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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pneumonia in the community affects between 1 and 5 per 1000 per year. The microbial aetiology is diverse and influenced by preexisting disease, seasonality, as well as animate and inanimate environmental sources; pneumococci, Legionella spp., Mycoplasma pneumoniae, and more recently Chlamydia pneumoniae are the predominant bacterial pathogens. Gram-negative enteric bacteria although less common are particularly virulent. Antibiotic resistance is well established for Haemophilus influenzae and Gram-negative bacillary infections, but has been a recent phenomenon in the case of Streptococcus pneumoniae, which is numerically the leading pathogen. Despite the concerns raised by this reduced susceptibility to penicillin, evidence that this has been translated into increased clinical failures is currently difficult to establish. Macrolide and tetracycline resistance among pneumococci is more common. beta-Lactamase production by H. influenzae has now reached levels where, in those with severe pneumonia, beta-lactamase stable agents are preferred. Consensus Guidelines on the treatment of community acquired pneumonia have been published by the British Thoracic Society, the American Thoracic Society, and from Expert Panels in Canada and France. These emphasize severity assessment and differentiate management in the community or hospital setting. The recommended regimens are compared and contrasted. In conclusion, mild/moderate pneumonia, when pneumococcal in nature, is likely to still respond to amoxycillin or penicillin G, but in higher dosages where pneumococcal resistance is documented. However, in severe infection where pneumococcal resistance, other beta-lactamase-producing pathogens, or an atypical infection could be operating, it is important that initial empirical therapy be broad spectrum and promptly administered. Treating multiresistant pneumococcal disease in those allergic to beta-lactams presents a particular dilemma. Glycopeptides are currently preferred.
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PMID:Pneumonia: the impact of antibiotic resistance on its management. 915 49

In 1995 the American Thoracic Society issued an official consensus statement on the treatment of hospital-acquired pneumonia (HAP). Classes of antimicrobials included in the list of antimicrobials deemed to be suitable for the empiric treatment of severe HAP were the aminoglycosides, quinolones, antipseudomonal penicillins, carbapenems, and beta-lactam/beta-lactamase inhibitor combinations. Aztreonam, a monobactam, was also listed and is unique among these agents based on its spectrum of activity being limited to the gram-negative bacillary bacteria combined with an excellent safety profile. This review focuses on the role of aztreonam in the treatment of nosocomial pneumonia in the critically ill patient.A review of the literature was performed using PubMed and secondary literature sources as to the clinical efficacy of aztreonam in the treatment of lower respiratory tract infections as well as its pharmacokinetic and safety profiles. An analysis of aztreonam's potential pharmacoeconomic advantages compared with other agents was also performed. Numerous studies have documented that aztreonam has effectiveness that is equal or superior to that of other suitable antibiotics in the treatment of nosocomial pneumonia. Its excellent safety profile makes it a particularly attractive agent compared with the aminoglycosides. Considering the potential costs of bacterial resistance from the use of broader-spectrum alternatives, a case can be made that aztreonam is a pharmacoeconomically sound choice as well.
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PMID:Role of aztreonam in the treatment of nosocomial pneumonia in the critically ill surgical patient. 1080 65

In 1995 the American Thoracic Society issued an official consensus statement on the treatment of hospital-acquired pneumonia (HAP). Classes of antimicrobials included in the list of antimicrobials deemed to be suitable for the empiric treatment of severe HAP were the aminoglycosides, quinolones, antipseudomonal penicillins, carbapenems, and beta-lactam/beta-lactamase inhibitor combinations. Aztreonam, a monobactam, was also listed and is unique among these agents based on its spectrum of activity being limited to the gram-negative bacillary bacteria combined with an excellent safety profile. This review focuses on the role of aztreonam in the treatment of nosocomial pneumonia in the critically ill patient.A review of the literature was performed using PubMed and secondary literature sources as to the clinical efficacy of aztreonam in the treatment of lower respiratory tract infections as well as its pharmacokinetic and safety profiles. An analysis of aztreonam's potential pharmacoeconomic advantages compared with other agents was also performed.Numerous studies have documented that aztreonam has effectiveness that is equal or superior to that of other suitable antibiotics in the treatment of nosocomial pneumonia. Its excellent safety profile makes it a particularly attractive agent compared with the aminoglycosides. Considering the potential costs of bacterial resistance from the use of broader-spectrum alternatives, a case can be made that aztreonam is a pharmacoeconomically sound choice as well.
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PMID:Role of aztreonam in the treatment of nosocomial pneumonia in the critically ill surgical patient. 1087 14

