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Hernández-Pérez JM, López-Charry CV. Is there any kind of relationship between alpha-1 antitrypsin levels and lung function parameters? J Bras Pneumol 2023; 49:e20220432. [PMID: 36790284 PMCID: PMC9970365 DOI: 10.36416/1806-3756/e20220432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- José María Hernández-Pérez
- . Departamento de Neumología. Hospital Universitario Nuestra Señora de Candelaria, 38010, Santa Cruz de Tenerife, España
| | - Claudia Viviana López-Charry
- . Departamento de Neumología. Hospital Universitario Nuestra Señora de Candelaria, 38010, Santa Cruz de Tenerife, España
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Nascimento-Carvalho CM. Delafloxacin as a treatment option for community-acquired pneumonia infection. Expert Opin Pharmacother 2021; 22:1975-1982. [PMID: 34346823 DOI: 10.1080/14656566.2021.1957098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality in adults. Bacterial pathogens are recognized to be frequent causative agents, which makes antibacterial treatment crucial for the evolution of these patients. There are several antimicrobial options available in daily practice. However, bacterial resistance is a problem. The chemical, pharmacokinetic, pharmacodynamics, and safety characteristics of delafloxacin, a fluoroquinolone, are discussed. The data from one phase 3 clinical trial evaluating the use of delafloxacin in adults with community-acquired pneumonia is also discussed, along with findings from other meaningful studies. In vitro data have shown that delafloxacin has broad spectrum activity. Results from phase 2 and phase 3 studies have demonstrated that delafloxacin use is safe. International guidelines have recommended respiratory fluoroquinolones as second option for non-severe cases and must be considered in very severe patients not improving to a betalactam/macrolide combination. Delafloxacin was compared to moxifloxacin in the phase 3 community-acquired pneumonia trial. Serious and life-long adverse events due to fluoroquinolones use have been recently reported. Delafloxacin may possibly replace currently available fluoroquinolones, particularly in the treatment of resistant pathogens, such as ciprofloxacin-resistant P. aeruginosa isolates when other drugs are inefficient.
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[Legionelosis en España, 2010-2015]. ACTA ACUST UNITED AC 2021; 41:168-178. [PMID: 33761200 PMCID: PMC8055583 DOI: 10.7705/biomedica.5367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Indexed: 11/21/2022]
Abstract
Introduction: Legionellosis is a bacterial respiratory disease with an environmental origin in the community or in hospitals; it is usually associated with devices, facilities, and buildings. The most common clinical form is the pneumonic, known as legionnaires’ disease.
Objective: To determine the evolution of legionellosis cases in Spain from 2010 to 2015.
Materials and methods: This was a descriptive study of time series with an analysis of the legionellosis cases notified to the Centro Nacional de Epidemiología (Government of Spain). Case distribution was determined according to sex, the autonomous community of origin, month, and age groups differentiating in the latter between men and women.
Results: Case count in men was more than double compared to that in women. The cases notified by nine of the autonomous communities showed an increase at the end of the period, especially in Castilla y León, Navarra, and the Basque Country but also notable in Castilla-La Mancha. A seasonal pattern was identified with an epidemic peak in July-September and a greater number of cases among 50-years old people from both sexes.
Conclusion: Despite its low prevalence compared to other respiratory diseases, legionellosis has a great impact on public health. Its distribution in Spain is global and heterogeneous with cases increasing in the last two years. Therefore, better disease prevention and control measures are recommended.
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Serrano L, Ruiz LA, Martinez-Indart L, España PP, Gómez A, Uranga A, García M, Santos B, Artaraz A, Zalacain R. Non-bacteremic pneumococcal pneumonia: general characteristics and early predictive factors for poor outcome. Infect Dis (Lond) 2020; 52:603-611. [PMID: 32552142 DOI: 10.1080/23744235.2020.1772991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Purpose: Nowadays, most cases of pneumococcal community-acquired pneumonia (PCAP) are diagnosed by positive urinary antigen. Our aims were to analyse process of care in patients hospitalised with non-bacteremic PCAP (NB-PCAP) and identify factors associated with poor outcome (PO) in this population.Methods: We conducted a prospective study, including patients hospitalised for NB-PCAP (positive urinary antigen and negative blood culture) over a 15 year period. We performed multivariate analysis of predisposing factors for PO, defined as need for mechanical ventilation and/or shock and/or in-hospital death.Results: Of the 638 patients included, 4.1% died in hospital and 12.8% had PO. Host-related factors were similar in patients with and without PO, but patients with PO had higher illness severity on admission. Adjusted analysis revealed the following independent factors associated with PO: being a nursing home resident (OR: 6.156; 95% CI: 1.827-20.750; p = .003), respiratory rate ≥30 breaths/min (OR: 3.030; 95% CI: 1.554-5.910; p = .001), systolic blood pressure <90 mmHg (OR: 4.789; 95% CI: 1.967-11.660; p = .001), diastolic blood pressure <60 mmHg (OR: 2.820; 95% CI: 1.329-5.986; p = .007), pulse rate ≥125 beats/min (OR: 3.476; 95% CI: 1.607-7.518; p = .002), pH <7.35 (OR: 9.323; 95% CI: 3.680-23.622; p < .001), leukocytes <4000/µL (OR: 10.007; 95% CI: 2.960-33.835; p < .001), and severe inflammation (OR: 2.364; 95% CI 1.234-4.526; p = .009). The area under the curve for predicting PO was 0.890 (95% CI: 0.851-0.929).Conclusions: Since patients with PO seem different and had worse in-hospital course, we identified eight independent risk factors for PO measurable on admission.
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Affiliation(s)
- Leyre Serrano
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Luis A Ruiz
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Lorea Martinez-Indart
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Pedro P España
- Unit of Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Ainhoa Gómez
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Ane Uranga
- Unit of Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Marta García
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Borja Santos
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Amaia Artaraz
- Unit of Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Rafael Zalacain
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
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Impact of Lymphocyte and Neutrophil Counts on Mortality Risk in Severe Community-Acquired Pneumonia with or without Septic Shock. J Clin Med 2019; 8:jcm8050754. [PMID: 31137863 PMCID: PMC6572378 DOI: 10.3390/jcm8050754] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 01/30/2023] Open
Abstract
Background: Community-acquired pneumonia (CAP) is a frequent cause of death worldwide. As recently described, CAP shows different biological endotypes. Improving characterization of these endotypes is needed to optimize individualized treatment of this disease. The potential value of the leukogram to assist prognosis in severe CAP has not been previously addressed. Methods: A cohort of 710 patients with CAP admitted to the intensive care units (ICUs) at Hospital of Mataró and Parc Taulí Hospital of Sabadell was retrospectively analyzed. Patients were split in those with septic shock (n = 304) and those with no septic shock (n = 406). A single blood sample was drawn from all the patients at the time of admission to the emergency room. ICU mortality was the main outcome. Results: Multivariate analysis demonstrated that lymphopenia <675 cells/mm3 or <501 cells/mm3 translated into 2.32- and 3.76-fold risk of mortality in patients with or without septic shock, respectively. In turn, neutrophil counts were associated with prognosis just in the group of patients with septic shock, where neutrophils <8850 cells/mm3 translated into 3.6-fold risk of mortality. Conclusion: lymphopenia is a preserved risk factor for mortality across the different clinical presentations of severe CAP (sCAP), while failing to expand circulating neutrophils counts beyond the upper limit of normality represents an incremental immunological failure observed just in those patients with the most severe form of CAP, septic shock.
