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1.
Int. j. med. surg. sci. (Print) ; 8(2): 1-15, jun. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1284390

ABSTRACT

La importancia de la evaluación inicial de la gravedad del paciente con neumonía es una acción diagnóstica de importancia bien establecida. El objetivo del trabajo fue evaluar la relación entre la frecuencia y calidad del proceso de estratificación de pacientes con neumonía, y el cumplimiento de las sugerencias de ubicación intrahospitalaria y de tratamiento antimicrobiano inicial de un instrumento de estratificación. Se realizó un estudio descriptivo sobre una población de 1,809 pacientes hospitalizados durante 10 años. Se analizó el comportamiento de los índices de ubicación intrahospitalaria y tratamiento antimicrobiano inicial acorde a la sugerencia de un instrumento de estratificación utilizado; en el análisis estadístico se utilizó el Odds ratio y el estadígrafo X2, con un nivel de significación de 95%. En los resultados se destacan que la ubicación intrahospitalaria estuvo acorde a la sugerencia del instrumento en el 96%, con el valor más bajo en los pacientes con neumonía grave y altas probabilidades de recuperación (82%, p<,05). Se constató mayor frecuencia de ubicación intrahospitalaria acorde a la sugerencia del instrumento en los pacientes bien estratificados (p<,05), fundamentalmente en los pacientes con neumonía grave y altas probabilidades de recuperación. La correspondencia del tratamiento antimicrobiano inicial con la propuesta del instrumento fue del 61%; el estrato IIIA mostró el valor más elevado (80%, p<,05). Como conclusiones del estudio se constató un elevado desempeño en el cumplimiento de la sugerencia de ubicación intrahospitalaria del instrumento de estratificación, no así en el cumplimiento de la sugerencia de tratamiento antimicrobiano inicial. Se demostró la existencia de una relación entre el proceso de estratificación y el cumplimiento de la ubicación intrahospitalaria sugerida por el instrumento empleado.


The initial evaluation of the patient's condition with pneumonia is a very important assistance action. The objective was evaluate the relationship between the frequency and quality of the stratification process of the patient with pneumonia, and the execution of suggestions of intrahospitalary location and the initial antimicrobial treatment of stratification instrument. A descriptive study was done on a population of 1,809 patients hospitalized during 10 years. The indexes of intrahospitalary location and of antimicrobian initial treatment were analized according to the suggestions of the instrument; in the statistical analysis it was used the odds ratio and the statistician X2, with a significant level of 95%. The intrahospitalary location was in agreement with the suggestion of the instrument in 96% of the cases, with the lowest value in patients with serious pneumonia and high recovery probabilities (82%, p <,05). The frequency of intrahospitalary location was bigger and veryfied with the suggestion of the instrument in the termed well stratified patients (p <,05), fundamentally in the patients with serious pneumonia and high recovery probabilities. The correspondence of the initial antimicrobial treatment with the proposal of the instrument was of 61%; the stratum IIIA showed the highest value (80%, p <,05). As conclusions, a high performance in the execution of the suggestion of the intrahospitalary location has been one of the characteristics of the process, although as a negative element it stands out the frequent non-fulfillment of the suggestion of the initial antimicrobial treatment. There was a relationship between the stratification process and the execution of the suggestion of the intrahospitalary location.


Subject(s)
Humans , Patient Admission/statistics & numerical data , Pneumonia/diagnosis , Pneumonia/drug therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Anti-Infective Agents/therapeutic use , Severity of Illness Index , Quality Management , Cuba , Patient Acuity , Hospitalization/statistics & numerical data
2.
Medicina (B.Aires) ; 81(1): 37-46, mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1287239

ABSTRACT

Resumen La neumonía adquirida en la comunidad (NAC) representa un importante problema sanitario y ~20% de los pacientes requiere hospitalización. El objetivo principal del trabajo fue determinar las características clínico-imagenológicas de los episodios de NAC que requirieron internación. Los objetivos secundarios fueron determinar el rédito diagnóstico de los estudios microbiológicos e identificar las complicaciones. Realizamos un estudio analítico retrospectivo en un hospital de tercer nivel durante el período 2017-2019, en adultos admitidos por NAC, excluyendo embarazadas. Identificamos 340 episodios en 321 pacientes, la mediana de edad fue 75 años (rango intercuartil 57-85). Los factores de riesgo más frecuentes fueron inmunocompromiso (30%), enfermedad neurológica (22%) y enfermedad renal crónica (17%). Según tres scores pronósticos de gravedad, CURB65, qSOFA y PSI/PORT, 216 (63.5%), 290 (85.3%) y 130 (38%) episodios fueron identificados como de bajo riesgo, respectivamente. Del total de los episodios, 49 (14.4%) requirieron internación en unidad de cuidados intensivos, 39 (11.5%) ventilación mecánica y se registraron 30 (8.8%) muertes durante la hospitalización. Los patrones de imagen más frecuentes fueron consolidativo en 134 (39.4%), intersticio-alveolar en 98 (28.8%) y mixto entre ambos patrones en 67 (19.7%) episodios. Identificamos el agente causal en 79 (23.2%) episodios. Los microorganismos aislados más frecuentemente fueron influenza en 37 (10.9%) y Streptococcus pneumoniae en 11 (3.2%). La mayoría de los episodios afectaron pacientes ancianos y el principal patrón radiológico fue el consolidativo. El agente causal se pudo identificar en uno de cada cuatro episodios y el método con mayor rédito diagnóstico fue el test para influenza.


Abstract Community-acquired pneumonia (CAP) represents a major health issue and ~20% of the patients require in-hospital attention. The main objective of the study was to determine clinical-imaging features of CAP episodes requiring hospitalization. The secondary objectives were to determine the diagnostic yield of microbiological analyses and the medical complications. A retrospective analytical study was conducted on adults admitted due to CAP in a third-level hospital in the period 2017-2019. Pregnant women were excluded. A total of 340 CAP episodes were identified in 321 patients; the median age was 75 years old (interquartile range 57-85). The most frequent risk factors were immunocompromise 102 (30%), neurological disease 75 (22%), and chronic kidney disease 58 (17%). According to three prognostic scores, CURB65, qSOFA and PSI/PORT, 216 (63.5%), 290 (83.5%) and 130 (38%) patients were identified as low risk, respectively. A total of 49 (14.4%) episodes required admission at the critical care unit and 39 (11.5%) required mechanical ventilation; 30 patients (8.8%) died during hospitalization. The radiologic patterns most frequently found were consolidation in 134 (39.4%), interstitial-alveolar pattern in 98 (28.8%), and the combination of both patterns in 67 (19.7%) episodes. Identification of the causal agent was achieved in 79 (23.2%) episodes. The most frequently isolated microorganisms were influenza virus in 37 (10.9%) episodes and Streptococcus pneumoniae in 11 (3.2%). Most of the hospitalized CAP patients were elderly with consolidative radiological patterns. The causal agent could be identified in less than a quarter of the patients, with the influenza test being the method with the highest diagnostic yield.


