![]() Previous studies in this field originating from the 1960s and 1970s are largely observational and suffer from flaws such as inhomogeneous patient populations and a lack of advanced statistical analysis therefore, they hardly form a valid basis for current management recommendations. 8 Given these variations and the potentially serious prognosis, it seems useful to determine which patients are at risk for these infections, thereby providing an additional target to ensure the adequacy of antimicrobial treatment and obviating the need for a general antimicrobial coverage of these pathogens in all patients. 6, 7 On the other hand, these pathogens have repeatedly been found to bear an adverse prognostic potential. The reported incidences of CAP in the general population have been quite variable, ranging from 0% to 9% for GNB 4, 5 and 0% to 5% for P aeruginosa. One of the major areas of debate includes the incidence of gram-negative bacteria (GNB) and Pseudomonas aeruginosa, and, as a result, the need for general coverage of these organisms when designing appropriate empirical antimicrobial treatment strategies. 1 - 3 This approach is based on microbial patterns derived from several large prospective epidemiological series originating from different regions. These pathogens are also an independent risk factor for death in patients with CAP.ĬURRENT GUIDELINES for the management of adult community-acquired pneumonia (CAP) recommend initial empirical antimicrobial treatment. Patients with probable aspiration, previous hospitalization or antimicrobial treatment, and pulmonary comorbidity are especially prone to GNB. 002).Ĭonclusions In our setting, in every tenth patient with CAP, an etiology due to GNB has to be considered. Infection with GNB was independently associated with death (relative risk, 3.4 95% CI, 1.6-7.4 P =. In a subgroup analysis of P aeruginosa pneumonia, pulmonary comorbidity (OR, 5.8 95% CI, 2.2-15.3 P<.001) and previous hospital admission (OR, 3.8 95% CI, 1.8-8.3 P =. 049), and the presence of pulmonary comorbidity (OR, 2.8 95% CI, 1.5-5.5 P =. Probable aspiration (odds ratio, 2.3 95% confidence interval, 1.02-5.2 P =. Sixty patients (11%) had CAP due to GNB, including P aeruginosa in 39 (65%). Results From January 1, 1997, until December 31, 1998, 559 hospitalized patients with CAP were included. Independent risk factors for CAP due to GNB and for death were identified by means of stepwise logistic regression analysis. ![]() Methods Consecutive patients with CAP hospitalized in our 1000-bed tertiary care university teaching hospital were studied prospectively. We determined the incidence of, prognosis of, and risk factors for CAP due to gram-negative bacteria (GNB), including Pseudomonas aeruginosa. Shared Decision Making and Communicationīackground Initial empirical antimicrobial treatment of patients with community-acquired pneumonia (CAP) is based on expected microbial patterns.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience. ![]()
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