and the pharmacokinetics/pharmacodynamics of the antibiotic. Int J Antimicrob Agents. 2009;33:58–64.
  • Cilli A. Community-acquired pneumonia in patients with chronic obstructive pulmonary disease. Curr Infect Dis Rep. 2015;17:444.
  • Grayston JT. Infections caused by Chlamydia pneumoniae strain TWAR. Clin Infect Dis. 1992;15:757–761.
  • Persson K, Boman J. Comparison of five serologic tests for diagnosis of acute infections by Chlamydia pneumoniae. Clin Diagn Lab Immunol. 2000;7:739–744.
  • Persson K, Haidl S. Evaluation of a commercial test for antibodies to the chlamydial lipopolysaccharide (Medac) for serodiagnosis of acute infections by Chlamydia pneumoniae (TWAR) and Chlamydia psittaci. Apmis. 2000;108:131–138.
  • Boman J, Allard A, Persson K, et al. Rapid diagnosis of respiratory Chlamydia pneumoniae infection by nested touchdown polymerase chain reaction compared with culture and antigen detection by EIA. J Infect Dis. 1997;175:1523–1526.
  • Ekman MR, Grayston JT, Visakorpi R, et al. An epidemic of infections due to Chlamydia pneumoniae in military conscripts. Clin Infect Dis. 1993;17:420–425.
  • Fajardo KA, Zorich SC, Voss JD, et al. Pneumonia outbreak caused by Chlamydophila pneumoniae among US air force academy cadets, Colorado, USA. Emerg Infect Dis. 2015;21:1049–1051.
  • Lieberman D, Schlaeffer F, Boldur I, et al. Multiple pathogens in adult patients admitted with community-acquired pneumonia: a one year prospective study of 346 consecutive patients. Thorax. 1996;51:179–184.
  • Miyashita N, Fukano H, Yoshida K, et al. Is it possible to distinguish between atypical pneumonia and bacterial pneumonia?: evaluation of the guidelines for community-acquired pneumonia in Japan. Respir Med. 2004;98:952–960.
  • Ruiz M, Ewig S, Marcos MA, et al. Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Crit Care Med. 1999;160:397–405.
  • Jennings LC, Anderson TP, Beynon KA, et al. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax. 2008;63:42–48.
  • Self WH, Williams DJ, Zhu Y, et al. Respiratory viral detection in children and adults: comparing asymptomatic controls and patients with community-acquired pneumonia. J Infect Dis. 2016;213:584–591.
  • Choi SH, Hong SB, Ko GB, et al. Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med. 2012;186:325–332.
  • Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza A (H1N1) - United States, may-august 2009. MMWR Morb Mortal Wkly Rep. 2009;58:1071–1074.
  • Foy HM, Kenny GE, McMahan R, et al. Mycoplasma pneumoniae in the community. Am J Epidemiol. 1971;93:55–67.
  • Farr BM, Kaiser DL, Harrison BD, et al. Prediction of microbial aetiology at admission to hospital for pneumonia from the presenting clinical features. British thoracic society pneumonia research subcommittee. Thorax. 1989;44:1031–1035.
  • Fang GD, Fine M, Orloff J, et al. New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases. Medicine (Baltimore). 1990;69:307–316.
  • Macfarlane JT, Miller AC, Roderick Smith WH, et al. Comparative radiographic features of community acquired Legionnaires' disease, pneumococcal pneumonia, mycoplasma pneumonia, and psittacosis. Thorax. 1984;39:28–33.
  • Metlay JP, Schulz R, Li YH, et al. Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med. 1997;157:1453–1459.
  • Lehtomaki K, Leinonen M, Takala A, et al. Etiological diagnosis of pneumonia in military conscripts by combined use of bacterial culture and serological methods. Eur J Clin Microbiol Infect Dis. 1988;7:348–354.
  • Holmberg H, Bodin L, Jonsson I, et al. Rapid aetiological diagnosis of pneumonia based on routine laboratory features. Scand J Infect Dis. 1990;22:537–545.
  • Örtqvist A, Grepe A, Julander I, et al. Bacteremic pneumococcal pneumonia in Sweden: clinical course and outcome and comparison with non-bacteremic pneumococcal and mycoplasmal pneumonias. Scand J Infect Dis. 1988;20:163–171.
  • Ponka A, Sarna S. Differential diagnosis of viral, mycoplasmal and bacteraemic pneumococcal pneumonias on admission to hospital. Eur J Respir Dis. 1983;64:360–368.
  • Bohte R, Hermans J, van den Broek PJ. Early recognition of Streptococcus pneumoniae in patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis. 1996;15:201–205.
  • Foy HM, Kenny GE, McMahan R, et al. Mycoplasma pneumoniae pneumonia in an urban area. Five years of surveillance. JAMA. 1970;214:1666–1672.
  • Woodhead MA, Macfarlane JT. Comparative clinical and laboratory features of legionella with pneumococcal and mycoplasma pneumonias. Br J Dis Chest. 1987;81:133–139.
  • Sopena N, Pedro-Botet ML, Sabria M, et al. Comparative study of community-acquired pneumonia caused by Streptococcus pneumoniae, Legionella pneumophila or Chlamydia pneumoniae. Scand J Infect Dis. 2004;36:330–334.
  • Mulazimoglu L, Yu VL. Can Legionnaires disease be diagnosed by clinical criteria? A critical review. Chest. 2001;120:1049–1053.
  • Sopena N, Sabria-Leal M, Pedro-Botet ML, et al. Comparative study of the clinical presentation of Legionella pneumonia and other community-acquired pneumonias. Chest. 1998;113:1195–1200.
  • Schuetz P, Litke A, Albrich WC, et al. Blood biomarkers for personalized treatment and patient management decisions in community-acquired pneumonia. Curr Opin Infect Dis. 2013;26:159–167.
  • Hedlund J, Hansson LO. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection. 2000;28:68–73.
  • Johansson N, Kalin M, Backman-Johansson C, et al. Procalcitonin levels in community-acquired pneumonia - correlation with aetiology and severity. Scand J Infect Dis. 2014;46:787–791.
