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Antibiotic Resistance in Community-Acquired Pneumonia Caused by Streptococcus pneumoniae, Methicillin-Resistant Staphylococcus aureus, and Acinetobacter baumannii

Pak-Leung Ho, MD; Vincent Chi-Chung Cheng, MBBS; Chung-Ming Chu, MD, FCCP
Author and Funding Information

Affiliations: From the Department of Microbiology and Centre of Infection (Drs. Ho and Cheng), Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, People's Republic of China; and the Department of Medicine and Geriatrics (Dr. Chu), United Christian Hospital, Hong Kong SAR, People's Republic of China.

Correspondence to: Pak-Leung Ho, MD, Division of Infectious Diseases, Department of Microbiology and Centre of Infection, Queen Mary Hospital, University of Hong Kong, Pokfulam Road, Hong Kong SAR, People's Republic of China; e-mail: plho@hkucc.hku.hk


This review was supported by research grants from the Research Fund for the Control of Infectious Diseases (RFCID) of the Health, Welfare and Food Bureau of the Hong Kong SAR Government and from the UDF Project-Research Centre of Emerging Infectious Diseases.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(4):1119-1127. doi:10.1378/chest.09-0285
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Antimicrobial therapy is the mainstay of management for community-acquired pneumonia (CAP). Accordingly, the choices of treatment are influenced by the likely etiologies, local resistance patterns of the pathogens, as well as patient factors. As the leading cause of acute CAP, the susceptibility patterns of Streptococcus pneumoniae have greatly influenced antimicrobial agents and dosage recommended for empirical treatment of this condition. The worldwide emergence of community-acquired methicillin-resistant Staphylococcus aureus has also led to discussion of this pathogen in recent revisions of the international CAP guidelines. This pathogen is important because of its resistance to antibiotics commonly recommended for the empirical treatment of CAP and the association with a rapidly fatal form of pneumonia characterized by tissue necrosis, pulmonary hemorrhage, and rapid progression to respiratory failure. In tropical regions of Australia and Asia, CAP due to Acinetobacter baumannii is also increasingly recognized. This review discusses their recent epidemiology, microbiology, clinical features, and treatment of CAP caused by these antimicrobial-resistant pathogens.


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