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. 2006 Aug 24;41(5):272–289. doi: 10.1016/S1579-2129(06)60222-X

Guidelines for the Diagnosis and Treatment of Community-Acquired Pneumonia. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR)

SEPAR Working Group on Community-Acquired Pneumonia; Tuberculosis and Respiratory Infections (TIR) Assembly*
PMCID: PMC7128950

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REFERENCES

  • 1.Woodhead MA, Macfarlane JT, McCracken JS, Rose DH, Finch RG. Prospective study of the aetiology and outcome of pneumonia in the community. Lancet. 1987;1:671–674. doi: 10.1016/s0140-6736(87)90430-2. [DOI] [PubMed] [Google Scholar]
  • 2.Jokinen C, Heiskanen L, Juvonen H, Kallinen S, Karkola K, Kporpi M. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol. 1993;137:977–988. doi: 10.1093/oxfordjournals.aje.a116770. [DOI] [PubMed] [Google Scholar]
  • 3.Almirall J, Bolíbar I, Vidal J, Sauca G, Coll P, Niklason B, Bartolomé B. Epidemiology of community acquired pneumonia in adults: a population-based study. Eur Respir J. 2000;15:757–763. doi: 10.1034/j.1399-3003.2000.15d21.x. [DOI] [PubMed] [Google Scholar]
  • 4.Santos de Unamuno C, Llorente MA, Carandell E, Gutiérrez M, Riera J, Ramírez A. Lugar de atención, etiología, y tratamiento de las neumonías adquiridas en la comunidad de Palma de Mallorca. Med Clin (Barc) 1998;110:290–294. [PubMed] [Google Scholar]
  • 5.Murrie M, Hueto J. Epidemiología de las neumonías adquiridas en la comunidad en el Área de Salud I de Navarra. Med Clin (Barc) 1991;97:50–52. [PubMed] [Google Scholar]
  • 6.Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS, Weissfeld LA. Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA. 1996;275:134–141. [PubMed] [Google Scholar]
  • 7.Woodhead M. Community-acquired pneumonia in Europe: causative pathogens and resistance patterns. Eur Respir J. 2002;20(Suppl 36):20–27. doi: 10.1183/09031936.02.00702002. [DOI] [PubMed] [Google Scholar]
  • 8.Álvarez FJ, del Castillo D, García Fernández A, Romero B, del Rey J, Soto G, Castillo J. Estudio prospectivo de 221 neumonías adquiridas en la comunidad seguidas de forma ambulatoria. Etiología y evolución clínico-radiológica. Med Clin (Barc) 2001;116:161–166. doi: 10.1016/s0025-7753(01)71760-5. [DOI] [PubMed] [Google Scholar]
  • 9.Zalacaín R, Talayero N, Achótegui V, Corral J, Barreña I, Sobradillo V. Neumonía adquirida en la comunidad. Fiabilidad de los criterios clínicos para decidir tratamiento ambulatorio. Arch Bronconeumol. 1997;33:74–79. doi: 10.1016/s0300-2896(15)30657-8. [DOI] [PubMed] [Google Scholar]
  • 10.Falguera M, Sacristán O, Nogués A, Ruiz A, García M, Manonelles A, Rubio-Caballero M. Non severe community pneumonia: correlation between cause and severity or comorbidity. Arch Int Med. 2001;161:1866–1872. doi: 10.1001/archinte.161.15.1866. [DOI] [PubMed] [Google Scholar]
  • 11.Blanquer J, Blanquer R, Borrás R, Nauffal D, Morales P, Menéndez R. Aetiology of community acquired pneumonia in Valencia, Spain: a multicentre prospective study. Thorax. 1991;46:508–511. doi: 10.1136/thx.46.7.508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Molinos L, Fernández R, Gullón JA, Rubinos G, Alonso MA, Escudero C. Neumonía adquirida en la comunidad con tratamiento hospitalario. Interés de la clínica y exámenes complementarios en la predicción de la etiología. Arch Bronconeumol. 1997;33:230–235. doi: 10.1016/s0300-2896(15)30612-8. [DOI] [PubMed] [Google Scholar]
  • 13.Ruiz M, Ewig S, Marcos MA, Martínez JA, Arancibia F, Mensa J, Torres A. Etiology of community-acquired pneumonia: impact of age, comorbidity and severity. Am J Respir Crit Care Med. 1999;160:397–405. doi: 10.1164/ajrccm.160.2.9808045. [DOI] [PubMed] [Google Scholar]
  • 14.Sopena N, Sabriá M, Pedro-Botet ML, Manterola JM, Matas L, Domínguez J. Prospective study of community-acquired pneumonia of bacterial etiology in adults. Eur J Clin Microbiol Infect Dis. 1999;18:852–858. doi: 10.1007/s100960050419. [DOI] [PubMed] [Google Scholar]
  • 15.Rosón B, Carratalá J, Dorca J, Casanova A, Manresa F, Gudiol F. Etiology, reasons for hospitalization, risk classes and outcomes of community acquired pneumonia in patients hospitalised on the basis of conventional admission criteria. Clin Infect Dis. 2001;33:158–165. doi: 10.1086/321808. [DOI] [PubMed] [Google Scholar]
