The Burden of Viruses in Pneumonia Associated With Acute Respiratory Failure An Underappreciated Issue
|
|
- Clement McDowell
- 6 years ago
- Views:
Transcription
1 [ Original Research ] The Burden of Viruses in Pneumonia Associated With Acute Respiratory Failure An Underappreciated Issue Andrew F. Shorr, MD, MPH; Kristen Fisher, MD; Scott T. Micek, PharmD; and Marin H. Kollef, MD BACKGROUND: Pneumonia associated with mechanical ventilation (MV) results in substantial mortality and represents a leading reason for the use of antibiotics. The role of viruses in this setting is unclear. Identifying a viral cause in such instances could facilitate antibiotic stewardship. METHODS: We performed a secondary analysis of a prospective cohort with pneumonia requiring MV. We included both cases occurring in the community and hospital-onset cases and classified patients according to the cause of the pneumonia. The prevalence of viral pathogens represented the primary end point. We identified variables independently associated with isolation of a viral organism as the sole pathogen. RESULTS: The cohort included 364 patients, and a virus was the sole pathogen in 79 cases (21.7%). The most common viruses included rhinovirus/enterovirus (n ¼ 20), influenza A (n ¼ 12), and respiratory syncytial virus (n ¼ 11). The rate of in-hospital death was high (37.2%) and did not differ from that seen in other patients (36.5%). The duration of MV, hospital length of stay, and 30-day readmission rates also did not differ based on the cause of pneumonia. Two variables were independently associated with recovery of a virus: an Acute Physiology and Health Evaluation II score of < 26 (adjusted odds ratio [AOR], 0.51; 95% CI, ; P ¼.027) and stem cell transplantation (SCT) (AOR, 4.39; 95% CI, ; P ¼.001). A sensitivity analysis excluding patients who underwent SCT did not substantially alter our observations. CONCLUSIONS: Viruses represent a major cause of pneumonia in critically ill patients requiring MV. Identifying such subjects presents an opportunity for discontinuing antibiotics. Clinicians should consider systematically evaluating patients with pneumonia requiring MV for viral pathogens. CHEST 2017; -(-):--- KEY WORDS: acute respiratory failure; bacteria; outcomes; pneumonia; virus ABBREVIATIONS: AOR = adjusted OR; CAP = community-acquired pneumonia; HAP = hospital-acquired pneumonia; LOS = length of stay; MV = mechanical ventilation; SCT = stem cell transplantation; VAP = ventilator-associated pneumonia AFFILIATIONS: From the Department of Medicine (Dr Shorr), Pulmonary and Critical Care Medicine Section (Dr Shorr), Medstar Washington Hospital Center, Washington, DC; the CardioPulmonary Associates of St. Lukes Hospital (Dr Fisher), Chesterfield, MO; the St. Louis College of Pharmacy (Dr Micek); and the Department of Medicine (Dr Kollef), Division of Pulmonary and Critical Care Medicine, Barnes Jewish Christian Hospital, St. Louis, MO. FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study. CORRESPONDENCE TO: Andrew F. Shorr, MD, MPH, Medstar Washington Hospital Center, 110 Irving St NW, Washington, DC 20010; andrew.shorr@gmail.com Copyright Ó 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. DOI: chestjournal.org 1
2 Pneumonia remains both a leading reason for mechanical ventilation (MV) and a potential complication of MV. Hence, the impact of pneumonia in the ICU remains substantial. 1,2 As such, multiple quality efforts focus on reducing the burden of pneumonia in the ICU, regardless of whether the pneumonia results in admission to the ICU or if it represents a consequence of MV. 2 Similarly, pneumonia in the setting of acute respiratory failure (ARF) continues to be a leading reason for antibiotic administration. 3,4 Appropriate and timely antibiotic administration is key to limiting morbidity and mortality in ARF and pneumonia. 5 This nexus between appropriate antibiotic therapy and outcomes has been demonstrated in diverse types of pneumonia, including severe community-acquired pneumonia (CAP), nosocomial pneumonia leading to ARF, and ventilatorassociated pneumonia (VAP). 5 Because of this relationship, intensivists often are quick to prescribe broad-spectrum antimicrobial agents in suspected cases of pneumonia. However, as a consequence, many patients are likely exposed unnecessarily to agents that are not specifically indicated. This overuse of antibiotics contributes to the escalating prevalence of resistant bacteria encountered in health care and further limits the options available to treat many emerging pathogens. One way to improve antibiotic prescribing and to increase rates of antibiotic de-escalation is to identify subjects who do not require further antibiotics because their pneumonic syndrome is caused by a viral pathogen. 6 Properly determining that the cause of a specific pneumonia is a viral pathogen can reassure the clinician that it is safe to discontinue further antibiotics (should no bacterial pathogen simultaneously be identified). In other words, better appreciating the range of pathogens encountered in pneumonia arising in or complicating ARF can foster improved antibiotic stewardship. Similarly, understanding the significance of viruses in ICU-related pneumonia could facilitate the development of both clinical decision aids and diagnostic tools that also might augment antibiotic stewardship. The significance of viral organisms in pneumonia historically was believed to be limited to immunosuppressed and transplant populations. Several contemporary analyses, however, illustrate the significance of viruses generally as important causes of pneumonia. Jain et al, 7 for instance, in an observational study of hospitalized patients with CAP noted that viruses were a more prevalent cause of the infection than were bacteria. Similarly, investigators have implicated viral organisms as a major cause of VAP. 8,9 Hong et al 9 isolated viruses in > 20% of VAP cases. To examine the epidemiology and outcomes associated with viral pneumonia seen in ARF, we conducted a retrospective analysis of pneumonia seen in patients undergoing MV. We hypothesized that viruses were common causes of pneumonia associated with ARF. We sought to describe the prevalence of viral organisms. We further aimed to assess the outcomes and risk factors associated with a viral cause in patients with pneumonia and respiratory failure requiring MV. Methods Study Overview This study was a secondary analysis of a prospective cohort of adult patients diagnosed with pneumonia in the setting of respiratory failure requiring MV during a 1-year period at a single center (January to December 2016). Prior aspects of this analysis, particularly information regarding bacterial causes and appropriate initial therapy, have been described elsewhere. 10 Briefly, the study was conducted between January 1, 2016 and December 31, We included only adults (age $ 18 years) admitted to the hospital for at least 48 hours and evaluated cases of pneumonia, regardless of whether it had a community or hospital onset. All subjects had to undergo MV for at least 24 hours to be included in the study cohort. In other words, we examined suspected cases of CAP, hospital-acquired pneumonia (HAP), and VAP. We excluded subjects transferred from other health-care facilities. As this study was retrospective, the hospital s institutional review board waived any need for informed consent (IRB No ). End Points and Definitions The isolation of a viral organism as the sole pathogen identified served as the primary end point for the study. We defined CAP, HAP, and VAP in accordance with the American Thoracic Society/Infectious Disease Society of America position statement on nosocomial pneumonia. 