Comparison of community-acquired pneumonia due to methicillin-resistant and methicillin-susceptible Staphylococcus aureus producing the Panton-Valentine leukocidin

International Journal of Tuberculosis and Lung Disease

Volumn 13, Issue 12, 2009, Pages 1476-1485

  Vardakas, K Z ^a,b   Matthaiou, D K ^a,b   Falagas, Matthew E ^a,c  

^a ALFA INSTITUTE OF BIOMEDICAL SCIENCES AIBS   (Greece)

^b G GENNIMATAS GENERAL HOSPITAL   (Greece)

^c TUFTS UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

Mortality; Pneumonia; S. aureus

Indexed keywords

ANTIINFECTIVE AGENT; METICILLIN; PANTON VALENTINE LEUKOCIDIN;

CLINICAL FEATURE; COMMUNITY ACQUIRED PNEUMONIA; DRUG SENSITIVITY; HUMAN; MEDICAL LITERATURE; METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS; MORTALITY; PRIORITY JOURNAL; REVIEW; TREATMENT OUTCOME; VIRUS CULTURE;

ANIMALS; ANTI-BACTERIAL AGENTS; BACTERIAL TOXINS; COMMUNITY-ACQUIRED INFECTIONS; EXOTOXINS; FEMALE; HUMANS; LEUKOCIDINS; MALE; METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS; MICROBIAL SENSITIVITY TESTS; PNEUMONIA, STAPHYLOCOCCAL; PROGNOSIS; STAPHYLOCOCCUS AUREUS;

EID: 74949123904     PISSN: 10273719     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (97)

