Personalized treatment of severe pneumonia in cancer patients.
Patients with cancer are at increased risk for sepsis as a consequence of immunosuppression. The hospital mortality remains elevated and it could be attributed to antibiotic failure because of the presence of multiresistant pathogens. Once the patient is critically ill, the use of the American Thoracic Society/Infectious Diseases Society of America classification does not seem very useful in the assessment of outcomes and the choice of antimicrobials. In critically ill patients, the characteristics of clinical response to antibiotics are usually inaccurate and occur late in the course of disease. So, the sequential evaluation of C-reactive protein-ratio is useful in the early identification of patients with antibiotic failure. To achieve safe and efficient antimicrobial therapy, we proposed an algorithm that may aid clinicians in their decision-making process.
a 1 Postgraduate Program of Internal Medicine - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Ligia S C F
LS
Rabello
b 2 Rede Institucional de Pesquisa e Inovação em Medicina Intensiva - Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brazil.|c 3 Intensive Care Unit and Infection Control Committee, Hospital das Clínicas, Postgraduation Program Pulmonology, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS), Brazil.
Thiago
T
Lisboa
a 1 Postgraduate Program of Internal Medicine - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.|d 4 D'Or Institute for Research and Education, Rio de Janeiro, Brazil.|e 5 Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
Marcio
M
Soares
a 1 Postgraduate Program of Internal Medicine - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.|d 4 D'Or Institute for Research and Education, Rio de Janeiro, Brazil.|e 5 Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
Jorge I F
JI
Salluh
D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D000066491:Clinical Decision-Making; D016638:Critical Illness / Q000628:therapy*; D003661:Decision Support Techniques; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D011014:Pneumonia / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D018570:Risk Assessment
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002097:C-Reactive Protein
antimicrobial; biomarker; cancer; multiresistant; outcome; pneumonia