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Gram-Negative Pneumonia


Presentation

  • Abstract A clinical efficacy study of amikacin in the treatment of 15 adults with nonbacteremic, gram-negative bacillary pneumonia is presented.[ncbi.nlm.nih.gov]
  • In 12 patients in whom other organisms resistant to gentamicin were also present, other antimicrobial agents were concomitantly administered.[ncbi.nlm.nih.gov]
  • The present review has the aim to update the current knowledge about the etiology, classifi cation, antimicrobial resistance, diagnosis, and therapy in CAP due to GNB.[caijournal.com]
  • Wunderink, MD Professor of Medicine, Northwestern Medicine, Feinberg School of Medicine, Chicago, IL, United States Date Tuesday, October 31 @ 5:30 AM 5:30am - 6:00am Breakfast & Registration 6:00am - 7:00am Presentation Welcome and Introductions Marin[medscape.org]
  • Rarely, a patient will present with pseudo-hemoptysis created artificially by various means.[ncbi.nlm.nih.gov]
Fever
  • Essentially, all had new lung infiltrates as shown by chest radiography, leukocytosis, recent onset of fever, and increased volume of purulent secretions. Half had multilobar pulmonary infiltrates.[ncbi.nlm.nih.gov]
  • I was worried what happened and fever was also there I consulted to doctor regarding fever , he checked blood , and it was typhoid and malaria I took antibiotic for 21 days with lots of pain in my chest my wife used to cut the medicine in four parts then[healthquestions.medhelp.org]
  • See your doctor promptly if you Have a high fever Have shaking chills Have a cough with phlegm that doesn't improve or gets worse Develop shortness of breath with normal daily activities Have chest pain when you breathe or cough Feel suddenly worse after[icdlist.com]
  • Your doctor might also suggest medication for pain and fever. Other things you can do to help yourself get better: Get lots of rest. Drink plenty of fluids (they’ll loosen up the gunk in your lungs so you can cough it out).[webmd.com]
  • This results in the fever, chills, and fatigue common in bacterial and fungal pneumonia. The neutrophils, bacteria, and fluid leaked from surrounding blood vessels fill the alveoli and result in impaired oxygen transportation.[en.wikipedia.org]
Chills
  • See your doctor promptly if you Have a high fever Have shaking chills Have a cough with phlegm that doesn't improve or gets worse Develop shortness of breath with normal daily activities Have chest pain when you breathe or cough Feel suddenly worse after[icdlist.com]
  • This results in the fever, chills, and fatigue common in bacterial and fungal pneumonia. The neutrophils, bacteria, and fluid leaked from surrounding blood vessels fill the alveoli and result in impaired oxygen transportation.[en.wikipedia.org]
  • Common symptoms are: High fever up to 105 F Coughing out greenish, yellow, or bloody mucus Chills that make you shake Feeling like you can’t catch your breath, especially when you move around a lot Feeling very tired Low appetite Sharp or stabby chest[webmd.com]
  • You may have fever, shaking chills, or a headache. You may feel confused, or have a heart rate that is faster than normal.[chemocare.com]
  • The genus Pseudomonas can be found almost everywhere: hospitals, nursing homes, and medical equipment; it’s all around us. [6],[8] Signs and symptoms of disease General symptoms of bacterial infections have a quick onset such as shaking chills and fever[austincc.edu]
Rigor
  • Pneumonia Fever Rigors Cough Runny nose (either direct bacterial pneumonia or accompanied by primary viral pneumonia) Dyspnea – shortness of breath Chest pain Shaking chills Pneumococcal pneumonia can cause coughing up of blood, or hemoptysis, characteristically[en.wikipedia.org]
  • Initial mild headache and myalgia leading to high fever, chills and repeated rigors; non-chest symptoms often predominate early on. Cough is nearly always present, initially unproductive but may lead to expectoration later.[patient.info]
  • Patients, particularly elderly and debilitated patients, should be instructed to seek prompt care should symptoms of dyspnea or fever and rigors develop.[emedicine.com]
Cough
  • See your doctor promptly if you Have a high fever Have shaking chills Have a cough with phlegm that doesn't improve or gets worse Develop shortness of breath with normal daily activities Have chest pain when you breathe or cough Feel suddenly worse after[icdlist.com]
  • Drink plenty of fluids (they’ll loosen up the gunk in your lungs so you can cough it out). Use a humidifier or take a warm bath (more gunk-loosening). Don’t smoke. Stay home until your fever goes down and you aren’t coughing anything out.[webmd.com]
  • Coughing is important because nonpulmonary sources of bleeding are not usually associated with hemoptysis.[ncbi.nlm.nih.gov]
  • Pneumonia Fever Rigors Cough Runny nose (either direct bacterial pneumonia or accompanied by primary viral pneumonia) Dyspnea – shortness of breath Chest pain Shaking chills Pneumococcal pneumonia can cause coughing up of blood, or hemoptysis, characteristically[en.wikipedia.org]
  • Cough Medications/Decongestants - may help you to be more comfortable if you are coughing a lot.[chemocare.com]
Dyspnea
  • Pneumonia Fever Rigors Cough Runny nose (either direct bacterial pneumonia or accompanied by primary viral pneumonia) Dyspnea – shortness of breath Chest pain Shaking chills Pneumococcal pneumonia can cause coughing up of blood, or hemoptysis, characteristically[en.wikipedia.org]
  • These medications must be used very cautiously if you have severe dyspnea. Discuss the risks and benefits of taking this medication with your doctor or healthcare provider.[chemocare.com]
  • A young healthy woman with chronic hemoptysis may well have a bronchial adenoma, but the same patient presenting with dyspnea and hemoptysis may have mitral stenosis or primary pulmonary hypertension; mucocutaneous telangiectasis are often seen in Osler-Weber-Rendu[ncbi.nlm.nih.gov]
  • In most cases (60%), the symptoms of dyspnea, cough, hypoxia, and low-grade fever resolve over 2-4 days.[clincalc.com]
  • Patients, particularly elderly and debilitated patients, should be instructed to seek prompt care should symptoms of dyspnea or fever and rigors develop.[emedicine.com]
Productive Cough
  • The material brought up from the lungs after a productive cough constitutes the material desired.[lungindia.com]
  • It is important to note that nursing home patients with pneumonia are less likely to present with classic signs and symptoms of the typical pneumonia presentation, such as fever, chills, chest pain, and productive cough, but instead these individuals[emedicine.com]
Rales
  • […] hypothermia ( 35 C) Tachypnea ( 18 respirations/min) Use of accessory respiratory muscles Tachycardia ( 100 bpm) or bradycardia ( 60 bpm) Central cyanosis Altered mental status Physical findings may include the following: Adventitious breath sounds, such as rales[emedicine.com]
Tachypnea
  • […] sputum Klebsiella species pneumonia: Red currant-jelly sputum Anaerobic infections: Often produce foul-smelling or bad-tasting sputum Signs of bacterial pneumonia may include the following: Hyperthermia (fever, typically 38 C) [1] or hypothermia ( 35 C) Tachypnea[emedicine.com]
Purpura
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
Distractibility
  • 10 tips to clear your brain fog. 12 reasons you're distracted. Exercises for your joints. Each one takes 10 minutes or less. Revitalize your life. WebMD the app Get trusted health information. Whenever. Wherever... with your iPhone, iPad or Android.[webmd.com]
Forgetful
  • Are you getting more forgetful? 10 tips to clear your brain fog. 12 reasons you're distracted. Exercises for your joints. Each one takes 10 minutes or less. Revitalize your life. WebMD the app Get trusted health information. Whenever.[webmd.com]

