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1.
ObjectiveThere is little information in the veterinary literature about the perioperative management of small animal patients with previously implanted pacemakers undergoing elective or emergency non-cardiac procedures. The purpose of this article is to review the current literature with regard to human patients, with previously implanted pacemakers, undergoing general anaesthesia. Using this and the current information on pacemakers and anaesthesia in dogs and cats, we provide recommendations for small animal patients in this situation.Databases usedGoogle Scholar, PubMed and CAB Abstracts using and interlinking and narrowing the search terms: “dog”, “cat”, “small animals”, “anaesthesia”, “pacemaker”, “perioperative”, “transvenous pacing”, “temporary pacing”. Scientific reports and human and small animal studies from the reference lists of the retrieved papers were reviewed. In addition, related human and veterinary cardiology and anaesthesia textbooks were also included to create a narrative review of the subject.ConclusionsThe best perioperative care for these animals comes from a multidisciplinary approach involving the anaesthetist, cardiologist, surgeon and intensive care unit team. When such an approach is not feasible, the anaesthetist should be familiar with pacemaker technology and how to avoid perioperative complications such as electromagnetic interference, lead damage and reprogramming of the device. The preanaesthetic assessment should be thorough. Information regarding the indication for pacemaker placement, complications during the procedure, location, type and programming of the pacemaker should be readily available. The anaesthetic management of these veterinary patients aims to preserve cardiovascular function while avoiding hypotension, and backup pacing should be available during the perioperative period. Further prospective studies are needed to describe the best perioperative care in small animals with a previously implanted pacemaker.  相似文献   

2.
Aims: To assess the prevalence of obesity in adult dogs and cats presented to first-opinion veterinary clinics in the North Island of New Zealand for routine vaccination appointments, using electronic medical records.

Methods: Ten first-opinion veterinary clinics across the North Island of New Zealand provided electronic medical records for all routine vaccination appointments for adult (>1 year old) dogs and cats between 1 January 2011 and 30 June 2016. Animals with a body condition score (BCS) of 6 or 7 on a 9-point scale and 4 on a 5-point scale were classified as overweight; those with a BCS of 8 or 9 on a 9-point scale and 5 on a 5-point scale were classified as obese. A total of 106,144 records were available over the study period, of which 48,041 (45.2%) had both a recorded weight and BCS.

Results: Of the 24,247 records for dogs with both BCS and weight, 6,324 (26.1%) were classified as overweight, and 551 (2.3%) as obese. The prevalence of dogs classified as overweight or obese was highest in dogs aged between 5–13 years. The odds of desexed dogs being classified as overweight or obese was greater than the odds for intact dogs (OR=1.42 (95% CI=1.29–1.57), p<0.001) adjusting for the effects of age. Of the 23,794 records for cats with a recorded weight and BCS, 5,222 (21.9%) were classified as overweight, and 622 (2.6%) as obese. The prevalence of cats classified as overweight or obese was highest in cats aged between 5–11 years. The odds of desexed cats being classified as overweight or obese tended to be greater than the odds for intact cats (OR=1.14 (95% CI=0.98–1.31); p=0.075), adjusting for the effects of age.

Conclusions: Although there are limitations with using electronic medical records to estimate the prevalence of obesity in companion animal populations, the results highlight that a significant number of animals presenting for routine vaccination appointments were classified as overweight or obese.

Clinical Relevance: It is important for veterinarians to record both patient body condition and weight during routine preventative care appointments to allow accurate ongoing monitoring of trends in obesity at both the patient and population levels.

Abbreviations: BCS: Body condition score  相似文献   


3.
The occurrence of the infection by the lungworm Eucoleus aerophilus (syn. Capillaria aerophila) in dogs and cats from Italy has been evaluated with conventional diagnostic procedures. Individual faecal samples from 569 dogs and 200 cats were undertaken to faecal flotation with sugar and zinc sulphate solution. Sixteen dogs (2.8%) and 11 cats (5.5%) scored positive for eggs of E. aerophilus when samples were processed with either of the two flotation solutions. Overall 14 of 16 dogs and eight of 11 cats infected by E. aerophilus showed respiratory symptoms and the most common were general respiratory distress, dry cough, wheezing and sneezing. These results indicate that E. aerophilus is not uncommon and that canine and feline capillariosis is of clinical importance. Given the impact that E. aerophilus infections may have upon animal health and its zoonotic potential, it is strongly advisable to routinely include this disease in the differential diagnosis of (cardio)-respiratory diseases of dogs and cats.  相似文献   

