[QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Brundage JF, Shanks GD. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Intensive Care Med. Tularemia as a biological weapon: medical and public health management. The Pneumonia Severity Index (PSI) score determined illness severity. Blood cultures should be obtained before the administration of antibiotics. 2009 Feb. 30(1):16-25. The https:// ensures that you are connecting to the Disclosure and Conflict of Interest: The authors have no conflicts of interest to disclose, financial or otherwise. Note that cavitation and associated pleural effusions are also observed in cases of anaerobic infections, gram-negative infections, and tuberculosis. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International cohort study results. doi: 10.1128/cmr.00015-22. [QxMD MEDLINE Link]. The primary outcomes included bacteremia, multidrug-resistant organism bacteremia, and appropriate management changes attributed to culture results, stratified by pneumonia classification (nonsevere community-acquired pneumonia, severe community-acquired pneumonia, or health care-associated pneumonia) and likelihood the bacteremia was due to pneumonia vs another infection. Introduction: Vertebral osteomyelitis and discitis in adults. Kobayashi M, Bennett NM, Gierke R, Almendares O, Moore MR, Whitney CG, et al. False-positive BC rates can be substantial. The site is secure. Kung HC, Hoyert DL, Xu JQ, Murphy SL, and the Division of Vital Statistics. The lung is heavy, boggy, and red. Even in pneumococcal pneumonia, the results are often negative. [QxMD MEDLINE Link]. 26 (11):594-599. The chest radiograph shows bilateral opacities with a predominantly peripheral distribution. The contribution of blood cultures to the clinical management of adult patients admitted to the hospital with community-acquired pneumonia: a prospective observational study. 2017 Nov 2;13(11):2742-2750. doi: 10.1080/21645515.2017.1371381. This site needs JavaScript to work properly. 169(16):1515-24. Sepsis is a substantial global health burden and is the leading cause of death among adults in intensive care units (ICUs). Flowchart indicating derivation of the study sample. Pneumonia - Diagnosis | NHLBI, NIH Prospective surveillance of . 1999 Jul 26. [QxMD MEDLINE Link]. Procalcitonin and C reactive protein in hospitalised adult patients with community acquired pneumonia, exacerbation of asthma and chronic obstructive pulmonary disease. 2017 Sep;140(3):e20171013. [Full Text]. 1993 Dec 22-29. 2005 May. 374(9700):1543-56. MMWR Morb Mortal Wkly Rep. 2015 Sep 4. Battula V, Krupanandan RK, Nambi PS, Ramachandran B. HHS Vulnerability Disclosure, Help Pokhrel B, Koirala T, Gautam D, Kumar A, Camara BS, Saw S, Daha SK, Gurung S, Khulal A, Yadav SK, Baral P, Gurung M, Shrestha S. Trop Med Infect Dis. Unauthorized use of these marks is strictly prohibited. 15(1):R32. However, as many as 30% of infections are not caused by serogroup 1 organisms. official website and that any information you provide is encrypted The following laboratory tests may not be useful for diagnostic purposes but are useful for classifying illness severity and site-of-care/admission decisions The utility of this practice is unknown. Bronchopneumonia, also known as multifocal or lobular pneumonia, is radiographically identified by its patchy appearance with peribronchial thickening and poorly defined air-space opacities. Gram stain showing Haemophilus influenzae. Blood cultures are recommended for patients admitted to the hospital for community-acquired pneumonia (CAP). 2017 Jan 23. Available at http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm. This condition can occasionally manifest as a round opacity stimulating a pulmonary mass, called round pneumonia. 