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Latest & greatest articles for pneumonia
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Pneumonia in the Immunocompetent Child. New 2019 ACR Appropriateness Criteria ® 1 Pneumonia in the Immunocompetent Child American College of Radiology ACR Appropriateness Criteria ® Pneumonia in the Immunocompetent Child Variant 1: Child. 3 months of age and older. Immunocompetent. Suspected uncomplicated community- acquired pneumonia in a well-appearing child who does not require hospitalization. Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography chest (...) Usually Not Appropriate ? CT chest with IV contrast Usually Not Appropriate ???? CT chest without and with IV contrast Usually Not Appropriate ???? CT chest without IV contrast Usually Not Appropriate ???? MRI chest without and with IV contrast Usually Not Appropriate O MRI chest without IV contrast Usually Not Appropriate O US chest Usually Not Appropriate O Variant 2: Child. 3 months of age and older. Immunocompetent. Community-acquired pneumonia that does not respond to initial outpatient treatment
Are Corticosteroids Beneficial in the Treatment of Community-Acquired Pneumonia? Are Corticosteroids Beneficial in the Treatment of Community-Acquired Pneumonia? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 74, Issue 1, Pages e1–e3 Are Corticosteroids Beneficial in the Treatment of Community-Acquired Pneumonia? x Thomas Seagraves , MD (EBEM Commentator) , x Michael Gottlieb , MD (EBEM Commentator (...) ) Department of Emergency Medicine, Rush University Medical Center, Chicago, IL DOI: | Publication History Published online: June 21, 2018 Expand all Collapse all Article Outline Take-Home Message For adult patients with severe community-acquired pneumonia, corticosteroids reduce morbidity and mortality. For pediatric patients and adults with nonsevere community-acquired pneumonia, corticosteroids appear to reduce morbidity, but not mortality. Methods Data Sources The authors searched the Cochrane Acute
Do Corticosteroids Benefit Patients With Influenza Pneumonia? Do Corticosteroids Benefit Patients With Influenza Pneumonia? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page To read this article in full, please review your options for gaining access at the bottom of the page. Article in Press Do Corticosteroids Benefit Patients With Influenza Pneumonia? x Michael Gottlieb , MD (EBEM Commentator) , x Thomas Seagraves , MD (EBEM (...) Commentator) , x Stephen R. Gore , MD (EBEM Commentator) Department of Emergency Medicine, Rush University Medical Center, Chicago, IL DOI: Publication History Published online: July 23, 2019 To view the full text, please login as a subscribed user or . Click to view the full text on ScienceDirect. Among patients with influenza pneumonia, corticosteroids are associated with increased mortality, longer length of stay in the ICU, and higher rates of secondary infection, although there are no data from
Oral Lefamulin vs Moxifloxacin for Early Clinical Response Among Adults With Community-Acquired Bacterial Pneumonia: The LEAP 2 Randomized Clinical Trial. New antibacterials are needed to treat community-acquired bacterial pneumonia (CABP) because of growing antibacterial resistance and safety concerns with standard care.To evaluate the efficacy and adverse events of a 5-day oral lefamulin regimen in patients with CABP.A phase 3, noninferiority randomized clinical trial conducted at 99 sites (...) in 19 countries that included adults aged 18 years or older with a Pneumonia Outcomes Research Team (PORT) risk class of II, III, or IV; radiographically documented pneumonia; acute illness; 3 or more CABP symptoms; and 2 or more vital sign abnormalities. The first patient visit was on August 30, 2016, and patients were followed up for 30 days; the final follow-up visit was on January 2, 2018.Patients were randomized 1:1 to receive oral lefamulin (600 mg every 12 hours for 5 days; n = 370
Excess Antibiotic Treatment Duration and Adverse Events in Patients Hospitalized With Pneumonia: A Multihospital Cohort Study. Randomized trials demonstrate no benefit from antibiotic treatment exceeding the shortest effective duration.To examine predictors and outcomes associated with excess duration of antibiotic treatment.Retrospective cohort study.43 hospitals in the Michigan Hospital Medicine Safety Consortium.6481 general care medical patients with pneumonia.The primary outcome (...) was the rate of excess antibiotic treatment duration (excess days per 30-day period). Excess days were calculated by subtracting each patient's shortest effective (expected) treatment duration (based on time to clinical stability, pathogen, and pneumonia classification [community-acquired vs. health care-associated]) from the actual duration. Negative binomial generalized estimating equations (GEEs) were used to calculate rate ratios to assess predictors of 30-day rates of excess duration. Patient outcomes
