GUIDELINES FROM THE INFECTIOUS DISEASES SOCIETY OF AMERICA Practice Guidelines for the Management of Community-Acquired Pneumonia in Adults

John G. Bartlett, Scott F. Dowell, Lionel A. Mandell, Thomas M. File, Jr., Daniel M. Musher, and Michael J. Fine Johns Hopkins University School of Medicine, Baltimore, Maryland, Centers for Disease Control and Prevention, Atlanta, Georgia, Northeastern Ohio Universities College of Medicine, Cleveland, Ohio, Baylor College of Medicine and Veterans Affairs Medical Center, Houston, Texas, and University of Pittsburgh, Pennsylvania, USA; and McMaster University, Toronto, Canada

[1]  M. Kolczak,et al.  Incidence of Community-Acquired Pneumonia Requiring Hospitalization Results of a Population-Based Active Surveillance Study in Ohio , 1997 .

[2]  M. Fine,et al.  A prediction rule to identify low-risk patients with community-acquired pneumonia. , 1997, The New England journal of medicine.

[3]  Sheldon L. Kaplan,et al.  Management of Infections Due to Antibiotic-Resistant Streptococcus pneumoniae , 1998, Clinical Microbiology Reviews.

[4]  B. Cunha,et al.  Doxycycline activity against Streptococcus pneumoniae. , 1995, Chest.

[5]  M. Fine,et al.  Prognosis of patients hospitalized with community-acquired pneumonia. , 1990, The American journal of medicine.

[6]  P. Fey,et al.  Antimicrobial Activities and Postantibiotic Effects of Clarithromycin, 14-Hydroxy-Clarithromycin, and Azithromycin in Epithelial Cell Lining Fluid against Clinical Isolates ofHaemophilus influenzae and Streptococcus pneumoniae , 1999, Antimicrobial Agents and Chemotherapy.

[7]  P. Mäkelä,et al.  Risk factors for pneumonia in the elderly. , 1994, The American journal of medicine.

[8]  J. Bartlett.  Anaerobic bacterial infections of the lung and pleural space. , 1993, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  A. Porath,et al.  Appropriateness of hospitalization of patients with community-acquired pneumonia. , 1996, Annals of emergency medicine.

[10]  M. Fine,et al.  Do pulmonary radiographic findings at presentation predict mortality in patients with community-acquired pneumonia? , 1996, Archives of internal medicine.

[11]  W. S. Jordan,et al.  Rhinovirus infections in an industrial population. II. Characteristics of illness and antibody response. , 1967, JAMA.

[12]  F. Blasi,et al.  Hospital Admission Decision for Patients with Community-Acquired Pneumonia , 2013, Current Infectious Disease Reports.

[13]  C. Kauffman,et al.  Survival of Streptococcus pneumoniae in sputum from patients with pneumonia , 1978, Journal of clinical microbiology.

[14]  R. Breiman,et al.  Pneumococcal bacteremia in Charleston County, South Carolina. A decade later. , 1990, Archives of internal medicine.

[15]  G. Kenny,et al.  Mycoplasma pneumoniae pneumonia in an urban area. Five years of surveillance. , 1970 .

[16]  E. Vittinghoff,et al.  Antibiotics in acute bronchitis: a meta-analysis , 1999, The American Journal of Medicine.

[17]  J. Wardrope,et al.  Does this patient have community-acquired pneumonia? , 1999, Journal of accident & emergency medicine.

[18]  M. Jacobs,et al.  Activities of RPR 106972 (a new oral streptogramin), cefditoren (a new oral cephalosporin), two new oxazolidinones (U-100592 and U-100766), and other oral and parenteral agents against 203 penicillin-susceptible and -resistant pneumococci , 1996, Antimicrobial agents and chemotherapy.

[19]  J. Pennington.  Penetration of antibiotics into respiratory secretions. , 1981, Reviews of infectious diseases.

[20]  B. Marston,et al.  Surveillance for Legionnaires' disease. Risk factors for morbidity and mortality. , 1994, Archives of internal medicine.

[21]  M. Fine,et al.  The Cost of Treating Patients with Community-Acquired Pneumonia , 1999 .

[22]  H. Sacks,et al.  The Efficacy of Influenza Vaccine in Elderly Persons , 1995, Annals of Internal Medicine.

