Management Of Community-acquired Pneumonia Research Articles

Blind Spots of Traditional Microbiological Tests for Severe Community-Acquired Pneumonia in Adults and Availability of Nonculture Techniques: A Nationwide Survey of Physicians in China

In China, no national survey has been conducted to evaluate physicians' attitudes and compliance with guidelines in the management of adult patients with community-acquired pneumonia (CAP). Therefore, this study aimed to evaluate physicians' awareness of the use of microbiological tests in the management of severe CAP (SCAP) and to investigate the availability of nonculture tests in China. A nationwide electronic questionnaire survey was conducted among Chinese physicians between March and July 2018, which assessed their viewpoints concerning the issues in the management of SCAP. A total of 6333 physicians completed this survey, evenly covering all career stages. Among these, 3208 (50.6%) and 1936 (30.6%) had blind spots in the application of blood and sputum cultures in the management of SCAP, respectively. Nonteaching hospital, nonrespirologists, and junior career stage were independently associated with misunderstandings. Regarding nonculture methods, 52.7% of the facilities had no access to polymerase chain reaction-based pathogen detection tests. The accessibility of urinary antigen tests for Streptococcus pneumoniae (42.5%) and Legionella pneumophila (38.5%) was also low. The main barriers were inland and remote region, lower hospital level, and nonteaching hospital. Insufficient use of sputum and blood cultures, together with low accessibility of major nonculture techniques, were noticeable barriers to achieving microbiological diagnosis of SCAP in China. To help curb the overuse of broad-spectrum antibiotics, further measures should be taken to raise awareness among nonspecialists and promote rapid nonculture tests, especially in nonteaching hospitals and developing regions.

Antibiotic Stewardship in Community-Acquired Pneumonia

Antibiotic stewardship (ABS) denotes structured and continuous measures to improve the quality of prescribing anti-infectives. The aim is to achieve optimal treatment results and to minimize undesirable effects, especially the emergence of antibiotic resistance. This review summarizes the most important ABS principles based on recently published studies with implications for the management of community-acquired pneumonia. Local guidelines, education and training and "prospective audit and feedback" are established strategies to improve the management of patients with community-acquired pneumonia. However, the implementation of ABS programs requires trained personnel and may be impeded by limited structural and time resources. Hence, electronic health records and computer-based interventions are useful support for ABS programs and offer potential to facilitate ABS in inpatient and outpatient care. PCR-based rapid diagnostic tests, PCT-guided algorithms and penicillin allergy testing are suitable procedures to supplement ABS programs.

Clinical practice guidelines for the management of community-acquired pneumonia: A critical appraisal using the AGREE II instrument.

The aim of this study was to appraise the methodological quality of published clinical practice guidelines (CPGs) of community-acquired pneumonia (CAP) using AGREE II instrument for further enhancing the CAP CPG development. We performed a systematic review of published CPGs on CAP from January 2007 to May 2019. All reviewers independently assessed each CPG using the AGREE II instrument. A standardised score was calculated for each of the six domains. Our search strategy identified 4125 citations but just 18 met our inclusion criteria. Agreement among reviewers was very good: 0.98. The domains that scored better were: "scope and purpose" and "clarity and presentation". Those that scored worse were "editorial independence", and "applicability". According to the AGREE II evaluation for each Guideline, the NICE, IDSA, BTS, SWAB, Korea, Consensur II, Colombian and Peruvian CPGs were the only recommended with no further modifications. In addition, ERS and SEPAR CPGs were recommended with modifications, with lower scores regarding the editorial independence and applicability. In conclusion, published CPGs for CAP management vary in quality with a need to improve the methodological and applicability rigour. This could be achieved following the standards for guidelines development and a better emphasis on how to apply CPGs recommendations in clinical practice.

Burden of Community-Acquired Pneumonia and Unmet Clinical Needs.

