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Respiratory Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Ian Pavord, Nayia Petousi, Nick Talbot
Patients with immunocompromise are more susceptible not only to the usual pathogenic organisms but also to a variety of opportunistic organisms. Management depends on the pathogen, so efforts should be directed towards microbiological diagnosis. This may include early bronchoalveolar lavage. Empirical treatment should be started while seeking the diagnosis.
Gastrointestinal Diseases
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Management should follow information obtained on history and examination and should be triaged based on presence or absence of alarm features (Table 11.4.1). Empirical treatment may be offered to support or confirm diagnosis.
Neurology
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
Empirical treatment is typically age dependent. Those >1 month but <50 years of age require vancomycin and ceftriaxone or cefotaxime. Those >50 years of age benefit from ampicillin, vancomycin and ceftriaxone or cefotaxime.
Updating cut-off values of severity scoring systems for community-acquired pneumonia to orchestrate more predictive accuracy
Published in Annals of Medicine, 2023
Qi Guo, Hai-yan Li, Wei-dong Song, Ming Li, Xiao-ke Chen, Hui Liu, Hong-lin Peng, Hai-qiong Yu, Nian Liu, Yan-hong Li, Zhong-dong Lü, Li-hua Liang, Qing-zhou Zhao, Mei Jiang
These studies were performed according to the principles of human experimentation guidelines of the United States Department of Health and Human Services. Our report was based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Patients suffering from CAP were cared for by respiratory physicians and intensivists in accordance with the IDSA/ATS guidelines [3] and the Surviving Sepsis Campaign guidelines [18,19]. PSI class ≥ IV, IDSA/ATS minor criteria ≥3, or CURB-65 score ≥3 was warranted a transfer to respiratory intensive care unit. Antibiotic regimens for the empirical treatment were prescribed based on the guidelines, and then adjusted in the light of subsequently cultured pathogens. All patients clinically stable and afebrile were discharged home [3].
Increasing incidence of pyogenic liver abscess in Southern Sweden: a population-based study from 2011 to 2020
Published in Infectious Diseases, 2023
Emma Svensson, Astrid Jönsson, Anna Bläckberg, Torgny Sunnerhagen, Ali Kiasat, Oskar Ljungquist
Our study shows that the aetiology of PLA is heterogenous, with a diversity of isolated anaerobic, aerobic, Gram-positive and Gram-negative and mono- and polymicrobial pathogens. However, Streptococcus spp. (dominated by the S. anginosus complex), E. coli and Klebsiella spp. (dominated by K. pneumoniae) accounted for the vast majority of both mono- and polymicrobial findings in both blood and abscess cultures. This is in line with previous reports [3, 21]. Enterococcus species and anaerobic bacteria, such as Bacteroides- and Clostridium species, were also prevalent in both mono- and polymicrobial blood cultures. Consequently, it is important to cover these pathogens in empirical treatment. Thus, piperacillin/tazobactam or a third-generation cephalosporin, such as cefotaxime, combined with metronidazole are reasonable alternatives for empirical treatment of PLA. Enterococci and Candida species were more common in abscess cultures than in blood cultures, which could be explained by lengthy treatment with broad-spectrum antimicrobials which could select for these pathogens in local cultures. The prevalence of ESBL-producing Enterobacterales (EPE) was very low, in accordance with the low-endemic situation in Sweden regarding multidrug-resistant bacteria compared to other regions of the world [22]. However, even in high-endemic settings, the prevalence of antibiotic resistance in Klebsiella spp. is low [23].
Community-acquired pneumonia in hospitalised patients: changes in aetiology, clinical presentation, and severity outcomes in a 10-year period
Published in Annals of Medicine, 2022
Júlia Sellarès-Nadal, Joaquín Burgos, María Teresa Martín-Gómez, Andrés Antón, Roger Sordé, Daniel Romero-Herrero, Pau Bosch-Nicolau, Anna Falcó-Roget, Cristina Kirkegaard, Dolors Rodríguez-Pardo, Oscar Len, Vicenç Falcó
We collected epidemiologic information (age, sex, residency in nursing home, smoking, alcohol consumption and vaccination status), comorbidities (hypertension, chronic obstructive pulmonary disease (COPD), diabetes mellitus, chronic renal failure, neurological disorders, and neoplasms) and immunosuppressive factors (solid organ transplantation, haematopoietic transplantation, chemotherapy, long-term use of corticosteroids, and HIV infection). We also registered clinical information, laboratory results, radiological findings, microbiological information, and severity data (septic shock and respiratory failure). Empirical treatment was recorded. Evolutive variables, such as admission at the Intensive Care Unit (ICU) and in-hospital mortality were collected. CURB-65 score and Pneumonia Severity Index (PSI) were calculated.