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Gea-Izquierdo E. Tendencias de mortalidad por afección del sistema respiratorio y neumonía en España: Serie 1992-2001. JOURNAL OF THE SELVA ANDINA RESEARCH SOCIETY 2018. [DOI: 10.36610/j.jsars.2018.090200068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pérez-Deago B, Alonso-Porcel C, Elvira-Menendez C, Murcia-Olagüenaga A, Martínez-Ibán M. [Epidemiology and management of community acquired pneumonia: more than 10 years experience]. Semergen 2018; 44:389-394. [PMID: 29574009 DOI: 10.1016/j.semerg.2018.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/24/2018] [Accepted: 01/29/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the characteristics of patients diagnosed with Community Acquired Pneumonia in this basic health area, their management, outcomes, and use of prognostic scales driven by the few studies carried out from Primary Care on these aspects. MATERIAL AND METHODS Descriptive cross-sectional study on a population diagnosed with Community Acquired Pneumonia if three urban health centres, during the period January 2000 to 31 July 2103. RESULTS Out of a sample of 1,290 patients obtained, 56.1% were men, and the mean age of the population was 61.9 years. There were 22.7% smokers. More than half (59.9%) had a disease in the prognostic scales, with Diabetes Mellitus present in 20%, and 36.1% with pulmonary disease (17.6% COPD, 11.8% asthma). Just under half (43.2%) of the total patients were diagnosed in Primary Care. There was a diagnostic X-ray in 92.7% of the cases, and a follow-up X-ray in 59.4%. Prognostic scales were recorded in 2% of the cases. The most commonly used antibiotics were amoxicillin-clavulanic (30.7%) and levofloxacin (30.4%). Having prior disease increases the risk of re-treatment by 1.6 (95% CI; 1.1-2.2)]. The mortality risk is multiplied by 5.3 on having a previous disease (95% CI; 1.3-19.2). CONCLUSIONS In the Primary Care setting, Community Acquired Pneumonia is a common and potentially serious disease which, in half the cases, occurs in patients with associated comorbidity. As regards treatment and management, is highlighted the wide use made of amoxicillin-clavulanic, compared to the low use of amoxicillin, combined therapy, and prognostic scales.
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Affiliation(s)
- B Pérez-Deago
- Servicio de Urgencias, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | - C Alonso-Porcel
- Servicio de Urgencias, Hospital Universitario de Cabueñes, Gijón, Asturias, España.
| | - C Elvira-Menendez
- Servicio de Urgencias, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | - A Murcia-Olagüenaga
- Servicio de Urgencias, Hospital Universitario de Cabueñes, Gijón, Asturias, España
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Llorens P, Román F, Merino E, Portilla J. Influencia del Pneumonia Severity Index en la toma de decisiones en el servicio de urgencias. Enferm Infecc Microbiol Clin 2014; 32:131. [DOI: 10.1016/j.eimc.2013.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/19/2013] [Indexed: 11/26/2022]
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Julián-Jiménez A, Palomo de los Reyes MJ, Parejo Miguez R, Laín-Terés N, Cuena-Boy R, Lozano-Ancín A. Improved Management of Community-Acquired Pneumonia in the Emergency Department. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2012.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Herrera-Lara S, Fernández-Fabrellas E, Cervera-Juan Á, Blanquer-Olivas R. Do Seasonal Changes and Climate Influence the Etiology of Community Acquired Pneumonia? ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2013.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Julián-Jiménez A, Palomo de los Reyes MJ, Parejo Miguez R, Laín-Terés N, Cuena-Boy R, Lozano-Ancín A. Improved management of community-acquired pneumonia in the emergency department. Arch Bronconeumol 2013; 49:230-40. [PMID: 23477946 DOI: 10.1016/j.arbres.2012.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 11/24/2012] [Accepted: 12/23/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the impact of implementing clinical practice guidelines (CPGs) in the treatment of community-acquired pneumonia (CAP) in the emergency department (ED) by analyzing case management decisions (admission or discharge, appropriateness and timeliness of antibiotic therapy, complementary tests) and the consequent results (clinical stabilization time, length of hospital stay, re-admission to ED and mortality). METHODS A prospective, observational, descriptive, comparative study carried out from 1st January 2008 to 1st August 2009 in two phases: before and after the implementation of the "Management of CAP in ED" SEMES-SEPAR (Spanish Society of Emergency Medicine - Spanish Society of Pneumology and Thoracic Surgery) clinical practice guidelines from 2008. Two hundred adult patients treated in the ED with a diagnosis of CAP were included in the study, both in the pre-intervention and post-intervention groups. RESULTS The application of the guidelines increased the administration of early and appropriate antibiotic therapy (P<.001) and shortened both the total antibiotic therapy (P<.001) and the intravenous antibiotic therapy (P=.042) times. Time to clinical stabilization (P=.027), length of hospital stay (1.14 days, P=.01), intra-hospital mortality (P=.004) and total 30-day mortality (P=.044) were all reduced. Assessment with the Pneumonia Severity Index (PSI) and biomarkers aided in appropriate decision-making concerning admission/discharge (P<.001). CONCLUSIONS The implementation of the SEMES-SEPAR 2008 guidelines, along with the use of PSI and biomarkers, significantly improved the entire treatment process of CAP. This benefitted both patients and the system by reducing mortality and improving the results of other patient management factors.