Community-acquired pneumonia (CAP) is the leading cause of death among infectious diseases and an important health problem, having considerable implications for healthcare systems worldwide. Despite important advances in prevention through vaccines, new rapid diagnostic tests and antibiotics, CAP management still has significant drawbacks. Mortality remains very high in severely ill patients presenting with respiratory failure or shock but is also high in the elderly. Even after a CAP episode, higher risk of death remains during a long period, a risk mainly driven by inflammation and patient-related co-morbidities. CAP microbiology has been altered by new molecular diagnostic tests that have turned viruses into the most identified pathogens, notwithstanding uncertainties about the specific role of each virus in CAP pathogenesis. Pneumococcal vaccines also impacted CAP etiology and thus had changed Streptococcus pneumoniae circulating serotypes. Pathogens from specific regions should also be kept in mind when treating CAP. New antibiotics for CAP treatment were not tested in severely ill patients and focused on multidrug-resistant pathogens that are unrelated to CAP, limiting their general use and indications for intensive care unit (ICU) patients. Similarly, CAP management could be personalized through the use of adjunctive therapies that showed outcome improvements in particular patient groups. Although pneumococcal vaccination was only convincingly shown to reduce invasive pneumococcal disease, with a less significant effect in pneumococcal CAP, it remains the best therapeutic intervention to prevent bacterial CAP. Further research in CAP is needed to reduce its population impact and improve individual outcomes.

Американские (atS/idSa, 2019) и российские (РРо/МакМах, 2019) рекомендации по ведению внебольничной пневмонии у взрослых. два взгляда на актуальную проблему

Американские (atS/idSa, 2019) и российские (РРо/МакМах, 2019) рекомендации по ведению внебольничной пневмонии у взрослых. два взгляда на актуальную проблему

The impact of first Timing of antibiotics for community acquired pneumonia in emergency department

Background and objective: For patients with community-acquired pneumonia (CAP), reported associations between timing of the first dose of antibiotics and short-term mortality are inconsistent. To reduce the risks of antibiotic overuse in the emergency department, this summary of the relevant literature identified patients with CAP who benefit most from early antibiotic administration. Methods: A PubMed and Google Scholar search was performed for articles concerning the epidemiology, prognosis, diagnosis, and preliminary management of CAP. Results: Duplicate studies were eliminated and 370 citations were screened. Finally, 16 studies met the eligibility criteria. The review found that, in the presence of sepsis, antibiotics should not be delayed but administered as soon as possible. For patients with moderate-to-severe symptoms, antibiotics should be administered if a diagnosis of CAP is highly likely. For stable, non-critically ill patients with CAP, the timing of antibiotics remains unclear, but available evidence does not indicate strict requirements. For best quality of care, antibiotic timing whether rapid or delayed depends on the clinical situation. Conclusions: In suspected cases of pneumonia presenting in the emergency department, starting antibiotics early solely to conform to dogmatic guidelines within a rigid timeframe has led to unnecessary antibiotic treatment of uninfected patients, while the outcomes of patients with pneumonia have not improved. Since severity of illness is the key factor associated with poor outcomes in pneumonia, the timing of initial antibiotic treatment should be guided by the severity of symptoms.

Economic evaluation of community acquired pneumonia management strategies: Asystematic review of literature.

BackgroundCommunity-acquired pneumonia (CAP) is a major cause of mortality and morbidity worldwide. Efficient use of resources is fundamental for best use of money among the available and novel treatment options for the management of pneumonia. The objective of this study was to systematically review the economic analysis of management strategies of pneumonia.MethodsA systematic search was performed using Academic Search Complete, MEDLINE, EconLit, Global health, MEDLINE complete and Embase databases using specific subject headings or key words in May 2018 without restricting publication year. All search results were recorded and any type of economic evaluation for management of CAP was included for detailed review. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used for quality appraisal.ResultsNineteen studies met the inclusion criteria; ten studies were trial based, five conducted analysis using model based techniques and the rest of the studies were either based on observational, record review or pre-post intervention studies. Most of the studies conducted cost-effectiveness analysis (n = 15) and compared different combinations of antimicrobials. Most were based on developed countries (n = 17), considered adult age groups (n = 16) and used a provider perspective (n = 14). Nine studies reported dominant alternatives (lower cost with higher benefit). Sensitivity analysis was performed by the majority of studies (n = 15). Fourteen studies were assessed as either being excellent, very good or good quality, with no relationship found between publication year and study quality. Methodological variation, type of microbial used, perspective, costs and outcome measures limit the compatibility among the results of the included studies.ConclusionEconomic evaluation of interventions for management of CAP to date supports cost-effectiveness of studied interventions. However, evidence relates largely to antimicrobials choice in older populations in developed countries. Parallel economic evaluation of different management strategies of CAP is recommended for both developed and developing countries to support rigorous and robust comparative economic analysis within health care systems.PROSPERO registration no: CRD42018097174