1. Groom A V, Wolsey D H, Naimi T S, et al. Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA 2001; 286: 1201-1205.
2. Purcell K, Fergie J. Epidemic of community-acquired methicillin-resistant Staphylococcus aureus infections: a 14-year study at Driscoll Children's Hospital. Arch Pediatr Adolesc Med 2005; 159: 980-985.
3. Zetola N, Francis J S, Nuermberger E L, Bishai W R. Community-acquired methicillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infect Dis 2005; 5: 275-286.
4. Gosbell I B. Epidemiology, clinical features and management of infections due to community methicillin-resistant Staphylococcus aureus (cMRSA). Intern Med J 2005; 35 (Suppl 2): S120-S135.
5. Athanassa Z, Siempos I I, Falagas M E. Impact of methicillin resistance on the mortality of S. aureus VAP: a systematic review. Eur Respir J 2008; 31: 625-632.
6. Wang J L, Chen S Y, Wang G T, et al. Comparison of both clinical features and mortality risk associated with bacteremia due to community-acquired methicillin-resistant Staphylococcus aureus and methicillin-susceptible S. aureus. Clin Infect Dis 2008; 46: 799-806.
7. Abraham J, Mansour C, Veledar E, Khan B, Lerakis S. Staphylococcus aureus bacteremia and endocarditis: the Grady Memorial Hospital experience with methicillin-sensitive S. aureus and methicillin-resistant S. aureus bacteremia. Am Heart J 2004; 147: 536-539.
8. Fowler V G Jr, Miro J M, Hoen B, et al.; ICE Investigators. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 2005; 293: 3012-3021.
9. Gillet Y, Vanhems P, Lina G, Bes M, Vandenesch F, Floret D, Etienne J. Factors predicting mortality in necrotizing community-acquired pneumonia caused by Staphylococcus aureus containing Panton-Valentine leukocidin. Clin Infect Dis 2007; 45: 315-321.
10. Gillet Y, Issartel B, Vanhems P, et al. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet 2002; 359: 753-759.
11. Lina G, Piémont Y, Godail-Gamot F, et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999; 29: 1128-1132.
12. Centers for Disease Control and Prevention. Community-associated methicillin-resistant Staphylococcus aureus infections in Pacific Islanders - Hawaii, 2001-2003. MMWR 2004; 53 (RR-33): 767-770.
13. Baldwin L N, Lowe A D. Panton-Valentine leukocidin associated with community acquired methicillin resistant Staphylococcus aureus: a case report and review of interim guidelines. Anaesthesia 2008; 63: 764-766.
14. Ebert M D, Sheth S, Fishman E K. Necrotizing pneumonia caused by community-acquired methicillin-resistant Staphylococcus aureus: an increasing cause of 'mayhem in the lung'. Emerg Radiol 2009; 16: 159-162.
15. Ho P L, Wong M P, Lai E L, Chan K H, Chiu S S. DNA typing of cytological samples for retrospective identification of an early case of Panton-Valentine leucocidin-positive, community-associated methicillin-resistant Staphylococcus aureus pneumonia. J Clin Micobiol 2008; 46: 2457-2458.
16. Ito T, Iijima M, Fukushima T, et al. Pediatric pneumonia death caused by community-acquired methicillin-resistant Staphylococcus aureus, Japan. Emerg Infect Dis 2008; 14: 1312-1314.
17. Tong S Y, Anstey N M, Lum G D, Lilliebridge R A, Stephens D P, Currie B J. Fatal community-associated methicillin-resistant Staphylococcus aureus pneumonia after influenza. Med J Aust 2008; 188: 61.
18. Valentini P, Parisi G, Monaco M, et al. An uncommon presentation for a severe invasive infection due to methicillin-resistant Staphylococcus aureus clone USA300 in Italy: a case report. Ann Clin Microbiol Antimicrob 2008; 7: 11.
19. Yee-Guardino S, Kumar D, Abughali N, Tuohy M, Hall G S, Kumar M L. Recognition and treatment of neonatal community-associated MRSA pneumonia and bacteremia. Pediatr Pulmonol 2008; 43: 203-205.
20. Adam H, McGeer A, Simor A. Fatal case of post-influenza, community-associated MRSA pneumonia in an Ontario teenager with subsequent familial transmission. Can Commun Dis Rep 2007; 33: 45-48.
