دورية أكاديمية
Impact of invasive strategy on management of antimicrobial treatment failure in institutionalized older people with severe pneumonia.
| العنوان: | Impact of invasive strategy on management of antimicrobial treatment failure in institutionalized older people with severe pneumonia. |
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| المؤلفون: | El-Solh AA; Division of Pulmonary, Critical Care, and Sleep Medicine, James P. Nolan Clinical Research Center, Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York 14215, USA. solh@buffalo.edu, Aquilina AT, Dhillon RS, Ramadan F, Nowak P, Davies J |
| المصدر: | American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2002 Oct 15; Vol. 166 (8), pp. 1038-43. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Thoracic Society Country of Publication: United States NLM ID: 9421642 Publication Model: Print Cited Medium: Print ISSN: 1073-449X (Print) Linking ISSN: 1073449X NLM ISO Abbreviation: Am J Respir Crit Care Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2000- : New York, NY : American Thoracic Society Original Publication: New York, NY : American Lung Association, c1994- |
| مواضيع طبية MeSH: | Nursing Homes*, Anti-Bacterial Agents/*therapeutic use , Cross Infection/*drug therapy , Pneumonia, Bacterial/*drug therapy, Aged ; Aged, 80 and over ; Cross Infection/diagnosis ; Cross Infection/mortality ; Female ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Pneumonia, Bacterial/diagnosis ; Pneumonia, Bacterial/mortality ; Prospective Studies ; Respiration, Artificial ; Survival Rate |
| مستخلص: | The aim of the study was to investigate the etiology and the impact of invasive quantitative sampling on the management of severe pneumonia in institutionalized older people with antimicrobial treatment failure. Fifty-two institutionalized patients aged 70 years and older hospitalized with a presumptive diagnosis of severe pneumonia and failure to respond to treatment after 72 hours of initiation of outpatient antimicrobial therapy were enrolled. Microbial investigation included blood culture, serology, pleural fluid, and bronchoalveolar samples. A definite etiology could be established in 24 of 52 (46%) patients. Methicillin-resistant Staphylococcus aureus (33%), enteric Gram-negative bacilli (24%), and Pseudomonas aeruginosa (14%) accounted for most isolates. Atypical infections (2%) were uncommon. Invasive bronchial sampling directed a change of microbial therapy in 8 (40%) and discontinuation of antibiotics in 2 of 20 cases (10%) of definite pneumonia. Overall hospital mortality was 42%. There was no difference in mortality among definite or unverified cases or those who had invasive bronchial sampling-guided change in therapy. We conclude that antimicrobial therapy should be targeted toward "nosocomial" pathogens in those institutionalized patients who received prior antibiotic treatment. When combined with microbial investigation, direct visualization of the tracheobronchial tree might be useful in determining the presence of bacterial pneumonia. |
| المشرفين على المادة: | 0 (Anti-Bacterial Agents) |
| تواريخ الأحداث: | Date Created: 20021016 Date Completed: 20030509 Latest Revision: 20061115 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1164/rccm.200202-123OC |
| PMID: | 12379545 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1073-449X |
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| DOI: | 10.1164/rccm.200202-123OC |