***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : An inadequate response to initial empirical treatment of community acquired pneumonia ( CAP ) represents a challenge for clinicians and requires early identification and intervention . A study was undertaken to quantify the incidence of failure of empirical treatment in CAP , to identify risk factors for treatment failure , and to determine the implication s of treatment failure on the outcome . Methods : A prospect i ve multicentre cohort study was performed in 1424 hospitalised patients from 15 hospitals .  Early treatment failure ( < 72 hours ) , late treatment failure , and in-hospital mortality were recorded . Results : Treatment failure occurred in 215 patients ( 15.1 % ) : 134 early failure ( 62.3 % ) and 81 late failure ( 37.7 % ) . The causes were infectious in 86 patients ( 40 % ) , non-infectious in 34 ( 15.8 % ) , and undetermined in 95 . The independent risk factors associated with treatment failure in a stepwise logistic regression analysis were liver disease , pneumonia risk class , leucopenia , multilobar CAP , pleural effusion , and radiological signs of cavitation . Independent factors associated with a lower risk of treatment failure were influenza vaccination , initial treatment with fluoroquinolones , and chronic obstructive pulmonary disease ( COPD ) . Mortality was significantly higher in patients with treatment failure ( 25 % v 2 % ) . Failure of empirical treatment increased the mortality of CAP 11-fold after adjustment for risk class . Conclusions : Although these findings need to be confirmed by r and omised studies , they suggest possible interventions to decrease mortality due to CAP BACKGROUND Clinical trials yielded conflicting data about the benefit of adding systemic corticosteroids for treatment of community-acquired pneumonia . We assessed whether short-term corticosteroid treatment reduces time to clinical stability in patients admitted to hospital for community-acquired pneumonia . METHODS In this double-blind , multicentre , r and omised , placebo-controlled trial , we recruited patients aged 18 years or older with community-acquired pneumonia from seven tertiary care hospitals in Switzerl and within 24 h of presentation . Patients were r and omly assigned ( 1:1 ratio ) to receive either prednisone 50 mg daily for 7 days or placebo . The computer-generated r and omisation was done with variable block sizes of four to six and stratified by study centre . The primary endpoint was time to clinical stability defined as time ( days ) until stable vital signs for at least 24 h , and analysed by intention to treat . This trial is registered with Clinical Trials.gov , number NCT00973154 . FINDINGS From Dec 1 , 2009 , to May 21 , 2014 , of 2911 patients assessed for eligibility , 785 patients were r and omly assigned to either the prednisone group ( n=392 ) or the placebo group ( n=393 ) . Median time to clinical stability was shorter in the prednisone group ( 3·0 days , IQR 2·5 - 3·4 ) than in the placebo group ( 4·4 days , 4·0 - 5·0 ; hazard ratio [ HR ] 1·33 , 95 % CI 1·15 - 1·50 , p<0·0001 ) . Pneumonia-associated complications until day 30 did not differ between groups ( 11 [ 3 % ] in the prednisone group and 22 [ 6 % ] in the placebo group ; odds ratio [ OR ] 0·49 [ 95 % CI 0·23 - 1·02 ] ; p=0·056 ) . The prednisone group had a higher incidence of in-hospital hyperglycaemia needing insulin treatment ( 76 [ 19 % ] vs 43 [ 11 % ] ; OR 1·96 , 95 % CI 1·31 - 2·93 , p=0·0010 ) . Other adverse events compatible with corticosteroid use were rare and similar in both groups . INTERPRETATION Prednisone treatment for 7 days in patients with community-acquired pneumonia admitted to hospital shortens time to clinical stability without an increase in complications . This finding is relevant from a patient perspective and an important determinant of hospital costs and efficiency . FUNDING Swiss National Science Foundation , Viollier AG , Nora van Meeuwen Haefliger Stiftung , Julia und Gottfried Bangerter-Rhyner Stiftung Objectives It has been suggested that statins have an effect on the modulation of the cytokine cascade and on the outcome of patients with community-acquired pneumonia ( CAP ) . The aim of this prospect i ve , r and omised , double-blind , placebo-controlled trial was to determine whether statin therapy given to hospitalised patients with CAP improves clinical outcomes and reduces the concentration of inflammatory cytokines . Setting A tertiary teaching hospital in Barcelona , Spain . Participants Thirty-four patients were r and omly assigned and included in an intention-to-treat analysis ( 19 to the simvastatin group and 15 to the placebo group ) . Intervention Patients were r and omly assigned to receive 20 mg of simvastatin or placebo administered in the first 24 h of hospital admission and once daily thereafter for 4 days . Outcome Primary end point was the time from hospital admission to clinical stability . The secondary end points were serum concentrations of inflammatory cytokines and partial pressure of arterial oxygen/fractional inspired oxygen ( PaO2/FiO2 ) at 48 h after treatment administration . Results The trial was stopped because enrolment was much slower than originally anticipated . The baseline characteristics of the patients and cytokine concentrations at the time of enrolment were similar in the two groups . No significant differences in the time from hospital admission to clinical stability were found between study groups ( median 3 days , IQR 2–5 vs 3 days , IQR 2–5 ; p=0.47 ) . No significant differences in PaO2/FiO2 ( p=0.37 ) , C reactive protein ( p=0.23 ) , tumour necrosis factor-α ( p=0.58 ) , interleukin 6 ( IL-6 ; p=0.64 ) , and IL-10 ( p=0.61 ) levels at 48 h of hospitalisation were found between simvastatin and placebo groups . Similarly , transaminase and total creatine kinase levels were similar between study groups at 48 h of hospitalisation ( p=0.19 , 0.08 and 0.53 , respectively ) . Conclusions Our results suggest that the use of simvastatin , 20 mg once daily for 4 days , since hospital admission did not reduce the time to clinical stability and the levels of inflammatory cytokines in hospitalised patients with CAP . Trial registration number IS RCT N91327214 Background : In the assessment of severity in community acquired pneumonia ( CAP ) , the modified British Thoracic Society ( mBTS ) rule identifies patients with severe pneumonia but not patients who might be suitable for home management . A multicentre study was conducted to derive and vali date a practical severity assessment model for stratifying adults hospitalised with CAP into different management groups . Methods : Data from three prospect i ve studies of CAP conducted in the UK , New Zeal and , and the Netherl and s were combined . A derivation cohort comprising 80 % of the data was used to develop the model . Prognostic variables were identified using multiple logistic regression with 30 day mortality as the outcome measure . The final model was tested against the validation cohort . Results : 1068 patients were studied ( mean age 64 years , 51.5 % male , 30 day mortality 9 % ) . Age ⩾65 years ( OR 3.5 , 95 % CI 1.6 to 8.0 ) and albumin < 30 g/dl ( OR 4.7 , 95 % CI 2.5 to 8.7 ) were independently associated with mortality over and above the mBTS rule ( OR 5.2 , 95 % CI 2.7 to 10 ) . A six point score , one point for each of Confusion , Urea > 7 mmol/l , Respiratory rate ⩾30/min , low systolic(<90 mm Hg ) or diastolic ( ⩽60 mm Hg ) Blood pressure ) , age ⩾65 years ( CURB-65 score ) based on information available at initial hospital assessment , enabled patients to be stratified according to increasing risk of mortality : score 0 , 0.7 % ; score 1 , 3.2 % ; score 2 , 3 % ; score 3 , 17 % ; score 4 , 41.5 % and score 5 , 57 % . The validation cohort confirmed a similar pattern . Conclusions : A simple six point score based on confusion , urea , respiratory rate , blood pressure , and age can be used to stratify patients with CAP into different management groups Background Community-acquired pneumonia ( CAP ) is generally considered a major cause of morbidity and mortality in the elderly . However , population -based data are very limited and its overall burden is unclear . This study assessed incidence and mortality from CAP among Spanish community-dwelling elderly . Methods Prospect i ve cohort study that included 11,240 individuals aged 65 