Effect of Increasing the Intensity of Implementing Pneumonia Guidelines

Yealy, Donald M.; Auble, Thomas E.; Stone, Roslyn A.; Lave, Judith R.; Meehan, Thomas P.; Graff, Louis; Fine, Jonathan; Obrosky, D. Scott; Mor, Maria K.; Whittle, Jeff; Fine, Michael J.

doi:10.7326/0003-4819-143-12-200512200-00006

Cited by 178 publications

(154 citation statements)

References 31 publications

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“…PCT stewardship markedly reduced antibiotic exposure in patients with CAP, mainly by individually reducing the median duration of antibiotic courses from 12 to 5 days. In the PCT group, antibiotic courses were markedly shorter, as suggested by current guidelines [72,76]. Conversely, CAP is associated with adverse outcome, especially in bacteraemic patients, and thus longer antibiotic courses are recommended [77][78][79].…”

Section: Pct For Antibiotic Stewardship Of Respiratory Tract Infectionsmentioning

confidence: 99%

Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators

Christ‐Crain¹,

Müller²

2007

Eur Respir J

225

149

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Used appropriately, biomarkers improve the assessment of respiratory tract infections and sepsis. Most prominently, circulating procalcitonin levels increase by a factor of several tens of thousands during sepsis. Using a sensitive assay, procalcitonin safely and markedly reduces antibiotic usage in respiratory tract infections and nonbacterial meningitis. Procalcitonin is the protopye of hormokine mediators. The term ''hormokine'' encompasses the cytokine-like behaviour of hormones during inflammation and infections. The concept is based on a ubiquitous expression of calcitonin peptides during sepsis. Adrenomedullin, another member of the calcitonin peptide superfamily, was shown to complement and improve the current prognostic assessment in lower respiratory tract infections. Other peptides share some features of hormokines, e.g. natriuretic peptide and copeptin. Hormokines are not only biomarkers of infection but are also pivotal inflammatory mediators. Like all mediators, their role during systemic infections is basically beneficial, possibly to combat invading microbes. However, at increased levels they can become harmful for their host. Multiple mechanisms of action were proposed. In several animal models the modulation and neutralisation of hormokines during infection was shown to improve survival, and thus might open new treatment options for severe infections, especially of the respiratory tract.

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Section: Pct For Antibiotic Stewardship Of Respiratory Tract Infectionsmentioning

confidence: 99%

Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators

Christ‐Crain¹,

Müller²

2007

Eur Respir J

225

149

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“…Thus both scoring systems use patient's age as an important parameter. However, these systems are not effective to assess patients with a high mortality risk as much as it is for measuring patients with a low mortality risk 8,9 . In addition to PSI and CURB-65, biological markers have been developed to predict the severity of pneumonia in patients during the early infection.…”

Section: Original Articlementioning

confidence: 99%

Usefulness of Plasma Procalcitonin to Predict Severity in Elderly Patients With Community-Acquired Pneumonia

Kim

Mok

Jeon

et al. 2012

Chest

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Background: Community-acquired pneumonia (CAP) is one of the leading causes of death among the elderly. Several studies have reported the clinical usefulness of serum procalcitonin, a biomarker of bacterial infection. However, the association between the levels of procalcitonin and the severity in the elderly with CAP has not yet been reported. The aim of this study was to evaluate usefulness of procalcitonin as a predictor of severity and mortality in the elderly with CAP. Methods: This study covers 155 CAP cases admitted to Pusan National University Hospital between January 2010 and December 2010. Patients were divided into two groups (≥65 years, n=99; ＜65 years, n=56) and were measured for procalcitonin, C-reactive protein (CRP), white blood cell, confusion, uremia, respiratory rate, blood pressure, 65 years or older (CURB-65) and pneumonia severity of index (PSI). Results: The levels of procalcitonin were significantly correlated with the CURB-65, PSI in totals. Especially stronger correlation was observed between the levels of procalcitonin and CURB-65 in the elderly (procalcitonin and CURB-65, ρ=0.408 with p＜0.001; procalcitonin and PSI, ρ=0.293 with p=0.003; procalcitonin and mortality, ρ =0.229 with p=0.023). The correlation between the levels of CRP or WBC and CAP severity was low. The existing cut-off value of procalcitonin was correlated with mortality rate, however, it was not correlated with mortality within the elderly. Conclusion: The levels of procalcitonin are more useful than the levels of CRP or WBC to predict the severity of CAP. However, there was no association between the levels of procalcitonin and mortality in the elderly.

