priate starting point for consultation by specialists.Substantial overlap exists among the patients whom these guidelines address and those discussed in recently published health care-associated pneumonia (HCAP).Pneumonia nonambulatory residents of nursing homes other long-term care facilities epidemiologically mirrors hospital-acquired should be treated according to HCAP guidelines.However, certain whose conditions are included designation better served management accordance with CAP...

John G. Bartlett,1 Scott F Dowell,2 Lionel A. Mandell,6 Thomas M. File, Jr.,3 Daniel Musher,4 and Michael J. Fine5 'Johns Hopkins University School of Medicine, Baltimore, Maryland, 2Centers for Disease Control Prevention, Atlanta, Georgia, 3Northeastern Ohio Universities College Cleveland, Ohio, 4Baylor Medicine Veterans Affairs Medical Center, Houston, Texas, 5University Pittsburgh, Pennsylvania, USA; 6McMaster University, Toronto, Canada

Recent antibiotic therapy b A respiratory fluoroquinolone c alone, an advanced macrolide d plus high-dose amoxicillin, e or amoxicillin-clavulanate f Comorbidities (COPD, diabetes, renal congestive heart failure, malignancy) No recent An a alone b-lactam g Suspected aspiration with infection Amoxicillin-clavulanate clindamycin Influenza bacterial superinfection Inpatient Medical ward h (regimen selected will depend on nature of therapy) ICU Pseudomonas is not issue either but patient has...

During 2004, a highly pathogenic avian influenza A (H5N1) virus caused poultry disease in eight Asian countries and infected at least 44 persons, killing 32; most of these persons had close contact with poultry. No evidence efficient person-to-person transmission has yet been reported. We investigated possible family cluster the Thailand.For each three involved patients, we reviewed circumstances timing exposures to other ill persons. Field teams isolated treated surviving patient,...

The severe acute respiratory syndrome (SARS) spread rapidly around the world, largely because persons infected with SARS-associated coronavirus (SARS-CoV) traveled on aircraft to distant cities. Although many commercial aircraft, risk, if any, of in-flight transmission is unknown.We attempted interview passengers and crew members at least 10 days after they had taken one three flights that transported a patient or patients SARS. All index met criteria World Health Organization for probable...

Objective. To test whether an educational outreach intervention for families and physicians, based on the Centers Disease Control Prevention (CDC) principles of judicious antibiotic use, decreases antimicrobial drug prescribing children younger than 6 years old. Setting. Twelve practices affiliated with 2 managed care organizations (MCOs) in eastern Massachusetts northwest Washington State. Patients. All enrolled Methods. Practices stratified by MCO size were randomized to or control groups....

Seasonal cycles of infectious diseases have been variously attributed to changes in atmospheric conditions, the prevalence or virulence pathogen, behavior host. Some observations about seasonality are difficult reconcile with these explanations. These include simultaneous appearance outbreaks across widespread geographic regions same latitude; detection pathogens off-season without epidemic spread; and consistency seasonal changes, despite wide variations weather human behavior. In contrast,...

Objective. To provide consensus recommendations for the management of acute otitis media (AOM) and surveillance drug-resistant Streptococcus pneumoniae (DRSP). Five questions were addressed: (1) Can amoxicillin remain best initial antimicrobial agent treating AOM in current period increasing prevalence DRSP? (2) What are suitable alternative agents use if fails? (3) Should empiric treatment vary by geographic region? (4) Where can clinicians learn about resistance patterns their patient...

Abstract Seasonal cycles of infectious diseases have been variously attributed to changes in atmospheric conditions, the prevalence or virulence pathogen, behavior host. Some observations about seasonality are difficult reconcile with these explanations. These include simultaneous appearance outbreaks across widespread geographic regions same latitude; detection pathogens off-season without epidemic spread; and consistency seasonal changes, despite wide variations weather human behavior. In...

Although Ebola virus (EBOV) is transmitted by unprotected physical contact with infected persons, few data exist on which specific bodily fluids are or the risk of fomite transmission. Therefore, we tested various clinical specimens from 26 laboratory-confirmed cases hemorrhagic fever, as well environmental collected an isolation ward, for presence EBOV. Virus was detected culture and/or reverse-transcription polymerase chain reaction in 16 54 (including saliva, stool, semen, breast milk,...

Respiratory syncytial virus (RSV), the most important cause of lower respiratory disease in infants and young children, is rarely considered among causes for community-acquired infection adults. All noninstitutionalized adults hospitalized with pneumonia two Ohio counties were evaluated between December 1990 May 1992. Fifty-three (4.4%) 1195 admitted during RSV seasons 4 (1.0%) 390 off-season had serologic evidence infection, making one four common pathogens identified. RSV-infected patients...