21. Agwu A, Brady K M, Ross T, Carroll K C, Halsey N A. Cholera-like diarrhea and shock associated with community-acquired methicillin-resistant Staphylococcus aureus (USA400 clone) pneumonia. Pediatr Infect Dis J 2007; 26: 271-273.
22. Balis E, Diacaki C, Tselioti P, et al. Community-acquired pneumonia and bacteremia due to methicillin-resistant Staphylococcus aureus carrying Panton-Valentine-leukocidin gene in Greece: two case reports and literature review. J Chemother 2007; 19: 703-708.
23. Magira E E, Zervakis D, Routsi C, et al. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: a lethal cause of pneumonia in an adult immunocompetent patient. Scand J Infect Dis 2007; 39: 466-469.
24. Nourse C, Starr M, Munckhof W. Community-acquired methicillin-resistant Staphylococcus aureus causes severe disseminated infection and deep venous thrombosis in children: literature review and recommendations for management. J Paediatr Child Health 2007; 43: 656-661.
25. Quadri A M, Hock Y L. Pulmonary pathology of Panton-Valentine leukocidin gene carrying methicillin-resistant Staphylococcus aureus pneumonia. Histopathology 2007; 51: 712-713.
26. Risson D C, O'Connor E D, Guard R W, Schooneveldt J M, Nimmo G R. A fatal case of necrotising pneumonia due to community-associated methicillin-resistant Staphylococcus aureus. Med J Aust 2007; 186: 479-480.
27. Tronci M, Parisi G, Pantosti A, et al. CA-MRSA strain with decreased vancomycin susceptibility as a cause of serious invasive infection in an immunocompetent adolescent. Clin Microbiol Infect 2007; 13 (Suppl 1): S449.
28. Vayalumkal J V, Whittingham H, Vanderkooi O, et al. Necrotizing pneumonia and septic shock: suspecting CA-MRSA in patients presenting to Canadian emergency departments. CJEM 2007; 9: 300-303.
29. Enayet I, Nazeri A, Johnson L B, Riederer K, Pawlak J, Saravolatz L D. Community-associated methicillin-resistant Staphylococcus aureus causing chronic pneumonia. Clin Infect Dis 2006; 42: e57-e60.
30. Fortunov R M, Hulten K G, Hammerman W A, Mason E O, Kaplan S L. Community-acquired Staphylococcus aureus infections in term and near-term previously healthy neonates. Pediatrics 2006; 118: 874-881.
31. Garnier F, Tristan A, François B, et al. Pneumonia and new methicillin-resistant Staphylococcus aureus clone. Emerg Infect Dis 2006; 12: 498-500.
32. Gerogianni I, Mpatavanis G, Gourgoulianis K, Maniatis A, Spiliopoulou I, Petinaki E. Combination of staphylococcal chromosome cassette SCCmec type V and Panton-Valentine leukocidin genes in a methicillin-resistant Staphylococcus aureus that caused necrotizing pneumonia in Greece. Diagn Microbiol Infect Dis 2006; 56: 213-216.
33. Hampson F G, Hancock S W, Primhak R A. Disseminated sepsis due to a Panton-Valentine leukocidin producing strain of community acquired methicillin-resistant Staphylococcus aureus and use of intravenous immunoglobulin therapy. Arch Dis Child 2006; 91: 201.
34. Jeyaratnam D, Reid C, Kearns A, Klein J. Community associated MRSA: an alert to paediatricians. Arch Dis Child 2006; 91: 511-512.
35. Jones T F, Creech C B, Erwin P, Baird S G, Woron A M, Schaffner W. Family outbreaks of invasive community-associated methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2006; 42: e76-e78.
36. Söderquist B, Berglund C, Strålin K. Community-acquired pneumonia and bacteremia caused by an unusual methicillin-resistant Staphylococcus aureus (MRSA) strain with sequence type 36, staphylococcal cassette chromosome mec type IV and Panton-Valentine leukocidin genes. Eur J Clin Microbiol Infect Dis 2006; 25: 604-606.
37. Adem P V, Montgomery C P, Husain A N, et al. Staphylococcus aureus sepsis and the Waterhouse-Friderichsen syndrome in children. N Engl J Med 2005; 353: 1245-1251.
38. Conly J, Gilbert M, Zahang K, et al. Rapidly progressive fatal necrotizing pneumonitis (FNP) secondary to Panton-Valentine leukocidin (PVL)+ SCCmec type IVa community-acquired methicillin-resistant S. aureus (CAMRSA) - a harbinger of the future? Can J Infect Dis Med Microbiol 2005; 16: 109-110.
