Infectious disease clinics of North America
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Infect. Dis. Clin. North Am. · Mar 2013
ReviewWhat is the best antimicrobial treatment for severe community-acquired pneumonia (including the role of steroids and statins and other immunomodulatory agents).
Community-acquired pneumonia (CAP) is the leading cause of death from infectious diseases in the United States. The mortality rate due to severe CAP has shown little improvement over the past few years, with a rate as high as 50% mainly in patients admitted to intensive care units. ⋯ Several therapies have been tested in patients with severe CAP in recent years. This article reviews recent data regarding different treatments including antimicrobials and adjunctive therapies in patients with severe CAP.
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Infect. Dis. Clin. North Am. · Mar 2013
ReviewWhat is the role of antimicrobial stewardship in improving outcomes of patients with CAP?
Community-acquired pneumonia (CAP) is one of the most common infectious diagnoses encountered in clinical practice and one of the leading causes of death in the United States. Adherence to antibiotic treatment guidelines is inconsistent and the erroneous diagnosis of CAP and misuse of antibiotics is prevalent in both inpatients and outpatients. This review summarizes interventions that may be promoted by antimicrobial stewardship programs to improve outcomes for patients with CAP.
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Infect. Dis. Clin. North Am. · Mar 2013
ReviewIs the present definition of health care-associated pneumonia the best way to define risk of infection with antibiotic-resistant pathogens?
Health care-associated pneumonia (HCAP) is associated with an increased risk of infection with multidrug-resistant pathogens compared with community-acquired pneumonia. Recent studies suggest that the designation of HCAP is a poor predictor of resistant pathogens and that antibiotic coverage for multidrug-resistant pathogens is not necessary in all patients with HCAP. This article reviews existing literature on HCAP, discusses the utility of the current definition of HCAP in identifying patients at risk for potentially drug-resistant pathogens, and compares how well the current HCAP designation predicts the risk of drug-resistant pathogens with other proposed algorithms for doing so.
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Infect. Dis. Clin. North Am. · Mar 2013
ReviewDoes empirical therapy with a fluoroquinolone or the combination of a β-lactam plus a macrolide result in better outcomes for patients admitted to the general ward?
Community-acquired pneumonia (CAP) is a frequent cause of morbidity and mortality in the United States and worldwide, in particular among older patients and those with significant comorbid conditions. Current guidelines recommend therapy with a fluoroquinolone or a β-lactam plus a macrolide for the treatment of hospitalized adults with CAP who do not require admission to an intensive care unit. This article provides a brief summary and overview of the existing literature on this topic categorized by the main results; the potential implications for future clinical practice and research are discussed.
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Infect. Dis. Clin. North Am. · Mar 2013
ReviewWhat is the association of cardiovascular events with clinical failure in patients with community-acquired pneumonia?
Cardiovascular disease is the leading cause of morbidity and mortality in the United States. Several investigators recently reported an increased risk of cardiovascular events (CVEs) in hospitalized patients with community-acquired pneumonia (CAP). ⋯ Future research may be necessary to identify patients at risk of CVEs during or after an episode of CAP. In these patients, therapeutics beyond antibiotics (eg, heparin or aspirin) may be indicated during and after hospitalization.