Hospital-acquired pneumonia (HAP) is associated with high morbidity and mortality. Early, appropriate, and adequate empiric therapy can increase the chance of survival. In 1995, the American Thoracic Society provided guidelines for the initial treatment of immunocompetent HAP patients, which is one of the principal HAP management approaches available to physicians today. However, these guidelines have several important limitations, including a lack of recommendations for duration of therapy and no recognition of newer drugs such as cefepime, trovafloxacin, and meropenem. Furthermore, they fail to distinguish among similar compounds (ie, beta-lactam/beta-lactamase inhibitor combinations) or to recommend specific antibiotics. The clinician using these guidelines needs to address local patterns of antimicrobial resistance, especially in ICUs. Effective computerized antibiotic management programs that incorporate information on local patterns of antimicrobial resistance can assist physicians in empiric therapy decision making, improve patient quality of care, and reduce medical costs.
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PMID:Guidelines and critical pathways for severe hospital-acquired pneumonia. 1117 78

The treatment of nosocomial pneumonia presents a major treatment challenge and one complicated by the rising prevalence of multidrug resistance among nosocomial pathogens. Contemporary treatment strategies for nosocomial pneumonia, which is most often attributable to Gram-negative bacilli or Staphylococcus aureus, mandate early empiric therapy with broad-spectrum antibacterial agents. The choice of agents for empiric therapy is fundamental to outcome, and the selection of inappropriate agents, to which pathogens are resistant, contributes significantly to morbidity and mortality. The adoption of practice guidelines, such as those proposed by the American Thoracic Society, can help to guide antibiotic selection, especially when combined with knowledge of local patterns of infection and antimicrobial susceptibility. Beta-Lactam/beta-lactamase inhibitor combinations, particularly those with activity against Pseudomonas aeruginosa, are among the core antibiotic agents considered suitable for empiric therapy of nosocomial pneumonia. They are particularly suited to use in hospitals with high rates of beta-lactamase-mediated resistance, especially resistance due to extended-spectrum beta-lactamases, infections with Acinetobacter spp. and those of mixed aetiology.
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PMID:Hospital-acquired respiratory tract infections: clinical experience with beta-lactam/beta-lactamase inhibitors. 1201 53

Nosocomial pneumonia or hospital-acquired pneumonia (HAP) causes considerable morbidity and mortality. It is the second most common nosocomial infection and the leading cause of death from hospital-acquired infections. In 1996 the American Thoracic Society (ATS) published guidelines for empirical therapy of HAP. This review focuses on the literature that has appeared since the ATS statement. Early diagnosis of HAP and its etiology is crucial in guiding empirical therapy. Since 1996, it has become clear that differentiating mere colonization from etiologic pathogens infecting the lower respiratory tract is best achieved by employing bronchoalveolar lavage (BAL) or protected specimen brush (PSB) in combination with quantitative culture and detection of intracellular microorganisms. Endotracheal aspirate and non-bronchoscopic BAL/PSB in combination with quantitative culture provide a good alternative in patients suspected of ventilator-associated pneumonia. Since culture results take 2-3 days, initial therapy of HAP is by definition empirical. Epidemiologic studies have identified the most frequently involved pathogens: Enterobacteriaceae, Haemophilus influenzae, Streptococcus pneumoniae and Staphylococcus aureus ('core pathogens'). Empirical therapy covering only the 'core pathogens' will suffice in patients without risk factors for resistant microorganisms. Studies that have appeared since the ATS statement issued in 1996, demonstrate several new risk factors for HAP with multiresistant pathogens. In patients with risk factors, empirical therapy should consist of antibacterials with a broader spectrum. The most important risk factors for resistant microorganisms are late onset of HAP (>/=5 days after admission), recent use of antibacterial therapy, and mechanical ventilation. Multiresistant bacteria of specific interest are methicillin-resistant S. aureus (MRSA), Pseudomonas aeruginosa, Acinetobacter calcoaceticus-baumannii, Stenotrophomonas maltophilia and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. Each of these organisms has its specific susceptibility pattern, demanding appropriate antibacterial treatment. To further improve outcomes, specific therapeutic options for multiresistant pathogens and pharmacological factors are discussed. Antibacterials developed since 1996 or antibacterials with renewed interest (linezolid, quinupristin/dalfopristin, teicoplanin, meropenem, new fluoroquinolones, and fourth-generation cephalosporins) are discussed in the light of developing resistance.Since the ATS statement, many reports have shown increasing incidences of resistant microorganisms. Therefore, one of the most important conclusions from this review is that empirical therapy for HAP should not be based on general guidelines alone, but that local epidemiology should be taken into account and used in the formulation of local guidelines.
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PMID:Nosocomial pneumonia : rationalizing the approach to empirical therapy. 1640 13