  • Le Bel J, Hausfater P, Chenevier-Gobeaux C, et al. Diagnostic accuracy of C-reactive protein and procalcitonin in suspected community-acquired pneumonia adults visiting emergency department and having a systematic thoracic CT scan. Crit Care. 2015;19:366.
  • Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med. 2008;121:219–225.
  • Nseir W, Farah R, Mograbi J, et al. Impact of serum C-reactive protein measurements in the first 2 days on the 30-day mortality in hospitalized patients with severe community-acquired pneumonia: a cohort study. J Crit Care. 2013;28:291–295.
  • Tamayose M, Fujita J, Parrott G, et al. Correlations between extent of X-ray infiltration and levels of serum C-reactive protein in adult non-severe community-acquired pneumonia. J Infect Chemother. 2015;21:456–463.
  • Christ-Crain M, Opal SM. Clinical review: the role of biomarkers in the diagnosis and management of community-acquired pneumonia. Crit Care. 2010;14:203
  • Schuetz P, Muller B, Christ-Crain M, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2012;Cd007498.
  • Menendez R, Martinez R, Reyes S, et al. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax. 2009;64:587–591.
  • Bruns AH, Oosterheert JJ, Hak E, et al. Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia. Eur Respir J. 2008;32:726–732.
  • Nouvenne A, Ticinesi A, Folesani G, et al. The association of serum procalcitonin and high-sensitivity C-reactive protein with pneumonia in elderly multimorbid patients with respiratory symptoms: retrospective cohort study. BMC Geriatr. 2016;16:16.
  • Brown JS. Biomarkers and community-acquired pneumonia. Thorax. 2009;64:556–558.
  • de Jager CP, Wever PC, Gemen EF, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS One. 2012;7:e46561.
  • Wyllie DH, Bowler IC, Peto TE. Relation between lymphopenia and bacteraemia in UK adults with medical emergencies. J Clin Pathol. 2004;57:950–955.
  • Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580–637.
  • Howell MD, Donnino M, Clardy P, et al. Occult hypoperfusion and mortality in patients with suspected infection. Intensive Care Med. 2007;33:1892–1899.
  • Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801–810.
  • Strålin K. Usefulness of aetiological tests for guiding antibiotic therapy in community-acquired pneumonia. Int J Antimicrob Agents. 2008;31:3–11.
  • Meehan TP, Fine MJ, Krumholz HM, et al. Quality of care, process, and outcomes in elderly patients with pneumonia. JAMA. 1997;278:2080–2084.
  • Bartlett JG, Finegold SM. Bacteriology of expectorated sputum with quantitative culture and wash technique compared to transtracheal aspirates. Am Rev Respir Dis. 1978;117:1019–1027.
  • Drew WL. Value of sputum culture in diagnosis of pneumococcal pneumonia. J Clin Microbiol. 1977;6: 62–65.
  • Cordero E, Pachon J, Rivero A, et al. Usefulness of sputum culture for diagnosis of bacterial pneumonia in HIV-infected patients. Eur J Clin Microbiol Infect Dis. 2002;21:362–367.
  • Musher DM, Montoya R, Wanahita A. Diagnostic value of microscopic examination of Gram-stained sputum and sputum cultures in patients with bacteremic pneumococcal pneumonia. Clin Infect Dis. 2004;39:165–169.
  • Fishman JA, Roth RS, Zanzot E, et al. Use of induced sputum specimens for microbiologic diagnosis of infections due to organisms other than Pneumocystis carinii. J Clin Microbiol. 1994;32:131–134.
  • Chuard C, Fracheboud D, Regamey C. Effect of sputum induction by hypertonic saline on specimen quality. Diagn Microbiol Infect Dis. 2001;39:211–214.
  • Murray PR, Washington JA. Microscopic and baceriologic analysis of expectorated sputum. Mayo Clin Proc. 1975;50:339–344.
  • Hedlund J, Örtqvist A, Kalin M. Nasopharyngeal culture in the pneumonia diagnosis. Infection. 1990;18:283–285.
  • Kalin M. Bacteremic pneumococcal pneumonia: value of culture of nasopharyngeal specimens and examination of washed sputum specimens. Eur J Clin Microbiol. 1982;1:394–396.
  • Strålin K, Törnqvist E, Kaltoft MS, et al. Etiologic diagnosis of adult bacterial pneumonia by culture and PCR applied to respiratory tract samples. J Clin Microbiol. 2006;44:643–645.
  • Murdoch DR, Laing RT, Mills GD, et al. Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia. J Clin Microbiol. 2001;39:3495–3498.
  • Gutierrez F, Masia M, Rodriguez JC, et al. Evaluation of the immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of community-acquired pneumonia in Spain. Clin Infect Dis. 2003;36:286–292.
  • Smith MD, Derrington P, Evans R, et al. Rapid diagnosis of bacteremic pneumococcal infections in adults by using the Binax NOW Streptococcus pneumoniae urinary antigen test: a prospective, controlled clinical evaluation. J Clin Microbiol. 2003;41:2810–2813.
  • Roson B, Fernandez-Sabe N, Carratala J, et al. Contribution of a urinary antigen assay (Binax NOW) to the early diagnosis of pneumococcal pneumonia. Clin Infect Dis. 2004;38:222–226.
  • Strålin K, Kaltoft MS, Konradsen HB, et al. Comparison of two urinary antigen tests for establishment of pneumococcal etiology of adult community-acquired pneumonia. J Clin Microbiol. 2004;42:3620–3625.
  • Andreo F, Dominguez J, Ruiz J, et al. Impact of rapid urine antigen tests to determine the etiology of community-acquired pneumonia in adults. Respir Med. 2006;100:884–891.
  • Sinclair A, Xie X, Teltscher M, et al. Systematic review and meta-analysis of a urine-based pneumococcal antigen test for diagnosis of community-acquired pneumonia caused by Streptococcus pneumoniae. J Clin Microbiol. 2013;51:2303–2310.
  • Horita N, Miyazawa N, Kojima R, et al. Sensitivity and specificity of the Streptococcus pneumoniae urinary antigen test for unconcentrated urine from adult patients with pneumonia: a meta-analysis. Respirology. 2013;18:1177–1183.
