Streptococcus pneumoniae: Epidemiology, risk factors, and clinical features

Seminars in Respiratory and Critical Care Medicine

Volumn 26, Issue 6, 2005, Pages 563-574

  Örtqvist, Åke ^a   Hedlund, Jonas ^a   Kalin, Mats ^a  

^a KAROLINSKA UNIVERSITY HOSPITAL   (Sweden)

Author keywords

Epidemiology; Pneumococcal pneumonia; Prevention; Treatment

Indexed keywords

AMOXICILLIN; BETA LACTAM ANTIBIOTIC; CARBAPENEM DERIVATIVE; CEFOTAXIME; CEFTRIAXONE; CEPHALOSPORIN DERIVATIVE; CHLORAMPHENICOL; CLINDAMYCIN; COTRIMOXAZOLE; INFLUENZA VACCINE; LEVOFLOXACIN; LINEZOLID; MACROLIDE; MOXIFLOXACIN; PENICILLIN G; PENICILLIN V; PNEUMOCOCCUS VACCINE; POLYSACCHARIDE VACCINE; PROTEIN POLYSACCHARIDE CONJUGATE VACCINE; QUINOLINE DERIVED ANTIINFECTIVE AGENT; QUINOLONE DERIVATIVE; TELITHROMYCIN; TETRACYCLINE DERIVATIVE; UNCLASSIFIED DRUG; VANCOMYCIN;

ANTIBIOTIC RESISTANCE; ASPLENIA; BLOOD CULTURE; CIGARETTE SMOKING; CLINICAL FEATURE; DRUG EFFICACY; GRAM STAINING; HEART DISEASE; HUMAN; LUNG DISEASE; PENICILLIN RESISTANCE; PRIORITY JOURNAL; REVIEW; RISK FACTOR; SPUTUM CULTURE; STREPTOCOCCUS PNEUMONIA; STREPTOCOCCUS PNEUMONIAE;

DRUG RESISTANCE, BACTERIAL; HUMANS; PNEUMOCOCCAL VACCINES; PNEUMONIA, PNEUMOCOCCAL; RISK ASSESSMENT; RISK FACTORS; STREPTOCOCCAL INFECTIONS; STREPTOCOCCUS PNEUMONIAE;

EID: 30344475502     PISSN: 10693424     EISSN: None     Source Type: Journal    
DOI: 10.1055/s-2005-925523     Document Type: Review

References (140)

