Healthcare-associated pneumonia in adults: management principles to improve outcomes

Craven, Donald E.; Palladino, Richard; McQuillen, Daniel P.

doi:10.1016/j.idc.2004.08.001

Cited by 55 publications

(33 citation statements)

References 72 publications

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“…18 years of age evaluated in the ED at LDS Hospital from 1996 to 2006 with International Statistical Classifi cation of Diseases, 9th edition (ICD-9) codes specifi c for a primary diagnosis of pneumonia (480-487.1), or respiratory failure or sepsis (518.x, 038.x) as a primary diagnosis with pneumonia secondary. Patients diagnosed with aspiration pneumonia (507.0), immunocompromised conditions including AIDS or receipt of antiretroviral therapy (042), solid organ transplants (v420-7), hematologic malignancies (v106.x, 200.x, 208.x), and those meeting criteria for health-care-associated pneumonia 18 were excluded. We included only the fi rst episode of pneumonia in a given 12-month period; however, 45 individuals presented with more than one case of pneumonia outside a 12-month period.…”

Section: Study Populationmentioning

confidence: 99%

CURB-65 Pneumonia Severity Assessment Adapted for Electronic Decision Support

Jones

Bewick

et al. 2011

Chest

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Section: Study Populationmentioning

confidence: 99%

CURB-65 Pneumonia Severity Assessment Adapted for Electronic Decision Support

Jones

Bewick

et al. 2011

Chest

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“…in intensive care patients, Hap accounts for 10-47% of nosocomial infections 4,5 , with a reported mortality of 20-60% (ref. [6][7][8][9] ). most frequently, Hap is associated with invasive airway management and mechanical ventilation, such as the case of ventilator-assisted pneumonia (Vap) (ref.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of hospital-acquired pneumonia: Results of a Central European multicenter, prospective, observational study compared with data from the European region

Herkel¹,

Uvizl²,

Doubravská³

et al. 2016

BIOMED PAP

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Background. Hospital-acquired pneumonia (HAP) is associated with high mortality. In Central Europe, there is a dearth of information on the prevalence and treatment of HAP. This project was aimed at collecting multicenter epidemiological data on patients with HAP in the Czech Republic and comparing them with supraregional data. Methods. This prospective, multicenter, ob servational study processed data from a database supported by a Czech Ministry of Health grant project. Included were all consecutive patients aged 18 and over who were admitted to participating intensive care units (ICUs) between 1 May 2013 and 31 December 2014 and met the inclusion criterion of having HAP. The primary endpoint was to analyze the relationships between 30-day mortality (during the stay in or after discharge from ICUs) and the microbiological etiological agent and adequacy of initial empirical antibiotic therapy in HAP patients. Results. The group dataset contained data on 330 enrolled patients. The final validated dataset involved 214 patients, 168 males (78.5%) and 46 females (21.5%), from whom 278 valid lower airway samples were obtained. The mean patient age was 59.9 years. The mean APACHE II score at admission was 21. Community-acquired pneumonia was identified in 13 patients and HAP in 201 patients, of whom 26 (12.1%) had early-onset and 175 (81.8%) had late-onset HAP. Twenty-two bacterial species were identified as etiologic agents but only six of them exceeded a frequency of detection of 5% (Klebsiella pneumoniae 20.4%, Pseudomonas aeruginosa 20.0%, Escherichia coli 10.8%, Enterobacter spp. 8.1%, Staphylococcus aureus 6.2% and Burkholderia cepacia complex 5.8%). Patients infected with Staphylococcus aureus had significantly higher rates of early-onset HAP than those with other etiologic agents. The overall 30-day mortality rate for HAP was 29.9%, with 19.2% mortality for early-onset HAP and 31.4% mortality for late-onset HAP. Patients with late-onset HAP receiving adequate initial empirical antibiotic therapy had statistically significantly lower 30-day mortality than those receiving inadequate initial antibiotic therapy (23.8% vs 42.9%). Patients with ventilatorassociated pneumonia (VAP) had significantly higher mortality than those who developed HAP with no association with mechanical ventilation (34.6% vs 12.7%). Patients having VAP treated with adequate initial antibiotic therapy had lower 30-day mortality than those receiving inadequate therapy (27.2% vs 44.8%). Conclusions. The present study was the first to collect multicenter data on the epidemiology of HAP in the Central European Region, with respect to the incidence of etiologic agents causing HAP. It was concerned with relationships between 30-day patient mortality and the type of HAP, etiologic agent and adequacy of initial empirical antibiotic therapy.

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“…The recommended regimens to be considered are an aminoglycoside OR an antipseudomonal fluoroquinolone plus an antipseudomonal b-lactam (a carbapenem, if extended-spectrum b-lactamase-producing pathogens or MDR Acinetobacter species are suspected) PLUS vancomycin or linezolid if MRSA is suspected [3,10]. With regard to the treatment of MRSA pneumonia, however, the guidelines acknowledge that vancomycin may be an inferior choice.…”

Section: Risk Factors For Infection With Multidrug-resistant (Mdr) Pamentioning

confidence: 99%

“…In addition, inappropriately prolonged antibiotic therapy may adversely affect both the individual patient and the more general bacterial ecology. Multiple studies have demonstrated that survival is significantly improved when the initial choice of antibiotics is "appropriate," defined as indicating that all isolated pathogens are susceptible to у1 of the administered antibiotics [3]. Considered more broadly, however, both empirical and definitive antibiotic therapy, to be considered appropriate, require timely initiation, administration in appropriate dosages consistent with pharmacokinetic and pharmacodynamic (PK/PD) information, and appropriate alteration of therapy in response to clinical responses and microbiological data as they become available.…”

mentioning

confidence: 99%

Principles of Antibiotic Therapy in Severe Infections: Optimizing the Therapeutic Approach by Use of Laboratory and Clinical Data

Deresinski¹

2007

Clinical Infectious Diseases

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The increasingly daunting problem of antimicrobial resistance has led to an intense focus on optimization of antibiotic therapy, with simultaneous goals of improving patient outcomes and minimizing the contribution of that therapy to making the available antibiotics obsolete. Although even appropriate antibiotic therapy drives resistance, inappropriate therapy may also have adverse effects on the individual patient, as well as on the bacterial ecology. Recent research has validated the benefit of intelligent utilization of both microbiological data and clinical assessment in the empirical selection of initial broad-spectrum therapy and in further guidance of therapeutic decisions throughout the course of illness by use of a systems approach. Thus, the optimal approach to the critically ill patient with infection involves the initiation of aggressive broad-spectrum empirical therapy followed by timely responses to microbiological and clinical results as they become available. An appropriate response to this information often involves de-escalation of therapy or even its discontinuation.

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Healthcare-associated pneumonia in adults: management principles to improve outcomes

Cited by 55 publications

References 72 publications

CURB-65 Pneumonia Severity Assessment Adapted for Electronic Decision Support

CURB-65 Pneumonia Severity Assessment Adapted for Electronic Decision Support

Epidemiology of hospital-acquired pneumonia: Results of a Central European multicenter, prospective, observational study compared with data from the European region

Principles of Antibiotic Therapy in Severe Infections: Optimizing the Therapeutic Approach by Use of Laboratory and Clinical Data

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