Community-acquired pneumonia

Elena Prina, Otavio T Ranzani, Antoni Torres, Elena Prina, Otavio T Ranzani, Antoni Torres

Abstract

Community-acquired pneumonia causes great mortality and morbidity and high costs worldwide. Empirical selection of antibiotic treatment is the cornerstone of management of patients with pneumonia. To reduce the misuse of antibiotics, antibiotic resistance, and side-effects, an empirical, effective, and individualised antibiotic treatment is needed. Follow-up after the start of antibiotic treatment is also important, and management should include early shifts to oral antibiotics, stewardship according to the microbiological results, and short-duration antibiotic treatment that accounts for the clinical stability criteria. New approaches for fast clinical (lung ultrasound) and microbiological (molecular biology) diagnoses are promising. Community-acquired pneumonia is associated with early and late mortality and increased rates of cardiovascular events. Studies are needed that focus on the long-term management of pneumonia.

Copyright © 2015 Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Microbiological investigations ICU=intensive care unit. *Others indicates fungal, tuberculosis cultures, PCR, specific serology, lung biopsy.
Figure 2
Figure 2
Acute management of the community-acquired pneumonia CAP=community-acquired pneumonia. CURB-65=Confusion Urea Respiratory rate Blood pressure and age ≥65 year old score. PSI=Pneumonia Severity Index. ICU=intensive care unit. *Combination with macrolide is preferred.
Figure 3
Figure 3
Acute and long-term assessment of community-acquired pneumonia

References

    1. Brown PD, Lerner SA. Community-acquired pneumonia. Lancet. 1998;352:1295–1302.
    1. File TM. Community-acquired pneumonia. Lancet. 2003;362:1991–2001.
    1. Mandell LA, Wunderink RG, Anzueto A, for the Infectious Diseases Society of America. the American Thoracic Society 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.
    1. Lim WS, Baudouin SV, George RC, for the Pneumonia Guidelines Committee of the BTS Standards of Care Committee BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64(suppl 3):iii1–iii55.
    1. Woodhead M, Blasi F, Ewig S, for the Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases Guidelines for the management of adult lower respiratory tract infections–full version. Clin Microbiol Infect. 2011;17(suppl 6):E1–E59.
    1. National Institute for Health and Care Excellence Pneumonia: Diagnosis and management of community- and hospital-acquired pneumonia in adults. NICE guidelines. 2014. (accessed Jan 15, 2015).
    1. Sanz F, Restrepo MI, Fernández-Fabrellas E. Does prolonged onset of symptoms have a prognostic significance in community-acquired pneumonia? Respirology. 2014;19:1073–1079.
    1. Arancibia F, Cortes CP, Valdés M. Importance of Legionella pneumophila in the etiology of severe community-acquired pneumonia in Santiago, Chile. Chest. 2014;145:290–296.
    1. Cunha BA. The atypical pneumonias: clinical diagnosis and importance. Clin Microbiol Infect. 2006;12(suppl 3):12–24.
    1. Bochud PY, Moser F, Erard P. Community-acquired pneumonia. A prospective outpatient study. Medicine (Baltimore) 2001;80:75–87.
    1. Haubitz S, Hitz F, Graedel L. Ruling out Legionella in community-acquired pneumonia. Am J Med. 2014;127:1010. e11–19.
    1. Metlay JP, Fine MJ. Testing strategies in the initial management of patients with community-acquired pneumonia. Ann Intern Med. 2003;138:109–118.
    1. Schuetz P, Kutz A, Grolimund E, for the ProHOSP Study Group Excluding infection through procalcitonin testing improves outcomes of congestive heart failure patients presenting with acute respiratory symptoms: results from the randomized ProHOSP trial. Int J Cardiol. 2014;175:464–472.
    1. GBD 2013 Mortality and Causes of Death Collaborators Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385:117–171.
    1. Millett ER, Quint JK, Smeeth L, Daniel RM, Thomas SL. Incidence of community-acquired lower respiratory tract infections and pneumonia among older adults in the United Kingdom: a population-based study. PLoS One. 2013;8:e75131.
    1. Ochoa-Gondar O, Vila-Córcoles A, de Diego C, for the EVAN-65 Study Group The burden of community-acquired pneumonia in the elderly: the Spanish EVAN-65 study. BMC Public Health. 2008;8:222.
