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Sample records for acquired pneumonia impact

  1. Hospital-acquired pneumonia

    Science.gov (United States)

    ... 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.

  2. Impact of microbiological samples in the hospital management of community-acquired, nursing home-acquired and hospital-acquired pneumonia in older patients.

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    Putot, A; Tetu, J; Perrin, S; Bailly, H; Piroth, L; Besancenot, J-F; Bonnotte, B; Chavanet, P; d'Athis, P; Charles, P-E; Sordet-Guépet, H; Manckoundia, P

    2016-03-01

    We investigated the positivity rate, the detection rates for non-covered pathogens and the therapeutic impact of microbiological samples (MS) in community-acquired pneumonia (CAP), nursing home-acquired pneumonia (NHAP) and hospital-acquired pneumonia (HAP) in elderly hospitalised patients. Patients aged 75 years and over with pneumonia and hospitalised between 1/1/2013 and 30/6/2013 in the departments of medicine (5) and intensive care (1) of our university hospital were included. Microbiological findings, intra-hospital mortality and one-year mortality were recorded. Among the 217 patients included, there were 138 CAP, 56 NHAP and 23 HAP. MS were performed in 89.9, 91.1 and 95.6 % of CAP, NHAP and HAP, respectively. Microbiological diagnosis was made for 29, 11.8 and 27.3 % of patients for CAP, NHAP and HAP, respectively (p = 0.05). Non-covered pathogens were detected for 8 % of CAP, 2 % of NHAP and 13.6 % of HAP (p = 0.1). The antimicrobial spectrum was significantly more frequently reduced when the MS were positive (46.7 % vs. 10.8 % when MS were negative, p = 10(-7)). The MS positivity rate was significantly lower in NHAP than in CAP and HAP. MS revealed non-covered pathogens in only 2 % of NHAP. These results show the poor efficiency and weak clinical impact of MS in the management of pneumonia in hospitalised older patients and suggest that their use should be rationalised.

  3. 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

  4. Nursing home-acquired pneumonia.

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    El Solh, Ali A

    2009-02-01

    Nursing home-acquired pneumonia (NHAP) was first described in 1978. Since then there has been much written regarding NHAP and its management despite the lack of well-designed studies in this patient population. The most characteristic features of patients with NHAP are the atypical presentation, which may lead to delay in diagnosis and therapy. The microbial etiology of pneumonia encompasses a wide spectrum that spans microbes recovered from patients with community-acquired pneumonia to organisms considered specific only to nosocomial settings. Decision to transfer a nursing home patient to an acute care facility depends on a host of factors, which include the level of staffing available at the nursing home, patients' advance directives, and complexity of treatment. The presence of risk factors for multidrug-resistant pathogens dictates approach to therapy. Prevention remains the cornerstone of reducing the incidence of disease. Despite the advance in medical services, mortality from NHAP remains high.

  5. 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.

  6. 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

  7. Impact of the pneumococcal 10-valent vaccine on reducing hospitalization for community-acquired pneumonia in children

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    da Silva, Sandra Rodrigues; de Mello, Luane Marques; da Silva, Anderson Soares; Nunes, Altacílio Aparecido

    2016-01-01

    Abstract Objective: To describe and analyze the occurrence of hospitalizations for community-acquired pneumonia in children before and after the pneumococcal 10-valent conjugate vaccine implementation into the National Immunization Program. Methods: This is an ecological study that includes records of children younger than one year old, vaccinated and not vaccinated with the pneumococcal 10-valent conjugate vaccine in the periods pre- and post-inclusion of the vaccine in the National Immunization Program in the area covered by the Regional Health Superintendence of Alfenas, state of Minas Gerais, Brazil. Vaccination was considered as the exposure factor and hospitalization for community-acquired pneumonia as the endpoint, using secondary annual data by municipality. The prevalence ratio and its 95% confidence interval (95%CI) were used to verify the association between variables. The Z test was used to calculate the difference between proportions. Results: Considering the 26 municipalities of the Regional Health Superintendence of Alfenas, there was a significant reduction in hospitalizations for community-acquired pneumonia in children younger than one year of age, with prevalence ratio (PR)=0.81 (95%CI: 0.74-0.89; p<0.05), indicating a 19% lower prevalence of hospitalization for community-acquired pneumonia in the post-vaccination period. Conclusions: The results suggest the effectiveness of the pneumococcal 10-valent conjugate vaccine in preventing severe cases of community-acquired pneumonia in children younger than one year of age. PMID:27108092

  8. 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

  9. Recognising and managing community-acquired pneumonia.

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    Gibson, Vanessa

    2015-11-18

    Pneumonia remains a significant cause of morbidity and mortality in the UK and yet the seriousness of the disease is underestimated. Pneumonia can be life-threatening because the delicate tissues of the alveoli and pulmonary capillaries are susceptible to damage from the inflammatory response. This damage leads to consolidation that prevents the diffusion of oxygen and carbon dioxide, and this in turn can lead to respiratory failure. This article summarises guidance on the diagnosis and management of community-acquired pneumonia, and also includes information on the prevention of pneumonia. This information should be valuable to nurses working in a variety of clinical areas since patients with community-acquired pneumonia are encountered in primary, intermediate, secondary and critical care.

  10. 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.

  11. 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

  12. Treatment of community-acquired pneumonia.

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    Lee, Young R; Houngue, Coovi; Hall, Ronald G

    2015-01-01

    Community-acquired pneumonia is the sixth leading cause of death in the USA. Adherence to the 2007 Infectious Diseases Society of America/American Thoracic Society community-acquired pneumonia guidelines has been associated with improved clinical outcomes. However, choice between guideline-recommended treatments is at the discretion of the prescribing clinician. This review is intended to discuss the characteristics of these treatment options including dosing frequency, dose adjustment for renal/hepatic dysfunction, serious/common adverse events, drug interactions, lung penetration, pharmacokinetic-pharmacodynamic target and effect of obesity to help guide antimicrobial selection. An increasing portion of patients are receiving expanded empiric coverage for methicillin-resistant Staphylococcus aureus as recommended by the American Thoracic Society and Infectious Diseases Society of America for healthcare-associated pneumonia. However, this expanded coverage may not be achieving the desired improvements in clinical outcomes. We expect this increasingly diverse spectrum of patients with pneumonia to eventually result in the merger of these two guidelines to include all patients with pneumonia.

  13. The Impact of Patient Profiles and Procedures on Hospitalization Costs through Length of Stay in Community-Acquired Pneumonia Patients Based on a Japanese Administrative Database.

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    Hironori Uematsu

    Full Text Available Community-acquired pneumonia is a common cause of patient hospitalization, and its burden on health care systems is increasing in aging societies. In this study, we aimed to investigate the factors that affect hospitalization costs in community-acquired pneumonia patients while considering the intermediate influence of patient length of stay.Using a multi-institutional administrative claims database, we analyzed 30,041 patients hospitalized for community-acquired pneumonia who had been discharged between April 1, 2012 and September 30, 2013 from 289 acute care hospitals in Japan. Possible factors associated with hospitalization costs were investigated using structural equation modeling with length of stay as an intermediate variable. We calculated the direct, indirect (through length of stay, and total effects of the candidate factors on hospitalization costs in the model. Lastly, we calculated the ratio of indirect effects to direct effects for each factor.The structural equation model showed that higher disease severities (using A-DROP, Barthel Index, and Charlson Comorbidity Index scores, use of mechanical ventilation, and tube feeding were associated with higher hospitalization costs, regardless of the intermediate influence of length of stay. The severity factors were also associated with longer length of stay durations. The ratio of indirect effects to direct effects on total hospitalization costs showed that the former was greater than the latter in the factors, except in the use of mechanical ventilation.Our structural equation modeling analysis indicated that patient profiles and procedures impacted on hospitalization costs both directly and indirectly. Furthermore, the profiles were generally shown to have greater indirect effects (through length of stay on hospitalization costs than direct effects. These findings may be useful in supporting the more appropriate distribution of health care resources.

  14. Community-acquired pneumonia among smokers.

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    Almirall, Jordi; Blanquer, José; Bello, Salvador

    2014-06-01

    Recent studies have left absolutely no doubt that tobacco increases susceptibility to bacterial lung infection, even in passive smokers. This relationship also shows a dose-response effect, since the risk reduces spectacularly 10 years after giving up smoking, returning to the level of non-smokers. Streptococcus pneumoniae is the causative microorganism responsible for community-acquired pneumonia (CAP) most frequently associated with smoking, particularly in invasive pneumococcal disease and septic shock. It is not clear how it acts on the progress of pneumonia, but there is evidence to suggest that the prognosis for pneumococcal pneumonia is worse. In CAP caused by Legionella pneumophila, it has also been observed that smoking is the most important risk factor, with the risk rising 121% for each pack of cigarettes smoked a day. Tobacco use may also favor diseases that are also known risk factors for CAP, such as periodontal disease and upper respiratory viral infections. By way of prevention, while giving up smoking should always be proposed, the use of the pneumococcal vaccine is also recommended, regardless of the presence of other comorbidities.

  15. Which individuals are at increased risk of pneumococcal disease and why? Impact of COPD, asthma, smoking, diabetes, and/or chronic heart disease on community-acquired pneumonia and invasive pneumococcal disease.

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    Torres, Antoni; Blasi, Francesco; Dartois, Nathalie; Akova, Murat

    2015-10-01

    Pneumococcal disease (including community-acquired pneumonia and invasive pneumococcal disease) poses a burden to the community all year round, especially in those with chronic underlying conditions. Individuals with COPD, asthma or who smoke, and those with chronic heart disease or diabetes mellitus have been shown to be at increased risk of pneumococcal disease compared with those without these risk factors. These conditions, and smoking, can also adversely affect patient outcomes, including short-term and long-term mortality rates, following pneumonia. Community-acquired pneumonia, and in particular pneumococcal pneumonia, is associated with a significant economic burden, especially in those who are hospitalised, and also has an impact on a patient's quality of life. Therefore, physicians should target individuals with COPD, asthma, heart disease or diabetes mellitus, and those who smoke, for pneumococcal vaccination at the earliest opportunity at any time of the year.

  16. 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.

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

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    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

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

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    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%).

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

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    Milačić Nena

    2015-07-01

    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. Ceftobiprole medocaril in the treatment of hospital-acquired pneumonia

    NARCIS (Netherlands)

    Scheeren, Thomas W. L.

    2015-01-01

    Ceftobiprole medocaril is a fifth-generation cephalosporin approved in Europe as single-agent therapy for hospital-acquired pneumonia (HAP), excluding ventilator-associated pneumonia (VAP). It is rapidly converted to the active metabolite ceftobiprole following intravenous administration. Ceftobipro

  1. 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.

  2. Improving outcomes in patients with community-acquired pneumonia

    OpenAIRE

    Bewick, Thomas

    2012-01-01

    Community-acquired pneumonia (CAP) is a leading cause of adult morbidity and mortality worldwide despite decades of effective antibiotics and vaccination initiatives. There have been no recent significant improvements in outcomes, including 30-day mortality. The bacterium Streptococcus pneumoniae is the most prevalent causative pathogen in CAP, being found in up to half of cases. In September 2006 a childhood pneumococcal vaccine (PCV-7) was introduced, leading to reductions in vaccine-type (...

  3. Combination antibiotic therapy for community-acquired pneumonia

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    Caballero, Jesus; Rello, Jordi

    2011-01-01

    Community-acquired pneumonia (CAP) is a common and potentially serious illness that is associated with morbidity and mortality. Although medical care has improved during the past decades, it is still potentially lethal. Streptococcus pneumoniae is the most frequent microorganism isolated. Treatment includes mandatory antibiotic therapy and organ support as needed. There are several antibiotic therapy regimens that include β-lactams or macrolides or fluoroquinolones alone or in combination. Co...

  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. 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

  6. Evolving trends in Streptococcus pneumoniae resistance: implications for therapy of community-acquired bacterial pneumonia.

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    Jones, Ronald N; Jacobs, Michael R; Sader, Helio S

    2010-09-01

    Pneumonia is a major infectious disease associated with significant morbidity, mortality and utilisation of healthcare resources. Streptococcus pneumoniae is the predominant pathogen in community-acquired pneumonia (CAP), accounting for 20-60% of bacterial cases. Emergence of multidrug-resistant S. pneumoniae has become a significant problem in the management of CAP. Although pneumococcal conjugate vaccine usage in children has led to significant decreases in morbidity and mortality due to S. pneumoniae in all age groups, disease management has been further complicated by the unexpected increase in resistant serotypes, such as 19A, in some regions. Until rapid and accurate diagnostic tests become available, initial treatment of CAP will remain empirical. Thus, selection of appropriate antimicrobial therapy for CAP must be based on prediction of the most likely pathogens and their local antimicrobial susceptibility patterns. This article reviews information on antimicrobial resistance patterns amongst S. pneumoniae and implications for managing CAP.

  7. Corticosteroids for all adult patients with community-acquired pneumonia?

    OpenAIRE

    Ger Rijkers; Simone Spoorenberg; Stefan Vestjens; Werner Albrich

    2015-01-01

    Corticosteroid therapy as adjunctive treatment in community-acquired pneumonia (CAP) is a promising but controversial subject. The potentially beneficial effect of corticosteroids is based on the ability of steroids to dampen an excessive inflammatory response that often occurs in patients with CAP. This excessive inflammatory response can cause damage to the lungs and other organs, and is associated with poor outcome.

  8. 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...

  9. Molecular characteristics of serotype 3 Streptococcus pneumoniae isolates among community-acquired pneumonia patients in Japan.

    Science.gov (United States)

    Isozumi, Rie; Ito, Yutaka; Ishida, Tadashi; Hirai, Toyohiro; Ito, Isao; Maniwa, Ko; Hayashi, Michio; Kagioka, Hitoshi; Hirabayashi, Masataka; Onaru, Koichi; Tomioka, Hiromi; Tomii, Keisuke; Gohma, Iwao; Osawa, Makoto; Imai, Seiichiro; Takakura, Shunji; Iinuma, Yoshitsugu; Chin, Kazuo; Ichiyama, Satoshi; Mishima, Michiaki

    2008-06-01

    In order to understand the spread of the erythromycin-resistant serotype 3 Streptococcus pneumoniae clone in Japan, we have assessed the molecular characteristics of this clone. Among 156 S. pneumoniae isolates recovered from adults with community-acquired pneumonia between 2003 and 2005, 42 were serotype 3 and 40 were sequence type (ST) 180/Netherlands(3)-31 by multilocus sequence typing. Thirty-eight of the 40 ST 180 isolates had acquired resistance to erythromycin via the ermB gene. Although the ermB-positive ST180 clone isolates were more susceptible to penicillin and trimethoprim-sulfamethoxazole than ermB-positive non-ST180 isolates and contained a less mutated pbp1a or pbp2b gene, without a mefA gene, the ST180 clone was highly prevalent among ermB-positive isolates. Routine surveillance for the ST180 S. pneumoniae clone may soon become necessary.

  10. Gatifloxacin used for therapy of outpatient community-acquired pneumonia caused by Streptococcus pneumoniae.

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    Jones, Ronald N; Andes, David R; Mandell, Lionel A; Gothelf, Samantha; Ehrhardt, Anton F; Nicholson, Susan C

    2002-09-01

    Gatifloxacin is an advanced-generation fluoroquinolone with demonstrated efficacy and safety as therapy for community-acquired pneumonia (CAP). As part of a phase IV postmarketing surveillance program (TeqCES), 136 outpatients with CAP whose sputum was culture-positive for Streptococcus pneumoniae were enrolled in an open-label trial of oral gatifloxacin 400 mg daily for 7 to 14 days. An antibiogram of isolates showed 100% susceptibility to gatifloxacin (MIC(90) 0.5 micro g/mL) and respective susceptibilities of 67%, 70%, and 80% to penicillin, erythromycin, and tetracycline. Clinical cure was achieved in 95.3% of evaluable patients, including seven patients infected with penicillin-resistant S. pneumoniae (MIC > or =2 micro g/mL). The bacteriologic eradication rate for S. pneumoniae was 94.5%. Diarrhea, nausea, and dizziness, the most common adverse events in CAP patients (pneumoniae including multidrug-resistant strains, with the newer 8-methoxy-fluoroquinolone, gatifloxacin.

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

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    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.

  12. Development and implementation of a performance improvement project in adult intensive care units: overview of the Improving Medicine Through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study

    OpenAIRE

    Mangino, Julie E.; Peyrani, Paula; Ford, Kimbal D; Daniel H. Kett; Zervos, Marcus J.; Welch, Verna L.; Scerpella, Ernesto G.; Ramirez, Julio A.; ,

    2011-01-01

    Introduction In 2005 the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) published guidelines for managing hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and healthcare-associated pneumonia (HCAP). Although recommendations were evidence based, collective guidelines had not been validated in clinical practice and did not provide specific tools for local implementation. We initiated a performance improvement project designated Improving...

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

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    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

  14. 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.

  15. [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.

  16. Тhe features of severe community acquired pneumonia

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    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.

  17. Mycoplasma pneumoniae and Chlamydia spp. infection in community-acquired pneumonia, Germany, 2011-2012.

    Science.gov (United States)

    Dumke, Roger; Schnee, Christiane; Pletz, Mathias W; Rupp, Jan; Jacobs, Enno; Sachse, Konrad; Rohde, Gernot

    2015-03-01

    Mycoplasma pneumoniae and Chlamydia spp., which are associated with community-acquired pneumonia (CAP), are difficult to propagate, and can cause clinically indistinguishable disease patterns. During 2011-2012, we used molecular methods to test adult patients in Germany with confirmed CAP for infection with these 2 pathogens. Overall, 12.3% (96/783) of samples were positive for M. pneumoniae and 3.9% (31/794) were positive for Chlamydia spp.; C. psittaci (2.1%) was detected more frequently than C. pneumoniae (1.4%). M. pneumoniae P1 type 1 predominated, and levels of macrolide resistance were low (3.1%). Quarterly rates of M. pneumoniae-positive samples ranged from 1.5% to 27.3%, showing a strong epidemic peak for these infections, but of Chlamydia spp. detection was consistent throughout the year. M. pneumoniae-positive patients were younger and more frequently female, had fewer co-occurring conditions, and experienced milder disease than did patients who tested negative. Clinicians should be aware of the epidemiology of these pathogens in CAP.

  18. 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.

  19. Acute Chlamydia pneumoniae and Mycoplasma pneumoniae infections in community-acquired pneumonia and exacerbations of COPD or asthma: therapeutic considerations.

    Science.gov (United States)

    Meloni, F; Paschetto, E; Mangiarotti, P; Crepaldi, M; Morosini, M; Bulgheroni, A; Fietta, A

    2004-02-01

    Rates of acute Chlamydia pneumoniae and Mycoplasma pneumoniae infections were determined in 115 adults hospitalized for community-acquired pneumonia (CAP), purulent exacerbations of COPD and acute exacerbations of bronchial asthma, by means of serology and molecular methods. Results were compared with those obtained in a matched control group. Common respiratory pathogens were isolated by cultures in 22.5% and 22.2% of CAP and exacerbated COPD patients, respectively. Cultures from exacerbated asthma patients were always negative. Serological and molecular evidence of current C. pneumoniae infection was obtained in 10.0%, 8.9% and 3.3% of CAP, COPD and asthma cases. The corresponding rates of acute M. pneumoniae infection were 17.5%, 6.7% and 3.3%, respectively. Finally, no difference was found between typical and atypical pathogen rates. These findings highlight the importance of taking into account C. pneumoniae and M. pneumoniae infections in guiding the choice of empirical antibacterial treatment for CAP and purulent exacerbations of COPD.

  20. Pulmonary Embolism Mimicking Community Acquired Pneumonia: A Case Report

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    Ibrahim Koc

    2016-02-01

    Full Text Available Acute pulmonary trombo embolism is a form of venous thromboembolism that is common and sometimes even may be fatal. Patients might present with variable clinical presentation and often have non-specific complaints which make the diagnosis challenging. Here we aimed to report a thirty years old male who was diagnosed with community acquired pneumonia but further investigations revealed pulmonary embolism. A thirty years old male presented to our clinic with right sided chest pain and shortness of breath. Chest radiograph revealed right sided consolidations and pleural effusion. His physical examination revealed high body temperature (38 C° and oxygen saturation on room air was 85 %. The patient did not respond to the antibiotherapy and oxygen supply. Computed tomography angiography of the chest revealed right sided pulmonary embolism with pneumonia. Blood and sputum cultures revealed no bacteria. Cardiovascular disease panel revealed heterozygous mutation in prothrombine G20210A and metilentetrahidrofolate reductase (MTHFR C677T. In conclusion pulmonary embolism may mimic community acquired pneumonia thus clinicians must be carefull during the diagnostic process.

  1. Antimicrobial Resistance and Clinical Outcomes in Nursing Home-Acquired Pneumonia, Compared to Community-Acquired Pneumonia

    Science.gov (United States)

    Kang, Yun-Seong; Ryoo, Soo Ryeong; Byun, Seung Joo; Jeong, Yun-Jeong; Oh, Jin Young

    2017-01-01

    Purpose Patients with nursing home-acquired pneumonia (NHAP) should be treated as hospital-acquired pneumonia (HAP) according to guidelines published in 2005. However, controversy still exists on whether the high mortality of NHAP results from multidrug resistant pathogens or underlying disease. We aimed to outline differences and factors contributing to mortality between NHAP and community-acquired pneumonia (CAP) patients. Materials and Methods We retrospectively evaluated patients aged 65 years or older with either CAP or NHAP from 2008 to 2014. Patients with healthcare-associated pneumonia other than NHAP or HAP were excluded. Results Among 317 patients, 212 patients had CAP and 105 had NHAP. Patients with NHAP had higher mortality, more frequently used a ventilator, and had disease of higher severity than CAP. The incidences of aspiration, tube feeding, and poor functional status were higher in NHAP. Twenty three out of 54 NHAP patients and three out of 62 CAP patients had multidrug resistant pathogens (p<0.001). Eleven patients with NHAP died at discharge, compared to 7 patients with CAP (p=0.009). However, there was no association between mortality rate and presence of multidrug-resistant pathogens. The number of involved lobes on chest X-ray [odds ratio (OR)=1.708; 95% confidence interval (CI), 1.120 to 2.605] and use of mechanical ventilation (OR=9.537; 95% CI, 1.635 to 55.632) were significantly associated with in-hospital mortality. Conclusion Patients with NHAP had higher mortality than patients with CAP. The excess mortality among patients with NHAP and CAP was related to disease severity but not to the presence of multidrug resistant pathogens. PMID:27873512

  2. Garenoxacin in the treatment of community-acquired pneumonia

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    Biswanath Biswas

    2014-12-01

    Full Text Available Community-acquired pneumonia (CAP is a major cause of adult mortality in Asia. Empirical use of antibiotics depends on the pathogens that are commonly responsible. Evolution of resistant pathogens in CAP has added to the burden of treating physicians. Microbiological culture and antibiotic sensitivity testing are helpful for the treatment of such respiratory tract infections. Klebsiella pneumoniae though uncommon pathogen of CAP has been reported in many cases. Garenoxacin a newer fl uoroquinolone has found its utility in the treatment of respiratory tract infections. Providing symptomatic relief to the patient with the use of analgesics, antipyretics and cough preparations are also an essential part of the management. [Int J Basic Clin Pharmacol 2014; 3(6.000: 1093-1095

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

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    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

  4. Community-acquired, health care-associated, and ventilator-associated pneumonia: three variations of a serious disease.

    Science.gov (United States)

    Scott, Susan S; Kardos, Cynthia B

    2012-09-01

    Pneumonia affects millions of people every year in the United States. Hospital-acquired pneumonia is associated with a mortality rate as high as 50%. Pneumonia is classified according to where it was acquired or by the infecting organism. This article explores the similarities and differences in three types of pneumonia seen routinely in the intensive care unit: community-acquired pneumonia, ventilator-associated pneumonia, and health care-associated pneumonia.

  5. Acquired severe pneumonia in the community in seropositive HIV patients.

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    Héctor Cruz de los Santos

    2004-12-01

    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.

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

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    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.

  7. [Nursing-home-acquired pneumococcal pneumonia--comparison of sputum cultures with Binax NOW Streptococcus pneumoniae urinary antigen assay].

    Science.gov (United States)

    Rikimaru, Toru; Nishiyama, Mamoru; Yonemitsu, Junko; Nagabuchi, Masako; Shimada, Akiko; Koga, Takeharu; Aizawa, Hisamichi

    2008-11-01

    To clarify the clinical significance of Pneumococcal pneumonia in nursing-home-acquired pneumonia, we examined the positive disease rate of using sputum cultures and the Binax NOW Streptococcus pneumoniae urinary antigen assay in 154 nursing-home patients with pneumonia. These included 54 males and 100 females with a mean age of 86.2 years. Bacteriological findings for sputum culture in 130 patients showed Streptococcus pneumoniae to be cultured in 11 cases (8%). In 72 in whom the Streptococcus pneumoniae-urinary antigen test (Binax NOW) was done, the urinary-antigen-positive rate (26/72 ; 36%) was higher than the culture positive rate for S. pneumoniae. Both examinations were done in 64 patients, among whom 5 in whom S. pneumoniae was cultured also had positive results for the urinary antigen test. Almost half of those undergoing percutaneous endoscopic gastroscopy (PEG) tube nutrition had positive results for the urinary antigen test, but not all such patients had positive cultures for S. pneumoniae. Although the culture-positive rate for S. pneumoniae in sputum was low, we concluded that S. pneumoniae was frequently linked to nursing-home-acquired pneumonia, especially in "total-care" patients.

  8. 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.

  9. Results of Performing Blood Cultures at Hospital Admission in Patients with Community-acquired Pneumonia

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    Iris González Morales

    2014-02-01

    Full Text Available Background: community-acquired pneumonia is a major health problem worldwide, in Cuba and in the province of Cienfuegos. Objective: to report the results of blood cultures performed at hospital admission in patients with community-acquired pneumonia. Methods: a prospective descriptive study was conducted in the Gustavo Aldereguía Lima Hospital in Cienfuegos, during the second half of 2012. It included 52 patients with community-acquired pneumonia who underwent blood culture at their admission to the hospital. Results: only five patients (9.6% of the cases had a positive test result; Streptococcus pneumoniae was isolated from only one positive culture; Staphylococcus aureus and Klebsiella pneumoniae were isolated from the rest. Conclusions: the percentage obtained in this study confirms the low diagnostic yield of blood cultures performed at admission in patients with community-acquired pneumonia; the low isolation rate of S. pneumoniae in our study was also significant.

  10. [Nutritional status and mortality in community acquired pneumonia].

    Science.gov (United States)

    Rodríguez-Pecci, María Soledad; Carlson, Damián; Montero-Tinnirello, Javier; Parodi, Roberto L; Montero, Antonio; Greca, Alcides A

    2010-01-01

    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 tool to appraise the nutritional status. Ninety-eight patients with CAP requiring hospitalization were included consecutively from October 2004 to September 2006. The clinical, bacteriological and laboratory features were recorded. Patient's nutritional condition was assessed using the SGA. The monitoring was performed until discharge, death or shunt. Persistent cough or fever, the presence of pleural effusion, malignancies or long hospitalization were associated with worse prognosis. Mortality increased in proportion to the degree of malnutrition. Thirty two CAP patients (32.65%) were classified as SGA-category A; 44 (44.90%) as SGA-B, and 22 (22.45%) as SGA-C. Pneumonia resulted in death in 3/32 SGA-A (9.37%), 8/44 SGA-B (18.18%) and 10/22 SGA-C patients. SGA-C patients showed significantly higher odds ratios for death in comparison to SGA-A patients (OR = 6.085, CI95%: 1.071-34.591; p = 0.042). Considering death as the outcome variable, SGA-A class had the highest negative predictive value (0.906), while SGA-C class showed the highest positive predictive value (0.455). These results link the nutritional status to the NAC evolution prognostic. SGA provides a simple estimation of the nutritional status and it is a good predictor of the risk of death in CAP patients.

  11. Ceftobiprole medocaril in the treatment of hospital-acquired pneumonia.

    Science.gov (United States)

    Scheeren, Thomas W L

    2015-01-01

    Ceftobiprole medocaril is a fifth-generation cephalosporin approved in Europe as single-agent therapy for hospital-acquired pneumonia (HAP), excluding ventilator-associated pneumonia (VAP). It is rapidly converted to the active metabolite ceftobiprole following intravenous administration. Ceftobiprole has a broad spectrum of activity, notably against methicillin-resistant Staphylococcus aureus, ampicillin-susceptible enterococci, penicillin-resistant pneumococci and Enterobacteriaceae not producing extended-spectrum β-lactamase. Ceftobiprole is primarily excreted renally by glomerular filtration, with minimal propensity for interaction with co-administered drugs. Normal dose is ceftobiprole 500 mg, administered by 2-h intravenous infusion every 8 h, with dose adjustment according to renal function. In a pivotal Phase III trial in patients with HAP, ceftobiprole monotherapy was as efficacious as ceftazidime/linezolid for clinical and microbiological cure and was noninferior to ceftazidime/linezolid in the subgroup of patients with HAP excluding VAP. Ceftobiprole and ceftazidime/linezolid were similarly well tolerated. Ceftobiprole is an efficacious and well-tolerated option for empirical treatment of patients with HAP (excluding VAP).

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

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    Donald E Low

    2003-01-01

    Full Text Available 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 specific guidelines, but it reviews the literature and presents currrent approaches to the treatment of PCAP. To compile the review, an expert panel was convened to provide a consensus. The review discusses the etiology, diagnosis and antimicrobial treatment of PCAP as well as indications for referral to a hospital emergency department. The goal of the review is to provide those involved with treatment of PCAP in the community setting with information that can be used to make effective treatment choices.

  13. Procalcitonin and community-acquired pneumonia (CAP) in children.

    Science.gov (United States)

    Giulia, Bivona; Luisa, Agnello; Concetta, Scazzone; Bruna, Lo Sasso; Chiara, Bellia; Marcello, Ciaccio

    2015-12-07

    The role of procalcitonin (PCT) as a biomarker for sepsis in adults is well documented, while its role in infections affecting neonatal children remains controversial. Among these infections, Community-Acquired pneumonia (CAP) has been studied extensively, because it's the second cause of death in children in developing countries, and one of the most frequent causes of hospitalization in industrialized countries. The PubMed database and the Cochrane Library were used to search for the following keywords: CAP, procalcitonin, and children. Thirteen articles were studied to determine the role of PCT in CAP management, specifically its usefulness for distinguishing pneumococcal infections from viral and unknown infections, for predicting severity and the correct antibiotic treatment. This paper focuses on the studies performed to identify the best inflammatory biomarker for CAP management. Although there is an increase in studies confirming the usefulness of PCT in CAP management in children, further studies are needed to have better understanding of its role for pediatric CAP management.

  14. Rapidly fatal community-acquired pneumonia due to Klebsiella pneumoniae complicated with acute myocarditis and accelerated idioventricular rhythm.

    Science.gov (United States)

    Chuang, Tzu-Yi; Lin, Chou-Jui; Lee, Shih-Wei; Chuang, Chun-Pin; Jong, Yuh-Shiun; Chen, Wen-Jone; Hsueh, Po-Ren

    2012-08-01

    We describe a previously healthy 52-year-old man with rapidly fatal community-acquired pneumonia caused by Klebsiella pneumoniae. The patient developed acute renal dysfunction, accelerated idioventricular rhythm (acute myocarditis), lactic acidosis and septic shock. He died within 15 hours after admission despite intravenous levofloxacin (750 mg daily) and aggressive medical treatment.

  15. 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

  16. 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.

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

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    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

  18. Viral and bacterial aetiology of community-acquired pneumonia in adults

    NARCIS (Netherlands)

    Huijskens, Elisabeth G. W.; van Erkel, Adriana J. M.; Palmen, Fernand M. H.; Buiting, Anton G. M.; Kluytmans, Jan A. J. W.; Rossen, John W. A.

    2013-01-01

    BACKGROUND: Modern molecular techniques reveal new information on the role of respiratory viruses in community-acquired pneumonia. In this study, we tried to determine the prevalence of respiratory viruses and bacteria in patients with community-acquired pneumonia who were admitted to the hospital.

  19. Pharmacotherapy and the risk for community-acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Mody Lona

    2010-07-01

    Full Text Available Abstract Background Some forms of pharmacotherapy are shown to increase the risk of community-acquired pneumonia (CAP. The purpose of this study is to investigate whether pharmacotherapy with proton pump inhibitors (PPI, inhaled corticosteroids, and atypical antipsychotics was associated with the increased risk for CAP in hospitalized older adults with the adjustment of known risk factors (such as smoking status and serum albumin levels. Methods A retrospective case-control study of adults aged 65 years or older at a rural community hospital during 2004 and 2006 was conducted. Cases (N = 194 were those with radiographic evidence of pneumonia on admission. The controls were patients without the discharge diagnosis of pneumonia or acute exacerbation of chronic obstructive pulmonary disease (COPD (N = 952. Patients with gastric tube feeding, ventilator support, requiring hemodialysis, metastatic diseases or active lung cancers were excluded. Results Multiple logistic regression analysis revealed that the current use of inhaled corticosteroids (adjusted odds ratio [AOR] = 2.89, 95% confidence interval [CI] = 1.56-5.35 and atypical antipsychotics (AOR = 2.26, 95% CI = 1.23-4.15 was an independent risk factor for CAP after adjusting for confounders, including age, serum albumin levels, sex, smoking status, a history of congestive heart failure, coronary artery disease, and COPD, the current use of PPI, β2 agonist and anticholinergic bronchodilators, antibiotic(s, iron supplement, narcotics, and non-steroidal anti-inflammatory drugs. The crude OR and the AOR of PPI use for CAP was 1.41 [95% CI = 1.03 - 1.93] and 1.18 [95% CI = 0.80 - 1.74] after adjusting for the above confounders, respectively. Lower serum albumin levels independently increased the risk of CAP 1.89- fold by decreasing a gram per deciliter (AOR = 2.89, 95% CI = 2.01 - 4.16. Conclusion Our study reaffirmed that the use of inhaled corticosteroids and atypical antipsychotics was both

  20. Risk factors for levofloxacin-nonsusceptible Streptococcus pneumoniae in community-acquired pneumococcal pneumonia: a nested case-control study.