  • Chen M, Zhou M, Xiao W, et al. The urinary antigen tests have high sensitivity in diagnosis of Pneumococcus caused community-acquired pneumonia posterior to antimicrobial therapy. Cell Biochem Biophys. 2014;70:1029–1034.
  • Murdoch DR, Laing RT, Cook JM. The NOW S. pneumoniae urinary antigen test positivity rate 6 weeks after pneumonia onset and among patients with COPD. Clin Infect Dis. 2003;37:153–154.
  • Marcos MA, Jimenez de Anta MT, de la Bellacasa JP, et al. Rapid urinary antigen test for diagnosis of pneumococcal community-acquired pneumonia in adults. Eur Respir J. 2003;21:209–214.
  • Andreo F, Prat C, Ruiz-Manzano J, et al. Persistence of Streptococcus pneumoniae urinary antigen excretion after pneumococcal pneumonia. Eur J Clin Microbiol Infect Dis. 2009;28:197–201.
  • Kashuba AD, Ballow CH. Legionella urinary antigen testing: potential impact on diagnosis and antibiotic therapy. Diagn Microbiol Infect Dis. 1996;24:129–139.
  • Blazquez RM, Espinosa FJ, Martinez-Toldos CM, et al. Sensitivity of urinary antigen test in relation to clinical severity in a large outbreak of Legionella pneumonia in Spain. Eur J Clin Microbiol Infect Dis. 2005;24:488–491.
  • Abdeldaim GM, Stralin K, Olcen P, et al. Quantitative fucK gene polymerase chain reaction on sputum and nasopharyngeal secretions to detect Haemophilus influenzae pneumonia. Diagn Microbiol Infect Dis. 2013;76:141–146.
  • Stralin K, Herrmann B, Abdeldaim G, et al. Comparison of sputum and nasopharyngeal aspirate samples and of the PCR gene targets lytA and Spn9802 for quantitative PCR for rapid detection of pneumococcal pneumonia. J Clin Microbiol. 2014;52:83–89.
  • Johansson N, Kalin M, Giske CG, et al. Quantitative detection of Streptococcus pneumoniae from sputum samples with real-time quantitative polymerase chain reaction for etiologic diagnosis of community-acquired pneumonia. Diagn Microbiol Infect Dis. 2008;60:255–261.
  • Yoshii Y, Shimizu K, Morozumi M, et al. Identification of pathogens by comprehensive real-time PCR versus conventional methods in community-acquired pneumonia in Japanese adults. Infect Dis (Lond). 2016;48:782–788.
  • Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev. 2004;17:697–728.
  • Daxboeck F, Krause R, Wenisch C. Laboratory diagnosis of Mycoplasma pneumoniae infection. Clin Microbiol Infect. 2003;9:263–273.
  • Nilsson AC, Bjorkman P, Persson K. Polymerase chain reaction is superior to serology for the diagnosis of acute Mycoplasma pneumoniae infection and reveals a high rate of persistent infection. BMC Microbiol. 2008;8:93.
  • Bernander S, Hanson HS, Johansson B, et al. A nested polymerase chain reaction for detection of Legionella pneumophila in clinical specimens. Clin Microbiol Infect. 1997;3:95–101.
  • Murdoch DR. Nucleic acid amplification tests for the diagnosis of pneumonia. Clin Infect Dis. 2003;36:1162–1170.
  • Gadsby NJ, Russell CD, McHugh MP, et al. Comprehensive molecular testing for respiratory pathogens in community-acquired pneumonia. Clin Infect Dis. 2016;62:817–823.
  • Petric M, Comanor L, Petti CA. Role of the laboratory in diagnosis of influenza during seasonal epidemics and potential pandemics. J Infect Dis. 2006;194(Suppl 2): S98–S110.
  • Nilsson AC, Brytting M, Serifler F, et al. Longitudinal clearance of seasonal influenza a viral RNA measured by real-time polymerase chain reaction in patients identified at a hospital emergency department. Scand J Infect Dis. 2010;42:679–686.
  • Meduri GU, Baselski V. The role of bronchoalveolar lavage in diagnosing nonopportunistic bacterial pneumonia. Chest 1991;100:179–190.
  • Pereira Gomes JC, Pedreira WL, Jr Jr., Araujo EM, et al. Impact of BAL in the management of pneumonia with treatment failure: positivity of BAL culture under antibiotic therapy. Chest. 2000;118:1739–1746.
  • Ison MG, Lee N. Influenza 2010-2011: lessons from the 2009 pandemic. Cleve Clin J Med. 2010;77:812–820.
  • Musher DM. How contagious are common respiratory tract infections?. N Engl J Med. 2003;348:1256–1266.
  • Laurie KL, Guarnaccia TA, Carolan LA, et al. Interval between infections and viral hierarchy are determinants of viral interference following influenza virus infection in a ferret model. J Infect Dis. 2015;212:1701–1710.
  • Tsang TK, Cowling BJ, Fang VJ, et al. Influenza a virus shedding and infectivity in households. J Infect Dis. 2015;212:1420–1428.
  • Wallensten A, Fredlund H, Runehagen A. Multiple human-to-human transmission from a severe case of psittacosis, Sweden, January-February 2013. Euro Surveill. 2014;19:
  • Hoellein A, Hecker J, Hoffmann D, et al. Serious outbreak of human metapneumovirus in patients with hematologic malignancies. Leuk Lymphoma. 2016;57:623–627.
  • Pica N, Bouvier NM. Environmental factors affecting the transmission of respiratory viruses. Curr Opin Virol. 2012;2:90–95.
  • Liao RS, Appelgate DM, Pelz RK. An outbreak of severe respiratory tract infection due to human metapneumovirus in a long-term care facility for the elderly in Oregon. J Clin Virol. 2012;53:171–173.
  • Hayden GE, Wrenn KW. Chest radiograph vs. computed tomography scan in the evaluation for pneumonia. J Emerg Med. 2009;36:266–270.
  • Self WH, Courtney DM, McNaughton CD, et al. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am J Emerg Med. 2013;31:401–405.
  • Franquet T. Imaging of pneumonia: trends and algorithms. Eur Respir J. 2001;18:196–208.
  • Chavez MA, Shams N, Ellington LE, et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res. 2014;15:50.