    1. File TM, Jr, Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgrad Med. 2010;122:130–141.
    1. Fine MJ, Auble TE, Yealy DM. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–250.
    1. Carratalà J, Fernández-Sabé N, Ortega L. Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients. Ann Intern Med. 2005;142:165–172.
    1. Ewig S, Birkner N, Strauss R. 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.
    1. Arnold FW, Wiemken TL, Peyrani P, Ramirez JA, Brock GN, for the CAPO authors Mortality differences among hospitalized patients with community-acquired pneumonia in three world regions: results from the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study. Respir Med. 2013;107:1101–1111.
    1. Woodhead M, Welch CA, Harrison DA, Bellingan G, Ayres JG. Community-acquired pneumonia on the intensive care unit: secondary analysis of 17,869 cases in the ICNARC Case Mix Programme Database. Crit Care. 2006;10(suppl 2):S1.
    1. Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax. 2012;67:71–79.
    1. Johnstone J, Marrie TJ, Eurich DT, Majumdar SR. Effect of pneumococcal vaccination in hospitalized adults with community-acquired pneumonia. Arch Intern Med. 2007;167:1938–1943.
    1. Carratalà J, Garcia-Vidal C, Ortega L. 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.
    1. Drijkoningen JJ, Rohde GG. Pneumococcal infection in adults: burden of disease. Clin Microbiol Infect. 2014;20(suppl 5):45–51.
    1. Howard LS, Sillis M, Pasteur MC, Kamath AV, Harrison BD. Microbiological profile of community-acquired pneumonia in adults over the last 20 years. J Infect. 2005;50:107–113.
    1. Said MA, Johnson HL, Nonyane BA, the AGEDD Adult Pneumococcal Burden Study Team Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques. PLoS One. 2013;8:e60273.
    1. Arnold FW, Summersgill JT, Lajoie AS, the Community-Acquired Pneumonia Organization (CAPO) Investigators A worldwide perspective of atypical pathogens in community-acquired pneumonia. Am J Respir Crit Care Med. 2007;175:1086–1093.
    1. Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet. 2011;377:1264–1275.
    1. Kyaw MH, Lynfield R, Schaffner W, the Active Bacterial Core Surveillance of the Emerging Infections Program Network Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med. 2006;354:1455–1463.
    1. Principi N, Esposito S. Macrolide-resistant Mycoplasma pneumoniae: its role in respiratory infection. J Antimicrob Chemother. 2013;68:506–511.
    1. Cao B, Zhao CJ, Yin YD. High prevalence of macrolide resistance in Mycoplasma pneumoniae isolates from adult and adolescent patients with respiratory tract infection in China. Clin Infect Dis. 2010;51:189–194.
    1. Webb BJ, Dascomb K, Stenehjem E, Dean N. Predicting risk of drug-resistant organisms in pneumonia: moving beyond the HCAP model. Respir Med. 2015;109:1–10.
    1. Prina E, Ranzani OT, Polverino E. Risk factors associated with potentially antibiotic-resistant pathogens in community-acquired pneumonia. Ann Am Thorac Soc. 2015;12:153–160.
    1. Alcón A, Fàbregas N, Torres A. Pathophysiology of pneumonia. Clin Chest Med. 2005;26:39–46.
    1. Ubeda C, Pamer EG. Antibiotics, microbiota, and immune defense. Trends Immunol. 2012;33:459–466.
    1. Torres A, Peetermans WE, Viegi G, Blasi F. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax. 2013;68:1057–1065.
    1. Wunderink RG, Waterer GW. Genetics of community-acquired pneumonia. Semin Respir Crit Care Med. 2005;26:553–562.
    1. Rautanen A, Mills TC, Gordon AC. Genome-wide association study of survival from sepsis due to pneumonia: an observational cohort study. Lancet Respir Med. 2015;3:53–60.
    1. Misch EA, Verbon A, Prins JM, Skerrett SJ, Hawn TRA. A TLR6 polymorphism is associated with increased risk of Legionnaires' disease. Genes Immun. 2013;14:420–426.
    1. Aabenhus R, Jensen JU, Jørgensen KJ, Hróbjartsson A, Bjerrum L. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Database Syst Rev. 2014;11 CD010130.
