Semin Respir Crit Care Med 2012; 33(03): 220-231
DOI: 10.1055/s-0032-1315634
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Microbiology and Risk Factors for Community-Acquired Pneumonia

Francisco Sanz Herrero
1   Department of Pneumology, Consorci Hospital General, Universitari de València, Valencia, Spain.
,
José Blanquer Olivas
2   Intensive Care Unit, Hospital Clínic, Universitari de València, Valencia, Spain.
› Author Affiliations
Further Information

Publication History

Publication Date:
20 June 2012 (online)

Abstract

The outcome of community-acquired pneumonia (CAP) depends on the interaction between the infectious agent and the host response. Nowadays the etiology of CAP can be established in ~60% of the cases, and Streptococcus pneumoniae remains the main etiological agent in outpatients, those hospitalized, or those requiring intensive care unit (ICU) admission. Recently, the development of nucleic acid amplification techniques has emphasized the role of viruses as important etiological agents in CAP. However, some demographic factors and comorbidities will determine a higher risk of pneumonia. Thus elderly patients or those with toxic habits (smoking, alcohol abuse), and the presence of various comorbidities (respiratory, metabolic, or renal) favor the development of pneumonia by altering the inflammatory response to infection.

Some medications like inhaled corticosteroids could play a role in CAP development in chronic obstructive pulmonary disease (COPD) patients. Fortunately some of these risk factors are preventable and modifiable, for example, through smoking cessation and pneumococcal and influenza vaccinations, which are the biggest successes.

 
  • References

  • 1 Apisarnthanarak A, Mundy LM. Etiology of community-acquired pneumonia. Clin Chest Med 2005; 26 (1) 47-55
  • 2 Jokinen C, Heiskanen L, Juvonen H , et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol 1993; 137 (9) 977-988
  • 3 Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax 2012; 67 (1) 71-79
  • 4 Almirall J, Bolíbar I, Vidal J , et al. Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Respir J 2000; 15 (4) 757-763
  • 5 File Jr TM, Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgrad Med 2010; 122 (2) 130-141
  • 6 World Health Organization. World Health Report 2003. Shaping the Future. Geneva: World Health Organization; 2003
  • 7 Ewig S, Birkner N, Strauss R , et al. New perspectives on community-acquired pneumonia in 388 406 patients: results from a nationwide mandatory performance measurement programme in healthcare quality. Thorax 2009; 64 (12) 1062-1069
  • 8 Lim WS, Baudouin SV, George RC , et al; 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. 03) iii1-iii55
  • 9 Torres A, Serra-Batlles J, Ferrer A , et al. Severe community-acquired pneumonia. Epidemiology and prognostic factors. Am Rev Respir Dis 1991; 144 (2) 312-318
  • 10 Carbonara S, Monno L, Longo B, Angarano G. Community-acquired pneumonia. Curr Opin Pulm Med 2009; 15 (3) 261-273
  • 11 Ewig S, Torres A, Angeles Marcos M , et al. Factors associated with unknown aetiology in patients with community-acquired pneumonia. Eur Respir J 2002; 20 (5) 1254-1262
  • 12 Garau J, Baquero F, Pérez-Trallero E , et al; NACER Group. Factors impacting on length of stay and mortality of community-acquired pneumonia. Clin Microbiol Infect 2008; 14 (4) 322-329
  • 13 Charles PG, Whitby M, Fuller AJ , et al; Australian CAP Study Collaboration. The etiology of community-acquired pneumonia in Australia: why penicillin plus doxycycline or a macrolide is the most appropriate therapy. Clin Infect Dis 2008; 46 (10) 1513-1521