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Ochoa Gondar O, Vila Córcoles A, Rodriguez Blanco T, de Diego Cabanes C, Salsench Serrano E, Hospital Guardiola I. [Ability of the modified CRB75 severity scale in assessing elderly patients with community acquired pneumonia]. Aten Primaria 2013; 45:208-15. [PMID: 23369644 PMCID: PMC6985519 DOI: 10.1016/j.aprim.2012.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 11/17/2012] [Accepted: 12/08/2012] [Indexed: 11/05/2022] Open
Abstract
Objetivo Comparar la utilidad de la escala CRB65, acrónimo inglés de confusión, taquipnea, hipotensión, edad ≥ 65 años, versus la escala modificada CRB75 para determinar el grado de severidad en pacientes mayores de 65 años con neumonía adquirida en la comunidad (NAC). Diseño Estudio de cohortes prospectivo. Emplazamiento Región Sanitaria de Tarragona. Participantes Se incluyeron 350 pacientes ≥ 65 años con NAC radiográficamente confirmada (ambulatoria u hospitalizada) diagnosticada durante 2008-2010. Mediciones principales La escala CRB65 considera confusión mental de nueva aparición; frecuencia respiratoria ≥ 30 resp./min; presión arterial sistólica < 90 mmHg o diastólica ≤ 60 mmHg y edad ≥ 65 años. La escala modificada CRB75 usa criterios similares pero edad ≥ 75 años. Ambas fueron calculadas al diagnóstico, y la mortalidad a los 30 días fue considerada como variable dependiente. Resultados La mortalidad global fue del 13,1% (4% en NAC ambulatorias y 15% en NAC hospitalizadas). La mortalidad fue 7,7% para CRB65 = 1, 22,5% en CRB65 = 2 y 50% en CRB65 = 3. La mortalidad en CRB75 = 0 fue 3,2%, en CRB75 = 1 fue 9,7%, en CRB75 = 2 fue 30% y en CRB75 = 3 del 45,5%. La capacidad discriminativa de ambas escalas para clasificar el riesgo de mortalidad a los 30 días fue aceptable, siendo el área bajo la curva ROC significativamente mejor en el CRB75 que en el CRB65 (0,735 vs 0,681; p < 0,01). Conclusión Ambas escalas son una herramienta aceptable para clasificar el riesgo de mortalidad a corto plazo en los pacientes con NAC. La escala CRB75 puede ser de mayor utilidad en pacientes mayores de 65 años.
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Affiliation(s)
- Olga Ochoa Gondar
- Dirección de Atención Primaria del Camp de Tarragona, Institut Català de la Salut, Tarragona, España.
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Herrera-Lara S, Fernández-Fabrellas E, Cervera-Juan Á, Blanquer-Olivas R. Do seasonal changes and climate influence the etiology of community acquired pneumonia? Arch Bronconeumol 2013; 49:140-5. [PMID: 23305778 DOI: 10.1016/j.arbres.2012.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/07/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Community acquired pneumonia (CAP) is a highly prevalent pathology whose etiology is determined by the characteristics of the geographic region, and the patient. The study of these features is essential for a proper therapeutic approach. Our aim was to study the changes of the causative agent of CAP brought about by the influence of seasonal and climatic changes in our geographic area. PATIENTS AND METHOD A prospective and longitudinal study of patients admitted with CAP was done from January 2006 to December 2009. We analyzed demographic data, comorbidities, severity, etiologic agent, complications and mortality. We correlated mean temperature and mean cumulative rainfall for each season with Streptococcus pneumoniae and Legionella pneumophila. Statistical analyses included: Chi squared test, Student's t test for independent samples, variance analysis and Spearman's correlation. RESULTS We included 243 patients, 64.6% men and 54.7% over the age of 65. The highest incidence of CAP was in the winter. Streptococcus pneumoniae was the most common causative agent for all seasons except in summer when the main agent was Legionella pneumophila. We observed a significant correlation between the lowest seasonal average temperature and pneumococcal etiology of CAP; inversely, with higher temperatures, Legionella pneumophila was more common. No etiological differences were found by season when related with environmental humidity. CONCLUSIONS In our area, Streptococcus pneumoniae was the most common etiological agent in winter with low temperatures; in summer, with high temperatures, the most frequent was Legionella pneumophila.
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Torres A, Barberán J, Falguera M, Menéndez R, Molina J, Olaechea P, Rodríguez A. [Multidisciplinary guidelines for the management of community-acquired pneumonia]. Med Clin (Barc) 2012; 140:223.e1-223.e19. [PMID: 23276610 DOI: 10.1016/j.medcli.2012.09.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/06/2012] [Indexed: 11/16/2022]
Abstract
Community-acquired pneumonia (CAP) is an infectious respiratory disease with an incidence that ranges from 3 to 8 cases per 1,000 inhabitants per year. This incidence increases with age and comorbidities. Forty per cent of CAP patients require hospitalization and around 10% of these patients are admitted in an Intensive Care Unit (ICU). Several studies have suggested that the implementation of clinical guidelines has a positive impact in the outcome of patients including mortality and length of stay. The more recent and used guidelines are those from Infectious Diseases Society of America/American Thoracic Society, published in 2007, the 2009 from the British Thoracic Society, and that from the European Respiratory Society/European Society of Clinical Microbiology and Infectious Diseases, published in 2010. In Spain, the most recently released guideline is the Sociedad Española de Neumología y Cirugía Torácica-2011 guideline. The present guidelines GNAC are designed to be used by the majority of health-care professionals that can participate in the care of CAP patients including diagnosis, decision of hospital and ICU admission, treatment and prevention. The Centro Cochrane Iberoamericano (CCIB) has participated in summarizing the previous guidelines and in the bibliography search. For each one of the following sections the panel of experts has developed a table with recommendations classified according to its evidence, strength and practical applicability using the Grading of Recommendations of Assessment Development and Evaluations (GRADE) system: 1. Epidemiology, microbiological etiology and antibiotic resistances.2. Clinical and microbiological diagnosis.3. Prognostic scales and decision of hospital admission.4. ICU admission criteria. 5. Empirical and definitive antibiotic treatment.6. Treatment failure. 7. Prevention.
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Fernández-Herranz J, de Miguel-Díez J, del Castillo-Rueda A, Bellón-Cano J, Jiménez-García R, Álvarez-Sala-Walther L. Influencia de la administración de corticoides sistémicos en el pronóstico de los pacientes con neumonía adquirida en la comunidad. Rev Clin Esp 2012; 212:337-43. [DOI: 10.1016/j.rce.2012.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 02/27/2012] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
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Delgado M, Alvarez MM, Carrascosa I, Rodríguez-Velasco M, Barrios JL, Canut A. [The routine use of the Pneumonia Severity Index in the emergency department: effect on process-of-care indicators and results in community acquired pneumonia]. Enferm Infecc Microbiol Clin 2012; 31:289-97. [PMID: 22728072 DOI: 10.1016/j.eimc.2012.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/24/2012] [Accepted: 04/27/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate process-of-care indicators (inappropriate hospitalisation, suitability and early antibiotic treatment) and outcome indicators (length of hospital stay, hospital readmission, ICU admission, and mortality) in the management of community-acquired pneumonia (CAP) when the SEPAR/IDSA guidelines were applied. PATIENTS AND METHODS An observational retrospective study conducted on patients diagnosed with CAP during the first semester of 2007 and 2008 (186 and 161 patients, respectively) in the emergency unit of a general hospital. Differences in the process-of-care and outcome indicators between 2007 and 2008 (with and without the Pneumonia Severity Index [PSI]) were evaluated. Moreover, the indicators were compared with those obtained in 2006 (110 patients), when the current guidelines were those of SEQ/ATS. RESULTS The SEPAR/IDSA guidelines improved the following process-of-care indicators: appropriateness of treatment, unjustified hospital readmission (39.4% in 2006 vs. 8.5% in 2007 [P<.001], and 17,2% in 2008 [P=.005]), and early treatment. However, outcome indicators did not change. In 2008, a decrease in the mortality of the patients of risk classes IV-V in which the PSI had been estimated was observed in comparison with the patients in which the PSI was not estimated (2.3% vs. 28.3%; P<.001). Moreover, the mortality rate of the patients of risk classes IV-V in which the PSI had been estimated was lower than those measured using the SEQ/ATS guidelines (22.7%; P=.003). CONCLUSION SEPAR/IDSA guidelines decreased the unjustified hospital readmission. In the second year of its application an increase in the number of patients who received early treatment, and a decrease of the mortality rate of the patients of risk classes IV-V in which the PSI had been estimated, were also observed.
