Community-acquired pneumonia
About: This article is published in The Lancet.The article was published on 1998-12-19. It has received 1403 citations till now. The article focuses on the topics: Community-acquired pneumonia.
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McMaster University1, Northwestern University2, University of Texas Health Science Center at San Antonio3, Johns Hopkins University4, University of Mississippi5, University of Utah6, LDS Hospital7, Centers for Disease Control and Prevention8, Baylor College of Medicine9, United States Department of Veterans Affairs10, Winthrop-University Hospital11, Stony Brook University12, University of Barcelona13
TL;DR: This work presents a meta-analyses of the immune system’s response to chronic obstructive pulmonary disease and shows clear patterns of decline in the immune systems of elderly patients with compromised immune systems.
Abstract: Lionel A. Mandell, Richard G. Wunderink, Antonio Anzueto, John G. Bartlett, G. Douglas Campbell, Nathan C. Dean, Scott F. Dowell, Thomas M. File, Jr. Daniel M. Musher, Michael S. Niederman, Antonio Torres, and Cynthia G. Whitney McMaster University Medical School, Hamilton, Ontario, Canada; Northwestern University Feinberg School of Medicine, Chicago, Illinois; University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, and Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas; Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi School of Medicine, Jackson; Division of Pulmonary and Critical Care Medicine, LDS Hospital, and University of Utah, Salt Lake City, Utah; Centers for Disease Control and Prevention, Atlanta, Georgia; Northeastern Ohio Universities College of Medicine, Rootstown, and Summa Health System, Akron, Ohio; State University of New York at Stony Brook, Stony Brook, and Department of Medicine, Winthrop University Hospital, Mineola, New York; and Cap de Servei de Pneumologia i Allergia Respiratoria, Institut Clinic del Torax, Hospital Clinic de Barcelona, Facultat de Medicina, Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer, CIBER CB06/06/0028, Barcelona, Spain.
5,558 citations
Cites background from "Community-acquired pneumonia"
...Based on collective data from recent studies [171]....
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...Doxycycline can be used as an alternative to a macrolide on the basis of scant data for treatment of Legionella infections [171, 223, 224]....
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...One explanation for the reduced mortality may be the presence of undiagnosed coinfection with an atypical pathogen; although reported to occur in 18%–38% of CAP cases in some studies [73, 175], much lower rates of undiagnosed coinfection are found in general [171] and specifically in severe cases [78]....
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01 Jan 2009
TL;DR: Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients and Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients.
Abstract: OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002
3,716 citations
TL;DR: This study highlights the need to understand more fully the role of Epstein-Barr virus in the development of central giant cell granuloma and its role in the immune system.
Abstract: John G. Bartlett,1 Scott F Dowell,2 Lionel A. Mandell,6 Thomas M. File, Jr.,3 Daniel M. Musher,4 and Michael J. Fine5 'Johns Hopkins University School of Medicine, Baltimore, Maryland, 2Centers for Disease Control and Prevention, Atlanta, Georgia, 3Northeastern Ohio Universities College of Medicine, Cleveland, Ohio, 4Baylor College of Medicine and Veterans Affairs Medical Center, Houston, Texas, and 5University of Pittsburgh, Pennsylvania, USA; and 6McMaster University, Toronto, Canada
2,292 citations
TL;DR: The incidence of community-acquired pneumonia requiring hospitalization was highest among the oldest adults and despite current diagnostic tests, no pathogen was detected in the majority of patients.
Abstract: Background Incidence estimates of hospitalizations for community-acquired pneumonia among children in the United States that are based on prospective data collection are limited. Updated estimates of pneumonia that has been confirmed radiographically and with the use of current laboratory diagnostic tests are needed. Methods We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among children younger than 18 years of age in three hospitals in Memphis, Nashville, and Salt Lake City. We excluded children with recent hospitalization or severe immunosuppression. Blood and respiratory specimens were systematically collected for pathogen detection with the use of multiple methods. Chest radiographs were reviewed independently by study radiologists. Results From January 2010 through June 2012, we enrolled 2638 of 3803 eligible children (69%), 2358 of whom (89%) had radiographic evidence of pneumonia. The median age of the children was 2 years (interquartile ...
2,088 citations
Harvard University1, University of Western Australia2, University of Texas Health Science Center at San Antonio3, McMaster University4, University of Washington5, Centers for Disease Control and Prevention6, Primary Children's Hospital7, University of Utah8, University of Pittsburgh9, University of Michigan10, Vanderbilt University11, University of Connecticut12, United States Department of Veterans Affairs13, Baylor College of Medicine14
TL;DR: Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions.
Abstract: Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.Methods: A multidisciplinary panel conducted pra...
1,708 citations
References
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TL;DR: Declines with age were found in measures of handicap and life satisfaction, but three quarters of those interviewed reported generally good health and rated their current quality of life as either good or excellent.