Subject(s)
Humans , Female , Adult , Aged , Pneumonia/epidemiology , Pneumonia/diagnostic imaging , Pneumonia, Pneumococcal , Community-Acquired Infections/diagnosis , Community-Acquired Infections/therapy , Community-Acquired Infections/epidemiology , Streptococcus pneumoniae , Retrospective Studies , Hospitalization
3.
Arch. argent. pediatr ; 119(1): 11-17, feb. 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1147054

ABSTRACT

Introducción. Las infecciones por Staphylococcus aureus resistente a meticilina adquirido de la comunidad (SARM-AC) se han incrementado en los últimos años. Neumonías necrotizantes y empiemas por SARM-AC son cada vez más frecuentes en niños.Objetivos. Determinar la prevalencia de neumonías por SARM-AC y sus características clínico-epidemiológicas, en comparación con las neumonías por Streptococcus pneumoniae (SP) en la misma población.Material y métodos. Estudio descriptivo, observacional, transversal, de pacientes internados con neumonía por SARM-AC en el Hospital de Niños Víctor J. Vilela (período: 1/2008-12/2017).Resultados. De 54 neumonías por Staphylococcus aureus, 46 (el 85 %) fueron SARM-AC. El índice de neumonías por SARM-AC varió de 4,9/10 000 (2008) a 10/10 000 egresos (2017). Presentaron sepsis/shock séptico el 41 %; empiema, el 96 %; neumotórax, el 35 %; requirieron drenaje pleural el 90 % y toilette quirúrgica el 55 %. Ingresaron a Terapia Intensiva el 65 %; la mitad necesitó asistencia respiratoria mecánica. Hubo dos muertes. Resistencia de las cepas: el 17 % a gentamicina, el 13 % a eritromicina, el 11 % a clindamicina. En las neumonías por SARM-AC vs. las neumonías por SP, se observó mayor riesgo de sepsis (IC 95 %; RR 7,38; 3,32-16,38) e ingreso a Terapia Intensiva (RR 4,29; 2,70-6,83). No hubo muertes por SP.Conclusiones. La prevalencia de neumonías por SARM-AC se duplicó durante la última década. Comparadas con las neumonías por SP, las neumonías por SARM-AC se acompañaron, más frecuentemente, de cuadros de sepsis y shockséptico, ingreso a Terapia Intensiva y asistencia respiratoria.


Introduction. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have increased in recent years. CA-MRSA necrotizing pneumonia and empyema are now more common in children.Objectives. To determine the prevalence of CA-MRSA pneumonia and its clinical and epidemiological characteristics compared to Streptococcus pneumoniae (SP) pneumonia in the same population.Material and methods. Descriptive, observational, cross-sectional study of patients hospitalized due to CA-MRSA pneumonia at Hospital de Niños Víctor J. Vilela (period: January 2008-December 2017).Results. Out of 54 Staphylococcus aureus pneumonia cases, 46 (85 %) corresponded to CA-MRSA. The rate of CA-MRSA pneumonia ranged from 4.9/10 000 (2008) to 10/10 000 hospital discharges (2017). Sepsis/septic shock was observed in 41 %; empyema, in 96 %; pneumothorax, in 35 %; 90 % of cases required pleural drainage and 55 %, surgical debridement. Also, 65 % of patients were admitted to the intensive care unit (ICU); half of them required assisted mechanical ventilation. Two patients died. Strain resistance: 17 %, gentamicin; 13 %, erythromycin; and 11 %, clindamycin. Compared to SP pneumonia, CA-MRSA pneumonia showed a higher risk for sepsis (95 % confidence interval; relative risk: 7.38; 3.32-16.38) and admission to the ICU (RR: 4.29; 2.70-6.83). No patient died due to SP pneumonia.Conclusions. The prevalence of CA-MRSA pneumonia doubled in the past decade. Compared to SP pneumonia, CA-MRSA pneumonia was more commonly accompanied by sepsis and septic shock, admission to the ICU, and ventilatory support requirement


Subject(s)
Humans , Male , Female , Child , Adolescent , Staphylococcal Infections/epidemiology , Community-Acquired Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus , Argentina/epidemiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/microbiology , Microbial Sensitivity Tests , Epidemiology, Descriptive , Incidence , Prevalence , Cross-Sectional Studies , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Hospitals, Pediatric
5.
Actual. SIDA. infectol ; 27(99): 3-11, 20190000. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1354179

ABSTRACT

ntroducción: Aunque la incidencia de neumonía adquirida en la comunidad (NAC) por Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-AC) es inferior al 10%, por su elevada mortalidad debe considerarse en los pacientes graves.Objetivo: Identificar factores de riesgo asociados con SAMR-AC en pacientes con NAC grave. Material y métodos: Estudio observacional, retrospectivo, que analizó pacientes con NAC con diagnóstico etiológico ingresados en terapia intensiva en un hospital público entre 2006 y 2017.Resultados: Se incluyeron 250 episodios de NAC, 53 por SAMR-AC y 197 por otros agentes. Los pacientes con SAMR fueron más jóvenes (35,6±13,4 vs 43,1±12,4, p<0,001) y mostraron mayores tasas de infecciones de piel y estructuras relacionadas (IPER) (58,4% vs 2,0%, p<0,001), empiema (15,9% vs 5,0%, p=0,006), compromiso radiológico bilateral (81,1% vs 36,0%, p<0,001), promedio de score APACHE II basal (16,7±3,8 vs 13,2±4,3, p<0,001) y requerimiento de ventilación mecánica (VM) (33,9 vs 17,6 p=0,009). La tasa de mortalidad fue significativamente mayor para los pacientes con SAMR-AC (35,8% vs 11,1%, p<0,001). Las variables que se asociaron con SAMR-AC fueron IPER (OR 67,99, IC 5% 21,94-210,65), compromiso radiológico bilateral (OR 7,63, IC 95% 3,67-16,11), scoreAPACHE II ≥ 15 (OR 4,37, IC 95% 2,08-9,16), edad ≤ 35 años RESUMENTRABAJO COMPLETO(OR 3,60, IC 95% 1,77-7,29), empiema (OR 3,32, IC 95% 1,24-8,10) y VM (OR 2,85, IC 95% 1,36-5,86). Conclusión: En pacientes con NAC grave, la presencia de IPER, compromiso radiológico bilateral, score APACHE II ≥ 15, edad ≤ 35 años, empiema y VM se asociaron significativamente con mayor probabilidad de infección por SAMR-AC