  • 14 Mandell L. Treatment of community-acquired pneumonia Down Under versus the United States: is it really that different?. Clin Infect Dis 2008; 46 (10) 1522-1524
  • 15 Clark NM, Lynch III JP. Influenza: epidemiology, clinical features, therapy, and prevention. Semin Respir Crit Care Med 2011; 32 (4) 373-392
  • 16 Walsh EE. Respiratory syncytial virus infection in adults. Semin Respir Crit Care Med 2011; 32 (4) 423-432
  • 17 Lynch III JP, Fishbein M, Echavarria M. Adenovirus. Semin Respir Crit Care Med 2011; 32 (4) 494-511
  • 18 Kroll JL, Weinberg A. Human metapneumovirus. Semin Respir Crit Care Med 2011; 32 (4) 447-453
  • 19 Greenberg SB. Update on rhinovirus and coronavirus infections. Semin Respir Crit Care Med 2011; 32 (4) 433-446
  • 20 Alfageme I, Aspa J, Bello S , et al; Grupo de Estudio de la Neumonía Adquirida en la Comunidad. Area de Tuberculosis e Infecciones Respiratorias (TIR)-SEPAR; Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). [Guidelines for the diagnosis and management of community-acquired pneumonia]. Arch Bronconeumol 2005; 41 (5) 272-289
  • 21 Marrie TJ, Bartlett JG, Thorner AR. Epidemiology, pathogenesis, and microbiology of community-acquired pneumonia in adults. UpToDate. http://www.uptodate.com/contents/epidemiology-pathogenesis-and-microbiology-of-community-acquired-pneumonia-in-adults . Accessed September 5, 2011
  • 22 Brown JS. Geography and the aetiology of community-acquired pneumonia. Respirology 2009; 14 (8) 1068-1071
  • 23 Woodhead M. The European vision of community-acquired pneumonia. Semin Respir Crit Care Med 2009; 30 (2) 136-145
  • 24 Falguera M, Sacristán O, Nogués A , et al. Nonsevere community-acquired pneumonia: correlation between cause and severity or comorbidity. Arch Intern Med 2001; 161 (15) 1866-1872
  • 25 Ruiz-González A, Falguera M, Nogués A, Rubio-Caballero M. Is Streptococcus pneumoniae the leading cause of pneumonia of unknown etiology? A microbiologic study of lung aspirates in consecutive patients with community-acquired pneumonia. Am J Med 1999; 106 (4) 385-390
  • 26 Westall GP, Paraskeva M. H1N1 influenza: critical care aspects. Semin Respir Crit Care Med 2011; 32 (4) 400-408
  • 27 Bulpa P, Dive A, Sibille Y. Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease. Eur Respir J 2007; 30 (4) 782-800
  • 28 Kaplan JE, Hanson D, Dworkin MS , et al. Epidemiology of human immunodeficiency virus-associated opportunistic infections in the United States in the era of highly active antiretroviral therapy. Clin Infect Dis 2000; 30 (Suppl. 01) S5-S14
  • 29 Nyamande K, Lalloo UG, John M. TB presenting as community-acquired pneumonia in a setting of high TB incidence and high HIV prevalence. Int J Tuberc Lung Dis 2007; 11 (12) 1308-1313
  • 30 Liam CK, Pang YK, Poosparajah S. Pulmonary tuberculosis presenting as community-acquired pneumonia. Respirology 2006; 11 (6) 786-792
  • 31 Song JH, Oh WS, Kang CI , et al; Asian Network for Surveillance of Resistant Pathogens Study Group. Epidemiology and clinical outcomes of community-acquired pneumonia in adult patients in Asian countries: a prospective study by the Asian network for surveillance of resistant pathogens. Int J Antimicrob Agents 2008; 31 (2) 107-114
  • 32 Boonsawat W, Boonma P, Tangdajahiran T, Paupermpoonsiri S, Wongpratoom W, Romphryk A. Community-acquired pneumonia in adults at Srinagarind Hospital. J Med Assoc Thai 1990; 73 (6) 345-352
  • 33 Hui KP, Chin NK, Chow K , et al. Prospective study of the aetiology of adult community acquired bacterial pneumonia needing hospitalisation in Singapore. Singapore Med J 1993; 34 (4) 329-334
