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Göksel Kıter Pamukkale University, Medical Faculty Chest Department What should we do to solve the problems in lower respiratory.

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Presentation on theme: "Göksel Kıter Pamukkale University, Medical Faculty Chest Department What should we do to solve the problems in lower respiratory."— Presentation transcript:

1 Göksel Kıter Pamukkale University, Medical Faculty Chest Department gokselkiter@yahoo.com What should we do to solve the problems in lower respiratory infections?

2 What should we do to solve the problems in pneumonia topic? Göksel Kıter Pamukkale University, Medical Faculty Chest Department gokselkiter@yahoo.com

3 The problem is not the inability to find the solution, it is the inability to recognize the problem. G.K.Chesterton

4 In this presentation The problems will be defined by reviewing –Related publications (2000-2007) –Previous congress presentation (2000-2007) –Previous presentation by Prof Dr Tevfik Özlü The suggestions to solve those problems will be discussed

5 National publications Turkish Thoracic Journal (in Turkish; 2000- 2007) Key word: “pneumonia” 21 articles –5 review articles –4 diagnosis and treatment guidelines (2002) –5 investigations –5 case reports –1 İİP review article Key word: “infection” –1 investigation

6 National publications Tuberculosis and Thoracic Journal (2000- 2007) Key word: “pneumonia” 40 articles –3 review articles –12 investigations –1 case report –24 other (2 tb-2 empiyema) Key word: “infection” –1 other

7 National publications Respiratory Journal (2000-2007) Key words: “pneumonia” 19 articles –7 investigations –2 case reports –10 other (1 empiyema review) Key word: “infection” –16 other

8 TTS Congresses YEAR TotalPnm (%)OPPDPP 200037929 (7.6)61112 200149220 (4)479 200265926 (3.9)4715 200370616 (2.2)0016 200486015 (1.7)5010 20056215 (0.8)500 2006428575052* 200735613 (3.6)580

9 www.pubmed.com 2005-2007 (.....1990) 19 articles 12 Infectious Diseases, 1 Infetion Control Consersium, 3 Pediatric Diseases, 1 Intensive Care Unit, 1 Internal Medicine Intensive Care Unit infections, Hospital aquired infections, infections over age 65 The antibiotic resistances of Streptococcus

10 Suggestion 1 In CAP; The efficacy of prevention methods Epidemiologic studies Improvement in diagnostic tools Treatment in outpatient clinics Microbiologic studies Antibiotic resistance rates Combining the data from clinic and lab. studies Sputum smear Gram staining of sputum HAP; Epidemiologic studies Patogen definition in any unit The efficacy of prevention methods Risk factors for severe disease Treatment options Best timing for ending therapy Pneumonia in ICU Epidemiologic studies Patogen definition in any unit The efficacy of prevention methods Risk factors for severe disease Treatment options Best timing for ending therapy

11 Antibiotic Consumption in 26 Countries Goossens.HA. Lancet 2005; 365:579-87

12 ChristCrainM et al., Lancet 2004; 363: 600-7 Randomizied controlled, open, Intervention Study in one Swiss Center 234 Patients admitted to an emergency department with suspected LRTI Standard-AB-Therapy (n=119) in according to Swiss guidelines PCT-guided AB-Therapy (n=123) Results: 50 % lower Antibiotic prescription in the PCT guided group No difference for all examined outcome parameters Procalcitonin Guided Therapy

13 Christ-Crain M et al, AJRCCM 2006; 174(1):84-93 Randomization ProCT Group Standard Group (without ProCT) <0.1 0.1-0.25 >0.25 ProCT (ug/L) AB treatment (prescription & duration according to evidence- based guidelines Follow-up ProCT Day 4 Day 6 Day 8 AB Therapy NO! No Yes CAP STOP or continue, based on the same cutoffs AB duration according to guidelines >0.5 YES! Follow-up after 4-6 wks incl. Rx Clinical and PCT control after 6-12h The ProCAP Study

14 The ProCAP Study – Antibiotic Duration p < 0.001 Standard group PCT group 2 4 6 8 10 12 13 20 15 17 19 Standard groupPCT group Antibiotic Prescriptoin (%) Christ-Crain M et al, AJRCCM 2006; 174(1):84-93 p < 0.001 Standard group PCT group 2 4 6 8 10 12 13 20 Antibiotic duration (days) 15 17 19

15 Suggestion 2 Drug efficacy and safety studies The reliable and pratical markes for the decision to start/stop the therapy

16 National Guidelines Ekim N, Köktürk O, Arseven O, Eraksoy H ve ark. Toplum Kökenli Pnömoni. Tanı ve Tedavi Rehberi. Toraks Bülteni 1998 ; 3:2-4. Pnömoniler (Bir devin uyanışı). Uçan ES (ed), İzmir, 1995

17 The consistency with hospitalization and treatment criteria: Highest in 1999 Mortality was 5% (Highest in 1999-14%) Table IV. Consistency with hospitalization criteria Table V. Consistency with treatment criteria %

18 Year: 2001 Volume: 49 Number: 3 297-311 The success rates in community-acquired pneumonia treated consistently or inconsistently with the Turkish Thoracic Society Pneumonia Guidelines Münire Gökırmak 1, H Canan Hasanoğlu 1, Zeki Yıldırım 1, Nurhan Köksal 1, Zeynep Orhan 1, Süleyman S Hacıevliyagil 1 İnönü Üniv. Turgut Özal Tıp Merk. Göğüs Hastalıkları Ana BD., Malatya Typical CAP (14), Atypical CAP (2), unclassified CAP (5), CAP in patients over age 60 or with accompanied disease (26), Mild-moderate CAP that requires hospitalization (30), Severe CAP that requires treatment in ICU (71) 36 (24%) treatment consistent with national quidelines success rate 92% (3 nonresponder treated with antistaph.) 112 treatment inconsistent with national quidelines success rate 76%, with second line treatment regimen 96% (3 exitus)

19 The indication to treat in ICU was in 49 cases 6 major: 1 with MV 43 minor: MV requirement in 7; all in the clinic Intermadiate / Intensive Care In-Hospital Mortality for Community Acquired Pneumonia and Evaluation According to National Diagnosis and Treatment Guidelines Original article Respiratory system infections

20 Fidan A et al. Toraks Dergisi, 2005;6(2):115-121 %13.9%6.1mortality The consistency to treatment criteria according to year and group CAP group Consistently treatedOvertreatedUndertreatedTotalYear

21 Suggestion 3

22 Every solution brings new problems. Solving the problem changes the problem. There is one solution for every problem. What is difficult is to find it. The complicated problems have simple and easily understandable wrong answers. They are the componets of the problem who don’t work on the solving process. Murphy’s Rules


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