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Affiliation(s)
- Miriam Delgado
- Servicio de Medicina Interna, Hospital Universitario de Álava-Sede Hospital Santiago, Osakidetza-Servicio Vasco de Salud, Vitoria-Gasteiz, Spain
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Abstract
Given the inherent difficulty of determining the cause of community-acquired pneumonia (CAP) (an etiological diagnosis is only established in 40-60 % of cases), assessment of severity plays a key role in stratifying CAP patients arriving at the emergency department in three groups according to the need for hospitalization: outpatient, hospitalization, and the need for intensive care unit (ICU) admission. The two most common severity scales used to assess the need for hospital admission in CAP are the Pneumonia Severity Index (PSI) and CURB-65 score while ATS-IDSA 2007 criteria are specific to evaluate the need for ICU admission. Because of the possible etiological differences between the three groups, distinct etiological tests and empiric antibiotic treatments will be required in each subgroup, although a possible pneumococcal etiology should always be considered, since Streptococcus pneumoniae is the most common etiology of CAP in all three groups. Clinical status must be reassessed 48 hours after empirical antibiotic treatment is started.
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Affiliation(s)
- José Blanquer
- Unidad Cuidados Intensivos Respiratorios, Hospital Clínic Universitari, Valencia, España.
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Ruiz-González A, Esquerda A, Falguera M, Abdulghani N, Cabezas P, Bielsa S, Porcel JM. Triggering receptor (TREM-1) expressed on myeloid cells predicts bacteremia better than clinical variables in community-acquired pneumonia. Respirology 2011; 16:321-5. [PMID: 21114709 DOI: 10.1111/j.1440-1843.2010.01905.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Some clinical variables are associated with bacteremia in patients with community-acquired pneumonia (CAP). The aim of this study was to analyse the accuracy of the soluble form of triggering receptor expressed on myeloid cells-1 (sTREM-1) to predict positive blood cultures in comparison with established clinical prognostic variables. METHODS In addition to collecting clinical and laboratory information, a commercially available immunoassay kit was used to measure the serum sTREM-1 levels on the first day of admit ion in patients with CAP. Receiver operating characteristic (ROC) curves were used to compare the ability of sTREM-1 and commonly used clinical variables to identify bacteremia. RESULTS Blood cultures yielded a pathogen in 13 (10.4%) out of 124 patient samples. The microorganisms isolated were Streptococcus pneumoniae (11 patients) and Klebsiella pneumoniae (2 patients). The presence of pleuritic chest pain, tachycardia and extreme white cell count (WCC) were associated with bacteremia. However, ROC curve analysis showed an accuracy of sTREM-1 (area under the receiver operating characteristic curve (AUC) 0.84, 95% CI: 0.72-0.95), which was higher than pleuritic chest pain (AUC 0.71, 95% CI: 0.57-0.84), tachycardia (AUC 0.73, 95% CI: 0.58-0.88) and extreme WCC (AUC 0.70, 95% CI: 0.55-0.85) for predicting positive blood cultures. Low admission sTREM-1 serum values had a high negative predictive value for excluding bacteremia (sTREM-1 <120 pg/mL = 98.8%). CONCLUSIONS This preliminary study suggests that the determination of sTREM-1 serum levels on admission may be more accurate than clinical variables for identifying bacteremic patients.
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Affiliation(s)
- Agustin Ruiz-González
- Department of Internal Medicine, Arnau de Vilanova University Hospital, Institut de Recerca Biomédica de Lleida, Lleida, Spain.
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Hinojosa Mena-Bernal J, Hinojosa Mena-Bernal C, González Sarmiento E, Almaráz Gómez A, Martín Santos S, Zapatero Gaviria A. Adecuación de los ingresos y de la asistencia facilitada a los pacientes con neumonía adquirida en la comunidad. Rev Clin Esp 2011; 211:179-86. [DOI: 10.1016/j.rce.2009.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2009] [Revised: 06/10/2009] [Accepted: 06/20/2009] [Indexed: 10/18/2022]
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Ruiz-González A, Falguera M, Porcel JM, Martínez-Alonso M, Cabezas P, Geijo P, Boixeda R, Dueñas C, Armengou A, Capdevila JA, Serrano R. C-reactive protein for discriminating treatment failure from slow responding pneumonia. Eur J Intern Med 2010; 21:548-52. [PMID: 21111942 DOI: 10.1016/j.ejim.2010.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 03/12/2010] [Accepted: 09/13/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND The management of patients with community-acquired pneumonia (CAP) who fail to improve constitutes a challenge for clinicians. This study investigated the usefulness of C-reactive protein (CRP) changes in discriminating true treatment failure from slow response to treatment. METHODS This prospective multicenter observational study investigated the behavior of plasma CRP levels on days 1 and 4 in hospitalized patients with CAP. We identified non-responding patients as those who had not reached clinical stability by day 4. Among them, true treatment failure and slow response situations were defined when initial therapy had to be changed or not after day 4 by attending clinicians, respectively. RESULTS By day 4, 78 (27.4%) out of 285 patients had not reached clinical stability. Among them, 56 (71.8%) patients were cured without changes in initial therapy (mortality 0.0%), and in 22 (28.2%) patients, the initial empirical therapy needed to be changed (mortality 40.9%). By day 4, CRP levels fell in 52 (92.9%) slow responding and only in 7 (31.8%) late treatment failure patients (p<0.001). A model developed including CRP behavior and respiratory rate at day 4 identified treatment failure patients with an area under the Receiver Operating Characteristic curve of 0.87 (CI 95%, 0.78-0.96). CONCLUSION Changes in CRP levels are useful to discriminate between true treatment failure and slow response to treatment and can help clinicians in management decisions when CAP patients fail to improve.
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Affiliation(s)
- Agustín Ruiz-González
- Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Lleida, Spain.