Workup

  • Urine assays Sputum, serum, and/or urinary antigen tests Immune serologic tests Histologic examination Histologic inflammatory lung changes vary according to whether the patient has lobar pneumonia, bronchopneumonia, or interstitial pneumonia. [2] See Workup[emedicine.com]
  • […] presence of cellulitis Joint, lung, and sinus aspiration Transtracheal aspiration Tympanocentesis Pericardiocentesis Laparoscopy and tubal cultures in women: For suspected NTHi Culdocentesis and peritoneal fluid cultures in women: For suspected NTHi See Workup[emedicine.com]
Pulmonary Infiltrate
  • Half had multilobar pulmonary infiltrates. Their mean age was 73 years, with none under age 50. Most had chronic obstructive pulmonary disease, congestive heart failure, or both.[ncbi.nlm.nih.gov]
  • . : Etiology and microbial patterns of pulmonary infiltrates in patients with orthotopic liver transplantation . Chest 2000, 117 ( 2 ):494–502. PubMed CrossRef Google Scholar 28.[link.springer.com]
  • Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med. 2000;162:505–11.[ccforum.biomedcentral.com]
Pleural Rub
  • Signs: tachypnoea, bronchial breathing, crepitations, pleural rub, dullness with percussion.[patient.info]

Treatment

  • Abstract Beta-lactam antibiotics form the backbone of treatment for Gram-negative pneumonia in mechanically ventilated patients in the intensive care unit.[ncbi.nlm.nih.gov]
  • Currently, the successful treatment of hospital-acquired gram-negative pneumonia depends on a clear and consistent definition of the disease process, knowledge that therapy with a single antibiotic is effective, and use of a concise treatment protocol[ncbi.nlm.nih.gov]
  • Key therapeutic questions are whether beta-lactams can safely replace aminoglycosides for the treatment of gram-negative pneumonia, and whether monotherapy or aminoglycoside and beta-lactam combination antibiotic treatment is superior.[ncbi.nlm.nih.gov]
  • There were no differences in the minor adverse effects observed in the two treatment groups. Overall, aztreonam was superior to tobramycin for treatment of pneumonia due to susceptible gram-negative bacteria in these critical care patients.[ncbi.nlm.nih.gov]
  • Number of Participants With Organ Failure [ Time Frame: Up to 7 days after the end of study treatment ] The overall number of participants with any organ failure was summarized for each treatment group.[clinicaltrials.gov]