    1. Christ-Crain M, Stolz D, Bingisser R. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med. 2006;174:84–93.
    1. Schuetz P, Müller B, Christ-Crain M. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2012;9 CD007498.
    1. Schuetz P, Balk R, Briel M. Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective. Clin Chem Lab Med. 2015;53:583–592.
    1. Fine MJ, Orloff JJ, Arisumi D. Prognosis of patients hospitalized with community-acquired pneumonia. Am J Med. 1990;88:1N–8N.
    1. Malcolm C, Marrie TJ. Antibiotic therapy for ambulatory patients with community-acquired pneumonia in an emergency department setting. Arch Intern Med. 2003;163:797–802.
    1. Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Vandervoort MK, Feagan BG. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA. 2000;283:749–755.
    1. Sinclair A, Xie X, Teltscher M, Dendukuri N. 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.
    1. Shimada T, Noguchi Y, Jackson JL. Systematic review and metaanalysis: urinary antigen tests for Legionellosis. Chest. 2009;136:1576–1585.
    1. van der Eerden MM, Vlaspolder F, de Graaff CS. Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomised study. Thorax. 2005;60:672–678.
    1. Falguera M, Ruiz-González A, Schoenenberger JA. Prospective, randomised study to compare empirical treatment versus targeted treatment on the basis of the urine antigen results in hospitalised patients with community-acquired pneumonia. Thorax. 2010;65:101–106.
    1. Schulte B, Eickmeyer H, Heininger A. Detection of pneumonia associated pathogens using a prototype multiplexed pneumonia test in hospitalized patients with severe pneumonia. PLoS One. 2014;9:e110566.
    1. Syrjälä H, Broas M, Suramo I, Ojala A, Lähde S. High-resolution computed tomography for the diagnosis of community-acquired pneumonia. Clin Infect Dis. 1998;27:358–363.
    1. Brenner DJ, Hall EJ. Computed tomography–an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–2284.
    1. Volpicelli G, Elbarbary M, Blaivas M, the International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577–591.
    1. Chavez MA, Shams N, Ellington LE. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res. 2014;15:50.
    1. Reissig A, Copetti R, Mathis G. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study. Chest. 2012;142:965–972.
    1. Ramirez P, Torres A. Should ultrasound be included in the initial assessment of respiratory patients? Lancet Respir Med. 2014;2:599–600.
    1. Restrepo MI, Mortensen EM, Rello J, Brody J, Anzueto A. Late admission to the ICU in patients with community-acquired pneumonia is associated with higher mortality. Chest. 2010;137:552–557.
    1. González-Moraleja J, Sesma P, González C, López ME, García JF, Alvarez-Sala JL. What is the cost of inappropriate admission of pneumonia patients? Arch Bronconeumol. 1999;35:312–316.
    1. Majumdar SR, Eurich DT, Gamble JM, Senthilselvan A, Marrie TJ. Oxygen saturations less than 92% are associated with major adverse events in outpatients with pneumonia: a population-based cohort study. Clin Infect Dis. 2011;52:325–331.
    1. Lim WS, van der Eerden MM, Laing R. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–382.
    1. Jones B, Gundlapalli AV, Jones JP, Brown SM, Dean NC. Admission decisions and outcomes of community-acquired pneumonia in the homeless population: a review of 172 patients in an urban setting. Am J Public Health. 2013;103(suppl 2):S289–S293.
    1. Salih W, Schembri S, Chalmers JD. Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observational data. Eur Respir J. 2014;43:842–851.
    1. Charles PG, Wolfe R, Whitby M, for the Australian Community-Acquired Pneumonia Study Collaboration SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008;47:375–384.
    1. Labarère J, Schuetz P, Renaud B, Claessens YE, Albrich W, Mueller B. Validation of a clinical prediction model for early admission to the intensive care unit of patients with pneumonia. Acad Emerg Med. 2012;19:993–1003.
    1. Renaud B, Schuetz P, Claessens YE, Labarère J, Albrich W, Mueller B. Proadrenomedullin improves Risk of Early Admission to ICU score for predicting early severe community-acquired pneumonia. Chest. 2012;142:1447–1454.
    1. 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.
    1. Ramírez P, Ferrer M, Martí V. Inflammatory biomarkers and prediction for intensive care unit admission in severe community-acquired pneumonia. Crit Care Med. 2011;39:2211–2217.
