Clinics in chest medicine
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Sepsis is a frequent and often fatal complication of pneumonia. This article discusses the epidemiology, pathophysiology, and treatment of sepsis in the setting of pneumonia. Particular consideration is given to the role of mechanical ventilation in amplifying organ dysfunction in sepsis and to treatments that have positive effects on sepsis mortality and respiratory dysfunction.
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Clinics in chest medicine · Mar 2005
ReviewPreventing pneumonia: the role for pneumococcal and influenza vaccines.
Streptococcus pneumoniae and influenza cause a wide spectrum of illness and result in substantial morbidity and mortality. They are significant public health concerns, and vaccines against both organisms exist. The pneumococcal polysaccharide vaccine has been available in its current form for over 20 years. ⋯ The role for revaccination remains controversial. Traditional influenza vaccine is composed of three virus types and decreases rates of serologically confirmed cases of influenza, hospital admissions for respiratory infection, and mortality. The pneumococcal and influenza vaccines are considered cost-effective options for pneumonia prevention.
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This article highlights the importance of providing adequate empirical antibiotic therapy for hospital-acquired pneumonia and avoiding the excessive use of antibiotics. To meet these goals, a strategy for the management of suspected ventilator-associated pneumonia should include obtaining reliable pulmonary specimens for direct microscope examination and cultures before new antibiotics are administered.
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As the field of solid organ transplantation has grown, so has the importance of infectious complications in this select group of patients. Chronic immunosuppression compromises the natural host defenses that typically prevent lower respiratory tract infections and makes the solid organ transplant recipient especially susceptible to pneumonia. ⋯ Lung transplant recipients are particularly susceptible to pneumonia and pose unique diagnostic dilemmas. An understanding of the time line for the different key pathogens after transplantation aids the initial evaluation and management.
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Clinics in chest medicine · Mar 2005
ReviewAntimicrobial resistance and treatment of community-acquired pneumonia.
This article discusses the problem of antimicrobial resistance and how it affects the management of community-acquired pneumonia (CAP). The discussion is limited to infection with Streptococcus pneumoniae and to the treatment of patients hospitalized in a medical ward or an intensive care unit because of pneumococcal CAP.