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|Title:||Severe community-acquired pneumonia in Singapore|
Severe community-acquired pneumonia
|Citation:||Lee, K.H., Hui, K.P., Tan, W.C., Lim, T.K. (1996-08). Severe community-acquired pneumonia in Singapore. Singapore Medical Journal 37 (4) : 374-377. ScholarBank@NUS Repository.|
|Abstract:||Background: There has been no previous study documenting the aetiology and prognosis of severe community-acquired pneumonia in Singapore. Patients with severe community-acquired pneumonia (SCAP) needing admission to a medical intensive care unit in Singapore were studied retrospectively. Methods: All patients admitted to the medical intensive care unit at National University Hospital from June 1991 to February 1993 with a diagnosis of community-acquired pneumonia were entered into the study. All patients had blood cultures, sputum cultures, serologies for Legionella and mycoplasma drawn on admission. APACHE II scores were determined prospectively. Results: Fifty-nine consecutive cases from June 1991 to February 1993 were identified with a mean age of 61 (SD 17) years. Nearly all the cases needed mechanical ventilation (90%) and overall mortality was 63%. An aetiological agent was identified in the majority of cases (68%), with Klebsiella pneumoniae being the most common agent (9 cases, 15%). Haemophilus influenzae and Streptococcus pneumoniae were identified in 8% (5 cases) and 5% (3 cases) of cases respectively. Pseudomonas pseudomallei was identified in 4 cases (7%) with a 100% mortality. Overall, gram-negative organisms were identified in 47% of cases. APACHE II was significantly higher in non-survivors. Age, creatinine levels, and the presence of bacteraemia were not prognostic features. Conclusion: SCAP in Singapore carries a high mortality with the predominance of gram-negative organisms. Empiric antibiotics should include gram-positive and gram-negative coverage with specific coverage for Pseudomonas pseudomallei.|
|Source Title:||Singapore Medical Journal|
|Appears in Collections:||Staff Publications|
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