    Science.gov (United States)

    Kang, C-I; Song, J-H; Kim, S H; Chung, D R; Peck, K R; So, T M; Hsueh, P-R

    2014-01-01

    This study was performed to evaluate the clinical features of community-onset levofloxacin-nonsusceptible pneumococcal pneumonia and to identify risk factors for levofloxacin resistance. Using the database of a surveillance study of community-acquired pneumococcal infections in Asian countries, we conducted a nested case-control study to identify risk factors for levofloxacin-nonsusceptible S. pneumoniae in community-acquired pneumonia in adults. Of 981 patients with pneumococcal pneumonia, 46 (4.7 %) had levofloxacin-nonsusceptible S. pneumoniae, of whom 39 evaluable cases were included in the analysis. All cases were from Korea, Taiwan, and Hong Kong. Among patients with levofloxacin-susceptible S. pneumoniae, 490 controls were selected based on patient country. Of the 39 cases of levofloxacin-nonsusceptible pneumococcal pneumonia, 23 (59.0 %) were classified as healthcare-associated, while 164 (33.5 %) of the 490 controls of levofloxacin-susceptible S. pneumoniae (P = 0.001) were classified as healthcare-associated. Multivariate analysis showed that previous treatment with fluoroquinolones, cerebrovascular disease, and healthcare-associated infection were significantly associated with levofloxacin-nonsusceptible pneumococcal pneumonia (all P < 0.05). Levofloxacin-nonsusceptible pneumococci pose an important new public health threat in our region, and more information on the emergence and spread of these resistant strains will be necessary to prevent spread throughout the population.

  1. [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.

  2. Steroids for community-acquired pneumonia? not in my house!

    Directory of Open Access Journals (Sweden)

    Kuberski T

    2016-11-01

    Full Text Available No abstract available. Article truncated at 150 words. In response to the paper by PR Bauer and VN Iyer (1 entitled “Corticosteroids and Influenza A Associated Acute Respiratory Distress Syndrome” published in the Southwest Journal of Pulmonary and Critical Care (SWJPCC on November 18, 2016. That paper presents a single case report of a patient with community-acquired pneumonia in Arizona attributed to influenza A. The patient was treated with steroids and improved. For a variety of reasons, a case report like this should not be published unless accompanied by a note pointing out the implications of such a report. The audience of SWJPCC is generally going to be made up of two groups, mainly from Arizona. Those with experience who would say that the treating physicians were lucky (but in the back of their minds this case might give them a reason to use steroids in similar circumstances and those with little or no experience, who will say …

  3. Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review

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    Leonor Pássaro

    2016-11-01

    Full Text Available Abstract Background Pneumonia is one of the leading hospital-acquired infections worldwide and has an important impact. Although preventive measures for ventilator-associated pneumonia (VAP are well known, less is known about appropriate measures for prevention of hospital-acquired pneumonia (HAP. Aim The purpose of this narrative review is to provide an overview of the current standards for preventing HAP in non-ventilated adult patients. Methods A search of the literature up to May 2015 was conducted using Medline for guidelines published by national professional societies or professional medical associations. In addition, a comprehensive search for the following preventive measures was performed: hand hygiene, oral care, bed position, mobilization, diagnosis and treatment of dysphagia, aspiration prevention, viral infections and stress bleeding prophylaxis. Findings Regarding international guidelines, several measures were recommended for VAP, whilst no specific recommendations for HAP prevention in non-ventilated patients are available. There is reasonable evidence available that oral care is associated with a reduction in HAP. Early mobilization interventions, swift diagnosis and treatment of dysphagia, and multimodal programmes for the prevention of nosocomial influenza cross-infection, have a positive impact on HAP reduction. The impact of bed position and stress bleeding prophylaxis remains uncertain. Systematic antibiotic prophylaxis for HAP prevention should be avoided. Conclusion Scant literature and little guidance is available for the prevention of HAP among non-ventilated adult patients. In addition, the criteria used for the diagnosis of HAP and the populations targeted in the studies selected are heterogeneous. Oral care was the most studied measure and was commonly associated with a decrease in HAP rate, although a broad range of interventions are proposed. No robust evidence is available for other measures. Further high

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

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    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

  5. Outcome of community-acquired pneumonia with cardiac complications

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    R. Eman Shebl

    2015-07-01

    Conclusions: Cardiac complications are common in the admitted patients with pneumonia and they are associated with increased pneumonia severity and increased cardiovascular risk, these complications adds to the risk of mortality, so optimal management of these events may reduce the burden of death associated with this infection.

  6. Persistent pathogens as risk factors of community-acquired pneumonia and acute bronchitis in children

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    O. V. Zhukova

    2016-01-01

    Full Text Available The aim of this study was to determine the relationship between infection with “persistent” agents of children and the possibility of the development of inflammatory diseases of the respiratory tract such as community-acquired pneumonia and acute bronchitis on the basis of risk management concepts.Materials and methods. 701 children in age from 15 days to 16 years were examined in Nizhny Novgorod and the Nizhny Novgorod region with clinically and radiologically confirmed diagnosis: community-acquired pneumonia, acute bronchitis. This study was performed in the period from 2005 to 2014. The control group consisted of 127 healthy children of different ages. The detection of M. pneumoniae, Сytomegalovirus, Herpes simplex I/II C. pneumoniae was performed by PCR. The concept of risk determination was based on the determination of the absolute risk in the exposed and the no exposed groups, attributable risk, relative risk, the population attributable risk, as well as determining the standard errors for each type of risk and confidence interval.Results. Attributable risk, relative risk, population-attributable risk are statistically significant figures. Attributable risk of development of community-acquired pneumonia was 29,26%; 27,37%; 25,70%; 20,21% for the M. pneumoniae, C. pneumoniae, CMV, HSV I / II respectively. The relative risk was 1,43 for the M. pneumoniae; 1,38 – for C. pneumoniae and CMV; 1,28- for HSV I / II. The presence of persistent pathogens is resulting in increased incidence of communityacquired pneumonia throughout the population (population attributable risk: 4,75% for M. pneumoniae, 0,23% for C. pneumoniae, 5,59% for the CMV and 1,08% for the HSV I/II. Similar calculations were performed for patients with acute bronchitis. The statistical analysis allowed to exclude C. pneumoniae and HSV I / II of the risk factors for communityacquired pneumonia and acute bronchitis.Conclusion. The findings suggest the influence of M

  7. 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; Daniel B Gregson

    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.

  8. Drug effects on the risk and prognosis of community-acquired pneumonia

    NARCIS (Netherlands)

    Garde, E.M.W. van de

    2007-01-01

    This thesis presents a series of studies exploring the hypothesis that both ACE-inhibitors and statins, besides their intended effects, reduce the risk of acquiring pneumonia. Furthermore, as the burden of pneumonia is not only determined by its incidence but also by a high mortality, another widely

  9. 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

  10. Efficacy of ceftobiprole in intensive care unit (ICU) patients with hospital-acquired pneumonia (HAP)

    NARCIS (Netherlands)

    Welte, T.; Scheeren, Thomas; Rodriguez, Alejandro H.; Demange, A.; Engelhardt, Marc

    2014-01-01

    Introduction: Ceftobiprole medocaril is a novel cephalosporin approved in Europe for the treatment of hospital-acquired pneumonia (HAP) excluding ventilator-associated pneumonia (VAP). Ceftobiprole exhibits broad bactericidal activity against Gram-positive and Gram-negative pathogens, including meth

  11. 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.

  12. 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

  13. Predictors of bacteraemia in patients with suspected community-acquired pneumonia

    NARCIS (Netherlands)

    van Werkhoven, Cornelis H; Huijts, Susanne M; Postma, Douwe F; Oosterheert, Jan Jelrik; Bonten, Marc J M

    2015-01-01

    INTRODUCTION: The diagnostic yield of blood cultures is limited in patients with community-acquired pneumonia (CAP). Yet, positive blood culture results provide important information for antibiotic treatment and for monitoring epidemiologic trends. We investigated the potential of clinical predictor

  14. 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.

  15. [CAPNETZ. The competence network for community-acquired pneumonia (CAP)]. [Article in German

    DEFF Research Database (Denmark)

    von Plessen, Christian

    2016-01-01

    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...... 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...

  16. Garenoxacin activity against isolates form patients hospitalized with community-acquired pneumonia and multidrug-resistant Streptococcus pneumoniae.

    Science.gov (United States)

    Jones, Ronald N; Sader, Helio S; Stilwell, Matthew G; Fritsche, Thomas R

    2007-05-01

    Community-acquired pneumonia (CAP) continues to cause significant morbidity worldwide, and the principal bacterial pathogens (Streptococcus pneumoniae and Haemophilus influenzae) have acquired numerous resistance mechanisms over the last few decades. CAP treatment guidelines have suggested the use of broader spectrum agents, such as antipneumococcal fluoroquinolones as the therapy for at-risk patient population. In this report, we studied 3087 CAP isolates from the SENTRY Antimicrobial Surveillance Program (1999-2005) worldwide and all respiratory tract infection (RTI) isolate population of pneumococci (14665 strains) grouped by antibiogram patterns against a new des-F(6)-quinolone, garenoxacin. Results indicated that garenoxacin was highly active against CAP isolates of S. pneumoniae (MIC(90), 0.06 microg/mL) and H. influenzae (MIC(90), 99.9% of strains were inhibited at pneumoniae strains to penicillin or erythromycin; however, coresistances were high among the beta-lactams (penicillins and cephalosporins), macrolides, tetracyclines, and trimethoprim/sulfamethoxazole. Analysis of S. pneumoniae isolates with various antimicrobial resistance patterns to 6 drug classes demonstrated that garenoxacin was active against >99.9% (MIC, pneumoniae that have created therapeutic dilemmas for all RTI presentations. Garenoxacin appears to be a welcome addition to the CAP treatment options, particularly for the emerging MDR pneumococci strains.

  17. Anthropometric measurements may be informative for nursing home-acquired pneumonia

    Science.gov (United States)

    Yardimci, Bulent; Aksoy, Sevki Murat; Ozkaya, Ismail; Demir, Tarik; Tezcan, Gulsen; Kaptanoglu, Aysegul Yildirim

    2016-01-01

    Objective: To evaluate the relationship between anthropometric measurements and Nursing Home-Acquired Pneumonia (NHAP) risk. Methods: Consecutive patients of 65 years or elderly who were living in the Balikli Rum Hospital Nursing Homes were included in this prospective study. At the beginning of this study, the patients’ anthropometrics values were measured. The patients were followed for one year, and any incidences of pneumonia attacks were recorded. The relationship between the anthropometric measurements and pneumonia occurrences was analyzed. Results: There were 133 inmates at the initial assessments. Of 108 patients who were eligible for the study, 77 (72.2%) were female and 37 (27.8%) were male. The mean age of the group was 79.8±10.5. Patients were assigned to a group according to the presence of pneumonia during the one -year follow-up. There were 74 (55.6%) patients who had suffered from at least one attack of pneumonia during the follow-up period. The mean triceps skinfold was significantly thinner in the pneumonia group, and the mean handgrip measurements in both the dominant and non-dominant hands were significantly weaker in the pneumonia group. Furthermore, the frequency of Chronic Obstructive Pulmonary Diseases (COPD) was significantly higher in this group (p < 0.001). Conclusions: The risk of pneumonia was high in the elderly population who live in nursing homes. Simple anthropometric values may be predictive of the potential for Nursing Home-Acquired Pneumonia. PMID:27375716

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

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    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.

  19. 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

  20. Hospital-acquired pneumonia guidelines in Europe : a review of their status and future development

    NARCIS (Netherlands)

    Mastertonl, R.; Craven, D.; Rei, J.; Struelens, M.; Frirnodt-Moller, N.; Chastre, J.; Ortqvist, A.; Cornagfia, G.; Lode'O, H.; Giarnarellou, H.; Bonten, M. J. M.; Eraksoy, H.; Davey, P.

    2007-01-01

    Hospital-acquired pneumonia (HAP) is the most common healthcare-acquired infection contributing to death. Effective management requires accurate diagnosis, administration of a suitable antibiotic regimen early in infection and implementation of prevention strategies. In recent years, there has been

  1. Clinical and microbiological characteristics of Klebsiella pneumoniae from community-acquired recurrent urinary tract infections.

    Science.gov (United States)

    Lin, W H; Kao, C Y; Yang, D C; Tseng, C C; Wu, A B; Teng, C H; Wang, M C; Wu, J J

    2014-09-01

    Understanding the pathogenesis of recurrent urinary tract infection (RUTI) and whether it is attributable to reinfection with a new strain or relapse with the primary infecting strain is of considerable importance. Because previous studies regarding community-acquired Klebsiella pneumoniae RUTI are inconclusive, we undertook this study to evaluate the characteristics of the host and the bacterial agent K. pneumoniae in RUTI. A prospective study was designed, using consecutive patients diagnosed with community-acquired K. pneumoniae-related UTI from January 2007 to December 2009. Of the total 468 consecutive episodes, we found 7 patients with RUTI. All the patients with RUTI were elderly (median, 74 years), with diabetes (100 %, 7 out of 7). Clinical K. pneumoniae isolates derived from the same patients with RUTI revealed identical genomic fingerprints, indicating that K. pneumoniae UTI relapsed despite appropriate antibiotic therapy. The antimicrobial resistance, growth curve and biofilm formation of the recurrent isolates did not change. K. pneumoniae strains causing RUTI had more adhesion and invasiveness than the colonization strains (p recurrent strains with the community-acquired UTI strains, the prevalence of diabetes mellitus was significant (100 % vs 53.7 %, p = 0.03) in the RUTI group. Our data suggest that K. pneumoniae strains might be able to persist within the urinary tract despite appropriate antibiotic treatment, and the greater adhesion and invasiveness in the recurrent strains may play an important role in recurrent infections.

  2. Severe virus associated community acquired pneumonia: predictors of lethality

    Directory of Open Access Journals (Sweden)

    T. O. Pertseva

    2016-06-01

    Full Text Available Despite the fact that the influenza virus pathogenicity factors have been well studied in vitro, in vivo lack is presented in understanding of the those risk factors, objective and laboratory parameters, which related most of all to the fatal virus-associated community-aquired pneumonia (CAP. That is why the purpose of the study was to study the clinical and laboratory characteristics of patients with severe virus-associated CAP during the 2015–2016 influenza epidemic and their role as predictors of patients’ mortality. To do this, patients with severe virus-associated CAP were examined. They were divided into 2 groups depending on the outcome of treatment: 1st- deaths from the virus-associated severe CAP and 2nd - patients with successful treatment of the severe virus-associated CAP. Special statistical method was used – one-dimensional analysis of variance to compare individual parameters between the two groups of patients (surviving and deceased. Pearson χ2 test (contingency table was used for categorical variables. Factors that were significant predictors of mortality as a result of univariate analysis were tested using multifactorial analysis using logistic regression. In the final model, each parameter must have had a significant impact on mortality. It was found that risk factors for death in patients with severe virus-associated CAP according to univariate analysis were: presence of obesity, disorders of consciousness, BH≥35 min, SaO2<80%, PaO2<50 mm Hg, mmHg PaCO2 ≥50 mmHg during hospitalization. Independent predictors of mortality according to the logistic regression are the presence of obesity, disorders of consciousness, PaO2<50 mm Hg, mmHg PaCO2 ≥50 mmHg. Given that among clinical and laboratory parameters key parameters that significantly influence the outcome, are indicators of the severity of hypoxia and hypoxemia, a major step in determining the severity of the patients with virus-associated severe emergency is

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

    Directory of Open Access Journals (Sweden)

    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.

  4. The role of Streptococcus pneumoniae in community-acquired pneumonia among adults in Europe: a meta-analysis.

    Science.gov (United States)

    Rozenbaum, M H; Pechlivanoglou, P; van der Werf, T S; Lo-Ten-Foe, J R; Postma, M J; Hak, E

    2013-03-01

    The primary objective of this meta-analysis was to estimate the prevalence of adult community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae in Europe, adjusted for possible independent covariates. Two reviewers conducted a systematic literature search using PubMed on English-language articles that involved human subjects with CAP during the period from January 1990 to November 2011 across European countries. A mixed-effects meta-regression model was developed and populated with 24,410 patients obtained from 77 articles that met the inclusion criteria. The model showed that the observed prevalence of S. pneumoniae in CAP significantly varies between European regions, even after adjusting for explanatory covariates, including patient characteristics, diagnostic tests, antibiotic resistance, and health-care setting. The probability of detecting S. pneumoniae was substantially higher in studies that performed more frequently a diagnostic polymerase chain reaction assay compared to all the other diagnostic tests included. Furthermore, S. pneumoniae was more likely to be confirmed as the cause of a CAP in studies with intensive care unit patients as compared to those with hospital- or community-treated patients. This study provides estimates of the average observed prevalence of S. pneumoniae, which could be used for projecting the health and economic benefits of pneumococcal immunization.

  5. Capsule Switching and Antimicrobial Resistance Acquired during Repeated Streptococcus pneumoniae Pneumonia Episodes.

    Science.gov (United States)

    Chang, Bin; Nariai, Akiyoshi; Sekizuka, Tsuyoshi; Akeda, Yukihiro; Kuroda, Makoto; Oishi, Kazunori; Ohnishi, Makoto

    2015-10-01

    Streptococcus pneumoniae colonizes the nasopharyngeal mucus in healthy people and causes otitis media, pneumonia, bacteremia, and meningitis. In this study, we analyzed an S. pneumoniae strain that caused 7 repeated pneumonia episodes in an 80-month-old patient with cerebral palsy during a period of 25 months. A total of 10 S. pneumoniae strains were obtained from sputum samples, and serotype 6B was isolated from samples from the first 5 episodes, whereas serotype 6A was isolated from samples from the last 2. Whole-genome sequencing showed clonality of the 10 isolates with 10 single nucleotide polymorphisms (SNPs) in the genomes. Among these SNPs, one single point mutation in the wciP gene was presumed to relate to the serotype switching from 6B to 6A, and the other mutations in parC and gyrA were related to fluoroquinolone resistance. These results suggested that an S. pneumoniae strain, which asymptomatically colonized the patient's nasopharynx or was horizontally transmitted from an asymptomatic carrier, caused the repeated pneumonia events. Phenotypic variations in the capsule type and antimicrobial susceptibility occurred during the carrier state. Hyporesponsiveness to serotypes 6B and 6A of S. pneumoniae was found even after vaccination with the 7-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine. After an additional vaccination with the 13-valent pneumococcal conjugate vaccine, opsonic activities for both serotypes 6A and 6B significantly increased and are expected to prevent relapse by the same strain.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Role of Atypical Bacteria in Hospitalized Patients With Nursing Home-Acquired Pneumonia.

    Science.gov (United States)

    Meyer-Junco, Laura

    2016-10-01

    Background: Nursing home-acquired pneumonia (NHAP) has been identified as one of the leading causes of mortality and hospitalization for long-term care residents. However, current and previous pneumonia guidelines differ on the appropriate management of NHAP in hospitalized patients, specifically in regard to the role of atypical bacteria such as Chlamydiae pneumonia, Mycoplasma pneumoniae, and Legionella. Objectives: The purpose of this review is to evaluate clinical trials conducted in hospitalized patients with NHAP to determine the prevalence of atypical bacteria and thus the role for empiric antibiotic coverage of these pathogens in NHAP. Methods: Comprehensive MEDLINE (1966-April 2016) and Embase (1980-April 2016) searches were performed using the terms "atypical bacteria", "atypical pneumonia", "nursing-home acquired pneumonia", "pneumonia", "elderly", "nursing homes", and "long term care". Additional articles were retrieved from the review of references cited in the collected studies. Thirteen published clinical trials were identified. Results: In the majority of studies, atypical bacteria were infrequently identified in patients hospitalized with NHAP. However, when an active community-acquired pneumonia (CAP) cohort was available, the rate of atypical bacteria between NHAP and CAP study arms was similar. Only 3 studies in this review adhered to recommended strategies for investigating atypical bacteria; in 2 of these studies, C. pneumoniae was the most common pathogen identified in NHAP cohorts. Conclusion: Although atypical bacteria were uncommon in most NHAP studies in this review, suboptimal microbial investigations were commonly performed. To accurately describe the role of atypical bacteria in NHAP, more studies using validated diagnostic tests are needed.

  8. Facility characteristics as independent prognostic factors of nursing home-acquired pneumonia

    OpenAIRE

    Lim, Che Wan; Choi, Younghoon; An, Chang Hyeok; Park, Sang Joon; Hwang, Hee-Jin; Chung, Jae Ho; Min, Joo-Won

    2016-01-01

    Background/Aims: Recently, the incidence of nursing home-acquired pneumonia (NHAP) has been increasing and is now the leading cause of death among nursing home residents. This study was performed to identify risk factors associated with NHAP mortality, focusing on facility characteristics. Methods: Data on all patients ≥ 70 years of age admitted with newly diagnosed pneumonia were reviewed. To compare the quality of care in nursing facilities, the following three groups were defined: patients...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Rapid urine antigen testing for Streptococcus pneumoniae in adults with community-acquired pneumonia: clinical use and barriers.

    Science.gov (United States)

    Harris, Aaron M; Beekmann, Susan E; Polgreen, Philip M; Moore, Matthew R

    2014-08-01

    Streptococcus pneumoniae (pneumococcus) is the most common bacterial etiology of community-acquired pneumonia (CAP) in adults, a leading cause of death. The majority of pneumococcal CAP is diagnosed by blood culture, which likely underestimates the burden of disease. The 2007 CAP guidelines recommend routine use of the rapid pneumococcal urinary antigen (UAg) test. To assess the how pneumococcal UAg testing is being used among hospitalized adult CAP patients and what barriers restrict its use, a Web-based survey was distributed in 2013 to 1287 infectious disease physician members of the Emerging Infectious disease Network of the Infectious Disease Society of America. Of 493 eligible responses, 65% use the pneumococcal UAg test. The primary barrier to UAg use was availability (46%). UAg users reported ordering fewer other diagnostic tests and tailoring antibiotic therapy. Increased access to UAg tests could improve pneumonia management and pneumococcal CAP surveillance.

  12. Atypical pneumonia

    Science.gov (United States)

    Walking pneumonia; Community-acquired pneumonia - atypical ... Bacteria that cause atypical pneumonia include: Mycoplasma pneumonia is caused by the bacteria Mycoplasma pneumoniae . It often affects people younger than age 40. Pneumonia due ...

  13. Systematic review and meta-analysis of a urine-based pneumococcal antigen test for diagnosis of community-acquired pneumonia caused by Streptococcus pneumoniae.

    Science.gov (United States)

    Sinclair, Alison; Xie, Xuanqian; Teltscher, Marty; Dendukuri, Nandini

    2013-07-01

    Standard culture methods for diagnosis of Streptococcus pneumoniae pneumonia take at least 24 h. The BinaxNOW urine-based test for S. pneumoniae (BinaxNOW-SP) takes only 15 min to conduct, potentially enabling earlier diagnosis and targeted treatment. This study was conducted to assess whether the use of BinaxNOW-SP at the time of hospital admission would provide adequate sensitivity and specificity for diagnosis of community-acquired pneumonia (CAP) in adult patients. We searched PubMed, EMBASE/OVID, Cochrane Collaboration, Centre for Reviews and Dissemination, INAHTA, and CADTH for diagnostic or etiologic studies of hospitalized predominately adult patients with clinically defined CAP that reported the diagnostic performance of BinaxNOW-SP versus cultures. Two authors independently extracted study details and diagnostic two-by-two tables. We found that 27 studies met our inclusion criteria, and three different reference standards were used between them. A bivariate meta-analysis of 12 studies using a composite of culture tests as the reference standard estimated the sensitivity of BinaxNOW-SP as 68.5% (95% credibility interval [CrI], 62.6% to 74.2%) and specificity as 84.2% (95% CrI, 77.5% to 89.3%). A meta-analysis of all 27 studies, adjusting for the imperfect and variable nature of the reference standard, gave a higher sensitivity of 74.0% (CrI, 66.6% to 82·3%) and specificity of 97.2% (CrI, 92.7% to 99.8%). The analysis showed substantial heterogeneity across studies, which did not decrease with adjustment for covariates. We concluded that the higher pooled sensitivity (compared to culture) and high specificity of BinaxNOW-SP suggest it would be a useful addition to the diagnostic workup for community-acquired pneumonia. More research is needed regarding the impact of BinaxNOW-SP on clinical practice.

  14. A prospective comparison of nursing- and healthcare-associated pneumonia (NHCAP) with community-acquired pneumonia (CAP).

    Science.gov (United States)

    Fukuyama, Hajime; Yamashiro, Shin; Tamaki, Hitoshi; Kishaba, Tomoo

    2013-08-01

    Nursing- and healthcare-associated pneumonia (NHCAP) has been proposed by the Japanese Respiratory Society as a new category of pneumonia considering the characteristics of the Japanese medical care environment. It is necessary to ascertain the epidemiology and clinical outcomes of NHCAP. A prospective study was conducted of patients with pneumonia who were hospitalized at our hospital from August 2011 to July 2012. We compared 192 cases of NHCAP with 114 cases of community-acquired pneumonia (CAP). Compared with CAP, NHCAP had a higher disease severity, higher 30-day mortality rate (10.9 vs. 3.5 %, P = 0.022), and longer length of hospital stay (median, 12 vs. 8 days, P pneumoniae was the most frequent causative pathogen in both NHCAP and CAP (33.9 vs. 34.8 %, P = 0.896). The incidence of atypical pathogens in NHCAP was low (1.7 %). Multidrug-resistant (MDR) pathogens were isolated more frequently in NHCAP than in CAP, but there was no significant difference (11.0 vs. 4.5 %, P = 0.135). Among 192 NHCAP patients, 122 (63.5 %) were aspiration pneumonia. Aspiration pneumonia was associated with poor outcomes and was considered a major characteristic of NHCAP. Our study suggested that many patients with NHCAP do not need broad-spectrum antibiotic therapy targeting MDR pathogens. Excess mortality in NHCAP patients is the result of patient backgrounds or disease severity rather than the presence of MDR pathogens.

  15. Are Pathogenic Leptospira Species Agents of Community-Acquired Pneumonia? Case Reports of Leptospirosis Presenting as Pneumonia.

    Science.gov (United States)

    Gasem, M Hussein; Farida, Helmia; Ahmed, Ahmed; Severin, Juliţte A; Suryanto, Agus; Isbandrio, Bambang; Verbrugh, Henri A; Hartskeerl, Rudy A; van den Broek, Peterhans J

    2016-01-01

    We 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. Results of qPCR analysis of throat swabs were concordant with those obtained with acute-phase serum samples, which suggests its potential for use as a noninvasive diagnostic tool for leptospirosis.

  16. Clinical evaluation of the need for carbapenems to treat community-acquired and healthcare-associated pneumonia.

    Science.gov (United States)

    Kamata, Kazuhiro; Suzuki, Hiromichi; Kanemoto, Koji; Tokuda, Yasuharu; Shiotani, Seiji; Hirose, Yumi; Suzuki, Masatsune; Ishikawa, Hiroichi

    2015-08-01

    Carbapenems have an overall broad antibacterial spectrum and should be protected against from the acquisition of drug resistance. The clinical advantages of carbapenem in cases of pneumonia have not been certified and the need for antipseudomonal antimicrobial agents to treat healthcare-associated pneumonia (HCAP) remains controversial. We introduced an antimicrobial stewardship program for carbapenem and tazobactam/piperacillin use and investigated the effects of this program on the clinical outcomes of 591 pneumonia cases that did not require intensive care unit management, mechanical ventilation or treatment with vasopressor agents [221 patients with community-acquired pneumonia (CAP) and 370 patients with HCAP]. Compared with the pre-intervention period, age, comorbidities and the severity and etiology of pneumonia did not differ during the intervention period. Carbapenems were rarely used during the intervention period in cases of pneumonia (CAP: 12% vs. 1%, HCAP: 13% vs. 1%), while antipseudomonal beta-lactam use was reduced from 33% to 8% among cases with HCAP. This reduction in the rate of carbapenem administration did not have an impact on the prognosis in the cases of CAP, and the in-hospital mortality was lower among the patients with HCAP during the intervention period (15% vs. 5%, p = 0.013). The causes of death in the cases of HCAP were not directly related to pneumonia during the intervention period. The current study shows that carbapenem use can be avoided in cases of CAP or HCAP that are not in a critical condition. The frequent use of antipseudomonal beta-lactams does not improve the clinical outcomes of HCAP.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  19. 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.

  20. 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...... the pharmacokinetic (PK) profile of moxifloxacin at 400 mg/day in 18 patients treated empirically for community-acquired pneumonia. We developed a population pharmacokinetic model to assess the potential efficacy of moxifloxacin and to simulate the maximal MICs for which recommended pharmacokinetic....... 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...

  1. 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...

  2. Audit of Physicians’ Adherence to a Preprinted Order Set for Community-Acquired Pneumonia

    Science.gov (United States)

    Fowkes, Curt T; Gee, Carol; Bluemink, Tammy; Cole, Dana; Falkner, Barbara L; Hamour, Abu A

    2010-01-01

    Background: Community-acquired pneumonia is the seventh leading cause of death in Canada. Previous studies have shown reductions in both mortality rate and length of hospital stay with the use of guideline-concordant empiric therapy and standardized preprinted orders. Objectives: The primary objective was to determine adherence to the preprinted order for community-acquired pneumonia at the University Hospital of Northern British Columbia (UHNBC). The study also had the following secondary objectives: to assess the appropriateness of prescribing of levofloxacin in relation to institutional recommendations; to determine adherence with recent guidelines from the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) for the treatment of community-acquired pneumonia; and to determine all-cause mortality, duration of IV antibiotic therapy, and length of stay for the various regimens reviewed. Methods: A retrospective observational chart review was conducted of patients with community-acquired pneumonia who were admitted between November 2007 and February 2008. Exclusion criteria were designed to eliminate patients who did not have this condition. Descriptive statistics were used to assess adherence with the preprinted order. Secondary outcomes were analyzed with the Pearson χ2 test, t tests, and analysis of variance. Results: In total, the charts for 113 patients were reviewed, and 58 patients were included in the study. The preprinted order for community-acquired pneumonia was used for 25 (43%) of the 58 patients; however, for only 4 (7%) of these admissions were all sections of the preprinted order used correctly. No statistically significant differences in length of stay were found for any of the antibiotic combinations assessed. However, the proportion of patients treated according to the IDSA–ATS guidelines was significantly greater when the preprinted order was used (p = 0.012). In addition, use of the preprinted order encouraged

  3. Antibiotic susceptibility in relation to genotype of Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae responsible for community-acquired pneumonia in children.

    Science.gov (United States)

    Morozumi, Miyuki; Chiba, Naoko; Okada, Takafumi; Sakata, Hiroshi; Matsubara, Keita; Iwata, Satoshi; Ubukata, Kimiko

    2013-06-01

    Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae are the main pathogens causing community-acquired pneumonia (CAP). We identified S. pneumoniae (n = 241), H. influenzae (n = 123), and M. pneumoniae (n = 54) as causative pathogens from clinical findings and blood tests from pediatric CAP patients (n = 903) between April 2008 and April 2009. Identification of genes mediating antimicrobial resistance by real-time PCR was performed for all isolates of these three pathogens, as was antibiotic susceptibility testing using an agar dilution method or broth microdilution method. The genotypic (g) resistance rate was 47.7 % for penicillin-resistant S. pneumoniae (gPRSP) possessing abnormal pbp1a, pbp2x, and pbp2b genes, 62.6 % for β-lactamase-nonproducing, ampicillin-resistant (gBLNAR) H. influenzae possessing the amino acid substitutions Ser385Thr and Asn526Lys, and 44.4 % for macrolide-resistant M. pneumoniae (gMRMP) possessing a mutation of A2063G, A2064G, or C2617A. Serotype 6B (20.3 %) predominated in S. pneumoniae, followed by 19F (15.4 %), 14 (14.5 %), 23F (12.0 %), 19A (6.2 %), and 6C (5.4 %). Coverage for the isolates by heptavalent pneumococcal conjugate vaccine (PCV7) and PCV13, respectively, was calculated as 68.5 and 80.9 %. A small number of H. influenzae were identified as type b (6.5 %), type e (0.8 %), or type f (0.8 %); all others were nontypeable. Proper use of antibiotics based on information about resistance in CAP pathogens is required to control rapid increases in resistance. Epidemiological surveillance of pediatric patients also is needed to assess the effectiveness of PCV7 and Hib vaccines after their introduction in Japan.

  4. 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

  5. Chlamydia psittaci : a relevant cause of community-acquired pneumonia in two Dutch hospitals

    NARCIS (Netherlands)

    Spoorenberg, S M C; Bos, W J W; van Hannen, E J; Dijkstra, F; Heddema, E R; van Velzen-Blad, H; Heijligenberg, R; Grutters, J C; de Jongh, B M; Meijvis, SCA

    2016-01-01

    BACKGROUND: Of all hospitalised community-acquired pneumonias (CAPs) only a few are known to be caused by Chlamydia psittaci. Most likely the reported incidence, ranging from of 0% to 2.1%, is an underestimation of the real incidence, since detection of psittacosis is frequently not incorporated in

  6. Revised SWAB guidelines for antimicrobial therapy of community-acquired pneumonia

    NARCIS (Netherlands)

    Schouten, JA; Prins, JM; Bonten, MJ; Degener, J; Janknegt, RE; Hollander, JMR; Jonkers, RE; Wijnands, WJ; Verheij, TJ; Sachs, APE; Kullberg, BJ

    2005-01-01

    The Dutch Working Party on Antibiotic Policy (SWAB) develops evidence-based guidelines, aimed at optimalisation of antibiotic use and limitation of the spread of antimicrobial resistance. A revision of the SWAB guideline for the treatment of community-acquired pneumonia (CAP), published in 1998, was

  7. 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...

