Community-acquired staphylococcal pneumonia* Pneumonia estafilocócica adquirida na comunidade (original) (raw)
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Community-acquired pneumonia: current data
Annals of Research Hospitals
Until recently, pneumonia categorization was based on the triad: (I) Community-acquired pneumonia (CAP); (II) Hospital-acquired pneumonia; (III) Pneumonia in immunosuppressed patients. Host's immune condition and the environment that pneumonia was acquired defined this classification which was clinically important for the microbial cause and treatment. According to this, the initial empirical antimicrobial treatment could be determined (1). A new term was introduced in 2005 from the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) (2): health-care associated pneumonia (HCAP). This new pneumonia category initially seemed to offer a new opportunity to treat patients who until now with the classic triad were not treated properly. Some patients
Clinical presentations and outcome of severe community-acquired pneumonia
Egyptian Journal of Chest Diseases and Tuberculosis, 2016
Background: Severe community-acquired pneumonia (SCAP) represents a frequent and potentially life-threatening condition. About 10% of all hospitalized patients with CAP require admission to the intensive care unit (ICU), and the mortality of these patients reaches 20-50%. Objective: To evaluate the clinical presentation, bacteriological profile and outcome of severe community-acquired pneumonia (SCAP). Patients and methods: 54 patients presented by symptoms and sign of severe community acquired pneumonia who were admitted to respiratory care unit of Alhussein, Al-Azhar University Hospital from August 2015 to March 2016 were subjected to full clinical examination, chest X ray, complete blood picture, sputum and blood culture, PCR for suspected cases of Influenza H1N1 and MERS-COV, treatment, follow up, data collections and statistical analysis. Results: The present study included 54 patients 26 males and 28 females with SCAP who were admitted to respiratory care unit of Alhussein, Al-Azhar University Hospital. The most common comorbidities were diabetes mellitus and hypertension. The most common presentations were fever, cough, dyspnea and hypoxemia. Two patients developed renal failure and 4 patients developed septic shock. The most common isolated organism was Streptococcus pneumoniae, Influenza H1N1, and Staphylococcus aureus. Mortality was 24% and it was common in patients with comorbidity than in patients without comorbidities. Conclusion: SCAP occurs more frequently in those with comorbidities. The most frequent isolated causative organism of SCAP is S. pneumoniae, Influenza H1N1 and S. aureus. SCAP is associated with significant mortality, early recognition and prompt treatment may improve outcome.
" Clinical Profile Of Community Acquired Pneumonia "
Background: Community acquired pneumonia (CAP) is an acute illness acquired in the community with symptoms suggestive of lower respiratory tract infection (LRTI) together with the presence of a chest radiography of intrapulmonary shadowing which is likely to be new and has no clear alternative cause. Objective: To study the clinical presentation of community acquired pneumonia (CAP) and the risk factors associated with community acquired pneumonia. Methods: Cross sectional, prospective study done at the. 50 patients admitted with a clinical diagnosis of pneumonia were evaluated and non-infectious causes were excluded. Clinical data was collated and analysed. Results: Total of 50 patients were included in our study. 82% were male and 18% were female. The age of patients ranged from 19 years to 80 years, with a mean of 49.72 years overall. 68% of patients were from rural areas and 32% were from urban areas.86% of patients stayed in-hospital for 5-10 days, 10% for 11-15 days, and 4% for 16-21 days. Predisposing factors include hypertension, diabetes, COPD, smoking and alcoholism. Presenting symptoms include fever, cough, expectoration, dyspnea and chest pain. Examination findings included increased vocal fremitus/resonance, bronchial breathing, whispering pectoriloquy and crepitations.
[Community-acquired pneumonia with infrequent presentation]
Boletin medico del Hospital Infantil de Mexico, 2017
A 20-year-old mother with preparatory schooling, housewife, denied tattoos, alcoholism, and smoking, apparently healthy. Father of 20 years of age, student, technical worker, denied tattoos, alcoholism, and smoking. The patient is an only son. His paternal grandfather suffers type 2 diabetes mellitus. The patient was born and lives in Mexico City in a house of their own built with enduring materials, with all basic services. Housing with two rooms cohabited with five people. Denied coexistence with animals. He received exclusive breastfeeding. The mother declares complete immunization scheme, although immunization record was not showed. Born of the first pregnancy, with prenatal control from the first month with nine visits, iron, and folic acid supplements. Borne after 38 weeks of pregnancy by vaginal delivery. He cried and breathed after birth. Apgar 8/9, weight 2480 g, size 42 cm. He was discharged with his mother 48 hours after delivery. Allergies, transfusion, traumatisms and p...
Community-acquired pneumonia as an emergency condition
Current opinion in critical care, 2018
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 antibi...
Journal of Critical Care, 2014
Childhood community-acquired pneumonia (CAP) is common, and recent data have shown that the number of children with severe CAP is increasing worldwide. Regardless of geographical area, severe cases are those at the highest risk of hospitalisation, prolonged hospitalisation and death, and therefore require prompt identification and the most effective treatment in order to reduce CAP-related morbidity and mortality. This review evaluates the available data concerning the diagnosis and treatment of severe and/or complicated cases of paediatric CAP in developed and developing countries. It also underlines the fact that any evidence-based recommendations require more research in various areas, including the aetiology of severe cases and the reasons for the complications, the better definition of first-choice antibiotic treatment and when surgery may be useful, and the role of chest physiotherapy.