4.
ObjectiveTo compare the perioperative use of analgesics and complication rates in dogs administered an erector spinae plane (ESP) block or a traditional opioid-based (OP) treatment as part of analgesic management during hemilaminectomy.Study designRetrospective cohort study.AnimalsMedical records of 114 client-owned dogs.MethodsGeneral data included demographics, duration of procedure, number of laminae fenestrated, perioperative use of steroid and non-steroidal anti-inflammatory drugs. Intra- and postoperative analgesics used in 48 hours and complications rates were compared between groups. Opioid use was expressed in morphine equivalents [ME (mg kg?1)]. Continuous data were compared using the Mann–Whitney U test and incidence of events with a Fisher's exact tests. Multiple linear regression was used to evaluate association between perioperative ME consumption (dependent variable) with other independent variables. Data are presented as median (range). Differences were considered significant when p < 0.05.ResultsGroup ESP comprised 42 dogs and group OP 72 dogs. No differences were observed in the general data. Intraoperative ME was 0.65 (0.20–3.74) and 0.79 (0.19–5.60) mg kg?1 in groups ESP and OP, respectively (p = 0.03). Intraoperative infusion of lidocaine was administered intravenously (IV) to 23.8% and 68% of groups ESP and OP, respectively (p < 0.0001). Intraoperative infusion of ketamine was administered IV to 21% and 40% of groups ESP and OP, respectively (p = 0.04). Regression analysis revealed the ESP block as the only independent variable affecting the perioperative ME consumption. Pharmacological intervention to treat cardiovascular complications was administered to 21.4% and 47.2% of dogs in groups ESP and OP, respectively (p = 0.008). There were no differences in postoperative complication rates.Conclusions and clinical relevanceESP block was associated with reduced perioperative opioid consumption, intraoperative adjuvant analgesic use and incidence of pharmacological interventions to treat cardiovascular complications in dogs undergoing hemilaminectomy.  相似文献   

5.
ObjectivesAn ultrasound (US)-guided ventral suprainguinal approach to block the femoral nerve (FN) within the iliopsoas muscle (IPM) has recently been described in dogs. The goal of the present study was to provide the operator with additional information to locate the FN within the IPM in dogs and cats using US.Study designThe study was carried out in three phases: a dissection of the FN (phase 1); an in vivoUS-assisted nerve study (phase 2), and an anatomical cross-sectional study (phase 3).AnimalsNine healthy adult beagle dogs and nine healthy adult cats.MethodsDissections were performed to investigate the anatomical characteristics of the FN and its related structures in one dog and one cat. Ultrasound scans of the left and right FN were performed in eight dogs and eight cats. The FN diameter and the distance between the FN and the external iliac artery (EIA) in US images and in anatomical cryosections were measured.ResultsThe median FN diameter did not differ significantly between cats and dogs (1.1 mm versus 1.0 mm) or between the two techniques (US versus anatomical cross-sectional study) (1.1 mm versus 1.1 mm in dogs; 1.0 mm versus 1.1 mm in cats). The US and anatomical measurements of the median distances between the FN and EIA differed significantly between dogs and cats (8.2 mm versus 5.8 mm by US; 5.7 mm versus 4.8 mm in the anatomical study).Conclusions and clinical relevanceThe distance between the EIA and FN is reproducible in beagle dogs and cats and can be used in locating the FN within the IPM.  相似文献   

6.
ObjectiveTo describe the effects of presurgical preparation with an isopropyl alcohol or water rinse on the perioperative rectal temperature (RT) of puppies and kittens.Study designRandomized clinical trial.AnimalsA total of 48 intact female mixed breed puppies and 43 intact female Domestic Short Hair kittens aged 8–18 weeks.MethodsAll animals were premedicated with intramuscular buprenorphine (0.02 mg kg–1) and acepromazine (0.05 mg kg–1). Anesthesia was induced with intravenous propofol (4 mg kg–1 to effect) for puppies or ketamine (5 mg kg–1) and midazolam (0.25 mg kg–1) for kittens. RT was measured every minute for the first 15 minutes at the beginning of hair/fur removal, then every 5 minutes for 45 minutes (dogs) and 35 minutes (cats). All animals were prepared for surgery using a 1.6% chlorhexidine solution, then rinsed with either isopropyl alcohol (group CA) or water (group CW).ResultsMean RT difference between the groups was not significant at any time point. The mean RT at 45 minutes for dogs was 35.9 °C and 36.0 °C in groups CA and CW, respectively (p = 0.74). The mean RT at 35 minutes for cats was 35.1 °C in both groups (p = 0.84).Conclusions and clinical relevanceThe use of either water or alcohol as a rinsing agent results in the same degree of perioperative temperature change. Other factors that contribute to perioperative hypothermia should be considered when choosing between these rinsing agents in surgical preparation of pediatric and small animals.  相似文献   

