Inclusion in an NLM database does not imply endorsement of, or agreement with, Bloos F, Marshall JC, Dellinger RP, et al. Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia. Pleural effusion. Systemic support may include proper hydration, nutrition, and early mobilization to create a positive host milieu to fight infection and speed recovery. Antimicrobial prescribing practices should not necessarily be based on national guidelines, but rather on patterns of MDR organisms at individual institutions. Study findings about the major causative bacteria of community-acquired pneumonia in Korea are summarized in Table 1. Prospective study of the aetiology and outcome of pneumonia in the community. Semin Respir Crit Care Med. The most important causative bacteria of bacterial pneumonia are S. pneumoniae. aLim WS, et al. Yoon HK. Chacko R, Rajan A, Lionel P, Thilagavathi M, Yadav B, Premkumar J. The information in this section is derived mainly from the current Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines for the management of CAP. Hospital-acquired infections due to gram-negative bacteria. Choi MJ, Song JY, Cheong HJ, Jeon JH, Kang SH, Jung EJ, Noh JY, Kim WJ. 3 A causal pathogen is often not identified. 2009 Dec;64(6):1123-5. doi: 10.1093/jac/dkp359. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Bae S, Lee J, Lee J, Kim E, Lee S, Yu J, Kang Y. Antimicrobial resistance in, Kim IS, Ki CS, Kim S, Oh WS, Peck KR, Song JH, Lee K, Lee NY. Discussion of empiric antibiotic therapy should be based on hospitalization status. Choi SH, Hong SB, Ko GB, Lee Y, Park HJ, Park SY, Moon SM, Cho OH, Park KH, Chong YP, Kim SH, Huh JW, Sung H, Do KH, Lee SO, Kim MN, Jeong JY, Lim CM, Kim YS, Woo JH, Koh Y. Murdoch DR, Laing RT, Cook JM. Diagnostic testing may require more complex studies when the cause of disease is less apparent. Failure to abide by these time parameters may be associated with poor outcome. Briones ML, Blanquer J, Ferrando D, Blasco ML, Gimeno C, Marn J. Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis. bronchodilation), Age, underlying diseases, acute progress, fever, pleuritic chest pain, Female gender, alcohol addiction, diabetes, chronic obstructive pulmonary disease, dry cough, Relatively young female, smoker, having no underlying diseases, diarrhea, neurological symptoms, severe pneumonia, multiple organ dysfunctions (, Young age, previous history of antibiotic use, multiple organ dysfunction is uncommon, Symptoms that persisted for a long period before hospital admission, headache. PCR can test various respiratory organ samples including nasopharyngeal samples, sputum, airway aspirates, and bronchoalveolar lavage fluid [31,32]. Leroy O, Saux P, Bdos JP, Caulin E. Comparison of levofloxacin and cefotaxime combined with ofloxacin for ICU patients with community-acquired pneumonia who do not require vasopressors. Moberley S, Holden J, Tatham DP, Andrews RM. Nuorti JP, Butler JC, Farley MM, Harrison LH, McGeer A, Kolczak MS, Breiman RF. Similar to 1918, the vast majority of deaths occurred in individuals younger than 65 years. Adjunctive therapies for community-acquired pneumonia: a systematic review. Administration of appropriate antibiotics at appropriate time, and use of a guideline on heparin administration for the prevention of thromboembolism have been observed to reduce mortality rates [168]. Empiric antibiotic therapy must be selected with this micro-organism in mind. J Lab Clin Med. 171(11):1209-23. Depending on the severity of the illness and type. 2016 Sep 1. High-resolution CT of the lung: patterns of disease and differential diagnoses. Therefore, the present revised guideline on the treatment of community-acquired pneumonia in Korea recommends the administration of -lactam or respiratory fluoroquinolone alone for patients with mild-moderate pneumonia who are hospitalized in general wards. Eliakim-Raz N, Robenshtok E, Shefet D, Gafter-Gvili A, Vidal L, Paul M, Leibovici L. Empiric antibiotic coverage of atypical pathogens for community-acquired pneumonia in hospitalized adults. Multiple randomized controlled trials have demonstrated that procalcitonin-based algorithms can safely reduce antibiotic use in 2 clinical scenarios. A 40-year-old patient with Chlamydia pneumonia. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. that prospectively compares -lactam administration, and -lactam + macrolide administration in the treatment of patients with severe pneumonia, 41.2% and 33.6% of the patients in the -lactam group, and the -lactam + macrolide group did not reach a clinically stable state after seven days, respectively (P = 0.07). Although some of the foreign clinical practice guidelines from which this guideline was adapted were scheduled for revisions in the near future, they were not presented during the developmental period, and could not be used in the development of this guideline. MMWR Morb Mortal Wkly Rep. 2009 Oct 2. There are not many domestic clinical studies on the causative bacteria of antibiotic treatment of severe community-acquired pneumonia. Transfer, if needed, is safe for a patient in otherwise stable condition who is being admitted for antibiotic therapy and pulmonary toilet. Vancomycin cannot reduce toxin production, and it is not yet clear if TMP-SMX and fluoroquinolones can reduce toxin production. If patient does not require treatment for underlying diseases, and does not require diagnostic tests, and a social environment in which the patient can be taken care of is established, discharge may be considered [136,157,161] (Table 11). The possibility of Legionella infection should always be considered when evaluating CAP, because delayed treatment significantly increases mortality. Ann Intern Med. Comparison of serological methods with PCR-based methods for the diagnosis of community-acquired pneumonia caused by atypical bacteria. 