Overuse of Broad-Spectrum Antibiotics for Pneumonia
The prevailing practice in many hospitals is to give immediate, often broad-spectrum, antibiotics to all hospitalized patients with possible infections. Two interlinked factors drive this practice: (1) clinicians fear that any delay in appropriate antibiotics may increase patients ’ risk for worse outcomes including death, and (2) it is uncomfortable to withhold antibiotics from a patient who may have an infection, even if the likelihood of infection is low; doing something feels more responsive, responsible, and patient-centric than doing nothing. The net result, however, is widespread use of antibiotics, much of which is unnecessary. Overprescribing is particularly pronounced in patients with pneumonia. Study after study has documented high rates of pneumonia overdiagnosis, suggesting a rush to treat despite equivocal evidence of disease. Up to half of hospitalized patients treated for pneumonia may not actually have pneumonia.
Publication date: Available online 3 April 2020Source: Autoimmunity ReviewsAuthor(s): Dennis McGonagle, Kassem Sharif, Anthony O'Regan, Charlie Bridgewood
Abstract Pneumocystis jirovecii pneumonia (PJP) occurs in immunocompromised hosts and is classified as PJP with human immunodeficiency virus (HIV) infection (HIV-PJP) and PJP without HIV infection (non-HIV PJP). Non-HIV PJP rapidly progresses to respiratory failure compared with HIV-PJP possibly due to the difference in immune conditions; namely, the prognosis of non-HIV PJP is worse than that of HIV PJP. However, the diagnosis of non-HIV PJP at the early stage is difficult. Herein, we report a case of severe non-HIV PJP successfully managed with veno-venous extracorporeal membrane oxygenation (V-V ECMO). A 54-yea...
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Publication date: Available online 7 April 2020Source: Academic RadiologyAuthor(s): Yiqi Hu, He Deng, Lu Huang, Liming Xia, Xin Zhou
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