Management decisions regarding community-acquired pneumonia

Current Opinion in Infectious Diseases

Volumn 12, Issue 2, 1999, Pages 133-136

  Marrie, Thomas J ^a,b  

^a Division of Infectious Diseases   (Canada)

^b QUEEN ELIZABETH II HEALTH SCIENCES CENTRE   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 0001357638     PISSN: 09517375     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001432-199904000-00005     Document Type: Article

References (16)

1. Centers for Disease Control and Prevention. Premature deaths, monthly mortality and monthly physician contacts - United States. MMWR 1997; 46:556.
2. Marston BJ, Plouffe JF, File TM, Hackman BA, Salstrom S-J, Lipman HB, Breiman RF. Incidence of community-acquired pneumonia requiring hospitalization: results of a population-based active surveillance study in Ohio. Arch Intern Med 1997; 157:1709-1718.
3. Coley CM, Li Y-H, Medsger AR, Marrie TJ, Fine MJ, Kapoor WN et al. Preferences for home vs hospital care among low risk patients with community-acquired pneumonia. Arch Intern Med 1996; 156:1565-1571.
4. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336:243-250. A pneumonia-specific severity of illness score was derived from the analysis of 14199 adults with CAP in a 1989 MedisGroups Hospital Database, and was validated with 1991 data on 38039 inpatients and with 944 outpatients and 1343 inpatients who were studied prospectively. Using 20 readily available data items, patients can be stratified into five risk classes. Patients in classes I-III have a less than 1 % mortality rate, whereas those in class IV have a 9% mortality rate, and those in class V have a 27% mortality rate. This scoring system can be used to assist with the site-of-care decision.
5. Atlas SJ, Benzer TI, Borowsky LH, Chang YC, Burnham DC, Metlay JP, et al. Safely increasing the proportion of patients with community-acquired pneumonia treated as outpatients. Arch Intern Med 1998; 158:1350-1356.
6. Marrie T, Lau C, Feagan B, Wheeler S, Wong C, for the capital study investigators and Janssen-Ortho Inc., Canada, 1998. A randomized controlled trial of a critical pathway for the management of community-acquired pneumonia. Sixth International Quinolone Meeting; 16-18 November, 1998; Denver, CO.
7. Niederman MS, Best JB, Campbell GD, Fein AM, Grossman RF, Mandell LA, et al. Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity and initial antimicrobial therapy. Am Rev Respir Dis 1993; 148:1418-1426.
8. Ewig S, Ruiz M, Mensa J, Marcos MA, Martinez JA, Arancibia F, et al. Severe community-acquired pneumonia. Assessment of severity criteria. Am J Respir Crit Care Med 1998; 158:1102-1108. This paper defines the sensitivity and specifity of a number of commonly used parameters for the diagnosis of severe CAP. In addition, the authors suggest that a rule with three minor (multilobe involvement; systolic blood pressure less than 90 mmHg; ratio of arterial oxygen pressure to fractional inspired oxygen less than 250) plus one of septic shock or mechanical ventilation should be used to define severe pneumonia.
9. Meehan TP, Fine MJ, Krumholz HM, Scinto JD, Galusha DH, Mockalis JT, et al. Quality of care, process and outcomes in elderly patients with pneumonia. JAMA 1997; 278:2080-2084. This retrospective review of Medicare patients with CAP shows that the prompt administration of antibiotics is associated with a lower mortality rate. In this study patients who received antibiotics within 8 h of presentation at the emergency room had a significantly lower mortality rate than those who started antibiotic therapy later.
10. Ramirez JA, Srinath L, Ahkee S, Raff MJ. Early switch from intravenous to oral cephalosporins in the treatment of hospitalized patients with community-acquired pneumonia. Arch Intern Med 1995; 155:1273-1276.
11. Ramirez JA, Ahkee S. Early switch from intravenous antimicrobial to oral clarithromycin in patients with community-acquired pneumonia. Infect Med 1997; 14:319-323.
12. Ramirez JA. Switch therapy in adult patients with pneumonia. Clin Pulm Med 1995; 2:327-333.
13. Fine MJ, Medsger AR, Stone RA, Marrie TJ, Coley CM, Singer DE, et al. The hospital discharge decision for patients with community-acquired pneumonia. Results from the pneumonia patient outcomes research team cohort study. Arch Intern Med 1997; 157: 47-56. A prospective study that explores the hospital discharge decision for patients hospitalized for the treatment of CAP. Physicians consider the normalization of temperature and respiratory rate and the ability to maintain oral intake to be the most important factors in deciding that patients are ready for discharge. Eight other factors were also considered in this decision. Discharge was delayed beyond stability because of investigation or treatment of co-morbidities or the completion of a standard course of antimicrobials.
14. Halm EA, Fine MJ, Marrie TJ, Coley CM, Kapoor WN, Obrosky DS, Singer DE. Time to clinical stability in patients hospitalized with community-acquired pneumonia. Implications for practice guidelines. JAMA 1998; 279:1452-1457. This study evaluates various definitions of stability for patients hospitalized for the treatment of CAP. Clinical deterioration was uncommon once stability was achieved.
15. Selker HP, Beshansky JR, Pauker SG, Kassirer JP. The epidemiology of delays in a teaching hospital. The development and use of a tool that detects unnecessary hospital days. Med Care 1989; 27:112-122.
16. Calkins DR, Davis RB, Reiley P, Phillips RS, Pineo KLC, Delbanco TL, Iezzoni LI. Patient-physician communication at hospital discharge and patients' understanding of the postdischarge treatment plan. Arch Intern Med 1997; 157:1026-1030.