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Respiratory Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Aref T. Senno, Ryan K. Brannon
Pneumonia is classified by setting of infection: (1) community acquired pneumonia (CAP): Acute infection acquired outside of the hospital, (2) hospital acquired pneumonia (HAP): Acquired 48 hours or more after admission to the hospital, (3) ventilator-associated pneumonia (VAP): Acquired 48 hours or more after endotracheal intubation. The category of healthcare-associated pneumonia introduced in the 2005 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines have since been abandoned due to likely over-treatment of antibiotic-sensitive organisms. The vast majority of cases of pneumonia in pregnant women in clinical practice and in the literature are cases of CAP.
Infections in Cirrhosis in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
John M. Horne, Laurel C. Preheim
Hospital-acquired pneumonia (HAP) may be caused by a wide variety of bacteria. It is defined as a pneumonia not incubating at the time of hospital admission, occurring 48 hours or more after admission, and not associated with mechanical ventilation [60]. In this new definition, patients with HAP and ventilator-associated pneumonia (VAP) are in two separate non-overlapping groups, and the term “healthcare-associated pneumonia” has been retired [60]. Common pathogens include aerobic gram-negative bacilli, such as P. aeruginosa, E. coli, K. pneumoniae, S. marcescens, Enterobacter species, Proteus species, and Acinetobacter species. S. aureus and S. pneumoniae predominate among gram-positive pathogens, and the incidence of MRSA nosocomial pneumonia is increasing. A number of risk factors have been identified for MDR bacteria [60] (Table 26.2).
Meropenem and Meropenem–Vaborbactam
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Anton Y. Peleg, Patrick N. A. Harris
The treatment of hospital-acquired or healthcare-associated pneumonia should be based on local microbiologic susceptibility data. Empirical therapy regimens should be institution specific, maximizing the coverage of causative organisms that are likely at a given time in the hospital stay, taking into account the severity of illness and previous antibiotic exposures of the patient. Meropenem is one of several therapeutic options for hospital-acquired or healthcare-associated pneumonia, although reserved for patients at high-risk for multidrug-resistant pathogens (ATS/IDSA, 2005). Two prospective, randomized studies have been performed that demonstrate the efficacy of meropenem (1 g every 8 hours) compared with ceftazidime plus an aminoglycoside (Sieger et al., 1997; Alvarez Lerma and Serious Infection Study Group, 2001), both showing a slight but significant benefit with meropenem (Table 38.10). Given the difficulties of diagnosing ventilator-associated pneumonia and the broad-spectrum nature of meropenem, it is important to reevaluate the patient at 48–72 hours to assess the clinical status and microbiologic data. Deescalation to a more narrow-spectrum, microbiologically guided therapy is ideal if possible.
The Spectrum of Infections in Patients with Lung Cancer
Published in Cancer Investigation, 2023
Damla Serce Unat, Ozlem Ulusan Bagci, Omer Selim Unat, Sukran Kose, Ayse Caner
Moreover, as neutropenic patients frequently receive health services, pneumonia in neutropenic patients can be classified as healthcare-associated pneumonia. Therefore, gram-negative enteric microorganisms (Pseudomonas spp., Klebsiella pneumoniae, Acinetobacter baumanii, etc.) and gram-positive resistant microorganism can frequently manifest in neutropenic patients (41). If neutropenia persists, fungal infections become more dangerous than bacteria (6). Aspergillosis is the most common fungal infection occurring in neutropenic patients, but other fungi (Trichosporon, Fusarium, and Rhizopus etc.) may be isolated from lung of the neutropenic patients. However, Histoplasma capsulatum, Coccioides immitis, and Cryptococcus neoformans pneumonia should be considered in patients with lung cancer living in endemic places (6).
Prognostic factors in elderly patients admitted to the intensive care unit with community-acquired pneumonia
Published in The Aging Male, 2020
Hakan Çelikhisar, Gülay Daşdemir Ilkhan, Çiğdem Arabaci
In this retrospective study, a total of 86 patients over 65 years old who were admitted to Izmir Esrefpaşa Municipal Hospital Intensive Care Unit with a diagnosis of community-acquired pneumonia between December 2015 and January 2018 were examined. The medical histories and demographic characteristics of the patients were recorded. Vital signs of the patients, the results of complete blood counts, bloodglucose levels, liver and kidney function tests, and arterial blood gas analyses at admission were recorded. Whether there was confusion or not was evaluated with a Glasgow coma scale. The results of chest X-ray and thorax computed tomography recorded. During ICU follow–up, intubation and mechanical ventilator necessity, requirements for tracheostomy, closed underwater drainage and/orcentral venous catheter (CVP) interventions, empirical antibiotic selection, length of hospital stay, comorbid diseases and mortality rates were recorded. Patients younger than 65 years of age, diagnosed with nosocomial pneumonia or healthcare-associated pneumonia, patients admitted to the ICU due to another causes than CAP, patients under any type of immunosuppressive treatments were excluded from the study. Pneumonia was clinically diagnosed in patients who had new pulmonary infiltrates on their chest radiographs and who had at least two of the followingsymptoms or findings: fever (>38 °C) or hypothermia (<36 °C), leukocytosis (>12 × 103/μL) or leukopenia (<4 × 103/μL), presence of purulent tracheal secretions, and a decline in oxygenation.
Is therapeutic anticoagulation improving renal outcomes in COVID-19?
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Sohaib Roomi, Waqas Ullah, Soban Farooq, Rehan Saeed, Shujaul Haq, Ammar Ali Ashfaq
A 67-year-old male with no significant past medical history presented to the hospital with myalgias, fever and shortness of breath for the past 10 days. He tested positive for COVID-19 a week ago and was quarantined at home but symptoms progressed, prompting a visit to the ER. Vital signs on presentation were as follows: temperature 102.8, BP 110/70, heart rate 94 bpm, respiratory rate 24/min, oxygen saturation 93% on 3 liters/minute of supplemental oxygen by nasal cannula. Over the next 3 days, his respiratory symptoms worsened and he got intubated in the ICU. He developed severe acute respiratory distress syndrome (ARDS) secondary to COVID-19 and got treatment with intravenous steroids, epoprostenol and furosemide in addition to hydroxychloroquine and prophylactic lovenox as per hospital policy. One week into the ICU, the patient developed acute renal failure, worsening over the next week. On hospital day 12, the patient became hypotensive, tachycardiac and desaturated to mid-80s on the same ventilator settings. Bedside echocardiogram revealed right ventricular dilatation with akinesis of the mid free wall (Figure 2). A provisional diagnosis of Pulmonary embolism was made and the patient was started on therapeutic heparin. His kidney functions improved following the onset of systemic anticoagulation. His hospital course was complicated by health care-associated pneumonia treated with broad-spectrum antibiotics but oxygen requirement remained high. On hospital day 23, he received a tracheostomy tube and later transferred to a nursing care facility.