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Bronchiectasis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Exacerbations should be treated according to up-to-date sputum culture results. If no previous cultures are available, broad-spectrum cover, which should include P. aeruginosa, should be started prior to the results from the current exacerbation being available. In cases of resistance, combination therapy may be needed to ensure adequate cover and this may necessitate the use of outpatient parenteral antibiotic services. Most patients will need 14 or more days of treatment for exacerbations.
Drug-Resistant Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Keertan Dheda, Aliasgar Esmail, Anzaan Dippenaar, Robin Warren, Jennifer Furin, Christoph Lange
Ideally, sputum smear microscopy and cultures should be performed at least once every 2 weeks until culture conversion has been achieved (some centers perform weekly examinations) and thereafter on a monthly basis until the end of therapy (the reality in endemic countries is that only monthly sputum culture testing is performed). The kinetics of quantitative grading of the sputum bacillary load (Table 16.7) and the time to positivity of M. tuberculosis cultures are very good indicators of treatment responses.243 A positive sputum culture status by the end of 6 months of therapy should be considered as failure of MDR-TB therapy.244
Case 15: Difficult to Treat Chest Infection
Published in Iqbal Khan, Medical Histories for the MRCP and Final MB, 2018
Additional investigations may be performed in certain situations.Peak flow rate measurements – to exclude the possibility of asthma if doubt remains.Alpha-1-antitrypsin – if the disease seems to be more severe than expected from the smoking history or if there is a family history of illness.CT scan – to investigate abnormalities on a chest X-ray.ECG and echocardiogram – if there is a suspicion of cor pulmonale.Pulse oximetry – to asses the need for oxygen therapy.Sputum culture – if the patient is producing purulent sputum and antibiotic therapy needs to be directed to the specific organism.
Early glycaemic variability increases 28-day mortality and prolongs intensive care unit stay in critically ill patients with pneumonia
Published in Annals of Medicine, 2022
Seong Ho Kim, Ji Young Kim, Eun Song Kim, Il Rae Park, Eun Yeong Ha, Seung Min Chung, Jun Sung Moon, Ji Sung Yoon, Kyu Chang Won, Hyoung Woo Lee
Patient characteristics, laboratory values, radiologic findings, pneumonia pathogens from sputum culture and treatment strategies were obtained from electronic medical records. Patient characteristics included age, sex, ICU stay and number of days from death. Disease severity was assessed using the Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score [14]. Anthropometric and laboratory results included body mass index (BMI), white blood cell (WBC) count, haemoglobin (Hb) level, platelet (Plt) count, C-reactive protein (CRP) level, blood urea nitrogen (BUN) level, creatinine level, estimated glomerular filtration rate (eGFR) and lactate level. Radiological findings included unilateral pneumonia, bilateral pneumonia and multiple ground-glass opacities. Treatment strategies included invasive mechanical ventilation (IMV), continuous renal replacement therapy (CRRT), extracorporeal membrane oxygen (ECMO), antibiotics and glucocorticoids.
Characteristics of pneumonia with negative chest radiography in cases confirmed by computed tomography
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Takatoshi Kitazawa, Hisanao Yoshihara, Kazunori Seo, Yusuke Yoshino, Yasuo Ota
The present study was limited by both a small sample size and the retrospective design. Furthermore, the method of the study allowed us to determine the prevalence of negative CR studies only in the presence of a positive CT result for pneumonia. The prevalence of negative CT scan in the prevalence of negative CR study were not determined. Infiltration of pneumonia has also shown poor interobserver reliability [19]. This study excluded pneumonia cases in which sputum was not collected for microbiological investigation. In the previous study of CAP, sputum culture was obtained in a small number of patients (39.6%) [20]. The exclusion of cases of unobtained sputum culture in this study could affect the results of characteristics of both groups. For clarifying the precise characteristics of CT confirmed pneumonia, additional prospective research including pneumonia patients whose sputum were uncollected will be required.
Association of MDR-TB treatment outcomes and HIV status in Zimbabwe: A retrospective study
Published in Cogent Medicine, 2020
The duration from acquisition of the sputum culture samples to the time of commencement of treatment was significantly longer in those who died than those who survived, (79 days, 95% CI 55–101) versus (56 days, 95% CI 48–84), p = 0.011. After acquisition of sputum samples, 22 patients died before the initiation of treatment. The median time period of follow-up; from the time of commencement of treatment to the time of event (death, conversion or date of censorship) was 7.1 months (95%CI 3.6–11.9). Median duration of treatment was 18.6 months; even in instances where cure/sputum culture-conversion was experienced in less than 18 months of treatment, the treatment policy still requires patients to complete an 18 months treatment course. Fifty-nine (72%) of 82 HIV-infected MDR-TB patients on MDR-TB treatment were also taking highly active antiretroviral therapy. Commencement of treatment resulted in culture-conversion/cure in 32 (18%) of the 174 who started treatment.