Severe Community-Acquired Pneumonia

  • Miguel Gallego
  • Jordi Rello


Pneumonia remains a common illness and a major cause of morbidity and mortality in the United States. In 1995, 82,900 deaths were caused by pneumonia [1]. The incidence of community-acquired pneumonia (CAP) is about 2 to 4/1000 persons/year, about 20% of whom require hospitalization [2].


Respir Crit Severe Pneumonia Pneumococcal Pneumonia Noninvasive Ventilation Protected Specimen Brush 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    US Department of Commerce, Bureau of the Census: Statistical Abstract of the United States, edn 118. Washington, DC, US Government Printing Office, 1998.Google Scholar
  2. 2.
    Ewing S, Torres A. Severe community-acquired pneumonia. Clin Chest Med 20:575, 1999.CrossRefGoogle Scholar
  3. 3.
    American Thoracic Society. Guidelines for the initial management of adults with community-acquired pneumonia: Diagnosis, assessment of severity and initial antimicrobial therapy. Am Rev Respir Dis 148:1418, 1993.CrossRefGoogle Scholar
  4. 4.
    European study on community-acquired pneumonia (ESOCAP) committee. Guidelines for management of adult community-acquired lower respiratory tract infections. Eur Respir J 11:986, 1998.CrossRefGoogle Scholar
  5. 5.
    Torres A, El-Ebiary M, Zavala E, Hernández C. Severe community-acquired pneumonia. Sem Respir Crit Care Med 17:265, 1996.CrossRefGoogle Scholar
  6. 6.
    Vallés J. Severe pneumonia: sources of infection and implications for prevention. Sepsis 1:199, 1998.CrossRefGoogle Scholar
  7. 7.
    Research Committee of the British Thoracic Society and the Public Health Laboratory Service. Community acquired pneumonia in adults in British hospitals in 1982–83: a survey of aetiology, mortality, prognostic factors and outcome. QJMed 62:195, 1987.Google Scholar
  8. 8.
    Ewig S, Ruiz M, Mensa J, Marcos M Angeles, Martínez JA, Arancibia F, et al. Severe community-acquired pneumonia: assessment of severity criteria. Am J Respir Crit Care Med 158:1102, 1998.PubMedCrossRefGoogle Scholar
  9. 9.
    Hirani NA, Macfarlane JT. Impact of management guidelines on the outcome of severe community acquired pneumonia. Thorax 52:17, 1997.PubMedCrossRefGoogle Scholar
  10. 10.
    Woodhead MA, Macfarlane JT, Rodgers FG, Laverick A, Pilkington R, Macrae AD. Etiology and outcome of severe community-acquired pneumonia. J Infect 10:204, 1985.PubMedCrossRefGoogle Scholar
  11. 11.
    Rello J, Valles J, Jubert P, Ferrer A, Domingo C, Mariscal D, et al. Lower respiratory tract infections following cardiac arrest and cardiopulmonary resucitacion. Clin Infect Dis 21:310, 1995.PubMedCrossRefGoogle Scholar
  12. 12.
    Pachón J, Prado MD, Capote F, Cuello JA, Garnacho J, Verano A. Severe community acquired pneumonia. Etiology, prognosis and treatment. Am Rev Respir Dis 142:369, 1990.PubMedCrossRefGoogle Scholar
  13. 13.
    Torres A, Serra-Batlles J, Ferrer A, Jimenez P, Celis R, Cobo E, et al. Severe community acquired pneumonia. Epidemiology and prognostic factors. Am Rev Respir Dis 114:312, 1991.CrossRefGoogle Scholar
  14. 14.
    Rello J, Quintana E, Ausina V, Net A, Prats G. A three-year study of severe community acquired pneumonia with emphasis in outcome. Chest 103:232, 1993.PubMedCrossRefGoogle Scholar
  15. 15.
    Moine P, Vercken JB, Chevret S, Chastang C, Gajdos P, and the French Study Group for Community-acquired Pneumonia in Intensive Care Unit. Severe community-acquired pneumonia. Etiology, epidemiology and prognosis factors. Chest 105:1487, 1994.PubMedCrossRefGoogle Scholar
  16. 16.
