Medicine
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Multicenter Study Clinical Trial
New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases.
Three hundred fifty-nine consecutive patients with community-acquired pneumonia admitted to university, community, and VA hospitals underwent a standardized evaluation, including specialized tests for Legionella spp. and Chlamydia pneumoniae (TWAR). The most common underlying illnesses were immunosuppression (36.3%), chronic obstructive pulmonary disease (32.4%), and malignancy (28.4%). The most frequent etiologic agents were Streptococcus pneumoniae (15.3%) and Hemophilus influenzae (10.9%). ⋯ Mortality was highest for Staphylococcus aureus (50%) and lowest for C. pneumoniae (4.5%) and Mycoplasma pneumoniae (0%). We document that specialized laboratory testing for C. pneumoniae and Legionella spp. should be more widely used rather than reserved for cases not responding to standard therapy. Furthermore, realization that C. pneumoniae and Legionella spp. are common etiologies for community-acquired pneumonia should affect empiric antibiotic prescription.
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We reviewed 149 episodes of septicemia caused by X. maltophilia and Pseudomonas spp. occurring over a 15-year period. The incidence of septicemia caused by these organisms increased in recent years and was most frequently associated with central venous catheterization. ⋯ Although the survival rate was superior to that seen with septicemia caused by other gram-negative organisms, recurrence of infection was significantly more frequent. Removal of central venous catheters is an essential component of therapy of this infection.