Updated concepts in the diagnosis and management of community-acquired pneumonia

Pneumonia accounts for about 1 million hospitalizations each year in the United States. It is the number one cause of death from infectious disease and eighth leading cause of death in the United States. This article reviews recent updates in best practices for diagnosing and managing pneumonia in the ED or primary care practice. Despite developments in the diagnosis of pneumonia, vital signs and chest examination findings can and should guide clinical management. Chest radiography is routinely used to diagnose pneumonia. However, a negative chest radiograph should not replace clinical impression. In immunocompetent patients with community-acquired pneumonia, the CURB-65 decision rule has a role in identifying high-risk patients, including those who will require ICU admission and a critical care intervention.

Management Of Community-Acquired Pneumonia: An Observational Study In UK Primary Care.

PurposeIn primary care, initial diagnosis of community-acquired pneumonia (CAP) is made on clinical judgment without radiological confirmation or knowledge of the causative organism. Use of CRB65 score has been recommended for assessing the severity of CAP and thereby determining clinical management, but it is not known how frequently these scores are used in primary care.Patients and methodsPrimary care consultations in adults with a diagnostic code for CAP between 1 January 2009 and 31 December 2016 were extracted from the Optimum Patient Care Research Database, which at the time of data extraction had over 3.4 million patients in the UK. Episodes without antibiotic prescription on day of diagnosis were excluded, as were records describing past events. Patients admitted to hospital on day of diagnosis were excluded, but were included in exploratory analysis of CRB65 recording.ResultsIn total, 4734 episodes of CAP in adults managed in primary care between 1 January 2009 and 31 December 2016 were included. A range of investigations/observations were recorded, including pulse rate (10.7%), chest examinations (9.1%) and blood tests (5.4%). CRB65 scores were recorded in 19 (0.4%) episodes of CAP, 17 of which were after the publication of the NICE guidelines in December 2014. CRB65 recording was no more frequent in 3819 episodes referred to hospital (12, 0.3%; p=0.63), but where recorded, CRB65 scores were higher (Median: 1.0 [interquartile range: 0.5–1.0] vs 2.0 [interquartile range: 1.0–2.0], p=0.04). The most commonly prescribed antibiotic was amoxicillin (40.3%), and 85.9% of episodes had a prescription length of seven days.ConclusionCRB65 scores are seldom recorded in UK primary care. Given that these scores are embedded in UK guidelines, further work is required to assess feasibility and barriers to use of CRB65 scores in primary care.

Clinical Progress Note: Procalcitonin in the Diagnosis and Management of Community-Acquired Pneumonia in Hospitalized Adults.

Community-acquired pneumonia (CAP) accounts for more than 1.5 million adult hospitalizations and 100,000 deaths each year in the United States.1 Antibiotic overuse in the hospital setting is an important contributor to the rise of antibiotic resistance, prompting increased efforts to limit inappropriate antibiotic use in hospitals.2 Procalcitonin, a precursor of the hormone calcitonin, is upregulated in bacterial infections and downregulated in viral infections. The US Food and Drug Administration has approved it as a serum biomarker to assist clinicians with decisions about using antibiotics.3 There is no consensus on how to best use procalcitonin in the management of CAP. We provide a practical update that includes a review of recent literature, added secondary analysis, and expert opinion surrounding the use of procalcitonin in the diagnosis and management of CAP in hospitalized adults.