64(7):598-603. sharing sensitive information, make sure youre on a federal eCollection 2022. Sputum Gram stain and culture should be performed before initiating antibiotic therapy (if a good-quality, contaminant-sparse specimen containing < 10 squamous epithelial cells per low-power field can be obtained). What Are the 4 Stages of Pneumonia? Gaynes R, Edwards JR. Overview of nosocomial infections caused by gram-negative bacilli. [QxMD MEDLINE Link]. Aims of blood culture: To confirm presence of microorganisms in the bloodstream Pathogenesis, treatment, and prevention of pneumococcal pneumonia. Brown SM, Jones BE, Jephson AR, Dean NC. Invasive pneumococcal (Streptococcus pneumoniae) infections and The presence of a parapneumonic pleural fluid can have important therapeutic implications. An official website of the United States government. Cillniz C, Ewig S, Polverino E, Marcos MA, Esquinas C, Gabarrs A, et al. Accessed: January 13, 2011. BMC Infect Dis. doi: 10.1001/jamanetworkopen.2020.2899. Other changes included 13 patients who discontinued macrolide therapy after antibiotic sensitivities were determined. The white blood cell (WBC) count should be more than 25 per low-power field in non-immunosuppressed patients. 63 (5):575-82. 64 (34):944-7. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Demographics, treatment, microbiologic results, and outcomes were examined. [New predictive models of bacteremia in the emergency department: a step forward]. JAMA Netw Open. Blood culture; Diagnostic test; Guideline; Hospital medicine; Incidence; Pneumonia. [Full Text]. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Routine blood cultures in pneumonia have extremely low yield and utility irrespective of severity and risk. Torres A, Cillniz C, Ferrer M, Gabarrs A, Polverino E, Villegas S, Marco F, Mensa J, Menndez R, Niederman M. Eur Respir J. Peleg AY, Hooper DC. The typical lung inflammatory response to the atypical bacteria results in an interstitial picture. 2005 May. 2009 Feb. 30(1):61-6. [QxMD MEDLINE Link]. Eggimann P, Pittet D. Infection control in the ICU. 2022 Dec 19;13:1048997. doi: 10.3389/fmicb.2022.1048997. Available at http://www.medscape.com/viewarticle/850564. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. 2 Traditionally, blood cultures (BCs) have been a routine part of the diagnostic investigation of this disease, and have been considered mandatory by some authors. 198(7):962-70. Typically, air bronchograms are absent. 2021 Dec 7;11(12):2287. doi: 10.3390/diagnostics11122287. N Engl J Med. Patient demographics, initial antibiotic choices, culture results in regards to antibiotic sensitivity, modifications in treatment based on blood culture results, complications and outcomes were noted in the charts. Oral decontamination techniques and ventilator-associated pneumonia. Meta-analysis showed that the overall prevalence of positive BCs was 5.14% (95% confidence interval 3.61-7.28). However, this technique has a high false-negative rate. Bookshelf The major downsides of obtaining blood cultures include their low diagnostic yield and the low degree of certainty that results improve clinical outcomes. 1996 Jul. Routine blood culture collection was formerly recommended by the IDSA/ATS guidelines issued in 2000 and by the Centers for Medicare and Medicaid Services (CMS) as a core performance measure for community-acquired pneumonia, 1,3-5 which led to a rapid rise in obtaining blood cultures in patients hospitalized with pneumonia or suspected . Models to predict resistance are derived from blood and respiratory culture results. [QxMD MEDLINE Link]. What Are the Stages of Pneumonia? - Verywell Health Imaging infection. N Engl J Med. 2009 Feb. 37(2):456-62. The Author(s) 2019. Early goal-directed therapy in the treatment of severe sepsis and septic shock. It is a serious infection in which the air sacs fill with pus and other liquid. 