  8. 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 with g...

  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. 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...... with guidelines for treatment and care of patients with CAP....

  11. Pharmacokinetics and Dosing of Ceftobiprole Medocaril for the Treatment of Hospital- and Community-Acquired Pneumonia in Different Patient Populations

    NARCIS (Netherlands)

    A. Torres; J.W. Mouton (Johan); Pea, F. (Federico)

    2016-01-01

    textabstractHospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP) are among the most common infections treated in the hospital setting, and together they place a significant burden on healthcare systems. Successful management of HAP and CAP depends on rapid initiation of empirical

  12. Atualização em pneumonia comunitária viral Update on viral community-acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Ozéas Galeno da Rocha Neto

    2013-02-01

    Full Text Available A pneumonia de origem viral é uma causa prevalente de infecção respiratória em adultos imunocompetentes. Tem apresentação variada, ocasionando desde formas leves a quadros graves de insuficiência respiratória com necessidade de ventilação mecânica. Contudo, em nosso país, há poucos estudos a respeito da apresentação clínica e diagnóstico dessa infecção. Dessa forma, os autores do presente artigo têm por objetivo revisar os principais agentes virais causadores de pneumonia na comunidade e discutir as modalidades diagnósticas e terapêuticas disponíveis atualmente.Viral pneumonia is a prevalent cause of respiratory infection in immunocompetent adults. It has varied presentation, from mild to severe respiratory failure, requiring mechanical ventilation. However, in Brazil, there have been few studies on the clinical presentation and diagnosis of this infection. Thus, the authors of the present article intend to review the main viral agents that cause community-acquired pneumonia and to discuss the currently available diagnostic and therapeutic methods.

  13. 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.

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

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    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

  15. Fluoroquinolones in community-acquired pneumonia: guide to selection and appropriate use.

    Science.gov (United States)

    Frei, Christopher R; Labreche, Matthew J; Attridge, Russell T

    2011-04-16

    Fluoroquinolone use has dramatically increased since the introduction of the first respiratory fluoroquinolone in the late 1990s. Over a relatively brief period of time, the respiratory fluoroquinolones have supplanted other first-line options as the predominant community-acquired pneumonia (CAP) therapy in hospitals. This article discusses the rise of the fluoroquinolone era, debates the comparative effectiveness of fluoroquinolones for CAP therapy, examines fluoroquinolone resistance and adverse drug reactions, and discusses new trends in pneumonia epidemiology and outcomes assessment. Overall, published data suggest that fluoroquinolone monotherapy is associated with improved patient survival compared with β-lactam monotherapy and similar survival to β-lactam plus macrolide combination therapy. Fluoroquinolone monotherapy may be associated with shorter hospital length of stay compared with β-lactam plus macrolide combination therapy, particularly in severe pneumonia or with high-dose therapy. There is insufficient evidence to conclude that any individual fluoroquinolone therapy is better than another with regards to patient mortality. Fluoroquinolones are generally well tolerated and Streptococcus pneumoniae resistance remains low; however, rare but serious adverse effects have been reported. Some members of the fluoroquinolone class have been removed from the market amidst safety concerns. Pneumonia classifications have changed and antipseudomonal fluoroquinolones may have a role in healthcare-associated pneumonia when administered in combination with other antipseudomonal and anti-methicillin-resistant Staphylococcus aureus therapies.

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

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    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.

  17. 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.

  18. Mycoplasma pneumonia

    Science.gov (United States)

    Walking pneumonia; Community-acquired pneumonia - mycoplasma; Community-acquired pneumonia - atypical ... Mycoplasma pneumonia usually affects people younger than 40. People who live or work in crowded areas such as schools ...

  19. Fluoroquinolones in the management of community-acquired pneumonia in primary care.

    Science.gov (United States)

    Wispelwey, Brian; Schafer, Katherine R

    2010-11-01

    A literature search was conducted to evaluate the pharmacokinetic and pharmacodynamic profile of the respiratory fluoroquinolones (gemifloxacin, levofloxacin and moxifloxacin) and their efficacy and safety in the management of community-acquired pneumonia (CAP). Data show that CAP is a common presentation in primary care practice, and is associated with high rates of morbidity and mortality, particularly in the elderly. Although the causative pathogens differ depending on treatment setting and patient factors, Streptococcus pneumoniae is the primary pathogen in all treatment settings. As a class, the respiratory fluoroquinolones have a very favorable pharmacokinetic and pharmacodynamic profile. Pharmacodynamic criteria suggest that moxifloxacin and gemifloxacin are more potent against S. pneumoniae, which may have the added benefit of reducing resistance selection and enhancing bacterial eradication. The respiratory fluoroquinolones are also generally well tolerated, and are first-line options for outpatient treatment of CAP in patients with comorbidities or previous antibiotic use.

  20. Fluorocycline TP-271 Is Potent against Complicated Community-Acquired Bacterial Pneumonia Pathogens

    Science.gov (United States)

    Fyfe, Corey; O’Brien, William; Hackel, Meredith; Minyard, Mary Beth; Waites, Ken B.; Dubois, Jacques; Murphy, Timothy M.; Slee, Andrew M.; Weiss, William J.; Sutcliffe, Joyce A.

    2017-01-01

    ABSTRACT TP-271 is a novel, fully synthetic fluorocycline antibiotic in clinical development for the treatment of respiratory infections caused by susceptible and multidrug-resistant pathogens. TP-271 was active in MIC assays against key community respiratory Gram-positive and Gram-negative pathogens, including Streptococcus pneumoniae (MIC90 = 0.03 µg/ml), methicillin-sensitive Staphylococcus aureus (MSSA; MIC90 = 0.25 µg/ml), methicillin-resistant S. aureus (MRSA; MIC90 = 0.12 µg/ml), Streptococcus pyogenes (MIC90 = 0.03 µg/ml), Haemophilus influenzae (MIC90 = 0.12 µg/ml), and Moraxella catarrhalis (MIC90 ≤0.016 µg/ml). TP-271 showed activity (MIC90 = 0.12 µg/ml) against community-acquired MRSA expressing Panton-Valentine leukocidin (PVL). MIC90 values against Mycoplasma pneumoniae, Legionella pneumophila, and Chlamydia pneumoniae were 0.004, 1, and 4 µg/ml, respectively. TP-271 was efficacious in neutropenic and immunocompetent animal pneumonia models, generally showing, compared to the burden at the start of dosing, ~2 to 5 log10 CFU reductions against MRSA, S. pneumoniae, and H. influenzae infections when given intravenously (i.v.) and ~1 to 4 log10 CFU reductions when given orally (p.o.). TP-271 was potent against key community-acquired bacterial pneumonia (CABP) pathogens and was minimally affected, or unaffected, by tetracycline-specific resistance mechanisms and fluoroquinolone or macrolide drug resistance phenotypes. IMPORTANCE Rising resistance rates for macrolides, fluoroquinolones, and β-lactams in the most common pathogens associated with community-acquired bacterial pneumonia (CABP) are of concern, especially for cases of moderate to severe infections in vulnerable populations such as the very young and the elderly. New antibiotics that are active against multidrug-resistant Streptococcus pneumoniae and Staphylococcus aureus are needed for use in the empirical treatment of the most severe forms of this disease. TP-271 is a promising

  1. Fulfilment assessment of the good clinical practices guidelines for community acquired pneumonia.

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    Iris Gonzalez Morales

    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.

  2. Ceftobiprole medocaril: a review of its use in patients with hospital- or community-acquired pneumonia.

    Science.gov (United States)

    Syed, Yahiya Y

    2014-09-01

    Ceftobiprole, the active metabolite of the prodrug ceftobiprole medocaril (Zevtera(®)), is a new generation broad-spectrum intravenous cephalosporin with activity against methicillin-resistant Staphylococcus aureus. Ceftobiprole exhibits potent in vitro activity against a number of Gram-positive and Gram-negative pathogens associated with hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP). It is the first cephalosporin monotherapy approved in the EU for the treatment of both HAP (excluding ventilator associated-pneumonia [VAP]) and CAP. In phase III trials, ceftobiprole medocaril was noninferior, in terms of clinical cure rates at the test-of-cure visit, to ceftazidime plus linezolid in patients with HAP and to ceftriaxone ± linezolid in patients with CAP severe enough to require hospitalization. In patients with HAP, noninferiority of ceftobiprole medocaril to ceftazidime plus linezolid was not demonstrated in a subset of patients with VAP. In patients with CAP, ceftobiprole medocaril was effective in those at risk for poor outcomes (pneumonia severity index ≥91, Pneumonia Patient Outcomes Research Team score IV-V or bacteraemic pneumonia). In the phase III trials, ceftobiprole medocaril was generally well tolerated, with ≈10 % of patients discontinuing the treatment because of adverse events. The most common treatment-related adverse events occurring in ceftobiprole recipients in the trials in patients with HAP or CAP included nausea, diarrhoea, infusion site reactions, vomiting, hepatic enzyme elevations and hyponatraemia. Therefore, ceftobiprole medocaril monotherapy offers a simplified option for the initial empirical treatment of patients with HAP (excluding VAP) and in those with CAP requiring hospitalization.

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

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    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.

  4. 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

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

    Science.gov (United States)

    Shah, Bashir Ahmed; Singh, Gurmeet; Naik, Muzafar Ahmed; Dhobi, Ghulam Nabi

    2010-01-01

    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 staphylococcus 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

  6. Adherence to clinical practice guidelines on community acquired pneumonia and its relation to mortality rates.

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    María Caridad Fragoso Marchante

    2010-08-01

    Full Text Available Background: Community acquired pneumonia is a common disease that is associated with significant morbidity and mortality rates. In the General University Hospital ´´Dr. Gustavo Aldereguía Lima¨ in Cienfuegos, there are guidelines for the management of patients with community-acquired pneumonia, but no studies have been conducted as to the relation between their compliance and the mortality rate. Objective: To assess the adherence to guidelines for diagnosis and treatment of community-acquired pneumonia and its relation to mortality in hospitalized patients. Methods: A descriptive, observational and prospective case series study was conducted in all patients with a diagnosis of pneumonia or bronchopneumonia at the moment of admission and discharge from June 2006 to May 31, 2007. The relation between the different variables and the mortality rate was analyzed as to the different types of risks and the overall compliance with the guidelines for each risk with mortality. A multivariate analysis (logistic regression was performed, with a 95% confidence interval. Results: The results are presented in tables of numbers and percent. Variables independently associated with mortality were: age (over 65 years old people, radiological lesions in more than one lobe or bilateral, atypical pneumonia debut, negative assessments as to the adherence to guidelines and inadequate treatments. Conclusion: The variables included in the study were enough to explain the final outcome of the patients, so it could be determined, for the first time in Cienfuegos, that the non-compliance with the guidelines of good clinical practice is related to mortality rates.

  7. Community-Acquired Pyelonephritis in Pregnancy Caused by KPC-Producing Klebsiella pneumoniae

    Science.gov (United States)

    Khatri, Asma; Naeger Murphy, Nina; Wiest, Peter; Osborn, Melissa; Garber, Kathleen; Hecker, Michelle; Hurless, Kelly; Rudin, Susan D.; Jacobs, Michael R.; Kalayjian, Robert C.; Salata, Robert A.; van Duin, David; Harris, Patrick N. A.

    2015-01-01

    Carbapenem-resistant Enterobacteriaceae (CRE) usually infect patients with significant comorbidities and health care exposures. We present a case of a pregnant woman who developed community-acquired pyelonephritis caused by KPC-producing Klebsiella pneumoniae. Despite antibiotic treatment, she experienced spontaneous prolonged rupture of membranes, with eventual delivery of a healthy infant. This report demonstrates the challenge that CRE may pose to the effective treatment of common infections in obstetric patients, with potentially harmful consequences to maternal and neonatal health. PMID:26185273

  8. Choosing the right combination therapy in severe community-acquired pneumonia

    OpenAIRE

    Waterer, Grant W.; Rello, Jordi

    2006-01-01

    Recent studies have suggested that combination antibiotic therapy is preferable to monotherapy for severe community-acquired pneumonia (CAP). In this issue Mortensen and colleagues present retrospective data suggesting that combination therapy with a cephalosporin and a fluoroquinolone is inferior to combination therapy with a cephalosporin and a macrolide. Several mechanisms exist by which quinolones could be inferior to macrolides in combination therapy, so if these findings are confirmed b...

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

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    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.

  10. Soluble RAGE as a severity marker in community acquired pneumonia associated sepsis

    OpenAIRE

    2012-01-01

    Abstract Background Community-acquired pneumonia (CAP) is considered the most important cause of death from infectious disease in developed countries. Severity assessment scores partially address the difficulties in identifying high-risk patients. A lack of specific and valid pathophysiologic severity markers affect early and effective sepsis therapy. HMGB-1, sRAGE and RAGE have been involved in sepsis and their potential as severity markers has been proposed. The aim of this study was to eva...

  11. 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.

  12. Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment.

    Science.gov (United States)

    Kothe, H; Bauer, T; Marre, R; Suttorp, N; Welte, T; Dalhoff, K

    2008-07-01

    Community-acquired pneumonia remains a major cause of mortality in developed countries. There is much discrepancy in the literature regarding factors influencing the outcome in the elderly population. Data were derived from a multicentre prospective study initiated by the German Competence Network for Community-Acquired Pneumonia. Patients with community-acquired pneumonia (n = 2,647; 1,298 aged or = 65 yrs) were evaluated, of whom 72.3% were hospitalised and 27.7% treated in the community. Clinical history, residence status, course of disease and antimicrobial treatment were prospectively documented. Microbiological investigations included cultures and PCR of respiratory samples and blood cultures. Factors related to mortality were included in multivariate analyses. The overall 30-day mortality was 6.3%. Elderly patients exhibited a significantly higher mortality rate that was independently associated with the following: age; residence status; confusion, urea, respiratory frequency and blood pressure (CURB) score; comorbid conditions; and failure of initial therapy. Increasing age remained predictive of death in the elderly. Nursing home residents showed a four-fold increased mortality rate and an increased rate of gram-negative bacillary infections compared with patients dwelling in the community. The CURB score and cerebrovascular disease were confirmed as independent predictors of death in this subgroup. Age and residence status are independent risk factors for mortality after controlling for comorbid conditions and disease severity. Failure of initial therapy was the only modifiable prognostic factor.

  13. [Efficacy and safety of azithromycin infusion in patients with mild or moderate community-acquired pneumonia].

    Science.gov (United States)

    Noguchi, Shingo; Yatera, Kazuhiro; Kawanami, Toshinori; Yamasaki, Kei; Uchimura, Keigo; Hata, Ryosuke; Tachiwada, Takashi; Oda, Keishi; Hara, Kanako; Suzuki, Yu; Akata, Kentarou; Ogoshi, Takaaki; Tokuyama, Susumu; Inoue, Naoyuki; Nishida, Chinatsu; Orihashi, Takeshi; Yoshida, Yugo; Kawanami, Yukiko; Taura, Yusuke; Ishimoto, Hiroshi; Obata, Hideto; Tsuda, Toru; Yoshii, Chiharu; Mukae, Hiroshi

    2014-06-01

    Azithromycin (AZM) is one of 15-membered rings macrolide antibiotics with wide spectrum of antimicrobial efficacy for Gram-positive and -negative bacteria and also atypical bacteria. So far, there had been no reports of the prospective studies evaluating efficacy and safety of AZM infusion in patients with mild or moderate community-acquired pneumonia (CAP). This study was conducted to evaluate prospectively the efficacy and safety of AZM in patients with mild or moderate CAP. AZM 500 mg was intravenously administered once daily, and the clinical efficacy were evaluated by clinical symptoms, peripheral blood laboratory findings and chest X-rays. Sixty-four patients were firstly registered, and eventually 61 and 62 patients were enrolled for the evaluation of clinical efficacy and safety of AZM, respectively. The efficacy of AZM in 61 patients evaluated was 88.5%. In addition, the efficacies of AZM in each pneumonia severity index by A-DROP system by the Japanese Respiratory Society (JRS) guideline in CAP were 85.2% in mild and 91.2% in moderate. Furthermore, the efficacy of AZM in each differentiation between suspicion of bacterial pneumonia and that of atypical pneumonia by JRS guideline in CAP were 91.7% in suspicion of atypical pneumonia, and its efficacy was high than that of bacterial pneumonia. Nineteen patients (20 cases; 15 with liver dysfunction, 4 with diarrhea, 1 with vascular pain) out of 62 patients were reported to have possible adverse effects of AZM. All of the patients with these adverse effects demonstrated mild dysfunction and continued AZM treatment, and these dysfunctions normalized soon after cessation of AZM. In conclusion, AZM is effective drug for patients with mild or moderate CAP, and we believe that it may be one of effective choice in the treatment of CAP patients who need hospitalization.

  14. Disease burden of intensive care unit-acquired pneumonia in China: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Yaowen Zhang

    2014-12-01

    Conclusions: ICU-acquired pneumonia/VAP remains a major cause of morbidity and mortality in patients in the ICU in China. Data on organisms causing disease in this population could help guide appropriate prevention strategies and treatment.

  15. 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.

  16. The role of haloaerosolotherapy in immunorehabilitation of convalescents after community acquired pneumonia

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    Olha Lemko

    2015-02-01

    Full Text Available Aim: Investigation of the peculiarities of different haloaerosoltherapy regimes influence (treatment with different intensity of haloaerosol load upon non-specific defense and cellular immunity at convalescents after community acquired pneumonia. Objectives: patients with community acquired pneumonia in the early convalescence period (after completing antibiotic therapy, who received treatment in conditions of artificial rock salt aerosol medium (haloaerosoltherapy. Material and Methods. 42 patients with non-severe community acquired pneumonia were examined in the early convalescence period before and after the course of haloaerosoltherapy, which was prescribed after antibacterial therapy. Immunological studies included: evaluation of phagocytic activity of neutrophils (PhAN - the percentage of phagocytic neutrophils, phagocytic number (PhN - average number of latex particles absorbed by a neutrophil; metabolism of neutrophils in the test with nitroblue tetrasolium (NBT-test spontaneous and induced, which allowed to assess the functional reserve of neutrophils (FR; calculation of cytochemical coefficient (CCC for lysosomal cationic proteins (LCP and for myeloperoxidase (MPO of neutrophils; number of T- and B-lymphocytes and their subpopulations (CD3+ -, CD4+ -, CD8+ -, CD22+ - lymphocytes, calculation the number of 0- lymphocytes and the ratio of CD4+ /CD8+ lymphocytes. Laboratory examinations were also conducted in 21 practically healthy individuals (control group. Two regimes of haloaerosoltherapy were used in recovery treatment of patients with community acquired pneumonia: treating complex №1 (TC-1 with standard haloaerosol load and with increased haloaerosol load (TC-2. Results. After completion the antibiotic therapy at patients with community acquired pneumonia the moderate inhibition of phagocytic activity of neutrophils (47,6±0,58% to 55,5±1,14% in control group remained and was accompanied with a decrease in neutrophil bactericidal

  17. Viruses and bacteria in sputum samples of children with community-acquired pneumonia.

    Science.gov (United States)

    Honkinen, M; Lahti, E; Österback, R; Ruuskanen, O; Waris, M

    2012-03-01

    Few comprehensive studies have searched for viruses and bacteria in children with community-acquired pneumonia (CAP). We identified 76 children hospitalized for pneumonia. Induced sputum samples were analysed for 18 viruses by antigen detection and PCR, and for six bacteria by culture and PCR. Viruses were found in 72% of samples, bacteria in 91%, and both in 66%. Rhinovirus (30%), human bocavirus (18%) and human metapneumovirus (14%) were the most commonly detected viruses. Two viruses were found in 22% of samples and three in 8%. The most common bacteria found were Streptococcus pneumoniae (50%), Haemophilus influenzae (38%), and Moraxella catarrhalis (28%). Rhinovirus-S. pneumoniae was the most commonly found combination of virus and bacterium (16%). All six children with treatment failure had both viruses and bacteria detected in the sputum. Otherwise, we found no special clinical characteristics in those with mixed viral-bacterial detections. With modern molecular diagnostic techniques, there are high rates of both viral and bacterial identification in childhood CAP. The clinical significance of mixed viral-bacterial infections remains unclear, although we found a potential association between them and treatment failure.

  18. Severe community-acquired Enterobacter pneumonia: a plea for greater awareness of the concept of health-care-associated pneumonia

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    Bébéar Cécile

    2011-05-01

    Full Text Available Abstract Background Patients with Enterobacter community-acquired pneumonia (EnCAP were admitted to our intensive care unit (ICU. Our primary aim was to describe them as few data are available on EnCAP. A comparison with CAP due to common and typical bacteria was performed. Methods Baseline clinical, biological and radiographic characteristics, criteria for health-care-associated pneumonia (HCAP were compared between each case of EnCAP and thirty age-matched typical CAP cases. A univariate and multivariate logistic regression analysis was performed to determine factors independently associated with ENCAP. Their outcome was also compared. Results In comparison with CAP due to common bacteria, a lower leukocytosis and constant HCAP criteria were associated with EnCAP. Empiric antibiotic therapy was less effective in EnCAP (20% than in typical CAP (97% (p Conclusions EnCAP is a severe infection which is more consistent with HCAP than with typical CAP. This retrospectively suggests that the application of HCAP guidelines should have improved EnCAP management.

  19. Single versus combination antibiotic therapy in adults hospitalised with community acquired pneumonia.

    Science.gov (United States)

    Rodrigo, Chamira; Mckeever, Tricia M; Woodhead, Mark; Lim, Wei Shen

    2013-05-01

    The benefits of β-lactam/macrolide combination therapy over β-lactam therapy alone for the treatment of hospitalised community-acquired pneumonia (CAP) in relation to pneumonia severity are uncertain. We studied 5240 adults hospitalised with CAP from 72 secondary care trusts across England and Wales. The overall 30-day inpatient (IP) death rate was 24.4%. Combination therapy was prescribed in 3239 (61.8%) patients. In a multivariable model, combination therapy was significantly associated with lower 30-day IP death rate in patients with moderate-severity CAP (adjusted OR 0.54, 95% CI 0.41 to 0.72) and high-severity CAP (adjusted OR 0.76, 95% CI 0.60 to 0.96) but not low-severity CAP.

  20. Optimal treatment strategies for community-acquired pneumonia: high-risk patients (geriatric and with comorbidity).

    Science.gov (United States)

    Carbon, C

    2001-01-01

    The four major factors predisposing individuals to community-acquired pneumonia (CAP) are chronic obstructive pulmonary disease, congestive heart failure, diabetes, and a high alcohol intake. The elderly are also at increased risk of severe infection. The introduction of fluoroquinolones with increased activity against Streptococcus pneumoniae and other CAP pathogens has been an important development, with recent guidelines recommending the use of respiratory fluoroquinolones as a first-line choice in outpatients with modifying factors, nursing home residents, and hospitalised patients in medical wards. Of the fluoroquinolones currently available that have antipneumococcal activity, levofloxacin is well tolerated and effective. It has been approved by the Food and Drug Administration (FDA) for treatment of CAP and widespread use has shown it to be very safe.

  1. 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.

  2. 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.

  3. 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.

  4. 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...... and outcome parameters were collected. Three groups were established according to the initial choice of antibiotic(s): penicillin only (n = 160); non-allergic patients starting broader spectrum therapy (n = 54); and patients with suspected penicillin allergy (n = 29). RESULTS: The overall mortality within...... with similar patterns of microbial pathogens and resistance....

  5. Community acquired bilateral upper lobe Pneumonia with acute adrenal insufficiency: A new face of Achromobacter xylosoxidans

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    Suman S Karanth

    2012-05-01

    Full Text Available AbstractAchromobacter xylosoxidans is an uncommon pathogen of low virulence known to cause serious nosocomial infection in the immunocompromised. Its inherent multi-drug resistance makes treatment difficult. Community-acquired infections are rare despite its ubiquitous existence. We present a 50-year-old immunocompetent woman who presented with one-month history of coughing with expectoration who was subsequently diagnosed with bilateral upper lobe pneumonia and acute adrenal insufficiency. Achromobacter xylosoxidans was isolated from sputum and bronchoalveolar lavage culture. The acute adrenal insufficiency recovered after appropriate antibiotic therapy. Amongst the myriad of presentations, we highlight the rarity of acute adrenal insufficiency triggered by the infection.

  6. Community acquired bilateral upper lobe pneumonia with acute adrenal insufficiency: A new face of Achromobacter Xylosoxidans.

    Science.gov (United States)

    Karanth, Suman S; Gupta, Anurag; Prabhu, Mukhyaprana

    2012-01-01

    Achromobacter xylosoxidans is an uncommon pathogen of low virulence known to cause serious nosocomial infection in the immunocompromised. Its inherent multi-drug resistance makes treatment difficult. Community-acquired infections are rare despite its ubiquitous existence. We present a 50-year-old immunocompetent woman who presented with one-month history of coughing with expectoration who was subsequently diagnosed with bilateral upper lobe pneumonia and acute adrenal insufficiency. Achromobacter xylosoxidans was isolated from sputum and bronchoalveolar lavage culture. The acute adrenal insufficiency recovered after appropriate antibiotic therapy. Amongst the myriad of presentations, we highlight the rarity of acute adrenal insufficiency triggered by the infection.

  7. Community acquired pneumonia in the elderly: the Pneumonia in Italian Acute Care for Elderly units (PIACE study protocol by the Italian Society of Hospital and Community Geriatrics (SIGOT

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    Filippo Luca Fimognari

    2017-01-01

    Full Text Available Pneumonia is a frequent cause of hospital admission in elderly patients. Diagnosis of pneumonia in elderly persons with comorbidity may be challenging, due to atypical presentation and complex clinical scenarios. Community-acquired pneumonia (CAP arises out-of-hospital in subjects without previous contact with the healthcare system. Healthcare associated pneumonia (HCAP occurs in patients who have frequent contacts with the healthcare system and should be treated with empiric broad spectrum antibiotic therapy also covering multi-drug resistant (MDR pathogens. Recent findings, however, have questioned this approach, because the worse prognosis of HCAP compared to CAP may better reflect increased level of comorbidity and frailty (poor functional status, older age of HCAP patients, as well as poorer quality of hospital care provided to such patients, rather than pneumonia etiology by MDR pathogens. The Pneumonia in Italian Acute Care for Elderly units (PIACE Study, promoted by the Società Italiana di Geriatria Ospedale e Territorio (SIGOT, is an observational prospective cohort study of patients consecutively admitted because of pneumonia to hospital acute care units of Geriatrics throughout Italy. Detailed information regarding clinical presentation, diagnosis, etiology, comprehensive geriatric assessment, antibiotic therapy, possible complications and comorbidities was recorded to identify factors potentially predicting in-hospital mortality (primary endpoint, 3-month mortality, length of hospital stay, postdischarge rate of institutionalization and other secondary endpoints. This paper describes the rationale and method of PIACE Study and reviews the main evidence on pneumonia in the elderly.

  8. THE OUTCOME OF ANTIBIOTIC THERAPY AMONG CHILDREN WITH SEVERE COMMUNITY ACQUIRED PNEUMONIA

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    M. R. Usman

    2015-08-01

    Full Text Available Background: The effect of human immunodeficiency virus (HIV status on the evolution of community acquired pneumonia (CAP is still controversial. There are controversies regarding antibiotic treatment outcome of CAP in HIV infected children. Objective: The aim of this study was to investigate possible differences in hospital outcomes, with compared the outcome of the treatment in severe CAP among HIV infected and HIV uninfected children which had an empiric antibiotic therapy. Methods: A case control study of 80 patients with severe CAP in Department of Child Health, Sanglah General Hospital, Bali-Indonesia. We evaluated clinical features for seeing the effectiveness of the antibiotic therapy according to Department of Child Health, Sanglah General Hospital’s clinical pathway for severe pneumonia between HIV infected and HIV uninfected patients. Results: 58% patients in failure treatment and 45% patients in favorable treatment were HIV infected. There were similar characteristics from both groups, except malnutrition condition was statistically significant contribute the outcome (OR 2.87 (95% CI 1.098 to 7.500, p= 0.031. There was no significantly statistic difference of the outcome in HIV infected as compared to HIV uninfected patients with severe CAP (OR 1.65 (95% CI 0.683 to 4.002, p= 0.263. Conclusion: HIV infection was not gave an effect on the outcome of severe CAP patients which had an antibiotic therapy based on Department of Child Health, Sanglah General Hospital’s clinical pathway for severe pneumonia.

  9. 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.

  10. Predictors of Severe Sepsis among Patients Hospitalized for Community-Acquired Pneumonia.

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    Beatriz Montull

    Full Text Available Severe sepsis, may be present on hospital arrival in approximately one-third of patients with community-acquired pneumonia (CAP.To determine the host characteristics and micro-organisms associated with severe sepsis in patients hospitalized with CAP.We performed a prospective multicenter cohort study in 13 Spanish hospital, on 4070 hospitalized CAP patients, 1529 of whom (37.6% presented with severe sepsis. Severe sepsis CAP was independently associated with older age (>65 years, alcohol abuse (OR, 1.31; 95% CI, 1.07-1.61, chronic obstructive pulmonary disease (COPD (OR, 1.75; 95% CI, 1.50-2.04 and renal disease (OR, 1.57; 95% CI, 1.21-2.03, whereas prior antibiotic treatment was a protective factor (OR, 0.62; 95% CI, 0.52-0.73. Bacteremia (OR, 1.37; 95% CI, 1.05-1.79, S pneumoniae (OR, 1.59; 95% CI, 1.31-1.95 and mixed microbial etiology (OR, 1.65; 95% CI, 1.10-2.49 were associated with severe sepsis CAP.CAP patients with COPD, renal disease and alcohol abuse, as well as those with CAP due to S pneumonia or mixed micro-organisms are more likely to present to the hospital with severe sepsis.

  11. 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.

  12. Ceftaroline in the management of complicated skin and soft tissue infections and community acquired pneumonia

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    Mpenge MA

    2015-04-01

    Full Text Available Mbiye A Mpenge,1 Alasdair P MacGowan2 1Department of Medical Microbiology, University Hospitals Bristol NHS Trust, Bristol Royal Infirmary, Bristol, England; 2Department of Medical Microbiology, North Bristol NHS Trust, Southmead Hospital, Bristol, England Abstract: Ceftaroline is a new parenteral cephalosporin approved by the European Medicines Agency (EMA and the US Food and Drug Administration (FDA for the treatment of complicated skin and soft tissue infections (cSSTIs including those due to methicillin-resistant Staphylococcus aureus (MRSA, and community-acquired pneumonia (CAP. Ceftaroline has broad-spectrum activity against gram-positive and gram-negative bacteria and exerts its bactericidal effects by binding to penicillin-binding proteins (PBPs, resulting in inhibition of bacterial cell wall synthesis. It binds to PBP 2a of MRSA with high affinity and also binds to all six PBPs in Streptococcus pneumoniae. In in vitro studies, ceftaroline demonstrated potent activity against Staphylococcus aureus (including MRSA and vancomycin-intermediate isolates, Streptococcus pneumoniae (including multidrug resistant isolates, Haemophilus influenzae, Moraxella catarrhalis, and many common gram-negative pathogens, excluding extended spectrum beta-lactamase (ESBL-producing Enterobacteriaceae and Pseudomonas aeruginosa. In Phase II and Phase III clinical trials, ceftaroline was noninferior to its comparator agents and demonstrated high clinical cure rates in the treatment of cSSTIs and CAP. It demonstrated favorable outcomes in patients treated for both regulatory-approved indications and unlicensed indications in a retrospective analysis. Ceftaroline is a safe and effective option for treatment in specific patient populations in which its efficacy and safety have been proven. This article reviews the challenges in the treatment of cSSTI and CAP, ceftaroline and its microbiology, pharmacology, efficacy, and safety data which support its use in

  13. C reactive protein, calcitonin and D-dimer in patients of community acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    Xue-Lin Zhang; Zhen Wang; Shu-Hui Lv; Hai-Jun Jing; Jian-Yun Kang; Jian-Qing Zhao

    2016-01-01

    Objective:To investigate the clinical significance of C- reactive protein (CRP), calcitonin (PCT) and D- two (D-D) in community acquired pneumonia.Methods:A total of 102 patients with community-acquired pneumonia (CAP) admitted from March 2015- March 2016 as the research objects. A total of 5 mL peripheral venous blood of CAP patients (within 24 h of admission, before antibiotic therapy) were collected, and centrifuged to obtain serum. Immune turbidimetric method was used in determination of CRP and DD, immune fluorescence method was used for determination of PCT.Results:As grade increasing, the levels of CRP, PCT, D-D were increased gradually, with significant difference among different levels (P<0.05); CRP, PCT and D-D levels of severe group were significantly higher than those of non severe group (P<0.05); death group, CRP, PCT and D-D levels of death group were significantly higher than those of the survival group (P< 0.05).Conclusions:CRP, PCT, D-D levels have certain correlation with degree of severity. They can be used as important indicators to judge the severity of the disease, and predict the prognosis. High levels of CRP, PCT, D-D indicate severity of the disease and poor prognosis.

  14. [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.

  15. [Consensus guidelines for the management of community acquired pneumonia in the elderly patient].

