title: The bacterial pneumonias: a new treatment paradigm.
abstract: Pneumonia is a common disease that carries a high mortality. Traditionally, pneumonia has been classified and treated according to the setting where the pneumonia develops, namely community-acquired pneumonia, health-care-associated pneumonia, and hospital-acquired pneumonia. This classification was based on the risk of a patient being infected with a hospital-acquired drug-resistant pathogen. A new treatment paradigm has been proposed based on the risk of the patient being infected with a community-acquired drug-resistant pathogen. The risk factors for infection with a community-acquired drug-resistant pathogen include (1) hospitalization for > 2 days during the previous 90 days, (2) antibiotic use during the previous 90 days, (3) nonambulatory status, (4) tube feeds, (5) immunocompromised status, (6) use of acid-suppressive therapy, (7) chronic hemodialysis during the preceding 30 days, (8) positive methicillin-resistant Staphylococcus aureus history within the previous 90 days, and (9) present hospitalization > 2 days. This article reviews this new treatment paradigm and other issues relevant to the diagnosis and management of pneumonia based on information from MEDLINE, EMBASE, and the Cochrane Register of Controlled Trials.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School , Norfolk, VA , USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Marik
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015415:Biomarkers; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016867:Immunocompromised Host; D009980:Influenza A virus; D007251:Influenza, Human / Q000453:epidemiology; D055624:Methicillin-Resistant Staphylococcus aureus; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D005765:Gastrointestinal Agents
keywords: Pneumonia; community-acquired pneumonia; drug-resistant pathogen; gram-negative bacteria; health-care–associated pneumonia; hospital-associated pneumonia