Outpatient management of community-acquired pneumonia.

Although most patients with community-acquired pneumonia (CAP) are treated as outpatients, the majority of data regarding CAP management is provided by hospitals, either from emergency department or inpatients. This was already noted in the first CAP guidelines, published in 1993, and the challenges regarding the outpatient management of CAP persist nowadays. These include the uncertainty of the initial diagnosis and risk stratification, the empirical choice of antibiotics, the overgrowing of antibiotic resistance bacteria and the relative scarcity of novel antibiotics. New molecular biology methods have changed the etiologic perspective of CAP, unveiling the role of virus. Diagnostic uncertainty may lead to antibiotic overuse and bacteria resistance. Novel antibiotics along with diagnostic improvement, related to the use of lung ultrasound and point-of-care biomarkers testing, may help to improve CAP treatment. Prevention, especially the use of antipneumococcal vaccine, is instrumental in reducing the burden of disease. Most of CAP cases are managed in the outpatient setting. However, most research is focused on hospitalized severe patients. New and awaited advances might contribute to aid diagnosis, cause and assessment of patients with CAP in the community. This knowledge might prove decisive in improving outcomes, as well as to the execution of stewardship programs that maintain current antibiotics, safeguard future ones and reinforce prevention.

Association of Chest Radiograph with Community Acquired Pneumonia among the Children Admitted in Dhaka Shishu Hospital

Background: Community-acquired pneumonia (CAP) is an infectious disease and common reason for hospitalization of children throughout the world. There are few published data about radiological findings and their relationship with community-acquired pneumonia (CAP) severity.
 Objective: This study was conducted to evaluate radiological findings in children with community acquired pneumonia (CAP) of different severity.
 Materials and method: A prospective study was conducted in the department of Paediatric Respiratory Medicine (Pulmonology) in Dhaka Shishu Hospital from November 2016 and April 2017. A total number of 35 children of 1 month to 10 years, who were admitted with cough or respiratory difficulty and radiological pneumonia were included in this study.
 Results: Majority of the study participants 18 (51.43%) were infants with a male preponderance. The most common symptom was cough (94.29%) followed by fever (82.86%) and respiratory distress (42.86%). Crepitation (54.29%), tachypnoea (42.86%) and chest indrawing (28.57%) were the most common signs. Out of total 35 children 17 (48.57%) cases had pneumonia and 18 (51.43%) cases had severe pneumonia. Among chest X-rays, severe pneumonia had greatest frequency of primary end point consolidation (PEP) on right side (n=10, 55.55%), right infiltrates (n=5, 27.78%), bilateral infiltrates (n=2, 11.11%) followed by right sided pleural effusion (n=3, 16.67%) and pneumothorax (n=2, 11.11%). There was no association found between CAP severity and presence of radiological findings of pneumonia.
 Conclusion: This study shows that severe CAP may not always be associated with positive radiological findings. This finding may be taken into consideration during the diagnosis and management of CAP.
 Delta Med Col J. Jan 2019 7(1): 21-25

The prognostic role of ultrasonographic air bronchogram in the management of community acquired pneumoniae in children

Chest ultrasound is a non-invasive method for evaluating children with suspected community-acquired pneumonia (CAP), allowing close follow-up and reduction of ionizing radiation. We studied the prognostic role of the change of ultrasonographic (US) air bronchogram in the management of CAP in terms of rate of complicated CAP, change in empiric antibiotic therapy, relationship to defervescence time, and length of hospitalization. Patients with diagnosis of CAP and radiographic evidence of lung consolidation were prospectively enrolled. The first chest US examination was performed within 12 h from admission and after 48 h. A new grading system (USINCHILD score) based on the presence and features of air bronchogram was adopted. Thirty six patients (mean age of 5 years) were stratified into two groups according to the presence of an increase in at least 1 grade of US score (Δ US grade), expression of an improvement of lung consolidation. The US grade after 48 h < 1 was associated with an increased risk of complicated CAP (OR: 160.88, p-value: 0.0109) and a longer defervescence time (70 h, p-value: 0.0047). Moreover, Δ US grade ≥ 1 was predictive of a short hospitalization (7 days, p-value: 0.0061). USINCHILD score could be an innovative biotechnology tool for the management of pediatric CAP.