  • 34 Cillóniz C, Ewig S, Polverino E , et al. Microbial aetiology of community-acquired pneumonia and its relation to severity. Thorax 2011; 66 (4) 340-346
  • 35 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 Hospitalized on the Basis Of Conventional Admission Criteria. Clin Infect Dis 2001; 33 (2) 158-165
  • 36 Dambrava PG, Torres A, Vallès X , et al. Adherence to guidelines' empirical antibiotic recommendations and community-acquired pneumonia outcome. Eur Respir J 2008; 32 (4) 892-901
  • 37 Lynch III JP, Zhanel GG. Streptococcus pneumoniae: epidemiology, risk factors, and strategies for prevention. Semin Respir Crit Care Med 2009; 30 (2) 189-209
  • 38 Briones ML, Blanquer J, Ferrando D, Blasco ML, Gimeno C, Marín J. Assessment of analysis of urinary pneumococcal antigen by immunochromatography for etiologic diagnosis of community-acquired pneumonia in adults. Clin Vaccine Immunol 2006; 13 (10) 1092-1097
  • 39 Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet 2011; 377 (9773) 1264-1275
  • 40 Lieberman D, Shimoni A, Shemer-Avni Y, Keren-Naos A, Shtainberg R, Lieberman D. Respiratory viruses in adults with community-acquired pneumonia. Chest 2010; 138 (4) 811-816
  • 41 Niederman MS. Viral community-acquired pneumonia: if we do not diagnose it and do not treat it, can it still hurt us?. Chest 2010; 138 (4) 767-769
  • 42 Christian MD, Poutanen SM, Loutfy MR, Muller MP, Low DE. Severe acute respiratory syndrome. Clin Infect Dis 2004; 38 (10) 1420-1427
  • 43 World Health Organization. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1). Reported to WHO. http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_08_31/en/index.html . Accessed September 5, 2011
  • 44 de Roux A, Ewig S, García E , et al. Mixed community-acquired pneumonia in hospitalised patients. Eur Respir J 2006; 27 (4) 795-800
  • 45 Torres A, Dorca J, Zalacaín R , et al. Community-acquired pneumonia in chronic obstructive pulmonary disease: a Spanish multicenter study. Am J Respir Crit Care Med 1996; 154 (5) 1456-1461
  • 46 Restrepo MI, Mortensen EM, Pugh JA, Anzueto A. COPD is associated with increased mortality in patients with community-acquired pneumonia. Eur Respir J 2006; 28 (2) 346-351
  • 47 Sanz F, Blanquer J. Community-acquired pneumonia in chronic obstructive pulmonary disease patients. Minerva pneumol 2009; 48: 85-94
  • 48 Fernández-Sabé N, Carratalà J, Rosón B , et al. Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine (Baltimore) 2003; 82 (3) 159-169
  • 49 de Roux A, Cavalcanti M, Marcos MA , et al. Impact of alcohol abuse in the etiology and severity of community-acquired pneumonia. Chest 2006; 129 (5) 1219-1225
  • 50 Osler W. The Principles and Practice of Medicine. New York: D Appleton; 1901
  • 51 Ewig S, Birkner N, Strauss R , et al. New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality. Thorax 2009; 64 (12) 1062-1069
  • 52 Butler SG, Stuart A, Leng X, Rees C, Williamson J, Kritchevsky SB. Factors influencing aspiration during swallowing in healthy older adults. Laryngoscope 2010; 120 (11) 2147-2152
  • 53 Ho JC, Chan KN, Hu WH , et al. The effect of aging on nasal mucociliary clearance, beat frequency, and ultrastructure of respiratory cilia. Am J Respir Crit Care Med 2001; 163 (4) 983-988
  • 54 Riquelme R, Torres A, El-Ebiary M , et al. Community-acquired pneumonia in the elderly: A multivariate analysis of risk and prognostic factors. Am J Respir Crit Care Med 1996; 154 (5) 1450-1455