1. Austrian R. Some observations on the pneumococcus and on the current status of pneumococcal disease and its prevention. Rev Infect Dis 1981;3(suppl 3):S1-17
2. Austrian R. The pneumococcus at the millennium: not down, not out. J Infect Dis 1999;179(suppl 2):S338-S341
3. Monto AS. Acute respiratory infection in children of developing countries: challenge of the 1990s. Rev Infect Dis 1989;11:498-505
4. Heffron R. Pneumonia: with special reference to pneumococcus lobar pneumonia. A Commonwealth Fund book. Cambridge, MA: The Commonwealth Fund; 1939, reprinted by Harvard University Press 1979
5. Kaiin M, Lindberg AA. Diagnosis of pneumococcal pneumonia: a comparison between microscopic examination of expectorate, antigen detection and cultural procedures. Scand J Infect Dis 1983;15:247-255
6. Burman LA, Norrby R, Trollfors B. Invasive pneumococcal infections: incidence, predisposing factors, and prognosis. Rev Infect Dis 1985;7:133-142
7. Örtqvist A, Hedlund J, Grillner L, et al. Aetiology, outcome and prognostic factors in community-acquired pneumonia requiring hospitalization. Eur Respir J 1990;3:1105-1113
8. Fang GD, Fine M, Orloff J, et al. New and emerging etiologies for community-acquired pneumonia with implications for therapy: a prospective multicenter study of 359 cases. Medicine (Baltimore) 1990;69:307-316
9. Ruiz-Gonzalez A, Falguera M, Nogues 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;106:385-390
10. 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;137:977-988
11. Scott JA, Hall AJ, Dagan R, et al. Serogroup-specific epidemiology of Streptococcus pneumoniae: associations with age, sex, and geography in 7000 episodes of invasive disease. Clin Infect Dis 1996;22:973-981
12. Marrie TJ. Pneumococcal pneumonia: epidemiology and clinical features. Semin Respir Infect 1999;14:227-236
13. Gessner BD, Ussery XT, Parkinson AJ, Breiman RF. Risk factors for invasive disease caused by Streptococcus pneumoniae among Alaska native children younger than two years of age. Pediatr Infect Dis J 1995;14:123-128
14. Takala AK, Jero J, Kela E, Ronnberg PR, Koskenniemi E, Eskola J. Risk factors for primary invasive pneumococcal disease among children in Finland. JAMA 1995;273:859-864
15. Davidson M, Schraer CD, Parkinson AJ, et al. Invasive pneumococcal disease in an Alaska native population, 1980 through 1986. JAMA 1989;261:715-718
16. Breiman RF, Spika JS, Navarro VJ, Darden PM, Darby CP. Pneumococcal bacteremia in Charleston County, South Carolina: a decade later. Arch Intern Med 1990;150:1401-1405
17. Magnus T, Andersen BM. Serotypes and resistance patterns of Streptococcus pneumoniae causing systemic disease in northern Norway. Eur J Clin Microbiol Infect Dis 1995;14:229-234
18. Hedlund J, Svenson SB, Kalin M, et al. Incidence, capsular types, and antibiotic susceptibility of invasive Streptococcus pneumoniae in Sweden. Clin Infect Dis 1995;21:948-953
19. Nielsen SV, Henrichsen J. Incidence of invasive pneumococcal disease and distribution of capsular types of pneumococci in Denmark, 1989-94. Epidemiol Infect 1996;117:411-416
20. Mufson MA, Stanek RJ. Epidemiology of invasive Streptococcus pneumoniae infections and vaccine implications among children in a West Virginia community, 1978-2003. Pediatr Infect Dis J 2004;23:779-781
21. O'Brien KL, Walters MI, Sellman J, et al. Severe pneumococcal pneumonia in previously healthy children: the role of preceding influenza infection. Clin Infect Dis 2000;30:784-789
22. Madhi SA, Klugman KP. A role for Streptococcus pneumoniae in virus-associated pneumonia. Nat Med 2004;10:811-813
23. Hodges RG, MacLeod CM. Epidemic pneumococcal pneumonia V: final consideration of the factors underlying the epidemic. Am J Hyg 1946;44:237-243
24. Musher DM, Groover JE, Reichler MR, et al. Emergence of antibody to capsular polysaccharides of Streptococcus pneumoniae during outbreaks of pneumonia: association with nasopharyngeal colonization. Clin Infect Dis 1997;24:441-446
