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Abstract: Poster Presentations |

The clinical effect of 4 days of Empirical Antibiotic Treatment EAT in patients class III with Community Acquired Pneumonia: The Morelia Experience FREE TO VIEW

E. A. Maldonado-Ortiz, MD*; Michael S. Niederman, MD; Julia Ramirez-Hernandez, Nurse; Cecilia Guerrero, MD; Ruben Solorio, MD; Marcela Garcia-Villa, MD; Beatriz Galvan, MD; Reyna Piñon, MD
Author and Funding Information

Hospital de la Mujer, Morelia, Mexico


Chest


Chest. 2004;126(4_MeetingAbstracts):846S. doi:10.1378/chest.126.4_MeetingAbstracts.846S-a
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Abstract

PURPOSE:  Duration of EAT in hospitalized patients p with community acquired pneumonia CAP is not defined and the rule is 7 to 10 days d. The potential risk of toxicity, resistance and cost could be an effect of non always justified prolonged antibiotics abs administration. Our objective is to evaluate the clinical impact of EAT during 4 d and the role of Clinical Pulmonary Infection score CPIS.

METHODS:  Consecutive hospitalized p with CAP admitted to 3 hospitals were included. Epidemiological and clinical/bacteriological data were recorded. EAT was administred < 3 hours h period after CAP diagnosis based on The Grupo Multicentrico Michoacano para el Control de las Infecciones Respiratorias GOMMICHIR local guidelines (Quinolones+Macrolides, Cephalosporines+Macrolides or Ertapenem+Macrolides ). EAT success or failure were evaluated at 72h and 28d. The CPIS value at admission and after 72 h was compared between p received EAT 4 vs > 5 d.

RESULTS:  62p were included, 98.3% were female, age 66.5+20, (17–99 yrs). 60p, (96.7%) had comorbidities and risk factors. 24/62p (38.7%) received previous abs. EAT success was present in 44/62p, (71%) but defervescence was evident and EAT stoped at 4 d in 40/44p, (90.9%) without readmission at 28th d. The length of exposure to abs was 4 d vs 11.9+6.8 ( 6–34 d) p=0.000 in < 4 and > treatment group respectively. CPI score decrease in EAT success p from 7.17 to 3.6 (p=0.000) and increase respectively in prolonged treatment group from 7.9 to 10.7 (p=0.000). The CPIS fall in responders at 72 h Fever and tracheal secretions are the most rapidly resonded components.

CONCLUSION:  In the Morelia experience, 4 d of combined EAT based on our local CAP guidelines is enougt to resolve CAP without readmission at 28th d. The evolution of CPIS at 72 h from admission is the “ golden tool ” to define EAT success in Class III CAP population.

CLINICAL IMPLICATIONS:  The short course of combined EAT in hospitalized patients could reduce potential toxicity and prolonged unnecesary antibiotic administration.

Clinical Pulmonary Infection Score evolution

CPISRespon- ders at admissionRespon- ders 72 hoursNon Respon- ders at admis- sionNon Respon- ders 72 hoursTemperature > to 39°C32 p, 80%3p, 7.5%15p, 68.1%14p, 63.6%Blood leukocites < 4000 or > 11.00023p, 57.5%NA14p, 63.6%17p, 77.2%Tracheal secretions ( purulent tracheal secretions))39p,97.5%NA20p, 90.9%18p, 81.8%Oxygenation: Pao2/ Fio2 > to 240 and no ARDS29p, 72.5%1p, 2.5%14p, 63.6%15p, 68.1%Pulmonary radiograph Localizad infiltrates39p, 97.5.%NA21p, 95.4%1p, 4.5%Progression of pulmonary infiltrate. Radiographic progresión (alter CHF anda ARDS excluded)NANA1p, 4.5%17p, 77.2%Culture of tracheal secretions Pathogenic bacteria cultured in moderate or heavy quantityNA22p, 55%1p, 4.5%22p, 100%

DISCLOSURE:  E.A. Maldonado-Ortiz, None.

Wednesday, October 27, 2004

12:30 PM- 2:00 PM


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