  • 55 Franceschi C, Bonafè M, Valensin S. Human immunosenescence: the prevailing of innate immunity, the failing of clonotypic immunity, and the filling of immunological space. Vaccine 2000; 18 (16) 1717-1720
  • 56 Plowden J, Renshaw-Hoelscher M, Engleman C, Katz J, Sambhara S. Innate immunity in aging: impact on macrophage function. Aging Cell 2004; 3 (4) 161-167
  • 57 Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde-Zwirble WT. Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med 2002; 165 (6) 766-772
  • 58 Schröder J, Kahlke V, Book M, Stüber F. Gender differences in sepsis: genetically determined?. Shock 2000; 14 (3) 307-310 , discussion 310–313
  • 59 Frei CR, Mortensen EM, Copeland LA , et al. Disparities of care for African-Americans and Caucasians with community-acquired pneumonia: a retrospective cohort study. BMC Health Serv Res 2010; 10: 143
  • 60 Restrepo MI, Velez MI, Serna G, Anzueto A, Mortensen EM. Antimicrobial resistance in Hispanic patients hospitalized in San Antonio, TX with community-acquired pneumonia. Hosp Pract (Minneap) 2010; 38 (4) 108-113
  • 61 Janssens JP, Krause KH. Pneumonia in the very old. Lancet Infect Dis 2004; 4 (2) 112-124
  • 62 Mehr DR, Zweig SC, Kruse RL , et al. Mortality from lower respiratory infection in nursing home residents. A pilot prospective community-based study. J Fam Pract 1998; 47 (4) 298-304
  • 63 El-Solh AA, Sikka P, Ramadan F, Davies J. Etiology of severe pneumonia in the very elderly. Am J Respir Crit Care Med 2001; 163 (3 Pt 1) 645-651
  • 64 Naimi TS, LeDell KH, Como-Sabetti K , et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003; 290 (22) 2976-2984
  • 65 American Thoracic Society; 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 (4) 388-416
  • 66 Nuorti JP, Butler JC, Farley MM , et al; Active Bacterial Core Surveillance Team. Cigarette smoking and invasive pneumococcal disease. N Engl J Med 2000; 342 (10) 681-689
  • 67 Centers for Disease Control and Prevention (CDC). Cigarette smoking-attributable mortality and years of potential life lost—United States, 1990. MMWR Morb Mortal Wkly Rep 1993; 42 (33) 645-649
  • 68 Almirall J, González CA, Balanzó X, Bolíbar I. Proportion of community-acquired pneumonia cases attributable to tobacco smoking. Chest 1999; 116 (2) 375-379
  • 69 Ewig S, Ruiz M, Torres A , et al. Pneumonia acquired in the community through drug-resistant Streptococcus pneumoniae. Am J Respir Crit Care Med 1999; 159 (6) 1835-1842
  • 70 Fernández-Solá J, Junqué A, Estruch R, Monforte R, Torres A, Urbano-Márquez A. High alcohol intake as a risk and prognostic factor for community-acquired pneumonia. Arch Intern Med 1995; 155 (15) 1649-1654
  • 71 Samokhvalov AV, Irving HM, Rehm J. Alcohol consumption as a risk factor for pneumonia: a systematic review and meta-analysis. Epidemiol Infect 2010; 138 (12) 1789-1795
  • 72 Happel KI, Nelson S. Alcohol, immunosuppression, and the lung. Proc Am Thorac Soc 2005; 2 (5) 428-432
  • 73 Raasch CE, Zhang P, Siggins II RW, LaMotte LR, Nelson S, Bagby GJ. Acute alcohol intoxication impairs the hematopoietic precursor cell response to pneumococcal pneumonia. Alcohol Clin Exp Res 2010; 34 (12) 2035-2043
  • 74 Almirall J, Bolíbar I, Serra-Prat M , et al; Community-Acquired Pneumonia in Catalan Countries (PACAP) Study Group. New evidence of risk factors for community-acquired pneumonia: a population-based study. Eur Respir J 2008; 31 (6) 1274-1284
  • 75 El-Solh AA, Pietrantoni C, Bhat A , et al. Colonization of dental plaques: a reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders. Chest 2004; 126 (5) 1575-1582