25. Kalin M. Pneumococcal serotypes and their clinical relevance. Thorax 1998;53:159-162
26. van Dam JE, Fleer A, Snippe H. Immunogenicity and immunochemistry of Streptococcus pneumoniae capsular polysaccharides. Antonie Van Leeuwenhoek 1990;58:1-47
27. Dillard JP, Vandersea MW, Yother J. Characterization of the cassette containing genes for type 3 capsular polysaccharide biosynthesis in Streptococcus pneumoniae. J Exp Med 1995;181:973-983
28. Garcia E, Arrecubieta C, Munoz R, Mollerach M, Lopez R. A functional analysis of the Streptococcus pneumoniae genes involved in the synthesis of type 1 and type 3 capsular polysaccharides. Microb Drug Resist 1997;3:73-88
29. Coffey TJ, Enright MC, Daniels M, et al. Recombinational exchanges at the capsular polysaccharide biosynthetic locus lead to frequent serotype changes among natural isolates of Streptococcus pneumoniae. Mol Microbiol 1998;27:73-83
30. Hermans PW, Sluijter M, Dejsirilert S, et al. Molecular epidemiology of drug-resistant pneumococci: toward an international approach. Microb Drug Resist 1997;3:243-251
31. Nesin M, Ramirez M, Tomasz A. Capsular transformation of a multidrug-resistant Streptococcus pneumoniae in vivo. J Infect Dis 1998;177:707-713
32. Nielsen SV, Henrichsen J. Capsular types of Streptococcus pneumoniae isolated from blood and CSF during 1982-1987. Clin Infect Dis 1992;15:794-798
33. Verhaegen J, Glupczynski Y, Verbist L, et al. Capsular types and antibiotic susceptibility of pneumococci isolated from patients in Belgium with serious infections, 1980-1993. Clin Infect Dis 1995;20:1339-1345
34. Robbins JB, Austrian R, Lee CJ, et al. Considerations for formulating the second-generation pneumococcal capsular polysaccharide vaccine with emphasis on the cross-reactive types within groups. J Infect Dis 1983;148:1136-1159
35. Butler JC, Breiman RF, Campbell JF, Lipman HB, Broome CV, Facklam RR. Pneumococcal polysaccharide vaccine efficacy: an evaluation of current recommendations. JAMA 1993;270:1826-1831
36. Butler JC, Breiman RF, Lipman HB, Hofmann J, Facklam RR. Serotype distribution of Streptococcus pneumoniae infections among preschool children in the United States, 1978-1994: implications for development of a conjugate vaccine. J Infect Dis 1995;171:885-889
37. Peltola H, Booy R, Schmitt HJ. What can children gain from pneumococcal conjugate vaccines? Eur J Pediatr 2004;163:509-516
38. Bruyn GA, Zegers BJ, van Furth R. Mechanisms of host defense against infection with Streptococcus pneumoniae. Clin Infect Dis 1992;14:251-262
39. Henriques Normark B, Kalin M, Örtqvist A, et al. Dynamics of penicillin-susceptible clones in invasive pneumococcal disease. J Infect Dis 2001;184:861-869
40. Gonzalez BE, Hulten KG, Kaplan SL, Mason EO Jr. Clonality of Streptococcus pneumoniae serotype 1 isolates from pediatric patients in the United States. J Clin Microbiol 2004;42:2810-2812
41. Watson DA, Musher DM, Verhoef J. Pneumococcal virulence factors and host immune responses to them. Eur J Clin Microbiol Infect Dis 1995;14:479-490
42. Musher DM, Groover JE, Rowland JM, et al. Antibody to capsular polysaccharides of Streptococcus pneumoniae. prevalence, persistence, and response to revaccination. Clin Infect Dis 1993;17:66-73
43. Hendley JO, Sande MA, Stewart PM, Gwaltney JM Jr. Spread of Streptococcus pneumoniae in families, I: Carriage rates and distribution of types. J Infect Dis 1975;132:55-61
44. Pons JL, Mandement MN, Martin E, et al. Clonal and temporal patterns of nasopharyngeal penicillin-susceptible and penicillin-resistant Streptococcus pneumoniae strains in children attending a day care center. J Clin Microbiol 1996;34:3218-3222