11 Initially, we identified patients for a potential diagnosis of pneumonia and concurrent ARF based on the physician ordering respiratory cultures. Following case finding based on the ordering of cultures, chest imaging was reviewed by one investigator (M. H. K.) (1) to ensure that there was an infiltrate consistent with a diagnosis of pneumonia and (2) to classify the pneumonia type based on the timing of the pneumonia relative to the onset of hospitalization and MV. We further required that all cases meet at least meet two of the following criteria: fever (> 38 C or < 35 C), leukocytosis or leukopenia, and purulent respiratory secretions to ensure the presence of pneumonia. We classified the results from respiratory cultures as demonstrating either a viral or a bacterial organism or as culture negative. Patients with both a bacterial and viral pathogen (ie, mixed infections) were classified as bacterial for purposes of our analysis given our focus on antibiotic stewardship. Respiratory specimens obtained through various approaches (eg, sputum, tracheal aspirate, and BAL) were included. We also reviewed results from blood cultures, pleural fluid cultures, and 2 Original Research [ - # - CHEST ]
3 urinary antigen tests to categorize subjects regarding the microbiological cause of their pneumonia. To identify viral agents, we relied on the results from a variety of viral specimens that were sent for qualitative nucleic acid tests for respiratory viruses (FilmArray Respiratory Panel; BioFire Diagnostics, Inc.). If only yeast was recovered, that was seen as a contaminant, and the test result was characterized as culture negative. All decisions regarding the ordering of respiratory cultures were undertaken by the patient s primary clinical team and were not guided by a formal protocol. Nonetheless, the ordering of viral testing was considered part of the routine standard evaluation for respiratory failure and pneumonia in the ICU. We recorded patient demographic characteristics along with comorbid illnesses such as coronary artery disease, congestive heart failure, COPD, and others. We calculated a Charlson comorbidity score for each patient to capture the global burden of chronic illness. 12 To assess immune status, we noted if the patient was receiving corticosteroids (> 10 mg of prednisone daily or equivalent), other immunosuppressive agents, or chemotherapy. We also recorded if the patient had undergone any form of transplantation (solid or stem cell transplantation [SCT]). For severity of illness, we calculated the Acute Physiology and Chronic Health (APACHE) II score along with determining whether the patient was in shock at the time of the pneumonia diagnosis. 13 Pneumonia type (eg, CAP, HAP, VAP) was determined, as noted earlier, based on definitions provided in recent guidelines. With respect to outcomes, we assessed in-hospital mortality along with the duration of MV, the ICU length of stay (LOS), and the overall hospital LOS (measured from the time of pneumonia diagnosis). Finally, we calculated the 30-day hospital readmission rate as a function of the cause of pneumonia. Statistical Analysis We compared categorical variables with the Fisher exact test and continuous variables with either the Student t test or the Mann- Whitney U test, as appropriate. Comparisons of continuous variables were analyzed with the Student t test if the data were parametrically distributed. If such data were nonparametric, we used the Mann- Whitney U test. All tests were two-tailed and P <.05 was considered to represent statistical significance. Time to event outcomes (eg, hospital LOS, duration of MV) were compared with the log-rank test. To determine factors independently associated with recovery of a viral cause, we used logistic regression. The regression was a stepwise backward approach, and we entered all variables significant at the 0.15 level in the univariate analysis into the model. Variables were assessed for colinearity. We assessed goodness of fit with the Hosmer- Lemeshow test. AORs and 95% CIs are presented when appropriate. After an initial review of data demonstrated a significant association between SCT and a viral cause, we performed a sensitivity analysis excluding patients who underwent SCT. All analyses were performed using SPSS, version 24.0 (IBM Corp.). Results The final cohort included 364 subjects (mean age, years; 44.2% men) with a high severity of illness (mean APACHE II score, ). Viruses alone were noted in 79 subjects (21.7%). The viruses isolated were diverse and included rhinovirus/enterovirus (n ¼ 20), influenza A (n ¼ 12), respiratory syncytial virus (n ¼ 11), metapneumovirus (n ¼ 8), parainfluenza (n ¼ 7), adenovirus (n ¼ 6), cytomegalovirus (n ¼ 5), and influenza B (n ¼ 1). There was no evident seasonality associated with the recovery of a virus as the cause of pneumonia. Viral testing was performed on respiratory samples obtained in > 95% of cases. In one case of viral pneumonia, concurrent blood culture results revealed a bacterial pathogen. In patients with other than solely viral infections, the majority had bacterial infections. Specifically, in 167 subjects (45.9% of the entire cohort), a bacterial organism was identified. In the remainder (n ¼ 118), neither a bacterial nor viral organism was recovered. In one patient, there was coinfection with both a bacterial pathogen and a virus. This subject had a communityonset infection. As Table 1 reveals, there were no differences between those with a viral cause alone and others with respect to demographic variables or comorbidities. Reflecting this, the median Charlson comorbidity score for the two cohorts was 3. The use of noncorticosteroid immunosuppressive drugs was more common in persons with viral pneumonia, but this difference only approached statistical significance. However, as Table 1 indicates, there was a strong link between SCT and a viral cause. Those who had received or were undergoing SCT were approximately 2 1 / 2 times (OR, 2.51; 95% CI, ) more likely to have a virus identified as the sole cause for their pneumonia in the setting of MV. In contrast, the cause of pneumonia (Fig 1) did not vary based on pneumonia type. For example, two-thirds of all viral cases represented community-onset infection, as did two-thirds of bacterial and culture-negative events. Regarding severity of illness, the APACHE II score was slightly lower in those with a viral infection. This difference, however, only represented a trend toward statistical significance. There was no difference in the prevalence of shock as a function of the type of culprit organism. Strikingly, 67.1% of viral pneumonias were complicated by shock. Outcomes (Table 2) were similar between patients with a viral pathogen and those with other causes of pneumonia. Crude mortality rates were high, with more than 37% of persons with respiratory failure and pneumonia from a virus dying while hospitalized. Viral pneumonia, furthermore, was associated with a median duration of MV of 6 days. chestjournal.org 3