    Leroy O, Santré C, Beuscart C, Georges H, Guery B, Jacquier JM, et al. A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit. Intensive Care Med 21:24, 1995.PubMedCrossRefGoogle Scholar
  17. 17.
    Rello J, Rodriguez R, Jubert P, Alvarez B and the Study Group of Severe Community-acquired Pneumonia. Severe community-acquired pneumonia in the elderly: epidemiology and prognosis. Clin Infect Dis 23:723, 1996.PubMedCrossRefGoogle Scholar
  18. 18.
    Grau I, Pallarés R. Neumonía neumocócica. En Infecciones Graves. Implicaciones terapeúticas de la Neumonía Extrahospitalaria Grave. Ed. Edika Med 1:17, 1988.Google Scholar
  19. 19.
    El-Ebiary M, Sarmiento X, Torres A, Nogué S, Mesalles E, Bodí M, et al. Prognostic factors of severe Legionella Pneumonia requiring admission to ICU. Am J Respir Crit Care Med 156:1467, 1997.PubMedCrossRefGoogle Scholar
  20. 20.
    Menéndez R, Córdoba J, de la Cuadra P, Cremades MJ, López-Hontagas JL, Salavert M, et al. Value of the polymerase chain reaction assay in noninvasive respiratory samples for diagnosis of community-acquired pneumonia. Am J Respir Crit Care Med 159:1868, 1999.PubMedCrossRefGoogle Scholar
  21. 21.
    Leeper KV, Torres A. Community-acquired pneumonia in the intensive care unit. Clin Chest Med 16:155, 1995.PubMedGoogle Scholar
  22. 22.
    Vanders Els NJ, Stover DE. Approach to the patient with pulmonary disease. Clin Chest Med 17:767, 1996.CrossRefGoogle Scholar
  23. 23.
    Barlett JG, Dowell SF, Mandell LA, File TM, Musher DM, Fine MS. Community-acquired pneumonia in adults: Practice guidelines for the management. Clin Infect Dis 31:347, 2000.CrossRefGoogle Scholar
  24. 24.
    Domínguez J, Gali N, Pedroso P, Hernández A, Matas L, Manterola, et al. Evaluacion del Binax Nowtm Legionella urinary antigen test para la detección del antígeno de Legionella en muestras de orina. Estudio preliminar. [Abstract] Arch Bronconeumol 35:46, 1993.Google Scholar
  25. 25.
    Antonelli M, Conti G, Riccioni L, Meduri U. Noninvasive positive-pressure ventilation via face mask during bronchoscopy with BAL in high-risk hypoxemic patients. Chest 110:724, 1996.PubMedCrossRefGoogle Scholar
  26. 26.
    Jiménez P, Saldías F, Meneses M, Silva ME, Wilson MG, Otth L. Diagnostic fiberoptic bronchoscopy in patients with community-acquired pneumonia. Comparison between bronchoalveolar lavage and telescoping plugged catheter cultures. Chest 103:1023, 1993.PubMedCrossRefGoogle Scholar
  27. 27.
    Vivés L, Biel P, Maler G, Labonne F, Lecoules N, Dufour M, et al. Acute community-acquired pneumonia of moderate and grave severity investigated by bronchoscopy. Analysis of 193 cases hospitalized in a general hospital. Rev Mai Respir 13:175, 1996.Google Scholar
  28. 28.
    Örtqvist A, Kalin M, Lejdeborn L, Lundberg B. Diagnostic fiberoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia. Chest 97:576, 1990.PubMedCrossRefGoogle Scholar
  29. 29.
    Zalacaín R, Llorente JL, Gaztelurrutia L, Pijoan JL, Sobradillo V. Influence of three factors on the diagnosis effectiveness of transthoracic needle aspiration in pneumonia. Chest 107:96, 1995.PubMedCrossRefGoogle Scholar
  30. 30.
