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Harrison’s infectious diseases. 1st ed. New York: McGraw-Hill; 2010: 2174. 50. Holzman RS, MS.
Mycoplasma pneumoniae and Atypical Pneumonia. A chest CT scan is also more sensitive in
detecting cavitation, adenopathy, interstitial disease and empyema. Appendix View this table: View
inline View popup Appendix B1. Causative Organisms Numerous microorganisms can cause CAP.
Further screening of the PubMed results and full papers identified 60 references meeting the
inclusion and exclusion criteria. The inevitable application of big data to health care. Burden of
community-acquired pneumonia in North American adults. YM, AM, HK, and C-YL reviewed and
analyzed the literature. Inclusion of control children reduces over-attribution of disease to non-
pathogenic organisms by allowing calculation of an adjusted odds ratio (aOR) for each pathogen and
estimation of the population-attributable fraction ( 13, 19 ). Etiology of community-acquired
pneumonia: increased microbiological yield with new diagnostic methods. Because improvement of
pulmonary opacities in patients with CAP lags behind clinical improvement, repeating chest imaging
studies is not recommended in patients who demonstrate clinical improvement. Additionally, most of
the studies considered pneumonia of any aetiology, but six were performed in patients with
pneumonia due to L. Methods Inclusion and Exclusion Criteria Our search was designed to identify
studies that used a CDR to diagnose, predict, or rule out CAP in the outpatient setting. Therefore, a
continual re-evaluation and documentation of the goal of treatment for the individual patient, the
measures to be taken in pursuit of this goal, and (where applicable) the limitations of treatment are
central tasks for the treating physician. Unfortunately, the test is not reliable in children since it
cannot distinguish between carriage and pathogenic pneumococcus ( 59 ). In the latter case, please
turn on Javascript support in your web browser and reload this page. OpenUrl CrossRef PubMed 11.
? Whiting PF, Rutjes AW, Westwood ME, et al. Nasopharyngeal carriage of Klebsiella pneumoniae
and other Gram-negative bacilli in pneumonia-prone age groups in Semarang, Indonesia. PhD Find
this author on Google Scholar Find this author on PubMed Search for this author on this site
Christopher C. IgM only tests are less sensitive and specific than IgG and IgM antibody titers from
paired specimens as IgM kinetics vary ( 23 ) and IgM seroconversion might not occur in the setting
of repeat infection ( 46 ). Chest imaging findings in hospitalized patients with H1N1 influenza.
Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent
decades, CAP ranks third as a cause of death in Brazil. The important clinical distinction must be
drawn between a mere delay in the achievement of stability on the one hand and clinically
progressive pneumonia on the other. Procalcitonin to initiate or discontinue antibiotics in acute
respiratory tract infections. Overall, 6 studies were determined to be at low risk of bias and the other
6 at moderate risk of bias. Furthermore, asymptomatic NP carriage may responsible for transmission
and often precedes LRT infection ( 27 ). These are typically developed with a multivariate analysis
using independent predictors such as demographics, signs, symptoms, and point-of-care (POC) tests.
The former can be caused by viruses; atypical bacteria bacteria that are neither Gram-negative nor
Gram-positive, including Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella
pneumophila; and fungi. We offer learning materials for Internal Medicine, Family Medicine, and
Physician Assistant certification and re-certification exams. Follow Us. Effect of pneumococcal
vaccination in hospitalized adults with community-acquired pneumonia.
MD, MS Find this author on Google Scholar Find this author on PubMed Search for this author on
this site. This is very useful for research and well-equipped facilities. In this setting, culture-negative
bacteria should remain in the differential and be sought by a molecular method targeting DNA ( 41 ).
A serologic diagnosis generally requires a 2-fold or greater increase in titers between paired serum
specimens. The included articles were reviewed in full and data on the study setting and
methodology, characteristics of the populations studied, pathogens and antibiotic treatments were
extracted. Ebell From the Department of Epidemiology and Biostatistics, College of Public Health,
(CSM, MHE, APD, YS, CCW), Department of Infectious Diseases, College of Veterinary Medicine
(EH), University of Georgia, Athens, GA. Multiresistant organisms enter into the differential
diagnosis only in patients with individual risk factors, such as. Procalcitonin kinetics in the prognosis
of severe community-acquired pneumonia. Detecting the presence of bacterial DNA by PCR can be
useful in diagnosing culture-negative cases of infection, especially in patients with suspected
infection and antibiotic therapy. Overall, patients presenting with no or 1 abnormal finding in the
pooled set had a low risk of CAP, with a probability of 4.0% given a baseline prevalence of 29.2%
and a SSLR of 0.19. The high-risk group with 4 or 5 abnormal findings had a 64.0% probability of
CAP and a SSLR of 8.3. The study by Van Vugt 9 and colleagues incorporated a POC test, c-
reactive protein (CRP). Diagnosing pneumonia in patients with acute cough: Clinical judgment
compared to chest radiography. Serology enhances molecular diagnosis of respiratory virus infections
other than influenza in children and adults hospitalized with community-acquired pneumonia.
Research on pneumonia etiologies conducted from the 1970s through the early 1990s showed 2
bacteria— Streptococcus pneumoniae and Haemophilus influenzae type b (Hib)— cause the majority
of fatal pneumonia cases in children, primarily in settings that lack access to basic healthcare such as
antibiotics and oxygen therapy ( 3, 4 ). Rapid diagnosis of bacteremic pneumococcal infections in
adults by using the Binax NOW Streptococcus pneumoniae urinary antigen test: a prospective,
controlled clinical evaluation. However, in terms of its pathogenicity, the presence of K. OpenUrl
CrossRef PubMed 6. ? Heckerling PS, Tape TG, Wigton RS, et al. While numerous studies have
previously shown pneumococcus to be the most common causative pathogen, the 2015 EPIC study
found that in nearly two-thirds of patients with CAP who required hospitalization, no pathogen was
detected. The physician’s impression of clinical severity should be objectified with properly
validated criteria. In the latter case, please turn on Javascript support in your web browser and reload
this page. Chest imaging findings in hospitalized patients with H1N1 influenza. Moreover, CAP
having been identified as an independent long-term risk factor for cardiovascular events ( 37 ), a
structured evaluation of all of the recognized cardiovascular risk factors and appropriately directed
treatment (if needed) are indicated as well. YM, AM, HK, and C-YL reviewed and analyzed the
literature. Antibiotic treatments did not differ according to the presence or absence of COPD, liver
disease or alcoholism. However, obtaining lower respiratory tract specimens from healthy control
children, though ideal for study design, may not be feasible in certain situations ( 21 ) and is
difficult to accomplish in clinical practice. Furthermore, there are often a substantial number of
patients in which the aetiology of CAP cannot be identified. Pneumonia research to reduce childhood
mortality in the developing world. Prediction of pneumonia in outpatients with acute cough--a
statistical approach. The CRB-65 score, which is easy to calculate without requiring any laboratory
tests, is recommended in Germany for this purpose (Table 1) ( 17 ). Duration of antibiotic use among
adults with uncomplicated community-acquired pneumonia requiring hospitalization in the United
States. Causative Organisms Numerous microorganisms can cause CAP.
Empirical selection of antibiotic treatment is the cornerstone of management of patients with
pneumonia. Download Free PDF View PDF Community-acquired pneumonia Douglas Pierini
Community-acquired pneumonia causes great mortality and morbidity and high costs worldwide.
Ceftaroline fosamil for community-acquired pneumonia and skin and skin structure infections: a
systematic review. All authors contributed to the article and approved the submitted version. If the
epidemiological setting is suggestive, patients with severe CAP should also be tested for influenza
viruses with the polymerase chain reaction (PCR). Cochrane Database Syst Rev 2014; 3: CD000245
CrossRef CrossRef. We also thank the Partnership for Enhanced Engagement in Research (PEER) -
Pneumonia in Pediatric Patients Study (PePPeS) team, Indonesia Research Partnership on Infectious
Diseases (INA-RESPOND) Network, Tangerang District Hospital, Kariadi Hospital and Sardjito
Hospital for their operational support and technical assistance. Clinical utility of blood cultures in
adult patients with community-acquired pneumonia without defined underlying risks. A clinical
decision rule (CDR) is an algorithm, point score, or simple heuristic (ie, rule of thumb”) that
categorizes patients as having a risk for disease as confirmed by a valid reference standard test. They
reveal that viral etiologies of CAP in those settings have likely been underestimated due to prior lack
of viral diagnostics, shifting pathogen prevalence associated with widespread deployment of Hib and
pneumococcal conjugate vaccines (PCV), improved socioeconomic and nutritional status, a sharp
decrease in measles incidence, and increased urbanization ( 3, 15 ). There is no individual symptom
or cluster of symptoms that can absolutely differentiate pneumonia from other acute respiratory
diseases, including upper and lower respiratory infections. Shower restriction and point-of-use filters
merit consideration during an outbreak. Serological evaluation of paired acute and convalescent
specimens is also used for diagnosis, especially of atypical bacterial agents ( 48 ) for which PCR
showed low sensitivity and poor concordance compared with the paired serology ( 49 ). Rockville,
MD: Agency for Healthcare Research and Quality (US); 2006. 2. ? Jain S, Self WH, Wunderink RG,
et al. Tables 2, 3 and 4 summarise these data to show the most common microbiological techniques,
the overall frequency of isolation of pathogens and the frequency of isolation of pathogens
specifically in HIV and COPD study cohorts. Crit Care 2012;16:R141. 41. Wunderink RG,
Niederman MS, Kollef MH, et al. Cigarette smoking and invasive pneumococcal disease. The
pneumonia etiology research for child health project: a 21st century childhood pneumonia etiology
study. Early chest computed tomography scan to assist diagnosis and guide treatment decision for
suspected community-acquired pneumonia. Clinical utility of blood cultures in adult patients with
community-acquired pneumonia without defined underlying risks. The results, which document over
a dozen causative pathogens, were published in The New England Journal of Medicine. Another is
that some types of rhinoviruses cause a runny nose while others cause severe pneumonia that leads to
hospitalization. Download citation Received: 10 December 2013 Accepted: 15 January 2014
Published: 15 February 2014 Issue Date: July 2014 DOI: Share this article Anyone you share the
following link with will be able to read this content: Get shareable link Sorry, a shareable link is not
currently available for this article. However, studies have failed to identify an association between
density and pathogen-confirmed pneumonia for M. Colonization density of the upper respiratory
tract as a predictor of pneumonia- Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus
aureus, and Pneumocystis jirovecii. Blasi Department of Internal Medicine, University Hospital, KU
Leuven, Leuven, Belgium W. E. Peetermans CNR Institute of Clinical Physiology, Pisa, and CNR
Institute of Biomedicine and Molecular Immunology, Palermo, Italy G. Effect of corticosteroids on
treatment failure among hospitalized patients with severe community-acquired pneumonia and high
inflammatory response: a randomized clinical trial. The recommended antimicrobial treatment of
choice for patients without comorbid conditions is monotherapy with high-dose amoxicillin. Notable
examples include antigen detection assays for S. Full details of the microbiological techniques used
and the pathogens isolated in each study are included in Supplementary Table 1.
Patients identified as low risk for CAP could avoid the need for CXR and antibiotics, reducing
overall health system costs, antibiotic use, and unnecessary radiation exposure. Usefulness of urinary
antigen detection by an immunochromatographic test for diagnosis of pneumococcal pneumonia in
children. Sixty-eight articles had full text review and after identifying an additional 42 articles
through a bibliography review, we excluded 98. More than half of all patients have at least one
chronic comorbid illness. Performance of a bedside C-reactive protein test in the diagnosis of
community-acquired pneumonia in adults with acute cough. A limitation of antigen detection assays
is their reliance on detectable quantities of antigen; performance is thus suboptimal compared with
molecular tests ( 45 ). These findings underscore the need for structured post-discharge care of
patients with CAP even after they have reached clinical stability and been discharged from the
hospital. A study was included if it used a CXR or computed tomography scan as the primary
reference standard and was given to all patients enrolled in the study. Additionally, interpretation of
results from routinely collected specimens (blood, sputum, and nasopharyngeal swabs) is
complicated by bacterial colonization and prolonged shedding of incidental respiratory viruses.
Effect of corticosteroids on treatment failure among hospitalized patients with severe community-
acquired pneumonia and high inflammatory response: a randomized clinical trial. We also need to
develop better diagnostic tests so that we can accurately target treatment and avoid antibiotic
overuse, and speed recovery.”. Risk factors for bronchiolitis severity: a retrospective review of
patients admitted to the university hospital from central region of Slovenia. With regard to
antipneumococcal vaccination, there are data from a large-scale, high-quality, prospective
randomized trial showing that a 13-valent conjugated vaccine (PCV13) lessens the frequency of
pneumococcal pneumonia due to the serotypes covered by the vaccine by 45%, and the frequency of
the invasive form infection by 75% ( 38 ). When not directly provided, they were calculated using
data from the study. Ebell From the Department of Epidemiology and Biostatistics, College of
Public Health, (CSM, MHE, APD, YS, CCW), Department of Infectious Diseases, College of
Veterinary Medicine (EH), University of Georgia, Athens, GA. Influence of age on symptoms at
presentation in patients with community-acquired pneumonia. Common causes and less common
causes are delineated in Table 1. Overall, 6 studies were determined to be at low risk of bias and the
other 6 at moderate risk of bias. We also thank the Partnership for Enhanced Engagement in
Research (PEER) - Pneumonia in Pediatric Patients Study (PePPeS) team, Indonesia Research
Partnership on Infectious Diseases (INA-RESPOND) Network, Tangerang District Hospital, Kariadi
Hospital and Sardjito Hospital for their operational support and technical assistance. Using current
literature on assessment of CAP causes in children, we developed an approach for identifying the
most likely causative pathogen(s) using blood and sputum culture, polymerase chain reaction (PCR),
and paired serology. As these manifestations are not sensitive or specific enough for definitive
diagnosis ( e1 ), a confirmatory chest x-ray is recommended. This discrepancy arises from differences
in the assessment of the efficacy of the PSV23 vaccine and of the significance of childhood
vaccination for the serotypes affecting adults that are amenable to prevention by vaccination ( 39, 40
). The analysis of the included papers was descriptive and no meta-analyses of data were performed.
Summary Estimates of Meta-Analysis for the Diagnostic Accuracy of Clinical Decision Rules that
Diagnose (Rule in) CAP Discussion In this systematic review, we identified 2 potentially useful low-
risk criteria for use in the outpatient setting to identify patients at very low risk of CAP: normal vital
signs, and normal vital signs plus normal pulmonary findings. Munich: Munich Dustri Verlag Dr Karl
Feistle (2016). Evaluation of the Vitek 2 system for rapid identification of clinical isolates of gram-
negative bacilli and members of the family Streptococcaceae. Results: The panel addressed 16
specific areas for recommendations spanning questions of diagnostic testing, determination of site of
care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Structured
follow-up care includes the follow-up of comorbid conditions and the initiation of recommended
preventive measures such as antipneumococcal and anti-influenza vaccination, the avoidance of
drugs that increase the risk, smoking cessation, and treatment of dysphagia, if present. For bacteria
than can be both a colonizer and pathogen, higher density has been associated with pathogenic status.
In patients with acute hypercapnic respiratory insufficiency or accompanying pulmonary edema,
non-invasive ventilation should be initiated ( 10 ). Download citation Received: 10 December 2013
Accepted: 15 January 2014 Published: 15 February 2014 Issue Date: July 2014 DOI: Share this
article Anyone you share the following link with will be able to read this content: Get shareable link
Sorry, a shareable link is not currently available for this article. Multiple mitigation efforts and
application of point of use water filters stopped the outbreak. Patients admitted to hospital with
suspected pneumonia and normal chest radiographs: epidemiology, microbiology, and outcomes.
Journal of Clinical Outcomes Management Hospitals filling as flu season worsens Journal of Clinical
Outcomes Management This is what a flu pandemic looks like Journal of Clinical Outcomes
Management. We are primarily limited by the quality of the included studies, with half of the
included studies judged to be a moderate risk of bias. Aetiology and prediction of pneumonia in
lower respiratory tract infection in primary care. Rapid diagnosis of bacteremic pneumococcal
infections in adults by using the Binax NOW Streptococcus pneumoniae urinary antigen test: a
prospective, controlled clinical evaluation. Although antigen detection tests are only available for
select organisms, they can play a critical role in treatment decisions. In a large, multi-country,
prospective study of over 2500 patients where the prevalence of CAP was 5%, the addition of CRP
to the score improved discrimination based on the area under the ROC and diagnostic accuracy. 9 Of
the 12 studies included, 3 were CDRs using a point score. The proposed pathogen determination
rules are shown in Table 1. Duration of antibiotic use among adults with uncomplicated community-
acquired pneumonia requiring hospitalization in the United States. Usefulness of urinary antigen
detection by an immunochromatographic test for diagnosis of pneumococcal pneumonia in children.
Cochrane Database Syst Rev 2012;(9):CD007498. 33. Boussekey N, Leroy O, Alfandari S, et al.
However, this may be because all of the studies in this review reporting penicillin resistance were
carried out in Spain, which has one of the highest levels of penicillin resistance of S. An Asian study
on the prevalence of atypical respiratory pathogens in community-acquired pneumonia. In patients
with COPD, we found that the aetiology of CAP was similar to that in patients without this
condition. Anti-influenza and antipneumococcal vaccination is recommended as standard prevention
for all persons over age 60 and as indicated prevention for those with comorbidities. A previously
ambulatory patient who is diagnosed with pneumonia within 48 hours after admission also meets the
criteria for CAP. Colonization density of the upper respiratory tract as a predictor of pneumonia-
Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Pneumocystis jirovecii.
