(CHEST 2001; 119:1563-1564) clew words: BAL; community-acquired pneumonia; ventilator-associated pneumonia Abbreviation: VAP = ventilator-associated pneumonia SEVERITY OF ILLNESS 1 Atlas SJ Benzer TI.

(CHEST 2001; 119:1563-1564)

clew words: BAL; community-acquired pneumonia; ventilator-associated pneumonia

Abbreviation: VAP = ventilator-associated pneumonia

SEVERITY OF ILLNESS

1 Atlas SJ Benzer TI, Borowsky LH et al. Safely increasing the proportion of patients with community-acquired pneumonia treated as outpatients: an interventional trial. Arch Intern M 1998; 158: 1350-1356

The pneumonia severity index of Fine et al[1] was evaluated prospectively in 166 patients and was compared to 147 consecutive retrospective reign over subjects with low-risk community-acquired pneumonia. Using this index, hospital admissions were significantly reduc to 42% from 57% for reign over subjects, but 9% of patients were later admitted to the hospital compared to 0% for mastery subjects. Patient satisfaction was also significantly lower (patients, 71%; have charge of subjects, 90%). While initial hospitalization rates did decrease, a 9% late admission rate using the pneumonia severity index raises disturbs that the use of similar an index might underestimate the severity of pneumonia.

2 Ewig s Ruiz M, Mensa J, et al. harsh community-acquired pneumonia: assessment of severity criteria. Am J Respir Crit Care M 1998; 158:1102-1108

This research attempted to validate the 10 American Thoracic Society criteria used to identify cases of strait-laced community-acquired pneumonia and to optimize the severity criteria according to a of recent origin prediction rule.[2] Three hundred ninety-four patients with community-acquired pneumonia who required hospitalization (64 patients were admitted to an ICU) were prospectively chronicleed American Thoracic So ciety criteria were set to be very sensitive yet not specific. Multivariate logistic regression analysis identified three minor criteria (systolic BP [is les than] 90 mm Hg multilobar involvement, and Pa[O.sub.2]/fraction of inspired oxygen ratio [is les than] 250) and pair major criteria (requirement for mechanical ventilation and the port of septic shock). The port of two minor criteria or single in kind major criterion had a sensitivity of 78% a specificity of 94% a positive predictive value of 75% and a negative predictive value of 95%

TREATMENT

3 Gleason PP Meehan TP Fine JM et al. Associations between initial antimicrobial therapy and medical issues for hospitalized elderly patients with pneumonia. Arch Intern M 1999; 159:2562-2572

This was a large inquiry using a Medicare database of 12945 inpatients ([is greater than or equal to] 65 years old) assessing the relationship between initial antimicrobial therapy and issue The primary physician selected antimicrobial therapy. results for different antimicrobial therapies were compared, and mortality was significantly lower when a macrolide plus a second-generation cephalosporin, a nonpseudomonal third-generation cephalosporin, or a fluoroquinolone alone was preferableed as the initial therapy. Mortality was significantly higher among patients receiving therapy with a [Beta]-lactam/[Beta-lactamase inhibitor plus a macrolide.

IV TO ORAL SWITCH

4 Ramirez JA, Vargas s Ritter GW, et al. Early switch from IV to oral antibiotics and early hospital discharge: a prospective observational cogitation of 200 consecutive patients with community-acquired pneumonia. Arch Intern M 1999; 159:2449-2454

In a prospective reflection of 200 consecutive hospitalized patients with community-acquired pneumonia, the switch from IV to oral antibiotic therapy was attempted when the following specific criteria were met: cough and shortness of breath improved; temperature was [is les than] 378 [degrees] C for at least 8 h; the WBC look upon was normalizing; and oral intake and GI absorption were adequate. An early switch within the first 3 days was accomplished in 133 patients, with alone 1 patient not responding. Early discharge occurr in 88 patients. Patient satisfaction was 95%

ETIOLOGY

5 Ruiz-Gonzalez A. Falguera M Nogues A, et al. Is Streptococcus pneumoniae the leading cause of pneumonia of unknown etiology? A microbiologic subject of attention of lung aspirates in consecutive patients with community-acquired pneumonia. Am J M 1999; 106:385-390

This is a prospective contemplation of 109 consecutive patients who underwent transthoracic needle aspiration along with routine diagnostic studies to identify the etiology of their community-acquired pneumonia. Routine diagnostic studies identified an etiology in 54 patients (50%) Transthoracic needle aspiration identified a other pathogen in 4 of these 54 patients, and in the remaining 55 patients who did not receive a diagnosis, a pathogen was identified in 36 patients. s pneumoniae was the most universal pathogen found, accounting for 25% of all cases

6 Rello J Sa-Borges M Correa H et al. Variations in etiology of ventilator-associated pneumonia across four treatment sites: implications for antimicrobial prescribing practices. Am J Respir Crit Care M 1999; 160:608-613

This is a retrospective cogitation from three different geographic locations comparing the pathogens win backed from patients with ventilator-associated pneumonia (VAP), using either a protected-specimen brush or BAL, to the outcomes reported by Trouillet et al.[3] Patients were separated into four form into groupss that were based on continuance of stay before the attack of pneumonia ([is less than] 7 days or [is greater than or equal to] 7 days) and prior use of antibiotics. deductions from the four institutions showed wide variations in the incidence of pathogens between hospitals, suggesting that antimicrobial therapy be in want ofs to be tailored for each institution based forward up-to-date information.

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