Skip to main content

Advertisement

SpringerLink
Log in

Community-acquired pneumonia: An overview

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Community-acquired pneumonia (CAP) accounts for a significant number of hospitalizations and outpatient visits, as well as substantial health care expenditures. CAP is particularly common among the elderly who account for more than 90% of deaths due to pneumonia. Streptococcus pneumoniae is believed to be the most common microbial etiology of CAP, but recent studies suggest that the atypical pathogens may be more common than previously thought, particularly among ambulatory patients. Recent studies have provided data regarding risk of mortality and process of care and outcomes. Increasing resistance among strains of S. pneumoniae has impacted the approach to the empiric therapy of CAP. The Infectious Diseases Society of America published guidelines for the evaluation and management of CAP this past year. Pathogen-specific therapy guided by the results of sputum gram stain and culture is emphasized. Despite enthusiasm for practice guidelines and clinical pathways, there remains insufficient published data to determine their impact on quality and cost of care in patients with CAP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. National Center for Health Statistics: Vital Statistics of the United States, 1989, Vol II: Mortality, Part A. Washington, DC: Public Health Service; 1993. US Dept. of Human and Health Services Publication (PHS) 93-1101.

    Google Scholar 

  2. Marrie TJ: Community-acquired pneumonia. Clin Infect Dis 1994, 18:501–505.

    PubMed  CAS  Google Scholar 

  3. Brown PD, Lerner SA: Community-acquired pneumonia. Lancet 1998, 352:1295–1302.

    Article  PubMed  CAS  Google Scholar 

  4. Marrie TJ, Peeling RW, Fine MJ, et al.: Ambulatory patients with community-acquired pneumonia: the frequency of atypical agents and clinical course. Am J Med 1996, 101:508–515.

    Article  PubMed  CAS  Google Scholar 

  5. Marston BJ, Plouffe JT, File TM, et al.: Incidence of communityacquired pneumonia requiring hospitalization. Arch Intern Med 1997, 157:1709–1718. This is the largest recently published study of CAP incidence and etiology, focusing on patients who require hospitalization. Interesting findings include a higher incidence of atypical pathogens among elderly patients than has been previously reported and the finding that M. pneumoniae was more common than S. pneumoniae. CAP incidence was found to be significantly higher among men that women and among blacks than whites although the reasons for these difference are unclear.

    Article  PubMed  CAS  Google Scholar 

  6. Torres A, Serra-Batiles J, Ferrer A, et al.: Severe communityacquired pneumonia: epidemiology and prognostic factors. Am Rev Respir Dis 1991, 144:312–318.

    PubMed  CAS  Google Scholar 

  7. Moine P, Vercken J, Chevret S, et al.: Severe communityacquired pneumonia: etiology, epidemiology, and prognosis factors. Chest 1994, 105:1487–1495.

    PubMed  CAS  Google Scholar 

  8. Woodhead M. Pneumonia in the elderly. J Antimicrob Chemother 1994, 34(suppl A):85–92.

    PubMed  Google Scholar 

  9. Fine MJ, Smith MA, Carson CA, et al.: Prognosis and outcomes of patients with community-acquired pneumonia. JAMA 1995, 274:134–141.

    Google Scholar 

  10. Lieberman D, Schieffer F, Boldur I, et al.: Multiple pathogens in adult patients admitted with community-acquired pneumonia: a one year prospective study of 346 consecutive patients. Thorax 1996, 51:179–184.

    Article  PubMed  CAS  Google Scholar 

  11. Metlay JP, Kapoor WN, Fine MJ: Does this patient have community-acquired pneumonia? JAMA 1997, 278:1440–1445. This article appeared as part of the JAMA series The Rational Clinical Examination. Metlay and colleagues found very little data of high quality on the accuracy of the clinical assessment of CAP. From four studies which met the criteria for level 1 evidence no single finding or combination of findings from the clinical evaluation consistently excluded or confirmed the diagnosis of CAP. This review of the literature supports the recommendation that chest radiography be done to confirm the diagnosis of CAP in all patients and points to the need for further research on the role of clinical assessment in CAP.

    Article  PubMed  CAS  Google Scholar 

  12. Metlay JP, Schulz R, Li Y, et al.: Influence of age on symptoms at presentation in patents with community-acquired pneumonia. Arch Intern Med 1997, 15:1453–1459.

    Article  Google Scholar 

  13. Riquelme R, Torres A, El-Ebiary M, et al.: Community-acquired pneumonia in the elderly. Am J Respir Crit Care Med 1997, 156:1908–1914.

    PubMed  CAS  Google Scholar 

  14. Bartlett JG, Breiman RF, Mandell LA, et al.: Communityacquired pneumonia in adults: guidelines for management. Clin Infect Dis 1998, 26:811–838. These are the most up to date guidelines for the evaluation and therapy of nonimmunocompromised adults with CAP. The strength of the evidence which supports each recommendation is specified. Pathogen specific therapy utilizing sputum gram stain and culture results is emphasized.

