Community-acquired Pneumonia in North American Emergency Departments: Drug Resistance and Treatment Success with Clarithromycin

Rowe, Brian H.; Campbell, Sam; Boudreaux, Edwin D.; Colman, Ian; Abu‐Laban, Riyad B.; Sivilotti, Marco L.A.; Clark, Sunday; Camargo, Carlos A.

doi:10.1197/j.aem.2007.02.026

Cited by 2 publications

(4 citation statements)

References 17 publications

(25 reference statements)

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“…Other commonly identifi ed pathogens included H infl uenzae, Moraxella catarrhalis, Staphylococcus aureus, and Gram-negative rods. 17,18,21,44,45,51,54,63,66,68 Few studies have examined the microorganisms responsible for CAP in outpatients. Sputum cultures, the primary diagnostic tool, are generally positive in only about one-third of outpatients treated for CAP.…”

Section: Microbiological Etiology and Resistance Patternsmentioning

confidence: 99%

“…18,45,51,77 In isolates obtained from outpatients with CAP, approximately 10% to 20% were penicillin resistant, and 20% to 30% were macrolide resistant. 63,66 While these fi gures provide insight into the extent of pneumococcal resistance, it is important to recognize that there is geographic variability in these resistance patterns, even within small geographic areas of North America. 78 It is also important to note that in January 2008, the Clinical and Laboratory Standards Institute published new higher penicillin breakpoints for nonmeningeal infections due to S pneumoniae.…”

Section: Microbiological Etiology and Resistance Patternsmentioning

confidence: 99%

“…Some studies have reported no deaths in adults treated for CAP on an outpatient basis. [60][61][62][63] Length of Stay Another outcome frequently reported in studies of patients hospitalized for CAP is LOS. Based on the NHDS, the average LOS for pneumonia discharges in 2006 was 5 days in those aged 15 to 44 years and 45 to 64 years and 5.6 days in those aged Ն 65 years.…”

Section: Mortalitymentioning

confidence: 99%

“…Most studies examining the etiology of CAP (Table 3) 17,18,45,51,63,66 have been conducted in hospitalized patients and mainly relied on blood and sputum cultures and Legionella urinary antigen assays to identify organisms. 17,18,44,45,54 In general, an organism was identifi ed in less than half of hospitalized patients, and more commonly in ICU patients than in ward patients.…”

Section: Microbiological Etiology and Resistance Patternsmentioning

confidence: 99%

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Burden of Community-Acquired Pneumonia in North American Adults

File¹,

Marrie²

2010

Postgraduate Medicine

403

277

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To determine the burden of community-acquired pneumonia (CAP) affecting adults in North America, a comprehensive literature review was conducted to examine the incidence, morbidity and mortality, etiology, antibiotic resistance, and economic impact of CAP in this population. In the United States, there were approximately 4.2 million ambulatory care visits for pneumonia in 2006. Pneumonia and influenza continue to be a common cause of death in the United States (ranked eighth) and Canada (ranked seventh). In 2005, there were>60,000 deaths due to pneumonia in persons aged>or=15 years in the United States alone. The hospitalization rate for all infectious diseases increased from 1525 hospitalizations per 100 000 persons in 1998 to 1667 per 100 000 persons in 2005. Admission to an intensive care unit was required in 10% to 20% of patients hospitalized with pneumonia. The mean length of stay for pneumonia was >or=5 days and the 30-day rehospitalization rate was as high as 20%. Mortality was highest for CAP patients who were hospitalized; the 30-day mortality rate was as high as 23%. All-cause mortality for CAP patients was as high as 28% within 1 year. Streptococcus pneumoniae continues to be the most frequently identified pathogen associated with CAP, and pneumococcal resistance to antimicrobials may make treatment more difficult. The economic burden associated with CAP remains substantial at >$17 billion annually in the United States. Despite the availability and widespread adherence to recommended treatment guidelines, CAP continues to present a significant burden in adults. Furthermore, given the aging population in North America, clinicians can expect to encounter an increasing number of adult patients with CAP. Given the significance of the disease burden, the potential benefit of pneumococcal vaccination in adults is substantial.

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