26 (11):594-599. [40]. Objective markers that can be used by clinicians to predict the death of patients with community-acquired pneumonia, or the severity of pneumonia in outpatient clinics, outpatient departments of medical institutions at the level of a hospital, and emergency departments may be useful for deciding whether to request hospitalization in a medical institution or to hospitalize a patient or not. Although guidelines have routinely recommended follow-up chest radiography in order to exclude underlying lung cancer, studies have found that the incidence of lung cancer following pneumonia is relatively low. The following antibiotics are recommended (in alphabetical order). This recommendation is based on a research finding S. pneumoniae isolated in Korea have low penicillin resistance when the antibacterial susceptibility standard developed by the CLSI (revised in January 2008), which has stricter criteria for the penicillin antibiotics of S. pneumoniae for patients without meningitis, is used. Therefore, appropriate initial antibiotic therapy for HAP and VAP may vary markedly according to hospital site. For patients with community-acquired pneumonia who require ICU admission, combination therapy is recommended over monotherapy. Postma DF, van Werkhoven CH, van Elden LJ, Thijsen SF, Hoepelman AI, Kluytmans JA, Boersma WG, Compaijen CJ, van der Wall E, Prins JM, Oosterheert JJ, Bonten MJ, CAP-START Study Group Antibiotic treatment strategies for community-acquired pneumonia in adults. MEDENOX Study. By using objective criteria, unnecessary hospitalization and its associated side effects can be minimized, and patients requiring hospitalization can be treated in a timely manner. According to the previous standards, S. pneumoniae are deemed to be susceptible to penicillin if MIC 0.06 g/mL, moderately resistant if MIC=0.1-1.0 g/mL, and highly resistant if MIC 2.0 g/mL. 163 (7):519-28. Chest radiograph shows dense consolidation in both lower lobes. Pneumonia Treatment Options - Verywell Health Clin Infect Dis. Repeated CRP measurement after three or four days of treatment can help identify patients who are at risk of treatment failure or who are at increased risk of complications. These criteria may also be applied to pneumonia caused by S. pneumoniae accompanied by bacteremia, which is known to have poor prognoses [158]. bPsychosis: Disorientation related to people, places, and time; or recently reduced level of consciousness. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Corresponding Author: Gee Young Suh, MD, PhD. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. The efficacious regimens are hand washing and isolation of patients with multiple resistant respiratory tract pathogens. For this reason, PCR may be more useful than serological tests for diagnosing Chlmydophila infection. In a retrospective study on 5,248 patients of advanced age who had pneumonia, there was no difference in the 14-day readmission rate, and the 30-day mortality rate between the patients who were discharged on the day that they switched to oral antibiotics, and those who were monitored for one more day after the switch [160]. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. The chest radiograph usually clears within four weeks in patients younger than 50 years without underlying pulmonary disease. KQ 14. On the other hand, cefuroxime has been excluded since S. pneumoniae isolated in Korea are highly resistant against the antibiotic. Pathogenesis, treatment, and prevention of pneumococcal pneumonia. The same investigators reported an expanded experience with antibiotic-resistant pneumococcal pneumonia for the years 1984 through 1993 . 2005 Sep 15. http://www.cdc.gov. [QxMD MEDLINE Link]. In addition, considering inpatients characteristics, the guideline recommends intravenous injections of -lactams including amoxicillin/clavulanic acid, ampicillin/sulbactam, cefotaxime, and ceftriaxone, or respiratory fluoroquinolones including gemifloxacin, levofloxacin, and moxifloxacin over oral antibiotics [expert opinion] [143,144]. Practitioner dilemna is not to worry too early (slow-resolving pneumonia with clinical cure in normal time but slow radiological resolution) or too late (non-resolving pneumonia with no clinical cure and persistence or radiological extension). It is traditionally accepted that patients who require mechanical ventilation due to respiratory failure, or have septic shock must be admitted and treated in an ICU. Reasonable options . Numerous randomized controlled clinical studies have been conducted to determine whether or not procalcitonin can be used as criteria for beginning or ceasing antibiotic use. A prediction rule to identify low-risk patients with community-acquired pneumonia. 