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S Ewig

Publications and source records attributed to S Ewig.

At least 55 records · Page 3Linked to original sources
PubMed2001

Defining severe community-acquired pneumonia.

Based on the recognition of the main pathophysiologic features of pneumonia and currently available data on prognosis and clinical severity assessment, key points for a definition of severe pneumonia are as follows: 1. Independent predictors of pneumonia severity are factors reflecting acute respiratory failure and severe sepsis or septic shock. 2. In view of the dependence of the development of acute respiratory failure on pulmonary comorbidities, radiographic extension may prove to be an additional independent predictor of severe respiratory compromise. 3. Vital sign abnormalities other than acute respiratory failure and severe hypotension may be independent predictors of severity, particularly in patients presenting in early and asymptomatic stages of severe sepsis. 4. Several pathogens have been shown to have adverse prognostic potential. Because the cause is unknown at the initial evaluation, however, pathogens cannot form part of the criteria for the initial severity assessment. 5. Because pneumonia is a dynamic process, any assessment of severity takes place at an arbitrary point of disease evolution. It would be desirable to define a set of parameters reflecting initial severity as well as a state of increased risk for early deterioration toward severe pneumonia. 6. Severity stratification within the population of patients with severe pneumonia may open the prospect of identifying patients who may have the greatest benefit from intensive care.

Age Factors↗
PubMed2001

Flexible bronchoscopy in nosocomial pneumonia.

In this article, an overview on the diagnostic performances of bronchoscopic techniques for the diagnosis of nosocomial pneumonia is given with special emphasis on the inherent problems of the methodology of validation applied to different studies. The current evidence about the importance of bronchoscopic techniques for the outcome is reviewed. It is outlined that future prospects of bronchoscopic investigations mainly include the evaluation of its role in the reassessment of the patient with pneumonia not responding to the initial antimicrobial treatment.

Anti-Infective Agents↗
PubMed2001

[Nosocomial pneumonia].

Nosocomial pneumonia is a frequent complication, particularly during mechanical ventilation. Microbial patterns differ according to the time of onset: whereas early onset pneumonia (up to the fourth day of hospitalization) is mostly caused by Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae, leading pathogens of late onset pneumonia (after the fourth day) additionally include gram-negative Enterobacteriaceae and potentially drug resistant microorganisms. These general patterns are modified in the presence of specific individual risk factors. The diagnostic work-up of pneumonia is aimed at the assessment of severity, the confirmation of the presence of pneumonia as well as the identification of the causal pathogens. The results of microbiological investigations must always be interpreted in the clinical context. Antimicrobial treatment must always be initiated empirically based on expected microbial patterns as outlined above. Nosocomial pneumonia in nonventilated and ventilated patients requires different empirical antimicrobial treatment approaches. All patients with antimicrobial treatment failures must be comprehensively reevaluated.

Anti-Bacterial Agents↗
PubMed2001

[Treatment of community-acquired lung abscess associated with aspiration].

The management of community-acquired lung abscess associated with aspiration is based on adequate antimicrobial treatment and effective drainage. Empiric antimicrobial treatment should cover basic microbial patterns and consist of aminopenicillin/beta-lactamase-inhibitor or clindamycin. Since the spectrum of clindamycin is restricted to Gram-positive microorganisms combination treatment of clindamycin with a second-generation cephalosporin may be warranted. It is crucial to continue antimicrobial treatment until complete resolution of the abscess cavity and the corresponding infiltrates. Drainage is frequently present spontaneously. Additional techniques to ensure effective drainage include bronchoscopic and percutaneous drainage. These techniques are only infrequently indicated in case of clinical failure and of delayed cavity closure. Indications for surgical emergency interventions are mainly limited to severe pulmonary hemorrhage. The clinical success rate of adequate antimicrobial treatment together with effective drainage reaches 75 - 90 %.

Anti-Bacterial Agents↗
PubMed2000

Pneumonia in the elderly--what makes the difference?

Pneumonia has a particularly high incidence in the elderly, the cardinal risk factors being comorbidity and malnutrition. The independent bearing of age on the aetiology of pneumonia is a matter of controversy and is probably limited. Streptococcus pneumoniae is uniformly the most frequent pathogen. Elderly patients with pneumonia are frequently oligosymptomatic. Quite often, mental confusion may be the only clinical symptom. Physical and chest radiograph examination have specific and important pitfalls. Mental confusion as a surrogate marker of severe sepsis should be added to the criteria for assessing the severity of disease. Pneumonia in the elderly is associated with a considerably increased mortality, but age does not appear to be an independent predictor of death. The disease continues to be the old man's friend: survivors of a pneumonia episode are more likely to die during follow-up as compared to controls. Antimicrobial treatment in the elderly should follow a risk-adopted approach. When selecting antimicrobial agents for the treatment of the elderly, peculiarities in pharmacokinetics, drug interactions and side effects should be considered. The rate of radiographic clearance is inversely correlated with age. All elderly individuals are candidates for vaccination against pneumococci and influenza, particularly in the presence of cardiopulmonary comorbidity and any degree of immunosuppression.

Age Factors↗
PubMed2000

Severity assessment in community-acquired pneumonia.

In current guidelines for the management of adults with community-acquired pneumonia (CAP), the triaging decision about hospitalization or intensive care unit (ICU) admission, and, as a consequence, selection of initial antimicrobial treatment is largely based on the assessment of pneumonia severity. The proposed severity criteria are mainly derived from studies determining predictors of adverse outcome. These include age, male sex, comorbidity, acute respiratory failure, severe sepsis and septic shock, extension of radiographic infiltrates, bacteraemia and CAP through several different pathogens such as Streptococcus pneumoniae, Staphylococcus aureus, Gram-negative enteric bacilli (GNEB), and signs of disease progression within the first 48-72 h. In addition, prediction rules and need for a complicated course in ambulatory and hospitalized patients, for the individual risk of death have been developed which may be helpful in determining the patient who might require hospitalization or intensive care, respectively. Risk classifications such as the scores developed by FINE et al. [40] are not only useful for identifying low risk patients who might safely be treated as outpatients, but apparently they will also play a major role in the evaluation of processes and outcomes of care for patients with CAP. Recent investigations have provided objective criteria for the definition of severe CAP requiring ICU admission. Whether the detection of infiltrates in the chest radiographs of patients with acute lower respiratory tract infection (LRTI) suggestive of mild pneumonia has an independent prognostic impact which fundamentally affects the concept of mild LRTI remains to be seen. Based on objective criteria for severity assessment it will be possible to define interventions aimed at reducing hospital admission rates, define a risk-adapted antimicrobial treatment regimen, reduce costs for antimicrobial treatment and supportive measures, shorten hospital stay, and, thereby, improve the quality of care for patients with community-acquired pneumonia.

Community-Acquired Infections↗
PubMed2000

Management of patients with community-acquired pneumonia in a primary care hospital: a critical evaluation.

The aim of the study was to evaluate routine management of patients with community-acquired pneumonia (CAP) with regard to severity patterns, diagnostic approaches and results, as well as initial empiric antimicrobial treatment and its impact on outcome. Two hundred and thirty-two consecutive patients with CAP admitted to a primary care hospital were studied prospectively. Patients were classified according to Fine's severity score. Severe pneumonia was defined as admission at the ICU. Diagnostic approaches and initial antimicrobial treatment were judged according to the guidelines of the European Respiratory Society (ERS). Fifty-five patients (24%) had mild, 156 (67%) moderate, and 21 (9%) severe CAP. At least one microbial examination was performed in 124 patients (54%). There was no association between microbial investigation and severity of CAP. Inadequate initial antimicrobial treatment was significantly more frequent in severe (18/21, 86%), than in mild (5/55, 9%) and moderate CAP (39/156, 25%, P < 0.0001). Conversely, antimicrobial overtreatment occurred significantly more often in mild (30/55, 55%) and moderate (77/156, 49%) than in severe CAP (0/21, 0%, P < 0.0001). Inadequate initial antimicrobial treatment was more frequent in non-responders [18/62 (29%) vs. 31/170, (18%), RR 1.6 95% CI 0.9-2.6, P = 0.07] and was associated with a longer duration of hospitalization (17 +/- 11 vs. 14 +/- 8 days, P = 0.03). Mortality was not affected by inadequate initial antimicrobial treatment [5/62 (8%) vs. 10/170 (6%), RR 1.4 95% CI 0.5-3.9, P=0.55]. Principal conceptual weaknesses which might be subject to intervention were (1) the hospitalization of patients with mild pneumonia at low risk of mortality; (2) the lack of association between microbial investigation and severity of CAP; (3) antimicrobial overtreatment of patients with non-severe CAP; and (4) inadequate antimicrobial treatment with increased number of primary treatment failures and duration of hospitalization.

Adult↗