    1. Dean NC, Silver MP, Bateman KA, James B, Hadlock CJ, Hale D. Decreased mortality after implementation of a treatment guideline for community-acquired pneumonia. Am J Med. 2001;110:451–457.
    1. Martínez R, Reyes S, Lorenzo MJ, Menéndez R. Impact of guidelines on outcome: the evidence. Semin Respir Crit Care Med. 2009;30:172–178.
    1. File TM, Jr, Marrie TJ. Does empiric therapy for atypical pathogens improve outcomes for patients with CAP? Infect Dis Clin North Am. 2013;27:99–114.
    1. 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.
    1. Asadi L, Sligl WI, Eurich DT. Macrolide-based regimens and mortality in hospitalized patients with community-acquired pneumonia: a systematic review and meta-analysis. Clin Infect Dis. 2012;55:371–380.
    1. Eliakim-Raz N, Robenshtok E, Shefet D. Empiric antibiotic coverage of atypical pathogens for community-acquired pneumonia in hospitalized adults. Cochrane Database Syst Rev. 2012;9 CD004418.
    1. Schembri S, Williamson PA, Short PM. Cardiovascular events after clarithromycin use in lower respiratory tract infections: analysis of two prospective cohort studies. BMJ. 2013;346:f1235.
    1. Mortensen EM, Halm EA, Pugh MJ. Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia. JAMA. 2014;311:2199–2208.
    1. Postma DF, van Werkhoven CH, van Elden LJ, for the CAP-START Study Group Antibiotic treatment strategies for community-acquired pneumonia in adults. N Engl J Med. 2015;372:1312–1323.
    1. Garin N, Genné D, Carballo S. 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.
    1. Sligl WI, Asadi L, Eurich DT, Tjosvold L, Marrie TJ, Majumdar SR. Macrolides and mortality in critically ill patients with community-acquired pneumonia: a systematic review and meta-analysis. Crit Care Med. 2014;42:420–432.
    1. Dellinger RP, Levy MM, Rhodes A, for the Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.
    1. American Thoracic Society. the Infectious Diseases Society of America Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416.
    1. Ewig S, Welte T, Chastre J, Torres A. Rethinking the concepts of community-acquired and health-care-associated pneumonia. Lancet Infect Dis. 2010;10:279–287.
    1. Dobler CC, Waterer G. Healthcare-associated pneumonia: a US disease or relevant to the Asia Pacific, too? Respirology. 2013;18:923–932.
    1. Aliberti S, Di Pasquale M, Zanaboni AM. Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia. Clin Infect Dis. 2012;54:470–478.
    1. Shorr AF, Zilberberg MD, Reichley R. Validation of a clinical score for assessing the risk of resistant pathogens in patients with pneumonia presenting to the emergency department. Clin Infect Dis. 2012;54:193–198.
    1. Shindo Y, Ito R, Kobayashi D. Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2013;188:985–995.
    1. Wunderink RG. Community-acquired pneumonia versus healthcare-associated pneumonia. The returning pendulum. Am J Respir Crit Care Med. 2013;188:896–898.
    1. Kuster SP, Rudnick W, Shigayeva A, for the Toronto Invasive Bacterial Diseases Network Previous antibiotic exposure and antimicrobial resistance in invasive pneumococcal disease: results from prospective surveillance. Clin Infect Dis. 2014;59:944–952.
    1. Zhong NS, Sun T, Zhuo C. Ceftaroline fosamil versus ceftriaxone for the treatment of Asian patients with community-acquired pneumonia: a randomised, controlled, double-blind, phase 3, non-inferiority with nested superiority trial. Lancet Infect Dis. 2015;15:161–171.
    1. Oldach D, Clark K, Schranz J. Randomized, double-blind, multicenter phase 2 study comparing the efficacy and safety of oral solithromycin (CEM-101) to those of oral levofloxacin in the treatment of patients with community-acquired bacterial pneumonia. Antimicrob Agents Chemother. 2013;57:2526–2534.
    1. Jefferson T, Jones MA, Doshi P. Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Cochrane Database Syst Rev. 2014;4 CD008965.
    1. Muthuri SG, Venkatesan S, Myles PR, the PRIDE Consortium Investigators Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. Lancet Respir Med. 2014;2:395–404.
    1. Barlow G, Nathwani D, Williams F. Reducing door-to-antibiotic time in community-acquired pneumonia: controlled before-and-after evaluation and cost-effectiveness analysis. Thorax. 2007;62:67–74.