Effectiveness of a Bundled Intervention Including Adjunctive Corticosteroids on Outcomes of Hospitalized Patients With Community-Acquired Pneumonia: A Stepped-Wedge Randomized Clinical Trial Community-acquired pneumonia remains a leading cause of hospitalization, mortality, and health care costs worldwide. Randomized clinical trials support the use of adjunctive corticosteroids, early progressive mobilization, antibiotic switching rules, and dietary interventions in improving outcomes. However (...) hospitals in Melbourne, Australia, among a consecutive sample of patients with community-acquired pneumonia. The primary analysis and preparation of results took place between May 14 and November 25, 2018.Treating clinical teams were advised to prescribe prednisolone acetate, 50 mg/d, for 7 days (in the absence of any contraindication) and de-escalate from parenteral to oral antibiotics according to standardized criteria. Algorithm-guided early mobilization and malnutrition screening and treatment were
Diagnostic accuracy of lung ultrasound performed by novice versus advanced sonographers for pneumonia in children: A systematic review and meta-analysis Childhood pneumonia is a leading cause of mortality worldwide. Growing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic alternative to chest x-ray for childhood pneumonia. However, it is unclear whether sonographer experience affects the diagnostic accuracy of LUS. We summarize the diagnostic accuracy of LUS (...) for pneumonia and compare the performance between novice and advanced sonographers with a systematic review and meta-analysis.We searched PubMed and EMBASE from inception to February 2018 for eligible studies that evaluated the utility of LUS in children suspected of having pneumonia against the reference standard of either imaging results alone or a combination of clinical, laboratory, and imaging results. We reported the study using the Preferred Reporting Items for a Systematic Review and Meta-analysis
Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study. Pneumonia is the leading cause of death among children younger than 5 years. In this study, we estimated causes of pneumonia in young African and Asian children, using novel analytical methods applied to clinical and microbiological findings.We did a multi-site, international case-control study in nine study sites in seven countries (...) : Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia. All sites enrolled in the study for 24 months. Cases were children aged 1-59 months admitted to hospital with severe pneumonia. Controls were age-group-matched children randomly selected from communities surrounding study sites. Nasopharyngeal and oropharyngeal (NP-OP), urine, blood, induced sputum, lung aspirate, pleural fluid, and gastric aspirates were tested with cultures, multiplex PCR, or both. Primary analyses were restricted
Guideline-Based Clinical Assessment Versus Procalcitonin-Guided Antibiotic Use in Pneumonia: A Pragmatic Randomized Trial Efforts to reduce unnecessary and unnecessarily long antibiotic treatment for community-acquired pneumonia have been attempted through use of procalcitonin and through guidelines based on serial clinical assessment. Our aim is to compare guideline-based clinical assessment- and procalcitonin algorithm-guided antibiotic use among patients with community-acquired pneumonia.We (...) performed a pragmatic, randomized, multicenter trial from November 2012 to April 2015 at 12 French hospitals. We included emergency department (ED) patients older than 18 years with community-acquired pneumonia. Patients were randomly assigned to either the procalcitonin-guided or clinical assessment group. In accordance with past studies, we hypothesized that serial clinical assessment would be superior to procalcitonin-guided care. The primary outcome was antibiotic duration, and secondary outcomes
XueBiJing Injection Versus Placebo for Critically Ill Patients With Severe Community-Acquired Pneumonia: A Randomized Controlled Trial To investigate whether XueBiJing injection improves clinical outcomes in critically ill patients with severe community-acquired pneumonia.Prospective, randomized, controlled study.Thirty-three hospitals in China.A total of 710 adults 18-75 years old with severe community-acquired pneumonia.Participants in the XueBiJing group received XueBiJing, 100 mL, q12 hours (...) , and the control group received a visually indistinguishable placebo.The primary outcome was 8-day improvement in the pneumonia severity index risk rating. Secondary outcomes were 28-day mortality rate, duration of mechanical ventilation and total duration of ICU stay. Improvement in the pneumonia severity index risk rating, from a previously defined endpoint, occurred in 203 (60.78%) participants receiving XueBiJing and in 158 (46.33%) participants receiving placebo (between-group difference [95% CI], 14.4