  • 16.Menéndez R, Córdoba J, de la Cuadra P, Cremades MJ, Lope Hontagas JL, Salavert M. Value of the polymerase chain reaction assay in noninvasive respiratory samples for diagnosis of community acquired pneumonia. Am J Respir Crit Care Med. 1999;159:1868–1873. doi: 10.1164/ajrccm.159.6.9807070. [DOI] [PubMed] [Google Scholar]
  • 17.Ruiz-González A, Falguera M, Nogués A, Rubio Caballero M. Is Streptococcus pneumoniae the leading cause of pneumonia of unknown aetiology? A microbiologic study of lung aspirates in consecutive patients with community acquired pneumonia. Am J Med. 1999;106:385–390. doi: 10.1016/s0002-9343(99)00050-9. [DOI] [PubMed] [Google Scholar]
  • 18.Rosón B, Fernández-Sabé N, Carratalá J, Verdaguer R, Dorca J, Manresa F. Contribution of a urinary antigen assay (Binax Now) to the early diagnosis of pneumococcal pneumonia. Clin Infect Dis. 2004;38:222–226. doi: 10.1086/380639. [DOI] [PubMed] [Google Scholar]
  • 19.de Roux A, Marcos MA, García E, Mensa J, Ewig S, Lode H. Viral community-acquired pneumonia in nonimmunocompromised adults. Chest. 2004;125:1343–1352. doi: 10.1378/chest.125.4.1343. [DOI] [PubMed] [Google Scholar]
  • 20.Pachón J, Prado MD, Capote F, Cuello JA, Garnacho J, Verano A. Severe community-acquired pneumonia. Etiology, prognosis and treatment. Am Rev Respir Dis. 1990;142:369–373. doi: 10.1164/ajrccm/142.2.369. [DOI] [PubMed] [Google Scholar]
  • 21.Torres A, Serra-Batllés J, Ferrer A, Jiménez P, Celis R, Cobo E. Severe community acquired pneumonia. Epidemiology and prognostic factors. Am Rev Respir Dis. 1991;114:312–318. doi: 10.1164/ajrccm/144.2.312. [DOI] [PubMed] [Google Scholar]
  • 22.Rello J, Quintana A, Ausina V, Net A, Prats G. A three-year study of severe community acquired pneumonia with emphasis on outcome. Chest. 1993;103:232–235. doi: 10.1378/chest.103.1.232. [DOI] [PubMed] [Google Scholar]
  • 23.Leroy O, Santré C, Beuscart C, Georges H, Guery B, Jacquier JM. A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit. Intensive Care Med. 1995;21:24–31. doi: 10.1007/BF02425150. [DOI] [PubMed] [Google Scholar]
  • 24.Rello J, Rodríguez R, Jubert P, Álvarez B, the study group on severe community acquired pneumonia Severe community acquired pneumonia in the elderly: epidemiology and prognosis. Clin Infect Dis. 1996;23:723–728. doi: 10.1093/clinids/23.4.723. [DOI] [PubMed] [Google Scholar]
  • 25.Rello J, Bodí M, Navarro M, Díaz E, Gallego M, Vallés J. Microbiological testing and outcome of patients with severe community-acquired pneumonia. Chest. 2003;123:174–180. doi: 10.1378/chest.123.1.174. [DOI] [PubMed] [Google Scholar]
  • 26.Zalacaín R, Torres A, Celis R, Blanquer J, Aspa J, Esteban L. on behalf of “Pneumonia in the elderly” working group. Area TIR. Community-acquired pneumonia in the elderly: Spanish multicentre study. Eur Respir J. 2003;21:294–302. doi: 10.1183/09031936.03.00064102. [DOI] [PubMed] [Google Scholar]
  • 27.Fernández-Sabé N, Carratalá J, Rosón B, Dorca J, Verdaguer R, Manresa F. Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine. 2003;82:159–169. doi: 10.1097/01.md.0000076005.64510.87. [DOI] [PubMed] [Google Scholar]
  • 28.el Solh AA, Aquiline AT, Dhillon RS, Ramadan F. Impact of invasive strategy on management of antimicrobial treatment failure in institutionalized older people with severe pneumonia. Am J Respir Crit Care Med. 2002;166:1038–1042. doi: 10.1164/rccm.200202-123OC. [DOI] [PubMed] [Google Scholar]
  • 29.Lim WS, MacFarlane JT. A prospective comparison of nursing home acquired pneumonia with community acquired pneumonia. Eur Respir J. 2001;18:362–368. doi: 10.1183/09031936.01.00204401. [DOI] [PubMed] [Google Scholar]
  • 30.Torres A, Dorca J, Zalacaín R, Bello S, el-Ebiary M, Molinos L. Community acquired pneumonia in chronic obstructive pulmonary disease: a Spanish multicenter study. Am J Respir Crit Care Med. 1996;154:1456–1461. doi: 10.1164/ajrccm.154.5.8912764. [DOI] [PubMed] [Google Scholar]
  • 31.Arancibia F, Bauer TT, Ewig S, Mensa J, González J, Niederman MS. Community-acquired pneumonia due to gram-negative bacteria and Pseudomonas aeruginosa: incidence, risk factors and prognosis. Arch Intern Med. 2002;162:1849–1858. doi: 10.1001/archinte.162.16.1849. [DOI] [PubMed] [Google Scholar]
