Pneumonia complications

Vancomycin-resistant infections (VRE) PO, IV 600 mg q 12h for 14-28 days. Pneumonia, complicated skin and skin-structure infections PO, IV 600 mg q 12h for... 

Eosinophihc pneumonia complicated by bronchial asthma has been attributed to levofloxacin (15). 

Mustard RA, Bohnen JMA, Rosati C, Schouten D. Pneumonia complicating abdominal sepsis. Arch Surg 1991 126 170-175. 

Ertapenem is a carbapenem that inhibits cell wall synthesis. It is indicated in the treatment of moderate to severe complicated intra-abdominal infections, complicated skin and skin structure infections, community-acquired pneumonia, complicated urinary tract infections (UTIs) (including pyelonephritis), and acute pelvic infections (including postpartum endomyometritis, septic abortion. 

Linezolid is FDA approved for treatment of infections caused by vancomycin-resistant E. faecium nosocomial pneumonia caused by methicillin-susceptible and methicillin-resistant strains of S. aureus community-acquired pneumonia caused by penicillin-susceptible strains of S. pneumoniae complicated skin and skin-structure infections caused by streptococci and methicillin-susceptible and -resistant strains of S. aureus and uncomplicated skin and skin-structure infections. In noncomparative studies, linezolid (600 mg twice daily) has had clinical and miaobiological cure rates in the range of 85 to 90% in treatment of a variety of infections (soft tissue, urinary tract, and bacteremia) caused by vancomycin-resistant E. faecium. A 200-mg, twice-daily dose was less effective, with clinical and microbiological cure rates of approximately 75 and 59%, respectively. The 600-mg, twice-daily dose, therefore, should be used for treatment of infections caused by enterococci. A 400-mg, twice-daily dosage regimen is recommended only for treatment of uncomplicated skin and skin-structure infections. 

In one patient respiratory syncytial virus pneumonia complicated his postoperative management. In contrast, this patient responded to inhaled nitric oxide with an increase in saturation from 48% to 87%, and the transpulmonary gradient decreased from 12 to 4 mm Hg without a change in left atrial pressure. He was subsequently managed for 93 hr on low-dose nitric oxide at doses of 3-10 ppm. Following resolution of his pneumonia, he made a good recovery. 

Infection risk Fatal Pneumocystis jirovecii pneumonia complicated immunosuppressive therapy in two patients with steroid-refractory ulcerative colitis taking steroids and tacrolimus [146" ]. Despite immediate therapy with high-dose co-trimoxazole and broad-spectrum antibiotics, both patients died with progressive respiratory failure. 

Although viral infections are important causes of both otitis media and sinusitis, they are generally self-limiting. Bacterial infections m complicate viral illnesses, and are also primary causes of ear and sinus infections. Streptococcus pneumoniae and Haemophilus influenzae are the commonest bacterial pathogens. Amoxycillin is widely prescribed for these infections since it is microbiologically active, penetrates the middle ear, and sinuses, is well tolerated and has proved effective. 

Some comatose patients are unconscious for less than 2 hours, do not show signs of severe toxicity, and have few complications. In other patients, coma lasts from 2 to 24 hours, and symptoms are more marked. Patients with severe toxicity, including status epi -lepticus and malignant hyperthermia, may remain in coma for 1 day to 3 weeks. These patients often have respiratory or metabolic acidosis. Comatose patients are susceptible to aspiration pneumonia and rhabdomyolysis. Head injury and intracerebral bleeding should be considered as the cause of the comatose state. 

Complicated exacerbation FEV, less than 50% predicted Comorbid cardiac disease Greater than or equal to 3 exacerbations per year Antibiotic therapy in the previous 3 months Above organisms plus drug-resistant pneumococci, P-lactamase-producing H. influenzae and M. catarrhalis, Escherichia coli, Proteus spp., Enterobacter spp., Klebsiella pneumoniae Oral P-Lactam/P-Iactamase inhibitor (amoxicil 1 i n-clavulanate) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, gemifloxacin, moxifloxacin) Intravenous P-Iactam/P-Iactamase inhibitor (ampicillin-sulbactam) Second- or third-generation cephalosporin (cefuroxime, ceftriaxone) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, moxifloxacin)... 

The outcome from intraabdominal infection is not determined solely by what transpires in the abdomen. Unsatisfactory outcomes in patients with intraabdominal infections may result from complications that arise in other organ systems. A complication commonly associated with mortality after intraabdominal infection is pneumonia.26 A high APACHE (Acute Physiology And Chronic Health Evaluation) II score, a low serum albumin, and a high New York Heart Association cardiac function status were significantly and independently associated with increased mortality from intraabdominal infection.27... 

Mustard RA, Bohnen JMA, Rosati C, Schouten D. Pneumonia com- Solomkin JS, Mazuski JE, Baron EJ, et al. Guidelines for the selection plicating abdominal sepsis. Arch Surg 1991 126 170-175. of anti-infective agents for complicated intraabdominal infec-... 

Measles, also known as rubeola, is characterized by a rash that is often complicated by diarrhea, middle ear infection, or pneumonia. Encephalitis occurs in 1 of every 1000 reported cases. Individuals who recover from encephalitis usually have permanent brain damage. Death occurs in 1 to 2 of every 1000 reported measles cases.8... 