  • 76 Paju S, Scannapieco FA. Oral biofilms, periodontitis, and pulmonary infections. Oral Dis 2007; 13 (6) 508-512
  • 77 Chatila WM, Thomashow BM, Minai OA, Criner GJ, Make BJ. Comorbidities in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2008; 5 (4) 549-555
  • 78 Lange P, Vestbo J, Nyboe J. Risk factors for death and hospitalization from pneumonia. A prospective study of a general population. Eur Respir J 1995; 8 (10) 1694-1698
  • 79 Sliedrecht A, den Elzen WP, Verheij TJ, Westendorp RG, Gussekloo J. Incidence and predictive factors of lower respiratory tract infections among the very elderly in the general population. The Leiden 85-plus Study. Thorax 2008; 63 (9) 817-822
  • 80 Jansen HM, Sachs AP, van Alphen L. Predisposing conditions to bacterial infections in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995; 151 (6) 2073-2080
  • 81 Marin A, Monsó E, Garcia-Nuñez M , et al. Variability and effects of bronchial colonisation in patients with moderate COPD. Eur Respir J 2010; 35 (2) 295-302
  • 82 Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med 2008; 359 (22) 2355-2365
  • 83 Gutierrez P, Closa D, Piñer R, Bulbena O, Menéndez R, Torres A. Macrophage activation in exacerbated COPD with and without community-acquired pneumonia. Eur Respir J 2010; 36 (2) 285-291
  • 84 File Jr TM, Monte SV, Schentag JJ , et al. A disease model descriptive of progression between chronic obstructive pulmonary disease exacerbations and community-acquired pneumonia: roles for underlying lung disease and the pharmacokinetics/pharmacodynamics of the antibiotic. Int J Antimicrob Agents 2009; 33 (1) 58-64
  • 85 Rabe KF, Hurd S, Anzueto A , et al; Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007; 176 (6) 532-555
  • 86 Burge PS, Calverley PM, Jones PW, Spencer S, Anderson JA, Maslen TK. Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ 2000; 320 (7245) 1297-1303
  • 87 Calverley PM, Anderson JA, Celli B , et al; TORCH investigators. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007; 356 (8) 775-789
  • 88 Ernst P, Gonzalez AV, Brassard P, Suissa S. Inhaled corticosteroid use in chronic obstructive pulmonary disease and the risk of hospitalization for pneumonia. Am J Respir Crit Care Med 2007; 176 (2) 162-166
  • 89 Calverley PM, Stockley RA, Seemungal TA , et al; Investigating New Standards for Prophylaxis in Reduction of Exacerbations (INSPIRE) Investigators. Reported pneumonia in patients with COPD: findings from the INSPIRE study. Chest 2011; 139 (3) 505-512
  • 90 Wilson AM, Lipworth BJ. Systemic dose-response relationships with oral and inhaled corticosteroids in asthmatics [abstract]. Thorax 1997; 52 (Suppl. 06) A57
  • 91 Lipworth BJ. Systemic adverse effects of inhaled corticosteroid therapy: a systematic review and meta-analysis. Arch Intern Med 1999; 159 (9) 941-955
  • 92 White DA. Drug-induced pulmonary infection. Clin Chest Med 2004; 25 (1) 179-187
  • 93 Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care 2003; 26 (2) 510-513
  • 94 Muller LM, Gorter KJ, Hak E , et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis 2005; 41 (3) 281-288
  • 95 Thomsen RW, Hundborg HH, Lervang HH, Johnsen SP, Schønheyder HC, Sørensen HT. Risk of community-acquired pneumococcal bacteremia in patients with diabetes: a population-based case-control study. Diabetes Care 2004; 27 (5) 1143-1147
  • 96 Kornum JB, Thomsen RW, Riis A, Lervang HH, Schønheyder HC, Sørensen HT. Diabetes, glycemic control, and risk of hospitalization with pneumonia: a population-based case-control study. Diabetes Care 2008; 31 (8) 1541-1545
