Addressing current challenges in antibiotic treatment of community acquired pneumonia
Community-acquired pneumonia (CAP) is the leading infectious cause of death and the fourth most common cause of global mortality in the world. The high incidence of CAP and the high burden of morbidity, mortality and their related costs have meant that research into CAP is among the most popular are...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2017 |
| País: | España |
| Institución: | CBUC, CESCA |
| Repositorio: | TDR. Tesis Doctorales en Red |
| OAI Identifier: | oai:www.tdx.cat:10803/593500 |
| Acceso en línea: | http://hdl.handle.net/10803/593500 |
| Access Level: | acceso abierto |
| Palabra clave: | Malalties infeccioses Enfermedades infecciosas Communicable diseases Pneumònia adquirida a la comunitat Neumonía adquirida en la comunidad Community-acquired pneumonia Antibiòtics Antibióticos Antibiotics Ciències de la Salut 616.9 |
| Sumario: | Community-acquired pneumonia (CAP) is the leading infectious cause of death and the fourth most common cause of global mortality in the world. The high incidence of CAP and the high burden of morbidity, mortality and their related costs have meant that research into CAP is among the most popular areas of investigation. Nowadays, although there has been important progress in CAP management, there are still controversial points and a great deal of room for improvement. Our investigation attempted to focus on some of the current challenges in CAP research. HYPOTHESIS 1. Mortality in community-acquired pneumonia might have decreased in recent years, and there could be certain factors related with this change. 2. Pre-hospital antibiotic treatments could have an impact on the etiology, clinical features and outcomes of patients hospitalized for community-acquired pneumonia. 3. Timing from admission to first dose of antibiotic administration could have an impact on 30-day mortality in patients with pneumonia. 4. Antibiotic de-escalation could be a safe and effective strategy in patients hospitalized with pneumococcal community-acquired pneumonia. 5. Hospitalized patients with community-acquired Legionella pneumonia would have different outcomes depending on the antibiotic treatment administered. 6. There could be differences in response to antibiotic treatment in community-acquired pneumonia based on multiple patient factors. In the first study: “Declining mortality among hospitalized patients with community-acquired pneumonia”, we found that: • Thirty-day mortality significantly decreased over time in hospitalized community-acquired pneumonia patients, despite an upward trend in patient age and other factors associated with poor outcomes. • Several changes in the management of community-acquired pneumonia and a general improvement in global care over time may have caused the observed outcomes. In the second study: “Impact of pre-hospital antibiotic use on community-acquired pneumonia”, we found that: • In our cohort, 17.3% of patients received pre-hospital antibiotic treatment. These patients were younger, with fewer comorbidities, and less frequently presented bacteraemia than those patients who had not received antibiotic before hospitalisation. • The prevalence of Legionella pneumophila was nearly three times higher in patients who received pre-hospital antibiotics, mainly those who received β-lactams. • Pre-hospital antibiotic use should be considered when choosing aetiological diagnostic tests and empirical antibiotic therapy in patients with community-acquired pneumonia. In the third study: “Timing of antibiotic administration and outcomes of hospitalized patients with community-acquired and healthcare-associated pneumonia”, we found that: • Patients receiving early treatment had significantly greater illness severity at admission. • Antibiotic administration within 4 or 8 hours of arrival at the emergency department did not improve rates of 30-day survival in hospitalized adults for community-acquired pneumonia or healthcare-associated pneumonia. In the fourth study: “Impact of antibiotic de-escalation on clinical outcomes in community-acquired pneumococcal pneumonia”, we found that: • Antibiotic de-escalation appears to be safe and effective in reducing the duration of hospital stay. • Antibiotic de-escalation did not adversely affect outcomes of patients with community-acquired pneumococcal penumonia, even those with bacteraemia and severe disease, and those who were clinically unstable at time of de-escalation. • De-escalation strategies should be more widely implemented in the management of hospitalized adults with community-acquired pneumococcal penumonia. In the fifth study: “Levofloxacin versus azithromycin for treating Legionella pneumonia: a propensity score analysis”, we found that: • No significant differences in relevant outcomes were found between patients with Legionella pneumonia treated with levofloxacin and those receiving azithromycin. In the sixth study: “Predictors for individual patient antibiotic treatment effect in hospitalised community-acquired pneumonia patients”, we found that: • Older age and smoking could influence the response to specific antibiotic regimens. • The effect modification of age and smoking should be considered as a hypothesis to be evaluated in future trials. |
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