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“…We found no association between guideline- accordance with the guidelines that had been implemented. (13) In a study that constituted an arm of the abovementioned study, Aujesky et al found that 78.7% of the hospitalizations among the 1,306 patients under study were in accordance with the pneumonia severity index after a high intensity of implementing guidelines. (14,15) Our finding might be due to the fact that the HC/ UFMG is a university hospital, reflecting greater knowledge of the guidelines for CAP.…”

Section: Discussionmentioning

confidence: 99%

Adesão a diretrizes e impacto nos desfechos em pacientes hospitalizados por pneumonia adquirida na comunidade em um hospital universitário

2012

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Objective: To evaluate the agreement between the criteria used for hospitalization of patients with communityacquired pneumonia (CAP) and those of the Brazilian Thoracic Association guidelines, and to evaluate the association of that agreement with 30-day mortality. Secondarily, to evaluate the agreement between the treatment given and that recommended in the guidelines with length of hospital stay, microbiological profile, 12-month mortality, complications, ICU admission, mechanical ventilation, and 30-day mortality. Methods: This was a retrospective study involving adult patients hospitalized between 2005 and 2007 at the Federal University of Minas Gerais Hospital das Clínicas, located in Belo Horizonte, Brazil. Medical charts and chest X-rays were reviewed. Results:Among the 112 patients included in the study, admission and treatment criteria were in accordance with the guidelines in 82 (73.2%) and 66 (58.9%), respectively. The 30-day and 12-month mortality rates were 12.3% and 19.4%, respectively. The 30-day mortality rate was lower for patients in whom the CRB-65 (mental Confusion, Respiratory rate, Blood pressure, and age ≥ 65 years) score was 1-2 and the antibiotic therapy was in accordance with the guidelines (p = 0.01). Cerebrovascular disease and appropriate antibiotic therapy showed independent associations with 30-day mortality. There was a trend toward an association between guidelineconcordant antibiotic therapy and shorter hospital stay. Conclusions: In the population studied, admission and treatment criteria that were in accordance with the guidelines were associated with favorable outcomes in hospitalized patients with CAP. Cerebrovascular disease, as a risk factor, and guideline-concordant antibiotic therapy, as a protective factor, were associated with 30-day mortality.Keywords: Pneumonia/therapy; Pneumonia/mortality; Hospitalization; Guideline adherence. ResumoObjetivo: Avaliar a concordância entre os critérios de hospitalização utilizados para a admissão de pacientes com pneumonia adquirida na comunidade (PAC) e aqueles da Sociedade Brasileira de Pneumologia e Tisiologia e avaliar a associação dessa concordância com a taxa de mortalidade em 30 dias. Secundariamente, avaliar a associação da concordância entre o tratamento instituído e as recomendações dessas diretrizes com duração da internação hospitalar, investigação microbiológica, mortalidade em 12 meses, complicações, internação em UTI, ventilação mecânica e mortalidade em 30 dias. Métodos: Estudo retrospectivo que incluiu pacientes adultos internados entre 2005 e 2007 no Hospital das Clínicas da Universidade Federal de Minas Gerais, na cidade de Belo Horizonte (MG). Foram revisados prontuários e radiografias de tórax. Resultados: Dentre os 112 pacientes incluídos, os critérios de internação e de tratamento foram concordantes com as diretrizes em 82 (73,2%) e 66 (58,9%), respectivamente. A taxa de mortalidade em 30 dias e em 12 meses foi de 12,3% e 19,4%, respectivamente. Pacientes com escore de CRP-65 (Confusão mental, frequênci...

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Effect of Increasing the Intensity of Implementing Pneumonia Guidelines

Cited by 178 publications

References 31 publications

Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators

Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators

Usefulness of Plasma Procalcitonin to Predict Severity in Elderly Patients With Community-Acquired Pneumonia

Adesão a diretrizes e impacto nos desfechos em pacientes hospitalizados por pneumonia adquirida na comunidade em um hospital universitário

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