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Martín-Sánchez FJ, González Del Castillo J, Herrero P, Perelló R. [Typical and atypical pneumonia: Clinical usefulness?]. Med Clin (Barc) 2010; 135:675; author reply 677-8. [PMID: 20022062 DOI: 10.1016/j.medcli.2009.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 07/21/2009] [Indexed: 11/17/2022]
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Menéndez R, Torres A, Aspa J, Capelastegui A, Prat C, Rodríguez de Castro F. Community-Acquired Pneumonia. New Guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1579-2129(11)60008-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bacteraemic community-acquired pneumonia due to Gram-negative bacteria: incidence, clinical presentation and factors associated with severity during hospital stay. Infection 2010; 38:453-8. [PMID: 20878457 DOI: 10.1007/s15010-010-0058-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 09/07/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Many studies have evaluated the clinical characteristics of Gram-negative bacteria (GNB) pneumonia. However, in most cases the bacteriological diagnosis is based on unreliable respiratory samples, and research rarely focuses on only bacteraemic patients. The aim of this study was to describe the incidence, clinical characteristics, outcomes, and factors associated with severity during the hospital stay of patients diagnosed with bacteraemic community-acquired pneumonia (CAP) due to GNB. MATERIALS AND METHODS Patients consecutively admitted with bacteraemic CAP due to GNB were enrolled in the study, with exclusion of additional foci of infection. RESULTS CAP due to GNB accounted for 1.2% of the total CAP cases admitted and 3.5% of those with a confirmed aetiological diagnosis. Fifty-one patients were studied (mean age: 73 ± 11.3 years). Escherichia coli (30 cases; 58.8%) and Klebsiella pneumoniae (9 cases; 17.6%) were the most commonly isolated strains. The main symptoms were fever, cough, and dyspnoea. Eleven (21.6%) patients presented mental confusion, ten (19.6%) followed a severe clinical course, and six (11.8%) died. Absence of fever, radiologically multilobar involvement, and the prescription of an inadequate empirical antimicrobial therapy were independent factors associated with severity during the hospital stay. CONCLUSION Bacteraemic CAP due to GNB is an uncommon entity. Among the patients studied, E. coli was the main GNB found. A total of 19.6% of patients followed a severe clinical course. The factors identified in this study may alert physicians to a group of patients at risk of suffering complications during their hospital stay.
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Menéndez R, Torres A, Aspa J, Capelastegui A, Prat C, Rodríguez de Castro F. [Community acquired pneumonia. New guidelines of the Spanish Society of Chest Diseases and Thoracic Surgery (SEPAR)]. Arch Bronconeumol 2010; 46:543-58. [PMID: 20832928 DOI: 10.1016/j.arbres.2010.06.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 06/18/2010] [Indexed: 10/19/2022]
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Julián-Jiménez A, Palomo de los Reyes MJ, Laín-Terés N. ¿Es posible mejorar el manejo de la neumonía adquirida en la comunidad en los servicios de urgencias hospitalarios? Arch Bronconeumol 2010; 46:448-9. [DOI: 10.1016/j.arbres.2010.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 03/09/2010] [Accepted: 03/11/2010] [Indexed: 11/24/2022]
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Tratamiento de la neumonía adquirida en la comunidad en hospitalización a domicilio: resultado clínico en casos con diferente nivel de gravedad. Med Clin (Barc) 2010; 135:47-51. [DOI: 10.1016/j.medcli.2009.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 11/30/2009] [Accepted: 12/01/2009] [Indexed: 10/19/2022]
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Vila Córcoles A, Ochoa Gondar O, Rodríguez Blanco T. [Usefulness of the CRB-65 scale for prognosis assessment of patients 65 years or older with community-acquired pneumonia]. Med Clin (Barc) 2010; 135:97-102. [PMID: 20462613 DOI: 10.1016/j.medcli.2009.09.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Revised: 08/20/2009] [Accepted: 09/15/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE The assessment of severity may be important to decide hospitalisation and type of treatment in community-acquired pneumonia (CAP) cases. This study evaluated the ability of the severity rule CRB-65 for the management of older adults with CAP. PATIENTS AND METHODS Population-based study including 473 patients 65 years or older with a radiographically confirmed CAP in the region of Tarragona (Spain). Treatment setting and clinical variables were considered for each patient, CRB-65 score (confusion, respiratory rate>or=30, systolic blood pressure<90 mmHg or diastolic<or=60 mmHg, age>or=65 years) was calculated at the time of diagnosis, and 30-day mortality was considered as a main dependent variable. RESULTS Overall mortality rate was 12.7% (15.5% among hospitalised and 1.7% in outpatient cases). Mortality was directly associated with the CRB-65 score, being 6.8% in score 1 (2.4% among patients 65-74 years and 10.1% in patients 75 years or older; P=.005), 26.1% in score 2, 41.7% in score 3 and 66.7% in score 4. For a breakpoint of CRB-65 score>or=2, sensitivity was 60% (95% CI: 42-78) and specificity was 80% (95% CI: 76-84). CONCLUSIONS The CRB-65 has an acceptable ability to classify mortality risk in elderly patients with CAP. Patients with CRB-65=1 have a relatively small mortality rate, which suggests that they could be managed as outpatients.
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Affiliation(s)
- Angel Vila Córcoles
- Servicio de Atención Primaria de Tarragona-Valls, Dirección de Atención Primaria Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
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Serrano-Heranz R, Sicilia-Urbán J, Sanz-Rojas P. Infecciones por neumococo. Clasificación. Factores predisponentes. Aspectos patogénicos de relevancia clínica o diagnóstica. Manifestaciones clínicas. Formas de comienzo. MEDICINE - PROGRAMA DE FORMACIÓN MÉDICA CONTINUADA ACREDITADO 2010; 10:3352-3359. [PMID: 32287886 PMCID: PMC7143697 DOI: 10.1016/s0304-5412(10)70042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sanz Herrero F, Malanda NM, Veiga BM, Sanjuán López MP. Nuevos retos en la neumonía comunitaria. Arch Bronconeumol 2010; 46 Suppl 6:22-6. [DOI: 10.1016/s0300-2896(10)70039-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cabezas P, Ruiz-González A, Falguera M. Factores que modifican la producción de proteína C reactiva en pacientes con neumonía adquirida en la comunidad. Arch Bronconeumol 2010; 46:48-9. [DOI: 10.1016/j.arbres.2009.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 05/04/2009] [Accepted: 05/09/2009] [Indexed: 10/20/2022]
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España PP, Capelastegui A, Quintana JM, Bilbao A, Diez R, Pascual S, Esteban C, Zalacaín R, Menendez R, Torres A. Validation and comparison of SCAP as a predictive score for identifying low-risk patients in community-acquired pneumonia. J Infect 2009; 60:106-13. [PMID: 19961875 DOI: 10.1016/j.jinf.2009.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 11/25/2009] [Accepted: 11/26/2009] [Indexed: 11/28/2022]
Abstract
PURPOSES (1) To validate the Severe Community Acquired Pneumonia (SCAP) score in predicting 30-day mortality. (2) To validate its ability to identifying patients at low risk of death. (3) To compare it against the Pneumonia Severity Index (PSI), and the British Thoracic Society's CURB-65 rules. METHODS The SCAP score was validated to predict 30-day mortality in an internal validation cohort of consecutive adult patients seen in one hospital. Consecutive inpatients from other three hospitals were used to externally validate the score and compare the SCAP with the PSI and CURB-65. The discriminatory power of these rules to predict 30-day mortality was tested by the Area under Curve (AUC), and their predictive accuracy with the sensitivity, specificity and predictive values. RESULTS The 30-day mortality rate increased directly with increasing SCAP score (class 0: 0.5%, to class 4: 66.5% risk) in the internal validation cohort, and from 1.3% to 29.2% in external cohort (P<0.001) with an AUC of 0.83 and 0.75, respectively (P=0.024). The SCAP score identified 62.4% (95% IC 58.8-66.0) low-risk patients, 52.5% (95% IC 48.8-56.2) the PSI and 46.2% (95% CI 42.5-49.9) the CURB-65 in the external cohort. Patients classified as low risk by the three rules had similar 30-day mortality (SCAP: 2.5%, PSI: 1.6% and CURB-65: 2.7%). CONCLUSION The SCAP is valid to predict 30-day mortality among low-risk patients and identifies a larger proportion of patients as low-risk than the other studied rules.