    1. Yu KT, Wyer PC. Evidence-based emergency medicine/critically appraised topic. Evidence behind the 4-hour rule for initiation of antibiotic therapy in community-acquired pneumonia. Ann Emerg Med. 2008;51:651–662.
    1. Welker JA, Huston M, McCue JD. Antibiotic timing and errors in diagnosing pneumonia. Arch Intern Med. 2008;168:351–356.
    1. Noritomi DT, Ranzani OT, Monteiro MB. Implementation of a multifaceted sepsis education program in an emerging country setting: clinical outcomes and cost-effectiveness in a long-term follow-up study. Intensive Care Med. 2014;40:182–191.
    1. Peake SL, Delaney A, Bailey M, for the ARISE Investigators. the ANZICS Clinical Trials Group Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371:1496–1506.
    1. Yealy DM, Kellum JA, Huang DT, for the ProCESS Investigators A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370:1683–1693.
    1. Mouncey PR, Osborn TM, Power GS, for the ProMISe Trial Investigators Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372:1301–1311.
    1. Azevedo LC, Park M, Salluh JI, for the ERICC (Epidemiology of Respiratory Insufficiency in Critical Care) investigators Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study. Crit Care. 2013;17:R63.
    1. Gajic O, Rana R, Winters JL. Transfusion-related acute lung injury in the critically ill: prospective nested case-control study. Am J Respir Crit Care Med. 2007;176:886–891.
    1. Carrillo A, Gonzalez-Diaz G, Ferrer M. Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure. Intensive Care Med. 2012;38:458–466.
    1. Brambilla AM, Aliberti S, Prina E. Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia. Intensive Care Med. 2014;40:942–949.
    1. Zhang Y, Fang C, Dong BR, Wu T, Deng JL. Oxygen therapy for pneumonia in adults. Cochrane Database Syst Rev. 2012;3 CD006607.
    1. Nava S, Ferrer M, Esquinas A. Palliative use of non-invasive ventilation in end-of-life patients with solid tumours: a randomised feasibility trial. Lancet Oncol. 2013;14:219–227.
    1. Gajic O, Frutos-Vivar F, Esteban A, Hubmayr RD, Anzueto A. Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients. Intensive Care Med. 2005;31:922–926.
    1. Póvoa P, Salluh JI. What is the role of steroids in pneumonia therapy? Curr Opin Infect Dis. 2012;25:199–204.
    1. Chen Y, Li K, Pu H, Wu T. Corticosteroids for pneumonia. Cochrane Database Syst Rev. 2011;3 CD007720.
    1. Shafiq M, Mansoor MS, Khan AA, Sohail MR, Murad MH. Adjuvant steroid therapy in community-acquired pneumonia: a systematic review and meta-analysis. J Hosp Med. 2013;8:68–75.
    1. Blum CA, Nigro N, Briel M. Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial. Lancet. 2015;385:1511–1518.
    1. Torres A, Sibila O, Ferrer M. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA. 2015;313:677–686.
    1. Nie W, Zhang Y, Cheng J, Xiu Q. Corticosteroids in the treatment of community-acquired pneumonia in adults: a meta-analysis. PLoS One. 2012;7:e47926.
    1. Cheng M, Pan ZY, Yang J, Gao YD. Corticosteroid therapy for severe community-acquired pneumonia: a meta-analysis. Respir Care. 2014;59:557–563.
    1. Confalonieri M, Annane D, Antonaglia C, Santagiuliana M, Borriello EM, Meduri GU. Is prolonged low-dose glucocorticoid treatment beneficial in community-acquired pneumonia? Curr Infect Dis Rep. 2013;15:158–166.
    1. Confalonieri M, Urbino R, Potena A. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med. 2005;171:242–248.
    1. Kalil AC, Sun J. Low-dose steroids for septic shock and severe sepsis: the use of Bayesian statistics to resolve clinical trial controversies. Intensive Care Med. 2011;37:420–429.
    1. Khan AR, Riaz M, Bin Abdulhak AA. The role of statins in prevention and treatment of community acquired pneumonia: a systematic review and meta-analysis. PLoS One. 2013;8:e52929.
    1. Menéndez R, Martinez R, Reyes S. Stability in community-acquired pneumonia: one step forward with markers? Thorax. 2009;64:987–992.