[23]  D. Podzamczer,et al.  Pneumonia due to Legionella pneumophila and pneumococcal pneumonia: similarities and differences on presentation. , 1989, The European respiratory journal.

[24]  D. Stott,et al.  Influenza Vaccination of Health Care Workers in Long-Term-Care Hospitals Reduces the Mortality of Elderly Patients , 1997, The Journal of infectious diseases.

[25]  J. Bartlett,et al.  Community-acquired pneumonia in adults: guidelines for management. The Infectious Diseases Society of America. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[26]  J. Bass,et al.  Diagnosis of bacterial pulmonary infections with quantitative protected catheter cultures obtained during bronchoscopy , 1983, Journal of clinical microbiology.

[27]  D Draper,et al.  Changes in sickness at admission following the introduction of the prospective payment system. , 1990, JAMA.

[28]  E. Barrett-Connor.  The nonvalue of sputum culture in the diagnosis of pneumococcal pneumonia. , 2015, The American review of respiratory disease.

[29]  Update: hantavirus pulmonary syndrome--United States, 1993. , 1993, MMWR. Morbidity and mortality weekly report.

[30]  M. Fine,et al.  Medical outcomes and antimicrobial costs with the use of the American Thoracic Society guidelines for outpatients with community-acquired pneumonia. , 1997, JAMA.

[31]  Ali S Khan,et al.  An outbreak of hantavirus pulmonary syndrome in western Paraguay. , 1997, The American journal of tropical medicine and hygiene.

[32]  D. Gremillion,et al.  Microscopic and bacteriological comparison of paired sputa and transtracheal aspirates , 1977, Journal of clinical microbiology.

[33]  P. Ward,et al.  Use of the oral neuraminidase inhibitor oseltamivir in experimental human influenza: randomized controlled trials for prevention and treatment. , 1999, JAMA.

[34]  L. Mandell,et al.  Antimicrobial treatment of community acquired pneumonia in adults: A conference report. , 1993, The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses.

[35]  G. Rosen,et al.  Acid aspiration induced lung injury. New insights and therapeutic options. , 1996, American journal of respiratory and critical care medicine.

[36]  J. A. Cuello,et al.  Severe community-acquired pneumonia. Etiology, prognosis, and treatment. , 1990, The American review of respiratory disease.

[37]  T. Marrie,et al.  A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. , 2000, JAMA.

[38]  D. MacKay,et al.  Treatment of acute bronchitis in adults without underlying lung disease , 1996, Journal of General Internal Medicine.

[39]  Cm Martin.  Asian influenza A in Boston, 1957-1958 , 1959 .

[40]  H. Flamm,et al.  [Mycoplasma infections in man]. , 1969, Deutsche medizinische Wochenschrift.

[41]  L. McMahon,et al.  Variation in Hospital Admissions Among Small Areas: A Comparison of Maine and Michigan , 1989, Medical care.

[42]  R. Breiman,et al.  Bacteremia with Streptococcus pneumoniae. Implications for therapy and prevention. Franklin County Pneumonia Study Group. , 1996, JAMA.

[43]  I. Williams,et al.  The value of routine microbial investigation in community-acquired pneumonia. , 1991, Respiratory medicine.

[44]  L. Jackson,et al.  Chlamydia pneumoniae (TWAR) , 1995, Clinical microbiology reviews.

[45]  S. Chodosh.  Acute bacterial exacerbations in bronchitis and asthma. , 1987, The American journal of medicine.

[46]  L. Mandell.  Antibiotics for pneumonia therapy. , 1994, The Medical clinics of North America.

[47]  P. Diehr,et al.  Prediction of pneumonia in outpatients with acute cough--a statistical approach. , 1984, Journal of chronic diseases.

[48]  M. Fisch,et al.  Predicting death in patients hospitalized for community-acquired pneumonia. , 1991, Annals of internal medicine.

[49]  D E Low,et al.  Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. Canadian Bacterial Surveillance Network. , 1999, The New England journal of medicine.

[50]  A. Cross,et al.  Efficacy of pneumococcal vaccine in high-risk patients. Results of a Veterans Administration Cooperative Study. , 1986, The New England journal of medicine.

