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Authors
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Medical Epidemiologist at Centers for Disease Control and PreventionSeema Jain, MD
Medical Epidemiologist at Centers for Disease Control and PreventionMedical Epidemiologist at Centers for Disease Control and Prevention
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Sarah H. Sell and Cornelius Vanderbilt Chair in Pediatrics at Vanderbilt UniversityKathryn Edwards, MD
Sarah H. Sell and Cornelius Vanderbilt Chair in Pediatrics at Vanderbilt UniversitySarah H. Sell and Cornelius Vanderbilt Chair in Pediatrics at Vanderbilt University
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Professor of Pulmonary Medicine at Northwestern UniversityRichard Wunderink, MD
Professor of Pulmonary Medicine at Northwestern UniversityProfessor of Pulmonary Medicine at Northwestern University
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Emergency Medicine Physician & Clinical Researcher at Vanderbilt University Medical CenterWesley Self, MD, MPH
Emergency Medicine Physician & Clinical Researcher at Vanderbilt University Medical CenterEmergency Medicine Physician & Clinical Researcher at Vanderbilt University Medical Center
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George and Esther Gross Presidential Professor / Chief, Division of Pediatric Infectious Diseases at University of UtahAndrew Pavia, MD, FAAP, FIDSA
George and Esther Gross Presidential Professor / Chief, Division of Pediatric Infectious Diseases at University of UtahGeorge and Esther Gross Presidential Professor / Chief, Division of Pediatric Infectious Diseases at University of Utah
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Assistant Professor of Pediatrics, Division of Hospital Medicine at Vanderbilt University School of MedicineDerek Williams, MD, MPH
Assistant Professor of Pediatrics, Division of Hospital Medicine at Vanderbilt University School of MedicineAssistant Professor of Pediatrics, Division of Hospital Medicine at Vanderbilt University School of Medicine
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Experts
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Pulmonary Section Chief, Director of Pulmonary and Critical Care Medicine Fellowship Program at Eastern Virginia Medical SchoolJoshua Sill, MD
Pulmonary Section Chief, Director of Pulmonary and Critical Care Medicine Fellowship Program at Eastern Virginia Medical SchoolPulmonary Section Chief, Director of Pulmonary and Critical Care Medicine Fellowship Program at Eastern Virginia Medical School
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Associate Professor at University of Wisconsin Hospital and ClinicsAnn Sheehy, MD, MS
Associate Professor at University of Wisconsin Hospital and ClinicsAssociate Professor at University of Wisconsin Hospital and Clinics
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Assistant Professor of Medicine at Texas A&M Health Science CenterSabitha Rajan, MD, MSc, FHM
Assistant Professor of Medicine at Texas A&M Health Science CenterAssistant Professor of Medicine at Texas A&M Health Science Center
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Associate Professor at the Department of Medicine, Division of Pulmonary/Critical Care Medicine at University of Texas Health Science Center at San AntonioMarcos Restrepo, MD, MSc, FCCP
Associate Professor at the Department of Medicine, Division of Pulmonary/Critical Care Medicine at University of Texas Health Science Center at San AntonioAssociate Professor at the Department of Medicine, Division of Pulmonary/Critical Care Medicine at University of Texas Health Science Center at San Antonio
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Director, Pulmonary and Critical Care Fellowship Program at Harvard-Brigham and Women’s HospitalCarolyn D’Ambrosio, MD, MSc
Director, Pulmonary and Critical Care Fellowship Program at Harvard-Brigham and Women’s HospitalDirector, Pulmonary and Critical Care Fellowship Program at Harvard-Brigham and Women’s Hospital