    García A, Rosón B, Pérez JL, Verdaguer R, Dorca J, Carratalà J, et al. Usefulness of PCR and antigen latex agglutination test with samples obtained by transthoracic needle aspiration for diagnosis of pneumococcal pneumonia. J Clin Microbiol 37:709, 1993.Google Scholar
  31. 31.
    Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS, Weissfeld LA, et al. Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA 275:134, 1996.PubMedCrossRefGoogle Scholar
  32. 32.
    Mufson MA, Oley G, Hughey D. Pneumococcal disease in a medium-sized community in the United States. JAMA 248:1486, 1982.PubMedCrossRefGoogle Scholar
  33. 33.
    Marrie TJ. Epidemiology of community-acquired pneumonia in the elderly. Semin Respir Infect 5:260, 1990.PubMedGoogle Scholar
  34. 34.
    Riquelme R, Torres A, El-Ebiary M, Puig de la Bellacasa J, Estruch R, Mensa J, et al. Community-acquired pneumonia in the elderly. A multivariate analysis of risk and prognostic factors. Am J Respir Crit Care Med 154:1450, 1996.PubMedCrossRefGoogle Scholar
  35. 35.
    Almirall J, Morato I, Riera A, Verdaguer A, Priu R, Coll P, et al. Incidence of community-acquired pneumonia and Chlamydia pneumoniae infection: a prospective multicenter study. Eur Respir J 6:14, 1993.PubMedGoogle Scholar
  36. 36.
    Lange P, Vestbo J, Nyboe J. Risk factors for death and hospitalization from pneumonia. A prospective study of a general population. Eur Respir J 8:1694, 1995.PubMedCrossRefGoogle Scholar
  37. 37.
    Torres A, Dorca J, Zalacain R, Bello S, El-Ebiary M, Molinos L, et al. Community-acquired pneumonia in chronic obstructive pulmonary disease. A Spanish Multicenter Study. Am J Respir Crit Care Med 154:1456, 1996.PubMedCrossRefGoogle Scholar
  38. 38.
    Seneff MG, Wagner DP, Wagner RD, Zimmerman JE, Knaus WA. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA 274:1852, 1995.PubMedCrossRefGoogle Scholar
  39. 39.
    Almirall J, Mesalles E, Klamburg J, Parra O, Agudo A. Prognostic factors of pneumonia requiring admission to the intensive care unit. Chest 107:511, 1995.PubMedCrossRefGoogle Scholar
  40. 40.
    Mundy LM, Auwaerter PG, Oldach D, Warner ML, Burton A, Vance E, et al. Community-acquired pneumonia: Impact of immune status. Am J Respir Crit Care Med 152:1309, 1995.PubMedCrossRefGoogle Scholar
  41. 41.
    Hirschtick RE, Glassroth J, Jordan MC, Wilcosky TC, Wallace JM, Kvale PA, and the Pulmonary Complications of HIV infection study group. Bacterial pneumonia in persons infected with the human immunodeficiency virus. N Engl J Med 333:845, 1995.PubMedCrossRefGoogle Scholar
  42. 42.
    Carratalà J, Rosón B, Fernández Sevilla A, Alcaide F, Gudiol F. Bacteriemic pneumonia in neutropenic patients with cancer: causes, empirical antibiotic therapy, and outcome. Arch Intern Med 158:868, 1998.PubMedCrossRefGoogle Scholar
  43. 43.
    Marfín AA, Sporrer J, Moore PS, Siefkin AD. Risk factors for adverse outcome in persons with pneumococcal pneumonia. Chest 107:457,1995.PubMedCrossRefGoogle Scholar
  44. 44.
    Meehan TP, Fine MJ, Krumholz HM, Scinto JD, Galusha DH, Mockalis JT, et al. Quality of care, process, and outcome in elderly patients with pneumonia. JAMA 278:2080, 1997.PubMedCrossRefGoogle Scholar
  45. 45.