4 TABLE 1 ] Patient Characteristics Variable Virus (n ¼ 79) Other (n ¼ 285) P Value Demographics Age, mean SD, y Male sex, % Race White, % Black, % Other, % Comorbidities CHF, % COPD, % DM, % ESRD, % Malignancy, % Charlson comorbidity score, median Immune status Corticosteroid administration, % Administration of other immunosuppressive medications, % HIV, % Solid organ transplantation, % Stem cell transplantation, % Metastatic malignancy, % HIV, % Severity of illness Shock, % APACHE II score, mean þ SD APACHE ¼ Acute Physiology and Chronic Health Evaluation; CHF ¼ congestive heart failure; DM ¼ diabetes mellitus; ESRD ¼ end stage renal disease. Logistic regression revealed two variables that were independently associated with the isolation of only a virus in pneumonia necessitating MV. An APACHE II score > 26 was linked to a lower risk of a viral organism (AOR, 0.51; 95% CI, ; P ¼.027). Conversely, SCT resulted in a significantly increased likelihood of a virus as the cause of pneumonia and respiratory failure (AOR, 4.39; 95% CI, ; P ¼.001). There was a trend toward viruses being a less frequent cause (AOR, 0.29; 95% CI, p; P ¼.100) in VAP. The overall model had good fit as demonstrated by the Hosmer-Lemeshow C-statistic (P ¼.791). In the sensitivity analysis excluding persons who had undergone or were receiving SCT, the cohort included 330 subjects, 20.3% of whom were classified as having a viral cause. The baseline characteristics of the remaining subjects did not generally vary as a function of whether the pneumonia was classified as viral or nonviral (data not shown). As with the overall analysis, two factors remained independently associated with the recovery of a virus alone. First, an APACHE II score > 26 continued to be connected with a reduced likelihood of a viral cause (AOR, 0.41; 95% CI, ; P ¼.010). Second, treatment with a noncorticosteroid immunosuppressive agent remained associated with a higher prevalence of viral organisms (AOR, 2.36; 95% CI, ; P ¼.010). More broadly, nearly 73% of the cohort was in no way immunocompromised (eg, met no criteria for being immunosuppressed). Among these patients with normal immune systems, viruses were isolated in 20.1%, indicating the generally high prevalence of such organisms. For the remaining cohort that was in any way immunosuppressed, a viral pathogen was responsible in 26.0% of instances (P ¼.255). Discussion This analysis of a cohort of patients with pneumonia while undergoing MV indicates that viruses are the sole cause of pneumonia in approximately 20% of cases. Moreover, viral pneumonia related to respiratory failure 4 Original Research [ - # - CHEST ]
5 print & web 4C=FPO % of Patients Viral Community Onset (n = 237) results in severe critical illness and often is associated with shock. Crude mortality rates and resource use in the setting of viral pneumonia and ARF are substantial and nearly indistinguishable from those related to bacterial infection. Since there are few effective agents to treat viral pulmonary infections, the scenario is essentially akin to patients with severe bacterial pneumonia who receive either delayed or inappropriate antibiotic therapy. Others have examined the epidemiology of pneumonia in more narrow cohorts of subjects. For example, Choi et al 8 documented the high prevalence of viruses in patients hospitalized with community-onset pneumonia. Specifically, they noted that more than one-third of those with health-care-associated pneumonia were infected with a virus. In a follow-up study, they observed that for 22.5% of persons with VAP, the infection was caused by a virus. As we found, they observed that the most common viruses recovered were respiratory syncytial virus and parainfluenza virus. Hong et al 9 further reported a high prevalence of viruses recovered in persons with HAP needing ICU admission. Garbino TABLE 2 ] Outcomes Other (Bacterial & Culture Negative) Hospital-acquired Ventilator-associated Pneumonia (n = 98) Pneumonia (n = 29) Figure 1 Viral etiology based on pneumonia type. Although no statistical difference in the overall distribution of pneumonia types between the population (P ¼.357), ventilator-associated pneumonia was less frequent amont viral cases (P <.05). Outcome Virus (n ¼ 79) Other (n ¼ 285) P Value Hospital mortality, % ICU LOS, median, d Hospital LOS, median, d Duration of MV, median Readmission, % LOS ¼ length of stay; MV ¼ mechanical ventilation. et al, 14 focusing mainly on immunosuppressed subjects, estimated that 17% of such patients undergoing BAL for pneumonia were infected with a viral organism. Finally, in an earlier report investigating the burden of viral pneumonia in nonventilated HAP, we documented that approximately 25% of patients had a virus as the sole culprit pathogen. 15 Our current analysis builds on and adds to these earlier evaluations not only by confirming the relatively high prevalence of viral pathogens in severe pneumonia but also by describing the mortality and morbidity burden associated with these infectious agents. Moreover, we did not restrict our analysis to a specific cohort of patients based on either pneumonia type (eg, CAP vs VAP) or immune status. Hence, we show more broadly that viruses are generally a key causative agent for pneumonia in critically ill patients with ARF, regardless of various pneumonia and patient characteristics. Those patients with viral pneumonia in the setting of ARF represent a potential target for antibiotic stewardship. Formally identifying that a virus is the only infectious agent recovered should facilitate the discontinuation of antibiotics. Since pneumonia represents the most common reason given by physicians for prescribing antibiotics in the ICU, rationally reducing their use when they will not confer benefit should constrain both costs and the ensuing selection pressure that drive antibiotic resistance. However, one cannot determine if a virus is present unless it is sought. In other words, our observations indicate that a search for a viral cause in ARF and pneumonia is prudent, especially if bacterial culture results are unrevealing. Thus, we recommend wider use of viral diagnostic technologies in patients with pneumonia who are receiving MV in the ICU. Unfortunately, clinical characteristics alone do not reliably allow the clinician to predict in whom a virus is unlikely to be present. As our multivariate analysis underscores, few factors are independently associated with the isolation of a virus. Even our attempt to enhance one s ability to stratify patients as to the likelihood of a viral cause through our sensitivity analysis reveals that baseline characteristics do not differ in substantial ways between those with and those without a viral organism as the sole cause for their pneumonia. In short, the select items we identified as independently connected with isolation of virus occur commonly in subjects with a bacterial infection. More importantly, the consistent finding, across various settings and types of pneumonia, that viruses cause chestjournal.org 5
