Pulmonary Infections, An Issue of Sleep Medicine Clinics

Michael Niederman

Description

This issue provides fully updated information on respiratory infections, including healthcare associated pneumonia, new diagnostic tests for pneumonia, epidemic viral pneumonia and other emerging pathogens, biomarkers to optimize antibiotic therapy for pneumonia, pharmacokinetics and pharmacodynamics to improve management of penumonia. Nosocomial tracheobronchitis and bronchiectasis are also discussed. Articles on CAP and VAP, including an examination of the impact of guidelines on outcomes, de-escalation therapy, inhaled antibiotic therapy and prevention of VAP are also included.

Sujets

• Thoracic Medicine
• Pulmonary Medicine
• Medical
• Médecine

Informations

• Publié par: Saunders
• Date de parution: 28 septembre 2011
• Nombre de lectures: 0
• EAN13: 9781455711987
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Respiratory Tract Infections: Advances in Diagnosis, Management and Prevention , Vol. 32, No. 3, September 2011
ISSN: 0272-5231
doi: 10.1016/S0272-5231(11)00069-4

Contributors
Clinics in Chest Medicine
Respiratory Tract Infections: Advances in Diagnosis, Management and Prevention
GUEST EDITOR: Michael S. Niederman, MD
ISSN  0272-5231
Volume 32 • Number 3 • September 2011

Respiratory Tract Infections: Advances in Diagnosis, Management and Prevention , Vol. 32, No. 3, September 2011
ISSN: 0272-5231
doi: 10.1016/S0272-5231(11)00070-0

Contents
Cover
Contributors
Forthcoming Issues
Respiratory Tract Infections: Advances in Diagnosis, Management and Prevention
New Diagnostic Tests for Pneumonia: What is Their Role in Clinical Practice?
Biomarkers to Optimize Antibiotic Therapy for Pneumonia Due To Multidrug-Resistant Pathogens
Optimizing Antibiotic Pharmacodynamics in Hospital-acquired and Ventilator-acquired Bacterial Pneumonia
Epidemic Viral Pneumonia and Other Emerging Pathogens
Defining Severe Pneumonia
The Use of Large Databases to Study Pneumonia: What is Their Value?
The Impact of Guidelines on the Outcomes of Community-acquired and Ventilator-associated Pneumonia
Healthcare-Associated Pneumonia: Approach to Management
De-Escalation Therapy: Is It Valuable for the Management of Ventilator-Associated Pneumonia?
Bronchiectasis: New Approaches to Diagnosis and Management
Diagnosis of Ventilator-Associated Respiratory Infections (VARI): Microbiologic Clues for Tracheobronchitis (VAT) and Pneumonia (VAP)
Aerosolized Antibiotics in the Intensive Care Unit
Should Management of Pneumonia be an Indicator of Quality of Care?
Prevention of VAP: Is Zero Rate Possible?
Index
Respiratory Tract Infections: Advances in Diagnosis, Management and Prevention , Vol. 32, No. 3, September 2011
ISSN: 0272-5231
doi: 10.1016/S0272-5231(11)00071-2

Forthcoming Issues
Respiratory Tract Infections: Advances in Diagnosis, Management and Prevention , Vol. 32, No. 3, September 2011
ISSN: 0272-5231
doi: 10.1016/j.ccm.2011.07.001

Preface
Respiratory Tract Infections: Advances in Diagnosis, Management and Prevention

Michael S. Niederman, MD,
Department of Medicine, Winthrop University Hospital, 222 Station Plaza North, Suite 509, Mineola, NY 11501, USA
E-mail address: [e-mail]