27th ed. For patients at increased risk of infection with Pseudomonas (acceptable for both ICU and non-ICU patients), choose one option below: IV antipseudomonal beta-lactam plus IV antipseudomonal quinolone (PO quinolone in non-ICU patients only), IV antipseudomonal beta-lactam plus IV aminoglycoside plus one of the following: (1) IV macrolide; (2) IV antipneumococcal quinolone (PO in non-ICU patients only); or (3) if the patient has a documented beta-lactam allergy, administer IV aztreonam plus IV aminoglycoside plus IV antipneumococcal quinolone (PO quinolone in non-ICU only). In a domestic study on pneumonia, Mycoplasma, C. pneumoniae, and Legionella accounted for 6.3-9.2%, 7.1-13.2%, and 0.5-3% of all cases of pneumonia [11,12,13]. In two small-scale studies, use of steroids produced better treatment outcomes as opposed to when they were not used [194,195]. [QxMD MEDLINE Link]. A prospective multi-institutional randomized controlled clinical study has recently published its findings regarding the use of the procalcitonin test as the criteria for cessation of antibiotic use in patients who are administered antibiotics within 24 hours after ICU admission due to an infection [212]. Haemophilus or Moraxella, which are respiratory pathogens, commonly cause pneumonia in patients with a lung disease. Mayo Clin Proc. In domestic studies, Legionella accounted for 0-5.3% of the causative bacteria of pneumonia, but they were more common compared with other atypical pathogens in patients with severe pneumonia requiring ICU admission [11,12,13]. N Engl J Med. KQ 15. Active Bacterial Core Surveillance Team. Antimicrobial Therapy for Bacterial Pneumonia, http://pda.ahrq.gov/clinic/psi/psicalc.asp, http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm, http://www.medscape.com/viewarticle/850564, https://pneumonia.org.au/public/journals/22/PublicFolder/ABSTRACTBOOKMASTERforwebupdated20-3-14.pdf, American Association for Bronchology and Interventional Pulmonology, American College of Critical Care Medicine, Association of Pulmonary and Critical Care Medicine Program Directors, World Association for Bronchology and Interventional Pulmonology, American Association for Respiratory Care, American College of Osteopathic Emergency Physicians, American Medical Student Association/Foundation, American College of Physicians-American Society of Internal Medicine, Royal College of Physicians and Surgeons of Canada. Confalonieri M, Urbino R, Potena A, Piattella M, Parigi P, Puccio G, Della Porta R, Giorgio C, Blasi F, Umberger R, Meduri GU. 5Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. [QxMD MEDLINE Link]. [Full Text]. A blood culture test is performed before antibiotic administration for all patients with moderate or severe community-acquired pneumonia. Waterer GW, Wunderink RG. Abstract Bacterial pathogens are the most frequent cause of pneumonia after transplantation. Lee MY, Ko KS, Oh WS, Park S, Lee JY, Baek JY, Suh JY, Peck KR, Lee NY, Song JH. Prior pneumococcal vaccination is associated with reduced death, complications, and length of stay among hospitalized adults with community-acquired pneumonia. Post-COVID pneumonia treatment: Medications and alternatives 43(3):513-42, viii. Further studies are needed to investigate the cost-effectiveness of the procalcitonin test in reducing the cost of antibiotic prescriptions, and it is yet too early to recommend antibiotic treatment according to procalcitonin test results in an actual clinical practice guideline. Many bacteria, viruses, and even fungi can cause pneumonia in people who are hospitalized. Am J Med. Brenner DJ, Hall EJ. Executive Summary: Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Benitez AJ, Thurman KA, Diaz MH, Conklin L, Kendig NE, Winchell JM. The role of gram-negative bacteria in healthcare-associated pneumonia. Tularemia as a biological weapon: medical and public health management. Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, Macfarlane JT, Read RC, Roberts HJ, Levy ML, Wani M, Woodhead MA, Pneumonia Guidelines Committee of the BTS Standards of Care Committee BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Pneumonia is a leading cause of hospitalization among both adults and children in the United States, accounting for more than 800,000 hospitalizations and more than 400,000 emergency department visits in 2014.1, 2 It is among the most expensive conditions treated in US hospitals with national aggregate costs of $9.5 billion in 2013. Mechanical ventilatory support with low tidal volumes (6 mL/kg of ideal body weight) in patients with respiratory failure secondary to bilateral pneumonia or acute respiratory distress syndrome (ARDS) Phua J, See KC, Chan YH, Widjaja LS, Aung NW, Ngerng WJ, et al. Silver Spring, Md: US Food and Drug Administration; July 8, 2008. The criteria for switching to oral treatment are: 1) reduced cough and dyspnea; 2) fever: body temperature in the last eight hours <37.8C; 3) normal leukocyte count in a blood test; and 4) sufficient oral ingestion and normal gastrointestinal absorption [156,157]. Respiratory viruses were detected in 60 patients (18.3%) [5]. Am J Respir Crit Care Med. It has also been reported that since some of the factors included in the minor standard (leukopenia, thrombocytopenia, and hypothermia) are rarely observed in patients, the predictive power of the minor standard does not change even after these factors are excluded, and that adding other factors can increase its predictive power [126]. [Full Text]. Evidence-based emergency medicine/critically appraised topic. An antibiotic treatment guideline development committee for lower respiratory tract infection in adults was formed in November 2016.
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