39. Francis J S, Doherty M C, Lopatin U, et al. Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes. Clin Infect Dis 2005; 40: 100-107.
40. Frazee B W, Salz T O, Lambert L, Perdreau-Remington F. Fatal community-associated methicillin-resistant Staphylococcus aureus pneumonia in an immunocompetent young adult. Ann Emerg Med 2005; 46: 401-404.
41. Gonzalez B E, Martinez-Aguilar G, Hulten K G, et al. Severe staphylococcal sepsis in adolescents in the era of community-acquired methicillin-resistant Staphylococcus aureus. Pediatrics 2005; 115: 642-648.
42. Hsu L Y, Tristan A, Koh T H, et al. Community-associated methicillin-resistant Staphylococcus aureus, Singapore. Emerg Infect Dis 2005; 11: 341-342.
43. Kravitz G R, Dries D J, Peterson M L, Schlievert P M. Purpura fulminans due to Staphylococcus aureus. Clin Infect Dis 2005; 40: 941-947.
44. Martin B T, Palasanthiran P, Gosbell I B, Barbagiannakos T, Best E J, Henry R L. Severe childhood pneumonitis caused by the Queensland strain of community-acquired methicillin-resistant Staphylococcus aureus. Med J Aust 2005; 182: 249.
45. McAdams R M, Mazuchowski E, Ellis M W, Rajnik M. Necrotizing staphylococcal pneumonia in a neonate. J Perinatol 2005; 25: 677-679.
46. Monaco M, Antonucci R, Palange P, Venditti M, Pantosti A. Methicillin-resistant Staphylococcus aureus necrotizing pneumonia. Emerg Infect Dis 2005; 11: 1647-1648.
47. Micek S T, Dunne M, Kollef M H. Pleuropulmonary complications of Panton-Valentine leukocidin-positive community-acquired methicillin-resistant Staphylococcus aureus: importance of treatment with antimicrobials inhibiting exotoxin production. Chest 2005; 128: 2732-2738.
48. Peleg A Y, Munckhof W J, Kleinschmidt S L, Stephens A J, Huygens F. Life-threatening community-acquired methicillin-resistant Staphylococcus aureus infection in Australia. Eur J Clin Microbiol Infect Dis 2005; 24: 384-387.
49. Torell E, Molin D, Tano E, Ehrenborg C, Ryden C. Community-acquired pneumonia and bacteraemia in a healthy young woman caused by methicillin-resistant Staphylococcus aureus (MRSA) carrying the genes encoding Panton-Valentine leukocidin (PVL). Scand J Infect Dis 2005; 37: 902-904.
50. Tseng M H, Wei B H, Lin W J. Fatal sepsis and necrotizing pneumonia in a child due to community-acquired methicillin-resistant Staphylococcus aureus: case report and literature review. Scand J Infect Dis 2005; 37: 504-507.
51. Miklaševics E, Hæggman S, Balode A. Report on the first PVL-positive community acquired MRSA strain in Latvia. Euro Surveill 2004; 9: 29-30.
52. Peleg A Y, Munckhof W J. Fatal necrotising pneumonia due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA). Med J Aust 2004; 181: 228-229.
53. Boussaud V, Parrot A, Mayaud C. Life-threatening hemoptysis in adults with community-acquired pneumonia due to Panton-Valentine leukocidin-secreting Staphylococcus aureus. Intensive Care Med 2003; 29: 1840-1843.
54. Mongkolrattanothai K, Boyle S, Kahana M D, Daum R S. Severe Staphylococcus aureus infections caused by clonally related community-acquired methicillin-susceptible and methicillin-resistant isolates. Clin Infect Dis 2003; 37: 1050-1058.
55. van der Flier M, van Dijk N B, Fluit A C, Fleer A, Wolfs T F, van Gestel J P. [Fatal pneumonia in an adolescent due to community-acquired MRSA positive for Panton-Valentine-leukocidin]. Ned Tijdschr Geneeskd 2003; 147: 1076-1079. [Dutch]
56. Dufour P, Gillet Y, Bes M, et al. Community-acquired methicillin- resistant Staphylococcus aureus infections in France: emergence of a single clone that produces Panton-Valentine leukocidin. Clin Infect Dis 2002; 35: 819-824.
57. Descloux E, Mohammedi I, Gillet Y, François B, Etienne J. [Necrotizing pneumonia in an adult due to methicillin-resistant Staphylococcus aureus producing Panton-Valentine leukocidin]. Reanimation 2007; 16: 256-258. [French]