6 nearly one-quarter of such infections emphasizes the need for newer and enhanced rapid diagnostic modalities for viral pathogens along with a necessity for clinical trials exploring novel treatment paradigms. Our study labors under several important limitations. First, this effort is technically retrospective in design and susceptible to various types of bias. However, all the data analyzed were prospectively collected. Second, viral testing was not required in all suspected cases, and our results thus likely represent a lower bound estimate of the true prevalence of viral causes. Likewise, not every patient underwent a standardized evaluation, and select diagnostic tests (eg, serum titers for certain bacterial pathogens) were not routinely ordered. Given that more extensive testing uniformly results in identifying greater numbers of culprit pathogens, we cannot exclude that bias from this phenomenon confounds our results. Our confirmation of the frequency of viruses in severe pneumonia, therefore, likely represents a lower-level estimate of the prevalence of such organisms. Third, no diagnostic test has perfect sensitivity and specificity. Therefore, there is the possibility of misclassification bias. Subjects with true bacterial infections were likely missed. For instance, we did not use procalcitonin to explore how many culturenegative patients might have actually had a high suspicion for a bacterial infection. Fourth, our project represents results from a single large academic hospital. Its generalizability to other settings must not be presumed. Fifth, some of the associations we noted in the multivariate analyses may reflect confounding by indication. In other words, immunosuppressed patients may not actually be at higher risk for viral pneumonia. Rather, because of the existing perception that they are, physicians were more aggressive with viral diagnostic techniques in those patients. The high rate of viral testing, conversely, suggests this may be a more narrow concern. Nonetheless, these various issues indicate that our conclusions should be viewed as hypothesis generating. Allaying many of these worries, however, is the general consistency of our basic findings with those of others who have examined this query from different vantage points. In conclusion, viral pathogens are important causes of pneumonia in patients with ARF who require MV. The viruses recovered are heterogeneous in type and reflect a degree of diversity similar to that encountered with bacterial organisms. Outcomes for patients receiving MV due to viral pneumonia are poor, and clinical covariates do not differentiate patients with distinct microbial causes. More aggressive efforts to search for viral pathogens represent a potential means for enhancing antibiotic stewardship. Acknowledgments Author contributions: A. F. S. is guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article. A. F. S., K. F.,S.T.M.,andM.H.K.haveallmade substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafting of the submitted article or critical revision for important intellectual content; and provision of final approval of the version to be published. They agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: M. H. K. is supported by the by the BJC Healthcare Foundation. A. F. S. has received research support from, served as a consultant to, or been a speaker for Accelerate, Achaogen, Alios, Allergan, Aridis, Astellas, AstraZeneca, Bayer, Cidara, Entasys, MedCo, Melinta, Merck, Nabriva, Paratek, and Tetraphase. None declared (K. F., S. T. M.). References 1. Nicolau DP, Dimopoulos G, Welte T, Luyt CE. Can we improve clinical outcomes in patients with pneumonia treated with antibiotics in the intensive care unit? Expert Rev Respir Med. 2016;10: Schreiber MP, Shorr AF. Challenges and opportunities in the treatment of ventilator-associated pneumonia. Expert Rev Anti Infect Ther. 2017;15: Doernberg SB, Chambers HF. Antimicrobial stewardship approaches in the intensive care unit. Infect Dis Clin North Am. 2017;31: Kollef MH, Bassetti M, Francois B, et al. The intensive care medicine research agenda on multidrug-resistant bacteria, antibiotics, and stewardship. Intensive Care Med. 2017;43(9): Zilberberg MD, Nathanson BH, Sulham K, Fan W, Shorr AF. Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis. BMC Infect Dis. 2017;17: Arnold HM, Micek ST, Skrupky LP, Kollef MH. Antibiotic stewardship in the intensive care unit. Semin Respir Crit Care Med. 2011;32: Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373: Choi SH, Hong SB, Ko GB, et al. Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med. 2012;186: Hong HL, Hong SB, Ko GB, et al. Viral infection is not uncommon in adult patients with severe hospital-acquired pneumonia. PLoS One. 2014;9:e Fisher K, Trupka T, Micek ST, Juang P, Kollef MH. A prospective one-year survey of combined pneumonia and respiratory failure. Surg Infect (Larchmt). 2017;18(7): Original Research [ - # - CHEST ]
7 11. Kalil AC, Metersky ML, Klompas M, et al. 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. Clin Infect Dis. 2016;63: Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47: Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13: Garbino J, Soccal PM, Aubert JD, et al. Respiratory viruses in bronchoalveolar lavage: a hospital-based cohort study in adults. Thorax. 2009;64: Shorr AF, Zilberberg MD, Micek ST, Kollef MH. Viruses are prevalent in non-ventilated hospital-acquired pneumonia. Respir Med. 2017;122: chestjournal.org 7
MDR AGENTS: RISK FACTORS AND THERAPEUTIC STRATEGIES
MDR AGENTS: RISK FACTORS AND THERAPEUTIC STRATEGIES 1 Marin H. Kollef, MD Professor of Medicine Virginia E. and Sam J. Golman Chair in Respiratory Intensive Care Medicine Washington University School of
More informationCare Guideline DRAFT for review cycle 08/02/17 CARE OF THE ADULT PNEUMONIA PATIENT
Care Guideline DRAFT for review cycle 08/02/17 CARE OF THE ADULT PNEUMONIA PATIENT Target Audience: All MHS employed providers within Primary Care, Urgent Care, and In-Hospital Care. The secondary audience
More informationVAP Are strict diagnostic criteria advisable?
VAP Are strict diagnostic criteria advisable? Javier Garau, MD, PhD 18th Infection and Sepsis Symposium, Porto, 27th February 2013 Limitations of current definitions Alternatives -Streamlined definition
More informationSupplementary Online Content
Supplementary Online Content Torres A, Sibila O, Ferrer M, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory
More informationCARE OF THE ADULT PNEUMONIA PATIENT
Care Guideline CARE OF THE ADULT PNEUMONIA PATIENT Target Audience: The target audience for this Care Guideline is all MultiCare providers and staff, including those associated with our clinically integrated
More informationDiagnosis of Ventilator- Associated Pneumonia: Where are we now?
Diagnosis of Ventilator- Associated Pneumonia: Where are we now? Gary French Guy s & St. Thomas Hospital & King s College, London BSAC Guideline 2008 Masterton R, Galloway A, French G, Street M, Armstrong
More informationChapter 22. Pulmonary Infections
Chapter 22 Pulmonary Infections Objectives State the incidence of pneumonia in the United States and its economic impact. Discuss the current classification scheme for pneumonia and be able to define hospital-acquired
More informationDiagnosis of Ventilator-Associated Pneumonia: A Pilot, Exploratory Analysis of a New Score Based on Procalcitonin and Chest Echography
CHEST 2014; 146(6): 1578-1585 文献精读 Diagnosis of Ventilator-Associated Pneumonia: A Pilot, Exploratory Analysis of a New Score Based on Procalcitonin and Chest Echography Giovanni Zagli, MD, PhD ; Morena
More informationCommunity Acquired & Nosocomial Pneumonias
Community Acquired & Nosocomial Pneumonias IDSA/ATS 2007 & 2016 Guidelines José Luis González, MD Clinical Assistant Professor of Medicine Outline Intro - Definitions & Diagnosing CAP treatment VAP & HAP
More informationRepeated Pneumonia Severity Index Measurement After Admission Increases its Predictive Value for Mortality in Severe Community-acquired Pneumonia
ORIGINAL ARTICLE Repeated Pneumonia Severity Index Measurement After Admission Increases its Predictive Value for Mortality in Severe Community-acquired Pneumonia Chiung-Zuei Chen, 1 Po-Sheng Fan, 2 Chien-Chung
More informationGuidelines. 14 Nov Marc Bonten
Guidelines 14 Nov 2014 Marc Bonten Treatment of Community-Acquired Pneumonia SWAB/ NVALT guideline 2011, replaced SWAB guideline 2005 Empirical treatment must cover the most likely causative pathogen.
