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.