Posts filed under ‘Infecciones respiratorias’

Safety and efficacy of CURB65-guided antibiotic therapy in community-acquired pneumonia

Journal of Antimicrobial Chemotherapy  Feb. 2011 V.66 N.2 P.416-423

James D. Chalmers1,*, Aran Singanayagam2, Ahsan R. Akram2, Gourab Choudhury2, Pallavi Mandal2 and Adam T. Hill2

 

1MRC Centre For Inflammation Research, Queens Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK

2Department of Respiratory Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK

Objectives

To determine whether the introduction of a community-acquired pneumonia (CAP) severity assessment tool to guide antibiotic selection could reduce broad-spectrum antibiotic prescribing without compromising patient safety.

Methods

A prospective before and after evaluation study. Empirical antibiotic prescribing was studied for 18 months from June 2006 to January 2008 (pre-intervention) and then for 18 months following the implementation of a CURB65-guided antibiotic therapy guideline in June 2008. The primary outcome was the use of broad-spectrum antibiotics (cephalosporin, amoxicillin plus clavulanic acid and macrolides) in patients with CAP. Safety outcomes were 30 day mortality, requirement for mechanical ventilation and/or vasopressor support (MV/VS), development of complicated pneumonia, time to clinical stability (TCS) and length of hospital stay.

Results

The introduction of CURB65-guided therapy resulted in an overall reduction in the prescription of cephalosporins (from 27.1% of patients receiving this agent in the overall pre-intervention cohort to 8.0% in the post-intervention cohort, P<0.0001) and macrolides (72.8% to 58.7%, P<0.0001), particularly among low-risk patients. There was a corresponding increase in the prescription of the narrower-spectrum agent amoxicillin (29.7% to 41.7%, P<0.0001) and an increase in the use of amoxicillin monotherapy (10.4% to 29.9%, P<0.0001). Co-amoxiclav use increased slightly as this agent replaced cephalosporins as first-line treatment for severe CAP. The guideline had no impact on 30 day mortality, MV/VS, complicated pneumonia, TCS or length of stay. Following the intervention, adherence to national guidelines increased from 25.4% of prescriptions to 61.9%, suggesting the potential for further improvements.

Conclusions

CURB65-guided antibiotic therapy was associated with a significant decrease in broad-spectrum antibiotic use. The intervention was safe with no impact on mortality, treatment failure or clinical response.

PDF

http://jac.oxfordjournals.org/content/66/2/416.full.pdf+html

 

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August 31, 2018 at 8:14 am

South African guideline for the management of community-acquired pneumonia in adults

Journal of Thoracic Disease June 2017 V.9 N.6 P.1469-1502.

South African Thoracic Society; Federation of Infectious Diseases Societies of Southern Africa.

Tom H. Boyles1, Adrian Brink1,2, Greg L. Calligaro3, Cheryl Cohen4,5, Keertan Dheda3, Gary Maartens6, Guy A. Richards7, Richard van Zyl Smit3, Clifford Smith8, Sean Wasserman1, Andrew C. Whitelaw9,10, Charles Feldman11; South African Thoracic Society, Federation of Infectious Diseases Societies of Southern Africa

Improving the care of patients with community-acquired pneumonia (CAP) in South Africa is particularly important because of the high burden of disease and the need to improve standards of antibiotic prescribing in the face of rising antimicrobial resistance (AMR). The purpose of this document is to provide clinicians guidance as to the recommended management of patients with CAP. This is an update for clinicians, which takes into account important advances and controversies in the management of patients with CAP.

FULL TEXT

http://jtd.amegroups.com/article/view/13850/11576

PDF

http://jtd.amegroups.com/article/view/13850/pdf

August 29, 2018 at 11:23 am

Respiratory Virus Infection During Pregnancy: Does It Matter?

The Journal of Infectious Diseases August 15, 2018 V.218 N.4 P.512-515

EDITOR’S CHOICE

Janet A Englund; Helen Y Chu

FULL TEXT

https://academic.oup.com/jid/article/218/4/512/4993270

PDF (CLIC en PDF)

 

August 13, 2018 at 6:24 pm

Prophylactic Antimicrobial Therapy for Acute Aspiration Pneumonitis

Clinical Infectious Diseases August 15, 2018 V.67 N.4 P.513-518

EDITOR’S CHOICE

Vlad Dragan; Yanliang Wei; Marion Elligsen; Alex Kiss; Sandra A N Walker

In a cohort of patients with acute aspiration pneumonitis, antibiotics within 48 hours of macroaspiration was not associated with reduced mortality compared to supportive care only, yet resulted in the need for more frequent antibiotic escalation and fewer antibiotic-free days.