Guideline Adherence in Diagnostic Testing and Treatment of Community-Acquired Pneumonia in Children.

The objective of this study was to determine emergency department (ED) physician adherence with the 2011 Pediatric Infectious Diseases Society (PIDS) and Infectious Diseases Society of America (IDSA) guidelines for outpatient management of children with mild-to-moderate community-acquired pneumonia (CAP). A cross-sectional survey of physicians on the American Academy of Pediatrics Section on Emergency Medicine Survey listserv was conducted. We evaluated ED physicians' reported adherence with the PIDS/IDSA guidelines through presentation of 4 clinical vignettes representing mild-to-moderate CAP of presumed viral (preschool-aged child), bacterial (preschool and school-aged child), and atypical bacterial (school-aged child) etiology. Of 120 respondents with analyzable data (31.4% response rate), use of chest radiograph (CXR) was nonadherent to the guidelines in greater than 50% of respondents for each of the 4 vignettes. Pediatric emergency medicine fellowship training was independently associated with increased CXR use in all vignettes, except for school-aged children with bacterial CAP. Guideline-recommended amoxicillin was selected to treat bacterial CAP by 91.7% of the respondents for preschool-aged children and by 75.8% for school-aged children. Macrolide monotherapy for atypical CAP was appropriately selected by 88.2% and was associated with obtaining a CXR (adjusted odds ratio, 3.9 [95% confidence interval, 1.4-11.1]). Guideline-adherent antibiotic use for all vignettes was independently associated with congruence between respondent's presumed diagnosis and the vignette's intended etiologic diagnosis. Reported ED CXR use in the management of outpatient CAP was often nonadherent to the PIDS/IDSA guidelines. Most respondents were adherent to the guidelines in their use of antibiotics. Strategies to increase diagnostic test accuracy are needed to improve adherence and reduce variation in care.

Epidemiological and clinical analysis of community-acquired Mycoplasma pneumonia in children from a Spanish population, 2010–2015

Introduction and objectivesMycoplasma pneumoniae (MP) is one of the most common etiological agents of community-acquired pneumonia (CAP) in children. We aimed to describe the clinical and epidemiological characteristics, treatment and outcome of children diagnosed with community-acquired MP pneumonia (CAMP) in a tertiary hospital in Valencia, Spain. Material and methodsMedical records of children <14 years with CAMP were retrospectively reviewed from January 2010 to December 2015. Patients with radiological evidence of pneumonia and microbiological confirmation of MP (PCR from nasopharyngeal swab and/or serum specific IgM) were considered CAMP. ResultsOne hundred and sixty two children were diagnosed with CAMP; median age 6 years (IQR: 4–9). The positive MP test rate among children with CAP progressively increased with age as did the empirical use of macrolides. There were two peaks of cases in 2011 and in 2015, being July, August, November and December the seasons with the higher number of cases. The most frequent radiological pattern was segmental infiltrate (62.3%) and 22 (13.6%) children had pleural effusion. It was noteworthy the mild symptomatology and low levels of inflammatory parameters that children with CAMP had. A macrolide was empirically initiated in 68.5% of cases. Hospital admission rate was inversely proportional to patient's age. ConclusionsAccording to this study, older, less symptomatic patients and with lower inflammatory parameters had the greatest rate of MP infection among children with CAP and thus they could benefit of empiric macrolide therapy. Therefore, knowing the epidemiology of a geographical area may be important for the management of CAP in children.