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Lead Moderators
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Pulmonary and Critical Care Medicine Fellow at Eastern Virginia Medical SchoolMatthew McLaughlin, DO
Pulmonary and Critical Care Medicine Fellow at Eastern Virginia Medical SchoolPulmonary and Critical Care Medicine Fellow at Eastern Virginia Medical School
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Moderators
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Chief Resident at University of Wisconsin Internal MedicineJill Zabih, MD
Chief Resident at University of Wisconsin Internal MedicineChief Resident at University of Wisconsin Internal Medicine
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Medical Student at Oakland University William Beaumont School of MedicineRenae Shibata
Medical Student at Oakland University William Beaumont School of MedicineMedical Student at Oakland University William Beaumont School of Medicine
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Fellow at Baylor Scott & WhiteChris Henry, MD
Fellow at Baylor Scott & WhiteFellow at Baylor Scott & White
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Critical Care Medicine - Translational Science PhD Student - University of Texas Health Science Center at San AntonioLuis Reyes, MD
Critical Care Medicine - Translational Science PhD Student - University of Texas Health Science Center at San AntonioCritical Care Medicine - Translational Science PhD Student - University of Texas Health Science Center at San Antonio
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Pulmonary Critical Care FellowYuriy Takhalov, MD
Pulmonary Critical Care FellowPulmonary Critical Care Fellow
About the Discussion
@NEJM Ask the Authors & Experts: Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults
Original Article
Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults
Background
Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radiographically and with the use of current laboratory diagnostic tests are needed.
Methods
We conducted active population-based surveillance for community-acquired pneu-monia requiring hospitalization among adults 18 years of age or older in five hospitals in Chicago and Nashville. Patients with recent hospitalization or severe immunosuppression were excluded. Blood, urine, and respiratory specimens were systematically collected for culture, serologic testing, antigen detection, and molecular diagnostic testing. Study radiologists independently reviewed chest radiographs. We calculated population-based incidence rates of community-acquired pneumonia requiring hospitalization according to age and pathogen.
Results
From January 2010 through June 2012, we enrolled 2488 of 3634 eligible adults (68%). Among 2320 adults with radiographic evidence of pneumonia (93%), the median age of the patients was 57 years (interquartile range, 46 to 71); 498 patients (21%) required intensive care, and 52 (2%) died. Among 2259 patients who had radiographic evidence of pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 853 (38%): one or more viruses in 530 (23%), bacteria in 247 (11%), bacterial and viral pathogens in 59 (3%), and a fungal or mycobacterial pathogen in 17 (1%). The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%). The annual incidence of pneumonia was 24.8 cases (95% confidence interval, 23.5 to 26.1) per 10,000 adults, with the highest rates among adults 65 to 79 years of age (63.0 cases per 10,000 adults) and those 80 years of age or older (164.3 cases per 10,000 adults). For each pathogen, the incidence increased with age.
Conclusions
The incidence of community-acquired pneumonia requiring hospitalization was highest among the oldest adults. Despite current diagnostic tests, no pathogen was detected in the majority of patients. Respiratory viruses were detected more frequently than bacteria. (Funded by the Influenza Division of the National Center for Immunizations and Respiratory Diseases.)