More informationGuess or get it right?
Guess or get it right? Antimicrobial prescribing in the 21 st century Robert Masterton Traditional Treatment Paradigm Conservative start with workhorse antibiotics Reserve more potent drugs for non-responders
More informationLate diagnosis of influenza in adult patients during a seasonal outbreak
ORIGINAL ARTICLE Korean J Intern Med 2018;33:391-396 Late diagnosis of influenza in adult patients during a seasonal outbreak Seong-Ho Choi 1, Jin-Won Chung 1, Tark Kim 2, Ki-Ho Park 3, Mi Suk Lee 3, and
More informationHerpes virus reactivation in the ICU. M. Ieven BVIKM
Herpes virus reactivation in the ICU M. Ieven BVIKM 07.04.2011 Introduction: Viruses identified in critically ill ICU patients Viral diseases have recently been the subject of numerous investigations in
More informationKatherine E. Kollef; Richard M. Reichley, RPh; Scott T. Micek, PharmD; and Marin H. Kollef, MD, FCCP
CHEST Original Research The Modified Score Outperforms Curb65 Pneumonia Severity Score as a Predictor of 30-Day Mortality in Patients With Methicillin- Resistant Staphylococcus aureus Pneumonia* Katherine
More informationOutcomes with micafungin in patients with candidaemia or invasive candidiasis due to Candida glabrata and Candida krusei
J Antimicrob Chemother 211; 66: 375 3 doi:1.193/jac/dkq446 Advance Access publication 8 December 21 Outcomes with micafungin in patients with candidaemia or invasive candidiasis due to Candida glabrata
More informationCOPD exacerbation. Dr. med. Frank Rassouli
Definition according to GOLD report: - «An acute event - characterized by a worsening of the patients respiratory symptoms - that is beyond normal day-to-day variations - and leads to a change in medication»
More informationHEALTHCARE-ASSOCIATED PNEUMONIA: EPIDEMIOLOGY, MICROBIOLOGY & PATHOPHYSIOLOGY
HEALTHCARE-ASSOCIATED PNEUMONIA: EPIDEMIOLOGY, MICROBIOLOGY & PATHOPHYSIOLOGY David Jay Weber, M.D., M.P.H. Professor of Medicine, Pediatrics, & Epidemiology Associate Chief Medical Officer, UNC Health
More informationNew Surveillance Definitions for VAP
New Surveillance Definitions for VAP 2012 Critical Care Canada Forum Toronto Dr. John Muscedere Associate Professor of Medicine, Queen s University Kingston, Ontario Presenter Disclosure Dr. J. G. Muscedere
More informationOutcomes of Moderate-to-Severe Pneumocystis Pneumonia Treated with Adjunctive Steroid in Non-HIV-Infected Patients
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Oct. 2011, p. 4613 4618 Vol. 55, No. 10 0066-4804/11/$12.00 doi:10.1128/aac.00669-11 Copyright 2011, American Society for Microbiology. All Rights Reserved. Outcomes
More informationRespiratory Syncytial Virus (RSV) in Older Adults: A Hidden Annual Epidemic. Webinar Agenda
Respiratory Syncytial Virus (RSV) in Older Adults: A Hidden Annual Epidemic Wednesday, November 2, 2016 12:00 PM ET Webinar Agenda Agenda Welcome and Introductions William Schaffner, MD, NFID Medical Director
More informationAntimicrobial Stewardship in Community Acquired Pneumonia
Antimicrobial Stewardship in Community Acquired Pneumonia Medicine Review Course 2018 Dr Lee Tau Hong Consultant Department of Infectious Diseases National Centre for Infectious Diseases Scope 1. Diagnosis
More informationCHEST VOLUME 117 / NUMBER 4 / APRIL, 2000 Supplement
CHEST VOLUME 117 / NUMBER 4 / APRIL, 2000 Supplement Evidence-Based Assessment of Diagnostic Tests for Ventilator- Associated Pneumonia* Executive Summary Ronald F. Grossman, MD, FCCP; and Alan Fein, MD,
More informationAccurate Diagnosis Of Postoperative Pneumonia Requires Objective Data
Accurate Diagnosis Of Postoperative Pneumonia Requires Objective Data David Ebler, MD David Skarupa, MD Andrew J. Kerwin, MD, FACS Jhun de Villa, MD Michael S. Nussbaum, MD, FACS J.J. Tepas III, MD, FACS
More informationCommunity Acquired Pneumonia. Abdullah Alharbi, MD, FCCP
Community Acquired Pneumonia Abdullah Alharbi, MD, FCCP A 68 y/ male presented to the ED with SOB and productive coughing for 2 days. Reports poor oral intake since onset due to nausea and intermittent
More informationVAP in COPD patients. Ignacio Martin-Loeches. St James s University Hospital. Trinity Centre for Health Sciences. Dublin Ireland.
VAP in COPD patients Ignacio Martin-Loeches St James s University Hospital. Trinity Centre for Health Sciences. Dublin Ireland. Outline Pathophysiology Is enough information? COPD trends in ICU How do
More informationHEALTHCARE-ASSOCIATED PNEUMONIA: DIAGNOSIS, TREATMENT & PREVENTION
HEALTHCARE-ASSOCIATED PNEUMONIA: DIAGNOSIS, TREATMENT & PREVENTION David Jay Weber, M.D., M.P.H. Professor of Medicine, Pediatrics, & Epidemiology Associate Chief Medical Officer, UNC Health Care Medical
More informationDisclosures. Objectives. Procalcitonin: Pearls and Pitfalls in Daily Practice
Procalcitonin: Pearls and Pitfalls in Daily Practice Sarah K Harrison, PharmD, BCCCP Clinical Pearl Disclosures The author of this presentation has no disclosures concerning possible financial or personal
More informationViral Threat on Respiratory Failure
Viral Threat on Respiratory Failure Younsuck Koh, MD, PhD, FCCM Department of Pulmonary and Critical Care Medicine Asan Medical Center University of Ulsan College of Medicine Seoul, Korea No Conflict of
More informationHospital-wide Impact of Mandatory Infectious Disease Consultation on Staphylococcus aureus Septicemia
Hospital-wide Impact of Mandatory Infectious Disease Consultation on Staphylococcus aureus Septicemia Amanda Guth 1 Amy Slenker MD 1,2 1 Department of Infectious Diseases, Lehigh Valley Health Network
More informationClinical Practice Management Guideline for Ventilator-Associated Pneumonia: Diagnosis, Treatment & Prevention
Clinical for Ventilator-Associated Pneumonia: Diagnosis, Treatment & Prevention Background Ventilator-associated pneumonia (VAP), a pneumonia that develops 48hrs after initiation of mechanical ventilation,
More informationInvasive Pulmonary Aspergillosis in
Infection & Sepsis Symposium Porto, April 1-3, 2009 Invasive Pulmonary Aspergillosis in Non-Immunocompromised Patients Stijn BLOT, PhD General Internal Medicine & Infectious Diseases Ghent University Hospital,
More informationEpidemiology and Etiology of Community-Acquired Pneumonia 761 Lionel A. Mandell
LOWER RESPIRATORY TRACT INFECTIONS Preface Thomas M. File, Jr xiii Community-Acquired Pneumonia: Pathophysiology and Host Factors with Focus on Possible New Approaches to Management of Lower Respiratory
More informationUpper...and Lower Respiratory Tract Infections
Upper...and Lower Respiratory Tract Infections Robin Jump, MD, PhD Cleveland Geriatric Research Education and Clinical Center (GRECC) Louis Stokes Cleveland VA Medical Center Case Western Reserve University
More informationFungal Infection in the ICU: Current Controversies
Fungal Infection in the ICU: Current Controversies Andrew F. Shorr, MD, MPH, FCCP, FACP Washington Hospital Center Georgetown University, Washington, DC Disclosures I have served as a consultant to, researcher/investigator
More informationTo develop guidelines for the use of appropriate antibiotics for adult patients with CAP and guidance on IV to PO conversion.
