Reaching Stability in Community-Acquired Pneumonia: The Effects of the Severity of Disease, Treatment, and the Characteristics of Patients

Abstract

Some characteristics of CAP are useful at the time of hospital admission to identify patients who will need a longer hospital stay to reach clinical stability. Empirical treatment that follows guidelines is associated with earlier clinical stability. Complications and treatment failure delay clinical stability.

Clinical Approach to Nonresponsive Pneumonia in Adults Diagnosed by a Primary Care Clinician: A Retrospective Study

“…dyspnea, confusion) may predict NRP. 16 Except for former smoking history, myalgia, respiratory rate and pulse oximetry readings (in those for whom this data was recorded), there were no differences in presenting signs, symptoms and comorbid conditions between cases and controls in our study. Nonetheless, cases received more diagnostic tests at the first visit.…”

“…21 Our choice of a 4-day window of antibiotic treatment in which there is no further deterioration of vital signs, symptoms or clinical findings is consistent with a prospective study of hospitalized CAP patients by the Menendez group, which observed a median of 4 days of antibiotic treatment to clinical stability using criteria similar to Halm. 16 Additionally, others have defined NRP in hospitalized CAP patients as those with lack of response after 3 to 4 days of appropriate antibiotic treatment, often with clinical deterioration. 7,8,9,17 The second portion of our definition of NRP, 10 days of antibiotic therapy without improvement, is consistent with the observation that 90% of pneumonia-related hospitalizations in a cohort of 944 CAP patients who were treated as outpatients occurred within 10 days of treatment.…”

“…In other studies causes of NRP included (but were not limited to) the following: overwhelming or progressive pneumonia, extrapulmonary spread, unusual, specific or resistant organisms, significant comorbid conditions, older age, incorrect antibiotic therapy, and malignant or nonmalignant clinical entities that present in conjunction with pneumonia or mimic the presentation of pneumonia (Table 6). [7][8][9][10]15,16,23,24 These previous studies involved almost exclusively hospitalized patients. However, in the previously referenced cohort of selected CAP patients treated as outpatients (with failure defined as need for hospitalization), those requiring hospitalization were older, of higher baseline risk class and had chronic cardiac and/or lung disease compared to those not hospitalized.…”

“…[7][8][9][10][11] Recent studies of NRP have all involved hospitalized patients. [7][8][9][10][12][13][14][15][16][17] Thus, little is known about NRP in patients initially seen in a primary care ambulatory clinic.…”

Neumonía en el anciano mayor de 80 años con ingreso hospitalario

“…Una rapidez excesiva de administrar anti- bióticos conllevaría a tratar procesos clínicos probables de neumonía sin evidencia de la misma. La mejoría del proceso clínico no está solamente en ese tiempo de primera dosis, sino en los riesgos de base y los cuidados posteriores que influyen decisivamente (12,16). En nuestro estudio se administran antibióticos, en 6,6 horas desde la llegada a puerta; que está entre la 8 y las 4 horas de la referencias descritas.…”