Medline ® Abstracts for References 2,76,81
of 'Treatment of community-acquired pneumonia in adults who require hospitalization'
Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG, Infectious Diseases Society of America, American Thoracic Society
Clin Infect Dis. 2007;44 Suppl 2:S27.
McMaster University Medical School, Hamilton, Ontario, Canada. firstname.lastname@example.org
Patterns of resolution of chest radiograph abnormalities in adults hospitalized with severe community-acquired pneumonia.
Bruns AH, Oosterheert JJ, Prokop M, Lammers JW, Hak E, Hoepelman AI
Clin Infect Dis. 2007;45(8):983.
BACKGROUND: Timing of follow-up chest radiographs for patients with severe community-acquired pneumonia (CAP) is difficult, because little is known about the time to resolution of chest radiograph abnormalities and its correlation with clinical findings. To provide recommendations for short-term, in-hospital chest radiograph follow-up, we studied the rate of resolution of chest radiograph abnormalities in relation to clinical cure, evaluated predictors for delayed resolution, and determined the influence of deterioration of radiographic findings during follow-up on prognosis.
METHODS: A total of 288 patients who were hospitalized because of severe CAP were followed up for 28 days in a prospective multicenter study. Clinical data and scores for clinical improvement at day 7 and clinical cure at day 28 were obtained. Chest radiographs were obtained at hospital admission and at days 7 and 28. Resolution and deterioration of chest radiograph findings were determined.
RESULTS: At day 7, 57 (25%) of the patients had resolution of chest radiographabnormalities, whereas 127 (56%) had clinical improvement (mean difference, 31%; 95% confidence interval, 25%-37%). At day 28, 103 (53%) of the patients had resolution of chest radiograph abnormalities, and 152 (78%) had clinical cure (mean difference, 25%; 95% confidence interval, 19%-31%). Delayed resolution of radiograph abnormalities was independently associated with multilobar disease (odds ratio, 2.87; P<or = .01); dullness to percussion at physical examination (odds ratio, 6.94; P<or = .01); high C-reactive protein level, defined as>200 mg/L (odds ratio, 4.24; P<or = .001); and high respiratory rate at admission, defined as>25 breaths/min (odds ratio, 2.42; P<or = .03). There were no significant differences in outcome at day 28 between patients with and patients without deterioration of chest radiograph findings during the follow-up period (P>.09).
CONCLUSIONS: Routine short-term follow-up chest radiographs (obtained<28 days after hospital admission) of hospitalized patients with severe CAP seem to provide no additional clinical value.
Division of Medicine, Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.
Early switch from intravenous to oral antibiotics and early hospital discharge: a prospective observational study of 200 consecutive patients with community-acquired pneumonia.
Ramirez JA, Vargas S, Ritter GW, Brier ME, Wright A, Smith S, Newman D, Burke J, Mushtaq M, Huang A
Arch Intern Med. 1999;159(20):2449.
To determine the proportion of patients who can be treated with early switch to oral antibiotics and early discharge, to evaluate clinical outcome and patient satisfaction for patients treated with early switch and early discharge, and to define the factors that interfere with early discharge for some of the patients who underwent early switch to oral antibiotic therapy. Design: Prospective study. Participants: Two hundred consecutive hospitalized patients with community-acquired pneumonia. Main Outcome Measures: Number of days needed to switch to oral therapy and length of hospital stay. Clinical outcome and satisfaction with care were evaluated for those patients treated with early switch and early discharge. Results: Early switch to oral antibiotics (within the first 3 days of hospitalization) was performed in 133 patients (67%). Clinical failure was documented in 1 patient. Early switch and early discharge was performed in 88 patients (44%). The mean length of hospital stay for this group was 3.4 days. The most common reason for prolonged hospitalization after the switch to oral antibiotics was the need for diagnostic workup. More than 95% of patients were satisfied with the care they had received. Conclusions: Using simple clinical andlaboratory criteria, a significant proportion of hospitalized patients with community-acquired pneumonia (44%) can be treated with early switch and early discharge. This model did not affect patient outcome, decreased the length of hospitalization, and was associated with a high level of patient satisfaction.
Department of Medicine, University of Louisville School of Medicine and Veterans Affairs Medical Center, KY 40202, USA.