years or older , who were followed from January 2002 until April 2005 . Primary endpoints were all-cause CAP ( hospitalised and outpatient ) and 30-day mortality after the diagnosis . All cases were radiographically proved and vali date d by checking clinical records . Results Incidence rate of overall CAP was 14 cases per 1,000 person-year ( 95 % confidence interval : 12.7 to 15.3 ) . Incidence increased dramatically by age ( 9.9 in people 65–74 years vs 29.4 in people 85 years or older ) , and it was almost double in men than in women ( 19.3 vs 10.1 ) . Hospitalisation rate was 75.1 % , with a mean length-stay of 10.4 days . Overall 30-days case-fatality rate was 13 % ( 15 % in hospitalised and 2 % in outpatient cases ) . Conclusion CAP remains as a major health problem in older adults . Incidence rates in this study are comparable with rates described in Northern Europe and America , but they largely doubled prior rates reported in other Southern European regions Objective To determine differences in aetiologies , initial antimicrobial treatment choices and outcomes in patients with nursing-home-acquired pneumonia ( NHAP ) compared with patients with community-acquired pneumonia ( CAP ) , which is a controversial issue . Methods Data from the prospect i ve multicentre Competence Network for Community-acquired pneumonia ( CAPNETZ ) data base were analysed for hospitalised patients aged ≥65 years with CAP or NHAP . Potential differences in baseline characteristics , comorbidities , physical examination findings , severity at presentation , initial laboratory investigations , blood gases , microbial investigations , aetiologies , antimicrobial treatment and outcomes were determined between the two groups . Results Patients with NHAP presented with more severe pneumonia as assessed by CRB-65 ( confusion , respiratory rate , blood pressure , 65 years and older ) score than patients with CAP but received the same frequency of mechanical ventilation and less antimicrobial combination treatment . There were no clinical ly relevant differences in aetiology , with Streptococcus pneumoniae the most important pathogen in both groups , and potential multidrug-resistant pathogens were very rare ( < 5 % ) . Only Staphylococcus aureus was more frequent in the NHAP group ( n=12 , 2.3 % of the total population , 3.1 % of those with microbial sampling compared with 0.7 % and 0.8 % in the CAP group , respectively ) . Short-term and long-term mortality in the NHAP group was higher than in the CAP group for patients aged ≥65 years ( 26.6 % vs 7.2 % and 43.8 % vs 14.6 % , respectively ) . However , there was no association between excess mortality and potential multidrug-resistant pathogens . Conclusions Excess mortality in patients with NHAP can not be attributed to a different microbial pattern but appears to result from increased comorbidities , and consequently , pneumonia is frequently considered and managed as a terminal event Background Age-related alterations in the clinical characteristics and performance of severity scoring systems for community-acquired pneumonia ( CAP ) are unknown . Methods Consecutive patients with CAP presenting to the emergency department were prospect ively studied . Patients were classified as younger adults ( age 18–64 years ) , elderly ( age 65–84 years ) and very old subjects ( age ≥85 years ) .  Clinical characteristics , complications , outcomes and validity of the  pneumonia severity index ( PSI ) and CURB-65 categories were compared across these three age categories . Results Analysis involved 348 ( 35.3 % ) younger adult patients , 438 ( 44.3 % ) elderly patients and 201 ( 20.0 % ) very old patients . Compared with younger adults , elderly and very old patients had a higher burden of comorbidities and a higher incidence of CAP-related complications . The 30-day mortality rate was 5.2 % in younger adults , 7.1 % in elderly patients and 9.5 % in very old patients . The area under the ROC curve ( AUCs ) for PSI were 0.87 ( 95 % CI 0.77 to 0.97 ) , 0.85 ( 95 % CI 0.803 to 0.897 ) and 0.69 ( 95 % CI 0.597 to 0.787 ) and 
    Output:
    
Pneumococcal and influenza vaccination comprise one of the most important preventive approaches for CAP in the elderly