  • 32.Marrie TJ. Bacteremic pneumococcal pneumonia: a continuously evolving disease. J Infect. 1992;24:247–255. doi: 10.1016/s0163-4453(05)80029-5. [DOI] [PubMed] [Google Scholar]
  • 33.Akbar DH. Bacterial pneumonia: comparison between diabetics and non-diabetics. Acta Diabetol. 2001;38:77–82. doi: 10.1007/s005920170017. [DOI] [PubMed] [Google Scholar]
  • 34.Ruiz M, Ewig S, Torres A, Arancibia F, Marco F, Mensa J. Severe community-acquired pneumonia. Risk factors and follow-up epidemiology. Am J Respir Crit Care Med. 1999;160:923–929. doi: 10.1164/ajrccm.160.3.9901107. [DOI] [PubMed] [Google Scholar]
  • 35.Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Eng J Med. 2001;344:665–671. doi: 10.1056/NEJM200103013440908. [DOI] [PubMed] [Google Scholar]
  • 36.Nuorti P, Butler J, Farley M, Harrison L, McGeer A, Kolczak M. The active bacterial core surveillance team. Cigarette smoking and invasive pneumococcal disease. N Engl J Med. 2000;342:681–689. doi: 10.1056/NEJM200003093421002. [DOI] [PubMed] [Google Scholar]
  • 37.Fernández J, López P, Orozco D, Merino J. Clinical study of an outbreak of Legionnaire's disease in Alcoy, Southeastern Spain. Eur J Clin Microbiol Infect Dis. 2002;21:729–735. doi: 10.1007/s10096-002-0819-9. [DOI] [PubMed] [Google Scholar]
  • 38.Agustí C, Rañó A, Filella X, González J, Moreno A, Xaubet A. Pulmonary infiltrates in patients receiving long-term glucocorticoid treatment. Etiology, prognostic factors and associated inflammatory response. Chest. 2003;123:488–498. doi: 10.1378/chest.123.2.488. [DOI] [PubMed] [Google Scholar]
  • 39.García-Fulgueiras A, Navarro C, Fenoll D, García J, González-Diego P, Jiménez-Bunuelas T. Legionnaires' disease outbreak in Murcia, Spain. Emerg Infect Dis. 2003;9:915–921. doi: 10.3201/eid0908.030337. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Sobradillo V, Ansola P, Baranda F, Corral C. Q fever pneumonia: a review of 164 cases in the Basque Country. Eur Respir J. 1989;2:263–266. [PubMed] [Google Scholar]
  • 41.Arnal R, Borderías L, Serón C, Zurutuza A. Etiología de la neumonía adquirida en la comunidad que requiere ingreso hospitalario en un período de 39 meses. Arch Bronconeumol. 2002;38(Suppl 2):57. [Google Scholar]
  • 42.Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell G. American Thoracic Society Guidelines for the management of adults with community-acquired pneumonia. Am J Respir Crit Care Med. 2001;163:1730–1754. doi: 10.1164/ajrccm.163.7.at1010. [DOI] [PubMed] [Google Scholar]
  • 43.Mandell LA, Bartlett JG, Dowell SF, File TM, Jr, Musher DM, Whitney C. Update of Practice Guidelines for the Management of Community-Acquired Pneumonia in Immunocompetent Adults. Clin Infect Dis. 2003;37:1405–1433. doi: 10.1086/380488. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Molinos L, López FJ, Faiña V. Neumonía adquirida en la comunidad. In: Villasante C, editor. Enfermedades respiratorias. Aula Médica; Madrid: 2002. pp. 333–340. [Google Scholar]
  • 45.Dorca J, Bello S, Blanquer JM, de Celis MR, Molinos L, Torres A. Diagnóstico y tratamiento de la neumonía adquirida en la comunidad. Arch Bronconeumol. 1997;33:240–246. doi: 10.1016/s0300-2896(15)30614-1. [DOI] [PubMed] [Google Scholar]
  • 46.Luna CM, Ramírez J, López H, Mazzei JA, Abreu de Oliveira JC, Pereira J. Grupo de trabajo de la Asociación Latinoamericana del Tórax (ALAT). Recomendaciones ALAT sobre la neumonía adquirida de la comunidad. Arch Bronconeumol. 2001;37:340–348. [PubMed] [Google Scholar]
  • 47.Katz DS, Leung AN. Radiology of pneumonia. Clin Chest Med. 1999;20:549–562. doi: 10.1016/s0272-5231(05)70235-5. [DOI] [PubMed] [Google Scholar]
  • 48.Bartlett JG, Dowell SF, Mandell LA, File TM, Jr, Musher DM, Fine MJ. Infectious Diseases Society of America. Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infect Dis. 2000;31:347–382. doi: 10.1086/313954. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.MacFarlane J, Bosswell T, Douglas G, Finch R, Holmes W, Honeybourne D. BTS guidelines for the management of community acquired pneumonia in adults. Thorax. 2001;56(Suppl 4):1iv–64iv. doi: 10.1136/thorax.56.suppl_4.iv1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.MacFarlane JT, Miller AC, Roderick Smith WH, Morris AH, Rose DH. Comparative radiographic features of community-acquired Legionnaires' disease, pneumococcal pneumonia, mycoplasma pneumonia and psittacosis. Thorax. 1984;39:28–33. doi: 10.1136/thx.39.1.28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Franquet T. Imaging of pneumonia: trends and algorithms. Eur Respir J. 2001;18:196–208. doi: 10.1183/09031936.01.00213501. [DOI] [PubMed] [Google Scholar]