[51]  W. Wilson,et al.  Tetracyclines, chloramphenicol, erythromycin, and clindamycin. , 1987, Mayo Clinic proceedings.

[52]  M. Fine,et al.  Hospitalization decision in patients with community-acquired pneumonia: a prospective cohort study. , 1990, The American journal of medicine.

[53]  M. Fine,et al.  Processes and outcomes of care for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team (PORT) cohort study. , 1999, Archives of internal medicine.

[54]  W. Kapoor,et al.  New and Emerging Etiologies for Community‐Acquired Pneumonia with Implications for Therapy: A Prospective Multicenter Study of 359 Cases , 1990, Medicine.

[55]  J. Ramirez,et al.  Diagnosis of Legionella pneumophila, Mycoplasma pneumoniae, or Chlamydia pneumoniae lower respiratory infection using the polymerase chain reaction on a single throat swab specimen. , 1996, Diagnostic microbiology and infectious disease.

[56]  M. Fine,et al.  Assessing prognosis and predicting patient outcomes in community-acquired pneumonia. , 1994, Seminars in respiratory infections.

[57]  R. T. Porter.  Legionnaires' disease. , 1978, British medical journal.

[58]  O. Ruuskanen,et al.  Diagnosis of Mycoplasma pneumoniaePneumonia in Children , 1998, Journal of Clinical Microbiology.

[59]  J. Ambler,et al.  Increased incidence of ciprofloxacin resistance in penicillin-resistant pneumococci in Northern Ireland. , 1998, The Journal of antimicrobial chemotherapy.

[60]  T. Marrie,et al.  Community-acquired pneumonia requiring hospitalization: 5-year prospective study. , 1989, Reviews of infectious diseases.

[61]  D. Miller,et al.  Endobronchial pH. Relevance of aminoglycoside activity in gram-negative bacillary pneumonia. , 1983, The American review of respiratory disease.

[62]  K. O'Brien,et al.  Cough Illness/Bronchitis—Principles of Judicious Use of Antimicrobial Agents , 1998, Pediatrics.

[63]  M J Koziel,et al.  Pulmonary complications of diabetes mellitus. Pneumonia. , 1995, Infectious disease clinics of North America.

[64]  C. Peters,et al.  Hantaviruses and hantavirus pulmonary syndrome. , 1994, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[65]  J. Duchin,et al.  Clinical features that differentiate hantavirus pulmonary syndrome from three other acute respiratory illnesses. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[66]  J. Hermans,et al.  Early recognition of Streptococcus pneumoniae in patients with community-acquired pneumonia. , 1996, European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology.

[67]  M. Hammerschlag.  Antimicrobial susceptibility and therapy of infections caused by Chlamydia pneumoniae , 1994, Antimicrobial Agents and Chemotherapy.

[68]  E. Benner,et al.  Superinfections of the lung. An evaluation by serial transtracheal aspirations. , 1974, The Western journal of medicine.

[69]  T. File,et al.  Reevaluation of the definition of Legionnaires' disease: use of the urinary antigen assay. Community Based Pneumonia Incidence Study Group. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[70]  W. Ghali,et al.  The impact of alcohol-related diagnoses on pneumonia outcomes. , 1997, Archives of internal medicine.

[71]  R. Heffron.  Pneumonia, with special reference to pneumococcus lobar pneumonia , 1939 .

[72]  J. Grayston.  Chlamydia pneumoniae, strain TWAR pneumonia. , 1992, Annual review of medicine.

[73]  K. Edwards,et al.  Prevalence and incidence of adult pertussis in an urban population. , 1996, JAMA.

[74]  G. Sarosi,et al.  Azithromycin vs cefuroxime plus erythromycin for empirical treatment of community-acquired pneumonia in hospitalized patients: a prospective, randomized, multicenter trial. , 2000, Archives of internal medicine.

[75]  S M Teutsch,et al.  Trends in infectious diseases mortality in the United States. , 1996, JAMA.

[76]  J. Bullowa,et al.  The Reliability of Sputum Typing and its Relation to Serum Therapy. , 1935 .

[77]  Alimuddin Zumla.  Mandell, Douglas, and Bennett's principles and practice of infectious diseases , 2010, The Lancet Infectious Diseases.