7.
Outcomes of cardiopulmonary arrest and resuscitation in clinically affected dogs and cats have not been adequately studied. We examined the records from 200 dogs and 65 cats that had received cardiopulmonary resuscitation for respiratory or cardiopulmonary arrest; none of the animals had been anesthetized or intubated at the time of arrest, and all had been hospitalized in a veterinary critical care facility. Cardiopulmonary arrest was found to be more common than respiratory arrest in dogs and cats. Hospital discharge rates for animals with cardiopulmonary arrest ranged from 4.1% for dogs to 9.6% for cats, and were consistent with those reported from studies of human beings with cardiopulmonary arrest. Hospital discharge rates for dogs and cats with respiratory arrest were 28% and 58.3%, respectively.  相似文献   

8.
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9.
Background: Parenteral nutrition (PN) is increasingly used to support hospitalized dogs and cats. Published assessments of outcome are limited. Objective: Evaluate type and prevalence of complications and risk factors for death and complications in dogs and cats receiving PN. Animals: Three hundred and nineteen dogs and 112 cats that received PN at a teaching hospital between 2000 and 2008. Methods: Retrospective case review. Diagnosis, duration of PN administration, concurrent enteral feeding, death, and mechanical, septic, and metabolic complications were abstracted from medical records. Association of each parameter with complications and death was analyzed by binary logistic regression. Results: Pancreatitis was the most common diagnosis (109/319 dogs, 34/112 cats), and 137/319 dogs and 51/112 cats died. Dogs and cats received 113 ± 40% and 103 ± 32% of resting energy requirement, respectively. Mechanical (81/319 dogs, 16/112 cats) and septic (20/319 dogs, 6/112 cats) complications were not associated with death (P > .05). Hyperglycemia was the most common metabolic complication (96/158 dogs, 31/37 cats). Hypercreatininemia in dogs (8/79) was the only complication associated with death (P < .01). Chronic kidney disease in dogs, hepatic lipidosis in cats, and longer duration of inadequate caloric intake before PN in both species were negatively associated with survival (P < .05). Factors positively associated with survival included longer duration of PN administration in both species, enteral feeding in cats with any disease, and enteral feeding in dogs with respiratory disease (P < .05). Conclusions and Clinical Importance: PN can be effectively used to provide the energy requirements of most critically ill dogs and cats. Most complications accompanying PN administration do not affect survival.  相似文献   

10.
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11.
ObjectiveTo evaluate the sedative and analgesic effects of intramuscular buprenorphine with either dexmedetomidine or acepromazine, administered as premedication to cats and dogs undergoing elective surgery.Study designProspective, randomized, blinded clinical study.AnimalsForty dogs and 48 cats.MethodsAnimals were assigned to one of four groups, according to anaesthetic premedication and induction agent: buprenorphine 20 μg kg?1 with either dexmedetomidine (dex) 250 μg m?2 or acepromazine (acp) 0.03 mg kg?1, followed by alfaxalone (ALF) or propofol (PRO). Meloxicam was administered preoperatively to all animals and anaesthesia was always maintained using isoflurane. Physiological measures and assessments of pain, sedation and mechanical nociceptive threshold (MNT) were made before and after premedication, intraoperatively, and for up to 24 hours after premedication. Data were analyzed with one-way, two-way and mixed between-within subjects anova, Kruskall–Wallis analyses and Chi squared tests. Results were deemed significant if p ≤ 0.05, except where multiple comparisons were performed (p ≤ 0.005).ResultsCats premedicated with dex were more sedated than cats premedicated with acp (p < 0.001) and ALF doses were lower in dex cats (1.2 ± 1.0 mg kg?1) than acp cats (2.5 ± 1.9 mg kg?1) (p = 0.041). There were no differences in sedation in dogs however PRO doses were lower in dex dogs (1.5 ± 0.8 mg kg?1) compared to acp dogs (3.3 ± 1.1 mg kg?1) (p < 0.001). There were no differences between groups with respect to pain scores or MNT for cats or dogs.ConclusionChoice of dex or acp, when given with buprenorphine, caused minor, clinically detectable, differences in various characteristics of anaesthesia, but not in the level of analgesia.Clinical relevanceA combination of buprenorphine with either acp or dex, followed by either PRO or ALF, and then isoflurane, accompanied by an NSAID, was suitable for anaesthesia in dogs and cats undergoing elective surgery. Choice of sedative agent may influence dose of anaesthetic induction agent.  相似文献   