  • 97 Koziel H, Koziel MJ. Pulmonary complications of diabetes mellitus. Pneumonia. Infect Dis Clin North Am 1995; 9 (1) 65-96
  • 98 Naqvi SB, Collins AJ. Infectious complications in chronic kidney disease. Adv Chronic Kidney Dis 2006; 13 (3) 199-204
  • 99 Slinin Y, Foley RN, Collins AJ. Clinical epidemiology of pneumonia in hemodialysis patients: the USRDS waves 1, 3, and 4 study. Kidney Int 2006; 70 (6) 1135-1141
  • 100 James MT, Quan H, Tonelli M , et al; Alberta Kidney Disease Network. CKD and risk of hospitalization and death with pneumonia. Am J Kidney Dis 2009; 54 (1) 24-32
  • 101 James MT, Laupland KB, Tonelli M, Manns BJ, Culleton BF, Hemmelgarn BR ; Alberta Kidney Disease Network. Risk of bloodstream infection in patients with chronic kidney disease not treated with dialysis. Arch Intern Med 2008; 168 (21) 2333-2339
  • 102 Viasus D, Garcia-Vidal C, Cruzado JM , et al. Epidemiology, clinical features and outcomes of pneumonia in patients with chronic kidney disease. Nephrol Dial Transplant 2011; 26 (9) 2899-2906
  • 103 Cendoroglo M, Jaber BL, Balakrishnan VS, Perianayagam M, King AJ, Pereira BJ. Neutrophil apoptosis and dysfunction in uremia. J Am Soc Nephrol 1999; 10 (1) 93-100
  • 104 Foley RN. Infections and cardiovascular disease in patients with chronic kidney disease. Adv Chronic Kidney Dis 2006; 13 (3) 205-208
  • 105 Borzio M, Salerno F, Piantoni L , et al. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis 2001; 33 (1) 41-48
  • 106 Tandon P, Garcia-Tsao G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Semin Liver Dis 2008; 28 (1) 26-42
  • 107 Viasus D, Garcia-Vidal C, Castellote J , et al. Community-acquired pneumonia in patients with liver cirrhosis: clinical features, outcomes, and usefulness of severity scores. Medicine (Baltimore) 2011; 90 (2) 110-118
  • 108 Cordero E, Pachón J, Rivero A , et al. Community-acquired bacterial pneumonia in human immunodeficiency virus-infected patients: validation of severity criteria. The Grupo Andaluz para el Estudio de las Enfermedades Infecciosas. Am J Respir Crit Care Med 2000; 162 (6) 2063-2068
  • 109 Navin TR, Rimland D, Lennox JL , et al. Risk factors for community-acquired pneumonia among persons infected with human immunodeficiency virus. J Infect Dis 2000; 181 (1) 158-164
  • 110 Hirschtick RE, Glassroth J, Jordan MC , et al; Pulmonary Complications of HIV Infection Study Group. Bacterial pneumonia in persons infected with the human immunodeficiency virus. N Engl J Med 1995; 333 (13) 845-851
  • 111 Klare B, Kubini R, Ewig S. Risk factors for pneumonia in patients with cardiovascular diseases [in German]. Pneumologie 2002; 56 (12) 781-788
  • 112 Fujiki R, Kawayama T, Ueyama T, Ichiki M, Aizawa H. The risk factors for mortality of community-acquired pneumonia in Japan. J Infect Chemother 2007; 13 (3) 157-165
  • 113 Fine MJ, Smith MA, Carson CA , et al. Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA 1996; 275 (2) 134-141
  • 114 Meijvis SC, Cornips MC, Voorn GP , et al. Microbial evaluation of proton-pump inhibitors and the risk of pneumonia. Eur Respir J 2011; 38 (5) 1165-1172
  • 115 Kollef MH, Morrow LE, Baughman RP , et al. Health care-associated pneumonia (HCAP): a critical appraisal to improve identification, management, and outcomes—proceedings of the HCAP Summit. Clin Infect Dis 2008; 46 (Suppl. 04) S296-S334 , quiz 335–338
  • 116 Yu VL, Chiou CC, Feldman C , et al; 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 (2) 230-237
  • 117 Vanderkooi OG, Low DE, Green K, Powis JE, McGeer A ; Toronto Invasive Bacterial Disease Network. Predicting antimicrobial resistance in invasive pneumococcal infections. Clin Infect Dis 2005; 40 (9) 1288-1297