ntroduction: Despite the incidence of community-acquired pneumonia (CAP) due to community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) being less than 10%, its presence should be considered in critical patients because of its high rate of mortality.Objectives: To identify risk factors associated with CA-MRSA in patients with severe CAP.Materials and method: A retrospective, observational study analysed episodes of etiological diagnosis in patients admitted in Intensive Care Unit in a public hospital between 2006 and 2017.Results: 250 episodes of NAC were included, among which 53 were caused by SAMR-AC and 197 by other agents. Patients with MRSA were the youngest (35.6±13.4 vs 43.1±12.4, p<0.001), and showed higher rates of skin and skin-structure infections (SSSI) (58.4% vs 2.0%, p<0.001), empyema (15.9% vs 5.0%, p=0.006), bilateral radiological compromise (81.1% vs 36.0%, p<0.001), average base-line APACHE II score (16.7±3.8 vs 13.2±4.3, p<0.001) and mechanical ventilation requirement rate (MV) (33.9 vs 17.6 p=0.009). The mortality rate was significantly higher than the one in CA-MRSA patients (35.8% vs 11.1%, p<0.001). The variables associated with CA-MRSA were SSSI (OR 67.99, IC 5% 21.94-210.65), bilateral radiological compromise (OR 7.63, IC 95% 3.67-16.11), APACHE II score ≥ 15 (OR 4.37, IC 95% 2.08-9.16), age ≤35 years (OR 3.60, IC 95% 1.77-7,29), empyema (OR 3.32, IC 95% 1.24-8.10) and MV (OR 2.85, IC 95% 1.36-5.86).Conclusion: The presence of SSSI, bilateral radiological compromise, APACHE II score ≥ 15, age ≤35 years, empyema and MV in patients with severe CAP was largely associated with higher probability of CA-MRSA infection


Subject(s)
Humans , Adult , Pneumonia/diagnosis , Staphylococcus aureus/immunology , Epidemiologic Factors , Risk Factors , Community-Acquired Infections/diagnosis , APACHE , Methicillin-Resistant Staphylococcus aureus , Observational Study , Hospitals, Public
7.
Rev. méd. Chile ; 146(12): 1371-1383, dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-991346

ABSTRACT

Background: Molecular biological techniques allow the identification of more pathogens associated with community-acquired pneumonia (CAP). Aim: To compare clinical and laboratory parameters of patients with CAP caused by different groups of pathogens. Material and Methods: In a prospective study, immunocompetent adult patients hospitalized with CAP were tested for the presence of a broad range of possible respiratory pathogens using bacterial cultures, polymerase chain reaction, urinary antigen testing and serology. Results: Pathogens were detected in 367 of 935 patients with CAP (39.2%). Streptococcus pneumoniae (10.7%) and influenza virus (6%) were the most frequently identified bacterial and viral pathogens, respectively. Pneumococcal pneumonia predominated in older adults, with multiple comorbidities, with elevation of inflammatory parameters and hypoxemia, like other bacterial pneumonias. Viral pneumonia predominated in elderly patients with multiple comorbidities, with a shorter hospital length of stay and lower mortality. Pneumonia associated with atypical microorganisms predominated in young adults, smokers, with subacute clinical evolution. Their hospital stays and lethality was similar to other bacterial pneumonias. Viral and classical bacterial pneumonias predominated in high risk pneumonia severity index categories. Although several variables were associated with the detection of a pathogen group, substantial overlap avoided the identification of reliable clinical predictors to distinguish etiologies. Conclusions: The clinical and radiographic characteristics were similar in pulmonary infections caused by classical bacteria, respiratory viruses and atypical microorganisms. Therefore, microbial testing for common respiratory pathogens is still necessary to optimize treatment.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pneumonia, Viral/virology , Pneumonia, Bacterial/microbiology , Immunocompetence , Pneumonia, Viral/diagnosis , Socioeconomic Factors , Severity of Illness Index , Prospective Studies , Risk Factors , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Community-Acquired Infections/virology , Pneumonia, Bacterial/diagnosis , Length of Stay
8.
J. bras. pneumol ; 44(4): 261-266, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-975932

ABSTRACT

ABSTRACT Objective: To describe the patient profile, mortality rates, the accuracy of prognostic scores, and mortality-associated factors in patients with community-acquired pneumonia (CAP) in a general hospital in Brazil. Methods: This was a cohort study involving patients with a clinical and laboratory diagnosis of CAP and requiring admission to a public hospital in the interior of Brazil between March 2014 and April 2015. We performed multivariate analysis using a Poisson regression model with robust variance to identify factors associated with in-hospital mortality. Results: We included 304 patients. Approximately 70% of the patients were classified as severely ill on the basis of the severity criteria used. The mortality rate was 15.5%, and the ICU admission rate was 29.3%. After multivariate analysis, the factors associated with in-hospital mortality were need for mechanical ventilation (OR: 3.60; 95% CI: 1.85-7.47); a Charlson Comorbidity Index score > 3 (OR: 1.30; 95% CI: 1.18-1.43); and a mental Confusion, Urea, Respiratory rate, Blood pressure, and age > 65 years (CURB-65) score > 2 (OR: 1.46; 95% CI: 1.09-1.98). The mean time from patient arrival at the emergency room to initiation of antibiotic therapy was 10 h. Conclusions: The in-hospital mortality rate of 15.5% and the need for ICU admission in almost one third of the patients reflect the major impact of CAP on patients and the health care system. Individuals with a high burden of comorbidities, a high CURB-65 score, and a need for mechanical ventilation had a worse prognosis. Measures to reduce the time to initiation of antibiotic therapy may result in better outcomes in this group of patients.


RESUMO Objetivo: Descrever o perfil dos pacientes, taxas de mortalidade, acurácia de escores prognósticos e fatores associados à mortalidade em pacientes com pneumonia adquirida na comunidade (PAC) em um hospital geral no Brasil. Métodos: Estudo de coorte envolvendo pacientes com diagnóstico clínico e laboratorial de PAC e necessidade de internação hospitalar entre março de 2014 e abril de 2015 em um hospital público do interior do Brasil. Foi realizada a análise multivariada mediante o modelo de regressão de Poisson com variância robusta para avaliar os fatores associados com mortalidade intra-hospitalar. Resultados: Foram incluídos 304 pacientes. Aproximadamente 70% dos pacientes foram classificados como graves de acordo com os critérios de gravidade utilizados. A taxa de mortalidade foi de 15,5% e a de necessidade de internação em UTI foi de 29,3%. Após a análise multivariada, os fatores associados à mortalidade intra-hospitalar foram necessidade de ventilação mecânica (OR = 3,60; IC95%: 1,85-7,47); Charlson Comorbidity Index > 3 (OR = 1,30; IC95%: 1,18-1,43); e mental Confusion, Urea, Respiratory rate, Blood pressure, and age > 65 years (CURB-65) > 2 (OR = 1,46; IC95%: 1,09-1,98). A média do tempo entre a chegada do paciente na emergência e o início da antibioticoterapia foi de 10 h. Conclusões: A taxa de mortalidade intra-hospitalar de 15,5% e a necessidade de internação em UTI em quase um terço dos pacientes demonstram o grande impacto da PAC nos pacientes e no sistema de saúde. Indivíduos com maior carga de comorbidades prévias, CURB-65 elevado e necessidade de ventilação mecânica apresentaram pior prognóstico. Ações para reduzir o tempo até o início da antibioticoterapia podem resultar em melhores desfechos nesse grupo de pacientes.


