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Sample records for acquired pneumonia impact

  1. Impact of admission blood glucose level on outcomes in community-acquired pneumonia in older adults

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    Bhattacharya RK; Mahnken JD; Rigler SK

    2013-01-01

    Rajib K Bhattacharya, Jonathan D Mahnken, Sally K RiglerUniversity of Kansas School of Medicine, Kansas City, KS, USABackground: Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in older adults. Although diabetes mellitus is a risk factor for pneumonia, the clinical impact of blood glucose level at the time of admission is not clear. Our goal was to examine the association between admission hyperglycemia and subsequent mortality, length of stay, and readmission ...

  2. Hospital-acquired pneumonia

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    ... tends to be more serious than other lung infections because: People in the hospital are often very sick and cannot fight off ... prevent pneumonia. Most hospitals have programs to prevent hospital-acquired infections.

  3. Impact of admission blood glucose level on outcomes in community-acquired pneumonia in older adults

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    Bhattacharya RK

    2013-05-01

    Full Text Available Rajib K Bhattacharya, Jonathan D Mahnken, Sally K RiglerUniversity of Kansas School of Medicine, Kansas City, KS, USABackground: Community-acquired pneumonia (CAP is a common cause of morbidity and mortality in older adults. Although diabetes mellitus is a risk factor for pneumonia, the clinical impact of blood glucose level at the time of admission is not clear. Our goal was to examine the association between admission hyperglycemia and subsequent mortality, length of stay, and readmission outcomes in older adults with CAP.Methods: A retrospective observational study was conducted using hospital data for community-acquired pneumonia admissions in 857 persons from January 1, 2008 to December 31, 2010. We examined the effects of admission glucose level on mortality, length of stay, and 30 day readmission, adjusted for demographic factors and comorbidity.Results: The mean age of the sample was 64 years, and 51% of the subjects were female. Inpatient mortality occurred in 4.6% and the median length of stay was 5 days (interquartile range 3–9 days. Readmission within 30 days occurred in 17%. We found little impact of first glucose measures on in-hospital mortality (P = 0.94, length of stay (P = 0.95, and 30-day readmission (P = 0.56. Subjects 65 years and older trended towards higher in-hospital mortality. Older age, cancer, heart failure, and cirrhosis were associated with adverse outcomes.Conclusion: Glucose level upon admission for community-acquired pneumonia was not associated with adverse outcomes within 30 days in older adults.Keywords: community-acquired pneumonia, hyperglycemia, readmission rates, hospital mortality

  4. Impact and indication of early systemic corticosteroids for very severe community-acquired pneumonia

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    Ugajin M

    2013-08-01

    Full Text Available Motoi Ugajin, Kenichi Yamaki, Natsuko Hirasawa, Takanori Kobayashi, Takeo YagiDepartment of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Aichi Prefecture, JapanBackground: The efficacy of systemic corticosteroids in community-acquired pneumonia (CAP has not yet been confirmed. We prospectively investigated the clinical features of patients treated with early adjunctive systemic corticosteroids and its clinical impact in very severe CAP.Methods: One hundred and one consecutive CAP patients having a pneumonia severity index of >130 points were enrolled from August 2010 through February 2013. Early adjunctive systemic corticosteroids were defined as administration of systemic corticosteroids equivalent to prednisone of ≥20 mg/day added to initial antibiotics. The multivariate analysis was performed to evaluate the independent factors associated with mortality.Results: Thirty-two patients (31.7% died within 28 days of admission. Early adjunctive systemic corticosteroids were administered in 30 patients (29.7%, who more frequently had alteration of mental status, serious respiratory failure, or underlying lung diseases and received fluoroquinolones as initial antibiotics. In most patients treated with early adjunctive systemic corticosteroids, the dosage was less than 60 mg/day of an equivalent to prednisone by bolus intravenous infusion for a period shorter than 8 days. The occurrence of adverse events did not differ between the groups. Factors independently associated with mortality were blood urea nitrogen (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.00–1.04, serum albumin (HR 0.44, 95% CI 0.22–0.86, a requirement for intensive care (HR 4.93, 95% CI 1.75–13.87, and the therapy with early adjunctive systemic corticosteroids (HR 0.29, 95% CI 0.11–0.81.Conclusion: Early adjunctive systemic corticosteroids may have an effect to reduce the mortality in very severe CAP, although a larger-scale study is necessary

  5. Pneumonia - adults (community acquired)

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    ... going to the bathroom After changing a baby's diaper After coming in contact with people who are ... pneumoniae. Vaccines are even more important for older adults and people with diabetes, asthma, emphysema, HIV, cancer, ...

  6. Pneumonia acquired in the Community

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    María Caridad Fragoso Marchante

    2007-06-01

    Full Text Available A bibliographical revision of the main aspects in the diagnosis and treatment of the patients suffering from pneumonia acquired in the community is carried out. Microorganisms responsible for this type of pneumonia are mention in this paper as well as the available diagnostic methods for germs isolation. Different guidelines for diagnosis and treatment of this disease published by several medical societies and scientific institutions are analyzed by means of a review of the stratification index of the patients used in each of them. Aspects related to the duration of the treatment and the possible causes associated with the unfavorable evolution are stated.

  7. Impact of guidelines on antibiotics prescription for community-acquired pneumonia

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    Lázaro A. Vélez

    2008-11-01

    Full Text Available PREVIOUS PRESENTATION: This study was presented in part at the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC; September 17, 2007; Chicago, Ill. CONFLICT OF INTEREST STATEMENT: Lázaro Vélez has received research funding from Astra-Zeneca and Roche Colombia, and has been a consultant for Pfizer. Other authors did not declare conflicts of interest. BACKGROUND: Community Acquired Pneumonia (CAP is an important reason to prescribe antibiotics in hospitals. Since etiologic diagnosis is cumbersome, most clinicians use initial broad coverage as suggested by local/international guidelines. This approach may induce overprescription of antibiotics, increasing costs, resistance and adverse effects. Our aim was to quantify the impact that overprescription of antibiotic has on the implementation of IDSA/ATS 2007 guidelines. METHODS: A prospective cohort study conducted at 11 hospitals in Medellín, Colombia, 2005-06. We included 205 adult CAP patients with an identified pathogen. Four categories of appropriateness were established: appropriate, insufficient, excessive and useless. To quantify the magnitude of antibiotic prescription, we compared the Defined Daily Doses (DDD of antibiotics suggested for the empiric treatment by IDSA/ATS 2007 guidelines according to severity (mild, moderate and severe CAP with the DDD of the antibiotics that would be prescribed based on the identified respiratory pathogen. FINDINGS: Empiric coverage recommended by IDSA/ATS resulted appropriate in 24.9%, insufficient in 2.4%, excessive in 57.6% and useless in 15.1%. Total antibiotic consumption for the included patients, according to identified pathogens, would be 2.255 DDD. Predicted antibiotic use based on IDSA/ATS guidelines would increase to 4.440 (97% more. The DDD raise was higher in moderate and severe categories compared to mild CAP (130%, 129.4% and 53.9%, respectively. INTERPRETATION: Implementation of IDSA/ATS 2007 guidelines for the

  8. The impact of heptavalent pneumococcal conjugate vaccine on the incidence of childhood community-acquired pneumonia and bacteriologically confirmed pneumococcal pneumonia in Japan.

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    Naito, S; Tanaka, J; Nagashima, K; Chang, B; Hishiki, H; Takahashi, Y; Oikawa, J; Nagasawa, K; Shimojo, N; Ishiwada, N

    2016-02-01

    Heptavalent pneumococcal conjugate vaccine (PCV7) was introduced to Japan in 2010. We investigated the impact of PCV7 on childhood community-acquired pneumonia (CAP) and pneumococcal pneumonia (PP). Children aged Japan, who were admitted to hospitals were enrolled to estimate the incidence of CAP based on the mid-year population. PP was determined by the presence of Streptococcus pneumoniae in cultured blood and/or sputum samples of CAP patients. The incidence of CAP and S. pneumoniae isolated from PP patients was compared before (April 2008-March 2009) and after (April 2012-March 2013) the introduction of PCV7 immunization. The annual incidence of CAP was reduced [incidence rate ratio 0·81, 95% confidence interval (CI) 0·73-0·90]. When comparing post-vaccine with pre-vaccine periods, the odds ratio for PP incidence was 0·60 (95% CI 0·39-0·93, P = 0·024). PCV7-covered serotypes markedly decreased (66·6% in pre-vaccine vs. 15·6% in post-vaccine, P culture-confirmed PP of vaccine serotypes was observed at 2 years after PCV7 vaccination. PMID:26122538

  9. Pseudomona pseudomallei community acquired pneumonia

    International Nuclear Information System (INIS)

    This is the first published case report en Colombia about pseudomona pseudomallei community acquired pneumonia. This uncommon pathogen is from the epidemiological standpoint a very important one and medical community should be aware to look after it in those patients where no other etiological pathogen is recovered. A brief summary about epidemiology is showed, emphasizing those regions where it can be found. Likewise, comments about the differential diagnosis are important since it should be considered in those patients where tuberculosis is suspected. This is particularly representative for countries with high tuberculosis rates. Furthermore, a microbiological review is shown, emphasizing on isolation techniques, descriptions about therapeutics and other regarding treatment issues according international standards. Finally; a description about the clinical picture, laboratory findings, treatment and evolution of the case reported are shown for discussion

  10. Inadequate treatment of ventilator-associated and hospital-acquired pneumonia: Risk factors and impact on outcomes

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    Piskin Nihal

    2012-10-01

    Full Text Available Abstract Background Initial antimicrobial therapy (AB is an important determinant of clinical outcome in patients with severe infections as pneumonia, however well-conducted studies regarding prognostic impact of inadequate initial AB in patients who are not undergoing mechanical ventilation (MV are lacking. In this study we aimed to identify the risk factors for inadequate initial AB and to determine its subsequent impact on outcomes in both ventilator associated pneumonia (VAP and hospital acquired pneumonia (HAP. Methods We retrospectively studied the accuracy of initial AB in patients with pneumonia in a university hospital in Turkey. A total of 218 patients with HAP and 130 patients with VAP were included. For each patient clinical, radiological and microbiological data were collected. Stepwise multivariate logistic regression analysis was used for risk factor analysis. Survival analysis was performed by using Kaplan-Meier method with Log-rank test. Results Sixty six percent of patients in VAP group and 41.3% of patients in HAP group received inadequate initial AB. Multiple logistic regression analysis revealed that the risk factors for inadequate initial AB in HAP patients were; late-onset HAP (OR = 2.35 (95% CI, 1.05-5.22; p = 0.037 and APACHE II score at onset of HAP (OR = 1.06 (95% CI, 1.01-1.12; p = 0.018. In VAP patients; antibiotic usage in the previous three months (OR = 3.16 (95% CI, 1.27-7.81; p = 0.013 and admission to a surgical unit (OR = 2.9 (95% CI, 1.17-7.19; p = 0.022 were found to be independent risk factors for inadequate initial AB. No statistically significant difference in crude hospital mortality and 28-day mortality was observed between the treatment groups in both VAP and HAP. However we showed a significant increase in length of hospital stay, duration of mechanical ventilation and a prolonged clinical resolution in the inadequate AB group in both VAP and HAP. Conclusion Our data

  11. Impact of neutrophil function on outcomes of community-acquired pneumonia in patients with cancer

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    Stefano Aliberti

    2008-06-01

    Full Text Available Some literature suggests that outcomes of CAP in patients with solid tumor without neutropenia may be better than in cancer patients with neutropenia. In order to investigate the role of neutrophils in this population, we retrospectively analyzed consecutive patients with CAP admitted to 3 tertiary care hospitals from 01/2001 through 12/2005. HIV patients were excluded. A total of 993 patients were classified as follows: Group 1: no active cancer; Group 2: solid cancer without neutropenia; Group 3: solid cancer without neutropenia or hematologic malignancy. Age, Pneumonia Severity Index (PSI, overall mortality, time to reach clinical stability (TCS and length of stay in hospital (LOS are summarized in the table. No significant differences were found for any of the outcomes between group 2 and 3. Our results suggest that physicians should aggressively manage cancer patients with CAP, regardless of the neutrophil count.

  12. Impact of an Educational Program to Reduce Healthcare Resources in Community-Acquired Pneumonia: The EDUCAP Randomized Controlled Trial.

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    Jordi Adamuz

    Full Text Available Additional healthcare visits and rehospitalizations after discharge are frequent among patients with community-acquired pneumonia (CAP and have a major impact on healthcare costs. We aimed to determine whether the implementation of an individualized educational program for hospitalized patients with CAP would decrease subsequent healthcare visits and readmissions within 30 days of hospital discharge.A multicenter, randomized trial was conducted from January 1, 2011 to October 31, 2014 at three hospitals in Spain. We randomly allocated immunocompetent adults patients hospitalized for CAP to receive either an individualized educational program or conventional information before discharge. The educational program included recommendations regarding fluid intake, adherence to drug therapy and preventive vaccines, knowledge and management of the disease, progressive adaptive physical activity, and counseling for alcohol and smoking cessation. The primary trial endpoint was a composite of the frequency of additional healthcare visits and rehospitalizations within 30 days of hospital discharge. Intention-to-treat analysis was performed.We assigned 102 patients to receive the individualized educational program and 105 to receive conventional information. The frequency of the composite primary end point was 23.5% following the individualized program and 42.9% following the conventional information (difference, -19.4%; 95% confidence interval, -6.5% to -31.2%; P = 0.003.The implementation of an individualized educational program for hospitalized patients with CAP was effective in reducing subsequent healthcare visits and rehospitalizations within 30 days of discharge. Such a strategy may help optimize available healthcare resources and identify post-acute care needs in patients with CAP.Controlled-Trials.com ISRCTN39531840.

  13. Immunomodulation in community-acquired pneumonia

    NARCIS (Netherlands)

    Remmelts, H.H.F.

    2013-01-01

    Community-acquired pneumonia (CAP) is a common disease with considerable morbidity and mortality, despite effective antibiotic treatment. In this thesis, we showed that the major causative microorganisms in CAP trigger distinct inflammatory response profiles in the host. While an inflammatory respon

  14. Hospital Acquired Pneumonia: Issues in Therapy

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    Lionel A Mandell

    1994-01-01

    Full Text Available In December 1992. a meeting was convened in Toronto to develop guidelines for the initial treatment of hospital acquired pneumonia. Issues considered related lo the patient. the possible drugs used for treatment, and the pathogen(s. From the perspective of the patient. the two major issues were the presence or absence of risk factors for specific microbial pathogens and the severity of illness upon clinical presentation, Criteria for defining severly ill patients were developed and are presented in this paper. Drug and pathogen related issues focused on selection of antimicrobial agents thal would provide coverage for the likely pathogens. Concern was also expressed regarding use of aminoglycosides as single-agent treatment of Gram-negative infections in the lung. and the issue of monotherapy versus combination therapy of Pseudomonas aeruginosa infections was discussed. The use of various diagnostic tests was briefly reviewed. including the protected specimen brush and bronchoalveolar lavage. Treatment regimens are presented in tabular format.

  15. Empirical management of community-acquired pneumonia : impact of concurrent A/H1N1 influenza pandemic on guideline implementation

    NARCIS (Netherlands)

    Cortoos, Pieter-Jan; Gilissen, Christa; Mol, Peter G. M.; Van den Bossche, Filip; Simoens, Steven; Willems, Ludo; Leenaers, Hilde; Vandorpe, Ludo; Peetermans, Willy E.; Laekeman, Gert

    2011-01-01

    Background: Guideline-concordant therapies have been proven to be associated with improved health and economic outcomes in the treatment of community-acquired pneumonia (CAP). However, actual use of CAP guidelines remains poor, but using tailored interventions looks promising. Based on local observa

  16. [Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia].

    Science.gov (United States)

    Deĭkina, O N; Mishin, V Iu; Demikhova, O V

    2007-01-01

    The purpose of this investigation was to enhance the efficiency of differential diagnosis of pneumonia and pulmonary tuberculosis. A hundred and fifty-nine adult patients were examined. These included 78 patients with pulmonary tuberculosis and 81 with community-acquired p neumonia. The clinical features of infiltrative pulmonary tuberculosis (n = 48) and mild community-acquired pneumonia (n = 51) were compared. The course of caseous pneumonia (n = 30) was compared with that of moderate and severe community-acquired pneumonia (n = 30). Significant differences in the manifestations of the intoxication and bronchopulmonary syndrome were not found in patients with community-acquired pneumonia and infiltrative pulmonary tuberculosis. Physical studies showed that in patients with community-acquired pneumonia, moist rale (54.9%) and crepitation (11.8%) were prevalent, but in those with infiltrative tuberculosis rale was absent in 60.4% of cases and the pattern of respiration was unchanged in 79.2%. Chest X-ray studies indicated that in patients with community-acquired pneumonia, lower lobar inflammatory changes were predominant in 62.8% of cases whereas in those with infiltrative pulmonary tuberculosis the process was mainly bilateral (43.8%) with the presence of destructive changes (83.3%) and bronchogenic dissemination (66.7%). In patients with caseous pneumonia, the intoxication syndrome was more significant than in those with severe community-acquired pneumonia. Chest X-ray studies demonstrated that in patients with caseous pneumonia, specific changes were bilateral with the involvement of 2 lobes or more, with destruction and bronchogenic dissemination while in those with community-acquired pneumonia, the pulmonary processes were predominantly bilateral (76.6%) at the lower lobar site (36.7%).

  17. [Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia].

    Science.gov (United States)

    Deĭkina, O N; Mishin, V Iu; Demikhova, O V

    2007-01-01

    The purpose of this investigation was to enhance the efficiency of differential diagnosis of pneumonia and pulmonary tuberculosis. A hundred and fifty-nine adult patients were examined. These included 78 patients with pulmonary tuberculosis and 81 with community-acquired p neumonia. The clinical features of infiltrative pulmonary tuberculosis (n = 48) and mild community-acquired pneumonia (n = 51) were compared. The course of caseous pneumonia (n = 30) was compared with that of moderate and severe community-acquired pneumonia (n = 30). Significant differences in the manifestations of the intoxication and bronchopulmonary syndrome were not found in patients with community-acquired pneumonia and infiltrative pulmonary tuberculosis. Physical studies showed that in patients with community-acquired pneumonia, moist rale (54.9%) and crepitation (11.8%) were prevalent, but in those with infiltrative tuberculosis rale was absent in 60.4% of cases and the pattern of respiration was unchanged in 79.2%. Chest X-ray studies indicated that in patients with community-acquired pneumonia, lower lobar inflammatory changes were predominant in 62.8% of cases whereas in those with infiltrative pulmonary tuberculosis the process was mainly bilateral (43.8%) with the presence of destructive changes (83.3%) and bronchogenic dissemination (66.7%). In patients with caseous pneumonia, the intoxication syndrome was more significant than in those with severe community-acquired pneumonia. Chest X-ray studies demonstrated that in patients with caseous pneumonia, specific changes were bilateral with the involvement of 2 lobes or more, with destruction and bronchogenic dissemination while in those with community-acquired pneumonia, the pulmonary processes were predominantly bilateral (76.6%) at the lower lobar site (36.7%). PMID:17338353

  18. Impact of pneumococcal vaccination in children on serotype distribution in adult community-acquired pneumonia using the serotype-specific multiplex urinary antigen detection assay.

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    Pletz, Mathias W; Ewig, Santiago; Rohde, Gernot; Schuette, Hartwig; Rupp, Jan; Welte, Tobias; Suttorp, Norbert; Forstner, Christina

    2016-04-29

    The aim of the study was to compare the distribution of the vaccine-serotypes covered by pneumococcal conjugate vaccines (PCV7 and PCV13) in adult patients with pneumococcal community-acquired pneumonia in Germany between the periods 2002-2006 and 2007-2011 using a novel serotype-specific multiplex urinary antigen detection assay (SSUA). Vaccination of children started with PCV7 in 2007, which was replaced by PCV13 in 2010. Following confirmation of the accuracy of SSUA in long-term stored urine samples from 112 patients with confirmed pneumonia and known pneumococcal serotype, urine samples of 391 CAPNETZ patients with documented pneumococcal pneumonia (i.e. positive BinaxNOW(®) Streptococcus pneumoniae urine antigen test) but unknown serotype were tested for the 13 vaccine-serotypes using SSUA. The proportion of PCV7-serotypes significantly decreased in adult patients with pneumonia from 30.6% (2002-6) to 13.3% (2007-11, ppneumococcal serotypes included by PCV13 remained stable during study period with a coverage of 61.5% (2002-06) and 59.7% (2007-11) in non-bacteremic pneumonia and 79% (for both periods) in bacteremic pneumonia, mainly due to an increase in pneumococcal serotypes 1, 3 and 7F during the second period. Thus, implementation of PCV7 in children in Germany in 2007 was associated with a significant decrease in vaccine-serotypes covered by PCV7 in adult patients with non-bacteremic pneumococcal pneumonia and with an elimination of PCV7 vaccine-serotypes in bacteremic pneumococcal pneumonia. PCV13 coverage remained high up to 2011, mainly due to an increase in serotypes 1, 3 and 7F. German Clinical Trials Register: DRKS00005274. PMID:27016653

  19. Severe community-acquired pneumonia caused by Mycoplasma pneumoniae in young female patient

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    Milancic Nena

    2015-09-01

    Full Text Available Mycoplasma pneumonia is common agent causing community acquired pneumonia in younger population. However, the course of illness is usually benign and is rarely associated with pulmonary complications. We report a 27 years old female patient with unilateral pneumonia followed by pleural effusion and adhesions on the same side. This potential source of infection should be considered in young patients where resolution of symptoms from pneumonia is delayed.

  20. Atypical pathogens in community acquired pneumonia of Egyptian children

    Institute of Scientific and Technical Information of China (English)

    Deraz TE; El Sahriggy SA; Shaheen MA; Motawea AA; Gomaa HE; Fawzy SH; Mohamed AA

    2009-01-01

    Objective:Diagnosis of atypical pathogens as an aetiology for community-acquired pneumonia (CAP)in chil-dren is a challenge world wide.The aim of this study was to detect the frequency of atypical pathogens as a cause of community-acquired pneumonia (CAP)in Egyptian children.Methods:From 50 children (with age ranged from 2 months to 1 2 years)hospitalized for community-acquired pneumonia;respiratory sputum samples were collected by induction or spontaneously.All samples were subjected to conventional cultures and Polymer-ase Chain Reaction(PCR)technique DNA extraction for identification of Mycoplasma,Chlamydia pneumoniae and Legionella pneumophila.Results:A definite pathogen was identified in 78% of the studied children;30%typical bacteria,8% candida albicans and atypical bacteria in 40% of the pneumonic children.Chlamydia pneumoniae was isolated from 26% of the children while Mycoplasma pneumoniae was isolated from 1 4%, whereas Legionella pneumophilla was not isolated at all.Conclusion:Atypical pathogens are evident as a po-tential aetiology for community-acquired pneumonia in (1 3.3%)of young and (80%)of older Egyptian chil-dren.

  1. Acquired Fanconi syndrome in patients with Legionella pneumonia

    OpenAIRE

    Kinoshita-Katahashi, Naoko; Fukasawa, Hirotaka; Ishigaki, Sayaka; Isobe, Shinsuke; Imokawa, Shiro; Fujigaki, Yoshihide; Furuya, Ryuichi

    2013-01-01

    Background Hyponatremia is often observed in patients with Legionella pneumonia. However, other electrolyte abnormalities are uncommon and the mechanism remains to be clarified. Case presentation We experienced two male cases of acquired Fanconi syndrome associated with Legionella pneumonia. The laboratory findings at admission showed hypophosphatemia, hypokalemia, hypouricemia and/or hyponatremia. In addition, they had the generalized dysfunction of the renal proximal tubules presenting decr...

  2. Early neurovascular uncoupling in the brain during community acquired pneumonia

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    Rosengarten, Bernhard; Krekel, Dennis; Kuhnert, Stefan; Schulz, Richard

    2012-01-01

    Introduction Sepsis leads to microcirculatory dysfunction and therefore a disturbed neurovascular coupling in the brain. To investigate if the dysfunction is also present in less severe inflammatory diseases we studied the neurovascular coupling in patients suffering from community acquired pneumonia. Methods Patients were investigated in the acute phase of pneumonia and after recovery. The neurovascular coupling was investigated with a simultaneous electroencephalogram (EEG)-Doppler techniqu...

  3. [Epidemiology of community-acquired pneumonia in children. Current data].

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    Marguet, C; Bocquel, N; Mallet, E

    1998-01-01

    Viruses, particularly syncitial respiratory virus, are the main aetiology of community-acquired lower respiratory tract infections in infants, while bacterial agents are more frequently responsible in children older than 3 years. Antimicrobial therapy must take into account the development of reduced susceptibility of penicillin to strains of Streptoccocus pneumoniae and Haemophilus influenzae with beta-lactamase, and high frequency of Mycoplasma pneumoniae and Chlamydia pneumoniae infections. Although the mortality rate has remained low in France, the morbidity appeared to increase in recent years. PMID:10223154

  4. [National consensus for management of community acquired pneumonia in adults].

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    Saldías P, Fernando; Pérez C, Carlos

    2005-01-01

    Community acquired pneumonia (CAP) is an acute respiratory infection that affects pulmonary parenchyma, and is caused by community acquired microorganisms. In Chile, pneumonia represents the main cause of death due to infectious diseases and is the third specific cause of mortality in adults. In 1999, an experts committee in representation of "Sociedad Chilena de Enfermedades Respiratorias", presented the first National Guidelines for the Treatment of Adult Community Acquired Pneumonia, mainly based in foreign experience and documents, and adapted it to our National Health System Organization. During the last decade, impressive epidemiological and technological changes have occurred, making the update of guidelines for treatment of NAC by several international scientific societies, necessary. These changes include: new respiratory pathogens that are being identified in CAP and affect adult patients (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila); the increasing senescent adult population that carries multiple co-morbidities; the emergence of antimicrobial resistance among respiratory pathogens associated to massive antibiotic prescription; the development by the pharmaceutical industry of new drugs that are effective for pneumonia treatment (macrolides, ketolides and respiratory fluorquinolones); and the development of new diagnostic techniques for detection of antigens, antibodies, and bacterial DNA by molecular biology, useful in respiratory infections. Based on these antecedents, an Advisory Committee of "Sociedad Chilena de Enfermedades Respiratorias" and "Sociedad Chilena de Infectología" has reviewed the national and international evidence about CAP management in adults in order to update clinical recommendations for our country.

  5. [Features of morbidity community-acquired pneumonia among young recruits].

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    Serdukov, D U; Gordienko, A V; Kozlov, M S; Mikhailov, A A; Davydov, P A

    2015-10-01

    Were examined 3338 military personnel of the combined training center. 183 of them diagnosed community-acquired pneumonia, in 3155 focal and infiltrative changes in lung tissue were not identified. The analisys of prevalence been made among young recruits of the acute respiratory illness before arriving in part and at the assembly point, foci of chronic infection, smoking, low body weight. 511 military personnel arrived at the training center in the disease state with symptoms of acute respiratory illness. Examined the relationship these risk factor to the development of community-acquired pneumonia in this category of servicemen. PMID:26827502

  6. Evaluation of different nucleic acid amplification techniques for the detection of M. pneumoniae, C. pneumoniae and Legionella spp. in respiratory specimens from patients with community-acquired pneumonia

    NARCIS (Netherlands)

    Loens, K; Beck, T; Ursi, D; Overdijk, M; Sillekens, P; Goossens, H; Ieven, M; Niesters, Bert

    2008-01-01

    The number of pathogens involved in community-acquired pneumonia, with varying susceptibilities to antimicrobials, is numerous constituting an enormous challenge for diagnostic microbiology. Differentiation of infections due to Streptococcus pneumoniae and those due to Mycoplasma pneumoniae, Chlamyd

  7. Overview of recent studies of community-acquired pneumonia.

    Science.gov (United States)

    Higgins, K; Singer, M; Valappil, T; Nambiar, S; Lin, D; Cox, E

    2008-12-01

    All recent studies of antibacterial drugs for the indication of community-acquired pneumonia submitted to the US Food and Drug Administration have been designed as noninferiority studies. We provide a summary of results of 7 recent clinical studies of oral antibacterial drugs for treatment of community-acquired pneumonia. In these 7 studies, the majority of patients enrolled had Pneumonia Patient Outcomes Research Team scores of I or II. The percentage of randomized subjects with pathogens identified at baseline ranged from 47% to 76%, and the percentage of subjects with Streptoccocus pneumoniae isolated at baseline ranged from approximately 6% to 20%. The primary end point in these studies was clinical cure, assessed 7-21 days after completion of therapy. Clinical cure rates were >80% in the intent-to-treat populations and >90% in the per-protocol populations. We also briefly summarize the results from several recently submitted clinical studies of intravenously administered antibacterial drugs for treatment of community-acquired pneumonia, in which we found similar results. PMID:18986282

  8. Antibiotic Treatment Strategies for Community-Acquired Pneumonia in Adults

    NARCIS (Netherlands)

    Postma, Douwe F.; Van Werkhoven, Cornelis H.; Van Elden, Leontine J R; Thijsen, Steven F T; Hoepelman, Andy I M; Kluytmans, Jan A J W; Boersma, Wim G.; Compaijen, Clara J.; Van Der Wall, Eva; Prins, Jan M.; Oosterheert, Jan J.; Bonten, Marc J M

    2015-01-01

    BACKGROUND The choice of empirical antibiotic treatment for patients with clinically suspected community-acquired pneumonia (CAP) who are admitted to non-intensive care unit (ICU) hospital wards is complicated by the limited availability of evidence. We compared strategies of empirical treatment (al

  9. MULTILOCI SEQUESTERANT STRAINS OF STREPTOCOCCUS PNEUMONIAE ISOLATED FROM ELDERLY PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA

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    A. V. Martynova

    2014-01-01

    Full Text Available Comuunity-acquired pneumonias in aged patients is the significant epidemiology problem for the public health of almost all the countries. Even more important the problem of microbiological monitoring and epidemiology surveillance for the S. pneumoniae strains as one of the ubiquitous pathogens causing as the community-acquired pneumonias as well the other infections of respiratory tract, what defines their different epidemiological meaning.Multilocus sequence typing is the perspective method of molecular epidemiological surveillance allowing to define the epidemiologically dangerous clones of the ubiquitous microorganisms as Streptococcus pneumomiae. The aim of our research was to conduct the multilocus sequence typing of pneumococci strains isolated in patients with community acquired pneumonias, bronchitis in aged patients.Materials and methods. There were taken 14 strains of S. pneumoniae, isolated in patients with community-acquired pneumonias (seven of them were multiresistant, eight strains were isolated from patients with the chronical onstructive lung diseases and four strains from carriers. Multilocus sequence typing was conduected according to method to M.C. Enright and B.G. Spratt (1998.Results. The strains, isolated in all populations were the related isolates of the species S. pneumoniae, the most of them had the unique genotype defining the sequence type for every strain. There were 6 strains of Taiwan 19F-14 genotype from 14 strains isolated in aged patients with community-acquired pneumonia. Among strains isolated from carriers there were prevailing the strai of R6 genotype.Conclusion. Multilocus sequence typing allows to identify the new genotypes and to prognose the appearing of epidemiologically dangerous strains with new peculiarities.

  10. 75 FR 73107 - Draft Guidance for Industry on Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated...

    Science.gov (United States)

    2010-11-29

    ... Pneumonia and Ventilator-Associated Bacterial Pneumonia: Developing Drugs for Treatment; Availability AGENCY... Pneumonia and Ventilator-Associated Bacterial Pneumonia: Developing Drugs for Treatment.'' The purpose of... antimicrobial drugs for the treatment of hospital- acquired bacterial pneumonia (HABP) and...

  11. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults

    OpenAIRE

    Coleman Rotstein; Gerald Evans; Abraham Born; Ronald Grossman; R Bruce Light; Sheldon Magder; Barrie McTaggart; Karl Weiss; Zhanel, George G

    2008-01-01

    Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are important causes of morbidity and mortality, with mortality rates approaching 62%. HAP and VAP are the second most common cause of nosocomial infection overall, but are the most common cause documented in the intensive care unit setting. In addition, HAP and VAP produce the highest mortality associated with nosocomial infection. As a result, evidence-based guidelines were prepared detailing the epidemiology, micro...

  12. Polymicrobial community-acquired pneumonia: An emerging entity.

    Science.gov (United States)

    Cillóniz, Catia; Civljak, Rok; Nicolini, Antonello; Torres, Antoni

    2016-01-01

    Polymicrobial aetiology in community-acquired pneumonia (CAP) is more common than previously recognized. This growing new entity can influence inflammation, host immunity and disease outcomes in CAP patients. However, the true incidence is complicated to determine and probably underestimated due mainly to many cases going undetected, particularly in the outpatient setting, as the diagnostic yield is restricted by the sensitivity of currently available microbiologic tests and the ability to get certain types of clinical specimens. The observed rate of polymicrobial cases may also lead to new antibiotic therapy considerations. In this review, we discuss the pathogenesis, microbial interactions in pneumonia, epidemiology, biomarkers and antibiotic therapy for polymicrobial CAP.

  13. Procalcitonin for detecting community-acquired bacterial pneumonia

    Directory of Open Access Journals (Sweden)

    Devi Gusmaiyanto

    2016-06-01

    Full Text Available Background Pneumonia is a major cause of morbidity andmortality in children under five years of age. Pneumonia can be ofbacterial or viral origin. It is difficult to distinguish between thesetwo agents based on clinical manifestations, as well as radiologicaland laboratory examinations. Furthermore, bacterial cultures taketime to incubate and positive results may only be found in 10-30%of bacterial pneumonia cases. Procalcitonin has been used as amarker to distinguish etiologies, as bacterial infections tend toincrease serum procalcitonin levels.Objective To determine the sensitivity, specificity, positivepredictive value and negative predictive value of procalcitoninin community-acquired bacterial pneumonia.Method This cross-sectional study was conducted in thePediatric Health Department of Dr. M. Djamil Hospital, Padang.Subjects were selected by consecutive sampling. Procalcitoninmeasurements and PCR screening were performed on bloodspecimens from 32 pneumonia patients and compared.Results Of the 32 subjects, most were boys (56.25%, under 5years of age (99%, and had poor nutritional status (68.75%.Using a cut-off point of 0.25 ng/mL, procalcitonin level hada sensitivity of 92%, specificity 50%, positive predictive value 88%, and negative predictive value 60% for diagnosing bacterial pneumonia. Using a cut-off point of 0.5 ng/mL, procalcitonin level had a specificity of 46%, specificity 83%, positive predictive value 91%, and negative predictive value 25%.Conclusion A cut-off point of 0.25 ng/mL of procalcitonin level may be more useful to screen for bacterial pneumonia than a cutoff point of 0.5 ng / mL. However, if the 0.25 ng/mL cut-off point is used, careful monitoring will be required for negative results, as up to 40% may actually have bacterial pneumonia. [PaediatrIndones. 2015;55:65-9.].

  14. Procalcitonin for detecting community-acquired bacterial pneumonia

    Directory of Open Access Journals (Sweden)

    Devi Gusmaiyanto

    2015-03-01

    Full Text Available Background Pneumonia is a major cause of morbidity and mortality in children under five years of age. Pneumonia can be of bacterial or viral origin. It is difficult to distinguish between these two agents based on clinical manifestations, as well as radiological and laboratory examinations. Furthermore, bacterial cultures take time to incubate and positive results may only be found in 10-30% of bacterial pneumonia cases. Procalcitonin has been used as a marker to distinguish etiologies, as bacterial infections tend to increase serum procalcitonin levels. Objective To determine the sensitivity, specificity, positive predictive value and negative predictive value of procalcitonin in community-acquired bacterial pneumonia. Method This cross-sectional study was conducted in the Pediatric Health Department of Dr. M. Djamil Hospital, Padang. Subjects were selected by consecutive sampling. Procalcitonin measurements and PCR screening were performed on blood specimens from 32 pneumonia patients and compared. Results Of the 32 subjects, most were boys (56.25%, under 5 years of age (99%, and had poor nutritional status (68.75%. Using a cut-off point of 0.25 ng/mL, procalcitonin level had a sensitivity of 92%, specificity 50%, positive predictive value 88%, and negative predictive value 60% for diagnosing bacterial pneumonia. Using a cut-off point of 0.5 ng/mL, procalcitonin level had a specificity of 46%, specificity 83%, positive predictive value 91%, and negative predictive value 25%. Conclusion A cut-off point of 0.25 ng/mL of procalcitonin level may be more useful to screen for bacterial pneumonia than a cut-off point of 0.5 ng / mL. However, if the 0.25 ng/mL cut-off point is used, careful monitoring will be required for negative results, as up to 40% may actually have bacterial pneumonia. [Paediatr Indones. 2015;55:65-9.].

  15. Failure of levofloxacin treatment in community-acquired pneumococcal pneumonia

    Directory of Open Access Journals (Sweden)

    Grossi Paolo

    2005-11-01

    Full Text Available Abstract Background Streptococcus pneumoniae is the leading cause of community-acquired pneumonia (CAP. High global incidence of macrolide and penicillin resistance has been reported, whereas fluoroquinolone resistance is uncommon. Current guidelines for suspected CAP in patients with co-morbidity factors and recent antibiotic therapy recommend initial empiric therapy using one fluoroquinolone or one macrolide associated to other drugs (amoxicillin, amoxicillin/clavulanate, broad-spectrum cephalosporins. Resistance to fluoroquinolones is determined by efflux mechanisms and/or mutations in the parC and parE genes coding for topoisomerase IV and/or gyrA and gyrB genes coding for DNA gyrase. No clinical cases due to fluoroquinolone-resistant S. pneumoniae strains have been yet reported from Italy. Case presentation A 72-year-old patient with long history of chronic obstructive pulmonary disease and multiple fluoroquinolone treatments for recurrent lower respiratory tract infections developed fever, increased sputum production, and dyspnea. He was treated with oral levofloxacin (500 mg bid. Three days later, because of acute respiratory insufficiency, the patient was hospitalized. Levofloxacin treatment was supplemented with piperacillin/tazobactam. Microbiological tests detected a S. pneumoniae strain intermediate to penicillin (MIC, 1 mg/L and resistant to macrolides (MIC >256 mg/L and fluoroquinolones (MIC >32 mg/L. Point mutations were detected in gyrA (Ser81-Phe, parE (Ile460-Val, and parC gene (Ser79-Phe; Lys137-Asn. Complete clinical response followed treatment with piperacillin/tazobactam. Conclusion This is the first Italian case of community-acquired pneumonia due to a fluoroquinolone-resistant S. pneumoniae isolate where treatment failure of levofloxacin was documented. Molecular analysis showed a group of mutations that have not yet been reported from Italy and has been detected only twice in Europe. Treatment with piperacillin

  16. Etiology of childhood community acquired pneumonia and its implications for vaccination

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    Nascimento-Carvalho Cristiana M.C.

    2001-01-01

    Full Text Available Pneumonia is an important cause of morbidity and mortality among children throughout the world. Vaccines are available for some organisms, but they are underutilized and/or still in development. To evaluate the potential impact of vaccines, we review studies in which the etiology of childhood community-acquired pneumonia was recorded. In North America and Europe (9 studies, the etiology of pneumonia was established in 62% of studied children (range 43%-88% by use of noninvasive specific methods for microbiologic diagnosis. The most often identified agents were S. pneumoniae (22%, respiratory syncytial virus (RSV (20%, Haemophilus influenzae (7%, and Mycoplasma pneumoniae (15%. In Africa and South America (8 studies, bacteria were recovered from 56% (range 32%-68% of severely ill children studied by lung aspirate. The most often isolated bacteria were Streptococcus pneumoniae (33% and Haemophilus influenzae (21%. A high percentage of H. influenzae strains were not serotype b. Throughout the world, children requiring hospitalization were most likely to have infection caused by pneumococcus H. influenzae or RSV. Out patients also had Mycoplasma pneumoniae. Countries in Africa and Asia recorded 2 to 10 times more children with pneumonia (7 to 40/100 annually than in the USA. Widespread use of pneumococcal and H. influenzae type b conjugate vaccines could reduce the frequency of childhood pneumonia by one-third. Further reduction will require development of non-type b H. influenzae, RSV and M. pneumoniae vaccines. This could result in a > 50% reduction of pneumonia in children. This goal should be sought and achieved as soon as possible.

  17. [ANEMIC SYNDROME IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA].

    Science.gov (United States)

    Budnevsky, A V; Esaulenko, I E; Ovsyannikov, E S; Labzhaniya, N B; Voronina, E V; Chernov, A V

    2016-01-01

    Community-acquired pneumonia remains a most widespread acute infectious disease of socio-economic significance all over the world. Up to 30% of the patients present with anemia responsible for the unfavourable prognosis and elevated mortality. Not infrequently, anemia is not diagnosed during the hospital stay und therefore remains uncorrected. Severe anemia results in enhanced hypercapnia and slowed maturation of red blood cells in the bone marrow which facilitates the development of ischemic syndrome. Hepcidin, a mediator of inflammation and iron-regulatory hormone, plays an important role in the clinical course of community-acquired pneumonia. Hepsidin production increases during inflammation; it suppresses erythtropoiesis and depletes the iron depot leading to so-called anemia of inflammation. Hypoxia and anemia activate erythtropoiesis, and the released erythropoietin inhibits hepsidin production. During pneumonia resolution, hepsidin promotes recovery from anemia by activating iron absorption. The curreni literature contains few data on the use of hepcidin as a diagnostic marker of anemia. The necessity oftreating anemia in patients with pneumonia under hospital conditions is a matter of discussion. Direct involvement of hepcidin in iron metabolism creates a prerequisite for the treatment of anemia. Medicamental suppression of its activity by stimulating erythtropoiesis can facilitate normalization of iron metabolism and restoration of hemoglobin level.

  18. [CAPNETZ. The competence network for community-acquired pneumonia (CAP)].

    Science.gov (United States)

    Suttorp, Norbert; Welte, Tobias; Marre, Reinhard; Stenger, Steffen; Pletz, Mathias; Rupp, Jan; Schütte, Hartwig; Rohde, Gernot

    2016-04-01

    CAPNETZ is a medical competence network for community-acquired pneumonia (CAP), which was funded by the German Ministry for Education and Research. It has accomplished seminal work on pneumonia over the last 15 years. A unique infrastructure was established which has so far allowed us to recruit and analyze more than 11,000 patients. The CAPNETZ cohort is the largest cohort worldwide and the results obtained relate to all relevant aspects of CAP management (epidemiology, risk stratification via biomarkers or clinical scores, pathogen spectrum, pathogen resistance, antibiotic management, prevention and health care research). Results were published in more than 150 journals and informed the preparation and update of the national S3-guideline. CAPNETZ was also the foundation for further networks like the Pneumonia Research Network on Genetic Resistance and Susceptibility for the Evolution of Severe Sepsis) (PROGRESS), the Systems Medicine of Community Acquired Pneumonia Network (CAPSyS) and SFB-TR84 (Sonderforschungsbereich - Transregio 84). The main recipients (Charité Berlin, University Clinic Ulm and the Hannover Medical School) founded the CAPNETZ foundation and transferred all data and materials rights to this foundation. Moreover, the ministry granted the CAPNETZ foundation the status of being eligible to apply for research proposals and receive research funds. Since 2013 the CAPNETZ foundation has been an associated member of the German Center for Lung Research (DZL). Thus, a solid foundation has been set up for CAPNETZ to continue its success story. PMID:26984399

  19. Тhe features of severe community acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Avramenko I.V.

    2015-06-01

    Full Text Available Based on data from a prospective analysis for the year of observation, the article presents information about the features of severe community acquired pneumonia in patients who were hospitalized at the department of pulmonology (or therapy, as well as department of the intensive care from three teaching hospitals in Dnepropetrovsk, namely "Dnipropetrovsk City Hospital №6», "Dnipropetrovsk City Hospital №2», "Dnipropetrovsk City Hospital №16», which are the clinical ones of "Dnepropetrovsk Medical Academy of the Ministry of Health Ukraine". Dependence of the severity of the condition shown on duration of illness before admission, features of season character of disease. The effect of breathing exercises on the course of the disease. The results can be the basis for a more personal approach to the development of diagnostic and therapeutic programs for patients with severe community-acquired pneumonia.

  20. Community-Acquired Pneumonia in Children: A Multidisciplinary Consensus Review

    OpenAIRE

    Low, Donald E.; Kellner, James D; Allen, Upton; Boucher, Francois D; Kovesi, Thomas; Riesman, John; Davidson, Ross; Joanne M Langley

    2003-01-01

    Community-acquired pneumonia (CAP) is common among children and may have viral, bacterial or, occasionally, other causes. The etiology is complex, with age-related trends, and differs from that in adult CAP, necessitating different management guidelines. There is an absence of current guidelines for the management of pediatric CAP (PCAP) that take into account changing etiologies, antimicrobial-resistance issues and the use of newly licensed antimicrobials. The present review does not provide...

  1. Community-acquired pneumonia in older patients: does age influence systemic cytokine levels in community-acquired pneumonia?

    LENUS (Irish Health Repository)

    Kelly, Emer

    2009-03-01

    Community-acquired pneumonia (CAP) is a major cause of death in the elderly. The age-related increase in comorbid illnesses plays a part but the effect of aging on the immune response may be equally important. We aimed to evaluate patients with CAP for evidence of a muted response to infection in elderly patients admitted to hospital compared with a younger patient group.

  2. Emerging Community-Acquired Methicillin-Resistant Staphylococcus Aureus Pneumonia

    Directory of Open Access Journals (Sweden)

    Dragana Orlovic

    2009-04-01

    Full Text Available Background: Methicillin-resistant Staphylococcus aureus (MRSA has been an important nosocomial pathogen worldwide for more than four decades. Community-acquired MRSA infections, generally occurring in previously healthy persons without recognizable risk factors for health care setting-related MRSA, are emerging as serious clinical and public health concerns. The most frequent of these community-based infections include skin and soft tissue infections and necrotizing pneumonias. A majority of causative community-acquired MRSA (CA-MRSA isolates are associated with genes that encode the virulence factor, Panton-Valentine leukocidin (PVL toxin. Aims & Objectives: To describe six cases of CA-MRSA pneumonia recently admitted to our community hospital in Florida, and discuss the epidemiology, clinical features, and management of these expanding infections. Methods/Study Design: The medical records of six patients with radiographically-confirmed pneumonia and positive sputum cultures for MRSA at the time of hospitalization at the Lawnwood Regional Medical Center and Heart Institute, Fort Pierce, Florida, from December 2006 through January 2007, were retrospectively reviewed. All patients were seen by one of the authors (DO, an infectious diseases consultant. Lawnwood Regional Medical Center is a 341-bed, acute care institution and regional referral center for four counties of Treasure Coast, FL. The hospital institution review board gave permission for this study. Results/Findings: Six patients (5 men, 1 woman with CA-MRSA pneumonia were identified. The mean patient age was 57 years (range, 32-79 years. Three patients had no history of previous hospital admission, while two patients had been last hospitalized two years prior to the study admission. Three elderly patients had known co-morbidities predisposing to pneumonia including carcinoma of the lung (2 patients, and cirrhosis, diabetes mellitus, chronic renal failure, COPD, and cardiomyopathy (1

  3. Independent radiographic prognostic factors in patients with hospital-treated community-acquired pneumonia

    International Nuclear Information System (INIS)

    Purpose: To evaluate the independent prognostic impact of the chest radiograph for mortality from community-acquired pneumonia requiring hospitalization. Methods: Chest radiographs of 67 patients with hospital-treated community-acquired pneumonia were analyzed with regard to the prognostic implications of radiographic patterns, extent and density of infiltrates, and its evolution during treatment. Results: Non-survivors had a significantly higher extent of infiltrates (p=0.008), density of infiltrates (p=0.05), and radiographic spread during follow-up within 48-72 hours (p=0.0001). In multivariate analysis, persistent or progressive infiltrates were associated with a 47fold increase, and persistent or progressive density of infiltrates with an 18fold increase in risk of mortality. The presence of both parameters could correctly predict 96% of survivors and 90% of non-survivors. Conclusions: The chest radiograph is an independent predictor of the severity of pneumonia. Both persistent or progressive infiltrates and persistent or progressive density of infiltrates are independently associated with mortality from community-acquired pneumonia. (orig.)

  4. Infection by Mycoplasma pneumoniae and its importance as an etiological agent in childhood community-acquired pneumonias

    Directory of Open Access Journals (Sweden)

    Letícia Alves Vervloet

    2007-10-01

    Full Text Available This manuscript reviewed the literature on infection by Mycoplasma pneumoniae with emphasis on etiological aspects of childhood community-acquired pneumonias. Bibliographical research was carried out from Pubmed Medline, MDConsult, HighWire, LILACS, and direct research over the past 10 years with the following keywords: Mycoplasma pneumoniae, pneumonia, and childhood. Fifty-four articles were selected. Mycoplasma pneumoniae has a high incidence in childhood. Clinical presentation includes respiratory and extrarespiratory symptoms. Mycoplasma pneumoniae lung infection can be confused with viral or bacterial pneumonia and is unresponsive to beta-lactams. In addition, co-infections have been reported. Mycoplasma pneumoniae infection occurs in all age groups, being less frequent and more severe in children under the age of five. Its incidence as a causal agent is high. Mycoplasma pneumoniae infections constitute 20%-40% of all community-acquired pneumonias; the severity is highly variable, and this condition may lead to severe sequelae. Mycoplasma pneumoniae frequency is underestimated in clinical practice because of the lack of specific features and a diagnosis that needs serology or PCR. Effective management of M. pneumoniae infections can usually be achieved with macrolides. In Brazil, epidemiological studies are needed in order to assess the incidence of this bacterium.

  5. KPC-producing Klebsiella pneumoniae enteric colonization acquired during intensive care unit stay: the significance of risk factors for its development and its impact on mortality.

    Science.gov (United States)

    Papadimitriou-Olivgeris, Matthaios; Marangos, Markos; Fligou, Fotini; Christofidou, Myrto; Sklavou, Christina; Vamvakopoulou, Sophia; Anastassiou, Evangelos D; Filos, Kriton S

    2013-10-01

    A prospective observational study of 226 intensive care unit (ICU) patients was conducted during a 25-month period. Rectal samples were taken at day 1, 4, and 7 and, afterwards, once weekly. Klebsiella pneumoniae was identified using standard techniques, whereas the presence of bla(KPC) gene was confirmed by PCR. During ICU stay, 72.6% of the patients were colonized with Klebsiella pneumoniae carbapenemases (KPC)-producing K. pneumoniae (KPC-Kp). Male gender, prior bed occupants, and patients in nearby beds colonized with KPC-Kp, tracheotomy, number of invasive catheters inserted, and number of antibiotics administered were the major risk factors for KPC-Kp colonization. ICU mortality (35.4%) was significantly related to Simplified Acute Physiology II score and respiratory insufficiency upon admission, cortisone administration, aminoglycoside administration, confirmed KPC-Kp infection, and severe sepsis or septic shock. The high prevalence of KPC-Kp enteric carriage in ICU patients and the significant mortality associated with KPC-Kp infection dictate the importance of early identification and isolation of such carriers.

  6. Streptococcus pneumoniae DNA Load in Blood as a Marker of Infection in Patients with Community-Acquired Pneumonia

    NARCIS (Netherlands)

    Peters, R.P.H.; Boer, de R.F.; Schuurman, T.; Gierveld, S.; Kooistra-Smid, M.; Agtmael, van M.A.; Vandenbroucke-Grauls, C.M.J.E.; Persoons, M.C.J.; Savelkoul, P.H.M.

    2009-01-01

    Direct detection of Streptococcus pneumoniae DNA in blood adds to culture results in the etiological diagnosis of patients with community-acquired pneumonia (CAP). Quantification of the amount of DNA, the bacterial DNA load (BDL), provides a measurement of DNAemia that may increase the understanding

  7. Clinical and economic burden of community-acquired pneumonia amongst adults in the Asia-Pacific region.

    Science.gov (United States)

    Song, Jae-Hoon; Thamlikitkul, Visanu; Hsueh, Po-Ren

    2011-08-01

    Community-acquired pneumonia (CAP) is an important cause of mortality and morbidity amongst adults in the Asia-Pacific region. Literature published between 1990 and May 2010 on the clinical and economic burden of CAP amongst adults in this region was reviewed. CAP is a significant health burden with significant economic impact in this region. Chronic obstructive pulmonary disease, cardiovascular disease, diabetes mellitus and advanced age were risk factors for CAP. Aetiological agents included Streptococcus pneumoniae, Klebsiella pneumoniae, Gram-negative bacteria, Mycobacterium tuberculosis, Burkholderia pseudomallei, Staphylococcus aureus and atypical pathogens (Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella spp.), with important differences in the prevalence of these pathogens within the region. Antibiotic resistance was significant but was not linked to excess mortality. Aetiological pathogens remained susceptible to newer antimicrobial agents. Rational antibiotic use is essential for preventing resistance, and increased surveillance is required to identify future trends in incidence and aetiology and to drive treatment and prevention strategies.

  8. Costs and health care resource utilization among chronic obstructive pulmonary disease patients with newly acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Lin J

    2014-07-01

    Full Text Available Junji Lin,1 Yunfeng Li,2 Haijun Tian,2 Michael J Goodman,1 Susan Gabriel,2 Tara Nazareth,2 Stuart J Turner,2,3 Stephen Arcona,2 Kristijan H Kahler21Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA; 2Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 3Ernest Mario School of Pharmacy, Rutgers University, New Brunswick, NJ, USA Background: Patients with chronic obstructive pulmonary disease (COPD are at increased risk for lung infections and other pathologies (eg, pneumonia; however, few studies have evaluated the impact of pneumonia on health care resource utilization and costs in this population. The purpose of this study was to estimate health care resource utilization and costs among COPD patients with newly acquired pneumonia compared to those without pneumonia. Methods: A retrospective claims analysis using Truven MarketScan® Commercial and Medicare databases was conducted. COPD patients with and without newly acquired pneumonia diagnosed between January 1, 2004 and September 30, 2011 were identified. Propensity score matching was used to create a 1:1 matched cohort. Patient demographics, comorbidities (measured by Charlson Comorbidity Index, and medication use were evaluated before and after matching. Health care resource utilization (ie, hospitalizations, emergency room [ER] and outpatient visits, and associated health care costs were assessed during the 12-month follow-up. Logistic regression was conducted to evaluate the risk of hospitalization and ER visits, and gamma regression models and two-part models compared health care costs between groups after matching. Results: In the baseline cohort (N=467,578, patients with newly acquired pneumonia were older (mean age: 70 versus [vs] 63 years and had higher Charlson Comorbidity Index scores (3.3 vs 2.6 than patients without pneumonia. After propensity score matching, the pneumonia cohort was nine times more likely

  9. Non-Intensive Care Unit Acquired Pneumonia: A New Clinical Entity?

    OpenAIRE

    Marta Di Pasquale; Stefano Aliberti; Marco Mantero; Sonia Bianchini; Francesco Blasi

    2016-01-01

    Hospital-acquired pneumonia (HAP) is a frequent cause of nosocomial infections, responsible for great morbidity and mortality worldwide. The majority of studies on HAP have been conducted in patients hospitalized in the intensive care unit (ICU), as mechanical ventilation represents a major risk factor for nosocomial pneumonia and specifically for ventilator-associated pneumonia. However, epidemiological data seem to be different between patients acquiring HAP in the ICU vs. general wards, su...

  10. The role of procalcitonin in adult patients with community-acquired pneumonia--a systematic review

    DEFF Research Database (Denmark)

    Berg, Peter; Lindhardt, Bjarne Ørskov

    2012-01-01

    Promising results in relation to severity assessment and treatment of patients with community-acquired pneumonia (CAP) have recently been presented from the study of procalcitonin (PCT) levels in these patients.......Promising results in relation to severity assessment and treatment of patients with community-acquired pneumonia (CAP) have recently been presented from the study of procalcitonin (PCT) levels in these patients....

  11. Clinical Practice Guidelines for Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia in Adults

    Directory of Open Access Journals (Sweden)

    Coleman Rotstein

    2008-01-01

    Full Text Available Hospital-acquired pneumonia (HAP and ventilator-associated pneumonia (VAP are important causes of morbidity and mortality, with mortality rates approaching 62%. HAP and VAP are the second most common cause of nosocomial infection overall, but are the most common cause documented in the intensive care unit setting. In addition, HAP and VAP produce the highest mortality associated with nosocomial infection. As a result, evidence-based guidelines were prepared detailing the epidemiology, microbial etiology, risk factors and clinical manifestations of HAP and VAP. Furthermore, an approach based on the available data, expert opinion and current practice for the provision of care within the Canadian health care system was used to determine risk stratification schemas to enable appropriate diagnosis, antimicrobial management and nonantimicrobial management of HAP and VAP. Finally, prevention and risk-reduction strategies to reduce the risk of acquiring these infections were collated. Future initiatives to enhance more rapid diagnosis and to effect better treatment for resistant pathogens are necessary to reduce morbidity and improve survival.

  12. Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia.

    Directory of Open Access Journals (Sweden)

    Eusebi Chiner

    Full Text Available We hypothesized that obstructive sleep apnea (OSA can predispose individuals to lower airway infections and community-acquired pneumonia (CAP due to upper airway microaspiration. This study evaluated the association between OSA and CAP.We performed a case-control study that included 82 patients with CAP and 41 patients with other infections (control group. The controls were matched according to age, sex and body mass index (BMI. A respiratory polygraph (RP was performed upon admission for patients in both groups. The severity of pneumonia was assessed according to the Pneumonia Severity Index (PSI. The associations between CAP and the Epworth Sleepiness Scale (ESS, OSA, OSA severity and other sleep-related variables were evaluated using logistic regression models. The associations between OSA, OSA severity with CAP severity were evaluated with linear regression models and non-parametric tests.No significant differences were found between CAP and control patients regarding anthropometric variables, toxic habits and risk factors for CAP. Patients with OSA, defined as individuals with an Apnea-Hypopnea Index (AHI ≥10, showed an increased risk of CAP (OR = 2·86, 95%CI 1·29-6·44, p = 0·01. Patients with severe OSA (AHI≥30 also had a higher risk of CAP (OR = 3·18, 95%CI 1·11-11·56, p = 0·047. In addition, OSA severity, defined according to the AHI quartile, was also significantly associated with CAP (p = 0·007. Furthermore, OSA was significantly associated with CAP severity (p = 0·0002, and OSA severity was also associated with CAP severity (p = 0·0006.OSA and OSA severity are associated with CAP when compared to patients admitted to the hospital for non-respiratory infections. In addition, OSA and OSA severity are associated with CAP severity. These results support the potential role of OSA in the pathogenesis of CAP and could have clinical implications. This link between OSA and infection risk should be explored to investigate the

  13. Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia

    Science.gov (United States)

    Chiner, Eusebi; Llombart, Mónica; Valls, Joan; Pastor, Esther; Sancho-Chust, José N.; Andreu, Ada Luz; Sánchez-de-la-Torre, Manuel; Barbé, Ferran

    2016-01-01

    Background We hypothesized that obstructive sleep apnea (OSA) can predispose individuals to lower airway infections and community-acquired pneumonia (CAP) due to upper airway microaspiration. This study evaluated the association between OSA and CAP. Methods We performed a case-control study that included 82 patients with CAP and 41 patients with other infections (control group). The controls were matched according to age, sex and body mass index (BMI). A respiratory polygraph (RP) was performed upon admission for patients in both groups. The severity of pneumonia was assessed according to the Pneumonia Severity Index (PSI). The associations between CAP and the Epworth Sleepiness Scale (ESS), OSA, OSA severity and other sleep-related variables were evaluated using logistic regression models. The associations between OSA, OSA severity with CAP severity were evaluated with linear regression models and non-parametric tests. Findings No significant differences were found between CAP and control patients regarding anthropometric variables, toxic habits and risk factors for CAP. Patients with OSA, defined as individuals with an Apnea-Hypopnea Index (AHI) ≥10, showed an increased risk of CAP (OR = 2·86, 95%CI 1·29–6·44, p = 0·01). Patients with severe OSA (AHI≥30) also had a higher risk of CAP (OR = 3·18, 95%CI 1·11–11·56, p = 0·047). In addition, OSA severity, defined according to the AHI quartile, was also significantly associated with CAP (p = 0·007). Furthermore, OSA was significantly associated with CAP severity (p = 0·0002), and OSA severity was also associated with CAP severity (p = 0·0006). Conclusions OSA and OSA severity are associated with CAP when compared to patients admitted to the hospital for non-respiratory infections. In addition, OSA and OSA severity are associated with CAP severity. These results support the potential role of OSA in the pathogenesis of CAP and could have clinical implications. This link between OSA and infection risk

  14. [Community acquired pneumonia in children: an update for outpatients management].

    Science.gov (United States)

    Wagner, Noémie; Gehri, Mario; Gervaix, Alain; Guinan, Stéphane; Barazzone-Argiroffo, Constance

    2016-02-17

    Pneumonia should be considered in febrile children with tachypnea and/or chest recession. Virus are the most common cause of pneumonia in children under 5 years old. Streptococcus pneumonia can be found at any age. Mycoplasma pneumonia is more frequent in older children. Systematic chest radiograph is not necessary but must be obtained in patients with hypoventilation and in those with failed initial antibiotic therapy. Mycoplasma pneumonia should be tested according to patient age and response to initial antibiotic. First line antibiotherapy is amoxicilline. Antibiotic treatment is frequently not necessary in children under 5 but should be considered depending on clinical presentation and C reactive protein value.

  15. Differentiation of tuberculous pneumonia and community-acquired pneumonia; usefulness of chest radiography and serum CA-125

    International Nuclear Information System (INIS)

    To determine whether tuberculous pneumonia can be distinguished from community-acquired pneumonia on the basis of chest radiographic findings only and the diagnostic utility of differences in serum CA-125 levels. Forty-five patients with a high fever (>38 .deg. C) in whom chest radiography revealed lobar consolidation were retrospectively studied. In 27 cases, the presence of acid-fast bacilli in sputum (n=21), the isolation of Mycobacterium tuberculosis from bronchoscopic biopsy tissue and sputum cultures (n=16), and improvement in the findings of serial radiography and in clinical symptoms during antituberculous therapy (n=1) let to a diagnosis of tuberculous pneumonia. A diagnosis of community-acquired pneumonia (n=18) was based on improvement in the serial radiographic findings obtained during antibacterial therapy (n=16), and the isolation of bacteria from sputum and pleural fluid culture (n=2). On the basis of independently analysed findings, radiologist determined the presence or absence of nodular density, cavitary lesions and loss of lung volume, while two radiologists differentiated between tuberculous pneumonia and community-acquired pneumonia. Initial chest radiographs of tuberculous pneumonia revealed nodular density in 89% of cases, cavitary lesions in 29%, and loss of lung volume nodular density was in 26%, while those of community-acquired pneumonia demonstrated nodular density in only 22%, cavitary lesions in 6%, and loss of lung volume in none was a significant statistical difference in nodular density, cavitary lesions and loss of lung volume (p < 0.005). The average serum CA-125 level in tuberculous pneumonia was 306.5 (range, 21.3-1078) U/ml, whereas the average level in community-acquired pneumonia was 38.0 (range, 11.3-114.8) U/ml (p < 0.005). Initial chest radiography can differentiate between tuberculous and community-acquired pneumonia on the basis of nodular density, cavitary lesions and loss of lung volume and differences in CA-125

  16. Differentiation of tuberculous pneumonia and community-acquired pneumonia; usefulness of chest radiography and serum CA-125

    Energy Technology Data Exchange (ETDEWEB)

    Park, Dong Man; Kim, Jeong Sook; Kim, Young Hwan; Kim, Su Young; Hur, Gham; Choi, Soo Jeon [Inje Univ. College of Medicine, Pusan (Korea, Republic of)

    2000-11-01

    To determine whether tuberculous pneumonia can be distinguished from community-acquired pneumonia on the basis of chest radiographic findings only and the diagnostic utility of differences in serum CA-125 levels. Forty-five patients with a high fever (>38 .deg. C) in whom chest radiography revealed lobar consolidation were retrospectively studied. In 27 cases, the presence of acid-fast bacilli in sputum (n=21), the isolation of Mycobacterium tuberculosis from bronchoscopic biopsy tissue and sputum cultures (n=16), and improvement in the findings of serial radiography and in clinical symptoms during antituberculous therapy (n=1) let to a diagnosis of tuberculous pneumonia. A diagnosis of community-acquired pneumonia (n=18) was based on improvement in the serial radiographic findings obtained during antibacterial therapy (n=16), and the isolation of bacteria from sputum and pleural fluid culture (n=2). On the basis of independently analysed findings, radiologist determined the presence or absence of nodular density, cavitary lesions and loss of lung volume, while two radiologists differentiated between tuberculous pneumonia and community-acquired pneumonia. Initial chest radiographs of tuberculous pneumonia revealed nodular density in 89% of cases, cavitary lesions in 29%, and loss of lung volume nodular density was in 26%, while those of community-acquired pneumonia demonstrated nodular density in only 22%, cavitary lesions in 6%, and loss of lung volume in none was a significant statistical difference in nodular density, cavitary lesions and loss of lung volume (p < 0.005). The average serum CA-125 level in tuberculous pneumonia was 306.5 (range, 21.3-1078) U/ml, whereas the average level in community-acquired pneumonia was 38.0 (range, 11.3-114.8) U/ml (p < 0.005). Initial chest radiography can differentiate between tuberculous and community-acquired pneumonia on the basis of nodular density, cavitary lesions and loss of lung volume and differences in CA-125

  17. Procalcitonin for detecting community-acquired bacterial pneumonia

    OpenAIRE

    Devi Gusmaiyanto; Finny Fitry Yani; Efrida Efrida; Rizanda Machmud

    2016-01-01

    Background Pneumonia is a major cause of morbidity andmortality in children under five years of age. Pneumonia can be ofbacterial or viral origin. It is difficult to distinguish between thesetwo agents based on clinical manifestations, as well as radiologicaland laboratory examinations. Furthermore, bacterial cultures taketime to incubate and positive results may only be found in 10-30%of bacterial pneumonia cases. Procalcitonin has been used as amarker to distinguish etiologies, as bacterial...

  18. Determinants for hospitalization in " low-risk" community acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Aliyu Muktar H

    2003-06-01

    Full Text Available Abstract Background A variable decision in managing community acquired pneumonia (CAP is the initial site of care; in-patient versus outpatient. These variations persist despite comprehensive practice guidelines. Patients with a Pneumonia Severity Index (PSI score lower than seventy have low risk for complications and outpatient antibiotic management is recommended in this group. These patients are generally below the age of fifty years, non-nursing home residents, HIV negative and have no major cardiac, hepatic, renal or malignant diseases. Methods A retrospective analysis of 296 low-risk CAP patients evaluated within a year one period at St. Agnes Hospital, Baltimore, Maryland was undertaken. All patients were assigned a PSI score. 208 (70% were evaluated and discharged from the emergency department (E.D. to complete outpatient antibiotic therapy, while 88 (30% were hospitalized. Patients were sub-stratified into classes I-V according to PSI. A comparison of demographic, clinical, social and financial parameters was made between the E.D. discharged and hospitalized groups. Results Statistically significant differences in favor of the hospitalized group were noted for female gender (CI: 1.46-5.89, p= 0.0018, African Americans (CI: 0.31-0.73, p= 0.004, insurance coverage (CI: 0.19-0.63, p= 0.0034, temperature (CI: 0.04-0.09, p= 0.0001 and pulse rate (CI: 0.03-0.14, p= 0.0001. No statistically significant differences were observed between the two groups for altered mental status, hypotension, tachypnea, laboratory/radiological parameters and social indicators (p>0.05. The average length of stay for in-patients was 3.5 days at about eight time's higher cost than outpatient management. There was no difference in mortality or treatment failures between the two groups. The documentation rate and justifications for hospitalizing low risk CAP patients by admitting physicians was less than optimal. Conclusions High fever, tachycardia, female gender

  19. Population-Based Surveillance for Hypermucoviscosity Klebsiella pneumoniae Causing Community-Acquired Bacteremia in Calgary, Alberta

    OpenAIRE

    Gisele Peirano; Johann DD Pitout; Laupland, Kevin B; Bonnie Meatherall; Gregson, Daniel B.

    2013-01-01

    The characteristics of hypermucoviscosity isolates among Klebsiella pneumoniae causing community-acquired bacteremia were investigated. The hypermucoviscous phenotype was present in 8.2% of K pneumoniae isolates, and was associated with rmpA and the K2 serotype; liver abscesses were the most common clinical presentation. The present analysis represents the first population-based surveillance study of hypermucoviscosity among K pneumoniae causing bacteremia.

  20. Prognostic factors for early clinical failure in patients with severe community-acquired pneumonia

    NARCIS (Netherlands)

    Hoogewerf, M; Oosterheert, J J; Hak, E; Hoepelman, I M; Bonten, M J M

    2006-01-01

    For patients with community-acquired pneumonia (CAP), clinical response during the first days of treatment is predictive of clinical outcome. As risk assessments can improve the efficiency of pneumonia management, a prospective cohort study to assess clinical, biochemical and microbiological predict

  1. Oxidative metabolism of neutrophils in patients with community-acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Demidchik Lyudmila Andreevna

    2016-04-01

    Full Text Available At the present time, available views show our limited knowledge of the peculiarities of the functional status of neutrophils and their metabolism in patients with community-acquired pneumonia (CAP. The studying of changes of metabolic status of neutrophils can broaden our views about pneumonia pathogenesis and define datum points of therapeutic effect.

  2. Comparative radiographic features of community acquired Legionnaires' disease, pneumococcal pneumonia, mycoplasma pneumonia, and psittacosis.

    OpenAIRE

    Macfarlane, J T; Miller, A. C.; Roderick Smith, W H; Morris, A. H.; Rose, D. H.

    1984-01-01

    The features of the chest radiographs of 49 adults with legionnaires' disease were compared with those of 91 adults with pneumococcal pneumonia (31 of whom had bacteraemia or antigenaemia), 46 with mycoplasma pneumonia, and 10 with psittacosis pneumonia. No distinctive pattern was seen for any group. Homogeneous shadowing was more frequent in legionnaires' disease (40/49 cases) (p less than 0.005), bacteraemic pneumococcal pneumonia (25/31) (p less than 0.01) and non-bacteraemic pneumococcal ...

  3. Significance of anaerobes and oral bacteria in community-acquired pneumonia.

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    Kei Yamasaki

    Full Text Available BACKGROUND: Molecular biological modalities with better detection rates have been applied to identify the bacteria causing infectious diseases. Approximately 10-48% of bacterial pathogens causing community-acquired pneumonia are not identified using conventional cultivation methods. This study evaluated the bacteriological causes of community-acquired pneumonia using a cultivation-independent clone library analysis of the 16S ribosomal RNA gene of bronchoalveolar lavage specimens, and compared the results with those of conventional cultivation methods. METHODS: Patients with community-acquired pneumonia were enrolled based on their clinical and radiological findings. Bronchoalveolar lavage specimens were collected from pulmonary pathological lesions using bronchoscopy and evaluated by both a culture-independent molecular method and conventional cultivation methods. For the culture-independent molecular method, approximately 600 base pairs of 16S ribosomal RNA genes were amplified using polymerase chain reaction with universal primers, followed by the construction of clone libraries. The nucleotide sequences of 96 clones randomly chosen for each specimen were determined, and bacterial homology was searched. Conventional cultivation methods, including anaerobic cultures, were also performed using the same specimens. RESULTS: In addition to known common pathogens of community-acquired pneumonia [Streptococcus pneumoniae (18.8%, Haemophilus influenzae (18.8%, Mycoplasma pneumoniae (17.2%], molecular analysis of specimens from 64 patients with community-acquired pneumonia showed relatively higher rates of anaerobes (15.6% and oral bacteria (15.6% than previous reports. CONCLUSION: Our findings suggest that anaerobes and oral bacteria are more frequently detected in patients with community-acquired pneumonia than previously believed. It is possible that these bacteria may play more important roles in community-acquired pneumonia.

  4. Efficacy of Corticosteroids in Community-acquired Pneumonia A Randomized Double-Blinded Clinical Trial

    NARCIS (Netherlands)

    Snijders, Dominic; Daniels, Johannes M. A.; de Graaff, Casper S.; van der Werf, Tjip S.; Boersma, Wim G.

    2010-01-01

    Rationale: Some studies have shown a beneficial effect of corticosteroids in patients with community-acquired pneumonia (CAP), possibly by diminishing local and systemic antiinflammatory host response. Objectives: To assess the efficacy of adjunctive prednisolone treatment in patients hospitalized w

  5. Hospital-acquired pneumonia in intensive care patients

    OpenAIRE

    Hyllienmark, Petra

    2013-01-01

    The present thesis describes the incidence and risk factors for pneumonia and especially ventilator-associated pneumonia (VAP) among Intensive Care Unit (ICU) patients. Bacteria in samples from the lower respiratory tract of patients receiving mechanical ventilation are reported, including the duration of treatment prior to the first occurrence of different pathogens. The frequency of VAP using Swedish criteria (Swedish Intensive Registry, SIR) was compared with the VAP rate me...

  6. Clinical effects and bronchoalveolar transfer of levofloxacin in patients with community-acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    林耀广; 苏薇; 徐作军; 白彦

    2001-01-01

    @@To evaluate the clinical effects and bronchoalveolar transfer of levofloxacin (LVFX) in patients with community-acquired pneumonia. Twenty-eight outpatients with community-acquired pneumonia (CAP) were observed in an open-label, noncomparative study. The concentrations of levofloxacin in serum and bronchoalveolar lavage fluid (BALF) were measured  by  high-performance  liquid  chromatography (HPLC) with fluorescence detection in 10 patients and 15 non-levofloxacin users.

  7. Non-Intensive Care Unit Acquired Pneumonia: A New Clinical Entity?

    Science.gov (United States)

    Di Pasquale, Marta; Aliberti, Stefano; Mantero, Marco; Bianchini, Sonia; Blasi, Francesco

    2016-01-01

    Hospital-acquired pneumonia (HAP) is a frequent cause of nosocomial infections, responsible for great morbidity and mortality worldwide. The majority of studies on HAP have been conducted in patients hospitalized in the intensive care unit (ICU), as mechanical ventilation represents a major risk factor for nosocomial pneumonia and specifically for ventilator-associated pneumonia. However, epidemiological data seem to be different between patients acquiring HAP in the ICU vs. general wards, suggesting the importance of identifying non ICU-acquired pneumonia (NIAP) as a clinical distinct entity in terms of both etiology and management. Early detection of NIAP, along with an individualized management, is needed to reduce antibiotic use and side effects, bacterial resistance and mortality. The present article reviews the pathophysiology, diagnosis, treatment and prevention of NIAP. PMID:26927074

  8. Non-Intensive Care Unit Acquired Pneumonia: A New Clinical Entity?

    Directory of Open Access Journals (Sweden)

    Marta Di Pasquale

    2016-02-01

    Full Text Available Hospital-acquired pneumonia (HAP is a frequent cause of nosocomial infections, responsible for great morbidity and mortality worldwide. The majority of studies on HAP have been conducted in patients hospitalized in the intensive care unit (ICU, as mechanical ventilation represents a major risk factor for nosocomial pneumonia and specifically for ventilator-associated pneumonia. However, epidemiological data seem to be different between patients acquiring HAP in the ICU vs. general wards, suggesting the importance of identifying non ICU-acquired pneumonia (NIAP as a clinical distinct entity in terms of both etiology and management. Early detection of NIAP, along with an individualized management, is needed to reduce antibiotic use and side effects, bacterial resistance and mortality. The present article reviews the pathophysiology, diagnosis, treatment and prevention of NIAP.

  9. Are pathogenic leptospira species agents of community-acquired pneumonia? case reports of leptospirosis presenting as pneumonia

    NARCIS (Netherlands)

    M.H. Gasem; H. Farida (Helmia); A. Ahmed (Ahmed); J.A. Severin (Julitte A.); A. Suryanto (Agus); B. Isbandrio; H.A. Verbrugh (Henri); R.A. Hartskeerl (Rudy); P.J. Van Den Broek (Peterhans J.)

    2016-01-01

    textabstractWe report four Indonesian cases meeting the clinical and radiological criteria for community-acquired pneumonia and other findings suggestive of leptospirosis. Quantitative PCR (qPCR) analyses of serum and urine samples and serology confirmed the diagnosis of leptospirosis in each. Resul

  10. Lipoid pneumonia presenting as non resolving community acquired pneumonia: a case report

    OpenAIRE

    Hadda, Vijay; Gopi C Khilnani; Ashu S Bhalla; Mathur, Sandeep

    2009-01-01

    Introduction Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat containing substances like, petroleum jelly, mineral oils, few laxatives etc. It usually presents as insidious onset chronic respiratory illness simulating interstitial lung diseases. Rarely, it may present as an acute respiratory illness, specially, when exposure to fatty substance is acute and/or massive. Radiologically, it may mimic carcinoma, acute or chronic pneumonia, ARDS, or a localized...

  11. TREATMENT OUTCOME PROFILE OF NON RESOLVING PNEUMONIA AMONG HOSPITALIZED COMMUNITY ACQUIRED PNEUMONIA PATIENTS IN TERTIARY CARE CENTRE: AN OBSERVATIONAL STUDY

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    Raveendra

    2014-07-01

    Full Text Available : BACKGROUND: Most of the times, a Community Acquired Pneumonia (CAP patient is being treated with empirical antibiotics by best guess method by the clinician. Patient who did not show expected clinical improvement or resolution on chest x- ray after 2 weeks of antibiotics is considered as unresolved or non-resolving pneumonia and is a major problem, contributing to increased mortality and morbidity in the medical wards. AIM OF STUDY: 1.Tostudy the clinical profile of unresolved pneumonia among CAP. 2. To know the treatment outcome in these cases. MATERIALS & METHODS: 80 hospitalized CAP patients who did not improve either clinically or radiologically after 2 weeks of broad spectrum antibiotics were included in the study. Details of these patients including investigations done at other higher centers were recorded and patients were followed up for 6 months or till death. RESULTS: Unresolved pneumonia was commonly observed in patients more than 50 years. Pulmonary tuberculosis was the commonest cause, followed by MDR varieties of CAP, Bronchogenic carcinoma. Multiple risk factors were noted, which includes cigarette smoking, alcohol, COPD, Diabetes, HIV positive status. Elderly age, multiple risk factors, antibiotic abuse and resistance resulted in majority of the cases. CONCLUSION: This study highlights the importance of early recognition and appropriate treatment of CAP to prevent unresolved pneumonia and use of invasive and latest investigations to recognize unresolved pneumonia, to decrease mortality and morbidity.

  12. Etiology of community-acquired pneumonia in hospitalized patients in Jordan

    International Nuclear Information System (INIS)

    To ascertain the causative organisms of community acquired pneumonia (Cap) in Jordanian patients requiring hospital admission. A prospective study of both adults and children admitted to Princess Basma and Princess Rahma Teaching Hospitals in Irbid, Jordan with a diagnosis of CAP over a 6-month period from April to October 2002. A total of 35 adult patients were admitted with a mean age of 47 years, and 63 children with a mean age of 3 years. A pathogen was isolated from 25 (71%) adults, and from 17 (27%) children, and sputum cultures gave the best diagnostic yield. In adults Streptococcus pneumoniae was the most common isolate (26%), followed by Chlamydia pneumoniae (23%), Haemophilus influenzae (17%), Mycoplasma pneumoniae (9%), and Legionella pneumophila and Klebsiella pneumoniae (6%) each. Seven of the 9 gram negative isolates were from patients with some co morbid illness. While in children, Chlamydia pneumoniae was the most common (14%), followed by Mycoplasma pneumoniae (6%), and Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa (3%) each. Streptococcus pneumoniae and atypical microorganisms are the most common cause of CAP in previously healthy adults; while in those with associated co morbid illness, gram negative organisms are the likely cause. In children, the overall detection rate of causative organisms was low with atypical microorganisms being the most common. (author)

  13. Older Adults: A Proposal for the Management of Community-acquired Pneumonia

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    Miguel Ángel Serra Valdés

    2016-04-01

    Full Text Available Background: community-acquired pneumonia is the leading cause of hospitalization among older adults. It has a high fatality rate. At present, there are several risk and prognosis scores and different clinical practice guidelines available. Objective: to develop a proposal for the management of community-acquired pneumonia in older adults, applicable in both primary care, and the hospital setting. Methods: a search on community-acquired pneumonia, especially in older adults or the elderly, was conducted using index terms and existing guidelines from different countries, companies and regional consensus included in Clinical Evidence, The Cochrane Library, PubMed, Google Scholar, MEDLINE, LIS, Scielo, Medscape, LILACS, Latindex, HINARI, MEDIGRAPHIC-NEWS and others. The publications providing high-quality evidence in accordance with the criteria of the Grading of Recommendations, Assessment, Development and Evaluations approach were selected. Results: a proposal for practical management of community-acquired pneumonia at any level of care in our health system was developed considering the list of medications currently available in the country. Epidemiology, risk factors, risk stratification, treatment, and fatality rate were considered. Conclusions: community-acquired pneumonia is a current problem and future challenge. This proposal can be used by professionals treating this condition at any level of care. Its application could improve care and quality of life and reduce the fatality rate and costs.