Epidemiological and clinical analysis of community-acquired Mycoplasma pneumonia in children from a Spanish population, 2010-2015

ResumenIntroducción y objetivosMycoplasma pneumoniae (MP) es uno de los agentes etiológicos más comunes de las neumonías adquiridas en la comunidad (NAC) en niños. Objetivo: describir las características clínicas y epidemiológicas, tratamiento y evolución de los pacientes con NAC por MP (NACM) en un hospital terciario de Valencia, España.Material y métodosSe revisaron retrospectivamente las historias clínicas de los niños < 14 años con NACM entre enero de 2010 y diciembre de 2015. Los pacientes con evidencia radiológica de neumonía y confirmación microbiológica de MP (PCR de exudado nasofaríngeo y/o anticuerpos IgM específicos frente a MP) se consideraron NACM.ResultadosUn total de 162 pacientes se diagnosticaron de NACM; mediana de edad de 6 años (rango intercuartílico: 4-9 años). La proporción de pruebas positivas para MP en pacientes con NAC, así como el uso empírico de macrólidos, aumentó progresivamente con la edad. Hubo un pico de casos en 2011 y en 2015, con un máximo de casos en julio, agosto, noviembre y diciembre. El patrón radiológico más frecuente fue el infiltrado segmentario (62,3%), mientras que 22 (13,6%) presentaron derrame pleural. Los niños con NACM desarrollaron una clínica leve, con poca elevación de parámetros inflamatorios. Se inició tratamiento empírico con un macrólido en el 68,5% de los casos. La necesidad de ingreso hospitalario fue inversamente proporcional a la edad del paciente.ConclusionesSegún este estudio, los niños con NAC de mayor edad tuvieron la mayor proporción de infección por MP, siendo poco sintomáticos y con escasa elevación de parámetros inflamatorios, pudiéndose beneficiar del tratamiento empírico con macrólidos. Por consiguiente, conocer la epidemiología de un área geográfica podría ser importante para el abordaje de las NAC en niños.

The Influence of National Guidelines on the Management of Community-Acquired Pneumonia in Children. Do Pediatricians Follow the Recommendations?

This is a retrospective study whose main objective was to analyze the influence of the Polish Guidelines for the Management of Respiratory Tract Infections of 2010 (PGMRTI) on in-hospital treatment of children with community-acquired pneumonia (CAP). Files from four Warsaw hospitals were reviewed to identify children with uncomplicated CAP, treated before (2008-2009) (pre-PGMRTI) and after (2011-2012) (post-PGMRTI) publication of the guidelines. Predefined data on the management were compared. A cohort of 2,359 children (1,081 pre-PGMRTI and 1,278 post-PGMRTI) was included. We found that co-amoxiclav was the most common first-line therapy in children >3months of age (34.6% and 40.4% pre- and post-PGMRTI, respectively), followed by cefuroxime (31.8% and 20.9% pre- and post-PGMRTI, respectively; p<0.0001) and macrolides (17.4% and 24.5% pre- and post-PGMRTI, respectively; p<0.0001). Amoxicillin was rarely used (5.4% and 4.9%, pre- and post-PGMRTI, respectively). The study revealed an overuse of inhaled bronchodilators, corticosteroids, and mucoactive drugs. Blood diagnostic tests were applied to a significant percentage of patients: blood cultures (41.2% and 44.5% pre-and post-PGMRTI, respectively) and serology for atypical pathogens (27.9% and 44.9% pre-and post-PGMRTI, respectively; p<0.0001). The number of follow-up chest X-rays increased (30.5% and 53.8% pre- and post-PGMRTI, respectively; p<0.0001). In conclusion, the study demonstrates an unsatisfactory influence of the guidelines on in-hospital management of CAP in children. Despite an explicit recommendation for the use of amoxicillin, it was still underused. Other methods of education and guideline dissemination are needed to optimize the prescribing of antibiotics.