Abstract: Mortality, morbidity, health, functional, and psychosocial outcomes were examined in 834 individuals with long term spinal cord injuries. All were treated at one of two British spinal injury centres: the National Spinal Injuries Centre at Stoke Mandeville Hospital or the Regional Spinal Injuries Centre in Southport; all were 20 or more years post injury. Using life table techniques, median survival time was determined for the overall sample (32 years), and for various subgroups based on level and completeness of injury and age at injury. With the number of renal deaths decreasing over time, the cause of death patterns in the study group as it aged began to approximate those of the general population. Morbidity patterns were found to be associated with age, years post injury, or a combination of these factors, depending upon the particular medical complication examined. A current medical examination of 282 of the survivors revealed significant declines in functional abilities associated with the aging process. Declines with age also were found in measures of handicap and life satisfaction, but three quarters of those interviewed reported generally good health and rated their current quality of life as either good or excellent.
565 citations
TL;DR: Though some cause-specific mortality rates for spinal cord injured persons have declined dramatically, many remain substantially above normal and improved methods for preventing and managing these fatal complications must be developed.
405 citations
Journal Article•
TL;DR: C. difficile was a common Nosocomial infection on this ward, resulting in asymptomatic carriage more often than diarrhea and accounting for one-fifth of all cases of nosocomial diarrhea.
Abstract: A prospective cohort study of 399 consecutive patients in a single ward over an 11-month period was conducted to identify risk factors for nosocomial C. difficile colonization and diarrhea. The incidence of asymptomatic carriage was 13.0/100 patient admissions and the incidence of C. difficile-associated diarrhea was 7.8/100 patient admissions. Increased age and more severe underlying illness were associated with increased risk of C. difficile carriage and diarrhea. Multivariate models adjusting for age and severity of underlying disease associated two risk factors with asymptomatic C. difficile carriage: stool softeners (relative risk [RR] = 2.04) and antacids (RR = 1.80). Five risk factors were associated with C. difficile-associated diarrhea: cephalosporin use (RR = 2.07), penicillin use (RR = 3.41), enemas (RR = 3.26), gastrointestinal stimulants (RR = 3.06), and stool softeners (RR = 1.74). C. difficile was a common nosocomial infection on this ward, resulting in asymptomatic carriage more often than diarrhea and accounting for one-fifth of all cases of nosocomial diarrhea.
398 citations
TL;DR: In this paper, a prospective cohort study of 399 consecutive patients in a single ward over an 11-month period was conducted to identify risk factors for nosocomial C. difficile colonization and diarrhea.
Abstract: A prospective cohort study of 399 consecutive patients in a single ward over an 11-month period was conducted to identify risk factors for nosocomial C. difficile colonization and diarrhea. The incidence of asymptomatic carriage was 13.0/100 patient admissions and the incidence of C. difficile-associated diarrhea was 7.8/100 patient admissions. Increased age and more severe underlying illness were associated with increased risk of C. difficile carriage and diarrhea. Multivariate models adjusting for age and severity of underlying disease associated two risk factors with asymptomatic C. difficile carriage: stool softeners (relative risk [RR] = 2.04) and antacids (RR = 1.80). Five risk factors were associated with C. difficile-associated diarrhea: cephalosporin use (RR = 2.07), penicillin use (RR = 3.41), enemas (RR = 3.26), gastrointestinal stimulants (RR = 3.06), and stool softeners (RR = 1.74). C. difficile was a common nosocomial infection on this ward, resulting in asymptomatic carriage more often than diarrhea and accounting for one-fifth of all cases of nosocomial diarrhea.
391 citations
TL;DR: The use of narrow-spectrum antibiotics for hospital treatment of community-acquired infections in the elderly should be encouraged.
Abstract: Toxin-producing Clostridium difficile is the commonest bacterial cause of nosocomial diarrhoea and is a well recognized cause of hospital outbreaks in elderly care units. High C. difficile disease rates have been associated with the use of broad-spectrum antibiotics, especially cephalosporins. An outbreak of C. difficile infection in the elderly care unit at Gloucestershire Royal NHS Trust continued despite increased ward cleaning and strict implementation of infection control measures. A restrictive antibiotic policy that would maintain colonization resistance in the gastrointestinal tract was introduced throughout this unit. Patients admitted with suspected infection were prescribed intravenous (i.v.) benzylpenicillin 1.2-1.8 g every 6 h to cover streptococcal infections and i.v. trimethoprim 200 mg twice daily to cover urinary tract pathogens and Haemophilus influenzae. If the patient had septic shock a single iv dose of gentamicin was given (120-180 mg) to cover more resistant gram-negative bacilli. The following were monitored before and after the policy change. The number of cases of C. difficile toxin-positive diarrhoea; cefuroxime and total antibiotic use on the elderly care wards; patient mortality rates; and length of hospital stay: two hundred and fifty-two and 234 patients respectively with a discharge diagnosis of infection were admitted before and after the antibiotic policy change. Mortality rates and length of hospital stay were unchanged. Cefuroxime prescribing and total antibiotic prescribing costs fell by 5150 pounds sterling and 8622 pounds sterling respectively in the 7 month period after the change. Thirty-seven cases of C. difficile diarrhoea occurred in the period before and 16 in the period after the policy change. The incidence of C. difficile diarrhoea and of cefuroxime use has remained low since then. The use of narrow-spectrum antibiotics for hospital treatment of community-acquired infections in the elderly should be encouraged. Outbreaks of C. difficile diarrhoea should be managed with the combined approach of infection control and strict antibiotic policies.
186 citations