  • Ye X, Xiao H, Chen B, et al. Accuracy of lung ultrasonography versus chest radiography for the diagnosis of adult community-acquired pneumonia: review of the literature and meta-analysis. PLoS One. 2015;10:e0130066.
  • Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–250.
  • Fine MJ, Singer DE, Hanusa BH, et al. Validation of a pneumonia prognostic index using the MedisGroups Comparative Hospital Database. Am J Med. 1993;94:153–159.
  • Ewig S, Ruiz M, Mensa J, et al. Severe community-acquired pneumonia. Assessment of severity criteria. Am J Respir Crit Care Med. 1998;158:1102–1108.
  • Lim WS, Macfarlane JT, Boswell TC, et al. Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines. Thorax. 2001;56:296–301.
  • Yealy DM, Auble TE, Stone RA, et al. Effect of increasing the intensity of implementing pneumonia guidelines: a randomized, controlled trial. Ann Intern Med. 2005;143: 881–894.
  • Orrick JJ, Segal R, Johns TE, et al. Resource use and cost of care for patients hospitalised with community acquired pneumonia: impact of adherence to infectious diseases society of america guidelines. Pharmacoeconomics. 2004;22:751–757.
  • Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–382.
  • Barlow G, Nathwani D, Davey P. The CURB65 pneumonia severity score outperforms generic sepsis and early warning scores in predicting mortality in community-acquired pneumonia. Thorax. 2007;62:253–259.
  • Bauer TT, Ewig S, Marre R, et al. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006;260:93–101.
  • Capelastegui A, Espana PP, Quintana JM, et al. Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J. 2006;27:151–157.
  • Myint PK, Kamath AV, Vowler SL, et al. Severity assessment criteria recommended by the British thoracic society (BTS) for community-acquired pneumonia (CAP) and older patients. Should SOAR (systolic blood pressure, oxygenation, age and respiratory rate) criteria be used in older people? A compilation study of two prospective cohorts. Age Ageing. 2006;35:286–291.
  • Loke YK, Kwok CS, Niruban A, et al. Value of severity scales in predicting mortality from community-acquired pneumonia: systematic review and meta-analysis. Thorax. 2010;65:884–890.
  • 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;65:878–883.
  • Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: for the third international consensus definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:775–787.
  • Myburgh JA. Fluid resuscitation in acute medicine: what is the current situation? J Intern Med. 2015;277:58–68.
  • Sanz F, Restrepo MI, Fernandez E, et al. Hypoxemia adds to the CURB-65 pneumonia severity score in hospitalized patients with mild pneumonia. Respir Care. 2011;56:612–618.
  • Eltzschig HK, Carmeliet P. Hypoxia and inflammation. N Engl J Med. 2011;364:656–665.
  • Wheeler AP, Bernard GR. Acute lung injury and the acute respiratory distress syndrome: a clinical review. Lancet. 2007;369:1553–1564.
  • Goossens H, Ferech M, Vander Stichele R, et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365:579–587.
  • Galanis I, Lindstrand A, Darenberg J, et al. Effects of PCV7 and PCV13 on invasive pneumococcal disease and carriage in Stockholm, Sweden. Eur Respir J. 2016;47:1208–1218.
  • Naucler P, Darenberg J, Morfeldt E, et al. Contribution of host, bacterial factors and antibiotic treatment to mortality in adult patients with bacteraemic pneumococcal pneumonia. Thorax 2013;68:571–579.
  • Swedres-Swarm 2016. Consumption of antibiotics and occurrence of antibiotic resistance in Sweden. In: Hellman J, Aspevall O, editors. A report on Swedish antibiotic utilisation and resistance in human medicine (Swedres) and Swedish veterinary antibiotic resistance monitoring (Svarm). Uppsala: Solna; 2016.
  • Cao B, Qu JX, Yin YD, et al. Overview of antimicrobial options for Mycoplasma pneumoniae pneumonia: focus on macrolide resistance. Clin Respir J. 2017;11:419–429.
  • Brown RJ, Macfarlane-Smith L, Phillips S, et al. Detection of macrolide resistant Mycoplasma pneumoniae in England, September 2014 to September 2015. Euro Surveill. 2015;20:30078.
  • Zheng X, Lee S, Selvarangan R, et al. Macrolide-resistant mycoplasma pneumoniae, United States. Emerg Infect Dis. 2015;21:1470–1472.
  • Gullsby K, Bondeson K. No detection of macrolide-resistant Mycoplasma pneumoniae from Swedish patients, 1996-2013. Infect Ecol Epidemiol. 2016;6:31374.
  • Nilsson AC, Jensen JS, Bjorkman P, et al. Development of macrolide resistance in Mycoplasma pneumoniae-infected Swedish patients treated with macrolides. Scand J Infect Dis. 2014;46:315–319.
  • Chironna M, Sallustio A, Esposito S, et al. Emergence of macrolide-resistant strains during an outbreak of Mycoplasma pneumoniae infections in children. J Antimicrob Chemother. 2011;66:734–737.
  • Malhotra-Kumar S, Lammens C, Coenen S, et al. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study. Lancet. 2007;369:482–490.
  • Barkai G, Greenberg D, Givon-Lavi N, et al. Community prescribing and resistant Streptococcus pneumoniae. Emerging Infect Dis. 2005;11:829–837.
  • Baquero F. Trends in antibiotic resistance of respiratory pathogens: an analysis and commentary on a collaborative surveillance study. J Antimicrob Chemother. 1996;38(Suppl A):117–132.
  • Rodriguez-Bano J, Navarro MD, Romero L, et al. Clinical and molecular epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli as a cause of nosocomial infection or colonization: implications for control. Clin Infect Dis. 2006;42:37–45.
  • Ena J, Arjona F, Martinez-Peinado C, et al. Epidemiology of urinary tract infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. Urology. 2006;68:1169–1174.
  • Urbanek K, Kolar M, Loveckova Y, et al. Influence of third-generation cephalosporin utilization on the occurrence of ESBL-positive Klebsiella pneumoniae strains. J Clin Pharm Ther. 2007;32:403–408.
  • Paterson DL. “Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis. 2004;38(Suppl 4):S341–S345.