Prognosis

  • A multivariate analysis of risk and prognosis . Chest 1988, 93 :318–324. PubMed Google Scholar 26. Pennington JE: Gram-negative bacterial pneumonia in the immunocompromised host . Semin Respir Infect 1986, 1 :145–150. PubMed Google Scholar 27.[link.springer.com]
  • Community-acquired pneumonia due to gram-negative bacteria and pseudomonas aeruginosa: Incidence, risk, and prognosis. Arch Intern Med 2002;162:1849-58. 8.[caijournal.com]
  • The prognosis of uncomplicated Hib pneumonia and nonencapsulated H influenzae infections is usually good.[emedicine.com]
  • Prognosis Mortality from CAP is less than 1% in those well enough to be managed in the community. [ 16 ] The mortality rate in patients admitted to hospital is 5-10% in those not requiring intensive care unit admission, as high as 25% in intubated patients[patient.info]
  • Patients older than 80 years of age had the highest mortality rate, which was 37.7%. [29] Prognosis Generally, the prognosis is good in otherwise healthy patients with uncomplicated pneumonia.[emedicine.com]

Etiology

  • Etiology of community-acquired pneumonia in a population-based study: Link between etiology and patients characteristics, process-of-care, clinical evolution and outcomes. BMC Infect Dis 2012;12:134. 20.[caijournal.com]
  • The clinical features, etiologic agents, population at risk, treatment, and outcome in patients with well-documented gram-negative pneumonia were compared in two groups of patients: those with bacteremic pneumonia and those with nonbacteremic pneumonia[ncbi.nlm.nih.gov]
  • Although gram staining of sputum may provide immediate etiologic clues, the diagnosis is proven only by isolation of the pathogen from blood or pleural fluid or by various invasive techniques since expectorated specimens from highly susceptible patients[ncbi.nlm.nih.gov]
  • Schaberg DR, Culver DH, Gaynes RP: Major trends in the microbial etiology of nosocomial infection . Am J Med 1991, 91 :72S-75S. PubMed CrossRef Google Scholar 24. Marrie TJ: Community-acquired pneumonia: epidemiology, etiology, treatment .[link.springer.com]
  • Etiology The distribution of pathogens that comprise the etiology of pneumonia (including HAP, VAP, and HCAP) varies from region to region [ 22 , 23 ].[ccforum.biomedcentral.com]

Epidemiology

  • ., Ballot, D.E. and Perovich, O. (2005) Epidemiology of Neonatal Sspsis at Johannesburg Hospital.[scirp.org]
  • This article reviews the epidemiologic characteristics, pathogenesis, and current management issues of GNB pneumonia.[link.springer.com]
  • Epidemiology of community-acquired pneumonia in adults: A population-based study. Eur Respir J 2000;15:757-63. 13. Laing R, Slater W, Coles C, Chambers S, Frampton C, Jackson R, et al .[caijournal.com]
  • Current epidemiology and trends in invasive Haemophilus influenzae disease--United States, 1989-2008. Clin Infect Dis . 2011 Dec. 53(12):1230-6. [Medline] .[emedicine.com]
  • Hospital-acquired pneumonia and ventilator-associated pneumonia: recent advances in epidemiology and management. Curr Opin Pulm Med. 2013;19:216–28.[ccforum.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • This most likely reflects an incomplete understanding of the complex pathophysiologic mechanism and thus invites examination of alternative mechanisms.[ncbi.nlm.nih.gov]
  • The effect of pathophysiology on pharmacokinetics in the critically ill patient—concepts appraised by the example of antimicrobial agents. Adv Drug Deliv Rev. 2014;77:3–11.[ccforum.biomedcentral.com]
  • Pathophysiology The causes for the development of pneumonia are extrinsic or intrinsic, and various bacterial causes are noted. Extrinsic factors include exposure to a causative agent, exposure to pulmonary irritants, or direct pulmonary injury.[emedicine.com]

Prevention

  • Preventing pneumonia is always better than treating it. Vaccines are available to prevent pneumococcal pneumonia and the flu. Other preventive measures include washing your hands frequently and not smoking.[icdlist.com]
  • The currently available therapeutic interventions to prevent the disease process are of limited usefulness.[ncbi.nlm.nih.gov]
  • Centers for Disease Control and Prevention: Guidelines for prevention of nosocomial pneumonia . Morbid Mortal Wkly Rep 1997, 46 :1–79. The most current guidelines on infection control measures to prevent nosocomial pneumonia. Google Scholar 15.[link.springer.com]
  • […] cardiac failure, etc.) should be among the preventive measures.[caijournal.com]
  • Immunization/vaccination is an essential component for prevention of Hib infections.[emedicine.com]

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