Abstract:
BACKGROUND:Although most experts recommend empirical antibiotic treatment, covering also atypical bacteria, for patients admitted to an intensive care unit (ICU), the data are not clear for patients admitted to a general ward. European guidelines recommend starting empirical treatment with a beta-lactam antibiotic with or without a macrolide, but the with/without is not clarified. We investigated whether the use of antibiotic coverage for atypical pathogens was guided by clinical parameters. METHODS:We retrospectively analysed 300 patients hospitalised with community-acquired pneumonia. Four parameters for possible atypical pneumonia (age <55 years, abdominal symptoms, sodium <130 mmol/l, immunosuppression) and three for pneumonia severity (pneumonia severity index [PSI], ICU admission, pO2 <8 kPa (60 mm Hg) or O2 saturation <90%) were defined and correlated with the probability of coverage for atypical pathogens. Correlations were calculated using the chi-square test for 2 x 2 tables. RESULTS:Patients younger than 55 years significantly more likely to receive coverage for atypical pathogens than older patients (odds ratio [OR] 2.68; 95% confidence interval [CI] 1.3-5.5, p = 0.009). In patients with a PSI >III the proportion receiving coverage for atypical bacteria was even smaller than in patients with less severe pneumonia (OR 0.77; 95% CI 0.60-0.99, p = 0.03), but no difference was found for PSI >IV compared with PSI ≤IV (OR = 1.03; 95% CI 0.61-1.74, p = 0.9). The other clinical parameters had no effect on antibiotic coverage: ICU admission (OR =1.39; 95% CI 0.87-2.4, p = 0.15); pO2 >8 kPa or O2-Saturation >90% (OR 1.36; 95% CI 0.85-2.17, p = 0.19); abdominal symptoms (OR 1.06; 95% CI 0.51-2.25, p = 0.88); sodium <130 mmol/l (OR 0.63; 95% CI 0.29-1.36, p = 0.2) or immunosuppression (OR 1.007; 95% CI 0.462-44, p = 1). There was also no correlation between the number of clinical parameters present and the coverage of atypical pathogens (r = 0.48). Mortality was no different between patients in whom atypical pathogens were covered compared with those with beta-lactam therapy alone (OR 1.2; 95% CI 0.66-2.25, p = 0.43). CONCLUSION:Physicians have difficulties deciding when to cover atypical pathogens in hospitalised patients with community-acquired pneumonia. Guidelines should clarify under what circumstances combination therapy is warranted.
journal_name
Swiss Med Wklyjournal_title
Swiss medical weeklyauthors
Piso RJ,Arnold C,Bassetti Sdoi
10.4414/smw.2013.13870subject
Has Abstractpub_date
2013-09-19 00:00:00pages
w13870eissn
1424-7860issn
1424-3997pii
smw-13870journal_volume
143pub_type
杂志文章abstract:BACKGROUND:In Switzerland, intravenous drug use accounts for the majority of hepatitis C virus (HCV) infections. Early HCV treatment prevents further transmissions and reduces morbidity and mortality due to decompensated liver cirrhosis and hepatocellular carcinoma. Nevertheless, patients in drug substitution programme...
journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:10.4414/smw.2017.14544
更新日期:2017-11-20 00:00:00
abstract:OBJECTIVE:To evaluate the current prevalence of self-reported interpersonal violence amongst patients consulting at the emergency department (ED) of a university hospital and to describe the characteristics of the violence sustained. METHODS:Ours was a cross-sectional study using a modified version of the Partner Viol...
journal_title:Swiss medical weekly
pub_type: 杂志文章
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abstract:BACKGROUND:Extracorporeal photopheresis (ECP) has been reported to be safe and the ultimate treatment option in lung transplant recipients with chronic lung allograft dysfunction (CLAD), the main overall cause of mortality in lung transplant recipients. However, ECP is not reimbursed in selected health jurisdictions, a...
journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:10.4414/smw.2017.14429
更新日期:2017-03-13 00:00:00
abstract::Perinatal care of pregnant women at high risk for preterm delivery and of preterm infants born at the limit of viability (22-26 completed weeks of gestation) requires a multidisciplinary approach by an experienced perinatal team. Limited precision in the determination of both gestational age and foetal weight, as well...
journal_title:Swiss medical weekly
pub_type: 杂志文章,评审
doi:10.4414/smw.2011.13280
更新日期:2011-10-18 00:00:00
abstract:PRINCIPLES:Drugs that either inhibit prostaglandin synthesis or antagonise angiotensin II effects are likely to impair renal function, especially in patients with an activated renin-angiotensin-aldosterone system. Of the former, nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, and newer agents with cycloo...
journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:2001/13/smw-09680
更新日期:2001-04-07 00:00:00
abstract:BACKGROUND:To compare the efficacy of two different regimens in treatment of brucellosis. METHODS:This randomised clinical trial study was conducted on 280 patients with brucellosis in Babol, Iran, from April 1999 to January 2002. One of the following two regimens was randomly prescribed for two months: co-trimoxazole...
journal_title:Swiss medical weekly
pub_type: 临床试验,杂志文章,随机对照试验
doi:2004/37/smw-10665
更新日期:2004-09-18 00:00:00
abstract:BACKGROUND:Low-molecular-weight heparins (LMWH) have been shown to be safer, more effective and more convenient than unfractionated heparin (UFH) in many clinical situations. However, their use is limited in patients with renal insufficiency (RI) due to bioaccumulation. METHOD:The literature is critically reviewed and...
