Lars Sörén

A New Diagnostic Approach to the Patient with Severe Pneumonia

36 patients with severe community-acquired pneumonia, treated in an intensive care unit (ICU), were examined in a prospective study using a comprehensive diagnostic program to establish an early etiological diagnosis. The resulting prompt and adequate antimicrobial therapy may have decreased the number of fatal cases. Special emphasis was placed on the use of a method incorporating fiberoptic bronchoscopy, together with protected brush sampling and bronchial lavage. An etiological diagnosis was established in 81% (29/36) of the cases. This etiological diagnosis was established within 48-72 h in 53% (19/36) of the patients, S. pneumoniae being the most frequent agent found (12 patients). This information, however, was poorly utilized since in only 11/19 of these patients was the antimicrobial therapy changed from a broad-spectrum antibiotic to a more specific narrow spectrum agent. The overall mortality rate was 22% (8/36). 7/8 patients who died had compromising factors. Most deaths in community-acquired pneumonia are still associated with pneumococcal infection. We conclude that fiberoptic bronchoscopy with brush samples via a plugged double lumen catheter provides the least misleading information concerning the etiological agent in pneumonia; sampling should be done as soon as possible after admission to the hospital, ideally before the need for ICU treatment; factors other than prompt antimicrobial therapy may influence the outcome of severe community-acquired pneumonia.

Surveillance of antibiotic resistance in ICUs in southeastern Sweden

Background: A study was designed to assess a computer‐based program for continuous registration of antibiotic resistance, statistics concerning severity of illness, and consumption of antibacterial drugs.

IN VITRO EFFECTS OF RUBELLA VIRUS, STRAIN RA 27/3, ON HUMAN LYMPHOCYTES

Investigation has been made of the specific in vitro stimulation of human lymphocytes by live or inactivated rubella virus of the strain RA 27/3. The thymidine incorporation of lymphocytes from blood donors with different serological immunity against rubella was measured following incubation with the viral antigens. UV-inactivated rubella virus caused a moderate degree of stimulation of lymphocytes from seropositive individuals. On the other hand, live rubella virus stimulated lymphocytes from donors with low titres of anti-rubella HI-antibodies but not lymphocytes from donors with high antibody titres. Possible explanations for this discrepancy are discussed.