Medline ® Abstracts for References 2,76,81

of 'Treatment of community-acquired pneumonia in adults who require hospitalization'

2
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Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.
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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
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Clin Infect Dis. 2007;44 Suppl 2:S27.
 
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McMaster University Medical School, Hamilton, Ontario, Canada. lmandell@mcmaster.ca
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76
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Radiographic resolution of community-acquired bacterial pneumonia in the elderly.
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El Solh AA, Aquilina AT, Gunen H, Ramadan F
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J Am Geriatr Soc. 2004;52(2):224.
 
OBJECTIVES: To investigate the radiographic clearance of proven community-acquired nontuberculous bacterial pneumonia in nonimmunocompromised older patients to provide working estimates of the rate of radiographic resolution as a function of the patient cumulative comorbidities, extent of initial radiographic involvement, functional status, and causative pathogens.
DESIGN: A prospective study.
PARTICIPANTS: Seventy-four patients aged 70 and older, consecutively admitted to a hospital for community-acquired bacterial pneumonia.
SETTING: A university-affiliated teaching hospital.
MEASUREMENTS: Chest radiographs were performed every 3 weeks from the date of admission for a total period of 12 weeks or until all radiographic abnormalities had resolved or returned to baseline.
RESULTS: Sixty-four patients (86%) completed the study. The rate of radiographic clearance was estimated at 35.1% within 3 weeks, 60.2% within 6 weeks, and 84.2% within 12 weeks. Radiographic resolution was significantly slower for those with high comorbidity index, bacteremia, multilobar involvement, and enteric gram-negative bacilli pneumonias. Multivariate regression analysis demonstrated that the comorbidity index (relative risk for clearance=0.67 per class index, P<.001) and multilobar disease (relative risk for clearance=0.24 for more than one lobe, P<.001) had independent predictive value (Cox proportional hazards regression model) on the rate of resolution.
CONCLUSION: The radiographic resolution of nontuberculous bacterial pneumonia in the elderly should take into account the extent of lobar disease and the burden of underlying illnesses. A waiting period of 12 to 14 weeks is recommended for slowly resolving pneumonia to be considered nonresolving.
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Division of Pulmonary, Critical Care, and Sleep Medicine, University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York, USA. solh@buffalo.edu
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81
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Effect of a 3-step critical pathway to reduce duration of intravenous antibiotic therapy and length of stay in community-acquired pneumonia: a randomized controlled trial.
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CarratalàJ, Garcia-Vidal C, Ortega L, Fernández-SabéN, Clemente M, Albero G, López M, CastellsaguéX, Dorca J, Verdaguer R, Martínez-Montauti J, Manresa F, Gudiol F
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Arch Intern Med. 2012;172(12):922.
 
BACKGROUND: The length of hospital stay (LOS) for community-acquired pneumonia (CAP) varies considerably, even though this factor has a major impact on the cost of care. We aimed to determine whether the use of a 3-step critical pathway is safe and effective in reducing duration of intravenous antibiotic therapy and length of stay in hospitalized patients with CAP.
METHODS: We randomly assigned 401 adults who required hospitalization for CAP to follow a 3-step critical pathway including early mobilization and use of objective criteria for switching to oral antibiotic therapy and for deciding on hospital discharge or usual care. The primary end point was LOS. Secondary end points were the duration of intravenous antibiotic therapy, adverse drug reactions, need for readmission, overall case-fatality rate, and patients' satisfaction.
RESULTS: Median LOS was 3.9 days in the 3-step group and 6.0 days in the usual care group (difference, -2.1 days; 95% CI, -2.7 to -1.7; P<.001). Median duration of intravenous antibiotic therapy was 2.0 days in the 3-step group and 4.0 days in the usual care group (difference, -2.0 days; 95% CI, -2.0 to -1.0; P<.001). More patients assigned to usual care experienced adverse drug reactions (4.5% vs 15.9% [difference, -11.4 percentage points; 95% CI, -17.2 to -5.6 percentage points; P<.001]). No significant differences were observed regarding subsequent readmissions, case fatality rate, and patients' satisfaction with care.
CONCLUSIONS: The use of a 3-step critical pathway was safe and effective in reducing the duration of intravenous antibiotic therapy and LOS for CAP and did not adversely affect patient outcomes. Such a strategy will help optimize the process of care of hospitalized patients with CAP, and hospital costs would be reduced.
TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN17875607.
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Infectious Disease Service, Bellvitge Institute for Biomedical Research (IDIBELL)-Hospital Universitari de Bellvitge, University of Barcelona, L'Hospitalet, Barcelona, Spain. jcarratala@ub.edu
PMID