  14. Community-acquired pneumonia: economics of inpatient medical care vis-à-vis clinical severity,

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    Vojislav Cupurdija

    2015-02-01

    Full Text Available Objective: To assess the direct and indirect costs of diagnosing and treating community-acquired pneumonia (CAP, correlating those costs with CAP severity at diagnosis and identifying the major cost drivers. Methods: This was a prospective cost analysis study using bottom-up costing. Clinical severity and mortality risk were assessed with the pneumonia severity index (PSI and the mental Confusion-Urea-Respiratory rate-Blood pressure-age ≥ 65 years (CURB-65 scale, respectively. The sample comprised 95 inpatients hospitalized for newly diagnosed CAP. The analysis was run from a societal perspective with a time horizon of one year. Results: Expressed as mean ± standard deviation, in Euros, the direct and indirect medical costs per CAP patient were 696 ± 531 and 410 ± 283, respectively, the total per-patient cost therefore being 1,106 ± 657. The combined budget impact of our patient cohort, in Euros, was 105,087 (66,109 and 38,979 in direct and indirect costs, respectively. The major cost drivers, in descending order, were the opportunity cost (lost productivity; diagnosis and treatment of comorbidities; and administration of medications, oxygen, and blood derivatives. The CURB-65 and PSI scores both correlated with the indirect costs of CAP treatment. The PSI score correlated positively with the overall frequency of use of health care services. Neither score showed any clear relationship with the direct costs of CAP treatment. Conclusions: Clinical severity at admission appears to be unrelated to the costs of CAP treatment. This is mostly attributable to unwarranted hospital admission (or unnecessarily long hospital stays in cases of mild pneumonia, as well as to over-prescription of antibiotics. Authorities should strive to improve adherence to guidelines and promote cost-effective prescribing practices among physicians in southeastern Europe.

  15. Severe pneumococcal pneumonia: impact of new quinolones on prognosis

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    Meybeck Agnes

    2011-03-01

    Full Text Available Abstract Background Most guidelines have been proposing, for more than 15 years, a β-lactam combined with either a quinolone or a macrolide as empirical, first-line therapy of severe community acquired pneumonia (CAP requiring ICU admission. Our goal was to evaluate the outcome of patients with severe CAP, focusing on the impact of new rather than old fluoroquinolones combined with β-lactam in the empirical antimicrobial treatments. Methods Retrospective study of consecutive patients admitted in a 16-bed general intensive care unit (ICU, between January 1996 and January 2009, for severe (Pneumonia Severity Index > or = 4 community-acquired pneumonia due to non penicillin-resistant Streptococcus pneumoniae and treated with a β-lactam combined with a fluoroquinolone. Results We included 70 patients of whom 38 received a β-lactam combined with ofloxacin or ciprofloxacin and 32 combined with levofloxacin. Twenty six patients (37.1% died in the ICU. Three independent factors associated with decreased survival in ICU were identified: septic shock on ICU admission (AOR = 10.6; 95% CI 2.87-39.3; p = 0.0004, age > 70 yrs. (AOR = 4.88; 95% CI 1.41-16.9; p = 0.01 and initial treatment with a β-lactam combined with ofloxacin or ciprofloxacin (AOR = 4.1; 95% CI 1.13-15.13; p = 0.03. Conclusion Our results suggest that, when combined to a β-lactam, levofloxacin is associated with lower mortality than ofloxacin or ciprofloxacin in severe pneumococcal community-acquired pneumonia.

  16. Streptoccocus pyogenes: a forgotten cause of severe community-acquired pneumonia.

    Science.gov (United States)

    Birch, C; Gowardman, J

    2000-02-01

    We report a case of severe community-acquired pneumonia caused by Streptococcus pyogenes (Lancefield Group A streptoccocus) that was complicated by a streptococcal toxic shock syndrome. Although this micro-organism is an uncommon cause of community-acquired pneumonia, previously well individuals may be infected and the clinical course may be fulminant. A household contact was the likely point of infection. Invasive group A streptococcal disease continues to remain an important cause of morbidity and mortality in the community and therefore will continue to be encountered by intensive care physicians. Treatment of Group A streptococcal infection remains penicillin; however, clindamycin should be added in severe infection. PMID:10701045

  17. Penicillin as empirical therapy for patients hospitalised with community acquired pneumonia at a Danish hospital

    DEFF Research Database (Denmark)

    Kirk, O; Glenthøj, Jonathan Peter; Dragsted, Ulrik Bak;

    2001-01-01

    INTRODUCTION: We report on the outcome of a study of patients hospitalised with community acquired pneumonia (HCAP) at a Danish university hospital. METHODOLOGY: In a retrospective study of 243 consecutive patients with radiographically verified HCAP, data on clinical and laboratory findings.......3%, respectively, p = 0.94, and the readmission rate 20.3%, 24.0%, and 14.8%, respectively; p = 0.63. CONCLUSION: Patients treated for community-acquired pneumonia at a Danish university hospital had clinical outcomes fully at height with findings from other countries, and half of the patients were successfully...

  18. Molecular detection of Mycoplasma pneumoniae by quantitative real-time PCR in patients with community acquired pneumonia

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    Rama Chaudhry

    2013-01-01

    Full Text Available Background & objectives: Mycoplasma pneumoniae is the most important and common cause of community-acquired pneumonia (CAP. The conventional detection methods (culture and serology lack sensitivity. PCR offers a better approach for rapid detection but is prone to carry over contamination during manipulation of amplification products. Quantitative real-time PCR (qRT-PCR method offers an attractive alternative detection method. In the present study, qRT-PCR, PCR and serology methods were used to detect M. pneumoniae infection in cases of pneumonias and findings compared. Methods: A total of 134 samples consisting of blood (for serology and respiratory secretions (for PCR and qRT-PCR from 134 patients were collected. The blood samples were tested for IgG, IgM and IgA using commercially available kits. For standardization of PCR of M. pneumoniae P1 gene was cloned in pGEMTEasy vector. Specific primers and reporter sequence were designed and procured for this fragment. The qRT-PCR assay was performed to prepare the standard curve for M. pneumoniae positive control DNA template and detection in patient samples. Results: Of the 134 patients, 26 (19% were positive for antibodies against M. pneumoniae. IgG was positive in 14.92 per cent (20 cases, IgM in 4.47 per cent (6 and IgA was positive in 5.22 per cent (7 cases. In the qRT-PCR assay 19 per cent (26 samples were positive. Of the 26 qRT-PCR positive samples, nine could be detected by serology. PCR was positive for 25 samples. An extra sample negative by PCR was detected by qRT-PCR. Thus, real-time PCR assay, PCR and serology in combination could detect M. pneumoniae infection in 43 patients. Interpretation & conclusions: The study shows that 17 patients were detected by serology alone, 17 were detected by qRT-PCR only and nine patients were positive by both serology and real-time PCR. Of the 134 samples tested, 25 were positive by conventional PCR, but qRT-PCR could detect one more sample that was

  19. The Seropositivity Rate of Atypical Agents in Patients with Community-Acquired Pneumonia

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    Ruhan Karakoc Gunes

    2007-08-01

    Full Text Available The aim of this study was to investigate the IgM antibody positivities of atypical pneumonia agents in patients with community-acquired pneumonia (CAP, and to compare the results with controls. The serum samples which were collected from 87 adult patients and 21 healthy controls have been investigated by a commercial ELISA (Pneumobact ELISA IgM, Vircell, Spain in which four different atypical pneumonia agents were fixed onto a slide. In the patients group, IgM positivity rates for the agents were as follows, respectively; 2.3% for Legionella pneumophila, 56.3% Chlamydia pneumoniae, 33.3% for Mycoplasma pneumoniae, 9.2% for Coxiella burnetii. The rates of IgM positivities in the control group varied 7% for all of the agents except M. Pneumoniae and C. Pneumoniae and 2 of these controls were positive for L. Pneumophila IgM, one was positive for C. Burnetii IgM. According to the statistical evaluation, there were significant differences for IgM seropositivities to Mycoplasma pneumoniae and Chlamydia Pneumoniae,between the patient and the control groups (p0.05. We showed that the seropositivity rate of atypical agents in patients with CAP was significantly higher when compared to healthy control group. This result suggests us, atypical agents might be responsible in CAP patients in a great amount. Furthermore, our study also suggests that clinical and radiological findings are not useful for discriminating atypical from typical pneumonia. [TAF Prev Med Bull 2007; 6(4.000: 279-284

  20. Community-Acquired Pneumonia: a Comparison between elderly and nonelderly patients

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    S. Jafari

    2006-08-01

    Full Text Available Background: Community-acquired pneumonia could be a life-threatening condition especially in elderly patients. The factors influencing the outcome in elderly patients are thought to be different from those in young adults. We compared the clinical and paraclinical profiles in elderly and nonelderly patients with community-acquired pneumonias. Methods: In this cross-sectional study, seventy nine patients who were hospitalized with community acquired pneumonia over a period of one year were included. Patients' medical records were reviewed; and data related to comorbid conditions, signs and symptoms, laboratory and radiographic findings were gathered using a checklist. Results: The clinical features, laboratory parameters and complications from pneumonia were almost similar in 41 elderly (group I, age ≥65years and 38 young (group II, age<65years subjects. Delirium was seen more in elderly group (p=0.05. The average body temperature and pulse rate were significantly higher in nonelderly group. Sixty one percent of elderly patients and 21% of young patients have Po2 less than 60 (p=0.02. Smoking (29.1%, neurological disturbances (19%, congestive heart failure (15.2%, chronic obstructive pulmonary disease and diabetes mellitus (13.9% were associated comorbidities in both groups. In non elderly group, immune compromise and IV drug use were more common as underlying comorbid conditions. Two of three mortalities were due to elder patients. Conclusion: Community acquired pneumonia could have more serious clinical and abnormal laboratory features in the elderly than younger patients. Mortality rate may be higher in older patients. Comorbid conditions are frequently seen in both elderly and nonelderly patients with community acquired pneumonia, but IV drug use and immune compromise are more frequent in nonelderly patients.

  1. Chest radiographic characteristics of community-acquired Legionella pneumonia in the elderly

    Institute of Scientific and Technical Information of China (English)

    Zhang Zhigang; Liu Xinmin; Chen Luzeng; Qiu Jianxing

    2014-01-01

    Background Legionella is an important community-acquired pneumonia pathogen.Although the elderly are especially susceptible to Legionella,few studies have looked at comparative radiographic features of Legionella pneumonia in this population.The aim of this study was to explore the chest radiographic characteristics of community-acquired Legionella pneumonia in the elderly.Methods Serial chest radiographs obtained in 34 patients hospitalized with serologically proven Legionella pneumonia were retrospectively reviewed.Chest x-ray features of an aged group of ≥65 years were assessed and compared with a non-aged group of <65 years old with regard to initial patterns and distributions of pulmonary abnormalities,accompanying signs,and progression.Results The most common initial presentation was a patchy alveolar infiltrate involving a single lobe,most often the lower lobe.There was no middle or lingular lobe involvement in the aged group patients,but bilateral pleural effusion was significantly more common in this group.In the aged group patients,radiographic progression following adequate therapy,despite a clinical response,was more often noted and the radiographs were less likely to have returned to the premorbid state at discharge,but the differences were not significant between the two groups.Conclusion The discrepancy between imaging findings and clinical symptoms seems more prominent in community-acquired Legionella pneumonia in the elderly.

  2. Analysis of factors that contribute to treatment failure in patients with community-acquired pneumonia.

    Science.gov (United States)

    Genné, D; Sommer, R; Kaiser, L; Saaïdia, A; Pasche, A; Unger, P F; Lew, D

    2006-03-01

    To determine the causes of treatment failure and to evaluate the prognostic factors in patients hospitalized for community-acquired pneumonia, a prospective, observational study of 228 adult patients hospitalized for a community-acquired pneumonia in the University Hospital of Geneva and the La Chaux-de-Fonds Community Hospital, Switzerland, was conducted. The percentage of patients who failed to improve (as defined by guidelines of the Infectious Disease Society of America) and the causes of treatment failure were assessed, and patients who failed to improve under antimicrobial therapy were compared with those who did improve. In the 54 (24%) patients who failed to improve, a mean increase in length of hospitalization of 4 days was observed. Most causes of treatment failure could be attributed to host factors (61%) rather than to the pathogen (16%) or to an inappropriate antibiotic regimen (3%). After adjusting for potentially confounding variables, concomitant neoplasia (OR 3.25; 95%CI 1.11-9.56), neurological disease (OR 2.34; 95%CI 1.07-5.13), and aspiration pneumonia (OR 2.97; 95%CI 29-6.86]) were associated with failure to improve, whereas monocytosis improved prognosis (OR 0.40; 95%CI 0.20-0.80). Almost one out of four patients hospitalized for community-acquired pneumonia failed to respond to empirical antibiotic treatment. Aspiration pneumonia, concomitant neoplasia, and neurological disease were factors positively associated with failure to improve, whereas monocytosis was linked to a better prognosis. PMID:16528540

  3. Use of proton pump inhibitors and the risk of community-acquired pneumonia

    DEFF Research Database (Denmark)

    Gulmez, Sinem Ezgi; Holm, Anette; Frederiksen, Henrik;

    2007-01-01

    BACKGROUND: Recently, the use of proton pump inhibitors (PPIs) has been associated with an increased risk of pneumonia. We aimed to confirm this association and to identify the risk factors. METHODS: We conducted a population-based case-control study using data from the County of Funen, Denmark....... Cases (n=7642) were defined as all patients with a first-discharge diagnosis of community-acquired pneumonia from a hospital during 2000 through 2004. We also selected 34 176 control subjects, who were frequency matched to the cases by age and sex. Data on the use of PPIs and other drugs......, on microbiological samples, on x-ray examination findings, and on comorbid conditions were extracted from local registries. Confounders were controlled by logistic regression. RESULTS: The adjusted odds ratio (OR) associating current use of PPIs with community-acquired pneumonia was 1.5 (95% confidence interval [CI...

  4. Clinical profile of hospital acquired pneumonia in a tertiary care hospital, South India

    OpenAIRE

    Vasuki V.

    2016-01-01

    Background: Hospital acquired infections continue to be an important cause of morbidity and mortality among hospitalized patients. Hospital acquired pneumonia (HAP) results in a significant increase in the cost of care of hospitalized patients. Its development prolongs a patient's stay in the Intensive Care Unit (ICU). Accurate information concerning the clinical profile of HAP is lacking in South India. This study was conducted prospectively to evaluate the clinical profile of HAP in ICU pat...

  5. Clinical Predictors of Hospital-acquired Pneumonia Associated with Acute Ischemic

    Directory of Open Access Journals (Sweden)

    Alexis Suárez Quesada

    2015-06-01

    Full Text Available Background: hospital-acquired pneumonia is a constant challenge given the current microbiological spectrum, antimicrobial resistance together with its high mortality, morbidity and hospital costs. Objective: to identify the clinical predictors of pneumonia associated with acute ischemic stroke. Methods: a prospective cohort study was conducted in 201 patients diagnosed with acute ischemic stroke consecutively admitted to the stroke unit of the General Carlos Manuel de Céspedes Teaching Hospital during the first seven days after the onset, from January 2012 through December 2013. The independent predictors of hospital-acquired pneumonia were obtained using multivariable logistic regression. Results: fifty six point seven percent were male. The mean age was 64.17 ± 14.33 years. Cases of hospital-acquired pneumonia associated with stroke accounted for 19, 9 %. Subjects who developed pneumonia were older (68.55 ± 13.51 vs. 63.08 ± 14.36 years, had a lower score in the Glasgow Coma Scale (8.00 ± 2.60 vs. 14.00 ± 2.82, and an increased number of leukocytes at admission (10.888 ± 3.487 vs. 9.233 ± 2.539 × 109/L. The following independent factors were identified: Glasgow Coma Scale ≤ 11 (OR: 26.099; 95 % CI 7.164-85.075, history of chronic obstructive pulmonary disease (OR: 8.896; 95 % CI 1.203-65.779, dysphagia (OR: 7.652; 95 % CI 2.369- 24.720, history of heart failure (OR: 4.583; 95 % CI 1.240- 16.932 and dysarthria/severe motor aphasia (OR: 4.222; 95 % CI 1.374- 12.975. Conclusions: the resulting logistic regression model is valid for predicting post-stroke pneumonia based on data routinely acquired.

  6. Elderly patients with community-acquired pneumonia are not treated according to current guidelines

    DEFF Research Database (Denmark)

    Lindhardt Damsgaard, Tove; Klausen, Henrik Hedegaard; Christiansen, Christina;

    2013-01-01

    Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in elderly patients, and the most important cause of death in the developed world. Optimised treatment and care will benefit patients as well as the health economy. This study investigated in-hospital compliance...

  7. Surfactant protein D (SP-D) serum levels in patients with community-acquired pneumonia

    DEFF Research Database (Denmark)

    Leth-Larsen, Rikke; Nordenbaek, Claudia; Tornoe, Ida;

    2003-01-01

    blood samples from 61 patients hospitalized for community-acquired pneumonia of suspected bacterial origin. On the day of admission to the hospital the serum SP-D concentration was significantly lower than that in healthy subjects. On day 5, the SP-D concentration had increased on average three times...

  8. Study on epidemic characteristics and etiology of community acquired pneumonia in Guangzhou from 2009 to 2012

    Institute of Scientific and Technical Information of China (English)

    刘慧

    2014-01-01

    Objective To investigate the epidemic characteristics and pathogenic spectrum of community acquired pneumonia(CAP)in Guangzhou from 2009 to 2012.Method 14 major comprehensive hospitals were selected from 11 districts as sentinel hospitals for CAP cases surveillance,including 18 982 223 in total during the 4years.The

  9. Aetiology and resistance patterns of community-acquired pneumonia in León, Nicaragua

    NARCIS (Netherlands)

    Matute, A J; Brouwer, W P; Hak, E; Delgado, E; Alonso, E; Hoepelman, I M

    2006-01-01

    We conducted a prevalence study to gain greater insight into the aetiology, bacterial resistance and risk factors for community-acquired pneumonia (CAP) in the region of León, Nicaragua. During the period from July 2002 to January 2005, all consecutive patients with signs and symptoms suggestive of

  10. Etiology and antimicrobial resistance of community-acquired pneumonia in adult patients in China

    Institute of Scientific and Technical Information of China (English)

    TAO Li-li; DENG Wei-wu; HU Bi-jie; HE Li-xian; WEI Li; XIE Hong-mei; WANG Bao-qing; LI Hua-ying; CHEN Xue-hua; ZHOU Chun-mei

    2012-01-01

    Background Appropriate antimicrobial therapy of community-acquired pneumonia (CAP) is mainly based on the distribution of etiology and antimicrobial resistance of major pathogens.We performed a prospective observational study of adult with CAP in 36 hospitals in China.Methods Etiological pathogens were isolated in each of the centers,and all of the isolated pathogens were sent to Zhongshan Hospital for antimicrobial susceptibility tests using agar dilution.Results A total of 593 patients were enrolled in this study,and 242 strains of bacteria were isolated from 225 patients.Streptococcus pneumoniae (79/242,32.6%) was the most frequently isolated pathogen,followed by Haemophilus influenzae (55/242,22.7%) and Klebsiella pneumoniae (25/242,10.3%).Totally 527 patients underwent serological tests for atypical pathogens; Mycoplasma pneumoniae and Chlamydia pneumoniae infections were identified in 205 (38.9%)and 60 (11.4%) patients respectively.Legionella pneumophila infections were identified in 4.0% (13/324) of patients.The non-susceptibility rate of isolated Streptococcus pneumoniae to erythromycin and penicillin was 63.2% and 19.1%respectively.Six patients died from the disease,the 30-day mortality rate was 1.1% (6/533).Conclusions The top three bacteria responsible for CAP in Chinese adults were Streptococcus pneumonia,Haemophitus influenza and Klebsiella pneumonia.There was also a high prevalence of atypical pathogens and mixed pathogens.The resistance rates of the major isolated pathogens were relatively low except for the high prevalence of macrolide resistance in Streptococcus pneumoniae.

  11. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland.

    Science.gov (United States)

    Jokinen, C; Heiskanen, L; Juvonen, H; Kallinen, S; Karkola, K; Korppi, M; Kurki, S; Rönnberg, P R; Seppä, A; Soimakallio, S

    1993-05-01

    Between September 1, 1981, and August 31, 1982, all patients with suspected or confirmed pneumonia among the 46,979 inhabitants of four municipalities in the province of Kuopio, Finland, were reported to a pneumonia register by their attending physicians. In addition, two study pathologists reported all cases of pneumonia found at autopsy, and two permanent registers were checked for retrospective identification of patients. Chest radiographs were obtained from 97% of all patients. The final diagnosis was based on radiologic or autopsy criteria. A total 546 patients (323 males and 223 females) had community-acquired pneumonia; of these, 37% were less than 15 years of age, and 31% were 60 years of age or older. Nineteen percent of the patients had defined chronic conditions, and 42% were admitted to hospital. The case fatality rate was 4%. The overall incidence of community-acquired pneumonia per 1,000 inhabitants per year was 11.6 (13.9 in males, 9.4 in females). The age-specific incidence per 1,000 inhabitants per year was as follows: age or = 75 years, 34.2. PMID:8317455

  12. Clinical evaluation of the role of ceftaroline in the management of community acquired bacterial pneumonia

    Directory of Open Access Journals (Sweden)

    Maselli DJ

    2012-02-01

    Full Text Available Diego J Maselli1, Juan F Fernandez1, Christine Y Whong2, Kelly Echevarria1,3, Anoop M Nambiar1,3, Antonio Anzueto1,3, Marcos I Restrepo1,3,41University of Texas Health Science Center, San Antonio, Texas, 2Memorial Hermann – Texas Medical Center, Houston, TX, 3South Texas Veterans Health Care System Audie l Murphy Division, San Antonio, TX, 4Veterans Evidence Research Dissemination and Implementation Center (VERDICT, San Antonio, TX, USAAbstract: Ceftaroline fosamil (ceftaroline was recently approved for the treatment of community-acquired pneumonia (CAP and complicated skin infections. This newly developed cephalosporin possesses a broad spectrum of activity against gram-positive and gram-negative bacteria. Most importantly, ceftaroline demonstrates potent in vitro antimicrobial activity against multi-drug resistant Streptococcus pneumoniae and methicillin-resistant strains of Staphylococcus aureus. In two Phase III, double-blinded, randomized, prospective trials (FOCUS 1 and FOCUS 2, ceftaroline was shown to be non-inferior to ceftriaxone for the treatment of CAP in hospitalized patients. Ceftaroline exhibits low resistance rates and a safety profile similar to that of other cephalosporins. In this review, we will evaluate the pharmacological characteristics, safety, antimicrobial properties, and efficacy of ceftaroline and its applications in the treatment of CAP.Keywords: s. pneumoniae, s. aureus, cephalosporins, pneumonia, ceftaroline, community acquired pneumonia

  13. Quantitative Analysis of Lung Ultrasonography for the Detection of Community-Acquired Pneumonia: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Francesco Corradi

    2015-01-01

    Full Text Available Background and Objective. Chest X-ray is recommended for routine use in patients with suspected pneumonia, but its use in emergency settings is limited. In this study, the diagnostic performance of a new method for quantitative analysis of lung ultrasonography was compared with bedside chest X-ray and visual lung ultrasonography for detection of community-acquired pneumonia, using thoracic computed tomography as a gold standard. Methods. Thirty-two spontaneously breathing patients with suspected community-acquired pneumonia, undergoing computed tomography examination, were consecutively enrolled. Each hemithorax was evaluated for the presence or absence of abnormalities by chest X-ray and quantitative or visual ultrasonography. Results. Quantitative ultrasonography showed higher sensitivity (93%, specificity (95%, and diagnostic accuracy (94% than chest X-ray (64%, 80%, and 69%, resp., visual ultrasonography (68%, 95%, and 77%, resp., or their combination (77%, 75%, and 77%, resp.. Conclusions. Quantitative lung ultrasonography was considerably more accurate than either chest X-ray or visual ultrasonography in the diagnosis of community-acquired pneumonia and it may represent a useful first-line approach for confirmation of clinical diagnosis in emergency settings.

  14. Community-acquired Klebsiella pneumoniae liver abscess: an emerging infection in Ireland and Europe.

    LENUS (Irish Health Repository)

    Moore, R

    2013-02-05

    INTRODUCTION: Klebsiella pneumoniae has emerged as a predominant cause of community-acquired mono-microbial pyogenic liver abscess. This was first described in Taiwan and has been widely reported in Asia. This infectious entity has been described in Europe, with single case reports predominating. METHODS: We present three cases in one year from our institution in Ireland and review the European literature to date. RESULTS\\/CONCLUSION: Klebsiella pneumoniae invasive liver abscess syndrome is now emerging in Europe and notably is not restricted to individuals of Asian descent.

  15. Ultrasound Monitoring and Age Sonographic Characteristics of Community-Acquired Pneumonia in Children

    OpenAIRE

    Т.I. Dianova; D.V. Safonov

    2015-01-01

    The aim of the investigation was to study ultrasound semiotics of community-acquired pneumonias in children of different age, and its dynamics in the course of treatment. Materials and Methods. Pneumonia semiotics study and dynamic monitoring of the disease have been carried out on the basis of chest ultrasound of 154 children divided into 4 age groups: 14 infants (9.1%) from birth to 3 months; 60 children (39.0%) from 3 months to 3 years of age; 49 children (31.8%) from 4 to 7 years of a...

  16. Clinical utility of telavancin for treatment of hospital-acquired pneumonia: focus on non-ventilator-associated pneumonia

    Directory of Open Access Journals (Sweden)

    Rubinstein E

    2014-05-01

    Full Text Available Ethan Rubinstein,1 Martin E Stryjewski,2 Steven L Barriere31University of Manitoba, Winnipeg, MB, Canada; 2Department of Medicine, Section of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas (CEMIC, Buenos Aires, Argentina; 3Theravance, Inc., South San Francisco, CA, USA Background: Hospital-acquired pneumonia (HAP is the most common health care-associated infection contributing to death. Studies have indicated that there may be differences in the causative pathogens and outcomes of ventilator-associated pneumonia (VAP and non-ventilator-associated pneumonia (NV-HAP. However, with limited NV-HAP-specific data available, treatment is generally based on data from studies of VAP. The Phase 3 Assessment of Telavancin for Treatment of Hospital-Acquired Pneumonia (ATTAIN studies were two double-blind randomized controlled trials that demonstrated the non-inferiority of telavancin to vancomycin for treatment of Gram-positive HAP. We conducted a post hoc subgroup analysis of patients enrolled in the ATTAIN studies who had NV-HAP. Methods: Data from the two ATTAIN studies were pooled, and patients with NV-HAP were analyzed. The all-treated (AT population consisted of all randomized patients who received ≥1 dose of study medication, and the clinically evaluable (CE population consisted of AT patients who were protocol-adherent or who died on or after study day 3, where death was attributable to the HAP episode under study. The primary endpoint was clinical response (cure, failure, or indeterminate at the follow-up/test of cure visit, conducted 7–14 days after the end of therapy. Results: A total of 1,076 patients (71.6% of overall ATTAIN AT population had NV-HAP (533 and 543 patients in the telavancin and vancomycin treatment groups, respectively. Clinical cure rates in the CE population were similar for patients with NV-HAP treated with telavancin and vancomycin (83.1% [201/242] and 84.1% [233/277], respectively. In

  17. Bacteriological and clinical profile of Community acquired pneumonia in hospitalized patients

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    Shah Bashir

    2010-01-01

    Full Text Available The aim of our study was to obtain comprehensive insight into the bacteriological and clinical profile of community-acquired pneumonia requiring hospitalization. The patient population consisted of 100 patients admitted with the diagnosis of community-acquired pneumonia (CAP, as defined by British Thoracic society, from December 1998 to Dec 2000, at the Sher- i-Kashmir institute of Medical Sciences Soura, Srinagar, India. Gram negative organisms were the commonest cause (19/29, followed by gram positive (10/29. In 71 cases no etiological cause was obtained. Pseudomonas aeruginosa was the commonest pathogen (10/29, followed by Staphylococcus aureus (7/29, Escherichia coli (6/29, Klebsiella spp. (3/29, Streptococcus pyogenes (1/29, Streptococcus pneumoniae (1/29 and Acinetobacter spp. (1/29. Sputum was the most common etiological source of organism isolation (26 followed by blood (6, pleural fluid (3, and pus culture (1. Maximum number of patients presented with cough (99%, fever (95%, tachycardia (92%, pleuritic chest pain (75%, sputum production (65% and leucocytosis (43%. The commonest predisposing factors were smoking (65%, COPD (57%, structural lung disease (21%, diabetes mellitus (13%, and decreased level of consciousness following seizure (eight per cent and chronic alcoholism (one per cent. Fourteen patients, of whom, nine were males and five females, died. Staphylococcus aureus was the causative organism in four, Pseudomonas in two, Klebsiella in one, and no organism was isolated in seven cases. The factors predicting mortality at admission were - age over 62 years, history of COPD or smoking, hypotension, altered sensorium, respiratory failure, leucocytosis, and s0 taphylococcus pneumonia and undetermined etiology. The overall rate of identification of microbial etiology of community-acquired pneumonia was 29%, which is very low, and if serological tests for legionella, mycoplasma and viruses are performed the diagnostic yield would

  18. Acute myocardial infarction versus other cardiovascular events in community-acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Stefano Aliberti

    2015-09-01

    Full Text Available The aim of the present study was to define the prevalence, characteristics, risk factors and impact on clinical outcomes of acute myocardial infarction (AMI versus other cardiovascular events (CVEs in patients with community-acquired pneumonia (CAP. This was an international, multicentre, observational, prospective study of CAP patients hospitalised in eight hospitals in Italy and Switzerland. Three groups were identified: those without CVEs, those with AMI and those with other CVEs. Among 905 patients, 21 (2.3% patients experienced at least one AMI, while 107 (11.7% patients experienced at least one other CVE. Patients with CAP and either AMI or other CVEs showed a higher severity of the disease than patients with CAP alone. Female sex, liver disease and the presence of severe sepsis were independent predictors for the occurrence of AMI, while female sex, age >65 years, neurological disease and the presence of pleural effusion predicted other CVEs. In-hospital mortality was significantly higher among those who experienced AMI in comparison to those experiencing other CVEs (43% versus 21%, p=0.039. The presence of AMI showed an adjusted odds ratio for in-hospital mortality of 3.57 (p=0.012 and for other CVEs of 2.63 (p=0.002. These findings on AMI versus other CVEs as complications of CAP may be important when planning interventional studies on cardioprotective medications.

  19. [Two Cases of Rapidly Progressive Community-acquired Pneumonia Due to Pseudomonas aeruginosa].

    Science.gov (United States)

    Takakura, Akira; Katono, Ken; Harada, Shinya; Igawa, Satoshi; Katagiri, Masato; Yanase, Nobuo; Masuda, Noriyuki

    2015-01-01

    Pseudomonas aeruginosa is a significant causative bacterium in hospital-acquired pneumonia and nursing and healthcare-associated pneumonia, but it seems to be rare in community-acquired pneumonia (CAP). We report two cases of severe CAP due to P. aeruginosa. Case 1: A 52-year-old man was referred to our hospital for chest and back pain. He was being treated for diabetes mellitus and had a long history of smoking. Chest images showed consolidation in the right upper lobe. Soon after hospitalization, he developed sepsis shock and died seven hours later. Case 2: A 73-year-old man with a history of heavy smoking was referred to our hospital for right chest pain. Chest images showed right upper lobe pneumonia. Although wide-spectrum antimicrobial agents were administrated, he died ten hours after admission. In both cases, there was a rapid progression to death, despite administration of a broad spectrum of antibiotics and treatment for sepsis. In cases of CAP involving the right upper lobe, the possibility of bacteremia and rapid progress should be considered. PMID:26548298

  20. Management of severe community-acquired pneumonia in Brazil: a secondary analysis of an international survey

    OpenAIRE

    Rabello, Lígia; Conceição, Catarina; Ebecken, Katia; Lisboa, Thiago; Bozza, Fernando Augusto; Soares, Márcio; Póvoa, Pedro; Salluh, Jorge Ibrain Figueira

    2015-01-01

    Objective This study aimed to evaluate Brazilian physicians’ perceptions regarding the diagnosis, severity assessment, treatment and risk stratification of severe community-acquired pneumonia patients and to compare those perceptions to current guidelines. Methods We conducted a cross-sectional international anonymous survey among a convenience sample of critical care, pulmonary, emergency and internal medicine physicians from Brazil between October and December 2008. The electronic survey ev...

  1. Time to Intubation Is Associated with Outcome in Patients with Community-Acquired Pneumonia

    OpenAIRE

    Hraiech, Sami; Alingrin, Julie; Dizier, Stéphanie; Brunet, Julie; Forel, Jean-Marie; La Scola, Bernard; Roch, Antoine; Papazian, Laurent; Pauly, Vanessa

    2013-01-01

    Introduction It has been suggested that delayed intensive care unit (ICU) transfer is associated with increased mortality for patients with community-acquired pneumonia (CAP). However, ICU admission policies and patient epidemiology vary widely across the world depending on local hospital practices and organizational constraints. We hypothesized that the time from the onset of CAP symptoms to invasive mechanical ventilation could be a relevant prognostic factor. Methods One hundred patients w...

  2. Biomarkers in community-acquired pneumonia: A state-of-the-art review

    Directory of Open Access Journals (Sweden)

    Renato Seligman

    2012-11-01

    Full Text Available Community-acquired pneumonia (CAP exhibits mortality rates, between 20% and 50% in severe cases. Biomarkers are useful tools for searching for antibiotic therapy modifications and for CAP diagnosis, prognosis and follow-up treatment. This non-systematic state-of-the-art review presents the biological and clinical features of biomarkers in CAP patients, including procalcitonin, C-reactive protein, copeptin, pro-ANP (atrial natriuretic peptide, adrenomedullin, cortisol and D-dimers.

  3. Regulation of Naturally Acquired Mucosal Immunity to Streptococcus pneumoniae in Healthy Malawian Adults and Children

    OpenAIRE

    Sarah J Glennie; Banda, Dominic; Mulwafu, Wakisa; Nkhata, Rose; Neil A Williams; Heyderman, Robert S.

    2012-01-01

    Worldwide, invasive pneumococcal disease caused by Streptococcus pneumoniae is most common in young children. In adults, disease rates decline following intermittent colonization and the acquisition of naturally acquired immunity. We characterized mucosal and systemic pneumococcal-specific T-cell responses in African children and adults who contend with intense rates of colonization, up to 100% and 60% respectively. We find most Malawian children have high pneumococcal-specific T-cell respons...

  4. Clinical data analysis of 19 cases of community-acquired adenovirus pneumonia in immunocompetent adults.

    Science.gov (United States)

    Yu, Hong-Xia; Zhao, Mao-Mao; Pu, Zeng-Hui; Wang, Yun-Qiang; Liu, Yan

    2015-01-01

    The aim of this study was to investigate the characteristics of clinical manifestations, laboratory tests and imaging changes of community-acquired adenovirus pneumonia in immunocompetent adults. A retrospective study was performed on 19 adult community-acquired adenovirus pneumonia cases in Yantai, whereby the clinical data were collected and analyzed. Of 19 cases, 14 (73.68%) had fever and 17 (89.47%) had cough symptoms. Moreover, 14 cases (73.68%) had normal white blood cell counts, while 11 cases (57.89%) exhibited a reduction in lymphocyte proportion. Among the 19 cases, 17 cases exhibited lesions in a single lung, while 2 cases involved bilateral lungs. The lesions predominantly exhibited ground glass-like changes. The clinical manifestations of adult community-acquired adenovirus pneumonia patients with normal immune functions were mild, with such presenting symptoms as fever, cough, and sputum; most patients did not exhibit high levels of white blood cells or low lymphocyte counts, and the imaging features (ground glass-like effusion) were indicative of single-lung involvement.

  5. Clinical and Radiological Characteristics of Tuberculous Pneumonia: Comparison with Typical Pulmonary Tuberculosis and Community-Acquired Pneumonia

    International Nuclear Information System (INIS)

    To evaluate the clinical and radiological characteristics of tuberculous pneumonia (TBPn). We compared the clinical presentation, pneumonia severity index (PSI), and radiological findings of 51 TBPn patients with those of typical pulmonary tuberculosis (PulTB) and community-acquired pneumonia (CAP) patients. The mean age of patients with TBPn was higher than that of patients with CAP or PulTB (66.6 ± 15.8 vs. 53.1 ± 17.1, 54.9 ± 15.7) (p < 0.05). Diabetes mellitus was more common in patients with TB than in those with CAP (24.1% vs. 8.2%) (p < 0.05). The PSI scores for TBPn and CAP were similar (79.5 ± 31.1 vs. 71.8 ± 28.3, respectively) and were higher than that for PulTB (64 ± 26.8) (p < 0.05). The ratio of lower lobe involvement was higher in TBPn and CAP than in PulTB (49% and 75.5% vs. 22.4%, respectively). Cavity formation and centrilobular nodules were more common in TBPn than in CAP (13.7% vs. 6.1% and 74.5% vs. 22.4%, respectively) (p < 0.05). Although TBPn shows a similar clinical presentation to CAP, it is more common in elderly patients and more commonly involves lower lobe involvement with cavity formation and centrilobular nodules. Therefore, in cases in which there may be diagnostic uncertainty, appropriate diagnostic procedures following these findings are required to differentiate these diseases.

  6. Clinical and Radiological Characteristics of Tuberculous Pneumonia: Comparison with Typical Pulmonary Tuberculosis and Community-Acquired Pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Jun; Kim, You Eun; Cho, Yu Ji; Jeong, Yi Yeong; Park, Mi Jung; Jeon, Kyoung Nyeo; Kim, Ho Cheol; Lee, Jong Deog; Kim, Jang Rak; Hwang, Young Sil [College of Medicine, Gyeongsang National University, Jinju (Korea, Republic of)

    2013-01-15

    To evaluate the clinical and radiological characteristics of tuberculous pneumonia (TBPn). We compared the clinical presentation, pneumonia severity index (PSI), and radiological findings of 51 TBPn patients with those of typical pulmonary tuberculosis (PulTB) and community-acquired pneumonia (CAP) patients. The mean age of patients with TBPn was higher than that of patients with CAP or PulTB (66.6 {+-} 15.8 vs. 53.1 {+-} 17.1, 54.9 {+-} 15.7) (p < 0.05). Diabetes mellitus was more common in patients with TB than in those with CAP (24.1% vs. 8.2%) (p < 0.05). The PSI scores for TBPn and CAP were similar (79.5 {+-} 31.1 vs. 71.8 {+-} 28.3, respectively) and were higher than that for PulTB (64 {+-} 26.8) (p < 0.05). The ratio of lower lobe involvement was higher in TBPn and CAP than in PulTB (49% and 75.5% vs. 22.4%, respectively). Cavity formation and centrilobular nodules were more common in TBPn than in CAP (13.7% vs. 6.1% and 74.5% vs. 22.4%, respectively) (p < 0.05). Although TBPn shows a similar clinical presentation to CAP, it is more common in elderly patients and more commonly involves lower lobe involvement with cavity formation and centrilobular nodules. Therefore, in cases in which there may be diagnostic uncertainty, appropriate diagnostic procedures following these findings are required to differentiate these diseases.

  7. Analysis of the effectiveness of physical rehabilitation according spirographic indicators in community-acquired pneumonia during convalescence

    Directory of Open Access Journals (Sweden)

    Kalmykova Y.S.

    2014-05-01

    Full Text Available Purpose : to make a program of physical rehabilitation for convalescents after community-acquired pneumonia, promotes normalization of respiratory function. The objectives of the study was to evaluate the dynamics spirographic indicators during convalescence community-acquired pneumonia. Material: the study involved 28 women aged 19 to 24 years with a diagnosis of community-acquired pneumonia after convalescent. Results: the positive influence of physiotherapy based dance aerobics; morning hygienic gymnastics; therapeutic massage and physical therapy on indicators of lung volumes, ventilation and bronchial patency according spirographic research. Conclusion: in community-acquired pneumonia during the convalescence period recommended physical rehabilitation, which includes curative gymnastics based on dance aerobics, morning hygienic gymnastics, massage therapy, physiotherapy. It improves the functionality of the cardiorespiratory system, nonspecific immunity and overall physical performance level.

  8. Assessment of Treatment of Community Acquired Severe Pneumonia by Two Different Antibiotics

    Science.gov (United States)

    Bilal, Jalal Ali; Eldouch, Widad; Abdin, Ali

    2016-01-01

    Introduction Pneumonia is common presentation in the emergency room and is still a cause of morbidity and mortality. The rationale of this study was to test the trend of paediatricians to achieve rapid response facing severe pneumonia, the lack of agreed on plan for the management of community acquired pneumonia (CAP) and the few experiences regarding injectable form of β-lactam antimicrobial. Materials and Methods This is a prospective case control study, purposive randomized sampling, three patients were excluded since their information was incomplete, 132 patients were randomly divided into groups, one group named control group (penicillin according to the guidelines of WHO 2013), 33 patients; second group treated by β-lactam inhibitors (Augmentin IV) 50 patients; and third group treated by 3rd generation cephalosporin (ceftriaxone) 49 patients. The study was conducted at the main tertiary care and paediatrics teaching hospital in Khartoum capital of Sudan. The study was completed within the duration from 2010 to 2011. Results Both group showed more or less similar results regarding response, as well as the failure rate however, the Augmentin and ceftriaxone groups showed a little bit better survival than the control group. Conclusion Antibiotics decrease the mortality rate among the pneumonia patients provided that it is given early in the disease. PMID:27437318

  9. Clinical evaluation of the role of ceftaroline in the management of community acquired bacterial pneumonia

    Science.gov (United States)

    Maselli, Diego J; Fernandez, Juan F; Whong, Christine Y; Echevarria, Kelly; Nambiar, Anoop M; Anzueto, Antonio; Restrepo, Marcos I

    2012-01-01

    Ceftaroline fosamil (ceftaroline) was recently approved for the treatment of community- acquired pneumonia (CAP) and complicated skin infections. This newly developed cephalosporin possesses a broad spectrum of activity against gram-positive and gram-negative bacteria. Most importantly, ceftaroline demonstrates potent in vitro antimicrobial activity against multi-drug resistant Streptococcus pneumoniae and methicillin-resistant strains of Staphylococcus aureus. In two Phase III, double-blinded, randomized, prospective trials (FOCUS 1 and FOCUS 2), ceftaroline was shown to be non-inferior to ceftriaxone for the treatment of CAP in hospitalized patients. Ceftaroline exhibits low resistance rates and a safety profile similar to that of other cephalosporins. In this review, we will evaluate the pharmacological characteristics, safety, antimicrobial properties, and efficacy of ceftaroline and its applications in the treatment of CAP. PMID:22355258

  10. Hospital acquired pneumonia with high-risk bacteria is associated with increased pulmonary matrix metalloproteinase activity

    Directory of Open Access Journals (Sweden)

    Droemann Daniel

    2008-08-01

    Full Text Available Abstract Background Neutrophil products like matrix metalloproteinases (MMP, involved in bacterial defence mechanisms, possibly induce lung damage and are elevated locally during hospital- acquired pneumonia (HAP. In HAP the virulence of bacterial species is known to be different. The aim of this study was to investigate the influence of high-risk bacteria like S. aureus and pseudomonas species on pulmonary MMPconcentration in human pneumonia. Methods In 37 patients with HAP and 16 controls, MMP-8, MMP-9 and tissue inhibitors of MMP (TIMP were analysed by ELISA and MMP-9 activity using zymography in bronchoalveolar lavage (BAL. Results MMP-9 activity in mini-BAL was increased in HAP patients versus controls (149 ± 41 vs. 34 ± 11, p Conclusion Pulmonary MMP concentrations and MMP activity are elevated in patients with HAP. This effect is most pronounced in patients with high-risk bacteria. Artificial ventilation may play an additional role in protease activation.

  11. A review of the role of Haemophilus influenzae in community-acquired pneumonia

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    Mary PE Slack

    2015-06-01

    Full Text Available In an era when Haemophilus influenzae type b (Hib conjugate vaccine is widely used, the incidence of Hib as a cause of community-acquired pneumonia (CAP has dramatically declined. Non-typeable H. influenzae (NTHi strains and, occasionally, other encapsulated serotypes of H. influenzae are now the cause of the majority of invasive H. influenzae infections, including bacteraemic CAP. NTHi have long been recognised as an important cause of lower respiratory tract infection, including pneumonia, in adults, especially those with underlying diseases. The role of NTHi as a cause of non-bacteraemic CAP in children is less clear. In this review the evidence for the role of NTHi and capsulated strains of H. influenzae will be examined.

  12. Prevalence of Ventilator Acquired Pneumonia in Organophosphorus Poisoning Patients in Tertiary Care Hospital

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    Merry Raphael

    2015-11-01

    Full Text Available Background: Ventilator associated pneumonia (VAP is a major cause of poor outcome among patients in the intensive care units (ICU world-wide. OP poisoning patients are very susceptible to respiratory associated problems especially respiratory muscle paralysis. Such patients generally need ventilation support which has high chances of getting VAP. Objective: To find out the Prevalence, causative organisms and treatment pattern of VAP in OP poisoning patients in tertiary care hospital in South India. Methods: A retrospective study was conducted in a tertiary care teaching hospital of South India from 2008 to 2013, total of 500 patients were enrolled for the study and data was collected from the medical records in a suitable designed case record form. Information regarding demographical details, severity assessment, type of pneumonia acquired, causative organisms for VAP, complications, treatment and outcome measures of patients was recorded. Data was entered in SPSS 20.0 and analyzed for the results. Results and Conclusion: The mean age of the Patients admitted was 33.31 ± 14.5 years and majority of them were found to be males (69.4% and (30.6% were females. Among the study population, 54 (10.8% patients acquired VAP. The most common organisms found to have caused pneumonia were gram negative organisms such as Pseudomonas aeruginosa (1.2%, Klebsiella pneumoniae (1.0% and Acinobacter (0.6%. The most commonly used antibiotics in the treatment of VAP were beta-lactam antibiotics like Cephalosporins (56.1%, Penicillins (31.9%. Respiratory problems are common in OP poisoning patients and hence are very susceptible to VAP. Proper screening and identification of organisms in the early stage with appropriate antibiotics will help in better outcome.

  13. Imaging of community-acquired pneumonia: Roles of imaging examinations, imaging diagnosis of specific pathogens and discrimination from noninfectious diseases

    Institute of Scientific and Technical Information of China (English)

    Atsushi; Nambu; Katsura; Ozawa; Noriko; Kobayashi; Masao; Tago

    2014-01-01

    This article reviews roles of imaging examinations in the management of community-acquired pneumonia(CAP), imaging diagnosis of specific CAP and discrimination between CAP and noninfectious diseases. Chest radiography is usually enough to confirm the diagnosis of CAP, whereas computed tomography is required to suggest specific pathogens and to discriminate from noninfectious diseases. Mycoplasma pneumoniae pneumonia, tuberculosis, Pneumocystis jirovecii pneumonia and some cases of viral pneumonia sometimes show specific imaging findings. Peribronchial nodules, especially tree-in-bud appearance, are fairly specific for infection. Evidences of organization, such as concavity of the opacities, traction bronchiectasis, visualization of air bronchograms over the entire length of the bronchi, or mild parenchymal distortion are suggestive of organizing pneumonia. We will introduce tips to effectively make use of imaging examinations in the management of CAP.

  14. Differentiation of bacterial and non-bacterial community-acquired pneumonia by thin-section computed tomography

    International Nuclear Information System (INIS)

    Background and objective: The management of community-acquired pneumonia (CAP) depends, in part, on the identification of the causative agents. The objective of this study was to determine the potential of thin-section computed tomography (CT) in differentiating bacterial and non-bacterial pneumonia. Patients and methods: Thin-section CT studies were prospectively examined in hospitalized CAP patients within 2 days of admission, followed by retrospective assessment by two pulmonary radiologists. Thin-section CT findings on the pneumonias caused by each pathogen were examined, and two types of pneumonias were compared. Using multivariate logistic regression analyses, receiver operating characteristic (ROC) curves were produced. Results: Among 183 CAP episodes (181 patients, 125 men and 56 women, mean age ± S.D.: 61.1 ± 19.7) examined by thin-section CT, the etiologies of 125 were confirmed (94 bacterial pneumonia and 31 non-bacterial pneumonia). Centrilobular nodules were specific for non-bacterial pneumonia and airspace nodules were specific for bacterial pneumonia (specificities of 89% and 94%, respectively) when located in the outer lung areas. When centrilobular nodules were the principal finding, they were specific but lacked sensitivity for non-bacterial pneumonia (specificity 98% and sensitivity 23%). To distinguish the two types of pneumonias, centrilobular nodules, airspace nodules and lobular shadows were found to be important by multivariate analyses. ROC curve analysis discriminated bacterial pneumonia from non-bacterial pneumonia among patients without underlying lung diseases, yielding an optimal point with sensitivity and specificity of 86% and 79%, respectively, but was less effective when all patients were analyzed together (70% and 84%, respectively). Conclusion: Thin-section CT examination was applied for the differentiation of bacterial and non-bacterial pneumonias. Though showing some potential, this examination at the present time would not

  15. Alveolar-arterial oxygen gradient, pneumonia severity index and outcomes in patients hospitalized with community acquired pneumonia.

    Science.gov (United States)

    Moammar, Mahmoud Q; Azam, Hamad M; Blamoun, Adel I; Rashid, Ashraf O; Ismail, Medhat; Khan, M Anees; DeBari, Vincent A

    2008-09-01

    The alveolar-arterial oxygen gradient (DeltaA-a) provides a useful assessment of ventilation/perfusion (V/Q) abnormalities. The objectives of the present study were to: (i) examine the correlation between the DeltaA-a and the pneumonia severity index (PSI); and (ii) determine whether these measures were comparable in predicting clinical outcomes. The present study was conducted at a 750-bed teaching hospital. It examined a retrospective cohort of 255 patients with community acquired pneumonia (CAP) over a 2 year period. Association between the CAP and DeltaA-a was investigated by regression models and correlation, as well as two logistic models for subjects bifurcated by low-risk/moderate-to-high risk. The decision levels (DL) for both PSI and DeltaA-a were then compared as predictors of both length of stay (LOS) and survival. The correlation between PSI and DeltaA-a was strong (rho = 0.76; P relationship. Both logistic models indicated a strong association (P < 0.001) between DeltaA-a and PSI and yielded an optimal DL for the DeltaA-a of < 89 mmHg. Inter-test agreement of DeltaA-a with PSI was 76.9% (kappa = 0.60; 95% confidence interval 0.47-0.72; P < 0.0001). At < 89 mmHg, the odds ratios for LOS were similar to those at PSI = 90 in predicting LOS in the range 3-7 days, inclusive. There was no significant difference in the ability of DeltaA-a and PSI to predict survival for either the low- or high-risk group (P = 0.363 and P = 0.951, respectively). The DeltaA-a correlates well with PSI and performs comparably in predicting two major outcomes in subjects hospitalized with CAP. PMID:18518885

  16. Clinical predictors for Legionella in patients presenting with community-acquired pneumonia to the emergency department

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    Frei Reno

    2009-01-01

    Full Text Available Abstract Background Legionella species cause severe forms of pneumonia with high mortality and complication rates. Accurate clinical predictors to assess the likelihood of Legionella community-acquired pneumonia (CAP in patients presenting to the emergency department are lacking. Methods We retrospectively compared clinical and laboratory data of 82 consecutive patients with Legionella CAP with 368 consecutive patients with non-Legionella CAP included in two studies at the same institution. Results In multivariate logistic regression analysis we identified six parameters, namely high body temperature (OR 1.67, p Legionella CAP. Using optimal cut off values of these six parameters, we calculated a diagnostic score for Legionella CAP. The median score was significantly higher in Legionella CAP as compared to patients without Legionella (4 (IQR 3–4 vs 2 (IQR 1–2, p Legionella pneumonia. Conversely, of the 73 patients (16% with ≥4 points, 66% of patients had Legionella CAP. Conclusion Six clinical and laboratory parameters embedded in a simple diagnostic score accurately identified patients with Legionella CAP. If validated in future studies, this score might aid in the management of suspected Legionella CAP.

  17. Value of rapid aetiological diagnosis in optimization of antimicrobial treatment in bacterial community acquired pneumonia.

    Science.gov (United States)

    Mareković, Ivana; Plecko, Vanda; Boras, Zagorka; Pavlović, Ladislav; Budimir, Ana; Bosnjak, Zrinka; Puretić, Hrvoje; Zele-Starcević, Lidija; Kalenić, Smilja

    2012-06-01

    In 80 adult patients with community acquired pneumonia (CAP) conventional microbiological methods, polymerase chain reaction (PCR) and serum C-reactive protein (CRP) levels were performed and the appropriateness of the empirical antimicrobial treatment was evaluated according to bacterial pathogen detected. The aetiology was determined in 42 (52.5%) patients, with Streptococcus pneumoniae as the most common pathogen. PCR applied to bronchoalveolar lavage (BAL) provided 2 and PCR on sputum samples 1 additional aetiological diagnosis of CAP The mean CRP values in the S. pneumoniae group were not significantly higher than in the group with other aetiological diagnoses (166.89 mg/L vs. 160.11 mg/L, p = 0.457). In 23.8% (10/42) of patients with determined aetiology, the empirical antimicrobial treatment was inappropriate. PCR tests need further investigation, particularly those for the atypical pathogens, as they are predominant in inappropriately treated patients. Our results do not support the use of CRP as a rapid test to guide the antimicrobial treatment in patients with CAP. PMID:22856222

  18. Linezolid has unique immunomodulatory effects in post-influenza community acquired MRSA pneumonia.

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    Urvashi Bhan

    Full Text Available Post influenza pneumonia is a leading cause of mortality and morbidity, with mortality rates approaching 60% when bacterial infections are secondary to multi-drug resistant (MDR pathogens. Staphylococcus aureus, in particular community acquired MRSA (cMRSA, has emerged as a leading cause of post influenza pneumonia.Linezolid (LZD prevents acute lung injury in murine model of post influenza bacterial pneumonia.Mice were infected with HINI strain of influenza and then challenged with cMRSA at day 7, treated with antibiotics (LZD or Vanco or vehicle 6 hours post bacterial challenge and lungs and bronchoalveolar lavage fluid (BAL harvested at 24 hours for bacterial clearance, inflammatory cell influx, cytokine/chemokine analysis and assessment of lung injury.Mice treated with LZD or Vanco had lower bacterial burden in the lung and no systemic dissemination, as compared to the control (no antibiotic group at 24 hours post bacterial challenge. As compared to animals receiving Vanco, LZD group had significantly lower numbers of neutrophils in the BAL (9×10(3 vs. 2.3×10(4, p < 0.01, which was associated with reduced levels of chemotactic chemokines and inflammatory cytokines KC, MIP-2, IFN-γ, TNF-α and IL-1β in the BAL. Interestingly, LZD treatment also protected mice from lung injury, as assessed by albumin concentration in the BAL post treatment with H1N1 and cMRSA when compared to vanco treatment. Moreover, treatment with LZD was associated with significantly lower levels of PVL toxin in lungs.Linezolid has unique immunomodulatory effects on host inflammatory response and lung injury in a murine model of post-viral cMRSA pneumonia.

  19. Pneumonia adquirida na comunidade e derrame pleural parapneumônico relacionados a Mycoplasma pneumoniae em crianças e adolescentes Mycoplasma pneumoniae-related community-acquired pneumonia and parapneumonic pleural effusion in children and adolescents

    Directory of Open Access Journals (Sweden)

    Letícia Alves Vervloet

    2012-04-01

    Full Text Available OBJETIVO: Determinar a prevalência e as características da pneumonia adquirida na comunidade (PAC e derrames pleurais parapneumônicos (DPP relacionados a Mycoplasma pneumoniae em um grupo de crianças e adolescentes. MÉTODOS: Estudo observacional retrospectivo com 121 pacientes hospitalizados com PAC e DPP em um hospital de referência terciária, entre 2000 e 2008, divididos em seis grupos (G1 a G6 segundo o agente etiológico: M. pneumoniae com ou sem coinfecção, em 44 pacientes; outros agentes que não M. pneumoniae, em 77; M. pneumoniae sem coinfecção, em 34; Streptococcus pneumoniae, em 36; Staphylococcus aureus, em 31; e coinfecção M. pneumoniae/S. pneumoniae, em 9, respectivamente. RESULTADOS: Na comparação entre os grupos, G1 apresentou frequências maiores em gênero feminino, tosse seca, uso prévio de beta-lactâmicos e na duração dos sintomas até a admissão, assim como menor uso de assistência ventilatória e de drenagem torácica que G2, enquanto G3 teve maiores frequências em uso prévio de beta-lactâmicos e tosse seca, maior duração dos sintomas antes da admissão e menor frequência de uso de drenos torácicos que G4 e G5, ao passo que G3 teve média de idade maior e menor frequência de náuseas/vômitos que G4, assim como menor uso de assistência ventilatória que G5. A coinfecção M. pneumoniae/S. pneumoniae aumentou a duração dos sintomas até a admissão. CONCLUSÕES: Nesta amostra, a prevalência de PAC e DPP por M. pneumoniae foi de 12,75%. Embora a doença apresentasse quadros mais leves que aquela por outros organismos, a evolução foi mais prolongada. Nossos dados sugerem a necessidade de uma maior diligência na investigação de M. pneumoniae em crianças e adolescentes com PAC e DPP em nosso meio.OBJECTIVE: To determine the prevalence and the characteristics of Mycoplasma pneumoniae-related community-acquired pneumonia (CAP and parapneumonic pleural effusion (PPE in children and adolescents

  20. [Microbiologic spectrum and prognostic factors of hospital-acquired pneumonia cases].

    Science.gov (United States)

    Sevinç, Can; Sahbaz, Sibel; Uysal, Ulker; Kilinç, Oğuz; Ellidokuz, Hülya; Itil, Oya; Gülay, Zeynep; Yunusoğlu, Sedat; Sargun, Serdar; Akkoyun, Kürşat Kaan; Uçan, Eyüp Sabri

    2007-01-01

    Nosocomial infections are an important cause of preventable morbidity and mortality; they also result in significant socioeconomic cost. Nosocomial pneumonia (NCP) is defined as pneumonia, which occurs 48 hours after hospitalization or after discharge from the hospital. It is the second or third most frequent infection among all hospital acquired infections, and the mortality of NCP is higher than the other hospital acquired infections. Patients, diagnosed as NCP were retrospectively analyzed in order to detect microbiological agent and prognostic factors. We evaluated 173 patients, 67.0% of them were male and 33.0% female. Comorbid diseases were present in 94.2% and a medical procedure had been applied in 75.1% of cases. A single agent was isolated in 79.2% of the cases while a mixt infection was present in 13.3%. In 7.5% of the cases, cultures were negative. Endotracheal aspirates were the most common materials (38.9%) used for detected microorganism and sputum cultures were used in 16.8% of the cases. Most commonly encountered microorganism were Pseudomonas aeruginosa, Acinetobacter spp. and Staphylococcus aureus respectively. NCP developed on approximately 18th day of hospitalization. Overall mortality rate was 45.2%. The effects of diabetes mellitus and chronic pulmonary diseases on mortality rate were analized by logistic regression analysis and it's evaluated that the mortality rates increase 3.7 times with diabetes mellitus and 2.4 times with chronic pulmonary diseases. There was no effect of mechanical ventilation history on mortality.

  1. Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies.

    OpenAIRE

    Corrales-Medina, Vicente F; Suh, Kathryn N.; Gregory Rose; Chirinos, Julio A.; Steve Doucette; D. William Cameron; Dean A Fergusson

    2011-01-01

    Editors' Summary Background Community-acquired pneumonia (CAP), that is, pneumonia infections contracted outside of hospital or health care settings, is a common condition and can be fatal, particularly to older people. For example, every year, an estimated 5–6 million people contract this form of pneumonia in the US, leading to 1.1 million people being admitted to hospitals and causing 60,000 deaths—the most frequent cause of infectious disease-related mortality. In the US for example, more ...

  2. Racial variations in processes of care for patients with community-acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Whittle Jeff

    2004-08-01

    Full Text Available Abstract Background Patients hospitalized with community acquired pneumonia (CAP have a substantial risk of death, but there is evidence that adherence to certain processes of care, including antibiotic administration within 8 hours, can decrease this risk. Although national mortality data shows blacks have a substantially increased odds of death due to pneumonia as compared to whites previous studies of short-term mortality have found decreased mortality for blacks. Therefore we examined pneumonia-related processes of care and short-term mortality in a population of patients hospitalized with CAP. Methods We reviewed the records of all identified Medicare beneficiaries hospitalized for pneumonia between 10/1/1998 and 9/30/1999 at one of 101 Pennsylvania hospitals, and randomly selected 60 patients at each hospital for inclusion. We reviewed the medical records to gather process measures of quality, pneumonia severity and demographics. We used Medicare administrative data to identify 30-day mortality. Because only a small proportion of the study population was black, we included all 240 black patients and randomly selected 720 white patients matched on age and gender. We performed a resampling of the white patients 10 times. Results Males were 43% of the cohort, and the median age was 76 years. After controlling for potential confounders, blacks were less likely to receive antibiotics within 8 hours (odds ratio with 95% confidence interval 0.6, 0.4–0.97, but were as likely as whites to have blood cultures obtained prior to receiving antibiotics (0.7, 0.3–1.5, to have oxygenation assessed within 24 hours of presentation (1.6, 0.9–3.0, and to receive guideline concordant antibiotics (OR 0.9, 0.6–1.7. Black patients had a trend towards decreased 30-day mortality (0.4, 0.2 to 1.0. Conclusion Although blacks were less likely to receive optimal care, our findings are consistent with other studies that suggest better risk-adjusted survival

  3. Prescription of antibiotics in community-acquired pneumonia in children: are we following the recommendations?

    Science.gov (United States)

    da Fonseca Lima, Eduardo Jorge; Lima, Débora Ellen Pessoa; Serra, George Henrique Cordeiro; Abreu e Lima, Maria Anaide Zacche S; de Mello, Maria Júlia Gonçalves

    2016-01-01

    Objective To assess the adequacy of antibiotic prescription in children hospitalized for pneumonia in a reference pediatric hospital in Brazil. Methods This was a cross-sectional study involving children aged between 1 month and 5 years who were hospitalized between October 2010 and September 2013. The classification of community-acquired pneumonia (CAP) was based on the clinical and radiological criteria of the World Health Organization (WHO). The analysis of antibiotic adequacy was performed according to the main guidelines on CAP treatment, which include the WHO guidelines, Brazilian Society of Pediatrics guidelines, and international guidelines (Pediatrics Infectious Diseases Society, the Infectious Disease Society of America, British Thoracic Society, and Consenso de la Sociedad latinoamericana de Infectología). A multivariate analysis was performed including variables that have statistical significance of P≤0.25 in the bivariate analysis. Results The majority of the 452 hospitalized children were classified as having severe or very severe CAP (85.18%), and inadequate empiric antimicrobial therapy was started in 26.10% (118/452) of them. Ampicillin was the most used empiric antibiotic therapy (62.17%) for pneumonia, followed by a combination of ampicillin and associated with gentamicin. The initially proposed regimen was modified in 29.6% of the patients, and the most frequent change was the replacement of ampicillin by oxacillin combined with chloramphenicol. The median hospitalization time was 8.5 days, and the lethality rate was 1.55%. There was no statistical difference in adequacy in relation to the severity of pneumonia or degree of malnutrition. In the bivariate analysis, inadequacy of antibiotic therapy regimen was higher in patients undergoing oxygen therapy (P<0.05), which was given to 219 patients (48.45%). Pleural effusion was observed in 118 patients (26.11%) and was associated with higher prescription inadequacy, and it was the only factor

  4. Outcomes in elderly Danish citizens admitted with community-acquired pneumonia. Regional differences, in a public healthcare system

    DEFF Research Database (Denmark)

    Hedegaard Klausen, Henrik; Petersen, J; Lindhardt, T;

    2012-01-01

    OBJECTIVES: To evaluate regional differences in and risk factors for admission, length of stay, mortality, and readmission for community-acquired pneumonia in elderly Danish patients. METHODS: National registry study on elderly Danish citizens with an acute admission in 2009 owing to community......-acquired pneumonia. We studied differences among hospitals in length of stay, in-hospital mortality, mortality within 30 days of discharge, and readmission within 30 days after discharge using Cox regression models with adjustments for age, sex, ventilatory support, and co-morbidity by Charlson's index score....... RESULTS: A total of 11,332 elderly citizens were admitted with community-acquired pneumonia. Mortality during admission and 30-days from discharge were 11.6% and 16.2%, respectively. Readmission rates within 30 days of discharge were 12.3%. There were significantly differences between hospitals in length...

  5. Telavancin in the treatment of Staphylococcus aureus hospital-acquired and ventilator-associated pneumonia: clinical evidence and experience.

    Science.gov (United States)

    Liapikou, Adamantia; Dimakou, Katerina; Toumbis, Michael

    2016-08-01

    Telavancin (TLV) is a lipoglycopeptide derivative of vancomycin (VAN), which has activity against Gram-positive aerobic bacteria, and is especially effective against methicillin-resistant Staphylococcus aureus (MRSA) and Gram-positive bacteria resistant to VAN. Comparative clinical studies of TLV have demonstrated noninferiority compared with VAN in the treatment of hospital-acquired Gram-positive pneumonia, with high cure rates for TLV-treated patients with monomicrobial S. aureus infection, including isolates with reduced VAN susceptibility. The results based on the patients' clinical response were supported by supplemental post-hoc analyses of 28-day mortality. In Europe and the USA, TLV is approved as a useful alternative for patients with difficult-to-treat, hospital-acquired MRSA pneumonia when there are very few alternatives. The present article reviews TLV's pharmacological characteristics and clinical efficacy resulting from clinical trials giving a detailed picture of its properties and position in the management of hospital-acquired pneumonia. PMID:27340253

  6. Hospital acquired pneumonia is linked to right hemispheric peri-insular stroke.

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    André Kemmling

    Full Text Available PURPOSE: Hospital acquired pneumonia (HAP is a major complication of stroke. We sought to determine associations between infarction of specific brain regions and HAP. METHODS: 215 consecutive acute stroke patients with HAP (2003-2009 were carefully matched with 215 non-pneumonia controls by gender, then NIHSS, then age. Admission imaging and binary masks of infarction were registered to MNI-152 space. Regional atlas and voxel-based log-odds were calculated to assess the relationship between infarct location and the likelihood of HAP. An independently validated penalized conditional logistic regression model was used to identify HAP associated imaging regions. RESULTS: The HAP and control patients were well matched by gender (100%, age (95% within 5-years, NIHSS (98% within 1-point, infarct size, dysphagia, and six other clinical variables. Right hemispheric infarcts were more frequent in patients with HAP versus controls (43.3% vs. 34.0%, p = 0.054, whereas left hemispheric infarcts were more frequent in controls (56.7% vs. 44.7%, p = 0.012; there was no significant difference between groups in the rate of brainstem strokes (p = 1.0. Of the 10 most infarcted regions, only right insular cortex volume was different in HAP versus controls (20 vs. 12 ml, p = 0.02. In univariate analyses, the highest log-odds regions for pneumonia were right hemisphere, cerebellum, and brainstem. The best performing multivariate model selected 7 brain regions of infarction and 2 infarct volume-based variables independently associated with HAP. CONCLUSIONS: HAP is associated with right hemispheric peri-insular stroke. These associations may be related to autonomic modulation of immune mechanisms, supporting recent hypotheses of stroke mediated immune suppression.

  7. Respiratory failure in patients with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia.

    Science.gov (United States)

    Maxfield, R A; Sorkin, I B; Fazzini, E P; Rapoport, D M; Stenson, W M; Goldring, R M

    1986-05-01

    Seven patients with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia were studied to define the pathophysiology of their respiratory failure. The patients had fever, cough, dyspnea, hypoxemia, and diffuse infiltrates on chest x-ray. Biopsies revealed a spectrum of alveolar filling, interstitial edema and infiltration, and fibrosis. The patients were studied on mechanical ventilation to assess the effect of positive end-expiratory pressure (PEEP) and supplemental oxygen on shunt fraction. Mean anatomic shunt (measured on 100% oxygen) was 34 +/- 8%, which increased significantly (p less than .001) to 43 +/- 9% when the FIO2 was decreased to 40% to 60% (physiologic shunt), indicating ventilation/perfusion (V/Q) imbalance or impaired diffusion. Increasing PEEP by 9 +/- 2 cm H2O reduced the anatomic shunt to 30 +/- 7% (p less than .01) and the physiologic shunt to 37 +/- 7% (p less than .02). There was a similar decrease in anatomic and physiologic shunts in five studies, a greater decrease in physiologic shunt in four, and a greater decrease in anatomic shunt in two. Evidence of alveolar recruitment with PEEP, measured by an increase in static thoracic compliance, was found in only one study. There was no correlation between the effect of PEEP on compliance and its effect on shunt. The data suggest that in patients with AIDS and P. carinii pneumonia, PEEP can decrease shunt by reducing the anatomic shunt, improving V/Q imbalance, and converting areas of anatomic shunt to areas of low V/Q. P. carinii pneumonia in patients with AIDS can produce a clinical and pathophysiologic pattern similar to that described in the adult respiratory distress syndrome. PMID:3516574

  8. Hospital-acquired pneumonia after lung resection surgery is associated with characteristic cytokine gene expression.

    LENUS (Irish Health Repository)

    White, Mary

    2012-02-01

    BACKGROUND: Infection in humans has been linked with altered cytokine gene transcription. It is unclear whether this phenomenon is a consequence of an established disease process or precedes the infective process. The primary end point of this study was to determine whether hospital-acquired pneumonia (HAP) was associated with differential gene expression of interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, and IL-23p19. The secondary end point was to identify whether alteration in gene expression preceded the clinical onset of infection. METHODS: Sixty consecutive patients undergoing elective thoracic surgery were recruited. HAP was diagnosed as per National Nosocomial Infection Surveillance guidelines. Messenger RNA (mRNA) and protein levels were analyzed preoperatively and 24 h and 5 days postoperatively. RESULTS: Forty-one patients had an uncomplicated recovery. Nineteen patients developed HAP. IL-6, IL-10, IL-12p35, IL-23p19, IL-27p28, TNF-alpha, and IFN-gamma mRNA and protein levels of IL-6, IL-23, and IFN-gamma in peripheral blood leukocytes were analyzed before surgery and 24 h and 5 days postsurgery. IL-23p19 mRNA levels were reduced in the pneumonia group (median, 4.19; 10th-90th centile range, 3.90-4.71) compared with the nonpneumonia group (4.50; 3.85-5.32) day 1 postsurgery (P=02). IFN-gamma mRNA levels were reduced in the pneumonia group (2.48; 1.20-3.20) compared with nonpneumonia group (2.81; 2.10-3.26) (P=03) day 5 postsurgery. Results are expressed as log to base 10 copy numbers of cytokine mRNA per 10 million beta-actin mRNA copy numbers. All values are given as median and 10th to 90th centile range. CONCLUSIONS: Cytokine gene expression is altered immediately following surgery in patients with postoperative HAP.

  9. Reading and interpretation of chest X-ray in adults with community-acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Diana Carolina Moncada

    2011-12-01

    Full Text Available INTRODUCTION: Traditional reading of chest X-rays usually has a low prognostic value and poor agreement. OBJECTIVE: This study aimed to determine the interobserver and intraobserver agreement using two reading formats in patients with community-acquired pneumonia, and to explore their association with etiology and clinical outcomes. METHODS: A pulmonologist and a radiologist, who were blind to clinical data, interpreted 211 radiographs using a traditional analysis format (type and location of pulmonary infiltrates and pleural findings, and a quantitative analysis (pulmonary damage categorized from 0 to 10. For both, the interobserver and intraobserver agreement was estimated (Kappa statistic and intraclass correlation coefficient. The latter was assessed in a subsample of 25 radiographs three months after the initial reading. Finally, the observers made a joint reading to explore its prognostic usefulness via multivariate analysis. RESULTS: Seventy-four chest radiographs were discarded due to poor quality. With the traditional reading, the mean interobserver agreement was moderate (0.43. It was considered good when the presence of pleural effusion, and the location of the infiltrates in the right upper lobe and both lower lobes, were evaluated; moderate for multilobar pneumonia; and poor for the type of infiltrates. The mean intraobserver agreement for each reviewer was 0.71 and 0.5 respectively. The quantitative reading had an agreement between good and excellent (interobserver 0.72, intraobserver 0.85 and 0.61. Radiological findings were neither associated to a specific pathogen nor to mortality. CONCLUSION: In patients with pneumonia, the interpretation of the chest X-ray, especially the smallest of details, depends solely on the reader.

  10. Inflammatory response in mixed viral-bacterial community-acquired pneumonia

    Science.gov (United States)

    2014-01-01

    Background The role of mixed pneumonia (virus + bacteria) in community-acquired pneumonia (CAP) has been described in recent years. However, it is not known whether the systemic inflammatory profile is different compared to monomicrobial CAP. We wanted to investigate this profile of mixed viral-bacterial infection and to compare it to monomicrobial bacterial or viral CAP. Methods We measured baseline serum procalcitonin (PCT), C reactive protein (CRP), and white blood cell (WBC) count in 171 patients with CAP with definite etiology admitted to a tertiary hospital: 59 (34.5%) bacterial, 66 (39.%) viral and 46 (27%) mixed (viral-bacterial). Results Serum PCT levels were higher in mixed and bacterial CAP compared to viral CAP. CRP levels were higher in mixed CAP compared to the other groups. CRP was independently associated with mixed CAP. CRP levels below 26 mg/dL were indicative of an etiology other than mixed in 83% of cases, but the positive predictive value was 45%. PCT levels over 2.10 ng/mL had a positive predictive value for bacterial-involved CAP versus viral CAP of 78%, but the negative predictive value was 48%. Conclusions Mixed CAP has a different inflammatory pattern compared to bacterial or viral CAP. High CRP levels may be useful for clinicians to suspect mixed CAP. PMID:25073709

  11. Utility of Plasma Osteopontin Levels in Management of Community-Acquired Pneumonia

    Science.gov (United States)

    Chang, Jer-Hwa; Hung, Wen-Yueh; Bai, Kuan-Jen; Yang, Shun-Fa; Chien, Ming-Hsien

    2016-01-01

    Osteopontin (OPN) is an essential cytokine involved in immune cell recruitment and an important regulator of inflammation. The purpose of this study was to examine differences in OPN plasma levels between before and after antibiotic treatment in hospitalized adult patients with community-acquired pneumonia (CAP). OPN levels were measured in 93 patients with CAP and 54 healthy controls using a commercial enzyme-linked immunosorbent assay (ELISA). The CURB-65, Pneumonia Severity Index (PSI), and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were used to determine the CAP severity in patients upon initial hospitalization. A decline in the number of white blood cells (WBCs) and neutrophils, and decreases in the levels of OPN and C-reactive protein (CRP) were observed after antibiotic treatment. Only the plasma level of OPN, but not CRP, was correlated with the severity of CAP based on the PSI (r = 0.514, p < 0.001), CURB-65 (r = 0.396, p < 0.001), and APACHE II scores (r = 0.473, p < 0.001). The OPN level also showed a significant correlation with the length of hospital stay (r = 0.210, p = 0.044). In conclusion, plasma level of OPN may act as diagnostic adjuvant biomarkers for CAP and further play a role in clinical assessment of the severity of CAP, which could potentially guide the development of treatment strategies. PMID:27647996

  12. Usefulness of Plasma YKL-40 in Management of Community-Acquired Pneumonia Severity in Patients

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    Hsiang-Ling Wang

    2013-11-01

    Full Text Available Plasma YKL-40 level has been reported as playing a significant role in community-acquired pneumonia (CAP. However, the correlation between plasma level of YKL-40 and the severity of CAP has not been reported. This study identifies the relationship between plasma level changes of the YKL-40 gene in adult patients hospitalized with CAP. The ELISA was used to measure the plasma YKL-40 level from 61 adult CAP patients before and after antibiotic treatment and from 60 healthy controls. The plasma YKL-40 levels were significantly increased in patients with CAP compared to normal controls. Moreover, the plasma concentration of YKL-40 correlated with the severity of CAP based on the pneumonia severity index (PSI score (r = 0.630, p < 0.001, the CURB-65 (confusion, uremia, respiratory rate, BP, age 65 years score (r = 0.640, p < 0.001, the Acute Physiology And Chronic Health Evaluation II (APACHE II score (r = 0.539, p < 0.001 and length of hospital stay (r = 0.321, p = 0.011, respectively. In conclusion, plasma YKL-40 may play a role in the diagnosis and clinical assessment of CAP severity, which could potentially guide the development of treatment strategies.

  13. Regulation of naturally acquired mucosal immunity to Streptococcus pneumoniae in healthy Malawian adults and children.

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    Sarah J Glennie

    Full Text Available Worldwide, invasive pneumococcal disease caused by Streptococcus pneumoniae is most common in young children. In adults, disease rates decline following intermittent colonization and the acquisition of naturally acquired immunity. We characterized mucosal and systemic pneumococcal-specific T-cell responses in African children and adults who contend with intense rates of colonization, up to 100% and 60% respectively. We find most Malawian children have high pneumococcal-specific T-cell responses in tonsil tissue and peripheral blood. In addition, frequent commensalism generates CD25(hi (Tregs which modulate mucosal pneumococcal-specific T-cell responses in some children and ≥50% of adults. We propose that immune regulation may prolong pneumococcal colonization and predispose vulnerable individuals to disease.

  14. Community-Acquired Pneumonia and Empyema Caused by Citrobacter koseri in an Immunocompetent Patient

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    Miguel Angel Ariza-Prota

    2015-01-01

    Full Text Available Citrobacter species, belonging to the family Enterobacteriaceae, are environmental organisms commonly found in soil, water, and the intestinal tracts of animals and humans. Citrobacter koseri is known to be an uncommon but serious cause of both sporadic and epidemic septicemia and meningitis in neonates and young infants. Most cases reported have occurred in immunocompromised hosts. The infections caused by Citrobacter are difficult to treat with usual broad spectrum antibiotics owing to rapid generation of mutants and have been associated with high death rates in the past. We believe this is the first case described in the literature of a community-acquired pneumonia and empyema caused by Citrobacter koseri in an immunocompetent adult patient.

  15. Lung scintigraphy in differential diagnosis of peripheral lung cancer and community-acquired pneumonia

    Science.gov (United States)

    Krivonogov, Nikolay G.; Efimova, Nataliya Y.; Zavadovsky, Konstantin W.; Lishmanov, Yuri B.

    2016-08-01

    Ventilation/perfusion lung scintigraphy was performed in 39 patients with verified diagnosis of community-acquired pneumonia (CAP) and in 14 patients with peripheral lung cancer. Ventilation/perfusion ratio, apical-basal gradients of ventilation (U/L(V)) and lung perfusion (U/L(P)), and alveolar capillary permeability of radionuclide aerosol were determined based on scintigraphy data. The study demonstrated that main signs of CAP were increases in ventilation/perfusion ratio, perfusion and ventilation gradient on a side of the diseased lung, and two-side increase in alveolar capillary permeability rate for radionuclide aerosol. Unlike this, scintigraphic signs of peripheral lung cancer comprise an increase in ventilation/perfusion ratio over 1.0 on a side of the diseased lung with its simultaneous decrease on a contralateral side, normal values of perfusion and ventilation gradients of both lungs, and delayed alveolar capillary clearance in the diseased lung compared with the intact lung.