  • 118 González C, Rubio M, Romero-Vivas J, González M, Picazo JJ. Bacteremic pneumonia due to Staphylococcus aureus: a comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms. Clin Infect Dis 1999; 29 (5) 1171-1177
  • 119 El Solh AA, Pietrantoni C, Bhat A, Bhora M, Berbary E. Indicators of potentially drug-resistant bacteria in severe nursing home-acquired pneumonia. Clin Infect Dis 2004; 39 (4) 474-480
  • 120 Arancibia F, Bauer TT, Ewig S , et al. Community-acquired pneumonia due to gram-negative bacteria and pseudomonas aeruginosa: incidence, risk, and prognosis. Arch Intern Med 2002; 162 (16) 1849-1858
  • 121 Whitney CG, Farley MM, Hadler J , et al; Active Bacterial Core Surveillance of the Emerging Infections Program Network. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003; 348 (18) 1737-1746
  • 122 Kyaw MH, Lynfield R, Schaffner W , et al. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med 2006; 354 (14) 1455-1463
  • 123 Stephens DS, Zughaier SM, Whitney CG , et al; Georgia Emerging Infections Program. Incidence of macrolide resistance in Streptococcus pneumoniae after introduction of the pneumococcal conjugate vaccine: population-based assessment. Lancet 2005; 365 (9462) 855-863
  • 124 Singleton RJ, Hennessy TW, Bulkow LR , et al. Invasive pneumococcal disease caused by nonvaccine serotypes among Alaska Native children with high levels of 7-valent pneumococcal conjugate vaccine coverage. JAMA 2007; 297 (16) 1784-1792
  • 125 Albrich WC, Baughman W, Schmotzer B, Farley MM. Changing characteristics of invasive pneumococcal disease in Metropolitan Atlanta, Georgia, after introduction of a 7-valent pneumococcal conjugate vaccine. Clin Infect Dis 2007; 44 (12) 1569-1576
  • 126 Johnstone J, Eurich DT, Minhas JK, Marrie TJ, Majumdar SR. Impact of the pneumococcal vaccine on long-term morbidity and mortality of adults at high risk for pneumonia. Clin Infect Dis 2010; 51 (1) 15-22
  • 127 Use of influenza A (H1N1) 2009 monovalent vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. National Center for Immunization and Respiratory Diseases. CDC (Centers for Disease Control and Prevention). MMWR Morb Mortal Wkly Rep 2009; 58 (RR-10) 1-8
  • 128 Chowell G, Bertozzi SM, Colchero MA , et al. Severe respiratory disease concurrent with the circulation of H1N1 influenza. N Engl J Med 2009; 361 (7) 674-679
  • 129 Liappis AP, Kan VL, Rochester CG, Simon GL. The effect of statins on mortality in patients with bacteremia. Clin Infect Dis 2001; 33 (8) 1352-1357
  • 130 Mortensen EM, Pugh MJ, Copeland LA , et al. Impact of statins and angiotensin-converting enzyme inhibitors on mortality of subjects hospitalised with pneumonia. Eur Respir J 2008; 31 (3) 611-617
  • 131 Ohkubo T, Chapman N, Neal B, Woodward M, Omae T, Chalmers J ; Perindopril Protection Against Recurrent Stroke Sutdy Collaborative Group. Effects of an angiotensin-converting enzyme inhibitor-based regimen on pneumonia risk. Am J Respir Crit Care Med 2004; 169 (9) 1041-1045
  • 132 Siempos II, Vardakas KZ, Kopterides P, Falagas ME. Adjunctive therapies for community-acquired pneumonia: a systematic review. J Antimicrob Chemother 2008; 62 (4) 661-668
  • 133 Nuorti JP, Butler JC, Farley MM , et al; Active Bacterial Core Surveillance Team. Cigarette smoking and invasive pneumococcal disease. N Engl J Med 2000; 342 (10) 681-689
  • 134 Tønnesen P, Carrozzi L, Fagerström KO , et al. Smoking cessation in patients with respiratory diseases: a high priority, integral component of therapy. Eur Respir J 2007; 29 (2) 390-417