Guidelines for the management of respiratory infection: Why do we need them, how should they be developed, and can they be useful?

Current Opinion in Pulmonary Medicine

Volumn 2, Issue 3, 1996, Pages 161-165

  Niederman, Michael S ^a  

^a WINTHROP UNIVERSITY HOSPITAL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AIDS RELATED COMPLEX; ANTIBIOTIC RESISTANCE; BACTERIAL INFECTION; BRONCHITIS; COMMUNICABLE DISEASE; CROSS INFECTION; EDITORIAL; EVIDENCE BASED MEDICINE; HEALTH INSURANCE; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; IMMUNE DEFICIENCY; LUNG TUBERCULOSIS; MICROBIOLOGY; PNEUMONIA; PRACTICE GUIDELINE; RESPIRATORY TRACT INFECTION; STANDARD; VIROLOGY; VIRUS INFECTION;

AIDS-RELATED OPPORTUNISTIC INFECTIONS; BACTERIAL INFECTIONS; BRONCHITIS; COMMUNITY-ACQUIRED INFECTIONS; CROSS INFECTION; DRUG RESISTANCE, MICROBIAL; EVIDENCE-BASED MEDICINE; HIV INFECTIONS; HUMANS; IMMUNOCOMPROMISED HOST; MANAGED CARE PROGRAMS; PNEUMONIA; PRACTICE GUIDELINES; RESPIRATORY TRACT INFECTIONS; TUBERCULOSIS, PULMONARY; VIRUS DISEASES;

EID: 0030132621     PISSN: 10705287     EISSN: None     Source Type: Journal    
DOI: 10.1097/00063198-199605000-00001     Document Type: Review

References (16)

1. Fein AM, Niederman MS: Guidelines for the initial management of community-acquired pneumonia: savory recipe or cookbook for disaster? Am J Respir Crit Care Med 1995, 152:1149-1153. An editorial review of the ATS guidelines for CAP that examines the concept of guidelines and the need for an ongoing commitment to validating outcomes that result from the use of guidelines. Potential problems with the process itself, as well as suggested changes to the published CAP guidelines, are presented. The problem of antimicrobial resistance and the possible impact of guidelines on future patterns of resistance are discussed.
2. Balter MS, Hyland RH, Low DE, Braude AC, Cole PJ, Hodder RV, McCombs JS, Allard C, Braidy J, Brown NE, et al.: Recommendation on the management of chronic bronchitis: a practical guide for Canadian physicians. Can Med Assoc J 1994, 151(suppl):5S-23S.
3. Niederman MS, Bass JB, Campbell GD, Fein AM, Grossman RF, Mandell LA, Marrie TJ, Sarosi GA, Torres A, Yu VL: 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.
4. Campbell GD, Niederman MS, Broughton WA, Craven DE, Fein AM, Fink MP, Gleeson K, Hornick DB, Lynch JP, Mandell LA, et al.: Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and prevention strategies. A consensus statement Am J Respir Crit Care Med 1996, in press.
5. Bates JH, Nardell E: Institutional control measures for tuberculosis in the era of multiple drug resistance: ACCP/ATS consensus conference. Chest 1995, 108:1690-1710.
6. Bartlett JG, Mundy LM: Community-acquired pneumonia. N Engl J Med 1995, 333:1618-1624.
7. Mundy LM, Auwaerter PG, Oldach D, Warner ML, Burton A, Vance E, Gaydos CA, Joseph JM, Gopalan R, Moore RD, et al.: Community-acquired pneumonia: impact of immune status. Am J Respir Crit Care Med 1995, 152:1309-1315. This report examines the bacteriology of CAP in 385 patients with varying immunologic status. A total of 221 patients were immune-suppressed, including 180 who were HIV-positive. The yield of specific diagnostic tests in each patient group is presented. As expected, Streptococcus pneumoniae was the most common pathogen in the non-HIV population, while Pneumocystis carinii was most common in the HIV-infected patients. Atypical pathogens were uncommonly found, suggesting that selective, not widespread, macrolide use is appropriate for patients with CAP.
8. Ingram JG, Plouffe JF: Danger of sputum purulence screens in culture of Legionella species. J Clin Microbiol 1994, 32:209-210.
9. Plouffe JF, File TM, Breiman RF, Hackman BA, Salastrom SJ, Marston BJ, Fields BS, and the Community Based Pneumonia Incidence Study Group: Reevaluation of the definition of Legionnaires' disease: use of the urinary antigen assay. Clin Infect Dis 1995, 20:1286-1291. This study examines the utility of a single diagnostic test for legionella infection. The urinary antigen test had the greatest sensitivity of all the methods examined, while serology was of very limited value unless both acute and convalescent titers were collected. The implication of the study is that a single acute titer for legionella infection has very low diagnostic yield.
10. Dahmash NS, Chowdhury M: Re-evaluation of pneumonia requiring admission to an intensive care unit: a prospective study. Thorax 1994, 49:71-76.
11. Leroy O, Santré C, Beuscart C, Georges H, Guery B, Jacquier JM, Beaucaire G: A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit Intensive Care Med 1995, 21:24-31. Two hundred ninety-nine patients with severe CAP were examined and bacteriology defined. A total of 66% of patients had an etiologic diagnosis established, with Streptococcus pneumoniae and gram-negative bacilli being the most common pathogens. Prognosis was associated with the efficacy of initial empiric therapy; mortality was 11% for the 68% of patients who received effective therapy, whereas mortality reached 60% for the patients receiving ineffective initial therapy.
12. Guyatt GH, Sackett DL, Sinclair JC, Hayward R, Cook DJ, Cook RJ: Users' guides to the medical literature: IX. A method for grading health care recommendations. JAMA 1995, 274:1800-1804. A group of proponents of evidence-based medicine present their ideas on how to use the medical literature for developing health care recommendations. The concept of evidence-based medicine is discussed, and the grading system used for evaluating published data is presented. Regardless of whether one agrees with this approach, all of the components of the method are discussed.
13. Naylor CD: Grey zones of clinical practice: some limits to evidence-based medicine. Lancet 1995, 345:840-842.
14. Grahame-Smith D: Evidence based medicine: Socratic dissent. BMJ 1995, 310:1126-1127. In a hypothetical discussion with Socrates, the concepts of evidence-based medicine and meta-analysis are examined skeptically. Socrates warns that evidence-based approaches may limit clinicians to using techniques of unequivocally proven value, thereby eliminating physician discretion in the interest of cost savings.
15. Ramirez JA, Srinath L, Ahkee S, Huang A, 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.
16. Berk SL: Justifying the use of blood cultures when diagnosing community-acquired pneumonia. Chest 1995, 108:891-892.