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Affiliation(s)
- Pedro P España
- Pneumology Service Hospital Galdakao, E-48960 Galdakao, Bizkaia, Spain.
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Tiempo hasta la administración de la primera dosis de antibiótico en las neumonías adquiridas en la comunidad en un Servicio de Urgencias Hospitalario. Rev Clin Esp 2009; 209:409-14. [DOI: 10.1016/s0014-2565(09)72512-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Olaechea PM. [Bacterial infections in critically ill patients: review of studies published between 2006 and 2008]. Med Intensiva 2009; 33:196-206. [PMID: 19558941 DOI: 10.1016/s0210-5691(09)71216-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A systematic revision of medical publications between 2006 and 2008 regarding bacterial infections that affect the critical patients was performed. Four subjects were selected: Community-acquired pneumonia, ventilator-associated pneumonia, catheter-related bloodstream infection and new antimicrobial treatments. When dealing with community-acquired pneumonia and due to the absence of completely reliable standards, it is necessary to follow the locally adapted guidelines of clinical practice, to identify patients related to the health-care system and admit patients to the ICU in accordance with the criteria. Regarding the etiological diagnosis of ventilator-associated pneumonia, any microbiological information available must be used. Due to the risk of multidrug bacteria, combined empiric therapy should be initiated immediately and then mono-therapy adjusted to the antibiogram should be established. Already established measures for mechanical ventilation associated pneumonia and catheter-related bacteriemias, which have been effective, should be implemented. The empirical treatment of catheter-related bacteremia must be directed towards the most probable pathogens according to the puncture site. The most recently sold antibiotics are basically directed towards multidrug gram positive resistant bacteria. However, for the treatment of gram negative resistant bacilli, the use of the new antimicrobials must be combined with a new evaluation of the antibiotics that have been used for years and the possibility of choosing different administration forms.
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Affiliation(s)
- Pedro M Olaechea
- Unidad de Cuidados Intensivos, Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain.
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Estella A, Monge MI, Pérez Fontaiña L, Sainz de Baranda A, Galá MJ, Moreno E. [Bronchoalveolar lavage for diagnosing pneumonia in mechanically ventilated patients]. Med Intensiva 2009; 32:419-23. [PMID: 19080864 DOI: 10.1016/s0210-5691(08)75718-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the diagnostic role of bronchoalveolar lavage (BAL) in mechanically ventilated patients with suspected pneumonia and to describe the clinical outcome in the different kinds of pneumonia in critically ill patients. DESIGN Descriptive study. SETTING A 17-bed medical and surgical intensive care unit. PATIENTS Mechanically ventilated patients admitted to the ICU from November 2003 to March 2006 with suspected pneumonia who underwent bronchoscopy with BAL. INTERVENTIONS BAL was performed by fiberoptic bronchoscopy with three aliquots of 50 ml sterile normal saline. Recovered BAL fluid was pro-cessed for microbiologic analysis. MAIN VARIABLES OF INTEREST Age, APACHE II score within the first 24 hours of admission, time on mechanical ventilation, ICU length of stay, mortality, and isolated bacteria were analyzed. RESULTS A total of 96 cases of suspected pneumonia with BAL were recruited, including 4 groups: community associated pneumonia (CAP), 12 cases, early-onset ventilator-associated pneumonia (VAP), 26 cases, late-onset ventilator-associated pneumonia, 43 cases, and immunocompromised patients, 15 cases. BAL was positive (> 10000 ufc/ml) in 40 (41.7%) patients (2, 16, 17 and 5 patients with CAP, early-onset VAP, late-onset VAP and immunocompromised, respectively). Mortality was 33.3%, 26.9%, 25.6% and 73.3% in CAP, early-onset VAP, late-onset VAP and immunocompromised patients respectively. CONCLUSIONS The low incidence of positive BAL in the CAP group supports using BAL only for particularly severe, selected cases. Mortality was very high in the immunocompromised patients. In the light of our personal experience, BAL is most useful in the diagnosis of pneumonia in the group of patients with VAP.
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Affiliation(s)
- A Estella
- Unidad de Cuidados Intensivos. Hospital del SAS de Jerez. Jerez. Cádiz. España
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Abstract
Quinolones act by inhibiting enzymes (topoisomerases) that are essential for DNA synthesis, and probably by fragmentation of chromosomal DNA. The bactericidal activity of these drugs depends on their concentration. Their spectrum has been broadened, particularly since the introduction of a fluorine atom at position 6 (fluorquinolones). Quinolones are used in a large variety of in-hospital and community infections, as the treatment of choice or as alternative therapy. Depending on the specific compound, they are used in urinary tract infections, sexually transmitted diseases, chronic osteomyelitis, respiratory tract infections, and severe systemic infections, among others. The emergence and spread of resistance to quinolones has limited their use in some conditions and may affect their application in the future. Strategies currently exist to minimize the spread of resistance. Quinolones are well tolerated and safe. The most common adverse effects involve the gastrointestinal tract and central nervous system.