    Science.gov (United States)

    González Del Castillo, Juan; Martín-Sánchez, Francisco Javier; Llinares, Pedro; Menéndez, Rosario; Mujal, Abel; Navas, Enrique; Barberán, José

    2014-01-01

    The incidence of community-acquired pneumonia increases with age and is associated with an elevated morbidity and mortality due to the physiological changes associated with aging and a greater presence of chronic disease. Taking into account the importance of this disease from an epidemiological and prognostic point of view, and the enormous heterogeneity described in the clinical management of the elderly, we believe a specific consensus document regarding this patient profile is necessary. The purpose of the present work was to perform a review of the evidence related to the risk factors for the etiology, the clinical presentation, the management and the treatment of community-acquired pneumonia in elderly patients with the aim of producing a series of specific recommendations based on critical analysis of the literature. This document is the result of the collaboration of different specialists representing the Spanish Society of Emergency Medicine and Emergency Care (SEMES), the Spanish Society of Geriatrics and Gerontology (SEGG), the Spanish Society of Chemotherapy (SEQ), the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Respiratory Medicine and Thoracic Surgery (SEPAR), Spanish Society of Home Hospitalization (SEHAD) and the Spanish Society of Infectious Disease and Clinical Microbiology (SEIMC).

  16. Prognostic scores and biomarkers for pediatric community-acquired pneumonia: how far have we come?

    Directory of Open Access Journals (Sweden)

    Uwaezuoke SN

    2017-02-01

    Full Text Available Samuel N Uwaezuoke,1 Adaeze C Ayuk2 1Pediatric Nephrology Firm, 2Pediatric Pulmonology Firm, Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria Abstract: This article aimed to review the current prognostic and diagnostic tools used for community-acquired pneumonia (CAP and highlight those potentially applicable in children with CAP. Several scoring systems have been developed to predict CAP mortality risk and serve as guides for admission into the intensive care unit. Over the years, clinicians have adopted these tools for improving site-of-care decisions because of high mortality rates in the extremes of age. The major scoring systems designed for geriatric patients include the Pneumonia Severity Index and the confusion, uremia, respiratory rate, blood pressure, age >65 years (CURB-65 rule, as well as better predictors of intensive care unit admission, such as the systolic blood pressure, multilobar chest radiography involvement, albumin level, respiratory rate, tachycardia, confusion, oxygenation and arterial pH (SMART-COP score, the Infectious Diseases Society of America/American Thoracic Society guidelines, the criteria developed by España et al as well as the systolic blood pressure, oxygenation, age and respiratory rate (SOAR criteria. Only the modified predisposition, insult, response and organ dysfunction (PIRO score has so far been applied to children with CAP. Because none of the tools is without its limitations, there has been a paradigm shift to incorporate biomarkers because they are reliable diagnostic tools and good predictors of disease severity and outcome, irrespective of age group. Despite the initial preponderance of reports on their utility in geriatric CAP, much progress has now been made in demonstrating their usefulness in pediatric CAP. Keywords: community-acquired pneumonia, children, scoring systems, biomarkers 

  17. 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

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    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

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

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    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

  19. 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

  20. 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.

  1. Cytokine Concentrations in Plasma from Children with Severe and Non-Severe Community Acquired Pneumonia.

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    Johanne Haugen

    Full Text Available Children in low and middle-income countries have a high burden of pneumonia. Measuring the cytokine responses may be useful to identify novel markers for diagnosing, monitoring, and treating pneumonia.To describe and compare a wide range of inflammatory mediators in plasma from children with WHO-defined severe and non-severe community acquired pneumonia (CAP, and explore to what extent certain mediators are associated with severity and viral detection.We collected blood samples from 430 children with severe (n = 43 and non-severe (n = 387 CAP. Plasma from these children were analysed for 27 different cytokines, and we measured the association with age, disease severity and viral detection.There were generally higher plasma concentrations of several cytokines with both pro-inflammatory and anti-inflammatory effects among children with severe CAP than in children with non-severe CAP. We found significantly higher concentrations of interleukin (IL-1, IL-4, IL-6, IL-8, IL-9, IL-15, eotaxin, basic fibroblast growth factor (b-FGF, granulocyte colony-stimulating factor (G-CSF, granulocyte-macrophage colony-stimulating factor (GM-CSF, and tumor necrosis factor-alpha (TNF-α in the group of severe CAP. Most of these associations persisted when adjusting for age in linear regression analyses. The cytokine response was strongly associated with age but to a lesser extent with viral etiology.The plasma concentrations of several cytokines, both with pro-inflammatory and anti-inflammatory effects, were higher among children with severe illness. In particular G-CSF and IL-6 reflected severity and might provide complementary information on the severity of the infection.ClinicalTrials.gov NCT00148733.

  2. Atrial Fibrillation Is an Independent Risk Factor for Hospital-Acquired Pneumonia.

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    Jinxiu Zhu

    Full Text Available Patients who were hospitalized for community-based pneumonia frequently had pre-existing atrial fibrillation (AF and had subsequent cardiovascular complications. Whether patients who had AF would be susceptible to the development of hospital-acquired pneumonia (HAP is a serious concern but this has not been investigated. In our clinics, we have made empirical observation of such susceptibility.To investigate the association between newly developed HAP and pre-existing AF, and to identify whether AF is an independent risk factor for HAP.Hospital data from 8657 sequentially admitted inpatients [1059 patients with AF and 7598 without AF (NAF] were collected from the Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China, from January 1, 2009 to December 31, 2011. Exclusion criteria were: having previous or current pneumonia, pacemakers, sick sinus syndrome and repeated hospitalization. The incidence of HAP (within 48 hours after hospitalization was identified among all the patients.Among the AF patients, 274 had HAP (adjusted rate 25.64% which was significantly higher than the 276 NAF patients who had HAP (adjusted rate 3.66%; P<0.001. The increased risk was also associated with high blood pressure, heart failure and age, but not with gender, smoking, coronary heart disease, diabetes, congenital heart disease. In addition, our multiple regression analysis indicates that AF is an independent risk factor for HAP.We have identified, for the first time, that AF is an important risk factor for HAP. Although additional clinical confirmation is needed, our data provide valuable evidence for use in prevention of HAP which is the most common cause of death from nosocomial infection.

  3. 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.

  4. Predictors of Mortality for Nursing Home-Acquired Pneumonia: A Systematic Review

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    Naveen Dhawan

    2015-01-01

    Full Text Available Background. Current risk stratification tools, primarily used for CAP, are suboptimal in predicting nursing home acquired pneumonia (NHAP outcome and mortality. We conducted a systematic review to evaluate current evidence on the usefulness of proposed predictors of NHAP mortality. Methods. PubMed (MEDLINE, EMBASE, and CINAHL databases were searched for articles published in English between January 1978 and January 2014. The literature search elicited a total of 666 references; 580 were excluded and 20 articles met the inclusion criteria for the final analysis. Results. More studies supported the Pneumonia Severity Index (PSI as a superior predictor of NHAP severity. Fewer studies suggested CURB-65 and SOAR (especially for the need of ICU care as useful predictors for NHAP mortality. There is weak evidence for biomarkers like C-reactive protein and copeptin as prognostic tools. Conclusion. The evidence supports the use of PSI as the best available indicator while CURB-65 may be an alternative prognostic indicator for NHAP mortality. Overall, due to the paucity of information, biomarkers may not be as effective in this role. Larger prospective studies are needed to establish the most effective predictor(s or combination scheme to help clinicians in decision-making related to NHAP mortality.

  5. Escherichia coli: an unknown and infrequent cause of community acquired pneumonia.

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    Ruiz, Luis Alberto; Zalacain, Rafael; Gómez, Ainhoa; Camino, Jesús; Jaca, Carmen; Núñez, Juan Manuel

    2008-01-01

    Our aim was to describe the incidence, clinical characteristics and outcome of community acquired pneumonia (CAP) caused by Escherichia coli through the analysis of a cohort of patients with this condition. This study includes all the patients who were admitted to our hospitals because of CAP caused by E. coli, diagnosed with highly reliable microbiological techniques, such as blood culture, bronchoscopic protected specimen brush (PSB) or transthoracic needle aspiration (TNA). 29 patients were enrolled, representing 0.4% of CAP cases admitted. Main symptoms were fever and dyspnoea. 18 patients were classified into class IV and class V of the Pneumonia Severity Index (PSI). Diagnosis was based on blood culture in 24 cases, PSB in 4 cases and by TNA in 1 case. Three of the patients died, the longer time evolution of the symptoms being the only factor related to higher mortality (p<0.05). Mean hospitalization time was 7.1+/-3.1 d, and correlated with severity at admission (r=0.43; p<0.003). This study demonstrates that CAP caused by E. coli is infrequent. It has an unspecific presentation and mortality rate is 10.3%, associated with longer time before admission to hospital.

  6. An appraisal of the evidence underlying performance measures for community-acquired pneumonia.

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    Wilson, Kevin C; Schünemann, Holger J

    2011-06-01

    Numerous organizations use performance measures to monitor the quality of care provided for a variety of clinical conditions. An appraisal of the evidence underlying such performance measures has never been reported. Our objective was to estimate the effects of interventions recommended by performance measures and to determine the quality of evidence from which those estimates derive, using the Joint Commission and the Centers for Medicare and Medicaid Services' performance measures for community-acquired pneumonia (CAP) as examples. We performed systematic reviews of the literature to identify evidence related to the performance measures for CAP. Metaanalyses were then performed to estimate the absolute and relative effects of the interventions recommended by the performance measures. The Grading Recommendations, Assessment, Development, and Evaluation system was used to determine the quality of evidence. The estimated effects favored the interventions recommended by five of the six performance measures. These included pneumococcal vaccination (incidence of pneumococcal pneumonia: relative risk [RR], 0.43; 95% confidence interval [CI], 0.24-0.75), blood cultures, antibiotic administration within 6 hours, use of a guideline-compliant antibiotic regimen, and influenza vaccination (incidence of symptomatic influenza: RR, 0.30; 95% CI, 0.22-0.40). However, among these performance measures, only influenza vaccination was supported by high-quality evidence. One-step smoking cessation counseling was contradicted by moderate-quality evidence (smoking quit rate: RR, 1.05; 95% CI, 0.90-1.22). The evidence supporting performance measures is frequently not of high quality and occasionally contradictory.

  7. 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.

  8. Clinical and bacteriological efficacies of sitafloxacin against community-acquired pneumonia caused by Streptococcus pneumoniae: nested cohort within a multicenter clinical trial.

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    Fujita, Jiro; Niki, Yoshihito; Kadota, Jun-Ichi; Yanagihara, Katsunori; Kaku, Mitsuo; Watanabe, Akira; Aoki, Nobuki; Hori, Seiji; Tanigawara, Yusuke; Cash, Haley L; Kohno, Shigeru

    2013-06-01

    We evaluated the clinical and bacteriological efficacy of oral sitafloxacin (STFX) in clinically diagnosed community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae. Additionally, we cultured these patient samples to test the minimal inhibitory concentrations (MICs) of levofloxacin (LVFX), moxifloxacin (MFLX), STFX, and penicillin G (PCG), as well as identified mutations in the quinolone resistance determinant regions (QRDRs) in LVFX-resistant strains. This study is a nested cohort from a prospective, multicenter clinical trial consisting of 139 patients with community-acquired pneumonia (CAP), from which 72 were included in this study. After diagnosis of CAP caused by S. pneumoniae, STFX (50 mg twice daily, or 100 mg once daily) was orally administered for 7 days. Sixty-five patient sputum samples were then cultured for MIC analysis. In a LVFX-resistant strain that was identified, mutations in the QRDRs of the gyrA, gyrB, parC, and parE genes were examined. Of 72 patients eligible for this study, S. pneumoniae was successfully cultured from the sputum of 65 patients, and only 7 patients were diagnosed by urinary antigen only. Clinical improvement of CAP was obtained in 65 of the 69 clinically evaluable patients (65/69, 94.2 %). Eradication of S. pneumoniae was observed in 62 patients of the 65 bacteriologically evaluable patients (62/65, 95.4 %). Additionally, STFX showed the lowest MIC distribution compared with LVFX, MFLX, and PCG, and no major adverse reactions were observed. STFX treatment in patients with CAP caused by S. pneumoniae was found to be highly effective both clinically (94.2 %) and bacteriologically (95.4 %).

  9. 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.

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

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    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.

  11. 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.

  12. 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.

  13. The Modern Diagnostic Approach to Community-Acquired Pneumonia in Adults.

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    Chalmers, James D

    2016-12-01

    Respiratory tract infections, the majority of which are community acquired, are among the leading causes of death worldwide and a leading indication for hospital admission. The burden of disease demonstrates a "U"-shaped distribution, primarily affecting young children as the immune system matures, and older adults as the process of immunosenescence and accumulation of comorbidities leads to increased susceptibility to infection. Diagnosis of community-acquired pneumonia (CAP) is traditionally based on demonstration of a new infiltrate on a chest radiograph in a patient presenting with an acute respiratory illness or sepsis. Advances in diagnosis have been slow, and although there are increasing data on the value of computed tomography or lung ultrasound as more sensitive diagnostic methodologies, they are not widely used as initial diagnostic tests. There are a wide range of differential diagnoses and pneumonia "mimics" which should be considered in patients presenting with CAP. Once the diagnosis of CAP has been made, identifying the causative microorganism is the next stage in the diagnostic process. Traditional culture-based approaches are relatively insensitive and achieve a positive diagnosis in only 30 to 70% of cases, even when rigorously applied. Urinary antigen tests, polymerase chain reaction assays, and even next-generation sequencing technologies have become available and are increasing the rates of positive diagnosis. In an era of increasing antimicrobial resistance, the accurate diagnosis of CAP and determining the causative pathogen are ever more important. Getting these both right is key in reducing both morbidity and mortality from CAP, and appropriate antimicrobial stewardship which is now an international healthcare priority.

  14. 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.

  15. Pneumonia

    Science.gov (United States)

    ... of pneumonia. Be sure to get the following vaccines: Flu vaccine can help prevent pneumonia caused by the flu virus. Pneumococcal vaccine lowers your chances of getting pneumonia from Streptococcus ...

  16. 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.

  17. 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

  18. 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

  19. Classification algorithms to improve the accuracy of identifying patients hospitalized with community-acquired pneumonia using administrative data.

    Science.gov (United States)

    Yu, O; Nelson, J C; Bounds, L; Jackson, L A

    2011-09-01

    In epidemiological studies of community-acquired pneumonia (CAP) that utilize administrative data, cases are typically defined by the presence of a pneumonia hospital discharge diagnosis code. However, not all such hospitalizations represent true CAP cases. We identified 3991 hospitalizations during 1997-2005 in a managed care organization, and validated them as CAP or not by reviewing medical records. To improve the accuracy of CAP identification, classification algorithms that incorporated additional administrative information associated with the hospitalization were developed using the classification and regression tree analysis. We found that a pneumonia code designated as the primary discharge diagnosis and duration of hospital stay improved the classification of CAP hospitalizations. Compared to the commonly used method that is based on the presence of a primary discharge diagnosis code of pneumonia alone, these algorithms had higher sensitivity (81-98%) and positive predictive values (82-84%) with only modest decreases in specificity (48-82%) and negative predictive values (75-90%).

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

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    Fonseca Lima EJ

    2016-06-01

    Full Text Available Eduardo Jorge da Fonseca Lima,1,2 Débora Ellen Pessoa Lima,3 George Henrique Cordeiro Serra,2 Maria Anaide Zacche S Abreu e Lima,2 Maria Júlia Gonçalves de Mello1,2 1Instituto de Medicina Integral Professor Fernando Figueira – IMIP, Recife, PE, Brazil; 2Faculdade Pernambucana de Saúde – FPS, Recife, PE, Brazil; 3Universidade de Pernambuco, Recife, PE, Brazil 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

  1. 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.)

  2. Development of quality indicators to evaluate antibiotic treatment of patients with community-acquired pneumonia in Indonesia

    NARCIS (Netherlands)

    Farida, H.; Rondags, A.; Gasem, M.H.; Leong, K.; Adityana, A.; Broek, P.J. van den; Keuter, M.; Natsch, S.S.

    2015-01-01

    OBJECTIVE: To develop an instrument for evaluating the quality of antibiotic management of patients with community-acquired pneumonia (CAP) applicable in a middle-income developing country. METHOD: A previous study and Indonesian guidelines were reviewed to derive potential quality of care indicator

  3. 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

  4. The scrutiny of identifying community-acquired pneumonia episodes quantified bias in absolute effect estimation in a population-based pneumococcal vaccination trial

    NARCIS (Netherlands)

    Van Werkhoven, Cornelis H.; Huijts, Susanne M.; Paling, Fleur P.; Bonten, Marc J M

    2016-01-01

    Objectives To determine the accurateness of detecting community-acquired pneumonia (CAP) in the Community-Acquired Pneumonia immunization Trial in Adults (CAPiTA), a community-based, double-blind, randomized placebo-controlled trial in which the needed to treat (NNT) for prevention of vaccine-type p

  5. [Clinical features and characteristics of community-acquired pneumonia associated with iron deficiency anemia in children of pre-school age].

    Science.gov (United States)

    Smiian, O I; Romanova, T O; Vasylyshyn, Kh I; Bynda, T P; Popov, S V; Vasyl'ieva, O H; Lypovs'ka, V V

    2014-01-01

    The most common clinical signs of community-acquired pneumonia associated with iron deficiency anemia in children of pre-preschool age are defined. Indicators of immunity cellular link in children with community-acquired pneumonia are studied. It is established that acute illness is characterized by disturbances in cellular immunity that are more expressed in patients with concomitant iron deficiency anemia.

  6. Clinical cure and mortality outcomes with ceftobiprole medocaril versus ceftazidime plus linezolid in patients with early versus late-onset hospital-acquired pneumonia.

    NARCIS (Netherlands)

    Scheeren, Thomas; Welte, T.; Capellier, G.; Saulay, Mikal; Engelhardt, M.

    2015-01-01

    Objectives: Ceftobiprole, the active moiety of the prodrug ceftobiprole medocaril, is a novel cephalosporin for intravenous use, approved in certain European countries for the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) excluding ventilator-associated pneumo

  7. Detection of IgM and IgG antibodies to Chlamydophila pneumoniae in pediatric community-acquired lower respiratory tract infections

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    Surinder Kumar

    2011-01-01

    Full Text Available Context: Chlamydophila pneumoniae (C. pneumoniae is an emerging infectious agent with a spectrum of clinical manifestations including lower and upper respiratory tract infections. Aims: To investigate the role of C. pneumoniae in community-acquired lower respiratory tract infections (LRTIs in children using serological tests. Settings and Design: Two hundred children, age 2 months to 12 years, hospitalized for community-acquired LRTIs were investigated for C. pneumoniae etiology. Materials and Methods: We investigated 200 children hospitalized for community-acquired LRTIs, using ELISA for detecting anti-C. pneumoniae IgM and IgG antibodies. The demographic, clinical and radiological findings for C. pneumoniae antibody positive and C. pneumoniae antibody negative cases were compared. Statistical Analysis Used: Data analysis was performed by Chi-square test and Fisher′s exact tests using Epi Info (2002. Results: Clinical and radiological findings in both the groups were comparable. Serological evidence of C. pneumoniae infection was observed in 12 (6% patients; specific IgM antibodies were detected in 11 (91.67%; specific IgG antibodies in 1 (8.33% patients, while 4-fold rise in C. pneumoniae IgG antibody titers were noted in none of the patients. Conclusions: C. pneumoniae has a role in community-acquired LRTIs, even in children aged < 5 years. Serological detection using ELISA would enable pediatricians in better management of C. pneumoniae infections.

  8. [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.

  9. Longitudinal analysis of pneumococcal antibodies during community-acquired pneumonia reveals a much higher involvement of Streptococcus pneumoniae than estimated by conventional methods alone.

    Science.gov (United States)

    van Mens, Suzan P; Meijvis, Sabine C A; Endeman, Henrik; van Velzen-Blad, Heleen; Biesma, Douwe H; Grutters, Jan C; Vlaminckx, Bart J M; Rijkers, Ger T

    2011-05-01

    In up to half of all cases of community-acquired pneumonia (CAP), no pathogen can be identified with conventional diagnostic methods. The most common identified causative agent is Streptococcus pneumoniae. In this study, pneumococcal antibody responses during CAP were analyzed to estimate the contribution of the pneumococcus to all cases of CAP for epidemiological purposes. Pneumococcal antibodies against 14 different serotypes were measured in serum of hospitalized CAP patients. Patients participated in one of two consecutive clinical trials in a general 600-bed teaching hospital in the Netherlands (between October 2004 and June 2009). A significant pneumococcal immune response was defined as at least a 2-fold increase in antibody concentrations against a single serotype between an early (day 1) and a late (day 30) serum sample of each patient with an end concentration above 0.35 μg/ml. A total of 349 adult CAP patients participated in two consecutive clinical trials. For 200 patients, sufficient serum samples were available to determine antibody responses: 62 pneumococcal pneumonia patients, 57 nonpneumococcal pneumonia patients, and 81 patients with an unidentified causative agent. A significant immune response was detected in 45% (28/62 patients) of pneumococcal pneumonia patients, in 5% (3/57) of nonpneumococcal pneumonia patients, and in 28% (23/81) of patients with an unidentified causative agent. The estimated contribution of pneumococci in patients with an unidentified causative agent was calculated to be 57% (95% confidence interval, 36 to 86%). A substantial fraction of pneumococcal pneumonia patients do not elicit a serotype-specific immune response.

  10. Macrolides vs. quinolones for community-acquired pneumonia: meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Skalsky, K; Yahav, D; Lador, A; Eliakim-Raz, N; Leibovici, L; Paul, M

    2013-04-01

    The relative efficacy, safety and ecological implications of macrolides vs. quinolones in the treatment of community-acquired pneumonia (CAP) are debatable. We performed a systematic review and meta-analysis of randomized controlled trials comparing any macrolide vs. any quinolone for the treatment of CAP among adult inpatients or outpatients, as monotherapy or both in combination with a beta-lactam. We did not limit inclusion by pneumonia severity, publication status, language or date of publication. The primary outcomes assessed were 30-day all-cause mortality and treatment failure. Two authors independently extracted the data. Fixed effect meta-analysis of risk ratios (RRs) with 95% confidence intervals was performed. Sixteen trials (4989 patients) fulfilling inclusion criteria were identified, mostly assessing outpatients with mild to moderate CAP. All-cause mortality was not significantly different for macrolides vs. quinolones, RR 1.03 (0.63-1.68, seven trials), with a low event rate (2%). Treatment failure was significantly lower with quinolones, RR 0.78 (0.67-0.91, 16 trials). The definition of failure used in the primary studies was not clearly representative of patients' benefit. Microbiological failure was lower with quinolones, RR 0.63 (0.49-0.81, 13 trials). All adverse events, adverse events requiring discontinuation and any premature antibiotic discontinuation were significantly more frequent with macrolides, mainly on account of gastrointestinal adverse events. Resistance development was not assessed in the trials. Randomized controlled trials show an advantage of quinolones in the treatment of CAP with regard to clinical cure without need for antibiotic modification at end of treatment and gastrointestinal adverse events. The clinical significance of this advantage is unclear.

  11. 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.

  12. 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

    Directory of Open Access Journals (Sweden)

    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.

  13. VALIDIFICATION OF SMART-COP IN PREDICTING THE NEED FOR IRVS IN COMMUNITY ACQUIRED PNEUMONIA (CAP PATIENTS

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    Uphar

    2015-12-01

    Full Text Available Pneumonia has been considered a health problem for ages. Despite being the cause of significant morbidity and mortality. Delay in ICU admission of CAP patients has been shown to be associated with increased mortality. The ‘SMART-COP’ is a simple tool that is the result of an extensive study on CAP called the Australian CAP Study (ACAPS. OBJECTIVE To assess the validity the SMART-COP severity scoring tool in patients of Community Acquired Pneumonia (CAP. MATERIALS AND METHODS Fifty patients of CAP admitted in the intensive care units of R. L. Jalappa Hospital, Kolar, above the age of 18yrs with a diagnosis of community acquired pneumonia. RESULTS We noted a progression in the need for ICU support and need for ventilatory and ionotropic support with increasing score assigned on the SMART-COP. Thirty day mortality in the patients also showed a linear pattern with increase in the score assigned to the patients. Mortality was high in the very high risk group and high risk group. CONCLUSION With 68.5% of the patients requiring invasive ventilator support and 75% of the patients requiring inotropic support in the high risk group, it can be safely concluded that SMART-COP scoring system can be used in the patients of community acquired pneumonia to predict the need for IRVS.

  14. 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

  15. 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.

  16. Application of serology and nested polymerase chain reaction for identifying Chlamydophila pneumoniae in community-acquired lower respiratory tract infections in children

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    Surinder Kumar

    2016-01-01

    Full Text Available Context: Chlamydophila pneumoniae is a common cause of community-acquired respiratory infections, including pneumonia, bronchitis, and upper respiratory tract infections. Since it is difficult to detect C. pneumoniae in clinical practice, specific etiological diagnosis is established only in a minority of cases. Aims: To investigate the role of C. pneumoniae in community-acquired lower respiratory tract infections (LRTIs in children, with the use of serological tests and nested polymerase chain reaction (PCR analysis. Settings and Design: One hundred children, age of 2 months to 12 years, hospitalized for community-acquired LRTIs were investigated for C. pneumoniae etiology. Materials and Methods: We investigated 100 children hospitalized for community-acquired LRTIs, using enzyme-linked immunosorbent assay for detecting anti-C. pneumoniae immunoglobulin M, and immunoglobulin G antibodies and nasopharyngeal aspirates for analysis of C. pneumoniae PCR. The demographic, clinical, and radiological findings for C. pneumoniae antibody positive and C. pneumoniae antibody negative cases were compared. Statistical Analysis Used: Data analysis was performed by Chi-square test and Fisher′s exact tests using Epi Info (2002. Results: Clinical and radiological findings in both the groups were comparable. A relatively higher rate of C. pneumoniae infection in children was observed below 5 years of age. Serological evidence of C. pneumoniae infection was observed in 12 (12% patients and nested PCR was positive in 5 (5% children. Thirteen (13% patients were diagnosed with C. pneumoniae infection by serology and/or nested PCR. Conclusions: Our study confirms that C. pneumoniae plays a significant role in community-acquired LRTIs in children of all ages, even in children aged <5 years.

  17. Biomarkers of Delirium in a Low-Risk Community-Acquired Pneumonia-Induced Sepsis.

    Science.gov (United States)

    Tomasi, Cristiane Damiani; Vuolo, Francieli; Generoso, Jaqueline; Soares, Márcio; Barichello, Tatiana; Quevedo, João; Ritter, Cristiane; Dal-Pizzol, Felipe

    2017-01-01

    There are different theories about the pathophysiology of sepsis-associated encephalopathy (SAE), and the majority of our knowledge was derived from critically ill patients. 7In less severe sepsis, it is probable that neuroinflammation can be a major aspect of SAE development. We hypothesized that in non-severe septic patients, blood biomarkers of inflammation, endothelial activation, coagulation, and brain function would be different when compared to patients with and without brain dysfunction. A total of 30 patients presenting with community-acquired pneumonia (CAP)-induced sepsis were included of which 10 (33 %) developed SAE. Eight medical patients admitted to the general ward, except due to sepsis or infection, which developed delirium were included as delirium, non-sepsis group. From all measured biomarkers, only brain-derived neurotrophic factor (BDNF), regulated upon activation normal T cell expressed, and presumably secreted (RANTES), and interleukin (IL)-10 where significantly different when compared to SAE and sepsis groups. In addition, SAE patients presented higher levels of BDNF, vascular cellular adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), platelet-derived growth factor (PDGF)-AB/BB and RANTES when compared to delirium patients. In conclusion, the profile of biomarkers differs between SAE, sepsis, and delirium patients, suggesting that pathways related to SAE are different from delirium and from sepsis itself.

  18. Vitamin D Level and Risk of Community-Acquired Pneumonia and Sepsis

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    Anna J. Jovanovich

    2014-06-01

    Full Text Available Previous research has reported reduced serum 25-hydroxyvitamin D (25(OHD levels is associated with acute infectious illness. The relationship between vitamin D status, measured prior to acute infectious illness, with risk of community-acquired pneumonia (CAP and sepsis has not been examined. Community-living individuals hospitalized with CAP or sepsis were age-, sex-, race-, and season-matched with controls. ICD-9 codes identified CAP and sepsis; chest radiograph confirmed CAP. Serum 25(OHD levels were measured up to 15 months prior to hospitalization. Regression models adjusted for diabetes, renal disease, and peripheral vascular disease evaluated the association of 25(OHD levels with CAP or sepsis risk. A total of 132 CAP patients and controls were 60 ± 17 years, 71% female, and 86% Caucasian. The 25(OHD levels <37 nmol/L (adjusted odds ratio (OR 2.57, 95% CI 1.08–6.08 were strongly associated with increased odds of CAP hospitalization. A total of 422 sepsis patients and controls were 65 ± 14 years, 59% female, and 91% Caucasian. The 25(OHD levels <37 nmol/L (adjusted OR 1.75, 95% CI 1.11–2.77 were associated with increased odds of sepsis hospitalization. Vitamin D status was inversely associated with risk of CAP and sepsis hospitalization in a community-living adult population. Further clinical trials are needed to evaluate whether vitamin D supplementation can reduce risk of infections, including CAP and sepsis.

  19. 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.

  20. 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.

  1. 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.

  2. General and health-related life satisfaction of patients with community-acquired pneumonia.

    Science.gov (United States)

    Schnoor, Maike; Schoefer, Yvonne; Henrich, Gerhard; Raspe, Heiner; Schaefer, Torsten

    2009-05-01

    When assessing the quality of care, patients' characteristics such as general and health-related life satisfaction, are of major significance. Our study examined the general and health-related life satisfaction of patients with community-acquired pneumonia (CAP). To quantify the general and health-related life satisfaction, we used the validated instrument Questions on Life Satisfaction(Modules) by Henrich and Herschbach. CAP cases included in the German competence network on CAP (CAPNETZ) were asked to answer questions on their personal satisfaction with aspects of their life and health and on the individual importance of each addressed aspect. Data were compared with a normal population sample. In addition, several subgroup analyses were conducted. One thousand eight hundred ninety-nine (50.5%) CAP patients returned the questionnaire within a median time of 3 days. The mean age of the study sample was 55.1 +/- 17.1 years, 47.0% were female. The CAP patients reported not only a lower satisfaction with health (52.1 +/- 42.6 vs. 74.4 +/- 41.5, p satisfaction (55.0 +/- 35.2 vs. 60.5 +/- 37.3, p satisfaction in patients with comorbidities (52.2 +/- 34.7) compared with patients without any underlying disease (58.1 +/- 35.4, p = 0.001). A non-significant lower general life satisfaction (53.3 +/- 35.1 vs. 57.0 5 +/- 35.2, p = 0.052) as well as a lower health-related life satisfaction (49.25 +/- 42.0 vs. 55.3 +/- 43.0, p = 0.602) could be observed in men compared with those in women. Patients aged 65 years and older and patients with a severe CAP reported a lower health-related life satisfaction, but a higher general life satisfaction than younger patients or patients with mild CAP. The lower general life satisfaction observed in patients with CAP was found to reflect comorbidity rather than the effects of the pneumonia itself.

  3. X-linked agammaglobulinemia in community-acquired pneumonia cases revealed by immunoglobulin level screening at hospital admission.

    Science.gov (United States)

    Vancikova, Z; Freiberger, T; Vach, W; Trojanek, M; Rizzi, M; Janda, A

    2013-11-01

    In children with primary immunodeficiencies, the onset of symptoms precedes the diagnosis and the initiation of appropriate treatment by months or years. This delay in diagnosis is due to the fact that while these disorders are rare, some of the infections seen in immunodeficient patients are common. Defective antibody production represents the largest group among these disorders, with otitis, sinusitis and pneumonia as the most frequent initial manifestation. We performed a prospective study of humoral immunity in children hospitalized due to community-acquired pneumonia in tertiary care hospital. Out of 254 patients (131 boys, 123 girls, median age 4.5 years) recruited over 3 years, we found 2 boys (age 11 and 21 months) lacking serum immunoglobulins and circulating B cells. Subsequent genetic analysis confirmed diagnosis of X-linked agammaglobulinemia. Despite their immunodeficiency, the pneumonia was uncomplicated in both patients and did not call for immunological evaluation. However, the immunoglobulin screening at admission allowed for an early diagnosis of the immunodeficiency and timely initiation of immunoglobulin substitution, the key prerequisite for a favorable course of the disease.Simple and inexpensive immuno-globulin measurement during the manage-ment of hospitalized children with community-acquired pneumonia may help in early identification of patients with compromised humoral immunity and prevent serious complications.

  4. 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.

  5. Causative agent distribution and antibiotic therapy assessment among adult patients with community acquired pneumonia in Chinese urban population

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    Liu Yong

    2009-03-01

    Full Text Available Abstract Background Knowledge of predominant microbial patterns in community-acquired pneumonia (CAP constitutes the basis for initial decisions about empirical antimicrobial treatment, so a prospective study was performed during 2003–2004 among CAP of adult Chinese urban populations. Methods Qualified patients were enrolled and screened for bacterial, atypical, and viral pathogens by sputum and/or blood culturing, and by antibody seroconversion test. Antibiotic treatment and patient outcome were also assessed. Results Non-viral pathogens were found in 324/610 (53.1% patients among whom M. pneumoniae was the most prevalent (126/610, 20.7%. Atypical pathogens were identified in 62/195 (31.8% patients carrying bacterial pathogens. Respiratory viruses were identified in 35 (19% of 184 randomly selected patients with adenovirus being the most common (16/184, 8.7%. The nonsusceptibility of S. pneumoniae to penicillin and azithromycin was 22.2% (Resistance (R: 3.2%, Intermediate (I: 19.0% and 79.4% (R: 79.4%, I: 0%, respectively. Of patients (312 from whom causative pathogens were identified and antibiotic treatments were recorded, clinical cure rate with β-lactam antibiotics alone and with combination of a β-lactam plus a macrolide or with fluoroquinolones was 63.7% (79/124 and 67%(126/188, respectively. For patients having mixed M. pneumoniae and/or C. pneumoniae infections, a better cure rate was observed with regimens that are active against atypical pathogens (e.g. a β-lactam plus a macrolide, or a fluoroquinolone than with β-lactam alone (75.8% vs. 42.9%, p = 0.045. Conclusion In Chinese adult CAP patients, M. pneumoniae was the most prevalent with mixed infections containing atypical pathogens being frequently observed. With S. pneumoniae, the prevalence of macrolide resistance was high and penicillin resistance low compared with data reported in other regions.

