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      Tratamiento de pacientes inmunocompetentes con neumonía adquirida en la comunidad Translated title: Treatment of immunocompetent patients with pneumonia acquired in the community

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          Abstract

          Se hizo una revisión bibliográfica actualizada sobre el tratamiento de pacientes con neumonía adquirida en la comunidad. Se consideraron las medidas terapéuticas generales y la administración de medicamentos según 4 grupos de estratificación: primero, los afectados tratados ambulatoriamente, sin historia de enfermedad cardiopulmonar, factores modificadores o uso reciente de antibióticos; segundo, aquellos con terapia ambulatoria y antecedentes de enfermedad cardiopulmonar o factores modificadores (o ambos) o aplicación reciente de antimicrobianos; tercero, personas hospitalizadas en salas convencionales; y cuarto, los individuos ingresados en la Unidad de Cuidados Intensivos (con riesgo de infección por Pseudomonas aeruginosa o sin este). Asimismo, se ofrecen criterios y recomendaciones sobre el alta hospitalaria de estos pacientes.

          Translated abstract

          An updated literature review on the treatment of patients with pneumonia acquired in the community was carried out. The general therapeutic measures and the administration of medications were considered according to 4 stratification groups: first, those affected who were under outpatient treatment, without history of cardiopulmonary disease, modifier factors or recent use of antibiotics; second, those under outpatient therapy and history of cardiopulmonary disease and/or modifier factors or recent consumption of antimicrobials; third, admitted patients in conventional rooms; and fourth, patients admitted in the Intensive Care Unit (with infection risk caused by Pseudomonas aeruginosa or without it). Likewise, approaches and recommendations on the hospital discharge of these patients are offered.

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          Most cited references73

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          BTS guidelines for the management of community acquired pneumonia in adults: update 2009.

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            Impact of antibiotics on expression of virulence-associated exotoxin genes in methicillin-sensitive and methicillin-resistant Staphylococcus aureus.

            Extracellular protein toxins contribute to the pathogenesis of a wide variety of Staphylococcus aureus infections. The present study investigated the effects that cell-wall active antibiotics and protein-synthesis inhibitors have on transcription and translation of genes for Panton-Valentine leukocidin, alpha-hemolysin, and toxic-shock syndrome toxin 1, in both methicillin-sensitive and methicillin-resistant S. aureus. Subinhibitory concentrations of nafcillin induced and prolonged mRNA for Panton-Valentine leukocidin, alpha-toxin, and toxic-shock syndrome toxin 1 and increased toxin production. In contrast, clindamycin and linezolid markedly suppressed translation, but not transcription, of toxin genes. These results suggest (1) that protein-synthesis inhibition is an important consideration in the selection of antimicrobial agents to treat serious infections caused by toxin-producing gram-positive pathogens and (2) that, by inducing and enhancing toxin production, inadvertent use of beta-lactam antibiotics to treat methicillin-resistant S. aureus infections may contribute to worse outcomes.
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              Pneumonia caused by methicillin-resistant Staphylococcus aureus.

              A recent increase in staphylococcal infections caused by methicillin-resistant Staphylococcus aureus (MRSA), combined with frequent, prolonged ventilatory support of an aging, often chronically ill population, has resulted in a large increase in cases of MRSA pneumonia in the health care setting. In addition, community-acquired MRSA pneumonia has become more prevalent. This type of pneumonia historically affects younger patients, follows infection with influenza virus, and is often severe, requiring hospitalization and causing the death of a significant proportion of those affected. Ultimately, hospital-acquired MRSA and community-acquired MRSA are important causes of pneumonia and present diagnostic and therapeutic challenges. Rapid institution of appropriate antibiotic therapy, including linezolid as an alternative to vancomycin, is crucial. Respiratory infection-control measures and de-escalation of initial broad-spectrum antibiotic regimens to avoid emergence of resistant organisms are also important. This article reviews the clinical features of, diagnosis of, and therapies for MRSA pneumonia.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                san
                MEDISAN
                MEDISAN
                Centro Provincial de Ciencias Médicas, Santiago de Cuba (Santiago de Cuba )
                1029-3019
                April 2012
                : 16
                : 4
                : 581-595
                Affiliations
                [1 ] Hospital General Dr. Juan Bruno Zayas Alfonso Cuba
                [2 ] Hospital Materno Sur Mariana Grajales Cuba
                Article
                S1029-30192012000400012
                48ea2609-97ca-4453-8ccf-34f05e25010a

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Cuba

                Self URI (journal page): http://scielo.sld.cu/scielo.php?script=sci_serial&pid=1029-3019&lng=en
                Categories
                MEDICINE, GENERAL & INTERNAL

                Internal medicine
                extra hospital pneumonia,immunocompetent patient,Pseudomonas aeruginosa,types of therapies,secondary health care,neumonía extrahospitalaria,paciente inmunocompetente,tipos de terapias,atención secundaria de salud

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