Archive for May 24, 2015

Benefits of WSES guidelines application for the management of intra-abdominal infections

World J of Emerg Surg 2015

Belinda De Simone1*, Federico Coccolini2 , Fausto Catena1, Massimo Sartelli3, Salomone Di Saverio4,

Rodolfo Catena5, Antonio Tarasconi6 and Luca Ansaloni2

1 Department of Emergency and Trauma Surgery, University Hospital of Parma, Via Gramsci 11, 43100 Parma, Italy

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411795/pdf/13017_2015_Article_13.pdf

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May 24, 2015 at 5:34 pm

Management of community-acquired pneumonia in older adults.

Ther Adv Infect Dis. 2014 Feb;2(1):3-16.

Simonetti AF1, Viasus D2, Garcia-Vidal C2, Carratalà J3.

1Department of Infectious Diseases, Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain.

2Department of Infectious Diseases, Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain and Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain.

3Department of Infectious Diseases, Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Feixa Llarga s/n, 08907, L’Hospitalet de Llobregat, Barcelona, Spain.

Abstract

Community-acquired pneumonia (CAP) is an increasing problem among the elderly.

Multiple factors related to ageing, such as comorbidities, nutritional status and swallowing dysfunction have been implicated in the increased incidence of CAP in the older population. Moreover, mortality in patients with CAP rises dramatically with increasing age.

Streptococcus pneumoniae is still the most common pathogen among the elderly, although CAP may also be caused by drug-resistant microorganisms and aspiration pneumonia. Furthermore, in the elderly CAP has a different clinical presentation, often lacking the typical acute symptoms observed in younger adults, due to the lower local and systemic inflammatory response.

Several independent prognostic factors for mortality in the elderly have been identified, including factors related to pneumonia severity, inadequate response to infection, and low functional status. CAP scores and biomarkers have lower prognostic value in the elderly, and so there is a need to find new scales or to set new cut-off points for current scores in this population.

Adherence to the current guidelines for CAP has a significant beneficial impact on clinical outcomes in elderly patients. Particular attention should also be paid to nutritional status, fluid administration, functional status, and comorbidity stabilizing therapy in this group of frail patients.

This article presents an up-to-date review of the main aspects of CAP in elderly patients, including epidemiology, causative organisms, clinical features, and prognosis, and assesses key points for best practices for the management of the disease.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4072047/pdf/10.1177_2049936113518041.pdf

May 24, 2015 at 12:49 pm

Management of severe community-acquired pneumonia in Brazil: a secondary analysis of an international survey.

Rev Bras Ter Intensiva. 2015 Jan-Mar;27(1):57-63.

Rabello L1, Conceição C2, Ebecken K1, Lisboa T3, Bozza FA1, Soares M1, Póvoa P2, Salluh JI1.

1Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brasil.

2Unidade Polivalente de Terapia Intensiva, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, CEDOC, Faculdade Médica NOVA, Nova Universidade de Lisboa, Lisboa, Portugal.

3Unidade de Terapia Intensiva e Comitê de Controle de Infecção, Hospital das Clínicas, Programa de Pós-Graduação em Pneumologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.

Abstract

OBJECTIVE:

This study aimed to evaluate Brazilian physicians’ perceptions regarding the diagnosis, severity assessment, treatment and risk stratification of severe community-acquired pneumonia patients and to compare those perceptions to current guidelines.

METHODS:

We conducted a cross-sectional international anonymous survey among a convenience sample of critical care, pulmonary, emergency and internal medicine physicians from Brazil between October and December 2008. The electronic survey evaluated physicians’ attitudes towards the diagnosis, risk assessment and therapeutic interventions for patients with severe community-acquired pneumonia.

RESULTS:

A total of 253 physicians responded to the survey, with 66% from Southeast Brazil. The majority (60%) of the responding physicians had > 10 years of medical experience. The risk assessment of severe community-acquired pneumonia was very heterogeneous, with clinical evaluation as the most frequent approach. Although blood cultures were recognized as exhibiting a poor diagnostic performance, these cultures were performed by 75% of respondents. In contrast, the presence of urinary pneumococcal and Legionella antigens was evaluated by less than 1/3 of physicians. The vast majority of physicians (95%) prescribe antibiotics according to a guideline, with the combination of a 3rd/4th generation cephalosporin plus a macrolide as the most frequent choice.

CONCLUSION:

This Brazilian survey identified an important gap between guidelines and clinical practice and recommends the institution of educational programs that implement evidence-based strategies for the management of severe community-acquired pneumonia.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396898/pdf/rbti-27-01-0057.pdf

May 24, 2015 at 12:46 pm


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