  6. СLINICAL AND IMMUNOLOGICAL EFFICIENCY OF IMUNOFAN AND POLYOXIDONIUM IN COMBINED THERAPY OF COMMUNITY-ACQUIRED PNEUMONIA

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    L. R. Mukhamadieva

    2009-01-01

    Full Text Available Abstract. A study was carried out in hundred-five patients with severe or mid-severe clinical courseof community-acquired pneumonia. Clinical observations showed that introduction of Imunofan andPolyoxidonium within combined therapeutic regimen administered to the patients, exerts a pronounced positive effect upon clinical course of disease and normalization of immune characteristics. Due to immunocorrective treatment with Imunofan and Polyoxidonium, the patients with community-acquired pneumonia, exhibited a distinct trend to earlier normalization of both cellular and humoral immunity indexes. This result provides further proofs for efficient treatment with immunomodulatory drugs, e.c., by means of Imunofan and Polyoxidonium.

  7. Use of serology and urine antigen detection to estimate the proportion of adult community-acquired pneumonia attributable to Streptococcus pneumoniae.

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    Watt, J P; Moïsi, J C; Donaldson, R L A; Reid, R; Ferro, S; Whitney, C G; Santosham, M; O'Brien, K L

    2010-12-01

    Streptococcus pneumoniae is a common cause of community-acquired pneumonia (CAP) but existing diagnostic tools have limited sensitivity and specificity. We enrolled adults undergoing chest radiography at three Indian Health Service clinics in the Southwestern United States and collected acute and convalescent serum for measurement of PsaA and PspA titres and urine for pneumococcal antigen detection. Blood and sputum cultures were obtained at the discretion of treating physicians. We compared findings in clinical and radiographic CAP patients to those in controls without CAP. Urine antigen testing showed the largest differential between CAP patients and controls (clinical CAP 13%, radiographic CAP 17%, control groups 2%). Serological results were mixed, with significant differences between CAP patients and controls for some, but not all changes in titre. Based on urine antigen and blood culture results, we estimated that 11% of clinical and 15% of radiographic CAP cases were due to pneumococcus in this population.

  8. Procalcitonin: Inflammatory Biomarker for Assessing the Severity of Community-Acquired Pneumonia – A Clinical Observation in Geriatric Patients

    OpenAIRE

    2013-01-01

    Community-acquired pneumonia is a common disease of the elderly and involves a high mortality risk. Demographic developments are creating new challenges for acute medical treatment strategies in geriatric patients with their underlying multimorbidity. In addition to the diagnostic parameters recorded on hospital admission, such as white cell count and C-reactive protein, procalcitonin, more than the risk scores CRB- and CURB-65 evaluated to date, appears to be a promising parameter for assess...

  9. Impaired acquired resistance of mice to Klebsiella pneumoniae infection induced by acute NO/sub 2/ exposure

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    Bouley, G.; Azoulay-Dupuis, E.; Gaudebout, C.

    1985-12-01

    The natural resistance of nonimmunized C57B1/6 mice to an intraperitoneal Klebsiella pneumoniae challenge was not significantly affected by prior continuous exposure to 20 ppm NO/sub 2/ for 4 days. In contrast, the acquired resistance of mice immunized just before and infected just after NO/sub 2/ exposure was seriously impaired. This could not be explained by the loss of appetite (about 30%) observed in NO/sub 2/ treated mice, for neither the natural nor acquired resistance of control air exposure mice given approximately 70% ad libitum food and water were significantly modified.

  10. Risk of heart failure after community acquired pneumonia: prospective controlled study with 10 years of follow-up.

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    Eurich, Dean T; Marrie, Thomas J; Minhas-Sandhu, Jasjeet K; Majumdar, Sumit R

    2017-02-13

    Objective To determine the attributable risk of community acquired pneumonia on incidence of heart failure throughout the age range of affected patients and severity of the infection.Design Cohort study.Setting Six hospitals and seven emergency departments in Edmonton, Alberta, Canada, 2000-02.Participants 4988 adults with community acquired pneumonia and no history of heart failure were prospectively recruited and matched on age, sex, and setting of treatment (inpatient or outpatient) with up to five adults without pneumonia (controls) or prevalent heart failure (n=23 060).Main outcome measures Risk of hospital admission for incident heart failure or a combined endpoint of heart failure or death up to 2012, evaluated using multivariable Cox proportional hazards analyses.Results The average age of participants was 55 years, 2649 (53.1%) were men, and 63.4% were managed as outpatients. Over a median of 9.9 years (interquartile range 5.9-10.6), 11.9% (n=592) of patients with pneumonia had incident heart failure compared with 7.4% (n=1712) of controls (adjusted hazard ratio 1.61, 95% confidence interval 1.44 to 1.81). Patients with pneumonia aged 65 or less had the lowest absolute increase (but greatest relative risk) of heart failure compared with controls (4.8% v 2.2%; adjusted hazard ratio 1.98, 95% confidence interval 1.5 to 2.53), whereas patients with pneumonia aged more than 65 years had the highest absolute increase (but lowest relative risk) of heart failure (24.8% v 18.9%; adjusted hazard ratio 1.55, 1.36 to 1.77). Results were consistent in the short term (90 days) and intermediate term (one year) and whether patients were treated in hospital or as outpatients.Conclusion Our results show that community acquired pneumonia substantially increases the risk of heart failure across the age and severity range of cases. This should be considered when formulating post-discharge care plans and preventive strategies, and assessing downstream episodes of

  11. Increased risk of community-acquired pneumonia in COPD patients with comorbid cardiovascular disease

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    Lin SH

    2016-12-01

    Full Text Available Sheng-Hao Lin,1,2 Diahn-Warng Perng,3,4 Ching-Pei Chen,5,6 Woei-Horng Chai,1 Chin-Shui Yeh,1 Chew-Teng Kor,7 Shih-Lung Cheng,8,9 Jeremy JW Chen,2,* Ching-Hsiung Lin1,10,11,* 1Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, 2Institute of Biomedical Sciences, National Chung Hsing University, Taichung, 3Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, 4School of Medicine, National Yang-Ming University, Taipei, 5Department of Internal Medicine, Division of Cardiology, Changhua Christian Hospital, 6Department of Beauty Science and Graduate Institute of Beauty Science Technology, Chien-Kuo Technology University, 7Department of Internal Medicine, Internal Medicine Research Center, Changhua Christian Hospital, Changhua, 8Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, 9Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli City, Taoyuan, 10Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, 11School of Medicine, Chung Shan Medical University, Taichung, Taiwan *These authors contributed equally to this work Background and objective: COPD patients with community-acquired pneumonia (CAP have worse clinical outcomes, as compared to those without COPD. Cardiovascular disease (CVD is a common comorbidity for COPD patients. Whether COPD with comorbid CVD will increase the risk of CAP is not well investigated. The incidence and factors associated with CAP in COPD patients with and without CVD were analyzed. Methods: The medical records of patients with newly diagnosed COPD between 2007 and 2010 were reviewed. The patients’ characteristics, medical history of CVD, occurrence of CAP, and type of medication were recorded. Kaplan–Meier curves were used to assess the differences in cumulative incidence of CAP. Cox’s proportional hazards regression model was used to determine the

  12. 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

  13. Increased risk of community-acquired pneumonia in COPD patients with comorbid cardiovascular disease

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    Lin, Sheng-Hao; Perng, Diahn-Warng; Chen, Ching-Pei; Chai, Woei-Horng; Yeh, Chin-Shui; Kor, Chew-Teng; Cheng, Shih-Lung; Chen, Jeremy JW; Lin, Ching-Hsiung

    2016-01-01

    Background and objective COPD patients with community-acquired pneumonia (CAP) have worse clinical outcomes, as compared to those without COPD. Cardiovascular disease (CVD) is a common comorbidity for COPD patients. Whether COPD with comorbid CVD will increase the risk of CAP is not well investigated. The incidence and factors associated with CAP in COPD patients with and without CVD were analyzed. Methods The medical records of patients with newly diagnosed COPD between 2007 and 2010 were reviewed. The patients’ characteristics, medical history of CVD, occurrence of CAP, and type of medication were recorded. Kaplan–Meier curves were used to assess the differences in cumulative incidence of CAP. Cox’s proportional hazards regression model was used to determine the adjusted hazard ratios with 95% confidence intervals in relation to factors associated with CAP in COPD patients with and without CVD. Results Among 2,440 patients, 475 patients (19.5%) developed CAP during the follow-up period. COPD patients who developed CAP were significantly older, had lower forced expiratory volume in 1 second, frequent severe exacerbation and comorbid CVD, as well as received inhaled corticosteroid (ICS)-containing therapy than those without CAP. The cumulative incidence of CAP was higher in COPD patients with CVD compared to those without CVD. Patients who received ICS-containing therapy had significantly increased risk of developing CAP compared to those who did not. Conclusion For patients with COPD, comorbid CVD is an independent risk factor for developing CAP. ICS-containing therapy may increase the risk of CAP among COPD patients. PMID:27980402

  14. Patients hospitalized for community-acquired pneumonia present reduced functional performance

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    Anderson José

    2013-08-01

    Full Text Available BACKGROUND: Symptoms of fatigue and dyspnea, treatment with oral corticosteroids, high circulating levels of cytokines, and oxidant/antioxidant imbalance in patients hospitalized with community-acquired pneumonia (CAP could affect the patients' exercise tolerance and peripheral muscle strength (PMS. OBJECTIVE: To evaluate the functional capacity (FC of patients hospitalized for CAP and to correlate the FC with length of hospital stay. METHOD: We prospectively evaluated 45 patients (49±16 years; CAP group and 20 healthy subjects (53±17 years; control group. They were randomized to perform, on separate days, a 6-minute walk test (6MWT, a test of PMS, and the Glittre test (GT. Additionally, the SF-36 questionnaire and the MRC scale were completed and evaluated. RESULTS: There were significant differences between the groups (CAP and controls for the 6MWT (381.3±108 vs. 587.1±86.8 m and GT (272.8±104.3 vs. 174±39 sec. The CAP group also presented worse health-related quality of life (HRQoL scores, reduced strength (quadriceps and biceps, and higher scores of dyspnea. The time required to perform the GT correlated with the length of hospital stay (r=0.35, P=0.02 and dyspnea (r=0.36, P=0.02. Significant correlations were observed between GT and 6MWT (r=-0.66, P=0.0001 and between GT with the physical functioning domain of SF-36 (r=-0.51, P=0.0001. CONCLUSIONS: Patients hospitalized for CAP presented with reduced FC, PMS, and HRQoL during hospitalization. In addition, GT performance was related to the length of hospital stay.

  15. Ceftaroline fosamil for community-acquired pneumonia and skin and skin structure infections: a systematic review.

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    El Hajj, Maguy Saffouh; Turgeon, Ricky D; Wilby, Kyle John

    2017-02-01

    Background Ceftaroline is a parentally administered cephalosporin that has an in vitro expanded spectrum of activity compared with other cephalosporins yet data is conflicting regarding its place in therapy. Aim of the Review To compare the efficacy and safety of ceftaroline against standard antibiotic regimens for community-acquired pneumonia (CAP) and complicated skin and skin structure infections (cSSSIs). Method The databases of MEDLINE, EBSCO, and Embase were searched up to June 2016. Manual review of references was completed and experts in the field were contacted for unpublished data. Randomized controlled trials of ceftaroline in CAP or cSSSI populations were included. Outcomes included clinical cure, mortality, adverse events, serious adverse events, and discontinuation due to adverse events. Meta-analysis was used to pool results for these outcomes. We performed subgroup analyses for gram positive infections in CAP and infections caused by methicillin-resistant Staphylococcus aureus in cSSSIs. Risk of bias was assessed for all studies. Results Six trials (three for each indication) were included, each of which had an unclear or high risk of bias in at least one domain. For CAP, ceftaroline was significantly more efficacious in achieving clinical cure than ceftriaxone [risk ratio (RR) 1.11, 95% confidence interval (CI) 1.04-1.19; I(2) = 47%]. For cSSSIs, there was no significant difference in clinical cure between ceftaroline and vancomycin plus aztreonam (RR 1.01, 95% CI 0.97-1.05; I(2) = 0%). No differences were found for overall mortality, serious adverse events, discontinuation due to adverse events, and overall adverse events. Conclusion Ceftaroline is a viable therapeutic alternative for patients with CAP and cSSSIs, yet identified risks of bias and poor external validity preclude it from being recommended as a first-line agent.

  16. Serum levels of immunoglobulins and severity of community-acquired pneumonia

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    de la Torre, Mari C; Torán, Pere; Serra-Prat, Mateu; Palomera, Elisabet; Güell, Estel; Vendrell, Ester; Yébenes, Joan Carles; Torres, Antoni; Almirall, Jordi

    2016-01-01

    Instruction There is evidence of a relationship between severity of infection and inflammatory response of the immune system. The objective is to assess serum levels of immunoglobulins and to establish its relationship with severity of community-acquired pneumonia (CAP) and clinical outcome. Methods This was an observational and cross-sectional study in which 3 groups of patients diagnosed with CAP were compared: patients treated in the outpatient setting (n=54), patients requiring in-patient care (hospital ward) (n=173), and patients requiring admission to the intensive care unit (ICU) (n=191). Results Serum total IgG (and IgG subclasses IgG1, IgG2, IgG3, IgG4), IgA and IgM were measured at the first clinical visit. Normal cutpoints were defined as the lowest value obtained in controls (≤680, ≤323, ≤154, ≤10, ≤5, ≤30 and ≤50 mg/dL for total IgG, IgG1, IgG2, IgG3, IgG4, IgM and IgA, respectively). Serum immunoglobulin levels decreased in relation to severity of CAP. Low serum levels of total IgG, IgG1 and IgG2 showed a relationship with ICU admission. Low serum level of total IgG was independently associated with ICU admission (OR=2.45, 95% CI 1.4 to 4.2, p=0.002), adjusted by the CURB-65 severity score and comorbidities (chronic respiratory and heart diseases). Low levels of total IgG, IgG1 and IgG2 were significantly associated with 30-day mortality. Conclusions Patients with severe CAP admitted to the ICU showed lower levels of immunoglobulins than non-ICU patients and this increased mortality. PMID:27933180

  17. Delirium is a predictor of in-hospital mortality in elderly patients with community acquired pneumonia.

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    Pieralli, Filippo; Vannucchi, Vieri; Mancini, Antonio; Grazzini, Maddalena; Paolacci, Giulia; Morettini, Alessandro; Nozzoli, Carlo

    2014-03-01

    Community acquired pneumonia (CAP) is a common reason for hospitalization and death in elderly people. Many predictors of in-hospital outcome have been studied in the general population with CAP. However, data are lacking on the prognostic significance of conditions unique to older patients, such as delirium and the coexistence of multiple comorbidities. The aim of this study was to evaluate predictors of in-hospital outcome in elderly patients hospitalized for CAP. In this retrospective study, consecutive patients with CAP aged ≥65 years were enrolled between January 2011 and June 2012 in two general wards. Clinical and laboratory characteristics were collected from electronic medical records. The end-point of the study was the occurrence of in-hospital death. 443 patients (mean age 81.8 ± 7.5, range 65-99 years) were enrolled. More than 3 comorbidities were present in 31 % of patients. Mean confusion, blood urea nitrogen, respiratory rate, blood pressure and age ≥65 years (CURB-65) score was 2.5 ± 0.7 points. Mean length of stay was 7.6 ± 5.7 days. In-hospital death occurred in 54 patients (12.2 %). At multivariate analysis, independent predictors of in-hospital death were: chronic obstructive pulmonary disease (COPD) (OR 6.21, p = 0.005), occurrence of at least one episode of delirium (OR 5.69, p = 0.017), male sex (OR 5.10, p patients with CAP older than 65 years are similar to those of younger patients. In this cohort of elderly patients, the occurrence of delirium was highly prevalent and represented a distinctive predictor of death.

  18. Predictors of Bacteraemia in Patients with Suspected Community-Acquired Pneumonia.

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    Cornelis H van Werkhoven

    Full Text Available The diagnostic yield of blood cultures is limited in patients with community-acquired pneumonia (CAP. Yet, positive blood culture results provide important information for antibiotic treatment and for monitoring epidemiologic trends. We investigated the potential of clinical predictors to improve the cost-benefit ratio of obtaining blood cultures.Data from two prospective cohort studies of adults with suspected CAP, admitted to non-ICU wards, were combined. Two models were created, one using readily available parameters and one additionally including laboratory parameters.3,786 patients were included (2,626 (69% with X-ray confirmed CAP. Blood cultures were obtained from 2,977 (79% patients (and from 2,107 (80% with X-ray confirmed CAP. 266 (8.9% of the patients with a blood culture had bacteraemia. Clinical predictors of bacteraemia were absence of pre-admission antibiotic treatment, pleuritic pain, gastro-intestinal symptoms, tachycardia, tachypnea, hypotension and absence of hypoxia. After including laboratory results in the model, younger age, C-reactive protein, leukocytosis or leukopenia, low thrombocyte count, low sodium level, elevated urea and elevated arterial pH were added, while gastro-intestinal symptoms and hypotension were no longer significant. The area under the receiver operating characteristics curve was 0.66 (95% confidence interval 0.63-0.70 for the first model and 0.76 (95% confidence interval 0.73-0.79 for the second model.In conclusion, in patients hospitalized with CAP, bacteraemia was moderately predictable using clinical parameters only. We recommend against the use of a risk prediction model for the decision to obtain blood cultures.

  19. 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.

  20. Case Fatality among Patients Hospitalized for Community-acquired Pneumonia according to Initial Antibiotic Treatment. A Comparison of Two Case Series

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    Luis Alberto Corona Martínez

    2016-04-01

    Full Text Available Background: community-acquired pneumonia is one of the major health problems worldwide and in the hospital of Cienfuegos.Objective: to determine the changes in the relationship between the type of antimicrobial agent used empirically at admission and case fatality for community-acquired pneumonia in two case series designed at different times.Methods: an observational, descriptive study was conducted to compare two case series of patients hospitalized due to the condition under study. The relationship between the antimicrobial agents selected (amoxicillin/sulbactam, cefuroxime, ceftriaxone and cefotaxime and case fatality was analyzed taking into account potentially confounding variables. In the statistical analysis, the Chi-square test was used to compare the proportions, and Fisher's exact test was applied, with a 95% confidence level (p <.05. Results: in the two case series, the same pattern was observed in terms of the antimicrobial agents associated with the lowest and highest case fatality: cefuroxime and cefotaxime, respectively. In contrast to the A series, the B series showed a more uniform behavior of case fatality with the use of the antimicrobials selected, which meant a considerable reduction in case fatality among patients treated initially with third-generation cephalosporins in the B series. In this sense, the most significant impact on case fatality was observed in patients receiving ceftriaxone.Conclusions: cefuroxime remains the initial empirical antimicrobial agent associated with the lowest case fatality among patients with community-acquired pneumonia. In the second case series, a clear reduction in case fatality was found in patients treated with ceftriaxone and cefotaxime.

  1. 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

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

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    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...

  3. The Most Common Detected Bacteria in Sputum of Patients with Community Acquired Pneumonia (CAP) Treated In Hospital

    Science.gov (United States)

    Cukic, Vesna; Hadzic, Armin

    2016-01-01

    Introduction: Community acquired pneumonia (CAP) is the most common infective pulmonary disease. Objective: To show the most common detected bacteria in bacterial culture of sputum in patients with CAP hospitalized in Clinic for Pulmonary Diseases and TB “Podhrastovi” in four-year period: from 2012 to 2015. Material and methods: This is the retrospective analysis. Each patient gave sputum 3 days in a row when admitted to hospital. Sputum has been examined: bacterial culture with antibiotics sensitivity, Gram stain, Mycobacterium tuberculosis; in cases with high temperature blood cultures were done; when we were suspicious about bronchial carcinoma bronchoscopy with BAL (bronchoalveolar lavage) was done. We show analyzed patients according to age, sex, whether they had pneumonia or bronchopneumonia, bacteria isolated in sputum and in BAL. Results: 360 patients with CAP were treated in four-year period (247 males and 113 females). 167 or 43, 39 % had pneumonia (119 males and 48 females). Number of males was significantly bigger (χ2 = 30,186; p<0,001). 193 or 53, 61 % had bronchopneumonia (128 males and 65 females). Number of males was significantly bigger (χ2 = 20,556; p<0,001). Number of patients with negative bacterial culture of sputum (131–78, 44%) was significantly bigger than number of patients with positive culture (36–21, 56%) (χ2 = 50,042; p<0,001) in pneumonia. Number of patients with negative bacterial culture of sputum (154- 79, 79%) was significantly bigger than number of patients with positive culture (39- 20, 21%) (χ2 = 68,523; p<0,001) in bronchopneumonia. Streptococcus pneumoniae was significantly most common detected bacterium compared with the number of other isolated bacteria; in pneumonia (χ2 =33,222; p<0,001) and in bronchopneumonia (χ2 =51,231; p<0,001). Conclusion: It is very important to detect the bacterial cause of CAP to administrate the targeted antibiotic therapy. PMID:27994296

  4. 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.

  5. A brief review of moxifloxacin in the treatment of elderly patients with community-acquired pneumonia (CAP

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    Anna M Ferrara

    2007-07-01

    Full Text Available Anna M FerraraDepartment of Haematological, Pneumological, Cardiovascular and Surgical Sciences, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, ItalyAbstract: Community-acquired pneumonia (CAP remains a common cause of morbidity and a potentially life-threatening illness throughout the world mainly in elderly patients. Initial antibacterial treatment, usually empirical, should be as effective as possible in order to assure rapid clinical resolution and reduce high rates of hospitalization and mortality especially affecting aged patients. New fluoroquinolones with potent activity against the most important respiratory pathogens including Streptococcus pneumoniae, a key pathogen mainly in old patients with CAP, have been recently suggested by several international guidelines as monotherapy for the treatment of most CAP patient categories. Among newer derivatives, moxifloxacin, an advanced generation 8-methoxy quinolone, has demonstrated good clinical and bacteriological efficacy in large, well designed clinical trials both in adults and old patients with CAP, achieving also in aged people efficacy comparable with that of standard treatments. Good pharmacokinetic characteristics such as excellent penetration into respiratory tract tissues and fluids, optimal bioavailability, simplicity of once-daily dosing, and good tolerability, represent potential advantages of moxifloxacin over other therapies. In addition, primarily due to a shorter length of hospital stay, moxifloxacin has been shown to save costs compared with standard therapy.Keywords: moxifloxacin, community-acquired pneumonia, elderly patients

  6. Soluble RAGE as a severity marker in community acquired pneumonia associated sepsis

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    Narvaez-Rivera Rodrigo M

    2012-01-01

    Full Text Available Abstract Background Community-acquired pneumonia (CAP is considered the most important cause of death from infectious disease in developed countries. Severity assessment scores partially address the difficulties in identifying high-risk patients. A lack of specific and valid pathophysiologic severity markers affect early and effective sepsis therapy. HMGB-1, sRAGE and RAGE have been involved in sepsis and their potential as severity markers has been proposed. The aim of this study was to evaluate HMGB-1, RAGE and sRAGE levels in patients with CAP-associated sepsis and determine their possible association with clinical outcome. Method We evaluated 33 patients with CAP-associated sepsis admitted to the emergency room and followed in the medical wards. Severity assessment scores (CURB-65, PSI, APACHE II, SOFA and serologic markers (HMGB-1, RAGE, sRAGE were evaluated on admission. Results Thirty patients with a diagnosis of CAP-associated sepsis were enrolled in the study within 24 hours after admission. Fourteen (46.6% had pandemic (H1N1 influenza A virus, 2 (6.6% had seasonal influenza A and 14 other diagnoses. Of the patients in the study group, 16 (53.3% had a fatal outcome. ARDS was observed in 17 (56.6% and a total of 22 patients had severe sepsis on admission (73%. The SOFA score showed the greatest difference between surviving and non-surviving groups (P = .003 with similar results in ARDS patients (P = .005. sRAGE levels tended to be higher in non-surviving (P = .058 and ARDS patients (P = .058. Logistic regression modeling demonstrated that SOFA (P = .013 and sRAGE (P = .05 were the only variables that modified the probability of a fatal outcome. Conclusion The association of elevated sRAGE with a fatal outcome suggests that it may have an independent causal effect in CAP. SOFA scores were the only clinical factor with the ability to identify surviving and ARDS patients.

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

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    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.

  8. Procalcitonin: inflammatory biomarker for assessing the severity of community-acquired pneumonia--a clinical observation in geriatric patients.

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    Heppner, H J; Bertsch, T; Alber, B; Esslinger, A S; Dragonas, C; Bauer, J M; Sieber, C C

    2010-01-01

    Community-acquired pneumonia is a common disease of the elderly and involves a high mortality risk. Demographic developments are creating new challenges for acute medical treatment strategies in geriatric patients with their underlying multimorbidity. In addition to the diagnostic parameters recorded on hospital admission, such as white cell count and C-reactive protein, procalcitonin, more than the risk scores CRB- and CURB-65 evaluated to date, appears to be a promising parameter for assessing the severity of pneumonia in elderly patients to allow early detection of severe courses and initiation of suitable treatment. The decisive factor is the dynamic course of the procalcitonin values over 3 consecutive days, as demonstrated in this case series.

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

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    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.

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

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    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

  11. Impact of oral simvastatin therapy on acute lung injury in mice during pneumococcal pneumonia

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    Boyd Angela R

    2012-05-01

    Full Text Available Abstract Background Recent studies suggest that the reported protective effects of statins (HMG-CoA reductase inhibitors against community-acquired pneumonia (CAP and sepsis in humans may be due to confounders and a healthy user-effect. To directly test whether statins are protective against Streptococcus pneumoniae, the leading cause of CAP, we examined the impact of prolonged oral simvastatin therapy at physiologically relevant doses in a mouse model of pneumococcal pneumonia. BALB/c mice were placed on rodent chow containing 0 mg/kg (control, 12 mg/kg (low simvastatin diet [LSD]; corresponds to 1.0 mg/kg/day, or 120 mg/kg (high simvastatin diet [HSD]; corresponds to 10 mg/kg/day simvastatin for four weeks, infected intratracheally with S. pneumoniae serotype 4 strain TIGR4, and sacrificed at 24, 36, or 42 h post-infection for assessment of lung histology, cytokine production, vascular leakage and edema, bacterial burden and bloodstream dissemination. Some mice received ampicillin at 12-h intervals beginning at 48 h post-infection and were monitored for survival. Immunoblots of homogenized lung samples was used to assess ICAM-1 production. Results Mice receiving HSD had reduced lung consolidation characterized by less macrophage and neutrophil infiltration and a significant reduction in the chemokines MCP-1 (P = 0.03 and KC (P = 0.02 and ICAM-1 in the lungs compared to control mice. HSD mice also had significantly lower bacterial titers in the blood at 36 (P = 0.007 and 42 (P = 0.03 hours post-infection versus controls. LSD had a more modest effect against S. pneumoniae but also resulted in reduced bacterial titers in the lungs and blood of mice after 42 h and a reduced number of infiltrated neutrophils. Neither LSD nor HSD mice had reduced mortality in a pneumonia model where mice received ampicillin 48 h after challenge. Conclusions Prolonged oral simvastatin therapy had a strong dose-dependent effect on protection

  12. 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

  13. Pattern of community and hospital acquired pneumonia in Egyptian military hospitals

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    Magdy Mohammad Khalil

    2013-01-01

    Conclusion: Our study showed that Gram positive organisms were the most prevalent in CAP especially Streptococcus pneumonia followed by Staphylococcus aureus, while Klebsiella was the most prevalent Gram negative organism. On the other hand our study showed that Gram negative organisms were the most prevalent in HAP especially Klebsiella followed by Pseudomonas aerginosa, while Staphylococcus haemolyticus was the most prevalent Gram positive organism.

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

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    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.

  15. A case-control study of community-acquired Acinetobacter baumannii pneumonia and melioidosis pneumonia in northeast Thailand: an emerging fatal disease with unique clinical features.

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    Patamatamkul, Samadhi; Klungboonkrong, Voravan; Praisarnti, Pakawas; Jirakiat, Kittitouch

    2017-01-01

    Acinetobacter baumannii is the emerging cause of severe and often fatal gram-negative, community-acquired pneumonia (CAP-AB) in Thailand. Due to its rarity, its specific clinical features are ill defined. In this retrospective study, we compared the demographic data, risk factors, clinical characteristics, radiographic pattern, and microbiological data between CAP-AB and Burkholderia pseudomallei CAP (CAP-BP) to identify the clinical features and risk factors of CAP-AB. CAP-AB was associated with a more productive cough and a shorter duration of symptoms, while CAP-BP was associated with more musculoskeletal symptoms. The white blood cell and neutrophil counts were significantly lower in the CAP-AB group. Gram staining of the sputum revealed a significantly higher amount of bacteria in the CAP-AB group. Lobar infiltration and unilateral right lung involvement were the most common radiographic patterns in the CAP-AB group. CAP-AB is associated with severe pneumonia and has unique clinical features that distinguish it from CAP-BP.

  16. Low prevalence of fluoroquinolone resistant strains and resistance precursor strains in Streptococcus pneumoniae from patients with community-acquired pneumonia despite high fluoroquinolone usage.

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    Pletz, Mathias W; van der Linden, Mark; von Baum, Heike; Duesberg, Christoph B; Klugman, Keith P; Welte, Tobias

    2011-01-01

    We investigated the usage of fluoroquinolones and the prevalence of fluoroquinolone resistant pneumococci and their precursors (first step mutants and efflux expressing isolates) in patients with community-acquired pneumonia, who were enroled into the German CAPNETZ surveillance study from 2002 to 2006 before the introduction of the pneumococcal conjugate vaccine (n=5780). Thirty-eight percent of all outpatients received fluoroquinolones. Moxifloxacin accounted for 70%, levofloxacin for 19% and ciprofloxacin for 9% of all fluoroquinolone prescriptions. One hundred and sixty-three pneumococcal isolates from 556 patients with pneumococcal pneumonia were analyzed for fluoroquinolone resistance, efflux phenotype, prevalence of mutations within the quinolone-resistance determining regions and clonality. None of the isolates exhibited fluoroquinolone resistance, 1.2% of the isolates contained a first step mutation and 6.7% exhibited an efflux phenotype. There was no clonal relationship among these strains at increased risk for fluoroquinolone resistance. The absence of fluoroquinolone resistance in the context of high fluoroquinolone usage might be explained by the high proportion of third-generation fluoroquinolones with enhanced activity against pneumococci.

  17. Antimicrobial susceptibility of Streptococcus pneumoniae isolates from vaccinated and non-vaccinated patients with a clinically confirmed diagnosis of community-acquired pneumonia in Belgium.

    Science.gov (United States)

    Lismond, Ann; Carbonnelle, Sylviane; Verhaegen, Jan; Schatt, Patricia; De Bel, Annelies; Jordens, Paul; Jacobs, Frédérique; Dediste, Anne; Verschuren, Frank; Huang, Te-Din; Tulkens, Paul M; Glupczynski, Youri; Van Bambeke, Françoise

    2012-03-01

    We assessed the in vitro susceptibility of Streptococcus pneumoniae isolates from patients with confirmed community-acquired pneumonia (CAP) to β-lactams, macrolides and fluoroquinolones and the association of non-susceptibility and resistance with serotypes/serogroups (STs/SGs), patient's risk factors and vaccination status. Samples (blood or lower respiratory tract) were obtained in 2007-2009 from 249 patients (from seven hospitals in Belgium) with a clinical and radiological diagnosis of CAP [median age 61 years (11.6% aged 94% ST19A), 73.5% resistant to macrolides and 18-21% intermediate to β-lactams; and SG6, 33% resistant to clarithromycin. Apparent vaccine failures: 3/17 for 7-valent vaccine (children; ST6B, 23F); 16/29 for 23-valent vaccine (adults ST3, 7F, 12F, 14, 19A, 22F, 23F, 33F). Isolates from nursing home residents, hospitalised patients and patients with non-respiratory co-morbidities showed increased MICs for amoxicillin, all β-lactams, and β-lactams and macrolides, respectively. Regarding antibiotic susceptibilities: (i) amoxicillin is still useful for empirical therapy but with a high daily dose; (ii) cefuroxime axetil and macrolides (but not telithromycin) are inappropriate for empirical therapy; and (iii) moxifloxacin and levofloxacin are the next 'best empirical choice' (no resistant isolates) but levofloxacin will require 500 mg twice-daily dosing for effective coverage.

  18. [Case report: Löffler's syndrome due to Ascaris lumbricoides mimicking acute bacterial community--acquired pneumonia].