OBJECTIVE. To determine the prevalence of Staphylococcus aureus strains among hospitalized patients at the beginning of their hospitalization and during their treatment and the resistance of strains to antibiotics, and to evaluate epidemiologic characteristics of these strains. PATIENTS AND METHODS. Sixty-one patients treated at the Department of Cardiac, Thoracic and Vascular Surgery were examined. Identification of Staphylococcus aureus strains was performed using plasmacoagulase and DNase tests. The resistance of Staphylococcus aureus to antibiotics, beta-lactamase production, phagotypes, and phagogroups were determined. The isolated Staphylococcus aureus strains were tested for resistance to methicillin by performing disc diffusion method using commercial discs (Oxoid) (methicillin 5 microg per disk and oxacillin 1 microg per disk). RESULTS. A total of 297 Staphylococcus aureus strains were isolated. On the first day of hospitalization, the prevalence rate of Staphylococcus aureus strains among patients was 67.3%, and it statistically significantly increased to 91.8% on days 7-10 of hospitalization (P<0.05). During hospitalization, patients were colonized with Staphylococcus aureus strains resistant to cephalothin (17.6% of patients, P<0.05), cefazolin (14.6%, P<0.05), tetracycline (15.0%, P<0.05), gentamicin (37.7%, P<0.001), doxycycline (30.7%, P<0.001), and tobramycin (10.6%, P>0.05). Three patients (4.9%) were colonized with methicillin-resistant Staphylococcus aureus strains, belonging to phage group II phage type 3A and phage group III phage types 83A and 77; 22.6-25.5% of Staphylococcus aureus strains were nontypable. During hospitalization, the prevalence rate of phage group II Staphylococcus aureus strains decreased from 39.6% to 5.7% (P<0.05) and the prevalence rate of phage group III Staphylococcus aureus strains increased to 29.5% (P<0.001). CONCLUSIONS. Although our understanding of Staphylococcus aureus is increasing, well-designed community-based studies with adequate risk factor analysis are required to elucidate further the epidemiology of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus. Surveillance of methicillin-resistant Staphylococcus aureus provides relevant information on the extent of the methicillin-resistant Staphylococcus aureus epidemic, identifies priorities for infection control and the need for adjustments in antimicrobial drug policy, and guides intervention programs.
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PMID:[Staphylococcus aureus prevalence among hospitalized patients]. 1879 36

Community-acquired pneumonia (CAP) is a common infectious disease with high morbidity and mortality. In this study, demographic features, underlying conditions, causative pathogens and factors affecting length of hospital stay and mortality were retrospectively investigated in patients who were diagnosed as CAP and followed-up in our unit between January 2005-December 2007. Among 97 patients 65 (67%) were male, 32 (33%) were female and the mean age was 62.7 (age range: 18-94) years. Patients were grouped according to criteria of Turkish Thoracic Society into four groups; 22 were group 2 (patients with risk factors, without aggrevating factors), 59 were group 3 (patients with aggrevating factors), and 16 were group 4 (patients who have necessity for intensive care) CAP. The patients have also been grouped according to criteria of American Thoracic Society (CURB-65 score = Confusion, Urea > 7 mmol/L, Respiratory rate > or = 30/min, low Blood pressure and being > or = 65 years old), as group I (n = 65), group II (n = 20), and group III (n = 12). During follow-up 11 (11.3%) patients required mechanical ventilation support and 6 (6.2%) patients have died. Causative pathogens were isolated from 14 (23.3%) out of 27 well-qualified sputum samples obtained from 60 patients who could produce sputum (8 Streptococcus pneumoniae, 2 methicillin-sensitive Staphylococcus aureus, 2 Klebsiella pneumoniae, 1 Haemophilus influenzae, 1 Moraxella catarrhalis). Thirty-seven of cases were treated with levofloxacin, 10 with moxifloxacin, 24 with ceftriaxone +/- clarithromycin, 16 with sulbactam-ampicillin +/- ciprofloxacin, 10 with beta-lactam/beta-lactamase inhibitor combinations, and fever declined within 2.5 days in 83 (85.6%) of them. The mean duration of hospital stay was estimated as 11.1 days. In the evaluation of the factors that affect the length of hospital stay, being > or = 65 years old, gender, underlying conditions, central venous catheterisation, presence of nasogastric tube, positive culture result, previous antibiotic treatment, fever continuing for > 3 days despite antibiotic therapy and scoring groups were not determined as risk factors (p > 0.05 for all of these parameters). However, mechanical ventilation was found as a significant risk factor (p < 0.05). In the evaluation of the factors that affect mortality, mechanical ventilation (p < 0.001), staying in intensive care unit (p < 0.001), being group 4 CAP (p < 0.001) and fever continuing for > 3 days despite antibiotic therapy (p = 0.05) were found to be significant risk factors. In conclusion, length of hospital stay, mortality and treatment costs in CAP patients could be reduced by defining the risk factors and starting empirical antibiotic therapy according to the national and international guidelines.
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PMID:[Factors effecting the duration of hospitalization and mortality in patients with community-acquired pneumonia]. 2008 12