TITLE

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome

AUTHOR(S)
Menéndez, R.; Torres, A.; Zalacaín, R.; Aspa, J.; Martín, Villascioras J. J.; Borderías, L.; Benítez, Moya J. M.; Ruiz-Manxano, J.; de Castro, F. Rodriguez; Blanquer, J.; Pérez, D.; Puzo, C.; Sánchez, Gascón F.; Galiardo, J.; Álvarez, C.; Molinos, L.
PUB. DATE
November 2004
SOURCE
Thorax;Nov2004, Vol. 59 Issue 11, p960
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: An inadequate response to initial empirical treatment of community acquired pneumonia (CAP) represents a challenge for clinicians and requires early identification and intervention. A study was undertaken to quantify the incidence of failure of empirical treatment in CAP, to identify risk factors for treatment failure, and to determine the implications of treatment failure on the outcome. Methods: A prospective multicentre cohort study was performed in 1424 hospitalised patients from 15 hospitals. Early treatment failure (<72 hours), late treatment failure, and in-hospital mortality were recorded. Results: Treatment failure occurred in 215 patients (15.1%): 134 early failure (62.3%) and 81 late failure (37.7%). The causes were infectious in 86 patients (40%), non-infectious in 34(15.8%), and undetermined in 95. The independent risk factors associated with treatment failure in a stepwise logistic regression analysis were liver disease, pneumonia risk class, leucopenia, multilobar CAP, pleural effusion, and radiological signs of cavitation. Independent factors associated with a lower risk of treatment failure were influenza vaccination, initial treatment with fluoroquinolones, and chronic obstructive pulmonary disease (COPD). Mortality was significantly higher in patients with treatment failure (25% v 2%). Failure of empirical treatment increased the mortality of CAP 11-fold after adjustment for risk class. Conclusions: Although these findings need to be confirmed by randomised studies, they suggest possible interventions to decrease mortality due to CAP.
ACCESSION #
17563388

 

Related Articles

  • Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia. Cardoso, Maria Regina A.; Nascimento-Carvalho, Cristiana M.; Ferrero, Fernando; Berezin, Eitan N.; Ruvinsky, Raúl; Camargos, Paulo A. M.; Sant'Anna, Clemax C.; Brandileone, Maria Cristina C.; March, Maria de Fátima P.; Feris-Iglesias, Jesus; Maggi, Ruben S.; Benguigui, Yehuda // Archives of Disease in Childhood;Mar2008, Vol. 93 Issue 3, p221 

    Objective: To determine whether the presence of in vitro penicillin-resistant Streptococcus pneumoniae increases the risk of clinical failure in children hospitalised with severe pneumonia and treated with penicillin/ampicillin. Design: Multicentre, prospective, observational study. Setting: 12...

  • Neumonía comunitaria por Streptococcus pyogenes complicada con derrame pleural. Reporte de un caso y revisión de la literatura. Huerta Martínez, Arianna; Gómez Toscano, Valeria; Monroy Colín, Víctor Antonio; de Colsa Ranero, Agustín // Revista de Enfermedades Infecciosas en Pediatria;oct-dic2011, Vol. 25 Issue 98, p71 

    Streptococcus pyogenes is an uncommon cause of community acquired pneumonia. It is rare in adults and is seen more frequently in pediatric patients, in whom can cause lung parenchymal involvement and occasionally pleural purulent effusion. We report a case of a two years old female patient,...

  • Should we give long-term macrolide therapy for COPD? Crosbie, Philip A. J.; Woodhead, Mark; Albert, Richard K. // Thorax;Oct2013, Vol. 68 Issue 10, p966 

    In this article, the authors debate on the topic related to the macrolide therapy in patients with chronic obstructive pulmonary disease (COPD). They reported that low-dose macrolides for exacerbation prevention, should not be recommended in the management of COPD. They informed that macrolides...

  • Trace elements in hemodialysis patients: a systematic review and meta-analysis. Tonelli, Marcello; Wiebe, Natasha; Hemmelgarn, Brenda; Klarenbach, Scott; Field, Catherine; Manns, Braden; Thadhani, Ravi; Gill, John // BMC Medicine;2009, Vol. 7, Special section p1 

    Background: Hemodialysis patients are at risk for deficiency of essential trace elements and excess of toxic trace elements, both of which can affect health. We conducted a systematic review to summarize existing literature on trace element status in hemodialysis patients. Methods: All studies...

  • Severe pneumonia in the elderly: a multivariate analysis of risk factors. Wei Li; Cheng Ding; Shaojun Yin // International Journal of Clinical & Experimental Medicine;2015, Vol. 8 Issue 8, p12463 

    Pneumonia is the second leading reason for hospitalization of medicare beneficiaries. The mortality rate is high, especially in the elderly. In this study, we aimed to determine the risk factors associated with severe pneumonia in the elderly. Retrospective study was conducted and data of old...

  • Fluticasone/salmeterol is associated with a higher risk of pneumonia and pneumonia related events in comparison with budesonide/formoterol in patients with COPD. Jabbar, Avais // Thorax;Nov2013, Vol. 68 Issue 11, p996 

    In this article, the author reflects on a PATHOS study related to the association of combined drug treatment process with fluticasone and salmeterol with higher risks of pneumonia and compares the impact of budesonide and formoterol on patients with chronic obstructive pulmonary disease (COPD)...

  • First COPD guide promotes shots, better management. Marselas, Kimberly // McKnight's Long-Term Care News;Dec2014, Vol. 35 Issue 12, p6 

    The article discusses the guidelines by American College of Chest Physicians and the Canadian Thoracic Society for the patients with chronic obstructive pulmonary disease having the increased risk of exacerbations and to use the pneumococcal and flu vaccines for the better management of disease.

  • Pneumonia in stroke patients with oropharyngeal dysphagia: a six-month follow-up study. Masiero, Stefano; Pierobon, Roberta; Previato, Chiara; Gomiero, Elisa // Neurological Sciences;Jun2008, Vol. 29 Issue 3, p139 

    The aim of the study was to estimate the frequency of pneumonia and to determine the risk factors for this complication in poststroke patients with oropharyngeal dysphagia (OD). We prospectively followed up 67 patients (mean age 72.9±12.2 years) in the first 6 months after stroke, during...

  • Capsular Types and Predicting Patient Outcomes in Pneumococcal Bacteremia. Garau, Javier; Calbo, Esther // Clinical Infectious Diseases;7/1/2007, Vol. 45 Issue 1, p52 

    The article evaluates the risk factors for increased disease severity and mortality in adults with invasive pneumococcal disease, including patient related variables and bacterial serotypes. The study authors analyzed data collected from a prospective, international, large-scale study of adult...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics