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Community-Acquired Pneumonia

2009· article· en· W4236249820 on OpenAlexaboutno aff
Michael S. Niederman

Bibliographic record

VenueAnnals of Internal Medicine · 2009
Typearticle
Languageen
FieldMedicine
TopicPneumonia and Respiratory Infections
Canadian institutionsnot available
Fundersnot available
KeywordsMedicinePneumoniaCommunity-acquired pneumoniaIntensive care unitPediatricsIntensive care medicinePneumococcal pneumoniaStreptococcus pneumoniaeInternal medicine

Abstract

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In the Clinic6 October 2009Community-Acquired PneumoniaChristine Laine, MD, MPH, Sankey Williams, MD, and Michael Niederman, MDChristine Laine, MD, MPH, Sankey Williams, MD, and Michael Niederman, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-7-200910060-01004 SectionsSupplemental MaterialAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Editor's Note: This issue of In the Clinic has been updated.Community-acquired pneumonia (CAP) can vary from a mild outpatient illness to a more severe disease requiring admission to a hospital or even an intensive care unit (ICU). Along with influenza, CAP is the eighth leading cause of death in persons older than age 65 in the United States and is the leading cause of death from infectious diseases. In contrast to hospital-acquired pneumonia, CAP occurs in the community. This distinction is becoming increasingly blurred because persons in contact with health care environments, such as nursing homes and chronic hemodialysis ...References1. American Lung Association. Trends in pneumonia and influenza morbidity and mortality, July 2007. Accessed at www.lungusa.org/atf/cf/%7B7a8d42c2-fcca-4604-8ade-7f5d5e762256%7D/ALA_LDD08_INFLUENZA_FINAL.PDF on 24 August 2009. Google Scholar2. Nuorti JP, Butler JC, Farley MM, et al. Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team. N Engl J Med. 2000;342:681-9. [PMID:10706897] Google Scholar3. Walker FJ, Singleton RJ, Bulkow LR, et al. Reactions after 3 or more doses of pneumococcal polysaccharide vaccine in adults in Alaska. Clin Infect Dis. 2005;40:1730-5. [PMID:15909258] Google Scholar4. Jackson LA, Neuzil KM, Yu O, et al. Effectiveness of pneumococcal polysaccharide vaccine in older adults. N Engl J Med. 2003;348:1747-55. [PMID:12724480] Google Scholar5. 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Community-acquired pneumonia due to gram-negative bacteria and pseudomonas aeruginosa: incidence, risk, and prognosis. Arch Intern Med. 2002;162:1849-58. [PMID:12196083] Google Scholar15. El-Solh AA, Pietrantoni C, Bhat A, et al. Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med. 2003;167:1650-4. [PMID:12689848] Google Scholar16. Carratalà J, Mykietiuk A, Fernández-Sabé N, et al. Health care-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes. Arch Intern Med. 2007;167:1393-9. [PMID:17620533] Google Scholar17. Mandell LA, Marrie TJ, Grossman RF, et al. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. The Canadian Community-Acquired Pneumonia Working Group. Clin Infect Dis. 2000;31:383-421. [PMID:10987698] Google Scholar18. Graffelman AW, le Cessie S, Knuistingh Neven A, et al. Can history and exam alone reliably predict pneumonia? J Fam Pract. 2007;56:465-70. [PMID:17543257] Google Scholar19. Hopstaken RM, Witbraad T, van Engelshoven JM, et al. Inter-observer variation in the interpretation of chest radiographs for pneumonia in community-acquired lower respiratory tract infections. Clin Radiol. 2004;59:743-52. [PMID:15262550] Google Scholar20. Syrjälä H, Broas M, Suramo I, et al. High-resolution computed tomography for the diagnosis of community-acquired pneumonia. Clin Infect Dis. 1998;27:358-63. [PMID:9709887] Google Scholar21. Metersky ML, Ma A, Bratzler DW, et al. Predicting bacteremia in patients with community-acquired pneumonia. Am J Respir Crit Care Med. 2004;169:342-7. [PMID:14630621] Google Scholar22. van der Eerden MM, Vlaspolder F, de Graaff CS, et al. Comparison between pathogen directed antibiotic treatment and empirical broad spectrum antibiotic treatment in patients with community acquired pneumonia: a prospective randomised study. Thorax. 