Clinical Audit on Management of Community-Acquired Pneumonia in Pediatric Intensive Care Unit

AbstractBackground: Paediatric respiratory disease is an important cause of morbidity in both the developing as well as the developed world. Community Acquired Pneumonia (CAP) means an infection of the lung caused by multiple microor-ganisms acquired outside the hospital setting, leading to inflammation of the lung tissue. It is typically associated with fever and respiratory symptoms such as cough and tachypnea, but symptoms may be non-specific in young children. Radio-graphic changes may be useful to confirm the diagnosis. It remains an important cause of death in children throughout the world, especially in developing countries.Aim of Study: To evaluate the following using the 2011 pediatric CAP guidelines in children admitted in the Pediatric Intensive Care Unit (PICU) in the period from 1st of January to 31st of December, 2016 as the reference standard where applicable and try to make Guidline for the management of Community-Acquired Pneumonia in infants and children older than 3 months of age at pediatric Intensive Care Unit (PICU), Assuit University Children Hospital.Patients and Methods: This study is a clinical audit on management of Community Acquired Pneumonia (CAP) among children admitted in the Pediatric Intensive Care Unit (PICU) in the period from 1st of January to 31st of December, 2016. Evaluation was done according to the guidelines of Community Acquired Pneumonia (CAP) in infants and children recommended by the Pediatric Infectious Disease Society and the Infectious Diseases Society of America, August, 2011.Results: Our study was done on children with Community Acquired Pneumonia admitted to the Pediatric Intensive Care Unit (PICU), Assuit University Children Hospital in in the period from 1st of January to 31st of December, 2016. Our study included sixty cases of them there were 36 males (60%) and 24 females (40%). Their ages ranged from 3 months up to 17 years. Fifty five out of sixty cases (91.7%) presented with history of fever while fourty five cases (75%) presented with history of cough. According to WHO guidelines for criteria of respiratory distress in children with pneumonia the most common sign of respiratory distress was pulse oximetry measurement <90% on room air as it was present in fifty two cases (86.7%), followed by tachypnea which was present in fourty four cases (73.3%), altered mental status in thirty five cases (58.3%), chest retraction in twenty five cases (41.7%), grunting was in twenty three cases (38.3%), dyspnea in eighteen cases (30%). Apnea was present in fifteen cases (25%) while there was no case who presented with nasal flaring.Conclusion: An accurate and rapid diagnosis of the path-ogen responsible for CAP provides for informed decision making, resulting in improved care with focused antimicrobial therapy, fewer unnecessary tests and procedures, and, for those who are hospitalized, potentially shorter inpatient stays. Unfortunately, in the diagnosis of CAP, particularly bacterial CAP, there are no single diagnostic tests that can be considered the reference standard.We decided in this clinical audit to evaluate how will the guidelines have been followed in the acute management of children with Community Acquired Pneumonia at Pediatric Intensive Care. After studying patients admitted at PICU for CAP we found that many points in the 2011 pediatric CAP guidelines was neglected and not followed the most common point was Tracheal Aspirates and it was done for only one case (1.7%) while many other points were followed strongly as Pulse Oximetry and Initial Chest Radiographs that were done for (100%) of cases.

Community-acquired pneumonia as an emergency condition.

Despite the improvements in its management, community-acquired pneumonia (CAP) still exhibits high global morbidity and mortality rates, especially in elderly patients. This review focuses on the most recent findings on the epidemiology, cause, diagnosis and management of CAP. There is consistent evidence that the trend in CAP mortality has declined over time. However, the mortality of pneumococcal CAP has not changed in the last two decades, with an increase in the rate of hospitalization and more severe forms of CAP. Streptococcus pneumoniae remains the most frequent cause of CAP in all settings, age groups and regardless of comorbidities. However, the implementation of molecular diagnostic tests in the last years has identified respiratory viruses as a common cause of CAP too. The emergency of multidrug-resistance pathogens is a worldwide concern. An improvement in our ability to promptly identify the causative cause of CAP is required in order to provide pathogen-directed antibiotic therapy, improve antibiotic stewardship programs and implement appropriate vaccine strategies. It is time to apply all the knowledge generated in the last decade in order to optimize the management of CAP.

Die ambulant erworbene Pneumonie

Da die Symptome der ambulant erworbenen Pneumonie nicht diagnoseweisend sind, ist daran zu denken und eine laborchemische sowie bildgebende Diagnostik einzuleiten schon die halbe Miete. Was Sie noch beachten sollten und wann Sie Betroffene besser in die Klinik einweisen, erfahren Sie in diesem Beitrag.