2008 Feb 14. Zhang B, Chen X, Yao X, Li M, Li Z, Liu B, Liu S, Liu Z, Huo J, Han Y. 2003 Apr;123(4):1142-50. doi: 10.1378/chest.123.4.1142. The alphabet soup of pneumonia: CAP, HAP, HCAP, NHAP, and VAP. 2017 Jun 8. Healthcare-associated atypical pneumonia. Prevalence of Antibiotic-Resistant Pathogens in Culture-Proven Sepsis and Outcomes Associated With Inadequate and Broad-Spectrum Empiric Antibiotic Use. Chest radiograph shows a vague, ill-defined opacity in the left lower lobe. 1985 Oct. 13(10):818-29. The role of computed tomography (CT) scanning in the diagnosis of pneumonia is not yet well defined. Clin Microbiol Rev. Crit Care Med. Blood Cultures in Pneumonia Feb 17, 2014 | Infectious Disease, Pulmonary By: Andrew Grock, MD A 75 year old woman is found to have pneumonia. In S aureus pneumonia, lobar enlargement with bulging of interlobular fissures can be seen in severe cases. Corbo J, Friedman B, Bijur P, Gallagher EJ. Best Clinical Practice: Blood Culture Utility in the Emergency MMWR Morb Mortal Wkly Rep. 2014 Sep 19. Marik PE. Antimicrobial Therapy for Bacterial Pneumonia, http://pda.ahrq.gov/clinic/psi/psicalc.asp, http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm, http://www.medscape.com/viewarticle/850564, https://pneumonia.org.au/public/journals/22/PublicFolder/ABSTRACTBOOKMASTERforwebupdated20-3-14.pdf, American Association for Bronchology and Interventional Pulmonology, American College of Critical Care Medicine, Association of Pulmonary and Critical Care Medicine Program Directors, World Association for Bronchology and Interventional Pulmonology, American Association for Respiratory Care, American College of Osteopathic Emergency Physicians, American Medical Student Association/Foundation, American College of Physicians-American Society of Internal Medicine, Royal College of Physicians and Surgeons of Canada. doi: 10.1001/jamanetworkopen.2019.5172. Given the level of evidence presented, these conclusions are likely to be reliable. Pathologically, bronchopneumonia stems from inflammation of large airways (bronchitis) with patchy (lobular) involvement. Over a two-year period, 1,805 patients were admitted with CAP, and 118 had blood cultures positive for S. pneumoniae. Claudius I, Baraff LJ. Since 2000, however, its impact has been blunted by the widespread use of vaccines that largely . sharing sensitive information, make sure youre on a federal Keywords: [3, 53] Diagnostic testing is also useful in classifying the severity of illness and site-of-care decisions (outpatient vs inpatient vs intensive care unit [ICU]). Chest. Methods: eCollection 2022. Radiology of pneumonia. 345(19):1368-77. The one case of appropriate antibiotic escalation occurred in a patient with vancomycin-resistant Enterococcus unrelated to pneumonia. Br J Nurs. 711-72. Crit Care. Lam AP, Wunderink RG. In the other cases, sputum studies and serology . Clin Infect Dis. BCs in pediatric CAP identified organisms in only a small percentage of patients, predominantly S. pneumoniae. Semin Respir Crit Care Med. [QxMD MEDLINE Link]. Accessed: January 13, 2011. A Randomized Trial of the Amikacin Fosfomycin Inhalation System for the Adjunctive Therapy of Gram-Negative Ventilator-Associated Pneumonia: IASIS Trial. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Copyright 2019 Elsevier Inc. All rights reserved. Chest radiography is considered the standard method for diagnosing the presence of pneumonia, that is, the presence of an infiltrate is required for the diagnosis. Paul Blackburn, DO, FACOEP, FACEP Attending Physician, Department of Emergency Medicine, Maricopa Medical Center, Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association, Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine, Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine, Ryland P Byrd Jr, MD Professor, Department of Internal Medicine, Division of Pulmonary Medicine and Critical Care Medicine, Program Director of Pulmonary Diseases and Critical Care Medicine Fellowship, East Tennessee State University, James H Quillen College of Medicine; Medical Director of Respiratory Therapy, James H Quillen Veterans Affairs Medical Center, Ryland P Byrd Jr, MD is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society, Christina Rager, MD Resident Physician, Internal and Emergency Medicine, Olive View-University of California at Los Angeles Medical Center, Christina