[78]  J E Heffner,et al.  Pleural fluid chemical analysis in parapneumonic effusions. A meta-analysis. , 1995, American journal of respiratory and critical care medicine.

[79]  J P Ornato,et al.  Clinical prediction rule for pulmonary infiltrates. , 1990, Annals of internal medicine.

[80]  E. P. Dellinger,et al.  Purpose of Quality Standards for Infectious Diseases , 1994 .

[81]  P. Edelstein.  Antimicrobial Chemotherapy for Legionnaires Disease: Time for a Change , 1998, Annals of Internal Medicine.

[82]  M. Heidelberger,et al.  PREVENTION OF PNEUMOCOCCAL PNEUMONIA BY IMMUNIZATION WITH SPECIFIC CAPSULAR POLYSACCHARIDES , 1945, The Journal of experimental medicine.

[83]  M. Hammerschlag.  Diagnostic methods for intracellular pathogens. , 1996, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[84]  T. Strine,et al.  Hantavirus pulmonary syndrome: the first 100 US cases. , 1996, The Journal of infectious diseases.

[85]  K. Carroll,et al.  Role of the microbiology laboratory in the diagnosis of lower respiratory tract infections. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[86]  B. Plikaytis,et al.  Antimicrobial resistance of Streptococcus pneumoniae in the United States, 1979-1987. The Pneumococcal Surveillance Working Group. , 1991, The Journal of infectious diseases.

[87]  P. Murray,et al.  Microscopic and baceriologic analysis of expectorated sputum. , 1975, Mayo Clinic proceedings.

[88]  M. Kalin,et al.  Etiological diagnosis of bacterial pneumonia by gram stain and quantitative culture of expectorates. Leukocytes or alveolar macrophages as indicators of sample representativity. , 1983, Scandinavian journal of infectious diseases.

[89]  G. Amsden.  Pneumococcal macrolide resistance--myth or reality? , 1999, The Journal of antimicrobial chemotherapy.

[90]  T. Ng,et al.  Emergence of Fluoroquinolone Resistance among Multiply Resistant Strains of Streptococcus pneumoniae in Hong Kong , 1999, Antimicrobial Agents and Chemotherapy.

[91]  Community-acquired pneumonia in adults in British hospitals in 1982-1983: a survey of aetiology, mortality, prognostic factors and outcome. The British Thoracic Society and the Public Health Laboratory Service. , 1987, The Quarterly journal of medicine.

[92]  D. Deegan.  Prevention of pneumococcal disease. , 1996, World of Irish nursing.

[93]  P. Fernandes,et al.  Comparative in vitro activities of new 14-, 15-, and 16-membered macrolides , 1988, Antimicrobial Agents and Chemotherapy.

[94]  M. Lye,et al.  Clinical prognostic indices of fatality in elderly patients admitted to hospital with acute pneumonia. , 1988, Age and ageing.

[95]  R. Light,et al.  Parapneumonic effusions. , 1980, The American journal of medicine.

[96]  D. Singer,et al.  Safely increasing the proportion of patients with community-acquired pneumonia treated as outpatients: an interventional trial. , 1998, Archives of internal medicine.

[97]  T. Wisborg.  [Fiberoptic bronchoscopy]. , 1988, Ugeskrift for laeger.

[98]  C. Cabellos,et al.  Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain. , 1995, The New England journal of medicine.

[99]  A. Schuchat,et al.  Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997. , 2000, American journal of public health.

[100]  D. Taylor-Robinson.  Infections due to species of Mycoplasma and Ureaplasma: an update. , 1996, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[101]  Sheldon P Stone,et al.  Community-acquired pneumonia , 1998, The Lancet.

[102]  T. Harrison,et al.  A criterion based audit of community-acquired pneumonia. , 1994, Respiratory medicine.

[103]  K. MacDonald,et al.  Community-acquired pneumonia: the future of the microbiology laboratory: focused diagnosis or syndromic management? , 1994, Seminars in respiratory infections.

[104]  D. Greenberg,et al.  Bacteriologic response to oral cephalosporins: are established susceptibility breakpoints appropriate in the case of acute otitis media? , 1997, The Journal of infectious diseases.

[105]  S. Kamholz,et al.  Rapid noninvasive diagnosis of Pneumocystis carinii from induced liquefied sputum. , 1988, Annals of internal medicine.