  • 52.Hasley PB, Albaum MN, Fuhrman CR, Britton CA, Marrie TJ, Singer DE. Do pulmonary radiographic findings at presentation predict mortality in patients with community-acquired pneumonia? Arch Intern Med. 1996;156:2206–2212. [PubMed] [Google Scholar]
  • 53.Riquelme R, Torres A, el-Ebiary M, de la Bellacasa JP, Estruch R, Mensa J. Community-acquired pneumonia in the elderly: a multivariate analysis of risk and prognostic factors. Am J Crit Care Med. 1996;154:450–455. doi: 10.1164/ajrccm.154.5.8912763. [DOI] [PubMed] [Google Scholar]
  • 54.Skerrett SJ. Diagnostic testing to establish a microbial cause is helpful in the management of community-acquired pneumonia. Semin Respir Infect. 1997;12:308–321. [PubMed] [Google Scholar]
  • 55.Arancibia F, Ewig S, Martínez JA, Ruiz M, Bauer T, Marcos MA. Antimicrobial treatment failures in patients with community-acquired pneumonia: causes and prognostic implications. Am J Respir Crit Care Med. 2000;162:154–160. doi: 10.1164/ajrccm.162.1.9907023. [DOI] [PubMed] [Google Scholar]
  • 56.Frias J, Gomis M, Prieto J, Mensa J, Bouza E, García-Rodríguez JA. Tratamiento empírico inicial de la neumonía adquirida en la comunidad. Rev Esp Quimioter. 1998;11:255–261. [PubMed] [Google Scholar]
  • 57.Huchon G, Woodhead M, the ERS Task Force Guidelines for management of adult community-acquired lower respiratory tract infections. Eur Respir J. 1998;11:986–991. doi: 10.1183/09031936.98.11040986. [DOI] [PubMed] [Google Scholar]
  • 58.Arancibia F, Ewig S, Martínez J, Ruiz M, Bauer T, Marcos M. Antimicrobial treatment failures in patients with community-acquired pneumonia: causes and prognostic implications. Am J Respir Crit Care Med. 2000;162:154–160. doi: 10.1164/ajrccm.162.1.9907023. [DOI] [PubMed] [Google Scholar]
  • 59.Rosón B, Carratalá J, Verdaguer R, Dorca J, Manresa F, Gudiol F. Prospective study of the uselfuness of sputum Gram stain in the initial approach to community-acquired pneumonia requiring hospitalization. Clin Infect Dis. 2000;31:869–874. doi: 10.1086/318151. [DOI] [PubMed] [Google Scholar]
  • 60.García-Vázquez E, Marcos M, Mensa J, de Roux A, Puig J, Font C. Assessment of the usefulness of sputum culture for diagnosis of community-acquired pneumonia using the PORT predictive scoring system. Arch Intern Med. 2004;164:1807–1811. doi: 10.1001/archinte.164.16.1807. [DOI] [PubMed] [Google Scholar]
  • 61.Campbell SG, Marrie TJ, Anstey R, Ackroyd-Stolarz S, Dickinson G. Utility of blood cultures in the management of adults with community acquired pneumonia discharged from the emergency department. Emerg Med J. 2003;20:521–523. doi: 10.1136/emj.20.6.521. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.Craven DE. Blood cultures for community-acquired pneumonia. Piecing together a mosaic for doing less. Am J Respir Crit Care Med. 2004;169:327–335. doi: 10.1164/rccm.2312015. [DOI] [PubMed] [Google Scholar]
  • 63.Waterer GW, Wunderink RG. The influence of the severity of community-acquired pneumonia on the usefulness of blood cultures. Respir Med. 2001;95:78–82. doi: 10.1053/rmed.2000.0977. [DOI] [PubMed] [Google Scholar]
  • 64.Metersky ML, Ma A, Bratzler DW, Houck PM. Predicting bacteremia in patients with community-acquired pneumonia. Am J Respir Crit Care Med. 2004;169:342–347. doi: 10.1164/rccm.200309-1248OC. [DOI] [PubMed] [Google Scholar]
  • 65.Marcos M, Jiménez de Anta M, de la Bellacasa J, González J, Martínez E, García E. Rapid urinary antigen test for diagnosis of pneumococcal community-acquired pneumonia in adults. Eur Respir J. 2003;21:209–214. doi: 10.1183/09031936.03.00058802. [DOI] [PubMed] [Google Scholar]