Page 1 of 5 TITLE: COMMUNITY-ACQUIRED PNEUMONIA (CAP) EMPIRIC MANAGEMENT OF ADULT PATIENTS AND IV TO PO CONVERSION GUIDELINES: These guidelines serve to aid clinicians in the diagnostic work-up, assessment
More informationUPDATE IN HOSPITAL MEDICINE
UPDATE IN HOSPITAL MEDICINE FLORIDA CHAPTER ACP MEETING 2016 Himangi Kaushal, M.D., F.A.C.P. Program Director Memorial Healthcare System Internal Medicine Residency DISCLOSURES None OBJECTIVES Review some
More informationSevere β-lactam allergy. Alternative (use for mild-moderate β-lactam allergy) therapy
Recommended Empirical Antibiotic Regimens for MICU Patients Notes: The antibiotic regimens shown are general guidelines and should not replace clinical judgment. Always assess for antibiotic allergies.
More informationSEPSIS RESULTING FROM PNEUMONIA FILE
13 January, 2018 SEPSIS RESULTING FROM PNEUMONIA FILE Document Filetype: PDF 521.12 KB 0 SEPSIS RESULTING FROM PNEUMONIA FILE Aspiration pneumonia is a type of lung infection. CAP's symptoms are the result
More informationPNEUMONIA IN CHILDREN. IAP UG Teaching slides
PNEUMONIA IN CHILDREN 1 INTRODUCTION 156 million new episodes / yr. worldwide 151 million episodes developing world 95% in developing countries 19% of all deaths in children
More informationABSTRACT PURPOSE METHODS
ABSTRACT PURPOSE The purpose of this study was to characterize the CDI population at this institution according to known risk factors and to examine the effect of appropriate evidence-based treatment selection
More informationPotential Conflicts of Interests
Potential Conflicts of Interests Research Grants Agency for Healthcare Research and Quality Akers Bioscience, Inc. Pfizer, Inc. Scientific Advisory Boards Pfizer, Inc. Cadence Pharmaceuticals Kimberly
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Jain S, Kamimoto L, Bramley AM, et al. Hospitalized patients
More informationClinical Infectious Diseases Advance Access published April 11, What is the real role of respiratory viruses in severe community-acquired
Clinical Infectious Diseases Advance Access published April 11, 2014 1 What is the real role of respiratory viruses in severe community-acquired pneumonia? Olli Ruuskanen 1 and Asko Järvinen 2 1 Department
More informationIschemic Stroke in Critically Ill Patients with Malignancy
Ischemic Stroke in Critically Ill Patients with Malignancy Jeong-Am Ryu 1, Oh Young Bang 2, Daesang Lee 1, Jinkyeong Park 1, Jeong Hoon Yang 1, Gee Young Suh 1, Joongbum Cho 1, Chi Ryang Chung 1, Chi-Min
More informationPneumonia Community-Acquired Healthcare-Associated
Pneumonia Community-Acquired Healthcare-Associated Edwin Yu Clin Infect Dis 2007;44(S2):27-72 Am J Respir Crit Care Med 2005; 171:388-416 IDSA / ATS Guidelines Microbiology Principles and Practice of Infectious
More informationResearch & Reviews of. Pneumonia
Chapter Clinical Presentation and Diagnosis of VAP in Adult ICU Patients Priyam Batra * ; Purva Mathur Research & Reviews of Department of Laboratory Medicine, AIIMS, Trauma Centre, New Delhi, India. *
More informationChapter 10 Respiratory System J00-J99. Presented by: Jesicca Andrews
Chapter 10 Respiratory System J00-J99 Presented by: Jesicca Andrews 1 Respiratory System 2 Respiratory Infections A respiratory infection cannot be assumed from a laboratory report alone; physician concurrence
More informationJohn Dallas MD, Sarah M Brown PhD, Karl Hock, Mitchell G Scott PhD, Lee P Skrupky PharmD, Walter A Boyle III MD and Marin H Kollef MD
Original Research Diagnostic Utility of Plasma Procalcitonin for Nosocomial Pneumonia in the Intensive Care Unit Setting John Dallas MD, Sarah M Brown PhD, Karl Hock, Mitchell G Scott PhD, Lee P Skrupky
More informationCommunity-Acquired Pneumonia OBSOLETE 2
Community-Acquired Pneumonia OBSOLETE 2 Clinical practice guidelines serve as an educational reference, and do not supersede the clinical judgment of the treating physician with respect to appropriate
More informationInadequate Empiric Antibiotic Therapy among Canadian. Hospitalized Solid-Organ Transplant Patients: Incidence and Impact on Hospital Mortality
Inadequate Empiric Antibiotic Therapy among Canadian Hospitalized Solid-Organ Transplant Patients: Incidence and Impact on Hospital Mortality by Bassem Hamandi A thesis submitted in conformity with the
More informationAcute Respiratory Infection. Dr Anthony Gibson
Acute Respiratory Infection Dr Anthony Gibson Range of Conditions Upper tract Common Cold coryza Sore Throat- Pharyngitis Sinusitis Epiglottitis Range of Conditions Lower Acute Bronchitis Acute Exacerbation
More informationAugmented Renal Clearance: Let s Get the Discussion Flowing
Augmented Renal Clearance: Let s Get the Discussion Flowing Terry Makhoul, PharmD PGY-2 Emergency Medicine Pharmacy Resident University of Rochester Medical Center Strong Memorial Hospital Disclosures
More informationPolmoniti: Steroidi sì, no, quando. Alfredo Chetta Clinica Pneumologica Università degli Studi di Parma
Polmoniti: Steroidi sì, no, quando Alfredo Chetta Clinica Pneumologica Università degli Studi di Parma Number of patients Epidemiology and outcome of severe pneumococcal pneumonia admitted to intensive
More informationSupplementary Online Content
Supplementary Online Content Gershengorn HB, Scales DC, Kramer A, Wunsch H. Association between overnight extubations and outcomes in the intensive care unit. JAMA Intern Med. Published online September
More informationOutcome of patients with hematologic malignancy admitted to the ICU
Outcome of patients with hematologic malignancy admitted to the ICU Geeta Mehta MD, FRCPC Mount Sinai Hospital Toronto, Canada CCCF November 2, 2016 Disclosures Hematologic Malignancy Advances in diagnostics,
More informationClostridium difficile associated diarrhea (CDAD) has emerged. Incidence of Clostridium difficile Infection in Inflammatory Bowel Disease
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2007;5:339 344 Incidence of Clostridium difficile Infection in Inflammatory Bowel Disease JOSEPH F. RODEMANN,* ERIK R. DUBBERKE, KIMBERLY A. RESKE, DA HEA SEO,*
More information11/19/2012. The spectrum of pulmonary diseases in HIV-infected persons is broad.