[106]  J. Steiner,et al.  Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. , 1999, JAMA.

[107]  M. Bergeron,et al.  Sequential antibiotic therapy: Effective cost management and patient care. , 1995, The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses.

[108]  D. Musher,et al.  Pneumococcal vaccine after 15 years of use. Another view. , 1994, Archives of internal medicine.

[109]  J. Bartlett.  Bacteriologic diagnosis in anaerobic pleuropulmonary infections. , 1993, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[110]  R. Adair,et al.  The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. , 1991, The New England journal of medicine.

[111]  H. Goossens,et al.  Relevance of nucleic acid amplification techniques for diagnosis of respiratory tract infections in the clinical laboratory , 1997, Clinical microbiology reviews.

[112]  J. Bartlett.  Anaerobic bacterial pneumonitis. , 1979, The American review of respiratory disease.

[113]  P. Hopewell,et al.  Pneumococcal Disease during HIV Infection , 1992, Annals of Internal Medicine.

[114]  P. Dans,et al.  Management of pneumonia in the prospective payment era. A need for more clinician and support service interaction. , 1984, Archives of internal medicine.

[115]  P. Forsberg,et al.  A new diagnostic approach to the patient with severe pneumonia. , 1989, Scandinavian journal of infectious diseases.

[116]  J. R. Parsons,et al.  Bacteremia With Streptococcus pneumoniae: Implications for Therapy and Prevention , 1996 .

[117]  R. Breiman,et al.  Preventing bacterial respiratory tract infections among persons infected with human immunodeficiency virus. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[118]  M. Fine,et al.  Evaluation of housestaff physicians’ preparation and interpretation of sputum gram stains for communityacquired pneumonia , 1991, Journal of General Internal Medicine.

[119]  S. Schönwald,et al.  Comparison of azithromycin and erythromycin in the treatment of atypical pneumonias. , 1990, The Journal of antimicrobial chemotherapy.

[120]  J. Lentino,et al.  Nonvalue of sputum culture in the management of lower respiratory tract infections , 1987, Journal of clinical microbiology.

[121]  R. Read.  Treating influenza with zanamivir , 1998, The Lancet.

[122]  M. Pfaller,et al.  Prevalence of antimicrobial resistance among respiratory tract isolates of Streptococcus pneumoniae in North America: 1997 results from the SENTRY antimicrobial surveillance program. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[123]  M. Jacobs,et al.  Susceptibility of penicillin-susceptible and -resistant pneumococci to dirithromycin compared with susceptibilities to erythromycin, azithromycin, clarithromycin, roxithromycin, and clindamycin , 1997, Antimicrobial agents and chemotherapy.

[124]  R. Speich,et al.  Shortcomings of chest radiography in detecting Pneumocystis carinii pneumonia. , 1994, Journal of acquired immune deficiency syndromes.

[125]  D. Snydman,et al.  Influence of blood culture results on antibiotic choice in the treatment of bacteremia. , 1994, Archives of internal medicine.

[126]  P. Zwadyk,et al.  The value of the sputum gram's stain in community-acquired pneumonia. , 1982, JAMA.

[127]  Albert Wu,et al.  Comparison of Three Regimens for Treatment of Mild to Moderate Pneumocystis carinii Pneumonia in Patients with AIDS: A Double-Blind, Randomized Trial of Oral Trimethoprim-Sulfamethoxazole, Dapsone-Trimethoprim, and Clindamycin-Primaquine , 1996, Annals of Internal Medicine.

[128]  J. Bartlett,et al.  The triple threat of aspiration pneumonia. , 1975, Chest.

[129]  R. D. Reid,et al.  Prevention of pneumococcal pneumonia by vaccination. , 1976, Transactions of the Association of American Physicians.

[130]  J. Dankert,et al.  Comparison of PCR, Culture, and Serological Tests for Diagnosis of Mycoplasma pneumoniae Respiratory Tract Infection in Children , 1999, Journal of Clinical Microbiology.

[131]  A. Easton,et al.  Evidence that Chlamydia pneumoniae causes pneumonia and bronchitis. , 1993, The Journal of infectious diseases.

[132]  P. Hoeprich.  Etiologic diagnosis of lower respiratory tract infections. , 1970, California medicine.

