The Challenging Diagnosis of Non-Community-Acquired Pneumonia in Non-Mechanically Ventilated Subjects: Value of Microbiological Investigation.
BACKGROUND: Early recognition and an attempt at obtaining microbiological documentation are recommended in patients with non-community-acquired pneumonia (NCAP), whether hospital-acquired (HAP) or health care-associated (HCAP). We aimed to characterize the clinical features and microbial etiologies...
| Publicado en: | Respiratory Care Vol. 61; no. 2; pp. 225 - 235 |
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| Autores principales: | , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Feb2016
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=112667906&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 112667906 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Feb2016 vid: 61 iid: 2 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 112667906 112667906 112667906 10.4187/respcare.04143 112667906 ppf: 225 ppct: 10 formats: fmt: @attributes: type: P tig: atl: The Challenging Diagnosis of Non-Community-Acquired Pneumonia in Non-Mechanically Ventilated Subjects: Value of Microbiological Investigation. aug: au: Messika, Jonathan Stoclin, Annabelle Bouvard, Eric Fulgencio, Jean-Pierre Ridel, Christophe Muresan, Ioan-Paul Boffa, Jean-Jacques Bachmeyer, Claude Denis, Michel Gounant, Valérie Esteso, Adoracion Loi, Valeria Verdet, Charlotte Prigent, Hélène Parrot, Antoine Fartoukh, Muriel affil: Service de Réanimation Médico-Chirurgicale, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France sug: subj: Pneumonia Diagnosis Cross Infection Human Funding Source Pneumonia Symptoms Pneumonia Microbiology Prospective Studies Academic Medical Centers Microbial Culture and Sensitivity Tests Intensive Care Units Methicillin-Resistant Staphylococcus Aureus France Descriptive Statistics Mann-Whitney U Test Chi Square Test McNemar's Test Wilcoxon Signed Rank Test Data Analysis Software Male Female Middle Age Aged Aged, 80 and Over Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: BACKGROUND: Early recognition and an attempt at obtaining microbiological documentation are recommended in patients with non-community-acquired pneumonia (NCAP), whether hospital-acquired (HAP) or health care-associated (HCAP). We aimed to characterize the clinical features and microbial etiologies of NCAP to assess the impact of microbiological investigation on their management. METHODS: This was a prospective 1-y study in a university hospital with 141 non-mechanically ventilated subjects suspected of having HAP (n = 110) or HCAP (n = 31). RESULTS: Clinical criteria alone poorly identified pneumonia (misdiagnosis in 50% of cases). Microbiological confirmation was achievable in 80 subjects (57%). Among 79 microorganisms isolated, 28 were multidrug-resistant aerobic Gram-negative bacilli and group HI Enterobacteriaceae and 6 were methicillin-resistant Staphylococcus aureus. Multidrug-resistant aerobic Gram-negative bacilli accounted for one third of the microorganisms in early-onset HAP and for 50% in late-onset HAP. Methicillin-resistant S. aureus was most often recovered from subjects with HCAP. Inappropriate empirical antibiotics were administered to 36% of subjects with confirmed pneumonia. Forty subjects were admitted to the ICU, 13 (33%) of whom died. Overall, 39 subjects (28%) died in the hospital. CONCLUSIONS: Integrating the microbiological investigation in the complex clinical diagnostic workup of patients suspected of having NCAP is mandatory. Respiratory tract specimens should be obtained whenever possible for appropriate management. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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