58. Teglia O, Gregorini E, Notario R, Fay F, Casellas J M. [Community-acquired methicillin-resistant Staphylococcus aureus]. Rev Med Rosario 2007; 73: 76-81. [Spanish]
59. Luque Moreno A, Duran Núñez A, Bergadà Masó A, Frick A, Gallés C. [Community-acquired, methicillin-resistant Staphylococcus aureus acute osteomyelitis and pneumonia]. An Pediatr (Barc) 2008; 68: 373-376. [Spanish]
60. Barrios M, Alcolea A, Negreira S, Chaves F. [Necrotizing pneumonia due to community-acquired methicillin resistant Staphylococcus aureus in a pediatric patient]. Enferm Infecc Microbiol Clin 2008; 26: 398-399. [Spanish]
61. Laporte-Turpin E, Marcoux M O, et al. Necrotizing pneumonia and arthritis due to Staphylococcus aureus producing Panton and Valentine leukocidin in a 10-year-old boy. Arch Pediatr 2006; 13: 449-452.
62. Beilouny B, Ciupea A, Eloy C, Simon G. Fatal community-acquired pneumonia due to Staphylococcus aureus carrying Panton-Valentine leukocidin genes after a stay in Africa. Intensive Care Med 2008; 34: 388-389.
63. Mushtaq F, Hildrew S, Okugbeni G, Ellis R W. Necrotizing haemorrhagic pneumonia proves fatal in an immunocompetent child due to Panton-Valentine leucocidin, toxic shock syndrome toxins 1 and 2 and enterotoxin C-producing Staphylococcus aureus. Acta Paediatr 2008; 97: 985-987.
64. Roberts J C, Gulino S P, Peak K K, Luna V A, Sanderson R. Fatal necrotizing pneumonia due to a Panton-Valentine leukocidin positive community-associated methicillin-sensitive Staphylococcus aureus and influenza co-infection: a case report. Ann Clin Microbiol Antimicrob 2008; 7: 5.
65. van Nieuwkoop C, Bernards A T, Compier E A, Kraemer C V, Visser L G. [Community-acquired Staphylococcus aureus pneumonia following influenza and the choice of empirical antibiotic treatment]. Ned Tijdschr Geneeskd 2008; 152: 822-826. [Dutch]
66. Chetchotisakd P, Anunnatsiri S, Puapermpoonsiri S, Prariyachatgul C, Chumpol J. A rapidly fatal case of Panton-Valentine leukocidin positive SA necrotizing pneumonia in an HIV-infected patient. Southeast Asian J Trop Med Public Health 2007; 38: 690-694.
67. Elizur A, Orscheln R C, Ferkol T W, Dunne W M Jr, Storch G A, Cannon C L. Transmission of Panton-Valentine leukocidin-positive Staphylococcus aureus between patients with cystic fibrosis. J Pediatr 2007; 151: 90-92.
68. Hyvernat H, Pulcini C, Carles D. Fatal Staphylococcus aureus haemorrhagic pneumonia producing Panton-Valentine leucocidin. Scand J Infect Dis 2007; 39: 183-185.
69. Schefold J C, Esposito F, Storm C, et al. Therapy-refractory Panton Valentine leukocidin-positive community-acquired methicillin-sensitive Staphylococcus aureus sepsis with progressive metastatic soft tissue infection: a case report. J Med Case Reports 2007; 1: 165.
70. Laifer G, Frei R, Adler H, Fluckiger U. Necrotising pneumonia complicating a nasal furuncle. Lancet 2006; 367: 1628.
71. Moumile K, Cadilhac C, Lina G, Berche P, Glorion C, Ferroni A. Severe osteoarticular infection associated with Panton-Valentine leukocidin-producing Staphylococcus aureus. Diagn Microbiol Infect Dis 2006; 56: 95-97.
72. Salliot C, Zeller V, Puechal X, et al. Panton-Valentine leukocidin-producing Staphylococcus aureus infections: report of 4 French cases. Scand J Infect Dis 2006; 38: 192-195.
73. Swaminathan A, Massasso D, Gotis-Graham I, Gosbell I. Fulminant methicillin-sensitive Staphylococcus aureus infection in a healthy adolescent, highlighting Panton-Valentine leucocidin syndrome. Intern Med J 2006; 36: 744-747.
74. Alonso-Tarrés C, Villegas M L, de Gispert F J, et al. Favorable outcome of pneumonia due to Panton-Valentine leukocidin-producing Staphylococcus aureus associated with hematogenous origin and absence of flu-like illness. Eur J Clin Microbiol Infect Dis 2005; 24: 756-759.