[133]  J. Steiner,et al.  Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. , 1997, JAMA.

[134]  R. Facklam,et al.  Pneumococcal vaccination. Controversies and opportunities. , 1990, Infectious disease clinics of North America.

[135]  M. Jacobs,et al.  Comparative activities of LY 333328, a new glycopeptide, against penicillin-susceptible and -resistant pneumococci , 1996, Antimicrobial agents and chemotherapy.

[136]  R. Hamm,et al.  Antibiotics and respiratory infections: are patients more satisfied when expectations are met? , 1996, The Journal of family practice.

[137]  G. Castellani,et al.  Community-acquired pneumonia in a cohort of former injection drug users with and without human immunodeficiency virus infection: incidence, etiologies, and clinical aspects. , 1996, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[138]  D. Looke,et al.  Delay in appropriate therapy ofLegionella pneumonia associated with increased mortality , 1996, European Journal of Clinical Microbiology and Infectious Diseases.

[139]  M. Cetron,et al.  The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. , 1995, The New England journal of medicine.

[140]  P. Saikku,et al.  Pneumonia due to Chlamydia pneumoniae: prevalence, clinical features, diagnosis, and treatment. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[141]  S. Jay,et al.  The radiographic resolution of Streptococcus pneumoniae pneumonia. , 1975, The New England journal of medicine.

[142]  A. Ortqvist.  Initial investigation and treatment of the patient with severe community-acquired pneumonia. , 1994, Seminars in respiratory infections.

[143]  T. Marrie,et al.  A positive response to any of seven intradermal antigens predicts favorable outcome in patients hospitalized with community-acquired pneumonia. , 1988, Clinical and investigative medicine. Medecine clinique et experimentale.

[144]  R. Grossman,et al.  AIRWAY INFECTION , 1998, Infectious Disease Clinics of North America.

[145]  Philip K. Russell,et al.  Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. , 2000, JAMA.

[146]  M. Fine,et al.  Quality of care, process, and outcomes in elderly patients with pneumonia. , 1997, JAMA.

[147]  D. Musher,et al.  Bacteremic and Nonbacteremic Pneumococcal Pneumonia A Prospective Study , 2000, Medicine.

[148]  Case definitions for infectious conditions under public health surveillance. Centers for Disease Control and Prevention. , 1997, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[149]  Benjamin A Lipsky,et al.  Diagnosing pneumonia by physical examination: relevant or relic? , 1999, Archives of internal medicine.

[150]  J. Macfarlane,et al.  Comparative radiographic features of community acquired Legionnaires' disease, pneumococcal pneumonia, mycoplasma pneumonia, and psittacosis. , 1984, Thorax.

[151]  M. Fine,et al.  Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. , 1996, JAMA.

[152]  D A Henderson,et al.  The looming threat of bioterrorism. , 1999, Science.

[153]  A. Ortqvist,et al.  Diagnostic fiberoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia. , 1990, Chest.

[154]  D. Singer,et al.  National trends in the use of antibiotics by primary care physicians for adult patients with cough. , 1998, Archives of internal medicine.

[155]  R. Rodríguez-Roisín,et al.  Severe community-acquired pneumonia. Epidemiology and prognostic factors. , 1991, The American review of respiratory disease.

[156]  A. Goldstein.  Acute bronchitis. , 1992, The Journal of family practice.

[157]  B. Ellis,et al.  An outbreak of hantavirus pulmonary syndrome, Chile, 1997. , 1998, Emerging infectious diseases.

[158]  J. Bartlett,et al.  Should fiberoptic bronchoscopy aspirates be cultured? , 2015, The American review of respiratory disease.

[159]  C. Kawakami,et al.  [Rapid diagnostic tests for influenza]. , 2003, Nihon rinsho. Japanese journal of clinical medicine.

[160]  M. Fine,et al.  Comparison of a disease-specific and a generic severity of illness measure for patients with community-acquired pneumonia , 1995, Journal of General Internal Medicine.

[161]  M. Leinonen,et al.  Aetiology, outcome and prognostic factors in community-acquired pneumonia requiring hospitalization. , 1990, The European respiratory journal.

[162]  Julie A. Pavlin,et al.  Medical Management of Biological Casualties Handbook [Third Edition] , 1998 .