2005;60:672-8. [PMID:16061709] Google Scholar23. Christ-Crain M, Stolz D, Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med. 2006;174:84-93. [PMID:16603606] Google Scholar24. Aujesky D, Auble TE, Yealy DM, et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med. 2005;118:384-92. [PMID:15808136] Google Scholar25. GenIMS Investigators. Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia. Ann Emerg Med. 2008;52:48-58.e2. [PMID:18342993] Google Scholar26. Infectious Diseases Society of America. 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:S27-72. [PMID:17278083] Google Scholar27. Liapikou A, Ferrer M, Polverino E, et al. Severe community-acquired pneumonia: validation of the Infectious Diseases Society of America/American Thoracic Society guidelines to predict an intensive care unit admission. Clin Infect Dis. 2009;48:377-85. [PMID:19140759] Google Scholar28. Graham WG, Bradley DA. Efficacy of chest physiotherapy and intermittent positive-pressure breathing in the resolution of pneumonia. N Engl J Med. 1978;299:624-7. [PMID:355879] Google Scholar29. Li JZ, Winston LG, Moore DH, et al. Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis. Am J Med. 2007;120:783-90. [PMID:17765048] Google Scholar30. Meehan TP, Fine MJ, Krumholz HM, et al. Quality of care, process, and outcomes in elderly patients with pneumonia. JAMA. 1997;278:2080-4. [PMID:9403422] Google Scholar31. Kanwar M, Brar N, Khatib R, et al. Misdiagnosis of community-acquired pneumonia and inappropriate utilization of antibiotics: side effects of the 4-h antibiotic administration rule. Chest. 2007;131:1865-9. [PMID:17400668] Google Scholar32. Feldman RB, Rhew DC, Wong JY, et al. Azithromycin monotherapy for patients hospitalized with community-acquired pneumonia: a 31/2-year experience from a veterans affairs hospital. Arch Intern Med. 2003;163:1718-26. [PMID:12885688] Google Scholar33. Gleason PP, Kapoor WN, Stone RA, et al. Medical outcomes and antimicrobial costs with the use of the American Thoracic Society guidelines for outpatients with community-acquired pneumonia. JAMA. 1997;278:32-9. [PMID:9207335] Google Scholar34. Brown RB, Iannini P, Gross P, et al. Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database. Chest. 2003;123:1503-11. [PMID:12740267] Google Scholar35. Mart'nez JA, Horcajada JP, Almela M, et al. 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;36:389-95. [PMID:12567294] Google Scholar36. Lujan M, Gallego M, Fontanals D, et al. Prospective observational study of bacteremic pneumococcal pneumonia: Effect of discordant therapy on mortality. Crit Care Med. 2004;32:625-31. [PMID:15090938] Google Scholar37. International Pneumococcal Study Group. An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome. Clin Infect Dis. 2003;37:230-7. [PMID:12856216] Google Scholar38. Community-Acquired Pneumonia Organization (CAPO) Investigators. A worldwide perspective of atypical pathogens in community-acquired pneumonia. Am J Respir Crit Care Med. 2007;175:1086-93. [PMID:17332485] Google Scholar39. Metersky ML, Ma A, Houck PM, et al. Antibiotics for bacteremic pneumonia: Improved outcomes with macrolides but not fluoroquinolones. Chest. 2007;131:466-73. [PMID:17296649] Google Scholar40. Rello J, Catalán M, D'az E, et al. Associations between empirical antimicrobial therapy at the hospital and mortality in patients with severe community-acquired pneumonia. Intensive Care Med. 2002;28:1030-5. [PMID:12185421] Google Scholar41. International Pneumococcal Study Group. Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med. 2004;170:440-4. [PMID:15184200] Google Scholar42. Micek ST, Dunne M, Kollef MH. Pleuropulmonary complications of Panton-Valentine leukocidin-positive community-acquired methicillin-resistant Staphylococcus aureus: importance of treatment with antimicrobials inhibiting exotoxin production. Chest. 