    Science.gov (United States)

    Acar, Ali; Oncül, Oral; Cavuşlu, Saban; Okutan, Oğuzhan; Kartaloğlu, Zafer

    2009-01-01

    In this study we present a patient with Loeffler's syndrome caused by Ascaris lumbricoides who presented with the clinical findings of community-acquired pneumonia (CAP). Our patient, who was twenty-five years old, and who had had symptoms such as coughing, expectorating, dyspnea and fever for approximately ten days, was hospitalized. We auscultated polyphonic rhonchuses at the both hemithoraxes. A chest X-ray revealed bilateral lower zone patch consolidation. Acute bacterial community acquired pneumonia (CAP) was diagnosed due to these findings and empirical antibiotic treatment was begun. Repeated sputum Gram stains were negative, and both sputum and blood cultures were sterile. A sputum smear was negative for acid-fast bacilli. The patient's fever and respiratory complaint did not respond to the empirical antibiotics therapy. During the course of advanced investigations, we measured peripheric eosinophilia, and high levels of total Eo and total IgE, and observed Ascaris lumbricoides eggs during stool examination. The patient was given a diagnosis of Loeffler's syndrome. Thereupon the patient was treated successfully with one dose of albendazol 400 mg. In conclusion, we suggest that Loeffler's syndrome must be considered early in the differential diagnosis for CAP when peripheric eosinophilia is seen in patients if they live in an endemic area for parasitic disease.

  19. Prevalence of Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae Isolates in Nosocomial and Community-Acquired Urinary Tract Infections

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    Latifpour, Mohammad; Gholipour, Abolfazl; Damavandi, Mohammad Sadegh

    2016-01-01

    Background Klebsiella pneumoniae is a family member of Enterobacteriaceae. Isolates of K. pneumoniae produce enzymes that cause decomposition of third generation cephalosporins. These enzymes are known as extended-spectrum beta-lactamase (ESBL). Resistance of K. pneumoniae to beta-lactamase antibiotics is commonly mediated by beta-lactamase genes. Objectives The aim of this study was to identify the ESBL produced by K. pneumoniae isolates that cause community-acquired and nosocomial urinary tract infections within a one-year period (2013 to 2014) in Kashani and Hajar university hospitals of Shahrekord, Iran. Patients and Methods From 2013 to 2014, 150 strains of K. pneumoniae isolate from two different populations with nosocomial and community-acquired infections were collected. The strains were then investigated by double disk synergism and multiplex polymerase chain reaction (PCR). Results The study population of 150 patients with nosocomial and community-acquired infections were divided to two groups of 75 each. We found that 48 of the K. pneumoniae isolates in the patients with nosocomial infection and 39 isolates in those with community-acquired infections produced ESBL. The prevalence of TEM1, SHV1 and VEB1 in ESBL-producing isolates in nosocomial patients was 24%, 29.3% and 10.6%, and in community-acquired patients, 17.3%, 22.7% and 8%, respectively. Conclusions The prevalence of ESBL-producing K. pneumoniae isolate is of great concern; therefore, continuous investigation seems essential to monitor ESBL-producing bacteria in patients with nosocomial and community-acquired infections. PMID:27226874

  20. 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

  1. Treatment of hospital-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus.

    Science.gov (United States)

    Ferrara, Anna M

    2007-07-01

    Nosocomial pneumonia and ventilator-assisted pneumonia may be polymicrobial and can be caused by a wide spectrum of pathogens. Potentially multidrug-resistant microorganisms often represent the 'core' pathogens of the most severe infections. Among Gram-positive pathogens, methicillin-resistant Staphylococcus aureus (MRSA) plays a key role, mainly in mechanically ventilated patients or in patients with specific risk factors. The mainstay of treatment for MRSA pneumonia has been glycopeptide antibiotics, i.e. vancomycin and, to a lesser extent, teicoplanin. However, owing to its insufficient penetration into lung compartments, vancomycin may result in therapeutic failure or slow clinical responses. Moreover, vancomycin serum levels must be monitored in order to minimise nephrotoxicity and to maximise the concentration in the lung. Finally, the emergence of staphylococci isolates with reduced susceptibility to vancomycin suggests that glycopeptides should no longer be considered as first-line antibacterial agents for Gram-positive lung infections. Among new therapeutic options, linezolid may be an appropriate choice for MRSA pulmonary infections owing to its good pharmacokinetic profile in the lung and its acceptable tolerability, especially in patients with renal insufficiency or in those receiving other nephrotoxic agents. However, to contain the increasing emergence of drug resistance among hospitalised patients, these novel antimicrobial agents should be used judiciously, restricting their use to patients not responsive to, or intolerant of, glycopeptides. Other new drugs under development appear to be promising and deserve further evaluation.

  2. 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.

  3. Efficacy and significance of various scores for pneumonia severity in the management of patients with community-acquired pneumonia in China

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    YANG Yan; XU Feng; SHI Li-yun; DIAO Ran; CHENG Yu-sheng; CHEN Xi-yuan; JING Ji-yong; WANG Xuan-ding; SHEN Hua-hao

    2012-01-01

    Background Community-acquired pneumonia (CAP) remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit (ICU),and receive intense treatment.The present study aimed to evaluate the role of the pneumonia severity index (PSI),CURB-65,and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.Methods A total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated.The ability of different pneumonia severity scores to predict mortality was compared for effectiveness,while the risk factors associated with 30-day mortality rates and hospital length of stay (LOS) were evaluated.The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.Results All three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group.As the risk level increased,the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged.The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94,0.91 and 0.89 for the PSI,CURB-65 and sepsis score,respectively.Compared with the corresponding control groups,the mortality was markedly increased in patients with a history of smoking,prior admission to ICU,respiratory failure,or co-morbidity of heart disease.The differences were also identified in LOS between control groups and patients with ICU treatment,heart,or cerebrovascular disease.Logistic regression analysis showed that age over 65 years,a history of smoking,and respiratory failure were closely related to mortality in the overall CAP cohort,whereas age,ICU admission,respiratory failure,and LOS at home between disease attack and hospital admission were identified as independent

  4. Are proton pump inhibitors associated with the development of community-acquired pneumonia? A meta-analysis.

    Science.gov (United States)

    Giuliano, Christopher; Wilhelm, Sheila M; Kale-Pradhan, Pramodini B

    2012-05-01

    This study was presented at the American College of Chest Physicians meeting in Pittsburgh (PA, USA) in October 2011. The study objective was to evaluate the association of proton pump inhibitors (PPIs) and community-acquired pneumonia (CAP). The design was a meta-analysis of nine case-controlled and cohort studies. 120,863 pneumonia cases from 1987 to 2006 were included in the meta-analysis. PubMed and Ovid Medline were searched from inception through May 2011 by two investigators independently using keywords: PPI, pneumonia, CAP, anti-ulcer, antacid, omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole. This meta-analysis only included case-controlled and cohort studies that were published in full in English and evaluated PPI use and CAP incidence. Studies were excluded if they included the following patients: pediatric, Helicobacter pylori treatment and critically ill. Bibliographies of recent review articles and systematic reviews were hand-searched. Quality of studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Two investigators independently extracted data into standardized data collection forms that were confirmed by a third investigator. Data were analyzed based on current use of PPIs, duration of PPI use (180 days) and PPI dose (high vs low). Overall association of PPI and CAP was analyzed using the random effects model (Comprehensive Meta analysis(®) Version 2.0). Nine studies met all criteria for the primary outcome. Newcastle-Ottawa Quality Assessment Scale scores ranged from 4 to 8 out of 9. Current use of PPIs (odds ratio [OR]: 1.39; 95% CI: 1.09-1.76), PPI use 180 days (OR: 1.10; 95% CI: 1.00-1.21). In conclusion, patients currently receiving PPIs, particularly <30 days or high dose, showed an association with CAP. Practitioners need to be vigilant about adverse effects of PPIs and consider alternative therapies.

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

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    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

  6. 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

  7. CHANGING BACTERIAL ORGANISMS AND ANTIMICROBIAL RESISTANCE PATTERN AMONG HOSPITALIZED COMMUNITY ACQUIRED PNEUMONIA PATIENTS IN A TERTIARY CARE CENTER

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    Raveendra Kodur

    2013-04-01

    Full Text Available ABSTRACT: BACKGROUND: Most of the times a Community Acquired Pneumonia (CAP patient is being treated with empirical antibiotics by best guess method by the clinician.MDR strains are being reported from c/s reports and Gram negative rods are fast increasing both in the etiolog y and mortality of CAP patients AIM OF STUDY: 1. To find out the profile of different bacteria causing CAP at a tertiary hospital. 2. To know the treatment outcome & drug resistance pattern among culture positive CAP patients. MATERIALS & METHODS: 450 CAP patients admitted & treated between Jan. to Dec.2012 at Victoria Hospital, Bangalore were included in this hospitalized cross sectional study. All relevant investigations including sputum c/s were done. RESULTS: Positive culture reports were obtained in 165(36.33% out of 450 patients Following are the isolates - Strept.pnemoniae 32.7%, Klebsiella 18.2%, Staph.aureas 10.9%, Psedomonas 10.9%, E.coli 5.4%, Acinetobacter 7.3%, H.influenza 5.4%, Mixed growth 10%. 76% of patients recovered from CAP, 6% went a gainst medical advice, 6.6% showed unresolved pneumonia & deaths in 5.33% of patients. High degree of resistance was noted to many antibiotics including to latest cephalosporins. CONCLUSION: This study highlights the importance of culture tests and selection of proper antibiotics and to avoid misuse & abuse of higher antibiotics to prevent the emergence of MDR strains. An antibiotic policy at every level may help.

  8. 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.

  9. 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.

  10. Factors That Negatively Affect the Prognosis of Pediatric Community-Acquired Pneumonia in District Hospital in Tanzania

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    Caggiano, Serena; Ullmann, Nicola; De Vitis, Elisa; Trivelli, Marzia; Mariani, Chiara; Podagrosi, Maria; Ursitti, Fabiana; Bertolaso, Chiara; Putotto, Carolina; Unolt, Marta; Pietravalle, Andrea; Pansa, Paola; Mphayokulela, Kajoro; Lemmo, Maria Incoronata; Mkwambe, Michael; Kazaura, Joseph; Duse, Marzia; Nieddu, Francesco; Azzari, Chiara; Cutrera, Renato

    2017-01-01

    Community-acquired pneumonia (CAP) is still the most important cause of death in countries with scarce resources. All children (33 months ± 35 DS) discharged from the Pediatric Unit of Itigi Hospital, Tanzania, with a diagnosis of CAP from August 2014 to April 2015 were enrolled. Clinical data were gathered. Dried blood spot (DBS) samples for quantitative real-time polymerase chain reaction (PCR) for bacterial detection were collected in all 100 children included. Twenty-four percent of patients were identified with severe CAP and 11% died. Surprisingly, 54% of patients were admitted with a wrong diagnosis, which increased complications, the need for antibiotics and chest X-rays, and the length of hospitalization. Comorbidity, found in 32% of children, significantly increased severity, complications, deaths, need for chest X-rays, and oxygen therapy. Malnourished children (29%) required more antibiotics. Microbiologically, Streptococcus pneumonia (S. p.), Haemophilus influenza type b (Hib) and Staphylococcus aureus (S. a.) were the bacteria more frequently isolated. Seventy-five percent of patients had mono-infection. Etiology was not correlated with severity, complications, deaths, oxygen demand, or duration of hospitalization. Our study highlights that difficult diagnoses and comorbidities negatively affect clinical evolution. S. p. and Hib still play a large role; thus, implementation of current vaccine strategies is needed. DBS is a simple and efficient diagnostic method for bacterial identification in countries with scarce resources. PMID:28335406

  11. Current concern for community-acquired pneumonia%社区获得性肺炎的新关注

    Institute of Scientific and Technical Information of China (English)

    何礼贤

    2009-01-01

    Current concerned topics for community-acquired pneumonia(CAP) have been reviewed. There are 3 aspects, including(1)the modified penicillin susceptibility breakpoint of Streptococcus pneumonia and choice of antibiotics treating CAP. (2) Risk factors, which may influence CAP conditions and pathogens were evaluated. (3) Severe CAP and complicating severe sepsis and controversy of glucocorticoid treatment.%文章对社区获得性肺炎新近引起关注的一些重要问题进行了介绍和讨论,包括肺炎链球菌对青霉素敏感性折点的调整与社区获得性肺炎(CAP)治疗药物选择、关于CAP不同临床状态或病原体的相关危险因素评估、重症CAP与严重脓毒症及糖皮质激素的应用等3方面问题.

  12. Community-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus in critically-ill patients: systematic review

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    Nuria Carballo

    2017-03-01

    Full Text Available Introduction: Community-acquired pneumonia (CAP is associated with high morbidity and mortality rates. Despite methicillin-resistant Staphylococcus aureus (MRSA having often been associated with nosocomial pneumonia, the condition of some MRSA CAP patients is severe enough to warrant their being admitted to ICU. Objective: The purpose of this study is to conduct a systematic review of the literature on antibiotic treatment of MRSA CAP in critically-ill patients. Material and methods: An online search was conducted for locating articles on MRSA CAP in critically ill patients. Relevant publications were identified in PUBMED, the BestPractice database, UpToDate database and the Cochrane Library for articles published in English within the December 2001 - April 2016 time frame. Results: A total of 70 articles were found to have been published, 13 (18.8% having been included and 57 (81.4% excluded. Cohort studies were predominant, having totaled 16 in number (20.7% as compared to one sole cross-sectional study (3.5%. Conclusions: The experience in the treatment of MRSA CAP in patients requiring admission to ICU is quite limited. Vancomycin or linezolid seem to be the treatments of choice for MRSA CAP, although there not be any specific recommendation in this regard. It may be useful to use alternative routes, such as administration via aerosolized antibiotics, continuous infusion or in association with other antibiotics.

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

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    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.

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

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    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.

  15. 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

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

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    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

  17. [MIPS: multicenter Italian pneumonia study. Results of an observational, prospective and multicenter study on the clinical approach to community-acquired pneumonia].

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    Artom, A; Artom, P; Rattenni, S; Castello, C; Lo Pinto, G

    2004-09-01

    In a survey of 25 Divisions of Internal Medicine and Pneumology throughout Italy, our study aimed to ascertain the diagnostic and therapeutic pathway, the gravity in accordance with Fine's score (PSI), the median hospital length of stay and mortality rate among patients consecutively hospitalized for community-acquired pneumonia (CAP), from January 1 to March 31, 2002. Overall 407 patients were evaluated, with a mean age of 69 years; the following Fine's scores: 28% less than 70, 21.4% between 71 and 90, 31.25% between 91 and 130, 19.4% more than130. A single chest radiography was performed in 27.2% of the patients, two chest radiographs in 55.2% of the patients, more than two chest radiographs in 13.2% of the patients. A CT scan of the thorax was performed in 20.1% of the patients; arterial blood gas tensions were measured in 73.4% of the patients. Antibiotics were used as follows: beta-lactams in 46.5% of the patients, fluoroquinolones in 30% of the patients, macrolides in 13.2% of the patients, glycopeptides in 2.2% of the patients, others in 2.9% of the patients. Mean hospital stay was 11 days; the 30-day in-hospital mortality was 9.6%. This study showed that a large number of patients with low-risk CAP were unnecessarily hospitalized.

  18. 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

  19. 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

  20. 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

  1. 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

  2. SWAB/NVALT (Dutch Working Party on Antibiotic Policy and Dutch Association of Chest Physicians) Guidelines on the Management of Community-Acquired Pneumonia in Adults

    NARCIS (Netherlands)

    Wiersinga, W. J.; Bonten, M. J.; Boersma, W. G.; Jonkers, R. E.; Aleva, R. M.; Kullberg, B. J.; Schouten, J. A.; Degener, J. E.; Janknegt, R.; Verheij, T. J.; Sachs, A. P. E.; Prins, J. M.

    2012-01-01

    The Dutch Working Party on Antibiotic Policy (SWAB) and the Dutch Association of Chest Physicians (NVALT) convened a joint committee to develop evidence-based guidelines on the diagnosis and treatment of community-acquired pneumonia (CAP). The guidelines are intended for adult patients with CAP who

  3. 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

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

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    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.

  5. Predictors for length of hospital stay in patients with community-acquired Pneumonia: Results from a Swiss Multicenter study

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    Suter-Widmer Isabelle

    2012-05-01

    Full Text Available Abstract Background Length of hospital stay (LOS in patients with community-acquired pneumonia (CAP is variable and directly related to medical costs. Accurate estimation of LOS on admission and during follow-up may result in earlier and more efficient discharge strategies. Methods This is a prospective multicenter study including patients in emergency departments of 6 tertiary care hospitals in Switzerland between October 2006 and March 2008. Medical history, clinical data at presentation and health care insurance class were collected. We calculated univariate and multivariate cox regression models to assess the association of different characteristics with LOS. In a split sample analysis, we created two LOS prediction rules, first including only admission data, and second including also additional inpatient information. Results The mean LOS in the 875 included CAP patients was 9.8 days (95%CI 9.3-10.4. Older age, respiratory rate >20 pm, nursing home residence, chronic pulmonary disease, diabetes, multilobar CAP and the pneumonia severity index class were independently associated with longer LOS in the admission prediction model. When also considering follow-up information, low albumin levels, ICU transfer and development of CAP-associated complications were additional independent risk factors for prolonged LOS. Both weighted clinical prediction rules based on these factors showed a high separation of patients in Kaplan Meier Curves (p logrank and a good calibration when comparing predicted and observed results. Conclusions Within this study we identified different baseline and follow-up characteristics to be strong and independent predictors for LOS. If validated in future studies, these factors may help to optimize discharge strategies and thus shorten LOS in CAP patients.

  6. 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

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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 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.

  7. 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.

  8. 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

  9. Risk Factors for Long-Term Mortality after Hospitalization for Community-Acquired Pneumonia: A 5-Year Prospective Follow-Up Study.

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    Jan C Holter

    Full Text Available Contributors to long-term mortality in patients with community-acquired pneumonia (CAP remain unclear, with little attention paid to pneumonia etiology. We examined long-term survival, causes of death, and risk factors for long-term mortality in adult patients who had been hospitalized for CAP, with emphasis on demographic, clinical, laboratory, and microbiological characteristics.Two hundred and sixty-seven consecutive patients admitted in 2008-2011 to a general hospital with CAP were prospectively recruited and followed up. Patients who died during hospital stay were excluded. Demographic, clinical, and laboratory data were collected within 48 hours of admission. Extensive microbiological work-up was performed to establish the etiology of CAP in 63% of patients. Mortality data were obtained from the Norwegian Cause of Death Registry. Cox regression models were used to identify independent risk factors for all-cause mortality.Of 259 hospital survivors of CAP (median age 66 years, 79 (30.5% died over a median of 1,804 days (range 1-2,520 days. Cumulative 5-year survival rate was 72.9% (95% CI 67.4-78.4%. Standardized mortality ratio was 2.90 for men and 2.05 for women. The main causes of death were chronic obstructive pulmonary disease (COPD, vascular diseases, and malignancy. Independent risk factors for death were the following (hazard ratio, 95% CI: age (1.83 per decade, 1.47-2.28, cardiovascular disease (2.63, 1.61-4.32, COPD (2.09, 1.27-3.45, immunocompromization (1.98, 1.17-3.37, and low serum albumin level at admission (0.75 per 5 g/L higher, 0.58-0.96, whereas active smoking was protective (0.32, 0.14-0.74; active smokers were younger than non-smokers (P < 0.001. Microbial etiology did not predict mortality.Results largely confirm substantial comorbidity-related 5-year mortality after hospitalization for CAP and the impact of several well-known risk factors for death, and extend previous findings on the prognostic value of serum albumin

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

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    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. Population pharmacokinetics of ceftaroline in patients with acute bacterial skin and skin structure infections or community-acquired bacterial pneumonia.

    Science.gov (United States)

    Van Wart, Scott A; Forrest, Alan; Khariton, Tatiana; Rubino, Christopher M; Bhavnani, Sujata M; Reynolds, Daniel K; Riccobene, Todd; Ambrose, Paul G

    2013-11-01

    Ceftaroline, the active form of ceftaroline fosamil, is a broad-spectrum cephalosporin antibiotic. A population pharmacokinetic (PPK) model for ceftaroline was developed in NONMEM® using data from 185 healthy subjects and 92 patients with acute bacterial skin and skin structure infection (ABSSSI). Data from 128 patients with community-acquired bacterial pneumonia (CABP) were used for external model validation. Healthy subjects received 50-2,000 mg ceftaroline fosamil via intravenous (IV) infusion over 1 hour or intramuscular (IM) injection q12h or q24h. ABSSSI and CABP patients received 600 mg of ceftaroline fosamil IV over 1 hour q12h. A three-compartment model with zero-order IV or parallel first-order IM input and first-order elimination described ceftaroline fosamil PK. A two-compartment model with first-order conversion of prodrug to ceftaroline and parallel linear and saturable elimination described ceftaroline PK. Creatinine clearance was the primary determinant of ceftaroline exposure. Good agreement between the observed data and both population (r(2)  = 0.93) and individual post-hoc (r(2)  = 0.98) predictions suggests the PPK model can adequately approximate ceftaroline PK using covariate information. Such a PPK model can evaluate dose adjustments for patients with renal impairment and generate ceftaroline exposures for use in pharmacokinetic-pharmacodynamic assessments of efficacy in patients with ABSSSI or CABP.

  12. 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

  13. Corticosteroids in the adjunctive therapy of community-acquired pneumonia: an appraisal of recent meta-analyses of clinical trials.

    Science.gov (United States)

    Feldman, Charles; Anderson, Ronald

    2016-03-01

    Improving the outcome of patients with community-acquired pneumonia (CAP) is an ongoing challenge, even in the setting of significant advances in antimicrobial chemotherapy and critical care. Recognition of the underlying involvement of inflammation-mediated organ dysfunction as a determinant of adverse outcomes in CAP has aroused intense interest in the protective potential of adjunctive anti-inflammatory therapies in CAP, particularly the role of corticosteroids (CS). This is the primary topic of the current review which is focused on an evaluation of the latest meta-analyses encompassing both recent and earlier clinical trials, with particular emphasis on the stringent meta-analysis undertaken by Siemieniuk and colleagues (Ann Intern Med 2015;163:519-528). The review highlights the findings and recommendations of these and related published commentaries/critiques, while providing a brief description of those sub-groups of patients who seemingly stand to benefit most from CS therapy. This is preceded by an overview of the mechanisms of the anti-inflammatory activities of CS, the interactions of these agents with macrolide antibiotics, and the potential benefits and risks of short-term administration of CS, concluding with a succinct appraisal of priority issues for ongoing and future research.

  14. 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

  15. 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

  16. The efficacy of high-dose penicillin for community-acquired pneumonia diagnosed by pneumococcal urine antigen test.

    Science.gov (United States)

    Oka, Hideaki; Ueda, Atsuhisa; Watanuki, Yuji; Tsukiji, Jun; Kuroda, Hideyo; Akashi, Syunsuke; Hirai, Yoshihiro; Fuyuki, Toshiharu; Kaneko, Takeshi; Ishigatsubo, Yoshiaki

    2009-04-01

    We analyzed the efficacy of both the Streptococcus pneumoniae urine antigen test as a quick diagnostic tool and the administration of high-dose penicillin in response to a positive S. pneumoniae urine antigen test. We conducted a retrospective analysis of 48 cases of pneumococcal pneumonia, in which the patients were treated with high-dose penicillin. All the cases were diagnosed by a positive urine antigen test. Treatment with high-dose penicillin was effective in 43 of the 48 patients. This treatment was also effective in 12 of 16 culture-confirmed cases with low susceptibility to penicillin. Eleven patients who were positive for the S. pneumoniae urine antigen test but culture-negative showed clinical improvement with high-dose penicillin. Pneumonia caused by S. pneumoniae appeared to be treated safely and effectively with high-dose penicillin based on positive results of the urine antigen test, as penicillin resistance was unlikely to be a problem.

  17. 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

    Directory of Open Access Journals (Sweden)

    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.

  18. Efficacy and safety of telithromycin 800 mg once daily for 7 days in community-acquired pneumonia: an open-label, multicenter study

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    Dunbar Lala M

    2005-05-01

    Full Text Available Abstract Background Community-acquired pneumonia (CAP remains a major cause of morbidity and mortality throughout the world. Telithromycin (a new ketolide has shown good in vitro activity against the key causative pathogens of CAP, including S pneumoniae resistant to penicillin and/or macrolides. Methods The efficacy and safety of telithromycin 800 mg orally once daily for 7 days in the treatment of CAP were assessed in an open-label, multicenter study of 442 adults. Results Of 149 microbiologically evaluable patients, 57 (9 bacteremic had Streptococcus pneumoniae. Of the 57 S pneumoniae pathogens isolated in these patients, 9 (2 bacteremic were penicillin- or erythromycin-resistant; all 57 were susceptible to telithromycin and were eradicated. Other pathogens and their eradication rates were: Haemophilus influenzae (96%, Moraxella catarrhalis (100%, Staphylococcus aureus (80%, and Legionella spp. (100%. The overall bacteriologic eradication rate was 91.9%. Of the 357 clinically evaluable patients, clinical cure was achieved in 332 (93%. In the 430 patients evaluable for safety, the most common drug-related adverse events were diarrhea (8.1% and nausea (5.8%. Conclusion Telithromycin 800 mg once daily for 7 days is an effective and well-tolerated oral monotherapy and offers a new treatment option for CAP patients, including those with resistant S pneumoniae.

  19. 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

  20. A Case of Influenza A (H3N2) Complicated by Community-Acquired Pneumonia and Death in a Young Healthy Adult during the 2013–2014 Season

    Science.gov (United States)

    Collins, Lauren F.; Anderson, Benjamin D.; Gray, Gregory C.

    2017-01-01

    With multiple available vaccines and antivirals, seasonal influenza A is typically a self-limited acutely debilitating illness in young healthy adults. Here, we illustrate unexpected morbidity and mortality in a relatively young and healthy patient seen at a large tertiary care academic medical center for seasonal influenza A (H3N2) complicated by community-acquired pneumonia, hypoxic respiratory failure, septic shock, and death.

  1. 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.

  2. 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.

  3. In-hospital mortality risk factors in community acquired pneumonia: evaluation of immunocompetent adult patients without comorbidities

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    Miguel Hernan Vicco

    2015-04-01

    Full Text Available Summary Objective: several scores were developed in order to improve the determination of community acquired pneumonia (CAP severity and its management, mainly CURB-65 and SACP score. However, none of them were evaluated for risk assessment of in-hospital mortality, particularly in individuals who were non-immunosuppressed and/or without any comorbidity. In this regard, the present study was carried out. Methods: we performed a cross-sectional study in 272 immunocompetent patients without comorbidities and with a diagnosis of CAP. Performance of CURB- 65 and SCAP scores in predicting in-hospital mortality was evaluated. Also, variables related to death were assessed. Furthermore, in order to design a model of in-hospital mortality prediction, sampled individuals were randomly divided in two groups. The association of the variables with mortality was weighed and, by multiple binary regression, a model was constructed in one of the subgroups. Then, it was validated in the other subgroup. Results: both scores yielded a fair strength of agreement, and CURB-65 showed a better performance in predicting in-hospital mortality. In our casuistry, age, white blood cell counts, serum urea and diastolic blood pressure were related to death. The model constructed with these variables showed a good performance in predicting in-hospital mortality; moreover, only one patient with fatal outcome was not correctly classified in the group where the model was constructed and in the group where it was validated. Conclusion: our findings suggest that a simple model that uses only 4 variables, which are easily accessible and interpretable, can identify seriously ill patients with CAP

  4. 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.

  5. 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.

  6. What is the most reliable marker in the differential diagnosis of pulmonary embolism and community-acquired pneumonia?

    Science.gov (United States)

    Ateş, Hale; Ateş, İhsan; Bozkurt, Bülent; Çelik, Hüseyin Tuğrul; Özol, Duygu; Yldrm, Zeki

    2016-04-01

    Because of similar clinical manifestations and laboratory findings, differential diagnosis of pulmonary embolism and community-acquired pneumonia (CAP) is generally difficult. Therefore, this study was conducted to find good markers for the easy, cheap, and fast differential diagnosis of pulmonary embolism and CAP. Thirty-four patients diagnosed with pulmonary embolism and 38 patients with CAP who were admitted to either emergency department or chest diseases outpatient clinic were included in this study. On admission and third day, complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate, procalcitonin (PCT), and D-dimer levels of each patient were measured. Neutrophil-to-lymphocyte ratio (NLR) was calculated using the formula NLR = neutrophil count/lymphocyte count. NLR/D-dimer and PCT/D-dimer ratios were also calculated. First day neutrophil count (P = 0.005), NLR (P = 0.002), CRP (P differential diagnosis of pulmonary embolism and CAP, CRP, PCT/D-dimer, and NLR/D-dimer were found to be independent predictive factors for the presence of CAP. Among these factors, NLR/D-dimer ratio was found to be the most sensitive (97.4%) to have the highest negative predictive value 96.7% and to be the most accurate (area under curve = 0.921) (91.7%) parameter for the differential diagnosis of pulmonary embolism and CAP. In this study, NLR/D-dimer ratio was found to be more sensitive and more selective with negative predictive value and area under curve for the differential diagnosis of pulmonary embolism and CAP compared with other laboratory tests.

  7. Chlamydia Pneumoniae Pneumonia: An Evolving Clinical Spectrum

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    David Megran

    1995-01-01

    Full Text Available Chlamydia pneumoniae is a recently recognized respiratory tract pathogen. It accounts for 6 to 10% of all cases of community acquired pneumonia requiring admission to hospital. Two patients hospitalized with C pneumoniae pneumonia are presented to illustrate its range of severity and the extrapulmonary manifestations.

  8. Chlamydia pneumoniae pneumonia: An evolving clinical spectrum

    Science.gov (United States)

    Megran, David; Peeling, Rosanna W; Marrie, Thomas J

    1995-01-01

    Chlamydia pneumoniae is a recently recognized respiratory tract pathogen. It accounts for 6 to 10% of all cases of community acquired pneumonia requiring admission to hospital. Two patients hospitalized with C pneumoniae pneumonia are presented to illustrate its range of severity and the extrapulmonary manifestations. PMID:22514396

  9. "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.

  10. Evaluation of the BinaxNOW® Streptococcus pneumoniae antigen test on fresh, frozen and concentrated urine samples in elderly patients with and without community-acquired pneumonia.

    Science.gov (United States)

    Saukkoriipi, Annika; Pascal, Thierry; Palmu, Arto A

    2016-02-01

    We evaluated the BinaxNOW® urine antigen test in elderly. For fresh un-concentrated urine samples, the sensitivity for pneumococcal pneumonia was 63% and specificity 97%. After freezing and concentration, the results comparable to positive control line in intensity at 60 min gave high sensitivity (81%) with no loss in specificity (96%).

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

    NARCIS (Netherlands)

    Schouten, M.; van 't Veer, C.; Roelofs, J.J.; Levi, M.; van der Poll, T.

    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 re

  12. Community acquired pneumonia due to gram negative bacilli and its antibiotic sensitivity pattern in a tertiary care centre

    OpenAIRE

    Ashish Jitendranath; Sudin Koshy

    2016-01-01

    Background: Gram negative bacteria along with Pseudomonas constitute a significant cause of morbidity and mortality due to pneumonia. As a result it is essential to have appropriate empirical antimicrobial treatment strategies based on the sensitivity pattern of a particular region. In cases with high likelihood of gram negative pneumonia it is essential to start appropriate empirical antibiotics as early as possible to reduce the morbidity and mortality. This study is done to know the antibi...

  13. Using cluster analysis of cytokines to identify patterns of inflammation in hospitalized patients with community-acquired pneumonia: a pilot study

    Science.gov (United States)

    Wiemken, Timothy L; Kelley, Robert R; Fernandez-Botran, Rafael; Mattingly, William A.; Arnold, Forest W.; Furmanek, Stephen P; Restrepo, Marcos I; Chalmers, James D; Peyrani, Paula; Cavallazzi, Rodrigo; Bordon, Jose; Aliberti, Stefano; Ramirez, Julio A.

    2017-01-01

    Introduction Patients with severe community-acquired pneumonia (CAP) are believed to have an exaggerated inflammatory response to bacterial infection. Therapies aiming to modulate the inflammatory response have been largely unsuccessful, perhaps reflecting that CAP is a heterogeneous disorder that cannot be modulated by a single anti-inflammatory approach. We hypothesize that the host inflammatory response to pneumonia may be characterized by distinct cytokine patterns, which can be harnessed for personalized therapies. Methods Here, we use hierarchical cluster analysis of cytokines to examine if patterns of inflammatory response in 13 hospitalized patients with CAP can be defined. This was a secondary data analysis of the Community-Acquired Pneumonia Inflammatory Study Group (CAPISG) database. The following cytokines were measured in plasma and sputum on the day of admission: interleukin (IL)-1β, IL-1 receptor antagonist (IL-1ra), IL-6, CXCL8 (IL-8), IL-10, IL-12p40, IL-17, interferon (IFN)γ, tumor necrosis factor (TNF)α, and CXCL10 (IP-10). Hierarchical agglomerative clustering algorithms were used to evaluate clusters of patients within plasma and sputum cytokine determinations. Results A total of thirteen patients were included in this pilot study. Cluster analysis identified distinct inflammatory response patterns of cytokines in the plasma, sputum, and the ratio of plasma to sputum. Conclusions Inflammatory response patterns in plasma and sputum can be identified in hospitalized patients with CAP. Characterization of the local and systemic inflammatory response may help to better discriminate patients for enrollment into clinical trials of immunomodulatory therapies.