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Authors
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Medical Epidemiologist at Centers for Disease Control and PreventionSeema Jain, MD
Medical Epidemiologist at Centers for Disease Control and Prevention
Medical Epidemiologist at Centers for Disease Control and Prevention
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Sarah H. Sell and Cornelius Vanderbilt Chair in Pediatrics at Vanderbilt UniversityKathryn Edwards, MD
Sarah H. Sell and Cornelius Vanderbilt Chair in Pediatrics at Vanderbilt University
Sarah H. Sell and Cornelius Vanderbilt Chair in Pediatrics at Vanderbilt University
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Professor of Pulmonary Medicine at Northwestern UniversityRichard Wunderink, MD
Professor of Pulmonary Medicine at Northwestern University
Professor of Pulmonary Medicine at Northwestern University
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Emergency Medicine Physician & Clinical Researcher at Vanderbilt University Medical CenterWesley Self, MD, MPH
Emergency Medicine Physician & Clinical Researcher at Vanderbilt University Medical Center
Emergency Medicine Physician & Clinical Researcher at Vanderbilt University Medical Center
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George and Esther Gross Presidential Professor / Chief, Division of Pediatric Infectious Diseases at University of UtahAndrew Pavia, MD, FAAP, FIDSA
George and Esther Gross Presidential Professor / Chief, Division of Pediatric Infectious Diseases at University of Utah
George and Esther Gross Presidential Professor / Chief, Division of Pediatric Infectious Diseases at University of Utah
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Assistant Professor of Pediatrics, Division of Hospital Medicine at Vanderbilt University School of MedicineDerek Williams, MD, MPH
Assistant Professor of Pediatrics, Division of Hospital Medicine at Vanderbilt University School of Medicine
Assistant Professor of Pediatrics, Division of Hospital Medicine at Vanderbilt University School of Medicine
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Experts
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Pulmonary Section Chief, Director of Pulmonary and Critical Care Medicine Fellowship Program at Eastern Virginia Medical SchoolJoshua Sill, MD
Pulmonary Section Chief, Director of Pulmonary and Critical Care Medicine Fellowship Program at Eastern Virginia Medical School
Pulmonary Section Chief, Director of Pulmonary and Critical Care Medicine Fellowship Program at Eastern Virginia Medical School
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Associate Professor at University of Wisconsin Hospital and ClinicsAnn Sheehy, MD, MS
Associate Professor at University of Wisconsin Hospital and Clinics
Associate Professor at University of Wisconsin Hospital and Clinics
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Assistant Professor of Medicine at Texas A&M Health Science CenterSabitha Rajan, MD, MSc, FHM
Assistant Professor of Medicine at Texas A&M Health Science Center
Assistant Professor of Medicine at Texas A&M Health Science Center
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Associate Professor at the Department of Medicine, Division of Pulmonary/Critical Care Medicine at University of Texas Health Science Center at San AntonioMarcos Restrepo, MD, MSc, FCCP
Associate Professor at the Department of Medicine, Division of Pulmonary/Critical Care Medicine at University of Texas Health Science Center at San Antonio
Associate Professor at the Department of Medicine, Division of Pulmonary/Critical Care Medicine at University of Texas Health Science Center at San Antonio
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Director, Pulmonary and Critical Care Fellowship Program at Harvard-Brigham and Women’s HospitalCarolyn D’Ambrosio, MD, MSc
Director, Pulmonary and Critical Care Fellowship Program at Harvard-Brigham and Women’s Hospital
Director, Pulmonary and Critical Care Fellowship Program at Harvard-Brigham and Women’s Hospital
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Lead Moderators
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Pulmonary and Critical Care Medicine Fellow at Eastern Virginia Medical SchoolMatthew McLaughlin, DO
Pulmonary and Critical Care Medicine Fellow at Eastern Virginia Medical School
Pulmonary and Critical Care Medicine Fellow at Eastern Virginia Medical School
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Moderators
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Chief Resident at University of Wisconsin Internal MedicineJill Zabih, MD
Chief Resident at University of Wisconsin Internal Medicine
Chief Resident at University of Wisconsin Internal Medicine
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Medical Student at Oakland University William Beaumont School of MedicineRenae Shibata
Medical Student at Oakland University William Beaumont School of Medicine
Medical Student at Oakland University William Beaumont School of Medicine
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Fellow at Baylor Scott & WhiteChris Henry, MD
Fellow at Baylor Scott & White
Fellow at Baylor Scott & White
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Critical Care Medicine - Translational Science PhD Student - University of Texas Health Science Center at San AntonioLuis Reyes, MD
Critical Care Medicine - Translational Science PhD Student - University of Texas Health Science Center at San Antonio
Critical Care Medicine - Translational Science PhD Student - University of Texas Health Science Center at San Antonio
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Pulmonary Critical Care FellowYuriy Takhalov, MD
Pulmonary Critical Care Fellow
Pulmonary Critical Care Fellow
