[Community acquired pneumonia: higher mortality than traffic accidents ].
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Community-Acquired Infections↗
Biomedical subjects
Paul Léophonte
Publications and source records attributed to Paul Léophonte.
[Treatment and prevention of pneumococcal pneumonia].
Streptococcus pneumoniae is the most commonly identified pathogen in patients with community-acquired pneumonia. 40% of isolated strains in France are of decreased sensibility to penicillin, two third being multiresistant to antibiotics. However, high doses of some beta-lactams are effective in vivo against the majority of circulating strains (MIC > 2 mg/L). For this reason according to French guidelines amoxicillin (3 g/day) is the first line recommended treatment. Telithromycin is an alternative, or ceftriaxone (1 g/day) in more severe cases. If the level of resistance increases (MIC > 4 mg/L) guidelines would be revisited. Effectiveness of pneumococcal vaccination has been confirmed in cases of bacteriemic pneumococcal pneumonia (elderly patients included). Vaccine is recommended among persons with comorbiditie(s) and 65 years old population.
Anti-Bacterial Agents↗
Limited operation for severe multisegmental bilateral bronchiectasis.
BACKGROUND: Some patients exhibiting severe multisegmental bilateral bronchiectasis are no longer improved with antibiotic treatment and drainage and, most of the time, operation is contraindicated. In our institution, limited operation has been offered to select patients for this indication. We report our data regarding the feasibility and utility of such a procedure. METHODS: We studied 16 patients who underwent surgical removal of nonlocalized disease between 1990 and 1999. We report the mortality and morbidity rates of this surgical procedure and the clinical, bacteriological, and functional data for each patient. RESULTS: There was no mortality and the morbidity was low (18%, all with favorable outcome). Symptoms such as hemoptysis, sputum production, or dyspnea were also improved. The recurring infections decreased in frequency in 8 patients and disappeared completely in 5 others. The bacteriological data assessment revealed disappearance of germs in 4 patients and persistence of chronic colonization in others. Postoperative spirometric data were not worsened and postoperative computed tomographic scans did not show progression of lesions not removed. CONCLUSIONS: These results suggest that, in properly selected patients, lasting symptomatic improvement can be achieved by resection. Limited operation may be indicated in nonlocalized bilateral bronchiectasis, provided that a target can be identified. This procedure is supported by physiopathologic arguments and is particularly relevant to patients with bronchiectasis with cystic and functionless territories.
Adolescent↗
[Respiratory pathology associated with pneumococcus].
Pneumococcal pneumonia is the leading cause of death due to infectious diseases in industrialized countries. Risk factors are mainly elderly and comorbidities. Increasing prevalence of multiresistant strains to antibiotics is a major problem for public health. Lobor consolidation remains the most frequent pattern, nevertheless less frequent than in the pre-antibiotic era; it's not significantly predictive of pneumococcal etiology. Extra-respiratory complications are more frequent in bacteremic pneumonia. Signs and symptoms are not different in HIV positive patients. There are no clinical predictive signs of penicillin-resistant pneumococcal pneumonia; nevertheless some risk factors have been identified: young age(particularly children in day-care centers), elderly patients, previous eéta-lactam treatment, nosocomial acquisition, prior hospitalization. Biologic diagnosis tools (blood cultures, sputum culture) are now completed by antigen-detection tests, particularly urinary antigen test. Most active béta-lactams on in vitro resistant strains (penicillin, amoxicillin, céfotaxime, ceftriaxone) remain the first line treatment. Mortality is near 12-15% cases among hospitalized patients, 95% of deaths concerning more than 60 years patients. Outcome is not significantly affected by drug resistance. Pneumococcal vaccination is a very important prevention among elderly and patients with underlying chronic medical conditions. Pneumococcal vaccine in France is largely ignored by general practitioners.
Anti-Bacterial Agents↗