    1. Halm EA, Fine MJ, Marrie TJ. Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines. JAMA. 1998;279:1452–1457.
    1. el Moussaoui R, de Borgie CA, van den Broek P. 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.
    1. Choudhury G, Mandal P, Singanayagam A, Akram AR, Chalmers JD, Hill AT. Seven-day antibiotic courses have similar efficacy to prolonged courses in severe community-acquired pneumonia—a propensity-adjusted analysis. Clin Microbiol Infect. 2011;17:1852–1858.
    1. Blasi F, Ostermann H, Racketa J, Medina J, McBride K, Garau J, for the REACH study group Early versus later response to treatment in patients with community-acquired pneumonia: analysis of the REACH study. Respir Res. 2014;15:6.
    1. Polgreen PM, Chen YY, Cavanaugh JE. An outbreak of severe Clostridium difficile-associated disease possibly related to inappropriate antimicrobial therapy for community-acquired pneumonia. Infect Control Hosp Epidemiol. 2007;28:212–214.
    1. Oosterheert JJ, Bonten MJ, Schneider MM. Effectiveness of early switch from intravenous to oral antibiotics in severe community acquired pneumonia: multicentre randomised trial. BMJ. 2006;333:1193.
    1. Li JZ, Winston LG, Moore DH, Bent S. Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis. Am J Med. 2007;120:783–790.
    1. Dimopoulos G, Matthaiou DK, Karageorgopoulos DE, Grammatikos AP, Athanassa Z, Falagas ME. Short- versus long-course antibacterial therapy for community-acquired pneumonia: a meta-analysis. Drugs. 2008;68:1841–1854.
    1. Oliveira CF, Botoni FA, Oliveira CR. Procalcitonin versus C-reactive protein for guiding antibiotic therapy in sepsis: a randomized trial. Crit Care Med. 2013;41:2336–2343.
    1. Aliberti S, Blasi F. Clinical stability versus clinical failure in patients with community-acquired pneumonia. Semin Respir Crit Care Med. 2012;33:284–291.
    1. Menéndez R, Torres A, Zalacaín R, for the Neumofail Group Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome. Thorax. 2004;59:960–965.
    1. Ott SR, Hauptmeier BM, Ernen C. Treatment failure in pneumonia: impact of antibiotic treatment and cost analysis. Eur Respir J. 2012;39:611–618.
    1. Mundy LM, Leet TL, Darst K, Schnitzler MA, Dunagan WC. Early mobilization of patients hospitalized with community-acquired pneumonia. Chest. 2003;124:883–889.
    1. Stolbrink M, McGowan L, Saman H. The Early Mobility Bundle: a simple enhancement of therapy which may reduce incidence of hospital-acquired pneumonia and length of hospital stay. J Hosp Infect. 2014;88:34–39.
    1. Jasti H, Mortensen EM, Obrosky DS, Kapoor WN, Fine MJ. Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia. Clin Infect Dis. 2008;46:550–556.
    1. Capelastegui A, España Yandiola PP, Quintana JM. Predictors of short-term rehospitalization following discharge of patients hospitalized with community-acquired pneumonia. Chest. 2009;136:1079–1085.
    1. Restrepo MI, Faverio P, Anzueto A. Long-term prognosis in community-acquired pneumonia. Curr Opin Infect Dis. 2013;26:151–158.
    1. Corrales-Medina VF, Alvarez KN, Weissfeld LA. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA. 2015;313:264–274.
    1. Yende S, D'Angelo G, Kellum JA, the GenIMS Investigators Inflammatory markers at hospital discharge predict subsequent mortality after pneumonia and sepsis. Am J Respir Crit Care Med. 2008;177:1242–1247.
    1. Corrales-Medina VF, Suh KN, Rose G. Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies. PLoS Med. 2011;8:e1001048.
    1. Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med. 2003;348:1322–1332.
    1. Tomczyk S, Bennett NM, Stoecker C, the Centers for Disease Control and Prevention (CDC) Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Morb Mortal Wkly Rep. 2014;63:822–825.
    1. Moberley S, Holden J, Tatham DP, Andrews RM. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev. 2013;1 CD000422.
    1. Bonten MJ, Huijts SM, Bolkenbaas M. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med. 2015;372:1114–1125.

Source: PubMed

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