Etiology of Community-Acquired Pneumonia in Hospitalized Patients in Chile *
CHEST Journal, 2007
The range and relative impact of microbial pathogens, particularly viral pathogens, as a cause of community-acquired pneumonia (CAP) in hospitalized adults has not received much attention. The aim of this study was to determine the microbial etiology of CAP in adults and to identify the risk factors for various specific pathogens. Methods: We prospectively studied 176 patients (mean [؎ SD] age, 65.8 ؎ 18.5 years) who had hospitalized for CAP to identify the microbial etiology. For each patient, sputum and blood cultures were obtained as well as serology testing for Mycoplasma pneumoniae and Chlamydophila pneumoniae, urinary antigen testing for Legionella pneumophila and Streptococcus pneumoniae, and a nasopharyngeal swab for seven respiratory viruses. Results: Microbial etiology was determined in 98 patients (55%). S pneumoniae (49 of 98 patients; 50%) and respiratory viruses (32%) were the most frequently isolated pathogen groups. Pneumococcal pneumonia was associated with tobacco smoking of > 10 pack-years (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2 to 5.4; p ؍ 0.01). Respiratory viruses were isolated more often in fall or winter (28%; p ؍ 0.011), and as an exclusive etiology tended to be isolated in patients > 65 years of age (20%; p ؍ 0.07). Viral CAP was associated with antimicrobial therapy prior to hospital admission (OR, 4.5; 95% CI, 1.4 to 14.6). Conclusions: S pneumoniae remains the most frequent pathogen in adults with CAP and should be covered with empirical antimicrobial treatment. Viruses were the second most common etiologic agent and should be tested for, especially in fall or winter, both in young and elderly patients who are hospitalized with CAP. (CHEST 2007; 131:779 -787)
Study of Community-Acquired Bacterial Pneumonias Presenting to Tertiary Care Centre
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND Patients attending the Pulmonology OPD with symptoms of cough with expectoration of more than 10 days with pulmonary shadows suggestive of pneumonia were included in our study. Patients' positive for AFB in the sputum and symptoms suggestive of tuberculosis were excluded. MATERIALS AND METHODS 156 patients diagnosed to have pneumonia were included in the study. Patients having a history of cough with expectoration and fever for 10 days or more were subjected to clinical, radiological and sputum examination. Patients in whom tuberculosis was excluded by clinical, radiological and sputum examination and having associated shadows in the chest x-ray above 20 years of age were taken into the study and subjected to thorough clinical examination, haematological and biochemical examination. Sputum was sent for Gram stain and culture and sensitivity. Sensitivity pattern of the organisms isolated were studied. RESULTS 85% of patients belong to 40 years and above age group. 73.12% of these patients are males and rest are females. 54% of the patients presented as bronchopneumonia by Radiology. Bilateral lesions present in 55% of patients followed by right-sided lesions in 26% and left-sided lesions in 19%. Cough, expectoration, fever and chest pain were the common symptoms and nearly all the patients had symptoms. Increased white cell count at the time of admission correlated with increased duration of hospital stay and is statistically significant (the p-value is <0.00001). Active and passive smoking is associated with pneumonia and the value is statistically significant (p<0.00001). Presence of comorbidities is associated with increased hospital stay and the value is statistically significant (p<0.00001). Individual comorbidities are not associated with increased prevalence of pneumonia. Presence of comorbidities compared to absence of comorbidities showed a statistically significant correlation (p value <0.00001). 48% of the patients were diagnosed as having gram-positive cocci and nearly 15% gram-negative bacilli. 5.12% had mixed organisms and 28% had normal Gram stain study. 3.20% patients had fungal elements in Gram stain study. 127 out of 156 patients were positive for bacterial pathogens by culture. Commonest organism isolated was Streptococcus pneumonia in 32.69% followed by Staph aureus in 18.59%, Klebsiella in 8.97%, Pseudomonas in 5.76%, Haemophilus influenza in 4.48%, mixed pathogens in 8.97% and Citrobacter in 1.92%. No organism was isolated by culture in 18.58%. Streptococcus pneumonia and Haemophilus influenzae organisms isolated in these patients were sensitive to routine drugs in all these patients. Nearly, 10% of Staphylococci, 7% of Klebsiella and 22% Pseudomonas organisms are found resistant to the routine drugs. Tazobactam-Piperacillin resistance was seen in both Klebsiella and Pseudomonas species and both were sensitive to meropenem. CONCLUSION Community acquired pneumonia occurs in the older age group among the adult population. Smoking has a significant correlation with development of pneumonia. Predominant number of patients are male. Bilateral and bronchopneumonia pattern is the commonest presentation. Comorbidities and initial white blood cell concentration enhance the duration of hospital stay and the values are statistically significant. Commonest organism isolated is Streptococcus pneumonia followed by Staphylococcus aureus, Klebsiella, Haemophilus and Pseudomonas. Staphylococci, Klebsiella and Pseudomonas species showed resistance. Tazobactam + Piperacillin resistance is seen among Klebsiella and Pseudomonas species isolated in our centre.