{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T11:18:04Z","timestamp":1783077484216,"version":"3.54.6"},"reference-count":75,"publisher":"Massachusetts Medical Society","issue":"26","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["N Engl J Med"],"published-print":{"date-parts":[[1998,6,25]]},"DOI":"10.1056\/nejm199806253382601","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T12:53:28Z","timestamp":1027774408000},"page":"1861-1868","source":"Crossref","is-referenced-by-count":215,"title":["An Outbreak of Multidrug-Resistant Pneumococcal Pneumonia and Bacteremia among Unvaccinated Nursing Home Residents"],"prefix":"10.1056","volume":"338","author":[{"given":"J. Pekka","family":"Nuorti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay C.","family":"Butler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Crutcher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon","family":"Guevara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Welch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Holder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Elliott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"150","reference":[{"key":"r001","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199304293281708"},{"key":"r002","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.150.7.1401"},{"key":"r003","doi-asserted-by":"publisher","DOI":"10.1001\/jama.275.3.194"},{"key":"r004","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-198502000-00010"},{"key":"r005","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1093\/oxfordjournals.aje.a117076","volume":"139","author":"Gray GC","year":"1994","journal-title":"Am J Epidemiol"},{"key":"r006","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/24.3.441"},{"key":"r007","doi-asserted-by":"publisher","DOI":"10.1001\/jama.244.13.1446"},{"key":"r008","doi-asserted-by":"publisher","DOI":"10.1378\/chest.99.1.147"},{"key":"r009","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199409083311004"},{"key":"r010","doi-asserted-by":"publisher","DOI":"10.1001\/jama.271.9.695"},{"key":"r011","first-page":"949","volume":"43","year":"1995","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"r012","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(93)90176-P"},{"key":"r013","first-page":"60","volume":"46","year":"1997","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"r014","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/168.6.1532"},{"key":"r015","doi-asserted-by":"publisher","DOI":"10.1001\/jama.271.23.1831"},{"key":"r016","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199508243330803"},{"key":"r017","doi-asserted-by":"publisher","DOI":"10.1097\/00006454-199509000-00004"},{"key":"r018","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/174.5.986"},{"key":"r019","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199408113310607"},{"key":"r020","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.153.11.1301"},{"key":"r021","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(81)90184-7"},{"key":"r022","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/157.2.256"},{"key":"r023","first-page":"923","volume":"144","author":"Rauch AM","year":"1990","journal-title":"Am J Dis Child"},{"key":"r024","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/166.6.1346"},{"key":"r025","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197810052991402"},{"key":"r026","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198707023170104"},{"key":"r027","doi-asserted-by":"publisher","DOI":"10.1016\/S0163-4453(87)91576-3"},{"key":"r028","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.94.07091635"},{"key":"r029","doi-asserted-by":"publisher","DOI":"10.1016\/0195-6701(94)90002-7"},{"key":"r030","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/173.2.374"},{"key":"r031","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/174.3.513"},{"key":"r032","first-page":"1","volume":"45","year":"1996","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"r033","unstructured":"Facklam RR, Washington JA II. Streptococcus and related catalase-negative gram-positive cocci. In: Balows A, ed. Manual of clinical microbiology. 5th ed. Washington, D.C.: American Society for Microbiology, 1991:238-57."},{"key":"r034","unstructured":"Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. 3rd ed. Approved standard. Villanova, Pa.: National Committee for Clinical Laboratory Standards, 1993. (NCCLS document M7-A3.)"},{"key":"r035","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.1128\/JCM.33.9.2233-2239.1995","volume":"33","author":"Tenover FC","year":"1995","journal-title":"J Clin Microbiol"},{"key":"r036","unstructured":"Herrmann KL, Erdman DD. Diagnosis by serologic assays. In: Lennette EH, Lennette DA, Lennette ET, eds. Diagnostic procedures for viral, rickettsial, and chlamydial infections. 7th ed. Washington, D.C.: American Public Health Association, 1995:121-38."},{"key":"r037","unstructured":"Dean AG, Dean JA, Coulombier D, et al. Epi Info, version 6: a word processing program for public health on IBM-compatible microcomputers. Atlanta: Centers for Disease Control and Prevention, 1994."