  • 66.Oosterheert JJ, Bonten MJ, Buskens E, Schneider MM, Hoepelman IM. Algorythm to determine cost savings of targeting antimicrobial therapy based on results of rapid diagnostic testing. J Clin Microb. 2003;41:4708–4713. doi: 10.1128/JCM.41.10.4708-4713.2003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 67.Roig J, Sabriá M, Pedro-Botet ML. Legionella sp.: community-acquired and nosocomial infection. Curr Opin Infect Dis. 2003;16:145–151. doi: 10.1097/00001432-200304000-00011. [DOI] [PubMed] [Google Scholar]
  • 68.Domínguez J, Blanco S, Prat C, Rivelo R, Sánchez MD, Pallarés MA. Rapid centrifugal method for Legionella antigen concentration in urine samples. Clin Microbiol Infect. 2004;10(Suppl 3):455. [Google Scholar]
  • 69.Rosón B, Carratalá J, Fernández-Sabé N, Tubau F, Manresa F, Gudiol F. Causes and factors associated with early failure in hospitalized patients with community acquired pneumonia. Arch Intern Med. 2004;164:502–508. doi: 10.1001/archinte.164.5.502. [DOI] [PubMed] [Google Scholar]
  • 70.Bello S, Chacón E, Hernández A. Técnicas no invasivas en el diagnóstico de las neumonías. Arch Bronconeumol. 1998;34(Suppl 2):31–40. [PubMed] [Google Scholar]
  • 71.Roig J, Soler X, Domingo C, de Celis G. Serological evidence of Legionella species infection in acute exacerbation of COPD. Eur Respir J. 2002;20:504–505. doi: 10.1183/09031936.02.02042002. [DOI] [PubMed] [Google Scholar]
  • 72.Domínguez J, Gali N, Matas L, Pedroso P, Blanco S, Jiménez M. PCR detection of Streptococcus pneumoniae DNA in serum samples for pneumococcal pneumonia diagnosis. Clin Microbiol Infect. 2001;7:164–166. doi: 10.1046/j.1198-743x.2001.00228.x. [DOI] [PubMed] [Google Scholar]
  • 73.Macfarlane J, Holmes W, Gard P, Macfarlane R, Rose D, Weston V. Prospective study of the incidence, aetiology and outcome of lower respiratory tract illness in the community. Thorax. 2001;56:109–114. doi: 10.1136/thorax.56.2.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 74.García A, Rosón B, Pérez JL, Verdaguer R, Dorca J, Carratalá J. Usefulness of PCR and antigen latex agglutination test with samples obtained by transthoracic needle aspiration for diagnosis of pneumococcal pneumonia. J Clin Microbiol. 1999;37:709–714. doi: 10.1128/jcm.37.3.709-714.1999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 75.Ruiz-González A, Nogués A, Falguera M, Porcel JM, Huelin E, Rubio-Caballero M. Rapid detection of pneumococcal antigen in lung aspirates: comparison with culture and PCR technique. Respir Med. 1997;91:201–206. doi: 10.1016/s0954-6111(97)90039-1. [DOI] [PubMed] [Google Scholar]
  • 76.Jiménez P, Saldias F, Meneses M, Silva ME, Wilson MG, Otth L. Diagnostic fiberoptic bronchoscopy in patients with community-acquired pneumonia. Comparison between bronchoalveolar lavage and telescoping plugged catheter cultures. Chest. 1993;103:1023–1027. doi: 10.1378/chest.103.4.1023. [DOI] [PubMed] [Google Scholar]
  • 77.Prats E, Dorca J, Pujol M, García L, Barreiro B, Verdaguer R. Effects of antibiotics on protected specimen brush sampling in ventilator-associated pneumonia. Eur Respir J. 2002;19:944–951. doi: 10.1183/09031936.02.00239302. [DOI] [PubMed] [Google Scholar]
  • 78.Torres A, Fabregas N, Ewig S, Puig de la Bellacasa J, Bauer T, Ramírez J. Sampling methods for ventilator-associated pneumonia: validation using different histologic and microbiological references. Crit Care Med. 2000;28:2799–2804. doi: 10.1097/00003246-200008000-00020. [DOI] [PubMed] [Google Scholar]
  • 79.Metlay JP, Fine MJ. Testing strategies in the initial management of patients with community-acquired pneumonia. Ann Intern Med. 2003;138:109–118. doi: 10.7326/0003-4819-138-2-200301210-00012. [DOI] [PubMed] [Google Scholar]
  • 80.Neill AM, Martin IR, Weir R, Anderson R, Chereshsky A, Epton MJ. Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax. 1996;51:1010–1016. doi: 10.1136/thx.51.10.1010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 81.Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–250. doi: 10.1056/NEJM199701233360402. [DOI] [PubMed] [Google Scholar]
  • 82.Atlas SJ, Benzer TI, Borowsky LH, Chang Y, Burnham DC, Metlay JP. Safely increasing the proportion of patients with community-acquired pneumonia treated as outpatients: an interventional trial. Arch Intern Med. 1998;158:1350–1356. doi: 10.1001/archinte.158.12.1350. [DOI] [PubMed] [Google Scholar]
  • 83.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. doi: 10.1001/jama.283.6.749. [DOI] [PubMed] [Google Scholar]