  16. Comorbidities as a driver of the excess costs of community-acquired pneumonia in U.S. commercially-insured working age adults

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    Polsky Daniel

    2012-10-01

    Full Text Available Abstract Background Adults with certain comorbid conditions have a higher risk of pneumonia than the overall population. If treatment of pneumonia is more costly in certain predictable situations, this would affect the value proposition of populations for pneumonia prevention. We estimate the economic impact of community-acquired pneumonia (CAP for adults with asthma, diabetes, chronic obstructive pulmonary disease (COPD and congestive heart failure (CHF in a large U.S. commercially-insured working age population. Methods Data sources consisted of 2003 through 2007 Thomson Reuters MarketScan Commercial Claims and Encounters and Thomson Reuters Health Productivity and Management (HPM databases. Pneumonia episodes and selected comorbidities were identified by ICD-9-CM diagnosis codes. By propensity score matching, controls were identified for pneumonia patients. Excess direct medical costs and excess productivity cost were estimated by generalized linear models (GLM. Results We identified 402,831 patients with CAP between 2003 through 2007, with 25,560, 32,677, 16,343, and 5,062 episodes occurring in patients with asthma, diabetes, COPD and CHF, respectively. Mean excess costs (and standard error, SE of CAP were $14,429 (SE=44 overall. Mean excess costs by comorbidity subgroup were lowest for asthma ($13,307 (SE=123, followed by diabetes ($21,395 (SE=171 and COPD ($23,493 (SE=197; mean excess costs were highest for patients with CHF ($34,436 (SE=549. On average, indirect costs comprised 21% of total excess costs, ranging from 8% for CHF patients to 27% for COPD patients. Conclusions Compared to patients without asthma, diabetes, COPD, or CHF, the excess cost of CAP is nearly twice as high for patients with diabetes and COPD and nearly three times as high for patients with CHF. Indirect costs made up a significant but varying portion of excess CAP costs. Returns on prevention of pneumonia would therefore be higher in adults with these comorbidities.

  17. [Microbiologic spectrum and prognostic factors of hospital-acquired pneumonia cases].

    Science.gov (United States)

    Sevinç, Can; Sahbaz, Sibel; Uysal, Ulker; Kilinç, Oğuz; Ellidokuz, Hülya; Itil, Oya; Gülay, Zeynep; Yunusoğlu, Sedat; Sargun, Serdar; Akkoyun, Kürşat Kaan; Uçan, Eyüp Sabri

    2007-01-01

    Nosocomial infections are an important cause of preventable morbidity and mortality; they also result in significant socioeconomic cost. Nosocomial pneumonia (NCP) is defined as pneumonia, which occurs 48 hours after hospitalization or after discharge from the hospital. It is the second or third most frequent infection among all hospital acquired infections, and the mortality of NCP is higher than the other hospital acquired infections. Patients, diagnosed as NCP were retrospectively analyzed in order to detect microbiological agent and prognostic factors. We evaluated 173 patients, 67.0% of them were male and 33.0% female. Comorbid diseases were present in 94.2% and a medical procedure had been applied in 75.1% of cases. A single agent was isolated in 79.2% of the cases while a mixt infection was present in 13.3%. In 7.5% of the cases, cultures were negative. Endotracheal aspirates were the most common materials (38.9%) used for detected microorganism and sputum cultures were used in 16.8% of the cases. Most commonly encountered microorganism were Pseudomonas aeruginosa, Acinetobacter spp. and Staphylococcus aureus respectively. NCP developed on approximately 18th day of hospitalization. Overall mortality rate was 45.2%. The effects of diabetes mellitus and chronic pulmonary diseases on mortality rate were analized by logistic regression analysis and it's evaluated that the mortality rates increase 3.7 times with diabetes mellitus and 2.4 times with chronic pulmonary diseases. There was no effect of mechanical ventilation history on mortality. PMID:17602343

  18. Community-acquired necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus producing Panton–Valentine leukocidin in a Chinese teenager: case report and literature review

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    Jie Chen

    2014-09-01

    Conclusions: To our knowledge, this is the first report from Mainland China of necrotizing pneumonia due to PVL-positive CA-MRSA among those aged older than 1 year. CA-MRSA necrotizing pneumonia should be considered in the differential diagnosis of severe community-acquired pneumonia, particularly in previously healthy individuals.

  19. Severe Community-Acquired Pneumonia Caused by Human Adenovirus in Immunocompetent Adults: A Multicenter Case Series.

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    Dingyu Tan

    Full Text Available Severe community-acquired pneumonia (CAP caused by human adenovirus (HAdV, especially HAdV type 55 (HAdV-55 in immunocompetent adults has raised increasing concerns. Clinical knowledge of severe CAP and acute respiratory distress syndrome induced by HAdV-55 is still limited, though the pathogen has been fully characterized by whole-genome sequencing.We conducted a multicentre retrospective review of all consecutive patients with severe CAP caused by HAdV in immunocompetent adults admitted to the Emergency Department Intensive Care Unit of two hospitals in Northern China between February 2012 and April 2014. Clinical, laboratory, radiological characteristics, treatments and outcomes of these patients were collected and analyzed.A total of 15 consecutive severe CAP patients with laboratory-confirmed adenovirus infections were included. The median age was 30 years and all cases were identified during the winter and spring seasons. HAdV-55 was the most frequently (11/15 detected HAdV type. Persistent high fever, cough and rapid progression of dyspnea were typically reported in these patients. Significantly increased pneumonia severity index (PSI, respiratory rate, and lower PaO2/FiO2, hypersensitive CRP were reported in non-survivors compared to survivors (P = 0.013, 0.022, 0.019 and 0.026, respectively. The rapid development of bilateral consolidations within 10 days after illness onset were the most common radiographic finding, usually accompanied by adjacent ground glass opacities and pleural effusions. Total mortality was 26.7% in this study. Corticosteroids were prescribed to 14 patients in this report, but the utilization rate between survivors and non-survivors was not significant.HAdV and the HAdV-55 sub-type play an important role among viral pneumonia pathogens in hospitalized immunocompetent adults in Northern China. HAdV should be tested in severe CAP patients with negative bacterial cultures and a lack of response to antibiotic

  20. Clinical efficacy and safety of moxifloxacin versus levofloxacin plus metronidazole for community-acquired pneumonia with aspiration factors

    Institute of Scientific and Technical Information of China (English)

    Sun Tieying; Sun Li; Wang Rongmei; Ren Xiaoping; Sui Dong-jiang; Pu Chun; Ren Yajuan

    2014-01-01

    Background Community-acquired pneumonia (CAP) is a common infectious disease throughout the world and the incidence continues to grow as the population ages.Aspiration is an important pathogenic mechanism for pneumonia in the elderly and the management of patients with community-acquired pneumonia with aspiration factors is a major medical problem.Our study aimed to assess whether moxifloxacin in comparison to levofloxacin plus metronidazole are effective and safe in the treatment of community-acquired pneumonia with aspiration factors.Methods In this prospective,multicenter,open-label,randomized controlled trial,77 patients with mild-to-moderate community-acquired pneumonia with aspiration factors were enrolled and randomly assigned to receive moxifloxacin or levofloxacin plus metronidazole.The primary efficacy variables were clinical outcomes in evaluable patients at a follow-up visit 7 to 14 days after the end of therapy.Results Seven days after the end of therapy a clinical cure was achieved for 76.7% (23 of 37) of efficacy-evaluable patients in the moxifloxacin group and 51.7% (15 of 40) of patients in the levofloxacin plus metronidazole group.There was a significant difference between the two groups (x2=4.002,P <0.05).Bacteriological success rates were similar in the moxifloxacin group (93.3%) and levofloxacin plus metronidazole group (96.4%),there was no significant difference between the two groups (P >0.05).The overall adverse event rate was 10.8% (4/37) in the moxifloxacin group versus 17.5% (7/40) in the levofloxacin plus metronidazole group,there was no significant difference between the two groups (P>0.05).No serious adverse events were observed.Conclusions Moxifloxacin is effective and safe for treatment of community-acquired pneumonia with aspiration factors.And the regimen of moxifloxacin monotherapy is more convenient compared with levofloxacin plus metronidazole.

  1. Microbial Etiology of Community-Acquired Pneumonia Among Infants and Children Admitted to the Pediatric Hospital, Ain Shams University

    Science.gov (United States)

    El Seify, Magda Yehia; Fouda, Eman Mahmoud; Ibrahim, Hanan Mohamed; Fathy, Maha Muhammad; Husseiny Ahmed, Asmaa Al; Khater, Walaa Shawky; El Deen, Noha Nagi Mohammed Salah; Abouzeid, Heba Galal Mohamed; Hegazy, Nancy Riyad Ahmed; Elbanna, Heba Salah Sayed

    2016-01-01

    Background While recognizing the etiology of community-acquired pneumonia is necessary for formulating local antimicrobial guidelines, limited data is published about this etiology in Egyptian pediatric patients. Objectives To determine the frequency of bacterial and viral pathogens causing community-acquired pneumonia (CAP) among immunocompetent Egyptian infants and preschool children. Methods Ninety infants and preschool-age children admitted to our hospital with CAP were prospectively included in the study. Etiological agents were identified using conventional bacteriological identification methods and IgM antibodies detection against common atypical respiratory bacteria and viruses. Results An etiology was identified in 59 patients (65.5%). Bacterial pathogens were detected in 43 (47.8%) of the cases while viral pathogens were detected in 23 (25.5%). Coinfection with more than one etiologic agent was evident in seven patients (7.8%). The most common typical bacterial cause of pneumonia was Staphylococcus aureus (n = 12, 13.3%), followed by Streptococcus pneumoniae and Klebsiella pneumoniae (n = 7, 7.8%, each). The commonest atypical bacterium was Mycoplasma pneumoniae (n = 10, 11.1%), whereas the commonest viral etiology was influenza viruses (n = 11, 12.2%). Conclusion Although we could not determine the causative agent in some studied cases, this study provides preliminary data regarding the spectrum and frequency of microorganisms causing CAP in Egyptian infants and preschool children.

  2. Diretrizes brasileiras para pneumonia adquirida na comunidade em adultos imunocompetentes - 2009 Brazilian guidelines for community-acquired pneumonia in immunocompetent adults - 2009

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    Ricardo de Amorim Corrêa

    2009-06-01

    Full Text Available A pneumonia adquirida na comunidade mantém-se como a doença infecciosa aguda de maior impacto médico-social quanto à morbidade e a custos relacionados ao tratamento. Os grupos etários mais suscetíveis de complicações graves situam-se entre os extremos de idade, fato que tem justificado a adoção de medidas de prevenção dirigidas a esses estratos populacionais. Apesar do avanço no conhecimento no campo da etiologia e da fisiopatologia, assim como no aperfeiçoamento dos métodos propedêuticos e terapêuticos, inúmeros pontos merecem ainda investigação adicional. Isto se deve à diversidade clínica, social, demográfica e estrutural, que são tópicos que não podem ser previstos em sua totalidade. Dessa forma, a publicação de diretrizes visa agrupar de maneira sistematizada o conhecimento atualizado e propor sua aplicação racional na prática médica. Não se trata, portanto, de uma regra rígida a ser seguida, mas, antes, de uma ferramenta para ser utilizada de forma crítica, tendo em vista a variabilidade da resposta biológica e do ser humano, no seu contexto individual e social. Esta diretriz constitui o resultado de uma discussão ampla entre os membros do Conselho Científico e da Comissão de Infecções Respiratórias da Sociedade Brasileira de Pneumologia e Tisiologia. O grupo de trabalho propôs-se a apresentar tópicos considerados relevantes, visando a uma atualização da diretriz anterior. Evitou-se, tanto quanto possível, uma repetição dos conceitos considerados consensuais. O objetivo principal do documento é a apresentação organizada dos avanços proporcionados pela literatura recente e, desta forma, contribuir para a melhora da assistência ao paciente adulto imunocompetente portador de pneumonia adquirida na comunidade.Community-acquired pneumonia continues to be the acute infectious disease that has the greatest medical and social impact regarding morbidity and treatment costs. Children and the

  3. Radiological findings of community-acquired methicillin-resistant and methicillin-susceptible staphylococcus aureus pediatric pneumonia in Hawaii

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    Erdem, Guliz; Bergert, Lora; Len, Kyra; Melish, Marian [University of Hawaii, John A. Burns School of Medicine, Department of Pediatrics, Honolulu, HI (United States); Kon, Kevin; DiMauro, Robert [Kapiolani Medical Center for Women and Children, Department of Radiology, Honolulu, HI (United States)

    2010-11-15

    Community-acquired Staphylococcus aureus (CA-SA) infections are common among pediatric patients in Hawaii. We wanted to characterize the radiological features of methicillin-susceptible (CA-MSSA) and methicillin-resistant (CA-MRSA) staphylococcal pneumonia in Hawaiian children. We retrospectively reviewed medical records and imaging studies of children with SA pneumonia identified from 1996 through 2007. Of 40 children, 26 (65%) had CA-MRSA pneumonia and 14 patients (35%) had CA-MSSA pneumonia. CA-MRSA patients were significantly younger than CA-MSSA patients (65% younger than 1 year vs. 36% older). In a majority (62%) of CA-MRSA patients, the consolidation was unilateral; in most of the CA-MSSA cases (79%), the consolidation was bilateral. Fifty percent of the patients with CA-MRSA and 21% of those with CA-MSSA had pneumatoceles (P = 0.1). CA-MRSA patients more commonly had pleural effusions (85% vs. 64% for CA-MSSA) and pleural thickening (50% vs. 36% for CA-MSSA). This case series describes the radiologic characteristics of CA-MRSA and CA-MSSA pneumonia in children in a highly endemic area. We found that CA-MRSA pneumonias are unilateral in a majority of pediatric pneumonia cases, are more common in children 1 year or younger, and have higher rates of complications in comparison to CA-MSSA patients. (orig.)

  4. Radiological findings of community-acquired methicillin-resistant and methicillin-susceptible staphylococcus aureus pediatric pneumonia in Hawaii

    International Nuclear Information System (INIS)

    Community-acquired Staphylococcus aureus (CA-SA) infections are common among pediatric patients in Hawaii. We wanted to characterize the radiological features of methicillin-susceptible (CA-MSSA) and methicillin-resistant (CA-MRSA) staphylococcal pneumonia in Hawaiian children. We retrospectively reviewed medical records and imaging studies of children with SA pneumonia identified from 1996 through 2007. Of 40 children, 26 (65%) had CA-MRSA pneumonia and 14 patients (35%) had CA-MSSA pneumonia. CA-MRSA patients were significantly younger than CA-MSSA patients (65% younger than 1 year vs. 36% older). In a majority (62%) of CA-MRSA patients, the consolidation was unilateral; in most of the CA-MSSA cases (79%), the consolidation was bilateral. Fifty percent of the patients with CA-MRSA and 21% of those with CA-MSSA had pneumatoceles (P = 0.1). CA-MRSA patients more commonly had pleural effusions (85% vs. 64% for CA-MSSA) and pleural thickening (50% vs. 36% for CA-MSSA). This case series describes the radiologic characteristics of CA-MRSA and CA-MSSA pneumonia in children in a highly endemic area. We found that CA-MRSA pneumonias are unilateral in a majority of pediatric pneumonia cases, are more common in children 1 year or younger, and have higher rates of complications in comparison to CA-MSSA patients. (orig.)

  5. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia

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    Nusbaumer Charly

    2007-03-01

    Full Text Available Abstract Background Community-acquired pneumonia (CAP is the most frequent infection-related cause of death. The reference standard to diagnose CAP is a new infiltrate on chest radiograph in the presence of recently acquired respiratory signs and symptoms. This study aims to evaluate the diagnostic and prognostic accuracy of clinical signs and symptoms and laboratory biomarkers for CAP. Methods 545 patients with suspected lower respiratory tract infection, admitted to the emergency department of a university hospital were included in a pre-planned post-hoc analysis of two controlled intervention trials. Baseline assessment included history, clinical examination, radiography and measurements of procalcitonin (PCT, highly sensitive C-reactive protein (hsCRP and leukocyte count. Results Of the 545 patients, 373 had CAP, 132 other respiratory tract infections, and 40 other final diagnoses. The AUC of a clinical model including standard clinical signs and symptoms (i.e. fever, cough, sputum production, abnormal chest auscultation and dyspnea to diagnose CAP was 0.79 [95% CI, 0.75–0.83]. This AUC was significantly improved by including PCT and hsCRP (0.92 [0.89–0.94]; p Conclusion PCT, and to a lesser degree hsCRP, improve the accuracy of currently recommended approaches for the diagnosis of CAP, thereby complementing clinical signs and symptoms. PCT is useful in the severity assessment of CAP.

  6. Do We Know When, What and For How Long to Treat? Antibiotic Therapy for Pediatric Community-acquired Pneumonia

    NARCIS (Netherlands)

    Esposito, Susanna; Cohen, Robert; Domingo, Javier Diez; Pecurariu, Oana Falup; Greenberg, David; Heininger, Ulrich; Knuf, Markus; Lutsar, Irja; Principi, Nicola; Rodrigues, Fernanda; Sharland, Mike; Spoulou, Vana; Syrogiannopoulos, George A.; Usonis, Vytautas; Vergison, Anne; Schaad, Urs B.

    2012-01-01

    Community-acquired pneumonia (CAP) is a common cause of morbidity among children in developed countries and accounts for an incidence of 10-40 cases per 1000 children in the first 5 years of life. Given the clinical, social and economic importance of CAP, there is general agreement that prompt and a

  7. Individualized treatment strategies in community-acquired pneumonia : from initial inflammatory response to long-term prognosis

    NARCIS (Netherlands)

    Bruns, A.H.W.

    2010-01-01

    Community-acquired pneumonia (CAP) is one of the most important causes of hospital admissions and together with influenza the third leading cause of death worldwide. Moreover, treatment of CAP largely contributes to the global burden of antibiotic resistance. In present thesis, we explored options f

  8. The Community-Acquired Pneumonia immunization Trial in Adults (CAPiTA) : What is the future of pneumococcal conjugate vaccination in elderly?

    NARCIS (Netherlands)

    Van Werkhoven, Cornelis H.; Bonten, Marc Jm

    2015-01-01

    Pneumococcal community-acquired pneumonia (PCAP) and invasive pneumococcal disease (IPD) are important causes of morbidity and mortality in elderly. In the Community-Acquired Pneumonia immunization Trial in Adults (CAPiTA), a randomized double-blind placebo-controlled trial of 84,496 community-dwell

  9. [Impact of vaccination on the epidemiology of childhood pneumonia].

    Science.gov (United States)

    Crisinel, Pierre-Alex

    2016-02-17

    The impact of vaccination on non-bacteremic Haemophilus influenza pneumonia is difficult to appreciate, in the absence of proper microbiological documentation. It has certainly been largely underestimated. Vaccination has reduced the incidence of pneumococcal pneumonia. However, the increase of incidence of empyema due to nonvaccine serotypes was observed in several countries. The replacement of Prevenar 7 by Prevenar 13 portends a decrease in the occurrence of these infections, but, unfortunately, without eliminating them completely.

  10. DIAGNOSTIC BEHAVIOR OF COMMUNITY-ACQUIRED PNEUMONIA: SURVEY CONDUCTED IN SOME REGIONS OF CHINA

    Institute of Scientific and Technical Information of China (English)

    TANG Wei; DENG Wei-wu

    2006-01-01

    Objective To analyze the spectrum of microbiological agents causing community-acquired pneumonia (CAP) in recent years. We also investigated the procedure of diagnosis as well as the empirical treatment for this disease in OPD (outpatient department) of pulmonary disease. Methods A total of 7097 patients from 150 hospitals in 24 provinces in China were enrolled in the study from Nov. 2002 to Mar. 2003. Every patient was diagnosed, treated and registered at the same time. Diagnostic behavior for doctors include chest radiograph and/or CT examination of the lung, as well as collecting sputum samples at the time of diagnosis for bacteria culture to identify the pathogen. Appointed staff fulfilled the questionnaires and information sheets in each center. After that,data were computerized and analyzed. Results There were 7404 valid information sheets and 7097 questionnaires taken into count. The majority CAP patients were from cities ( 77.3% ), most of those who had medical insurance. Most CAP patients had productive cough (81.1% ), and 76.7% and 18.2% CAP patients received chest film and CT examination respectively for diagnosis. Only 24% patients received sputum sample tested and with 36% got positive results. Streptococcus pneumoniae remained the main pathogen of CAP (43. 2% ). Most doctors used to prescribe β-lactam antibiotics as the first line of empirical therapy of CAP (51.1%) with oral taken as the main method for drug using (66.3% ). Conclusion This survey provides a key point of empirical therapy in China.The procedure for diagnosing as well as the empirical treatment of CAP in OPD of pulmonary disease in China still to be improved, especially in accessing the pathogen. Guidelines developed to recognize and evaluate CAP should base on epidemiological information of the pathogen prevalence, then could offer a rational approach to the initial management of the CAP patients.

  11. Pneumonia acquired in the Community Neumonía adquirida en la comunidad

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    Dianelis Sierra Martínez

    Full Text Available A bibliographical revision of the main aspects in the diagnosis and treatment of the patients suffering from pneumonia acquired in the community is carried out. Microorganisms responsible for this type of pneumonia are mention in this paper as well as the available diagnostic methods for germs isolation. Different guidelines for diagnosis and treatment of this disease published by several medical societies and scientific institutions are analyzed by means of a review of the stratification index of the patients used in each of them. Aspects related to the duration of the treatment and the possible causes associated with the unfavorable evolution are stated.
    Se realizó una revisión bibliográfica de los aspectos fundamentales en el diagnóstico y tratamiento de los pacientes con neumonía adquirida en la comunidad. Se hace referencia a los microorganismos responsables de las neumonías, así como a los métodos diagnósticos disponibles para el aislamiento de los gérmenes. Se analizan las diferentes Guías de Diagnóstico y Tratamiento de la enfermedad, emitidas por varias sociedades e instituciones científicas, mediante una revisión de los índices para la estratificación de los pacientes, utilizados por cada una de ellas. Además, se abordan aspectos relacionados con la duración del tratamiento y las posibles causas relacionadas con su evolución desfavorable.

  12. Internal and External Validation of a multivariable Model to Define Hospital-Acquired Pneumonia After Esophagectomy

    NARCIS (Netherlands)

    Weijs, Teus J; Seesing, Maarten F J; van Rossum, Peter S N; Koëter, Marijn; van der Sluis, Pieter C; Luyer, Misha D P; Ruurda, Jelle P; Nieuwenhuijzen, Grard A P; van Hillegersberg, Richard

    2016-01-01

    BACKGROUND: Pneumonia is an important complication following esophagectomy; however, a wide range of pneumonia incidence is reported. The lack of one generally accepted definition prevents valid inter-study comparisons. We aimed to simplify and validate an existing scoring model to define pneumonia

  13. Exame do escarro no manejo clínico dos pacientes com pneumonia adquirida na comunidade Sputum examination in the clinical management of community-acquired pneumonia

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    Leonardo Gilberto Haas Signori

    2008-03-01

    Full Text Available OBJETIVO: Este estudo retrospectivo avaliou a freqüência do uso da bacteriologia do escarro no manejo clínico de pacientes com pneumonia adquirida na comunidade (PAC em um hospital geral, e se a utilização deste método modificou a mortalidade. MÉTODOS: Os prontuários de pacientes internados no Hospital Nossa Senhora da Conceição, em Porto Alegre (RS Brasil, para tratamento de PAC entre maio e novembro de 2004 foram revisados quanto aos seguintes aspectos: idade; sexo; gravidade da pneumonia (escore de Fine; presença de expectoração; bacteriologia do escarro; história de tratamento; resposta clínica; troca de tratamento; e mortalidade. RESULTADOS: Foram avaliados 274 pacientes com PAC, sendo 134 do sexo masculino. Dentre os 274 pacientes, 79 (28,8% apresentavam, de acordo com o escore de Fine, classe II; 45 (16,4%, classe III; 97 (35,4%, classe IV; e 53 (19,3%, classe V. Em 92 pacientes (33,6%, uma amostra de escarro foi colhida para exame bacteriológico. Obtivemos amostra válida em 37 casos (13,5% e diagnóstico etiológico em 26 (9,5%, o que resultou em modificação do tratamento em apenas 9 casos (3,3%. A mortalidade geral foi 18,6%. Idade acima de 65 anos, a gravidade da PAC e a ausência de escarro associaram-se à maior mortalidade. A bacteriologia do escarro não influenciou o desfecho clínico, nem a taxa de mortalidade. CONCLUSÃO: O exame do escarro foi uma ferramenta diagnóstica utilizada na minoria dos pacientes, e não trouxe benefício detectável no manejo clínico dos pacientes com PAC tratados em ambiente hospitalar.OBJECTIVE: To evaluate the frequency of the use of sputum examination in the clinical management of community-acquired pneumonia (CAP in a general hospital and to determine whether its use has an impact on mortality. METHODS: The medical records of CAP patients treated as inpatients between May and November of 2004 at the Nossa Senhora da Conceição Hospital, located in Porto Alegre, Brazil, were

  14. Drug-resistance in Streptococcus pneumoniae isolates among Spanish middle aged and older adults with community-acquired pneumonia

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    Raga-Luria Xavier

    2009-03-01

    Full Text Available Abstract Background Pneumococcal diseases remain a major cause of morbidity and mortality worldwide. Updated data on drug-resistance from different populations may be important to recognize changes in disease patterns. This study assessed current levels of penicilin resistance among Streptococcus Pneumoniae causing pneumonia in Spanish middle age and older adults. Methods Antimicrobial susceptibility was tested for 104 consecutive isolates of Streptococcus pneumoniae recovered from patients 50 years or older with radiographically confirmed pneumonia in the region of Tarragona (Spain between 2002 and 2007. According to the minimum inhibitory concentration of tested antimicrobials (penicillin, erythromycin, cefotaxime and levofloxacin strains were classified as susceptible or resistant. Antimicrobial resistance was determined for early cases (2002–2004 and contemporary cases (2005–2007. Results Twenty-seven (25.9% were penicillin-resistant strains (19 strains with intermediate resistance and 8 strains with high resistance. Penicillin-resistance was higher in 2002–2004 than in 2005–2007 (39.5% vs 18.2%, p = 0.017. Of 27 penicillin-resistant strains, 10 (37% were resistant to erythromycin, 8 (29.6% to cefotaxime, 2 (7.4% to levofloxacin, and 4 (14.8% were identified as multidrug resistant. Case-fatality rate was higher among those patients who had an infection caused by any penicillin susceptible strain (16.9% than in those with infections due to penicillin-resistant strains. Conclusion Resistance to penicillin among Streptococcus pneumoniae remains high, but such resistance does not result in increased mortality in patients with pneumococcal pneumonia.

  15. Adesão a diretrizes e impacto nos desfechos em pacientes hospitalizados por pneumonia adquirida na comunidade em um hospital universitário Adherence to guidelines and its impact on outcomes in patients hospitalized with community-acquired pneumonia at a university hospital

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    Carla Discacciati Silveira

    2012-04-01

    evaluate the agreement between the criteria used for hospitalization of patients with community-acquired pneumonia (CAP and those of the Brazilian Thoracic Association guidelines, and to evaluate the association of that agreement with 30-day mortality. Secondarily, to evaluate the agreement between the treatment given and that recommended in the guidelines with length of hospital stay, microbiological profile, 12-month mortality, complications, ICU admission, mechanical ventilation, and 30-day mortality. METHODS: This was a retrospective study involving adult patients hospitalized between 2005 and 2007 at the Federal University of Minas Gerais Hospital das Clínicas, located in Belo Horizonte, Brazil. Medical charts and chest X-rays were reviewed. RESULTS: Among the 112 patients included in the study, admission and treatment criteria were in accordance with the guidelines in 82 (73.2% and 66 (58.9%, respectively. The 30-day and 12-month mortality rates were 12.3% and 19.4%, respectively. The 30-day mortality rate was lower for patients in whom the CRB-65 (mental Confusion, Respiratory rate, Blood pressure, and age > 65 years score was 1-2 and the antibiotic therapy was in accordance with the guidelines (p = 0.01. Cerebrovascular disease and appropriate antibiotic therapy showed independent associations with 30-day mortality. There was a trend toward an association between guideline-concordant antibiotic therapy and shorter hospital stay. CONCLUSIONS: In the population studied, admission and treatment criteria that were in accordance with the guidelines were associated with favorable outcomes in hospitalized patients with CAP. Cerebrovascular disease, as a risk factor, and guideline-concordant antibiotic therapy, as a protective factor, were associated with 30-day mortality.

  16. Duration of Antimicrobial Therapy in Community Acquired Pneumonia: Less Is More

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    Marilia Rita Pinzone

    2014-01-01

    Full Text Available Community acquired pneumonia (CAP represents the most common cause of infection-related morbidity and mortality worldwide. Appropriate treatment of CAP is challenging and sometimes limited by the availability to obtain rapid and timely identification of the etiologic agent in order to initiate or deescalate the correct antimicrobial therapy. As a consequence, prescribers frequently select empiric antimicrobial therapy using clinical judgment, local patterns of antimicrobial resistance, and, sometimes, individual patient expectations. These issues may contribute to prolonged courses of inappropriate therapy. In this review, we discuss the evidence and recommendations from international guidelines for the management of CAP and the clinical trials that specifically addressed duration of antimicrobial therapy for CAP in adults. In randomized controlled trials comparing the clinical efficacy of a short-course antimicrobial regimen versus an extended-course regimen, no differences in terms of clinical success, bacterial eradication, adverse events, and mortality were observed. The use of biomarkers, such as procalcitonin, to guide the initiation and duration of antimicrobial therapy may reduce total antibiotic exposure and treatment duration, healthcare costs, and the risk of developing antimicrobial resistance. In clinical practice, antimicrobial stewardship interventions may improve the management of CAP and may help in reducing treatment duration. Sometimes “less is more” in CAP.

  17. Using data-driven rules to predict mortality in severe community acquired pneumonia.

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    Chuang Wu

    Full Text Available Prediction of patient-centered outcomes in hospitals is useful for performance benchmarking, resource allocation, and guidance regarding active treatment and withdrawal of care. Yet, their use by clinicians is limited by the complexity of available tools and amount of data required. We propose to use Disjunctive Normal Forms as a novel approach to predict hospital and 90-day mortality from instance-based patient data, comprising demographic, genetic, and physiologic information in a large cohort of patients admitted with severe community acquired pneumonia. We develop two algorithms to efficiently learn Disjunctive Normal Forms, which yield easy-to-interpret rules that explicitly map data to the outcome of interest. Disjunctive Normal Forms achieve higher prediction performance quality compared to a set of state-of-the-art machine learning models, and unveils insights unavailable with standard methods. Disjunctive Normal Forms constitute an intuitive set of prediction rules that could be easily implemented to predict outcomes and guide criteria-based clinical decision making and clinical trial execution, and thus of greater practical usefulness than currently available prediction tools. The Java implementation of the tool JavaDNF will be publicly available.

  18. Viral infection in community-acquired pneumonia: a systematic review and meta-analysis

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    Michael Burk

    2016-06-01

    Full Text Available The advent of PCR has improved the identification of viruses in patients with community-acquired pneumonia (CAP. Several studies have used PCR to establish the importance of viruses in the aetiology of CAP. We performed a systematic review and meta-analysis of the studies that reported the proportion of viral infection detected via PCR in patients with CAP. We excluded studies with paediatric populations. The primary outcome was the proportion of patients with viral infection. The secondary outcome was short-term mortality. Our review included 31 studies. Most obtained PCR via nasopharyngeal or oropharyngeal swab. The pooled proportion of patients with viral infection was 24.5% (95% CI 21.5–27.5%. In studies that obtained lower respiratory samples in >50% of patients, the proportion was 44.2% (95% CI 35.1–53.3%. The odds of death were higher in patients with dual bacterial and viral infection (OR 2.1, 95% CI 1.32–3.31. Viral infection is present in a high proportion of patients with CAP. The true proportion of viral infection is probably underestimated because of negative test results from nasopharyngeal or oropharyngeal swab PCR. There is increased mortality in patients with dual bacterial and viral infection.

  19. The potential of molecular diagnostics and serum procalcitonin levels to change the antibiotic management of community-acquired pneumonia.

    Science.gov (United States)

    Gilbert, David; Gelfer, Gita; Wang, Lian; Myers, Jillian; Bajema, Kristina; Johnston, Michael; Leggett, James

    2016-09-01

    Two diagnostic bundles were compared in 127 evaluable patients admitted with community-acquired pneumonia (CAP). Diagnostic modalities in all patients included cultures of sputum (if obtainable) and blood, urine for detection of the antigens of Streptococcus pneumoniae and Legionella pneumophila, and nasal swabs for PCR probes for S. pneumoniae and Staphylococcus aureus. At least one procalcitonin level was measured in all patients. For virus detection, patients were randomized to either a 5-virus, lab-generated PCR panel or the broader and faster FilmArray PCR panel. Overall, an etiologic diagnosis was established in 71% of the patients. A respiratory virus was detected in 39%. The potential for improved antibiotic stewardship was evident in 25 patients with only detectable respiratory virus and normal levels of PCT. PMID:27377675

  20. [Prophylaxis of Community-Acquired Pneumonia Outbreaks with Pneumococcal Polysaccharide Vaccine. Prospects Analysis for Russian Military Community].

    Science.gov (United States)

    Guchev, I A; Klochkov, O I; Sinopalnikov, A I

    2016-01-01

    Pneumococcal pneumonia and other diseases caused by pneumococci still remain the main factors of high morbidity and mortality rates throughout the world. Pneumococci as the leading pathogens of community-acquired pneumonia (CAP), acute otitis media and sinusitis also cause a number of other serious systemic disorders including invasive infections with high mortality in spite of the antimicrobial resistance status and adequate antimicrobials choice. Pneumococcal infections are responsible for 5-35% or more of community-acquired pneumonias. The burden of pneumonia (up to 100-200 per thousand) is recorded among military recruits in training centers. Since the specific environment of the soldiers could be carrected, their health protection requires medical surveillance. For these reasons, polysaccharide and more immunogenic conjugated pneumococcal vaccines were developed. There is now an urgent need to understand whether such vaccines are effective in military conscripts. Controversy about the effectiveness and value of the polysaccharide (PPV-23) vaccine as a CAP morbidity restriction measure still persists. There were implemented plenty of metaanalyses of pneumococcal vaccines in adults. Some of them showed that the vaccine was effective against bacteremic pneumococcal pneumonia in 'low risk' healthy adults and elders. There have been a number of poor quality observational studies in Russia where 'all pneumonia cases' were considered as an endpoint. It remains controversial whether these observational studies provide adequate evidence to justify the use of the polysaccharide vaccine in the groups of healthy young men for whom it is being advocated. In our analysis we found weak evidence supporting pneumococcal vaccination with PPV-23 for this group. Nevertheless, favorable tendency was found to immunize. It is the reason for a trail to find pharmacoepidemiological support for vaccination by novel conjugated vaccines with better immunogenicity. PMID:27337866

  1. Empyema associated with community-acquired pneumonia: A Pediatric Investigator's Collaborative Network on Infections in Canada (PICNIC study

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    Le Saux Nicole

    2008-09-01

    Full Text Available Abstract Background Although the incidence of serious morbidity with childhood pneumonia has decreased over time, empyema as a complication of community-acquired pneumonia continues to be an important clinical problem. We reviewed the epidemiology and clinical management of empyema at 8 pediatric hospitals in a period before the widespread implementation of universal infant heptavalent pneumococcal vaccine programs in Canada. Methods Health records for children Results 251 children met inclusion criteria; 51.4% were male. Most children were previously healthy and those ≤ 5 years of age comprised 57% of the cases. The median length of hospitalization was 9 days. Admissions occurred in all months but peaked in winter. Oxygen supplementation was required in 77% of children, 75% had chest tube placement and 33% were admitted to an intensive care unit. While similarity in use of pain medication, antipyretics and antimicrobial use was observed, a wide variation in number of chest radiographs and invasive procedures (thoracentesis, placement of chest tubes was observed between centers. The most common organism found in normally sterile samples (blood, pleural fluid, lung biopsy was Streptococcus pneumoniae. Conclusion Empyema occurs most commonly in children under five years and is associated with considerable morbidity. Variation in management by center was observed. Enhanced surveillance using molecular methods could improve diagnosis and public health planning, particularly with regard to the relationship between immunization programs and the epidemiology of empyema associated with community-acquired pneumonia in children.

  2. The current status of community-acquired pneumonia management and prevention in children under 5 years of age in India: a review.

    Science.gov (United States)

    Yadav, Krishna Kumar; Awasthi, Shally

    2016-06-01

    India has the highest number of global deaths of children under 5 years of age. In the year 2015, it was reported that there were 5.9 million deaths of children under 5 years of age globally, of which 1.2 million (20%) occurred in India alone. Currently, India has an under 5 mortality rate of 48 per 1000 live births. Community-acquired pneumonia contributes to about one sixth of this mortality. Fast breathing is the key symptom of community-acquired pneumonia. The World Health Organization recently categorized community-acquired pneumonia in children under 5 years of age into two, pneumonia, and severe pneumonia. Fast breathing with or without chest in-drawing is categorized as pneumonia and fast breathing with any of danger signs as severe pneumonia. Because effective vaccines against two of the common organisms causing community-acquired pneumonia, namely Streptococcus pneumoniae and Haemophilus influenzae type b, are available, there should be urgent and phased introduction into the Indian Universal Immunization Programme. Several preventable risk factors of community-acquired pneumonia such as lack of exclusive breast feeding for first 6 months of life, inappropriate complimentary feeding, iron deficiency anemia, malnutrition, and indoor air pollution should be adequately addressed. The community should be aware about the signs and symptoms of community-acquired pneumonia and its danger signs so that delay in qualified care seeking can be avoided. To achieve the sustainable development goal of ⩽25 under five deaths per 1000 live births by 2030, a multipronged approach is the need of the hour. PMID:27536353

  3. Detection and serotyping of pneumococci in community acquired pneumonia patients without culture using blood and urine samples

    OpenAIRE

    Elberse, K. (Karin); Mens, S.; Cremers, A.J.; Meijvis, S.C.A.; Vlaminckx, B.; de Jonge, M. I.; Meis, J. F. G. M.; Blauwendraat, C.; Pol, I. van de; Schouls, L. M.

    2015-01-01

    Background Treatment of community acquired pneumonia (CAP) patients with antibiotics before laboratory-confirmed diagnosis leads to loss of knowledge on the causative bacterial pathogen. Therefore, an increasing number of pneumococcal infections is identified using non-culture based techniques. However, methods for serotyping directly on the clinical specimen remain scarce. Here we present three approaches for detection and serotyping of pneumococci using samples from patients with CAP. Metho...

  4. Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units

    OpenAIRE

    Cheng, Yusheng; Lu, Zhiwei; Tu,Xiongwen; Chen, Liang; Chen, Hu; Yang, Jian; Wang, Jinyan; Zhang, Liqin

    2016-01-01

    Zhiwei Lu,* Yusheng Cheng,* Xiongwen Tu, Liang Chen, Hu Chen, Jian Yang, Jinyan Wang, Liqin Zhang Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People’s Republic of China *These authors contributed equally to this work Purpose: The aim of this study was to appraise the effect of community-acquired pneumonia (CAP) on inhospital mortality in critically ill acute exacerbation of COPD (AECOPD) patients admitted to a respiratory intens...

  5. Understanding variation in quality of antibiotic use for community-acquired pneumonia: Effect of patient, professional and hospital factors

    OpenAIRE

    Schouten, Jeroen; Hulscher, Marlies; Kullberg, Bart Jan; Cox, Angela; Gyssens, Inge; Van Der Meer, Jos,; Grol, Richard

    2005-01-01

    textabstractObjectives: To develop effective and targeted interventions to improve care for patients with community-acquired pneumonia (CAP), insight is needed into the factors that influence the quality of antibiotic use. Therefore, we measured the performance of nine quality indicators and studied determinants of variation in the quality of antibiotic use. Patients and methods: Data on 498 prospectively included patients with CAP from eight medium-sized Dutch hospitals were extracted from t...

  6. INFECTION WITH HHV-6 OF MILITARY MEN AFFECTED BY COMMUNITY-ACQUIRED PNEUMONIA

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    Brusnik SV

    2016-09-01

    Full Text Available Human herpesvirus, 6 type (HHV-6 was isolated at the end of the 20th century from the blood leukocytes of patients with lymphoproliferative diseases. Serological studies conducted in different countries, indicate ubiquitylation of the HHV-6 and the existence of two antigenic variants - HHV-6A and HHV-6B. Their high tropism is determined in vitro to lymphocytic, nervous and dendritic cells of the CNS. Virus replicates in many cell, primary and passaged cultures of different origins. The reproduction cycle of HHV-6 continues on average 4-5 days forming syncytiums and intracytoplasmic and intranuclear inclusions. Significant destruction and lysis almost 90 % of infected cells is reported after 5-10 day of monitoring. The utility of experimentation investigating the role of HHV-6 in the development of acute and chronic diseases in respiratory tract is caused by the fact that many patients, particularly those with chronic diseases, have complaints to chronic fatigue, decreased performance and low-grade temperature more than 3-6 months. Several studies demonstrate the presence of HHV-6 in saliva, salivary and bronchiolar glands, in swabs from pharyngonasal cavity and gorge. Tropism of HHV-6 to oropharyngeal epithelium with the possibility of finding the virus in the saliva and swabs from pharyngonasal cavity and gorge was found at the end of 20th century. This fact gave the basis for work determining the level of infection by this pathogen in patients with infectious and inflammatory pathology of the respiratory tract. Materials and methods. Serological studies were conducted with 38 soldiers affected by community-acquired pneumonia. Most of the surveyed patients were ranged in age from 20 to 45 years old, middle age (32,5±1,5 years. Patients were in stationary treatment in the Kharkov military hospital. The criteria for inclusion in the study on the infection of HHV-6 were soldiers affected by community-acquired pneumonia with atypical course of

  7. Signs and symptoms indicative of community-acquired pneumonia in infants under six months

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    Maria de Fátima Bazhuni Pombo March

    2005-04-01

    Full Text Available OBJECTIVE: Evaluation of the clinical signs and symptoms predicting bacterial and viral pneumonia, in accordance with the Brazilian National Control Program for Acute Respiratory (ARI. METHODS: Observational prospective study. Seventy-six children from birth to six months of age who had pneumonia were studied in the emergency room. The patients were subdivided into two groups, based on radiological findings (gold-standard: 47 had bacterial pneumonia, and 29 had viral pneumonia. The frequencies, sensitivities, and specificities of the signs and symptoms were evaluated. RESULTS: The sensibilities and sensitivities of general findings in bacterial pneumonia were, respectively: fever 53.2%/40.0%; hypoactivity 68.4%/55.6% and prostration detected by the doctor 72.7%/55.0%. The same findings in viral pneumonias showed, respectively: 37.9%/40.0%, 66.7%/55.6% and 66.7%/55.6%. The sensibilities and sensitivities of respiratory findings in bacterial pneumonia were, respectively: coughing 66.0/38.1%, Respiratory rate = 50 ripm 76.6%/38.1%, altered respiratory auscultation 91.3%/10.5%, and chest indrawing 46.7%/80.0%. The same findings in viral pneumonias were, respectively: 69.0%/38.1%, 86.2%/38.1%, 85.7%/10.5% and 44.8%/80.0%. CONCLUSION: Analysis of signs and symptoms in each group did not distinguish bacterial from viral pneumonia. Our findings reinforce the adequacy of the ARI program in Brazil, which gives an early diagnosis of pneumonia, independent of its etiology.

  8. Optimizing antibiotic therapy of group IV community-acquired pneumonia patients

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    Dziublyk Ya.O.

    2014-06-01

    Full Text Available The aim of the study was to evaluate the clinical and economical effectiveness of differentiated antibacterial therapy of group IV patients with community-acquired pneumonia (CAP. Materials and methods. 42 patients, admitted to the hospital with severe CAP without risk factors for P. aeruginosa infection were randomized in three groups in 1:1:1 ratio. All patients received sequential antibacterial therapy with i.v. amoxicillin/clavulanate or ceftriaxone, or ertapenem in combination with azithromycin switched to oral amoxicillin/clavulanate, cefuroxime axetil in combination with oral azithromycin or levofloxacin, respectively, after initial improvement in 3–4 days. A comparative effectiveness analysis was performed based on clinical, laboratory and economic data. Results. Treatment outcomes in all subgroups of patients were similar: in 1st subgroup the cure rate was (28,6  12,1 %, improvement – in (49,4  13,2 % of patients; in 2nd and 3rd subgroups the cure/improvement rates were (35,7  12,8 and (42,9 13,2 %, respectively (р  0,05. Conclusion. Antibacterial therapy, always empiric and differentiated depending on severity of disease, con¬comitant conditions and previous use of antibiotics within 3 months of the onset of the disease, is a milestone of treatmet of CAP patients. A sequential antibiotic therapy with either aminopenicillin (amoxicillin/clavulanate of 3rd generation cephalosporin (ceftriaxone/cefuroxime axetil in combination with macrolide (azithromycin or carbapenem (ertapenem, followed by levofloxacin is recommended in hospitalized clinical group IV CAP patients without risk factors for P. aeruginosa infection. In current group of patients pharmacoeconomic analysis confirmed the expediency of administration a sequential antibiotic therapy with parenteral amoxicillin/clavulanat or ceftriaxone in combination with azithromycin, followed by oral amoxicillin/clavulanat or cefuroxime axetil in combination with

  9. Pneumonia

    Science.gov (United States)

    ... restroom and before eating. Use lukewarm water and soap for at least 20 seconds. If soap and water are not available, using an alcohol- ... at higher risk for pneumonia? Do I have bacterial, viral or fungal pneumonia? What’s the best treatment? ...

  10. Predictors of inhospital mortality and re-hospitalization in older adults with community-acquired pneumonia: a prospective cohort study

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    Marrie Tom

    2010-05-01

    Full Text Available Abstract Background A better understanding of potentially modifiable predictors of in-hospital mortality and re-admission to the hospital following discharge may help to improve management of community-acquired pneumonia in older adults. We aimed to assess the associations of potentially modifiable factors with mortality and re-hospitalization in older adults hospitalized with community-acquired pneumonia. Methods A prospective cohort study was conducted from July 2003 to April 2005 in two Canadian cities. Patients aged 65 years or older hospitalized for community-acquired pneumonia were followed up for up to 30 days from initial hospitalization for mortality and these patients who were discharged alive within 30 days of initial hospitalization were followed up to 90 days of initial hospitalization for re-hospitalization. Separate logistic regression analyses were performed identify the predictors of mortality and re-hospitalization. Results Of 717 enrolled patients hospitalized for community-acquired pneumonia, 49 (6.8% died within 30 days of hospital admission. Among these patients, 526 were discharged alive within 30 days of hospitalization of whom 58 (11.2% were re-hospitalized within 90 days of initial hospitalization. History of hip fracture (odds ratio (OR = 4.00, 95% confidence interval (CI = (1.46, 10.96, P = .007, chronic obstructive pulmonary disease (OR = 2.31, 95% CI = (1.18, 4.50, P = .014, cerebrovascular disease (OR = 2.11, 95% CI = (1.03, 4.31, P = .040 were associated with mortality. Male sex (OR = 2.35, 95% CI = (1.13, 4.85, P = .022 was associated with re-hospitalization while vitamin E supplementation was protective (OR = 0.37 (0.16, 0.90, P = .028. Lower socioeconomic status, prior influenza and pneumococcal vaccinations, appropriate antibiotic prescription upon admission, and lower nutrition risk were not significantly associated with mortality or re-hospitalization. Conclusion Chronic comorbidities appear to be the most

  11. The upper respiratory tract microbiome of hospitalised patients with community-acquired pneumonia of unknown aetiology: a pilot study

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    Timothy L Wiemken

    2015-01-01

    Full Text Available   The composition of the upper respiratory tract microbiome may play an important role in the development of lower respiratory tract infections. Here, we characterised the microbiome of the nasopharynx and oropharynx of hospitalised patients with community-acquired pneumonia (CAP with unknown aetiology in an attempt to obtain insight into the aetiology of CAP. A random sample of 10 patients hospitalised with CAP previously enrolled in a separate clinical trial (ClinicalTrials.gov registry, Study ID: NCT01248715 in which a complete microbiological workup was not able to define an aetiology were analysed in this pilot study. This larger trial (n = 1,221 enrolled patients from 9 adult hospitals in Louisville, Kentucky, USA. Nasopharyngeal and oropharyngeal swabs were obtained for metagenomic analysis. Polymerase chain reaction (PCR for Streptococcus pneumoniae was performed in all patients. One patient had a distinct nasophararyngeal microbiome consisting largely of Haemophilus influenzae. This was the only patient with a negative PCR for S. pneumoniae in both nasophararyngeal and oropharyngeal specimens. Overall, substantial differences were found between nasophararyngeal and oropharyngeal microbiomes. The upper respiratory tract microbiome of only one patient suggested H. influenzae as a probable aetiology of CAP. Although this was a pilot study of only 10 patients, the presence of S. pneumoniae in the upper respiratory tract of the other 9 patients warrants further investigation.

  12. Effects of Hospital-Based Physical Therapy on Hospital Discharge Outcomes among Hospitalized Older Adults with Community-Acquired Pneumonia and Declining Physical Function

    OpenAIRE

    Kim, Sun Jung; Lee, Joo Hun; Han, Boram; Lam, Julia; Bukowy, Elizabeth; Rao, Avinash; Vulcano, Jordan; Andreeva, Anelia; Bertelson, Heather; Shin, Hyun Phil; Yoo, Ji Won

    2015-01-01

    To examine whether hospital-based physical therapy is associated with functional changes and early hospital readmission among hospitalized older adults with community-acquired pneumonia and declining physical function. Study design was a retrospective observation study. Participants were community-dwelling older adults admitted to medicine floor for community-acquired pneumonia (n = 1,058). Their physical function using Katz activities of daily living (ADL) Index declined between hospital adm...

  13. Pneumonia

    Science.gov (United States)

    ... better than treating it. Vaccines are available to prevent pneumococcal pneumonia and the flu. Other preventive measures include washing your hands frequently and not smoking. NIH: National Heart, Lung, and Blood Institute

  14. IL-6 and TNF-α serum levels are associated with early death in community-acquired pneumonia patients

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    M.R. Bacci

    2015-05-01

    Full Text Available Community-acquired pneumonia (CAP is amongst the leading causes of death worldwide. As inflammatory markers, cytokines can predict outcomes, if interpreted together with clinical data and scoring systems such as CURB-65, CRB, and Acute Physiology and Chronic Health Evaluation II (APACHE II. The aim of this study was to determine the impact of inflammatory biomarkers on the early mortality of hospitalized CAP patients. Twenty-seven CAP patients needing hospitalization were enrolled for the study and samples of interleukin-1 (IL-1 and interleukin-6 (IL-6, tumor necrosis factor alpha (TNF-α, C-reactive protein (CRP, and homocystein were collected at the time of admission (day 1 as well as on the seventh day of the treatment. There was a significant reduction in the levels of IL-6 between the first and the second collections. Median IL-6 values decreased from 24 pg/mL (day 1 to 8 pg/mL (day 7 (P=0.016. The median levels of TNF-α were higher in patients: i with acute kidney injury (AKI (P=0.045, ii requiring mechanical ventilation (P=0.040, iii with short hospital stays (P=0.009, iv admitted to the intensive care unit (ICU (P=0.040, v who died early (P=0.003, and vi with worse CRB scores (P=0.013. In summary, IL-6 and TNF-α levels were associated with early mortality of CAP patients. Longer admission levels demonstrated greater likelihood of early death and overall mortality, necessity of mechanical ventilation, and AKI.

  15. IL-6 and TNF-α serum levels are associated with early death in community-acquired pneumonia patients.

    Science.gov (United States)

    Bacci, M R; Leme, R C P; Zing, N P C; Murad, N; Adami, F; Hinnig, P F; Feder, D; Chagas, A C P; Fonseca, F L A

    2015-05-01

    Community-acquired pneumonia (CAP) is amongst the leading causes of death worldwide. As inflammatory markers, cytokines can predict outcomes, if interpreted together with clinical data and scoring systems such as CURB-65, CRB, and Acute Physiology and Chronic Health Evaluation II (APACHE II). The aim of this study was to determine the impact of inflammatory biomarkers on the early mortality of hospitalized CAP patients. Twenty-seven CAP patients needing hospitalization were enrolled for the study and samples of interleukin-1 (IL-1) and interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), and homocystein were collected at the time of admission (day 1) as well as on the seventh day of the treatment. There was a significant reduction in the levels of IL-6 between the first and the second collections. Median IL-6 values decreased from 24 pg/mL (day 1) to 8 pg/mL (day 7) (P=0.016). The median levels of TNF-α were higher in patients: i) with acute kidney injury (AKI) (P=0.045), ii) requiring mechanical ventilation (P=0.040), iii) with short hospital stays (P=0.009), iv) admitted to the intensive care unit (ICU) (P=0.040), v) who died early (P=0.003), and vi) with worse CRB scores (P=0.013). In summary, IL-6 and TNF-α levels were associated with early mortality of CAP patients. Longer admission levels demonstrated greater likelihood of early death and overall mortality, necessity of mechanical ventilation, and AKI. PMID:25714883

  16. IL-6 and TNF-α serum levels are associated with early death in community-acquired pneumonia patients

    Energy Technology Data Exchange (ETDEWEB)

    Bacci, M.R.; Leme, R.C.P.; Zing, N.P.C. [Departamento de Cliníca Médica, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Murad, N. [Departamento de Cardiologia, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Adami, F.; Hinnig, P.F. [Departamento de Cliníca Médica, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Feder, D. [Departamento de Farmacologia, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Chagas, A.C.P. [Departamento de Cardiologia, Faculdade de Medicina do ABC, Santo André, SP (Brazil); Fonseca, F.L.A. [Departamento de Cliníca Médica, Faculdade de Medicina do ABC, Santo André, SP (Brazil)

    2015-02-24

    Community-acquired pneumonia (CAP) is amongst the leading causes of death worldwide. As inflammatory markers, cytokines can predict outcomes, if interpreted together with clinical data and scoring systems such as CURB-65, CRB, and Acute Physiology and Chronic Health Evaluation II (APACHE II). The aim of this study was to determine the impact of inflammatory biomarkers on the early mortality of hospitalized CAP patients. Twenty-seven CAP patients needing hospitalization were enrolled for the study and samples of interleukin-1 (IL-1) and interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), and homocystein were collected at the time of admission (day 1) as well as on the seventh day of the treatment. There was a significant reduction in the levels of IL-6 between the first and the second collections. Median IL-6 values decreased from 24 pg/mL (day 1) to 8 pg/mL (day 7) (P=0.016). The median levels of TNF-α were higher in patients: i) with acute kidney injury (AKI) (P=0.045), ii) requiring mechanical ventilation (P=0.040), iii) with short hospital stays (P=0.009), iv) admitted to the intensive care unit (ICU) (P=0.040), v) who died early (P=0.003), and vi) with worse CRB scores (P=0.013). In summary, IL-6 and TNF-α levels were associated with early mortality of CAP patients. Longer admission levels demonstrated greater likelihood of early death and overall mortality, necessity of mechanical ventilation, and AKI.

  17. A Pilot Study of Quantitative Loop-mediated Isothermal Amplification-guided Target Therapies for Hospital-acquired Pneumonia

    Institute of Scientific and Technical Information of China (English)

    Fang Wang; Ran Li; Ying Shang; Can Wang; Guo-Qing Wang; De-Xun Zhou; Dong-Hong Yang

    2016-01-01

    Background:It is important to achieve the definitive pathogen identification in hospital-acquired pneumonia (HAP),but the traditional culture results always delay the target antibiotic therapy.We assessed the method called quantitative loop-mediated isothermal amplification (qLAMP) as a new implement for steering of the antibiotic decision-making in HAP.Methods:Totally,76 respiratory tract aspiration samples were prospectively collected from 60 HAP patients.DNA was isolated from these samples.Specific DNA fragments for identifying 11 pneumonia-related bacteria were amplified by qLAMP assay.Culture results of these patients were compared with the qLAMP results.Clinical data and treatment strategies were analyzed to evaluate the effects of qLAMP results on clinical data.McNemar test and Fisher's exact test were used for statistical analysis.Results:The detection of Staphylococcus aureus,Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumonia,Stenotrophomonas maltophilia,Streptococcus pneumonia,and Acinetobacter baumannii by qLAMP was consistent with sputum culture (P > 0.05).The qLAMP results of 4 samples for Haemophilus influenzae,Legionella pneumophila,or Mycoplasma pneumonia (MP) were inconsistent with culture results;however,clinical data revealed that the qLAMP results were all reliable except 1 MP positive sample due to the lack of specific species identified in the final diagnosis.The improvement of clinical condition was more significant (P < 0.00l) in patients with pathogen target-driven therapy based on qLAMP results than those with empirical therapy.Conclusion:qLAMP is a more promising method for detection of pathogens in an early,rapid,sensitive,and specific manner than culture.

  18. Moxifloxacin pharmacokinetic profile and efficacy evaluation in empiric treatment of community-acquired pneumonia

    DEFF Research Database (Denmark)

    Öbrink-Hansen, Kristina; Hardlei, Tore Forsingdal; Brock, Birgitte;

    2015-01-01

    for each patient were evaluated against epidemiological cutoff MIC values for Streptococcus pneumoniae, Haemophilus influenzae, and Legionella pneumophila. PK-PD targets adopted were a Cmax/MIC of ≥12.2 for all pathogens, an fAUC0-24/MIC of >34 for S. pneumoniae, and an fAUC0-24/MIC of >75 for H....... influenzae and L. pneumophila. Individual predicted estimates for Cmax/MIC and fAUC0-24/MIC as well as simulated maximal MICs resulting in target attainment for oral and intravenous administration of the drug were suitable for S. pneumoniae and H. influenzae but not for L. pneumophila. These results indicate...

  19. Influence of socioeconomic status on community-acquired pneumonia outcomes in elderly patients requiring hospitalization: a multicenter observational study

    Directory of Open Access Journals (Sweden)

    Carratalà Jordi

    2010-07-01

    Full Text Available Abstract Background The associations between socioeconomic status and community-acquired pneumonia outcomes in adults have been studied although studies did not always document a relationship. The aim of this multicenter observational study was to determine the association between socioeconomic status and community-acquired pneumonia outcomes in the elderly, in the context of a public health system providing universal free care to the whole population. Methods A total of 651 patients aged ≥65 years hospitalized due to community-acquired pneumonia through the emergency departments of five Spanish public hospitals were recruited and followed up between May 2005 and January 2007. The primary outcomes studied were: length of stay, intensive care unit admission, overall mortality and readmission. Socioeconomic status was measured using both individual and community data: occupation [categorized in six social groups (I, II, III, IVa, IVb and V], educational level (≤ primary level or ≥ secondary level and disposable family income of the municipality or district of residence [>12,500 € (high municipality family income and ≤12,500 € (low municipality family income]. The six social groups were further categorized as upper/middle social class (groups I-IVb and lower class (group V. Bivariate and multivariate analyses were performed. OR and their 95% confidence intervals were calculated. All statistical tests were two tailed and statistical significance was established as p Results 17.7% of patients lived in a municipality or district with a high municipality family income and 63.6% were upper/middle social class (I-IVb. Only 15.7% of patients had a secondary education. The adjusted analysis showed no association between pneumonia outcomes and social class, educational level or municipality family income. However, length of stay increased significantly in patients in whom the factors, living alone and being a smoker or ex-smoker coincided (p

  20. Advancing New Antibacterial Drug Development for Treatment of Hospital-Acquired and Ventilator-Associated Bacterial Pneumonia.

    Science.gov (United States)

    Toerner, Joseph G; Rubin, Daniel

    2016-08-15

    The Clinical Trials Transformation Initiative (CTTI), a public-private partnership comprised of representatives from academia, the pharmaceutical industry, and the federal government including the US Food and Drug Administration, formed a group working toward a common goal of intensified research to facilitate the development of new antibacterial drug therapies for treatment of hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP). The summary of the CTTI HABP/VABP project in this supplement of Clinical Infectious Diseases is a first step in this direction. PMID:27481951

  1. The Impact of Hospital-Acquired Conditions on Medicare..

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in The Impact of Hospital-Acquired Conditions on Medicare Program Payments, published in Volume 4, Issue 4 of the Medicare and...

  2. Characteristic of the Oxidative Stress in Blood of Patients in Dependence of Community-Acquired Pneumonia Severity

    Science.gov (United States)

    Muravlyova, Larissa; Molotov–Luchankiy, Vilen; Bakirova, Ryszhan; Klyuyev, Dmitriy; Demidchik, Ludmila; Lee, Valentina

    2016-01-01

    BACKGROUND: At the present time the alternation of the oxidative metabolism is considered as one of the leading pathogenic mechanisms in the development and progression of community-acquired pneumonia (CAP). However the nature and direction of the oxidative protein changes in CAP patient’s blood had been almost unexplored. AIM: To define oxidative and modified proteins in erythrocytes and blood plasma of CAP patients. MATERIAL AND METHODS: Blood plasma and erythrocytes obtained from: 42 patients with moderate severity pneumonia, 12 patients with grave severity pneumonia and 32 healthy volunteers. Content of advanced oxidation protein products, malondialdehyde and reactive carbonyl derivatives were estimated as indicators of the oxidative stress and oxidative damage of proteins. RESULTS: In patients with grave severity the level of oxidative proteins and MDA in erythrocytes exceeded both: control values and similar meanings in CAP patients with moderate severity. The further growth of MDA in this group patients’ blood plasma was observed, but the level of oxidative proteins decreased in comparison with those in CAP patients with moderate severity. CONCLUSION: To sum up, our derived data show, that injury of erythrocytes’ redox-status and blood plasma components plays an essential role in development and progression CAP. PMID:27275344

  3. Community-acquired Pseudomonas aeruginosa-pneumonia in a previously healthy man occupationally exposed to metalworking fluids

    Directory of Open Access Journals (Sweden)

    Fernando Peixoto Ferraz de Campos

    2014-09-01

    Full Text Available Although the Pseudomonas aeruginosa infection is well known and frequently found in hospitals and nursing care facilities, many cases are also reported outside these boundaries. In general, this pathogen infects debilitated patients either by comorbidities or by any form of immunodeficiency. In cases of respiratory infection, tobacco abuse seems to play an important role as a risk factor. In previously healthy patients, community-acquired pneumonia (CAP with P. aeruginosa as the etiological agent is extremely rare, and unlike the cases involving immunocompromised or hospitalized patients, the outcome is severe, and is fatal in up to 61.1% of cases. Aerosolized contaminated water or solutions are closely linked to the development of respiratory tract infection. In this setting, metalworking fluids used in factories may be implicated in CAP involving previously healthy people. The authors report the case of a middle-aged man who worked in a metalworking factory and presented a right upper lobar pneumonia with a rapid fatal outcome. P. aeruginosa was cultured from blood and tracheal aspirates. The autopsy findings confirmed a hemorrhagic necrotizing pneumonia with bacteria-invading vasculitis and thrombosis. A culture of the metalworking fluid of the factory was also positive for P. aeruginosa. The pulsed-field gel electrophoresis showed that both strains (blood culture and metalworking fluid were genetically indistinguishable. The authors highlight the occupational risk for the development of this P. aeruginosa-infection in healthy people.

  4. Clinical and epidemiological characteristics of severe community-acquired pneumonia in children after introduction of the 10-valent pneumococcal vaccine

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    Lima EJF

    2015-08-01

    Full Text Available Eduardo JF Lima,1,2 Maria JG Mello,1,2 Maria FPM Albuquerque,3 Maria IL Lopes,4 George HC Serra,2 Maria AZ Abreu-Lima,2 Jailson B Correia1 1Instituto de Medicina Integral Prof. Fernando Figueira - IMIP Recife; 2Faculdade, Pernambucana de Saúde - FPS Recife; 3Centro de Pesquisas Aggeu Magalhães, FIOCRUZ; 4Hospital das Clínicas, Universidade Federal de Pernambuco - UFPE, Recife, Pernambuco, Brazil Background: Pneumonia is an important cause of morbimortality in Brazil, despite the extensive vaccination coverage and the socioeconomic improvement in the past years. Objective: To describe the epidemiological and clinical characteristics of severe community-acquired pneumonia in children after the introduction of the 10-valent pneumococcal conjugate vaccine (PCV10. Methods: A prospective study included children <5 years old hospitalized for pneumonia between October 2010 and September 2013 in a tertiary hospital. Newborns and children with comorbidities were excluded. Pneumonia classification followed the clinical and radiological criteria established by World Health Organization (WHO. Clinical history, nutritional status, immunizations, diagnosis, disease course, and prognosis were analyzed. Results: Among 452 children, almost 70% were <2 years, with no sex differences, and 10% had weight-for-age z score below than -2.0. Family income was up to one minimum wage in half the households, and 40% of mothers had completed high school. The suitability of both influenza and PCV10 vaccine schedules was ~50%. The first medical care happened later than 72 hours after the onset of symptoms in 42% of cases. Pneumonia was classified as severe or very severe in 83.9% of patients and for 23% as complicated. Global mortality was 1.5%. Hypoxia, diagnosed in 51.5% of children, looked like a better prognosis predictor than the WHO classification. Conclusion: New strategies for health care are necessary, such as the incorporation of peripheral saturometry as the

  5. Nasopharyngeal carriage of community-acquired, antibiotic-resistant Streptococcus pneumoniae in a Zambian paediatric population.

    OpenAIRE

    Woolfson, A; Huebner, R.; Wasas, A; Chola, S.; Godfrey-Faussett, P.; Klugman, K.

    1997-01-01

    The emergence of antibiotic-resistant Streptococcus pneumoniae is an international health problem. Apart from South Africa few data on pneumococcal resistance are available for sub-Saharan Africa. This study examines the nasopharyngeal carriage and prevalence of antibiotic resistance in pneumococci isolated from 260 Zambian children aged < 6 years. Pneumococci were isolated from 71.9% of the children; the odds of carrying organisms were twice as high among children < 2 years of age compared w...

  6. Prevalence of Ventilator Acquired Pneumonia in Organophosphorus Poisoning Patients in Tertiary Care Hospital

    OpenAIRE

    Merry Raphael; Seyed Hanif Karimzad; Jatin Agarwal; Anirudh Arun Bhandakar; Girish Thunga; Shreedhar N; Vijayanarayana K; Muralidhar Varma; Sureshwar Pandey

    2015-01-01

    Background: Ventilator associated pneumonia (VAP) is a major cause of poor outcome among patients in the intensive care units (ICU) world-wide. OP poisoning patients are very susceptible to respiratory associated problems especially respiratory muscle paralysis. Such patients generally need ventilation support which has high chances of getting VAP. Objective: To find out the Prevalence, causative organisms and treatment pattern of VAP in OP poisoning patients in tertiary care hospital in Sout...

  7. Acquired resistance to innate immune clearance promotes Klebsiella pneumoniae ST258 pulmonary infection

    Science.gov (United States)

    Ahn, Danielle; Peñaloza, Hernán; Wang, Zheng; Wickersham, Matthew; Parker, Dane; Patel, Purvi; Koller, Antonius; Chen, Emily I.; Bueno, Susan M.; Uhlemann, Anne-Catrin; Prince, Alice

    2016-01-01

    Adaptive changes in the genome of a locally predominant clinical isolate of the multidrug-resistant Klebsiella pneumoniae ST258 (KP35) were identified and help to explain the selection of this strain as a successful pulmonary pathogen. The acquisition of 4 new ortholog groups, including an arginine transporter, enabled KP35 to outcompete related ST258 strains lacking these genes. KP35 infection elicited a monocytic response, dominated by Ly6Chi monocytic myeloid-derived suppressor cells that lacked phagocytic capabilities, expressed IL-10, arginase, and antiinflammatory surface markers. In comparison with other K. pneumoniae strains, KP35 induced global changes in the phagocytic response identified with proteomics, including evasion of Ca2+ and calpain activation necessary for phagocytic killing, confirmed in functional studies with neutrophils. This comprehensive analysis of an ST258 K. pneumoniae isolate reveals ongoing genetic adaptation to host microenvironments and innate immune clearance mechanisms that complements its repertoire of antimicrobial resistance genes and facilitates persistence in the lung. PMID:27777978

  8. Guidelines and management of hospitalized patients with community-acquired pneumonia: the Italian experience of the FASTCAP study

    Directory of Open Access Journals (Sweden)

    I. Iori

    2013-05-01

    Full Text Available BACKGROUND Nowadays few data are available addressing the validation of guidelines concerning diagnosis and treatment of Community-Acquired Pneumonia (CAP in clinical practice. AIM OF THE STUDY To evaluate the impact of compliance to the recommendations issued by the Italian Federation of Internal Medicine (FADOI in 2002 on the management of hospitalised CAP. METHODS National, multicentre, interventional, “before-after” survey, performed in 31 hospitals in Italy. All patients with CAP of Fine class IV or V (excluding those who were directly admitted to intensive care units were included. The study was composed of three consecutive periods: 1 a retrospective phase (RP; 2 guideline implementation; 3 a prospective phase (PP. Results were expressed as Odds Ratios (OR with 95% confidence intervals (95% CI adjusted for risk factors and corrected for multiple comparisons in subgroups. RESULTS A significant increase in use of combinations was observed in the PP (p = 0.006. Moreover, a shift of prescription from β-lactams to fluoroquinolones as initial monotherapy was recorded. Therapies adherent to FADOI recommendations increased by 10.9% in the PP (p < 0.001. Therapeutic success improved after implementation of recommendations (73.9 vs 71.5%; OR = 0.83; 95% CI = 0.69-1.00; p = 0.049. The difference was particularly evident in Fine class V (58.0 vs 52.5%; OR = 0.71; 95% CI = 0.51-0.98; p = 0.036, where a trend towards a lower mortality occurred (23.1 vs 26.3%; OR = 0.71; 95% CI = 0.48-1.05; p = 0.090. Therapies compliant with FADOI recommendations showed a higher success rate in both study phases (76.6% vs 70.3%; OR = 0.74; 95% CI = 0.60-0.90; p = 0.004. Levofloxacin was the most clinically effective first-cycle therapy with 79.1% of success, the least effective being an antipneumococcal cephalosporin alone with 68.6% (OR = 0.72; 95% CI = 0.51-1.01; p = 0.053. Etiologic diagnosis was obtained in less than 12% of patients in both study phases. Mean

  9. Neumonía grave del adulto adquirida en la comunidad SEVERE COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

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    Francisco Arancibia H.

    2005-04-01

    Full Text Available El paciente con neumonía grave adquirida en la comunidad es aquel que necesita de la vigilancia y monitorización de una Unidad de Cuidados Intensivos (UCI donde, si es necesario, puede recibir apoyo especializado con conexión a un ventilador mecánico y/o soporte hemodinámico. Los pacientes que requieren tratamiento en la UCI representan entre 10 y 30% de los pacientes hospitalizados por neumonía. En esta categoría, la tasa de complicaciones, estadía en el hospital y mortalidad son elevadas. Los criterios para neumonía grave de la Sociedad Americana de Tórax (American Thoracic Society-ATS son: criterios mayores: necesidad de ventilación mecánica y presencia de shock séptico; criterios menores: presión sistólica 20 mg/dl y confusión mental. En todos los pacientes con neumonía adquirida en la comunidad se recomienda evaluar la gravedad de la infección en el momento de su admisión al hospital. Esta evaluación es preferible realizarla junto a un médico con experiencia, y si presenta criterios de mal pronóstico se sugiere trasladar precozmente a la UCI. Son útiles para esta evaluación los criterios de la ATS y los criterios de la BTS modificados (CURB. En los pacientes con neumonía grave adquirida en la comunidad se recomienda solicitar los siguientes exámenes microbiológicos: tinción de Gram y cultivo de expectoración, hemocultivos, tinción de Gram y cultivo de líquido pleural, antígeno urinario de Legionella pneumophila, antígenos de virus influenza A y B (período epidémico de otoño-invierno, y serología para microorganismos atípicos (Mycoplasma pneumoniae y Chlamydia pneumoniaePatients with severe community acquired pneumonia (CAP need continuous surveillance and monitoring at intensive care units (ICU, where they can receive specialized support as mechanical ventilation and/or hemodynamic support. Patients that require ICU admittance represent 10 to 30% of all patients interned because a pneumonia. In this

  10. Neumonia adquirida en la comunidad en dos poblaciones hospitalarias Community-acquired pneumonia in patients from two different hospitals

    Directory of Open Access Journals (Sweden)

    O. J. Caberlotto

    2003-01-01

    Full Text Available Se estudiaron en forma prospectiva pacientes con diagnóstico de neumonía adquirida en la comunidad que acudieron a la consulta en un hospital general y en un centro especializado en medicina respiratoria ubicados en la provincia de Buenos Aires, y que requirieron internación. Se evaluaron la distribución por sexo y edad, las comorbilidades asociadas, los agentes etiológicos, su incidencia y la mortalidad. Se incluyeron 52 pacientes (marzo 1998-febrero 1999 del Hospital General de Agudos Manuel Belgrano (HMB y 23 pacientes (junio 2000-mayo 2001 del Hospital del Tórax Dr. Antonio A. Cetrángolo (HCET. Se excluyeron pacientes con tuberculosis o micosis pulmonar, neoplasia de pulmón y diagnóstico serológico para HIV. Se completó una historia clínica y se realizaron estudios microbiológicos para gérmenes comunes, virus respiratorios y micobacterias. Para el estudio de los agentes productores de neumonías atípicas (Chlamydia spp, Coxiella burnetii, Mycoplasma pneumoniae y Legionella spp. y como complemento del estudio virológico, se utilizaron pruebas serológicas. No se observaron diferencias por sexo y edad en los dos grupos. En el HMB las comorbilidades más frecuentes fueron EPOC, diabetes e insuficiencia cardíaca, en tanto que en el HCET fueron EPOC, asma y fibrosis pulmonar. Se obtuvo un diagnóstico microbiológico en el 48% y 65.2% de los pacientes para ambos grupos. Los agentes hallados más frecuentemente fueron Mycoplasma pneumoniae, Streptococcus pneumoniae, influenza A y Legionella spp, este último germen con una incidencia del 12% en pacientes que evolucionaron favorablemente y que en su mayoría pertenecían al HMB. La mortalidad fue similar para ambos grupos (13.3%. En el HMB estuvo relacionada con la existencia de comorbilidades en 7 de 8 casos y en el HCET con el agravamiento de la insuficiencia respiratoria crónica.Patients hospitalized with community acquired pneumonia were studied prospectively in two hospitals

  11. Prevalence and clinical features of respiratory syncytial virus in children hospitalized for community-acquired pneumonia in northern Brazil

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    Lamarão Letícia

    2012-05-01

    Full Text Available Abstract Background Childhood pneumonia and bronchiolitis is a leading cause of illness and death in young children worldwide with Respiratory Syncytial Virus (RSV as the main viral cause. RSV has been associated with annual respiratory disease outbreaks and bacterial co-infection has also been reported. This study is the first RSV epidemiological study in young children hospitalized with community-acquired pneumonia (CAP in Belém city, Pará (Northern Brazil. Methods With the objective of determining the prevalence of RSV infection and evaluating the patients’ clinical and epidemiological features, we conducted a prospective study across eight hospitals from November 2006 to October 2007. In this study, 1,050 nasopharyngeal aspirate samples were obtained from hospitalized children up to the age of three years with CAP, and tested for RSV antigen by direct immunofluorescence assay and by Reverse Transcription Polymerase Chain Reaction (RT-PCR for RSV Group identification. Results RSV infection was detected in 243 (23.1% children. The mean age of the RSV-positive group was lower than the RSV-negative group (12.1 months vs 15.5 months, pppppp Conclusion The present study highlights the relevance of RSV infection in hospitalized cases of CAP in our region; our findings warrant the conduct of further investigations which can help design strategies for controlling the disease.

  12. Plasma Monocyte Chemoattractant Protein-1 Level as a Predictor of the Severity of Community-Acquired Pneumonia.

    Science.gov (United States)

    Yong, Kok-Khun; Chang, Jer-Hwa; Chien, Ming-Hsien; Tsao, Shih-Ming; Yu, Ming-Chih; Bai, Kuan-Jen; Tsao, Thomas Chang-Yao; Yang, Shun-Fa

    2016-01-29

    Monocyte chemoattractant protein (MCP)-1 increases in the serum of immunocompetent patients with community-acquired pneumonia (CAP). However, the correlation between the circulating level of MCP-1 and severity of CAP remains unclear. This study investigated differential changes in the plasma MCP-1 levels of patients with CAP before and after an antibiotic treatment and further analyzes the association between the CAP severity and MCP-1 levels. We measured the plasma MCP-1 levels of 137 patients with CAP and 74 healthy controls by using a commercial enzyme-linked immunosorbent assay. Upon initial hospitalization, Acute Physiology and Chronic Health Evaluation II (APACHE II); confusion, urea level, respiratory rate, blood pressure, and age of >64 years (CURB-65); and pneumonia severity index (PSI) scores were determined for assessing the CAP severity in these patients. The antibiotic treatment reduced the number of white blood cells (WBCs) and neutrophils as well as the level of C-reactive protein (CRP) and MCP-1. The plasma MCP-1 level, but not the CRP level or WBC count, correlated with the CAP severity according to the PSI (r = 0.509, p < 0.001), CURB-65 (r = 0.468, p < 0.001), and APACHE II (r = 0.360, p < 0.001) scores. We concluded that MCP-1 levels act in the development of CAP and are involved in the severity of CAP.

  13. Influence of HIV infection on the clinical presentation and outcome of adults with acute community-acquired pneumonia in Yaounde, Cameroon: a retrospective hospital-based study

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    Yone Eric Walter

    2012-08-01

    Full Text Available Abstract Background The impact of HIV infection on the evolution of acute community-acquired pneumonia (CAP is still controversial. The aim of this study was to investigate possible differences in the clinical presentation and in-hospital outcomes of patients with CAP with and without HIV infection in a specialised service in Yaounde. Methods Medical files of 106 patients (51 men aged 15 years and above, admitted to the Pneumology service of the Yaounde Jamot Hospital between January 2008 and May 2012, were retrospectively studied. Results Sixty-two (58.5% patients were HIV infected. The median age of all patients was 40 years (interquartile range: 31.75-53 and there was no difference in the clinical and radiological profile of patients with and without HIV infection. The median leukocyte count (interquartile range was 14,600/mm3 (10,900-20,600 and 10,450/mm3 (6,400-16,850 respectively in HIV negative and HIV positive patients (p = 0.002. Median haemoglobin level (interquartile range was 10.8 g/dl (8.9-12 in HIV negative and 9.7 g/dl (8–11.6 in HIV positive patients (p = 0.025. In-hospital treatment failure on third day (39.5% vs. 25.5.1%, p = 0.137 and mortality rates (9% vs. 14.5%, p = 0.401 were similar between HIV negative and HIV positive patients. Conclusion Clinical and radiological features as well as response to treatment and in hospital fatal outcomes are similar in adult patients hospitalised with acute community-acquired pneumonia in Yaounde. In contrast, HIV infected patients tend to be more anaemic and have lower white cell counts than HIV negative patients. Larger prospective studies are needed to consolidate these findings.

  14. Time to first antibiotic and mortality in adults hospitalised with community-acquired pneumonia: a matched-propensity analysis.

    Science.gov (United States)

    Daniel, Priya; Rodrigo, Chamira; Mckeever, Tricia M; Woodhead, Mark; Welham, Sally; Lim, Wei Shen

    2016-06-01

    A matched-propensity analysis of national data from the British Thoracic Society community-acquired pneumonia audit was conducted (n=13 725). Overall, time to first antibiotic (TFA) was ≤4 h in 63%. Adjusted 30-day inpatient (IP) mortality was lower for adults with TFA ≤4 h compared with TFA >4 h (adjusted OR 0.84, 95% CI 0.74 to 0.94; p=0.003). Increasing TFA was associated with greater OR of 30-day IP mortality (p value for trend=0.001), but no TFA threshold was evident. Although we found an association between TFA and mortality, we cannot say whether this is causal or whether TFA might just be a quality measure for overall or other processes of care. PMID:26559161

  15. Seroepidemiology of Coxiella burnetii Infection and its Frequency as a Cause of Community-Acquired Pneumonia in Canada

    Directory of Open Access Journals (Sweden)

    Thomas J Marrie

    2002-01-01

    Full Text Available The present study tested acute and convalescent serum samples from 788 patients hospitalized for community-acquired pneumonia in seven Canadian provinces for antibodies to Coxiella burnetii. One hundred nine patients (13.8% had antibodies to this microorganism, and seven patients had acute Q fever. Serological evidence of infection with C burnetii was present in patients from all seven provinces. Three of the seven cases of acute Q fever were from Manitoba, suggesting that there may be unrecognized cases of Q fever in this province. In addition, a case of acute Q fever in Newfoundland, where there had previously been no reported cases, was noted, although subsequently, an outbreak of Q fever on goat farms has been reported.