  14. Impact of temperature on childhood pneumonia estimated from satellite remote sensing.

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    Xu, Zhiwei; Liu, Yang; Ma, Zongwei; Li, Shenghui; Hu, Wenbiao; Tong, Shilu

    2014-07-01

    The effect of temperature on childhood pneumonia in subtropical regions is largely unknown so far. This study examined the impact of temperature on childhood pneumonia in Brisbane, Australia. A quasi-Poisson generalized linear model combined with a distributed lag non-linear model was used to quantify the main effect of temperature on emergency department visits (EDVs) for childhood pneumonia in Brisbane from 2001 to 2010. The model residuals were checked to identify added effects due to heat waves or cold spells. Both high and low temperatures were associated with an increase in EDVs for childhood pneumonia. Children aged 2-5 years, and female children were particularly vulnerable to the impacts of heat and cold, and Indigenous children were sensitive to heat. Heat waves and cold spells had significant added effects on childhood pneumonia, and the magnitude of these effects increased with intensity and duration. There were changes over time in both the main and added effects of temperature on childhood pneumonia. Children, especially those female and Indigenous, should be particularly protected from extreme temperatures. Future development of early warning systems should take the change over time in the impact of temperature on children's health into account.

  15. Inter-observer variation in the interpretation of chest radiographs for pneumonia in community-acquired lower respiratory tract infections

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    Hopstaken, R.M. E-mail: rogier.hopstaken@hag.unimaas.nl; Witbraad, T.; Engelshoven, J.M.A. van; Dinant, G.J

    2004-08-01

    AIM: To assess inter-observer variation in the interpretation of chest radiographs of individuals with pneumonia versus those without pneumonia. MATERIALS AND METHODS: Chest radiographs of out-patients with a lower respiratory tract infection (LRTI) were assessed for the presence of infiltrates by radiologists from three local hospitals and were reassessed by one university hospital radiologist. Various measures of inter-observer agreement were calculated. RESULTS: The observed proportional agreement was 218 in 243 patients (89.7%). Kappa was 0.53 (moderate agreement) with a 95% confidence interval of 0.37 to 0.69. The observed positive agreement (59%) was much lower than for negative agreement (94%). Kappa was considerably lower, if chronic obstructive pulmonary disease was present ({kappa}=0.20) or Streptococcus pneumoniae ({kappa}=-0.29) was the infective agent. CONCLUSION: The overall inter-observer agreement adjusted for chance was moderate. Inter-observer agreement in cases with pneumonia was much worse than the agreement in negative (i.e. non-pneumonia) cases. A general practitioner's selection of patients with a higher chance of having pneumonia for chest radiography would thus not improve the observer agreement.

  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. Antibacterial activity and PK/PD of ceftriaxone against penicillin-resistant Streptococcus pneumoniae and beta-lactamase-negative ampicillin-resistant Haemophilus influenzae isolates from patients with community-acquired pneumonia.

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    Ohno, Akira; Ishii, Yoshikazu; Kobayashi, Intetsu; Yamaguchi, Keizo

    2007-10-01

    The suitability of ceftriaxone for penicillin-resistant Streptococcus pneumoniae (PRSP) and ampicillin-resistant Haemophilus influenzae (especially beta-lactamase-negative ampicillin-resistant (BLNAR) H. influenzae) and the relationship between in vitro antimicrobial activities and pharmacokinetic parameters were evaluated. The values for percentage of time above the MIC (%T>MIC) for ceftriaxone, cefotiam, flomoxef, sulbactam/cefoperazone, sulbactam/ampicillin, and meropenem, using 400 S. pneumoniae isolates and 430 H. influenzae isolates from patients with community-acquired pneumonia (CAP) from more than 100 geographically diverse medical centers during January to July of 2005, were calculated by measuring the MIC for each isolate and by using patameters of pharmacokinetics. A broth microdilution method was used to determine the MIC, using the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Meropenem showed the lowest MIC against penicillin-susceptible S. pneumoniae, followed by sulbactam/cefoperazone and ceftriaxone. Ceftriaxone had the best activity against penicillin-resistant S. pneumoniae and beta-lactamase-negative and beta-lactamase-producing ampicillin-resistant H. influenzae. Ceftriaxone was unique, showing a long elimination half-life and low MIC values where its serum level duration time was above the MIC for longer than other cephalosporins. Accordingly, the %T>MIC of ceftriaxone for a once-daily administration greatly exceeded the efficacy levels of those for the other antibacterial agents tested. Ceftriaxone has an excellent balance between in vitro antimicrobial activities and pharmacokinetic profiles; and therefore remains effective as a therapeutic agent against PRSP and BLNAR H. influenzae in CAP.

  20. 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.

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

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    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 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.

  2. [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.

  3. Detection of Streptococcus pneumoniae and identification of pneumococcal serotypes by real-time polymerase chain reaction using blood samples from Italian children ≤ 5 years of age with community-acquired pneumonia.

    Science.gov (United States)

    Marchese, Anna; Esposito, Susanna; Coppo, Erika; Rossi, Giovanni A; Tozzi, Alberto; Romano, Mariateresa; Da Dalt, Liviana; Schito, Gian Carlo; Principi, Nicola

    2011-09-01

    Streptococcus pneumoniae is a leading cause of severe life-threatening infections. Laboratory identification and serotyping of this pathogens is desirable to monitor vaccine impact and coverage; however, especially in pediatric patients, the yield of traditional microbiological diagnostic procedures can be very low. The aim of this study was to develop real-time polymerase chain reaction (PCR)-based assays to be performed directly on blood samples to identify the most common capsular serotypes causing pneumonia in Italian children (≤ 5 years of ages) after the introduction of the 7-valent conjugate vaccine. Our real-time PCR-based assays showed high sensitivity (at least 35 fg of pneumococcal DNA), and they were validated with 49 well-characterized pneumococcal isolates, 8 nonpneumococcal isolates, 13 simulated blood clinical samples loaded with S. pneumoniae of known serotypes, and 46 blood clinical samples. All the strains tested and the simulated blood clinical samples were correctly typed by the technique. Real-time PCR allowed serotyping in 37/46 children ≤ 5 years of age (80.4%) in whom pneumonia was diagnosed in four Italian hospitals. Non-PCV7 serotypes accounted for at least 47.8% (22/46) of cases, serotype 19A being the most common (34.7%, 16/46). Although, it is not known at present whether the incidence of 19A serotype is attributable to the use of PCV7 only, expanding pneumococcal serotype coverage has clearly the potential to prevent a larger number of pneumonias in Italian children less than ≤ 5 years of age. Molecular methods are of increasing importance in the diagnosis of pneumococcal pneumonia and in monitoring serotype distribution and replacement.

  4. Clinical efficacy of carbapenems on hospital-acquired pneumonia in accordance with the Japanese Respiratory Society Guidelines for management of HAP.

    Science.gov (United States)

    Ito, Masaru; Kaneko, Takeshi; Goto, Hideto; Yamaguchi, Nobuhiro; Fujisawa, Shin; Ono, Shigeru; Morita, Satoshi; Miyazawa, Naoki; Kanamori, Heiwa; Watanuki, Yuji; Ishigatsubo, Yoshiaki

    2011-12-01

    Hospital-acquired pneumonia (HAP) is the second most common cause of hospital-acquired infection and is the leading cause of death. In 2002, the Japanese Respiratory Society (JRS) published guidelines for the diagnosis and treatment of HAP (JRS GL 2002). In these guidelines, treatment with carbapenems is recommended for all disease types of HAP, excluding cases of mild or moderate pneumonia with no risk factors, and cases with early-onset ventilation-acquired pneumonia. To evaluate the efficacy of carbapenems on HAP in accordance with JRS GL 2002, we conducted a prospective study of HAP patients treated with carbapenems based on JRS GL 2002. The results of this study were also analyzed based on the revised guidelines published in June 2008 (JRS GL 2008), and the validity of the new guidelines was examined. Of the 33 subjects, 19 were judged as responders to the treatment, corresponding to a response rate of 57.6%. There were 3 deaths, corresponding to a mortality rate of 9.1%. The efficacy of carbapenems for the treatment of HAP based on JRS GL 2002 was confirmed. The severity rating system in JRS GL 2002 has a tendency to overestimate the severity of the cases and may lead to overtreatment in some cases. On the other hand, the severity rating system by JRS GL 2008 seemed to be more accurate and closely correlated with the efficacy of the treatment. It is suggested that JRS GL 2008 is more useful in clinical practice for accurately judging the severity of the disease and initiating appropriate subsequent antibiotic therapy.

  5. Discussion on nursing the elderly patients with community acquired pneumonia%高龄社区获得性肺炎患者护理探讨

    Institute of Scientific and Technical Information of China (English)

    齐新荣; 李佳林; 王茹欣; 苏红; 陈星; 张家玮

    2015-01-01

    目的:探讨高龄社区获得性肺炎患者护理要点,以提高高龄老年社区获得性肺炎护理水平。方法对35例≥80岁老年社区获得性肺炎患者的临床资料及护理进行回顾性分析。结果本组患者住院时间6~46 d,其中治愈32例,死亡3例。结论高龄老年社区获得性肺炎患者基础病多,临床症状不典型,病情凶险,护理应侧重环境管理、饮食卧位管理、呼吸道管理、基础护理、心理护理、预防院内交叉感染,同时重视呼吸频率与血压、意识障碍等风险因素的评估,实施科学个体化整体护理,促进患者康复。%ObjectiveTo explore the clinical nursing care of elderly community acquired pneumonia in the elderly to improve the nursing level of community acquired pneumonia in the elderly patients.Methods 35 patients aged 80 and over community acquired pneumonia and nursing care of patients with clinical data were retrospectively analyzed.Results 32 cases were cured, 3 cases died, the length of hospital stay was 6 to 46 days.Conclusion Elderly community acquired pneumonia in patients with underlying disease are common, and the clinical symptoms are not typical but with dangerous condition. Care should be focused on management environment and diet managing clinostats. Environmental management, diet and position management, airway management, basic nursing, psychological nursing, prevention of hospital cross infection should be focused on. Besides, we should pay attention to the respiratory rate and blood pressure changes, disturbance of consciousness risk factors assessment, and carry out the implementation of scientiifc individualized holistic nursing care to promote the rehabilitation of patients.

  6. 成人及儿童社区与医院获得肺炎链球菌的耐药性分析%Analysis on drug resistance of community acquired and hospital acquired Streptococcus pneumoniae in adults and children

    Institute of Scientific and Technical Information of China (English)

    张勇昌; 张九进; 陈月新; 赖伟忠

    2014-01-01

    目的:探讨成人及儿童社区与医院获得肺炎链球菌对常用抗菌药物的耐药性,为临床合理用药提供参考依据。方法对2010年1月-2012年12月分离肺炎链球菌411株,采用法国生物梅里埃公司的VITEK-2 Com-pact全自动细菌鉴定仪进行鉴定及药物敏感试验,采用SPSS 17.0统计软件进行分析。结果共411株肺炎链球菌社区获得肺炎链球菌为349株,成人占23.50%、儿童占76.50%;医院获得肺炎链球菌62株,成人占51.61%、儿童占48.39%;儿童社区获得与医院获得肺炎链球菌对青霉素、阿莫西林、红霉素、磺胺甲噁唑/甲氧苄啶、头孢噻肟的耐药率均高于成人社区获得与医院获得肺炎链球菌,而对左氧氟沙星、莫西沙星的耐药率低于成人社区获得与医院获得肺炎链球菌,差异均有统计学意义。结论儿童社区获得肺炎链球菌对β-内酰胺抗菌药物的耐药率高于成人,临床治疗应减少经验性用药,建议依据药敏结果选择抗菌药物进行治疗。%OBJECTIVE To discuss the drug resistance of community acquired and hospital acquired Streptococcus pneumoniae to commonly antibiotics used in adults and children ,so as to provide the basis for the clinical medica-tion .METHODS Using the France Biomeriex VITEK-2 Compact ,411 strains of Streptococcus pneumoniae from Jan .2010 to Dec .2012 were isolated and tested for the drug sensitivity .Data were analyzed by SPSS 17 .0 . RESULTS Among 411 strains of S . pneumoniae ,349 were community acquired ,including 23 .50% in adults , 76 .50% in children and 62 were hospital acquired ,including 51 .61% in adults ,48 .39% in children .The resist-ance rates of community and hospital acquired Streptococcus pneumoniae to penicillin ,amoxicilin ,erythromycin , sulfamethoxazole/trimethoprim ,and cefotaxime in children were significanty higher than that in adults ,while the resistances to levofloxacin and moxifloxacin

  7. Etiología de la neumonía adquirida en la comunidad en el adulto inmunocompetente ETIOLOGY OF COMMUNITY-ACQUIRED PNEUMONIA IN IMMUNOCOMPETENT ADULTS

    Directory of Open Access Journals (Sweden)

    Rodrigo Moreno B.

    2005-04-01

    Full Text Available En la situación clínica ideal, el tratamiento antimicrobiano empírico prescrito en la neumonía del adulto adquirida en la comunidad (NAC debería estar basado en el resultado de los estudios microbiológicos realizados en el medio nacional. La información disponible sobre la etiología en el medio ambulatorio y la UCI es relativamente escasa, en comparación con la referida al medio intrahospitalario. En los estudios diseñados específicamente para estudiar los agentes causales, en 40-50% de los casos no se identifica el patógeno respiratorio, lo que pone de manifiesto las dificultades de los métodos diagnósticos. En todos los escenarios de atención, Streptococcus pneumoniae es el principal patógeno respiratorio aislado en la NAC del adulto, siendo responsable de 16% de los casos tratados en el medio ambulatorio y de alrededor de 22% de los casos admitidos al hospital y la UCI. Aproximadamente un tercio de los casos son causados por un conjunto de varios microorganismos: Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, virus respiratorios, Staphylococcus aureus, bacilos gramnegativos y Legionella sp, siendo cada uno responsable de menos de 10% de los casos. En general, la distribución de los microorganismos varía escasamente en los tres entornos de atención: ambulatorio, sala de cuidados generales y UCI. Entre las excepciones destaca una mayor frecuencia de infección por bacilos gramnegativos, S. aureus y Legionella sp en la UCI, y de C. pneumoniae en el medio ambulatorio. En Chile, la etiología de la NAC en el adulto hospitalizado es similar a la comunicada en estudios extranjeros, y no se dispone de información específica sobre la NAC de manejo ambulatorio y de la que cursa en forma graveIn an ideal clinical setting, empiric antimicrobial treatment prescribed in adult community acquired pneumonia (CAP should be based on national etiological surveillance and in vitro susceptibility assays. Available

  8. Viruses and Gram-negative bacilli dominate the etiology of community-acquired pneumonia in Indonesia, a cohort study

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    Helmia Farida

    2015-09-01

    Conclusions: Viruses and Gram-negative bacilli are dominant causes of CAP in this region, more so than S. pneumoniae. Most of the bacteria have wild type susceptibility to antimicrobial agents. Patients with severe disease and those with unknown etiology have a higher mortality risk.

  9. Dissemination of multidrug-resistant blaCTX-M-15/IncFIIk plasmids in Klebsiella pneumoniae isolates from hospital- and community-acquired human infections in Tunisia.

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    Mansour, Wejdene; Grami, Raoudha; Ben Haj Khalifa, Anis; Dahmen, Safia; Châtre, Pierre; Haenni, Marisa; Aouni, Mahjoub; Madec, Jean-Yves

    2015-11-01

    This study investigated the molecular features of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae from hospital- and community-acquired (HA/CA) infections in the region of Mahdia, Tunisia. Among 336 K. pneumoniae isolates recovered from both clinical contexts between July 2009 and December 2011, 49 and 15 were ESBL producers and originated from clinical and community sources, respectively. All isolates produced the CTX-M-15 enzyme. As shown by Southern blot on S1 nuclease treatment followed by pulsed-field gel electrophoresis (PFGE) gels, the blaCTX-M-15 gene was carried on IncFII (n=4), IncFIIk (n=25), IncL/M (n=4), IncK (n=1), or untypeable (n=15) plasmids in HA isolates. In CA isolates, the blaCTX-M-15 gene was carried on IncFIIk (n=6), IncFII (n=1), IncHI1 (n=1), or untypeable (n=7) plasmids. In all, 23 and 11 PFGE types were found among the HA and CA isolates. Multilocus sequence typing on representative isolates shows diverse sequence types (STs), such as ST307, ST101, ST39, ST4, ST140, ST15, and ST307 in HA isolates and ST101, ST664, and ST323 in CA isolates. This study is the first comprehensive report of ESBL plasmids in K. pneumoniae from HA and CA infections in Tunisia.

  10. Risk of hospitalization for community acquired pneumonia with renin-angiotensin blockade in elderly patients: a population-based study.

    Directory of Open Access Journals (Sweden)

    Sachin Shah

    Full Text Available OBJECTIVE: To characterize the 90-day risk of hospitalization with pneumonia among patients treated with different anti-hypertensive drug classes. DESIGN: Population based cohort study using five linked databases. PARTICIPANTS: Individuals over the age of 65 who filled a new outpatient prescription for one of four anti-hypertensive medications: ACE inhibitors (n = 86 775, ARBs (n = 33,953, calcium channel blockers (CCB, n = 34,240, beta blockers (BB, n = 35,331 and thiazide diuretics (n = 64 186. PRIMARY OUTCOME: Hospitalization with pneumonia within 90 days of a qualifying prescription. We adjusted for ten a priori selected covariates, including age, sex, diabetes and number of visits to a family doctor. RESULTS: Baseline characteristics of the groups were relatively well matched, except for age, sex, diabetes and frequency of family doctor visits. 128 of the 86 775 patients (0.15% initiated on an ACE inhibitor and 43 of the 33953 patients (0.13% of patients initiated on an ARB were hospitalized with pneumonia in the subsequent 90 days. 135 of 64 186 patients (0.21% initiated on a thiazide, 112 of 35 331 patients (.32% initiated on a BB, and 89 of 34 240 (0.26% patients initiated on a CCB achieved the primary outcome. Compared to calcium channel blockers, ACE inhibitors (adjusted OR 0.61, 95% CI 0.46 to 0.81 and ARBs (adjusted OR 0.52, 95% CI 0.36 to 0.76 were associated with a lower risk of pneumonia. No benefit was seen with thiazides (adjusted OR 0.87, 95% CI 0.66 to 1.14 or beta blockers (adjusted OR 1.21, 95% CI 0.91 to 1.60. CONCLUSION: Initiating medications that block the renin angiotensin system, compared to other anti-hypertensive medications, is associated with a small absolute reduction in the 90 day risk of hospitalization with pneumonia.

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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.

  14. THE PARADOXICAL EFFECT ON PNEUMONIA OF CHRONIC INHALED CORTICOSTEROIDS

    OpenAIRE

    Sibila, Oriol; Anzueto, Antonio; Restrepo, Marcos I.

    2013-01-01

    Community-acquired pneumonia (CAP) is the leading infectious cause of death in developed countries. Several studies have shown that the risk of pneumonia is increased in patients with Chronic Obstructive Pulmonary Disease (COPD) who are receiving chronic inhaled corticosteroids (ICS). The impact of ICS On pneumonia prognosis is controversial. Recent studies have shown that COPD patients with prior ICS use have less mortality after developing CAP as compared with patients with COPD without pri...

  15. Severe Hyponatremia due to Levofloxacin Treatment for Pseudomonas aeruginosa Community-Acquired Pneumonia in a Patient with Oropharyngeal Cancer

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    Mihaela Mocan

    2016-01-01

    Full Text Available Hyponatremia (serum Na levels of <135 mEq/L is the most common electrolyte imbalance encountered in clinical practice, affecting up to 15–28% of hospitalized patients. This case report refers to a middle-aged man with severe hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion related to four possible etiological factors: glossopharyngeal squamous cell carcinoma, cisplatin treatment, right basal pneumonia with Pseudomonas aeruginosa, and the treatment with Levofloxacin. This case report discusses a rare complication of common conditions and of a common treatment. To our knowledge this is the first case of hyponatremia related to Levofloxacin and the second related to fluoroquinolones.

  16. 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/).

  17. Risk factors for hospital-acquired pneumonia in patients of neurosurgery department and preventive countermeasures%NICU重症患者医院获得性肺炎危险因素分析与预防控制措施

    Institute of Scientific and Technical Information of China (English)

    付艳

    2012-01-01

    目的 探讨神经外科重症监护病房(NICU)患者医院获得性肺炎相关因素及预防控制措施.方法 采用回顾性调查方法,对NICU 368例医院获得性肺炎患者相关因素进行分析.结果 医院NICU重症患者医院获得性肺炎发生率10.33%,其危险因素与患者的年龄、基础疾病、神智状态、住院时间、床单位使用面积、气管切开等侵入性操作有密切关系.结论 减少医院获得性肺炎的危险因素是降低医院获得性肺炎发生行之有效的控制措施.%OBJECTIVE To explore the related factors for hospital-acquired pneumonia in neurosurgery intensive care unit (N1CU) so as to propose countermeasures for control and prevention. METHODS By the means of retrospective survey, the related factors for hospital-acquired pneumonia in 368 patients in NICU were analyzed. RESULTS The incidence of hospital-acquired pneumonia in NICU was 10. 33% ; the age of the patient,underlying disease, consciousness, length of hospital stay, the space for each bed, and the invasive operations like tracheotomy were the risk factors which were closely related to hospital-acquired pneumonia. CONCLUSION To reduce the risk factors for hospital-acquired pneumonia is essential and effective to reduce the incidence of hospital-acquired pneumonia.

  18. Community acquired pneumonia due to gram negative bacilli and its antibiotic sensitivity pattern in a tertiary care centre

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    Ashish Jitendranath

    2016-08-01

    Results: During the study period in 120 cases of pneumonia, there was growth of pathogenic organism. Among the GNB isolated Klebsiella spp was the most common organism isolated at 33.9% followed by Pseudomonas aeruginosa and Escherichia coli at 22.1%. Out of the 53 gram negative samples isolated 4 (7% were Amp C positive, 10 (18.8% were ESBL positive and there was one single case of MBL. The antibiotic sensitivity showed that all the isolates were sensitive to colisitin (100%, while Klebsiella spp, Pseudomonas spp, and Escherichia coli were 100% sensitive to imipenem and meropenem. Resistance pattern of all the isolates showed that the isolates exhibited high resistance to amoxycillin-clavulunate, cefuroxime and cotrimoxazole. While resistance against ceftazidime and cefipime was >40%. On the other hand, isolates showed a low level of resistance against piperacillin tazobactam and cefoperazone-sulbactam. Extremely low level of resistance was observed against imipenem and meropenem, while colistin showed no resistance among the isolates obtained in this study. Conclusions: The study showed that gram-negative bacteria and P. aeruginosa form a relevant part of the microbial pattern of CAP in patients who require hospitalization, particularly those with severe CAP. Initiating antibiotics with gram negative coverage should be considered in this subgroup of patients since initiating the correct antibiotic plays a critical role in the outcome of pneumonia. [Int J Res Med Sci 2016; 4(8.000: 3121-3124

  19. Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain

    Science.gov (United States)

    Soldevila, Núria; Toledo, Diana; Torner, Núria; Force, Luis; Pérez, María José; Martín, Vicente; Rodríguez-Rojas, Lourdes; Astray, Jenaro; Egurrola, Mikel; Sanz, Francisco; Castilla, Jesús

    2017-01-01

    Pneumococcal pneumonia is a serious cause of morbidity and mortality in the elderly, but investigation of the etiological agent of community-acquired pneumonia (CAP) is not possible in most hospitalized patients. The aim of this study was to estimate the effect of pneumococcal polysaccharide vaccination (PPSV23) in preventing CAP hospitalization and reducing the risk of intensive care unit admission (ICU) and fatal outcomes in hospitalized people aged ≥65 years. We made a multicenter case-control study in 20 Spanish hospitals during 2013–2014 and 2014–2015. We selected patients aged ≥65 years hospitalized with a diagnosis of pneumonia and controls matched by sex, age and date of hospitalization. Multivariate analysis was performed using conditional logistic regression to estimate vaccine effectiveness and unconditional logistic regression to evaluate the reduction in the risk of severe and fatal outcomes. 1895 cases and 1895 controls were included; 13.7% of cases and 14.4% of controls had received PPSV23 in the last five years. The effectiveness of PPSV23 in preventing CAP hospitalization was 15.2% (95% CI -3.1–30.3). The benefit of PPSV23 in avoiding ICU admission or death was 28.1% (95% CI -14.3–56.9) in all patients, 30.9% (95% CI -32.2–67.4) in immunocompetent patients and 26.9% (95% CI -38.6–64.8) in immunocompromised patients. In conclusion, PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP. PMID:28187206

  20. 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

    Directory of Open Access Journals (Sweden)

    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

  1. 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

  2. A randomised, double-blind trial comparing ceftobiprole medocaril with ceftriaxone with or without linezolid for the treatment of patients with community-acquired pneumonia requiring hospitalisation.

    Science.gov (United States)

    Nicholson, Susan C; Welte, Tobias; File, Thomas M; Strauss, Richard S; Michiels, Bart; Kaul, Pratibha; Balis, Dainius; Arbit, Deborah; Amsler, Karen; Noel, Gary J

    2012-03-01

    Community-acquired pneumonia (CAP) is a serious infection requiring hospitalisation in 20% of cases. The novel cephalosporin ceftobiprole has microbiological activity against the major bacterial pathogens causing CAP, including Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae, as well as against Staphylococcus aureus, including meticillin-resistant S. aureus (MRSA). This was a multicentre, double-blind study in which 706 patients with CAP severe enough to require hospitalisation were randomised to ceftobiprole or to an expert-recommended course of ceftriaxone ± linezolid (comparator group). Clinical and microbiological outcomes were determined 7-14 days after completion of therapy (test-of-cure visit). For the 469 clinically evaluable patients, cure rates were 86.6% vs. 87.4% for ceftobiprole and comparator, respectively [95% confidence interval (CI) of the difference, -6.9% to 5.3%]; in the intention-to-treat (ITT) analysis of 638 CAP patients, these cure rates were 76.4% vs. 79.3%, respectively (95% CI of the difference, -9.3% to 3.6%). A typical bacterial pathogen was identified in 29% of the ITT population. Microbiological eradication rates in the 144 microbiologically evaluable patients were 88.2% and 90.8% for the respective treatment groups (95% CI of the difference, -12.6% to 7.5%). Both study drugs were well tolerated, with but a minority of patients requiring premature discontinuation due to an adverse event (6% in the ceftobiprole group and 4% in the comparator group). The overall incidence of treatment-related adverse events was higher in the ceftobiprole group, primarily owing to differences in rates of self-limited nausea (7% vs. 2%) and vomiting (5% vs. 2%). In summary, ceftobiprole was non-inferior to the comparator (ceftriaxone ± linezolid) in all clinical and microbiological analyses conducted, suggesting that ceftobiprole has a potential role in treating hospitalised patients with CAP. [ClinicalTrials.gov identifier

  3. Development and laboratory evaluation of a real-time PCR assay for detecting viruses and bacteria of relevance for community-acquired pneumonia.

    Science.gov (United States)

    Edin, Alicia; Granholm, Susanne; Koskiniemi, Satu; Allard, Annika; Sjöstedt, Anders; Johansson, Anders

    2015-05-01

    Community-acquired pneumonia may present with similar clinical symptoms, regardless of viral or bacterial cause. Diagnostic assays are needed to rapidly discriminate between causes, because this will guide decisions on appropriate treatment. Therefore, a quantitative real-time PCR (qPCR) assay with duplex reactions targeting eight bacteria and six viruses was developed. Technical performance was examined with linear plasmids. Upper and lower respiratory tract specimens were used to compare the qPCR assay with standard microbiological methods. The limit of detection was 5 to 20 DNA template copies with approximately 1000-fold differences in concentrations of the two competing templates. SDs for positive controls were 95% for M. pneumoniae, Streptococcus pyogenes, respiratory syncytial virus, and influenza A virus; whereas it was only 56% for Haemophilus influenzae. Multiple microbial agents were identified in 19 of 44 sputum and 19 of 50 nasopharynx specimens. We conclude that in parallel qPCR detection of the targeted respiratory bacteria and viruses is feasible. The results indicate good technical performance of the assay in clinical specimens.

  4. 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

  5. 200例成人社区获得性肺炎病原体研究%200 Cases of Adult Community-Acquired Pneumonia Pathogens Research

    Institute of Scientific and Technical Information of China (English)

    田占红

    2013-01-01

    Objective Through investigation and analysis of adult community-acquired pneumonia pathogens and pathogenic characteristics of the crowd,provide a basis for clinical treatment.Methods A retrospective analysis of our hospital in March 2010 to February 2012 period 200 cases of community-acquired pneumonia in patients with sputum culture and treatment of clinical data and the results were summarized.Results Information on a total of 200 cases,including 60 years of age were 30 cases,170 cases more than 60 years of age;to mostly elderly patients.Which cured 106 patients(53%),improved in 60 cases (30%) healed in 15 cases (7.5%),9 deaths(4.5%),10 patients left the hospital (5%).Status of sputum culture results showed that:sputum culture within 60 years as Vice mainly Haemophilus influenzae in 11 cases,36.7%.Patients over the age of 60 sputum culture results Haemophilus parainfluenzae in 68 cases,40%;results,mainly in patients with sputum culture Haemophilus parainfluenzae infection based.Conclusion Adult patients with community-acquired pneumonia,mostly elderly,Haemophilus parainfluenzae is a community-acquired pneumonia is one of the main pathogens.%  目的通过调查分析成人社区获得性肺炎致病人群及致病菌特点,为临床治疗提供依据。方法回顾性分析我院2010年3月~2012年2月期间200例社区获得性肺炎患者痰培养临床资料及治疗情况,并对结果进行总结。结果资料共200例,其中60岁以下者共30例,60岁以上者170例;以老年患者居多。其中治愈106例(53%),好转60例(30%),未愈15例(7.5%),9例死亡(4.5%),10例自动出院(5%)。痰培养结果状况显示:60岁以内的痰培养主要为副流感嗜血杆菌11例,36.7%。60岁以上患者痰培养结果显示副流感嗜血杆菌68例,占40%;结果显示,患者痰培养主要为副流感嗜血杆菌感染为主。结论成人社区获得性肺炎患者以老年人居多,副流感嗜血杆

  6. 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.

  7. Analysis of the Antibiotic Resistance of Streptococcus Pneumonia Isolated from Community Acquired Pneumonia in Children%儿童社区获得性肺炎病例肺炎链球菌分离株的耐药分析

    Institute of Scientific and Technical Information of China (English)

    何丽芸; 王应建; 李季美

    2012-01-01

    Objective To analyze the antibiotic resistance of Streptococcus pneumonia of community acquired pneumonia (CAP) in children. Methods From Jan 2007 to Dec. 2010, efforts were made to isolate S. pneumonia from throat swab and sputum samples in 4780 children with CAP, aged from 28 days to 8 years old, and to test the antimicrobial susceptibility of these clinical isolates by means of sputum culture and streptococcus bacteria identification plate identification. Results A total of 344 strains of S. pneumonia were isolated from throat swab and sputum. The prevalence of S. pneumonia non梥usceptible to penicillin was 45.6%. The resistance rates of S. pneumonia to the commonly used antibiotic were penicillin 38.5%, erythromycin 38.3%, clindamycin 4.8%, cefo?taxime 16.0% , ceftriaxone 16.4% and ofloxacin 3.6% during the period from 2007 to 2008, respectively. From 2009 to 2010, the resistance rates of S. pneumonia to the antibiotic were increased; it was 60.9% , 68.0% , 42.6%, 36.7%, 32.3% and 3.1%, respectively. No vancomycin resistance strain was found. The resistance rate of penicillin non-susceptible S. pneumonia (PNSSP) was higher than that of penicillin susceptible S. pneumonia ( PSSP). Conclusion The S. pneumonia isolated from children with CAP is susceptive to vancomycin and ofloxacin. There is an increasing tendency of the resistance rates of S. pneumonia to penicillin, erythromycin, clindamycin , cefotaxime and ceftriaxone in Kunming region.%目的 分析昆明地区社区获得性肺炎住院病例中肺炎链球菌感染的耐药状况.方法 对2007年1月至2010年12月间年龄28d~8岁的4 780例诊断为社区获得性肺炎(CAP)住院患儿进行痰培养,采用链球菌细菌鉴定板鉴定,并行药敏试验.结果 从所检测CAP患儿痰液中培养分离出344株肺炎链球菌,它们对青霉素不敏感率为45.6%; 2007年至2008年肺炎链球菌对青霉素、红霉素、克林霉素、头孢噻肟、头孢曲松、氧氟

  8. 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

  9. 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

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

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    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

  11. 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

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    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

  12. Estudo de casos hospitalizados por pneumonia comunitária no período de um ano A study of community-acquired pneumonia inpatients in a period of a year

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    RICARDO DE AMORIM CORRÊA

    2001-09-01

    Full Text Available Introdução: Apesar dos avanços obtidos nos métodos propedêuticos, cerca de 50% dos casos de pneumonia adquirida na comunidade não têm sua etiologia esclarecida, inclusive os hospitalizados. Apesar disso, a terapêutica adequada proporciona baixas taxas de mortalidade na maioria dos casos. Objetivos: Descrever a epidemiologia, formas de apresentação, o rendimento dos testes diagnósticos, a permanência hospitalar, a morbidade e mortalidade de 42 pacientes consecutivos, internados para tratamento de PAC. Métodos: Foram incluídos pacientes com quadro clínico compatível com PAC, opacidade radiológica pulmonar recente e com dois itens entre febre, tosse produtiva e leucocitose. A solicitação de exames complementares obedeceu à necessidade de cada caso. Resultados: Dos 42 pacientes, com idade de 64,7 ± 16,8 anos, 27 (64,3% masculinos, 27 (64% apresentavam co-morbidades. Dezessete (40,5% estavam em uso de antibióticos à admissão. Pneumonia grave ocorreu em oito casos (19%; não houve diferença quanto à gravidade (p = 0,57 e permanência hospitalar (p = 0,25 entre os grupos > de 60 ou Introduction: Besides the improvement we have had in the diagnostic methods, the causative agent in around 50% of the cases of community-acquired pneumonia (CAP remains unknown, even in inpatients. Despite that, adequate empirical therapy results in low mortality in the majority of the cases. Goals: To describe the epidemiology, the clinical presentation, the utility of diagnostic tests, the duration of hospital stay, the morbidity and mortality rates of 42 consecutive inpatients with CAP. Methods: The inclusion criteria were the presence of a recent pulmonar infiltrate in the CXR and two items out of fever (38ºC, productive cough and leukocytosis (> 10,000/mm³, in the presence of a compatible clinical syndrome. The subsidiary tests were performed as required on individual basis. Results: Forty-two patients, aged 64.7 ± 16.8 years, 27 (64.3% male

  13. Epidemiología de la neumonía del adulto adquirida en la comunidad EPIDEMILOGY OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

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    Gonzalo Valdivia C.