  • 84.Arnold FW, Ramírez JA, McDonald LC, Xia EL, España PP, Capelastegui A. Hospitalization for community-acquired pneumonia: the pneumonia severity index versus clinical judgment. A prediction rule to identify allocation of inpatient care in community-acquired pneumonia. Chest. 2003;124:121–124. doi: 10.1378/chest.124.1.121. [DOI] [PubMed] [Google Scholar]
  • 85.Menéndez R, Cremades MJ, Martínez-Moragón E, Soler JJ, Reyes S, Perpiñá M. Duration of length of stay in pneumonia: influence of clinical factors and hospital type. Eur Respir J. 2003;22:643–648. doi: 10.1183/09031936.03.00026103. [DOI] [PubMed] [Google Scholar]
  • 86.España PP, Capelastegui A, Quintana JM, Soto A, Gorordo I, García-Urbaneja M. A prediction rule to identify allocation of inpatient care in community-acquired pneumonia. Eur Respir J. 2003;21:695–701. doi: 10.1183/09031936.03.00057302. [DOI] [PubMed] [Google Scholar]
  • 87.Angus DC, Marrie TJ, Obrosky DS, Clermont G, Dremsizov TT, Coley C. Severe community-acquired pneumonia: use of intensive care services and evaluation of American and British Thoracic Society Diagnostic criteria. Am J Respir Crit Care Med. 2002;166:717–723. doi: 10.1164/rccm.2102084. [DOI] [PubMed] [Google Scholar]
  • 88.Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–382. doi: 10.1136/thorax.58.5.377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 89.Ewig S, Kleinfeld T, Bauer T, Seifert K, Schafer H, Goke N. Comparative validation of prognostic rules for community-acquired pneumonia in an elderly population. Eur Respir J. 1999;14:370–375. doi: 10.1034/j.1399-3003.1999.14b22.x. [DOI] [PubMed] [Google Scholar]
  • 90.Ewig S, Ruiz M, Mensa J, Marcos MA, Martínez JA, Arancibia F. Severe community-acquired pneumonia. Assessment of severity criteria. Am J Respir Crit Care Med. 1998;158:1102–1108. doi: 10.1164/ajrccm.158.4.9803114. [DOI] [PubMed] [Google Scholar]
  • 91.Kamath A, Pasteur MC, Slade MG, Harrison BD. Recognising severe pneumonia with simple clinical and biochemical measurements. Clin Med. 2003;3:54–56. doi: 10.7861/clinmedicine.3-1-54. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 92.Ewig S, de Roux A, Bauer T, García E, Mensa J, Niederman M. Validation of predictive rules and indices of severity for community acquired pneumonia. Thorax. 2004;59:421–427. doi: 10.1136/thx.2003.008110. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 93.Mortensen EM, Coley CM, Singer DE, Marrie TJ, Obrosky DS, Kapoor WN. Causes of death for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med. 2002;162:1059–1064. doi: 10.1001/archinte.162.9.1059. [DOI] [PubMed] [Google Scholar]
  • 94.Pascual FE, Matthay MA, Bacchetti P, Wachter RM. Assessment of prognosis in patients with community-acquired pneumonia who require mechanical ventilation. Chest. 2000;117:503–512. doi: 10.1378/chest.117.2.503. [DOI] [PubMed] [Google Scholar]
  • 95.Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Sociedad Española de Quimioterapia (SEQ), Sociedad Española de Medicina Interna (SEMI) y Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) Tratamiento antibiótico empírico inicial de la neumonía adquirida en la comunidad en el paciente adulto inmunocompetente. Rev Esp Quimioter. 2003;16:457–466. [PubMed] [Google Scholar]
  • 96.Aspa J, Rajas O, Rodríguez de Castro F, Blanquer J, Zalacaín R, Fenoll A. Drug-resistant pneumococcal pneumonia: Clinical relevance and related factors. Clin Infect Dis. 2004;38:787–798. doi: 10.1086/381886. [DOI] [PubMed] [Google Scholar]
  • 97.Baquero F, García Rodríguez J, García de Lomas J, Aguilar L. Antimicrobial resistance of 1,113 Streptococcus pneumoniae isolates from patients with respiratory tract infections in Spain: results a multicenter surveillance study. Antimicrob Agents Chemother. 1999;43:357–359. doi: 10.1128/aac.43.2.357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 98.Urban C, Rahman N, Zhao X, Mariano N, Segal-Maurer S, Drlica K. Fluoroquinolone-resistant Streptococcus pneumoniae associated with levofloxacin therapy. J Infect Dis. 2001;184:794–798. doi: 10.1086/323086. [DOI] [PubMed] [Google Scholar]
  • 99.Ho P, Tse W, Tsang K, Kwok T, Ng T, Cheng V. Risk factors for acquisition of levofloxacin-resistant Streptococcus pneumoniae: a case-control study. Clin Infect Dis. 2001;32:701–707. doi: 10.1086/319222. [DOI] [PubMed] [Google Scholar]