  16. An unusual masquerade of community acquired pneumonia: Left-side unilateral pulmonary edema

    Directory of Open Access Journals (Sweden)

    Akashdeep Singh

    2013-01-01

    Full Text Available The diagnosis of pneumonia is clinical, based on the history of lower respiratory tract symptoms, physical, and/or radiographic signs of consolidation. Several diseases such as congestive heart failure, pulmonary embolism, and chemical pneumonitis may present with similar symptoms, signs, and chest radiographs, thus delaying the definitive diagnosis and initiation of appropriate treatment. Unilateral pulmonary edema (UPE is a rare clinical entity that is often misdiagnosed at first as a focal lung disease. We have presented an unusual case of left-sided UPE in a 76-year-old man who developed acute heart failure resulting from dietary and pharmacological noncompliance. The patient was successfully managed with decongestive therapy and non-invasive mechanical ventilation.

  17. Clinical Characteristics of Q Fever and Etiology of Community-Acquired Pneumonia in a Tropical Region of Southern Taiwan: A Prospective Observational Study

    Science.gov (United States)

    Lai, Chung-Hsu; Chang, Lin-Li; Lin, Jiun-Nong; Chen, Wei-Fang; Wei, Yu-Feng; Chiu, Chien-Tung; Wu, Jiun-Ting; Hsu, Chi-Kuei; Chen, Jung-Yueh; Lee, Ho-Sheng; Lin, Hsi-Hsun; Chen, Yen-Hsu

    2014-01-01

    Background The clinical characteristics of Q fever are poorly identified in the tropics. Fever with pneumonia or hepatitis are the dominant presentations of acute Q fever, which exhibits geographic variability. In southern Taiwan, which is located in a tropical region, the role of Q fever in community-acquired pneumonia (CAP) has never been investigated. Methodology/Principal Findings During the study period, May 2012 to April 2013, 166 cases of adult CAP and 15 cases of acute Q fever were prospectively investigated. Cultures of clinical specimens, urine antigen tests for Streptococcus pneumoniae and Legionella pneumophila, and paired serologic assessments for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Q fever (Coxiella burnetii) were used for identifying pathogens associated with CAP. From April 2004 to April 2013 (the pre-study period), 122 cases of acute Q fever were also included retrospectively for analysis. The geographic distribution of Q fever and CAP cases was similar. Q fever cases were identified in warmer seasons and younger ages than CAP. Based on multivariate analysis, male gender, chills, thrombocytopenia, and elevated liver enzymes were independent characteristics associated with Q fever. In patients with Q fever, 95% and 13.5% of cases presented with hepatitis and pneumonia, respectively. Twelve (7.2%) cases of CAP were seropositive for C. burnetii antibodies, but none of them had acute Q fever. Among CAP cases, 22.9% had a CURB-65 score ≧2, and 45.8% had identifiable pathogens. Haemophilus parainfluenzae (14.5%), S. pneumoniae (6.6%), Pseudomonas aeruginosa (4.8%), and Klebsiella pneumoniae (3.0%) were the most common pathogens identified by cultures or urine antigen tests. Moreover, M. pneumoniae, C. pneumoniae, and co-infection with 2 pathogens accounted for 9.0%, 7.8%, and 1.8%, respectively. Conclusions In southern Taiwan, Q fever is an endemic disease with hepatitis as the major presentation and is not a common etiology of CAP

  18. Clinical characteristics of Q fever and etiology of community-acquired pneumonia in a tropical region of southern Taiwan: a prospective observational study.

    Directory of Open Access Journals (Sweden)

    Chung-Hsu Lai

    Full Text Available The clinical characteristics of Q fever are poorly identified in the tropics. Fever with pneumonia or hepatitis are the dominant presentations of acute Q fever, which exhibits geographic variability. In southern Taiwan, which is located in a tropical region, the role of Q fever in community-acquired pneumonia (CAP has never been investigated.During the study period, May 2012 to April 2013, 166 cases of adult CAP and 15 cases of acute Q fever were prospectively investigated. Cultures of clinical specimens, urine antigen tests for Streptococcus pneumoniae and Legionella pneumophila, and paired serologic assessments for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Q fever (Coxiella burnetii were used for identifying pathogens associated with CAP. From April 2004 to April 2013 (the pre-study period, 122 cases of acute Q fever were also included retrospectively for analysis. The geographic distribution of Q fever and CAP cases was similar. Q fever cases were identified in warmer seasons and younger ages than CAP. Based on multivariate analysis, male gender, chills, thrombocytopenia, and elevated liver enzymes were independent characteristics associated with Q fever. In patients with Q fever, 95% and 13.5% of cases presented with hepatitis and pneumonia, respectively. Twelve (7.2% cases of CAP were seropositive for C. burnetii antibodies, but none of them had acute Q fever. Among CAP cases, 22.9% had a CURB-65 score ≧2, and 45.8% had identifiable pathogens. Haemophilus parainfluenzae (14.5%, S. pneumoniae (6.6%, Pseudomonas aeruginosa (4.8%, and Klebsiella pneumoniae (3.0% were the most common pathogens identified by cultures or urine antigen tests. Moreover, M. pneumoniae, C. pneumoniae, and co-infection with 2 pathogens accounted for 9.0%, 7.8%, and 1.8%, respectively.In southern Taiwan, Q fever is an endemic disease with hepatitis as the major presentation and is not a common etiology of CAP.

  19. Enterovirus D68-associated community-acquired pneumonia in children living in Milan, Italy

    NARCIS (Netherlands)

    Esposito, Susanna; Zampiero, Alberto; Ruggiero, Luca; Madini, Barbara; Niesters, Hubert; Principi, Nicola

    2015-01-01

    Background: An increasing number of children infected by enterovirus D68 (EV-D68) and affected by severe respiratory illness, muscle weakness and paralysis were described in the USA and Canada in 2014 Objectives: To investigate the potential involvement of EV-D68 in determining community-acquired pn

  20. Epidemiology of community-acquired pneumonia and implications for vaccination of children living in developing and newly industrialized countries: A systematic literature review

    Science.gov (United States)

    DeAntonio, Rodrigo; Yarzabal, Juan-Pablo; Cruz, James Philip; Schmidt, Johannes E.; Kleijnen, Jos

    2016-01-01

    ABSTRACT This systematic review evaluated the epidemiology of community-acquired pneumonia in children <6 y of age within 90 developing and newly industrialized countries. Literature searches (1990–2011), based on MEDLINE, EMBASE, Cochrane, CAB Global Health, WHO, UNICEF, country-specific websites, conferences, health-technology-assessment agencies, and the reference lists of included studies, yielded 8,734 records; 62 of 340 studies were included in this review. The highest incidence rate among included studies was 0.51 episodes/child-year, for children <5 y of age in Bangladesh. The highest prevalence was in Chinese children <6 months of age (37.88%). The main bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae and the main viral pathogens were respiratory syncytial virus, adenovirus and rhinovirus. Community-acquired pneumonia remains associated with high rates of morbidity and mortality. Improved and efficient surveillance and documentation of the epidemiology and burden of community-acquired pneumonia across various geographical regions is warranted. PMID:27269963

  1. Integrated assessment of inflammatory process accompanying community-acquired pneumonia by means of radiometry

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    Kondratjev A.S.

    2011-12-01

    Full Text Available The purpose of the article is to analyze possibility of active SHF radiometry use for inflammation monitoring in lower departments of lungs. Materials and methods: Analysis of humoral immunity (cytokine, complement and immunoglobu-lin status, angiogenesis, and modifications of extracellular matrix has been made by immune-enzyme method. Serum concentration of IL-1(3, IL-1Ra, TGF-(31, C3 and C5a components of complement system and lg M, lg G, VEGF-A, ММП-13 and TIMMP-2 has been estimated in the research. Intensity of radiation of lungs has been studied. Results: Synchronism of radiation dynamics with molecular markers has been determined. The period of changes of specified mediators is about 2 days. Critical time points of pathological process (3, 6, 8, 11 and 16 days have been found out. Conclusions: It has been proved that SHF radiation of lungs may be applied in treatment of pneumonia for pathology monitoring

  2. Effect of practical use of preoperative immunonutrition with Impact on prevention of postoperative pneumonia after esophagectomy

    International Nuclear Information System (INIS)

    To clarify the clinical benefits of administering immune-enhancing diet, Impact, we examined retrospectively the effect of preoperative immunonutrition with Impact on prevention of postoperative pneumonia after esophagectomy. In 47 patients without preoperative radiotherapy, no patient who preoperatively administered Impact ≥2,250 mL failed to develop pneumonia. The patients whose postoperative hospital stay was more than 30 days were administered Impact ≤2,000 mL except for one case. These results suggest that even preoperative administration of less amount of Impact than an estimated maximum dose, depending on patients' condition, may be beneficial to prevent postoperative pneumonia and a long hospital stay after surgery. (author)

  3. Time for first antibiotic dose is not predictive for the early clinical failure of moderate-severe community-acquired pneumonia

    NARCIS (Netherlands)

    Bruns, A. H. W.; Oosterheert, J. J.; Hustinx, W. N. M.; Gaillard, C. A. J. M.; Hak, E.; Hoepelman, A. I. M.

    2009-01-01

    The time to first antibiotic dose (TFAD) has been mentioned as an important performance indicator in community-acquired pneumonia (CAP). However, the advice to minimise TFAD to 4 hours (4 h) is only based on database studies. We prospectively studied the effect of minimising the TFAD on the early cl

  4. D-dimer levels in assessing severity and clinical outcome in patients with community-acquired pneumonia. A secondary analysis of a randomised clinical trial

    NARCIS (Netherlands)

    Snijders, Dominic; Schoorl, Margreet; Schoorl, Marianne; Bartels, Piet C.; van der Werf, Tjip S.; Boersma, Wim G.

    2012-01-01

    Background: D-dimer levels are in several studies elevated in patients with CAP. In this study we assess the use of D-dimer levels and its association with severity assessment and clinical outcome in patients hospitalised with community-acquired pneumonia. Methods: In a subset of randomised trial pa

  5. The value of signs and symptoms in differentiating between bacterial, viral and mixed aetiology in patients with community-acquired pneumonia

    NARCIS (Netherlands)

    Huijskens, Elisabeth G. W.; Koopmans, Marion; Palmen, Fernand M. H.; van Erkel, Adriana J. M.; Mulder, Paul G. H.; Rossen, John W. A.

    2014-01-01

    Current diagnostics for community-acquired pneumonia (CAP) include testing for a wide range of pathogens, which is costly and not always informative. We compared clinical and laboratory parameters of patients with CAP caused by different groups of pathogens to evaluate the potential for targeted dia

  6. Evaluation of Patients with Community-Acquired Pneumonia Caused by Zoonotic Pathogens in an Area with a High Density of Animal Farms

    NARCIS (Netherlands)

    Huijskens, E. G. W.; Smit, L. A. M.; Rossen, J. W. A.; Heederik, D.; Koopmans, Marion

    2016-01-01

    Intensive animal farming could potentially lead to outbreaks of infectious diseases. Clinicians are at the forefront of detecting unusual diseases, but the lack of specificity of zoonotic disease symptoms makes this a challenging task. We evaluated patients with community-acquired pneumonia (CAP) wi

  7. Evaluation of Patients with Community-Acquired Pneumonia Caused by Zoonotic Pathogens in an Area with a High Density of Animal Farms

    NARCIS (Netherlands)

    Huijskens, E. G .W.; Smit, L. A. M.; Rossen, J. W. A.; Heederik, D; Koopmans, M

    2015-01-01

    Intensive animal farming could potentially lead to outbreaks of infectious diseases. Clinicians are at the forefront of detecting unusual diseases, but the lack of specificity of zoonotic disease symptoms makes this a challenging task. We evaluated patients with community-acquired pneumonia (CAP) wi

  8. The clinical significance of changes in red blood cell distribution width in patients with community-acquired pneumonia

    Science.gov (United States)

    Lee, Sang-Min; Lee, Jae Hyuk; Kim, Kyuseok; Jo, You Hwan; Lee, Jungyoup; Kim, Joonghee; Hwang, Ji Eun; Ko, Young Sang; Ha, Chulmin; Jang, Sujin; Park, Hyunmi

    2016-01-01

    Objective Red cell distribution width (RDW) is associated with mortality in patients with community-acquired pneumonia (CAP). However, little is known about the effect of changes in RDW during treatment on mortality. Thus, the objective of this study was to evaluate the association between RDW changes and mortality in hospitalized patients with CAP. Methods Retrospective analyses were performed using medical records of patients hospitalized for CAP from April 2008 to February 2014. The abstracted laboratory values included RDW (from days one to four), clinical variables, and pneumonia severity index (PSI) scores. The ΔRDWn-1 was defined as the change in RDW calculated as: (RDWday1-RDWday-n)/RDWday1×100 (%), where ‘day n’ refers to hospital day. Results During the study period, a total of 1,069 patients were hospitalized for CAP. The 30-day mortality was 100/1,069 (9.4%). The median RDW at baseline was 14.1% (range, 11.1 to 30.2) and differed significantly between survivors and non-survivors (P<0.05). There were 470 patients with available serial RDW data (30-day mortality 58/470 [12.3%]). Of those, age, PSI score, blood urea nitrogen level, total protein concentration, albumin level, RDW at day 1, and the ΔRDW4-1 differed significantly between survivors and non-survivors. Multivariate Cox regression analysis showed that the significance of the relationship between ΔRDW4-1 and 30-day mortality risk remained after adjusting for age, PSI score, RDW at day 1, total protein concentration, and initial albumin level. Conclusion RDW change from day 1 to day 4 was an independent predictor of mortality in patients with CAP.

  9. Etiology of community-acquired pneumonia in a population-based study: Link between etiology and patients characteristics, process-of-care, clinical evolution and outcomes

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    Capelastegui Alberto

    2012-06-01

    Full Text Available Abstract Background The etiologic profile of community-acquired pneumonia (CAP for each age group could be similar among inpatients and outpatients. This fact brings up the link between etiology of CAP and its clinical evolution and outcome. Furthermore, the majority of pneumonia etiologic studies are based on hospitalized patients, whereas there have been no recent population-based studies encompassing both inpatients and outpatients. Methods To evaluate the etiology of CAP, and the relationship among the different pathogens of CAP to patients characteristics, process-of-care, clinical evolution and outcomes, a prospective population-based study was conducted in Spain from April 1, 2006, to June 30, 2007. Patients (age >18 with CAP were identified through the family physicians and the hospital area. Results A total of 700 patients with etiologic evaluation were included: 276 hospitalized and 424 ambulatory patients. We were able to define the aetiology of pneumonia in 55.7% (390/700. The most frequently isolated organism was S. pneumoniae (170/390, 43.6%, followed by C. burnetti (72/390, 18.5%, M. pneumoniae (62/390, 15.9%, virus as a group (56/390, 14.4%, Chlamydia species (39/390, 106%, and L. pneumophila (17/390, 4.4%. The atypical pathogens and the S. pneumoniae are present in pneumonias of a wide spectrum of severity and age. Patients infected by conventional bacteria were elderly, had a greater hospitalization rate, and higher mortality within 30 days. Conclusions Our study provides information about the etiology of CAP in the general population. The microbiology of CAP remains stable: infections by conventional bacteria result in higher severity, and the S. pneumoniae remains the most important pathogen. However, atypical pathogens could also infect patients in a wide spectrum of severity and age.

  10. Computed tomography of the lungs in acquired immunodeficiency syndrome. An early indicator of interstitial pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Hartelius, H.; Gaub, J.; Jensen, L.I.; Jensen, J.; Faber, V.

    Computed tomography of the chest was performed on 42 occasions as part of the diagnostic work-up in 26 homosexual men with, or suspected of the acquired immunodeficiency syndrome (AIDS). In 17 cases both the chest radiographs and the lung scans were abnormal, and bronchoscopy and/or lung biopsy established an etiologic diagnosis in the majority of these cases. In 9 cases CT of the lungs revealed unequivocal interstitial infiltration in the presence of a normal chest radiography, and subsequently and etiologic agent was demonstrated in all these cases. In 9 cases, patients with symptoms indicative of pulmonary infection had both a normal chest radiograph and a normal lung scan, and in none of these cases did the clinical course or additional diagnostic procedures indicate the presence of current opportunistic lung infection. CT of the lungs seems to identify accurately those patients with severe HIV-related diseases in whom invasive diagnostic procedures such as bronchoalveolar lavage and/or lung biopsy should be done.

  11. Summary of Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society

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    Lionel A Mandell

    2000-01-01

    Full Text Available Community-acquired pneumonia (CAP is a serious illness with a significant impact on individual patients and society as a whole. Over the past several years, there have been significant advances in our knowledge and understanding of the etiology of the disease, and an appreciation of problems such as mixed infections and increasing antimicrobial resistance. The development of additional fluoroquinolone agents with enhanced activity against Streptococcus pneumoniae has been important as well. It was decided that the time had come to update and modify the previous CAP guidelines, which were published in 1993. The current guidelines represent a joint effort by the Canadian Infectious Disease Society and the Canadian Thoracic Society, and they address the etiology, diagnosis and initial management of CAP. The diagnostic section is based on the site of care, and the treatment section is organized according to whether one is dealing with outpatients, inpatients or nursing home patients.

  12. Summary of Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Disease Society and the Canadian Thoracic Society

    Directory of Open Access Journals (Sweden)

    Lionel A Mandell

    2000-01-01

    Full Text Available Community-acquired pneumonia (CAP is a serious illness with a significant impact on individual patients and society as a whole. Over the past several years, there have been significant advances in the knowledge and understanding of the etiology of the disease, and an appreciation of problems such as mixed infections and increasing antimicrobial resistance. The development of additional fluoroquinolone agents with enhanced activity against Streptococcus pneumoniae has been important as well. It was decided that the time had come to update and modify the previous CAP guidelines, which were published in 1993. The current guidelines represent a joint effort by the Canadian Infectious Diseases Society and the Canadian Thoracic Society, and they address the etiology, diagnosis and initial management of CAP. The diagnostic section is based on the site of care, and the treatment section is organized according to whether one is dealing with outpatients, inpatients or nursing home patients.

  13. Antibiotic expected effectiveness and cost under real life microbiology: evaluation of ertapenem and ceftriaxone in the treatment of community-acquired pneumonia for elderly patients in Spain

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    Grau S

    2014-02-01

    Full Text Available Santiago Grau,1 Virginia Lozano,2 Amparo Valladares,3 Rafael Cavanillas,4 Yang Xie,5 Gonzalo Nocea3 1Hospital del Mar, Barcelona, Spain; 2Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain; 3Outcomes Research Merck Sharp and Dohme Ltd, Madrid, Spain; 4Medical Affairs, Merck Sharp and Dohme Ltd, Madrid, Spain; 5Global Health Outcomes, Merck Sharp and Dohme Ltd, Whitehouse Station, NJ, USA Background: Clinical efficacy of antibiotics may be affected by changes in the susceptibility of microorganisms to antimicrobial agents. The purpose of this study is to assess how these changes could affect the initial efficacy of ertapenem and ceftriaxone in the treatment of community-acquired pneumonia (CAP in elderly patients and the potential consequences this may have in health care costs. Methods: Initial efficacy in elderly was obtained from a combined analysis of two multicenter, randomized studies. An alternative scenario was carried out using initial efficacy data according to the pneumonia severity index (PSI. Country-specific pathogens distribution was obtained from a national epidemiological study, and microbiological susceptibilities to first- and second-line therapies were obtained from Spanish or European surveillance studies. A decision analytic model was used to compare ertapenem versus ceftriaxone for CAP inpatient treatment. Inputs of the model were the expected effectiveness previously estimated and resource use considering a Spanish national health system perspective. Outcomes include difference in proportion of successfully treated patients and difference in total costs between ertapenem and ceftriaxone. The model performed one-way and probabilistic sensitivity analyses. Results: First-line treatment of CAP with ertapenem led to a higher proportion of successfully treated patients compared with ceftriaxone in Spain. One-way sensitivity analysis showed that length of stay was the key parameter of the model. Probabilistic

  14. [Critical evaluation and predictive value of clinical presentation in out-patients with acute community-acquired pneumonia].

    Science.gov (United States)

    Mayaud, C; Fartoukh, M; Prigent, H; Parrot, A; Cadranel, J

    2006-01-01

    Diagnostic probability of community-acquired pneumonia (CAP) depends on data related to age and clinical and radiological findings. The critical evaluation of data in the literature leads to the following conclusions: 1) the prevalence of CAP in a given population with acute respiratory disease is 5% in outpatients and 10% in an emergency care unit. This could be as low as 2% in young people and even higher than 40% in hospitalized elderly patients; 2) the collection of clinical data is linked to the way the patient is examined and to the expertise of the clinician. The absolute lack of "vital signs" has a good negative predictive value in CAP; presence of unilateral crackles has a good positive predictive value; 3) there is a wide range of X-ray abnormalities: localized alveolar opacities; interstitial opacities, limited of diffused. The greatest radiological difficulties are encountered in old people with disorders including chronic respiratory or cardiac opacities and as a consequence of the high prevalence of bronchopneumonia episodes at this age; 4) among patients with lower respiratory tract (LRT) infections, the blood levels of leukocytes, CRP and procalcitonine are higher in CAP patients, mainly when their disease has a bacterial origin. Since you have not a threshold value reliably demonstrated in large populations with LRT infections or acute respiratory disease, presence or absence of these parameters could only be taken as a slight hint for a CAP diagnosis. PMID:17084571

  15. Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units

    Science.gov (United States)

    Lu, Zhiwei; Cheng, Yusheng; Tu, Xiongwen; Chen, Liang; Chen, Hu; Yang, Jian; Wang, Jinyan; Zhang, Liqin

    2016-01-01

    Purpose The aim of this study was to appraise the effect of community-acquired pneumonia (CAP) on inhospital mortality in critically ill acute exacerbation of COPD (AECOPD) patients admitted to a respiratory intensive care unit. Patients and methods A retrospective observational study was performed. Consecutive critically ill AECOPD patients receiving treatment in a respiratory intensive care unit were reviewed from September 1, 2012, to August 31, 2015. Categorical variables were analyzed using chi-square tests, and continuous variables were analyzed by Mann–Whitney U-test. Kaplan–Meier analysis was used to assess the association of CAP with survival of critically ill AECOPD patients for univariate analysis. Cox’s proportional hazards regression model was performed to identify risk factors for multivariate analysis. Results A total of 80 consecutive eligible individuals were reviewed. These included 38 patients with CAP and 42 patients without CAP. Patients with CAP had a higher inhospital rate of mortality than patients without CAP (42% vs 33.3%, Pcritically ill AECOPD patients (CAP: hazard ratio, 5.29; 95% CI, 1.50–18.47, Pcritically ill AECOPD patients. PMID:27563239

  16. The Lebanese Society for Infectious Diseases and Clinical Microbiology (LSIDCM) guidelines for adult community-acquired pneumonia (Cap) in Lebanon.

    Science.gov (United States)

    Moghnieh, Rima; Yared Sakr, Nadine; Kanj, Souha S; Musharrafieh, Umayya; Husni, Rula; Jradeh, Mona; Al-Awar, Ghassan; Matar, Madona; Jureij, Wafa; Antoine, Saad; Azar, Eid; Abi Hanna, Pierre; Minari, Afaf; Hammoud, Jamale; Kfoury, Joumana; Mahfouz, Tahsin; Abou Chakra, Diaa; Zaatari, Mohamad; Tabbarah, Zuhayr A

    2014-01-01

    Adult community-acquired pneumonia (CAP) is a common cause of morbidity and mortality which is managed by different disciplines in a heterogeneous fashion. Development of consensus guidelines to standardize these wide variations in care has become a prime objective. The Lebanese Society of Infectious Diseases and Clinical Microbiology (LSIDCM) convened to set Lebanese national guidelines for the management of CAP since it is a major and a prevalent disease affecting the Lebanese population. These guidelines, besides being helpful in direct clinical practice, play a major role in establishing stewardship programs in hospitals in an effort to contain antimicrobial resistance on the national level. These guidelines are intended for primary care practitioners and emergency medicine physicians. They constitute an appropriate starting point for specialists' consultation being based on the available local epidemiological and resistance data. This document includes the following: 1/ Rationale and scope of the guidelines; 2/ Microbiology of CAP based on Lebanese data; 3/ Clinical presentation and diagnostic workup of CAP; 4/ Management and prevention strategies based on the IDSA/ATS Consensus Guidelines, 2007, and the ESCMID Guidelines, 2011, and tailored to the microbiological data in Lebanon; 5/ Comparison to regional guidelines. The recommendations made in this document were graded based on the strength of the evidence as in the 2007 IDSA/ATS Consensus Guidelines. Hopefully, these guidelines will be an important step towards standardization of CAP care in Lebanon and set the agenda for further research in this area. PMID:24684125

  17. Problems and solutions on issues of medical care quality in community-acquired pneumonia in hospitals of Saratov region

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    Lotsmanov Yu.F.

    2011-06-01

    Full Text Available Qualitative assessment of diagnostics and treatment of patients with community-acquired pneumonia (CAP was carried out in ten therapeutic departments of urban and district hospitals of Saratov region, using quality indicators (Qls. Each case of CAP was assessed in expert health care quality (HCQ card according to the diagnostic and treatment quality federal standards and the basic Ql. The application of Ql in CAP patients allowed revealing the following: low CAP agent isolation rate; late hospitalization of CAP patients; low frequency of sputum bacteriological and bacterioscopic investigations prior to antibiotic therapy; insufficient frequency of step-by-step introduction of antibiotics. Recommendations on CAP patients dispenserization were not properly prescribed; recommendations on vaccination were absent. The basic measures of HCQ improvement are as follows: organizing for each CAP patient therapeutic and diagnostic quality control according to Ql; quick administrative decisions; using of HCQ expertise during the first 2-3 days of treatment to correct diagnosis and treatment; optimizing hospital diagnostic resources (laboratory and instrumental and rational pharmacotherapy

  18. The Queensland experience of participation in a national drug use evaluation project, Community-acquired pneumonia – towards improving outcomes nationally (CAPTION

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    Tett Susan E

    2009-08-01

    Full Text Available Abstract Background Multicentre drug use evaluations are described in the literature infrequently and usually publish only the results. The purpose of this paper is to describe the experience of Queensland hospitals participating in the Community-Acquired Pneumonia Towards Improving Outcomes Nationally (CAPTION project, specifically evaluating the implementation of this project, detailing benefits and drawbacks of involvement in a national drug use evaluation program. Methods Emergency departments from nine hospitals in Queensland, Australia, participated in CAPTION, a national quality improvement project, conducted in 37 Australian hospitals. CAPTION was aimed at optimising prescribing in the management of Community-Acquired Pneumonia according to the recommendations of the Australian Therapeutic Guidelines: Antibiotic 12th edition. The project involved data collection, and evaluation, feedback of results and a suite of targeted educational interventions including audit and feedback, group presentations and academic detailing. A baseline audit and two drug use evaluation cycles were conducted during the 2-year project. The implementation of the project was evaluated using feedback forms after each phase of the project (audit or intervention. At completion a group meeting with the hospital coordinators identified positive and negative elements of the project. Results Evaluation by hospitals of their participation in CAPTION demonstrated both benefits and drawbacks. The benefits were grouped into the impact on the hospital dynamic such as; improved interdisciplinary working relationships (e.g. between pharmacist and doctor, recognition of the educational/academic role of the pharmacist, creation of ED Pharmacist positions and enhanced involvement with the National Prescribing Service, and personal benefits. Personal benefits included academic detailing training for participants, improved communication skills and opportunities to present at

  19. Improving antibiotic prescribing for adults with community acquired pneumonia: Does a computerised decision support system achieve more than academic detailing alone? – a time series analysis

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    Black James F

    2008-07-01

    Full Text Available Abstract Background The ideal method to encourage uptake of clinical guidelines in hospitals is not known. Several strategies have been suggested. This study evaluates the impact of academic detailing and a computerised decision support system (CDSS on clinicians' prescribing behaviour for patients with community acquired pneumonia (CAP. Methods The management of all patients presenting to the emergency department over three successive time periods was evaluated; the baseline, academic detailing and CDSS periods. The rate of empiric antibiotic prescribing that was concordant with recommendations was studied over time comparing pre and post periods and using an interrupted time series analysis. Results The odds ratio for concordant therapy in the academic detailing period, after adjustment for age, illness severity and suspicion of aspiration, compared with the baseline period was OR = 2.79 [1.88, 4.14], p Conclusion Deployment of a computerised decision support system was associated with an early improvement in antibiotic prescribing practices which was greater than the changes seen with academic detailing. The sustainability of this intervention requires further evaluation.

  20. Impact of Preceding Flu-Like Illness on the Serotype Distribution of Pneumococcal Pneumonia

    Science.gov (United States)

    Song, Joon Young; Nahm, Moon H.; Cheong, Hee Jin; Kim, Woo Joo

    2014-01-01

    Background Even though the pathogenicity and invasiveness of pneumococcus largely depend on capsular types, the impact of serotypes on post-viral pneumococcal pneumonia is unknown. Methods and Findings This study was performed to evaluate the impact of capsular serotypes on the development of pneumococcal pneumonia after preceding respiratory viral infections. Patients with a diagnosis of pneumococcal pneumonia were identified. Pneumonia patients were divided into two groups (post-viral pneumococcal pneumonia versus primary pneumococcal pneumonia), and then their pneumococcal serotypes were compared. Nine hundred and nineteen patients with pneumococcal pneumonia were identified during the study period, including 327 (35.6%) cases with post-viral pneumococcal pneumonia and 592 (64.4%) cases with primary pneumococcal pneumonia. Overall, serotypes 3 and 19A were the most prevalent, followed by serotypes 19F, 6A, and 11A/11E. Although relatively uncommon (33 cases, 3.6%), infrequently colonizing invasive serotypes (4, 5, 7F/7A, 8, 9V/9A, 12F, and 18C) were significantly associated with preceding respiratory viral infections (69.7%, P<0.01). Multivariate analysis revealed several statistically significant risk factors for post-viral pneumococcal pneumonia: immunodeficiency (OR 1.66; 95% CI, 1.10–2.53), chronic lung diseases (OR 1.43; 95% CI, 1.09–1.93) and ICI serotypes (OR 4.66; 95% CI, 2.07–10.47). Conclusions Infrequently colonizing invasive serotypes would be more likely to cause pneumococcal pneumonia after preceding respiratory viral illness, particularly in patients with immunodeficiency or chronic lung diseases. PMID:24691515

  1. A Prospective Study of Inpatients to Determine Microbial Etiology and Therapeutic Outcome of Antibiotics for Community-Acquired Pneumonia in Pakistan

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    Sahar Rehman

    2013-06-01

    Full Text Available Introduction: Community-acquired pneumonia (CAP is among the common diseases that causes illness and death world-wide. Limited data is available for the treatment of patients with CAP and/or medical outcome of CAP patients in Pakistan. This cross-sectional and prospective study was done to determine etiology of CAP patients and to evaluate the therapeutic effects of antibiotics commonly used in treating CAP patients in two different inner-city hospitals, Pakistan. Methods: The study was conducted on 200 hospitalized patients presenting clinical and radiographic evidences of CAP. The patients were assessed for the causative pathogen and their prescriptions were analyzed for the management and treatment of CAP and associated symptoms of pneumonia. Finally the medical outcomes were evaluated. Results: On establishing the microbial etiology of pneumonia among different CAP causing pathogens, K. pneumoniae was found to be the most identified causative agent (30% followed by S. pneumoniae (23%. Majority of the patients received cephalosporin antibiotics (80% followed by aminoglycosides (65% and penicillins (50% either as monotherapy or combination treatment. Therapeutic success was observed to occur in majority of the patients. The recovery of CAP patients occurred probably because they received antibiotics which are recommended by WHO and American Thoracic Society. Another reason for successful therapeutic outcome was found to be the significant patient compliance for treatment. Conclusion: There is a great need for such types of investigational studies to be conducted in developing countries which may guide the empirical therapy and help in defining proper treatment guidelines.

  2. Estado nutricional y mortalidad en neumonía de la comunidad Nutritional status and mortality in community acquired pneumonia

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    María Soledad Rodríguez-Pecci

    2010-04-01

    Full Text Available Las neumonías constituyen una causa mayor de morbimortalidad, y entre los factores de riesgo se incluye el estado nutricional. En el presente estudio se analizó la relación entre malnutrición y mortalidad en Neumonía Aguda de la Comunidad (NAC y se utilizó la Escala de Evaluación Global Subjetiva (EGS como método de valoración del estado nutricional de los pacientes con NAC. En este estudio prospectivo observacional se incluyeron en forma consecutiva 98 pacientes con NAC que requirieron hospitalización, de octubre de 2004 a septiembre de 2006. Se registraron características clínicas, bacteriológicas y de laboratorio y se evaluó nutricionalmente a cada paciente utilizando la EGS. El seguimiento se realizó hasta el alta médica, derivación o muerte. La persistencia de tos o fiebre, la presencia de derrame pleural, neoplasias o larga hospitalización se asociaron a peor pronóstico. La mortalidad aumentó proporcionalmente con el grado de desnutrición. Treinta y dos pacientes (32.65% fueron clasificados como categoría EGS-A; 44 (44.90% como EGS-B, y 22 (22.45% como EGS-C. Fallecieron 3 de 32 EGS-A (9.37%, 8 de 44 EGS-B (18.18% y 10 de 22 EGS-C. El riesgo de muerte fue significativamente mayor en el grupo EGS-C que en el EGS-A; OR = 6.085 (CI95% 1.071- 34.591 p = 0.042. Considerando la muerte como variable de egreso, la categoría EGS-A mostró el mayor valor predictivo negativo (0.906, y EGS-C el mayor valor predictivo positivo (0.455. La EGS realizada al ingreso fue un instrumento útil para identificar el estado nutricional y un buen pronosticador de riesgo de muerte en NAC.Pneumonias are a major cause of morbidity and mortality and their prognosis depends on many factors including nutritional status. This study analyzed the relationship between malnutrition and the risk of death in Community Acquired Pneumonia (CAP patients. This is a prospective observational study. The Subjective Global Assessment (SGA was used as a screening

  3. Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community-acquired-pneumonia

    OpenAIRE

    Scala, Raffaele; Naldi, Mario; Maccari, Uberto

    2010-01-01

    Introduction Inefficient clearance of copious respiratory secretion is a cause of non-invasive positive pressure ventilation (NPPV) failure, especially in chronic respiratory patients with community-acquired-pneumonia (CAP) and impaired consciousness. We postulated that in such a clinical scenario, when intubation and conventional mechanical ventilation (CMV) are strongly recommended, the suction of secretions with fiberoptic bronchoscopy (FBO) may increase the chance of NPPV success. The obj...

  4. Prognostic value of mid-regional pro-adrenomedullin (MR-proADM) in patients with community-acquired pneumonia: a systematic review and meta-analysis

    OpenAIRE

    Liu, Dan; Xie, Lixin; Zhao, Haiyan; Liu, Xueyao; Cao, Jie

    2016-01-01

    Background The early identification of patients at risk of dying from community-acquired pneumonia (CAP) is critical for their treatment and for defining hospital resource consumption. Mid-regional pro-adrenomedullin (MR-proADM) has been extensively investigated for its prognostic value in CAP. However, the results are conflicting. The purpose of the present meta-analysis was to explore the diagnostic accuracy of MR-proADM for predicting mortality in patients suffering from CAP, particularly ...

  5. The Queensland experience of participation in a national drug use evaluation project, Community-acquired pneumonia – towards improving outcomes nationally (CAPTION)

    OpenAIRE

    Tett Susan E; Pulver Lisa K; Coombes Judith

    2009-01-01

    Abstract Background Multicentre drug use evaluations are described in the literature infrequently and usually publish only the results. The purpose of this paper is to describe the experience of Queensland hospitals participating in the Community-Acquired Pneumonia Towards Improving Outcomes Nationally (CAPTION) project, specifically evaluating the implementation of this project, detailing benefits and drawbacks of involvement in a national drug use evaluation program. Methods Emergency depar...

  6. Effects of Hospital-Based Physical Therapy on Hospital Discharge Outcomes among Hospitalized Older Adults with Community-Acquired Pneumonia and Declining Physical Function.

    Science.gov (United States)

    Kim, Sun Jung; Lee, Joo Hun; Han, Boram; Lam, Julia; Bukowy, Elizabeth; Rao, Avinash; Vulcano, Jordan; Andreeva, Anelia; Bertelson, Heather; Shin, Hyun Phil; Yoo, Ji Won

    2015-06-01

    To examine whether hospital-based physical therapy is associated with functional changes and early hospital readmission among hospitalized older adults with community-acquired pneumonia and declining physical function. Study design was a retrospective observation study. Participants were community-dwelling older adults admitted to medicine floor for community-acquired pneumonia (n = 1,058). Their physical function using Katz activities of daily living (ADL) Index declined between hospital admission and 48 hours since hospital admission (Katz ADL Index 6→5). The intervention group was those receiving physical therapy for ≥ 0.5 hour/day. Outcomes were Katz ADL Index at hospital discharge and all-cause 30-day hospital readmission rate. The intervention and control groups did not differ in the Katz ADL Index at hospital discharge (p = 0.11). All-cause 30-day hospital readmission rate was lower in the intervention than in control groups (OR = 0.65, p = 0.02). Hospital-based physical therapy has the benefits toward reducing 30-day hospital readmission rate of acutely ill older adults with community-acquired pneumonia and declining physical function. PMID:26029475

  7. Vitamin D status and community-acquired pneumonia: results from the third National Health and Nutrition Examination Survey.

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    Sadeq A Quraishi

    Full Text Available OBJECTIVE: To investigate the association between serum 25-hydroxyvitamin D [25(OHD] level and history of community-acquired pneumonia (CAP. PATIENTS AND METHODS: We identified 16,975 individuals (≥17 years from the third National Health and Nutrition Examination Survey (NHANES III with documented 25(OHD levels. To investigate the association of 25(OHD with history of CAP in these participants, we developed a multivariable logistic regression model, adjusting for demographic factors (age, sex, race, poverty-to-income ratio, and geographic location, clinical data (body mass index, smoking status, asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes mellitus, stroke, chronic kidney disease, neutropenia, and alcohol consumption, and season. Locally weighted scatterplot smoothing (LOWESS was used to depict the relationship between increasing 25(OHD levels and the cumulative frequency of CAP in the study cohort. RESULTS: The median [interquartile range (IQR] serum 25(OHD level was 24 (IQR 18-32 ng/mL. 2.1% [95% confidence interval (CI: 1.9-2.3] of participants reported experiencing a CAP within one year of their participation in the national survey. After adjusting for demographic factors, clinical data, and season, 25(OHD levels <30 ng/mL were associated with 56% higher odds of CAP [odds ratio 1.56; 95% confidence interval: 1.17-2.07] compared to levels ≥30 ng/mL. LOWESS analysis revealed a near linear relationship between vitamin D status and the cumulative frequency of CAP up to 25(OHD levels around 30 ng/mL. CONCLUSION: Among 16,975 participants in NHANES III, 25(OHD levels were inversely associated with history of CAP. Randomized controlled trials are warranted to determine the effect of optimizing vitamin D status on the risk of CAP.

  8. Relationship between the use of inhaled steroids for chronic respiratory diseases and early outcomes in community-acquired pneumonia.

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    Jordi Almirall

    Full Text Available BACKGROUND: The role of inhaled steroids in patients with chronic respiratory diseases is a matter of debate due to the potential effect on the development and prognosis of community-acquired pneumonia (CAP. We assessed whether treatment with inhaled steroids in patients with chronic bronchitis, COPD or asthma and CAP may affect early outcome of the acute pneumonic episode. METHODS: Over 1-year period, all population-based cases of CAP in patients with chronic bronchitis, COPD or asthma were registered. Use of inhaled steroids were registered and patients were followed up to 30 days after diagnosis to assess severity of CAP and clinical course (hospital admission, ICU admission and mortality. RESULTS: Of 473 patients who fulfilled the selection criteria, inhaled steroids were regularly used by 109 (23%. In the overall sample, inhaled steroids were associated with a higher risk of hospitalization (OR=1.96, p = 0.002 in the bivariate analysis, but this effect disappeared after adjusting by other severity-related factors (adjusted OR=1.08, p=0.787. This effect on hospitalization also disappeared when considering only patients with asthma (OR=1.38, p=0.542, with COPD alone (OR=4.68, p=0.194, but a protective effect was observed in CB patients (OR=0.15, p=0.027. Inhaled steroids showed no association with ICU admission, days to clinical recovery and mortality in the overall sample and in any disease subgroup. CONCLUSIONS: Treatment with inhaled steroids is not a prognostic factor in COPD and asthmatic patients with CAP, but could prevent hospitalization for CAP in patients with clinical criteria of chronic bronchitis.

  9. CYP1A1, GCLC, AGT, AGTR1 gene-gene interactions in community-acquired pneumonia pulmonary complications.

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    Salnikova, Lyubov E; Smelaya, Tamara V; Golubev, Arkadiy M; Rubanovich, Alexander V; Moroz, Viktor V

    2013-11-01

    This study was conducted to establish the possible contribution of functional gene polymorphisms in detoxification/oxidative stress and vascular remodeling pathways to community-acquired pneumonia (CAP) susceptibility in the case-control study (350 CAP patients, 432 control subjects) and to predisposition to the development of CAP complications in the prospective study. All subjects were genotyped for 16 polymorphic variants in the 14 genes of xenobiotics detoxification CYP1A1, AhR, GSTM1, GSTT1, ABCB1, redox-status SOD2, CAT, GCLC, and vascular homeostasis ACE, AGT, AGTR1, NOS3, MTHFR, VEGFα. Risk of pulmonary complications (PC) in the single locus analysis was associated with CYP1A1, GCLC and AGTR1 genes. Extra PC (toxic shock syndrome and myocarditis) were not associated with these genes. We evaluated gene-gene interactions using multi-factor dimensionality reduction, and cumulative gene risk score approaches. The final model which included >5 risk alleles in the CYP1A1 (rs2606345, rs4646903, rs1048943), GCLC, AGT, and AGTR1 genes was associated with pleuritis, empyema, acute respiratory distress syndrome, all PC and acute respiratory failure (ARF). We considered CYP1A1, GCLC, AGT, AGTR1 gene set using Set Distiller mode implemented in GeneDecks for discovering gene-set relations via the degree of sharing descriptors within a given gene set. N-acetylcysteine and oxygen were defined by Set Distiller as the best descriptors for the gene set associated in the present study with PC and ARF. Results of the study are in line with literature data and suggest that genetically determined oxidative stress exacerbation may contribute to the progression of lung inflammation.

  10. Risk factors for infection with multidrug-resistant bacteria in non-ventilated patients with hospital-acquired pneumonia

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    Renato Seligman

    2013-06-01

    Full Text Available OBJECTIVE: To identify risk factors for the development of hospital-acquired pneumonia (HAP caused by multidrug-resistant (MDR bacteria in non-ventilated patients. METHODS: This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria. RESULTS: Of the 140 patients diagnosed with HAP, 59 (42.1% were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763. Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527. Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002. CONCLUSIONS: In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP.

  11. Efficacy and Safety of Intravenous Moxifloxacin Versus Cefoperazone with Azithromycin in the Treatment of Community Acquired Pneumonia

    Institute of Scientific and Technical Information of China (English)

    XU Shuyun; XIONG Shengdao; XU Yongjian; LIU Jin; LIU Huiguo; ZHAO Jianping; XIONG Weining

    2006-01-01

    To compare the efficacy, safety, and tolerability of intravenous moxifloxacin with those of a commonly used empirical antibiotic regimen, cefoperazone and azithromycin in the treatment of community acquired pneumonia (CAP) in adult patients requiring initial parenteral therapy, 40 patients with CAP were divided into two groups, a moxifloxacin group (n=20) and a control group(n=20), which were treated for 7 to 14 days. The patients in the moxifloxacin group were intravenously given 400 mg of moxifloxacin (AveloxR) once a day. Patients in the control group were administered 2.0 g of cefoperazone twice a day and azithromycin 0.5 g once a day. Clinical, bacteriological, and laboratory examinations were performed before the treatment, and at the end of the treatment. Our results showed that there was no significant difference in the clinical efficacy rate between two treatment groups at end of therapy (90 % for moxifloxacin, 95 % for cefoperazone plus azithromycin) (P>0.05). The bacteriologic eradication rate at the end of treatment was 90 % in the moxifloxacin group and 80 % in the cefoperazone-plus-azithromycin group, whereas there was no significant difference between the two groups (P>0.05). In addition, both drugs were well-tolerated in this trial, with the number of drug-related adverse events being comparable. It is concluded that moxifloxacin is an effective and well-tolerated treatment for CAP and was equivalent to the commonly used empirical treatment of cefoperazone plus azithromycin. Moxifloxacin is likely to offer clinicians an alternative for reliable empirical CAP treatment in the face of increasing antibiotic resistance.

  12. Respiratory Review of 2012: Pneumonia

    OpenAIRE

    Yoon, Young-Soon

    2012-01-01

    Pneumonia is the cause of significant morbidity and mortality, despite advances in diagnosis and antibacterial treatment. Pneumonia is often misdiagnosed and mistreated up until recently. Recent classification of pneumonia consists of community-acquired pneumonia, health care-associated pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. The etiology, risk factors, and treatment are different among them. This article briefly introduces new concepts and ideas in biomar...

  13. The clinical utility of induced sputum for the diagnosis of bacterial community-acquired pneumonia in HIV-infected patients: a prospective cross-sectional study

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    Rosemeri Maurici da Silva

    2006-04-01

    Full Text Available BACKGROUND: Bacterial pneumonias have been overcoming pneumocytosis in frequency. Controversy still remains about how to manage immunocompromised patients and those with lung diseases. Sputum analysis is a noninvasive and simple method, and when interpreted according to specific criteria it may help with diagnosis. We conducted a study to evaluate sensitivity, specificity, positive and negative predicted values, and the accuracy of induced sputum (IS for bacterial community-acquired pneumonia diagnosis in HIV-positive patients. MATERIAL AND METHODS: This cross sectional study evaluated a diagnostic procedure in a reference hospital for HIV patients in Florianópolis, SC, Brazil. From January 1, 2001 to September 30, 2002, 547 HIV-positive patients were analyzed and 54 inpatients with pulmonary infection were selected. Bronchoalveolar lavage (BAL and transbronchial lung biopsy (TBLB were considered the gold standards. Gram stains and quantitative cultures of IS and BAL were obtained. The cut-offs for quantitative cultures were 10(6 CFU/mL for IS and 10(4 CFU/mL for BAL. RESULTS: The mean age was 35.7 years, 79.6% were males and 85.2% were caucasians. The mean lymphocyte count was 124.8/mm³. Bacterial pneumonia was diagnosed in 20 patients. The most prevalent bacteria was Streptococcus pneumoniae. Considering IS for the diagnosis of bacterial pneumonia, sensitivity was 60%, specificity 40%, the positive predictive value was 80%, negative predictive value 20% and accuracy 56%. CONCLUSION: IS with quantitative culture can be helpful for the diagnosis of bacterial pneumonia in HIV-positive patients.

  14. "I really should've gone to the doctor": older adults and family caregivers describe their experiences with community-acquired pneumonia

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    Lohfeld Lynne

    2006-05-01

    Full Text Available Abstract Background Responding to acute illness symptoms can often be challenging for older adults. The primary objective of this study was to describe how community-dwelling older adults and their family members responded to symptoms of community-acquired pneumonia (CAP. Methods A qualitative study that used face-to-face semi-structured interviews to collect data from a purposeful sample of seniors aged 60+ and their family members living in a mid-sized Canadian city. Data analysis began with descriptive and interpretive coding, then advanced as the research team repeatedly compared emerging thematic categories to the raw data. Searches for disconfirming evidence and member checking through focus groups provided additional data and helped ensure rigour. Results Community-acquired pneumonia symptoms varied greatly among older adults, making decisions to seek care difficult for them and their family members. Both groups took varying amounts of time as they attempted to sort out what was wrong and then determine how best to respond. Even after they concluded something was wrong, older adults with confirmed pneumonia continued to wait for days, to over a week, before seeking medical care. Participants provided diverse reasons for this delay, including fear, social obligations (work, family, leisure, and accessibility barriers (time, place, systemic. Several older adults and family members regretted their delays in seeking help. Conclusion Treatment-seeking delay is a variable, multi-phased decision-making process that incorporates symptom assessment plus psychosocial and situational factors. Public health and health care professionals need to educate older adults about the potential causes and consequences of unnecessary waits. Such efforts may reduce the severity of community-acquired pneumonia upon presentation at clinics and hospitals, and that, in turn, could potentially improve health outcomes.

  15. Guideline-adherent initial intravenous antibiotic therapy for hospital-acquired/ventilator-associated pneumonia is clinically superior, saves lives and is cheaper than non guideline adherent therapy

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    Wilke MH

    2011-07-01

    Full Text Available Abstract Introduction Hospital-acquired pneumonia (HAP often occurring as ventilator-associated pneumonia (VAP is the most frequent hospital infection in intensive care units (ICU. Early adequate antimicrobial therapy is an essential determinant of clinical outcome. Organisations like the German PEG or ATS/IDSA provide guidelines for the initial calculated treatment in the absence of pathogen identification. We conducted a retrospective chart review for patients with HAP/VAP and assessed whether the initial intravenous antibiotic therapy (IIAT was adequate according to the PEG guidelines Materials and methods We collected data from 5 tertiary care hospitals. Electronic data filtering identified 895 patients with potential HAP/VAP. After chart review we finally identified 221 patients meeting the definition of HAP/VAP. Primary study endpoints were clinical improvement, survival and length of stay. Secondary endpoints included duration of mechanical ventilation, total costs, costs incurred on the intensive care unit (ICU, costs incurred on general wards and drug costs. Results We found that 107 patients received adequate initial intravenous antibiotic therapy (IIAT vs. 114 with inadequate IIAT according to the PEG guidelines. Baseline characteristics of both groups revealed no significant differences and good comparability. Clinical improvement was 64% over all patients and 82% (85/104 in the subpopulation with adequate IIAT while only 47% (48/103 inadequately treated patients improved (p Drug costs for the hospital stay were also lower (EUR 4,069 vs. EUR 4,833 yet not significant. The most frequent types of inadequate therapy were monotherapy instead of combination therapy, wrong type of penicillin and wrong type of cephalosporin. Discussion These findings are consistent with those from other studies analyzing the impact of guideline adherence on survival rates, clinical success, LOS and costs. However, inadequately treated patients had a higher

  16. FASTCAP study on the management of hospitalized patients with community-acquired pneumonia: pharmacoeconomic analysis of the prospective phase

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    C. Lazzaro

    2013-05-01

    Full Text Available BACKGROUND The economic evaluation of guide-lines based hospital management of Community- Acquired Pneumonia (CAP with antibiotic therapy is rarely reported in literature. AIM OF THE STUDY To compare costs and effectiveness of 5 different antibiotic courses administered to Fine IV and V class patients with CAP, hospitalized in 31 Italian Internal Medicine (IM Departments and enrolled in the prospective phase of the multicentre FASTCAP study after the implementation of the Italian Federation of Internal Medicine (FADOI recommendations on the management of patients with CAP admitted to IM. METHODS 5 main antibiotic courses, administered to 786 patients, were considered (3 monotherapies: levofloxacin, 213 patients; amoxycillin/clavulanate, 134 patients; ceftriaxone, 166 patients; 2 combination therapies: amoxycillin/clavulanate + advanced macrolide, 137 patients; ceftriaxone + advanced macrolide, 136 patients. A cost analysis and two cost/effectiveness analyses (comparing, after the 1st cycle of therapy, cost to outcome for both Fine IV and V classes and cost to avoided mortality during hospitalization for Fine V class only were carried out adopting the hospital viewpoint. Health care cost, reported in euros 2007, included: drugs acquisition; nursing time; devices for ev administration; hospitalization in inpatient setting. RESULTS The least and the most costly therapies are levofloxacin (3,032.19 ± 2,045.34 euros and ceftriaxone (3,666.95 ± 2,389.46 euros in Fine IV class and amoxycillin/clavulanate (2,989.37 ± 2,242.15 euros and ceftriaxone + advanced macrolide (4,633.59 ± 2,491.57 euros in Fine V class. As far as the therapeutic outcome is concerned, levofloxacin dominates comparators in Fine IV class, whereas amoxycillin/clavulanate + advanced macrolide is both the most costly (3,433.16 ± 1,725.63 euros and the most effective option (69.6%; 95% CI: 54.3-82.3% in Fine V class. In Fine V class ceftriaxone + advanced macrolide reports both

  17. Evaluating the use of blood cultures in the management of children hospitalized for community-acquired pneumonia.

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    Russell J McCulloh

    Full Text Available Blood cultures are often recommended for the evaluation of community-acquired pneumonia (CAP. However, institutions vary in their use of blood cultures, and blood cultures have unclear utility in CAP management in hospitalized children.To identify clinical factors associated with obtaining blood cultures in children hospitalized with CAP, and to estimate the association between blood culture obtainment and hospital length of stay (LOS.We performed a multicenter retrospective cohort study of children admitted with a diagnosis of CAP to any of four pediatric hospitals in the United States from January 1, 2011-December 31, 2012. Demographics, medical history, diagnostic testing, and clinical outcomes were abstracted via manual chart review. Multivariable logistic regression evaluated patient and clinical factors for associations with obtaining blood cultures. Propensity score-matched Kaplan-Meier analysis compared patients with and without blood cultures for hospital LOS.Six hundred fourteen charts met inclusion criteria; 390 children had blood cultures obtained. Of children with blood cultures, six (1.5% were positive for a pathogen and nine (2.3% grew a contaminant. Factors associated with blood culture obtainment included presenting with symptoms of systemic inflammatory response syndrome (OR 1.78, 95% CI 1.10-2.89, receiving intravenous hydration (OR 3.94, 95% CI 3.22-4.83, receiving antibiotics before admission (OR 1.49, 95% CI 1.17-1.89, hospital admission from the ED (OR 1.65, 95% CI 1.05-2.60, and having health insurance (OR 0.42, 95% CI 0.30-0.60. In propensity score-matched analysis, patients with blood cultures had median 0.8 days longer LOS (2.0 vs 1.2 days, P < .0001 without increased odds of readmission (OR 0.94, 95% CI 0.45-1.97 or death (P = .25.Obtaining blood cultures in children hospitalized with CAP rarely identifies a causative pathogen and is associated with increased LOS. Our results highlight the need to refine the role of

  18. Differences in characteristics between healthcare-associated and community-acquired infection in community-onset Klebsiella pneumoniae bloodstream infection in Korea

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    Jung Younghee

    2012-10-01

    Full Text Available Abstract Background Healthcare-associated (HCA infection has emerged as a new epidemiological category. The aim of this study was to evaluate the impact of HCA infection on mortality in community-onset Klebsiella pneumoniae bloodstream infection (KpBSI. Methods We conducted a retrospective study in two tertiary-care hospitals over a 6-year period. All adult patients with KpBSI within 48 hours of admission were enrolled. We compared the clinical characteristics of HCA and community-acquired (CA infection, and analyzed risk factors for mortality in patients with community-onset KpBSI. Results Of 553 patients with community-onset KpBSI, 313 (57% were classified as HCA- KpBSI and 240 (43% as CA-KpBSI. In patients with HCA-KpBSI, the severity of the underlying diseases was higher than in patients with CA-KpBSI. Overall the most common site of infection was the pancreatobiliary tract. Liver abscess was more common in CA-KpBSI, whereas peritonitis and primary bacteremia were more common in HCA-KpBSI. Isolates not susceptible to extended-spectrum cephalosporin were more common in HCA- KpBSI than in CA-KpBSI (9% [29/313] vs. 3% [8/240]; p = 0.006. Overall 30-day mortality rate was significantly higher in HCA-KpBSI than in CA-KpBSI (22% [70/313] vs. 11% [27/240]; p = 0.001. In multivariate analysis, high Charlson’s weighted index of co-morbidity, high Pitt bacteremia score, neutropenia, polymicrobial infection and inappropriate empirical antimicrobial therapy were significant risk factors for 30-day mortality. Conclusions HCA-KpBSI in community-onset KpBSI has distinctive characteristics and has a poorer prognosis than CA-KpBSI, but HCA infection was not an independent risk factor for 30-day mortality.

  19. [Pneumonia awareness year, 2004: scientific impact through publications in Archivos de Bronconeumología].

    Science.gov (United States)

    Rajas Naranjo, Olga; Aspa Marco, Javier

    2006-10-01

    Pneumonia is a common and potentially serious infectious disease. Morbidity and mortality rates continue to be high in spite of major advances and steady progress in diagnosis and treatment. The economic impact of the disease is also great. It is therefore necessary to enlist the public, primary care and emergency physicians, and public policy administrators to join forces to treat and prevent pneumonia for the common good. The annual incidence of pneumonia in the population over the age of 14 years is 1.6 to 2.6 episodes/1000 inhabitants. The mortality rate is 14.1 per 100,000 inhabitants, and the associated costs are 115 million euros annually. The RESPIRA Foundation and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) declared 2004 to be pneumonia awareness year with the aim of coordinating efforts to raise awareness, distribute information, and foster debate. PMID:17067522

  20. Associations of hospital characteristics with nosocomial pneumonia after cardiac surgery can impact on standardized infection rates.

    Science.gov (United States)

    Sanagou, M; Leder, K; Cheng, A C; Pilcher, D; Reid, C M; Wolfe, R

    2016-04-01

    To identify hospital-level factors associated with post-cardiac surgical pneumonia for assessing their impact on standardized infection rates (SIRs), we studied 43 691 patients in a cardiac surgery registry (2001-2011) in 16 hospitals. In a logistic regression model for pneumonia following cardiac surgery, associations with hospital characteristics were quantified with adjustment for patient characteristics while allowing for clustering of patients by hospital. Pneumonia rates varied from 0·7% to 12·4% across hospitals. Seventy percent of variability in the pneumonia rate was attributable to differences in hospitals in their long-term rates with the remainder attributable to within-hospital differences in rates over time. After adjusting for patient characteristics, the pneumonia rate was found to be higher in hospitals with more registered nurses (RNs)/100 intensive-care unit (ICU) admissions [adjusted odds ratio (aOR) 1·2, P = 0·006] and more RNs/available ICU beds (aOR 1·4, P hospital characteristics had no significant association with pneumonia. SIRs calculated on the basis of patient characteristics alone differed substantially from the same rates calculated on the basis of patient characteristics and the hospital characteristic of RNs/100 ICU admissions. Since SIRs using patient case-mix information are important for comparing rates between hospitals, the additional allowance for hospital characteristics can impact significantly on how hospitals compare.

  1. Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings.

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    Floyd, Jessica; Wu, Lindsey; Hay Burgess, Deborah; Izadnegahdar, Rasa; Mukanga, David; Ghani, Azra C

    2015-12-01

    It is estimated that pneumonia is responsible for 15% of childhood deaths worldwide. Recent research has shown that hypoxia and malnutrition are strong predictors of mortality in children hospitalized for pneumonia. It is estimated that 15% of children under 5 who are hospitalized for pneumonia have hypoxaemia and that around 1.5 million children with severe pneumonia require oxygen treatment each year. We developed a deterministic compartmental model that links the care pathway to disease progression to assess the impact of introducing pulse oximetry as a prognostic tool to distinguish severe from non-severe pneumonia in under-5 year olds across 15 countries with the highest burden worldwide. We estimate that, assuming access to supplemental oxygen, pulse oximetry has the potential to avert up to 148,000 deaths if implemented across the 15 countries. By contrast, integrated management of childhood illness alone has a relatively small impact on mortality owing to its low sensitivity. Pulse oximetry can significantly increase the incidence of correctly treated severe cases as well as reduce the incidence of incorrect treatment with antibiotics. We also found that the combination of pulse oximetry with integrated management of childhood illness is highly cost-effective, with median estimates ranging from US$2.97 to $52.92 per disability-adjusted life year averted in the 15 countries analysed. This combination of substantial burden reduction and favourable cost-effectiveness makes pulse oximetry a promising candidate for improving the prognosis for children with pneumonia in resource-poor settings.

  2. Focus on JNJ-Q2, a novel fluoroquinolone, for the management of community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections.

    Science.gov (United States)

    Jones, Travis M; Johnson, Steven W; DiMondi, V Paul; Wilson, Dustin T

    2016-01-01

    JNJ-Q2 is a novel, fifth-generation fluoroquinolone that has excellent in vitro and in vivo activity against a variety of Gram-positive and Gram-negative organisms. In vitro studies indicate that JNJ-Q2 has potent activity against pathogens responsible for acute bacterial skin and skin structure infections (ABSSSI) and community-acquired bacterial pneumonia (CABP), such as Staphylococcus aureus and Streptococcus pneumoniae. JNJ-Q2 also has been shown to have a higher barrier to resistance compared to other agents in the class and it remains highly active against drug-resistant organisms, including methicillin-resistant S. aureus, ciprofloxacin-resistant methicillin-resistant S. aureus, and drug-resistant S. pneumoniae. In two Phase II studies, the efficacy of JNJ-Q2 was comparable to linezolid for ABSSSI and moxifloxacin for CABP. Furthermore, JNJ-Q2 was well tolerated, with adverse event rates similar to or less than other fluoroquinolones. With an expanded spectrum of activity and low potential for resistance, JNJ-Q2 shows promise as an effective treatment option for ABSSSI and CABP. Considering its early stage of development, the definitive role of JNJ-Q2 against these infections and its safety profile will be determined in future Phase III studies. PMID:27354817

  3. Antimicrobial susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis isolated from community-acquired respiratory tract infections in China: Results from the CARTIPS Antimicrobial Surveillance Program.

    Science.gov (United States)

    Zhang, Yawei; Zhang, Feifei; Wang, Hui; Zhao, Chunjiang; Wang, Zhanwei; Cao, Bin; Du, Yan; Feng, Xianju; Hu, Yunjian; Hu, Bijie; Ji, Ping; Liu, Zhiyong; Liu, Yong; Liao, Wanzhen; Lu, Juan; Sun, Hongli; Wang, Zhongxin; Xu, Xiuli; Xu, Xuesong; Yang, Qing; Yu, Yunsong; Zhang, Rong; Zhuo, Chao

    2016-06-01

    This study investigated the antimicrobial susceptibilities of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis isolates causing adult community-acquired respiratory tract infections (CARTIs) in China. A multicentre resistance surveillance study (CARTIPS) investigating 1046 clinical isolates from 19 hospitals in China was conducted from 2013 to 2014. Based on the minimum inhibitory concentration (MIC) breakpoints of oral penicillin, the percentages of penicillin-resistant, penicillin-intermediate and penicillin-susceptible S. pneumoniae were 44.1%, 13.7%, and 42.2%, respectively. The rates of penicillin-non-susceptible S. pneumoniae ranged from 27.9% to 72.2% in different cities, with the highest rate in Nanchang. Macrolides, including azithromycin, clarithromycin and erythromycin, showed the lowest activities against S. pneumoniae isolates, with resistance rates of 90.5%, 92.2% and 93.0%, respectively. However, 98% of these strains were susceptible to levofloxacin and moxifloxacin. For H. influenzae isolates, most of the antimicrobials agents exhibited good activities. However, ampicillin and trimethoprim/sulfamethoxazole showed relatively lower activity against H. influenzae, with resistance rates of 35.0% and 54.4%, respectively. β-lactamase production rates amongst H. influenzae and M. catarrhalis were 31.0% and 87.1%, respectively. In addition, a total of 15 β-lactamase-negative ampicillin-resistant (BLNAR) strains identified in this study were resistant to ampicillin, amoxicillin/clavulanic acid, cefaclor and cefuroxime. Most of the antimicrobial agents showed excellent activity against M. catarrhalis, with susceptibility rates of >90%. The results from the current study confirmed the regional variations in antimicrobial susceptibility of major CARTI pathogens and provided some choices for the treatment of these organisms. Continuous national surveillance of the epidemiology of CARTIs is strongly warranted in China.

  4. Treatment of severe community-acquired pneumonia with oral amoxicillin in under-five children in developing country: a systematic review.

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    Rashmi Ranjan Das

    Full Text Available OBJECTIVE: To assess the evidence regarding efficacy of oral amoxicillin compared to standard treatment for WHO-defined severe community acquired pneumonia in under-five children in developing country. DESIGN: Systematic review and meta-analysis of data from published Randomized trials (RCTs. DATA SOURCES: MEDLINE (1970- July 2012 via PubMed, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 7, July 2012, and EMBASE (1988- June 2012. METHODS: Eligible trials compared oral amoxicillin administered in ambulatory setting versus standard treatment for WHO-defined severe community acquired pneumonia in children under-five. Primary outcomes were proportion of children developing treatment failure at 48 hr, and day 6. GRADE criteria was used to rate the quality of evidence. RESULTS: Out of 281 full text articles assessed for eligibility, 5 trials including 12364 children were included in the meta-analysis. Oral amoxicillin administered either in hospital or community setting is effective in treatment of severe pneumonia and is not inferior to the standard treatment. None of the clinical predictors of treatment failure by 48 hr (very severe disease, fever and lower chest indrawing, and voluntary with-drawl and loss to follow up was significant between the two groups. The clinical predictors of treatment failure that were significant by day 6 were very severe disease, inability to drink, change of antibiotic, and fever alone. The effect was almost consistent across the studies. CONCLUSION: Though oral amoxicillin is effective in treatment of severe CAP in under-five children in developing country, the evidence generated is of low-quality. More trials with uniform comparators are needed in order to strengthen the evidence.

  5. TGF-β Blood Levels Distinguish Between Influenza A (H1N1)pdm09 Virus Sepsis and Sepsis due to Other Forms of Community-Acquired Pneumonia.

    Science.gov (United States)

    Rendón-Ramirez, Erick J; Ortiz-Stern, Alejandro; Martinez-Mejia, Corazon; Salinas-Carmona, Mario C; Rendon, Adrian; Mata-Tijerina, Viviana L; Rosas-Taraco, Adrian G

    2015-06-01

    There is a strong interest in finding adequate biomarkers to aid in the diagnosis and prognosis of influenza A (H1N1)pdm09 virus infection. In this study, serum levels of inflammatory cytokines and laboratory markers were evaluated to assess their usefulness as biomarkers of influenza A (H1N1)pdm09 and their association with fatal cases. Serum samples of consecutive patients with a clinical presentation suggestive of influenza A (H1N1)pdm09 and progression to sepsis were evaluated. Serum inflammatory cytokines and routine laboratory tests were performed and correlated with positivity for influenza A (H1N1)pdm09 influenza by real time reverse transcription polymerase chain reaction and the results of three clinical severity scores (Sequential Organ Failure Assessment [SOFA], CURB-65, and Acute Physiology and Chronic Health Evaluation II [APACHE II]). High SOFA scores and some of its individual components, but not CURB-65 or APACHE II scores, correlate with fatal cases regardless of etiology. Total and unconjugated bilirubin, Ca(++), Cl(-), prothrombin times, and partial thromboplastin times discriminate influenza A (H1N1)pdm09 from other causes of community-acquired pneumonia. High levels of IL-8, IL-10, and IL-17 were increased in influenza A (H1N1)pdm09 patients when compared with controls (pH1N1)pdm09 patients and non-(H1N1)pdm09 patients when compared with controls (pH1N1)pdm09 patients, and patients with other causes of community-acquired pneumonia. TGF-β levels were negatively correlated with SOFA on admission in influenza A (H1N1)pdm09 patients. TGF-β levels are a useful tool for differentiating influenza A (H1N1)pdm09 from other causes of pneumonia progressing to sepsis.

  6. The information and support needs of patients discharged after a short hospital stay for treatment of low-risk Community Acquired Pneumonia: implications for treatment without admission

    Directory of Open Access Journals (Sweden)

    Entwistle Vikki A

    2008-07-01

    Full Text Available Abstract Background There is increasing evidence that patients with low-risk community acquired pneumonia (CAP can be effectively treated as outpatients. This study aimed to explore patients' experiences of having pneumonia and seeking health care; their perceptions of the information provided by health professionals; how they self managed at home; their information and support needs; and their beliefs and preferences regarding site of care. Methods We conducted qualitative, semi-structured interviews with 15 patients who had a confirmed diagnosis of low-risk CAP and had received fewer than 3 days hospital care. Interviews were audio recorded and transcribed, and data were analysed thematically. Results Most patients left hospital with no clear understanding of pneumonia, its treatment or follow-up and most identified additional-other specific information needs when they got home. Some were unable to independently address their activities of daily living in their first days at home. Main concerns after discharge related to the cause and implications of pneumonia, symptom trajectory and prevention of transmission. Most sought advice from their GP in their first days at home, and indicated they would have appreciated a follow-up phone call or visit to discuss their concerns. Patients' preferences for site of care varied and appeared to be influenced by beliefs about safety (fear of rapid deterioration at home or acquiring an infection in hospital, family burden, access to support, or confidence in home-care services. Those who received intravenous (IV medication were more likely to state a preference for hospital care. Conclusion Trends to support community-based treatment of CAP should be accompanied by increased attention to the information and support needs of patients who go home to self-manage. Although some information needs can be anticipated and addressed on diagnosis, specific needs often do not become apparent until patients return home

  7. Detection of respiratory viral and bacterial pathogens causing pediatric community-acquired pneumonia in Beijing using real-time PCR

    Institute of Scientific and Technical Information of China (English)

    Tie-Gang Zhang; Ai-Hua Li; Min Lyu; Meng Chen; Fang Huang; Jiang Wu

    2015-01-01

    Objective: The aim of this study was to determine the etiology and prevalence of pediatric CAP in Beijing using a real-time polymerase chain reaction (PCR) technique. Methods: Between February 15, 2011 and January 18, 2012, 371 pediatric patients with CAP were enrolled at Beijing Children's Hospital. Sixteen respiratory viruses and two bacteria were detected from tracheal aspirate specimens using commercially available multiplex real-time reverse transcription PCR (RT-PCR) kits. Results: A single viral pathogen was detected in 35.3%of enrolled patients, multiple viruses in 11.6%, and virus/bacteria co-infection in 17.8%. In contrast, only 6.5%of patients had a single bacterial pathogen and 2.2%were infected with multiple bacteria. The etiological agent was unknown for 26.7% of patients. The most common viruses were respiratory syncytial virus (RSV) (43.9%), rhinovirus (14.8%), parainfluenza virus (9.4%), and adenovirus (8.6%). In patients under three years of age, RSV (44.6%), rhinovirus (12.8%), and Streptococcus pneumoniae (9.9%) were the most frequent pathogens. In children aged 3e7 years, S. pneumoniae (38.9%), RSV (30.6%), Haemophilus influenzae (19.4%), and adenovirus (19.4%) were most prevalent. Finally in children over seven years, RSV (47.3%), S. pneumoniae (41.9%), and rhinovirus (21.5%) infections were most frequent. Conclusions: Viral pathogens, specifically RSV, were responsible for the majority of CAP in pediatric patients. However, both S. pneumoniae and H. influenzae contributed as major causes of disease. Commercially available multiplexing real-time PCR allowed for rapid detection of the etiological agent. Copyright © 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

  8. Inpatient rehabilitation improves functional capacity, peripheral muscle strength and quality of life in patients with community-acquired pneumonia: a randomised trial

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    Anderson José

    2016-04-01

    Full Text Available Question: Among people who are hospitalised for community-acquired pneumonia, does an inpatient exercise-based rehabilitation program improve functional outcomes, symptoms, quality of life and length of hospital stay more than a respiratory physiotherapy regimen? Design: Randomised trial with concealed allocation, intention-to-treat analysis and blinding of some outcomes. Participants: Forty-nine adults hospitalised for community-acquired pneumonia. Intervention: The experimental group (n = 32 underwent a physical training program that included warm-up, stretching, peripheral muscle strength training and walking at a controlled speed for 15 minutes. The control group (n = 17 underwent a respiratory physiotherapy regimen that included percussion, vibrocompression, respiratory exercises and free walking. The intervention regimens lasted 8 days. Outcome measures: The primary outcome was the Glittre Activities of Daily Living test, which assesses the time taken to complete a series of functional tasks (eg, rising from a chair, walking, stairs, lifting and bending. Secondary outcomes were distance walked in the incremental shuttle walk test, peripheral muscle strength, quality of life, dyspnoea, lung function, C-reactive protein and length of hospital stay. Measures were taken 1 day before and 1 day after the intervention period. Results: There was greater improvement in the experimental group than in the control group on the Glittre Activities of Daily Living test (mean between-group difference 39 seconds, 95% CI 20 to 59 and the incremental shuttle walk test (mean between-group difference 130 m, 95% CI 77 to 182. There were also significantly greater improvements in quality of life, dyspnoea and peripheral muscle strength in the experimental group than in the control group. There were no between-group differences in lung function, C-reactive protein or length of hospital stay. Conclusion: The improvement in functional outcomes after an

  9. Clinical and Laboratory Findings in Patients With Acute Respiratory Symptoms That Suggest the Necessity of Chest X-ray for Community-Acquired Pneumonia

    International Nuclear Information System (INIS)

    Pneumonia is a common illness in all parts of the world and is considered as a major cause of death among all age groups. Nevertheless, only about 5% of patients referring to their primary care physicians with acute respiratory symptoms will develop pneumonia. This study was performed to derive practical criteria for performing chest radiographs for the evaluation of community-acquired pneumonia (CAP). A total of 420 patients with acute respiratory symptoms and positive findings on chest radiograph were evaluated from December 2008 to December 2009. The subjects were referred to outpatient clinics or emergency departments of Birjand's medical university hospitals, Iran, and were enrolled as positive cases. A checklist was completed for each patient including their demographic information, clinical signs and symptoms (cough, sputum production, dyspnea, chest pain, fever, tachycardia, and tachypnea), abnormal findings in pulmonary auscultation and laboratory findings (erythrocyte sedimentation rate, C-reactive protein levels, and white blood cell count). An equal number of age-matched individuals with acute respiratory symptoms, but insignificant findings on chest radiography, were included as the control group. Finally, the diagnostic values of different findings were compared. The data showed that vital signs and physical examination findings are useful screening parameters for predicting chest radiograph findings in outpatient settings. Therefore, by implementing a prediction rule, we would be able to determine which patients would benefit from a chest X-Ray (sensitivity, 94% and specificity, 57%). This study's findings suggest that requesting chest radiographs might not be necessary in patients with acute respiratory symptoms unless the vital signs and/or physical examination findings are abnormal. Considering the 94% sensitivity of this rule for predicting CAP, a chest radiograph is required for patients with unreliable follow-ups or moderate to high

  10. Evidence for short duration of antibiotic treatment for non-severe community acquired pneumonia (CAP in children - are we there yet? A systematic review of randomised controlled trials

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    Shalom Ben-Shimol

    2014-03-01

    Full Text Available Context: The ideal duration of antibiotic treatment for childhood community acquired pneumonia (CAP has not yet been established. Objective: A literature search was conducted to evaluate the efficacy of shorter than 7 days duration of oral antibiotic treatment for childhood non-severe CAP. Data sources: A systematic literature search was performed using the PubMed database. The search was limited to randomised controlled trials (RCTs conducted between January 1996 and May 2013 in children up to 18 years old. Search terms included pneumonia, treatment, duration, child, children, days, short, respiratory infection and non-severe (nonsevere. Study selection: Only RCTs of oral antibiotic treatment for non-severe CAP in children were included. Data extraction: Independent extraction of articles was done by 3 authors using a preformed questionnaire. Data synthesis: Eight articles meeting the selection criteria were identified: 7 from 2 developing countries (India and Pakistan, and 1 from a developed country (The Netherlands. Studies from developing countries used the World Health Organization clinical criteria for diagnosing CAP, which includes mainly tachypnoea. None of those studies included fever, chest radiography or any laboratory test in their case definition. The Dutch study case definition used laboratory tests and chest radiographies (x-rays in addition to clinical criteria. Five articles concluded that 3 days of treatment are sufficient for non-severe childhood CAP, 2 articles found 5 days treatment to be sufficient, and one article found no difference between 3 days of amoxicillin treatment and placebo. Conclusions: The efficacy of short duration oral antibiotic treatment for non-severe CAP in children has not been established in developed countries. Current RCTs from developing countries used clinical criteria that may have failed to appropriately identify children with true bacterial pneumonia necessitating antibiotic treatment. More RCTs

  11. Focus on JNJ-Q2, a novel fluoroquinolone, for the management of community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections

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    Jones TM

    2016-06-01

    Full Text Available Travis M Jones,1,2 Steven W Johnson,1,3 V Paul DiMondi,1,4 Dustin T Wilson,1,2 1Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, 2Department of Pharmacy, Duke University Hospital, Durham, 3Department of Pharmacy, Forsyth Medical Center, Novant Health, Winston-Salem, 4Department of Pharmacy, Durham VA Medical Center, Durham, NC, USA Abstract: JNJ-Q2 is a novel, fifth-generation fluoroquinolone that has excellent in vitro and in vivo activity against a variety of Gram-positive and Gram-negative organisms. In vitro studies indicate that JNJ-Q2 has potent activity against pathogens responsible for acute bacterial skin and skin structure infections (ABSSSI and community-acquired bacterial pneumonia (CABP, such as Staphylococcus aureus and Streptococcus pneumoniae. JNJ-Q2 also has been shown to have a higher barrier to resistance compared to other agents in the class and it remains highly active against drug-resistant organisms, including methicillin-resistant S. aureus, ciprofloxacin-resistant methicillin-resistant S. aureus, and drug-resistant S. pneumoniae. In two Phase II studies, the efficacy of JNJ-Q2 was comparable to linezolid for ABSSSI and moxifloxacin for CABP. Furthermore, JNJ-Q2 was well tolerated, with adverse event rates similar to or less than other fluoroquinolones. With an expanded spectrum of activity and low potential for resistance, JNJ-Q2 shows promise as an effective treatment option for ABSSSI and CABP. Considering its early stage of development, the definitive role of JNJ-Q2 against these infections and its safety profile will be determined in future Phase III studies. Keywords: JNJ-Q2, fluoroquinolone, ABSSSI, CABP, MRSA

  12. 莫西沙星有效治疗老年人社区获得性肺炎%Moxifloxacin in the Treatment of Elderly Patients with Community Acquired Pneumonia

    Institute of Scientific and Technical Information of China (English)

    伏杭江; 游云鹏

    2011-01-01

    Community acquired pneumonia is a common infectious disease in the elderly patients.The new generation fluoroquinolone moxifloxacin has a definite clinical effect and high safety, can be widely used in the treatment of elderly patients with community acquired pneumonia.%社区获得性肺炎是老年人常见的感染性疾病.新一代的氟喹诺酮类药物莫西沙星临床疗效确切、安全性高,可作为老年人社区获得性肺炎经验治疗用药.

  13. RNA viruses in community-acquired childhood pneumonia in semi-urban Nepal; a cross-sectional study

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    Basnet Sudha

    2009-07-01

    Full Text Available Abstract Background Pneumonia is among the main causes of illness and death in children Methods From July 2004 to June 2007, we examined nasopharyngeal aspirates (NPA from 2,230 cases of pneumonia (World Health Organization criteria in children 2 to 35 months old recruited in a randomized trial of zinc supplementation at a field clinic in Bhaktapur, Nepal. The specimens were examined for respiratory syncytial virus (RSV, influenza virus type A (InfA and B (InfB, parainfluenza virus types 1, 2 and 3 (PIV1, PIV2, and PIV3, and human metapneumovirus (hMPV using a multiplex reverse transcriptase polymerase chain reaction (PCR assay. Results We identified 919 virus isolates in 887 (40.0% of the 2,219 NPA specimens with a valid PCR result, of which 334 (15.1% yielded RSV, 164 (7.4% InfA, 129 (5.8% PIV3, 98 (4.4% PIV1, 93 (4.2% hMPV, 84 (3.8% InfB, and 17 (0.8% PIV2. CAP occurred in an epidemic pattern with substantial temporal variation during the three years of study. The largest peaks of pneumonia occurrence coincided with peaks of RSV infection, which occurred in epidemics during the rainy season and in winter. The monthly number of RSV infections was positively correlated with relative humidity (rs = 0.40, P = 0.01, but not with temperature or rainfall. An hMPV epidemic occurred during one of the three winter seasons and the monthly number of hMPV cases was also associated with relative humidity (rs = 0.55, P = 0.0005. Conclusion Respiratory RNA viruses were detected from NPA in 40% of CAP cases in our study. The most commonly isolated viruses were RSV, InfA, and PIV3. RSV infections contributed substantially to the observed CAP epidemics. The occurrence of viral CAP in this community seemed to reflect more or less overlapping micro-epidemics with several respiratory viruses, highlighting the challenges of developing and implementing effective public health control measures.

  14. Hospital Acquired Pneumonia is an Independent Predictor of Poor Global Outcome in Severe Traumatic Brain Injury up to 5 Years after Discharge

    Science.gov (United States)

    Kesinger, Matthew R.; Kumar, Raj G.; Wagner, Amy K.; Puyana, Juan C.; Peitzman, Andrew P.; Billiar, Timothy R.; Sperry, Jason L.

