Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Jun 2012
ReviewCommunity-acquired pneumonia: genomics, epigenomics, transcriptomics, proteomics, and metabolomics.
Community-acquired pneumonia remains a significant health problem with very little progress having been made over the past 2 to 3 decades. Recent technological advances have opened up whole new avenues of exploration in the fields of genomics, epigenomics, transcriptomics, proteomics, and metabolomics. ⋯ This review discusses recent studies in pneumonia using these new approaches as well as relevant research in sepsis and other diseases. Current and potential future uses of these platforms are discussed, and both key findings and key barriers to further progress are highlighted.
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Semin Respir Crit Care Med · Jun 2012
ReviewBiomarkers and community-acquired pneumonia: tailoring management with biological data.
Community-acquired pneumonia (CAP) is the leading cause of death from infectious diseases worldwide, with an incidence of 0.3 to 0.5% in the adult population. A new diagnostic and prognostic approach relies on evaluation of biomarkers as an expression of the host's inflammatory response against the microorganism. C-reactive protein (CRP), procalcitonin (PCT), and cytokines are the most frequently studied, whereas pro-adrenomedullin (pro-ADM), pro-vasopressin (pro-VNP), and others are currently obtaining promising results. ⋯ During treatment, ~15% of hospitalized CAP patients develop treatment failure, and almost 6% may manifest rapidly progressive pneumonia. Initially increased and persistent raised levels of biomarkers and cytokines have been shown to identify patients at risk of treatment failure, thereby aiding clinical management. Data from the literature appear to support the use of biomarkers in routine clinical practice to improve the decision making in CAP.
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Semin Respir Crit Care Med · Jun 2012
ReviewTechnology implementation impacting the outcomes of patients with CAP.
Community-acquired pneumonia (CAP) combined with influenza is the eighth leading cause of death in the United States. This article examines the literature to understand and describe whether technology implementation has impacted the outcomes of patients with CAP. ⋯ Twenty-six articles were included in this review. We surveyed this literature for answers to the following questions: Can technology be used to improve quality of care and guideline compliance in CAP? How can we overcome the behavioral bottleneck that prevents adoption of computerized decision support systems? How reliable are our data in the era of electronic medical records? What are the risks associated with technology implementation? No articles demonstrated that technology implementation improves outcomes in the care of patients with CAP.
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Semin Respir Crit Care Med · Jun 2012
ReviewAntibiotic resistance of pathogens causing community-acquired pneumonia.
Community-acquired pneumonia remains an important cause of disease and death in both developed and developing countries and therefore continues to have a major medical impact. The mortality remains high despite the ready availability of potent antimicrobial agents to which the organisms are susceptible. ⋯ Furthermore, it is also being recognized that antibiotic resistance or treatment failures may occur not only through traditional microbial antibiotic resistance mechanisms but also through less well defined mechanisms, particularly those developed by the microbes in relation to their quorum sensing/biofilm machinery. Much recent research in this field has been focused on evaluating the clinical impact of antibiotic resistance on optimal antibiotic treatment and antimicrobial choices, as well as alternative strategies to deal with antibiotic resistance and treatment failures.
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Although pneumonia is currently considered the eighth leading cause of death in the United States this estimate includes only short-term mortality. Evidence suggests that pneumonia may have significant longer-term effects and that hospitalization for pneumonia is associated with higher long-term mortality than for many other major medical conditions. Reasons for this increased mortality appear to be due to several factors, including cardiovascular disease, neoplasms, and alterations in immune function. Clinicians need to be aware that even for those patients who survive the initial episode of pneumonia there will still be an impact upon their potential survival for the coming years.