Improving outcomes from community-acquired pneumonia

Waterer, Grant; Bennett, Lesley

doi:10.1097/mcp.0000000000000155

Cited by 11 publications

(11 citation statements)

References 66 publications

(18 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nesse sentido, a aquisição de infecção nestes sítios pode estar relacionada principalmente a elevada microbiota endógena do trato respiratório e digestivo que pode facilitar a infecção em pacientes imunocomprometidos 22,23 . A pneumonia é uma das mais frequentes patologias em pacientes com sepse, visto que o sítio respiratório é uma das principais fontes dos processos infecciosos, fato que está associado a maior frequência do uso de ventilação mecânica e permanência prolongada em UTI, conforme mostrado em nossos dados 5,24,25 .…”

Section: ▄ Resultadosunclassified

Fatores de risco associados ao agravamento de sepse em pacientes em Unidade de Terapia Intensiva

Barros¹,

Maia

Monteiro

2016

Cad. saúde colet.

View full text Add to dashboard Cite

Resumo Introdução a sepse é um grave problema de saúde pública e uma das principais causas de morte em Unidade de Terapia Intensiva (UTI). Objetivo este trabalho avaliou o agravamento e a mortalidade de pacientes sepse em UTI, relacionando aos fatores de risco, diferentes etiologias e terapêuticas. Metodologia O estudo foi observacional descritivo, e avaliou os casos de sepse (sepse, sepse severa e choque séptico) no período de janeiro de 2009 a dezembro de 2010. Resultados dos 212 pacientes internados em UTI, 181 apresentaram sepse nas diferentes gravidades, cuja mortalidade por sepse na UTI foi de 63%, principalmente nos pacientes com choque séptico (53%), seguida da sepse grave (8,3%). Além disso, os fatores de risco associados ao agravamento da sepse foram: idade superior que 65 anos, maior tempo médio de internação na UTI, elevada frequência de comorbidades e a utilização de procedimentos invasivos. O maior consumo de antibióticos foi de carbapenêmicos, e as principais cepas multirresistentes isoladas foram MRSA, VRE, P. aeruginosa e A. baumannii resistente a carbapenêmicos. Conclusão este estudo mostrou uma elevada mortalidade por sepse na UTI, principalmente em pacientes com choque séptico com comorbidades, que foram submetidos aos procedimentos invasivos e com maior tempo de internação.

show abstract

Section: ▄ Resultadosunclassified

Fatores de risco associados ao agravamento de sepse em pacientes em Unidade de Terapia Intensiva

Barros¹,

Maia

Monteiro

2016

Cad. saúde colet.

View full text Add to dashboard Cite

show abstract

“…10,11 One of the pitfalls of using mortality to judge quality of care in CAP is that it does not differentiate preventable from inevitable mortality. 12 The standardized mortality ratio (SMR) attempts to compare the rate of expected deaths to observed deaths with the assumption that a discrepancy relates to quality of care. However, analysis of hospital deaths in CAP rarely identifies deficiencies in care, which if corrected, would have changed the outcome.…”

Section: Mortalitymentioning

confidence: 99%

Determining best outcomes from community‐acquired pneumonia and how to achieve them

Hadfield

Bennett

2017

Respirology

Self Cite

View full text Add to dashboard Cite

Community-acquired pneumonia (CAP) is a common acute medical illness with a standard, effective treatment that was introduced before the evidenced-based medicine era. Mortality rates have improved in recent decades but improvements have been minimal when compared to other conditions such as acute coronary syndromes. The standardized approach to treatment makes CAP a target for comparative performance and outcome measures. While easy to collect, simplistic outcomes such as mortality, readmission and length of stay are difficult to interpret as they can be affected by subjective choices and health care resources. Proposed clinical-and patient-reported outcomes are discussed below and include measures such as the time to clinical stability (TTCS) and patient satisfaction, which can be compared between health institutions. Strategies to improve these outcomes include use of a risk stratification tool, local antimicrobial guidelines with antibiotic stewardship and care bundles to include early administration of antibiotics and early mobilization.

show abstract

“…1 An early and appropriate antibiotic therapy has shown to improve the outcome of patients with CAP reducing in-hospital mortality. 2 However, the length of the antibiotic treatment represents a controversial and debated issue. 3 Several available guidelines on CAP, agree to interrupt the antibiotic therapy when a clinical stabilization is achieved according to defined clinical and laboratory criteria with a range of treatment duration suggested between 5 and 14 days.…”

Section: Introductionmentioning

confidence: 99%

The real life application of a procalcitonin-based algorithm to reduce antibiotic exposure in hospitalized patients with community acquired pneumonia: a proof of concept

et al. 2016

View full text Add to dashboard Cite

Community-acquired pneumonia (CAP) represents a common cause of hospitalization in Internal Medicine wards and a frequent cause of antibiotic prescription. An approach based on procalcitonin (PCT) algorithm, has shown to reduce the antibiotic exposure without affecting outcome, in patients admitted to hospital for pneumonia We conducted a study to evaluate the role of a PCT algorithm in a real-life perspective, to reduce the length of antibiotic treatment (AT) in patients hospitalized with CAP. We performed a prospective case-control study, enrolling patients with CAP admitted to an Internal Medicine ward of Careggi Hospital, between December 2013 and February 2014. We used a validated algorithm of AT guided by PCT in CAP. Discontinuation of AT was strongly indicated when PCT level was normal or reduced by 80% in patients with PCT values higher than 10 pg/mL on admission. PCT was drawn on admission, 24 h, 4 th day and 6 th day from admission. The outcomes evaluated were the length of AT, the length of in hospital stay, mortality and serious adverse clinical events. Forty-six patients were consecutively enrolled. On 20 patients, AT was discontinued according to protocol and on 26 patients the AT was continued on clinical judgement. At the baseline, both groups were similar regarding clinical, laboratory, microbiology characteristics, and CURB-65 score. PCT guidance reduced total antibiotic exposure (5.1±1.5 vs 9.1±5.8 days, P=0.005) without any increase of mortality or serious clinical event. In our study, a PCT algorithm was a useful and safe tool to guide the AT in patients with CAP, reducing the antibiotic exposure.

show abstract

Improving outcomes from community-acquired pneumonia

Cited by 11 publications

References 66 publications

Fatores de risco associados ao agravamento de sepse em pacientes em Unidade de Terapia Intensiva

Fatores de risco associados ao agravamento de sepse em pacientes em Unidade de Terapia Intensiva

Determining best outcomes from community‐acquired pneumonia and how to achieve them

The real life application of a procalcitonin-based algorithm to reduce antibiotic exposure in hospitalized patients with community acquired pneumonia: a proof of concept

Contact Info

Product

Resources

About