The 23-valent pneumococcal polysaccharide vaccine is recommended for use in all adults 65 years of age or older and adults less than 65 years who have medical comorbidities that increase the risk for serious complications from S. pneumoniae infection, such as chronic pulmonary disorders, cardiovascular disease, diabetes mellitus, chronic liver disease, chronic renal failure, functional or anatomic asplenia, and immunosuppressive disorders. Alaskan natives and certain Native American populations are also at increased risk. Children over the age of 2 years may be vaccinated with the 23-valent pneumococcal polysaccharide vaccine if they are at increased risk for invasive S. pneumoniae infections, such as children with sickle cell anemia or those receiving cochlear implants. 

Parenteral nutrition can be a lifesaving therapy in patients with intestinal failure, but the oral or enteral route is preferred when providing nutrition support ( when the gut works, use it ). Compared with PN, enteral nutrition generally is associated with fewer infectious complications (e.g., pneumonia, intraabdominal abscess, and catheter-related infections) and potentially improved outcomes.1-3 However, if used in appropriate patients (i.e., patients with questionable intestinal function or when the intestine cannot be used), PN can be used safely and effectively and may improve nutrient delivery.4 Indications for PN are listed in Table 97-1.1... 

Infectious complications of EN include aspiration pneumonia and infections related to delivery of contaminated EN formula. Aspiration is a complication with GI, mechanical, and infectious implications. Although GI infections owing to contamination of enteral formulas have been reported uncommonly, there is ample opportunity for these formulas to be seeded with organisms during the processes of transferring from the can to the delivery bag with ready-to-use formulas and during the process of reconstitution with powdered formulas. The so-called closed systems of delivery, wherein the formulas come from the manufacturer premixed in a delivery bag, should help to decrease the chance of formula contamination. 

Acute complications of SCD include fever and infection (e.g., sepsis caused by encapsulated pathogens such as Streptococcus pneumoniae), stroke, acute... 

Complications of influenza may include exacerbation of underlying comorbidities, primary viral pneumonia, secondary bacterial pneumonia or other respiratory illnesses (e.g., sinusitis, bronchitis, otitis), encephalopathy, transverse myelitis, myositis, myocarditis, pericarditis, and Reye s syndrome. 

The goals of treatment include reduction in signs and symptoms, eradication of infection, and prevention of complications. Avoidance of unnecessary antibiotic use is another goal in view of S. pneumoniae. 

The urinary pathogens in complicated or nosocomial infections may include E. coli, which accounts for less than 50% of these infections, Proteus spp., Klebsiella pneumoniae, Enterobacter spp., Pseudomonas aeruginosa, staphylococci, and enterococci. Candida spp. have become common causes of urinary infection in the critically ill and chronically catheterized patient. 

Complicated coli Proteus mirabiiis Klebisella pneumoniae Pseudomonas aeruginosa Enterococcus faecalis 1. Quinolone x 14 days (B, III)0 2. Extended-spectrum penicillin plus aminoglycoside (B, III)0 Severity of illness will determine duration of IV therapy culture results should direct therapy Oral therapy may complete 14 days of therapy... 

The history and physical examination should be obtained while initial therapy is being provided. A history of previous asthma exacerbations (e.g., hospitalizations, intubations) and complicating illnesses (e.g., cardiac disease, diabetes) should be obtained. The patient should be examined to assess hydration status use of accessory muscles of respiration and the presence of cyanosis, pneumonia, pneumothorax, pneumomediastinum, and upper airway obstruction. A complete blood count may be appropriate for patients with fever or purulent sputum. 

Symptoms Symptoms appear about ten to twenty days after the Q fever rickettsia are inhaled. The symptoms resemble flu symptoms and include fever, chills, headache, fatigue and muscle aches. About one half of persons with symptoms will have pneumonia evident on chest X-ray and some of these will have a cough or chest pain. The complications of meningitis or and inflammation of the heart may arise, but these are uncommon. Normally, the duration of Q fever is two days to two weeks at which time the disease resolves without permanent effects on the individual. 

Symptoms Q fever typically presents as an undifferentiated illness, with fever, chills, cough, headache, weakness, and chest pain occurring as early as ten days after exposure. Onset may be sudden or insidious. Pneumonia is present in some cases, but pulmonary syndromes are usually not prominent. Victims are not generally critically ill, and the illness last from two days to two weeks. Complications include hepatitis and a peculiar form of chronic endocarditus that may be largely responsible for the few fatal cases that occur. 

One definition of post-operative paralytic ileus is the failure of the patient to pass faeces or flatus within 60 hr. of the termination of a surgical abdominal operation . A somewhat similar condition may arise in cases of gross mechanical obstruction of the gut. It is well known also that operations involving handling of the gut or the peritoneum are especially liable to cause paralytic ileus. Peritonitis and post-operative pain, inadequately treated with morphia, also precipitate paralytic ileus. Pneumonia, meningitis and typhoid predispose to paralytic ileus, whilst severe hypothyroidism can also be complicated by a paralytic ileus. 

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