Michael S. Niederman, MD, Guest Editor
Respiratory tract infections are common and remain a major source of morbidity, mortality, and economic cost worldwide, despite advances in modern medicine. In fact, often as a consequence of progress in acute and chronic disease management, we have created patient populations at increased risk for immune impairment and for one specific respiratory infection, pneumonia. In 2004, pneumonia, along with influenza, was the eighth leading cause of death in the United States, the sixth leading cause of death in those over age 65, and the number one cause of death from infectious diseases. Patients at risk for pneumonia include not only previously healthy individuals, as well as the elderly with complex chronic illnesses, but also patients hospitalized for other illness, as well as those with novel forms of immunosuppressive illness as the result of new pharmacologic therapies, organ transplantation, or infection with the HIV virus. In addition to our need to face increasingly complex hosts, we must also confront organisms causing respiratory infection that continue to evolve, with new pathogens being recognized (particularly epidemic viruses) and many organisms that were previously easily managed with antimicrobial agents, now being resistant to commonly used therapies. At the same time, few new antibiotics are being developed, making it necessary to get the most from our current therapies. This can be done through a better understanding of pharmacokinetics and pharmacodynamics, more vigilant use of antimicrobial stewardship, application of new diagnostic methods employing molecular techniques and biomarkers, and by seeking novel routes of therapy, such as the delivery of aerosolized agents. In an effort to improve patient management and responsible antibiotic use, guidelines for managing respiratory infection have proliferated over the past 2 decades, and the value of this approach is now being documented. Prevention has become even more important in our current era of limited new therapies, but the benefits of such efforts may be overstated, as exemplified by the current belief that “zero ventilator-associated pneumonia” is a readily achievable goal.
This issue of Clinics in Chest Medicine has brought together an international group of experts to address the current challenges in respiratory infection management, highlighting the common forms of parenchymal disease, including community-acquired pneumonia, nosocomial pneumonia, and the recently defined and controversial entity of health-care-associated pneumonia. In addition, airway infections, including bronchiectasis and ventilator-associated tracheobronchitis, are discussed.
The monograph begins with a review of new diagnostic methods for pneumonia, highlighting the advances in molecular medicine and biomarker measurement that may eventually help us treat infections in a more targeted fashion, allowing for accurate therapy, without the overuse of our best antimicrobials. The role of biomarkers to optimize the management of multidrug-resistant pathogens, particularly in critically ill patients, is also discussed. In an effort to optimize current therapy, the potential to get more from what we already have is highlighted by a discussion of optimizing drug dosing and infusion strategies, through a better understanding of pharmacokinetics and pharmacodynamics. In the setting of community-acquired pneumonia, we have recently learned much about the potential of epidemic viral infections, which are discussed, followed by an analysis of how to define and recognize, as soon as possible, severe forms of pneumonia that must be managed aggressively, usually in an ICU setting. In our efforts to better understand how to manage pneumonia, investigators have been able to glean useful insights from retrospective and prospective evaluation of large databases, and the insights from such studies are examined in a discussion written by several authors who have used this methodology. Then, a careful assessment of the impact of guidelines on the management of community and nosocomial pneumonia is presented. This discussion provides a framework for subsequent discussions of health-care-associated pneumonia, and how this entity fits into current guidelines for management, followed by an examination of de-escalation therapy, a management strategy that is now an integral part of nosocomial pneumonia guidelines.
Airway infections are also discussed, first with a review of bronchiectasis, which is primarily a chronic, outpatient disease, followed by an examination of ventilator-asscociated tracheobronchitis, a common illness in chronically ventilated patients, which may need therapy, and if managed successfully may prevent the subsequent development of pneumonia. In an effort to manage both airway infection and pneumonia due to drug-resistant pathogens, aerosolized antibiotics may be valuable, and the data from recent studies are examined to demonstrate the potential value of this therapy, which is often used as an adjunctive measure to systemic antimicrobial therapy. Finally, the monograph concludes by examining a modern consequence of our understanding of pneumonia, namely the measurement of processes of care in pneumonia management, as a tool to define the quality of care in a given hospital. This has become important in community-acquired pneumonia in the United States, with the development of “core measures” to evaluate inpatient care. In addition, in the management of ventilator-associated pneumonia, measurement of infection rates has become an important outcome, with the push to apply prevention strategies and achieve a zero rate of ventilator-associated pneumonia. While both of these approaches may be admirable, they have risen to a level of controversy with the public reporting of the results of these measurements.
I hope that you will find the discussions in this volume to be contemporary and stimulating. I want to thank all of the authors for their outstanding efforts to compile the most up-to-date information in their reviews and for all the efforts necessary to prepare their contributions. I also want to acknowledge the support provided by Sarah Barth of Elsevier and the support of my family for encouragement during work on this project.
Respiratory Tract Infections: Advances in Diagnosis, Management and Prevention , Vol. 32, No. 3, September 2011
ISSN: 0272-5231
doi: 10.1016/j.ccm.2011.05.011

New Diagnostic Tests for Pneumonia: What is Their Role in Clinical Practice?

Thomas M. File, Jr., MD, MSc a , b , *
a Infectious Disease Section, Internal Medicine Department, Northeastern Ohio Universities College of Medicine and Pharmacy, PO Box 95, Rootstown, OH 44272, USA
b Infectious Disease Service, HIV Research, Summa Health System, 75 Arch Street, Suite 506, Akron, OH 44304, USA
* Infectious Disease Service, Summa Health System, 75 Arch Street, Suite 506, Akron, OH 44304.
E-mail address: [e-mail]

Abstract
The utility of diagnostic studies to determine the etiologic agents of community-acquired pneumonia has been controversial in part because of the lack of rapid, accurate, easily performed, and cost-effective methods. Advancements in molecular testing methods and biological markers are becoming available with marked expansion of diagnostic capability for infectious diseases. Subsequent studies and clinical experience will clarify their real clinical value.

Keywords
• Pneumonia • Diagnosis • Molecular studies
The utility of diagnostic studies to determine the