},{"key":"r038","doi-asserted-by":"publisher","DOI":"10.2307\/2530643"},{"key":"r039","unstructured":"Stratified analysis. In: Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research: principles and quantitative methods. New York: Van Nostrand Reinhold, 1982:320-76."},{"key":"r040","first-page":"1","volume":"46","year":"1997","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"r041","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/13.1.56"},{"key":"r042","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/15.1.95"},{"key":"r043","doi-asserted-by":"crossref","first-page":"2282","DOI":"10.1128\/AAC.39.10.2282","volume":"39","author":"McDougal LK","year":"1995","journal-title":"Antimicrob Agents Chemother"},{"key":"r044","doi-asserted-by":"crossref","first-page":"2176","DOI":"10.1128\/AAC.36.10.2176","volume":"36","author":"McDougal LK","year":"1992","journal-title":"Antimicrob Agents Chemother"},{"key":"r045","first-page":"23","volume":"43","year":"1994","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"r046","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(96)70326-8"},{"key":"r047","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/171.4.890"},{"key":"r048","doi-asserted-by":"publisher","DOI":"10.1086\/646957"},{"key":"r049","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1111\/j.1532-5415.1986.tb04301.x","volume":"34","author":"Zimmer JG","year":"1986","journal-title":"J Am Geriatr Soc"},{"key":"r050","doi-asserted-by":"publisher","DOI":"10.1086\/647256"},{"key":"r051","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1542\/peds.92.6.761","volume":"92","author":"Tan TQ","year":"1993","journal-title":"Pediatrics"},{"key":"r052","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/171.6.1491"},{"key":"r053","doi-asserted-by":"publisher","DOI":"10.1086\/647257"},{"key":"r054","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198109243051304"},{"key":"r055","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.150.7.1465"},{"key":"r056","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(87)90761-3"},{"key":"r057","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-194209010-00003"},{"key":"r058","doi-asserted-by":"publisher","DOI":"10.1016\/S0163-4453(88)94147-3"},{"key":"r059","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/18.1.35"},{"key":"r061","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1001\/archpedi.1986.02140250109044","volume":"140","author":"Douglas RM","year":"1986","journal-title":"Am J Dis Child"},{"key":"r062","doi-asserted-by":"publisher","DOI":"10.1084\/jem.82.6.445"},{"key":"r063","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.28.3.293"},{"key":"r064","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/15.1.84"},{"key":"r065","unstructured":"Carter R, Sorenson G, Kornblum J, Kiehlbauch J, Leggiardo R, Layton M. Outbreak of multidrug-resistant Streptococcus pneumoniae (MDRSP) at a long-term care facility for persons with AIDS. In: Program and abstracts of the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy, Toronto, September 28\u2013October 1, 1997. Washington, D.C.: American Society for Microbiology, 1997:55. abstract."},{"key":"r066","doi-asserted-by":"publisher","DOI":"10.2165\/00002512-199608050-00003"},{"key":"r067","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/17.1.66"},{"key":"r068","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198611203152104"},{"key":"r069","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)07358-3"},{"key":"r070","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199111213252101"},{"key":"r071","doi-asserted-by":"crossref","first-page":"653","DOI":"10.7326\/0003-4819-108-5-653","volume":"108","author":"Sims RV","year":"1988","journal-title":"Ann Intern Med"},{"key":"r072","doi-asserted-by":"publisher","DOI":"10.1001\/jama.270.15.1826"},{"key":"r073","doi-asserted-by":"publisher","DOI":"10.1001\/jama.278.16.1333"},{"key":"r074","first-page":"853","volume":"45","year":"1996","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"r075","first-page":"720","volume":"110","author":"Snow R","year":"1995","journal-title":"Public Health Rep"},{"key":"r076","unstructured":"Strahan GW. An overview of nursing homes and their current residents: data from the 1995 National Nursing Home Survey. Advance data from vital and health statistics. No. 280. Hyattsville, Md.: National Center for Health Statistics, 1997. (DHHS publication no. (PHS) 97-1250.)"}],"container-title":["New England Journal of Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJM199806253382601","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,23]],"date-time":"2023-04-23T20:23:07Z","timestamp":1682281387000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.nejm.org\/doi\/abs\/10.1056\/NEJM199806253382601"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1998,6,25]]},"references-count":75,"journal-issue":{"issue":"26","published-print":{"date-parts":[[1998,6,25]]}},"alternative-id":["10.1056\/NEJM199806253382601"],"URL":"https:\/\/doi.org\/10.1056\/nejm199806253382601","relation":{},"ISSN":["0028-4793","1533-4406"],"issn-type":[{"value":"0028-4793","type":"print"},{"value":"1533-4406","type":"electronic"}],"subject":[],"published":{"date-parts":[[1998,6,25]]}}}