RESUMO
Pneumonia remains one of the most common reasons for admission of emergency department (ED) patients to the hospital. Pneumonia also remains one of the most common causes of death in our patients. As with many emergent conditions, the ED management of these patients initiated by ED physicians contributes greatly to the survival and successful management of these patients. Specifically, the recognition of severe pneumonias, precise choice of diagnostic tests, and appropriate antibiotics can have an impact on the outcome.
Assuntos
Serviço Hospitalar de Emergência , Pneumonia Bacteriana , Pneumonia Viral , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Hospitalização , Humanos , Planejamento de Assistência ao Paciente , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Guias de Prática Clínica como Assunto , Índice de Gravidade de DoençaRESUMO
Influenza and pneumococcal pneumonia remain among the most significant causes of morbidity and mortality of any of the infectious disease emergencies presenting to emergency departments (EDs). Because the ED has become a recommended location at which immunizations have been administered to prevent several infections, pneumococcal and influenza vaccinations can have an impact on the care of ED patients. ED personnel are uniquely positioned to vaccinate a substantial number of patients who would not otherwise be vaccinated, including many high-risk populations. In addition to decreasing vaccine-preventable mortality and morbidity from influenza and pneumococcal diseases, EDs that implement and monitor a systematic approach to these vaccinations can attenuate ED overcrowding and facilitate patient flow. ED vaccination strategies have been proved to be successful and reimbursable and are advocated by several major clinical practice advisory groups.
Assuntos
Serviço Hospitalar de Emergência , Vacinas contra Influenza/uso terapêutico , Vacinas Pneumocócicas/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Pré-Escolar , Controle de Doenças Transmissíveis , Humanos , Lactente , Vacinação em Massa , Pessoa de Meia-Idade , Guias de Prática Clínica como AssuntoRESUMO
Pneumonia caused by Streptococcus pneumoniae is the most deadly form of community-acquired pneumonia. The death rate of bacteremic pneumococcal pneumonia has remained constant over the past 50 years. Several retrospective reviews of bacteremic pneumococcal pneumonia suggest that dual therapy with a beta-lactam and a macrolide antimicrobial agent is associated with a lower case fatality rate than therapy with a beta-lactam alone. These studies are reviewed, potential mechanisms are suggested, and future studies are discussed.
Assuntos
Antibacterianos/uso terapêutico , Pneumonia Pneumocócica/tratamento farmacológico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Cefalosporinas/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/mortalidade , Suscetibilidade a Doenças , Farmacorresistência Bacteriana Múltipla , Quimioterapia Combinada/uso terapêutico , Humanos , Macrolídeos/uso terapêutico , Pneumonia Pneumocócica/complicaçõesRESUMO
Azithromycin is highly active against Legionella pneumophila and has been shown to be efficacious in animal models and in clinical studies of patients with legionnaires disease. This open, prospective, multicenter trial evaluated azithromycin for the treatment of legionnaires disease. Twenty-five hospitalized patients with community-acquired pneumonia and a positive result of a L. pneumophila serogroup 1 urinary antigen assay received monotherapy with intravenous azithromycin (500 mg/day) for 2-7 days, followed by oral azithromycin (1500 mg administered over the course of 3 or 5 days). The mean total duration of intravenous plus oral therapy was 7.92 days. The overall cure rate among clinically evaluable patients was 95% (20 of 21 patients) at 10-14 days after therapy and 96% (22 of 23 patients) at 4-6 weeks after therapy. The results of this study support previously reported data demonstrating that azithromycin is both safe and efficacious for the treatment of hospitalized patients with legionnaires disease.
Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Legionella , Doença dos Legionários/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Azitromicina/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
This international collaborative survey identified culture-confirmed legionellosis in 508 patients with sporadic community-acquired legionellosis. Legionella pneumophila constituted 91.5% of the isolates. Serogroup 1 was the predominant serogroup (84.2%), and serogroups 2-13 (7.4%) accounted for the remaining serogroups. The Legionella species most commonly isolated were L. longbeachae (3.9%) and L. bozemanii (2.4%), followed by L. micdadei, L. dumoffii, L. feeleii, L. wadsworthii, and L. anisa (2.2% combined). L. longbeachae constituted 30.4% of the community-acquired Legionella isolates in Australia and New Zealand.