    2016-01-01

    Objectives Long-term outcomes following traumatic brain injury (TBI) correlate with initial head injury severity and other acute factors. Hospital-acquired pneumonia (HAP) is a common complication in TBI. Little information exists regarding the significance of infectious complications on long-term outcomes post-TBI. We sought to characterize risks associated with HAP on outcomes 5 years post-TBI. Methods Ddata from the merger of an institutional trauma registry and the TBI Model Systems outcome data. Individuals with severe head injuries (Abbreviated Injury Scale≥4), who survived to rehabilitation were analyzed. Primary outcome was Glasgow Outcome Scaled-Extended (GOSE) at 1, 2, and 5 years. GOSE was dichotomized into LOW (GOSEPneumonia TBI PMID:25757128

  15. Cumulative clinical experience from over a decade of use of levofloxacin in community-acquired pneumonia: critical appraisal and role in therapy

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    Noreddin AM

    2011-10-01

    Full Text Available Ayman M Noreddin1, Walid F Elkhatib2, Kenji M Cunnion3, George G Zhanel41Department of Pharmacy Practice, Hampton University, Hampton, VA, USA; 2Department of Microbiology and Immunology, Ain-Shams University, Cairo, Egypt; 3Department of Pediatrics, East Virginia Medical School, Norfolk, VA, USA; 4Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada Abstract: Levofloxacin is the synthetic L-isomer of the racemic fluoroquinolone, ofloxacin. It interferes with critical processes in the bacterial cell such as DNA replication, transcription, repair, and recombination by inhibiting bacterial topoisomerases. Levofloxacin has broad spectrum activity against several causative bacterial pathogens of community-acquired pneumonia (CAP. Oral levofloxacin is rapidly absorbed and is bioequivalent to the intravenous formulation such that patients can be conveniently transitioned between these formulations when moving from the inpatient to the outpatient setting. Furthermore, levofloxacin demonstrates excellent safety, and has good tissue penetration maintaining adequate concentrations at the site of infection. The efficacy and tolerability of levofloxacin 500 mg once daily for 10 days in patients with CAP are well established. Furthermore, a high-dose (750 mg and short-course (5 days of once-daily levofloxacin has been approved for use in the US in the treatment of CAP, acute bacterial sinusitis, acute pyelonephritis, and complicated urinary tract infections. The high-dose, short-course levofloxacin regimen maximizes its concentration-dependent antibacterial activity, decreases the potential for drug resistance, and has better patient compliance.Keywords: levofloxacin, community-acquired pneumonia, pharmacodynamics, resistance, pharmacokinetics, clinical use

  16. Community-acquired pneumonia due to pandemic A(H1N12009 influenzavirus and methicillin resistant Staphylococcus aureus co-infection.

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    Ronan J Murray

    Full Text Available BACKGROUND: Bacterial pneumonia is a well described complication of influenza. In recent years, community-onset methicillin-resistant Staphylococcus aureus (cMRSA infection has emerged as a contributor to morbidity and mortality in patients with influenza. Since the emergence and rapid dissemination of pandemic A(H1N12009 influenzavirus in April 2009, initial descriptions of the clinical features of patients hospitalized with pneumonia have contained few details of patients with bacterial co-infection. METHODOLOGY/PRINCIPAL FINDINGS: Patients with community-acquired pneumonia (CAP caused by co-infection with pandemic A(H1N12009 influenzavirus and cMRSA were prospectively identified at two tertiary hospitals in one Australian city during July to September 2009, the period of intense influenza activity in our region. Detailed characterization of the cMRSA isolates was performed. 252 patients with pandemic A(H1N12009 influenzavirus infection were admitted at the two sites during the period of study. Three cases of CAP due to pandemic A(H1N12009/cMRSA co-infection were identified. The clinical features of these patients were typical of those with S. aureus co-infection or sequential infection following influenza. The 3 patients received appropriate empiric therapy for influenza, but inappropriate empiric therapy for cMRSA infection; all 3 survived. In addition, 2 fatal cases of CAP caused by pandemic A(H1N12009/cMRSA co-infection were identified on post-mortem examination. The cMRSA infections were caused by three different cMRSA clones, only one of which contained genes for Panton-Valentine Leukocidin (PVL. CONCLUSIONS/SIGNIFICANCE: Clinicians managing patients with pandemic A(H1N12009 influenzavirus infection should be alert to the possibility of co-infection or sequential infection with virulent, antimicrobial-resistant bacterial pathogens such as cMRSA. PVL toxin is not necessary for the development of cMRSA pneumonia in the setting of pandemic

  17. TGF-β Blood Levels Distinguish Between Influenza A (H1N1)pdm09 Virus Sepsis and Sepsis due to Other Forms of Community-Acquired Pneumonia

    Science.gov (United States)

    Rendón-Ramirez, Erick J.; Ortiz-Stern, Alejandro; Martinez-Mejia, Corazon; Salinas-Carmona, Mario C.; Rendon, Adrian; Mata-Tijerina, Viviana L.

    2015-01-01

    Abstract There is a strong interest in finding adequate biomarkers to aid in the diagnosis and prognosis of influenza A (H1N1)pdm09 virus infection. In this study, serum levels of inflammatory cytokines and laboratory markers were evaluated to assess their usefulness as biomarkers of influenza A (H1N1)pdm09 and their association with fatal cases. Serum samples of consecutive patients with a clinical presentation suggestive of influenza A (H1N1)pdm09 and progression to sepsis were evaluated. Serum inflammatory cytokines and routine laboratory tests were performed and correlated with positivity for influenza A (H1N1)pdm09 influenza by real time reverse transcription polymerase chain reaction and the results of three clinical severity scores (Sequential Organ Failure Assessment [SOFA], CURB-65, and Acute Physiology and Chronic Health Evaluation II [APACHE II]). High SOFA scores and some of its individual components, but not CURB-65 or APACHE II scores, correlate with fatal cases regardless of etiology. Total and unconjugated bilirubin, Ca++, Cl−, prothrombin times, and partial thromboplastin times discriminate influenza A (H1N1)pdm09 from other causes of community-acquired pneumonia. High levels of IL-8, IL-10, and IL-17 were increased in influenza A (H1N1)pdm09 patients when compared with controls (p<0.05). IL-6 levels were significantly elevated in influenza A (H1N1)pdm09 patients and non-(H1N1)pdm09 patients when compared with controls (p<0.05). TGF-β serum levels discern between healthy controls, influenza A (H1N1)pdm09 patients, and patients with other causes of community-acquired pneumonia. TGF-β levels were negatively correlated with SOFA on admission in influenza A (H1N1)pdm09 patients. TGF-β levels are a useful tool for differentiating influenza A (H1N1)pdm09 from other causes of pneumonia progressing to sepsis. PMID:25923384

  18. Cryptogenic Organizing Pneumonia Repeatedly Misdiagnosed as Community Acquired Pneumonia%隐源性机化性肺炎反复误诊为社区获得性肺炎

    Institute of Scientific and Technical Information of China (English)

    梅周芳; 钱凌; 都勇; 施劲东; 何炜; 揭志军

    2015-01-01

    Objective To study the diagnosis and treatment of cryptogenic organizing pneumonia (COP), so as to re-duce misdiagnosis rate. Methods Clinical data of one case of community acquired pneumonia misdiagnosed as COP in our hospital was retrospectively analyzed, with a review of literature. Results The patient had been hospitalized 5 months before for lung exudation. CT scanning in a local hospital supported diagnosis of CAP and anti-infection therapy failed to respond. Our hospital chest CT scan showed multiple exudation in both lungs; bronchoscopy checked patency of every lumen; B type ul-trasound revealed no enlarged superficial lymph nodes; lung biopsy and pathological examination showed COP, the patient's symptoms were significantly relieved after high dose glucocorticoid pulse therapy for one week and at the same time, most le-sions were absorbed. Conclusion For multiple pulmonary exudative consolidation patients with long course of disease, re-fractory to conventional anti infection treatment, especially for the glucocorticoid sensitivity, COP should be considered and fi-beroptic bronchoscopy or CT guided percutaneous lung biopsy should be performed in order to reduce the misdiagnosis and mis-treatment rates.%目的:探讨隐源性机化性肺炎(cryptogenic organizing pneumonia, COP)的诊治要点,以减少误诊。方法回顾分析我科收治的1例误诊为社区获得性肺炎(community acquired pneumonia, CAP)的 COP 临床资料,并复习相关文献。结果本例因发现双肺反复渗出性病灶5个月就诊。病程中多次就诊当地医院行胸部 CT 扫描诊断为CAP,反复予抗感染治疗无效。入我院后查血常规未见明显异常,胸部 CT 检查示两肺上叶、右肺下叶多发炎性病灶;纤维支气管镜未见异常;B 超检查未见全身浅表淋巴结增大;肿瘤标志物检测、痰病原学及感染生物标志物检查均(-)。后行 CT 引导下经皮肺穿刺活检病理检查,并结

  19. Atypical pneumonia

    Science.gov (United States)

    ... America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis . 2007;44:S27-S72. PMID: 17278083 ... by: Denis Hadjiliadis, MD, Associate Professor of Medicine, Pulmonary, Allergy and Critical Care, Perelman ...

  20. Understanding Pneumonia

    Science.gov (United States)

    ... and Diseases > Lung Disease Lookup > Pneumonia Learn About Pneumonia 5 Facts You Should Know about Pneumonia Pneumonia ... vaccinated and practicing good health habits What Is Pneumonia? Pneumonia is an infection in one or both ...

  1. Fatores associados às complicações em crianças pré-escolares com pneumonia adquirida na comunidade Factors associated with complications of community-acquired pneumonia in preschool children

    Directory of Open Access Journals (Sweden)

    Pollyana Garcia Amorim

    2012-10-01

    Full Text Available OBJETIVO: Identificar os fatores socioeconômicos e clínicos associados à evolução para complicações em crianças internadas com pneumonia adquirida na comunidade (PAC. MÉTODOS: Estudo longitudinal prospectivo em crianças diagnosticadas com PAC (12-59 meses de idade internadas em enfermarias gerais de pediatria de dois hospitais na região de Campinas (SP. Os critérios de exclusão foram ter fibrose cística, cardiopatia, malformação pulmonar, neuropatias e doenças genéticas. PAC foi diagnosticada por características clínicas e radiológicas. Os dados foram coletados dos prontuários médicos e por um questionário semiestruturado. Os sujeitos foram divididos em dois grupos (PAC complicada e não complicada. Foram comparadas variáveis socioeconômicas e clínicas, e foi realizada análise de regressão logística multivariada. RESULTADOS: Das 63 crianças incluídas, 29 e 34, respectivamente, apresentaram PAC não complicada e PAC complicada. Não houve diferenças estatisticamente significantes entre os grupos quanto a idade na admissão, idade gestacional, peso ao nascer, gênero ou variáveis socioeconômicas. Houve diferenças significantes entre os grupos em relação a pneumonia anterior (p = 0,03, antibioticoterapia prévia (p = 0,004, tempo de início da doença (p = 0,01, duração da febre antes da internação (p OBJECTIVE: To identify socioeconomic factors and clinical factors associated with the development of complications in preschool children hospitalized with community-acquired pneumonia (CAP. METHODS: This was a prospective longitudinal study involving children (12-59 months of age diagnosed with CAP and admitted to the pediatric wards of two hospitals in the metropolitan area of Campinas, Brazil. Children with cystic fibrosis, heart disease, pulmonary malformations, neurological disorders, or genetic diseases were excluded. The diagnosis of CAP was based on clinical and radiological findings. Data were

  2. Impact of the factor V Leiden mutation on the outcome of pneumococcal pneumonia: a controlled laboratory study

    Science.gov (United States)

    2010-01-01

    Introduction Streptococcus (S.) pneumoniae is the most common cause of community-acquired pneumonia. The factor V Leiden (FVL) mutation results in resistance of activated FV to inactivation by activated protein C and thereby in a prothrombotic phenotype. Human heterozygous FVL carriers have been reported to be relatively protected against sepsis-related mortality. We here determined the effect of the FVL mutation on coagulation, inflammation, bacterial outgrowth and outcome in murine pneumococcal pneumonia. Methods Wild-type mice and mice heterozygous or homozygous for the FVL mutation were infected intranasally with 2*106 colony forming units of viable S. pneumoniae. Mice were euthanized after 24 or 48 hours or observed in a survival study. In separate experiments mice were treated with ceftriaxone intraperitoneally 24 hours after infection and euthanized after 48 hours or observed in a survival study. Results The FVL mutation had no consistent effect on activation of coagulation in either the presence or absence of ceftriaxone therapy, as reflected by comparable lung and plasma levels of thrombin-antithrombin complexes and fibrin degradation products. Moreover, the FVL mutation had no effect on lung histopathology, neutrophil influx, cytokine and chemokine levels or bacterial outgrowth. Remarkably, homozygous FVL mice were strongly protected against death due to pneumococcal pneumonia when treated with ceftriaxone, which was associated with more pronounced FXIII depletion; this protective effect was not observed in the absence of antibiotic therapy. Conclusions Homozygosity for the FVL mutation protects against lethality due to pneumococcal pneumonia in mice treated with antibiotics. PMID:20682036

  3. Evaluation of Patients with Community-Acquired Pneumonia Caused by Zoonotic Pathogens in an Area with a High Density of Animal Farms.

    Science.gov (United States)

    Huijskens, E G W; Smit, L A M; Rossen, J W A; Heederik, D; Koopmans, M

    2016-03-01

    Intensive animal farming could potentially lead to outbreaks of infectious diseases. Clinicians are at the forefront of detecting unusual diseases, but the lack of specificity of zoonotic disease symptoms makes this a challenging task. We evaluated patients with community-acquired pneumonia (CAP) with known and unknown aetiology in an area with a high livestock density and a potential association with animal farms in the proximity. Between 2008 and 2009, a period coinciding with a large Q fever outbreak in the Netherlands, patients with CAP were tested for the presence of possible respiratory pathogens. The presence and number of farm animals within 1 km of the patients' home address were assessed using geographic information system (GIS) and were compared between cases and age-matched control subjects. Of 408 patients with CAP, pathogens were detected in 275 (67.4%) patients. The presence of sheep and the number of goats were associated with CAP caused by Coxiella burnetii in a multiple logistic regression model (P animal farms (P > 0.10). The use of GIS in combination with aetiology of CAP could be potentially used to target diagnostics and to identify outbreaks of rare zoonotic disease.

  4. Distribution and antimicrobial susceptibility of bacteria from adults with community-acquired pneumonia or complicated skin and soft tissue infections in France: the nationwide French PREMIUM study.

    Science.gov (United States)

    Leprince, C; Desroches, M; Emirian, A; Coutureau, C; Anais, L; Fihman, V; Soussy, C J; Decousser, J W

    2015-10-01

    The empirical therapy of community-acquired pneumonia (CAP) and complicated skin and soft tissue infections (cSSTIs) must be based on updated bacterial distribution and susceptibility data. A nationwide study consecutively collected 1288 isolates from CAP (n=467) and cSSTIs (n=821) from 18 French hospitals between 2012 and 2013. The MIC values of commonly used antimicrobial agents, including ceftaroline, were determined. Bacterial distribution featured Pneumococcus, Haemophilus influenzae, and Staphylococcus aureus for CAPs and S. aureus, β-hemolytic streptococci and Enterobacteriaceae for cSSTIs. Antimicrobial susceptibility testing indicated i) the sustained third-generation cephalosporins and levofloxacin activity against pneumococci and H. influenzae, ii) no methicillin-resistant Staphylococcus aureus emergence among respiratory pathogens, iii) the high in vitro activity of ceftaroline against staphylococci from cSSTIs (98.7% susceptibility), and iv) the worrisome decreasing fluoroquinolone and third-generation cephalosporin susceptibilities among Enterobacteriaceae. This laboratory-based survey depicts a contrasting situation and supports the scoring of patients for the resistant pathogen risk before empirical therapy. PMID:26166208

  5. Acquired severe pneumonia in the community in seropositive HIV patients. Neumonía grave adquirida en la comunidad en paciente seropositiva al virus de inmunodeficiencia humana.

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    Rubén Bembibre Taboada

    Full Text Available Infection due to the Human Immunodeficiency Virus (HIVhas become a principal health problem worldwide mainly in underdeveloped countries. In these patients, respiratory infections constitute the greatest cause of morbimortality rate in which Pneumocystis Carinii is the most frequently found pathogen. However, this article describes the case of a woman who is seropositive to HIV and who developed a severe and rapidly fatal community acquired pneumonia dur to Sthaphylococcus aureus, a very rare and less common infection in this kind of patients.

    La infección por el virus de la inmunodeficiencia humana se ha convertido en el principal problema sanitario en el mundo, particularmente en los países subdesarrollados. En estos pacientes la infección respiratoria es la mayor causa de morbilidad y mortalidad, en cuyos casos el Pneumcystis carinii es el germen más comúnmente encontrado. Sin embargo, en el presente trabajo se describe una paciente seropositiva al virus de la inmunodeficiencia humana que desarrolló una neumonía adquirida en la comunidad, severa y rápidamente fatal, por Sthaphylococcus aureus, infección poco común en este tipo de pacientes.

  6. Evaluation of Patients with Community-Acquired Pneumonia Caused by Zoonotic Pathogens in an Area with a High Density of Animal Farms.

    Science.gov (United States)

    Huijskens, E G W; Smit, L A M; Rossen, J W A; Heederik, D; Koopmans, M

    2016-03-01

    Intensive animal farming could potentially lead to outbreaks of infectious diseases. Clinicians are at the forefront of detecting unusual diseases, but the lack of specificity of zoonotic disease symptoms makes this a challenging task. We evaluated patients with community-acquired pneumonia (CAP) with known and unknown aetiology in an area with a high livestock density and a potential association with animal farms in the proximity. Between 2008 and 2009, a period coinciding with a large Q fever outbreak in the Netherlands, patients with CAP were tested for the presence of possible respiratory pathogens. The presence and number of farm animals within 1 km of the patients' home address were assessed using geographic information system (GIS) and were compared between cases and age-matched control subjects. Of 408 patients with CAP, pathogens were detected in 275 (67.4%) patients. The presence of sheep and the number of goats were associated with CAP caused by Coxiella burnetii in a multiple logistic regression model (P 0.10). The use of GIS in combination with aetiology of CAP could be potentially used to target diagnostics and to identify outbreaks of rare zoonotic disease. PMID:26214299

  7. Impact of Interstitial Pneumonia on the Survival and Risk Factors Analysis of Patients with Hematological Malignancy

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    Wei-Liang Chen

    2013-01-01

    Full Text Available Background. The emergence of interstitial pneumonia (IP in patients with hematological malignancy (HM is becoming a challenging scenario in current practice. However, detailed characterization and investigation of outcomes and risk factors on survival have not been addressed. Methods. We conducted a retrospective study of 42,584 cancer patients covering the period between 1996 and 2008 using the institutional cancer registry system. Among 816 HM patients, 61 patients with IP were recognized. The clinical features, laboratory results, and histological types were studied to determine the impact of IP on survival and identify the profile of prognostic factors. Results. HM patients with IP showed a significant worse survival than those without IP in the 5-year overall survival (P=0.027. The overall survival showed no significant difference between infectious pneumonia and noninfectious interstitial pneumonia (IIP versus nIIP (P=0.323. In a multivariate Cox regression model, leukocyte and platelet count were associated with increased risk of death. Conclusions. The occurrence of IP in HM patients is associated with increased mortality. Of interest, nIIP is a prognostic indicator in patients with lymphoma but not in patients with leukemia. However, aggressive management of IP in patients with HM is strongly advised, and further prospective survey is warranted.

  8. Compliance with guidelines-recommended processes in pneumonia: impact of health status and initial signs.

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    Rosario Menéndez

    Full Text Available Initial care has been associated with improved survival of community-acquired pneumonia (CAP. We aimed to investigate patient comorbidities and health status measured by the Charlson index and clinical signs at diagnosis associated with adherence to recommended processes of care in CAP. We studied 3844 patients hospitalized with CAP. The evaluated recommendations were antibiotic adherence to Spanish guidelines, first antibiotic dose 65 (OR, 1.51 and COPD (OR, 1.80 were protective factors. The combination of antibiotic adherence and timing <6 hours was negatively associated with confusion (OR, 0.69 and a high Charlson score (OR, 0.92 adjusting for severity and hospital effect, whereas age was not an independent factor. Deficient health status and confusion, rather than age, are associated with lower compliance with antibiotic therapy recommendations and timing, thus identifying a subpopulation more prone to receiving lower quality care.

  9. The National Early Warning Score (NEWS) for outcome prediction in emergency department patients with community-acquired pneumonia: results from a 6-year prospective cohort study

    Science.gov (United States)

    Sbiti-Rohr, Diana; Kutz, Alexander; Christ-Crain, Mirjam; Thomann, Robert; Zimmerli, Werner; Hoess, Claus; Henzen, Christoph; Mueller, Beat; Schuetz, Philipp

    2016-01-01

    Objective To investigate the accuracy of the National Early Warning Score (NEWS) to predict mortality and adverse clinical outcomes for patients with community-acquired pneumonia (CAP) compared to standard risk scores such as the pneumonia severity index (PSI) and CURB-65. Design Secondary analysis of patients included in a previous randomised-controlled trial with a median follow-up of 6.1 years. Settings Patients with CAP included on admission to the emergency departments (ED) of 6 tertiary care hospitals in Switzerland. Participants A total of 925 patients with confirmed CAP were included. NEWS, PSI and CURB-65 scores were calculated on admission to the ED based on admission data. Main outcome measure Our primary outcome was all-cause mortality within 6 years of follow-up. Secondary outcomes were adverse clinical outcome defined as intensive care unit (ICU) admission, empyema and unplanned hospital readmission all occurring within 30 days after admission. We used regression models to study associations of baseline risk scores and outcomes with the area under the receiver operating curve (AUC) as a measure of discrimination. Results 6-year overall mortality was 45.1% (n=417) with a stepwise increase with higher NEWS categories. For 30 day and 6-year mortality prediction, NEWS showed only low discrimination (AUC 0.65 and 0.60) inferior compared to PSI and CURB-65. For prediction of ICU admission, NEWS showed moderate discrimination (AUC 0.73) and improved the prognostic accuracy of a regression model, including PSI (AUC from 0.66 to 0.74, p=0.001) and CURB-65 (AUC from 0.64 to 0.73, p=0.015). NEWS was also superior to PSI and CURB-65 for prediction of empyema, but did not well predict rehospitalisation. Conclusions NEWS provides additional prognostic information with regard to risk of ICU admission and complications and thereby improves traditional clinical-risk scores in the management of patients with CAP in the ED setting. Trial registration number

  10. Presence of the Panton-Valentine Leukocidin Genes in Methicillin-Resistant Staphylococcus aureus Is Associated with Severity and Clinical Outcome of Hospital-Acquired Pneumonia in a Single Center Study in China.

    Science.gov (United States)

    Zhang, Chuanling; Guo, Liang; Chu, Xu; Shen, Limeng; Guo, Yuanyu; Dong, Huali; Mao, Jianfeng; van der Veen, Stijn

    2016-01-01

    The Panton-Valentine leukocidin (PVL) genes of methicillin-resistant Staphylococcus aureus (MRSA) have previously been associated with severe infections. Here, the impact of the PVL genes on severity of disease and clinical outcome of patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) due to MRSA was investigated in a single center observational study in a hospital in China. HAP due to MRSA was diagnosed in 100 patients and 13 of the patients were PVL positive, while VAP was diagnosed in 5 patients and 2 were PVL positive. The PVL positive patient group showed a significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (14.3 ±7.8 vs. 10.1 ±4.7, P = 0.005) and significantly more patients with CRP levels >80 mg/L (8/15 vs. 12/90, P = 0.006) or WBC counts >15x109/L (7/15 vs. 12/90, P = 0.006), indicating that the severity of disease is affected by the presence of the PVL genes. The outcome of the study was defined by 30-day mortality. Four (27%) of the PVL positive patients and four (4%) of the PVL negative patients died within 30 days (P = 0.01, Fisher exact test). Kaplan-Meier survival curves were generated for the PVL positive and PVL negative patient groups, which differed significantly (P = 0.003). Among the patients that died, the mean interval between diagnosis and death was shorter for the PVL positive patients (9.3 ±5.6 vs. 40.8 ±6.6 days, P = 0.013). Further analysis within the HAP and VAP patient groups showed that the presence of PVL in MRSA impacted the severity of disease and clinical outcome of HAP, but for VAP the number of patients included in the study was too low. In conclusion, in this single center study in a Chinese hospital the presence of the PVL genes in MRSA impacted the severity of disease and clinical outcome in patients with HAP due to MRSA. PMID:27249225

  11. Prevalence and correlates of treatment failure among Kenyan children hospitalised with severe community-acquired pneumonia: a prospective study of the clinical effectiveness of WHO pneumonia case management guidelines

    Science.gov (United States)

    Agweyu, Ambrose; Kibore, Minnie; Digolo, Lina; Kosgei, Caroline; Maina, Virginia; Mugane, Samson; Muma, Sarah; Wachira, John; Waiyego, Mary; Maleche-Obimbo, Elizabeth

    2014-01-01

    Objective To determine the extent and pattern of treatment failure (TF) among children hospitalised with community-acquired pneumonia at a large tertiary hospital in Kenya. Methods We followed up children aged 2–59 months with WHO-defined severe pneumonia (SP) and very severe pneumonia (VSP) for up to 5 days for TF using two definitions: (i) documentation of pre-defined clinical signs resulting in change of treatment (ii) primary clinician's decision to change treatment with or without documentation of the same pre-defined clinical signs. Results We enrolled 385 children. The risk of TF varied between 1.8% (95% CI 0.4–5.1) and 12.4% (95% CI 7.9–18.4) for SP and 21.4% (95% CI 15.9–27) and 39.3% (95% CI 32.5–46.4) for VSP depending on the definition applied. Higher rates were associated with early changes in therapy by clinician in the absence of an obvious clinical rationale. Non-adherence to treatment guidelines was observed for 70/169 (41.4%) and 67/201 (33.3%) of children with SP and VSP, respectively. Among children with SP, adherence to treatment guidelines was associated with the presence of wheeze on initial assessment (P = 0.02), while clinician non-adherence to guideline-recommended treatments for VSP tended to occur in children with altered consciousness (P razonamiento clínico obvio. Se observaba una no adherencia a las guías de tratamiento en 70/169 (41.4%) y 67/201 (33.3%) de los niños con NS y NMS respectivamente. Entre los niños con SP, la adherencia a las guías de tratamiento estaba asociada con la presencia de sibilancias en la evaluación inicial (P=0.02) mientras que la no adherencia del clínico a los tratamientos recomendados por las guías para NMS tendían a ocurrir en niños con un estado alterado de consciencia (P<0.001). Utilizando el pareamiento por puntaje de propensión para equilibrar los grupos en la distribución de las características clínicas de base de los niños con NMS, se observó que no exist

  12. Clinical features and antimicrobial resistance of community-acquired pneumonia caused by Klebsiella pneumoniae in infants%婴幼儿社区获得性肺炎克雷伯菌肺炎的临床特点及耐药分析

    Institute of Scientific and Technical Information of China (English)

    何丽芸; 王应建; 李季美

    2012-01-01

    目的 探讨婴幼儿社区获得性肺炎克雷伯菌肺炎的临床特点及耐药特征.方法 收集2007 ~2011年65例婴幼儿社区获得性肺炎克雷伯菌肺炎住院病例,对其临床资料进行回顾性分析.结果 65例患儿中,≤3个月小婴儿37例(57%),4个月~ 17例(26%),7个月~7例(11%),13 ~24个月4例(6%).患儿临床表现及X线胸片特点与其他细菌性肺炎无明显差异.产超广谱β内酰胺酶(ESBLs)肺炎克雷伯菌检出40株,检出率为62%.肺炎克雷伯菌对亚胺培南、美罗培南、阿米卡星敏感率为100%,但对青霉素、头孢菌素普遍耐药;产ESBLs菌株对青霉素类、头孢菌素类、阿莫西林/棒酸、氨苄西林/舒巴坦、复方新诺明、庆大霉素、环丙沙星及氨曲南的耐药率显著高于非产ESBLs菌株,呈多重耐药性.结论 社区获得性肺炎克雷伯菌肺炎常见于3个月内的小婴儿.产ESBLs菌株在肺炎克雷伯菌社区获得性肺炎感染中非常流行,其耐药率高,且呈多重耐药性.%Objective To study the clinical features and antimicrobial resistance of community-acquired pneumonia caused by Klebsiella pneumoniae in infants. Methods The clinical data of 65 infants with community-acquired pneumonia caused by Klebsiella pneumoniae between 2007 and 2011 were retrospectively studied. Results Of the 65 infants, 37 cases (57% ) were aged ≤ 3 months, 17 cases (26% ) over 4 months, 7 cases (11%) over 7 months and 4 cases (6% ) between 13 and 24 months. There were no significant differences in clinical manifestations and chest X-ray features between the infants with community-acquired pneumonia caused by Klebsiella pneumoniae and those with other bacterial pneumonia. Forty strains (62% ) of ESBLs-producing Klebsiella pneumoniae were detected. Klebsiella pneumoniae was 100% sensitive to imipenem, meropenem and amikacin but resistant to penicillins and cephalosporins. The resistance rates of ESBLs-producing strains to

  13. 肺炎理疗电极贴片辅治小儿社区获得性肺炎90例临床观察%Clinical observation on treating 90 cases of pediatric community-acquired pneumonia with pneumonia physiotherapy electrode patch

    Institute of Scientific and Technical Information of China (English)

    李雪梅; 林莉

    2012-01-01

      Objective: To investigate the status of treating pediatric community-acquired pneumonia with pneumonia physiotherapy electrode patch. Methods:180 cases of community-acquired pneumonia were randomly divided into observation group and treatment groups, the two groups were given conventional treatment, and the observation group on this basis, the application pneumonia physiotherapy electrode patches and meridian pulse therapeutic apparatus adjuvant therapy. Results: The observation group and treatment group cure rate was 97%,87%, the difference was statistically significant (P<0.05). Conclusion: Pneumonia physiotherapy electrode patch transdermal medicine delivery assisted treatment of pediatric community acquired pneumonia results significantly, worth implementing in clinical.%  目的:探讨肺炎理疗电极贴片治疗社区获得性肺炎的状况.方法:180例社区获得性肺炎患儿随机分为观察组和治疗组,两组均给予常规治疗,观察组在此基础上,应用肺炎理疗电极贴片并通过经穴脉冲治疗仪辅助治疗.结果:观察组和治疗组治愈显效率分别为97%,87%,两组比较差异有统计学意义(P<0.05).结论:肺炎理疗电极贴片经皮给药辅治小儿社区获得性肺炎效果明显,值得推行于临床.

  14. Outcome of ventilator-associated pneumonia: Impact of antibiotic therapy and other factors

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    Noyal Mariya Joseph

    2012-02-01

    Full Text Available BackgroundVentilator-associated pneumonia (VAP is the most frequent infection in patients intubated for longer than 48 hours. There is a great interest in determining the factors influencing the outcome of VAP, as it may help in reducing the associated morbidity and mortality. This study aimed to determine the impact of appropriate antibiotic therapy based on endotracheal aspirate cultures on the outcome of VAP. We have also studied the other factors that may influence the outcome of VAP.MethodA cohort study was conducted in the intensive care units of a tertiary care hospital in South India over a period of 15 months.The outcome of VAP was assessed by prolongation of the duration of mechanical ventilation and/ or death of the patient.ResultsThe duration of mechanical ventilation was significantly prolonged in patients with VAP (16.61 ± 8.2 d vs. 8.21 ± 5.9 d, P 2 days in administering the first dose of appropriate antibiotic therapy significantly prolonged the duration of ventilation (P < 0.0001. Infection by multi-drug resistant pathogens, polymicrobial infection and time of onset of VAP did not have significant impact on the outcome of VAP.ConclusionEarly administration of appropriate antibiotic therapy, based on the antibiogram of the VAP pathogens identified by quantitative culture of endotracheal aspirate, could lead to an improved outcome of patients with ventilator-associated pneumonia.

  15. Gemifloxacin for the treatment of community-acquired pneumonia and acute exacerbation of chronic bronchitis: a meta-analysis of randomized controlled trials

    Institute of Scientific and Technical Information of China (English)

    ZHANG Lei; WANG Rui; Falagas E. Matthew; CHEN Liang-an; LIU You-ning

    2012-01-01

    Background Gemifloxacin is a fluoroquinolone antibiotic with broad spectrum of antibacterial activity.The aim of the study was to evaluate the comparative effectiveness and safety of gemifloxacin for the treatment of patients with community-acquired pneumonia (CAP) or acute exacerbation of chronic bronchitis (AECB).Methods We performed a meta-analysis of randomized controlled trials (RCTs) comparing gemifloxacin with other approved antibiotics.The PubMed,EMBASE,Chinese Biomedical Literature Database and the Cochrane Central Register of Controlled Trials were searched,with no language restrictions.Results Ten RCTs,comparing gemifloxacin with other quinolones (in 5 RCTs) and β-lactams and/or macrolides (in 5 RCTs),involving 3940 patients,were included in this meta-analysis.Overall,the treatment success was higher for gemifloxacin when compared with other antibiotics (odds ratio 1.39,95% confidence interval 1.15-1.68 in intention-to-treat patients,and 1.33,1.02-1.73 in clinically evaluable patients).There was no significant difference between the compared antibiotics regarding microbiological success (1.19,0.84-1.68) or all-cause mortality (0.82,0.41-1.63).The total drug related adverse events were similar for gemifloxacin when compared with other quinolones (0.89,0.56-1.41),while lower when compared with β-lactams and/or macrolides (0.71,0.57-0.89).In subgroup analyses,administration of gemifloxacin was associated with fewer cases of diarrhoea and more rashes compared with other antibiotics (0.66,0.48-0.91,and 2.36,1.18-4.74,respectively).Conclusions The available evidence suggests that gemifloxacin 320 mg oral daily is equivalent or superior to other approved antibiotics in effectiveness and safety for CAP and AECB.The development of rash represents potential limitation of gemifloxacin.

  16. Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Adult Community-Acquired Pneumonia: Review of the Literature and Meta-Analysis.

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    Xiong Ye

    Full Text Available Lung ultrasonography (LUS is being increasingly utilized in emergency and critical settings. We performed a systematic review of the current literature to compare the accuracy of LUS and chest radiography (CR for the diagnosis of adult community-acquired pneumonia (CAP. We searched in Pub Med, EMBASE dealing with both LUS and CR for diagnosis of adult CAP, and conducted a meta-analysis to evaluate the diagnostic accuracy of LUS in comparison with CR. The diagnostic standard that the index test compared was the hospital discharge diagnosis or the result of chest computed tomography scan as a "gold standard". We calculated pooled sensitivity and specificity using the Mantel-Haenszel method and pooled diagnostic odds ratio using the DerSimonian-Laird method. Five articles met our inclusion criteria and were included in the final analysis. Using hospital discharge diagnosis as reference, LUS had a pooled sensitivity of 0.95 (0.93-0.97 and a specificity of 0.90 (0.86 to 0.94, CR had a pooled sensitivity of 0.77 (0.73 to 0.80 and a specificity of 0.91 (0.87 to 0.94. LUS and CR compared with computed tomography scan in 138 patients in total, the Z statistic of the two summary receiver operating characteristic was 3.093 (P = 0.002, the areas under the curve for LUS and CR were 0.901 and 0.590, respectively. Our study indicates that LUS can help to diagnosis adult CAP by clinicians and the accuracy was better compared with CR using chest computed tomography scan as the gold standard.

  17. Tratamiento de la neumonía del adulto adquirida en la comunidad TREATMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

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    Alejandro Díaz F.

    2005-04-01

    so antibiotic treatment is empirically prescribed. In Chile, one third of Streptococcus pneumoniae strain isolates has diminished susceptibility to penicillin; in-vitro erythromycin resistance is about 10-15% and cefotaxime resistance 2-10%. It is recommended to classify patients with community acquired pneumonia in four risk categories: Group 1: patients under 65 years without co-morbidities, in ambulatory attendance. Treatment: oral amoxicillin 1 g TID, 7 days. Group 2: patients over 65 years and / or co-morbidities, in ambulatory attendance. Treatment: oral amoxicillin/clavulanate 500/125 mg TID or 875/125 mg BID, or cefuroxime 500 mg BID, 7 days. Group 3: patients admitted to general wards with criteria of moderate severity. Treatment: ceftriaxone 1-2 g once a day or cefotaxime 1 g TID, IV, 7-10 days. Group 4: patients with severe CAP that must be interned into ICU. Treatment: ceftriaxone 2 g once a day or cefotaxime 1 g TID, IV, associated to erythromycin 500 QID, levofloxacin 500-1.000 mg once a day, or moxifloxacin 400 mg/once a day, IV, 10-14 days. In the presence of allergy to or treatment failure with betalactam drugs and/or positive serology for Mycoplasma, Chlamydia or Legionella sp it is recommended to add: erythromycin 500 mg QID, IV or oral, oral clarithromycin 500 mg BID, or oral azythromycin 500 mg once a day

  18. THE ROLE OF TUMOR NECROSIS FACTOR-α G–308A, INTERLEUKIN-1β C–511T AND INTERLEUKIN-10 G–1082A GENE POLYMORPHISMS IN THE DEVELOPMENT OF SLOWLYRESOLVED COURSE OF COMMUNITY-ACQUIRED PNEUMONIA

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    V. I. Sovalkin

    2013-01-01

    Full Text Available Purpose: To study the distribution of genotypes and alleles tumor necrosis factor-α G–308A, interleukin1β C–511T, interleukin-10 G–1082A in patients with slowlyresolved pneumonia and their association with clinical and radiologicalfeatures of the disease.Materials and Methods: We investigated 89 patients with community-acquired pneumonia, of which 37 people had a slowlyresolving course of the disease.The genotype distribution of studied polymorpisms corresponded the Hardy–Weinberg equilibrium.Results: We determined that the tumor necrosis factor-α G–308A and interleukin-10 G–1082A gene polymorphisms were associated with the long course of pneumonia. Slow resolution of the disease in patients who are carriers of GA and AA genotypes of tumor necrosis factor-α contributed to a severe course. The intensity of inflammation in these patients was reflected in the high rates of erythrocyte sedimentation rate and C-reactive protein. Prolonged duration in patients who are carriers of GG genotype of IL-10 was associated with significant clinical and laboratory manifestations at onset of the disease and more frequent development of pleural effusion. The frequencies of alleles and genotypes of interleukin-1β in observed patients did not differ. Conclusions: The data can be used for prognosis of slowlyresolved pneumonia

  19. Aspiration pneumonia

    Science.gov (United States)

    Anaerobic pneumonia; Aspiration of vomitus; Necrotizing pneumonia; Aspiration pneumonitis ... The type of bacteria that caused the pneumonia depends on: Your ... facility, for example) Whether you were recently hospitalized ...

  20. 合肥地区老年社区获得性肺炎的特点分析%Hefei area older community-acquired pneumonia characteristics

    Institute of Scientific and Technical Information of China (English)

    沈晔婧; 徐爱晖

    2012-01-01

    Objective To analyze the clinical features of elderly community-acquired pneumonia( CAP) ,to provide a reference for clinical diagnosis and treatment. Methods A retrospective analysis was carried out on clinical datas of 330 adult CAP patients from January 2009 to December 2010 to compare the clinical features ..etiology and background diseases between elderly CAP patients and non-elderly about clinical data. Results Elderly CAP patients had more background diseases and complications, higher mortality but lower cure rate, their clinical symptoms were not typical, the pathogenic bacteria that they had were mostly Gram-negative bacteria(/>>0. OS). Conclusions As old patients have more background disease .failures in immunity and dysfunctional organs, they have more incidence and mortality. Grasping of the clinical features of elderly CAP patients is conducive to accurate diagnosis, rational drug use, and improves the cure rate.%目的 分析老年社区获得性肺炎(CAP)患者的临床特征.方法 分析我院呼吸内科2009年1月-2010年12月的330例成人CAP患者的临床资料,比较老年CAP患者和非老年CAP患者的病原学检查、临床特征、基础疾病及疗效等情况.结果 老年CAP患者病原菌多为革兰阴性杆菌,呼吸系统的临床症状不典型,基础疾病多,容易出现并发症;出院治愈率、致死率分别低于和高于非老年患者,但差异无统计学意义.结论 老年人由于免疫力低,器官功能减退,合并多种基础疾病,临床症状不典型使其发病率高、漏诊率高、死亡率高,因此掌握老年CAP患者的临床特征、及早诊断、合理用药,对于改善老年CAP的预后极其重要.

  1. Passive smoking at home is a risk factor for community-acquired pneumonia in older adults: a population-based case–control study

    Science.gov (United States)

    Almirall, Jordi; Serra-Prat, Mateu; Bolíbar, Ignasi; Palomera, Elisabet; Roig, Jordi; Hospital, Imma; Carandell, Eugenia; Agustí, Mercè; Ayuso, Pilar; Estela, Andreu; Torres, Antoni

    2014-01-01

    Objective To assess whether passive smoking exposure at home is a risk factor for community-acquired pneumonia (CAP) in adults. Setting A population-based case-control study was designed in a Mediterranean area with 860 000 inhabitants >14 years of age. Participants 1003 participants who had never smoked were recruited. Primary and secondary outcome measures Risk factors for CAP, including home exposure to passive smoking, were registered. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period. Methods A population-based case-control study was designed to assess risk factors for CAP, including home exposure to passive smoking. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period. The subgroup of never smokers was selected for the present analysis. Results The study sample included 471 patients with CAP and 532 controls who had never smoked. The annual incidence of CAP was estimated to be 1.14 cases×10–3 inhabitants in passive smokers and 0.90×10−3 in non-passive smokers (risk ratio (RR) 1.26; 95% CI 1.02 to 1.55) in the whole sample. In participants ≥65 years of age, this incidence was 2.50×10−3 in passive smokers and 1.69×10−3 in non-passive smokers (RR 1.48, 95% CI 1.08 to 2.03). In this last age group, the percentage of passive smokers in cases and controls was 26% and 18.1%, respectively (p=0.039), with a crude OR of 1.59 (95% CI 1.02 to 2.38) and an adjusted (by age and sex) OR of 1.56 (95% CI 1.00 to 2.45). Conclusions Passive smoking at home is a risk factor for CAP in older adults (65 years or more). PMID:24928592

  2. Prevención de la neumonía adquirida en la comunidad PREVENTION OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

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    Manuel Barros M.

    2005-04-01

    epidemiaPolysaccharide 23 valent pneumococcal vaccine commercially available from 1983 includes 23 serotypes of Streptococcus pneumoniae, representing near 90% of strains involved in invasive pneumococcal disease in immune competent adults. Vaccine confers protection against invasive pneumococcal disease. Immunization is recommended in adults over 65 years old, in patients affected by chronic diseases (cardiopathies, COPD, nephropathies, diabetes mellitus, hepatic cirrhosis, chronic breakage in brain-blood barrier, functional or anatomical asplenia, alcoholism, in immunocompromised hosts, including HIV infection, chemotherapy treatment and hematological malignancies. Influenza vaccine is prepared with particulated antigens, including two influenza A strains and one influenza B strain, selected according to influenza epidemiological worldwide surveillance the year before. On account of continuous antigenic changes (drifts, it is necessary to modify the vaccine antigen's composition yearly. Cost/effectiveness evaluation has confirmed the efficacy of influenza vaccine in reducing morbidity and mortality associated to influenza epidemic and health economical resources involved in patient care. Besides, clinical trials have confirmed that immunization reduces the risk of acquiring pneumonia, of hospitalization and death in elderly people during the influenza epidemic, when vaccine antigenic composition is similar to the circulating strains. Vaccination is recommended annually in healthy adults over 65 years old, in patients with chronic diseases (cardiopathies, COPD, nephropathies, diabetes mellitus, hepatic cirrhosis, chronic breakage of blood-brain barrier, functional or anatomical asplenia, alcoholism. It is also recommended in women who will be in the second or third trimester of pregnancy during the influenza season, in immunocompromised hosts, in institutionalized patients (geriatrics, health care workers, and travelers to geographical areas that are affected by the

  3. The impact of pneumolysin on the macrophage response to Streptococcus pneumoniae is strain-dependent.

    Directory of Open Access Journals (Sweden)

    Richard M Harvey

    Full Text Available Streptococcus pneumoniae is the world's leading cause of pneumonia, bacteremia, meningitis and otitis media. A major pneumococcal virulence factor is the cholesterol-dependent cytolysin, which has the defining property of forming pores in cholesterol-containing membranes. In recent times a clinically significant and internationally successful serotype 1 ST306 clone has been found to express a non-cytolytic variant of Ply (Ply306. However, while the pneumococcus is a naturally transformable organism, strains of the ST306 clonal group have to date been virtually impossible to transform, severely restricting efforts to understand the role of non-cytolytic Ply in the success of this clone. In this study isogenic Ply mutants were constructed in the D39 background and for the first time in the ST306 background (A0229467 to enable direct comparisons between Ply variants for their impact on the immune response in a macrophage-like cell line. Strains that expressed cytolytic Ply were found to induce a significant increase in IL-1β release from macrophage-like cells compared to the non-cytolytic and Ply-deficient strains in a background-independent manner, confirming the requirement for pore formation in the Ply-dependent activation of the NLRP3 inflammasome. However, cytolytic activity in the D39 background was found to induce increased expression of the genes encoding GM-CSF (CSF2, p19 subunit of IL-23 (IL23A and IFNβ (IFNB1 compared to non-cytolytic and Ply-deficient D39 mutants, but had no effect in the A0229467 background. The impact of Ply on the immune response to the pneumococcus is highly dependent on the strain background, thus emphasising the importance of the interaction between specific virulence factors and other components of the genetic background of this organism.

  4. Pneumonia in the immunocompetent patient.

    Science.gov (United States)

    Reynolds, J H; McDonald, G; Alton, H; Gordon, S B

    2010-12-01

    Pneumonia is an acute inflammation of the lower respiratory tract. Lower respiratory tract infection is a major cause of mortality worldwide. Pneumonia is most common at the extremes of life. Predisposing factors in children include an under-developed immune system together with other factors, such as malnutrition and over-crowding. In adults, tobacco smoking is the single most important preventable risk factor. The commonest infecting organisms in children are respiratory viruses and Streptoccocus pneumoniae. In adults, pneumonia can be broadly classified, on the basis of chest radiographic appearance, into lobar pneumonia, bronchopneumonia and pneumonia producing an interstitial pattern. Lobar pneumonia is most commonly associated with community acquired pneumonia, bronchopneumonia with hospital acquired infection and an interstitial pattern with the so called atypical pneumonias, which can be caused by viruses or organisms such as Mycoplasma pneumoniae. Most cases of pneumonia can be managed with chest radiographs as the only form of imaging, but CT can detect pneumonia not visible on the chest radiograph and may be of value, particularly in the hospital setting. Complications of pneumonia include pleural effusion, empyema and lung abscess. The chest radiograph may initially indicate an effusion but ultrasound is more sensitive, allows characterisation in some cases and can guide catheter placement for drainage. CT can also be used to characterise and estimate the extent of pleural disease. Most lung abscesses respond to medical therapy, with surgery and image guided catheter drainage serving as options for those cases who do not respond. PMID:21088086

  5. Clinical Efficiency of the Treatment of Community-acquired Pneumonia with Penicillin and Azithromycin%青霉素、阿奇霉素对社区获得性肺炎治疗的临床观察

    Institute of Scientific and Technical Information of China (English)

    张运谋; 余宗洋; 孙茂群

    2011-01-01

    目的 社区获得性肺炎是社区居民的常见病、多发病,是威胁人类健康常见的感染性疾病之一,目前临床上广泛倾向选用高效广谱抗生素治疗常见的感染性疾病,导致药物滥用和耐药性增加,而本课题组使用青霉素、阿奇霉素治疗社区获得性肺炎,观察其临床疗效,为在社区等基层医院治疗社区获得性肺炎积累经验,提供临床参考.方法 对到芙蓉社康中心就诊的162例社区获得性肺炎患者根据其临床特点不同分剐使用青霉素、阿奇霉素治疗.结果 青霉素治疗组有效率83.3%,阿奇霉素治疗组有效率76.7%.结论 青霉素、阿奇霉素是治疗社区获得性肺炎的有效药物,临床上对既往健康人群的门诊轻症患者应大力推广应用,避免药物滥用.%Objective To investigate clinical efficiency of the treatment of community-acquired pneumonia with penicillin and azithromycin,and to provide experience and clinical reference for treatment of community acquired pneumonia in basic hospital.Methods According to different clinical features, 162 cases of patients with community-acquired pneumonia were treated with penicillin or azithromycin. Results The clinical efficiency in Penicillin treatment group was 83.3%, in azithromycin group was 76.7%. Conclusion Penicillin and azithromycin were effective drugs for the treatment of community acquired pneumonia,this treatment should be promoted in mild cases which were healthy previously in clinic, drug abuse should be avoided.

  6. [Pneumonia: The urgent problem of 21st century medicine].

    Science.gov (United States)

    Chuchalin, A G

    2016-01-01

    The paper analyzes the systematic reviews and meta-analyses on the strategic issues of pneumonia, which have been published in the past 3 years. It discusses the prevalence and mortality rates of acquired pneumonia, hospital-acquired (nosocomial) pneumonia, healthcare-associated pneumonia, ventilator-associated pneumonia, and Mycoplasma pneumonia, and the specific features of their etiology, diagnosis, and treatment. A large number of investigations emphasize the relevance of this problem in current clinical practice.

  7. Pneumonia associada à ventilação mecânica: impacto da multirresistência bacteriana na morbidade e mortalidade Ventilator-associated pneumonia: impact of bacterial multidrug-resistance on morbidity and mortality

    Directory of Open Access Journals (Sweden)

    Paulo José Zimermann Teixeira

    2004-12-01

    Full Text Available INTRODUÇÃO: A pneumonia associada à ventilação mecânica é a infecção hospitalar mais comum nas unidades de terapia intensiva. OBJETIVO: Determinar o impacto da multirresistência dos microorganismos na morbidade e mortalidade dos pacientes com pneumonia associada à ventilação mecânica. MÉTODO: Estudo de coorte retrospectivo. Em 40 meses consecutivos, 91 pacientes sob ventilação mecânica tiveram o diagnóstico de pneumonia. Os casos foram divididos entre causados por microorganismo multirresistente e causados por microorganismo sensível à antibioticoterapia. RESULTADOS: Pneumonia foi causada por microorganismo multirresistente em 75 casos (82,4% e por microorganismo sensível 16 (17,6% deles. As características clínicas e epidemiológicas não foram estatisticamente diferentes entre os grupos. O Staphylococcus aureus foi responsável por 27,5% dos episódios de pneumonia associada à ventilação mecânica e a Pseudomonas aeruginosa por 17,6%. A doença foi de início recente em 33 pacientes (36,3% e de início tardio em 58 deles (63,7%. Os tempos de ventilação mecânica, de internação em unidade de terapia intensiva e de internação hospitalar total não diferiram. O tratamento empírico foi considerado inadequado em 42 pacientes com pneumonia por microorganismo multirresistente (56% e em 4 com pneumonia por microorganismo sensível (25% (p = 0,02. Óbito ocorreu em 46 pacientes com a pneumonia por microorganismo multirresistente (61,3%, e em 4 daqueles com pneumonia por microorganismo sensível (25% (p = 0,008. CONCLUSÃO: A multirresistência bacteriana não determinou nenhum impacto na morbidade, mas esteve associada à maior mortalidade.BACKGROUND: Ventilator-associated pneumonia is the most common nosocomial infection occurring in intensive care units. OBJECTIVE: To determinate the impact of multidrug-resistant bacteria on morbidity and mortality in patients with ventilator-associated pneumonia. METHOD

  8. Clinical Analysis of 213 Neonates with Community-acquired Pneumonia%新生儿社区感染性肺炎213例临床分析

    Institute of Scientific and Technical Information of China (English)

    刘华君; 许红波; 王太森; 刘文彬; 汤雪晴; 吕洁

    2014-01-01

    目的:分析新生儿社区感染性肺炎的临床特点。方法对213例新生儿社区感染性肺炎的临床资料进行回顾性分析。结果(1)临床表现和体征:气促173例,发绀128例,咳嗽137例,口吐白沫121例,发热86例,三凹征97例,肺部呼吸音粗87例,肺部闻及干湿啰音92例,黄疸95例。(2)病原学:痰培养阳性82例,其中革兰阴性杆菌64例。(3)感染指标:白细胞(WBC)升高108例,C反应蛋白升高40例,降钙素原升高87例。(4) X线胸片:双肺纹理增多、模糊,肺门影模糊137例,小点片状影31例。(5)心脏彩超检查有先心病116例。结论新生儿社区感染性肺炎的临床表现不典型,痰培养阳性率较低,感染指标特异性不高,X线胸片大多有改变,合并先心病的患儿患社区感染性肺炎的比例明显较高,因此诊断和治疗时需进行综合考虑。%Objective To analyze the clinical features of neonatal community-acquired pneumonia (CAP). Methods A retrospective analysis was made to the clinical data of 213 neonates with CAP. Results Clinical manifestations and physical signs: dyspnea was found in 173 ccases, cyanosis in 128 cases, cough in 137 cases, buccal foam in 121 cases, fever in 86 cases, three depression sign in 97 cases, crude breath in 87 cases, rales or rhonchi in 92 cases and jaundice in 95 cases;etiological study:out of 82 positive cases of spu-tum culture, there were 64 cases with Gram-positive bacteria;infection index:WBC increase was found in 108 cases, C-reactive pro-tein increase in 40 cases and procalcitionin ( PCT ) increase in 87 cases;chest X-ray findings:increased blur imaging of lung-marking and hilar was found in 137 cases and images of dotted flake shadows in 31 cases;cardiac color ultrasound indicated congenital heart dis-ease (CHD)) in 116 cases. Conclusions The clinical manifestations of neonatal CAP are atypical with low positive rate of sputum cul

  9. Etiology and severity of community acquired pneumonia in children from Uruguay: a 4-year study Etiologia e severidade de pneumonia adquirida comunitariamente em crianças uruguaias: um estudo de 4 anos

    Directory of Open Access Journals (Sweden)

    Maria Hortal

    1994-06-01

    Full Text Available The 4-year study (1987-1990 covered the major clinical-epidemiological characteristics of pneumonia in children as diagnosed at the emergency service of the Children's Hospital, as well as etiologies, and factors involved in the most severe cases. Etiology was determined in 47.7% of the 541 pneumonia cases, involving 283 pathogens of which 38.6% were viruses and 12.6% bacteria. Viral and mixed etiologies were more frequent in children under 12 months of age. Bacteria predominated in ages between 6 and 23 months. Among the viruses, respiratory syncytial virus predominated (66%. The bacterial pneumonias accounted for 12.2% of the recognized etiologies. The most important bacterial agents were S. pneumoniae (64% and H. influenzae (19%. H. influenzae and mixed infections had a relevant participation during the 1988 season, pointing to annual variations in the relative participation of pathogens and its possible implication in severity of diseases. Correlation of severity and increased percentage of etiological diagnosis was assessed: patients with respiratory rates over 70 rpm, or pleural effusion and/or extensive pulmonary parenchyma compromise yielded higher positive laboratory results. Various individual and family risk factors were recognized when comparing pneumonia children with healthy controls.O estudo de quatro anos de duração (1987-1990 abarcou as principais características clínico-epidemiológicas de pneumonia em crianças, tal como foi diagnosticado no serviço de emergência do Hospital Infantil, e também as etiologias e fatores implicados nos casos mais severos. Determinou-se a etiologia em 47.7% dos 541 casos de pneumonia, que incluíam 283 patógenos, dos quais 38.6% eram virus e 12.6% bactérias. Observou-se etiologia viral e mista mais freqüentemente nas crianças de menos de 12 meses. A etiologia bacteriana prevaleceu nas idades entre 6 e 23 meses. Com relação aos virus, a predominância foi de RSV com prevalência de 66

  10. 莫西沙星与左氧氟沙星治疗社区获得性肺炎的对比分析%Clinical analysis on efficacy of moxifloxacin and levofloxacin in treatment of community acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    宋雪梅

    2013-01-01

    Objective To explore the efficacy of moxifloxacin and levofloxacin in treatment of community acquired pneumonia. Methods The clinical data of patients with community acquired pneumonia were collected, and they were divided into moxifloxacin group ( 30 cases ) and levofloxacin group ( 30 cases ). Results The duration for disappearance of coughing, defervescent time, normalized time for blood routine examination , and time for X - ray lung shadow apparent absorption > 50% in patients of moxifloxacin group were lower than those of patients in levofloxacin group, the total effectiveness rate of clinical cure in patients of moxifloxacin group was higher than that of patients in levofloxacin group. The rate of bacterial clearance in patients of moxifloxacin group was better than that of patients in levofloxacin group, and their difference was statistically significant ( P 50%时间均低于左氧氟沙星组,莫西沙星组细菌清除率和临床治疗总有效率均明显优于左氧氟沙星组,差异均有统计学意义(P<0.05).结论 莫西沙星治疗社区获得性肺炎临床症状改善明显,效果优于左氧左氧氟沙星,值得临床推广应用.

  11. The clinical characteristics,treatment and outcome of macrolide-resistant Mycoplasma pneumoniae pneumonia in children

    Institute of Scientific and Technical Information of China (English)

    鲍芳

    2013-01-01

    Objective To investigate the drug resistance of My-coplasma pneumoniae among children with community-acquired pneumonia (CAP) ,and to explore the clinical and radiological characteristics of and the role of azithromycin in the treatment of of macrolide-resistant (MR) Mycoplasma pneumoniae pneumonia.Methods Cases of CAP in children (n=179) were prospectively enrolled in

  12. Changes in serum inflammatory factors in wheezing infants with community-acquired pneumonia%婴幼儿喘息性社区获得性肺炎患儿血清炎症因子的变化

    Institute of Scientific and Technical Information of China (English)

    郁志伟; 钱俊; 顾晓虹; 张晓娟; 潘剑蓉; 居慧莉

    2015-01-01

    目的:通过测定婴幼儿喘息性社区获得性肺炎(CAP)患儿血清炎症因子的变化,了解婴幼儿喘息性肺炎是否与哮喘有相似的免疫机制。方法喘息性CAP 47例、非喘息性CAP 42例、正常对照30例婴幼儿纳入该研究。比较3组间外周血C反应蛋白、降钙素原、可溶性髓系细胞触发受体-1、γ干扰素、白细胞介素4、白细胞介素10及骨膜蛋白水平。结果喘息性和非喘息性肺炎组血降钙素原、可溶性髓系细胞触发受体-1、白细胞介素4、白细胞介素10含量均高于正常对照组(P<0.05);喘息性肺炎组γ干扰素/白细胞介素4比值低于非喘息性肺炎组和正常对照组(P<0.05);喘息性肺炎组骨膜蛋白水平高于非喘息性肺炎组和正常对照组(P<0.05)。结论婴幼儿喘息性肺炎存在γ干扰素/白细胞介素4比值失衡,存在气道嗜酸性粒细胞炎症,提示婴幼儿喘息性肺炎与哮喘有相似的免疫机制。%ObjectiveTo study whether infantile wheezing pneumonia has similar immune mechanisms to asthma by determining the levels of serum inlfammatory factors in wheezing infants with community-acquired pneumonia (CAP). MethodsForty-two infants with CAP but without wheezing, 47 infants with CAP and wheezing, and 30 healthy infants as a control were recruited in the study. The peripheral blood levels of C-reactive protein, procalcitonin, soluble triggering receptor expressed on myeloid cell-l, interferon-γ, interleukin-4, interleukin-10, and periostin were compared in the three groups.ResultsThe serum levels of procalcitonin, soluble triggering receptor expressed on myeloid cell-l, interleukin-4 and interleukin-10 in the two CAP groups were higher than in the control group (P<0.05). The ratio of interferon-γ/interleukin-4 in the wheezing pneumonia group was lower than in the non-wheezing pneumonia and control groups (P<0.05). The serum level of periostin in the wheezing pneumonia group

  13. 莫西沙星与左氧氟沙星治疗社区获得性肺炎的临床研究%The Clinical stady of moxifloxacin and levofloxacin in the treatment of community-acquired pneumonia for the treatment community-acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    曾峰; 林雅; 肖靖华; 廖美玲

    2011-01-01

    目的 探讨莫西沙星和左氧氟沙星治疗社区获得性肺炎的疗效.方法 选择社区获得性肺炎患者120例,随机分成莫西沙星组60例和左氧氟沙星组60例,分别给予治疗7d,运用药物经济学的成本-效果分析方法进行评价.结果 莫西沙星组和左氧氟沙星组治疗有效率分别为98.33%和71.67%,细菌清除率分别为91.67和65.57%,不良反应发生率分别为8.33%和13.33%,成本-效果比分别为21.87%和10.26%.结论 莫西沙星组的治疗有效率和细菌清除率明显优于左氧氟沙星组(P<0.01),莫西沙星治疗社区获得性肺炎在临床治疗中是优选方案.%Objective To study the clinical Value in moxifloxacin and levofloxacin for the treatment of community-acquired pneumonia (CAP). Methods 120 patients of CAP were chosen and divided randomly into team of moxifloxacin and team of levofloxacin. These two categories of patients were given separate treatments for 7 days which were analyzed and appraised by the cost-effect method in pharmacoeconomic research. Results The Overall clinical effective rate for team of moxifloxacin was 98.33% and for team of levofloxcine was 71. 67% ; the bacterial clearance rate for team of moxifloxacin wag 91. 67% and for team of levofloxcine was 65. 57% ; Occurrence of the adverse reaction for team moxifloxacin was 8. 33% and for team levofloxcine was 13.33% , and the cost-effectiveness ratios were 21. 87 and 10. 26. Conclusion The overall clinical effective rate and the bacterial clearance rate of team moxifloxacin is better than that of team levofloxcine. Moxifloxacin for the treatment CAP is the preferred plan in the clinic.

  14. 老年人社区获得性肺炎的临床特点及误诊情况分析%The clinical characteristics of elderly patients with community acquired pneumonia and analysis of misdiagnosis.

    Institute of Scientific and Technical Information of China (English)

    武莉莉; 王健

    2011-01-01

    目的 探讨老年社区获得性肺炎的临床特点.方法 总结分析479例社区获得性肺炎(CAP)住院患者的临床资料,对照分析老年组与非老年组的临床表现、辅助检查,误诊情况及治疗转归.结果 老年社区获得性肺炎临床表现及实验室检查不典型,易并发多种并发症;加之老年人常有基础疾患,故本病误诊、漏诊率较高,预后差,治疗时间长.结论 依据老年社区获得性肺炎的临床特点,对老年患者应做到早诊断、早治疗,防止并发症的发生.常规胸部X线检查,及时确诊、合理使用抗生素及综合治疗是提高治愈率的关键.%Objective To discuss the clinical characteristics of elderly patients with community acquired pneumonia. Methods Summary and analysis 479 cases clinical date of inpatients with CAP, comparative analysis of elder group and Non - elder group's clinical characteristics,assistant examination, misdiagnosis and prognosis. Results Clinical characteristics and lab examination of elderly patients with community acquired pneumonia were atypical and easy to cause other complications, and also the elderly patients general had basic disease. So, the rate of misdiagnosis, fail to diagnosis was higher and general need longer time to be cured. Conclusion According to the clinical characteristics of elderly patients with community acquired pneumonia, the elder should be early diagnosis and early treatment, and prevent happening of complications.And the key for improving the cure rate is through general chest X examination and timely accurate diagnosis, reasonable using antibiotic and comprehensive treatment.

  15. The Clinical Observation of Severe Community Acquired Pneumonia Merger Atelectasis in Children%儿童重症社区获得性肺炎合并肺不张的临床观察

    Institute of Scientific and Technical Information of China (English)

    鲁金玲

    2013-01-01

    Objective:To explore the clinical treatment of severe community acquired pneumonia merger atelectasis in children. Methods:80 cases of children being diagnosed with severe community acquired pneumonia merger atelectasis were randomly divided into the observation group and the control group, 40 cases in each group. 2 groups were given conventional treatment, observation group was given Ceftriaxone sodium treatment on the basis of conventional therapy, each group's therapy was 4 weeks. Compared cough mitigation, pyretolysis and lung reexpansion situation of two groups. Results:The cough mitigation time, pyretolysis time and lung reexpansion situation time of observation group significantly lower than control group(P<0.01);the effective power of observation group higher than control group(P<0.05). Conclusions:Azithromycin combined with Ceftriaxone sodium in the treatment of severe community acquired pneumonia merger atelectasis in children had obviously effect.%目的:探讨儿童重症社区获得性肺炎合并肺不张的临床治疗。方法:儿童重症社区获得性肺炎合并肺不张的患儿80例,随机分为观察组和对照组,每组40例。2组均给予常规治疗,观察组在常规治疗基础上加用头孢曲松钠治疗,疗程4周,对比两组咳嗽缓解、退热、肺复张及疗效情况。结果:观察组的咳嗽缓解时间、退热时间及肺复张时间均明显低于对照组(P<0.01);观察组的有效率高于对照组(P<0.05)。结论:阿奇霉素联合头孢曲松钠治疗儿童重症社区获得性肺炎合并肺不张效果明显。

  16. 血液灌流对急性重度有机磷中毒的疗效观察%Values of serum procalcitonin in predicting severity and prognosis of community-acquired pneumonia in-patients

    Institute of Scientific and Technical Information of China (English)

    朱小生; 方长太; 白兆青

    2011-01-01

    目的 探讨血液灌流对重度急性有机磷农药中毒(AOPP)的临床疗效,促进其推广及应用.方法 回顾性分析重症有机磷中毒患者的临床资料,将其分为血液灌流(HP)治疗组和对照组.所有病例均予以积极的内科治疗(洗胃、氯磷定、阿托品和机械通气等).对治疗组及对照组病人进行回顾性对照分析.结果 行HP组清醒时间,CHE活性恢复时间,住院时间均明显短于对照组,阿托品及氯磷定用药总量明显小于对照组,治愈率明显高于对照组.结论 HP能迅速清除体内毒物,明显缩短病程,提高重度AOPP抢救的成功率,应加强宣教及推广.%Aim To investigate the relationship of serum procalcitonin to severity and prognosis of community acquired pneumonia in-patients. Methods Retrospective analysis was made of community-acquired pneumonia in-patients admitted to hospital from July 2009 to July 2010. Results Among 324 cases of community-acquired pneumonia admitted,248 cases were included for analysis. The mean levels of serum procalcitonin,neutrophil number,average duration of intravenous antibiotic therapy, average hospital stay,PSI scale and CURB 65 score were(0.22±0.34) μg· L -1,(8.92±2.47)x109 ·L -1,(8.7 ±2.6)days,(9.2±2.4)days,67.8 ±33.5,2.12 ±0.45.The correlation indices of serum procalcitonin to PSI and CURB-65 score and duration of intravenous antibiotic therapy, average hospital stay were 0. 845,0.22,0. 404 and 0. 443,respectively. The mean procalcitonin levels of severe CAP and deaths were( 5.87 ± 2.83 ) μg · L -1 and( 2.42 ± 1.28 ) μg · L -1, respectively. The sensitivity and specificity of serum procalcitonin more than 0.5 μg · L -1 on admission were 0.714 and 0. 844 in predicting death. Conclusion The serum level of procalcitonin on admission is correlated with severity of community-acquired pneumonia in patients,and PCT≥0. 335 μg · L -1 may indicate poorer prognosis.

  17. 降钙素原在儿童社区获得性肺炎中的诊断价值%The diagnosis value of procalcitonin on children community acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    申建伟

    2015-01-01

    降钙素原(procalcitonin,PCT)作为细菌感染的早期诊断指标,是反映机体严重感染的一个生物学指标,可对细菌感染进行预测判断.儿童社区获得性肺炎(community acquired pneumonia,CAP)是5岁以下儿童发病和死亡的主要病因,目前诊断主要限于临床表现、胸片和血常规,但仍缺乏特异性,主要还要依靠临床经验,PCT在儿童CAP中的诊断价值越来越得到认可,本文主要就PCT在儿童CAP中的临床诊断价值作一综述.

  18. 降钙素原在儿童社区获得性肺炎的临床应用%The role of procalcitonin in children with community acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    萨日娜; 王爱琼

    2013-01-01

    降钙素原(procalcitonin,PCT)是降钙素的前体物质,是近年来新发现的诊断细菌感染的指标。在儿童社区获得性肺炎中检测其血清浓度,可用于早期估计感染病原体的种类,评价感染的严重程度,指导用药及判断预后等。%Procalcitonin (PCT), a precursor of hormone calcitonin, is used as an indicator of bacterial infections in recent years. PCT plays an important role in early identiifcation of pathogens, evaluation of the severity of infection, medication guidance and prognosis judgment in children with community acquired pneumonia.

  19. Pneumocystis carinii pneumonia in acquired immunodeficiency syndrome - correlation of high-resolution computed tomography and anatomopathology; Pneumocistose na sindrome da imunodeficiencia adquirida: correlacao da tomografia computadorizada de alta resolucao com a anatomopatologia

    Energy Technology Data Exchange (ETDEWEB)

    Marchiori, Edson; Moreira, Luiza Beatriz [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia]. E-mail: edmarchiori@zipmail.com.br; Capone, Domenico [Universidade do Estado, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina; Moraes, Heleno Pinto de [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Patologia; Pereira, Cyntia Inez Guedes Soares

    2001-12-01

    We present the main findings observed on the high-resolution computed tomography examinations of 15 patients with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia. The high-resolution computed tomography and autopsy findings of 5 patients were also compared. The most frequently observed high-resolution computed tomography patterns were ground-glass attenuation, consolidation areas, crazy-paving pattern and cysts. Nodules and intralobular reticulation were less frequently observed. Ground-glass attenuation and consolidation areas corresponded to alveolar filling with inflammatory exudate. Thickening of the interlobular septa was due to cell infiltration and edema. One patient presented interlobular reticulation, and the pathology study revealed alveolar septa thickening due to cell infiltration and fibrosis. Nodules observed in one of the patients corresponded to a patchy intra alveolar accumulation of microorganisms and inflammatory cells forming a 'granulomatous' pattern. (author)

  20. How recent advances in molecular tests could impact the diagnosis of pneumonia.

    Science.gov (United States)

    Murdoch, David R

    2016-01-01

    Molecular diagnostic tests have been the single major development in pneumonia diagnostics over recent years. Nucleic acid detection tests (NATs) have greatly improved the ability to detect respiratory viruses and bacterial pathogens that do not normally colonize the respiratory tract. In contrast, NATs do not yet have an established role for diagnosing pneumonia caused by bacteria that commonly colonize the nasopharynx due to difficulties discriminating between pathogens and coincidental carriage strains. New approaches are needed to distinguish infection from colonization, such as through use of quantitative methods and identification of discriminating cut-off levels. The recent realization that the lung microbiome exists has provided new insights into the pathogenesis of pneumonia involving the interaction between multiple microorganisms. New developments in molecular diagnostics must account for this new paradigm.

  1. Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates

    OpenAIRE

    Farooqui, H; Jit, M.; Heymann, DL; Zodpey, S.

    2015-01-01

    The burden of severe pneumonia in terms of morbidity and mortality is unknown in India especially at sub-national level. In this context, we aimed to estimate the number of severe pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children younger than 5 years in 2010. We adapted and parameterized a mathematical model based on the epidemiological concept of potential impact fraction developed CHERG for this analysis. The key parameters that determine the distribution ...

  2. ‘Presenting CXR phenotype of H1N1’ flu compared with contemporaneous non-H1N1, community acquired pneumonia, during pandemic and post-pandemic outbreaks’

    International Nuclear Information System (INIS)

    Highlights: • Patients with H1N1 pneumonia demonstrated more opacified zones on chest x-ray than patients with non-H1N1 pneumonias. • A particular ‘phenotype’ of chest x-ray changes was identified in H1N1 patients. • This H1N1 ‘phenotype’ was the same for the two evaluated ‘flu seasons, during both pandemic and post pandemic stages. - Abstract: Aims: To review, phenotype and assess potential prognostic value of initial chest X-ray findings in patients with H1N1 influenza during seasonal outbreaks of 2009 and 2010, in comparison with non-H1N1, community acquired pneumonia (CAP). Methods: We retrospectively identified 72 patients admitted to hospital with pneumonia during the seasons of 2009 and 2010. H1N1 cases were confirmed by virology PCR. Presenting chest X-rays were jointly read by 2 radiologists, who were ‘blinded’ to further patient details and divided into 6 zones. Total number of opacified zones, the pattern and distribution of changes and length of hospital stay were recorded. Results: Patients with H1N1 demonstrated more opacified zones (mean of 2.9 compared with 2.0; p = 0.006), which were bilateral in two-thirds compared with a quarter of those with non-H1N1 CAP (p = 0.001). H1N1 radiographs were more likely to be ‘patchy’ versus ‘confluent’ changes of non-H1N1 CAP (p = 0.03) and more often demonstrated peripheral distribution (p = 0.01). H1N1 patients tended to stay in hospital longer (not significant; p = 0.08). A positive correlation existed between number of affected zones and length of inpatient stay, which was statistically significant for the cohorts combined (p = 0.02). The findings were the same for the two evaluated seasons. Conclusion: H1N1 patients demonstrated more extensive disease, which was more likely bilateral, ‘patchy’, and peripheral in distribution. With increasing global cases of H1N1, knowledge of the typical findings of the H1N1 presenting chest X-ray may assist with early triage of patients

  3. ‘Presenting CXR phenotype of H1N1’ flu compared with contemporaneous non-H1N1, community acquired pneumonia, during pandemic and post-pandemic outbreaks’

    Energy Technology Data Exchange (ETDEWEB)

    Minns, F.C., E-mail: Fiona.Minns@nhslothian.scot.nhs.uk [Department of Radiology, New Royal Infirmary Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA (United Kingdom); Nimhuineachain, A, E-mail: draideen@gmail.com [Department of Radiology, New Royal Infirmary Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA (United Kingdom); Beek, E.J.R. van, E-mail: Edwin-vanbeek@ed.ac.uk [Clinical Research Imaging Centre, University of Edinburgh, 47 Little France Crescent, Edinburgh, Midlothian EH16 4TJ (United Kingdom); Ritchie, G., E-mail: drgillritchie@hotmail.com [Department of Radiology, New Royal Infirmary Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA (United Kingdom); Hill, A., E-mail: adam.hill318@nhs.net [Department of Respiratory Medicine, New Royal Infirmary, Edinburgh (United Kingdom); Murchison, J.T., E-mail: john.murchison@nhslothian.scot.nhs.uk [Department of Radiology, New Royal Infirmary Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA (United Kingdom)

    2015-09-15

    Highlights: • Patients with H1N1 pneumonia demonstrated more opacified zones on chest x-ray than patients with non-H1N1 pneumonias. • A particular ‘phenotype’ of chest x-ray changes was identified in H1N1 patients. • This H1N1 ‘phenotype’ was the same for the two evaluated ‘flu seasons, during both pandemic and post pandemic stages. - Abstract: Aims: To review, phenotype and assess potential prognostic value of initial chest X-ray findings in patients with H1N1 influenza during seasonal outbreaks of 2009 and 2010, in comparison with non-H1N1, community acquired pneumonia (CAP). Methods: We retrospectively identified 72 patients admitted to hospital with pneumonia during the seasons of 2009 and 2010. H1N1 cases were confirmed by virology PCR. Presenting chest X-rays were jointly read by 2 radiologists, who were ‘blinded’ to further patient details and divided into 6 zones. Total number of opacified zones, the pattern and distribution of changes and length of hospital stay were recorded. Results: Patients with H1N1 demonstrated more opacified zones (mean of 2.9 compared with 2.0; p = 0.006), which were bilateral in two-thirds compared with a quarter of those with non-H1N1 CAP (p = 0.001). H1N1 radiographs were more likely to be ‘patchy’ versus ‘confluent’ changes of non-H1N1 CAP (p = 0.03) and more often demonstrated peripheral distribution (p = 0.01). H1N1 patients tended to stay in hospital longer (not significant; p = 0.08). A positive correlation existed between number of affected zones and length of inpatient stay, which was statistically significant for the cohorts combined (p = 0.02). The findings were the same for the two evaluated seasons. Conclusion: H1N1 patients demonstrated more extensive disease, which was more likely bilateral, ‘patchy’, and peripheral in distribution. With increasing global cases of H1N1, knowledge of the typical findings of the H1N1 presenting chest X-ray may assist with early triage of patients

  4. 儿童社区获得性肺炎病原体及细菌药敏结果分析%Pathogens and antibiotic resistance of community-acquired pneumonia in children

    Institute of Scientific and Technical Information of China (English)

    刘俊英

    2012-01-01

    Objective To investigate the pathogens and antibiotic resistance of community-acquired pneumonia (CAP) in children. Methods Pathogens were isolated from sputum specimens, drug sensitivity testing was done using the disc diffusion method (KB method) , and atypical pathogens and viruses were detected using immunofluorescence Results A total of 385 strains of pathogens were isolated from 651 children with CAP. These consisted of 142 strains of bacteria, 105 strains of viruses, and 138 strains of atypical pathogens. The pathogen most often detected was Mycoplasma pneumoniae (MP), with 108 strains delected. There were 54 strains of respiratory syncytial virus, 47 of hemophilus, 27 of parainfluenza virus, 23 of Chlamydiu pneumoniae , and 21 of Streptococcus pneumoniae. Eighty-nine children had a mixed infection. Hemophilus was resistant to ciprofloxacin and sensitive to azithromycin, vancomycin, and amoxicillin/clavu-lanate potassium. Conclusion MP was the predominant pathogen in children with community-acquired pneumonia. The isolates had little drug resistance.%目的 了解2011年医院儿童社区获得性肺炎(CAP)感染病原体类型及细菌的耐药情况. 方法 收集患儿痰液,进行菌种鉴定,KB纸片法进行药敏试验;非典型病原体、呼吸道合胞病毒等采用免疫荧光法检测鉴定. 结果 651例CAP患儿病原体感染385例,感染率为59.14%,其中检出细菌142株,病毒105株,非典型病原体138株.检出菌株数最多的是肺炎支原体,为108株(占28.05%),其次为呼吸道合胞病毒,为54株(占14.03%),其他病原体,如嗜血杆菌(47株),副流感病毒(27株),肺炎衣原体(23株)和肺炎链球菌(21株).患儿混合感染89例,以病毒和细菌混合感染为主.嗜血杆菌对环丙沙星耐药率最高,为55.32%;嗜血杆菌、肺炎链球菌和肺炎克雷伯菌对阿奇霉素、万古霉素、阿莫西林/克拉维酸敏感. 结论 CAP患儿以肺炎支原体感染为主,分离细菌对常见抗生素耐药性较低.

  5. Analysis of pathogens and drug sensitivity of community-acquired pneumonia in the elderly%老年性社区获得性肺炎病原菌及药敏结果分析

    Institute of Scientific and Technical Information of China (English)

    赵爽; 邓旺; 王导新

    2015-01-01

    ObjectiveTo investigate the pathogen distribution and antibiotic sensitivity of community-acquired pneumonia (CAP) from the elderly patients in order to provide references for clinical treatment and scientific use of the antibacterial drugs.Methods A retrospective analysis was carried out on the results of sputum culture of 165 elderly with CAP in the People’s Hospital of Hechuan District from 2012 to 2014.Results Among the 112 totally-isolated strains of bacteria, the leading 5 bacteria wereKlebsiella pneumoniae (28 strains, 25.0%),Escherichia coli (17 strains, 15.1%), Pseudomonas aeruginosa (12 strains, 10.7%),Streptococcus pneumoniae (11 strains, 9.8%), andHaemophilus influenzae (10 strains, 8.9%). The results of drug sensitivity test showed that,K.pneumoniae,E.coli,P. aeruginosa and Str. pneumoniae had good sensitivity to beta lactam/beta lactamase inhibitor and imipenem. But most strains ofStre. pneumoniae were resistant to penicillin.Conclusion Gram-negative bacteria are the main pathogenic bacteria in CAP in the elderly. Empirical selection of antibiotics with beta lactam/beta lactamase inhibitor compound preparation is more appropriate for the treatment.%目的:分析老年性社区获得性肺炎(CAP)的病原菌分布及药物敏感情况,为临床治疗和科学使用抗菌药物提供数据支持。方法对2012~2014年重庆市合川区人民医院收治的165例老年性CAP患者的痰培养结果进行回顾性统计分析。结果共分离出细菌112株,前5位分别是肺炎克雷伯菌28株(25.0%)、大肠埃希菌17株(15.1%)、铜绿假单胞菌12株(10.7%)、肺炎链球菌11株(9.8%)、流感嗜血菌10株(8.9%)。药敏试验结果显示,肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、肺炎链球菌均对β−内酰胺类/β−内酰胺酶抑制剂及亚胺培南有良好敏感性,肺炎链球菌对青霉素耐药率较高。结论老年CAP以革兰阴性杆菌感染为主,在经验选择

  6. Impact of Hfq on global gene expression and virulence in Klebsiella pneumoniae.

    Directory of Open Access Journals (Sweden)

    Ming-Ko Chiang

    Full Text Available Klebsiella pneumoniae is responsible for a wide range of clinical symptoms. How this bacterium adapts itself to ever-changing host milieu is still a mystery. Recently, small non-coding RNAs (sRNAs have received considerable attention for their functions in fine-tuning gene expression at a post-transcriptional level to promote bacterial adaptation. Here we demonstrate that Hfq, an RNA-binding protein, which facilitates interactions between sRNAs and their mRNA targets, is critical for K. pneumoniae virulence. A K. pneumoniae mutant lacking hfq (Δhfq failed to disseminate into extra-intestinal organs and was attenuated on induction of a systemic infection in a mouse model. The absence of Hfq was associated with alteration in composition of envelope proteins, increased production of capsular polysaccharides, and decreased resistance to H(2O(2, heat shock, and UV irradiation. Microarray-based transcriptome analyses revealed that 897 genes involved in numerous cellular processes were deregulated in the Δhfq strain. Interestingly, Hfq appeared to govern expression of many genes indirectly by affecting sigma factor RpoS and RpoE, since 19.5% (175/897 and 17.3% (155/897 of Hfq-dependent genes belong to the RpoE- and RpoS-regulon, respectively. These results indicate that Hfq regulates global gene expression at multiple levels to modulate the physiological fitness and virulence potential of K. pneumoniae.