Validity of SMART-COP score in prognosis and severity of community acquired pneumonia in the emergency department Determining prognosis in community acquired pneumonia (CAP), is very important. Many scores are introduced up to now for prediction of pneumonia prognosis like SMART-COP.To evaluate validity of SMART-COP score in prognosis and severity of CAP in emergency department (ED).All patients older than 18 years old with clinical suspicion of CAP (meeting the inclusion criteria), were
Should HIV-uninfected patients with Pneumocystis pneumonia be treated with corticosteroids? Chiefs’ Inquiry Corner – March 17th, 2019 – Clinical Correlations Search Chiefs’ Inquiry Corner – March 17th, 2019 March 18, 2019 3 min read Propofol is a short-acting, intravenous sedative-hypnotic that is metabolized by the liver and excreted in the urine as conjugates of 2,6-diisopropyl-1,4 quinol. The pharmacokinetics of propofol favor its use for the induction/maintenance of anesthesia (...) with other causes of immunocompromise, especially in those with solid organ or liquid transplants, chronic steroid use, chemotherapeutics, and other immunosuppressive medications. As the use of immunosuppressive agents has increased in recent years, so has the rate of non-HIV associated Pneumocystis pneumonia (PCP). The use of steroids in HIV-infected patients with PCP has been well established, but the role of steroids in HIV-uninfected patients is much less clear. Patients with PCP who are not infected
Solithromycin monotherapy for treatment of community-acquired bacterial pneumonia: A meta-analysis of randomised controlled trials Solithromycin is a new monotherapy option for community-acquired bacterial pneumonia (CABP) patients. However, the efficacy and safety of solithromycin monotherapy for the treatment of CABP remains controversial. The aim of this meta-analysis was to evaluate the role that solithromycin played in the treatment of CABP.We systematically retrieved randomised controlled
Preoperative chlorhexidine mouthwash to reduce pneumonia after cardiac surgery: A systematic review and meta-analysis Postoperative pneumonia is one of the most common complications after cardiac surgery, entailing increased patient morbidity, mortality, and health care burden. The primary aim of this study was to assess whether preoperative chlorhexidine mouthwash is associated with reduced postoperative pneumonia after cardiac surgery.A comprehensive systematic search of NLM Pubmed, Embase (...) , Scopus, and Cumulative Index of Nursing and Allied Health was executed to include the studies since inception to June 27, 2017, which assessed the effects of preoperative chlorhexidine gluconate mouthwash on postoperative pneumonia. Studies were identified by 2 independent reviewers, and data were extracted using a predefined protocol. Random effects models were run to obtain risk ratios with 95% confidence intervals. Quality of evidence was evaluated using Grading of Recommendations Assessment
Community-acquired pneumonia Community-acquired pneumonia - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Community-acquired pneumonia Last reviewed: February 2019 Last updated: February 2019 Summary Risk factors relate to environment, lifestyle factors, patient status, and comorbidities. Typically characterised by a new lung infiltrate on chest x-ray, together with one or more of the following: fever, chills, cough (...) , sputum production, dyspnoea, myalgia, arthralgia, pleuritic pain. Diagnosis should include a chest x-ray, although this has been challenged by studies using CT scanning. Initial treatment is empirical with antibiotics, following international guidelines and local epidemiology. Definition Community-acquired pneumonia (CAP) is defined as pneumonia acquired outside hospital or healthcare facilities. Clinical diagnosis is based on a group of signs and symptoms related to lower respiratory tract infection
Omadacycline for Community-Acquired Bacterial Pneumonia. Omadacycline, a new once-daily aminomethylcycline antibiotic agent that can be administered intravenously or orally, reaches high concentrations in pulmonary tissues and is active against common pathogens that cause community-acquired bacterial pneumonia.In a double-blind trial, we randomly assigned (in a 1:1 ratio) adults with community-acquired bacterial pneumonia (Pneumonia Severity Index risk class II, III, or IV) to receive (...) reported in 41.1% of the patients in the omadacycline group and 48.5% of the patients in the moxifloxacin group; the most frequent events were gastrointestinal (10.2% and 18.0%, respectively), and the largest difference was for diarrhea (1.0% and 8.0%). Twelve deaths (8 in the omadacycline group and 4 in the moxifloxacin group) occurred during the trial.Omadacycline was noninferior to moxifloxacin for the treatment of community-acquired bacterial pneumonia in adults. (Funded by Paratek Pharmaceuticals