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Printable Handouts
Navigable Slide Index
- Introduction
- Financial disclosure
- Aims and objectives
- CAP in European ICUs
- Review of challenges surrounding CAP
- Defining pneumonia severity: CURB-65
- Avoiding delayed admission to the ICU
- Criteria for severe CAP: 2007 guidelines
- Use of PCT to guide site of care decision
- CAP bacteriology: viruses are common
- Antibiotic principles in 2019 CAP guidelines
- Inpatient antiobiotic recommendations 2019 guidelines
- 2019 CAP guidelines vs. 2007 guidelines
- Combination therapy: macrolide vs. quinolone
- Routine macrolide use in severe CAP?
- No quinolone monotherapy of severe CAP
- May need antibiotics even with viral infection
- Empiric antibiotic use in COVID-19 CAP
- How should CAP management change with COVID
- Windows for antibiotic use in COVID-19
- Bacterial infection with BAL diagnosis in COVID
- PCT in COVID: a potential biomarker
- Use of PCT for antimicrobial stewardship
- End of Part 1
Topics Covered
- Community-acquired pneumonia
- Defining pneumonia severity
- CAP bacteriology
- CAP therapy guidelines
- COVID-19 and CAP
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Therapeutic Areas:
Talk Citation
Niederman, M.S. (2022, May 31). New concepts in the management of CAP: a focus on severe illness - treatment and therapies [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved November 9, 2024, from https://doi.org/10.69645/BJLR8881.Export Citation (RIS)
Publication History
Financial Disclosures
- Professor Niederman has been a consultant for Bayer, AbbVie, Pfizer, Gilead, Merck, Nabriva and N8 Medical. He has also received research grants from Bayer, Merck and Shionogi.
New concepts in the management of CAP: a focus on severe illness - treatment and therapies
Published on May 31, 2022
28 min
Other Talks in the Series: Periodic Reports: Advances in Clinical Interventions and Research Platforms
Transcript
Please wait while the transcript is being prepared...
0:00
Hello.
My name is Dr.
Michael Niederman.
I am currently a professor
of clinical medicine
at Weill Cornell
Medical College,
and I work in the Pulmonary and
Critical Care Medicine Division
at New York Presbyterian
Weill Cornell Medical Center.
I'm very happy to
be with you today
to discuss an important topic,
namely that of new concepts in
the management of
community-acquired pneumonia (CAP).
I'll be focusing specifically
on severe illness.
0:27
I've listed here my
financial disclosures,
which include my consulting
arrangements with a number
of pharmaceutical companies
and research grants.
These are disclosures
that would be
potentially relevant to
the presentation today.
0:42
I'd like to review the aims and
objectives of our presentation.
We will review the criteria for
severe community-acquired
pneumonia,
we will define the bacteriology
of community-acquired pneumonia,
focusing again specifically
on severe CAP.
We'll examine the new versus
the older CAP guidelines.
We'll examine the efficacy of
specific therapies
for severe CAP.
We'll compare macrolides
versus quinolones
as part of a combination
therapy with β-lactams,
and we'll define the
role of steroids
and other adjunctive therapies.
We'll discuss when to treat
for multi-drug resistant
(MDR) pathogens,
and we'll identify
new therapies for
severe MDR pathogen CAP.
1:24
Let me start by reviewing
some epidemiologic data about
community-acquired
pneumonia in European ICUs.
This study, which is now
almost a decade old,
looked at over
1100 patients with
community-acquired pneumonia in
17 ICUs in the GenOSept study.
The 28-day mortality
was reported at 17%,
and the mortality at six
months was higher at 27%.
This escalation, if you will,
in mortality at six months,
is very common in community-acquired
pneumonia and points
out that community-acquired
pneumonia is really part of
a systemic process where
the implications and
consequences continue long after
the patient leaves the hospital.
In this study,
Streptococcus pneumonia or
pneumococcus was the
most common pathogen
occurring in nearly 30%,
but more than 30% were
of an unknown etiology,
and about 7% were due
to inherit
gram-negative bacteria.
Septic shock was a univariate,
but not a multivariate
predictor of mortality.
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