45. Ekdahl K, Ahlinder I, Hansson HB, et al. Duration of nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae: experiences from the South Swedish Pneumococcal Intervention Project. Clin Infect Dis 1997;25:1113-1117
46. Klugman KP, Friedland IR. Antibiotic-resistant pneumococci in pediatric disease. Microb Drug Resist 1995;1:5-8
47. Tomasz A, Corso A, Severina EP, et al. Molecular epidemiologic characterization of penicillin-resistant Streptococcus pneumoniae invasive pediatric isolates recovered in six Latin-American countries: an overview. PAHO/Rockefeller University Workshop. Pan American Health Organization. Microb Drug Resist 1998;4:195-207
48. Klugman KP, Madhi SA, Huebner RE, Kohberger R, Mbelle N, Pierce N. A trial of a 9-valent pneumococcal conjugate vaccine in children with and those without HIV infection. N Engl J Med 2003;349:1341-1348
49. Davidson M, Parkinson AJ, Bulkow LR, Fitzgerald MA, Peters HV, Parks DJ. The epidemiology of invasive pneumococcal disease in Alaska, 1986-1990: ethnic differences and opportunities for prevention. J Infect Dis 1994;170:368-376
50. Sankilampi U, Herva E, Haikala R, Liimatainen O, Renkonen OV, Leinonen M. Epidemiology of invasive Streptococcus pneumoniae infections in adults in Finland. Epidemiol Infect 1997;118:7-15
51. Kalin M, Örtqvist A, Almela M, et al. Prospective study of prognostic factors in community-acquired bacteremic pneumococcal disease in 5 countries. J Infect Dis 2000;182:840-847
52. Örtqvist A, Grepe A, Julander I, Kalin M. Bacteremic pneumococcal pneumonia in Sweden: clinical course and outcome and comparison with non-bacteremic pneumococcal and mycoplasmal pneumonias. Scand J Infect Dis 1988;20:163-171
53. Austrian R, Gold J. Pneumococcal bacteremia with especial reference to bacteremic pneumococcal pneumonia. Ann Intern Med 1964;60:759-776
54. Gransden WR, Eykyn SJ, Phillips I. Pneumococcal bacteraemia: 325 episodes diagnosed at St Thomas's Hospital. Br Med J (Clin Res Ed) 1985;290:505-508
55. Watanakunakorn C, Bailey TA. Adult bacteremic pneumococcal pneumonia in a community teaching hospital, 1992-1996: a detailed analysis of 108 cases. Arch Intern Med 1997;157:1965-1971
56. Lipsky BA, Boyko EJ, Inui TS, Koepsell TD. Risk-factors for acquiring pneumococcal infections. Arch Intern Med 1986;146:2179-2185
57. Nuorti JP, Butler JC, Farley MM, et al. Cigarette smoking and invasive pneumococcal disease. N Engl J Med 2000;342:681-689
58. Bisharat N, Omari H, Lavi I, Raz R. Risk of infection and death among post-splenectomy patients. J Infect 2001;43:182-186
59. Foss Abrahamsen A, Hoiby EA, Hannisdal E, et al. Systemic pneumococcal disease after staging splenectomy for Hodgkin's disease 1969-1980 without pneumococcal vaccine protection: a follow-up study 1994. Eur J Haematol 1997;58:73-77
60. Brayton RG, Stokes PE, Schwartz MS, Louria DB. Effect of alcohol and various diseases on leukocyte mobilization, phagocytosis and intracellular bacterial killing. N Engl J Med 1970;282:123-128
61. Jareo PW, Preheim LC, Gentry MJ. Ethanol ingestion impairs neutrophil bactericidal mechanisms against Streptococcus pneumoniae. Alcohol Clin Exp Res 1996;20:1646-1652
62. Perlino CA, Rimland D. Alcoholism, leukopenia, and pneumococcal sepsis. Am Rev Respir Dis 1985;132:757-760
63. Janoff EN, O'Brien J, Thompson P, et al. Streptococcus pneumoniae colonization, bacteremia, and immune response among persons with human immunodeficiency virus infection. J Infect Dis 1993;167:49-56
64. Hirschtick RE, Glassroth J, Jordan MC, et al. Bacterial pneumonia in persons infected with the human immunodeficiency virus. Pulmonary Complications of HIV Infection Study Group. N Engl J Med 1995;333:845-851
65. Feldman C, Glatthaar M, Morar R, et al. Bacteremic pneumococcal pneumonia in HIV-seropositive and HIV-seronegative adults. Chest 1999;116:107-114
66. Gilks CF, Ojoo SA, Ojoo JC, et al. Invasive pneumococcal disease in a cohort of predominantly HIV-1 infected female sex-workers in Nairobi, Kenya. Lancet 1996;347:718-723