  7. 三亚地区儿童社区获得性肺炎病原菌分布及耐药性分析%Pathogenic bacteria distribution of pediatric community acquired pneumonia and bacterial resistance in Sanya

    Institute of Scientific and Technical Information of China (English)

    麦珍; 阮细玲

    2014-01-01

    目的:了解三亚地区儿童社区获得性肺炎病原菌分布情况及耐药特点,为临床合理使用抗菌药物提供依据。方法回顾分析三亚地区2011年1月至2013年12月确诊的儿童社区获得性肺炎住院患儿阳性痰培养标本485例。结果485株病原菌中,革兰阴性菌占65.36%,革兰阳性菌占29.28%,真菌占5.36%。排名前五位的细菌是肺炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌、大肠埃希菌、肺炎链球菌。革兰阴性菌对阿米卡星、哌拉西林/他唑巴坦、左氧氟沙星、碳青霉烯类抗菌药物的耐药率均小于20.0%。未发现对万古霉素和利奈唑胺耐药的阳性球菌。结论三亚地区儿童社区获得性肺炎病原菌以革兰阴性菌为主,耐药现象与文献报道存在一定差异,因此临床医生应参照本地区流行病学特点合理使用抗菌药物,以控制细菌耐药率的上升。%Objective To analyze the pathogenic bacteria distribution of pediatric community acquired pneumo‐nia and bacteria resistance in Sanya ,so as to provide a basis for rational use of antibiotics .Methods A total of 485 patients confirmed with community acquired pneumonia were enrolled in this study .The sputum culture results and drug susceptibility test were analyzed .Results In all 485 bacterial isolates ,gram negative bacterium strains accoun‐ted for 65 .36% ,gram positive bacterium strains accounted for 29 .28% ,and fungi were accounted for 5 .36% .Kleb‐siella pneumoniae ,Staphylococcus aureus ,Acinetobacter baumanii ,Escherichia coli and Streptococcus pneumoniae were the most common isolates .Less than 20% gram negative bacterium strains were resistant to amikacin ,piperacil‐lin /tazobactam ,levofloxacin and carbapenem .No vancomycin and linezolid resistant gram positive bacterium strains were found .Conclusion Gram negative bacterium strains were the most common pathogenic bacteria of pediatric community

  8. Neumonía aguda de la comunidad y hemorragia pulmonar por leptospirosis en el área metropolitana Buenos Aires Community acquired pneumonia and pulmonary hemorrhage in leptospirosis in the Buenos Aires metropolitan area

    Directory of Open Access Journals (Sweden)

    Alfredo Seijo

    2011-04-01

    %. The technique of chain reaction (PCR was useful for diagnosis in samples obtained post mortem. A strain classified in serogroup canicola was isolated from blood culture. Pneumonia was classified into three types: non-severe pneumonia course with little overall impact; severe pneumonia associated with systemic clinical forms with jaundice, renal failure, thrombocytopenia, and pulmonary hemorrhage, and of serious course, not associated with jaundice, kidney failure or thrombocytopenia. Antibiotic treatment started in the early stages of disease (average 3.2 days had no influence on the development of severe pneumonia. It is puggested to consider three clinical forms of leptospirosis: anicteric, icteric (with its evolutionary variants and pulmonary hemorrhage.

  9. Diagnóstico clínico-radiológico de la neumonía del adulto adquirida en la comunidad CLINICAL AND RADIOLOGICAL DIAGNOSIS OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

    Directory of Open Access Journals (Sweden)

    Rodrigo Gil D.

    2005-04-01

    Full Text Available La neumonía del adulto adquirida en la comunidad es un cuadro de evolución aguda, caracterizado por compromiso del estado general, fiebre, calofríos, tos, expectoración mucopurulenta y dificultad respiratoria; asociado en el examen físico a taquicardia, taquipnea, fiebre y signos focales en el examen pulmonar. La probabilidad que un paciente con síntomas respiratorios agudos tenga una neumonía depende de la prevalencia de la enfermedad en el ambiente donde se presenta y de las manifestaciones clínicas del enfermo. Se estima que la prevalencia de neumonía en los servicios de atención ambulatoria corresponde a 3-5% de las consultas por patología respiratoria. El diagnóstico clínico de neumonía sin confirmación radiográfica carece de precisión ya que el cuadro clínico (historia y examen físico no permite diferenciar con certeza al paciente con neumonía de otras condiciones respiratorias agudas (infecciones de la vía aérea superior, bronquitis, influenza. El diagnóstico de neumonía es clínico-radiográfico: la historia y examen físico sugieren la presencia de una infección pulmonar, pero el diagnóstico de certeza se establece cuando se confirma la presencia de infiltrados pulmonares en la radiografía de tórax. El cuadro clínico y los hallazgos de la radiografía de tórax no permiten predecir con certeza el agente etiológico de la infección pulmonar. La radiografía de tórax permite confirmar el diagnóstico clínico, establecer su localización, extensión y gravedad; además permite diferenciar la neumonía de otras patologías, detectar posibles complicaciones, y puede ser útil en el seguimiento de los pacientes de alto riesgo. La resolución de los infiltrados radiográficos a menudo ocurre varias semanas o meses después de la mejoría clínica, especialmente en el anciano y en la neumonía multilobar manejada en la UCICommunity acquired pneumonia in adults is an acute disease characterized by worsening in

  10. Carbapenem-resistant Acinetobacter baumannii acquired before liver transplantation: Impact on recipient outcomes.

    Science.gov (United States)

    Freire, Maristela Pinheiro; Pierrotti, Ligia Câmera; Oshiro, Isabel Cristina Villela Soares; Bonazzi, Patrícia Rodrigues; Oliveira, Larissa Marques de; Machado, Anna Silva; Van Der Heijden, Inneke Marie; Rossi, Flavia; Costa, Silvia Figueiredo; D'Albuquerque, Luiz Augusto Carneiro; Abdala, Edson

    2016-05-01

    Infection with carbapenem-resistant Acinetobacter baumannii (CRAB) after liver transplantation (LT) is associated with high mortality. This study aimed to identify risk factors for post-LT CRAB infection, as well as to evaluate the impact of pre-LT CRAB acquisition on the incidence of post-LT CRAB infection. This was a prospective cohort study of all patients undergoing LT at our facility between October 2009 and October 2011. Surveillance cultures (SCs) were collected immediately before LT and weekly thereafter, until discharge. We analyzed 196 patients who were submitted to 222 LTs. CRAB was identified in 105 (53.6%); 24 (22.9%) of these patients were found to have acquired CRAB before LT, and 85 (81.0%) tested positive on SCs. Post-LT CRAB infection occurred in 56 (28.6%), the most common site being the surgical wound. Multivariate analysis showed that the risk factors for developing CRAB infection were prolonged cold ischemia, post-LT dialysis, LT due to fulminant hepatitis, and pre-LT CRAB acquisition with pre-LT CRAB acquisition showing a considerable trend toward significance (P = 0.06). Among the recipients with CRAB infection, 60-day mortality was 46.4%, significantly higher than among those without (P < 0.001). Mortality risk factors were post-LT infection with multidrug-resistant bacteria, LT performed because of fulminant hepatitis, retransplantation, prolonged cold ischemia, longer LT surgical time, and pre-LT CRAB acquisition, the last showing a trend toward significance (P = 0.08). In conclusion, pre-LT CRAB acquisition appears to increase the risk of post-LT CRAB infection, which has a negative impact on recipient survival. Liver Transplantation 22 615-626 2016 AASLD.

  11. Influenza and bacterial pneumonia - constant companions

    OpenAIRE

    Wunderink, Richard G.

    2010-01-01

    Sequential or concomitant influenza and bacterial pneumonia are two common syndromes seen in community-acquired pneumonia. Inadequacies of diagnostic testing make separating simple pneumonia with either bacteria or influenza from concomitant or sequential influenza with both microorganisms difficult, although the novel 2009 H1N1 epidemic may improve the availability of molecular testing for viruses. Given the frequency of viral pneumonia and diagnostic limitations, empirical antivirals may be...

  12. Infection with and carriage of Mycoplasma pneumoniae in children

    NARCIS (Netherlands)

    P.M. Meyer Sauteur (Patrick); W.W.J. Unger (Wendy W.J.); D. Nadal (David); C. Berger (Christoph); C. Vink (Cornelis); A.M.C. van Rossum (Annemarie)

    2016-01-01

    textabstract"Atypical" pneumonia was described as a distinct and mild form of community-acquired pneumonia (CAP) already before Mycoplasma pneumoniae had been discovered and recognized as its cause. M. pneumoniae is detected in CAP patients most frequently among school-aged children from 5 to 15 yea

  13. Preterm and term neonates transplacentally acquire IgG antibodies specific to LPS from Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa.

    Science.gov (United States)

    Silveira Lessa, Ana Lúcia; Krebs, Vera Lúcia Jornada; Brasil, Tatiana Braga; Pontes, Gerlândia Neres; Carneiro-Sampaio, Magda; Palmeira, Patricia

    2011-07-01

    High incidences of Gram-negative bacteria are found in neonatal nosocomial infections. Our aim was to investigate placental transmission of immunoglobulin G (IgG) reactive with lipopolysaccharide from Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli O111, O6 and O26. The total and lipopolysaccharide-specific IgM and IgG were determined in 11 maternal/umbilical-cord sera aged ≤33 weeks (GI); 21 aged >33 and <37 weeks (GII); and 32 term newborns (GIII). The total and lipopolysaccharide-specific IgM concentrations were equivalent in maternal sera. The total IgG concentrations were equivalent in maternal and newborn sera, with the exception of GIII newborns as compared with their mothers (P<0.0001) and with neonates from GI and GII (P<0.05). Lipopolysaccharide-specific IgG concentrations were lower in GI neonates than in their mothers (P<0.01) and lower in GII (P<0.05). Lower lipopolysaccharide-specific IgG levels were observed among neonates only for O111 in GI (P<0.05) and for O26 and Pseudomonas in GII, both as compared with GIII (P<0.05). The anti-lipopolysaccharide IgG transfer ratios were lower in GI (except for O26) and in GII (except for Klebsiella and O111) as compared with GIII (P<0.05). Our results suggest that the greater susceptibility to infections in preterm infants is influenced (besides the humoral response) by factors intrinsic and extrinsic to the condition of prematurity. PMID:21481015

  14. 重症肺炎患者血清皮质醇的动态变化及临床意义%Dynamic monitoring of plasma cortisol level in patients with severe community-acquired pneumonia and its clinical significance

    Institute of Scientific and Technical Information of China (English)

    麦玉梅; 李伟峰; 黄文杰

    2016-01-01

    Objective To evaluate the dynamic monitoring of plasma cortisol level in patients with severe community-acquired pneumonia ( SCAP) and its clinical significance. Methods The cortisol level in 70 SCAP pa-tients were determined on the 1st, 3rd, and 5th days after admission, and calculated the PSI score on the first day. They were divided into the survival group and the death group according their prognosis. Another 30 cases of non-SCAP hospitalized at the same period were enrolled as the control group. Results 23 cases of the SCAP group died and the mortality was 32. 8%. The first day ' PSI score and the cortisol level in the SCAP group were significantly higher than those in the non-serious pneumonia group ( P<0. 05 ) . The area under the curve of the PSI score and cortisol in the diagnosis of severe pneumonia were 0. 886 and 0. 827. The mean cortisol level was different significant-ly among different PSI groups (P<0. 05). The plasma cortisol level in the death group was significantly higher than that in the survival group (P<0. 05). Conclusion Plasma cortisol level can effectively evaluate the severity of illness in patients with community acquired pneumonia, and it could be useful for the diagnosis and prognosis assessment of SCAP.%目的探讨重症社区获得性肺炎( SCAP)患者血清皮质醇( COR)水平的动态变化及临床意义。方法测定70例重症社区获得性肺炎患者入院后第1、3、5天清晨8:00血清COR水平,同时计算第1天PSI评分,根据预后分为死亡组和存活组。另随机选择同期住院的30例普通社区获得性肺炎( CAP)患者作为对照组并进行统计分析。结果重症肺炎组死亡23例,死亡率32.8%。重症肺炎组PSI评分、COR水平明显高于普通肺炎组,差异有统计学意义。 ROC曲线分析显示入院PSI评分、COR水平诊断重症肺炎曲线下面积( AUC)分别为0.886、0.827。血清COR水平随着PSI分级增加而逐渐升高,差异有统计学意义

  15. Pneumonia (image)

    Science.gov (United States)

    Pneumonia is an inflammation of the lungs caused by an infection. Many different organisms can cause it, including bacteria, viruses, and fungi. Pneumonia is a common illness that affects millions of ...

  16. Mycoplasma pneumonia

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000082.htm Mycoplasma pneumonia To use the sharing features on this page, please enable JavaScript. Mycoplasma pneumonia is an infection of the lungs by ...

  17. 莫西沙星与左氧氟沙星治疗社区获得性肺炎的效果分析%The Clinical Analyze of Curing Community Acquired Pneumonia by Moxifloxacin and Levofloxacin

    Institute of Scientific and Technical Information of China (English)

    刘锋涛; 张玮

    2013-01-01

      目的:探讨莫西沙星与左氧氟沙星治疗社区获得性肺炎(CAP)的效果情况。方法:分析我院收治的社区获得性肺炎患者临床资料,依据治疗方式不同分为莫西沙星组40例和左氧氟沙星组40例。结果:莫西沙星组咳嗽消失时间、体温恢复正常时间、血常规恢复时间、胸部阴影明显吸收>50%时间均低于左氧氟沙星组,莫西沙星组临床治疗总有效率明显高于左氧氟沙星组,P50%time of moxifloxacin group were lower than levofloxacin group,the clinical curing total efficiency of moxifloxacin group were higher than levofloxacin group,The pulmonary function and quality of life of detection group were better than control group,P<0.05,the difference were statistical significance. Conclusion:The clinical symptoms of curing community acquired pneumonia by moxifloxacin was obviously and effect of good,which was to be used.

  18. No Carbapenem Resistance in Pneumonia Caused by Klebsiella Species

    OpenAIRE

    Yayan, Josef; Ghebremedhin, Beniam; Rasche, Kurt

    2015-01-01

    Abstract Klebsiella species are a common cause of community- and nosocomial-acquired pneumonia. Antibiotic resistance to the class of carbapenem in patients with pneumonia caused by Klebsiella species is unusual. New studies report carbapenem resistance in patients with pneumonia caused by Klebsiella species. This article examines, retrospectively, antibiotic resistance in patients with community- and nosocomial-acquired pneumonia caused by Klebsiella species. The data of all patients with co...

  19. Eficacia y seguridad de la fisioterapia respiratoria en pacientes adultos con neumonía adquirida en la comunidad Efficacy and safety of chest physiotherapy in adult patients with community-acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Fernando Saldías P

    2012-09-01

    tratamiento adyuvante de rutina en pacientes adultos con neumonía comunitaria no complicada.Pneumonia is one of the most common health problems affecting all age groups around the world. Chest physiotherapy includes a variety of techniques, such as conventional chest physiotherapy (i.e., percussion and postural drainage, active cycle of breathing techniques, positive expiratory pressure (using devices to maintain 10 to 25 cm of water pressure during expiration, and osteopathic manipulation. In theory, these techniques could help keep airways open, improve secretion clearance, and increase gas exchange. Chest physiotherapy has been widely used as an adjunctive therapy for pneumonia in adults without any reliable evidence. We evaluate the evidence examining the efficacy and safety of chest physiotherapy in adult patients with community-acquired pneumonia. Results: Six randomized controlled trials have assessed four types of chest physiotherapy, namely conventional chest physiotherapy, osteopathic manipulative treatment (including paraspinal inhibition, rib raising, and diaphragmatic or soft myofascial release, active cycle of breathing techniques (including active breathing control, thoracic expansion exercises andforced expiration technique and positive expiratory pressure, in community-acquired pneumonia hospitalized patients. None of these techniques (versus no physiotherapy or placebo therapy reduce mortality or improve cure rate. Limited evidence indicates that osteopathic manipulative treatment (versus placebo therapy and positive expiratory pressure (versus no physiotherapy can slightly reduce the duration of hospital stay (by 2.0 and 1.4 days, respectively. In addition, positive expiratory pressure (versus no physiotherapy can slightly reduce the duration offever by 0.7 day, and osteopathic manipulative treatment (versus placebo therapy might reduce the duration of antibiotic use by 1.93 days. No severe adverse events were reported. In summary, the available evidence

  20. Significance of serum procalcitonin in children community acquired pneumonia%血清降钙素原在儿童社区获得性肺炎中意义

    Institute of Scientific and Technical Information of China (English)

    杨志雄

    2015-01-01

    Objective:To explore the clinical diagnosis and treatment guidance value of serum procalcitonin(PCT) in children community acquired pneumonia.Methods:Children with the diagnosis of bronchial pneumonia and clinical considerations of bacterial infection were divided into A group(the effective group) and B group(no significant effect group) according to the antibiotic treatment effect.The relationships between serum PCT,sputum culture and clinical diagnosis were compared in two groups.Results:In A,B two groups,the positive patients with PCT and sputum culture were 31 cases,11 cases and 1 case,2 cases. The total positive rate of PCT and sputum culture,PCT positive rate of two groups,the positive rate of PCT and sputum culture of A group were compared with significant difference(P<0.05).Conclusion:Serum PCT is an ideal marker of bacterial infection.It plays an important role in the treatment of children with CAP.%目的:探讨血清降钙素原(PCT)在儿童社区获得性肺炎临床诊断及治疗中的指导价值。方法:对确诊支气管肺炎并临床考虑为细菌感染的患儿,以抗生素治疗效果分为A组(有效组)及B组(疗效不显组),比较两组血清PCT与痰培养及临床诊断之间的关系。结果:在A、B两组中,PCT与痰培养阳性者分别为31例、11例和1例、2例。PCT与痰培养总阳性率、两组患儿 PCT 阳性率、A 组患儿 PCT 与痰培养阳性率比较差异均有统计学意义(P<0.05)。结论:血清PCT是一项较为理想的细菌感染标志物,对儿童CAP治疗有重要意义。

  1. Clinical observation on levofloxacin for the treatment of community acquired pneumonia in elderly patients%左氧氟沙星治疗老年社区获得性肺炎临床观察

    Institute of Scientific and Technical Information of China (English)

    曾清; 胡继华; 邱元吉

    2008-01-01

    Objective To observe the efficacy and safety of levofloxacin for the theatment of com-munity acquired pneumonia(CAP) in the elderly patients. Methods Thirty-six elderly inpatients with CAP between May 2005 and May 2007 were treated with levofloxacin at a dosage intravenously of 500 mg once a day for 5 to 14 days treatment. Results Streptococcus pneumoniae of multiple drugs-resistant were found in sputum of 22 patients,pseudomonas aeruginosa in 8 patients and haemophilus influenzae in 6 patients de-pending on the results of the sputum culture. The total clinical efficacy rate of levofloxacin was 75.0% and bacteria elimination rate was 82.1%,and 16.7% patients showed related side effect of diarrhea,skin-rash and kidney injury. Conclusions Levofloxacin is an effective with little side effect in treatment of CAP in the elderly.%目的 了解左氧氟沙星治疗老年社区获得性肺炎(CAP)的临床有效性和不良反应的发生情况.方法 老年CAP患者36例,均应用左氧氟沙星治疗,每日1次0.5 g静脉滴注,疗程5~14 d.结果 22例痰培养检出多药耐药的肺炎链球菌,8例检出铜绿假单胞菌,6例检出流感嗜血杆菌,临床有效率为75.0%;细菌清除率为82.1%;相关腹泻、皮疹、肾损害各2例,占16.7%.结论 左氧氟沙星治疗老年CAP疗效好,不良反应发生率相对较低.

  2. Viral pneumonia

    Science.gov (United States)

    ... off infection. Vaccines may help prevent pneumonia in children, the elderly, and people with diabetes, asthma, emphysema , HIV, cancer, or other chronic conditions. A drug called palivizumab ( ...

  3. Impact of chlorhexidine mouthwash prophylaxis on probable ventilator-associated pneumonia in a surgical intensive care unit

    OpenAIRE

    Enwere, Emmanuel N; Elofson, Kathryn A; Forbes, Rachel C.; Gerlach, Anthony T

    2016-01-01

    Background: Prevention of ventilator-associated pneumonia is a healthcare goal. Although data is inconsistent, some studies suggest that oral chlorhexidine may decrease rates of pneumonia in mechanically-ventilated patients. We sought to assess the rate of pneumonia in the Surgical Intensive Care Unit (SICU) pre and post implementation of routine chlorhexidine mouthwash prophylaxis. Materials and Methods: A retrospective cohort study was conducted, including patients between 1/1/2009 and 12/3...

  4. 医院获得性肺炎病原菌细菌耐药性分析%Drug resistance pattern of bacteria from patients with hospital-acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    汪瑞忠; 方琴; 房华; 杜丽华; 毛美丽; 奚峰; 孙孝峰; 瞿静华; 丁爱民

    2011-01-01

    目的 了解上海市浦东新区人民医院住院患者医院获得性肺炎(HAP)病原菌耐药情况的现状,为经验用药提供依据.方法 收集2008-2009年HAP患者100例的分离菌进行细菌耐药性分析.结果 金葡菌占第1位,耐甲氧西林金葡菌(MRSA)检出率为52.4%;耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率为87.5%;除万古霉素、替考拉宁、利奈唑胺、利福平外,MRSA、MRCNS与甲氧西林敏感金葡菌(MSSA)之间的耐药率有很大的差别.产超广谱β内酰胺酶(ESBLs)肺炎克雷伯菌检出率为42.9%#产ESBLs和非产ESBLs的肺炎克雷伯菌之间的耐药率有很大的差别.嗜麦芽窄食单胞菌排列第2位.结论 HAP患者中MRSA的检出率高于该院2005年的检出率;MRCNS的检出率与该院2005年检出率相近;产ESBLs肺炎克雷伯菌的检出率比该院2005年的检出率稍高.HAP患者中MRSA、MRCNS、产ESBLs肺炎克雷伯菌的细菌耐药率比2008年本市平均水平低,建议各地区建立自己的细菌耐药情况数据库.%Objective To understand the antibiotic resistance pattern of the bacterial pathogens isolated from patients with hospital-acquired pneumonia (HAP) in People's Hospital of Pudoug District. Methods The bacterial pathogens (n = 100) isolated from HAP patients were tested for susceptibility to antibiotics. Results S. aureus was the most frequently isolated pathogen from HAP patients. The prevalence of MRSA was 52.4%. About 87.5% of the coagulase-negative Staphylococcus isolates were resistant to methicillin (MRCNS). With the exception of vancomycin, teicoplanin, linezolid, rifampin, methicillin-resistant Staphylococcus showed the antibiotic resistance pattern very different from the methicillin-susceptible Staphylococcus. ESBLs were produced in 42. 9% of the K. pneumoniae isolates. ESBLs-positive and ESBLs-negative K. pneumoniae strains showed very different resistance pattern. Conclusions The antibiotic resistance pattern has been

  5. Clinical analysis of the characteristics of hospital acquired pneumonia in 119 aged patients%119例高龄患者院内获得性肺炎的临床分析

    Institute of Scientific and Technical Information of China (English)

    黄带发; 张丽辉; 贺顺川; 林朝胜; 马雅心

    2012-01-01

    Objective To explore the clinical characteristics of aged patients with hospital acquired pneumonia (HAP) in veteran officers' wards and intervention measures. Methods Prognosis of HAP,bacterial distribution and drug resistance of 119 patients from our ward in the past three years were retrospectively analyzed. Results (1) The rate of qualified sputum samples was lower and multidrug resistance bacterium was higher. (2) The incidence of HAP in patients hospitalized 3 to 6 months was 16. 7% and that of HAP in those hospitalized over 6 months was 44. 3% ,higher than those hospitalized less than 1 month( P = 0.013,P = 0.001). The rate of multidrug resistance was 70. 0% in patients who used long term broad - spectrum antibiotics. (3) The mortality (6.7% )in aged patients with HAP was obviously higher than the average mortality (2.6% ,P = 0. 001) of patients hospitalized in our department in recent 5 years. (4) It might be safe to cease applying antibiotics in symptomless chronic germ- carrying patients. Conclusion The rates of HAP and multidrug resistance bacterium are high in aged inpatients of veteran officers' ward,and mortality of these patients increase significantly.%目的 探讨干部病房高龄患者院内获得性肺炎(hospital acquire pneumonia,HAP)感染的临床特点及干预措施.方法 对我科近3年的119例高龄HAP患者的发病原因,细菌分布、耐药情况及预后进行分析.结果 ①高龄HAP患者痰标本合格率低,细菌耐药发生率高.②住院时间超过3~6月的患者,HAP发生率16.7%,6月以上为44.3%,明显高于住院短于1月的患者(P=0.013,P=0.001).长期使用广谱抗生素超过3次者,多药耐药发生率达70.0%.③高龄患者HAP感染死亡率6.7%,明显高于我科近5年的住院平均死亡率2.6%(P=0.001).4.长期带菌而无明显感染症状患者可停抗生素观察.结论 干部病房高龄患者长期住院易发生HAP,并且细菌多药耐药发生率高,显著增加患者死亡危险.

  6. 莫西沙星序贯治疗老年社区获得性肺炎的药物经济学评价%Pharmacoeconomic efficacy of moxifloxacin sequential therapy for community-acquired pneumonia in elderly patients

    Institute of Scientific and Technical Information of China (English)

    王媛媛; 刘丽萍; 操艺; 洪钰; 李丽莉

    2012-01-01

    目的 对莫西沙星两种不同给药方案治疗老年社区获得性肺炎进行药物经济学评价.方法 将80例患者随机分为莫西沙星序贯治疗组(序贯组)和莫西沙星静脉滴注组(对照组),每组各40例.序贯治疗组给予莫西沙星注射液0.4 g,静脉滴注,1次·d-1,5 d后,病情好转,改为莫西沙星片0.4 g,口服,1次·d-1,总疗程11 d;对照组给予莫西沙星注射液0.4 g,静脉滴注,1次·d-1,总疗程11 d.评价临床疗效及药物经济学.结果 序贯组和对照组痊愈率分别为57.5%、62.5%(P>0.05),有效率分别为90.0%、92.5%(P>0.05),不良反应发生率分别为7.5%、10%(P>0.05).序贯治疗组的成本-效果比为2 000.0,低于对照组(3 864.9).结论 莫西沙星序贯治疗老年社区获得性肺炎疗效高、安全、经济.%Objective To evaluate pharmacoeconomic efficacy of two different dosage regimens of moxifloxacin in the treatment of community acquired pneumonia in elderly patients. Method A total of 80 patients were randomly enrolled into 2 groups: moxifloxacin injection followed by tablet ( sequential group ) and moxifloxacin injection group ( control group ). Moxifloxacin was administered by intravenous infusion,400 mg/250 ml once daily for 11 days in control group( n =40 ). In sequential group( n =40 ),moxifloxacin was given by intravenous infusion 400 mg/250 ml, once daily for 5 days, followed by oral administration at the same dose. The total treatment duration was also 11 days. After the end of therapy,to the clinical efficacy and pharmacoeconomic efficacy were evaluation. Results For sequential group vs. Control group,the cute rate was 57. 5% vs 62. 5%( P>0. 05 ),the effective rate was 90. 0% vs 92. 5%( P >0. 05 ),and the incidence of ADRs was 7. 5% vs 10% ( P > 0. 05 ). The cost-effectiveness of sequential group( 2 000. 0 ) was lower than control group ( 3864. 9 )o Conclusion Moxifloxacin sequential therapy is efficacious, safety and cost-effective for community-acquired

  7. 莫西沙星序贯治疗老年社区获得性肺炎的疗效研究%Sequential moxifloxacin therapy in treatment of elderly patients with community-acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    王玉珠

    2011-01-01

    Objective To evaluate the efficacy, safety and cost of sequential moxifloxacin therapy in elder patients with community acquired pneumonia compared with moxifloxacin injection. Methods 80 elder patients with community acquired pneumonia were randomly divided into two groups, which were treated with moxifioxacin injection followed by tablet (sequential group) or moxifloxacin injection group (control group). Results The effective rate for the sequential group was 90.00%. While for the control group was 92.50%. There was no statistically significant difference between the two groups (P>0.05 ). The bacterial eradication rate in the two groups was 88. 23% and 88.89%, respectively.There was also no significant difference between the two group ( P>0.05 ). The average cost and the incidence of adverse drug reaction of the sequential group was lower than that of the control group. Conclusion The sequential moxifloxacin therapy for CAP is safe, effective, and cost-saved compared with full-course moxifloxacin infusion.%目的 研究莫西沙星序贯治疗老年社区获得性肺炎的疗效.安全性和治疗费用.方法 80例老年社区获得性肺炎患者先予以莫西沙星注射液400 mg/250 ml静脉滴注.每天1次,治疗5~7 d.临床症状改善后,随机分成序贯组和对照组.序贯组40例改口服莫西沙星片剂400 mg,每天1次.对照组40例继续静脉滴注莫西沙星注射液400mg/250 ml,每天1次.两组总疗程10 d.观察疗效、药物的不良反应和治疗费用.结果 两组的有效率无明显差异(P>0.05),分别为90.00%和92.50%.两组细菌清除率分别为88.23%和88.89%,无明显差异(P>0.05).序贯组的治疗费用、不良反应均明显低于对照组(P<0.05).结论 莫西沙星序贯治疗老年社区获得性肺炎疗效确切、安全,且节约费用.

  8. 国外社区获得性肺炎( CAP)诊治指南解读%Interpretation of guidelines for the management of community-acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    佘丹阳

    2012-01-01

    Community-acquired pneumonia (CAP) is a serious, growing health problem around the world. To improve the management of patients with CAP, new evidence-based guidelines have been issued by many different academic organizations. The most widely referenced guidelines are those of the Infectious Diseases Society of America (IDSA), the American Thoracic Society (ATS) and the British Thoracic Society (BTS). According to the documents, the accurate assessment of severity, the correct site-of-care decisions, the reasonable selection of diagnostic tests for etiology, as well as the appropriate empirical antimicrobial therapy on the basis of clinical risks and local susceptibility patterns are crucial areas for improvement in CAP management%社区获得性肺炎(CAP)是一种危害人类健康的常见疾病.为了改进CAP的诊疗工作,各国的相关学术组织先后依据新的循证医学证据制订了CAP的诊治指南,其中,以美国感染性疾病学会(IDSA)、美国胸科学会(ATS)以及英国胸科学会(BTS)等制订的CAP诊治指南影响较大.根据这些指南,在社区获得性肺炎的诊治中,准确判断病情严重程度、正确选择初治地点、合理安排病原学检查以及根据临床风险和局部致病原耐药状况有针对性地进行经验性抗感染治疗,是提高整体诊疗水平的关键环节.

  9. Pathogenic bacteria of hospital acquired pneumonia and drug resistance analysis%重症监护病房患者中医院获得性肺炎致病菌分布特点及耐药性分析

    Institute of Scientific and Technical Information of China (English)

    唐志军; 毛智荣; 沈思娣; 屠春林; 胡建荣

    2011-01-01

    目的 探讨重症监护病房(ICU)患者中医院获得性肺炎的致病菌分布特点及其耐药情况,指导临床合理用药.方法 对本院ICU收治的患者发生医院获得性肺炎且痰液病原菌培养获阳性结果的747例患者进行分析.结果 本组病例中革兰阳性菌感染患者170例(22.8%),常见致病菌为金黄色葡萄球菌107例335株(62.9%),溶血葡萄球菌39例(22.9%)73株;对苯唑西林耐药的金黄色葡萄球菌检出率83.6%(280/335),但未发现对万古霉素和利奈唑胺耐药的菌株.革兰阴性菌感染患者共497例(66.5%),常见致病菌分布依次为鲍曼不动杆菌151例(30.4%)441株,铜绿假单胞菌110例(22.1%)567株,肺炎克雷伯菌106例(21.3%)301株,大肠埃希菌27例(5.4%)57株.真菌感染80例(10.7%),常见致病菌为白色念珠菌38例(47.5%),光滑念珠菌21例(26.3%),热带念珠菌18例(22.5%),曲霉菌2例(2.5%).结论 机械通气的患者金黄色葡萄球菌、鲍曼不动杆菌、铜绿假单胞菌和真菌的检出率更高.葡萄球菌感染的患者万古霉素、利奈唑胺为首选药物,对革兰阴性菌往往需根据药敏试验选择相应抗生素,氨基糖苷类抗生素是一个重要的选择,往往需联合用药.%Objective To investigate the distribution and drug resistance of the pathogenic bacteria of intensive care unit(ICU) hospital-acquired pneumonia. Methods Totally 747 patients who suffered from hospital-acquired pneumonia and acquired a positive result after cultivation were enrolled. Results Among the patients, 170 were infected with gram-positive bacterium(22.8% )and the frequently-seen pathogenic bacteria were Staphylococcus aureus(62.9%) and S. haemolyticus(22.9%). The methicillin resistant Stophylococcus aureus(MRSA)incidence was 83.6% and no strains resistant to vancomycin and linezolid was found. Four hundred and ninty-seven patients were affected by Gram-negative bacillus(66.5% ). Frequently-seen pathogenic bacteria included Acinetobocter

  10. The impact of onset time on the isolated pathogens and outcomes in ventilator associated pneumonia.

    Science.gov (United States)

    Khan, Raymond; Al-Dorzi, Hasan M; Tamim, Hani M; Rishu, Asgar H; Balkhy, Hanan; El-Saed, Aiman; Arabi, Yaseen M

    2016-01-01

    Several guidelines base the empirical therapy of ventilator-associated pneumonia (VAP) on the time of onset. However, there is emerging evidence that the isolated microorganisms may be similar regardless of onset time. This study evaluated the characteristics and outcomes of VAP with different onset times. All of the mechanically ventilated patients admitted to the ICU of a 900-bed tertiary-care hospital between 01/08/2003 and 31/12/2010 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. The patients were categorized into four groups: EO if VAP occurred within 4 days of intubation and hospital admission; LO if VAP occurred after 4 days of admission; EL if VAP occurred within 4 days of intubation, but after the fourth hospitalization day; and LL if VAP occurred after the fourth day of intubation and hospitalization. Out of the 394 VAP episodes, 63 (16%) were EO episodes, 331 (84.0%) were LO episodes, 40 (10.1%) were EL episodes and 291 (73.1%) were LL episodes. The isolated microorganisms were comparable among the four groups, with a similar rate of potentially multidrug resistant organisms in the EO-VAP (31.7%), LO-VAP (40.8%), EL-VAP (37.5%) and LL-VAP (43.3%) samples. The hospital mortality was 24% for EO-VAP cases, 28% for LO-VAP cases, 40% for EL-VAP cases and 49% for LL-VAP cases. However, in the adjusted multivariate analysis, neither LO-VAP, EL-VAP nor LL-VAP was associated with an increased risk of hospital mortality compared with EO-VAP (OR, 0.86 95% CI, 0.34-2.19; 1.22; 95% CI, 0.41-3.68, and 0.95; 95% CI, 0.43-2.10, respectively). In this study, the occurrence of potential multidrug resistant pathogens and the mortality risk were similar regardless of VAP timing from hospital admission and intubation. The bacterial isolates obtained from the VAP cases did not follow an early vs. late-onset pattern, and thus, these terms may not be clinically helpful. PMID:26460144

  11. 50例重症院内获得性肺炎的诊治分析%Analysis of the diagnosis and treatment of 50 cases with severe hospital-acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    丁仁彧; 梁英健; 章志丹; 马晓春

    2012-01-01

    目的:观察重症院内获得性肺炎患者的细菌耐药情况和预后.方法:对50例重症HAP患者进行前瞻性观察研究,分析患者一般情况、初始痰培养和药物敏感性、机械通气时间以及病死率.结果:初始细菌培养阳性菌株53株,其中革兰阴性菌39株(73.6%),以铜绿假单胞菌(28.3%)、鲍曼不动杆菌(18.9%)、肺炎克雷伯杆菌(11.3%)为多见;革兰阳性菌14株(26.4%),均为耐甲氧西林金黄色葡萄球菌(MRSA).细菌耐药情况严重.所有患者30 d粗病死率为16%(8/50).在43例初始细菌培养阳性患者中,恰当初始抗生素应用率为63.8% (27/43);治疗组恰当与不恰当组的机械通气时间分别为8.9±5.2d和15.4±10.1d,有显著性差异(P<0.05);2组30d粗病死率分别为11.1%和25.0%,无显著性差异(P>0.05).结论:重症院内获得性肺炎的致病菌耐药率高,恰当初始抗生素治疗可以降低机械通气时间.应加强细菌耐药监测及合理应用抗生素.%Objective :To observe the drug resistance to antimicrobics in treating patients with severe hospital -acquired pneumonia (HAP) and its prognosis. Methods:Fifty cases with severe HAP were included in the prospective study. Initial sputum bacterial culture,bacterial sensitivity,days of mechanical ventilation and mortality were analyzed. Results:Totally 53 strains of pathogens were isolated by initial bacterial culture. The G bacteria was 39 (73. 6% ) among which pseudomonas aeruginosa (28. 3% ) , Acinetobacter baumannii (18.9%) and Klebsiella pneumoniae (11.3%) were commonly seen. G bacteria was 26.4% in which all were methicillin-resistant staphylococcus aureus (MRSA). The condition of drug resistance was serious. The overall crude 30-day mortality rate was 16% (8/50). Of 43 cases whose initial bacterial culturing were positive,27 patients received appropriate initial antimicrobial therapy( AIAT,63.8% ). Days of mechanical ventilation in AIAT group and non-AIAP group

  12. SMART-COP评分对重症社区获得性肺炎的诊断价值%Diagnostic value of SMART-COP score in diagnosis of severe community-acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    许莉; 韩娟; 颜浩

    2015-01-01

    Objective To explore the value of SMART-COP score in diagnosis of severe communityacquired pneumonia patients (SCAP).Methods Totally 180 patients of community-acquired pneumonia (CAP),including 90 cases of SCAP and 90 cases of common CAP,were retrospectively analyzed.The SMART-COP score was assessed.The receiver operating characteristic (ROC) curve of SMART-COP score in diagnosing SCAP was drawn by taking the standard of American Thoracic Society/Infectious Diseases Society of America statement as gold standard,and the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio and Youden index were obtained.Results Taking 4 scores as cut-off value,the value of SMART-COP in diagnosing SCAP was high,with sensitivity of 78.9%,specificity of 80.0%,positive likelihood ratio of 3.944,negative likelihood ratio of 0.264 and Youden index of 0.589.Conclusion The sensitivity and specificity of SMART-COP score in diagnosing SCAP is high with cut-off value of 4.%目的 探讨SMART-COP评分对重症社区获得性肺炎(SCAP)的诊断价值.方法 回顾性分析2011年1月至2013年12月成都市第二人民医院社区获得性肺炎(CAP)患者180例,其中SCAP 90例,普通CAP90例,对2组进行SMART-COP评分,以美国胸科学会/美国感染病学会2007年SCAP诊断标准作为金标准绘制SMART-COP评分诊断SCAP的受试者工作特征曲线,获得SMART-COP评分诊断SCAP界值及相应的敏感度、特异度、阳性似然比、阴性似然比和Youden指数.结果 以4分为界值,SMART-COP评分诊断SCAP的效能最高,其敏感度为78.9%,特异度为80.0%,准确率为79.4%,阳性似然比为3.944,阴性似然比为0.264,Youden指数为0.589.结论 根据SMART-COP评分诊断重症肺炎敏感度及特异度均较好,最佳临界值为4分.

  13. Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates.

    Science.gov (United States)

    Farooqui, Habib; Jit, Mark; Heymann, David L; Zodpey, Sanjay

    2015-01-01

    The burden of severe pneumonia in terms of morbidity and mortality is unknown in India especially at sub-national level. In this context, we aimed to estimate the number of severe pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children younger than 5 years in 2010. We adapted and parameterized a mathematical model based on the epidemiological concept of potential impact fraction developed CHERG for this analysis. The key parameters that determine the distribution of severe pneumonia episode across Indian states were state-specific under-5 population, state-specific prevalence of selected definite pneumonia risk factors and meta-estimates of relative risks for each of these risk factors. We applied the incidence estimates and attributable fraction of risk factors to population estimates for 2010 of each Indian state. We then estimated the number of pneumococcal pneumonia cases by applying the vaccine probe methodology to an existing trial. We estimated mortality due to severe pneumonia and pneumococcal pneumonia by combining incidence estimates with case fatality ratios from multi-centric hospital-based studies. Our results suggest that in 2010, 3.6 million (3.3-3.9 million) episodes of severe pneumonia and 0.35 million (0.31-0.40 million) all cause pneumonia deaths occurred in children younger than 5 years in India. The states that merit special mention include Uttar Pradesh where 18.1% children reside but contribute 24% of pneumonia cases and 26% pneumonia deaths, Bihar (11.3% children, 16% cases, 22% deaths) Madhya Pradesh (6.6% children, 9% cases, 12% deaths), and Rajasthan (6.6% children, 8% cases, 11% deaths). Further, we estimated that 0.56 million (0.49-0.64 million) severe episodes of pneumococcal pneumonia and 105 thousand (92-119 thousand) pneumococcal deaths occurred in India. The top contributors to India's pneumococcal pneumonia burden were Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan in that order. Our results

  14. Granzyme A impairs host defense during Streptococcus pneumoniae pneumonia.

    Science.gov (United States)

    van den Boogaard, Florry E; van Gisbergen, Klaas P J M; Vernooy, Juanita H; Medema, Jan P; Roelofs, Joris J T H; van Zoelen, Marieke A D; Endeman, Henrik; Biesma, Douwe H; Boon, Louis; Van't Veer, Cornelis; de Vos, Alex F; van der Poll, Tom

    2016-08-01

    Streptococcus pneumoniae is the most common causative pathogen in community-acquired pneumonia (CAP). Granzyme A (GzmA) is a serine protease produced by a variety of cell types involved in the immune response. We sought to determine the role of GzmA on the host response during pneumococcal pneumonia. GzmA was measured in bronchoalveolar lavage fluid (BALF) harvested from CAP patients from the infected and contralateral uninfected side and in lung tissue slides from CAP patients and controls. In CAP patients, GzmA levels were increased in BALF obtained from the infected lung. Human lungs showed constitutive GzmA expression by both parenchymal and nonparenchymal cells. In an experimental setting, pneumonia was induced in wild-type (WT) and GzmA-deficient (GzmA(-/-)) mice by intranasal inoculation of S. pneumoniae In separate experiments, WT and GzmA(-/-) mice were treated with natural killer (NK) cell depleting antibodies. Upon infection with S. pneumoniae, GzmA(-/-) mice showed a better survival and lower bacterial counts in BALF and distant body sites compared with WT mice. Although NK cells showed strong GzmA expression, NK cell depletion did not influence bacterial loads in either WT or GzmA(-/-) mice. These results implicate that GzmA plays an unfavorable role in host defense during pneumococcal pneumonia by a mechanism that does not depend on NK cells. PMID:27343190

  15. The impact of specific and non-specific immunity on the ecology of Streptococcus pneumoniae and the implications for vaccination.

    Science.gov (United States)

    Flasche, Stefan; Edmunds, W John; Miller, Elizabeth; Goldblatt, David; Robertson, Chris; Choi, Yoon Hong

    2013-11-22

    More than 90 capsular serotypes of Streptococcus pneumoniae coexist despite competing for nasopharyngeal carriage and a gradient in fitness. The underlying mechanisms for this are poorly understood and make assessment of the likely population impact of vaccination challenging. We use an individual-based simulation model to generalize widely used deterministic models for pneumococcal competition and show that in these models short-term serotype-specific and serotype non-specific immunity could constitute the mechanism governing between-host competition and coexistence. We find that non-specific immunity induces between-host competition and that serotype-specific immunity limits a type's competitive advantage and allows stable coexistence of multiple serotypes. Serotypes carried at low prevalence show high variance in carriage levels, which would result in apparent outbreaks if they were highly pathogenic. Vaccination against few serotypes can lead to elimination of the vaccine types and induces replacement by others. However, in simulations where the elimination of the targeted types is achieved only by a combination of vaccine effects and the competitive pressure of the non-vaccine types, a universal vaccine with similar-type-specific effectiveness can fail to eliminate pneumococcal carriage and offers limited herd immunity. Hence, if vaccine effects are insufficient to control the majority of serotypes at the same time, then exploiting the competitive pressure by selective vaccination can help control the most pathogenic serotypes.

  16. Viral pneumonia

    Science.gov (United States)

    More serious infections can result in respiratory failure, liver failure, and heart failure. Sometimes, bacterial infections occur during or just after viral pneumonia, which may lead to more serious forms ...

  17. Prolonged Glucocorticoid Treatment in ARDS: Impact on Intensive Care Unit-Acquired Weakness

    Science.gov (United States)

    Meduri, Gianfranco Umberto; Schwingshackl, Andreas; Hermans, Greet

    2016-01-01

    Systemic inflammation and duration of immobilization are strong independent risk factors for the development of intensive care unit-acquired weakness (ICUAW). Activation of the pro-inflammatory transcription factor nuclear factor-κB (NF-κB) results in muscle wasting during disuse-induced skeletal muscle atrophy (ICU bed rest) and septic shock. In addition, NF-κB-mediated signaling plays a significant role in mechanical ventilation-induced diaphragmatic atrophy and contractile dysfunction. Older trials investigating high dose glucocorticoid treatment reported a lack of a sustained anti-inflammatory effects and an association with ICUAW. However, prolonged low-to-moderate dose glucocorticoid treatment of sepsis and ARDS is associated with a reduction in NF-κB DNA-binding, decreased transcription of inflammatory cytokines, enhanced resolution of systemic and pulmonary inflammation, leading to fewer days of mechanical ventilation, and lower mortality. Importantly, meta-analyses of a large number of randomized controlled trials investigating low-to-moderate glucocorticoid treatment in severe sepsis and ARDS found no increase in ICUAW. Furthermore, while the ARDS network trial investigating methylprednisolone treatment in persistent ARDS is frequently cited to support an association with ICUAW, a reanalysis of the data showed a similar incidence with the control group. Our review concludes that in patients with sepsis and ARDS, any potential direct harmful neuromuscular effect of glucocorticoids appears outweighed by the overall clinical improvement and reduced duration of organ failure, in particular ventilator dependency and associated immobilization, which are key risk factors for ICUAW. PMID:27532030

  18. Prolonged Glucocorticoid Treatment in ARDS: Impact on Intensive Care Unit-Acquired Weakness.

    Science.gov (United States)

    Meduri, Gianfranco Umberto; Schwingshackl, Andreas; Hermans, Greet

    2016-01-01

    Systemic inflammation and duration of immobilization are strong independent risk factors for the development of intensive care unit-acquired weakness (ICUAW). Activation of the pro-inflammatory transcription factor nuclear factor-κB (NF-κB) results in muscle wasting during disuse-induced skeletal muscle atrophy (ICU bed rest) and septic shock. In addition, NF-κB-mediated signaling plays a significant role in mechanical ventilation-induced diaphragmatic atrophy and contractile dysfunction. Older trials investigating high dose glucocorticoid treatment reported a lack of a sustained anti-inflammatory effects and an association with ICUAW. However, prolonged low-to-moderate dose glucocorticoid treatment of sepsis and ARDS is associated with a reduction in NF-κB DNA-binding, decreased transcription of inflammatory cytokines, enhanced resolution of systemic and pulmonary inflammation, leading to fewer days of mechanical ventilation, and lower mortality. Importantly, meta-analyses of a large number of randomized controlled trials investigating low-to-moderate glucocorticoid treatment in severe sepsis and ARDS found no increase in ICUAW. Furthermore, while the ARDS network trial investigating methylprednisolone treatment in persistent ARDS is frequently cited to support an association with ICUAW, a reanalysis of the data showed a similar incidence with the control group. Our review concludes that in patients with sepsis and ARDS, any potential direct harmful neuromuscular effect of glucocorticoids appears outweighed by the overall clinical improvement and reduced duration of organ failure, in particular ventilator dependency and associated immobilization, which are key risk factors for ICUAW. PMID:27532030

  19. Efficacy Observation of Minocycline in Treatment of Senile Hospital Acquired Pneumonia in 28 Cases%米诺环素治疗老年医院获得性肺炎28例

    Institute of Scientific and Technical Information of China (English)

    汤小斌; 龙恩武; 季平; 袁浩宇

    2014-01-01

    目的:观察米诺环素治疗老年医院获得性肺炎的疗效及不良反应。方法收集医院获得性肺炎老年患者56例,随机分成两组,米诺环素联合头孢哌酮钠舒巴坦钠组和头孢哌酮钠舒巴坦钠组,采用统计学方法进行疗效分析。结果联合用药组和头孢哌酮钠舒巴坦钠组治疗老年医院获得性肺炎的总有效率分别为85.71%和71.43%,联合用药组治疗效果较好,组间比较具有统计学差异( P<0.05)。结论与单用头孢哌酮钠舒巴坦钠相比,米诺环素与头孢哌酮钠舒巴坦钠联合用药治疗老年医院获得性肺炎的效果更理想。%Objective To investigate the clinical efficacy and adverse reactions of minocycline for treating senile hospital acquired pneu-monia ( HAP ) in order to provide reference for clinical medication. Methods 56 senile cases of HAP in our hospital were collected and randomly divided into 2 groups. The two groups were treated with sulbactam sodium and cefoperazone sodium and minocycline combined with sulbactam sodium and cefoperazone sodium, respectively. The effects were analyzed and compared between the two groups by the statistical method. Resuts The effective rates of the sulbactam sodium and cefoperazone sodium group and the combined medication group were 85. 71% and 71. 43% respectively. The combined medication group had better curative effect, the difference between the two groups had statistical significance ( P<0. 05 ) . Conclusion Minocycline combined with sulbactam sodium and cefoperazone sodium has the ideal effect in the treatment of senile HAP compared with simple sulbactam sodium and cefoperazone sodium.

  20. Impact of varying metal ion- and carbohydrate concentrations on gene expression in the human pathogen Streptococcus pneumoniae

    NARCIS (Netherlands)

    Shafeeq, Sulman

    2012-01-01

    Streptococcus pneumoniae is een grampositieve menselijke ziekteverwekker die jaarlijks verantwoordelijk is voor de dood van miljoenen mensen, voornamelijk kinderen, en veroorzaakt pneumokokken infecties zoals longontsteking, hersenvliesontsteking, middenoor ontsteking en sepsis. De bacterie leeft on

  1. Investigation of distribution and drug resistance of pathogenic bacteria causing hospital-acquired pneumonia in senile patients%老年医院获得性肺炎的病原菌构成与耐药性调查

    Institute of Scientific and Technical Information of China (English)

    江玮; 蒋海平

    2013-01-01

    .RESULTS Totally 292 strains pathogenic bacteria isolated from sputum of the 277 elderly patients with pneumonia included the gram-negative bacilli (68.8%),gram-positive cocci (23.3%) and fungi (7.9%).The Klebsiella pneunmoniae (25.0%),Pseudomonas aeruginosa (20.2%),Staphyloccocus aureus (19.2 %),Escherichia coli (9.6 %) and Acinetobacter baumannii (9.2 %) ranked the top five species of pathogens,all the strains above were resistant to the commonly used antibiotics in different degree.The most sensitive drugs against the gram-negative bacteria included amikacin,imipenem,meropenem,cefoperazone/sulbactam,and piperazine/tazobactam,with the drug susceptibility rate varying between 100.0% and 74.1%;the most sensitive drugs against the gram-positive bacteria included vancomycin and teicoplanin,with the drug susceptibility rate of 100.0%;the detection rates of the imipenem-resistant P.aeruginosa and A.baumannii were 10.2% and 14.8%,respectively;the isolation rate of the extended spectrum β-lactamase (ESBLs)-producing Enterobacteriaceae was 45.5%;the isolation rate of the methicillin-resistant Staphylococci was 41.1%.CONCLUSION The drug resistance of the pathogens causing the hospital-acquired pneumonia in the senile patients increases year by year,it is necessary to take comprehensive treatment measures to postpone the increasing trend of bacterial resistance.

  2. How Is Pneumonia Treated?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is Pneumonia Treated? Treatment for pneumonia depends on the type ... can go back to their normal routines. Bacterial Pneumonia Bacterial pneumonia is treated with medicines called antibiotics. ...

  3. Predictive value of red cell distribution width in aged patients with community acquired pneumonia%红细胞分布宽度对老年社区获得性肺炎预后的探讨

    Institute of Scientific and Technical Information of China (English)

    陈小军; 张泓

    2015-01-01

    目的:探讨红细胞分布宽度( red cell distribution width, RDW)对老年社区获得性肺炎( community acquired pneumonia, CAP)预后的预测价值。方法回顾性分析安徽医科大学第一附属医院急诊内科及急诊重症监护室205例老年CAP患者。根据入院时RDW将患者分为4组,对比各组间相关指标( CURB-65计分、器官衰竭及ICU入住率、住院天数、30 d死亡率)的差异,并就RDW对老年CAP住院患者死亡预测价值进行统计学分析。结果 CURB-65计分、器官衰竭发生率、ICU入住率、30 d死亡率4组间进行两两比较,差异有统计学意义( P<0.05);RDW预测老年CAP死亡的受试者工作曲线( ROC)的曲线下面积( AUC)=0.75。结论 RDW可作为临床对老年CAP患者病情严重程度的评估指标之一,对预测老年CAP患者死亡预后有一定意义。%Objective To investigate the predictive value of red cell distribution width ( RDW) in the aged patients with community acquired pneumonia(CAP). Methods 205 elderly patients with CAP from the Emergency Medical Ward and Emergency Intensive Care Unit of the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed.According to RDW on admission, the patients with CAP were divided into four groups.CURB-65 scores, organ failure, intensive care unit occupancy, the duration of hospital stay and 30 -day mortality outcomes were detected and compared among the groups, and RDW was statistically analyzed to predict mortality in these patients. Results Among the four groups, CURB-65, incidence of organ failure, ICU occupancy rate and 30-day mortality were statistically different (P<0.05).ROC curve was drawn to evaluate the predictive role of RDW in elderly CAP death, the area under the curve ( AUC) =0.75.Conclusion RDW can be used as a clinical evaluation of the severity of disease in elderly patients with CAP of one of the indicators.It is of some

  4. Clinical characteristics of children with Mycoplasma pneumoniae infection hospitalized during the Danish 2010-2012 epidemic

    DEFF Research Database (Denmark)

    Sørensen, Cristel M; Schønning, Kristian; Rosenfeldt, Vibeke

    2013-01-01

    Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. Pneumonia may be the most severe manifestation of respiratory M. pneumoniae infection. The most typical symptoms in children are cough and wheezing, which are often accompanied by upper respiratory tract manifestations...

  5. Bacterial Pneumonia in Older Adults.

    Science.gov (United States)

    Marrie, Thomas J; File, Thomas M

    2016-08-01

    Community-acquired pneumonia is common in the elderly person; its presentation in this population is often confounded by multiple comorbid illnesses, including those that result in confusion. Although severity-of-illness scoring systems might aid decision-making, clinical judgment following a careful assessment is key in deciding on the site of care and appropriate therapy.

  6. Impact of a family-focused intervention on self-concept after acquired brain injury.

    Science.gov (United States)

    Kelly, Amber; Ponsford, Jennie; Couchman, Grace

    2013-01-01

    The present study examined the impact of a family inclusive intervention on the multidimensional self-concept of individuals with traumatic brain injury (TBI). Forty one individuals with TBI and a matched control group completed the Tennessee Self-Concept Scale: Second Edition (TSCS: 2), the Rosenberg Self-Esteem Scale (RSE), the Family Assessment Device (FAD), and the Hospital Anxiety and Depression Scale (HADS) on two occasions: at immediate contact (pre-group, T1) and post-group (3 months after initial contact, T2). Controls did not attend the intervention. Total scores for the measures, as well as scores on subdomains of self-concept, taken pre- and post-intervention for the TBI sample and at the same time for matched controls were compared between groups using Multivariate Analysis of Variance (MANOVA); followed by a series of repeated measures analyses of variance (ANOVA) to determine whether significant changes occurred. Contrary to the main aim, the use of a family-focused intervention did not result in self-concept improvement, either globally or across self-concept domains. Nor did mood or family functioning improve for the TBI sample. Measures remained stable across time for the controls. PMID:23656483

  7. Impact of community-acquired paediatric rotavirus gastroenteritis on family life: data from the REVEAL study

    Directory of Open Access Journals (Sweden)

    Talayero José MP

    2010-03-01

    Full Text Available Abstract Background Rotavirus is the leading cause of acute gastroenteritis (AGE and the most frequent cause of severe diarrhoea in children aged less than 5 years. Although the epidemiology of rotavirus gastroenteritis (RVGE is well documented, there are few data on the impact of RVGE on the families of affected children. Methods Data associated with the burden of RVGE, including number of working days lost, levels of parental stress, the need for alternative childcare arrangements and additional nappies used, were extracted from questionnaires completed by parents of children participating in a prospective, multicentre, observational study (Rotavirus gastroenteritis Epidemiology and Viral types in Europe Accounting for Losses in public health and society, REVEAL, conducted during 2004-2005 in selected areas of Belgium, France, Germany, Italy, Spain, Sweden, and the United Kingdom to estimate the incidence of RVGE in children aged less than 5 years seeking medical care as a result of AGE. Results 1102 children with RVGE were included in the present analysis. The proportion of RVGE cases that required at least one parent or other person to be absent from work was 39%-91% in the hospital setting, 44%-64% in the emergency department, and 20%-64% in primary care. Self-reported levels of parental stress were generally high (mean stress levels, ≥ 5 on a 10-point visual analogue scale. Additional childcare arrangements were required in up to 21% of RVGE episodes. The mean number of nappies used per day during RVGE episodes was approximately double that used when the child was not ill. Conclusions Paediatric RVGE cases cause disruption to families and parental stress. The burden of RVGE on children and their families could be substantially reduced by routine rotavirus vaccination of infants.

  8. Comparative Studv of Moxifloxacin and Piperacillin Sulbactam Sodium in Treatment of Community Acquired Pneumonia%莫西沙星与哌拉西林舒巴坦钠治疗社区获得性肺炎的比较研究

    Institute of Scientific and Technical Information of China (English)

    李芝兰; 郭胜利; 范永红

    2012-01-01

    目的 比较莫西沙星与哌拉西林舒巴坦钠治疗社区获得性肺炎的临床疗效. 方法 2010年3月-2011年3月,98例社区获得性肺炎患者随机分为两组,A组49例采用莫西沙星治疗,B组49例采用哌拉西林舒巴坦钠治疗,比较观察两组的临床疗效以及主要症状、体征恢复情况. 结果 A组的总有效率和细菌清除率明显高于B组(P<0.05).A组咳嗽消失、体温恢复正常、血常规恢复正常和胸部影像明显吸收时间明显短于B组(P<0.05). 结论 与哌拉西林舒巴坦钠比较,莫西沙星对社区获得性肺炎进行治疗,疗效显著,并且患者症状、体征恢复较快,是治疗获得性肺炎的良好选择.%Objective To compare the clinical efficacy of moxifloxacin and piperacillin sulbactam sodium in the treatment of community acquired pneumonia. Methods Ninety- eight patients with community acquired pneumonia hospitalized in the 264 Hospital of Chinese PLA from March 2010 to March 2011 were randomly divided group A and group B (each n=49). Group A was treated with moxifloxacin, while group B was received piperacillin sulbactam sodium. The effective rate, the main clinical symptoms and physical signs were compared between the two groups. Results The total effective rate and bacterial clearance rate in group A were significantly higher than those in group B (P<0.05). The time of cough disappearance, the duration of returning to normal body temperature, returning to normal blood, and obvious absorption of pneumonic foci in group A were significantly shorter than those in group B (P<0.05). Conclusions Compared with piperacillin sulbactam sodium, moxifloxacin has the advantages of good therapeutic effects and rapid recovery of the patients in the treatment of community acquired pneumonia. It is a good choice for community acquired pneumonia.

  9. Drug resistance analysis of Streptococcus pneumoniae isolated from paediatric patients hospitalized for community-acquired pneumonia in Xiangtan central hospital%湘潭市中心医院社区获得性肺炎住院患儿肺炎链球菌的耐药性研究

    Institute of Scientific and Technical Information of China (English)

    龚晓辉; 唐曼娟; 谭菊香

    2012-01-01

    Objective To investigate the drug resistance of Streptococus pneumoniae (SP) isolated from paediatric patients hospitalized for community-acquired pneumonia in Xiangtan central hospital. Methods A total of 115 SP strains isolated from children in hospital from 2010 to 2011 were analyzed. Bacterial susceptibility test was carried out by using Kirby-Bauer and E-test metods. Results The resistance rates of SP against penicillin, erythromycin, clindamycin, levofloxacin, ceftriaxone, vancomycin, linezolid and sulfamethoxazole-trimethoprim were 6.1%, 95.6%, 94.8%, 1.7%, 6.9%, 0%, 0% and 73.9% respectively. Conclusion The susceptible rate of SP to erythromycin and clindamycin is extremely low, but it is very high to penicillin and ceftriaxone.%目的 了解湘潭市中心医院因社区获得性肺炎住院的患儿肺炎链球菌(SP)的耐药情况.方法 对本院2010-2011年住院患儿分离的115株SP进行分析,采用K-B纸片琼脂扩散法及浓度梯度法(E测试)检测SP对青霉素、头孢曲松、红霉素、克林霉素、左氧氟沙星、万古霉素、利奈唑胺、复方磺胺甲噁唑的耐药性.结果 115株SP中青霉素敏感肺炎链球菌(PSSP)占86.1%,青霉素中介肺炎链球菌(PISP)占7.8%,青霉素耐药肺炎链球菌(PRSP)占6.1%.SP对红霉素、克林霉素及复方磺胺甲噁唑的耐药率分别为95.6%、94.8%和73.9%,左氧氟沙星的耐药率为1.7%,头孢曲松的耐药率为6.9%,未发现对万古霉素及利奈唑胺耐药的SP菌株.结论 本院分离的SP对儿科常用抗生素青霉素及头孢曲松钠仍高度敏感,但对大环内酯类抗生素红霉素、林可酰胺类抗生素克林霉素耐药情况严重.

  10. Pneumonia complicada por pneumatocele gigante em criança com síndrome da imunodeficência adquirida: importância da fisioterapia respiratória Pneumonia complicated by a giant pneumatocele in a child with acquired immunodeficiency syndrome: importance of chest physiotherapy

    Directory of Open Access Journals (Sweden)

    Silvia Regina M. de Paula

    2010-06-01

    Full Text Available OBJETIVO: Descrever os efeitos do tratamento fisioterapêutico na prevenção de complicações respiratórias de uma criança com síndrome da imunodeficiência adquirida, que apresentava pneumatocele gigante. DESCRIÇÃO DO CASO: Criança com oito anos de idade, do sexo feminino, encaminhada para acompanhamento fisioterapêutico em hospital universitário devido a quadro de hipersecreção pulmonar, histórico de pneumonias e presença de pneumatocele gigante. A conduta fisioterapêutica incluiu técnicas de higiene brônquica ativa, envolvendo fluxo aéreo expiratório, com o intuito de promover a desobstrução pulmonar sem causar risco de complicações à criança. O seguimento foi multiprofissional e direcionado à prevenção de infecções recorrentes e de ruptura da bolha, que tornariam necessária a internação hospitalar. Durante o acompanhamento, o quadro pulmonar manteve-se estável, sem aumento ou ruptura da pneumatocele, radiograficamente visível. COMENTÁRIOS: A atuação da fisioterapia respiratória nos casos de pneumatocele gigante não está definida na literatura. Não há, até o momento, evidências de seus efeitos benéficos, bem como diretrizes a respeito dos métodos mais eficientes e seguros. Ao contrário, muito se discute sobre os riscos e complicações decorrentes dessa intervenção. No presente caso, a assistência fisioterapêutica regular foi importante para garantir a estabilidade do quadro pulmonar da criança, sendo necessários estudos com desenho metodológico apropriado para verificação de eficácia clínica.OBJECTIVE: To describe the effects of chest physiotherapy in preventing respiratory complications in a child with acquired immunodeficiency syndrome and a giant pneumatocele. CASE DESCRIPTION: An eight-year-old female child was sent to the physiotherapy service of a university hospital due to pulmonary hypersecretion, repeated pneumonias and presence of a giant pneumatocele. The physiotherapy

  11. 颅脑手术患者医院获得性肺炎危险因素及病原菌分析%Risk factors for hospital-acquired pneumonia in patients undergoing craniocerebral surgery and analysis of pathogens

    Institute of Scientific and Technical Information of China (English)

    章洪院; 孙耕耘

    2013-01-01

    OBJECTIVE To investigate the risk factors for hospital -acquired pneumonia in the patients undergoing cranioceiebral surgery and analyze the distribution and drug resistance of the pathogens so as to provide basis for the clinical prevention. METHODS A total of 583 patients undergoing craniocerebral surgery were retrospectively analyzed. The non-conditional logistic regression analysis was performed to find out the risk factors for HAP, the sputum culture for the HAP patients and the data of drug susceptibility testing were investigated, RESULTS Totally 57 patients(9. 8%) developed HAP. Univariate analysis indicated that the following factors including the underlying diseases, craniocerebral injury, emergency operation, combined anesthesia, tracheotomy, endotracheal intubation,nasogastric tube,mechanical ventilation,more than 1 day of commencing enteral feeding,proton pump inhibitor,antiepileptic drug, glucocorticoid, blood transfusion, hypoproteinaemia, acute physiological and chronic health evaluation Ⅱ (APACHEII) score≥ 20, and grading of Glasgow Coma Score(GCS) were related to the incidence of HAP, the differences were statistically significant (P<0. 05). Multivariate analysis revealed that the tracheotomy, gastric tube indwelling, and grade of GCS were the independent risk factors for HAP. There were 140 (81.4%) strains of gram-negative bacteria which were the main pathogens causing HAP,among which there were 62 (36. 0%) strains of Acinetobacter baumannii,26 (15. 1%) strains of Klebsiella pneumoniae, and 22 (12. 8%) strains of Pseudomonas aeruginosa. There were 23 (13. 4%) strains of gram-positive bacteria, the majority of which was Staphylococcus aureus (17 strains , 9. 9%), and there were 6 strains of MRSA with the detection rate of 35. 3%. CONCLUSION The tracheotomy,gastric tube indwelling, and severity of consciousness disorder are the risk factors for HAP in the patients undergoing craniocerebral surgery. The gram-negative bacteria are the main

  12. Impact of 13-Valent Pneumococcal Conjugate Vaccination on Streptococcus pneumoniae Carriage in Young Children in Massachusetts

    Science.gov (United States)

    Lee, Grace M.; Kleinman, Ken; Pelton, Stephen I.; Hanage, William; Huang, Susan S.; Lakoma, Matthew; Dutta-Linn, Maya; Croucher, Nicholas J.; Stevenson, Abbie; Finkelstein, Jonathan A.

    2014-01-01

    Background In April 2010, a 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 for use in the United States. We evaluated rates of pneumococcal colonization, by serotype and antibiotic resistance, in Massachusetts communities where serial cross-sectional surveillance has been conducted for the past decade. Methods Nasopharyngeal swabs were obtained from children 0 to <7 years of age and seen by primary care providers for well child or acute illness visits in 2001, 2004, 2007, 2009, and 2011. Pneumococcal isolates were serotyped by Quellung reaction and classified as PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, 23F), additional PCV13 serotypes (1, 3, 5, 6A, 7F, 19A), or non-PCV13 serotypes. Changes in colonization and impact of PCV13 were assessed using generalized linear mixed models, adjusting for known risk factors and accounting for clustering by community. Results Introduction of PCV13 did not affect the rate of overall pneumococcal colonization (31% in 2011). Colonization with non-PCV13 serotypes increased between 2001 and 2011 for all children (odds ratio [OR] per year, 1.12; 95% confidence interval [CI], 1.10, 1.15; P < .0001). 19A remained the second most common serotype in 2011, although a decline from 2009 was observed. Penicillin (7%), erythromycin (28%), ceftriaxone (10%), and clindamycin (10%) nonsusceptibility were commonly identified, concentrated among a small number of serotypes (including 19A, 35B, 15B/C, and 15A). Among healthy children 6–23 months old, colonization with PCV13 serotypes was lower among recipients of PCV13 vaccine (adjusted OR, 0.30; 95% CI, 0.11, 0.78). This effect was not observed in 6- to 23-month-old children with a concomitant respiratory tract infection (adjusted OR 1.36; 95% CI, 0.66, 2.77) or children 2 to <7 years old (adjusted OR, 1.17; 95% CI, 0.58, 2.34). Conclusions 13-Valent pneumococcal conjugate vaccine reduced the prevalence of colonization with PCV13 serotypes among children 6–23 months old, but its

  13. Pathogen distribution and risk factors of hospital-acquired pneumonia in the aged patients%老年患者医院获得性肺炎的影响因素及病原学分布特点

    Institute of Scientific and Technical Information of China (English)

    曹征; 朱健; 尹小燕

    2013-01-01

    Objective To investigate the clinical characteristics and pathogens distribution in patients with Hospital-acquired pneumonia.Methods A retrospective observational study involving 50 patients with HAP who were hospitalized in emergency ward was conducted from January 2010 to December 2011.50 patients with CAP were in-cluded as control.The clinical characteristics,laboratory data and prognosis were collected and analyzed.Results Compared with CAP group,the patients in HAP group were characterized by higher average age,longer hospitaliza-tion,much more complications,higher ratio of smokers,higher level of white blood cell counts,lower level of serum al-bumin and oxygenation Index,and higher level of mortality.Re-admissions in HAP group were higher than that in CAP group (40% ).Gram-negative bacilli were the major organism in HAP group(54.3%),of which 62.9% was multi-drug-resistant bacilli.While Gram-positive bacilli were the major organism in CAP group (63.6%),with no multi-drug-resistant bacilli..There were significant difference between the two groups (P <0.05).Conclusions The age, chronic disease and unhealthy lifestyle were the risk factors for patients with HAP.Gram-negative bacilli were the dominant pathogen of HAP with high porporation of MDR.%目的:探讨老年患者医院获得性肺炎的临床症状表现、实验室指标、病原学分布及预后等各方面特点,为采取有效的预防及治疗措施提供必要的依据。方法急诊病房(含 ICU)内50例新发老年医院获得性肺炎(HAP)病例为研究对象,同时选取同时期入院的50例老年社区获得性肺炎(CAP)病例作为对照,对临床特征、实验室指标及预后情况等特点进行统计学分析。结果HAP 患者较 CAP 患者平均年龄更大,住院周期长,合并基础疾病多,吸烟者比例高,实验室指标中血白细胞计数高,血清白蛋白低,氧合指数低,预后中病死率高;HAP 患者构成中反复多次入

  14. Hiponatremia como factor de riesgo de muerte en pacientes internados por neumonía adquirida en la comunidad Hyponatremia as a risk factor of death in patients with community-acquired pneumonia requiring hospitalization

    Directory of Open Access Journals (Sweden)

    Ricardo E. Barcia

    2006-12-01

    Full Text Available Investigamos si la hiponatremia es un factor de riesgo de muerte en pacientes internados por neumonía adquirida en la comunidad (NAC y estimamos el peso relativo de otros factores de riesgo de muerte por NAC, en un estudio de cohorte, prospectivo, multicéntrico, en 5 Servicios de Clínica Médica del Area Metropolitana de Buenos Aires. Evaluamos adultos con NAC ingresados entre 21 de marzo de 2000 y 21 de diciembre del mismo año. Los factores de riesgo que mostraron asociación con evolución por análisis univariado, fueron sometidos a análisis de regresión logística, con un nivel de significación de a de 0.05. En 9 meses se internaron 238 pacientes con NAC: 150 (63% varones y 88 (36% mujeres, con edades medias 52.99 (±20.35 y 55.06 (±20.94 años, respectivamente. Fallecieron 25/238 (10.5%. En análisis multivariado, se asociaron significativamente con evolución: enfermedad vascular encefálica (EVE (B: 2.614, pWe investigated whether hyponatremia is a risk factor of death in patients hospitalized with community-acquired pneumonia (CAP and estimated the relative risk of death by CAP of other risk factors. The design was prospective multicentre cohort study. In 5 centers in Buenos Aires, Argentina, we studied adults hospitalized with CAP between March 21, 2000 and December 21, 2000. Using stepwise logistic regression, we analyzed risk factors that showed a univariate association with mortality; a significance level was 0.05. During a 9-month period, 238 patients were admitted with CAP: 150 (63% male and 88 (36% female, mean age 52.99 (±20.35 and 55.06 (±20.94, respectively. Mortality was 10.5% (25/238. By multivariate analysis, the following variables were statistically associated with evolution: cerebrovascular disease (CD (B: 2.614, p<0.001, RRE: 13.6, IC 95%: 3.7-49.6; hyponatremia at admission or during hospitalization (B: 1.994, p<0.001, RRE: 7.3, IC 95%: 2.5-20.8; and elevated blood urea (B: 0.016, p= 0.003, RRE: 1.016, IC 95

  15. Viral Infections of Refractory Community-acquired pneumonia children hospitalized in Chengdu%难治性社区获得性肺炎的住院儿童病毒感染状况研究

    Institute of Scientific and Technical Information of China (English)

    杨涛毅; 郭丽春; 陈桂华; 张彤

    2015-01-01

    Objective To understand the common viral infections of Community acquired pneumonia children hospitalized in Chengdu and provide theoretical basis for the prevention. Methods Collecting 391 specimens of RCAP and CAP children from the hospitals in Chengdu during November,2012 to October,2014. Common respiratory viruses including influenza virus,parainflu-enza virus,respiratory syncytial virus,coronavirus,human metapneumovirus,human boca virus,human adenovirus,human rhinovi-rus and enterovirus were detected in 391 sputum specimens simultaneous-Resultsly by multiplex RT- PCR. EBVCA-IgG , EB-VEA-Ig M and CMV-IgM were detected by ELISA. Results Totally 97 positive samples were identified from 391 specimens,the positive rate was 24. 81% (92/391) ,The positive rate was 20. 73% (40/193) in RCAP children, in which,the mostly detected human metapneumovirus,human adenovirus and EB-Viral. The highest detection rate of virus in winter was 43. 58% and the de-tection rate was not statistically significant between children of different gender. 193 cases of children with RCAP get viral positive identification with other pathogens at the same time were for 34cases (78. 72%). Conclusion Virall infection is one of the CAP and RCAP children hospitalization main pathogens. Viral infection of RCAP had a lower detection rate. Human metapneumovirus, adenovirus, and EB-Viral rhinovirus were the main pathogens leading to the RCAP in Chengdu,mixed infections were common.%目的 通过住院患儿社区获得性肺炎( CAP)和难治性社区获得性肺炎( RCAP)病毒感染临床特点的比较,了解成都地区病毒性RCAP的住院儿童的感染状况和特点,为RCAP的预防和治疗提供理论依据. 方法 对391 例RCAP和CAP住院患儿痰液进行流感病毒、副流感病毒、呼吸道合胞病毒、冠状病毒、人偏肺病毒、人博卡病毒、人腺病毒、人鼻病毒和肠道病毒核酸检测及EB病毒和巨细胞病毒IgM抗体检测,痰液和血清细菌学

  16. Risk factors of hospital-acquired pneumonia caused by carbapenem-resistant acinetobacter baumannii%耐碳青霉烯类鲍氏不动杆菌医院获得性肺炎危险因素分析

    Institute of Scientific and Technical Information of China (English)

    王玲; 杨连松; 王清华; 王剑利

    2011-01-01

    目的 探讨耐碳青霉烯类鲍氏不动杆菌(CRAB)医院获得性肺炎的危险因素.方法 采用病例对照研究,收集2005年1月-2010年12月鲍氏不动杆菌(ABA)引起的医院获得性肺炎92例,分为CRAB 医院获得性肺炎组30例和碳青霉烯类敏感鲍氏不动杆菌(CSAB)医院获得性肺炎组62例;采用单因素分析及多因素logistic回归分析.结果 单因素分析发现,APACHEⅡ评分≥16分、气管插管或气管切开、机械通气、分离出ABA前<2周曾应用过亚胺培南或美罗培南、≥2种抗菌药物联合应用与CRAB感染有关;多因素logistic回归分析发现,APACHEⅡ≥16分(OR=4.144,95%Cl 1.346~12.761,P=0.013)及分离出CRAB前<2周曾应用过亚胺培南或美罗培南(OR=3.236,95%Cl 1.128~9.282,P=0.029)是独立危险因素;CRAB组死亡11例,CSAB组死亡19例,2组死亡率差异无统计学意义.结论APACHEⅡ≥16分及分离出CRAB前<2周曾应用过亚胺培南或美罗培南,是CRAB医院获得性肺炎的独立危险因素.%OBJECTIVE To study the risk factors of hospital acquired pneumonia (HAP) caused by carbapenemresistant Acinetobacter baumannii (CRAB).METHODS A retrospective case control study was conducted for the patients who had HAP caused by A.baumannii (ABA) between Jan 2005 and Dec 2010.There were 30 cases of HAP caused by CRAb and 62 cases of HAP caused by CSAB (carbapenem-senstive A.baumannii).Univariate analysis (T test and chi-square test) and multivariate logistic regression were used for statistics analysis.RESULTS Univariate analysis revealed that five factors were associated with the infection caused by CRAB, which were APACHE Ⅱ score ≥ 16, imipenem/meropenem used less than 2 weeks before isolation of CRAB, and combination therapy of antibiotics, invasive mechanical ventilation, endotracheal intubation/tracheotomy.Multivariate logistic regression analysis identified two independent factors, which were APACHEⅡ score ≥16 (OR=4.144) and imipenem

  17. The value of serum procalcitonin in treatment of community acquired pneumonia in outpatient%血清降钙素原监测在门诊治疗社区获得性肺炎中的作用

    Institute of Scientific and Technical Information of China (English)

    龙威; 邓星奇; 唐建国; 谢娟; 张奕翠; 张羽; 高育瑶; 陆刚

    2009-01-01

    目的 探讨血清降钙素原(PCT)监测在门诊接受治疗的社区获得性肺炎(CAP)患者的抗生素使用中的临床意义.方法 选2006年11月-2008年2月符合CAP诊断标准的门诊接受治疗的CAP患者127例,随机分为PCT监测组(63例)和常规治疗组(64例),人选患者监测血清PCT水平.在相旧常规治疗的基础上,常规治疗组由经治医师按照我国CAP治疗指南决定抗生素治疗方案;PCT监测组按照血清PCT水平决定是否使用抗生素,在血清PCT≥0.25μg/L时进行抗生素治疗,PCT0.05),PCT监测组的抗生素使用率、抗生素疗程及抗生素费用均低于常规治疗组(P值均小于0.05),2组患者的预后无明显差异.结论 门诊接受治疗的CAP患者可以依据PCT水平指导抗生素应用,能够减少抗生素用量,缩短抗生素疗程,降低抗生素费用.%Objective To evaluate the value of serum procalcitonin (PCT)on antibiotic use in treatment of community acquired pneumonia (CAP) in outpatient. Methods From November 2006 to February 2008, a total of 127 patients with CAP in outpatient were randomly assigned into two groups:PCT group(n=63)and control group(n =64). PCT levels of all patients were measured after study admission. On the base of similarly normal treatment, the control group received antibiotics according to the attending physicians and the PCT group were treated with antibiotics according to serum PCT levels: antibiotic treatment was applied with PCT level ≥ 0. 25 μg/L and was discouraged with PCT level 0.05) ;rate and costs of antibiotics use was lower, antibiotic duration of the PCT group was shorter than that ofthecontroigroup(P<0.05,P<0.001,P<0.001).Conclusion PCT could be used in treatment of CAP for antibiotic use in outpatient, which may reduce antibiotic use, shorten antibiotic duration and lower costs of antibiotic.