OpenUrl CrossRef PubMed 23. ? Obermeyer Z, Emanuel EJ. Clin Infect Dis 2016;63:e61-e111. 3.
Musher DM, Thorner AR. Furthermore, a more standardised approach to the diagnostic tests used
will make comparisons across different studies more valid. Outbreaks have been linked to exposure
to cooling towers ICU admissions. Combination antibiotic therapy lowers mortality among severely
ill patients with pneumococcal bacteremia. Polysaccharide conjugate vaccine against pneumococcal
pneumonia in adults. Prediction of pneumonia in outpatients with acute cough--a statistical approach.
Any systematic reviews that appeared in our results were reviewed for relevant articles that fit our
inclusion and exclusion criteria. To limit this impact, we only included prospective studies where all
participants received the same reference standard. However, in terms of its pathogenicity, the
presence of K.
Two randomized trials demonstrated no benefit from steroid administration with respect to hard
endpoints such as mortality or organ failure ( 35, e12 ). An evaluation of clinical stability criteria to
predict hospital course in community-acquired pneumonia. Despite advances in medical science,
pneumonia remains a major cause of morbidity and mortality. The diagnosis of strep throat in adults
in the emergency room. Our goal is to identify the combination(s) of signs (including vital signs),
symptoms, and POC tests with the lowest negative likelihood ratio (LR?), to help physicians
confidently rule out CAP without having to obtain a CXR in the outpatient setting. However,
children have difficulty expectorating sputum, leading to frequent use of induction techniques to
obtain LRT specimens. Even after discharge from the hospital, there is still a high mortality related to
comorbidities, particularly in elderly patients: according to a recent German study, in a group of
patients whose median age was over 80, most of whom had chronic neurological or cardiac disease,
the post-discharge mortality within 30 days of hospitalization was 4.7% ( 2, 9 ). These figures have
led to major conceptual changes in the characterization and treatment of CAP. Harvill From the
Department of Epidemiology and Biostatistics, College of Public Health, (CSM, MHE, APD, YS,
CCW), Department of Infectious Diseases, College of Veterinary Medicine (EH), University of
Georgia, Athens, GA. Rising rates of macrolide-resistant Mycoplasma pneumoniae in the central
United States. If more than one paper reported different aspects of the same study, all relevant
papers were included. The overall model had an AUROCC of 0.77 (0.73 to 0.81). The low-risk
group with a score of zero, had 0.7% probability of CAP given a prevalence of 5.2%, with a SSLR
of 0.14. The SSLRs for moderate and high-risk groups were 0.76 and 4.3, respectively. The
remaining 9 studies reported the accuracy of 18 simple heuristics that predict a dichotomous outcome
of CAP versus no CAP (Appendix B4). Causes and factors associated with early failure in
hospitalized patients with community-acquired pneumonia. The results, which document over a
dozen causative pathogens, were published in The New England Journal of Medicine. It accounts for
more than 138 million new cases and almost one million deaths annually, mostly amongst children
under 5 years old ( 1, 2 ). Rockville, MD: Agency for Healthcare Research and Quality (US); 2006.
2. ? Jain S, Self WH, Wunderink RG, et al. Inclusion of control children reduces over-attribution of
disease to non-pathogenic organisms by allowing calculation of an adjusted odds ratio (aOR) for
each pathogen and estimation of the population-attributable fraction ( 13, 19 ). Methods: Cases were
defined by syndrome compatible with Legionella pneumonia with laboratory-confirmed Legionella
infection. While numerous studies have previously shown pneumococcus to be the most common
causative pathogen, the 2015 EPIC study found that in nearly two-thirds of patients with CAP who
required hospitalization, no pathogen was detected. Current and past strategies for bacterial culture in
clinical microbiology. To limit this impact, we only included prospective studies where all
participants received the same reference standard. Abnormal vital signs include fever, hypothermia,
tachypnea, tachycardia, and oxygen desaturation. A minimum standard for all hospitalized patients is
the re-evaluation of stability criteria once per day (Box 3) ( 10 ). Furthermore, there are often a
substantial number of patients in which the aetiology of CAP cannot be identified. The full text
review and all data abstraction methods described hereafter were performed independently, in
parallel, by 2 authors with a third author who helped resolve any discrepancies. Prevention and
control of seasonal influenza with vaccines. Community-Acquired Infections Meta-Analysis
Outpatients Pneumonia Prospective Studies Systematic Review Community-acquired pneumonia
(CAP) is a significant source of morbidity and mortality for adults in the United States. Klebsiella
pneumoniae: going on the offense with a strong defense. Thus interpretation must account for the
possibility of contamination, which we have incorporated in our pathogen identification rules.