67. Peltola VT, McCullers JA. Respiratory viruses predisposing to bacterial infections: role of neuraminidase. Pediatr Infect Dis J 2004;23(Suppl 1):S87-S97
68. Gross PA, Hermogenes AW, Sacks HS, Lau J, Levandowski RA. The efficacy of influenza vaccine in elderly persons: a meta-analysis and review of the literature. Ann Intern Med 1995;123:518-527
69. Nichol KL, Margolis KL, Wuorenma J, Von Sternberg T. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med 1994;331:778-784
70. Christenson B, Hedlund J, Lundbergh P, Örtqvist A. Additive preventive effect of influenza and pneumococcal vaccines in elderly persons. Eur Respir J 2004;23:363-368
71. Abraham-Van Parijs B. Review of pneumococcal conjugate vaccine in adults: implications on clinical development. Vaccine 2004;22:1362-1371
72. Cornu C, Yzebe D, Leophonte P, Gaillat J, Boissel JP, Cucherat M. Efficacy of pneumococcal polysaccharide vaccine in immunocompetent adults: a meta-analysis of randomized trials. Vaccine 2001;19:4780-4790
73. Dear K, Holden J, Andrews R, Tatham D. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev 2003;(4):CD000422
74. Fine MJ, Smith MA, Carson CA, et al. Efficacy of pneumococcal vaccination in adults: a meta-analysis of randomized controlled trials. Arch Intern Med 1994;154:2666-2677
75. Hutchison BG, Oxman AD, Shannon HS, Lloyd S, Altmayer CA, Thomas K. Clinical effectiveness of pneumococcal vaccine: meta-analysis. Can Fam Physician 1999;45:2381-2393
76. Melegaro A, Edmunds WJ. The 23-valent pneumococcal polysaccharide vaccine, I: Efficacy of PPV in the elderly: a comparison of meta-analyses. Eur J Epidemiol 2004;19:353-363
77. Moore RA, Wiffen PJ, Lipsky BA. Are the pneumococcal polysaccharide vaccines effective? Meta-analysis of the prospective trials. BMC Fam Pract 2000;1:1
78. Watson L, Wilson BJ, Waugh N. Pneumococcal polysaccharide vaccine: a systematic review of clinical effectiveness in adults. Vaccine 2002;20:2166-2173
79. Austrian R, Douglas RM, Schiffman G, et al. Prevention of pneumococcal pneumonia by vaccination. Trans Assoc Am Physicians 1976;89:184-194
80. Smit P, Oberholzer D, Hayden-Smith S, Koornhof HJ, Hilleman MR. Protective efficacy of pneumococcal polysaccharide vaccines. JAMA 1977;238:2613-2616
81. Honkanen PO, Keistinen T, Miettinen L, et al. Incremental effectiveness of pneumococcal vaccine on simultaneously administered influenza vaccine in preventing pneumonia and pneumococcal pneumonia among persons aged 65 years or older. Vaccine 1999;17:2493-2500
82. Örtqvist A, Hedlund J, Burman LA, et al. Randomised trial of 23-valent pneumococcal capsular polysaccharide vaccine in prevention of pneumonia in middle-aged and elderly people. Swedish Pneumococcal Vaccination Study Group. Lancet 1998;351:399-403
83. Shapiro ED, Berg AT, Austrian R, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med 1991;325:1453-1460
84. Jackson LA, Neuzil KM, Yu OC, et al. Effectiveness of pneumococcal polysaccharide vaccine in older adults. N Engl J Med 2003;348:1747-1755
85. Nichol KL, Baken L, Wuorenma J, Nelson A. The health and economic benefits associated with pneumococcal vaccination of elderly persons with chronic lung disease. Arch Intern Med 1999;159:2437-2442
86. Hedlund J, Christenson B, Lundbergh P, Örtqvist A. Effects of a large-scale intervention with influenza and 23-valent pneumococcal vaccines in elderly people: a 1-year follow-up. Vaccine 2003;21:3906-3911
87. Breiman RF, Keller DW, Phelan MA, et al. Evaluation of effectiveness of the 23-valent pneumococcal capsular polysaccharide vaccine for HIV-infected patients. Arch Intern Med 2000;160:2633-2638
88. French N, Nakiyingi J, Carpenter LM, et al. 23-valent pneumococcal polysaccharide vaccine in HIV-1-infected Ugandan adults: double-blind, randomised and placebo controlled trial. Lancet 2000;355:2106-2111