  • 100.Davidson R, Cavalcanti R, Brunton J, Bast D, de Azavedo J, Kibsey P. Resistance to levofloxacin and failure of treatment of pneumococcal pneumonia. N Engl J Med. 2002;346:747–750. doi: 10.1056/NEJMoa012122. [DOI] [PubMed] [Google Scholar]
  • 101.Anderson K, Tan J, File T, Jr, DiPersio J, Willey B, Low D. Emergence of levofloxacin-resistance pneumococci in immunocompromised adults after therapy for community-acquired pneumonia. Clin Infect Dis. 2003;37:376–381. doi: 10.1086/376642. [DOI] [PubMed] [Google Scholar]
  • 102.Houck PM, Bratzler DW, Nsa W, Ma A, Bartlett JG. Timing of antibiotic administration and outcomes for medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med. 2004;164:637–644. doi: 10.1001/archinte.164.6.637. [DOI] [PubMed] [Google Scholar]
  • 103.Battleman DS, Callahan M, Thaler HR. Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia: link between quality of care and resource utilization. Arch Intern Med. 2002;162:682–688. doi: 10.1001/archinte.162.6.682. [DOI] [PubMed] [Google Scholar]
  • 104.Gleason PP, Meehan TP, Fine JM, Galusha DH, Fine MJ. Associations between initial antimicrobial therapy and medical outcomes for hospitalized elderly patients with pneumonia. Arch Intern Med. 1999;159:2562–2572. doi: 10.1001/archinte.159.21.2562. [DOI] [PubMed] [Google Scholar]
  • 105.Brown RB, Ianini P, Gross P, Kunkel M. Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of ahospital claims-made database. Chest. 2003;123:1503–1511. doi: 10.1378/chest.123.5.1503. [DOI] [PubMed] [Google Scholar]
  • 106.Martínez JA, Horcajada P, Almela M, Marco F, Soriano A, García E. Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia. Clin Infect Dis. 2003;36:389–395. doi: 10.1086/367541. [DOI] [PubMed] [Google Scholar]
  • 107.Fogarty C, Siami G, Kohler R. Multicenter, open-label, randomized study to compare the safety and efficacy of levofloxacin versus ceftriaxone sodium and erythromycin followed by clarithromycin and amoxicillin-clavulanate in the treatment of serious community-acquired pneumonia in adults. Clin Infect Dis. 2004;38(Suppl 1):16–23. [Google Scholar]
  • 108.Álvarez-Lerma F, Palomar M, Olaechea P, León C, Sánchez Bermejo B. Estudio observacional sobre el uso de levofloxacino en pacientes ingresados en UCI. Enferm Infecc Microbiol Clin. 2004;22:220–226. doi: 10.1016/s0213-005x(04)73070-0. [DOI] [PubMed] [Google Scholar]
  • 109.Finch R, Schurmann D, Collins O, Kubin R, McGivern J, Bobbaers H. Randomized controlled trial of sequential intravenous (i.v.) and oral moxifloxacin compared with sequential i.v. and oral coamoxiclav with or without clarithromycin in patients with community-acquired pneumonia requiring initial parenteral treatment. Antimicrob Agents Chemother. 2002;46:1746–1754. doi: 10.1128/AAC.46.6.1746-1754.2002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 110.Menéndez R, Torres A, Zalacaín R, Aspa J, Martín Villasclaras J, Borderías L. Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome. Thorax. 2004;59:960–965. doi: 10.1136/thx.2003.017756. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 111.Radberg G, Nilsson LE, Svensson S. Development of quinoloneimipenem cross resistance in Pseudomonas aeruginosa during exposure to ciprofloxacin. Antimicrob Agents Chemother. 1990;34:2142–2147. doi: 10.1128/aac.34.11.2142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 112.Siegel RE, Halpern NA, Almenoff PL, Lee A, Cadhin R, Greene JG. A prospective randomized study of inpatient i.v. antibiotics for community-acquired pneumonia. The optimal duration of therapy. Chest. 1996;110:965–971. doi: 10.1378/chest.110.4.965. [DOI] [PubMed] [Google Scholar]
  • 113.Halm EA, Fine MJ, Marrie TJ, Coley CM, Kapoor WN, Obrosky DS. Time to clinical stability in patients hospitalized with community-acquired pneumonia. Implications for practice guidelines. JAMA. 1998;279:1452–1457. doi: 10.1001/jama.279.18.1452. [DOI] [PubMed] [Google Scholar]
  • 114.Menéndez R, Torres A, Rodríguez de Castro F, Zalacaín R, Aspa J, Martín Villasclaras J. Reaching stability in community-acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients. Clin Infect Dis. 2004;39:1783–1790. doi: 10.1086/426028. [DOI] [PubMed] [Google Scholar]