The spectrum of pulmonary diseases in HIV-infected persons is broad. HIV-associated Opportunistic infections Neoplasms Miscellaneous conditions Non HIV-associated Antiretroviral therapy (ART)-associated
More informationCAP, HCAP, HAP, VAP. 1. In 1898, William Osler described community-acquired pneumonia as:
1. In 1898, William Osler described community-acquired pneumonia as: Brad Sharpe, M.D. Professor of Clinical Medicine Department of Medicine UCSF sharpeb@medicine.ucsf.edu I have no relevant financial
More informationMicrobiology Laboratory Directors, Infection Preventionists, Primary Care Providers, Emergency Department Directors, Infectious Disease Physicians
MEMORANDUM DATE: October 1, 2009 TO: FROM: SUBJECT: Microbiology Laboratory Directors, Infection Preventionists, Primary Care Providers, Emergency Department Directors, Infectious Disease Physicians Michael
More informationThe Role of POCT in Management of Infectious Disease in the Critical Care Setting
The Role of POCT in Management of Infectious Disease in the Critical Care Setting Nathan A Ledeboer Associate Professor of Pathology Medical College of Wisconsin Medical Director, Microbiology and Molecular
More informationUsefulness of Procalcitonin in the management of Infections in ICU. P Damas CHU Sart Tilman Liège
Usefulness of Procalcitonin in the management of Infections in ICU P Damas CHU Sart Tilman Liège Procalcitonin Peptide 116 AA Produced by parenchymal cells during «sepsis»: IL1, TNF, IL6 : stimulators
More informationinfection control and hospital epidemiology january 2008, vol. 29, no. 1 original article
infection control and hospital epidemiology january 2008, vol. 29, no. 1 original article Development of an Algorithm for Surveillance of Ventilator-Associated Pneumonia With Electronic Data and Comparison
More informationRSV Surveillance in the U.S.
RSV Surveillance in the U.S. Susan I. Gerber, MD Respiratory Virus Program Division of Viral Diseases National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention
More informationOpen Forum Infectious Diseases Advance Access published February 11, 2016
Open Forum Infectious Diseases Advance Access published February 11, 2016 1 A Critical Reappraisal of Prolonged Neutropenia as a Risk Factor for Invasive Pulmonary Aspergillosis Michael S. Abers 1,2, Musie
More informationCritical Review Form Clinical Prediction or Decision Rule
Critical Review Form Clinical Prediction or Decision Rule Development and Validation of a Multivariable Predictive Model to Distinguish Bacterial from Aseptic Meningitis in Children, Pediatrics 2002; 110:
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Blum CA, Nigro N, Briel M, et al. Adjunct prednisone
More informationOutcomes of Patients with Preoperative Weight Loss following Colorectal Surgery
Outcomes of Patients with Preoperative Weight Loss following Colorectal Surgery Zhobin Moghadamyeghaneh MD 1, Michael J. Stamos MD 1 1 Department of Surgery, University of California, Irvine Nothing to
More informationClostridium Difficile Infection: Applying New Treatment Guidelines and Strategies to Reduce Recurrence Rate
Clostridium Difficile Infection: Applying New Treatment Guidelines and Strategies to Reduce Recurrence Rate Objectives Summarize the changing epidemiology and demographics of patients at risk for Clostridium
More informationHAP/VAP care bundle interventions - a UK approach. Dr R G Masterton NHS Ayrshire & Arran
HAP/VAP care bundle interventions - a UK approach Dr R G Masterton NHS Ayrshire & Arran How Hazardous Is Health Care? (Leape and Amalberti) Total lives lost per year 100,000 10,000 1,000 100 10 1 HAZARDOUS
More informationHospital-acquired Pneumonia
Hospital-acquired Pneumonia Hospital-acquired pneumonia (HAP) Pneumonia that occurs at least 2 days after hospital admission. The second most common and the leading cause of death due to hospital-acquired
More informationGUIDE TO INFECTION CONTROL IN THE HOSPITAL. Carbapenem-resistant Enterobacteriaceae
GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 47: Carbapenem-resistant Enterobacteriaceae Authors E-B Kruse, MD H. Wisplinghoff, MD Chapter Editor Michelle Doll, MD, MPH) Topic Outline Key Issue Known
More informationOHSU. Update in Sepsis
Update in Sepsis Jonathan Pak, MD June 1, 2017 Structure of Talk 1. Sepsis-3: The latest definition 2. Clinical Management - Is EGDT dead? - Surviving Sepsis Campaign Guidelines 3. A novel therapy: Vitamin
More informationOutline. Pharmacists Improving Outcomes in the Management of. of Infectious Diseases. Threats Against Desired Outcomes 7/11/2010
Pharmacists Improving Outcomes in the Management of Infectious Diseases Christine Teng, MSc(Clin Pharm) BCPS Assistant Professor Dept of Pharmacy, National University of Singapore Principal Pharmacist
More informationIdentifyingRiskFactorsforAcuteExacerbationsofChronicObstructivePulmonaryDisease
Global Journal of Medical Research: F Diseases Volume 18 Issue 5 Version 1.0 Type: Double Blind Peer Reviewed International Research Journal Publisher: Global Journals Online ISSN: 2249-4618 & Print ISSN:
More informationVentilator Associated Pneumonia. ICU Fellowship Training Radboudumc
Ventilator Associated Pneumonia ICU Fellowship Training Radboudumc Attributable mortality VAP Meta-analysis of individual patient data from randomized prevention studies Attributable mortality mainly results
More informationPneumococcal pneumonia
Pneumococcal pneumonia Wei Shen Lim Consultant Respiratory Physician & Honorary Professor of Medicine Nottingham University Hospitals NHS Trust University of Nottingham Declarations of interest Unrestricted
More informationARDS during Neutropenia. D Mokart DAR IPC GRRRRROH 2010
ARDS during Neutropenia D Mokart DAR IPC GRRRRROH 2010 Definitions Neutropenia is a decrease in circulating neutrophil white cells in the peripheral blood. neutrophil count of 1,000 1,500 cells/ml = mild
More informationLinezolid for treatment of ventilator-associated pneumonia: a cost-effective alternative to vancomycin Shorr A F, Susla G M, Kollef M H
Linezolid for treatment of ventilator-associated pneumonia: a cost-effective alternative to vancomycin Shorr A F, Susla G M, Kollef M H Record Status This is a critical abstract of an economic evaluation
More informationMICROBIOLOGICAL TESTING IN PICU
MICROBIOLOGICAL TESTING IN PICU This is a guideline for the taking of microbiological samples in PICU to diagnose or exclude infection. The diagnosis of infection requires: Ruling out non-infectious causes
More informationBrice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine
Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine Discuss advances in predicting prognosis Understand dwhat we know (and don t know) about the Microbiology Recognize important
More informationBlood cultures in ED. Dr Sebastian Chang MBBS FACEM
Blood cultures in ED Dr Sebastian Chang MBBS FACEM Why do we care about blood cultures? blood cultures are the most direct method for detecting bacteraemia in patients a positive blood culture: 1. can
More informationPediatric influenza-associated deaths in Arizona,
Pediatric influenza-associated deaths in Arizona, 2004-2012 (Poster is shared here as an 8.5 x11 document for easier viewing. All content is identical, though graphs and tables are formatted differently.)