Subject(s)
Humans , Male , Female , Aged , Pneumonia/diagnosis , Pneumonia/mortality , Pneumonia/drug therapy , Prognosis , Severity of Illness Index , Brazil , Comorbidity , Risk Factors , Cohort Studies , Hospital Mortality , Community-Acquired Infections/diagnosis , Community-Acquired Infections/mortality , Community-Acquired Infections/drug therapy , Hospitals, Public , Inpatients , Intensive Care Units , Anti-Bacterial Agents/therapeutic use
9.
Arch. argent. pediatr ; 116(2): 119-125, abr. 2018. tab, graf
Article in English, Spanish | LILACS, BINACIS | ID: biblio-887457

ABSTRACT

Introducción: Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-ac) son motivo de consulta frecuente en pediatría. La mayoría se presentan como infecciones de piel y partes blandas; sin embargo, en la última década, se ha constatado un aumento de las infecciones invasivas. Objetivos: El objetivo principal es describir las características clínico-epidemiológicas de las infecciones producidas por SAMR-ac. El objetivo secundario es comparar la prevalencia, presentación clínica y susceptibilidad antibiótica con un período previo de estudio (1/2004-12/2007). Material y métodos: Estudio descriptivo, prospectivo, de tipo transversal. Criterios de inclusión: niños con diagnóstico de infección por SAMR-ac admitidos en el Hospital de Niños de Rosario, período de enero de 2008 a diciembre de 2014. Criterios de exclusión: internación reciente, antibiótico o cirugía previa, comorbilidades o inmunocompromiso. Resultados: De 728 niños con infecciones por Staphylococcus aureus, 529 (73%) fueron por SAMR-ac. La tasa de incidencia de infecciones por SAMR-ac varió de 12,2/10 000 egresos hospitalarios de 2004 a 145/10 000 del 2014: 75% (391) fueron infecciones de piel y partes blandas; 8% (43), os teo articular es; 6% (30), pleuropulmonares; 5% (24), sepsis. Se observó un aumento en el número de infecciones invasivas en el 2º período sin significancia estadística (OR= 0,895; IC: 0,52-1,53). La resistencia a gentamicina, clindamicina y eritromicina se mantuvo estable en ambos períodos. Conclusión: Las infecciones por SAMR-ac fueron cada vez más frecuentes, principalmente, las de piel y partes blandas. Se observó un aumento en el número de infecciones invasivas sin significancia estadística. La resistencia antibiótica se mantuvo estable.


Introduction: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are a common reason for consultation in pediatrics. Most of them present as skin and soft tissue infections; however, invasive infections have increased during the last decade. Objectives: The main objective was to describe the clinical-epidemiological characteristics of CA-MRSA infections. The secondary objective was to compare prevalence, clinical presentation and antibiotic susceptibility with a pre-study period (1/2004-12/2007). Material and methods: This is a descriptive, prospective, cross-sectional study. Inclusion criteria: children who have been diagnosed with CA-MRSA infection and admitted to Hospital de Niños de Rosario between January 2008 and December 2014. Exclusion criteria: recent hospitalization, previous antibiotic treatment or surgery, comorbidities or immune compromise. Results: Out of 728 cases of children with Staphylococcus aureus infections, 529 (73%) were due to CA-MRSA. The incidence rate of CA-MRSA infections varied from 12.2/10 000 hospital discharges in 2004 to 145/10 000 in 2014: 75% (391) were skin and soft tissue infections; 8% (43) were osteoarticular infections; 6% (30), pleuropulmonary infections; 5% (24), sepsis. There was an increase in the number of invasive infections in the second period, with no statistical significance (OR= 0.895; CI: 0.52-1.53). Gentamicin, clindamycin and erythromycin resistance remained stable throughout both periods. Conclusion: CA-MRSA infections were increasingly more frequent, mainly skin and soft tissue infections. An increase was observed in the number of invasive infections, with no statistical significance. Antibiotic resistance remained stable.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Staphylococcal Infections/epidemiology , Community-Acquired Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus , Argentina/epidemiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/microbiology , Staphylococcal Infections/drug therapy , Microbial Sensitivity Tests , Incidence , Prevalence , Cross-Sectional Studies , Prospective Studies , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Hospitals, Pediatric , Anti-Bacterial Agents/therapeutic use
10.
Rev. pediatr. electrón ; 14(1): 35-37, 2017.
Article in Spanish | LILACS | ID: biblio-969292

ABSTRACT

La neumonía adquirida en la comunidad ocurre en pacientes previamente sanos y su principal etiología es viral. Dentro de las etiologías bacterianas la principal en el recién nacido es el S. agalactiae y en los mayores es S. pneumoniae. Es la principal causa de muerte en niños menores de 5 años de edad en el mundo. Su diagnóstico se basa en la anamnesis y los hallazgos clínicos clásicos, pudiendo complementarse el estudio con radiografía de tórax e identificación viral con métodos rápidos. Su manejo depende de la etiología, y se indica antibioticoterapia (de elección amoxicilina v.o. o ampicilina e.v.) solo frente a la sospecha fundada de etiología bacteriana. Además se debe dar soporte según los requerimientos del paciente, incluyendo la hospitalización si cumple los criterios para ésta. La necesidad de cirugía está restringida principalmente para el manejo de empiemas.


Community acquired pneumonia occurs in previously healthy children and its ethnology is viral. Bacterial ethnology are S. agalactiaein neonates and S. pneumoniaein the olders. Is the main cause of death in children under 5 years of age. Diagnosis is made base on clinical features and chest X ray. Treatment depends on the etiology and antibiotics, preference oral amoxicilin or iv ampiciline, are indicated when a bacterial ethnology is suspected.


Subject(s)
Humans , Child , Pneumonia/diagnosis , Pneumonia/therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/therapy , Pneumonia/complications , Pneumonia/etiology , Community-Acquired Infections/complications , Community-Acquired Infections/etiology
11.
Rev. chil. enferm. respir ; 33(2): 99-112, 2017. tab
Article in Spanish | LILACS | ID: biblio-899667

ABSTRACT

Introducción: La neumonía adquirida en la comunidad (NAC) ocasiona morbilidad y mortalidad significativa en la población adulta. Objetivos: Examinar las variables clínicas y de laboratorio medidas en la admisión al hospital que permiten predecir los eventos adversos clínicamente relevantes en pacientes adultos hospitalizados por neumonía comunitaria. Métodos: Evaluamos las variables clínicas y de laboratorio asociadas a eventos adversos serios en una cohorte de adultos hospitalizados por NAC. Los eventos adversos examinados fueron la admisión a UCI, necesidad de ventilación mecánica, shock séptico, complicaciones cardiovasculares y generales y estadía prolongada en el hospital y mortalidad a 30 días. Las variables predictoras fueron sometidas a análisis univariado y multivariado en un modelo de regresión logística. Resultados: Se evaluaron 659 pacientes, edad: 67 ± 18 años, 52% varones, 77% tenía comorbilidad, 23% fueron admitidos a la UCI, 12% requirieron ventilación mecánica, 31% presentaron complicaciones en el hospital, la estadía media en el hospital fue 9 días y 9,9% fallecieron en el seguimiento a 30 días. Las comorbilidades, inestabilidad hemodinámica y disfunción renal se asociaron con la admisión a UCI, riesgo de complicaciones y estadía prolongada en el hospital. El uso de ventilación mecánica y shock séptico fue más frecuente en pacientes con inestabilidad hemodinámica y disfunción renal. La edad avanzada, enfermedades cardiovasculares y respiratorias crónicas, sospecha de aspiración, taquipnea y disfunción renal se asociaron al riesgo de eventos cardiovasculares en el hospital. Conclusión: Las variables clínicas y de laboratorio medidas en la admisión al hospital permiten predecir el riesgo de eventos adversos serios en el adulto hospitalizado por neumonía.