89. Lucero M, Dulalia V, Parreno R, et al. Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and pneumonia with consolidation on x-ray in children under two years of age. Cochrane Database Syst Rev 2004;(4):CD004977
90. Black SB, Shinefield HR, Ling S, et al. Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than five years of age for prevention of pneumonia. Pediatr Infect Dis J 2002;21:810-815
91. Whitney CG, Farley MM, Hadler J, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003;348:1737-1746
92. Marfin AA, Sporrer J, Moore PS, Siefkin AD. Risk factors for adverse outcome in persons with pneumococcal pneumonia. Chest 1995;107:457-462
93. Torres JM, Cardenas O, Vasquez A, Schlossberg D. Streptococcus pneumoniae bacteremia in a community hospital. Chest 1998;113:387-390
94. Marrie TJ. Pneumonia in the elderly. Curr Opin Pulm Med 1996;2:192-197
95. Metlay JP, Schulz R, Li YH, et al. Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med 1997;157:1453-1459
96. Berk SL. Bacterial pneumonia in the elderly: the observations of Sir William Osler in retrospect. J Am Geriatr Soc 1984;32:683-685
97. Brandenburg JA, Marrie TJ, Coley CM, et al. Clinical presentation, processes and outcomes of care for patients with pneumococcal pneumonia. J Gen Intern Med 2000;15:638-646
98. Mufson MA. Pneumococcal infections. JAMA 1981;246:1942-1948
99. Tilghman RC, Finland M. Clinical significance of bacteremia in pneumococcic pneumonia. Arch Intern Med 1937;59:602-619
100. Mufson MA, Kruss DM, Wasil RE, Metzger WI. Capsular types and outcome of bacteremic pneumococcal disease in the antibiotic era. Arch Intern Med 1974;134:505-510
101. Örtqvist A, Kalin M, Julander I, Mufson MA. Deaths in bacteremic pneumococcal pneumonia: a comparison of two populations-Huntington, WVa, and Stockholm, Sweden. Chest 1993;103:710-716
102. Murphy TF, Sethi S. Bacterial infection in chronic obstructive pulmonary disease. Am Rev Respir Dis 1992;146:1067-1083
103. Kalin M. Bacteremic pneumococcal pneumonia: value of culture of nasopharyngeal specimens and examination of washed sputum specimens. Eur J Clin Microbiol 1982;1:394-396
104. Krantz I, Alestig K, Trollfors B, Zackrisson G. The carrier state in pertussis. Scand J Infect Dis 1986;18:121-123
105. Bartlett JG, Dowell SF, Mandell LA, File TM Jr, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis 2000;31:347-382
106. BTS Guidelines for the Management of Community Acquired Pneumonia in Adults. Thorax 2001;56(Suppl 4):IV1-64
107. Bohte R, Hermans J, van den Broek PJ. Early recognition of Streptococcus pneumoniae in patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 1996;15:201-205
108. Farr BM, Kaiser DL, Harrison BD, Connolly CK. Prediction of microbial aetiology at admission to hospital for pneumonia from the presenting clinical features. British Thoracic Society Pneumonia Research Subcommittee. Thorax 1989;44:1031-1035
109. Musher DM. Infections caused by Streptococcus pneumoniae: clinical spectrum, pathogenesis, immunity, and treatment. Clin Infect Dis 1992;14:801-807
110. Ort S, Ryan JL, Barden G, D'Esopo N. Pneumococcal pneumonia in hospitalized patients: clinical and radiological presentations. JAMA 1983;249:214-218
111. Örtqvist A, Hedlund J, Wretlind B, Carlstrom A, Kalin M. Diagnostic and prognostic value of interleukin-6 and C-reactive protein in community-acquired pneumonia. Scand J Infect Dis 1995;27:457-462
112. Light RW, Girard WM, Jenkinson SG, George RB. Parapneumonic effusions. Am J Med 1980;69:507-512
113. Macfarlane JT, Miller AC, Roderick Smith WH, Morris AH, Rose DH. Comparative radiographic features of community acquired Legionnaires' disease, pneumococcal pneumonia, mycoplasma pneumonia, and psittacosis. Thorax 1984;39:28-33
114. Shann F. Etiology of severe pneumonia in children in developing countries. Pediatr Infect Dis 1986;5:247-252
