Management of Community-Acquired Pneumonia at a Tertiary-Care Teaching Hospital
Bibliographic record
Abstract
ABSTRACT Background: The rising resistance of pathogens commonly implicated in hospital-acquired pneumonia to currently recommended empiric therapy may necessitate a change in the management of this condition. Objective: To determine the current therapeutic approach to the management of hospital-acquired pneumonia at an urban tertiary care hospital and to determine the need for a change to the institution’s guidelines, according to patterns of bacterial culture and sensitivity. Methods: A chart review was performed to identify patients in whom hospital-acquired pneumonia was diagnosed between January 1 and December 31, 2003. Results: The charts of 50 patients (15% of the 325 patients with a diagnosis of hospital-aquired pneumonia) were reviewed. Most patients (43 or 86%) had stayed on a ward, and the overall mean age was 77 years. The initial choice of antimicrobial regimen was selected empirically for 41 (82%) of the patients; levofloxacin 500 mg daily was the most commonly chosen single agent (15/41 or 37%). Ceftriaxone was also chosen frequently (10/41 or 24%) for the empiric management of hospital-acquired pneumonia. For patients whose therapy was culture-directed, the most commonly chosen agent was ciprofloxacin (5/9 or 56%). Sputum samples were obtained from 19 of the patients, and 3 species of bacteria were each cultured in more than 15% of these 19 samples: methicillin-sensitive Staphylococcus aureus (MSSA) (3/19 or 16%), Hemophilus influenzae (4/19 or 21%), and Serratia marcescens (3/19 or 16%). Conclusions: MSSA, Hemophilus influenzae, and Serratia marcescens were the most common causes of hospital-acquired pneumonia at this institution, but multidrug-resistant strains of these problematic organisms were not a concern. Therefore, broad-spectrum antibiotics, such as carbapenems, ceftazidime, and ciprofloxacin may be reserved for targeted use in appropriate patients. These agents should not be used in the routine empiric management of hospital-acquired pneumonia in the authors’ institution at this time. RESUME Historique : La resistance croissante des agents pathogenes generalement mis en cause dans la pneumonie nosocomiale au traitement empirique actuellement recommande pourrait commander un changement dans la prise en charge de cette affection. Objectif : Determiner l’approche therapeutique actuelle dans la prise en charge de la pneumonie nosocomiale au sein d’un hopital urbain de soins tertiaires ainsi que la necessite de modifier les lignes directrices de l’etablissement selon les antibiogrammes. Methodes : Une analyse des dossiers medicaux de patients chez qui l’on a diagnostique une pneumonie nosocomiale entre le 1er janvier et le 31 decembre 2003 a ete effectuee. Resultats : Les dossiers de 50 patients ont ete examines (15 % des 325 patients avec un diagnostic de pneumonie nosocomiale). L’âge moyen des patients etait de 77 ans et la plupart d’entre eux (43 ou 86 %) avaient sejourne dans un service hospitalier. L’antibiotherapie a ete selectionnee de facon empirique chez 41 (82 %) des patients; la levofloxacine administree a raison de 500 mg par jour etait l’antibiotique le plus souvent choisi (15 patients sur 41 ou 37 %). La ceftriaxone etait egalement choisie souvent (10 patients sur 41 ou 24 %) pour le traitement empirique de la pneumonie nosocomiale. Chez les patients dont le traitement etait fonde sur les resultats de la culture, l’antibiotique le plus souvent retenu etait la ciprofloxacine (5 patients sur 9 ou 56 %). Des echantillons de crachat ont ete preleves chez 19 des patients et trois souches de bacteries ont ete chacune cultivees dans plus de 15 % des 19 echantillons : Staphylococcus aureus sensible a la methicilline (3 echantillons sur 19 ou 16 %), Haemophilus influenzae (4 echantillons sur 19 ou 21 %) et Serratia marcescens (3 echantillons sur 19 ou 16 %). Conclusions : S. aureus sensible a la methicilline, Haemophilus influenzae et S. marcescens etaient les principaux agents pathogenes responsables de la pneumonie nosocomiale dans cet etablissement, et les souches de ces microorganismes resistantes a de multiples antibiotiques ne posaient pas probleme. Par consequent, les antibiotiques a large spectre, comme les carbapenemes, la ceftazidime et la ciprofloxacine peuvent etre reserves pour un usage cible chez des patients choisis. Ces agents ne devraient pas etre utilises comme traitement empirique systematique de la pneumonie nosocomiale dans cet etablissement pour le moment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".