  • MacKenzie FM, Bruce J, Struelens MJ, et al. Antimicrobial drug use and infection control practices associated with the prevalence of methicillin-resistant Staphylococcus aureus in European hospitals. Clin Microbiol Infect. 2007;13: 269–276.
  • Lee SS, Kim HS, Kang HJ, et al. Rapid spread of methicillin-resistant Staphylococcus aureus in a new hospital in the broad-spectrum antibiotic era. J Infect. 2007;55:358–362.
  • LeBlanc L, Pepin J, Toulouse K, et al. Fluoroquinolones and risk for methicillin-resistant Staphylococcus aureus, Canada. Emerg Infect Dis. 2006;12:(9):1398–405.
  • Fine MJ, Smith MA, Carson CA, et al. Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA. 1996;275:134–141.
  • 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;44(Suppl 2):S27–S72.
  • Nie W, Li B, Xiu Q. β-Lactam/macrolide dual therapy versus β-lactam monotherapy for the treatment of community-acquired pneumonia in adults: a systematic review and meta-analysis. J Antimicrob Chemother. 2014;69: 1441–1446.
  • Hedlund J, Örtqvist A, Ahlqvist T, et al. Management of patients with community-acquired pneumonia treated in hospital in Sweden. Scand J Infect Dis. 2002;34:887–892.
  • Postma DF, van Werkhoven CH, van Elden LJ, et al. Antibiotic treatment strategies for community-acquired pneumonia in adults. N Engl J Med. 2015;372:1312–1323.
  • Garin N, Genne D, Carballo S, et al. β-Lactam monotherapy vs β-lactam-macrolide combination treatment in moderately severe community-acquired pneumonia: a randomized noninferiority trial. JAMA Intern Med. 2014;174:1894–1901.
  • Baddour LM, Yu VL, Klugman KP, et al. Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med. 2004;170:440–444.
  • Waterer GW. Are macrolides now obligatory in severe community-acquired pneumonia?. Intensive Care Med. 2010;36:562–564.
  • Chan R, Hemeryck L, O'Regan M, et al. Oral versus intravenous antibiotics for community acquired lower respiratory tract infection in a general hospital: open, randomised controlled trial. BMJ. 1995;310:1360–1362.
  • MacGregor RR, Graziani AL. Oral administration of antibiotics: a rational alternative to the parenteral route. Clin Infect Dis. 1997;24:457–467.
  • Castro-Guardiola A, Viejo-Rodriguez AL, Soler-Simon S, et al. Efficacy and safety of oral and early-switch therapy for community-acquired pneumonia: a randomized controlled trial. Am J Med. 2001;111:367–374.
  • Nordbring F. Current practice in penicillin dosing. J Antimicrob Chemother. 1981;8(Suppl C):1–6.
  • Örtqvist A. Antibiotic treatment of community-acquired pneumonia in clinical practice: a European perspective. J Antimicrob Chemother. 1995;35:205–212.
  • Fredlund H, Bodin L, Back E, et al. Antibiotic therapy in pneumonia: a comparative study of parenteral and oral administration of penicillin. Scand J Infect Dis. 1987;19:459–466.
  • Blandhol M, Tysland T, Blix HS, et al. Antibiotic switch during treatment with antibiotics against respiratory tract infections in ambulatory care in Norway. Infect Dis (Lond). 2017;1–5.
  • Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J. 2005;26:1138–1180.
  • Pallares R. Treatment of pneumococcal pneumonia. Semin Respir Infect. 1999;14:276–284.
  • Garau J. Role of beta-lactam agents in the treatment of community-acquired pneumonia. Eur J Clin Microbiol Infect Dis. 2005;24:83–99.
  • Daniel P, Rodrigo C, McKeever TM, et al. Time to first antibiotic and mortality in adults hospitalised with community-acquired pneumonia: a matched-propensity analysis. Thorax. 2016;71:568–570.
  • Lee JS, Giesler DL, Gellad WF, et al. Antibiotic therapy for adults hospitalized with community-acquired pneumonia: a systematic review. JAMA. 2016;315:593–602.
  • Quattromani E, Powell ES, Khare RK, et al. Hospital-reported data on the pneumonia quality measure “Time to First Antibiotic Dose are not associated with inpatient mortality: results of a nationwide cross-sectional analysis”. Acad Emerg Med. 2011;18:496–503.
  • Houck PM, Bratzler DW, Nsa W, et al. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med. 2004;164:637–644.
  • Taccone FS, Bond O, Cavicchi FZ, et al. Individualized antibiotic strategies. Curr Opin Anaesthesiol. 2016;29:166–171.
  • Kumar A. An alternate pathophysiologic paradigm of sepsis and septic shock: implications for optimizing antimicrobial therapy. Virulence. 2014;5:80–97.
  • Nathwani D. Sequential switch therapy for lower respiratory tract infections: a European perspective. Chest. 1998;113(3 Suppl):211S–218S.
  • Halm EA, Fine MJ, Kapoor WN, et al. Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia. Arch Intern Med. 2002;162:1278–1284.
  • Rhew DC, Tu GS, Ofman J, et al. Early switch and early discharge strategies in patients with community-acquired pneumonia: a meta-analysis. Arch Intern Med. 2001;161:722–727.
  • Cunha BA. Oral or intravenous-to-oral antibiotic switch therapy for treating patients with community-acquired pneumonia. Am J Med. 2001;111:412–413.
  • Carratala J, Garcia-Vidal C, Ortega L, 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;172:922–928.
  • Siegel RE, Alicea M, Lee A, et al. Comparison of 7 versus 10 days of antibiotic therapy for hospitalized patients with uncomplicated community-acquired pneumonia: a prospective, randomized, double-blind study. Am J Ther. 1999;6:217–222.
  • el Moussaoui R, de Borgie CA, van den Broek P, et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ. 2006;332:1355.
  • Dunbar LM, Wunderink RG, Habib MP, et al. High-dose, short-course levofloxacin for community-acquired pneumonia: a new treatment paradigm. Clin Infect Dis. 2003;37:752–760.
  • Edelstein PH. Antimicrobial chemotherapy for Legionnaires disease: time for a change. Ann Intern Med. 1998;129: 328–330.
  • Mykietiuk A, Carratala J, Fernandez-Sabe N, et al. Clinical outcomes for hospitalized patients with Legionella pneumonia in the antigenuria era: the influence of levofloxacin therapy. Clin Infect Dis. 2005;40:794–799.
  • Dunbar LM, Khashab MM, Kahn JB, et al. Efficacy of 750-mg, 5-day levofloxacin in the treatment of community-acquired pneumonia caused by atypical pathogens. Curr Med Res Opin. 2004;20:555–563.
  • Corey GR. Staphylococcus aureus bloodstream infections: definitions and treatment. Clin Infect Dis. 2009;48(Suppl 4):S254–S259.
  • Ison MG. Optimizing antiviral therapy for influenza: understanding the evidence. Expert Rev anti Infect Ther. 2015;13:417–425.
  • Kaiser L, Wat C, Mills T, et al. Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations. Arch Intern Med. 2003;163:1667–1672.
  • McGeer A, Green KA, Plevneshi A, et al. Antiviral therapy and outcomes of influenza requiring hospitalization in Ontario, Canada. Clin Infect Dis. 2007;45:1568–1575.
  • Ruf BR, Szucs T. Reducing the burden of influenza-associated complications with antiviral therapy. Infection. 2009;37:186–196.
  • Dobson J, Whitley RJ, Pocock S, et al. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet. 2015;385:1729–1737.
  • Louie JK, Yang S, Acosta M, et al. Treatment with neuraminidase inhibitors for critically ill patients with influenza A (H1N1)pdm09. Clin Infect Dis. 2012;55:1198–1204.
  • Lee N, Ison MG. Diagnosis, management and outcomes of adults hospitalized with influenza. Antivir Ther (Lond). 2012;17:143–157.
  • Kiatboonsri S, Kiatboonsri C, Theerawit P. Fatal respiratory events caused by zanamivir nebulization. Clin Infect Dis. 2010;50:620.
  • Siston AM, Rasmussen SA, Honein MA, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA. 2010;303:1517–1525.
  • Corley A, Rickard CM, Aitken LM, et al. High-flow nasal cannulae for respiratory support in adult intensive care patients. Cochrane Database Syst Rev. 2017;5:Cd010172.
  • Yang M, Yan Y, Yin X, etet al. Chest physiotherapy for pneumonia in adults. Cochrane Database Syst Rev. 2013;Cd006338.
  • Andrews J, Sathe NA, Krishnaswami S, et al. Nonpharmacologic airway clearance techniques in hospitalized patients: a systematic review. Respir Care. 2013;58:2160–2186.
  • Mundy LM, Leet TL, Darst K, et al. Early mobilization of patients hospitalized with community-acquired pneumonia. Chest. 2003;124:883–889.
  • Vincent JL. High-flow oxygen cannula: a very effective method to correct severe hypoxemia. J Thorac Dis. 2015;7:E207–E208.
  • Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372:2185–2196.
  • Crimi C, Noto A, Princi P, et al. A European survey of noninvasive ventilation practices. Eur Respir J. 2010;36:362–369.
  • Antonelli M, Conti G, Rocco M, et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med. 1998;339:429–435.
  • Confalonieri M, Potena A, Carbone G, et al. Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med. 1999;160:1585–1591.
  • Hilbert G, Gruson D, Vargas F, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med. 2001;344:481–487.
  • Ferrer M, Esquinas A, Leon M, et al. Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med. 2003;168: 1438–1444.
  • Delclaux C, L'Her E, Alberti C, et al. Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask. A Randomized Controlled Trial. JAMA. 2000;284:2352–2360.
  • Cosentini R, Brambilla AM, Aliberti S, et al. Helmet continuous positive airway pressure vs oxygen therapy to improve oxygenation in community-acquired pneumonia: a randomized, controlled trial. Chest. 2010;138:114–120.
  • Brambilla AM, Aliberti S, Prina E, et al. Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia. Intensive Care Med. 2014;40:942–949.
  • Plant PK, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet. 2000;355:1931–1935.
  • Torres A, Ferrer M. What’s new in severe community-acquired pneumonia? Corticosteroids as adjunctive treatment to antibiotics. Intensive Care Med. 2016;42: 1276–1278.
  • Confalonieri M, Urbino R, Potena A, et al. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med. 2005;171:242–248.
  • Siemieniuk RA, Meade MO, Alonso-Coello P, et al. Corticosteroid therapy for patients hospitalized with community-acquired pneumonia: a systematic review and meta-analysis. Ann Intern Med. 2015;163:519–528.
  • Wu WF, Fang Q, He GJ. Efficacy of corticosteroid treatment for severe community-acquired pneumonia: a meta-analysis. Am J Emerg Med. 2017;
  • Wan YD, Sun TW, Liu ZQ, et al. Efficacy and safety of corticosteroids for community-acquired pneumonia: a systematic review and meta-analysis. Chest. 2016;149:209–219.
  • Gorman SK, Slavik RS, Marin J. Corticosteroid treatment of severe community-acquired pneumonia. Ann Pharmacother. 2007;41:1233–1237.
  • Salluh JI, Povoa P, Soares M, et al. The role of corticosteroids in severe community-acquired pneumonia: a systematic review. Crit Care. 2008;12:R76.
  • Chen Y, Li K, Pu H, etet al. Corticosteroids for pneumonia. Cochrane Database Syst Rev. 2011;Cd007720.
  • Briel M, Bucher HC, Boscacci R, etet al. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV-infection. Cochrane Database Syst Rev. 2006;3:CD006150.
  • Walters JA, Gibson PG, Wood-Baker R, etet al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2009;CD001288.
  • Viasus D, Garcia-Vidal C, Simonetti AF, et al. The effect of simvastatin on inflammatory cytokines in community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial. BMJ Open. 2015;5:e006251.
  • Chopra V, Rogers MA, Buist M, et al. Is statin use associated with reduced mortality after pneumonia? A systematic review and meta-analysis. Am J Med. 2012;125:1111–1123.
  • Lin CF, Chang YH, Liu JC, et al. Statin use associated with a reduced risk of pneumonia requiring hospitalization in patients with myocardial infarction: a nested case-control study. BMC Cardiovasc Disord. 2016;16:24.