115. Steinum O, Alestig K, Brorson JE. Culture from epipharynx of little value in bacterial pneumonia. Scand J Infect Dis 1987;19:309-312
116. Davidson M, Tempest B, Palmer DL. Bacteriologic diagnosis of acute pneumonia: comparison of sputum, transtracheal aspirates, and lung aspirates. JAMA 1976;235:158-163
117. Örtqvist A, Kalin M, Lejdeborn L, Lundberg B. Diagnostic fiberoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia. Chest 1990;97:576-582
118. Garcia-Vazquez E, Marcos MA, Mensa J, et al. Assessment of the usefulness of sputum culture for diagnosis of community-acquired pneumonia using the PORT predictive scoring system. Arch Intern Med 2004;164:1807-1811
119. Madison JM, Irwin RS. Expectorated sputum for community-acquired pneumonia: a sacred cow. Arch Intern Med 2004;164:1725-1727
120. Musher DM. Gram stain and culture of sputum to diagnose bacterial pneumonia. J Infect Dis 1985;152:1096
121. Marrie TJ. Community-acquired pneumonia. Clin Infect Dis 1994;18:501-513
122. Musher DM, Montoya R, Wanahita A. Diagnostic value of microscopic examination of Gram-stained sputum and sputum cultures in patients with bacteremic pneumococcal pneumonia. Clin Infect Dis 2004;39:165-169
123. Farrington M, Rubenstein D. Antigen detection in pneumococcal pneumonia. J Infect 1991;23:109-116
124. Venkatesan P, Macfarlane JT. Role of pneumococcal antigen in the diagnosis of pneumococcal pneumonia. Thorax 1992;47:329-331
125. Murdoch DR, Laing RT, Mills GD, et al. Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia. J Clin Microbiol 2001;39:3495-3498
126. Ishida T, Hashimoto T, Arita M, Tojo Y, Tachibana H, Jinnai M. A 3-year prospective study of a urinary antigen-detection test for Streptococcus pneumoniae in community-acquired pneumonia: utility and clinical impact on the reported etiology. J Infect Chemother 2004;10:359-363
127. Dowell SF, Garman RL, Liu G, Levine OS, Yang YH. Evaluation of Binax NOW, an assay for the detection of pneumococcal antigen in urine samples, performed among pediatric patients. Clin Infect Dis 2001;32:824-825
128. Hedlund J, Örtqvist A, Kalin M. Nasopharyngeal culture in the pneumonia diagnosis. Infection 1990;18:283-285
129. Taylor SN, Sanders CV. Unusual manifestations of invasive pneumococcal infection. Am J Med 1999;107 (suppl 1A):12S-27S
130. Pallares R, Gudiol F, Linares J, et al. Risk factors and response to antibiotic therapy in adults with bacteremic pneumonia caused by penicillin-resistant pneumococci. N Engl J Med 1987;317:18-22
131. Kaplan SL, Mason EO Jr. Management of infections due to antibiotic-resistant Streptococcus pneumoniae. Clin Microbiol Rev 1998;11:628-644
132. Garau J. Clinical perspectives on the management of community-acquired pneumonia. Diagn Microbiol Infect Dis 1996;25:205-211
133. Chen DK, McGeer A, de Azavedo JC, Low DE. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. Canadian Bacterial Surveillance Network. N Engl J Med 1999;341:233-239
134. Ho PL, Que TL, Tsang DN, Ng TK, Chow KH, Seto WH. Emergence of fluoroquinolone resistance among multiply resistant strains of Streptococcus pneumoniae in Hong Kong. Antimicrob Agents Chemother 1999;43:1310-1313
135. Davidson R, Cavalcanti R, Brunton JL, et al. Resistance to levofloxacin and failure of treatment of pneumococcal pneumonia. N Engl J Med 2002;346:747-750
136. Mandell LA, Marrie TJ, Grossman RF, Chow AW, Hyland RH. 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
137. Niederman MS, Mandell LA, Anzueto A, et al. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001;163:1730-1754
138. Waterer GW, Somes GW, Wunderink RG. Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia. Arch Intern Med 2001;161:1837-1842
139. Martinez 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;36:389-395
140. Baddour LM, Yu VL, Klugman KP, et al. Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med 2004;170:440-444