Rager, MD is a member of the following medical societies: American College of Physicians, American Medical Student Association/Foundation, and Phi Beta Kappa, Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital, Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association, Dana A Stearns, MD Assistant Director of Undergraduate Education, Department of Emergency Medicine, Massachusetts General Hospital; Assistant Professor of Surgery, Harvard Medical School, Dana A Stearns, MD is a member of the following medical societies: American College of Emergency Physicians, James M Stephen, MD, FAAEM, FACEP Assistant Professor, Tufts University School of Medicine; Attending Physician, Director of Medical Informatics and Graduate Education, Department of Emergency Medicine, Tufts Medical Center, James M Stephen, MD, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians, Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference. Before Appropriate management changes occurred in 8 cases (1.8%; 7 de-escalation and 1 escalation of antibiotics); only 1 with bacteremia likely due to pneumonia (de-escalation). Epub 2022 Aug 29. Klebsiella has a tendency to occur in the upper lobes. Pneumococcal antigen tests for serum, urine, and saliva samples have been developed. 2009 Dec. 24(4):337-42. Only 2 (0.4%) had multidrug-resistant organisms (both health care-associated pneumonia), one of whom was due to pneumonia. Community-Acquired Pneumonia: Updated Recommendations from the - AAFP CT patterns of disease may be broken down into abnormalities that cause either increased or decreased lung opacity. Seven of the S. pneumoniae isolates were resistant to erythromycin. Accessed: January 13, 2011. After eliminating patients whose charts were not available for review, patients who had other diagnoses related to Pneumococcal sepsis (e.g. A Legionella serum antibody titer of 1:128 or more is suggestive of the diagnosis. Clin Infect Dis. 2021 Apr 20;6(2):55. doi: 10.3390/tropicalmed6020055. [55]. Med Clin North Am. Espaa PP, Capelastegui A, Gorordo I, Esteban C, Oribe M, Ortega M, et al. Their yield may be higher in patients with more severe pneumonia/infection. J Lab Clin Med. Limited usefulness of initial blood cultures in community acquired pneumonia. 8600 Rockville Pike Please enable it to take advantage of the complete set of features! Although it seems apparent that blood cultures are helpful in establishing an etiologic diagnosis for a patient with CAP, if the results do not affect management, obtaining blood cultures is not cost effective. The potential for false-positive results renders it less useful than other tests. US can identify septations within the fluid collection that may not be visible on CT scans. Among 267 patients hospitalized with COVID-19 pneumonia, 38 had early blood cultures drawn. This site needs JavaScript to work properly. Diagnostic Accuracy of Routinely Available Biomarkers to Predict Bacteremia in Children With Community-Acquired Pneumonia: A Secondary Analysis of the GPIP/ACTIV Pneumonia Study in France, 2009-2018. Community-acquired pneumonia is diagnosed by clinical features (e.g., cough, fever, pleuritic chest pain) and by lung imaging, usually an infiltrate seen on chest radiography. [QxMD MEDLINE Link]. Justina Gamache, MD Resident Physician, Department of Internal Medicine, Olive View-UCLA Medical CenterDisclosure: Nothing to disclose. Crit Care. 2009 Dec. 37(12):3166-8. 2015 May;45(5):1353-63. doi: 10.1183/09031936.00152514. With a CURB-65 of 3 and a PORT score of 95, she is correctly treated her for community acquired pneumonia with Ceftriaxone and Azithromycin, and admitted. Image in a 50-year-old patient with Haemophilus influenzae pneumonia. Stedman's Medical Dictionary. Antimicrobial de-escalation strategies in hospitalized patients with pneumonia, intra-abdominal infections, and bacteremia. A prediction rule to identify low-risk patients with community-acquired pneumonia. Indeed, the use of blood cultures only rarely dictates a change in empiric antibiotics. Clipboard, Search History, and several other advanced features are temporarily unavailable. Pneumolysin: a multifunctional pneumococcal virulence factor. In addition, pleural effusions can be identified by chest radiographs. 