Elevated temperature was the most common shared sign or symptom, found in 10 of the 12 studies.
In patients with COPD, we found that the aetiology of CAP was similar to that in patients without
this condition.
Reasons why emergency department providers do not rely on the pneumonia severity index to
determine the initial site of treatment for patients with pneumonia. Intravenous beta-lactam
antibiotics should be given initially, in combination with a macrolide if acute organ dysfunction is
present. Details of the study designs and populations are summarised in Table 1. A recent meta-
analysis has shown that all nine of these criteria are predictors for the need for organ-replacement
therapy; if more than two criteria are met, the sensitivity and specificity are 79% and 82%,
respectively (positive likelihood ratio: 4.3) ( 26 ). Moreover, in an interventional trial, the
implementation of a treatment algorithm incorporating these criteria (Box 1) lowered the mortality of
high-risk patients of this type from 24% (in historical controls) to 6% ( 25 ). There should also be a
repeated microbiological evaluation, including bronchoscopy if indicated, as well as a meticulous
evaluation for extrapulmonary infectious and non-infectious differential diagnoses and
complications, such as pulmonary embolism or hitherto unrecognized immunosuppressed state
(including HIV infection). For example, in patients being initially treated with a macrolide as part of
combination therapy, the macrolide can be discontinued if there is a clinical response and the absence
of atypical pathogens is demonstrated. Results Our initial search strategy identified 974 articles (
Figure 1 ). Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the
relevant research and applied Grading of Recommendations, Assessment, Development, and
Evaluation methodology for clinical recommendations. Strategies for reduction in duration of
antibiotic use in hospitalized patients. However, obtaining lower respiratory tract specimens from
healthy control children, though ideal for study design, may not be feasible in certain situations ( 21
) and is difficult to accomplish in clinical practice. Data on the preventive efficacy of vaccination
against influenza in patients with CAP are sparse, but the recommendation to vaccinate is
nonetheless justified because of its demonstrated efficacy against influenza and the significance of
influenza for the incidence and severity of CAP. Tables 2, 3 and 4 summarise these data to show the
most common microbiological techniques, the overall frequency of isolation of pathogens and the
frequency of isolation of pathogens specifically in HIV and COPD study cohorts. For combination
therapy, the most common combinations were beta-lactams combined with macrolides or quinolones.
It also occurs especially:at the extremes of life - neonate. Moreover, CAP having been identified as
an independent long-term risk factor for cardiovascular events ( 37 ), a structured evaluation of all of
the recognized cardiovascular risk factors and appropriately directed treatment (if needed) are
indicated as well. Non-polio enteroviruses among healthy children in the Philippines. Pneumonia
research to reduce childhood mortality in the developing world. No general indication for
corticosteroid treatment can be derived from these data ( 10 ). It seems reasonable as well for
patients with chronic accompanying illnesses, such as congestive heart failure, COPD, renal or
hepatic insufficiency, or diabetes mellitus, to undergo individually adapted clinical follow-up at close
intervals to check for possible organ decompensation, progression, or complications. Methods: A
systematic review of MEDLINE for prospective studies that used at least 2 signs, symptoms, or
point-of-care tests to determine the likelihood of CAP. Pneumonia can be classified as community-
acquired, hospital-acquired, or ventilator-associated. Laboratory methods for determining pneumonia
etiology in children. Showering is a modifiable risk factor for nosocomial Legionella pneumonia.
Methods Inclusion and Exclusion Criteria Our search was designed to identify studies that used a
CDR to diagnose, predict, or rule out CAP in the outpatient setting. A limitation of antigen detection
assays is their reliance on detectable quantities of antigen; performance is thus suboptimal compared
with molecular tests ( 45 ). Three studies evaluated a simple point score (see Appendix B3 for
calculation of the scores, which had varying points assigned to each of the symptoms).
Consequently, healthcare providers, particularly those in low-resource settings, are likely to overtreat
non-bacterial pneumonia with antibiotics ( 11 ). Microbial etiology of pneumonia: epidemiology,
diagnosis and resistance patterns. Clinical utility of urinary antigen detection for diagnosis of
community-acquired, travel-associated, and nosocomial legionnaires’ disease.