Introduction: Community-acquired pneumonia (CAP) causes significant morbidity and mortality in adult population. Objectives: To assess clinical and laboratory variables measured at hospital admission associated to clinically relevant adverse outcomes in patients hospitalized with community-acquired pneumonia. Methods: We prospectively assessed clinical and laboratory variables associated to serious adverse events in a cohort of CAP hospitalized adult patients. Major adverse outcomes were admission to ICU, need for mechanical ventilation, septic shock, prolonged hospital stay, cardiovascular and in-hospital complications and 30-day mortality. The clinical and laboratory variables measured at hospital admission associated to serious adverse events were assessed by univariate and multivariate analysis using logistic regression models. Results: 659 CAP hospitalized immunocompetent adult patients were assessed, mean age: 67 years, 52% were male, 77% had comorbidities, 23% were admitted to the intensive care unit (ICU), 12% needed mechanical ventilation, 31% had hospital complication, mean hospital length of stay was 9 days and 9.9% died at 30-days follow up. Comorbidities, hemodynamic instability and renal dysfunction were associated with ICU admission, risk of complications, and prolonged hospital stay. Mechanical ventilation requirement and septic shock were more frequent in patients with hemodynamic instability and renal dysfunction. Advanced age, chronic cardiovascular and respiratory diseases, aspiration pneumonia, tachypnea, and renal dysfunction were associated with high risk of cardiovascular events in the hospital. Conclusion: The clinical and laboratory variables measured at hospital admission allow us to predict the risk of serious adverse events in CAP hospitalized adult patients.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pneumonia/diagnosis , Community-Acquired Infections/diagnosis , Pneumonia/mortality , Prognosis , Cardiovascular Diseases/epidemiology , Comorbidity , Logistic Models , Multivariate Analysis , Prospective Studies , Risk Factors , Community-Acquired Infections/mortality , Hospitalization , Immunocompetence , Intensive Care Units , Length of Stay
12.
J. bras. pneumol ; 42(5): 348-355, Sept.-Oct. 2016. tab, graf
Article in English | LILACS | ID: lil-797954

ABSTRACT

ABSTRACT Objective: To determine the prevalence of and the factors associated with latent Mycobacterium tuberculosis infection (LTBI) in prisoners in the state of Minas Gerais, Brazil. Methods: This was a cross-sectional cohort study conducted in two prisons in Minas Gerais. Tuberculin skin tests were performed in the individuals who agreed to participate in the study. Results: A total of 1,120 individuals were selected for inclusion in this study. The prevalence of LTBI was 25.2%. In the multivariate analysis, LTBI was associated with self-reported contact with active tuberculosis patients within prisons (adjusted OR = 1.51; 95% CI: 1.05-2.18) and use of inhaled drugs (adjusted OR = 1.48; 95% CI: 1.03-2.13). Respiratory symptoms were identified in 131 (11.7%) of the participants. Serological testing for HIV was performed in 940 (83.9%) of the participants, and the result was positive in 5 (0.5%). Two cases of active tuberculosis were identified during the study period. Conclusions: Within the prisons under study, the prevalence of LTBI was high. In addition, LTBI was associated with self-reported contact with active tuberculosis patients and with the use of inhaled drugs. Our findings demonstrate that it is necessary to improve the conditions in prisons, as well as to introduce strategies, such as chest X-ray screening, in order to detect tuberculosis cases and, consequently, reduce M. tuberculosis infection within the prison system.


RESUMO Objetivo: Determinar a prevalência e os fatores associados à infecção latente por Mycobacterium tuberculosis (ILTB) em pessoas privadas de liberdade no Estado de Minas Gerais. Métodos: Estudo de coorte transversal realizado em duas penitenciárias em Minas Gerais. Foi realizada a prova tuberculínica nos indivíduos que aceitaram participar do estudo. Resultados: Foram selecionados 1.120 indivíduos para a pesquisa. A prevalência da ILTB foi de 25,2%. Na análise multivariada, a ILTB esteve associada com relato de contato com caso de tuberculose ativa dentro da penitenciária (OR ajustada = 1,51; IC95%: 1,05-2,18) e uso de drogas inaláveis (OR ajustada = 1,48; IC95%: 1,03-2,13). Foram identificados 131 pacientes sintomáticos respiratórios (11,7%). O teste anti-HIV foi realizado em 940 (83,9%) dos participantes, sendo positivo em 5 indivíduos (0,5%). Dois casos de tuberculose ativa foram identificados no período do estudo. Conclusões: A prevalência de ILTB dentro das penitenciárias estudadas foi alta. Além disso, a ILTB estava associada ao relato de contato com casos de tuberculose e ao uso de drogas inaláveis. Nossos achados demonstram que é necessária a melhoria das condições de encarceramento e a utilização de outras estratégias, como a triagem por radiografia de tórax, para a descoberta de casos de tuberculose e redução da infecção pelo M. tuberculosis no sistema penitenciário.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Latent Tuberculosis/epidemiology , Mycobacterium tuberculosis/isolation & purification , Prisoners/statistics & numerical data , Brazil/epidemiology , Community-Acquired Infections/diagnosis , Community-Acquired Infections/epidemiology , Cross-Sectional Studies , Latent Tuberculosis/microbiology , Latent Tuberculosis/transmission , Prevalence , Illicit Drugs/adverse effects , Tuberculin Test
13.
Med. infant ; 23(3): 206-212, Sept.2016. tab, ilus
Article in Spanish | LILACS | ID: biblio-884035