  • Polgreen LA, Cook EA, Brooks JM, et al. Increased statin prescribing does not lower pneumonia risk. Clin Infect Dis. 2015;60:1760–1766.
  • Chung SD, Tsai MC, Lin HC, et al. Statin use and clinical outcomes among pneumonia patients. Clin Microbiol Infect. 2014;20:879–885.
  • Roson B, Carratala J, Fernandez-Sabe N, et al. Causes and factors associated with early failure in hospitalized patients with community-acquired pneumonia. Arch Intern Med. 2004;164:502–508.
  • Akram AR, Chalmers JD, Taylor JK, et al. An evaluation of clinical stability criteria to predict hospital course in community-acquired pneumonia. Clin Microbiol Infect. 2013;19:1174–1180.
  • Andersen SB, Baunbaek Egelund G, Jensen AV, et al. Failure of CRP decline within three days of hospitalization is associated with poor prognosis of community-acquired pneumonia. Infect Dis (Lond). 2017;49:251–260.
  • Rome L, Murali G, Lippmann M. Nonresolving pneumonia and mimics of pneumonia. Med Clin North Am. 2001;85:1511–1530, xi.
  • Niederman MS, Mandell LA, Anzueto A, et al. Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001;163:1730–1754.
  • Heffner JE, McDonald J, Barbieri C, et al. Management of parapneumonic effusions. An analysis of physician practice patterns. Arch Surg. 1995;130:433–438.
  • Davies HE, Davies RJ, Davies CW. Management of pleural infection in adults: British thoracic society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii41–ii53.
  • Diacon AH, Brutsche MH, Soler M. Accuracy of pleural puncture sites: a prospective comparison of clinical examination with ultrasound. Chest. 2003;123:436–441.
  • Zhu Z, Hawthorne ML, Guo Y, et al. Tissue plasminogen activator combined with human recombinant deoxyribonuclease is effective therapy for empyema in a rabbit model. Chest. 2006;129:1577–1583.
  • Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011;365:518–526.
  • Piccolo F, Popowicz N, Wong D, et al. Intrapleural tissue plasminogen activator and deoxyribonuclease therapy for pleural infection. J Thorac Dis. 2015;7:999–1008.
  • Goharian V, Tabatabaee SA, Mozafarhashemi S, et al. A comparison between subpleural patient-controlled analgesia by bupivacaine and intermittent analgesia in post-operative thoracotomy: A double-blind randomized clinical trial. J Res Med Sci. 2011;16:1210–1216.
  • Pothula V, Krellenstein DJ. Early aggressive surgical management of parapneumonic empyemas. Chest. 1994;105:832–836.
  • Maskell NA, Batt S, Hedley EL, et al. The bacteriology of pleural infection by genetic and standard methods and its mortality significance. Am J Respir Crit Care Med. 2006;174:817–823.
  • Meyer CN, Rosenlund S, Nielsen J, et al. Bacteriological aetiology and antimicrobial treatment of pleural empyema. Scand J Infect Dis. 2011;43:165–169.
  • Desai H, Agrawal A. Pulmonary emergencies: pneumonia, acute respiratory distress syndrome, lung abscess, and empyema. Med Clin North Am. 2012;96:1127–1148.
  • Seo H, Cha SI, Shin KM, et al. Focal necrotizing pneumonia is a distinct entity from lung abscess. Respirology.. 2013;18:1095–1100.
  • Yazbeck MF, Dahdel M, Kalra A, et al. Lung abscess: update on microbiology and management. Am J Ther. 2014;21:217–221.
  • Schattner A, Dubin I, Gelber M. Double jeopardy - concurrent lung abscess and pleural empyema. QJM. 2016;
  • Bartlett JG. Anaerobic bacterial infections of the lung. Chest. 1987;91:901–909.
  • Kuhajda I, Zarogoulidis K, Tsirgogianni K, et al. Lung abscess-etiology, diagnostic and treatment options. Ann Transl Med. 2015;3:183
  • Bartlett JG. How important are anaerobic bacteria in aspiration pneumonia: when should they be treated and what is optimal therapy. Infect Dis Clin North Am. 2013;27:149–155.
  • Wang JL, Chen KY, Fang CT, et al. Changing bacteriology of adult community-acquired lung abscess in Taiwan: Klebsiella pneumoniae versus anaerobes. Clin Infect Dis. 2005;40:915–922.
  • Stock CT, Ho VP, Towe C, et al. Lung abscess. Surg Infect (Larchmt). 2013;14:335–336.
  • Schiza S, Siafakas NM. Clinical presentation and management of empyema, lung abscess and pleural effusion. Curr Opin Pulm Med. 2006;12:205–211.
  • Gudiol F, Manresa F, Pallares R, et al. Clindamycin vs penicillin for anaerobic lung infections. High rate of penicillin failures associated with penicillin-resistant Bacteroides melaninogenicus. Arch Intern Med. 1990;150:2525–2529.
  • Levison ME, Mangura CT, Lorber B, et al. Clindamycin compared with penicillin for the treatment of anaerobic lung abscess. Ann Intern Med. 1983;98:466–471.
  • Allewelt M, Schuler P, Bolcskei PL, et al. Ampicillin + sulbactam vs clindamycin +/- cephalosporin for the treatment of aspiration pneumonia and primary lung abscess. Clin Microbiol Infect. 2004;10:163–170.
  • Fernandez-Sabe N, Carratala J, Dorca J, et al. Efficacy and safety of sequential amoxicillin-clavulanate in the treatment of anaerobic lung infections. Eur J Clin Microbiol Infect Dis. 2003;22:185–187.
  • Ott SR, Allewelt M, Lorenz J, et al. Moxifloxacin vs ampicillin/sulbactam in aspiration pneumonia and primary lung abscess. Infection. 2008;36:23–30.
  • Lorber B. Bacterial lung abscess. In: Mandell G, Bennett J, Dolin R, editors. Mandell, Douglas and Bennett’s principles and practice of infectious diseases. 7th ed. Philadelphia: Churchill Livingstone; 2010. p. 925–9.