2005;128:2732-8. [PMID:16236949] Google Scholar43. Salluh JI, Verdeal JC, Mello GW, et al. Cortisol levels in patients with severe community-acquired pneumonia. Intensive Care Med. 2006;32:595-8. [PMID:16552616] Google Scholar44. Salluh JI, P—voa P, Soares M, et al. The role of corticosteroids in severe community-acquired pneumonia: a systematic review. Crit Care. 2008;12:R76. [PMID:18547407] Google Scholar45. PROWESS Clinical Evaluation Committee. Severe community-acquired pneumonia as a cause of severe sepsis: data from the PROWESS study. Crit Care Med. 2005;33:952-61. [PMID:15891319] Google Scholar46. Fishbane S, Niederman MS, Daly C, et al. The impact of standardized order sets and intensive clinical case management on outcomes in community-acquired pneumonia. Arch Intern Med. 2007;167:1664-9. [PMID:17698690] Google Scholar47. Musher DM, Rueda AM, Kaka AS, et al. The association between pneumococcal pneumonia and acute cardiac events. Clin Infect Dis. 2007;45:158-65. [PMID:17578773] Google Scholar48. Rhew DC, Hackner D, Henderson L, et al. The clinical benefit of in-hospital observation in 'low-risk' pneumonia patients after conversion from parenteral to oral antimicrobial therapy. Chest. 1998;113:142-6. [PMID:9440581] Google Scholar49. Nathan RV, Rhew DC, Murray C, et al. In-hospital observation after antibiotic switch in pneumonia: a national evaluation. Am J Med. 2006;119:512.e1-7. [PMID:16750965] Google Scholar50. El Solh AA, Aquilina AT, Gunen H, et al. Radiographic resolution of community-acquired bacterial pneumonia in the elderly. J Am Geriatr Soc. 2004;52:224-9. [PMID:14728631] Google Scholar51. Falguera M, Mart'n M, Ruiz-González A, et al. Community-acquired pneumonia as the initial manifestation of serious underlying diseases. Am J Med. 2005;118:378-83. [PMID:15808135] Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCorrection: In the Clinic: Community-Acquired Pneumonia Metrics Cited byManagement of pneumoniaImpact of pre-hospital antibiotic use on community-acquired pneumoniaPneumoniaVitamin D Status and Community-Acquired Pneumonia: Results from the Third National Health and Nutrition Examination SurveyThe role of vitamin D supplementation in the risk of developing pneumonia: three independent case–control studiesAddition of Vitamin D Status to Prognostic Scores Improves the Prediction of Outcome in Community-Acquired PneumoniaPopulation-based cohort study of outpatients with pneumonia: rationale, design and baseline characteristicsBiomarkers define the clinical response to dexamethasone in community-acquired pneumoniaCommunity-Acquired Pneumonia: An Unfinished BattleComparative antibiotic failure rates in the treatment of community-acquired pneumonia: Results from a claims analysisAmiodaroneThe Viriato StudyCommunity Acquired Pneumonia 6 October 2009Volume 151, Issue 7Page: ITC4-1KeywordsAntibioticsInfectious diseasesIntensive care unitsMedical risk factorsPathogensPneumoniaSputumThoraxVaccines ePublished: 6 October 2009 Issue Published: 6 October 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. 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Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame machine prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.

metaresearch head score (Codex)0.001
metaresearch head score (Gemma)0.004
Version: metacan-v3-hybrid-931329e0061cValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Not applicable · Consensus signal: Not applicable
GenreCandidate signal: Review · Consensus signal: none
Teacher disagreement score0.094
Threshold uncertainty score0.315

Distilled classifier scores by category (both heads)

CategoryCodexGemma
Metaresearch0.0010.004
Meta-epidemiology (narrow)0.0010.000
Meta-epidemiology (broad)0.0010.001
Bibliometrics0.0010.002
Science and technology studies0.0010.000
Scholarly communication0.0020.001
Open science0.0010.002
Research integrity0.0010.002
Insufficient payload (model declined to judge)0.0940.031

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.080
GPT teacher head0.384
Teacher spread0.304 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designNot applicable
Domainnot available
GenreReview

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

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Citations17
Published2009
Admission routes1
Has abstractyes

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Same venueAnnals of Internal MedicineSame topicPneumonia and Respiratory InfectionsFrench-language works237,207