ABSTRACT

A Mycoplasma pneumoniae se lo ha descrito como causante de diversas patologías, pero la más frecuente es la neumonía de la comunidad, en la que puede asociarse a otros patógenos. Afecta pincipalmente a niños de edad escolar y adultos jóvenes, aunque en las últimas décadas es frecuente hallarlo también en niños menores de 5 años. El daño celular ocurre sobre el epitelio de bronquios y bronquiolos por acumulación de peróxido de hidrógeno y radicales superóxido producidos durante su metabolismo celular. Recientemente se ha reportado que en estos eventos patogénicos también participa una citotoxina conocida como CARDS toxin (community-acquired respiratory distress syndrome) que la bacteria expresa como factor de virulencia, ya que induce una importante respuesta inflamatoria celular. Los métodos moleculares son más sensibles y rápidos que los métodos de diagnóstico tradicionales y se consideran de elección. No obstante, para lograr un diagnóstico óptimo, se aconseja la combinación de estos métodos junto con los serológicos. En el presente estudio se optimiza un método de PCR en tiempo real con iniciadores dirigidos a la región del gen que codifica la CARDS toxin. El método demostró ser muy sensible y rápido para el diagnóstico clínico de M. pneumoniae, con una concordancia қ: 0,95 con el método convencional de PCR anidada que emplea como target al gen que codifica para la citoadhesina P1. A su vez es mucho menos laborioso e implica un menor riesgo de contaminación, lo que permite el manejo de un alto número de muestras clínicas (AU)


Mycoplasma pneumoniae has been described as the cause of different infections, the most common of which is communityacquired pneumonia, possibly associated with other pathogens. Community-acquired pneumonia mainly affects school-age children and young adults, although over the past decades the disease has also been found in children under 5 years of age. Cell damage occurs on the epithelium of the bronchi and bronchioles due to accumulation of hydrogenous peroxide and superoxide radicals produced during cell metabolism. Recently, it has been reported that in these pathogenic events a cytotoxin known as CARDS toxin (community-acquired respiratory distress syndrome) participates, expressed by the bacteria as a factor of virulence, as it induces an important inflammatory cell response. The molecular methods are more sensitive and faster than the traditional diagnostic methods, and are considered the methods of choice; however, for an optimal diagnosis, a combination of these methods together with serological studies is recommended. In the current study, a real-time PCR method with markers targeted to the region of the gene encoding the CARDS toxin was optimized. The method showed to be very sensitive and fast for the clinical diagnosis of M. pneumoniae, with a қ agreement of 0.95 with the conventional nested PCR method that uses the gene encoding cytoadhesin P1 as a target. Additionally, the new method is much easier with a lower risk of contamination, which allows management of a large number of clinical samples (AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Bacterial Toxins/toxicity , Community-Acquired Infections/diagnosis , Mycoplasma pneumoniae/genetics , Mycoplasma pneumoniae/isolation & purification , Pneumonia, Mycoplasma/diagnosis , Real-Time Polymerase Chain Reaction/methods
14.
Rev. cuba. pediatr ; 88(1): 55-66, ene.-mar. 2016. ilus
Article in Spanish | LILACS, CUMED | ID: lil-775058

ABSTRACT

INTRODUCCIÓN: las infecciones respiratorias agudas, sobre todo las neumonías, son uno de los principales problemas de salud en los niños menores de 5 años de edad en los países en desarrollo. OBJETIVO: caracterizar la neumonía grave adquirida en la comunidad en el servicio de Neumología. MÉTODOS: se realizó un trabajo prospectivo descriptivo, de corte transversal. Se seleccionaron los pacientes que ingresaron en el servicio de Neumología, con una neumonía grave adquirida en la comunidad, procedentes de la Unidad de Terapia Intensiva o del Cuerpo de Guardia, desde diciembre de 2005 a diciembre de 2010. Se incluyeron 187 pacientes con aparente salud anterior, seguidos por consulta al egreso hasta su alta médica. Se practicó un análisis descriptivo de las variables clínicas, radiológicas y de tratamiento. RESULTADOS: de 187 pacientes el 76,4 % eran menores de 5 años, y el 53,5 % femeninos. El factor de riesgo más frecuente fue la no lactancia materna exclusiva (91,6 %) en el grupo de edad de 1-4 años. La fiebre, la polipnea y el tiraje estuvieron presentes en la mayoría de ellos. El pulmón derecho fue el más afectado en el 57,7 %, pero se registró mayor cifra de complicaciones en el izquierdo (58,2%). Las complicaciones más frecuentes fueron: el derrame pleural y el absceso pulmonar en 40,6 y 10,2 %, respectivamente. El tratamiento con penicilina cristalina sola se usó en el 36,3 % de los pacientes, y se logró una buena evolución clínica, sin hacer cambios terapéuticos. CONCLUSIONES: los pacientes en su totalidad evolucionan de forma favorable con los esquemas de antibióticos utilizados.


INTRODUCTION: acute respiratory infections, mainly pneumonias, are the main health problems in children aged under 5 years in developing countries. OBJECTIVE: to characterize the community-acquired severe pneumonia in the pneumonia management service. METHODS: a prospective, descriptive and cross-sectional study was conducted. There were selected those patients who were admitted to the pneumonia management service with community-acquired severe pneumonia and had been referred from the intensive care unit or the emergency service in the period of December 2005 to December 2010. One hundred and eighty seven patients in apparent healthy condition before the disease, who had been followed-up from the time of discharge from the hospital until their final medical discharge, were included in the research. A descriptive analysis of the clinical, radiological and therapeutic variables was made. RESULTS: of 187 patients, 76.4 % were aged under 5 years, 53.5 % were females. The most common risk factor was non-exclusive breastfeeding (91.6 %) in the 1-4 year age group. Fever, polypnea and tirage were present in most of them. The right lung was the most affected in 57.7 % of cases, but the left lung provided the highest number of complications (58.2 %). The most common complications were pleural effusion and the pulmonary abscess in 40.6 % and 10.2 %, respectively. The single crystalline penicillin treatment was used in 36.7 % of patients with good clinical progression with no further therapeutic changes. CONCLUSIONS: all the patients has favorable recovery with the antibiotic treatments used.


Subject(s)
Humans , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Epidemiology, Descriptive , Cross-Sectional Studies , Prospective Studies , Community-Acquired Infections/diagnosis
15.
Article in English | WPRIM | ID: wpr-220492

ABSTRACT

BACKGROUND/AIMS: Efforts to decrease the use of extended-spectrum cephalosporins are required to prevent the selection and transmission of multi-drug resistant pathogens, such as extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. The objectives of this study were to assess the clinical efficacy of intravenous cefuroxime as an empirical antibiotic for the treatment of hospitalized women with acute pyelonephritis (APN) caused by Escherichia coli. METHODS: We analyzed the clinical and microbiologic database of 328 hospitalized women with community-onset APN. RESULTS: Of 328 women with APN, 22 patients had cefuroxime-resistant E. coli APN, and 306 patients had cefuroxime-susceptible E. coli APN. The early clinical success rates were significantly higher (p = 0.001) in the cefuroxime-susceptible group (90.8%, 278/306) than in the cefuroxime-resistant group (68.2%, 15/22) at 72 hours. The clinical cure rates at 4 to 14 days after completing antimicrobial therapy were not significantly different in the cefuroxime-resistant or -susceptible groups, with 88.2% (15/17) and 97.8% (223/228; p = 0.078), respectively. The microbiological cure rates were not significantly different and were 90.9% (10/11) and 93.4% (128/137), respectively (p =0.550). The median duration of hospitalization in the cefuroxime-resistant and -susceptible groups was 10 days (interquartile range [IQR], 8 to 13) and 10 days (IQR, 8 to 14), respectively (p =0.319). CONCLUSIONS: Cefuroxime, a second-generation cephalosporin, can be used for the initial empirical therapy of community-onset APN if tailored according to uropathogen identification and susceptibility results, especially in areas where the prevalence rate of ESBL-producing uropathogens is low.