  • Wali SO. An update on the drainage of pyogenic lung abscesses. Ann Thorac Med. 2012;7:3–7.
  • Almirall J, Gonzalez CA, Balanzo X, et al. Proportion of community-acquired pneumonia cases attributable to tobacco smoking. Chest. 1999;116:375–379.
  • Nuorti JP, Butler JC, Farley MM, et al. Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team. N Engl J Med. 2000;342:681–689.
  • Holmberg H, Kragsbjerg P. Association of pneumonia and lung cancer: the value of convalescent chest radiography and follow-up. Scand J Infect Dis. 1993;25:93–100.
  • Smeeth L, Cook C, Thomas S, et al. Risk of deep vein thrombosis and pulmonary embolism after acute infection in a community setting. Lancet. 2006;367:1075–1079.
  • Chen YG, Lin TY, Huang WY, et al. Association between pneumococcal pneumonia and venous thromboembolism in hospitalized patients: a nationwide population-based study. Respirology. 2015;20:799–804.
  • Woodhead MA, Macfarlane JT, McCracken JS, et al. Prospective study of the aetiology and outcome of pneumonia in the community. Lancet. 1987;1:671–674.
  • Menendez R, Perpina M, Torres A. Evaluation of nonresolving and progressive pneumonia. Semin Respir Infect. 2003;18:103–111.
  • Demicheli V, Rivetti D, Deeks JJ, et al. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev. 2000;CD001269.
  • Monto AS, Ohmit SE, Petrie JG, et al. Comparative efficacy of inactivated and live attenuated influenza vaccines. N Engl J Med. 2009;361:1260–1267.
  • Govaert TM, Thijs CT, Masurel N, et al. The efficacy of influenza vaccination in elderly individuals. A randomized double-blind placebo-controlled trial. JAMA. 1994;272:1661–1665.
  • Jefferson T, Rivetti D, Rivetti A, et al. Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review. Lancet. 2005;366:1165–1174.
  • Govaert TM, Sprenger MJ, Dinant GJ, et al. Immune response to influenza vaccination of elderly people. A randomized double-blind placebo-controlled trial. Vaccine. 1994;12:1185–1189.
  • Honkanen PO, Keistinen T, Kivela SL. Reactions following administration of influenza vaccine alone or with pneumococcal vaccine to the elderly. Arch Intern Med. 1996;156:205–208.
  • Beyer WE, Palache AM, de Jong JC, et al. Cold-adapted live influenza vaccine versus inactivated vaccine: systemic vaccine reactions, local and systemic antibody response, and vaccine efficacy. A meta-analysis. Vaccine. 2002;20:1340–1353.
  • Beyer WE, de Bruijn IA, Palache AM, et al. Protection against influenza after annually repeated vaccination: a meta-analysis of serologic and field studies. Arch Intern Med. 1999;159:182-8.
  • Burls A, Jordan R, Barton P, et al. Vaccinating healthcare workers against influenza to protect the vulnerable–is it a good use of healthcare resources? A systematic review of the evidence and an economic evaluation. Vaccine. 2006;24:4212–4221.
  • Hayward AC, Harling R, Wetten S, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ. 2006;333:1241.
  • Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who work with the elderly. Cochrane Database Syst Rev. 2010;CD005187.
  • Moberley S, Holden J, Tatham DP, et al. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev. 2013;Cd000422.
  • Örtqvist A, Hedlund J, Burman LÅ, et al. Randomised trial of 23-valent pneumococcal capsular polysaccharide vaccine in prevention of pneumonia in middle-aged and elderly people. Swedish pneumococcal vaccination study group. Lancet. 1998;351:399–403.
  • Honkanen PO, Keistinen T, Miettinen L, et al. Incremental effectiveness of pneumococcal vaccine on simultaneously administered influenza vaccine in preventing pneumonia and pneumococcal pneumonia among persons aged 65 years or older. Vaccine. 1999;17:2493–2500.
  • Shapiro ED, Berg AT, Austrian R, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med. 1991;325:1453–1460.
  • Butler JC, Breiman RF, Campbell JF, et al. Pneumococcal polysaccharide vaccine efficacy. An evaluation of current recommendations. JAMA. 1993;270:1826–1831.
  • Bonten MJ, Huijts SM, Bolkenbaas M, et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med. 2015;372:1114–1125.
  • Font B, Lliminana C, Fontanals D, et al. Eleven-year study of recurrent pneumococcal bacteremia. Eur J Clin Microbiol Infect Dis. 2001;20:636–638.
  • Törling J, Hedlund J, Konradsen HB, et al. Revaccination with the 23-valent pneumococcal polysaccharide vaccine in middle-aged and elderly persons previously treated for pneumonia. Vaccine. 2003;22:96–103.
  • Waites KB, Canupp KC, Chen YY, et al. Revaccination of adults with spinal cord injury using the 23-valent pneumococcal polysaccharide vaccine. J Spinal Cord Med. 2008;31:53–59.
  • Musher DM, Rueda AM, Nahm MH, et al. Initial and subsequent response to pneumococcal polysaccharide and protein-conjugate vaccines administered sequentially to adults who have recovered from pneumococcal pneumonia. J Infect Dis. 2008;198:1019–1027.
  • Jackson LA, Benson P, Sneller VP, et al. Safety of revaccination with pneumococcal polysaccharide vaccine. JAMA. 1999;281:243–248.
  • Schuetz P, Koller M, Christ-Crain M, et al. Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings. Epidemiol Infect. 2008;136:1628–1637.
  • Schaaf B, Kruse J, Rupp J, et al. Sepsis severity predicts outcome in community-acquired pneumococcal pneumonia. Eur Respir J. 2007;30:517–524.
  • Kruger S, Ewig S, Marre R, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J. 2008;31:349–355.
  • Bont J, Hak E, Hoes AW, et al. Predicting death in elderly patients with community-acquired pneumonia: a prospective validation study reevaluating the CRB-65 severity assessment tool. Arch Intern Med. 2008;168:1465–1468.
  • Man SY, Lee N, Ip M, et al. Prospective comparison of three predictive rules for assessing severity of community-acquired pneumonia in Hong Kong. Thorax. 2007;62:348–353.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.