FULL TEXT

https://academic.oup.com/cid/article/67/4/513/4846855

PDF (CLIC en PDF)

August 12, 2018 at 8:17 pm

Pneumonia associated with mechanical ventilation. Update and recommendations inter- Societies SADI-SATI.

Medicina (B Aires). 2018;78(2):99-106.

Article in Spanish

Cornistein W1, Colque ÁM2, Staneloni MI3, Monserrat Lloria M4, Lares M5, González AL5, Fernández Garcés A6, Carbone E7.

Author information

1 Hospital General de Agudos Dr. Cosme Argerich, Hospital Universitario Austral, Buenos Aires, Argentina. E-mail: wandacornistein@gmail.com.

2 Complejo Médico Churruca Visca, Buenos Aires, Argentina.

3 Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

4 Hospital Prof. Alejandro Posadas, Buenos Aires, Argentina.

5 Hospital Interzonal General de Agudos San Martín de La Plata, Argentina.

6 Clínica AMEBPBA (Mutual de Empleados del Banco de la Provincia de Buenos Aires), Argentina.

7 Hospital Aeronáutico Central, Buenos Aires, Argentina.

Abstract

Representatives of the Argentine Society of Infectious Diseases (SADI) and the Argentine Society of Intensive Therapy (SATI) worked together on the development of specific recommendations for the diagnosis, treatment and prevention of ventilator-associated pneumonia (VAP). The methodology used was the analysis of the literature published in the last 15 years, complemented with the opinion of experts and local data. This document aims to offer basic tools to optimize diagnosis based on clinical and microbiological criteria, orientation in empirical and targeted antibiotic schemes, news on posology and administration of antibiotics in critical patients and to promote effective measures to reduce the risk of VAP. It also offers a diagnostic and treatment algorithm and considerations on inhaled antibiotics. The joint work of both societies -infectious diseases and intensive care- highlights the concern for the management of VAP and the importance of ensuring improvement in daily practices. This guideline established recommendations to optimize the diagnosis, treatment and prevention of VAP in order to reduce morbidity and mortality, days of hospitalization, costs and resistance to antibiotics due to misuse of antimicrobials.

PDF

http://www.medicinabuenosaires.com/PMID/29659359.pdf

July 31, 2018 at 3:47 pm

Severe Community-Acquired Pneumonia due to Acinetobacter baumannii in North America: Case Report and Review of the Literature

Open Forum Infectious Diseases, March 2018 V.5 N.3

David P Serota; Mary Elizabeth Sexton; Colleen S Kraft; Federico Palacio

Acinetobacter baumannii is a rare but emerging cause of fulminant community-acquired pneumonia (CAP-AB). We describe a patient from a rural area who developed acute respiratory distress syndrome and septic shock. We describe risk factors and characteristics of this syndrome and review published cases of CAP-AB from North America.

FULL TEXT

https://academic.oup.com/ofid/article/5/3/ofy044/4926000

PDF (CLIC en PDF)

July 30, 2018 at 9:24 am

An Updated Review of Iclaprim: A Potent and Rapidly Bactericidal Antibiotic for the Treatment of Skin and Skin Structure Infections and Nosocomial Pneumonia Caused by Gram-Positive Including Multidrug-Resistant Bacteria

Open Forum Infectious Diseases, February 2018 V.5 N.2

REVIEW ARTICLE

David B Huang; Catherine D Strader; James S MacDonald; Mark VanArendonk; Richard Peck …

New antibiotics are needed because of the increased morbidity and mortality associated with multidrug-resistant bacteria. Iclaprim, a bacterial dihydrofolate reductase inhibitor, not currently approved, is being studied for the treatment of skin infections and nosocomial pneumonia caused by Gram-positve bacteria, including multidrug-resistant bacteria. Iclaprim showed noninferiority at –10% to linezolid in 1 of 2 phase 3 studies for the treatment of complicated skin and skin structure infections with a weight-based dose (0.8 mg/kg) but did not show noninferiority at –10% to linezolid in a second phase 3 study. More recently, iclaprim has shown noninferiority at –10% to vancomycin in 2 phase 3 studies for the treatment of acute bacterial skin and skin structure infections with an optimized fixed dose (80 mg). A phase 3 study for the treatment of hospital-acquired bacterial and ventilator-associated bacterial pneumonia is upcoming. If, as anticipated, iclaprim becomes available for the treatment of skin and skin structure infections, it will serve as an alternative to current antibiotics for treatment of severe infections. This article will provide an update to the chemistry, preclinical, pharmacology, microbiology, clinical and regulatory status of iclaprim.

FULL TEXT

https://academic.oup.com/ofid/article/5/2/ofy003/4791932

PDF (CLIC en PDF)

 

July 30, 2018 at 9:19 am

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