Guidelines for the Management of Adults with Community-acquired Pneumonia

Niederman, Michael S.; Mandell, Lionel A.; Anzueto, Antonio; Bass, John B.; Broughton, William A.; Campbell, G. Douglas; Dean, Nathan C.; File, Thomas M.; Fine, Michael J.; Groß, Peter; Martínez, Fernando J.; Marrie, Thomas J.; Plouffe, Joseph F.; Ramirez, Julio A.; Sarosi, George A.; Torres, Antoni; Wilson, Ruth P.; Yu, Victor L.

doi:10.1164/ajrccm.163.7.at1010

Cited by 1,874 publications

(407 citation statements)

References 144 publications

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“…Clinical failure was defined as: death within 30 days of admission; readmission within 30 days of discharge; tube thoracostomy, thoracotomy or decortication required during hospitalisation or within 30 days; or pleural fluid results consistent with complicated PPE or empyema as defined by the American College of Chest Physician guidelines [14,15]. Data on patients with clinical failure were reviewed and discussed amongst a panel of six infectious and pulmonary disease physicians to classify the outcome as PPE related, PPE unrelated or not evaluable.…”

Section: Study Outcomesmentioning

confidence: 99%

Computed tomography measurements of parapneumonic effusion indicative of thoracentesis

Moffett

Panchabhai²,

Anaya³

et al. 2011

Eur Respir J

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Patients with parapneumonic effusions (PPE) measuring ,1 cm by lateral decubitus radiograph (LDR) or ,5 cm by lateral erect radiograph (LER) do not require thoracentesis. No such data exist for chest computed tomography (CCT). The objective of this study was to identify a PPE measurement by CCT that indicates the need for thoracentesis.A secondary data analysis of two pneumonia databases was conducted to identify patients with PPE. Measurements of PPE using LDR, LER and CCT were correlated by linear regression analysis. The clinical outcome of community-acquired pneumonia patients managed with the newly defined CCT measurement was evaluated.PPE was identified in 419 out of 1,460 patients with possible pneumonia. PPE measurements of 1 cm and 5 cm by LDR and LER, respectively, correlated with a measurement of 2.5 cm by CCT. Out of 95 patients with CCT measurements ,2.5 cm, 31 poor clinical outcomes were reported: outcome was PPE related (n51); outcome was PPE unrelated (n526); and outcome was not evaluable (n54). The single case of poor outcome also measured ,1 cm by LDR.This study indicates that patients with community-acquired pneumonia and a PPE measuring ,2.5 cm by CCT can be managed without the need for thoracentesis.

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Section: Study Outcomesmentioning

confidence: 99%

Computed tomography measurements of parapneumonic effusion indicative of thoracentesis

Moffett

Panchabhai²,

Anaya³

et al. 2011

Eur Respir J

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“…A respiratory fluoroquinolone (which should be used alone for a penicillin-allergic patient) and β-lactam plus a macrolide (preferred β-lactam agent includes cefotaxime, ceftriaxone, ampicillin, and ertapenem for selected patients; with doxycycline) plus azithromycin were classified as recommended regimen for hospital treatment [6]. The specific selection of empirical antibiotic therapy should be based on certain guidelines such as risk stratification of the patient; severity of pneumonia (based on physical findings, chest X-ray, and laboratory assessments), elderly patient, presence of co-morbidities and existence of identified clinical risk factor for drug-resistant or unidentified pathogen and; resistance pattern of local Antibiotic therapy of choice for community-acquired pneumonia in Malaysian Hajj pilgrims: the pattern and associated factors epidemiology [38,39]. In addition, patients who were admitted to hospital because of CAP should be treated with antibiotic therapy within a timeline of 4 to 8 h after arrival.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic therapy of choice for community-acquired pneumonia in Malaysian Hajj pilgrims: the pattern and associated factors

Dzaraly¹,

Rahman²,

Haque³

et al. 2017

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Introduction: Pneumonia is a potentially life-threatening illness that poses global health teething troubles particularly among elderly population and performing Hajj. Empirical antibiotic treatment has been recommended for all suspected community-acquired pneumonia (CAP) patients as initial treatment on admission. Aim of the research: To describe the antibiotic therapy of CAP and determine the associated factors related to the treatment options among Malaysian Hajj pilgrims. Material and methods: This was a cross-sectional study involving 91 patients who were admitted to Tabung Haji Hospital, Makkah in 2012, with the clinical diagnosis of pneumonia during Hajj season. The antibiotic treatment for the patients as well as demographic factors and co-morbidity, which potentially influence the treatment options, were studied. Results: The mean age of the hajj pilgrims was 71.4 ±8.7 years. The most frequently prescribed antibiotic was levofloxacin (44.0%), followed by azithromycin (40.7%), cefuroxime (23.1%), ampicillin + sulbactam (16.5%), and amoxicillin + clavulanate (15.4%). The age of patients was significantly associated with levofloxacin, azithromycin, and meropenem (p = 0.032, 0.028, and 0.026, respectively). Patients with diabetes were statistically significantly highly prescribed with cefuroxime (p = 0.036). Conclusions: Levofloxacin and azithromycin were classified as the most common antibiotic treatment given to Malaysian Hajj pilgrim with CAP and their choice was associated with older age of patients. Otherwise, cefuroxime was the prescription of choice in diabetics.