12.
Objective: To determine the frequency of postoperative pulmonary complications (PPCs) in dogs following laparotomy, characterize the nature of PPCs, and identify disease‐related risk factors for PPCs in dogs. Design: Retrospective clinical study. Setting: University‐affiliated small animal teaching hospital. Animals: One hundred and sixty‐two dogs without preoperative pulmonary pathology that underwent laparotomy surgery. Interventions: None. Measurements and main results: Cases were evaluated for factors including patient signalment, preexisting disease, primary and ancillary surgical procedure(s), development of postoperative pulmonary disease, characteristics of perioperative hospitalization and therapy, and survival. Twenty‐two percent of dogs in the study developed PPCs. PPCs included respiratory arrest (n=4), acute respiratory distress syndrome (ARDS) (n=3), pneumonia (n=8), hypoventilation (n=13), and transient hypoxemia (n=8). Dogs that developed PPCs had a significantly longer duration of oxygen therapy, longer duration of stay in intensive care unit (ICU), and decreased survival. Dogs with perioperative vomiting or regurgitation were more likely to develop PPCs. Animals that underwent exploratory laparotomy for biliary or septic peritonitis were also more likely to develop PPCs. Conclusions: PPCs occur in dogs following laparotomy and contribute significantly to the morbidity and mortality of these surgical patients. In this patient population, animals with vomiting, regurgitation, or peritonitis may be at a higher risk of developing PPCs. Animals with the identified risk factors should be monitored carefully postoperatively for development of pulmonary complications.  相似文献   

13.
ObjectivesThe pathogenesis and presentation of aortic thrombosis (AT) in dogs is not well characterized and an effective antithrombotic therapy for AT in dogs has not been identified. Our goal is to report the clinical presentation and results of therapies in dogs with AT.AnimalsTwenty-six client-owned dogs.MethodsRetrospective review of medical records of dogs diagnosed with AT between 2003 and 2010.ResultsTwenty-six dogs had an apparent primary mural aortic thrombus. None had structural heart disease at diagnosis. Twenty dogs were ambulatory with varying degrees of pelvic limb dysfunction. Duration of ambulatory dysfunction was 7.8 weeks (range 1 day–52 weeks). A majority of dogs (58%) had no concurrent conditions at diagnosis.Fourteen dogs were treated with a standard warfarin protocol for a median period of 22.9 months (range 0.5–53 months). Ambulatory function improved in all dogs treated with warfarin. Time until clinical improvement was 13.9 days (range 2–49 days). Dogs treated with warfarin did not become non-ambulatory, die or undergo euthanasia related to AT, or have a known serious hemorrhagic event.ConclusionsThe pathogenesis of AT in dogs is distinct from that of aortic thromboembolism (ATE) in cats. Aortic thrombosis in dogs is more likely to involve local thrombosis in the distal aorta with embolization to the arteries of the pelvic limb resulting in chronic progressive ambulatory dysfunction. Chronic warfarin administration is well-tolerated and appears to be an effective short-term and long-term therapy for dogs with AT.  相似文献   

