Community-acquired pneumonia

Abstract

Community-acquired pneumonia causes great mortality and morbidity and high costs worldwide. Empirical selection of antibiotic treatment is the cornerstone of management of patients with pneumonia. To reduce the misuse of antibiotics, antibiotic resistance, and side-effects, an empirical, effective, and individualised antibiotic treatment is needed. Follow-up after the start of antibiotic treatment is also important, and management should include early shifts to oral antibiotics, stewardship according to the microbiological results, and short-duration antibiotic treatment that accounts for the clinical stability criteria. New approaches for fast clinical (lung ultrasound) and microbiological (molecular biology) diagnoses are promising. Community-acquired pneumonia is associated with early and late mortality and increased rates of cardiovascular events. Studies are needed that focus on the long-term management of pneumonia.

Severe Pneumococcal Pneumonia Causes Acute Cardiac Toxicity and Subsequent Cardiac Remodeling

“…Lower respiratory tract infections cost the healthcare system more than 10 billion dollars annually in the United States (1,2). Community-acquired pneumonia (CAP) and influenza infections together are the fourth most prevalent cause of death worldwide (3).…”

Corticosteroids in the adjunctive therapy of community-acquired pneumonia: an appraisal of recent meta-analyses of clinical trials

“…Much has been written regarding what constitutes appropriate and/or optimal antibiotic treatment, and this has been extensively reviewed elsewhere (1,(7)(8)(9). However, while it is well recognised that inappropriate initial antibiotic therapy is associated with a worse outcome, it is also noted that even in the setting of appropriate initial antibiotic treatment, many patients still die (10).…”

“…However, while it is well recognised that inappropriate initial antibiotic therapy is associated with a worse outcome, it is also noted that even in the setting of appropriate initial antibiotic treatment, many patients still die (10). This has resulted in considerable interest in the potential role of adjunctive, anti-inflammatory therapies in the management of patients with CAP, particularly among the more seriously ill patients (1,(7)(8)(9)11,12). Shindo and colleagues recently studied risk factors for 30-day mortality in patients with CAP who had received appropriate antibiotic therapy, with the aim of trying to identify patients who were most likely to benefit from adjunctive therapy (10).…”

“…Awareness of the threat posed by CAP-associated, inflammation-mediated tissue damage and organ dysfunction, seemingly exacerbated by co-existent comorbidities, has motivated exploration of the therapeutic potential of adjunctive anti-inflammatory therapies (1,7,9,11,12). Foremost amongst these are corticosteroids (CS) and macrolides (1), with more recent interest in statins and platelet-targeted pharmacological agents (13).…”

Shrinking Autonomy for Tatarstan and Gagauzia: The Perils of Flexible Institutional Design

“…78 For example, despite the victory in the constitutional court noted above (on the teaching of Tatar and Russian 'in equal measure'), in practice the amount of teaching of, and through the medium of, Tatar, has incrementally decreased since the 2000s. 79 The shrinking of territorial autonomy and the resulting limitations in the promotion of Tatar interests indicate a tendency for law and policy for the protection of minority rights to be treated as having primarily a symbolic, rather than an instrumental, role. 80 For example, in relation to language legislation, it has been suggested that relevant legal provisions -such as those declaring regional languages co-official alongside Russian at the level of republicsnever intended to be fully implemented, but merely to fulfil a symbolic function.…”