  18. Prevent Pneumonia

    Centers for Disease Control (CDC) Podcasts

    2015-08-06

    CDC’s Matthew Westercamp explains what pneumonia is, its symptoms, and how to prevent it.  Created: 8/6/2015 by National Center for Immunization and Respiratory Diseases (NCIRD), Division of Bacterial Diseases (DBD), Respiratory Diseases Branch (RDB).   Date Released: 8/6/2015.

  19. Climate change and large-scale land acquisitions in Africa: Quantifying the future impact on acquired water resources

    Science.gov (United States)

    Chiarelli, Davide Danilo; Davis, Kyle Frankel; Rulli, Maria Cristina; D'Odorico, Paolo

    2016-08-01

    Pressure on agricultural land has markedly increased since the start of the century, driven by demographic growth, changes in diet, increasing biofuel demand, and globalization. To better ensure access to adequate land and water resources, many investors and countries began leasing large areas of agricultural land in the global South, a phenomenon often termed "large-scale land acquisition" (LSLA). To date, this global land rush has resulted in the appropriation of 41million hectares and about 490 km3 of freshwater resources, affecting rural livelihoods and local environments. It remains unclear to what extent land and water acquisitions contribute to the emergence of water-stress conditions in acquired areas, and how these demands for water may be impacted by climate change. Here we analyze 18 African countries - 20 Mha (or 80%) of LSLA for the continent - and estimate that under present climate 210 km3 year-1of water would be appropriated if all acquired areas were actively under production. We also find that consumptive use of irrigation water is disproportionately contributed by water-intensive biofuel crops. Using the IPCCA1B scenario, we find only small changes in green (-1.6%) and blue (+2.0%) water demand in targeted areas. With a 3 °C temperature increase, crop yields are expected to decrease up to 20% with a consequent increase in the water footprint. When the effect of increasing atmospheric CO2concentrations is accounted for, crop yields increase by as much as 40% with a decrease in water footprint up to 29%. The relative importance of CO2 fertilization and warming will therefore determine water appropriations and changes in water footprint under climate change scenarios.

  20. Epidemiology and outcome of pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA in Canadian hospitals.

    Directory of Open Access Journals (Sweden)

    Manal Tadros

    Full Text Available BACKGROUND: MRSA remains a leading cause of hospital-acquired (HAP and healthcare-associated pneumonia (HCAP. We describe the epidemiology and outcome of MRSA pneumonia in Canadian hospitals, and identify factors contributing to mortality. METHODS: Prospective surveillance for MRSA pneumonia in adults was done for one year (2011 in 11 Canadian hospitals. Standard criteria for MRSA HAP, HCAP, ventilator-associated pneumonia (VAP, and community-acquired pneumonia (CAP were used to identify cases. MRSA isolates underwent antimicrobial susceptibility testing, and were characterized by pulsed-field gel electrophoresis (PFGE and Panton-Valentine leukocidin (PVL gene detection. The primary outcome was all-cause mortality at 30 days. A multivariable analysis was done to examine the association between various host and microbial factors and mortality. RESULTS: A total of 161 patients with MRSA pneumonia were identified: 90 (56% with HAP, 26 (16% HCAP, and 45 (28% CAP; 23 (14% patients had VAP. The mean (± SD incidence of MRSA HAP was 0.32 (± 0.26 per 10,000 patient-days, and of MRSA VAP was 0.30 (± 0.5 per 1,000 ventilator-days. The 30-day all-cause mortality was 28.0%. In multivariable analysis, variables associated with mortality were the presence of multiorgan failure (OR 8.1; 95% CI 2.5-26.0, and infection with an isolate with reduced susceptibility to vancomycin (OR 2.5, 95% CI 1.0-6.3. CONCLUSIONS: MRSA pneumonia is associated with significant mortality. Severity of disease at presentation, and infection caused by an isolate with elevated MIC to vancomcyin are associated with increased mortality. Additional studies are required to better understand the impact of host and microbial variables on outcome.

  1. Adult bacteremic pneumococcal pneumonia acquired in the community: A prospective study on 101 patients Neumonía neumocóccica bacteriémica de la comunidad: Un estudio prospectivo en 101 pacientes

    Directory of Open Access Journals (Sweden)

    J. H. Gentile

    2003-01-01

    Full Text Available Our objective was to describe incidence, clinical, radiographic and microbiological features of bacteremic pneumococcal pneumonia (BPP in our environment. A total of 101 patients (7 were treated as outpatients, older than 18 years of age suffering BPP were prospectively evaluated. The incidence was 2.8 cases per 1000 admissions, 50 were males, mean age was 59.9 years (19-97, mortality was 11.8%. Eighty three percent of fatalities occurred within 3 days of admission. Mortality rate increased with advancing age. Fever, cough and chest pain were the commonest presenting symptoms and 44% of patients had extrapulmonary manifestations. Cigarette smoking, chronic obstructive lung disease, alcoholism and congestive heart failure (CHF were the commonest underlying conditions. CHF was more frequent in non-survivors (p = 0.002. A lobar pattern at chest radiograph predominated in survivors and a diffuse pattern in non-survivors (p = 0.007. Pleural effusion (20.7%, empyema (7.9% and respiratory failure (7.9% were the main complications. Underlying diseases were present in 100% of non-survivors (p = 0.03. Ninety four percent of patients were treated with beta-lactam antibiotics. Streptococcus pneumoniae was isolated from sputum in 6 cases. Three out of 101 S. pneumoniae isolates recovered from blood samples (one from each patient presented organisms resistant to penicillin. We observed an incidence of BPP that is similar to the observed in other countries. There are clinical and radiographic differences between survivors and non-survivors. Penicillin-resistant S. pneumoniae is still an unusual problem in our area.Se evaluaron en forma prospectiva 101 pacientes > 18 años admitidos al hospital con diagnóstico de NNB. El objetivo fue conocer la incidencia y describir las características de la enfermedad, así como la susceptibilidad antibiótica de cepas invasivas de Streptococcus pneumoniae. Se halló una incidencia de 2.8 casos/1000 admisiones; 50 fueron

  2. Chlamydia pneumoniae Inhibits Activated Human T Lymphocyte Proliferation by the Induction of Apoptotic and Pyroptotic Pathways

    OpenAIRE

    Olivares-Zavaleta, Norma; Carmody, Aaron; Messer, Ronald; Whitmire, William M.; Caldwell, Harlan D.

    2011-01-01

    Chlamydia pneumoniae is an omnipresent obligate intracellular bacterial pathogen that infects numerous host species. C. pneumoniae infections of humans are a common cause of community acquired pneumonia but have also been linked to chronic diseases such as atherosclerosis, Alzheimer’s disease, and asthma. Persistent infection and immune avoidance are believed to play important roles in the pathophysiology of C. pneumoniae disease. We found that C. pneumoniae organisms inhibited activated but ...

  3. Adult bacteremic pneumococcal pneumonia acquired in the community: A prospective study on 101 patients Neumonía neumocóccica bacteriémica de la comunidad: Un estudio prospectivo en 101 pacientes

    OpenAIRE

    J. H. Gentile; M. D. Sparo; M. E. Mercapide; C. M. Luna

    2003-01-01

    Our objective was to describe incidence, clinical, radiographic and microbiological features of bacteremic pneumococcal pneumonia (BPP) in our environment. A total of 101 patients (7 were treated as outpatients), older than 18 years of age suffering BPP were prospectively evaluated. The incidence was 2.8 cases per 1000 admissions, 50 were males, mean age was 59.9 years (19-97), mortality was 11.8%. Eighty three percent of fatalities occurred within 3 days of admission. Mortality rate increase...

  4. H1N1 influenza pneumonia and bacterial coinfection.

    Science.gov (United States)

    Calbo, Esther; Robles, Alejandro; Sangil, Anna; Benet, Susana; Viladot, Maria Eugenia; Pascual, Vanesa; Barreiro, Bienvenido

    2011-12-01

    The model described by Bewick et al seems to be able to distinguish between H1N1 influenza-related pneumonia and non-H1N1 community acquired pneumonia (CAP) based on five criteria. However, bacterial infection in the influenza group has not been accurately excluded. Therefore, this model could misidentify these patients and lead to an inappropriate treatment. We conducted a prospective observational study to compare mixed pneumonia vs viral pneumonia. In the mixed pneumonia group patients were older, had higher levels of procalcitonine and higher scores of severity. In our cohort the model proposed by Bewick et al would not identify patients with coinfection. PMID:21994246

  5. Repertoire of intensive care unit pneumonia microbiota.

    Directory of Open Access Journals (Sweden)

    Sabri Bousbia

    Full Text Available Despite the considerable number of studies reported to date, the causative agents of pneumonia are not completely identified. We comprehensively applied modern and traditional laboratory diagnostic techniques to identify microbiota in patients who were admitted to or developed pneumonia in intensive care units (ICUs. During a three-year period, we tested the bronchoalveolar lavage (BAL of patients with ventilator-associated pneumonia, community-acquired pneumonia, non-ventilator ICU pneumonia and aspiration pneumonia, and compared the results with those from patients without pneumonia (controls. Samples were tested by amplification of 16S rDNA, 18S rDNA genes followed by cloning and sequencing and by PCR to target specific pathogens. We also included culture, amoeba co-culture, detection of antibodies to selected agents and urinary antigen tests. Based on molecular testing, we identified a wide repertoire of 160 bacterial species of which 73 have not been previously reported in pneumonia. Moreover, we found 37 putative new bacterial phylotypes with a 16S rDNA gene divergence ≥ 98% from known phylotypes. We also identified 24 fungal species of which 6 have not been previously reported in pneumonia and 7 viruses. Patients can present up to 16 different microorganisms in a single BAL (mean ± SD; 3.77 ± 2.93. Some pathogens considered to be typical for ICU pneumonia such as Pseudomonas aeruginosa and Streptococcus species can be detected as commonly in controls as in pneumonia patients which strikingly highlights the existence of a core pulmonary microbiota. Differences in the microbiota of different forms of pneumonia were documented.

  6. Difference of clinical features in childhood Mycoplasma pneumoniae pneumonia

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    Kang Jin-Han

    2010-07-01

    Full Text Available Abstract Background M. pneumoniae pneumonia (MP has been reported in 10-40% of community-acquired pneumonia cases. We aimed to evaluate the difference of clinical features in children with MP, according to their age and chest radiographic patterns. Methods The diagnosis of MP was made by examinations at both admission and discharge and by two serologic tests: the indirect microparticle agglutinin assay (≥1:40 and the cold agglutinins titer (≥1:32. A total of 191 children with MP were grouped by age: ≤2 years of age (29 patients, 3-5 years of age (81 patients, and ≥6 years of age (81 patients. They were also grouped by pneumonia pattern: bronchopneumonia group (96 patients and segmental/lobar pneumonia group (95 patients. Results Eighty-six patients (45% were seroconverters, and the others showed increased antibody titers during hospitalization. Among the three age groups, the oldest children showed the longest duration of fever, highest C-reactive protein (CRP values, and the most severe pneumonia pattern. The patients with segmental/lobar pneumonia were older and had longer fever duration and lower white blood cell (WBC and lymphocyte counts, compared with those with bronchopneumonia. The patient group with the most severe pulmonary lesions had the most prolonged fever, highest CRP, highest rate of seroconverters, and lowest lymphocyte counts. Thrombocytosis was observed in 8% of patients at admission, but in 33% of patients at discharge. Conclusions In MP, older children had more prolonged fever and more severe pulmonary lesions. The severity of pulmonary lesions was associated with the absence of diagnostic IgM antibodies at presentation and lymphocyte count. Short-term paired IgM serologic test may be mandatory for early and definitive diagnosis of MP.

  7. 慢性阻塞性肺疾病伴社区获得性肺炎60例病原菌及其耐药性分析%The clinical analysis of 60 patients with chronic obstructive pulmonary disease and community-acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    欧阳雪飞

    2014-01-01

    目的 对COPD伴社区获得性肺炎病原菌和耐药情况进行分析,为临床合理用药提供依据.方法 对60例COPD伴社区获得性肺炎患者的痰液标本进行病原菌检测和药敏性试验.结果 病原菌以肺炎链球菌为主24例(40%),其次为肺炎克雷伯菌10例(13.3%)、流感嗜血杆菌8例(16.7%)、肺炎支原体6例(8.3%)、甲型溶血性链球菌5例(6.7%)、金黄色葡萄球菌4例(3.3%)、嗜肺军团菌2例(3.3%)、其它1例(1.67%);药敏试验显示革兰阴性菌具有较高的耐药率.流感嗜血杆菌、肺炎链球菌、嗜肺军团菌体对青霉素具有较高的耐药率.肺炎支原体、肺炎克雷伯菌对阿奇霉素表现出一定的耐药率.金黄色葡萄球菌、甲型溶血性链球菌对头孢噻吩表现出耐药性.结论 COPD伴社区获得性肺炎患者感染病菌情况主要以革兰阴性菌抗生素耐药较为严重.在之后的临床使用抗生素选择其它类的抗生素,提高临床药物抗菌疗效.%Objective To analyze the pathogens and drug resistance of patients with chronic obstructive pulmonary disease and community-acquired pneumonia,in order to provide the evidence for rational drug use in the future.Methods The sputum specimens of 60 patients with chronic obstructive pulmonary disease and communityacquired pneumonia were detected for pathogens and drug sensitivity.Results 24 patients were infected with pathogens Streptococcus pneumoniae(40%).8 cases were infected with Haemophilus influenza(16.7%).10 patients were infected with Klebsiella pneumonia (13.3%).6 patients were infected with Mycoplasma lung (8.3%).5 patients were infected with alpha-hemolytic streptococcus (6.7%).4 patients were infected with Staphylococcus aureus (3.3%).Two patients were infected with Legionella pneumophila (3.3%).Unknown pathogen was one case (1.67%).Drug sensitive test showed that gram-negative bacteria had high resistance rate.Haemophilus influenzae

  8. Impact of seropositivity to Chlamydia pneumoniae and anti-hHSP60 on cardiovascular events in hemodialysis patients

    OpenAIRE

    Esposito, Pasquale; Tinelli, Carmine; Libetta, Carmelo; Gabanti, Elisa; Rampino, Teresa; Dal Canton, Antonio

    2010-01-01

    Autoimmunity to heat shock protein 60 (HSP60) has been related to atherosclerosis. Chlamydia pneumoniae (CP), the most studied infectious agent implicated in promoting atherosclerosis, produces a form of HSP60, which can induce an autoimmune response, due to high antigenic homology with human HSP60 (hHSP60). In this study, we evaluated the correlations among anti-hHSP60 antibodies, CP infection, and cardiovascular disease (CVD) in a high-risk population, such as patients undergoing hemodialys...

  9. FastStats: Pneumonia

    Science.gov (United States)

    ... this? Submit What's this? Submit Button NCHS Home Pneumonia Recommend on Facebook Tweet Share Compartir Data are ... Mortality data Centers for Disease Control and Prevention: Pneumonia American Lung Association : Pneumonia Get Email Updates To ...

  10. What Is Pneumonia?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. What Is Pneumonia? Pneumonia (nu-MO-ne-ah) is an infection in ... such as bacteria, viruses, and fungi—can cause pneumonia. The infection inflames your lungs' air sacs, which ...

  11. Mycoplasma pneumoniae Infections

    Science.gov (United States)

    ... Issues Listen Español Text Size Email Print Share Mycoplasma pneumoniae Infections Page Content Article Body Some lung ... walking pneumonia), are caused by an organism called Mycoplasma pneumoniae. It is spread from person to person ...

  12. Nosocomial and Community-Acquired Staphylococcus Aureus Bacterimias from 1980 to 1993: Impact of Intravascular Devices and Methicillin Resistance

    NARCIS (Netherlands)

    J.P. Steinberg; C.C. Clarke; B.O. Hackman

    1996-01-01

    textabstractThe rate of nosocomial bacteremia due to Staphylococcus aureus has increased over the past decade, but trends in community-acquired S. aureus bacteremia are less certain. This hospital-based observational study compares nosocomial and community-acquired S. aureus bacteremias during 1980-

  13. 血清维生素D与儿童社区获得性肺炎的相关性研究%Correlation research of serum vitamin D and community-acquired pneumonia in children

    Institute of Scientific and Technical Information of China (English)

    杨华琴

    2015-01-01

    Objective To analyze correlation between serum vitamin D and community-acquired pneumonia (CAP) in children and discusses its clinical value in evaluating the degree of CAP. Methods A total of 194 cases of children with CAP were selected and randomly divided into severe CAP group with 20 cases, common CAP group with 174 cases; con-trol group included 194 cases of normal children. The serum 25-(OH) D3 level, serumc-reactive protein (CRP),blood sedimentation (ESR), blood routine, arterial blood gas were detected, and acute physiology and chronic health evaluation score Ⅱ (APACHEⅡ) score were recorded. The diagnostic value of serum 25-(OH) D3 level for CAP was evaluated by ROC curve. Results The serum 25-(OH)D3 level, PaO2, CRP, WBC count, ESR, PMN%, APACHEⅡ among three groups were statistically different(F=4.53,199.47, 476.92, 175.90, 801.71, 35.57, 219.86,P<0.05). Pearson correlation analysis showed that serum 25-(OH)D3 level was negatively correlated with CRP, WBC count, ESR, PMN%, APACHEⅡscore(r=-0.46,-0.27,-0.22,-0.12,-0.21,P<0.05) while positively correlated with PaO2(r=0.38,P<0.05). The multi-variable logistic regression analysis showed that serum 25-(OH)D3 level was high risk factor of severe CAP. The ROC curve analysis showed that serum 25-(OH)D3 had good diagnostic value for severe CAP (area under the curve was 0.86, 95% CI was 0.76~0.94, P<0.05). Conclusion Serum vitamin D is closely related to severity of CAP in children and a high risk factor for severe CAP. Early detection of serum vitamin D has clinical significances in evaluating degree of CAP to some extent.%目的:分析血清维生素D与儿童社区获得性肺炎(CAP)的相关性,探讨其在判断儿童CAP病情严重程度上的意义。方法选取194例儿童CAP,按照疾病程度分:重症CAP患儿20例(Ⅰ组)和普通CAP患儿174例(Ⅱ组),另外按照1∶1匹配选取门诊体检的正常儿童194例为对照组(Ⅲ组)。测定三组儿童的血清25-

  14. Analysis of Prognostic Risk Factors in Patients with Community Acquired Pneumonia Complicated with Acute Kidney Injury%社区获得性肺炎伴发急性肾损伤的预后危险因素分析

    Institute of Scientific and Technical Information of China (English)

    李家瑞; 张红燕; 尚跃丰; 曹书华

    2014-01-01

    目的:探讨社区获得性肺炎(CAP)患者伴发急性肾损伤(AKI)的预后危险因素。方法456例CAP患者为无伴发AKI(N-AKI)组和伴发AKI组。AKI组又根据RIFLE的严重程度级别分为3个亚组:危险(Risk)、损伤(Injury)和衰竭(Failure)组。比较各组患者CAP的严重程度,各项临床指标和预后评估指标的差别;多因素分析采用Logistic回归模型,生存分析采用Kaplan-Meier法,分析影响CAP患者预后不良的危险因素及RIFLE标准在预后评估中作用。结果456例CAP患者中有30%(135例)伴发AKI,诊断为Risk 61例(45.2%),Injury 23例(17%), Failure 51例(37.8%)。CAP患者PSI评分为Ⅰ~Ⅲ级的患者(300例)中有23.3%(70例)伴发AKI,PSI分级≥IV的患者(156例)中有41.7%(65例)伴发AKI,差异有统计学意义(P75岁、合并肾外器官衰竭是住院CAP患者预后不良的危险因素。结论住院CAP患者伴发AKI的预后不良。RIFLE诊断及分级标准可有效评估CAP伴发AKI患者的预后。%Objective To explore clinical characteristics and prognostic risk factors in patients with community ac-quired pneumonia(CAP)complicated with acute kidney injury(AKI).Methods In total, 456 CAP patients were included based on the diagnostic guide.According to whether the patients were accompanied with AKI,the patients were divided in-to two groups(non-AKI group and AKI group). AKI group were further divided into risk group, injury group and failure group by RIFLE criteria using admission creatinine.Severity in CAP patients,clinical indexes and prognostic evaluation in-dexes were compared between different groups. Multiple factors were analyzed using Logistic regression model,survival analysis were examined by Kaplan-Meier, which analyzed the risk factors of poor prognosis in CAP patients and the role of RIFLE criteria in prognostic evaluation. Results Thirty percent(135)of the total 456 CAP patients were

  15. Clinical analysis on risk factors of community acquired pneumonia of elderly people%老年人社区获得性肺炎危险因素的临床分析

    Institute of Scientific and Technical Information of China (English)

    王崧; 刁蔚欣

    2015-01-01

    Objective To study risk factors that are apt to influence acquired pneumonia during actual incidence.Methods choose 340 cases CAP patients in our hospital duirng March 2012 and March,2015, aging more than 65. Patients were studied as observation group by logistic regression analysis with CPA risk factors, and compare them with 320 cases of non-CPA disease in the same period.Results regression analysis showed that there is obvious difference between observation and control group with smoking(χ2=62.98), cerebrovascular disease (χ2=33.64), respiratory diseases (χ2=68.87),malignant tumors (χ2=22.75), diabetes mellitus (χ2=29.96), heart failure (χ2=5.98), inhalated agents(χ2=36.48) and other respiratory diseases (χ2=24.86) and other factors(P<0.05). Logistic regression analysis for multiple factors of CPA showed there is obvious difference between observation and control group with smoking(OR=3.188), cerebrovascular disease(OR=35.85), respiratory diseases(OR=13.64),malignant tumors(OR=18.01), diabetes mellitus(0R=33.86)and other factors(P<0.05).Conclusion smoking, cerebrovascular disease, respiratory system disease, malignant tumors, diabetes mellitus, heart failure, inhalation agents and other factors are apt to cause CPA disease of the elderly, and thus they are the main risk factors.%目的:研究社区获得性肺炎在实际发病的过程中,容易受到何种危险因素的影响。方法在2012年3月至2015年3月时间段,从我院选择共有340例CAP患者,患者年龄均大于65岁。把患者作为观察组进行研究,通过logistic回归分析方法对CPA危险因素进行有关分析,并与同期未得CPA病症患者320例进行对比。结果通过回归分析得知,观察组与对照组在吸烟(χ2=62.98)、脑血管病(χ2=33.64)、呼吸系统疾病(χ2=68.87)、恶性肿瘤(χ2=22.75)、糖尿病(χ2=29.96)、心衰(χ2=5.98)、吸入制剂(χ2=36.48)、其他呼吸疾病(χ2=24.86)等因素

  16. 尿毒症患者医院获得性肺炎临床特点与易患因素分析%Clinical characteristics of hospital-acquired pneumonia in uremia patients and analysis of risk factors

    Institute of Scientific and Technical Information of China (English)

    刘广建; 陈晓阳; 陈锦海

    2015-01-01

    目的:观察尿毒症患者医院获得性肺炎(HAP)的临床特点,分析其易患因素,为临床防治提供参考。方法回顾性分析2008年1月-2012年12月430例尿毒症住院患者的临床资料,观察 HAP发生率、年龄、病原学特点,通过多因素logistic分析其 HAP易患因素。结果430例尿毒症患者中发生 HAP32例,发生率7.4%;共培养病原菌25株,其中革兰阴性菌19株占76.0%,13株为多药耐药(MDR)菌,革兰阳性菌为6株占24.0%,2株为MDR;肺炎双球菌和金黄色葡萄球菌对青霉素、氨苄西林、红霉素完全耐药,未发现万古霉素的耐药株,主要革兰阴性菌对美罗培南较敏感,耐药率<25.0%;多因素logistic回归分析结果显示,住院时间>5 d、接受维持性血液透析、血清白蛋白<30 g/L、年龄>60岁是发生 HAP的独立危险因素。结论缩短患者住院时间,加强营养支持治疗,规范血液透析管理,提高病原菌检出率,根据致病菌培养特点早期、合理使用抗菌药物等有助于尿毒症患者 H AP的防治。%OBJECTIVE To observe the clinical characteristics of hospital-acquired pneumonia (HAP)in uremia pa-tients and analyze the risk factors so as to provide guidance for the clinical prevention and treatment.METHODS The clinical data of 430 uremia patients who were hospitalized from Jan 2008 to Dec 2012 were retrospectively ana-lyzed,the incidence of HAP,age,and etiological characteristics were observed,and the multivariate logistic anal-ysis was performed for the risk factors for HAP.RESULTS The HAP occurred in 32 of 430 uremia patients with the incidence rate of 7.4%.A total of 25 strains of pathogens have been cultured,including 19 (76.0%)strains of gram-negative bacteria and 6 (24.0%)strains of gram-positive bacteria;there were 13 strains of multidrug-resist-ant gram-negative bacteria and 2 strains of multidrug-resistant gram-positive bacteria. The

  17. The impact of acquired brain damage in terms of epidemiology, economics and loss in quality of life

    Directory of Open Access Journals (Sweden)

    Larrañaga Isabel

    2011-04-01

    Full Text Available Abstract Background Patients with acquired brain damage (ABD have suffered a brain lesion that interrupts vital development in the physical, psychological and social spheres. Stroke and traumatic brain injury (TBI are the two main causes. The objectives of this study were to estimate the incidence and prevalence of ABD in the population of the Basque Country and Navarre in 2008, to calculate the associated cost of the care required and finally to assess the loss in health-related quality of life. Methods On the one hand, a cross-sectional survey was carried out, in order to estimate the incidence of ABD and its consequences in terms of costs and loss in quality of life from the evolution of a sample of patients diagnosed with stroke and TBI. On the other hand, a discrete event simulation model was built that enabled the prevalence of ABD to be estimated. Finally, a calculation was made of the formal and informal costs of ABD in the population of the Basque Country and Navarre (2,750,000 people. Results The cross-sectional study showed that the incidences of ABD caused by stroke and TBI were 61.8 and 12.5 cases per 100,000 per year respectively, while the overall prevalence was 657 cases per 100,000 people. The SF-36 physical and mental component scores were 28.9 and 44.5 respectively. The total economic burden was calculated to be 382.14 million euro per year, distributed between 215.27 and 166.87 of formal and informal burden respectively. The average cost per individual was 21,040 € per year. Conclusions The main conclusion of this study is that ABD has a high impact in both epidemiological and economic terms as well as loss in quality of life. The overall prevalence obtained is equivalent to 0.7% of the total population. The substantial economic burden is distributed nearly evenly between formal and informal costs. Specifically, it was found that the physical dimensions of quality of life are the most severely affected. The prevalence

  18. 莫西沙星对老年肾功能不全社区获得性肺炎的治疗效果及安全性评价%Efficiency and safety of moxifloxacin in treatment of elderly community acquired pneumonia with renal dysfunction

    Institute of Scientific and Technical Information of China (English)

    杭晨晨; 王烁

    2014-01-01

    Objective To evaluate the effectiveness and safety of moxifloxacinin treatment of community acquired pneumonia in elderly patients with renal dysfunction , so as to provide safe and effective antibiotics for the treatment of community acquired pneumonia for patients . elderly renal dysfunction .Methods A total of 128 elderly patients with community acquired pneumonia , who enrolled the emergency department of the hospital from Jan 2011 to Dec 2013 , were divided into two groups according to the renal function .The normal group ( n =63 ) and the renal dysfunction group without hemodialysis ( n =65 ) were both treated with moxifloxacin .The clinical efficacies and the adverse reactions were observed .Results There was no statistically difference in the clinical effective rates (81.0% vs.87.7%, P=0.294), the pathogensclearance rate (80.56% vs.88.37%, P=0.335) and the incidence of the adverse reactions (7.93% vs.9.23%, P=0.794) between the two groups.There was no significant difference of moxifloxacin plasma concentration between the two groups at each time point.The plasma concentration was stable in the whole protocol .Conclusion Moxifloxacincan achieve good clinic effect in the treatment of community acquired pneumonia with renal dysfunction in elderly patients with less adverse reaction .%目的:评估莫西沙星在老年肾功能不全社区获得性肺炎( community acquired pneumonia, CAP)中的治疗效果及安全性,为临床治疗老年肾功能不全CAP选择安全、高效的抗菌药物。方法选取2011-01~2013-12在急诊科住院的128例老年CAP患者,根据肾功能状况分为肾功能正常组(n=63)和肾功能不全但未透析组(n=65),均给予莫西沙星治疗,观察临床疗效及不良反应。结果肾功能正常组与肾功能不全组比较,治疗有效率(81.0%vs.87.7%,P=0.294),细菌清除率(80.56%vs.88.37%,P=0.335),不良反应发生率(7.93%vs.9

  19. Observation on effect of sequential treatment about levofloxacin and azithromycin in treating case with community acquired pneumonia%左氧氟沙星及阿奇霉素序贯疗法治疗社区获得性肺炎的疗效观察

    Institute of Scientific and Technical Information of China (English)

    肖艳红

    2011-01-01

    目的 探讨左氧氟沙星及阿奇霉素序贯疗法治疗社区获得性肺炎(CAP)的临床效果.方法 将2009年1月-2010年1月间在我院住院治疗的CAP患者56例随机分为左氧氟沙星组和阿奇霉素组,各28例;阿奇霉素组给予阿奇霉素序贯疗法,左氧氟沙星组给-予左氧氟沙星治疗.结果 左氧氟沙星组总有效率为85.71%,阿奇霉素组为82.14%,两组比较差异无显著性(P>0.05).左氧氟沙星组细菌清除率为80.00%,阿奇霉素组为76.92%,两组比较差异无显著性(P>0.05).两组患者均未见明显的药物不良反应.结论 左氧氟沙星及阿奇霉素序贯疗法治疗社区获得性肺炎疗效相当.%Objective To explore the sequential treatment effect of using levofloxacin and azithromycin to treat the patients with community acquired pneumonia. Methods The 56 cases with community acquired pneumonia in our hospital from January 2009 to January 2010 were divided into the levofloxacin group and the azithromycin group averagely; the levofloxacin group was given levofloxacin sequential treatment, and the azithromycin group was given azithromycin sequential treatment. Results The total effective rate was 85.71% in levofloxacin group and 82.14% in azithromycin group; there was no significant difference between them ( P>0.05 ). The clearance rate was 80.00% in levofloxacin group and 76.92% in azithromycin group; there was no significant difference between them ( P> 0.05 ). Conclusion The levofloxacin sequential treatment and the azithromycin sequential treatment have similar effect on the treatment of community acquired pneumonia.

  20. Neumonía adquirida en la comunidad en adultos, en el curso de la campaña de invierno 2003 en el Hospital San Juan de Dios COMMUNITY ACQUIRED PNEUMONIA IN ADULTS DURING WINTER 2003 CAMPAIGN AT A SANTIAGO GENERAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Karen Dintrans A

    2005-01-01

    Full Text Available La neumonía adquirida en la comunidad (NAC continúa siendo una condición de alta prevalencia y potencialmente letal. El Streptococcus pneumoniae, es el agente etiológico más frecuente de las NAC. El objetivo del presente estudio, es describir las características clínicas y demográficas, así como también la evolución, de los pacientes adultos ingresados por NAC al servicio de medicina del Hospital San Juan de Dios. Nosotros estudiamos en forma retrospectiva a 200 pacientes adultos ingresados con diagnóstico de NAC. Se confirmó el diagnóstico en 170 de ellos. El promedio de edad fue de 68 años. La vacunación antiinfluenza en mayores de 65 años fue de 51%. De la comorbilidad no respiratoria, la hipertensión arterial y la diabetes mellitus, fueron las más prevalentes (59% y 31% respectivamente, Neumonía en adultos. Campaña invierno 2003 - K. Dintrans A. et al. seguidas por la insuficiencia cardíaca (22%. La comorbilidad respiratoria más frecuente fue la enfermedad pulmonar obstructiva crónica (EPOC: 19%. El esquema antibiótico de elección fue una cefalosporina de tercera generación asociada a un macrólido. La terapia secuencial se realizó en 140 pacientes (82%, empleándose una fluoroquinolona antineumocócica en 90% de los casos. La mediana de los días de hospitalización fue de 6 días. Un 40% de los pacientes requirió traslado a una unidad de mayor complejidad. La letalidad asociada a los pacientes con diagnóstico confirmado de NAC, llegó al 11%. En solo un paciente se aisló un Streptococcus pneumoniae resistente a la penicilina en los hemocultivos. Conclusión: La NAC es una entidad prevalente especialmente en pacientes adultos mayores, con características clínicas y demográficas específicas, cuya mortalidad y curso clínico se pueden conocer y modificarCommunity acquired pneumonia (CAP continues being a condition of high prevalence, and potentially lethal. Streptococcus pneumoniae is the most frequent

  1. Fulfilment assessment of the good clinical practices guidelines for community acquired pneumonia. Evaluación del cumplimiento de la guía de práctica clínica para el tratamiento de la neumonía adquirida en la comunidad.

    Directory of Open Access Journals (Sweden)

    Miguel A. Mosquera Fernández

    2009-07-01

    Full Text Available Background: Community acquired pneumonia is the most common cause of infections found during the medical practice. Objective: To assess the fulfilment of the good clinical practices guidelines for the treatment of community acquired pneumonia. Methods: Prospective, descriptive study of series of cases developed in the Hospital “Dr. Gustavo Aldereguía Lima” between January, 1st and June 30th, 2006. 500 patients were studied which main diagnosis was pneumonia or bronchial pneumonia. The assessment tool includes four questions. A single-varied analysis was performed, with a confidence interval of 95%. The final result of this measurement was the fulfilment of the guidelines as excellent, fine, acceptable and not well, as well as the outcome in living and dead patients. Results: Patients older than 65 years of age are the most affected by  this disease and fatality is also higher in this age group; 40, 6% of admitted patients are classified as type III. Not performing thoracic radiography and inappropriate treatment led to a higher lethality risk. 53, 2 % of the clinical histories reflects a bad fulfillment of the guide, likewise the biggest lethality  was found  in that group (36,8 percent. Conclusions: The patients with pneumonias non serious are those that more are admitted in the center, with a non negligible lethality, although the highest  was found in the classes IV and V of pnemonia, that were considered the most serious pneumonias. The global adherence to the guide can be related with the final outcome of the patient.
    Fundamento: La neumonía adquirida en la comunidad es la causa más común de infecciones encontradas en la práctica médica. Objetivo: Evaluar el cumplimiento de la guía de práctica clínica para el tratamiento de la neumonía adquirida en la comunidad. Métodos: Estudio descriptivo

  2. Predictors of mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment.

    Science.gov (United States)

    Zarkotou, O; Pournaras, S; Tselioti, P; Dragoumanos, V; Pitiriga, V; Ranellou, K; Prekates, A; Themeli-Digalaki, K; Tsakris, A

    2011-12-01

    Bloodstream infections (BSIs) caused by Klebsiella pneumoniae carbapenemases (KPC)-producing K. pneumoniae (KPC-KP) are associated with high mortality rates. We investigated outcomes, risk factors for mortality and impact of appropriate antimicrobial treatment in patients with BSIs caused by molecularly confirmed KPC-KP. All consecutive patients with KPC-KP BSIs between May 2008 and May 2010 were included in the study and followed-up until their discharge or death. Potential risk factors for infection mortality were examined by a case-control study. Case-patients were those who died from the BSI and control-patients those who survived. Appropriate antimicrobial therapy was defined as treatment with in vitro active antimicrobials for at least 48 h. A total of 53 patients were identified. Overall mortality was 52.8% and infection mortality was 34%. Appropriate antimicrobial therapy was administered to 35 patients; mortality due to infection occurred in 20%. All 20 patients that received combination schemes had favourable infection outcome; in contrast, seven of 15 patients given appropriate monotherapy died (p 0.001). In univariate analysis, risk factors for mortality were age (p catheter-related bacteraemia (p 0.04), prior surgery (p 0.014) and other therapeutic interventions (p 0.015) were significantly associated with survival. Independent predictors of mortality were age, APACHE II score at infection onset and inappropriate antimicrobial treatment. Among them, appropriate treatment is the only modifiable independent predictor of infection outcome.

  3. Association of Mycoplasma pneumoniae infection and childhood asthma

    Institute of Scientific and Technical Information of China (English)

    YADAV Shakti Nrisingh; GAUTAM Mahesh Kumar; JIANG Li

    2015-01-01

    Mycoplasma pneumoniae is a frequent cause of acute respiratory infections in both children and adults.It can cause pharyngitis, otitis, tracheobronchitis, or community-acquired pneumonia, but may also remain totally asymptomatic.Mycoplasma pneumoniae is an organism that reportedly has a strong relationship to asthma.The role of atypical bacterial infection in the pathogenesis of asthma is a subject of continuing debate. There is an increasing body of literature concerning the association between Mycoplasma pneumoniae ( M. pneumoniae) and asthma pathogenesis.Moreover, many studies investigating such a link have been uncontrolled and have provided conflicting evidence, in part due to the difficulty in accurately diagnosing infection with these atypical pathogens. Large, general population-based prospective studies are necessary to investigate the development of asthma induced by M. pneumoniae infection in humans. This manuscript will review the relationship between M.pneumoniae infection and childhood asthma.

  4. Pneumococcal pneumonia prevention among adults: is the herd effect of pneumococcal conjugate vaccination in children as good a way as the active immunization of the elderly?

    Science.gov (United States)

    Prato, Rosa; Fortunato, Francesca; Martinelli, Domenico

    2016-01-01

    The indirect protection of adults as a result of pneumococcal conjugate vaccination of infants has been discussed from different epidemiological points of view. In some countries, including Italy, even after pediatric vaccination, vaccine serotypes are still responsible for most pneumonia and invasive diseases in the elderly. Although the Community-Acquired Pneumonia Immunization Trial in Adults (CAPITA) produced encouraging results, it has not showed the efficacy of the 13-valent conjugate vaccine in preventing pneumococcal community-acquired pneumonia regardless of the number of episodes and serotype. Addressing these points by monitoring the direct impact of adult vaccination in real life distinguished from the effects of herd immunity will assist public health decision-making on the most effective adult pneumococcal vaccination strategies.

  5. Acquired Techniques

    DEFF Research Database (Denmark)

    Lunde Nielsen, Espen; Halse, Karianne

    2013-01-01

    Acquired Techniques - a Leap into the Archive, at Aarhus School of Architecture. In collaboration with Karianne Halse, James Martin and Mika K. Friis. Following the footsteps of past travelers this is a journey into tools and techniques of the architectural process. The workshop will focus upon...

  6. Acquired blepharoptosis

    NARCIS (Netherlands)

    Oosterhuis, HJGH

    1996-01-01

    A review is given of the aetiology and possible treatment of acquired (non-congenital) blepharoptosis, which is a common but not specific sign of neurological disease: The diagnostic categories of upper eyelid drooping are scheduled as (a) pseudo-ptosis due to a local process or overactivity of eye

  7. CT manifestations of adult mycoplasma pneumoniae pneumonia

    International Nuclear Information System (INIS)

    Objective: To study the conventional CT and HRCT manifestations of adult mycoplasma pneumoniae pneumonia. Methods: Conventional CT and HRCT were performed in 16 adult patients with mycoplasma pneumoniae pneumonia proven by serology. The CT images were retrospectively analyzed. Results: Areas of ground-glass opacity (GGO) were found in 12 cases. GGO showed lobular or patchy distribution in 9 cases. Air-space consolidation was observed in 8 cases, 'tree in bud' sign in 9, thickening of the interlobular septa in 3, and thickening of bronchovascular bundle in 1. 15 cases had two or more findings simultaneously. Conclusion: Mycoplasma pneumoniae pneumonia has some characteristic CT findings, which can help to distinguish it from bacterial pneumonia

  8. Fungal Pneumonia: A Silent Epidemic Coccidioidomycosis (Valley Fever)

    Science.gov (United States)

    Fungal pneumonia: a silent epidemic Coccidioidomycosis (valley fever) Coccidioidomycosis, a fungal disease called “cocci” or “valley fever,” is a major cause of community-acquired pneumonia in the southwestern US. A costly problem • In ...

  9. A 54-year-old man referred with nonresolving pneumonia.

    Science.gov (United States)

    Catteeuw, Julie; Koegelenberg, Coenraad F N; Bruwer, Johannes W; Sissolak, Gerhard; Schroeter, Leocardea; Mohamed, Nooroudien; Irusen, Elvis M

    2014-09-01

    A 54-year-old man was referred with nonresolving pneumonia. He had been treated for community-acquired pneumonia 6 weeks earlier. He reported grade 2 dyspnea, malaise, and a nonproductive cough. He had also experienced three episodes of minimal hemoptysis but denied weight loss, fever, or any other constitutional symptoms. He was a nonsmoker and was being treated for dyslipidemia. PMID:25180750

  10. Recurrent pseudomonal pneumonia in a young immunocompetent adult something fishy?

    Directory of Open Access Journals (Sweden)

    Saravu K

    2011-05-01

    Full Text Available Community-acquired pneumonia due to Pseudomonasaeruginosa typically occurs in patients with pre-existing lungdisease and immunocompromised individuals. We reportthe case of a previously healthy young adult who presentedwith recurrent episodes of pneumonia due to Pseudomonasaeruginosa complicated by pleural effusion. Careful andextensive evaluation ultimately revealed the unusual reasonbehind the patient’s illness.

  11. Significance of serum procalcitonin,C-reactive protein,and lipopolysaccharide in diagnosis of community-acquired pneumonia%血清降钙素原与 C-反应蛋白及内毒素对社区获得性肺炎诊断的研究

    Institute of Scientific and Technical Information of China (English)

    马小琴; 胡蓉蓉; 许金菊

    2015-01-01

    OBJECTIVE To explore the significance of serum procalcitonin (PCT ) ,C-reactive protein (CRP) ,and lipopolysaccharide in diagnosis of community-acquired pneumonia and prediction of illness condition so as to pro -vide guidance for early diagnosis ,treatment ,and prediction of prognosis .METHODS Totally 50 patients with com-munity-acquired pneumonia who were hospitalized from Jan 2012 to Oct 2013 were assigned as the study group , meanwhile ,49 healthy people who underwent physical examination in the outpatient department were set as the control group ;the early morning fasting blood samples were collected ,then the serum was extracted to detect the PCT by using Brahms rapid semi-quantitative method of Germany ,the CRP was determined with the use of auto-immune scattering rate turbidimetry ,and the LPS was detected by means of ELISA .RESULTS Of 50 cases of com-munity-acquired pneumonia ,there were 40 cases with the level of PCT no less than 0 .5μg/L ,45 cases with the level of CRP no less than 10mg/L ,46 cases with the level of LPS no less than 10pg /L ,and 24 cases with the white blood cells (WBC) counts more than 10 × 109 /L ,higher than those of the control group (P< 0 .05) .The sensitivity of the PCT was 82 .0% ,the CRP 90 .0% ,the LPS 93 .0% ,the WBC 46 .0% ;the specificity of the PCT was 87 .0% ,the CRP 63 .0% ,the LPS 32 .0% ,the WBC 93 .0% .The level of PCT was higher in the pa-tients with severe community-acquired pneumonia than in the patients with mild community-acquired pneumonia (P< 0 .05) .Both the sensitivity and specificity in the diagnosis and prediction of illness condition were high and balanced .CONCLUSION The detection of the levels of PCT ,CRT ,and LPS has certain value in diagnosis of com-munity-acquired pneumonia ,and the PCT plays a certain role in the prediction of illness condition .%目的:探讨血清降钙素原(PCT )与 C-反应蛋白(CRP)和内毒素(LPS)对社区获得性肺炎诊断、病情判断的意义,为早

  12. 70岁以上2型糖尿病鼻饲患者院内获得性肺炎与营养的关系探讨%Study on the Relationship of Hospital-acquired Pneumonia and Nutrition in Type 2 Diabetes Mellitus on Nasal Feeding over 70

    Institute of Scientific and Technical Information of China (English)

    余立平; 陈宁; 邱芳晖

    2012-01-01

    Objective To explore whether the nutrition status of type 2 diabetes mellitus on nasal feeding over 70 years old is related to hospital - acquired pneumonia and what the influence of nutrition status is. Methods The Malnutrition Diagnostic Criteria was adopted to evaluate the nutrition status of type 2 diabetes mellitus on nasal feeding over 70 years old including both pneumonia infectors and non - pneumonia infectors, their serum albumin, glycosylated hemoglobin and lymphocyte count were detected and their BMI, IBW, triceps skin - flod thickness and the upper arm muscles were measured and calculated. Last, the antibiotics varieties and antibiotics consumption in malnutrition group were summed up. Results The differences between central upper arm circumference, serum albumin arm, ideal percentage constitution, body mass index in both groups were statistically significant ( P < 0. 05 ). The differences in antibiotics varieties, antibiotics consumption, glycosylated hemoglobin between malnutrition group and normal nutrition group while the type 2 diabetes mellitus suffered pneumonia were significant ( P < 0.05 ). Conclusion Central upper arm circumference, serum albumin arm, ideal percentage constitution, body mass index, were the related factors for type 2 diabetes mellitus on nasal feeding over 70 years old complicated with some hospital - acquired pneumonia. Malnutrition patients under infection were found to have used more kinds of antibiotics for long time of antibiotics consumption and their glycated hemoglobin levels were a little high.%目的 了解70岁以上2型糖尿病鼻饲进食患者营养状态与发生院内获得性肺炎之间的关系,观察营养状态对院内获得性肺炎的影响.方法 运用营养不良诊断标准对发生感染的和未发生感染的70岁以上2型糖尿病鼻饲进食患者进行评定,检测血清清蛋白、糖化血红蛋白、淋巴细胞计数,测量并计算体质指数、理想体质百分数、三头肌皮褶

  13. Lipoid pneumonia: An uncommon entity

    Directory of Open Access Journals (Sweden)

    Khilnani G

    2009-10-01

    Full Text Available Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat-containing substances like petroleum jelly, mineral oils, certain laxatives, etc. It usually presents as an insidious onset, chronic respiratory illness simulating interstitial lung diseases. Rarely, it may present as an acute respiratory illness, especially when the exposure to fatty substance(s is massive. Radiological findings are diverse and can mimic many other diseases including carcinoma, acute or chronic pneumonia, ARDS, or a localized granuloma. Pathologically it is a chronic foreign body reaction characterized by lipid-laden macrophages. Diagnosis of this disease is often missed as it is usually not considered in the differential diagnoses of community-acquired pneumonia; it requires a high degree of suspicion. In suspected cases, diagnosis may be confirmed by demonstrating the presence of lipid-laden macrophages in sputum, bronchoalveolar lavage fluid, or fine needle aspiration cytology/biopsy from the lung lesion. Treatment of this illness is poorly defined and constitutes supportive therapy, repeated bronchoalveolar lavage, and corticosteroids.

  14. Lipoid pneumonia: an uncommon entity.

    Science.gov (United States)

    Khilnani, G C; Hadda, V

    2009-10-01

    Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat-containing substances like petroleum jelly, mineral oils, certain laxatives, etc. It usually presents as an insidious onset, chronic respiratory illness simulating interstitial lung diseases. Rarely, it may present as an acute respiratory illness, especially when the exposure to fatty substance(s) is massive. Radiological findings are diverse and can mimic many other diseases including carcinoma, acute or chronic pneumonia, ARDS, or a localized granuloma. Pathologically it is a chronic foreign body reaction characterized by lipid-laden macrophages. Diagnosis of this disease is often missed as it is usually not considered in the differential diagnoses of community-acquired pneumonia; it requires a high degree of suspicion. In suspected cases, diagnosis may be confirmed by demonstrating the presence of lipid-laden macrophages in sputum, bronchoalveolar lavage fluid, or fine needle aspiration cytology/biopsy from the lung lesion. Treatment of this illness is poorly defined and constitutes supportive therapy, repeated bronchoalveolar lavage, and corticosteroids. PMID:19901490

  15. Clinical analysis of 30 cases nosocomial acquired pneumonia of acinetobacter baumanii in neurology intensive care unit%神经内科重症监护病房医院获得性鲍曼不动杆菌肺炎30例临床分析

    Institute of Scientific and Technical Information of China (English)

    李燕华; 李吕力; 范秉林; 陈渊

    2014-01-01

    Objetcive To analyze the occurring characteristic and preventive measures of nosocomial ac -quired pneumonia of acinetobacter baumanii(Ab)in neurology intensive care unit(NICU).Metho ds The data of nosocomial infection for the medical records in NICU were analyzed by prospective monitoring studies.Results Noso-comial acquired pneumonia of Ab occurred in 9.04%patients admitted to the NICU.The most patients with nosoco-mial acquired pneumonia of Ab had chronic diseases and underwent many kinds of invading operation.The rate of nosocomial acquired pneumonia of Ab in stroke patients were higher.In the vitro drug susceptibility test,only the sen-sitive rates of carbapenems and cefoperazone sulbactam were higher, and Ab were multi-resistant to cephalosporins, aminoglycosides and fluoroquinolone antibiotics.Conclusion The drug resistance of Ab is severe and multi-resistant to antibiotics, so it is necessary to obey aseptic operation rule strictly, use the antibiotics rationally and strengthen monitoring of drug resistance of Ab.%目的:分析神经内科重症监护病房( NICU)医院获得性鲍曼不动杆菌肺炎发生的特点及防治措施。方法采取前瞻性研究的方法,对NICU发生医院感染患者的临床资料进行分析。结果 NICU医院获得性鲍曼不动杆菌肺炎感染发生率为9.04%。鲍曼不动杆菌肺炎患者多合并有各种慢性疾病和各种侵袭性诊疗;脑卒中患者合并鲍曼不动杆菌肺炎比率较高。鲍曼不动杆菌除了对碳青霉烯类、头孢哌酮舒巴坦抗菌药物有较高的敏感性外,对头孢菌素类、氨基甙类和氟喹诺酮类等抗菌素均耐药严重。结论 NICU鲍曼不动杆菌对抗菌药物的耐药率较高且呈多重耐药态势,医务人员应当严格遵守无菌技术操作规程,合理选择抗生素,并加强对鲍曼不动杆菌耐药的监测。

  16. Pneumonia complicada por pneumatocele gigante em criança com síndrome da imunodeficência adquirida: importância da fisioterapia respiratória Pneumonia complicated by a giant pneumatocele in a child with acquired immunodeficiency syndrome: importance of chest physiotherapy

    OpenAIRE

    Silvia Regina M. de Paula; Melissa Pinto Gurgel; Luciana Macchiaverni; Fabíola Meister Pereira; Maria Ângela G. de O. Ribeiro; Camila Isabel S. Santos

    2010-01-01

    OBJETIVO: Descrever os efeitos do tratamento fisioterapêutico na prevenção de complicações respiratórias de uma criança com síndrome da imunodeficiência adquirida, que apresentava pneumatocele gigante. DESCRIÇÃO DO CASO: Criança com oito anos de idade, do sexo feminino, encaminhada para acompanhamento fisioterapêutico em hospital universitário devido a quadro de hipersecreção pulmonar, histórico de pneumonias e presença de pneumatocele gigante. A conduta fisioterapêutica incluiu técnicas de h...

  17. Antibiotic Resistance Related to Biofilm Formation in Klebsiella pneumoniae.

    Science.gov (United States)

    Vuotto, Claudia; Longo, Francesca; Balice, Maria Pia; Donelli, Gianfranco; Varaldo, Pietro E

    2014-01-01

    The Gram-negative opportunistic pathogen, Klebsiella pneumoniae, is responsible for causing a spectrum of community-acquired and nosocomial infections and typically infects patients with indwelling medical devices, especially urinary catheters, on which this microorganism is able to grow as a biofilm. The increasingly frequent acquisition of antibiotic resistance by K. pneumoniae strains has given rise to a global spread of this multidrug-resistant pathogen, mostly at the hospital level. This scenario is exacerbated when it is noted that intrinsic resistance to antimicrobial agents dramatically increases when K. pneumoniae strains grow as a biofilm. This review will summarize the findings about the antibiotic resistance related to biofilm formation in K. pneumoniae.

  18. Predictors of mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment.

    Science.gov (United States)

    Zarkotou, O; Pournaras, S; Tselioti, P; Dragoumanos, V; Pitiriga, V; Ranellou, K; Prekates, A; Themeli-Digalaki, K; Tsakris, A

    2011-12-01

    Bloodstream infections (BSIs) caused by Klebsiella pneumoniae carbapenemases (KPC)-producing K. pneumoniae (KPC-KP) are associated with high mortality rates. We investigated outcomes, risk factors for mortality and impact of appropriate antimicrobial treatment in patients with BSIs caused by molecularly confirmed KPC-KP. All consecutive patients with KPC-KP BSIs between May 2008 and May 2010 were included in the study and followed-up until their discharge or death. Potential risk factors for infection mortality were examined by a case-control study. Case-patients were those who died from the BSI and control-patients those who survived. Appropriate antimicrobial therapy was defined as treatment with in vitro active antimicrobials for at least 48 h. A total of 53 patients were identified. Overall mortality was 52.8% and infection mortality was 34%. Appropriate antimicrobial therapy was administered to 35 patients; mortality due to infection occurred in 20%. All 20 patients that received combination schemes had favourable infection outcome; in contrast, seven of 15 patients given appropriate monotherapy died (p 0.001). In univariate analysis, risk factors for mortality were age (p infection onset (p appropriate antimicrobial treatment (p 0.003), combinations of active antimicrobials (p 0.001), catheter-related bacteraemia (p 0.04), prior surgery (p 0.014) and other therapeutic interventions (p 0.015) were significantly associated with survival. Independent predictors of mortality were age, APACHE II score at infection onset and inappropriate antimicrobial treatment. Among them, appropriate treatment is the only modifiable independent predictor of infection outcome. PMID:21595793

  19. Analysis on the pathogens, susceptibility and misapplication of antibiotics of community acquired pneumonia in the elderly community%老年社区获得性肺炎病原学、药敏及抗生素滥用状况分析

    Institute of Scientific and Technical Information of China (English)

    杨盛权; 周志文; 周立仁; 王玉成

    2014-01-01

    性进行动态监测。%Objective To analyze the distribution and drug resistance of the pathogens of community ac-quired pneumonia, and to discuss the effect of misapplication of antibiotics on the distribution of community acquired pneumonia in the elderly community. Methods A total of 218 elderly patients in the Second People's Hospital of Huangmei from June 2008 to May 2013 were selected and underwent aetiology test and susceptibility test. One hun-dred and forty-two patients who had the history of misapplication of antibiotic were selected as the antibiotics misap-plication group, and 76 patients who used antibiotic regularly were enrolled as the regular treatment group. The differ-ence of positive rate of bacterial culture and the positive rate of atypical pathogens were compared. Results 147 of the 218 cases were positive in aetiology test, including 115 bacteria (52.%) and 32 atypical pathogens (14.7%). Six cas-es were found with mixed infection of bacteria and atypical pathogens by Mycoplasma pneumonia mixed with bacteria. The top four bacteria found were Hemophilies influenzae (34 cases, 15.6%), Streptococcus pneumonia (31 cases, 14.2%), Klebsiella pneumonia (29 cases, 13.3%) and Escherichia coli (9 cases, 4.1%). Hemophilies were 64.7%resistant to Cotrimoxaxole, 44.1%resistant to Piperacilin, 38.2%resistant to Ampicil and Sulactam. Streptococcus pneumoniae were 67.7% resistant to Ampicil and Sulbactam, Klebsiella pneumoniae were 61.3% resistant to Ampicil and Sul-bactam, and Escherichia coli were 33.3%resistant to piperacillin. Pathogenic bacteria had higher resistant rates to Ampicil and Sulbactam, Aztreonam, Acm, Bactrim, Pieracillin and Ceftazidime than other antibacterial agents. 65.1%of the 218 patients had history of abused use of antibiotics. The positive rate of bacterial and atypical patho-gens showed significant differences between antibiotics misapplication group and regular treatment group, P<0.05. Conclusion The community acquired pneumonia for the elderly are caused mainly by

  20. A prospective evaluation of community acquired gastroenteritis in paediatric practices: impact and disease burden of rotavirus infection

    OpenAIRE

    Fruhwirth, M; Karmaus, W; Moll-Schuler, I; Brosl, S; Mutz, I

    2001-01-01

    AIMS—To examine the disease burden and epidemiology of community acquired rotavirus gastroenteritis in Austrian children treated in a paediatric practice.
METHODS—A prospective, population based, multicentre study in four paediatric practices and two children's hospitals (Innsbruck and Leoben). Children ⩽ 48 months of age presenting with gastroenteritis during a six month period of rotavirus peak between December 1997and May 1998 were included. Prospective testing of stoo...

  1. Unusual complication of Mycoplasma pneumonia in a five-year-old child

    Directory of Open Access Journals (Sweden)

    Pratap Kumar Patra

    2013-02-01

    Full Text Available Mycoplasma pneumoniae is common agent causing community acquired pneumonia in children. However, the course of illness is usually benign and is rarely associated with pulmonary complications. We report a five-year-old child with massive pleural effusion and empyema secondary to Mycoplasma pneumonia infection. This potential yet rare source of infection should be considered in young patients where resolution of symptoms from pneumonia is delayed.

  2. Unusual complication of Mycoplasma pneumonia in a five-year-old child

    OpenAIRE

    Pratap Kumar Patra; Arun Babu Thirunavukkarasu

    2013-01-01

    Mycoplasma pneumoniae is common agent causing community acquired pneumonia in children. However, the course of illness is usually benign and is rarely associated with pulmonary complications. We report a five-year-old child with massive pleural effusion and empyema secondary to Mycoplasma pneumonia infection. This potential yet rare source of infection should be considered in young patients where resolution of symptoms from pneumonia is delayed.

  3. Persistent Pneumonia in an Infant.

    Science.gov (United States)

    Padilla, Kristen; Logan, Latania; Codispoti, Christopher; Jones, Carolyn; Van Opstal, Elizabeth

    2015-07-01

    A 4-month-old boy with past medical history of eczema presented with fever and cough; a chest radiograph showed lung consolidation, and he was initially treated with amoxicillin for presumed community-acquired pneumonia. After several days, his fever persisted. He was also profoundly anemic. Antibiotic coverage was broadened because of the concern for resistant organisms; he began to improve and was discharged from the hospital. However, at 5 months of age, his fever returned, and he continued to demonstrate lung consolidation on chest radiograph. Additionally, he had lost weight and continued to be anemic. Splenic cysts were noted on abdominal ultrasound. He was diagnosed with an unusual etiology for his pneumonia and improved with the appropriate therapy. An underlying immunodeficiency was suspected, but initial testing was nondiagnostic. At 12 months of age, he presented with another infection, and the final diagnosis was made. PMID:26122810

  4. Impacto do sistema de aspiração traqueal aberto e fechado na incidência de pneumonia associada à ventilação mecânica: revisão de literatura Impact of the open and closed tracheal suctioning system on the incidence of mechanical ventilation associated pneumonia: literature review

    Directory of Open Access Journals (Sweden)

    Fernanda Maia Lopes

    2009-03-01

    Full Text Available A pneumonia é a infecção nosocomial mais comum em unidades de terapia intensiva, sendo a ventilação mecânica um fator fortemente associado ao seu desenvolvimento. O objetivo deste estudo foi descrever o impacto do sistema de aspiração traqueal aberto e fechado na incidência de pneumonia associada à ventilação mecânica. Realizou-se uma pesquisa na base de dados Pubmed para identificar tentativas controladas aleatórias, publicadas no período de 1990 a novembro de 2008. Nove estudos foram incluídos. Dos estudos revisados, sete não observaram redução significante da incidência de pneumonia associada à ventilação mecânica com o uso do sistema fechado comparado ao aberto, sendo que dois destes verificaram que o uso do sistema fechado resulta em incremento nas taxas de colonização sem incrementar sua incidência e um observou que o uso do sistema fechado não incrementa a colonização do trato respiratório e reduz a expansão de infecção resultando em redução nas taxas de sepse. Apenas dois estudos verificaram redução na incidência de pneumonia associada à ventilação mecânica com o uso do sistema fechado, e um destes revelou um risco 3.5 vezes maior de desenvolvimento desta infecção com o sistema aberto. Os resultados sugerem que o impacto do sistema de aspiração traqueal aberto e fechado é semelhante para o desenvolvimento da pneumonia associada à ventilação mecânica, assim a escolha do tipo de sistema de aspiração traqueal deve ser baseada em outros parâmetros. Entretanto, o sistema fechado aumenta o risco de colonização do trato respiratório, mas apresenta como vantagens a manutenção da ventilação mecânica e o menor prejuízo hemodinâmico.Pneumonia is the most common nosocominal infection in intensive care units and mechanical ventilation is a significant factor associated to its development. The objective of this study was to describe the impact of the open and closed tracheal suction

  5. Learning-By-Being-Acquired

    DEFF Research Database (Denmark)

    Colombo, Massimo G.; Moreira, Solon; Rabbiosi, Larissa

    In this paper we study post-acquisition integration in terms of R&D team reorganization—i.e., the creation of new teams with both inventors of the acquiring and acquired firms—and assess its impact on knowledge transfer in the period that follows the acquisition. Drawing on social identity and self......-categorization theories, we argue that R&D team reorganization increases the acquired inventors’ use of the prior stock of technological knowledge of the acquiring firm after the acquisition. Furthermore, this effect is enhanced if acquired inventors have higher innovation ability relative to their acquiring peers...... but is weakened for acquired inventors with high preacquisition ingroup collaborative strength. We construct a sample of 3,625 acquired inventors implementing the coarsened exact matching (CEM) technique and empirically test our arguments applying a difference-in-differences setup in a longitudinal data setting...

  6. Antibiogram Typing and Biochemical Characterization of Klebsiella pneumoniae after Biofield Treatment

    OpenAIRE

    Trivedi, Mahendra Kumar

    2015-01-01

    Klebsiella pneumoniae (K. pneumoniae) is a common nosocomial pathogen causing respiratory tract (pneumoniae) and blood stream infections. Multidrug-resistant (MDR) isolates of K. pneumoniae infections are difficult to treat in patients in health care settings. Aim of the present study was to determine the impact of Mr. Trivedi’s biofield treatment on four MDR clinical lab isolates (LS) of K. pneumoniae (LS 2, LS 6, LS 7, and LS 14). Samples were divided into two groups i.e. control and ...

  7. The clinical analysis of patients aged≥80 years with hospital infection of mycotic pneumonia

    Institute of Scientific and Technical Information of China (English)

    周春

    2012-01-01

    Objective To analyze the clinical characteristics of hospital-acquired mycotic pneumonia in elderly patients (aged≥80 years).Methods The clinical data were reviewed on 64 cases of elderly patients aged 80-93 years with hospital-acquired infection of mycotic pneumonia

  8. 重症肺炎的诊治%The diagnosis and treatment of severe pneumonia

    Institute of Scientific and Technical Information of China (English)

    施毅; 印洁

    2009-01-01

    @@ 重症肺炎既可发生于社区获得性肺炎(community acquired pneumonia,CAP),为重症社区获得性肺炎(SCAP),也可发生于医院获得性肺炎(hospital acquired pneumonia,HAP),为重症医院获得性肺炎(SHAP).

  9. The impact of methicillin- and aminoglycoside-resistant Staphylococcus aureus on the pattern of hospital-acquired infection in an acute hospital.

    Science.gov (United States)

    Meers, P D; Leong, K Y

    1990-10-01

    Infections due to methicillin- and aminoglycoside-resistant Staphylococcus aureus (MARSA) appeared in a new teaching hospital shortly after it opened. The effect this had on the pattern of hospital-acquired infections in the four years that followed is described. No control measures were applied and MARSA became endemic. New infections appeared at a rate of about four for each 1000 patients discharged. It established itself at different levels of incidence in various specialist units, patients under intensive care being most severely affected. MARSA was implicated in half of all hospital-acquired infections due to S. aureus but it was not more pathogenic than its more sensitive counterpart. It had little impact on the life of the hospital. PMID:1979573

  10. Pneumonia - adults - discharge

    Science.gov (United States)

    You have pneumonia, which is an infection in your lungs. In the hospital, your doctors and nurses helped you breathe better. ... body get rid of the germs that cause pneumonia. They also made sure you got enough liquids ...

  11. Pneumocystis Pneumonia (PCP)

    Science.gov (United States)

    ... 2014 Select a Language: Fact Sheet 515 Pneumocystis Pneumonia (PCP) WHAT IS PCP? HOW IS PCP TREATED? ... BEST? THE BOTTOM LINE WHAT IS PCP? Pneumocystis pneumonia (PCP or pneumocystis) is the most common opportunistic ...

  12. 多耐药肺炎克雷伯菌获得性耐药基因检测及指标聚类分析%The investigation of acquired resistance genes and hierarchical cluster analysis in multidrug-resistant Klebsiella pneumoniae

    Institute of Scientific and Technical Information of China (English)

    陈菁; 孙桂芹

    2011-01-01

    Objective To investigate the distribution of 65 kinds of acquired resistance genes and 7 kinds of genetic markers of mobile genetic elements, and the correlation between acquired resistance genes and genetic markers of mobile genetic elements in multidrug-resistant Klebsiella pneumoniae (K. Pneumoniae). Method From October 2007 to June 2009, 20 strains of multidrug-resistant K. Pneumoniae were collected from Shaoxing People's Hospital, China. Then, 65 kinds of acquired resistance genes to beta-lactams, aminoglycosides, quinolones, and 7 kinds of genetic markers of mobile genetic elements: conjugal plasmids, transposons, insertion sequences, and integrons were analyzed by PCR. And hierarchical cluster analysis was used to investigate the correlation between acquired resistance genes and genetic markers of mobile genetic elements. Result In the 20 strains of K. Pneumoniae, 14 kinds of acquired resistance genes were detected (including 6 kinds of acquired beta-lactam-resistance genes, 6 kinds of acquired aminoglycoside-resistance genes, 2 kinsd of acquired quinolone-resistance genes) , and 6 kinds of genetic markers of mobile genetic elements were detected (including 2 kinds of conjugal plasmids, 3 kinds of transposon and insertion sequences, 1 kind of integron). The other 52 kinds of genes were not detectable. Two clusters were divided by hierarchical cluster analysis depending on positive genes. Conclusion In this group of K. Pneumoniae, acquired resistance genes played a role in resistant phenotypes of antimicrobial a-gents. Horizontal transfer of mobile genetic elements brought rapid spread of resistance of bacterial pathogens, not only a-mong the same kinds of pathogens, but among the different kinds. In addition, hierarchical cluster analysis showed that correlation might exist between OXA-1, aac(6')- Ⅰ b.qnrB, IMP, aadA5, VEB, KPC, qnrS and traA,which suggested that these genes might exist in F conjugal plasmids; correlation might exist between DHA, aph(3

  13. Streptococcus pneumoniae capsular polysaccharide antibodies of old people in naturally acquired active immunity%老年人自然免疫状态下抗肺炎链球菌抗体的检测

    Institute of Scientific and Technical Information of China (English)

    陈许; 张洁; 黄瑾

    2011-01-01

    目的 探讨自然免疫状态下血清抗肺炎链球菌荚膜多糖特异性抗体值,为老年人是否需常规使用PPV23免疫提供参考.方法 健康人85例(健康组),分为青年、中年、老年组;老年COPD患者18例(C()PD组),ELISA检测血清特异性抗体.结果健康组:IgA老年组同中、青年组差异无统计学意义;IgM青年组高于其他两组(P<0.05);总IgG差异无统计学意义,IgG4老年及中年组高于青年组(P<0.05).IgM浓度与年龄负相关(r=-0.274,P<0.05),IgG4与年龄正相关(r=0.342,P<0.05).COPD组和健康老年人组差异无统计学意义.结论 未发现健康及COPD老年人血清抗肺炎链球菌保护性抗体整体水平低下,不支持该人群常规使用PPV23.%Objective To explore the necessary for elderly individuals to immunize with pneumococcal vaccine polyvalent, antibodies of several isotypes and subclasses that specific to streptococcus pneumoniae capsular polysaccharide (CPS) in serum. Methods The specific antibodies in serum were measured in 85 health adults and 18 elderly patients with chronic obstructive pulmonary disease (COPD) by indirect Enzyme Linked Immunosorbent Assay (ELISA). Results The health adults were split into aged, meddle-aged and young groups. The level of IgA in aged group was not lower than other two groups in statistics{P 0.05). The level of IgM in health individuals negatively correlated with age( r= -0.274,P0. 05). Conclusions There is no significant decline on overall levels of the protective antibodies in serum of health aged individuals and elderly patient with COPD,so it does not support introducing pneumococcal vaccine polyvalent to those populations as common practice.

  14. 降钙素原联合内毒素鲎试验在儿童社区获得性肺炎中的临床应用%The clinical application of procalcitonin and endotoxin limulus in community - acquired pneumonia of children

    Institute of Scientific and Technical Information of China (English)

    王萍; 王华彬; 罗开源

    2016-01-01

    Objective:To evaluate the clinical diagnostic value of procalcitonin(PCT)combined with endotoxin Limulus test in children community - acquired pneumonia. Methods:From January 2014 to December 2015,admissions 120 cases of community - acquired pneumonia in children,according to etiology findings will be divided into groups of bacteria and non -bacterial group,the group of children with bacterial subdivided into Gram - negative bacteria infection group(A group)and non - Gram - negative bacteria infection group(group B),all children with procalcitonin,quantitative determination of endo-toxin limulus test,observe the test results. Results:According to test results can be seen in children with positive rates of bacte-rial infection procalcitonin group was higher than that of children of non - bacterial group,the comparison of the data between the two groups of children was significantly(P ﹤ 0. 05),with statistical significance. Endotoxin by the Limulus test,found that children with serum toxin A group changed significantly in the serum group B toxin no significant change,data comparison be-tween the two groups of children was significantly(P ﹤ 0. 05),with statistical significance. Conclusion:Serum procalcitonin for early diagnosis of children with community - acquired pneumonia have greater clinical value,quantitative LAL endotoxin assay can determine the type of bacteria,to prevent the wrong use of antibiotics,due to the direction of reducing medication errors ef-fective treatment for clinical medicine has important reference value.%目的:探讨降钙素原(PCT)联合内毒素鲎试验在儿童社区获得性肺炎临床诊断中的应用价值。方法:选取2014年1月—2015年12月接诊的120例社区获得性肺炎患儿,根据病原学检查结果将其分成细菌组与非细菌组,将细菌性组患儿再分为革兰阴性菌感染组(A 组)和非革兰阴性菌感染组(B 组),将所有患儿进行降钙素原、内毒素鲎定量

  15. Impact of cefepime therapy on mortality among patients with bloodstream infections caused by extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli.

    Science.gov (United States)

    Chopra, Teena; Marchaim, Dror; Veltman, Jennifer; Johnson, Paul; Zhao, Jing J; Tansek, Ryan; Hatahet, Dania; Chaudhry, Khawar; Pogue, Jason M; Rahbar, Hiro; Chen, Ting-Yi; Truong, Thientu; Rodriguez, Victor; Ellsworth, Joseph; Bernabela, Luigino; Bhargava, Ashish; Yousuf, Adnan; Alangaden, George; Kaye, Keith S

    2012-07-01

    Extended-spectrum-β-lactamase (ESBL)-producing pathogens are associated with extensive morbidity and mortality and rising health care costs. Scant data exist on the impact of antimicrobial therapy on clinical outcomes in patients with ESBL bloodstream infections (BSI), and no large studies have examined the impact of cefepime therapy. A retrospective 3-year study was performed at the Detroit Medical Center on adult patients with BSI due to ESBL-producing Klebsiella pneumoniae or Escherichia coli. Data were collected from the medical records of study patients at five hospitals between January 2005 and December 2007. Multivariate analysis was performed using logistic regression. One hundred forty-five patients with BSI due to ESBL-producing pathogens, including K. pneumoniae (83%) and E. coli (16.5%), were studied. The mean age of the patients was 66 years. Fifty-one percent of the patients were female, and 79.3% were African-American. Fifty-three patients (37%) died in the hospital, and 92 survived to discharge. In bivariate analysis, the variables associated with mortality (P catheter. In multivariate analysis, the predictors of in-hospital mortality included stay in the intensive care unit (odds ratio [OR], 2.17; 95% confidence interval [CI], 0.98 to 4.78), presence of a central-line catheter prior to positive culture (OR, 2.33; 95% CI, 0.77 to 7.03), presence of a rapidly fatal condition at the time of admission (OR, 5.13; 95% CI, 2.13 to 12.39), and recent prior hospitalization (OR, 1.92; 95% CI, 0.83 to 4.09). When carbapenems were added as empirical therapy to the predictor model, there was a trend between empirical carbapenem therapy and decreased mortality (OR, 0.61; 95% CI, 0.26 to 1.50). When added to the model, receipt of empirical cefepime alone (n = 43) was associated with increased mortality, although this association did not reach statistical significance (OR, 1.66; 95% CI, 0.71 to 3.87). The median length of hospital stay was shorter for patients

  16. Epidemiology and risk factors for community-acquired blood stream infection caused by extended spectrum β-lactamases-producing Escherichia coli and Klebsiella pneumonia strains%社区获得性血流感染产 ESBLs 大肠埃希菌与肺炎克雷伯菌流行情况及危险因素初步分析

    Institute of Scientific and Technical Information of China (English)

    钟敏; 张凯; 黄湘宁; 殷琳; 刘鑫; 喻华; 黄文芳; 唐荣珍; 奉婷

    2016-01-01

    Objective To investigate the incidences, risk factors, genotypes and epidemiology of community-acquired blood stream infection caused by extended spectrum β-lactamases (ESBLs)-producing Escherichia coli and Klebsiella pneumonia strains and to analyze the sensitivity of those ESBLs producing strains to commonly used antibiotics. Methods Forty-two patients who were diagnosed with community-ac-quired blood stream infection caused by Escherichia coli or Klebsiella pneumonia strains in Sichuan Provincial People′s Hospital were recruited in this study. Disc diffusion method was used for the phenotypic confirmato-ry test of ESBLs. Agar dilution method was performed to measure the antimicrobial susceptibility of the ESBLs-producing strains to 13 clinically commonly used antibiotics. Genotypes of the ESBLs-producing strains were identified by polymerase chain reaction (PCR). Multilocus sequence typing (MLST) was used to analyze the epidemiology of ESBLs-producing strains. Logistic regression analysis was performed to analyze the risk factors for community-acquired blood stream infection. Results The ESBLs-producing Escherichia coli strains accounted for 56. 3% (18 / 32) and the ESBLs-producing Klebsiella pneumoniae strains accounted for 20% (2 / 10). All of the 20 ESBLs-producing strains were sensitive to imipenem, meropenem, ertapen-em, nitrofurantoin and moxalactam. The ESBLs-producing strains sensitive to amikacin, piperacillin-tazobactam and fosfomycin accounted for 95% , 90% and 85% , respectively. Drug resistance rates of the 20 strains to cefotaxime, levofloxacin, ciprofloxacin and cefepime were relatively high accounting for 100% , 80% , 80% and 75% , respectively. Among the 20 ESBLs-producing strains, 7 strains only carried the CTM gene, while the other 13 strains were all positive for two genotypes of ESBLs, mainly identified as TEM+CTM-M-14 and TEM+CTM-15 genotypes. The 18 Escherichia coli strains were classified into 10 ST types, most of which were ST131

  17. Impacto da vacina conjugada contra Streptococcus pneumoniae em doenças invasivas Impact of pneumococcal conjugate vaccine on the prevention of invasive pneumococcal diseases

    Directory of Open Access Journals (Sweden)

    Lucia Ferro Bricks

    2006-07-01

    Full Text Available OBJETIVOS: Rever os estudos que avaliam o impacto da vacina conjugada 7-valente na incidência de doenças invasivas por pneumococo e analisar o possível impacto dessa vacina no Brasil. FONTE DE DADOS:Foram pesquisadas as bases de dados MEDLINE, LILACS, Cochrane Database Reviews (janeiro de 2000 a janeiro de 2006, selecionando-se para análise os artigos contendo as seguintes palavras-chave: Streptococcus pneumoniae, pneumococo, vacina conjugada, resistência, antibióticos e meningite. Também foi realizada busca de informações sobre o tema nos sites do Centers for Disease Control, Ministério da Saúde e Centro de Vigilância Epidemiológica do Estado de São Paulo. SÍNTESE DOS DADOS: A vacina conjugada 7-valente reduziu a incidência de doenças invasivas por pneumococo, número de consultas por doenças respiratórias de vias aéreas superiores e inferiores, consumo de antibióticos e incidência de doenças invasivas por pneumococo por cepas resistentes a antibióticos não apenas nas crianças vacinadas, como em adultos e idosos. No Brasil, os coeficientes de incidência de doenças invasivas por pneumococo em crianças menores de 5 anos são elevados, a taxa de letalidade de meningites pneumocócicas é alta e as taxas de resistência parcial e plena à penicilina aumentaram substancialmente nos últimos 5 anos. CONCLUSÕES:Devido aos benefícios diretos e indiretos do uso em larga escala da vacina conjugada 7-valente, essa vacina deve ser incluída no calendário básico de imunização do Brasil.OBJECTIVES: To evaluate the impact of heptavalent pneumococcal conjugate vaccine in invasive pneumococcal diseases in the United States, and to analyze the potential impact of this vaccine in Brazil. SOURCES OF DATA: MEDLINE, LILACS, Cochrane Database Reviews, as well as the websites of the Centers for Disease Control and Prevention (CDC, Brazilian Ministry of Health and Centro de Vigilância Epidemiológica do Estado de São Paulo from

  18. The clinical feature and countermeasures of hospital-acquired pneumonia in non-surgical treatment elderly inpatients with lung cancer%老年肺癌非手术治疗医院内获得性肺炎的临床特点分析及对策

    Institute of Scientific and Technical Information of China (English)

    黄虎威; 周建英

    2009-01-01

    Objective To analyze the clinical feature and treatment strategy of Hospital-acquired pneumonia (HAP) in old age patients with lung cancer. Method 275 cases of HAP in non-surgically treated elderly inpatients with lung cancer during January 2006 to December 2008 were included and analyzed retrospectively. Result Among these patients, 165 cases occurred Central-type lung cancer, squamous cell carcinoma were prone to develop HAP; HAP caused by gram-negative bacteria was significantly higher than that caused by gram-positive bacteria and fungi; HAP infection rate in radiotherapy plus chemotherapy group was higher than that in chemotherapy or radiotherapy alone group; Along with the decrease of neutrophilic leukocyte, the infection rate was significantly higher, especially when the neutrophilic leukocyte < 1.0 × 10~9/L. Conclusion According to the clinical feature of HAP in non-surgically treated elderly inpatients with lung cancer, the prevention of HAP should be a fundamental measure, and treatment should be given in time once the infection occurs.%目的 探讨老年肺癌非手术治疗患者医院内获得性肺炎的临床特点及对策.方法 对2006年1月至2008年12月住院的275例非手术治疗老年肺癌的医院内获得性肺炎(Hospital-acquired pneumonia,HAP)情况进行回顾性分析.结果 本组病例发生院内获得性肺炎165例.以中央型肺癌、鳞癌易发院内获得性肺炎;由革兰阴性菌导致的HAP明显高于革兰阳性菌与真菌;放疗加化疗HAP感染率高于单纯放疗或化疗;随着白细胞下降,感染率明显增高,特别是粒细胞<1.0×10~9/L者感染率最高.结论 根据老年肺癌非手术治疗院内获得性肺炎的临床特点把HAP的预防作为根本措施,一旦出现感染应及时治疗.