14.
ObjectiveThe provision of general anesthesia is common in veterinary hospitals and procedures include some level of risk, up to and including mortality. A quality initiative was introduced with a focus on reducing canine and feline anesthesia mortality. This paper describes the development and implementation of risk-based medical quality standards (MQS) and resultant impacts on anesthesia mortality.Study designThis was a qualitative observational study. MQS focused on the provision of anesthesia were researched, developed and implemented. Anesthesia mortality rates, captured via an automated process based on the electronic medical record, were recorded before and after implementation. Compliance to standards was determined via hospital auditing.AnimalsClient-owned dogs and cats presenting to Banfield Pet Hospital (a national network of primary care hospitals) for elective and nonelective general anesthesia procedures. Over the course of the study, 2,038,318 dogs and 350,410 cats had a general anesthesia event.MethodsLiterature reviews and analysis of veterinary patient medical records identified risk factors associated with anesthesia mortality. Risk factors informed the development of MQS. Evidence-based standards focused on the provision of general anesthesia were written, reviewed, evaluated and edited. Implementation occurred over 6 months via a robust communication plan. Anesthesia mortality rates were continuously monitored before, during and after the introduction of standards. Compliance with all quality standards was assessed via hospital-based auditing performed on an annual basis.ResultsPrior to quality standards implementation, anesthesia mortality rates for dogs and cats combined was 7.4 deaths/10,000 procedures. At 6 months after implementation, the mortality rate was 6.24 deaths/10,000 procedures, representing a 16% decrease. Compliance with standards improved over time with continued focus and education.Conclusions and clinical relevanceDevelopment, implementation and continued focus on MQS can improve anesthetic safety and reduce anesthesia mortality in primary care veterinary hospitals.  相似文献   

15.
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16.
Objectives: This article discusses the toxicity of the most common poisonous plants known to cause life‐threatening systemic effects or death in dogs and cats as reported to the ASPCA Animal Poison Control Center (APCC). Data sources: The article presents an overview of geographic distribution, toxic principle, clinical signs, clinical chemistry alterations, and treatment of intoxication as reported in the literature and based upon data retrieved from the APCC between January 2001 and December 2003. Summary: Most plant exposures in dogs or cats result in mild to moderate signs of vomiting and diarrhea while liver, kidney, central nervous system, or cardiovascular effects are rare. Some garden or household plants can cause serious systemic effects or death when a small amount of plant material has been ingested. Based on APCC records, the most frequently reported poisonous plants causing serious systemic effects include Lily (Lilium and Hemerocallis spp.), Azalea (Rhododendron spp.), Oleander (Nerium oleander), Sago palm (Cycas spp.), Castor bean (Ricinus communis), Kalanchoe (Kalanchoe spp.), and Autumn Crocus (Colchicum autumnale). Conclusion: Despite the variety of toxins present in the plants listed above, early clinical signs of toxicosis in dogs and cats can be nonspecific and can include vomiting, lethargy, anorexia, salivation, or diarrhea. Cardiac arrhythmias may be present with oleander, azalea, or kalanchoe ingestion. Evidence of liver or kidney damage (Cycas, Lilium, Hemerocallis spp., Ricinus communis) may occur 1–2 days after the exposure. Treatment consists of early decontamination and supportive care and may vary according to the type of plant involved and clinical signs present.  相似文献   

17.
ObjectiveTo perform preliminary evaluations into the ocular analgesic effect of topical 1% morphine in a clinical setting and to determine onset, duration and complications.Study designProspective, randomised, blinded clinical study.AnimalsTwenty six dogs and seventeen cats, all client‐owned.MethodsDogs and cats with corneal ulceration requiring medical treatment or corneal conditions requiring surgery were included and randomly assigned to receive one drop of topical morphine (group M) or base solution (group B). Recordings were made prior to application and at 5, 10, 20, 30, 40, 50 and 60 minutes, then 2, 3, 4, 5 and 6 hours. Corneal aesthesiometry, blink rates and scores for blepharospasm (BLEPH), conjunctival hyperaemia (CH) and lacrimation (LAC) were recorded. Statistical analyses used anova,t‐tests and Mann–Whitney U tests as relevant.ResultsNo significant effect of treatment group on any recordings was found at any time point in either dogs or cats. Adverse effects of increased BLEPH, CH or blink rate were observed in six animals (three cats from group M and three dogs from group B), occurring within 5 minutes of drop application and lasting for between 10 minutes and 6 hours.Conclusions and clinical relevanceTopical ocular morphine showed no measurable analgesic effect against corneal pain in dogs and cats.  相似文献   