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Affiliation(s)
- Juan-Ignacio Alós
- Servicio de Microbiología, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
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de Ory F, Minguito T. [Comparison of five commercial assays for the detection of Legionella pneumophila antigens in urine]. Enferm Infecc Microbiol Clin 2009; 27:81-4. [PMID: 19254639 DOI: 10.1016/j.eimc.2008.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 03/27/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Antigenuria detection is the main approach for diagnosing Legionella infections. The aim of this study was to compare 5 commercially available methods for detecting Legionella pneumophila soluble antigens in urine. METHODS Seventy-one urine samples were tested, 62 from patients with bacterial infection and 9 from patients with respiratory syncytial virus infection. All samples were assayed for the presence of L. pneumophila by immunoenzymatic (ELISA) (Binax and Bartels), and immunochromatographic (IC) (Binax, SAS and Uni-Gold) methods. RESULTS Identical results (35 positive and 17 negative) were obtained by the 5 assays in 52 samples (73.2%). Samples showing discrepant results were classified by the majority criterion, and/or other laboratory results (serology), and/or epidemiological findings. On this basis, 51 samples were ultimately classified as positive, and 20 as negative. Sensitivity values of ELISA-Binax, ELISA-Bartels, IC-Binax, IC-SAS and IC-Uni-Gold were 80.4, 100, 82.4, 86.3, and 70.6%, respectively. Corresponding values for specificity were 90, 95, 100, 95 and 100%. CONCLUSIONS The results indicate that the methods compared are all adequate for diagnosing Legionella infection, although some have certain limitations regarding sensitivity.
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Affiliation(s)
- Fernando de Ory
- Servicio de Microbiología Diagnóstica, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España.
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Yandiola PPE, Capelastegui A, Quintana J, Diez R, Gorordo I, Bilbao A, Zalacain R, Menendez R, Torres A. Prospective comparison of severity scores for predicting clinically relevant outcomes for patients hospitalized with community-acquired pneumonia. Chest 2009; 135:1572-1579. [PMID: 19141524 DOI: 10.1378/chest.08-2179] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The comparative accuracy and discriminatory power of three validated rules for predicting clinically relevant outcomes other than mortality in patients hospitalized with community-acquired pneumonia (CAP) are unknown. METHODS We prospectively compared the newly developed severe community-acquired pneumonia (SCAP) score, pneumonia severity index (PSI), and the British Thoracic Society confusion, urea > 7 mmol/L, respiratory rate > or = 30 breaths/min, BP < 90 mm Hg systolic or < 60 mm Hg diastolic, age > or = 65 years (CURB-65) rule in an internal validation cohort of 1,189 consecutive adult inpatients with CAP from one hospital and an external validation cohort of 671 consecutive adult inpatients from three other hospitals. Major adverse outcomes were admission to ICU, need for mechanical ventilation, progression to severe sepsis, or treatment failure. Mean hospital length of stay (LOS) was also evaluated. The rules were compared based on sensitivity, specificity, and area under the curve (AUC) of the receiver operating characteristic. RESULTS The rate of all adverse outcomes and hospital LOS increased directly with increasing SCAP, PSI, or CURB-65 scores (p < 0.001) in both cohorts. Patients classified as high risk by the SCAP score showed higher rates of adverse outcomes (ICU admission, 35.8%; mechanical ventilation, 16.4%; severe sepsis, 98.5%; treatment failure, 22.4%) than PSI and CURB-65 high-risk classes. The discriminatory power of SCAP, as measured by AUC, was 0.75 for ICU admission, 0.76 for mechanical ventilation, 0.79 for severe sepsis, and 0.61 for treatment failure in the external validation cohort. AUC differences with PSI or CURB-65 were found. CONCLUSIONS The SCAP score is as accurate or better than other current scoring systems in predicting adverse outcomes in patients hospitalized with CAP while helping classify patients into different categories of increasing risk for potentially closer monitoring.
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Affiliation(s)
| | | | - José Quintana
- Research Unit, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Rosa Diez
- Service of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Inmaculada Gorordo
- Service of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Amaia Bilbao
- Basque Foundation for Health Innovation and Research, Sondika, Bizkaia, Spain
| | | | - Rosario Menendez
- Service of Pneumonology, Hospital Universitario La Fe, Valencia, Spain
| | - Antonio Torres
- Hospital Clinic Institut d'Investigacions Biomédiques August Pi i Sunyer, Universita de Barcelona, Barcelona, Spain
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Capdevila JA, Gavagnach M, Martínez S, Torres A. [Critical evaluation of clinical practice guidelines]. Med Clin (Barc) 2008; 130:376-9. [PMID: 18381030 DOI: 10.1157/13117462] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Josep Anton Capdevila
- Comisión de Medicina y Especialidades Relacionadas, Consell Català d'Especialistes en Ciències de la Salut, Institut d'Estudis de la Salut, Departament de Salut, Generalitat de Catalunya.
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Serra Sanchis B, Martínez Moragón E, Aguar M, Fernández Fabrellas E, Sanz F, Blanquer J. [Pneumonia in the elderly population over 70 years with limited functional condition: case-control study of institutionalized patients]. Rev Clin Esp 2007; 207:548-54. [PMID: 18021642 DOI: 10.1157/13111572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Community acquired pneumonia (CAP) of the elderly is an increasingly important growing health problem due to its prevalence and mortality. Among the factors that are usually related with poor evolution are advanced age, poor functional status and coming from a socio-health care institution such as residential homes for the elderly. In this study, we have chosen a population over 70 years of age with limited functional capacity (Barthel Index < 50) in order to know if coming from a residential home for the elderly is an isolated factor that is associated to worse prognosis of CAP. PATIENTS AND METHODS We selected 87 patients over 70 years from a prospective and multicenter study of the hospitalized CAPs during one year. We analyzed the evolution and course of the CAP based on place or origin and then conducted a case-control study of the elderly over 70 years with the Barthel under 50, including 21 elderly from residences and 21 from the own home. RESULTS In elderly patients over 70 years with CAP, those coming from the residence have a confusional picture more often and come to emergency with lower values of systolic and diastolic blood pressure, lower arterial oxygen saturation, greater involvement on the x-ray, Fine Index is worse and die more often. When we limit the population to those over 70 years with Barthel under 50, we do not find differences in institutionalized patients versus the others. CONCLUSION In the elderly over 70 years with CAP, patients from assisted living residences have greater mortality. However, when functional capacity is bad (Barthel < 50), place or origin (community or elderly residence) loses importance and becomes a variable that has no more influence than others in the clinical evolution and course of the CAP.
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Bello Dronda S, Vilá Justribó M. ¿Seguiremos teniendo antibióticos mañana? Arch Bronconeumol 2007. [DOI: 10.1157/13108785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dronda SB, Justribó MV. [Will we still have antibiotics tomorrow?]. Arch Bronconeumol 2007; 43:450-9. [PMID: 17692246 DOI: 10.1016/s1579-2129(07)60102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Since the discovery of antibiotics, it has been generally believed that these antimicrobials are capable of curing almost all bacterial infections. More recently, the appearance of increasing resistance to antibiotics and the emergence of multiresistant microorganisms have given rise to growing concern among physicians, and that concern has now started to filter through to society in general. The problem is further aggravated by a situation that not many people are currently aware of, that is, the limited prospects for future development of new antibiotics in the short to medium term. Appropriate use of available antibiotics based on a thorough understanding of their in vivo activity and the emergence of new forms of administration, such as inhalers, may help to alleviate the problem.