75. Chalumeau M, Bidet P, Lina G, et al. Transmission of Panton-Valentine leukocidin - producing Staphylococcus aureus to a physician during resuscitation of a child. Clin Infect Dis 2005; 41: e29-e30.
76. Hsu L Y, Koh T H, Anantham D, Kurup A, Chan K P, Tan B H. Panton-Valentine leukocidin-positive Staphylococcus aureus, Singapore. Emerg Infect Dis 2004; 10: 1509-1510.
77. Klein J L, Petrovic Z, Treacher D, Edgeworth J. Severe community-acquired pneumonia caused by Panton-Valentine leukocidin-positive Staphylococcus aureus: first reported case in the United Kingdom. Intensive Care Med 2003; 29: 1399.
78. Miyashita T, Shimamoto Y, Nishiya H, et al. Destructive pulmonary embolism in a patient with community-acquired staphylococcal bacteremia. J Infect Chemother 2002; 8: 99-102.
79. Le Thomas I, Mariani-Kurkdjian P, Collignon A, et al. Breast milk transmission of a Panton-Valentine leukocidin-producing Staphylococcus aureus strain causing infantile pneumonia. J Clin Microbiol 2001; 39: 728-729.
80. Honarpour N, Mao J T. A case of fatal community-acquired necrotizing pneumonia caused by panton-valentine leukocidin positive methicillin-sensitive Staphylococcus aureus. Curr Resp Med Rev 2007; 3: 49-51.
81. Hörnig-Franz I, Kahl B C, Tebbe W, et al. [Necrotising pneumonia caused by Staphylococcus aureus (pvl gene positive). Lethal pneumonia in a 12 year old immunocompetent female]. Mon Kind 2007; 155 (Suppl): S10-S15. [German]
82. Torbin E, Andersson O, Kasemo A U, et al. PVL-positiva Staph aureus gav nekrotiserande pneumoni. Lakartidningen 2007; 7: 509-513. [Swedish]
83. US Centers for Disease Control and Prevention. Severe methicillin-resistant Staphylococcus aureus community-acquired pneumonia associated with influenza - Louisiana and Georgia, December 2006-January 2007. MMWR 2007; 56 (RR-14): 325-329.
84. Rubinstein E, Kollef M H, Nathwani D. Pneumonia caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2008; 46 (Suppl 5): S378-S385.
85. Labandeira-Rey M, Couzon F, Boisset S, et al. Staphylococcus aureus Panton-Valentine leukocidin causes necrotizing pneumonia. Science 2007; 315: 1130-1133.
86. Miller L G, Perdreau-Remington F, Bayer A S, et al. Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation. Clin Infect Dis 2007; 44: 471-482.
87. Fine M J, Auble T E, Yealy D M, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336: 243-250.
88. Lim W S, van der Eerden M M, Laing R, et al. Defining community-acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58: 377-382.
89. Houck P M, Bratzier D W, Nsa W, Ma A, Bartlett J G. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004; 164: 637-644.
90. Meehan T P, Fine M J, Krumholz H M, et al. Quality of care, process, and outcomes in elderly patients with pneumonia. JAMA 1997; 278: 2080-2084.
91. Siempos I I, Vardakas K Z, Kopterides P, Falagas M E. Adjunctive therapies for community acquired pneumonia: a systematic review. J Antimicrob Chemother 2008; 62: 661-668.
92. Kuint J, Barzilai A, Regev-Yochay G, Rubinstein E, Keller N, Maayan-Metzger A. Comparison of community-acquired methicillin-resistant Staphylococcus aureus bacteremia to other staphylococcal species in a neonatal intensive care unit. Eur J Pediatr 2007; 166: 319-325.
93. Kaplan S L, Hulten K G, Gonzalez B E, et al. Three-year surveillance of community-acquired Staphylococcus aureus infections in children. Clin Infect Dis 2005; 40: 1785-1791.
94. Fowler V G Jr, Olsen M K, Corey G R, et al. Clinical identifiers of complicated Staphylococcus aureus bacteremia. Arch Intern Med 2003; 163: 2066-2072.
95. Baddour L M, Yu V L, Klugman K P, et al.; International Pneumococcal Study Group. Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med 2004; 170: 440-444.
96. Waterer G W, Somes G W, Wunderink R G. Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia. Arch Intern Med 2001; 161: 1837-1842.
97. Martinez J A, Horcajada J P, Almela M, et al. Addition of a macrolide to a b-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.