[163]  J. Bartlett.  Diagnostic accuracy of transtracheal aspiration bacteriologic studies. , 2015, The American review of respiratory disease.

[164]  P. Edelstein.  Antimicrobial chemotherapy for legionnaires' disease: a review. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[165]  J. Bartlett,et al.  Community‐Acquired Pneumonia: Impact of Immune Status , 1996, American journal of respiratory and critical care medicine.

[166]  N. Joshi,et al.  Doxycycline revisited. , 1997, Archives of internal medicine.

[167]  R. Gleckman,et al.  Sputum gram stain assessment in community-acquired bacteremic pneumonia , 1988, Journal of clinical microbiology.

[168]  A. Mushlin,et al.  Predicting the need for hospitalization of ambulatory patients with pneumonia , 1991, Journal of General Internal Medicine.

[169]  James E. Childs,et al.  Long-term studies of hantavirus reservoir populations in the southwestern United States: rationale, potential, and methods. , 1999, Emerging infectious diseases.

[170]  A. Monto,et al.  Oral rimantadine hydrochloride therapy of influenza A virus H3N2 subtype infection in adults , 1986, Antimicrobial Agents and Chemotherapy.

[171]  T. Quinn,et al.  Prevalence of asymptomatic nasopharyngeal carriage of Chlamydia pneumoniae in subjectively healthy adults: assessment by polymerase chain reaction-enzyme immunoassay and culture. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[172]  H. Dalton,et al.  Transportation delay and the microbiological quality of clinical specimens. , 1975, American journal of clinical pathology.

[173]  M. Utell,et al.  Predictors of mortality in the immunocompromised patient with pulmonary infiltrates. , 1986, Archives of internal medicine.

[174]  A. Henríquez,et al.  Quantitative culture of bronchoalveolar lavage from patients with anaerobic lung abscesses. , 1991, The Journal of infectious diseases.

[175]  I. Suramo,et al.  High-resolution computed tomography for the diagnosis of community-acquired pneumonia. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[176]  R. Wise,et al.  Streptococcus pneumoniae resistance to fluoroquinolones , 1996, The Lancet.

[177]  L. Otth,et al.  Diagnostic fiberoptic bronchoscopy in patients with community-acquired pneumonia. Comparison between bronchoalveolar lavage and telescoping plugged catheter cultures. , 1993, Chest.

[178]  S. Sahn.  Management of complicated parapneumonic effusions. , 1993, The American review of respiratory disease.

[179]  S. Dowell,et al.  Failure of treatment of pneumonia associated with highly resistant pneumococci in a child. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[180]  P. Appelbaum,et al.  Antimicrobial resistance in Streptococcus pneumoniae: an overview. , 1992, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[181]  M. Steinhoff,et al.  Effectiveness of influenza vaccine in health care professionals: a randomized trial. , 1999, JAMA.

[182]  R. Breiman,et al.  Pneumococcal polysaccharide vaccine efficacy. An evaluation of current recommendations. , 1993, JAMA.

[183]  T. File,et al.  A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia , 1997, Antimicrobial agents and chemotherapy.

[184]  R. S. Levy,et al.  Clindamycin compared with penicillin for the treatment of anaerobic lung abscess. , 1983, Annals of internal medicine.

[185]  B. Hjelle,et al.  Hantaviruses: a global disease problem. , 1997, Emerging infectious diseases.

[186]  J. Dorca,et al.  Clindamycin vs penicillin for anaerobic lung infections. High rate of penicillin failures associated with penicillin-resistant Bacteroides melaninogenicus. , 1990, Archives of internal medicine.

[187]  F. Speizer,et al.  Role of infection in chronic bronchitis. , 1975, The New England journal of medicine.

[188]  J. Bartlett,et al.  A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture. , 2015, The American review of respiratory disease.

[189]  Introduction to Table V. Premature deaths, monthly mortality, and monthly physician contacts--United States. , 1982, MMWR. Morbidity and mortality weekly report.

[190]  C. Brambilla,et al.  [Monotherapy using amoxicillin/clavulanic acid as treatment of first choice in community-acquired lung abscess. Apropos of 57 cases]. , 1993, Revue de pneumologie clinique.