More informationSepsis: What Is It Really?
Sepsis: What Is It Really? Steven D. Burdette, MD, FIDSA, FACP Professor of Medicine Wright State University Boonshoft School of Medicine Director of Antimicrobial Stewardship for Premier Health and Miami
More informationResearch Article Eosinophil as a Protective Cell in S. aureus Ventilator-Associated Pneumonia
Hindawi Publishing Corporation Mediators of Inflammation Volume 2013, Article ID 152943, 5 pages http://dx.doi.org/10.1155/2013/152943 Research Article Eosinophil as a Protective Cell in S. aureus Ventilator-Associated
More informationNQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE. Measure Information Form Collected For: CMS Outcome Measures (Claims Based)
Last Updated: Version 4.3 NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE Measure Information Form Collected For: CMS Outcome Measures (Claims Based) Measure Set: CMS Mortality Measures Set
More informationESCMID Online Lecture Library. by author
INFLUENZA IN CHILDREN Cristian Launes Infectious Diseases Unit. Department of Paediatrics. Hospital Sant Joan de Déu (Universitat de Barcelona) Innovation in Severe Acute Respiratory Infections (SARI),
More informationClinical Development Challenges: Trial Designs and Endpoints
Clinical Development Challenges: Trial Designs and Endpoints Menno de Jong Department of Medical Microbiology Academic Medical Center, University of Amsterdam ISIRV - Options IX for the Control of Influenza
More informationProtocols for Laboratory Verification of Performance of the FilmArray Respiratory Panel (RP) EZ
Protocols for Laboratory Verification of Performance of the FilmArray Respiratory Panel (RP) EZ Purpose This document provides examples of procedures to assist your laboratory in developing a protocol
More informationRespiratory Pathogen Panel TEM-PCR Test Code:
Respiratory Pathogen Panel TEM-PCR Test Code: 220000 Tests in this Panel Enterovirus group Human bocavirus Human coronavirus (4 types) Human metapneumovirus Influenza A - Human influenza Influenza A -
More informationEarly infection diagnosis
Procalcitonin in the EMERGENCY DEPARTMENT Early infection diagnosis and risk assessment with Procalcitonin (PCT) Early differential diagnosis and therapy decision in the emergency department Antibiotic
More informationAppendix Identification of Study Cohorts
Appendix Identification of Study Cohorts Because the models were run with the 2010 SAS Packs from Centers for Medicare and Medicaid Services (CMS)/Yale, the eligibility criteria described in "2010 Measures
More informationDiscriminating between simple and perforated appendicitis
1 Discriminating between simple and perforated appendicitis Bröker M.E.E. 1, Van Lieshout E.M.M., PhD 2, Van der Elst M., MD PhD 1, Stassen L.P.S., MD PhD 3, Schepers T., MD PhD 1 1 Department of Surgery,
More informationPneumonia Severity Scores:
Pneumonia Severity Scores: Are they Accurate Predictors of Mortality? JILL McEWEN, MD FRCPC Clinical Professor Department of Emergency Medicine University of British Columbia Vancouver, BC Canada President,
More informationOriginal Article Mahidol Univ J Pharm Sci 2015; 42 (4), MT. Nguyen 1, TD. Dang Nguyen 1* 1
Original Article Mahidol Univ J Pharm Sci 2015; 42 (4), 195-202 Investigation on hospital-acquired pneumonia and the association between hospital-acquired pneumonia and chronic comorbidity at the Department
More informationCurrent and Emerging Legionella Diagnostics
Current and Emerging Legionella Diagnostics Nicole Wolter Centre for Respiratory Diseases and Meningitis (CRDM) National Institute for Communicable Diseases nicolew@nicd.ac.za 7 th FIDSSA Conference, Cape
More informationwithout the permission of the author Not to be copied and distributed to others
Emperor s Castle interior-prato What is the Role of Inhaled Polymyxins for Treatment of Respiratory Tract Infections? Helen Giamarellou CONCLUSIONS: Patients with Pseudomonas and Acinetobacter VAP may
More informationProspective audit and feedback of piperacillin-tazobactam use in a 1115 bed acute care hospital
Prospective audit and feedback of piperacillin-tazobactam use in a 1115 bed acute care hospital Final Results Nathan Beahm, BSP, PharmD(student) September 10, 2016 Objectives Review background information
More informationComplications after HSCT. ICU Fellowship Training Radboudumc
Complications after HSCT ICU Fellowship Training Radboudumc Type of HSCT HSCT Improved outcome due to better HLA matching, conditioning regimens, post transplant supportive care Over one-third have pulmonary
More informationTop 5 papers in clinical mycology
Top 5 papers in clinical mycology Dirk Vogelaers Department of General Internal Medicine University Hospital Ghent Joint symposium BVIKM/BSIMC and SBMHA/BVMDM Influenza-associated aspergillosis in critically
More information