2003 May. Metersky ML, Ma A, Bratzler DW, Houck PM. The etiology of community-acquired pneumonia among children under 5years of age in mainland China, 2001-2015: A systematic review. We also compared characteristics and outcomes of patients with positive cultures by site. Cooper MS, Stewart PM. Careers. Wrotek A, Robakiewicz J, Pawlik K, Rudzinski P, Pilarska I, Jaro A, Imieowska A, Jarzbowska M, Zabocka K, Jackowska T. J Clin Med. Clin Infect Dis. Lung tissue can be visually evaluated and bronchial washing specimens can be obtained with the aid of a fiberoptic bronchoscope. HHS Vulnerability Disclosure, Help 43(3):497-512, viii. An advantage to identifying an organism such as Streptococcus pneumoniae would be in determining its sensitivity to penicillin, thus allowing therapy to be narrowed to penicillin if the minimum inhibitory concentration of the organism was acceptably low. [QxMD MEDLINE Link]. Accessed: June 1, 2010. The most obvious indication for extensive diagnostic testing is in the critically ill patient. Trials. MMWR Morb Mortal Wkly Rep. 2009 Oct 2. Bonten M, Bolkenbaas M, Huijts S, et al. Alveolar septa become widened and edematous and usually have a mononuclear inflammatory infiltrate of lymphocytes, histiocytes, and plasma cells. Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza A (H1N1) - United States, May-August 2009. 270(24):2957-63. Robbins and Cotran: Pathologic Basis of Disease. This descriptive observational study included all adult patients with COVID-19 pneumonia admitted to the Internal Medicine ward of Hospital Durand between April 1, 2020 and July 30, 2020, who had blood cultures drawn within 5 days from hospital admission. Centers for Disease Control and Prevention. While awaiting culture results, most patients are routinely treated with a second- or third-generation cephalosporin, with or without a macrolide antibiotic. [QxMD MEDLINE Link]. Radiographically, lobar pneumonia, or focal or nonsegmental pneumonia, is manifested as nonsegmental, homogeneous consolidation involving one, or less commonly, multiple lobes. Radiographically, the disease manifests with a reticular or reticulonodular pattern. An elevated international normalized ratio (INR) has been associated with more severe illness. Clin Infect Dis. [QxMD MEDLINE Link]. Only two antibiotic changes were made in patients who had a penicillin-resistant strain. eCollection 2020. Clinical resistance encountered in the respiratory surveillance program (RESP) study: a review of the implications for the treatment of community-acquired respiratory tract infections. This site needs JavaScript to work properly. Chacko R, Rajan A, Lionel P, Thilagavathi M, Yadav B, Premkumar J. V. 2.6b. Of 456 pneumonia hospitalizations, 30 (6.6%) had bacteremia, with a greater incidence in severe community-acquired pneumonia (14.7%) than nonsevere community-acquired pneumonia (7.8%) and health care-associated pneumonia (6.6%; P = .12). Available at http://bit.ly/fkBFeA. 2001 Nov. 85(6):1461-91, x. Blood cultures are of limited utility in nonsevere community-acquired pneumonia, though routinely recommended for severe community-acquired pneumonia or health care-associated pneumonia due to perceived greater bacteremia risk, particularly with multidrug-resistant organisms. Vincent JL, Moreno R, Takala J, Willatts S, De Mendona A, Bruining H, et al. [QxMD MEDLINE Link]. Sputum cultures for the evaluation of bacterial pneumonia Perhaps many of the physicians who managed these patients trained in the post-penicillin era and simply are not comfortable using this weaker antibiotic. Doctors call this a systemic infection. Chest computed tomography scan shows ill-defined, airspace infiltrate in the left lower lobe. For inpatients, CT scanning may identify pulmonary infections earlier than plain radiography. The 3 studies that examined BC-driven changes in management had conflicting results. Ketai L, Jordan K, Marom EM. Its absence is likely to expand the differential beyond infectious processes. 