18.
Feline anesthetic deaths in veterinary practice   总被引：1，自引：0，他引：1  
Anesthetic complications appear relatively rare, though recent work suggests they are more common in cats than dogs. Current estimates indicate that approximately 0.11% (1 in 895 anesthetics) of healthy cats die of an anesthetic-related death, which is more than twice as frequent as has been recently reported in dogs (0.05% or 1 in 1849). Most of these deaths occurred in the postoperative period. A number of risk factors have been associated with death, including patient health status, age, weight, and procedure type and urgency. Endotracheal intubation and fluid therapy have been reported to be associated with increased odds of anesthetic death in cats and may reflect higher risk techniques in cats compared with dogs. Monitoring patient pulse and the use of a pulse oximeter were also recently reported to be associated with reduced risk of anesthetic death. These data can help veterinarians care for their patient under anesthesia and address greater attention to patient assessment and management before anesthesia, as well as more careful fluid administration and patient monitoring during and after anesthesia, which could reduce perioperative complications in cats.  相似文献   

19.
ObjectiveTo evaluate the anaesthetist’s ability to predict abnormalities in preanaesthetic blood test results obtained from cats and dogs older than 8 years and to describe the impact of these preanaesthetic blood test results on the American Society Anesthesiologists (ASA) physical status classification, anaesthetic protocol and procedures.Study designObservational, prospective, clinical multi-centre study.AnimalsA total of 333 cats and dogs.MethodsAfter a clinical examination and review of the animal´s clinical history the anaesthetist completed the first part of a set of questions including ASA status and anticipated abnormalities in blood tests. After this, blood results were presented, and the anaesthetist completed the second part of the set of questions, including changes in ASA status or anaesthetic protocol, and procedure delay or cancellation. Preanaesthetic blood tests included: haematocrit, total proteins, electrolytes, glucose, lactate, urea and creatinine. Examiners were classified as senior clinicians, clinicians, anaesthesia residents or nurses, and interns. For statistical analysis, the chi-square test was used. A p value < 0.05 was considered significant.ResultsThe ASA status increased in three dogs and one cat (1.2%); in two of them abnormalities were not expected by the examiner. The anaesthetic protocol changed in seven animals (2.1%); the most common change related to fluid therapy. Anaesthesia was delayed in two dogs (0.6%) to administer intravenous fluid therapy. No cases were cancelled. Abnormalities were more commonly found [37 out of 58 assessments (approximately 64%)] when the anaesthetist predicted them compared to when they were unexpected [49 of 275 assessments (approximately 18%); p < 0.001].Conclusions and clinical relevanceRoutine non-targeted blood tests in cats and dogs older than 8 years led to few changes in the anaesthetic management, and anaesthetists correctly predicted blood test results in most cases.  相似文献   

20.
Objective – To compare airway microbiological culture and susceptibility results in 2 groups of dogs and cats: 1 with respiratory failure requiring positive pressure ventilation (PPV) and 1 with respiratory disease. Design – Retrospective study. Setting – University teaching hospital. Animals – Fifty‐two dogs and cats requiring PPV that had an airway microbiologic culture submitted from October 1, 2003 to October 31, 2008 were included. One hundred and four airway microbiologic cultures from dogs and cats with respiratory disease not requiring PPV were randomly sampled for comparison. Interventions – None. Measurements and Main Results – Patients with respiratory failure were more likely to have a gram‐negative enteric isolate identified (P<0.001), while patients with respiratory disease were more likely to have a gram‐negative nonenteric isolate (P<0.001) or anaerobic isolate (P<0.001) identified. Aerobic bacterial isolates from patients with respiratory failure were less likely to be susceptible to ampicillin (P=0.006), amoxicillin/clavulonate (P<0.001), chloramphenicol (P=0.004), enrofloxacin (P<0.001), ticarcillin/clavulonate (P=0.004), and the combination of ampicillin with enrofloxacin (P<0.001) than were aerobic bacterial isolates from patients with respiratory disease. Conclusions – Canine and feline patients with respiratory failure severe enough to require PPV exhibit a different pattern of bacterial isolates cultured from their airways when compared with isolates from patients with respiratory disease that has not resulted in ventilator dependence. These isolates are more likely to be resistant to commonly used antimicrobials/antimicrobial combinations than patients in the respiratory disease group. These findings suggest that in canine and feline patients with infectious lower respiratory tract disease, consideration of the severity of the pulmonary insult may allow for better prediction of likely isolates and their antimicrobial susceptibilities. Further prospective studies with a standardized collection technique are warranted.  相似文献   

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