Subject(s)
Administration, Intravenous , Aged , Anti-Bacterial Agents/administration & dosage , Cefuroxime/administration & dosage , Community-Acquired Infections/diagnosis , Databases, Factual , Drug Resistance, Bacterial , Escherichia coli/drug effects , Escherichia coli Infections/diagnosis , Female , Hospitalization , Humans , Microbial Sensitivity Tests , Middle Aged , Pyelonephritis/diagnosis , Remission Induction , Retrospective Studies , Time Factors , Treatment Outcome , Urinalysis , Urinary Tract Infections/diagnosis , Urine/microbiology
16.
Medicina (B.Aires) ; 75(4): 245-257, Aug. 2015. tab
Article in Spanish | LILACS | ID: biblio-841505

ABSTRACT

La neumonía adquirida en la comunidad (NAC) en adultos es causa frecuente de morbilidad y mortalidad, especialmente en adultos mayores y en sujetos con comorbilidades previas. La mayoría de los episodios son de etiología bacteriana, Streptococcus pneumoniae es el patógeno aislado con mayor frecuencia. La vigilancia epidemiológica permite conocer los cambios en los microorganismos productores y su sensibilidad a los antimicrobianos; recientemente se ha observado un incremento en aislamientos de Staphylococcus aureus resistente a la meticilina y Legionella sp. La radiografía de tórax resulta imprescindible como herramienta diagnóstica. El score CURB-65 y la oximetría de pulso permiten estratificar a los pacientes en aquellos que requieren manejo ambulatorio, hospitalización en sala general o unidad de terapia intensiva. Los estudios diagnósticos y el tratamiento antimicrobiano empírico también se basan en esta estratificación. Los biomarcadores tales como procalcitonina o proteína-C reactiva no son parte de la evaluación inicial dado que su utilización no demostró modificar el manejo de los episodios de NAC. El tratamiento antibiótico sugerido para pacientes ambulatorios menores de 65 años sin comorbilidades es amoxicilina; pacientes ≥ 65 años o con comorbilidades: amoxicilina-clavulánico/sulbactam; hospitalizados en sala general: ampicilina sulbactam con o sin claritromicina; pacientes admitidos a unidad de terapia intensiva: ampicilina-sulbactam más claritromicina. La duración del tratamiento es de 5 a 7 días para tratamiento ambulatorio y 7 a 10 para los hospitalizados. En época de circulación del virus de la influenza se sugiere el agregado de oseltamivir para los pacientes hospitalizados y para aquellos con comorbilidades.


Community-acquired pneumonia in adults is a common cause of morbidity and mortality particularly in the elderly and in patients with comorbidities. Most episodes are of bacterial origin, Streptococcus pneumoniae is the most frequently isolated pathogen. Epidemiological surveillance provides information about changes in microorganisms and their susceptibility. In recent years there has been an increase in cases caused by community-acquired meticillin resistant Staphylococcus aureus and Legionella sp. The chest radiograph is essential as a diagnostic tool. CURB-65 score and pulse oximetry allow stratifying patients into those who require outpatient care, general hospital room or admission to intensive care unit. Diagnostic studies and empirical antimicrobial therapy are also based on this stratification. The use of biomarkers such as procalcitonin or C-reactive protein is not part of the initial evaluation because its use has not been shown to modify the initial approach. We recommend treatment with amoxicillin for outpatients under 65 year old and without comorbidities, for patients 65 years or more or with comorbidities amoxicillin-clavulanic/sulbactam, for patients hospitalized in general ward ampicillin-sulbactam with or without the addition of clarithromycin, and for patients admitted to intensive care unit ampicillin-sulbactam plus clarithromycin. Suggested treatment duration is 5 to 7 days for outpatients and 7 to 10 for those who are hospitalized. During the influenza season addition of oseltamivir for hospitalized patients and for those with comorbidities is suggested.


Subject(s)
Humans , Adult , Middle Aged , Aged , Pneumonia, Pneumococcal/diagnosis , Pneumonia, Pneumococcal/microbiology , Pneumonia, Pneumococcal/drug therapy , Pneumonia, Pneumococcal/epidemiology , Streptococcus pneumoniae , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Anti-Bacterial Agents/therapeutic use
17.
Rev. méd. Chile ; 143(5): 553-561, tab
Article in Spanish | LILACS | ID: lil-751699

ABSTRACT

Background: The clinical usefulness of blood cultures in the management of patients hospitalized with community-acquired pneumonia (CAP) is controversial. Aim: To determine clinical predictors of bacteremia in a cohort of adult patients hospitalized for community-acquired pneumonia. Material and Methods: A prospective cohort of 605 immunocompetent adult patients aged 16 to 101 years (54% male) hospitalized for CAP was studied. The clinical and laboratory variables measured at admission were associated with the risk of bacteremia by univariate and multivariate analysis using logistic regression models. Results: Seventy seven percent of patients had comorbidities, median hospital stay was 9 days, 7.6% died in hospital and 10.7% at 30 days. The yield of the blood cultures was 12.6% (S. pneumoniae in 69 patients, H. influenzae in 3, Gram negative bacteria in three and S. aureus in one). These results modified the initial antimicrobial treatment in one case (0.2%). In a multivariate analysis, clinical and laboratory variables associated with increased risk of bacteremia were low diastolic blood pressure (Odds ratio (OR): 1.85, 95% confidence intervals (CI) 1.02 to 3.36, p < 0.05), leukocytosis e" 15,000/mm³ (OR: 2.18, 95% CI 1.22 to 3.88, p < 0.009), serum urea nitrogen e" 30 mg/dL (OR: 2.23, 95% CI 1.22 to 4.05, p < 0.009) and serum C-reactive protein e" 30 mg/dL (OR: 2.20, 95% CI 1.22 to 3.97, p < 0.01). Antimicrobial use before hospital admission significantly decreased the blood culture yield (OR: 0.14, 95% CI 0.04 to 0.46, p < 0.002). Conclusions: Blood cultures do not contribute significantly to the initial management of patients hospitalized for community-acquired pneumonia. The main clinical predictors of bacteremia were antibiotic use, hypotension, renal dysfunction and systemic inflammation.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Bacteremia/diagnosis , Pneumonia, Bacterial/diagnosis , Analysis of Variance , Anti-Bacterial Agents/therapeutic use , Bacteremia/complications , Bacteremia/drug therapy , Bacteremia/microbiology , Cardiovascular Diseases/complications , Community-Acquired Infections/complications , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Hospitalization/statistics & numerical data , Hypotension/complications , Length of Stay/statistics & numerical data , Microbial Sensitivity Tests , Prognosis , Prospective Studies , Pneumonia, Bacterial/complications , Pneumonia, Bacterial/drug therapy , Pneumonia, Pneumococcal/complications , Pneumonia, Pneumococcal/diagnosis , Pneumonia, Pneumococcal/drug therapy , Pneumonia, Pneumococcal/microbiology , Renal Insufficiency/complications , Streptococcus pneumoniae/isolation & purification
18.
Rev. bras. ter. intensiva ; 27(1): 57-63, Jan-Mar/2015. tab, graf
Article in Portuguese | LILACS | ID: lil-744685