    PubMed  CAS  Google Scholar 

  15. Niederman MS, Bass J, Campbell GD, et al.: Guidelines for the initial management of adults with community acquired pneumonia: diagnosis, assessment of severity and initial antimicrobial therapy. Am Rev Respir Dis 1993, 148:1418–1426.

    PubMed  CAS  Google Scholar 

  16. British Thoracic Society: Guidelines for the management of community-acquired pneumonia in adults admitted to hospital. Br J Hosp Med 1993, 49:346–50.

    Google Scholar 

  17. Mandella LA, Niederman M: The Canadian communityacquired pneumonia consensus conference group. Can J Infect Dis 1993, 4:25–28.

    Google Scholar 

  18. Meehan TP, Fine MJ, Krumble HM, et al.: Quality of care, process and outcomes in elderly patients with pneumonia. JAMA 1997, 278:2080–2084. The incidence of CAP in the elderly is significantly higher than among younger individuals and over 90% of deaths due to CAP occur in elderly patients. In this retrospective cohort study several processes of care were found to be associated with improved survival. The finding that institutions varied widely in the performance of these processes of care suggests that there are opportunities to improve the care of elderly patients with CAP and perhaps reduce mortality.

    Article  PubMed  CAS  Google Scholar 

  19. Schwartz DN, Furumoto-Sawson A, Itokatu GS, et al.: Preventing mismanagement of community-acquired pneumonia at an urban public hospital. Chest 1998, 113:194S-198S.

    PubMed  CAS  Google Scholar 

  20. Reimer LG, Carroll KC: Role of the microbiology laboratory in the diagnosis of lower respiratory tract infections. Clin Infect Dis 1998, 26:742–748. This review includes a discussion of the appropriate use of the clinical microbiology laboratory in the diagnosis of patients with CAP.

    PubMed  CAS  Google Scholar 

  21. Fine MJ, Hough LJ, Medsger AR, et al.: The hospital admission decision for patients with community-acquired pneumonia. Arch Intern Med 1997, 157:36–44.

    Article  PubMed  CAS  Google Scholar 

  22. Fine MJ, Auble TE, Yealy DM, et al.: A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997, 336:243–250. Utilizing data from a large cohort of inpatients with CAP, these investigators derived a prediction rule which classified patients into risk groups with respect to 30-day mortality. The prediction rule was then validated with data from two additional cohorts, including outpatients. Utilization of the prediction rule can assist clinicians in more accurately predicting the risk of mortality from CAP and may help in decisions regarding the need for hospitalization.

    Article  PubMed  CAS  Google Scholar 

  23. Atlas SJ, Benzer TI, Borosky LH, et al.: Safely increasing the proportion of patients with community-acquired pneumonia treated as outpatients. Arch Intern Med 1998, 158:1350–1356.

    Article  PubMed  CAS  Google Scholar 

  24. Gleason PP, Kapoor WN, Stone RA, et al.: Medical outcomes and antimicrobial cost with the use of the American Thoracic Society guidelines for outpatients with community-acquired pneumonia. JAMA 1997, 278:32–39.

    Article  PubMed  CAS  Google Scholar 

  25. Halm EA, Fine MJ, Marrie TJ, et al.: Time to clinical stability in patients hospitalized with community-acquired pneumonia. JAMA 1998, 279:1452–1457.

    Article  PubMed  CAS  Google Scholar 

  26. Rhew DL, 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, 113:146–149.

    Google Scholar 

  27. Gilbert K, Gleason PP, Singer DE, et al.: Variations in antimicrobial use and cost in more than 2,000 patients with community-acquired pneumonia. Am J Med 1998, 104:17–27.

    Article  PubMed  CAS  Google Scholar 

  28. Woolf SH, Do clinical practice guidelines define good medical care? Chest 1998, 113:1665–1715. A thoughtful review of the potential benefits and harms of clinical practice guidelines with recommendations for proper practice guideline development.

    Google Scholar 

  29. Ortqvist A, Hedlund J, Burman L, et al.:Randomized trial of 23-valent pneumococcal capsular polysaccharide vaccine in prevention of pneumonia in middle-aged and elderly people. Lancet 1998, 351:399–403.

    Article  PubMed  CAS  Google Scholar 

  30. Centers for Disease Control and Prevention: Prevention of pneumococcal disease: recommendations at the Advisory Committee on Immunization practices. MMWR 1997, 46:1–24.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center; and Harper Hospital, 4 Yellow Center, 3990 John R., 48201, Detroit, MI, USA

    Mettassebia B. Kanno MD & Patricia D. Brown MD

Authors
  1. Mettassebia B. Kanno MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patricia D. Brown MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kanno, M.B., Brown, P.D. Community-acquired pneumonia: An overview. Curr Infect Dis Rep 1, 49–56 (1999). https://doi.org/10.1007/s11908-999-0010-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-999-0010-x

Keywords

Search

Navigation