Infectious disease clinics of North America
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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.
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Infect. Dis. Clin. North Am. · Mar 2013
ReviewBiomarkers: what is their benefit in the identification of infection, severity assessment, and management of community-acquired pneumonia?
Biomarkers have been proposed as tools that can guide the management of patients with community-acquired pneumonia, providing information that supplements the usually available clinical data. Among the available biomarkers, procalcitonin has been studied extensively and seems promising for several purposes. The use of biomarkers needs further study, to validate their utility in daily practice, especially given the limitations of the current tools for identifying the need for antibiotic therapy in patients with influenza and secondary bacterial pneumonia, in patients with aspiration syndromes, and in those infected with atypical pathogens.
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Infect. Dis. Clin. North Am. · Sep 2012
ReviewTravel trends and patterns of travel-associated morbidity.
Improved data collection methods have produced a clearer picture of travel-associated health risks and at-risk travelers. Examination of the causes of mortality and morbidity has led to a change in emphasis on ways of reducing morbidity. There are unanswered questions that relate to the contribution of medical comorbidities on travel-associated illness, how communication can enhance or influence behavior change, and the best strategies to influence the travelers at greatest risk. Enhanced data collection methods and better denominator data are necessary to provide more precise risk information and help inform policy and thereby reduce morbidity in tourists and travelers.