41(6):848-54. This website also contains material copyrighted by 3rd parties. Results: Among 138 561 hospitalizations of patients with pneumonia who had blood or respiratory cultures obtained at admission, 12 888 (9.3%) yielded positive cultures: 6438 respiratory cultures, 5992 blood cultures, and 458 both respiratory and blood cultures. 2022 Dec 21;35(4):e0001522. Slovis BS, Brigham KL. Current guidelines strongly recommend collection of blood cultures (BCs) in children requiring hospitalization for presumed moderate to severe bacterial community-acquired pneumonia (CAP). 2001 Mar 1. In addition, pulmonary vasculitis can produce areas of pulmonary infarction that radiographically resembles invasive aspergillosis. [QxMD MEDLINE Link]. Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: a systematic review and meta-analysis. Gotway MB, Reddy GP, Webb WR, Elicker BM, Leung JW. 2002 Jun 20. 2012;7 Suppl 1:S13-21. Cultures of the sputum have similar limitations. Available at https://pneumonia.org.au/public/journals/22/PublicFolder/ABSTRACTBOOKMASTERforwebupdated20-3-14.pdf. If you log out, you will be required to enter your username and password the next time you visit. Specifications manual for national hospital inpatient quality measures. Bacterial pneumonia. Klebsiella can cause severe infections in your lungs, bladder, brain, liver, eyes, blood, and wounds. [QxMD MEDLINE Link]. Pneumonia 2014;3:95. Arch Intern Med. Association Between Alcohol Use Disorders and Outcomes of Patients Hospitalized With Community-Acquired Pneumonia. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Blood cultures are of limited utility in nonsevere community-acquired pneumonia, though routinely recommended for severe community-acquired pneumonia or health care-associated pneumonia due to perceived greater bacteremia risk, particularly with multidrug-resistant organisms. (Left) Gram stain demonstrating gram-positive cocci in pairs and chains and (right) culture positive for Streptococcus pneumoniae. Linear patter - Interlobular septal thickening (smooth, nodular, irregular), parenchymal bands, subpleural lines, and irregular linear opacities may be seen. The https:// ensures that you are connecting to the Forgie S, Marrie TJ. Symptoms of pneumonia vary to mild to severe. [QxMD MEDLINE Link]. Tackling empirical antibiotic therapy for ventilator-associated pneumonia in your ICU: guidance for implementing the guidelines. Semin Respir Crit Care Med. Bethesda, MD 20894, Web Policies 2001 Dec 17;111 Suppl 9A:30S-35S discussion 36S-38S. JAMA Netw Open. Crit Care Med. Accessibility 1. Arch Intern Med. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Centers for Disease Control and Prevention. sharing sensitive information, make sure youre on a federal 107(1A):34S-43S. We compared these results to understand if organisms and resistance patterns differed by site. Blood tests are used to confirm an infection and to try to identify the type of organism causing the infection. Epub 2017 Aug 23. Among respiratory cultures, the most common pathogens were Staphylococcus aureus (34%) and Pseudomonas aeruginosa (17%), whereas blood cultures most commonly grew Streptococcus pneumoniae (33%), followed by S. aureus (22%). Share cases and questions with Physicians on Medscape consult. 1 It affects more than 900,000 people annually in the United States . Haemophilus influenzae type b vaccine; Streptococcus pneumoniae; bacteremia; blood culture; community-acquired pneumonia; meta-analysis; pediatric; pneumococcal conjugate vaccine; systematic review. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. A total of 891 patients were identified in the study period with a diagnosis of pneumococcal pneumonia and with blood culture results.
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