  • 115.Rhew DC, Tu GS, Ofman J, Henning JM, Richards MS, Weingarten SR. Early switch and early discharge strategies in patients with community-acquired pneumonia: a meta-analysis. Arch Intern Med. 2001;161:722–727. doi: 10.1001/archinte.161.5.722. [DOI] [PubMed] [Google Scholar]
  • 116.Dunbar LM, Wunderink RG, Habib MP, Smith LG, Tennenberg AM, Khashab MM. High-dose, short-course levofloxacin for community-acquired pneumonia: a new treatment paradigm. Clin Infect Dis. 2003;37:752–760. doi: 10.1086/377539. [DOI] [PubMed] [Google Scholar]
  • 117.Plouffe J, Schwartz DB, Kolokathis A, Sherman BW, Arnow PM, Gezon PA. Clinical efficacy of intravenous followed by oral azithromycin monotherapy in hospitalized patients with community-acquired pneumonia. Antimicrob Agents Chemother. 2000;44:1796–1802. doi: 10.1128/aac.44.7.1796-1802.2000. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 118.Mandell LA, File TM. Short-course treatment of community-acquired pneumonia. Clin Infect Dis. 2003;37:761–763. doi: 10.1086/377567. [DOI] [PubMed] [Google Scholar]
  • 119.Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Meduri G. 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(5 Pt 1):1585–1591. doi: 10.1164/ajrccm.160.5.9903015. [DOI] [PubMed] [Google Scholar]
  • 120.Jolliet P, Abajo B, Pasquina P, Chevrolet JC. Non-invasive pressure support ventilation in severe community-acquired pneumonia. Intensive Care Med. 2001;27:812–821. doi: 10.1007/s001340100869. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 121.Ferrer M, Esquinas A, León M, González G, Alarcón A, Torres A. Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med. 2003;168:1438–1444. doi: 10.1164/rccm.200301-072OC. [DOI] [PubMed] [Google Scholar]
  • 122.Baudouin SV. The pulmonary physician in critical care. 3: Critical care management of community acquired pneumonia. Thorax. 2002;57:267–271. doi: 10.1136/thorax.57.3.267. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 123.Rodríguez de Castro F. Bronquitis aguda. Neumonía extrahospitalaria. In: Farreras P, Rozman C, editors. Medicina Interna. 15th ed. Elsevier España; Madrid: 2004. pp. 792–799. [Google Scholar]
  • 124.Menéndez R, Perpiñá M, Torres A. Evaluation of nonresolving and progressive pneumonia. Semin Respir Infect. 2003;18:103–111. [PubMed] [Google Scholar]
  • 125.Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR. 1997;46(RR-8):1–24. [PubMed] [Google Scholar]
  • 126.Fedson DS, Harward MP, Reid RA, Kaiser DL. Hospital-based pneumococcal immunization: epidemiologic rationale from the Shenandoah study. JAMA. 1990;264:1117–1122. [PubMed] [Google Scholar]
  • 127.Fedson DS. Improving the use of pneumococcal vaccine through a strategy of hospital-based immunization: a review of its rationale and implications. J Am Geriatr Soc. 1985;33:142–150. doi: 10.1111/j.1532-5415.1985.tb02281.x. [DOI] [PubMed] [Google Scholar]
  • 128.Fedson DS, Wajda A, Nicol P, Hammond GW, Kaiser DL, Roos LL. Clinical effectiveness of influenza vaccination in Manitoba. JAMA. 1993;270:1956–1961. [PubMed] [Google Scholar]
  • 129.Nichol KL, Margolis KL, Wuorenma J, von Sternberg T. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med. 1994;331:778–784. doi: 10.1056/NEJM199409223311206. [DOI] [PubMed] [Google Scholar]
  • 130.Harper SA, Fukuda K, Uyeki TM, Cox NJ, Bridges CB. Prevention and control of influenza recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR. 2004;53(RR06):1–40. [PubMed] [Google Scholar]
  • 131.Margolis KL, Nichol KI, Poland GA, Pluhar RE. Frequency of adverse reactions to influenza vaccine in the elderly: a randomized, placebo-controlled trial. JAMA. 1990;264:1139–1141. [PubMed] [Google Scholar]
  • 132.Kaplan JE, Katona P, Hurwitz ES, Schonberger LB. Guillain-Barré syndrome in the United States, 1979-1980 and 1980-1981: lack of an association with influenza vaccination. JAMA. 1982;248:698–700. [PubMed] [Google Scholar]
  • 133.Harger JH, Ernst JM, Thurnau GR, Moawad A, Momirova V, Landon MB. Risk factors and outcome of varicella-zoster virus pneumonia in pregnant women. J Infect Dis. 2002;185:422–427. doi: 10.1086/338832. [DOI] [PubMed] [Google Scholar]

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