Abstract Influenza A (H5N1) is endemic in poultry across much of Southeast Asia, but limited information exists on the distinctive features few human cases. In Thailand, we instituted nationwide surveillance and tested respiratory specimens by polymerase chain reaction viral isolation. From January 1 to March 31, 2004, reviewed 610 reports identified 12 confirmed 21 suspected All case-patients resided villages that experienced abnormal chicken deaths, 9 lived households whose backyard...

We detected human bocavirus (HBoV) infection in 4.5% of hospitalized patients with pneumonia rural Thailand. However, the role HBoV as a pathogen is unclear.We compared that asymptomatic control enrolled between 1 September 2004 and 31 August 2005 same hospitals examined outpatients influenza-like illness for tested 13 additional respiratory viruses. Epidemiologic clinical characteristics are described.HBoV was 20 (3.9%) 512 3 (1%) 280 patients. Coinfection other viruses 83% 90% outpatients....

The surviving members of 27 households in which someone had been infected with Ebola virus were interviewed order to define the modes transmission hemorrhagic fever (EHF). Of 173 household contacts primary cases, 28 (16%) developed EHF. All secondary cases direct physical contact ill person (rate ratio [RR], undefined; P < .001), and among those contact, exposure body fluids conferred additional risk (RR, 3.6; 95% confidence interval [CI], 1.9-6.8). After adjusting for fluids, adult family...

Otitis media is the leading indication for outpatient antimicrobial use in United States. Overdiagnosis of and unnecessary prescribing this condition has contributed to spread resistance. A critical step reducing identify subset patients who are unlikely benefit from antibiotics. Conscientiously distinguishing acute otitis (AOM) with effusion (OME), deferring antibiotics OME will accomplish goal, avoid up 8 million courses annually. Criteria defining these conditions presented, as well...

An outbreak of severe pneumococcal pneumonia among children occurred in Iowa from November 1995 through January 1996. associated influenza disease was predominantly caused by A (H1N1) for the first time since 1989. We conducted a case-control study to determine whether preceding infection directly with illness. identified 13 pneumonia. Patients were more likely than control subjects report experiencing an influenza-like illness 7-28 days admission (matched odds ratio [OR], 12.4; 95%...

This article introduces a set of principles to define judicious antimicrobial use for five conditions that account the majority outpatient in United States. Data from National Center Health Statistics indicate recent years, approximately three fourths all antibiotics have been prescribed otitis media, sinusitis, bronchitis, pharyngitis, or nonspecific upper respiratory tract infection.1Antimicrobial drug rates are highest children1; therefore, pediatric age group represents focus present...

Abstract Pneumococcal infections increase each winter, a phenomenon that has not been well explained. We conducted population-based active surveillance for all cases of invasive pneumococcal disease in seven states; plotted annualized weekly rates by geographic location, age, and latitude; assessed correlations time-series analysis. In areas, exhibited distinct winter seasonality, including an among children the fall preceding adults sharp spike incidence year between December 24 January 7....

Background. In response to the dramatic emergence of resistant pneumococci, more judicious use antibiotics has been advocated. Physician beliefs, their prescribing practices, and attitudes patients have evaluated previously in separate studies. Methods. This 3-part study included a statewide mailed survey, office chart reviews, parent telephone interviews. We compared survey responses 366 licensed pediatricians family physicians Georgia recently published recommendations on diagnosis...

In our evaluation of a new assay for the detection pneumococcal antigen in urine (Binax NOW; Binax), test result was no more likely to be positive among 88 children with radiographically confirmed pneumonia than 198 control subjects; however, it significantly who were nasopharyngeal carriers pneumococci. This is not useful distinguishing from those are merely colonized.

Health care workers continued to contract severe acute respiratory syndrome (SARS), even after barrier precautions were widely implemented.We explored the possible contribution of contaminated hospital surfaces SARS transmission by swabbing in 2 hospitals and testing swab samples reverse-transcriptase polymerase chain reaction (RT-PCR) viral culture.Twenty-six 94 tested positive for RNA. Swab secretions from each 4 patients examined RT-PCR, as 12 43 swabs patient rooms 10 47 other parts...

Antibiotics are widely prescribed for children with nonspecific upper respiratory tract infections, contributing to the recent emergence of resistant pneumococci. To understand reasons overprescription antibiotics, we conducted focus groups parents and pe-diatricians family physicians assess their attitudes regarding use antibiotics. Physicians asserted that own antibiotic prescribing could be safely reduced. Parental expectation receive antibiotics was a major factor influencing overuse...

Most children will suffer between 3 and 8 colds per year, over half of patients seen for the common cold are given an antimicrobial prescription. Unnecessary therapy can be avoided by recognizing signs symptoms that part usual course these diseases. Controlled trials treatment reviewed. These consistently fail to show changes or outcome. Furthermore, with viral rhinosinusitis is not effective way prevent bacterial complications. Mucopurulent rhinitis (thick, opaque, discolored nasal...