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Torres Martí A, Quintano Jiménez J, Martínez Ortiz de Zárate M, Rodríguez Pascual C, Prieto Prieto J, Zalacaín Jorge R. Tratamiento antimicrobiano de la enfermedad pulmonar obstructiva crónica en el anciano. Semergen 2007. [DOI: 10.1016/s1138-3593(07)73852-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Villena Garrido V, Ferrer Sancho J, Hernández Blasco L, de Pablo Gafas A, Pérez Rodríguez E, Rodríguez Panadero F, Romero Candeira S, Salvatierra Velázquez A, Valdés Cuadrado L. [Diagnosis and treatment of pleural effusion]. Arch Bronconeumol 2007. [PMID: 16945266 DOI: 10.1157/13090586] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Villena Garrido V, Ferrer Sancho J, Hernández Blasco L, de Pablo Gafas A, Pérez Rodríguez E, Rodríguez Panadero F, Romero Candeira S, Salvatierra Velázquez A, Valdés Cuadrado L. [Diagnosis and treatment of pleural effusion]. Arch Bronconeumol 2007; 42:349-72. [PMID: 16945266 DOI: 10.1016/s1579-2129(06)60545-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vallès X, Marcos A, Pinart M, Piñer R, Marco F, Mensa JM, Torres A. Hospitalized community-acquired pneumonia due to Streptococcus pneumoniae: Has resistance to antibiotics decreased? Chest 2006; 130:800-6. [PMID: 16963678 DOI: 10.1378/chest.130.3.800] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To determine the incidence and trends of pneumococcal community-acquired pneumonia (CAP) resistant to antibiotics, to describe clinical and microbiological features of pneumococcal CAP, and to ascertain prognostic risk factors in a third-level hospital. DESIGN AND SETTING We performed a prospective study of all well-defined pneumococcal CAP hospitalizations in the Hospital Clínic de Barcelona (Spain) over 2 years of follow-up, and results were compared with a previous study. MEASUREMENTS AND RESULTS One hundred twenty-five patients were included (mean age, 59.6 years; 71.2% male and 28.8% female). Mortality was 7% (n = 9). Twenty-four percent were HIV-1 seropositive (n = 30), and 53% had at least one comorbidity (n = 65). Nonsusceptibility to penicillin, ceftriaxone, and erythromycin accounted for 34%, 9%, and 33%, respectively. A decrease in penicillin (p = 0.01) and cephalosporin (p < 0.001) resistance was observed on comparison with a previous study, while macrolide resistance remained unchanged. Serotype 1 infection was overrepresented (8%, n = 10). A bad outcome was related to female gender (relative risk [RR], 9.1; confidence interval [CI], 1.3 to 61.3), pleural effusion (RR, 13.35; CI, 1.9 to 93.1), and prior oral corticoid intake (RR, 10.59; CI, 1.2 to 91.2), whereas drug-resistant strains were not. CONCLUSIONS We found a decrease in drug resistance compared with a previous report and a relatively high incidence of serotype 1 pneumococcal CAP. We also observed a high prevalence of HIV-1 infection among individuals with pneumococcal pneumonia. We confirm the lack of association of drug resistance with mortality and length of hospitalization. Mortality was associated with female gender, pleural effusion, and previous oral corticoid treatment. These results should be better ascertained in further studies.
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Affiliation(s)
- Xavier Vallès
- Institut Clínic de Pneumologia i Cirurgia Toràcica, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Rajas Naranjo O, Aspa Marco J. 2004: Año de la Neumonía. Consecuencias e impacto científico en Archivos de Bronconeumología. Arch Bronconeumol 2006. [DOI: 10.1157/13093398] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Rajas Naranjo O, Aspa Marco J. [Pneumonia awareness year, 2004: scientific impact through publications in Archivos de Bronconeumología]. Arch Bronconeumol 2006; 42:541-52. [PMID: 17067522 PMCID: PMC7128974 DOI: 10.1016/s1579-2129(06)60582-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 08/02/2006] [Indexed: 10/31/2022]
Abstract
Pneumonia is a common and potentially serious infectious disease. Morbidity and mortality rates continue to be high in spite of major advances and steady progress in diagnosis and treatment. The economic impact of the disease is also great. It is therefore necessary to enlist the public, primary care and emergency physicians, and public policy administrators to join forces to treat and prevent pneumonia for the common good. The annual incidence of pneumonia in the population over the age of 14 years is 1.6 to 2.6 episodes/1000 inhabitants. The mortality rate is 14.1 per 100,000 inhabitants, and the associated costs are 115 million euros annually. The RESPIRA Foundation and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) declared 2004 to be pneumonia awareness year with the aim of coordinating efforts to raise awareness, distribute information, and foster debate.
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Affiliation(s)
- Olga Rajas Naranjo
- Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, España.
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Briones ML, Blanquer J, Ferrando D, Blasco ML, Gimeno C, Marín J. Assessment of analysis of urinary pneumococcal antigen by immunochromatography for etiologic diagnosis of community-acquired pneumonia in adults. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2006; 13:1092-7. [PMID: 17028212 PMCID: PMC1595326 DOI: 10.1128/cvi.00090-06] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Revised: 05/23/2006] [Accepted: 07/26/2006] [Indexed: 11/20/2022]
Abstract
The limitations of conventional microbiologic methods (CMM) for etiologic diagnosis of community pneumococcal pneumonia have made faster diagnostic techniques necessary. Our aim was to evaluate the usefulness of the immunochromatography (ICT) technique for detecting urinary Streptococcus pneumoniae antigen in the etiologic diagnosis of community-acquired pneumonias (CAP). This was a prospective study on in-patients with CAP in a tertiary hospital conducted from October 2000 to March 2004. Apart from using CMM to reach an etiologic diagnosis, we determined pneumococcal antigen in concentrated urine by ICT. We also determined the urinary pneumococcal antigen (UPA) content in patients from two control groups to calculate the specificity of the technique. One group was comprised of in-patients diagnosed with chronic obstructive pulmonary disease (COPD) or asthma, with respiratory infection, and without pneumonia; the other group included fractures. We studied 959 pneumonia patients and determined UPA content in 911 (95%) of them. We diagnosed the etiology of 253 cases (28%) using CMM; S. pneumoniae was the most common etiologic agent (57 cases). ICT analysis was positive for 279 patients (31%). Using this technique, the percentage of diagnoses of pneumococcal pneumonias increased by 26%, while the overall etiologic diagnosis increased from 28 to 49%. The technique sensitivity was 81%; the specificity oscillated between 80% in CAP with nonpneumococcal etiology and 99% for patients with fractures without infections. Determination of UPA is a rapid, simple analysis with good sensitivity and specificity, which increased the percentage of etiologic diagnoses. Positive UPA may persist in COPD patients with probable pneumococcal colonization or recent pneumococcal infections.
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Affiliation(s)
- Maria Luisa Briones
- Pneumology Department, Respiratory Intensive Care Unit, Hospital Clínico Universitario, Universitat de Valencia, Spain.
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