    Confalonieri M, Potena A, Carbone G, Delia Porta R, Tolley EA, Meduri GU. Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care 160:1585, 1999.CrossRefGoogle Scholar
  46. 46.
    Antonelli M, Conti G, Rocco M, Bufi M, De Blasi RA, Vivino G, et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med 339:429, 1998.PubMedCrossRefGoogle Scholar
  47. 47.
    The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301, 2000.CrossRefGoogle Scholar
  48. 48.
    Rello J. Therapy for severe community-acquired pneumonia. Clin Infect Dis 25:160, 1997.CrossRefGoogle Scholar
  49. 49.
    Cantón R, Loza E, Valdezate S, Baquero F. Otros patógenos respiratorios de la comunidad and nuevas fluorquinolonas. Enf Infec Microbiol Clin 16(Supl.):12, 1998.Google Scholar
  50. 50.
    Martín M, Gómez-Lus ML, Aguilar L, Martínez P, Giménez MJ, Prieto J. Effect of clavulanic acid and/or polymorphonuclear neutrophils on amoxicillin bactericidal activity against Streptococcus pneumoniae. Eur J Clin Microbiol Infect Dis 16:512, 1997.PubMedCrossRefGoogle Scholar
  51. 51.
    Liñares J, Pallarés R, Alonso T, Pérez JL, Ayats J, Gudiol F, et al. Trends in antimicrobial resistance of clinical isolates of Streptococcus pneumoniae in Bellvitge Hospital, Barcelona, Spain (1979–1990). Clin Infect Dis 15:99, 1992.PubMedCrossRefGoogle Scholar
  52. 52.
    Gallego M, Rello J. Neumonia extrahospitalaria grave. Arch Bronchoneumol 36(suppl 4):6l, 2000.Google Scholar
  53. 53.
    Schülin T, Wennersten CB, Ferraro MJ, Moellering RC, Eliopoulos GM. Susceptibilities of Legionella spp. to newer antimicrobials in vitro. Antimicrob Agents Chemother 42:1520, 1998.PubMedGoogle Scholar
  54. 54.
    Clavo AJ, Girón JA, López D, Canueto J, Sanchez A, Vergara A, et al. Multivariate analysis of risk factors for infection due to penicillin-resistant and multidrug-resistant Streptococcus pneumoniae: a multicenter study. Clin Infect Dis 24:1062, 1997.Google Scholar
  55. 55.
    Pallarés R, Liñares J, Vadillo M, Cabellos C, Manresa F, Viladrich P, et al. Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain. N Engl J Med 333:474, 1995.PubMedCrossRefGoogle Scholar
  56. 56.
    Einarsson S, Kristjanson M, Kristinsson K, Kjartansson G, Johnsson S. Pneumonia cause by penicillin-non-susceptible and penicillin-susceptible pneumococci in adults: a case-control study. Scand J Infect Dis 30:253, 1998.PubMedCrossRefGoogle Scholar
  57. 57.
    Ewing S, Ruiz M, Torres A, Marco F, Martinez JA, Sanchez M, et al. Pneumonia acquired in the community through drug-resistant Streptococcus pneumoniae. Am J Respir Crit Care Med 159:1835, 1999.CrossRefGoogle Scholar
  58. 58.
    Metlay JP, Hofmann J, Cetron MS, Fine MJ, Farley MM, Whitney C, et al. Impact of penicillin susceptibility on medical outcomes for adult patients with bacteremic pneumococcal pneumonia. Clin Infect Dis 30:520, 2000.PubMedCrossRefGoogle Scholar
  59. 59.
    Bodí M, Ardanuy C, Rello J. Resistant Gram positive cocci as cause of respiratory infection in crtically ill patients. Crit Care Med 29(In Suppl.):N82, 2001.PubMedCrossRefGoogle Scholar
  60. 60.
    Rello J, Bodí M, Díaz E. Appropiate antibiotic therapy for Staphylococcal pneumonia (letter). Clin Infect Dis 31:1314, 2000.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Miguel Gallego
  • Jordi Rello

There are no affiliations available

Personalised recommendations