ABSTRACT

Objetivo: Avaliar a percepção dos médicos brasileiros quanto ao diagnóstico, à avaliação de gravidade, ao tratamento e à estratificação de risco em pacientes com pneumonia grave adquirida na comunidade, e compará-la com as diretrizes atuais. Métodos: Estudo transversal realizado por meio da aplicação de um questionário anônimo a uma amostra de médicos brasileiros especialistas em cuidados intensivos, medicina de emergência, medicina interna e pneumologia. Entre outubro e dezembro de 2008, foram avaliadas as atitudes dos médicos no diagnóstico, a avaliação de risco e as intervenções terapêuticas para pacientes com pneumonia grave adquirida na comunidade. Resultados: Responderam ao questionário 253 médicos, sendo 66% da Região Sudeste do Brasil. A maioria (60%) dos médicos que responderam tinha mais de 10 anos de experiência. Verificou-se que a avaliação de risco de pneumonia grave adquirida na comunidade foi muito heterogênea, sendo a avaliação clínica a forma de avaliação de risco mais frequente. As hemoculturas foram habitualmente realizadas por 75% dos médicos, entretanto, foi reconhecido seu fraco desempenho diagnóstico. Por outro lado, a pesquisa de antígenos urinários de Pneumococo e Legionella foi solicitada por menos de um terço dos médicos. A maioria (95%) prescreveu antibióticos de acordo com as diretrizes. A combinação de uma cefalosporina de terceira ou quarta geração com um macrolídeo foi a escolha mais comum. Conclusão: Este inquérito brasileiro demonstrou diferenças entre as diretrizes publicadas e a prática clínica. Isso leva à necessidade de se desenvolverem programas educacionais e de adoção de protocolos para implementar estratégias baseadas em evidências no manejo da pneumonia grave adquirida na comunidade. .


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. .


Subject(s)
Humans , Pneumonia/therapy , Practice Patterns, Physicians'/statistics & numerical data , Practice Guidelines as Topic , Community-Acquired Infections/therapy , Pneumonia/diagnosis , Pneumonia/physiopathology , Severity of Illness Index , Brazil , Cross-Sectional Studies , Surveys and Questionnaires , Retrospective Studies , Community-Acquired Infections/diagnosis , Community-Acquired Infections/physiopathology , Risk Assessment/methods , Anti-Bacterial Agents/therapeutic use
19.
Medical Principles and Practice. 2015; 24 (2): 189-194
in English | IMEMR | ID: emr-171511

ABSTRACT

This study investigated clinical factors associated with negative urinary antigen tests [UAT] implemented for the diagnosis of pneumococcal community-acquired pneumonia [CAP] in adult patients. We reviewed the medical records of 755 adult patients who completed the UAT in our hospital between 2009 and 2012. Of these, we evaluated 63 patients with bacteriologically confirmed definite pneumococcal CAP [33 were UAT-positive, and 30 were UAT-negative]. There was no significant difference between the UAT-positive and the UAT-negative patients regarding age, dehydration, respiratory failure, orientation, blood pressure [ADROP] score [the CAP severity score proposed by the Japanese Respiratory Society], gender, white blood cell counts, liver/kidney function tests, or urinalysis. However, serum C-reactive protein [CRP] concentrations were 31% lower in the UAT-negative patients than in the UAT-positive patients [p = 0.02]. Furthermore, the prothrombin time-international normalized ratio was 50% higher in the UAT-negative patients than in the UAT-positive patients, although the difference did not reach statistical significance [p = 0.06]. The prevalence of comorbidities was similar in both UAT-positive and UAT-negative patients. However, warfarin had been prescribed in 8 [27%] of the UAT-negative patients compared to only 1 [3%] of the UAT-positive patients [odds ratio = 11.6; p = 0.01]. These results suggested that low serum CRP concentrations and the use of warfarin increased the possibility with which false-negative UAT results occurred in these patients with pneumococcal CAP


Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Aged, 80 and over , Community-Acquired Infections/diagnosis , Streptococcus pneumoniae , Antigens/urine , Adult , Retrospective Studies
20.
Article in English | WPRIM | ID: wpr-216627

ABSTRACT

BACKGROUND/AIMS: Nursing home-acquired pneumonia (NHAP) is included under healthcare-associated pneumonia. However, the optimal treatment strategy for NHAP has been controversial in several studies. We evaluated the clinical features of NHAP compared to community-acquired pneumonia (CAP) in elderly patients admitted with pneumonia. METHODS: This was a retrospective study in elderly patients aged > or = 65 years with NHAP or CAP who were hospitalized at Jeju National University Hospital between January 2012 and April 2013. RESULTS: A total of 209 patients were enrolled, and 58 (27.7%) had NHAP. The patients with NHAP were older, had more frequent central nervous system disorders, and showed worse clinical parameters. Potential drug-resistant pathogens were more frequently detected in the NHAP group (22.4% vs. 9.9%, p = 0.018), and the incidences of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were 8.6% and 10.3%, respectively. In-hospital mortality occurred in 13 patients (22.4%) with NHAP and 17 patients (11.2%) with CAP (p = 0.039). In multivariate analyses, only higher pneumonia severity index (PSI) score was associated with increased mortality (p < 0.001), and the PSI score was higher in the NHAP group than that in the CAP group. CONCLUSIONS: Elderly patients admitted with NHAP showed more severe pneumonia at onset, higher rates of potentially drug-resistant pathogens, and worse clinical outcomes than those with CAP. However, higher in-hospital mortality in those with NHAP seemed to be related to the PSI score reflecting host factors and severity of pneumonia rather than the type of pneumonia or the presence of drug-resistant pathogens.


Subject(s)
Age Factors , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Chi-Square Distribution , Community-Acquired Infections/diagnosis , Cross Infection/diagnosis , Drug Resistance, Bacterial , Female , Homes for the Aged , Hospital Mortality , Hospitals, Teaching , Humans , Logistic Models , Male , Microbial Sensitivity Tests , Multivariate Analysis , Nursing Homes , Odds Ratio , Patient Admission , Pneumonia, Bacterial/diagnosis , Republic of Korea , Retrospective Studies , Risk Factors , Severity of Illness Index , Treatment Outcome
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