journal_title:Swiss medical weekly
pub_type: 杂志文章,评审
doi:smw-11284
更新日期:2009-08-08 00:00:00
abstract::Malnutrition has been defined as a “state resulting from lack of uptake or intake of nutrition, leading to altered body composition and body cell mass, as well as to diminished physical and mental function and impaired clinical outcome from disease.” Particularly for the multimorbid medical inpatient, ther...
journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:10.4414/smw.2020.20204
更新日期:2020-04-15 00:00:00
abstract:QUESTIONS UNDER STUDY:The aim of the study was to analyse the effects of supplementary health insurance on the incidence of hospitalisations for musculoskeletal conditions in Switzerland. METHODS:Cross sectional and small area analyses of surgical interventions for major musculoskeletal disorders in Switzerland were c...
journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:10.4414/smw.2011.13152
更新日期:2011-02-03 00:00:00
abstract::Cells reside in mechanically rich and dynamic microenvironments, and the complex interplay between mechanics and biology is widely acknowledged. Recent research has yielded insights linking the mechanobiology of cells, human physiology, and pathophysiology. In particular, we have learned of the cell's astounding abili...
journal_title:Swiss medical weekly
pub_type: 杂志文章,评审
doi:10.4414/smw.2013.13766
更新日期:2013-03-14 00:00:00
abstract::Dementia with Lewy bodies (DLB) accounts for 15-20% of all autopsy confirmed dementias in old age. Characteristic histopathological changes are intracellular Lewy bodies and Lewy neurites, with abundant senile plaques but sparse neurofibrillary tangles. Core clinical features are fluctuating cognitive impairment, pers...
journal_title:Swiss medical weekly
pub_type: 杂志文章,评审
doi:2003/09/smw-10028
更新日期:2003-03-08 00:00:00
abstract:AIMS OF THE STUDY:Healthy adults have had the option to receive prescriptionless vaccination against influenza in pharmacies of several Swiss cantons since the 2015/16 influenza season. We aimed to assess in a cost-benefit analysis the resulting net benefits for the Swiss economy and public health, and the benefits tha...
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pub_type: 杂志文章
doi:10.4414/smw.2019.20161
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journal_title:Swiss medical weekly
pub_type: 杂志文章,评审
doi:10.4414/smw.2014.14040
更新日期:2014-12-04 00:00:00
abstract::Cartilage hair hypoplasia (CHH) is a rare autosomal recessive ribosomopathy characterised by skeletal and integumentary system manifestations. It may also present with varied forms and intensities of haematopoietic and/or immune disorders. We report a 27-year-old female who presented a picture of combined immunodefici...
journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:10.4414/smw.2018.14606
更新日期:2018-04-24 00:00:00
abstract::Rehabilitation can be referred to as a "black box" because little is known about what specific interventions comprise the rehabilitation process, including patients with spinal cord injury (SCI). Despite that rehabilitation professionals can "see" daily what rehabilitation looks like, the contribution of each interven...
journal_title:Swiss medical weekly
pub_type: 杂志文章,评审
doi:10.4414/smw.2012.13673
更新日期:2012-09-20 00:00:00
abstract::In this review article, we aim at analysing the role of stress in addiction and relapse. In order to do so, we first offer a summary of the findings from affective neuroscience trying to understand compulsive reward-seeking behaviours. These behaviours are characterised by an imbalance between the considerable amount ...
journal_title:Swiss medical weekly
pub_type: 杂志文章,评审
doi:10.4414/smw.2019.20151
更新日期:2019-11-29 00:00:00
abstract:AIMS OF THE STUDY:The purpose of this study was to establish a new computed tomography (CT) sign for pulmonary congestion (Kerley B lines in the lung apex in patients with cardiac or renal insufficiency) and to find the best signs to differentiate between pulmonary congestion and interstitial lung disease (ILD). METHO...
journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:10.4414/smw.2019.20119
更新日期:2019-09-02 00:00:00
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journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:10.4414/smw.2012.13575
更新日期:2012-05-31 00:00:00
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journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:10.4414/smw.2013.13834
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journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:10.4414/smw.2012.13577
更新日期:2012-05-31 00:00:00
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pub_type: 杂志文章,多中心研究
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pub_type: 杂志文章,评审
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更新日期:2015-12-21 00:00:00
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journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:smw-12956
更新日期:2010-02-20 00:00:00
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journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:2006/35/smw-11502
更新日期:2006-09-02 00:00:00
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journal_title:Swiss medical weekly
pub_type: 临床试验,杂志文章,随机对照试验
doi:2001/01/smw-05828
更新日期:2001-01-12 00:00:00
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journal_title:Swiss medical weekly
pub_type: 杂志文章
doi:2007/07/smw-11606
更新日期:2007-02-24 00:00:00
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pub_type: 杂志文章
doi:10.4414/smw.2017.14515
更新日期:2017-10-22 00:00:00
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journal_title:Swiss medical weekly
pub_type: 杂志文章,评审
doi:10.4414/smw.2015.14233
更新日期:2015-12-23 00:00:00
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pub_type: 杂志文章,评审
doi:10.4414/smw.2012.13574
更新日期:2012-05-09 00:00:00
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journal_title:Swiss medical weekly
pub_type: 杂志文章,评审
doi:
更新日期:2006-06-10 00:00:00