Risk factors and antibiotic therapy in P. aeruginosa community-acquired pneumonia.

BACKGROUND AND OBJECTIVE: Current guidelines recommend empirical treatment against Pseudomonas aeruginosa in community-acquired pneumonia (CAP) patients with specific risk factors. However, evidence to support these recommendations is limited. We evaluate the risk factors and the impact of antimicrobial therapy in patients hospitalized with CAP due to P. aeruginosa. METHODS: We performed a retrospective population-based study of >150 hospitals. Patients were included if they had a diagnosis of CAP and P. aeruginosa was identified as the causative pathogen. Univariate and multivariate analyses were performed using the presence of risk factors and 30-day mortality as the dependent measures. RESULTS: Seven hundred eighty-one patients with P. aeruginosa pneumonia were identified in a cohort of 62 689 patients with pneumonia (1.1%). Of these, 402 patients (0.6%) were included in the study and 379 (0.5%) were excluded due to health care-associated pneumonia or immunosuppression. In patients with CAP due to P. aeruginosa, 272 (67.8%) had no documented risk factors. These patients had higher rates of dementia and cerebrovascular disease. Empirical antibiotic therapy against P. aeruginosa within the first 48 h of presentation was independently associated with lower 30-day mortality in patients with CAP due to P. aeruginosa (hazard ratio (HR) 0.42, 95% confidence interval (CI): 0.23-0.76) and in patients without risk factors for P. aeruginosa CAP (HR 0.40, 95% CI: 0.21-0.76). CONCLUSIONS: Risk factor recommended by current guidelines only detect one third of the patients admitted with CAP due to P. aeruginosa. Risk factors did not define the whole benefit observed due to empirical therapy covering P. aeruginosa.

Impact of macrolide therapy in patients hospitalized with Pseudomonas aeruginosa community-acquired pneumonia.

BACKGROUND: Several studies have described a clinical benefit of macrolides due to their immunomodulatory properties in various respiratory diseases. We aimed to assess the effect of macrolide therapy on mortality in patients hospitalized for Pseudomonas aeruginosa community-acquired pneumonia (CAP). METHODS: We performed a retrospective population-based study of > 150 hospitals in the US Veterans Health Administration. Patients were included if they had a diagnosis of CAP and P aeruginosa was identified as the causative pathogen. Patients with health-care-associated pneumonia and immunosuppression were excluded. Macrolide therapy was considered when administered within the first 48 h of admission. Univariate and multivariable analyses were performed using 30-day mortality as the dependent measure. RESULTS: We included 402 patients with P aeruginosa CAP, of whom 171 (42.5%) received a macrolide during the first 48 h of admission. These patients were older and white. Macrolide use was not associated with lower 30-day mortality (hazard ratio, 1.14; 95% CI, 0.70-1.83; P = .5). In addition, patients treated with macrolides had no differences in ICU admission, use of mechanical ventilation, use of vasopressors, and length of stay (LOS) compared with patients not treated with macrolides. A subgroup analysis among patients with P aeruginosa CAP in the ICU showed no differences in baseline characteristics and outcomes. CONCLUSIONS: Macrolide therapy in the first 48 h of admission is not associated with decreased 30-day mortality, ICU admission, need for mechanical ventilation, and LOS in hospitalized patients with P aeruginosa CAP. Larger cohort studies should address the benefit of macrolides as immunomodulators in patients with P aeruginosa CAP.

RU486 / RU486

La controversia detrás la píldora es más de política. RU 486 no es un simple, comentario sobre un remedio a largo plazo. Un aborto farmacéutico puede durar hasta 48 horas, con cuatro visitas médicas requeridas. El proceso involucra una dos - parte de dosis de mifepristone y misoprostol. Mifepristone bloquea los efectos de progesterona y termina la preñez. La segunda dosis, misoprostol, ocasiona contracciones para expulsar el huevo dentro de 24 horas RU 486 es un 96 por ciento efectivo y considerado para ser un procedimiento noinvasor. Las mujeres pueden tomar RU 486 inmediatamente después que ellos detectan preñez. El aborto quirúrgico, sin embargo, requiere que las mujeres tengan no mas de siete de semanas encintas para poder realizarce la operación. Sin embargo, los problemas verdaderos yacen no con el proceso de tomar RU 486, pero con la pugna política sobre su legalización. En 1989, la Administración de Bush emitió un "el alerta de importación" prohibiendo investigación adicional y el uso de mifepristone El Presidente Clinton levantó la prohibición contra RU 486 en el Enero 1993...