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“…Pnömoniler içerisinde toplum kökenli pnömoni (TKP) nedeni ile hastaneye yatırılmış hastaların %5-10'unda, yaşamı tehdit eden pnömoni tanısı ile yoğun bakım tedavisi gerekir [8]. Amerikan Toraks Derneği (ATS) ve Türk Toraks Derneği'nin oluşturduğu TKP tanı ve tedavi rehberinde; yaşamı tehdit eden pnö-moniler 4.grup olarak kabul edilmiştir [9,10]. Pseudomonas aeruginosa'nın TKP etkeni olarak görülme sıklığı çalışmalarda %0-5 arasında değişirken, yaşamı tehdit eden TKP etkeni olarak görülme sıklığı %5-7 arasında değişmektedir [2,3].…”

Section: Discussionunclassified

“…Amerikan Toraks Derneği'nin 2001 yılı TKP tanı ve tedavi rehberinde; 4. grup P.aeruginosa riski olanlar ve olmayanlar olarak iki gruba ayrılmıştır. Aynı rehbere göre P.aeruginosa riskini arttıran faktörler; yapısal akciğer hastalıkları, uzun süreli kortikosteroid tedavisi, son bir ayda yedi günden fazla geniş spektrumlu antibiyotik tedavisi ve malnutrisyon olarak bildirilmiştir [9]. Bizim hastamızda P.aeruginosa riskini arttıran hiçbir faktör tespit edilememiştir.…”

Section: Discussionunclassified

Fatal Progression of Pseudomonas Aeruginosa Pneumonia in a Health Care Worker

Kıraklı¹,

Koca²,

Uçar³

et al. 2010

Tur Toraks Der

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ÖZETPseudomonas aeruginosa pnömonisine bağlı olarak 48 saat içinde septik şok ve çoklu organ yetmezliği gelişen 43 yaşında sağlıklı erkek olgu sunulmuştur. Sistemik semptomlarla başvu-ran olguda akciğer grafisinde sol üst zondaki minimal lezyonun 36 saat sonra sol akciğerin tamamını kapladığı gözlendi. Hasta solunum yetmezliği nedeniyle invaziv mekanik ventilasyon desteği için yoğun bakım ünitesine alındı. Uygun antibiyotik ve destek tedavisine rağmen hastada pansitopeni, septik şok ve çoklu organ yetmezliği gelişti ve hasta başvurusundan yaklaşık 48 sonra kaybedildi. GİRİŞPseudomonas aeruginosa (P.aeruginosa); öncelikle hastane kökenli bir patojen olup, gram negatif basiller arasında hastane kökenli pnömoniye en çok neden olan etkendir [1]. Pseudomonas aeruginosa'nın toplum kökenli pnömoni (TKP) etkeni olarak görülme sıklığı, çalışmalarda %0-5 arasında değişirken, yaşamı tehdit eden TKP etkeni olarak görülme sıklığı %5-7 arasında değişmektedir [2,3]. İnsanların normal florasında da bulunabilen P. aeruginosa'nın immun sistemi normal insanlarda nadiren septisemiye neden olduğu, fakat prognozun immunsuprese hastalardaki P.aeruginosa septisemisinden daha iyi olduğu bildirilmektedir [4].Hastane kökenli pnömonide mortaliteyi artıran faktörlerden biri yüksek riskli patojenler (P. aeruginosa gibi) ile infeksiyondur [5,6].Sağlıklı hastada, P. aeruginosa pnömonisinin neden olduğu fulminan fatal seyir literatürde nadir görülmesi nedeniyle sunulmuştur. OLGUKırk üç yaşında, göğüs hastalıkları kliniğinde personel olarak çalışan erkek hasta, iki gün önce başlayan halsizlik, kırgınlık ve iki saat önce başlayan, üşüme-titremeyle birlikte yükselen ateş şikayetleriyle acil servise başvurdu. Anamnezde; öz ve soy geçmişinde bir özellik yoktu, sürekli ilaç kullanımı, sigara, alkol ya da uyuşturucu bağımlılığı yoktu. Hastanın klinikteki görevi sorgulandı-ğında, hastalara ait kan, balgam, idrar gibi materyalleri laboratuvara taşımak, hastaların tetkikleri sırasında transportu sağlamak ve klinik temizliği ile uğraştığı öğrenildi.Ateş (38,5°C) dışında diğer vital bulguları normal olan hastada, solunum sistemi ve diğer sistem muayeneleri normaldi. Laboratuvar tetkiklerinde; lökositoz (24.500/ mm 3 ) ve polimorfonükleer lökosit hakimiyeti (%86 nötro-fil) dışında patolojik bulguya rastlanmadı. Akciğer grafisinde; sol üst zonda, birinci kot ön kavsi üzerine süperpoze, yaklaşık 4x3 cm boyutlarında infiltrasyon izlendi (Şekil 1). Balgam asidorezistan basil (ARB) bakısı negatif olarak OLGU SUNUMU CASE REPORT

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Guidelines for the Management of Adults with Community-acquired Pneumonia

Cited by 1,874 publications

References 144 publications

Computed tomography measurements of parapneumonic effusion indicative of thoracentesis

Computed tomography measurements of parapneumonic effusion indicative of thoracentesis

Antibiotic therapy of choice for community-acquired pneumonia in Malaysian Hajj pilgrims: the pattern and associated factors

Fatal Progression of Pseudomonas Aeruginosa Pneumonia in a Health Care Worker

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