  19. 社区获得性肺炎患儿年龄与感染病原菌情况差异分析%Analysis of the difference between the age and the infection pathogens in sick children with community acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    罗洪霞

    2013-01-01

    Objective To understand the situation of the various types of pathogens and the drug sensitivity in different ages of children who were infected with community acquired pneumonia in our hospital. Methods According to the study on the sputum culture of common pathogenic bacteria in children who sufferred from community acquired pneumonia in our hospital in recent three years, the percentage of infection pathogens in the children in every age grade was analyzed statistically. Results Among the 430 sputum culture cases of sick children, the pathogenic bacteria infection rate of Escherichia coll, Klebslella pneumonlae, Streptococcus pneumonlae, Haemophllus Influenzae, Staphylococ-cus aureus and Enterobacter cloacae was 32. 3% ,20. 2% ,14. 8% ,13. 2% ,13% ,7. 2% respectively. The infection rate and the percentage of infection pathogen were different between each age group because of the ages. Conclusion Before the results of the sputum culture and drug sensitivity come out,the sensitive antibiotics treatment could be closen based on the age.%目的 了解我院社区获得性肺炎患儿中不同年龄段患儿易感的病原菌种类及其药物敏感情况.方法 针对我院近3年社区获得性肺炎住院患儿痰培养常见病原菌,统计分析患儿各年龄阶段感染的病原菌种类的差异.结果 430例患儿痰培养结果中,大肠埃希菌占32.3%,肺炎克雷伯菌占20.2%,肺炎链球菌占14.8%,流感嗜血杆菌占13.2%,金黄色葡萄球菌占13%,阴沟肠杆菌占7.2%.各年龄组患儿感染率的高低及感染病原菌的百分比因年龄不同而异.结论 在痰培养及药敏结果出来之前,可根据不同年龄段患儿易患病原菌的百分比,有针对性地选择敏感抗生素治疗.

  20. The Predictive Value of Three Scales on Ventilatory Pattern Choice in Patients with Severe Community-acquired Pneumonia%三种评价量表对重症社区获得性肺炎患者通气方式的预测意义

    Institute of Scientific and Technical Information of China (English)

    魏薇; 陈传熹; 曹钰

    2009-01-01

    目的 探讨3种重症社区获得性肺炎(CAP)危重度分层评分量表SMART-COP、CURB-65和IDSA/ATS对患者通气方式的预测意义. 方法 采集98例重症CAP患者入院时的相关数据,分别计算SMART-COP、CURB-65和IDSA/ATS次要标准的计分,根据患者24 h内实际采用的通气方式来评估此3种评价量表对通气方式的预测价值. 结果 3种评分量表的分值高低对预测患者采取非有创通气或有创通气均有统计学意义(P0.05). 结论 3种评分量表对重症CAP患者通气方式均有一定预测价值,相比而言,SMART-COP比CURB-65和IDSA/AT次要标准更具有优势.%Objective To evaluate the predictive value of three scales, including SMAT-COP, CURB-65 and the minor criteria for severe community-acquired pneumonia (CAP) proposed by IDSA/ATS, on the ventilatory pattern choice in patients with severe community-acquired pneumonia. Methods The scores of the three scales were calculated in 98 patients with severe CAP with the admission data, and compared between the non-invasive ventilation group and invasive ventilation group. Results There were significant differences in SMAT-COP, CURB-65 and IDSA/ATS minor criteria between non-invasive ventilation group and invasive ventilation group (P0. 05). Conclusion The three scales all have predictive values on ventilatory pattern choice in patients with severe CAP.SMART-COP has better predictive values than the other two.

  1. Impact of seropositivity to Chlamydia pneumoniae and anti-hHSP60 on cardiovascular events in hemodialysis patients.

    Science.gov (United States)

    Esposito, Pasquale; Tinelli, Carmine; Libetta, Carmelo; Gabanti, Elisa; Rampino, Teresa; Dal Canton, Antonio

    2011-03-01

    Autoimmunity to heat shock protein 60 (HSP60) has been related to atherosclerosis. Chlamydia pneumoniae (CP), the most studied infectious agent implicated in promoting atherosclerosis, produces a form of HSP60, which can induce an autoimmune response, due to high antigenic homology with human HSP60 (hHSP60). In this study, we evaluated the correlations among anti-hHSP60 antibodies, CP infection, and cardiovascular disease (CVD) in a high-risk population, such as patients undergoing hemodialysis (HD). Thirty-two patients (67.9 ± 13.9 years; male/female, 23:9) on regular HD were enrolled. Global absolute cardiovascular risk (GCR) was assessed using the Italian CUORE Project's risk charts, which evaluate age, gender, smoking habits, diabetes, systolic blood pressure, and serum cholesterol. The occurrence of cardiovascular events during a 24-month follow-up was recorded. Seropositivity to CP and the presence of anti-hHSP60 antibodies were tested by specific enzyme-linked immunosorbent assays. Inflammation was assessed by measurement of C-reactive protein (CRP) serum levels. Fifteen healthy sex and age-matched (61.9 ± 9.5 years; male/female, 11:4) subjects were the control group. Fifteen of 32 patients resulted seropositive for CP. CP + patients were older than CP-, while they did not differ for GCR, CRP, and dialytic parameters. CVD incidence was significantly higher in CP+ (9 CP+ vs 2 CP-, p < 0.05). Cox analysis recognized that the incidence of CVD was independently correlated with seropositivity to CP (HR, 7.59; p = 0.01; 95% CI = 1.63-35.4). On the other hand, there were no significant differences in anti-hHSP60 levels among CP+, CP- and healthy subjects: 18.11 μg/mL (14.8-47.8), 31.4 μg/mL (23.2-75.3), and 24.72 μg/mL (17.7-41.1), respectively. Anti-hHSP60 did not correlate to GCR, CRP, and incidence of CVD. In conclusion, our data suggest that anti-hHSP60 autoimmune response is not related to CP infection and CP-related CVD risk

  2. Pathogen Changes and Risk Factor Analysis of Community-acquired Pneumonia in the Elderly of A Hospital in Zhe- jiang Province in Recent 5 Years%浙江省某院5年来老年社区获得性肺炎的病原体变迁及危险因素分析

    Institute of Scientific and Technical Information of China (English)

    钟雷; 裘雨林

    2014-01-01

    目的:了解我院老年社区获得性肺炎(CAP)的病原体和耐药性变迁,分析 CAP 发病的高危因素,为老年 CAP 的预防和治疗提供指导意见。方法回顾性分析2008-2012年的315例老年 CAP 患者的资料,对痰标本进行培养、分离和鉴定,药敏试验采用 K - B 法。对相关危险因素进行单因素和多因素 Logistic 回归分析。结果315份痰标本病原体培养阳性113份,阳性率为35.9%,2008-2012年各年阳性率分别为36.2%(21/58)、33.9%(19/56)、36.1%(22/61)、36.4%(24/66)和36.5%(27/74),差异无统计学意义(χ2=0.574,P ﹥0.05);共分离出130株病原体,革兰阳性菌43株(占33.1%),革兰阴性菌51株(占39.2%),非典型病原体36株(占27.7%)。其中分布最多的4种病原体为肺炎链球菌、肺炎支原体、流感嗜血杆菌和肺炎克雷伯菌,分别占23.9%、20.8%、15.4%和14.6%。2008-2012年肺炎链球菌(由34.8%下降至18.8%)和流感嗜血杆菌(由26.1%下降至9.4%)的比重逐年下降,肺炎克雷伯菌(由8.7%上升至18.8%)和肺炎支原体(由13.0%上升至31.3%)逐年上升;肺炎链球菌对青霉素的耐药率在5年都很高,且在后2年达到100%。多因素 Logistic 回归分析显示年龄、吸烟史、烟龄、慢性阻塞性肺疾病(COPD)、哮喘、慢性支气管炎、肺结核、支气管扩张和肺癌是 CAP 的独立危险因素(P ﹤0.05)。结论本地区老年 CAP 的病原体构成和耐药性均发生了明显变迁,由以往以肺炎链球菌为主,逐渐变为以肺炎支原体为主,耐药性增强且呈多重耐药特点;吸烟和呼吸道疾病是老年 CAP 的高危因素。%Objective To explore the pathogen changes and drug - resistance evolution of community - acquired pneu-monia(CAP)in the elderly,and to analyze the risk factors related to CAP,in order to to provide guidance

  3. CT features of legionella pneumonia, compared with streptococcal pneumonia. A collaborative study

    International Nuclear Information System (INIS)

    Legionella pneumophila pneumonia (LPP) is of serious concern for chest physicians for its potential lethality and difficulty of diagnosis. In spite of widespread use of urine antigen detection method, it remains one of the most difficult-to-treat disease among community acquired pneumonia. We investigated CT images of 38 cases of LPP, comparing them with wide spread Streptococcus pneumoniae pneumonia (SPP). We find that sharply demarcated consolidation scattered in ground-glass opacity is the most striking and pathognomonic feature of LPP, which is rarely found in SPP. Bronchiolitis was not found in LPP, while it is a relatively common finding in SPP, which could be the second clue of differentiation of these two diseases. (author)

  4. 老年急性脑卒中患者医院获得性肺炎的病原菌分布与耐药性监测%Distribution and drug resistance of pathogens causing hospital-acquired pneumonia in elderly patients with acute stroke

    Institute of Scientific and Technical Information of China (English)

    牟静; 陈慧

    2014-01-01

    目的:监测并分析老年急性脑卒中患者医院获得性肺炎(HAP)的病原菌分布及耐药性,为临床用药提供参考。方法选择医院2012年3月-2013年3月42例老年急性脑卒中合并HAP患者资料进行回顾性分析,采用ATB-Expression分析仪对培养的病原菌进行鉴定,药敏试验采用K-B纸片法。结果共培养出病原菌57株,其中革兰阴性菌36株占63.16%,前3位菌依次为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌,分别占17.54%、14.04%、8.77%,革兰阳性菌18株占31.58%,前3位菌依次为金黄色葡萄球菌、溶血葡萄球菌和表皮葡萄球菌,分别占12.28%、8.77%、7.01%,真菌3株占5.26%,以白色假丝酵母菌和热带假丝酵母菌为主,分别占3.51%、1.75%;革兰阴性菌中肺炎克雷伯菌及其他病原菌对氨苄西林、左氧氟沙星、庆大霉素、头孢曲松、头孢噻肟、氨苄西林/舒巴坦等临床常用抗菌药物的耐药率均>50.0%,对美罗培南、亚胺培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦较敏感;革兰阳性菌对青霉素、左氧氟沙星、克林霉素普遍耐药,未发现耐万古霉素的菌株。结论随着抗菌药物的广泛应用,老年急性脑卒中HAP患者的病原菌耐药率居高不下,加强治疗中各环节的感染控制,杜绝或降低医源性感染,做好消毒隔离,避免患者间交叉感染,是预防和控制医院感染的重要举措,同时应避免在同一病区长时间使用同一种抗菌药物,以控制耐药菌株的滋生。%OBJECTIVE To analyze the distribution and drug resistance of pathogens causing hospital-acquired pneu-monia in elderly patients with acute stroke so as to provide guidance for clinical medication .METHODS A total of 42 elderly patients with acute stroke complicated with hospital-acquired pneumonia ,who were treated in the hospi-tal from Mar 2012 to Mar

  5. A retrospective analysis of risk factor, pathogen and prognosis of hospital-acquired pneumonia in adult patients in Shanghai%上海地区成人医院获得性肺炎易患因素、病原学及预后分析

    Institute of Scientific and Technical Information of China (English)

    李宁; 沈策; 周龙女; 张伯膺; 程齐俭; 韩立中; 李敏; 黄绍光; 倪语星; 奚峰; 郭雪君; 周新

    2011-01-01

    Objective To investigate the clinical features, risk factors, antibiotic resistance, and clinical outcomes of hospital-acquired pneumonia ( HAP) in adult patients in Shanghai hospitals. Methods From November 2007 to December 2009, the clinical and microbiological data of HAP cases were prospectively reviewed in seven large general hospitals in Shanghai region. Results A total of 204 cases were included in the analysis. The mean age of these patients was (68 ± 17) years (58. 3%>70 years). The underlying conditions included cerebral vascular disease, diabetes mellitus and abdominal surgery. Ventilator-associated pneumonia accounted for 20.6% of the cases. The case mortality was 15. 7%. Increased heart rate, decreased arterial PH, hypoxia, hyperglycemia, increased plasma creatinine and vasopressor use were associated with the poor outcome in these HAP patients. Of all the bacterial strains isolated from HAP, 64.9% were gram-negative bacilli, including A. Baumannii, P. Aeruginosa, K. Pneumoniae, and E. Colt. The prevalence of methicillin-resistant Staphylococcus aureus was 65. 4% in the S. Aureus isolates. No vancomycin-resistant MRSA was identified. Conclusions Advanced age, cerebrovascular diseases and diabetes are risk factors of HAP. Septic shock is the most important complication associated with poor prognosis of HAP. Common pathogens of HAP include A. Baumannii, P. Aeruginosa, K. Pneumoniae, E. Coli, and S. Aureus (MRSA 65.4%).%目的 本研究对上海地区医院获得性肺炎(HAP)的病原菌和临床结局进行前瞻性研究,探讨上海地区HAP的临床特点、易患因素、病原菌的耐药状况及对临床预后的影响因素.方法 采用前瞻性观察性研究方法,收集2007年11月-2009年12月上海市7所大型综合性医院住院并确诊为HAP患者的临床资料及微生物学标本进行细菌培养、鉴定和药敏试验.结果 本组共收集HAP 204例,患者平均年龄(68±17)岁,70岁以上患者占58.3%.患者的基础疾病

  6. Case analysis of clinical pharmacists participated in anti-infective treatment of severe hospital-acquired pneumonia%临床药师参与医院获得性肺炎病人抗感染治疗病例分析

    Institute of Scientific and Technical Information of China (English)

    张晋萍; 葛卫红; 戴令娟

    2012-01-01

    Objective: To explore the method of clinical pharmacists participating in designing therapy regimens and carrying out pharmaceutical care. Methods: The clinical pharmacists participated in therapy of a patient with severe hospital-acquired pneumonia, analyzed the regimen, offered suggestion and provided pharmaceutical care. Results: The suggestion provided by clinical pharmacists was accepted by doctors. Finally,the patient was cured and discharged from the hospital. Conclusion: Clinical pharmacists' participation is helpful for doctors to make safe and effective medication.%目的:探讨临床药师参与药物治疗方案的制定与药学监护的方法.方法:临床药师参与了呼吸科1例医院获得性肺炎病人的治疗,分析评价治疗方案,提出药学建议,并进行药学服务.结果:临床药师的建议被采纳,病人的病情好转出院.结论:临床药师的参与可以协助医师制订安全、有效的治疗方案.

  7. Role of Amoxicillin and Clavulanate Potassium in Treatment of Community-acquired Pneumonia%阿莫西林克拉维酸钾复方制剂在社区获得性肺炎治疗中的作用

    Institute of Scientific and Technical Information of China (English)

    唐晓燕

    2012-01-01

    Community - acquired pneumonia ( CAP) is a common infectious disease. Its resistance has become increasingly prominent in long—term clinical course of medication. Amoxicillin and clavulanate potassium has been recognized gradually due to its significant effect on CAP. Different matching dosage regimen has different antimicrobial efficacy. This paper gives 2 best matching dosage regimens by clinical trials.%社区获得性肺炎(CAP)是临床常见的感染性疾病,在长期临床用药过程中,CAP的耐药性问题日益突出,阿莫西林克拉维酸钾复方制剂在CAP中的治疗地位由于其疗效显著而逐渐被肯定.阿莫西林克拉维酸钾复方制剂不同配比的给药方案抗菌疗效也不尽相同,本研究通过临床实验也给出了两者最佳配比.

  8. Impact of diabetes mellitus on pneumonia mortality in a senior population:results from the NHANES III follow-up study

    Institute of Scientific and Technical Information of China (English)

    Jian Liu

    2013-01-01

    Objective To examine whether diabetes mellitus increases the risk of pneumonia mortality among seniors in the U.S. general popula-tion. Methods&Results The NHANES III follow-up study data were used. After excluding individuals from other minorities, being hos-pitalized with pneumonia in the previous year at baseline, or death of pneumonia during the first year of follow-up, a total of 3,707 subjects aged 65 years or older (1,794 men and 1,913 women) who had no missing information on variables for the analysis were included. Approxi-mately 16% of seniors at baseline were diabetics, which was defined as either having been diagnosed by a physician, currently taking pills/insulin lowering blood glucose, or HbA1c higher than 6.4%. During an average 11 years of follow-up, a total of 98 deaths due to pneu-monia were recorded (ICD-10:J12-J18). Cox-regression models were used to estimate the risk association between pneumonia mortality and diabetes mellitus. After adjustment for the covariates at baseline, the hazard ratios of pneumonia death were 1.30 (95%CI:0.64-2.70) for pre-diabetics and 2.28 (95%CI:1.18-4.39) for diabetics, respectively. Among those covariates, only age (HR (95%CI);1.16 (1.13-1.20)), gender as female (0.35 (0.22-0.61)) and physical fitness measured as having no problem walking 1+mile during the previous month (0.38 (0.20-0.67)) reached statistical significance. Conclusions The results suggest that diabetes mellitus is a strong risk predictor of pneumonia mortality and the evaluation of physical fitness may also be useful in the risk prediction of pneumonia mortality for seniors.

  9. Pneumonia in older residents of long-term care facilities.

    Science.gov (United States)

    Furman, Christian Davis; Rayner, Abi V; Tobin, Elisabeth Pelcher

    2004-10-15

    Compared with community-dwelling persons, residents in long-term care facilities have more functional disabilities and underlying medical illnesses and are at increased risk of acquiring infectious diseases. Pneumonia is the leading cause of morbidity and mortality in this group. Risk factors include unwitnessed aspiration, sedative medication, and comorbidity. Recognition may be delayed because, in this population, pneumonia often presents without fever, cough, or dyspnea. Accurate identification of the etiologic agent is hampered because most patients cannot produce a suitable sputum specimen. It is difficult to distinguish colonization from infection. Colonization by Staphylococcus aureus and gram-negative organisms can result from aspiration of oral or gastric contents, which could lead to pneumonia. Aspiration of gastric contents also can produce aspiration pneumonitis. This condition is not infectious initially and may resolve without antibiotics. Antibiotics for the treatment of pneumonia should cover Streptococcus pneumoniae, Haemophilus influenzae, gram-negative rods, and S. aureus. Acceptable choices include quinolones or an extended-spectrum beta-lactam plus a macrolide. Treatment should last 10 to 14 days. Pneumonia is associated with significant mortality for up to two years. Dementia is related independently to the death rate within the first week after pneumonia, regardless of treatment. Prevention strategies include vaccination against S. pneumoniae and influenza on admission to the care facility. This article focuses on recent recommendations for the recognition of respiratory symptoms and criteria for the designation of probable pneumonia, and provides a guide to hospitalization, antibiotic use, and prevention.

  10. Heat resistance mediated by a new plasmid encoded Clp ATPase, ClpK, as a possible novel mechanism for nosocomial persistence of Klebsiella pneumoniae

    DEFF Research Database (Denmark)

    Bojer, Martin Saxtorph; Struve, Carsten; Ingmer, Hanne;

    2010-01-01

    Klebsiella pneumoniae is an important opportunistic pathogen and a frequent cause of nosocomial infections. We havecharacterized a K. pneumoniae strain responsible for a series of critical infections in an intensive care unit over a two-year period. The strain was found to be remarkably...... of Clp ATPases in acquired environmental fitness and highlights the challenges of mobile genetic elements in fighting nosocomial infections...... resistant to lethal heat shock. Furthermore, one third of a collection of nosocomial K. pneumoniae isolates carry clpK and exhibit a heat resistant phenotype. The discovery of ClpK as a plasmid encoded factor and its profound impact on thermal stress survival sheds new light on the biological relevance...

  11. Heat resistance mediated by a new plasmid encoded Clp ATPase, ClpK, as a possible novel mechanism for nosocomial persistence of Klebsiella pneumoniae

    DEFF Research Database (Denmark)

    Bojer, Martin Saxtorph; Struve, Carsten; Ingmer, Hanne;

    2010-01-01

    Klebsiella pneumoniae is an important opportunistic pathogen and a frequent cause of nosocomial infections. We have characterized a K. pneumoniae strain responsible for a series of critical infections in an intensive care unit over a two-year period. The strain was found to be remarkably...... of Clp ATPases in acquired environmental fitness and highlights the challenges of mobile genetic elements in fighting nosocomial infections....... resistant to lethal heat shock. Furthermore, one third of a collection of nosocomial K. pneumoniae isolates carry clpK and exhibit a heat resistant phenotype. The discovery of ClpK as a plasmid encoded factor and its profound impact on thermal stress survival sheds new light on the biological relevance...

  12. Heat Resistance Mediated by a New Plasmid Encoded Clp ATPase, ClpK, as a Possible Novel Mechanism for Nosocomial Persistence of Klebsiella pneumoniae

    DEFF Research Database (Denmark)

    Bojer, Martin Saxtorph; Struve, Carsten; Ingmer, Hanne;

    2010-01-01

    Klebsiella pneumoniae is an important opportunistic pathogen and a frequent cause of nosocomial infections. We have characterized a K. pneumoniae strain responsible for a series of critical infections in an intensive care unit over a two-year period. The strain was found to be remarkably...... of Clp ATPases in acquired environmental fitness and highlights the challenges of mobile genetic elements in fighting nosocomial infections....... resistant to lethal heat shock. Furthermore, one third of a collection of nosocomial K. pneumoniae isolates carry clpK and exhibit a heat resistant phenotype. The discovery of ClpK as a plasmid encoded factor and its profound impact on thermal stress survival sheds new light on the biological relevance...

  13. Heat resistance mediated by a new plasmid encoded Clp ATPase, ClpK, as a possible novel mechanism for nosocomial persistence of Klebsiella pneumoniae

    DEFF Research Database (Denmark)

    Bojer, Martin Saxtorph; Struve, Carsten; Ingmer, Hanne;

    2010-01-01

    Klebsiella pneumoniae is an important opportunistic pathogen and a frequent cause of nosocomial infections. We havecharacterized a K. pneumoniae strain responsible for a series of critical infections in an intensive care unit over a two-year period. The strain was found to be remarkably...... Clp ATPases in acquired environmental fitness and highlights the challenges of mobile genetic elements in fighting nosocomial infections...... resistant to lethal heat shock. Furthermore, one third of a collection of nosocomial K. pneumoniae isolates carry clpK and exhibit a heat resistant phenotype. The discovery of ClpK as a plasmid encoded factor and its profound impact on thermal stress survival sheds new light on the biological relevance of...

  14. Preventing Hospital-acquired Infections in Low-income and Middle-income Countries: Impact, Gaps, and Opportunities.

    Science.gov (United States)

    Bardossy, Ana Cecilia; Zervos, John; Zervos, Marcus

    2016-09-01

    In low-income and middle-income countries (LMIC) health care-associated infections (HAIs) are a serious concern. Many factors contribute to the impact in LMIC, including lack of infrastructure, inconsistent surveillance, deficiency in trained personnel and infection control programs, and poverty- related factors. In LMIC the risk of HAIs may be up to 25% of hospitalized patients. Building infection control capacity in LMIC is possible where strategies are tailored to the specific needs of LMIC. Strategies must start with simple, cost-effective measures then expand to include more complicated measures. Goals for short-term, medium-term, and long-term actions should be planned and resources prioritized. PMID:27515149

  15. Infection with and Carriage of Mycoplasma pneumoniae in Children

    Science.gov (United States)

    Meyer Sauteur, Patrick M.; Unger, Wendy W. J.; Nadal, David; Berger, Christoph; Vink, Cornelis; van Rossum, Annemarie M. C.

    2016-01-01

    “Atypical” pneumonia was described as a distinct and mild form of community-acquired pneumonia (CAP) already before Mycoplasma pneumoniae had been discovered and recognized as its cause. M. pneumoniae is detected in CAP patients most frequently among school-aged children from 5 to 15 years of age, with a decline after adolescence and tapering off in adulthood. Detection rates by polymerase chain reaction (PCR) or serology in children with CAP admitted to the hospital amount 4–39%. Although the infection is generally mild and self-limiting, patients of every age can develop severe or extrapulmonary disease. Recent studies indicate that high rates of healthy children carry M. pneumoniae in the upper respiratory tract and that current diagnostic PCR or serology cannot discriminate between M. pneumoniae infection and carriage. Further, symptoms and radiologic features are not specific for M. pneumoniae infection. Thus, patients may be unnecessarily treated with antimicrobials against M. pneumoniae. Macrolides are the first-line antibiotics for this entity in children younger than 8 years of age. Overall macrolides are extensively used worldwide, and this has led to the emergence of macrolide-resistant M. pneumoniae, which may be associated with severe clinical features and more extrapulmonary complications. This review focuses on the characteristics of M. pneumoniae infections in children, and exemplifies that simple clinical decision rules may help identifying children at high risk for CAP due to M. pneumoniae. This may aid physicians in prescribing appropriate first-line antibiotics, since current diagnostic tests for M. pneumoniae infection are not reliably predictive. PMID:27047456

  16. 肺炎支原体肺炎及其并发症的诊治进展%Advance in the diagnosis and treatment of Mycoplasma pneumoniae pneumonia and related complications

    Institute of Scientific and Technical Information of China (English)

    张永明

    2011-01-01

    @@ 肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia, MPP)为5岁以上儿童及青少年中最常见的下呼吸道感染性疾病.文献报道,肺炎支原体(My-coplasma pneumoniae, MP)感染占儿童社区获得性肺炎(community acquired pneumonia, CAP)病原的10%-40%以上[1].

  17. The History of Mycoplasma pneumoniae Pneumonia.

    Science.gov (United States)

    Saraya, Takeshi

    2016-01-01

    In the United States in the 1930s, although the pathogen was not known, atypical pneumonia was clinically distinguished from pneumococcal pneumonia by its resistance to sulfonamides. Reimann (1938) reported seven patients with an unusual form of tracheo bronchopneumonia and severe constitutional symptoms. He believed the clinical picture of this disease differed from that of the disease caused by influenza viruses or known bacteria and instead suspected "primary atypical pneumonia." For many years, the responsible infectious agent was tentatively classified as a filterable virus that could pass through a Seitz filter to remove bacteria and was reported to be a psittacosis-like or new virus. After that, Eaton et al. (1942, 1944, 1945) identified an agent that was the principal cause of primary atypical pneumonia using cotton rats, hamsters, and chick embryos. Eaton et al. (1942, 1944, 1945) did not perform an inoculation study in human volunteers. During the 1940s, there were three groups engaged in discovering the etiology of the primary atypical pneumonia. (1) Commission on Acute Respiratory Diseases Diseases directed by John Dingle, (2) Dr. Monroe Eaton's group, the Virus Research Laboratory of the California State Public Health Department, (3) The Hospital of the Rockefeller Institute for Medical Research directed by Horsfall. During 1940s, the members of the Commission on Acute Respiratory Diseases concluded that the bacteria-free filtrates obtained from the patients, presumably containing a virus, could induce primary atypical pneumonia in human volunteers via Pinehurst trials. During 1950s, serological approaches for identification of the Eaton agent developed such as Fluorescent-Stainable Antibody, and at the beginning of the1960s, the Eaton agent successfully grew in media, and finally accepted as a cause of primary atypical pneumonia. Thus, technical difficulties with visualizing the agent and failure to recognize the full significance of the Pinehurst

  18. How Can Pneumonia Be Prevented?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Can Pneumonia Be Prevented? Pneumonia can be very serious and ... t last as long Fewer serious complications Pneumococcal Pneumonia Vaccine A vaccine is available to prevent pneumococcal ...

  19. Symptoms, Diagnosis and Treatment of Pneumonia

    Science.gov (United States)

    ... Lung Health and Diseases > Lung Disease Lookup > Pneumonia Pneumonia Symptoms, Causes, and Risk Factors Anyone can get ... risk for pneumonia. What Are the Symptoms of Pneumonia? Pneumonia symptoms can vary from mild to severe, ...

  20. Acute exogenous lipoid pneumonia, on a fire eating

    International Nuclear Information System (INIS)

    A case of an adult 19 years of age, fire juggler and manipulator is presented. The young came in to the medical emergency service of the Hospital Dr. Rafael A. Calderon Guardia, because of a sudden episode of right thoracic pain and dyspnea. A right pleural effusion was documented and a round mass at the base of the left lung. A suggestive clinic of bronchopneumonia started after hours, it was localized first as community acquired pneumonia. Considering his work history and clinical characteristics, the case was reoriented and concluded that this is what the medical literature in English is called fire-eater pneumonia, uncommon aspiration pneumonia which was a literature review. (author)

  1. Evaluación del juicio clínico y las guías de decisión en la pesquisa de pacientes adultos con neumonía adquirida en la comunidad en la unidad de emergencia Comparison of physician judgment and decision aids for diagnosing community-acquired pneumonia in the emergency department

    Directory of Open Access Journals (Sweden)

    FERNANDO SALDÍAS P

    2007-06-01

    , Singal, Heckerling and Gennis, for diagnosing community-acquired pneumonia in the emergency department. Design: Prospective observational investigation with preradiograph survey of physician's clinical diagnosis of pneumonia in immunocompetent adult patients presenting with fever or respiratory complaints. All patients had uniform clinical data collected, including chest radiographs and sufficient information to retrospectively apply the four clinical prediction rules. Setting: the emergency department of a major urban teaching hospital from Santiago, Chile. Participants: Adult patients presenting with recent history of acute cough, sputum production, chest pain, dyspnea or fever. Results: Of 325 patients, 112 (34% had pneumonia. The sensitivity (0.79, specificity (0.66, positive predictive value (0.55 and negative predictive value (0.85 of physician judgment were very similar to the Diehr rule. The sensitivity of the Heckerling (0.84 and Gennis (0.92 rules exceeded that of physician judgment but specificities were lower (0.41 and 0.31, respectively. The accuracy of physician judgment (0.70 and the Diehr rule (0.69 exceeded that of the other decision rules. Conclusions: Physician's judgment prior to observation of radiography has moderate sensitivity and specificity to diagnose pneumonia in the emergency setting. The accuracy and specificity of physician judgment exceeded that of all four decision rules to diagnose pneumonia in adult patients

  2. Evaluation of Curetis Unyvero, a multiplex PCR-based testing system, for rapid detection of bacteria and antibiotic resistance and impact of the assay on management of severe nosocomial pneumonia.

    Science.gov (United States)

    Jamal, Wafaa; Al Roomi, Ebtehal; AbdulAziz, Lubna R; Rotimi, Vincent O

    2014-07-01

    Health care-associated pneumonia due to multidrug-resistant organisms represents a major therapeutic challenge. Unfortunately, treatment is dependent on empirical therapy, which often leads to improper and inadequate antimicrobial therapy. A rapid multiplex PCR-based Unyvero pneumonia application (UPA) assay that assists in timely decision-making has recently become available. In this study, we evaluated the performance of UPA in detecting etiological pathogens and resistance markers in patients with nosocomial pneumonia (NP). The impact of this assay on the management of severe nosocomial pneumonia was also assessed. Appropriate specimens were processed by UPA according to the manufacturer's protocol in parallel with conventional culture methods. Of the 56 patients recruited into the study, 49 (87.5%) were evaluable. Of these, 27 (55.1%) and 4 (8.2%) harbored multiple bacteria by the PCR assay and conventional culture, respectively. A single pathogen was detected in 8 (16.3%) and 4 (8.2%) patients, respectively. Thirteen different genes were detected from 38 patients, including the ermB gene (40.8%), the blaOXA-51-like gene (28.6%), the sul1 (28.6%) and int1 (20.4%) integrase genes, and the mecA and blaCTX-M genes (12.3% each). The time from sample testing to results was 4 h versus 48 to 96 h by UPA and culture, respectively. Initial empirical treatment was changed within 5 to 6 h in 33 (67.3%) patients based on the availability of UPA results. Thirty (62.2%) of the patients improved clinically. A total of 3 (6.1%) patients died, mainly from their comorbidities. These data demonstrate the potential of a multiplex PCR-based assay for accurate and timely detection of etiological agents of NP, multidrug-resistant (MDR) organisms, and resistance markers, which can guide clinicians in making early antibiotic adjustments.

  3. Hubungan Kadar Procalcitonin dengan beratnya Pneumonia Komunitas

    OpenAIRE

    Manullang, Doharjo

    2016-01-01

    Background The assessment of level severity in patient with Community Acquired Pneumonia (CAP) is very important determine the next management of disease. Procalcitonin (PCT) is known as one of biomarker sepsis and infection. The application of PCT is known to be used in diagnosis, to help clinician to decide antibiotic treatment and to make prognosis. It is still controversy whether the PCT early admission is related in clinical scoring system or prognostic score. Objective To...

  4. Identification of Streptococcus pneumoniae

    OpenAIRE

    Kaijalainen, Tarja

    2006-01-01

    Objectives: Streptococcus pneumoniae, pneumococcus, is an importanthuman pathogen that causes both serious invasive infections, suchas septicaemia, meningitis and pneumonia, as well as mild upper respiratoryinfections. It also belongs to the normal nasopharyngeal microbialflora. The purpose of this study was to compare bacteriologicalphenotypic methods with genetechnological methods in the identificationof pneumococci, especially among suspect pneumococcal isolateslacking one or more typical ...

  5. Bronchitis and Pneumonia

    Science.gov (United States)

    ... What is the difference between bronchitis and pneumonia? Bronchitis is most often a bacte- rial or viral infection that causes swelling of the tubes (bronchioles) leading to the lungs. Pneumonia is an acute or chronic disease marked by inflammation of the ...

  6. Impact of Empiric Antimicrobial Therapy on Outcomes in Patients with Escherichia coli and Klebsiella pneumoniae Bacteremia: A Cohort Study

    Directory of Open Access Journals (Sweden)

    Furuno Jon P

    2008-09-01

    Full Text Available Abstract Background It is unclear whether appropriate empiric antimicrobial therapy improves outcomes in patients with bacteremia due to Escherichia coli or Klebsiella. The objective of this study is to assess the impact of appropriate empiric antimicrobial therapy on in-hospital mortality and post-infection length of stay in patients with Escherichia coli or Klebsiella bacteremia while adjusting for important confounding variables. Methods We performed a retrospective cohort study of adult patients with a positive blood culture for E. coli or Klebsiella between January 1, 2001 and June 8, 2005 and compared in-hospital mortality and post-infection length of stay between subjects who received appropriate and inappropriate empiric antimicrobial therapy. Empiric therapy was defined as the receipt of an antimicrobial agent between 8 hours before and 24 hours after the index blood culture was drawn and was considered appropriate if it included antimicrobials to which the specific isolate displayed in vitro susceptibility. Data were collected electronically and through chart review. Survival analysis was used to statistically assess the association between empiric antimicrobial therapy and outcome (mortality or length of stay. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HR and 95% confidence intervals (CI. Results Among 416 episodes of bacteremia, 305 (73.3% patients received appropriate empiric antimicrobial therapy. Seventy-one (17% patients died before discharge from the hospital. The receipt of appropriate antimicrobial agents was more common in hospital survivors than in those who died (p = 0.04. After controlling for confounding variables, there was no association between the receipt of appropriate empiric antimicrobial therapy and in-hospital mortality (HR, 1.03; 95% CI, 0.60 to 1.78. The median post-infection length of stay was 7 days. The receipt of appropriate antimicrobial agents was not associated

  7. Antibacterial Agent Adjustment Performed by Clinical Pharmacists in the Treatment of One Case of Hospi-tal-acquired Pneumonia%临床药师参与1例医院获得性肺炎患者抗菌药物调整

    Institute of Scientific and Technical Information of China (English)

    张金莲; 李莉霞

    2014-01-01

    目的::小结临床药师在协同查房中调整抗菌药物治疗的工作。方法:临床药师参入1例医院获得性肺炎病例查房,与医生共同确定、抗菌药选择并实行药学服务。结果:临床药师协同查房,关注病程发展,病史,用药史,选用正确的抗菌药覆盖可疑病原菌及时控制感染。结论:临床药师参与药物治疗,主动提出抗菌药使用建议,为患者和医师提供药学服务提高药物治疗质量。%Objective:To summary the antibacterial agent therapy adjustment performed by clinical pharmacists in the collabora-tive rounds. Methods:Combined with physicians, clinical pharmacists participated in the ward round and antibacterial agent selection for one case of hospital-acquired pneumonia, meanwhile, pharmaceutical care was performed for the patient. Results:Clinical pharma-cists chose appropriate antibacterial agents for the patient to cover the suspected pathogens and control the infection in time through par-ticipating in the ward round and paying attention to the disease course progress, medical history and medication history. Conclusion:Clinical pharmacists can enhance the quality of drug therapy through participating in the drug therapy, providing the proposal for the antibacterial agent use and performing pharmaceutical service for physicians and patients.

  8. Chronic obstructive pulmonary disease severity is associated with severe pneumonia

    Directory of Open Access Journals (Sweden)

    Jung Seop Eom

    2015-01-01

    Full Text Available CONTEXT: Chronic obstructive pulmonary disease (COPD is a heterogeneous disorder, and various aspects of COPD may be associated with the severity of pneumonia in such patients. AIMS: We examined the risk factors associated with severe pneumonia in a COPD population. MATERIALS AND METHODS: We performed a retrospective observational study using a prospectively collected database of pneumonia patients who were admitted to our hospital through emergency department between 2008 and 2012. Patients with hospital-acquired pneumonia and those with an immunocompromised status were excluded. RESULTS: Of 148 pneumonia patients with COPD for whom chest computed tomography (CT scans were available, 106 (71.6% and 42 (28.4% were classified as non-severe and severe pneumonia, respectively. Multivariate logistic regression analysis revealed that the severity of airflow limitation [odds ratio (OR, 2.751; 95% confidence interval (CI, 1.074-7.050; P = 0.035] and the presence of emphysema on a chest CT scan (OR, 3.366; 95% CI, 1.104-10.265; P = 0.033 were independently associated with severe pneumonia in patients with COPD. CONCLUSIONS: The severity of COPD including the airflow limitation grade and the presence of pulmonary emphysema were independently associated with the development of severe pneumonia.

  9. Observation of clinical efficacy of amoxicillin and clavulanate potassium injection combined with compound danshen injection in treatment of community acquired pneumonia%注射用阿莫西林克拉维酸钾联合复方丹参注射液治疗社区获得性肺炎临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    郁殿明

    2014-01-01

    目的:观察注射用阿莫西林克拉维酸钾联合丹参注射液治疗社区获得性肺炎的临床疗效。方法选取我院2013年1月~2014年5月期间收治的社区获得性肺炎患者80例,随机分成治疗组和对照组各40例,治疗组采用注射用阿莫西林克拉维酸钾联合复方丹参注射液静滴,对照组单独应用阿莫西林克拉维酸钾静滴,两组患者均连续静脉用药7d。于疗程结束后1周评价疗效,分别比较两组患者的临床表现,包括体温改变、咳嗽的变化及肺部体征的变化,并进行胸片及血常规检查,同时记录不良反应发生情况及症状消退的时间,对比分析两组的临床效果和用药安全性。结果治疗组总有效率92.50%,明显高于对照组的72.50%,两组患者退热时间方面无显著差异,但治疗组咳嗽消失时间、X线改变恢复正常平均时间及白细胞恢复正常时间均明显短于对照组,差异有统计学意义。结论使用注射用阿莫西林克拉维酸钾联合复方丹参注射液治疗社区获得性肺炎较单独应用阿莫西林克拉维酸钾可以明显缩短疗程,提高疗效,有一定的临床借鉴意义。%Objective To observe the clinical efficacy of amoxicillin and clavulanate potassium injection combined with compound danshen injection in treatment of community acquired pneumonia. Methods Eighty patients with community acquired pneumonia treated in our hospital from January 2013 to May 2014 were selected and randomly divided into the treatment group and the control group, with 40 patients in each group. The treatment group received amoxicillin and clavulanate potassium injection combined with compound danshen injection and the control group received the intra-venous infusion of single amoxicillin and clavulanate potassium. Both groups received intravenous medication for 7 continuous days. The efficacy was evaluated one week after the end of treatment. Clinical

  10. Osteopontin promotes host defense during Klebsiella pneumoniae-induced pneumonia

    NARCIS (Netherlands)

    G.J.W. van der Windt; J.J. Hoogerwerf; A.F. de Vos; S. Florquin; T. van der Poll

    2010-01-01

    Klebsiella pneumoniae is a common cause of nosocomial pneumonia. Osteopontin (OPN) is a phosphorylated glycoprotein involved in inflammatory processes, some of which is mediated by CD44. The aim of this study was to determine the role of OPN during K. pneumoniae-induced pneumonia. Wild-type (WT) and

  11. Vibration Response Imaging: evaluation of rater agreement in healthy subjects and subjects with pneumonia

    OpenAIRE

    Makris Demosthenes; Kerenidi Theodora; Triantaris Apostolos; Zygoulis Paris; Preau Sebastien; Daenas Christos; Bartziokas Konstantinos; Gourgoulianis Konstantinos I; Daniil Zoe

    2010-01-01

    Abstract Background We evaluated pulmonologists variability in the interpretation of Vibration response imaging (VRI) obtained from healthy subjects and patients hospitalized for community acquired pneumonia. Methods The present is a prospective study conducted in a tertiary university hospital. Twenty healthy subjects and twenty three pneumonia cases were included in this study. Six pulmonologists blindly analyzed images of normal subjects and pneumonia cases and evaluated different aspects ...

  12. Alcohol abuse and Streptococcus pneumoniae infections: Consideration of Virulence Factors and Impaired Immune Responses

    OpenAIRE

    Bhatty, Minny; Pruett, Stephen B.; Swiatlo, Edwin; Nanduri, Bindu

    2011-01-01

    Alcohol is the most frequently abused substance in the world. Both acute and chronic alcohol consumption have diverse and well documented effects on the human immune system, leading to increased susceptibility to infections like bacterial pneumonia. S. pneumoniae is the most common bacterial etiology of community acquired pneumonia world-wide. The frequency and severity of pneumococcal infections in individuals with a history of alcohol abuse is much higher than the general population. Despit...

  13. R-roscovitine Reduces Lung Inflammation Induced by Lipoteichoic Acid and Streptococcus pneumoniae

    OpenAIRE

    Hoogendijk, Arie J.; Roelofs, Joris J. T. H.; Duitman, JanWillem; van Lieshout, Miriam H. P.; Blok, Dana C; van der Poll, Tom; Wieland, Catharina W.

    2012-01-01

    Bacterial pneumonia remains associated with high morbidity and mortality. The gram-positive pathogen Streptococcus pneumoniae is the most common cause of community-acquired pneumonia. Lipoteichoic acid (LTA) is an important proinflammatory component of the gram-positive bacterial cell wall. R-roscovitine, a purine analog, is a potent cyclin-dependent kinase (CDK)-1, −2, −5 and −7 inhibitor that has the ability to inhibit the cell cycle and to induce polymorphonuclear cell (PMN) apoptosis. We ...

  14. Antipsychotic drug use and community-acquired pneumonia

    NARCIS (Netherlands)

    G. Trifirò (Gianluca)

    2011-01-01

    textabstractAntipsychotics are generally distinguished as atypical and typical agents, which are indicated in the treatment of acute and chronic psychoses and other psychiatric disorders. In April 2005, the US Food and Drug Administration issued a warning about the increased risk of all-cause mortal

  15. Computed tomographic study on Mycoplasma pneumoniae pneumonia

    International Nuclear Information System (INIS)

    Serologically proven 21 patients with Mycoplasma pneumoniae pneumonia that showed infiltrative shadows on chest radiograms were studied by computed tomography (CT). Localization of the lesion and the fashion of its progression through the lung were analyzed. Following 3 loci were defined on the basis of the investigations of critical analysis of the chest radiograms, and of radiopathological analysis of the experimental animal model of mycoplasmal pneumonia with soft X-ray image. I: Peribronchial and periarterial interstitium. II: Bronchiole and its surroundings. III: Lung parenchyma, on hilar area as IIIh, on marginal area as IIIm. Even in the early phase of this disease, radiopathological findings on CT have been distributed in all loci mentioned above. The Shadow disappeared from locus III approximately 14th day from the onset. The shadow have remained, however, loci I, II for a long period. Those findings suggest that locus I and II are one of the major focus of Mycoplasma neumoniae pneumonia. Volume loss in the locus III was observed 78 % of the cases at 28th day from the onset. The shadow on locus IIIh was more prominent than locus IIIm. Reported analytical method with CT could be widely applied to disclose a radiopathological details in other infectious diseases of the lung. (author)

  16. Risk factors of combined hospital-acquired pneumonia in patients with acute intracerebral hemorrhage and analysis of prognosis%急性脑出血术后合并医院获得性肺炎危险因素及预后分析

    Institute of Scientific and Technical Information of China (English)

    徐将荣

    2011-01-01

    目的 分析急性脑出血术后合并医院获得性肺炎(HAP)患者的危险因素及其影响预后.方法 选取2007年4月-2010年4月医院神经外科住院的72例急性脑出血术后合并HAP患者,按年龄分为:高龄组(≥75岁)36例,低龄组(<75岁)36例;分析两组患者的收缩压(SP)、舒张压(DP)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、白色假丝酵母菌(CAL)感染率、MRSA感染率、肺炎克雷伯菌(KPN)感染率与随访1年后生活自理能力评分(BI)的相关性,并比较两组BI、再出血率及死亡率的差异.结果 两组患者的SP、HbA1c、TC、CAL感染率、MRSA感染率、KPN感染率与BI值均呈负相关关系,r值分别为-0.854、-0.901、-0.742、-0.886、-0.911、-0.798;而DP与BI值均无明显相关,r值为-0.114.结论 急性脑出血术后合并HAP患者危险因素有SP、HbAlc、TC、CAL感染率、MRSA感染率、KPN感染率,且高龄患者预后差.%OBJECTIVE To analyze the risk factors effecting on prognosis of patients with acute intracerebral hemorrhage(ICH) post-operation complicated hospital-acquired pneumonia ( HAP). METHODS A total of 72 patients with acute 1CH post-operation complicated HAP in our hospital were divided into two groups, senility group (age>75) and young group (age<75), each group involved 36 patients, according the age. The factors of SP, DP, HbAlc, TC, Candida albicans(CA) infection rate, MRSA infection rate and Klebsiella pneumoniae(KP) infection rate were analyzed, the correlation to the value of Barthel index(BI) after 1 year follow-up. And Bl, recurrency rate and mortality rate were compared between two groups. RESULTS The negative correlation coefficients of SP, HbAlc, TC, CA infection rate, MRSA infection rate, KP infection rate with BI were confirmed, and DP was no correlation coefficients with these indexs. And the difference of BI, recurrency rate and mortality rate were present between two groups(P<0. 05). CONCLUSION The risk factors effecting on

  17. Impact of pneumococcal conjugate vaccine in children morbidity and mortality in Peru: Time series analyses.

    Science.gov (United States)

    Suarez, Victor; Michel, Fabiana; Toscano, Cristiana M; Bierrenbach, Ana Luiza; Gonzales, Marco; Alencar, Airlane Pereira; Ruiz Matus, Cuauhtemoc; Andrus, Jon K; de Oliveira, Lucia H

    2016-09-01

    Streptococcus pneumoniae is the leading cause of bacterial pneumonia, meningitis and sepsis in children worldwide. Despite available evidence on pneumococcal conjugate vaccine (PCV) impact on pneumonia hospitalizations in children, studies demonstrating PCV impact in morbidity and mortality in middle-income countries are still scarce. Given the disease burden, PCV7 was introduced in Peru in 2009, and then switched to PCV10 in late 2011. National public healthcare system provides care for 60% of the population, and national hospitalization, outpatient and mortality data are available. We thus aimed to assess the effects of routine PCV vaccination on pneumonia hospitalization and mortality, and acute otitis media (AOM) and all cause pneumonia outpatient visits in children under one year of age in Peru. We conducted a segmented time-series analysis using outcome-specific regression models. Study period was from January 2006 to December 2012. Data sources included the National information systems for hospitalization, mortality, outpatient visits, and RENACE, the national database of aggregated weekly notifications of pneumonia and other acute respiratory diseases (both hospitalized and non-hospitalized). Study outcomes included community acquired pneumonia outpatient visits, hospitalizations and deaths (ICD10 codes J12-J18); and AOM outpatient visits (H65-H67). Monthly age- and sex-specific admission, outpatient visit, and mortality rates per 100,000 children aged Peru. PMID:27521230

  18. Pneumonia (For Parents)

    Science.gov (United States)

    ... a medicine to treat your child's cough because cough suppressants stop the lungs from clearing mucus, which isn't helpful in some types of pneumonia. Over-the-counter cough and cold medications are not recommended for any ...

  19. Pneumonia in adults - discharge

    Science.gov (United States)

    ... In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious ... ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 69. Mandell LA. Streptococcus pneumoniae infections. In: Goldman L, Schafer ...

  20. [Thousand faces of Streptococcus pneumonia (pneumococcus) infections].

    Science.gov (United States)

    Szabó, Bálint Gergely; Lénárt, Katalin Szidónia; Kádár, Béla; Gombos, Andrea; Dezsényi, Balázs; Szanka, Judit; Bobek, Ilona; Prinz, Gyula

    2015-11-01

    Incidence and mortality rates of infections caused by Streptococcus pneumoniae (pneumococcus) are high worldwide and in Hungary among paediatric as well as adult populations. Pneumococci account for 35-40% of community acquired adult pneumonias requiring hospitalization, while 25-30% of Streptococcus pneumoniae pneumonias are accompanied by bacteraemia. 5-7% of all infections are fatal but this rate is exponentially higher in high risk patients and elderly people. Mortality could reach 20% among patients with severe invasive pneumococcal infections. Complications may develop despite administration of adequate antibiotics. The authors summarize the epidemiology of pneumococcal infections, pathogenesis of non-invasive and invasive disease and present basic clinical aspects through demonstration of four cases. Early risk stratification, sampling of hemocultures, administration of antibiotics and wider application of active immunization could reduce the mortality of invasive disease. Anti-pneumococcal vaccination is advisable for adults of ≥50 years and high risk patients of ≥18 years who are susceptible to pneumococcal disease. PMID:26498896

  1. Bronchoscopy in lipoid pneumonia.

    OpenAIRE

    Kameswaran, M.; Annobil, S H; Benjamin, B.; Salim, M.

    1992-01-01

    Forcible administration of rendered animal fat to infants is a tradition in south western Saudi Arabia. Accidental inhalation may result in a resistant form of lipoid pneumonia. A series of 24 cases of lipoid pneumonia, 22 of which were diagnosed by bronchoscopy with bronchial lavage and microscopic examination of the aspirate, are reported. The technique is described briefly and the results analysed. A high index of suspicion together with bronchoscopy and bronchial lavage of all cases of re...

  2. Streptococcus pneumoniae colonisation in children and adolescents with asthma: impact of the heptavalent pneumococcal conjugate vaccine and evaluation of potential effect of thirteen-valent pneumococcal conjugate vaccine

    OpenAIRE

    Esposito, S.; L. Terranova; M.F. Patria; Marseglia, G L; Miraglia del Giudice, M; Bodini, A; Martelli, A.; Baraldi, E; O. Mazzina; Tagliabue, C.; A. Licari; V. Ierardi; M. Lelii; Principi, N

    2016-01-01

    Background The main aim of this study was to evaluate Streptococcus pneumoniae carriage in a group of school-aged children and adolescents with asthma because these results might indicate the theoretical risk of invasive pneumococcal disease (IPD) of such patients and the potential protective efficacy of the 13-valent pneumococcal conjugate vaccine (PCV13). Methods Oropharyngeal samples were obtained from 423 children with documented asthma (300 males, 70.9 %), and tested for the autolysin-A-...

  3. Streptococcus pneumoniae oropharyngeal colonization in school-age children and adolescents with type 1 diabetes mellitus: Impact of the heptavalent pneumococcal conjugate vaccine.

    Science.gov (United States)

    Principi, Nicola; Iughetti, Lorenzo; Cappa, Marco; Maffeis, Claudio; Chiarelli, Franco; Bona, Gianni; Gambino, Monia; Ruggiero, Luca; Patianna, Viviana; Matteoli, Maria Cristina; Marigliano, Marco; Cipriano, Paola; Parlamento, Silvia; Esposito, Susanna

    2016-01-01

    This study evaluated Streptococcus pneumoniae colonization in children and adolescents with type 1 diabetes mellitus (DM1) to investigate the theoretical risk of invasive pneumococcal disease (IPD) in these patients and the potential protective efficacy of pneumococcal conjugate vaccines (PCVs). An oropharyngeal swab was obtained from 299 patients aged 6-17 y with DM1 who were enrolled during routine clinical visits. DNA from swabs was analyzed for S. pneumoniae using real-time polymerase chain reaction. S. pneumoniae was identified in the swabs of 148 subjects (49.8%). Colonization was strictly age-related and declined significantly in the group aged ≥15 years (odds ratio [OR] 0.28; 95% confidence interval [CI], 0.14-0.57). Carriage was also significantly influenced by sex (lower in females: OR 0.56; 95% CI, 0.35-0.91), ethnicity (less common among non-Caucasians: OR 0.34; 95% CI, 0.13-0.89), parental smoking habit (more frequent among children with at least one smoker between parents: OR 1.76; 95% CI, 0.90-2.07), and the administration of antibiotic therapy in the previous 3 months (less frequent among patients who received antibiotics: OR 0.21; 95% CI, 0.07-0.62). Multivariate analyses of the entire study population showed no association between carriage and PCV7 vaccination status. Serotypes 19F, 9V, and 4 were the most frequently identified serotypes. In conclusion, school-age children and adolescents with DM1 are frequently colonized by S. pneumoniae, and protection against pneumococcal carriage following infant and toddler vaccination was not effective after several years. Together with the need to increase vaccine uptake in all the children aged <2 years, these results suggest that PCV booster doses are needed in DM1 patients to maintain the protection offered by these vaccinations.

  4. Reversed halo sign in pneumocystis pneumonia: a case report

    International Nuclear Information System (INIS)

    The reversed halo sign may sometimes be seen in patients with cryptogenic organizing pneumonia, but is rarely associated with other diseases. We present a case study of a 32-year-old male patient with acquired immunodeficiency syndrome, who had previously been treated with chemotherapy for non-Hodgkin's lymphoma. A chest X-ray showed bilateral patchy infiltrates. High-resolution computed tomography revealed the reversed halo sign in both upper lobes. The patient was diagnosed with pneumocystis pneumonia, which was successfully treated with sulfamethoxazole trimethoprim; the reversed halo sign disappeared, leaving cystic lesions. Cases such as this one are rare, but show that the reversed halo sign may occur in patients who do not have cryptogenic organizing pneumonia. Physicians can avoid making an incorrect diagnosis and prescribing the wrong treatment by carefully evaluating all clinical criteria rather than assuming that the reversed halo sign only occurs with cryptogenic organizing pneumonia

  5. Reversed halo sign in pneumocystis pneumonia: a case report

    Directory of Open Access Journals (Sweden)

    Hashimoto Kimio

    2010-11-01

    Full Text Available Abstract Background The reversed halo sign may sometimes be seen in patients with cryptogenic organizing pneumonia, but is rarely associated with other diseases. Case presentation We present a case study of a 32-year-old male patient with acquired immunodeficiency syndrome, who had previously been treated with chemotherapy for non-Hodgkin's lymphoma. A chest X-ray showed bilateral patchy infiltrates. High-resolution computed tomography revealed the reversed halo sign in both upper lobes. The patient was diagnosed with pneumocystis pneumonia, which was successfully treated with sulfamethoxazole trimethoprim; the reversed halo sign disappeared, leaving cystic lesions. Cases such as this one are rare, but show that the reversed halo sign may occur in patients who do not have cryptogenic organizing pneumonia. Conclusion Physicians can avoid making an incorrect diagnosis and prescribing the wrong treatment by carefully evaluating all clinical criteria rather than assuming that the reversed halo sign only occurs with cryptogenic organizing pneumonia.

  6. 颅脑外伤术后医院获得性肺炎危险因素分析及防治措施%Analysis of the risk factors and preventive measurement for hospital acquired pneumonia for postoperative severe traumatic brain injury patients

    Institute of Scientific and Technical Information of China (English)

    张玉玲

    2008-01-01

    Objective To investigate the risk factors and preventive measurement of hospital acquired pneumonia(HAP) for severe traumatic brain injury patients after surgery. Methods A total of 406 cases of patients operated for severe traumatic brain injury from Oct 2004 to Sep 2007 were retrospectively analyzed, and the risk factors were summarized. Results Fifty - one out of 57 cases of patients with HAP were satisfactorily cured, the other 6 cases dead. The risk factors prone to HAP were operative anesthesia, respiratory machine application, long hospitalization, respiratory tract incision, examination, mis - inspiration, reflec-ted high hoed suger level, antibacterial use, polluted air condition etc. Conclusion Enhancing consciousness of infection can-troll, reinforcing sickroom management, keeping air condition sterilized, strictly complying with asepsis operative rules, using antibacterial correctly are significant measures to prevent HAP.%目的 探讨颅脑外伤术后医院获得性肺炎危险因素及防治措施.方法 收集我院2004年10月至2007年9月颅脑外伤术后住院患者406例,对发生医院获得性肺炎的危险因素进行回顾性分析.结果 57例医院获得性肺炎患者经积极治疗,51例治疗效果满意,死亡6例.造成医院获得性肺炎的危险因素有手术麻醉方式、接受机械通气、住院时间长、气管切开、昏迷、误吸、应激性高血糖、抗菌药物应用、空气环境污染等.结论 增强感染控制意识,加强病房管理,做好空气消毒,严格无菌操作规程,合理应用抗菌药物是预防医院获得性肺炎的重要措施.

  7. Early Mycoplasma pneumoniae infection presenting as multiple pulmonary masses: an unusual presentation in a child

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Edward; Altes, Talissa; Anupindi, Sudha A. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

    2008-04-15

    Mycoplasma pneumoniae is a major cause of community-acquired pneumonia. Because most children are not imaged prior to onset of clinical symptoms, the appearance of early Mycoplasma infection has not been extensively studied. We present the case of an 11-year-old boy with large pulmonary masses incidentally detected during spine MRI evaluation for scoliosis. Eight days later, the patient developed acute respiratory symptoms, and the masses seen previously had evolved into a diffuse bronchiolitis. Diagnostic testing identified Mycoplasma pneumoniae as the likely etiology. We briefly review chest CT findings of infection by Mycoplasma and compare them to this unusual presentation of Mycoplasma pneumonia with subclinical imaging findings. (orig.)

  8. Early Mycoplasma pneumoniae infection presenting as multiple pulmonary masses: an unusual presentation in a child

    International Nuclear Information System (INIS)

    Mycoplasma pneumoniae is a major cause of community-acquired pneumonia. Because most children are not imaged prior to onset of clinical symptoms, the appearance of early Mycoplasma infection has not been extensively studied. We present the case of an 11-year-old boy with large pulmonary masses incidentally detected during spine MRI evaluation for scoliosis. Eight days later, the patient developed acute respiratory symptoms, and the masses seen previously had evolved into a diffuse bronchiolitis. Diagnostic testing identified Mycoplasma pneumoniae as the likely etiology. We briefly review chest CT findings of infection by Mycoplasma and compare them to this unusual presentation of Mycoplasma pneumonia with subclinical imaging findings. (orig.)

  9. Mycoplasma pneumoniae: Current Knowledge on Macrolide Resistance and Treatment.

    Science.gov (United States)

    Pereyre, Sabine; Goret, Julien; Bébéar, Cécile

    2016-01-01

    Mycoplasma pneumoniae causes community-acquired respiratory tract infections, particularly in school-aged children and young adults. These infections occur both endemically and epidemically worldwide. M. pneumoniae lacks cell wall and is subsequently resistant to beta-lactams and to all antimicrobials targeting the cell wall. This mycoplasma is intrinsically susceptible to macrolides and related antibiotics, to tetracyclines and to fluoroquinolones. Macrolides and related antibiotics are the first-line treatment of M. pneumoniae respiratory tract infections mainly because of their low MIC against the bacteria, their low toxicity and the absence of contraindication in young children. The newer macrolides are now the preferred agents with a 7-to-14 day course of oral clarithromycin or a 5-day course of oral azithromycin for treatment of community-acquired pneumonia due to M. pneumoniae, according to the different guidelines worldwide. However, macrolide resistance has been spreading for 15 years worldwide, with prevalence now ranging between 0 and 15% in Europe and the USA, approximately 30% in Israel and up to 90-100% in Asia. This resistance is associated with point mutations in the peptidyl-transferase loop of the 23S rRNA and leads to high-level resistance to macrolides. Macrolide resistance-associated mutations can be detected using several molecular methods applicable directly from respiratory specimens. Because this resistance has clinical outcomes such as longer duration of fever, cough and hospital stay, alternative antibiotic treatment can be required, including tetracyclines such as doxycycline and minocycline or fluoroquinolones, primarily levofloxacin, during 7-14 days, even though fluoroquinolones and tetracyclines are contraindicated in all children and in children fluoroquinolones has never been reported in M. pneumoniae clinical isolates but reduced susceptibility was reported in in vitro selected mutants. This article focuses on M. pneumoniae

  10. Chlamydia pneumoniae Promotes Dysfunction of Pancreatic Beta Cells

    Science.gov (United States)

    Rodriguez, Annette R.; Plascencia-Villa, Germán; Witt, Colleen M.; Yu, Jieh-Juen; José-Yacamán, Miguel; Chambers, James P.; Perry, George; Guentzel, M. Neal; Arulanandam, Bernard P.

    2015-01-01

    The human pathogen Chlamydia pneumoniae has been implicated in chronic inflammatory diseases including type 2 diabetes. Therefore, we designed a study to evaluate pancreatic beta cells and mast cells during chlamydial infection. Our study revealed that C. pneumoniae infected mast cells significantly (p< 0.005) decreased beta cell ATP and insulin production, in contrast to uninfected mast cells co-cultured with beta cells. Infected mast cells exhibited pyknotic nuclei and active caspase-3 and caspase-1 expression. Additionally, ex vivo analyses of tissues collected from C. pneumoniae infected mice showed increased interleukin-1β production in splenocytes and pancreatic tissues as was observed with in vitro mast cell-beta cell co-cultures during C. pneumoniae infection. Notably, infected mast cells promoted beta cell destruction. Our findings reveal the negative effect of C. pneumoniae on mast cells, and the consequential impact on pancreatic beta cell function and viability. PMID:25863744

  11. Impact of pneumococcal conjugate vaccine in children morbidity and mortality in Peru: Time series analyses.

    Science.gov (United States)

    Suarez, Victor; Michel, Fabiana; Toscano, Cristiana M; Bierrenbach, Ana Luiza; Gonzales, Marco; Alencar, Airlane Pereira; Ruiz Matus, Cuauhtemoc; Andrus, Jon K; de Oliveira, Lucia H

    2016-09-01

    Streptococcus pneumoniae is the leading cause of bacterial pneumonia, meningitis and sepsis in children worldwide. Despite available evidence on pneumococcal conjugate vaccine (PCV) impact on pneumonia hospitalizations in children, studies demonstrating PCV impact in morbidity and mortality in middle-income countries are still scarce. Given the disease burden, PCV7 was introduced in Peru in 2009, and then switched to PCV10 in late 2011. National public healthcare system provides care for 60% of the population, and national hospitalization, outpatient and mortality data are available. We thus aimed to assess the effects of routine PCV vaccination on pneumonia hospitalization and mortality, and acute otitis media (AOM) and all cause pneumonia outpatient visits in children under one year of age in Peru. We conducted a segmented time-series analysis using outcome-specific regression models. Study period was from January 2006 to December 2012. Data sources included the National information systems for hospitalization, mortality, outpatient visits, and RENACE, the national database of aggregated weekly notifications of pneumonia and other acute respiratory diseases (both hospitalized and non-hospitalized). Study outcomes included community acquired pneumonia outpatient visits, hospitalizations and deaths (ICD10 codes J12-J18); and AOM outpatient visits (H65-H67). Monthly age- and sex-specific admission, outpatient visit, and mortality rates per 100,000 children aged impact in morbidity and mortality in children aged <1year. Vaccine effectiveness was 26.2% (95% CI 16.9-34.4) for AOM visits, 35% (95% CI 8.6-53.8) for mortality due to pneumonia, and 20.6% (95% CI 10.6-29.5) for weekly cases of pneumonia hospitalization and outpatient visits notified to RENACE. We used secondary data sources which are usually developed for other non-epidemiologic purposes. Despite some data limitations, our results clearly demonstrate the overall benefit of PCV vaccination in Peru.

  12. Pneumonia Can Be Prevented -- Vaccines Can Help

    Science.gov (United States)

    ... What's this? Submit Button Past Emails CDC Features Pneumonia Can Be Prevented—Vaccines Can Help Language: English ... of an adult patient with pneumonia. What Is Pneumonia? Pneumonia is an infection of the lungs that ...

  13. Antibiogram Typing and Biochemical Characterization of Klebsiella pneumoniae after Biofield Treatment

    OpenAIRE

    Trivedi, Mahendra; Branton, Alice; Trivedi, Dahryn

    2015-01-01

    Klebsiella pneumoniae (K. pneumoniae) is a common nosocomial pathogen causing respiratory tract (pneumoniae) and blood stream infections. Multidrug-resistant (MDR) isolates of K. pneumoniae infections are difficult to treat in patients in health care settings. Aim of the present study was to determine the impact of Mr. Trivedi’s biofield treatment on four MDR clinical lab isolates (LS) of K. pneumoniae (LS 2, LS 6, LS 7, and LS 14). Samples were divided into two groups i.e. control and biofie...

  14. Association study of TLR4 polymorphisms with severe community-acquired pneumonia susceptibility and outcome%TLR4基因多态性与重症社区获得性肺炎易感性和预后的关联

    Institute of Scientific and Technical Information of China (English)

    宋振举; 童朝阳; 孙湛; 姚晨玲; 邵勉; 黄培志

    2009-01-01

    目的 探讨Toll样受体4(toll-like-receptor4,TLR4)基因单核苷酸多态性(single nucleotide polymorphism,SNP)与中国汉族人群重症社区获得性肺炎(severe community-acquired pneumonia,SCAP)的易感性和预后的相关性.方法 收集2005年5月至2008年4月复旦大学附属中山医院急诊科收治的360例社区获得性肺炎(conununity-acquired pneumonia,CAP)患者进行前瞻性研究.排除既往患有自身免疫性疾病、正在应用免疫抑制剂、AIDS和肿瘤患者.本研究获得复旦大学附属中山医院伦理委员会同意.根据患者的病情程度分为SCAP组和NSCAP组,每组各180例.根据患者30 d内是否存活,分为存活组和死亡组,存活组300例,死亡组60例.利用Hapmap中国人群数据库选择SNPs和标签SNPs(TagSNPs),利用Primer 3软件设计引物;采用DNA抽提试剂盒提取外周血DNA,PER-直接测序法进行SNPs分型.基因型频率和等位基因频率在各组之间的比较采用χ2检验.结果 TLR4基因3个TagSNPs(rs2149356,rs11536879,rs1927907)等位基因频率分布在研究样本中符合Hardy-Weinberg平衡.TagSNPs等位基因频率和基因型频率在SCAP组和非重症肺炎(non-SCAP,NSCAP)组相比,差异无统计学意义;存活组和死亡组相比,差异无统计学意义(P>0.05);研究发现由rs2149356和rs11536879组成的3种单倍型(GA,TA,TG)频率在SCAP组和NSCAP组差异无统计学意义,在死亡组和存活组中差异无统计学意义(P>0.05).结论 TLR4基因多态性与中国汉族人群SCAP的易感性和预后无相关性.%Objective To investigate the possible association of TLR4 polymorphisms with susceptibility and prognosis of SCAP.Method A total of 360 CAP patients hospitalized in emergency department of Zhongshan hospital from May 2005 to April 2008 were enrolled in this case-control study.Patients were excluded if they had metastatic tumors,autoimmune diseases,AIDS or received immunosuppressive drugs.This study was approved by the

  15. A compendium for Mycoplasma pneumoniae

    Directory of Open Access Journals (Sweden)

    Gretchen Lynn Parrott

    2016-04-01

    Full Text Available Historically, atypical pneumonia was a term used to describe an unusual presentation of pneumonia. Currently, it is used to describe the multitude of symptoms juxtaposing the classic symptoms found in cases of pneumococcal pneumonia. Specifically, atypical pneumonia is a syndrome resulting from a relatively common group of pathogens including Chlamydophila sp., and Mycoplasma pneumoniae. The incidence of M. pneumoniae pneumonia in adults is less than the burden experienced by children. Transmission rates among families indicate children may act as a reservoir and maintain contagiousness over a long period of time ranging from months to years. In adults, M. pneumoniae typically produces a mild, walking pneumonia and is considered to be one of the causes of persistent cough in patients. M. pneumoniae has also been shown to trigger the exacerbation of other lung diseases. It has been repeatedly detected in patients with bronchitis, asthma, chronic obstructive pulmonary disorder and cystic fibrosis. Recent advances in technology allow for the rapid diagnosis of M. pneumoniae through the use of polymerase chain reaction (PCR or rapid antigen tests. With this, more effort has been afforded to identify the causative etiologic agent in all cases of pneumonia. However, previous practices, including the overprescribing of macrolide treatment in China and Japan, have created increased incidence of macrolide-resistant M. pneumoniae. Reports from these countries indicate that >85% of M. pneumoniae pneumonia pediatric cases are macrolide-resistant. Despite its extensively studied past, the smallest bacterial species still inspires some of the largest questions. The developments in microbiology, diagnostic features and techniques, epidemiology, treatment and vaccines, and upper respiratory conditions associated with M. pneumoniae in adult populations are included within this review.

  16. A Compendium for Mycoplasma pneumoniae.

    Science.gov (United States)

    Parrott, Gretchen L; Kinjo, Takeshi; Fujita, Jiro

    2016-01-01

    Historically, atypical pneumonia was a term used to describe an unusual presentation of pneumonia. Currently, it is used to describe the multitude of symptoms juxtaposing the classic symptoms found in cases of pneumococcal pneumonia. Specifically, atypical pneumonia is a syndrome resulting from a relatively common group of pathogens including Chlamydophila sp., and Mycoplasma pneumoniae. The incidence of M. pneumoniae pneumonia in adults is less than the burden experienced by children. Transmission rates among families indicate children may act as a reservoir and maintain contagiousness over a long period of time ranging from months to years. In adults, M. pneumoniae typically produces a mild, "walking" pneumonia and is considered to be one of the causes of persistent cough in patients. M. pneumoniae has also been shown to trigger the exacerbation of other lung diseases. It has been repeatedly detected in patients with bronchitis, asthma, chronic obstructive pulmonary disorder, and cystic fibrosis. Recent advances in technology allow for the rapid diagnosis of M. pneumoniae through the use of polymerase chain reaction or rapid antigen tests. With this, more effort has been afforded to identify the causative etiologic agent in all cases of pneumonia. However, previous practices, including the overprescribing of macrolide treatment in China and Japan, have created increased incidence of macrolide-resistant M. pneumoniae. Reports from these countries indicate that >85% of M. pneumoniae pneumonia pediatric cases are macrolide-resistant. Despite its extensively studied past, the smallest bacterial species still inspires some of the largest questions. The developments in microbiology, diagnostic features and techniques, epidemiology, treatment and vaccines, and upper respiratory conditions associated with M. pneumoniae in adult populations are included within this review. PMID:27148202

  17. A cohort study of bacteremic pneumonia

    Science.gov (United States)

    Guillamet, Cristina Vazquez; Vazquez, Rodrigo; Noe, Jonas; Micek, Scott T.; Kollef, Marin H.

    2016-01-01

    Abstract Bacteremic pneumonia is usually associated with greater mortality. However, risk factors associated with hospital mortality in bacteremic pneumonia are inadequately described. The study was a retrospective cohort study, conducted in Barnes-Jewish Hospital (2008–2015). For purposes of this investigation, antibiotic susceptibility was determined according to ceftriaxone susceptibility, as ceftriaxone represents the antimicrobial agent most frequently recommended for hospitalized patients with community-acquired pneumonia as opposed to nosocomial pneumonia. Two multivariable analyses were planned: the first model included resistance to ceftriaxone as a variable, whereas the second model included the various antibiotic-resistant species (methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae). In all, 1031 consecutive patients with bacteremic pneumonia (mortality 37.1%) were included. The most common pathogens associated with infection were S aureus (34.1%; methicillin resistance 54.0%), Enterobacteriaceae (28.0%), P aeruginosa (10.6%), anaerobic bacteria (7.3%), and Streptococcus pneumoniae (5.6%). Compared with ceftriaxone-susceptible pathogens (46.8%), ceftriaxone-resistant pathogens (53.2%) were significantly more likely to receive inappropriate initial antibiotic treatment (IIAT) (27.9% vs 7.1%; P mechanical ventilation, immune suppression, prior hospitalization, prior antibiotic administration, septic shock, comorbid conditions, and severity of illness. In the second multivariable analysis that included the antibiotic-resistant species, IIAT was still associated with excess mortality, and P aeruginosa infection was identified as an independent predictor of mortality (OR 1.6, 95% CI 1.1–2.2, P = 0.047), whereas infection with ceftriaxone-resistant Enterobacteriaceae (OR 0.6, 95% CI 0.4–1.0, P = 0.050) was associated with lower mortality. More than one-third of our patients hospitalized with bacteremic

  18. Klebsiella pneumoniae oropharyngeal carriage in rural and urban Vietnam and the effect of alcohol consumption.

    Directory of Open Access Journals (Sweden)

    Trinh Tuyet Dao

    Full Text Available INTRODUCTION: Community acquired K. pneumoniae pneumonia is still common in Asia and is reportedly associated with alcohol use. Oropharyngeal carriage of K. pneumoniae could potentially play a role in the pathogenesis of K. pneumoniae pneumonia. However, little is known regarding K. pneumoniae oropharyngeal carriage rates and risk factors. This population-based cross-sectional study explores the association of a variety of demographic and socioeconomic factors, as well as alcohol consumption with oropharyngeal carriage of K. pneumoniae in Vietnam. METHODS AND FINDINGS: 1029 subjects were selected randomly from age, sex, and urban and rural strata. An additional 613 adult men from a rural environment were recruited and analyzed separately to determine the effects of alcohol consumption. Demographic, socioeconomic, and oropharyngeal carriage data was acquired for each subject. The overall carriage rate of K. pneumoniae was 14.1% (145/1029, 95% CI 12.0%-16.2%. By stepwise logistic regression, K. pneumoniae carriage was found to be independently associated with age (OR 1.03, 95% CI 1.02-1.04, smoking (OR 1.9, 95% CI 1.3-2.9, rural living location (OR 1.6, 95% CI 1.1-2.4, and level of weekly alcohol consumption (OR 1.7, 95% CI 1.04-2.8. CONCLUSION: Moderate to heavy weekly alcohol consumption, old age, smoking, and living in a rural location are all found to be associated with an increased risk of K. pneumoniae carriage in Vietnamese communities. Whether K. pneumoniae carriage is a risk factor for pneumonia needs to be elucidated.

  19. Klebsiella pneumoniae Oropharyngeal Carriage in Rural and Urban Vietnam and the Effect of Alcohol Consumption

    Science.gov (United States)

    Dao, Trinh Tuyet; Liebenthal, Dror; Tran, Toan Khanh; Ngoc Thi Vu, Bich; Ngoc Thi Nguyen, Diep; Thi Tran, Huong Kieu; Thi Nguyen, Chuc Kim; Thi Vu, Huong Lan; Fox, Annette; Horby, Peter; Van Nguyen, Kinh; Wertheim, Heiman F. L.

    2014-01-01

    Introduction Community acquired K. pneumoniae pneumonia is still common in Asia and is reportedly associated with alcohol use. Oropharyngeal carriage of K. pneumoniae could potentially play a role in the pathogenesis of K. pneumoniae pneumonia. However, little is known regarding K. pneumoniae oropharyngeal carriage rates and risk factors. This population-based cross-sectional study explores the association of a variety of demographic and socioeconomic factors, as well as alcohol consumption with oropharyngeal carriage of K. pneumoniae in Vietnam. Methods and Findings 1029 subjects were selected randomly from age, sex, and urban and rural strata. An additional 613 adult men from a rural environment were recruited and analyzed separately to determine the effects of alcohol consumption. Demographic, socioeconomic, and oropharyngeal carriage data was acquired for each subject. The overall carriage rate of K. pneumoniae was 14.1% (145/1029, 95% CI 12.0%–16.2%). By stepwise logistic regression, K. pneumoniae carriage was found to be independently associated with age (OR 1.03, 95% CI 1.02–1.04), smoking (OR 1.9, 95% CI 1.3–2.9), rural living location (OR 1.6, 95% CI 1.1–2.4), and level of weekly alcohol consumption (OR 1.7, 95% CI 1.04–2.8). Conclusion Moderate to heavy weekly alcohol consumption, old age, smoking, and living in a rural location are all found to be associated with an increased risk of K. pneumoniae carriage in Vietnamese communities. Whether K. pneumoniae carriage is a risk factor for pneumonia needs to be elucidated. PMID:24667800

  20. Idiopathic interstitial pneumonia

    International Nuclear Information System (INIS)

    In order to identify and classify the basic CT appearance of interstitial pneumonia, radiologic-pathologic correlative study was performed using inflated and fixed lungs from autopsy and surgery. The patterns of the abnormalities on the CT images of interstitial pneumonia were classified into 7 categories. Important pathological changes which affected the CT images were alveolar collapse and airway dilatation. Based on the result of above study, we analyzed CT of 22 patients with IIP. The lesions which were classified into a hazy density, micronodular densities, confluence of various sized ring like shadows and subpleural bullous changes were frequently recognized together mostly in the periphery of the lung. (author)

  1. Role of Nucleotide-Binding Oligomerization Domain-Containing (NOD 2 in Host Defense during Pneumococcal Pneumonia.

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    Tijmen J Hommes

    Full Text Available Streptococcus (S. pneumoniae is the most common causative pathogen in community-acquired pneumonia. Nucleotide-binding oligomerization domain-containing (NOD 2 is a pattern recognition receptor located in the cytosol of myeloid cells that is able to detect peptidoglycan fragments of S. pneumoniae. We here aimed to investigate the role of NOD2 in the host response during pneumococcal pneumonia. Phagocytosis of S. pneumoniae was studied in NOD2 deficient (Nod2-/- and wild-type (Wt alveolar macrophages and neutrophils in vitro. In subsequent in vivo experiments Nod2-/- and Wt mice were inoculated with serotype 2 S. pneumoniae (D39, an isogenic capsule locus deletion mutant (D39Δcps or serotype 3 S. pneumoniae (6303 via the airways, and bacterial growth and dissemination and the lung inflammatory response were evaluated. Nod2-/- alveolar macrophages and blood neutrophils displayed a reduced capacity to internalize pneumococci in vitro. During pneumonia caused by S. pneumoniae D39 Nod2-/- mice were indistinguishable from Wt mice with regard to bacterial loads in lungs and distant organs, lung pathology and neutrophil recruitment. While Nod2-/- and Wt mice also had similar bacterial loads after infection with the more virulent S. pneumoniae 6303 strain, Nod2-/- mice displayed a reduced bacterial clearance of the normally avirulent unencapsulated D39Δcps strain. These results suggest that NOD2 does not contribute to host defense during pneumococcal pneumonia and that the pneumococcal capsule impairs recognition of S. pneumoniae by NOD2.

  2. Streptococcus pneumoniae as an agent of nosocomial infection: treatment in the era of penicillin-resistant strains

    OpenAIRE

    F. Paradisi; Corti, G.; R. Cinelli

    2001-01-01

    Abstract. Streptococcus pneumoniae is a well-known agent of community-acquired infections such as sinusitis, otitis media, pneumonia, bacterial meningitis, bacteremia, and acute exacerbations of chronic bronchitis. However, the role of S.pneumoniae as a cause of nosocomial infections of respiratory tract, bloodstream, and central nervous system is more and more recognised, primarily in high-risk patients with depression of their immune function. Therapy of pneumococcal infections is made diff...

  3. ASSOCIATION OF MYCOPLASMA PNEUMONIAE WITH RESPIRATORY TRACT INFECTIONS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Osama Mohammed Saed Abdul-Wahab

    2013-01-01

    Full Text Available Mycoplasma pneumoniae is one of four most common species of organisms that are responsible for most clinically significant infections in humans. It is a frequent cause of acute respiratory infections in both children and adults. The organism can cause pharyngitis, otitis, tracheobronchitis, or community-acquired pneumonia, but patients may also remain totally asymptomatic. Aim of this prospective study for children, was to investigate the association of M. pneumoniae with respiratory tract infections in a Saudi population. This study was designed as a case-control study in which 90 patients (Mean age of the patients in case group was 5.94±2.73 and in control group was 6.51±2.26 of either sexes were included. These patients were classified into two groups: first group (case group, included 45 patients who had been admitted in hospital with diagnosis of respiratory tract infections and the second group (control group, included 45 healthy patients who had no history of respiratory tract infections. Both the groups were age and sex matched. Presence of IgM antibodies to Mycoplasma pneumoniae was assessed by ELISA technique in both groups. In the case group, 4 (9% cases out of 45 children were positive for anti-mycoplasma anti