    2005-04-01

    first specific one in senescent adults over 80 years old. The incidence and mortality of community acquired pneumonia (CAP increase in both extreme ages of life (less than one year old and over 65 years old. In the population over 65 years old, mortality is extremely increased, rising to rates of 6.6 deaths per 1.000 inhabitants. High variability in pneumonia hospitalization rate has been observed in different geographic areas, probably due to different medical criteria used to evaluate the severity of illness, access to healthcare systems and characteristics of the evaluated population. About 20% of patients affected with CAP require hospitalization due to the severity of pulmonary infection and to the risk of complications or death, and the necessity of healthcare resources are focused in these patients. Several clinical-epidemiological parameters able to modify clinical presentation and severity of pneumonia have been identified, such as advanced age, presence of co-morbidities, host immune competence, tobacco and alcohol consumption, place of acquiring the infection, etiology and environmental pollution

  14. Hospitalisation with community-acquired pneumonia among patients with type 2 diabetes: an observational population-based study in Spain from 2004 to 2013

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    López-de-Andrés, Ana; de Miguel-Díez, Javier; Jiménez-Trujillo, Isabel; Hernández-Barrera, Valentín; de Miguel-Yanes, José M; Méndez-Bailón, Manuel; Pérez-Farinós, Napoleón; Salinero-Fort, Miguel Á ngel; Jiménez-García, Rodrigo

    2017-01-01

    Objectives To describe trends in the incidence and outcomes of community-acquired pneumonia (CAP) hospitalisations among patients with or without diabetes in Spain (2004–2013). Design Retrospective, observational study using the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos (CMBD)). Setting Spain. Participants We used national hospital discharge data to select all hospital admissions for CAP. Main outcome measures Incidence was calculated overall and stratified by diabetes status: type 2 diabetes mellitus (T2DM) and no diabetes. Results We identified 901 136 admissions for CAP (24.8% with T2DM). Incidence rates of CAP increased significantly in patients with T2DM over time. The incidence was higher among people with T2DM for all time periods. Patients with T2DM were older and had higher comorbidity index than non-diabetics. Streptococcus pneumoniae decreased over time for both groups. Time trend analyses showed significant decreases in mortality during admission for CAP for patients with and without T2DM. Factors associated with higher mortality in both groups included: older age, higher comorbidity, mechanical ventilation, red cell transfusion, readmission and Staphylococcus aureus detection. Diabetes was associated with a lower in-hospital mortality (OR 0.92, 95% CI 0.91 to 0.94) after a CAP hospitalisation. Conclusions CAP incidence rates were higher and increased over time at a higher rate among patients with T2DM. Mortality decreased over time in all groups. The presence of diabetes is not a risk factor for death during admission for CAP. PMID:28057653

  15. Effect of Prior Atorvastatin Treatment on the Frequency of Hospital Acquired Pneumonia and Evolution of Biomarkers in Patients with Acute Ischemic Stroke: A Multicenter Prospective Study

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    Yu, Yuetian

    2017-01-01

    Objective. To investigate whether prior treatment of atorvastatin reduces the frequency of hospital acquired pneumonia (HAP). Methods. Totally, 492 patients with acute ischemic stroke and Glasgow Coma Scale ≤ 8 were enrolled in this study. Subjects were assigned to prior atorvastatin treatment group (n = 268, PG) and no prior treatment group (n = 224, NG). All the patients were given 20 mg atorvastatin every night during their hospital stay. HAP frequency and 28-day mortality were measured. Levels of inflammatory biomarkers [white blood cell (WBC), procalcitonin (PCT), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6)] were tested. Results. There was no significant difference in the incidence of HAP between PG and NG (25.74% versus. 24.55%, p > 0.05) and 28-day mortality (50.72% versus 58.18%, p > 0.05). However, prior statin treatment did modify the mortality of ventilator associated pneumonia (VAP) (36.54% versus 58.14%, p = 0.041) and proved to be a protective factor (HR, 0.564; 95% CI, 0.310~0.825, p = 0.038). Concentrations of TNF-α and IL-6 in PG VAP cases were lower than those in NG VAP cases (p < 0.01). Conclusions. Prior atorvastatin treatment in patients with ischemic stroke was associated with a lower concentration of IL-6 and TNF-α and improved the outcome of VAP. This clinical study has been registered with ChiCTR-ROC-17010633 in Chinese Clinical Trial Registry. PMID:28357403

  16. Effect of Prior Atorvastatin Treatment on the Frequency of Hospital Acquired Pneumonia and Evolution of Biomarkers in Patients with Acute Ischemic Stroke: A Multicenter Prospective Study

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    Yuetian Yu

    2017-01-01

    Full Text Available Objective. To investigate whether prior treatment of atorvastatin reduces the frequency of hospital acquired pneumonia (HAP. Methods. Totally, 492 patients with acute ischemic stroke and Glasgow Coma Scale ≤ 8 were enrolled in this study. Subjects were assigned to prior atorvastatin treatment group (n=268, PG and no prior treatment group (n=224, NG. All the patients were given 20 mg atorvastatin every night during their hospital stay. HAP frequency and 28-day mortality were measured. Levels of inflammatory biomarkers [white blood cell (WBC, procalcitonin (PCT, tumor necrosis factor-alpha (TNF-α, and interleukin-6 (IL-6] were tested. Results. There was no significant difference in the incidence of HAP between PG and NG (25.74% versus. 24.55%, p>0.05 and 28-day mortality (50.72% versus 58.18%, p>0.05. However, prior statin treatment did modify the mortality of ventilator associated pneumonia (VAP (36.54% versus 58.14%, p=0.041 and proved to be a protective factor (HR, 0.564; 95% CI, 0.310~0.825, p=0.038. Concentrations of TNF-α and IL-6 in PG VAP cases were lower than those in NG VAP cases (p<0.01. Conclusions. Prior atorvastatin treatment in patients with ischemic stroke was associated with a lower concentration of IL-6 and TNF-α and improved the outcome of VAP. This clinical study has been registered with ChiCTR-ROC-17010633 in Chinese Clinical Trial Registry.

  17. Does empirical treatment of community-acquired pneumonia with fluoroquinolones delay tuberculosis treatment and result in fluoroquinolone resistance in Mycobacterium tuberculosis? Controversies and solutions.

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    Shen, Gwan-Han; Tsao, Thomas Chang-Yao; Kao, Shang-Jyh; Lee, Jen-Jyh; Chen, Yen-Hsu; Hsieh, Wei-Chung; Hsu, Gwo-Jong; Hsu, Yen-Tao; Huang, Ching-Tai; Lau, Yeu-Jun; Tsao, Shih-Ming; Hsueh, Po-Ren

    2012-03-01

    The role of fluoroquinolones (FQs) as empirical therapy for community-acquired pneumonia (CAP) remains controversial in countries with high tuberculosis (TB) endemicity owing to the possibility of delayed TB diagnosis and treatment and the emergence of FQ resistance in Mycobacterium tuberculosis. Although the rates of macrolide-resistant Streptococcus pneumoniae and amoxicillin/clavulanic acid-resistant Haemophilus influenzae have risen to alarming levels, the rates of respiratory FQ (RFQ) resistance amongst these isolates remain relatively low. It is reported that ca. 1-7% of CAP cases are re-diagnosed as pulmonary TB in Asian countries. A longer duration (≥ 7 days) of symptoms, a history of night sweats, lack of fever (> 38 °C), infection involving the upper lobe, presence of cavitary infiltrates, opacity in the lower lung without the presence of air, low total white blood cell count and the presence of lymphopenia are predictive of pulmonary TB. Amongst patients with CAP who reside in TB-endemic countries who are suspected of having TB, imaging studies as well as aggressive microbiological investigations need to be performed early on. Previous exposure to a FQ for >10 days in patients with TB is associated with the emergence of FQ-resistant M. tuberculosis isolates. However, rates of M. tuberculosis isolates with FQ resistance are significantly higher amongst multidrug-resistant M. tuberculosis isolates than amongst susceptible isolates. Consequently, in Taiwan and also in other countries with TB endemicity, a short-course (5-day) regimen of a RFQ is still recommended for empirical therapy for CAP patients if the patient is at low risk for TB.

  18. Community-acquired bacterial pneumonia in human immunodeficiency virus-infected patients: validation of severity criteria. The Grupo Andaluz para el Estudio de las Enfermedades Infecciosas.

    Science.gov (United States)

    Cordero, E; Pachón, J; Rivero, A; Girón, J A; Gómez-Mateos, J; Merino, M D; Torres-Tortosa, M; González-Serrano, M; Aliaga, L; Collado, A; Hernández-Quero, J; Barrera, A; Nuño, E

    2000-12-01

    Severity criteria for community-acquired pneumonia (CAP) have always excluded patients with human immunodeficiency virus (HIV) infection. A 1-yr, multicenter, prospective observational study of HIV-infected patients with bacterial CAP was done to validate the criteria used in the American Thoracic Society (ATS) guidelines for CAP, and to determine the prognosis-associated factors in the HIV-infected population with bacterial CAP. Overall, 355 cases were included, with an attributable mortality of 9.3%. Patients who met the ATS criteria had a longer hospital stay (p = 0.01), longer duration of fever (p < 0.001), and higher attributable mortality (13.1% versus 3.5%, p = 0.02) than those who did not. Three factors were independently related to mortality: CD4(+) cell count < 100/microl, radiologic progression of disease, and shock. Pleural effusion, cavities, and/or multilobar infiltrates at admission were independently associated with radiologic progression. A prognostic rule based on the five criteria of shock, CD4(+) cell count < 100/microl, pleural effusion, cavities, and multilobar infiltrates had a high negative predictive value for mortality (97.1%). The attributable mortality for severe pneumonia was 11.3%, as compared with 1.3% for nonsevere disease (p = 0.008). The ATS severity criteria are valid in HIV-infected patients with bacterial CAP. Our study provides the basis for identification of patients who may require hospitalization determined by clinical judgment and the five clinical criteria of shock, a CD4(+) cell count < 100/microl, pleural effusion, cavities, and multilobar involvement. These prognostic factors should be validated in independent cohort studies.

  19. Assessing, treating and preventing community acquired pneumonia in older adults: findings from a community-wide survey of emergency room and family physicians

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    Loeb Mark

    2005-08-01

    Full Text Available Abstract Background Respiratory infections, like pneumonia, represent an important threat to the health of older Canadians. Our objective was to determine, at a community level, family and emergency room physicians' knowledge and beliefs about community acquired pneumonia (CAP in older adults and to describe their self-reported assessment, management and prevention strategies. Methods All active ER and family physicians in Brant County received a mailed questionnaire. An advance notification letter and three follow-up mailings were used to maximize physician participation rate. The questionnaire collected information about physicians' assessment, management, and prevention strategies for CAP in older adults (≥60 years of age plus demographic, training, and practice characteristics. The analysis highlights differences in approaches between office-based and emergency department physicians. Results Seventy-seven percent of physicians completed and returned the survey. Although only 16% of physicians were very confident in assessing CAP in older adults, more than half reported CAP to be a very important health concern in their practices. In-service training for family physicians was associated with increased confidence in CAP assessment and more frequent use of diagnostic tests. Family physicians who reported always requesting chest x-rays were also more likely to request pulse oximetry (OR 5.6, 95% CI 1.40 to 22.5 and recommend both follow-up x-rays (OR 5.4, 95% CI 1.7 to 16.6 and pneumococcal vaccination (OR 3.4, 95% CI 1.1 to 10.0. Conclusion The findings of this study provide a snapshot of how non-specialists from a non-urban Ontario community assess, manage and prevent CAP in older adults and highlight differences between office-based and emergency department physicians. This information can guide researchers and clinicians in their efforts to improve the management and prevention of CAP in older adults.

  20. Granzymes A and B Regulate the Local Inflammatory Response during Klebsiella pneumoniae Pneumonia.

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    García-Laorden, M Isabel; Stroo, Ingrid; Blok, Dana C; Florquin, Sandrine; Medema, Jan Paul; de Vos, Alex F; van der Poll, Tom

    2016-01-01

    Klebsiella pneumoniae is a common cause of hospital-acquired pneumonia. Granzymes (gzms), mainly found in cytotoxic lymphocytes, have been implicated as mediators of infection and inflammation. We here sought to investigate the role of gzmA and gzmB in the host response to K. pneumoniae-induced airway infection and sepsis. For this purpose, pneumonia was induced in wild-type (WT) and gzmA-deficient (gzmA-/-), gzmB-/- and gzmAxB-/- mice by intranasal infection with K. pneumoniae. In WT mice, gzmA and gzmB were mainly expressed by natural killer cells. Pneumonia was associated with reduced intracellular gzmA and increased intracellular gzmB levels. Gzm deficiency had little impact on antibacterial defence: gzmA-/- and gzmAxB-/- mice transiently showed modestly higher bacterial loads in the lungs but not in distant organs. GzmB-/- and, to a larger extent, gzmAxB-/- mice displayed transiently increased lung inflammation, reflected in the semi-quantitative histology scores and levels of pro-inflammatory cytokines and chemokines. Most differences between gzm-deficient and WT mice had disappeared during late-stage pneumonia. Gzm deficiency did not impact on distant organ injury or survival. These results suggest that gzmA and gzmB partly regulate local inflammation during early pneumonia but eventually play an insignificant role during pneumosepsis by the common human pathogen K. pneumoniae.

  1. Etiology Study of Community-acquired Pneumonia and Drug Resistance%社区获得性肺炎的病原学研究及耐药性分析

    Institute of Scientific and Technical Information of China (English)

    赵海峰; 付研

    2012-01-01

    目的 了解我院南区社区获得性肺炎(CAP) 的病原学特征及耐药情况,合理使用抗生素.方法 对205 例符合CAP 诊断标准的患者留取痰或血进行细菌培养,采用血清学方法检测血中肺炎支原体、肺炎衣原体、嗜肺军团菌抗体等非典型病原体.结果 193 例细菌培养显示,病原分离阳性79 例(40.9%);200 例血清学检查,在非典型病原体感染中以肺炎支原体感染最为常见.结论 CAP 的病原谱及其对药物敏感性的差异为临床合理使用抗生素提供了理论依据.%Objective:To learn the etiological characteristics and drug resistance of community-acquired pneumonia(CAP) in Southern District of Beijing Tongren Hospital,so as to provide evidence for empiric antibiotic therapy. Methods:Collect specimens of sputum or blood for bacterial culture from 205 patients who met the diagnostic criteria of community-acquired pneumonia, apply serological methods to detect Mycoplasma pneumoniae antibody, Chlamydia pneumoniae antibody and Legionella pneumophila antibody. Results:Pathogens isolated were 79 cases (40.9%) from 193 patients, in which Klebsiella pneumoniae ranks first,followed by Streptococcus pneumoniae; Mycoplasma pneumoniae is the most common in 200 cases of serological examination. The sensitive antibiotics for pathogens were identified. Conclusions:Based on the test of drug resistance, the pathogens sensitive antibiotics should be used for treatment of CAP patients.

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

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    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

  3. 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.

  4. Biological features of biofilm-forming ability of Acinetobacter baumannii strains derived from 121 elderly patients with hospital-acquired pneumonia.

    Science.gov (United States)

    Zhang, Duchao; Xia, Jingjing; Xu, Yaping; Gong, Meiliang; Zhou, Yu; Xie, Lixin; Fang, Xiangqun

    2016-02-01

    This study is to investigate a biological activity of Acinetobacter baumannii isolates from sputum specimens of 121 elderly patients with hospital-acquired pneumonia. The ability of the isolates to form biofilms was quantitatively assessed by crystal violet staining, and adhesive property was examined using Giemsa staining. Biofilm-forming ability by the isolates was employed to test antimicrobial resistance and examine sources and clinical manifestations. The isolates grew as biofilm on abiotic surface at the indicated temperatures after a 48 h of incubation. 27.3 % of the isolates were strongly biofilm-positive in the samples, and 84.8 % displayed high adhesion ability (P < 0.05). All of the isolates showed antibiotic resistance at different levels, and the isolates produced strong biofilm exhibited low-level resistance to gentamicin, minocycline and ceftazidime (P < 0.05). The patients' experience in ICU, use of antibiotics and estimation of APACHE II (<17) were related to incidence of strong biofilm formation with no clinical manifestations found in the study. All clinical isolates are able to form biofilms which refer to adhesive efficiency and antibiotic resistance. Patient experiences in ICU surveillance, use of antibiotics and APACHE II scores are involved in biofilm-forming ability by the nosocomial pathogen derived from the hospitalized patients.

  5. Development of a new resequencing pathogen microarray based assay for detection of broad-spectrum respiratory tract viruses in patients with community-acquired pneumonia.

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    Hongwei Shen

    Full Text Available A Resequencing Pathogen Microarray (RPM is a single, highly multiplexed assay for detecting and differentiating similarly related pathogens by using closely overlapping probe sets to determine a target organism's nucleotide sequence. In this study, a new RPM (RPM-IVDC1 that consisted of 224-bp detector tiles corresponding to 9 influenza A subtypes, 11 rhinoviruses, 28 enteroviruses and 38 other respiratory viruses was developed and optimized to provide individual and simultaneous detection sensitivities ranging from 15 to 750 genomic copies for 16 common respiratory pathogens. A total of 110 consecutive patients with community-acquired pneumonia (CAP admitted to 5 district general hospitals in Beijing during a 1-year period were assessed using the new assay. Among the children (under age 5 and adult patients (above age 18, respiratory syncytial virus (RSV and rhinovirus (RV were the most common etiological agents, respectively, which is consistent with reference assays. Atypical pathogens that may cause CAP-like illness, including rubella virus, measles virus, influenza type C virus, human herpesvirus (HHV were also detected. The results show the capability of RPM-IVDC1 for the accurate detection and identification of multiple virus types, which may be of significant use in epidemic surveillance and outbreak investigations of atypical pathogens.

  6. Comparison of Luminex xTAG® RVP fast assay and real time RT-PCR for the detection of respiratory viruses in adults with community-acquired pneumonia.

    Science.gov (United States)

    Luchsinger, Vivian; Prades, Yara; Ruiz, Mauricio; Pizarro, Rolando; Rossi, Patricio; Lizama, Luis; Garmendia, María Luisa; Meza, Angela; Larrañaga, Carmen; Avendaño, Luis F

    2016-07-01

    Community-acquired pneumonia (CAP) is the third cause of death worldwide. Viruses are frequently detected in adult CAP. Highly sensitive diagnostic techniques should be used due to poor viral shedding. Different sampling methods can affect viral detection, being necessary to establish the optimal type of sample for identifying respiratory viruses in adults. The detection rates of respiratory viruses by Luminex xTAG® RVP fast assay, real time RT-PCR (rtRT-PCR) (Sacace®), and immunofluorescence assay (IFA) in adult CAP were performed in nasopharyngeal swabs (NPS) and aspirates (NPA) from 179 hospitalized adults. Positivity was 47.5% for Luminex®, 42.5% for rtRT-PCR (P = 0.3), and 2.7% for IFA (2.7%) (P viruses in 112 NPA and 35 (34.3%) and 31 (30.4%) in 102 NPS, respectively (P viruses in CAP adults. Both molecular techniques yielded better results with nasopharyngeal aspirate than swabs.

  7. 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.

  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. Bacteria and viruses in hospitalized infants with community acquired pneumonia%社区获得性肺炎婴幼儿喘息与病原体检出关系分析

    Institute of Scientific and Technical Information of China (English)

    冯英; 罗征秀; 符州; 罗健; 刘恩梅

    2013-01-01

    To explore the associations between the presence of bacteria and virus in the nasopharyngeal secretions, and wheezing, condition and hospitalization period in infants with community acquired pneumonia. Methods Clinical data, inclu-ding detection of bacteria and viruses, conditions and hospitalization period, of 1106 hospitalized infants with community ac-quired pneumonia from March 2009 to February 2010 were retrospectively analyzed. The infants were classiifed into wheezing (697 cases) and non-wheezing (409 cases) groups. Results Viruses were detected in 540 infants (48.8%), and the total detection rate of viruses and detection rate of respiratory syncytial virus in wheezing group were signiifcantly higher than those of non-wheezing group (P=0.000). Bacteria were detected in 590 cases (53.3%) and no signiifcance was found between two groups (P=0.821). The detection rate of Streptococcus pneumonia was higher in wheezing group than that of non-wheezing group (P=0.038). Comparing to the infants detected with both viruses and bacteria, no signiifcances were found in the occurrence of severe pneumonia and hos-pitalization period in those infants detected with viruses only (P>0.05), as well as in the wheezing time of period (P>0.05). Con-clusions Wheezing in infants with community acquired pneumonia is related to the infection of viruses, especially to respiratory syncytial viruses. Virus infection accompanying bacterial infection has no impact on duration of hospitalization and wheezing. The infection of Streptococcus pneumonia may relate to wheezing in infants.%目的:分析住院治疗的社区获得性肺炎婴幼儿的鼻咽分泌物中病毒、细菌检出与喘息及病情、住院日的关系。方法回顾性分析2009年3月-2010年2月住院治疗的1106例社区获得性肺炎婴幼儿鼻咽抽吸物的细菌培养、呼吸道7种病毒检测结果,以及病情、住院日等临床资料。按病程中是否出现喘息将婴幼儿分为喘息组(697

  10. 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

  11. 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

  12. 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 definiciones: (a) documentación de signos clínicos pre-definidos que resultaron en un cambio de tratamiento (b) decisión del clínico principal de cambiar el tratamiento con o sin documentación de los mismos signos clínicos pre-definidos. Resultados Incluimos a 385 niños. El riesgo de FT varió entre un 1.8% (IC 95% 0.4 a 5.1) y 12.4% (IC 95% 7.9 a 18.4) para NS y 21.4% (IC 95% 15.9 a 27) y 39.3% (IC 95% 32.5 a 46.4) para NMS dependiendo de la definición que se aplicase. Unas mayores tasas estaban asociadas con cambios tempranos en la terapia por el clínico y en ausencia de un razonamiento clínico obvio. Se observaba una no adherencia a las guías de tratamiento en 70/169 (41

  13. Evaluación de la gravedad en la neumonía del adulto adquirida en la comunidad EVALUATING SEVERITY OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

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    Fernando Saldías P.

    2005-04-01

    Full Text Available La evolución del paciente con neumonía adquirida en la comunidad puede variar entre un cuadro infeccioso banal de bajo riesgo de complicaciones hasta uno de extrema gravedad con riesgo vital. En general, el adulto inmunocompetente sin co-morbilidad ni criterios de gravedad manejado en el medio ambulatorio tiene bajo riesgo de complicaciones y muerte (letalidad menor de 1-2%, elevándose a 5-15% en los pacientes con co-morbilidad y/o factores de riesgo específicos que son admitidos al hospital y a 20-50% en aquellos admitidos a la Unidad de Cuidados Intensivos. La evaluación de la gravedad en el paciente con neumonía permite predecir la evolución de la enfermedad, orientar el lugar de manejo, la extensión del estudio microbiológico, y el tratamiento antimicrobiano empírico. Se sugiere clasificar a los enfermos en tres categorías de riesgo: pacientes con bajo riesgo (mortalidad inferior a 1-2% susceptibles de tratamiento ambulatorio; pacientes con alto riesgo (mortalidad entre 20-30% que deben ser manejados en unidades especializadas del hospital; y pacientes con riesgo intermedio, con co-morbilidad y/o factores de riesgo de evolución complicada y muerte, pero que no es posible clasificar en una categoría precisa. En el medio ambulatorio, donde no se dispone de exámenes complementarios, se recomienda evaluar la gravedad de los pacientes con neumonía considerando las siguientes variables clínicas: edad sobre 65 años, presencia de co-morbilidad, compromiso de conciencia, alteración de los signos vitales, compromiso radiográfico multilobar o bilateral, presencia de cavitación o efusión pleural, y SaO2 Clinical evolution in patients affected by community acquired pneumonia varies from a mild and low risk infectious disease to an extremely severe, life threatening disease. Commonly, immunocompetent adults without co-morbidities or severe risk factors cared for at out patient clinic have low risk of complications and death (mortality

  14. 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.

  15. 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.

  16. Incidence of viral infection detected by PCR and real-time PCR in childhood community-acquired pneumonia: a meta-analysis.

    Science.gov (United States)

    Wang, Min; Cai, Feng; Wu, Xiaodong; Wu, Ting; Su, Xin; Shi, Yi

    2015-04-01

    Several studies examining the incidence of viral infection in childhood community-acquired pneumonia (CAP) utilizing polymerase chain reaction (PCR) or real-time PCR methods have been reported. We systematically searched Pubmed and Embase for studies reporting the incidence of respiratory viral infection in childhood CAP. The pooled incidences of viral infection were calculated with a random-effects model. Sources of heterogeneity were explored by subgroup analysis and a univariant metaregression analysis. We included 21 eligible reports in our study. We found significant heterogeneity on the incidence of viral infection in childhood CAP. The random effects pooled incidence was 57.4% (95% confidence interval (CI): 50.8-64.1). The pooled incidence of mixed infection was 29.3% (95%CI: 23.0-35.6) with considerable heterogeneity. The pooled incidence of mixed infection was 29.3% (95%CI: 23.0-35.6). Rhinovirus, respiratory syncytial virus (RSV) and bocavirus were found to be the three most common viruses in childhood CAP. We also demonstrated that respiratory viruses were detected in 76.1% of patients aged ≤ 1 year, 63.1% of patients aged 2-5 years and 27.9% of patients aged ≥ 6 years. We conclude that respiratory viruses are widely detected in paediatric patients with CAP by PCR or real-time PCR methods. More than half of viral infections are probably concurrent with bacterial infections. Rhinovirus, RSV and bocavirus are the three most frequent viruses identified in childhood CAP; the incidence of viral infection decreased with age.

  17. 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.

  18. Hospital-acquired Pneumonia due to Achromobacter spp. in a Geriatric Ward in China: Clinical Characteristics, Biofilm Production, Antibiotic Resistance and Integrons of Isolated Strains.

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    Xiangqun eFang

    2016-05-01

    Full Text Available Background: Hospital-acquired pneumonia (HAP due to Achromobacter has become a substantial concern in recent years. However, HAP due to Achromobacter in the elderly is rare.Methods: A retrospective analysis was performed on 15 elderly patients with HAP due to Achromobacter spp., in which the sequence types (STs, integrons, biofilm production and antibiotic resistance of the Achromobacter spp. were examined. Results: The mean age of the 15 elderly patients was 88.8±5.4 years. All patients had at least 3 underlying diseases and catheters. Clinical outcomes improved in 10 of the 15 patients after antibiotic and/or mechanical ventilation treatment, but three patients had chronic infections lasting more than 1 year. The mortality rate was 33.3% (5/15. All strains were resistant to aminoglycosides, aztreonam, nitrofurantoin, and third- and fourth-generation cephalosporins (except ceftazidime and cefoperazone. Six new STs were detected. The most frequent ST was ST306. ST5 was identified in two separate buildings of the hospital. ST313 showed higher MIC in cephalosporins, quinolones and carbapenems, which should be more closely considered in clinical practice. All strains produced biofilm and had integron I and blaOXA-114-like. The main type was blaOXA-114q. The variable region of integron I was different among strains, and the resistance gene of the aminoglycosides was most commonly inserted in integron I. Additionally, blaPSE-1 was first reported in this isolate. Conclusion: Achromobacter spp. infection often occurs in severely ill elders with underlying diseases. The variable region of integrons differs, suggesting that Achromobacter spp. is a reservoir of various resistance genes.

  19. 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.

  20. Clinical analysis of 45 patients with community acquired pneumonia complicated with type two diabetes%社区获得性肺炎合并2型糖尿病45例临床分析

    Institute of Scientific and Technical Information of China (English)

    仇凤荣

    2011-01-01

    目的 探讨社区获得性肺炎合并2型糖尿病患者的临床特点及诊治措施,提高治愈率.方法 回顾性分析45例肺炎合并2型糖尿病患者的临床资料.结果 社区获得性肺炎合并2型糖尿病患者具有症状隐匿、营养代谢紊乱、病情重、感染不易控制、病死率高等临床特点,给予严格控制血糖、选用敏感抗生素控制感染、改善肺功能及营养支持等针对性的治疗后,38例治愈,2例因病情危重家属放弃治疗自动出院,5例死于多器官功能衰竭,临床治愈率为84.44%.结论 社区获得性肺炎合并2型糖尿病患者较单纯社区获得性肺炎患者具有独特的临床特点,需要给予针对性的治疗.%Objective To investigate clinical characteristics about patients of community acquired pneumonia complicated with type two diabetes and the methods of diagnosis and therapy, in order to improve recovery rate.Methods To analyze clinical data methods of diagnosis and therapy and therapeutic effect of forty five patients who were diagnozed community acquired pneumonia complicated with type two diabetes. Results The clinical characteristics of patients of community acquired pneumonia complicated with type two diabetes are delitescence of symptom,metabolic disturbance,severe pathogenetic condition,difficult control of infection and high fatality rate cetera,after afford homologue treatments including regimenting blood glucose, selecting sensitive antibiotics to control infection, ameliorating pulmonary function and nutritional support and so on, thirty eight patients were cured, two patients were given up because of severe pathogenetic conditions,five patients died because of multiple organ failure,recovery rate was 84. 44%. Conclusion Compared to patients of purecommunity acquired pneumonia, the patients of community acquired pneumonia complicated with type two diabetes had unique clinical characteristics, and need to give special treatment

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

    Directory of Open Access Journals (Sweden)

    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

  2. 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

  3. Risk of pneumonia and urinary tract infection within the first week after total hip arthroplasty and the impact on survival

    Science.gov (United States)

    Glassou, Eva N; Hansen, Torben B; Pedersen, Alma B

    2017-01-01

    Background Pneumonia and urinary tract infections (UTIs) increase morbidity and mortality. There is little epidemiological evidence from large population-based studies on risk factors for these infections and subsequent mortality in total hip arthroplasty (THA) patients. Aim To examine the risk factors of postoperative pneumonia and UTI after THA and their impact on survival. Patients and methods We used the Danish Hip Arthroplasty Register to identify THAs due to osteoarthritis registered from 2000 to 2013. We collected data about comorbidities, mortality and infections in relation to primary hospitalization and potential predictive variables from administrative databases. Regression models were used to estimate associations between potential risk factors and infection, and subsequently, between infection and mortality. Results In total 84,812 THAs were included. The cumulative incidence of pneumonia and UTI within 7 days of the primary procedure were 0.21 (95% confidence interval [CI]: 0.18–0.25) and 0.29 (95% CI: 0.26–0.33), respectively. Patient-related risk factors for infection were being 80 years or older, gender and a comorbidity burden at time of surgery. The hazard ratio (HR) of dying within 90 days of the primary THA was 10.67 (95% CI: 5.79–19.57) compared to patients without pneumonia. For patients with UTIs, the HR was 1.64 (95% CI: 0.41–6.59) compared to those without a UTI. Conclusion Pneumonia was associated with an increased short-term risk of dying, despite adjustment for coexisting comorbidity and other potential confounders. Age, gender and comorbidity were the most important risk factors for pneumonia and UTIs. Individual initiatives to reduce the risk of pneumonia in select patient groups may be essential to the effort to optimize outcomes after a THA. PMID:28176979

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

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    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.

  5. 老年人院内获得性肺炎的临床分析%Clinical analysis of hospital-acquired pneumonia in senile people

    Institute of Scientific and Technical Information of China (English)

    陈艺坛; 陈志斌; 潘云虎; 蓝行远

    2004-01-01

    目的探讨老年人院内获得性肺炎(HAP)的临床、病原学特点、易患因素及防治对策.方法对36例老年HAP患者进行回顾性分析.结果36例老年HAP患者的临床表现不典型,病原菌主要以G-杆菌为主,占71.1%;同时两种细菌或细菌和真菌的混合感染严重,占46.2%.革兰氏阴性菌主要对头孢哌酮、头孢他啶、泰能、氧哌嗪青霉素、环丙沙星、丁胺卡那霉素敏感;而G+主要是金黄色葡萄球菌,主要对万古霉素敏感.结论老年人生理功能的退变,机体抵抗力低下,合并慢性基础疾病,营养不良、肺功能低下,同时反复大量使用多种抗生素,是造成HAP的主要危险因素;增强免疫功能、加强营养及病房的空气消毒是主要的防治措施.%Objectiye: To investigate clinical and etiological characteristics, predisposing factors of hospital-acquired pneumonia (HAP) in senile people and to explore the preventive and therapeutic strategies.Methods: 36 elderly cases with HAP were retrospectively analyzed. Results: The clinical features of HAP in the elderly were atypical. The pathogens were chiefly G- bacilli (accounting for 71.1%) while mixed infections of two bacteria or bacterium and fungus were also common (46.2%). The G- bacilli were mainly sensitive to Cefoperazone, Ceftazidime, Tienam, Piperacillin, Ciprofloxacin and Amikacin. The G+ bacterium was mainly Staphylococcus aureaus that was sensitive to Vancomycin. Conclusions: Degeneration of physiological function,decreased body resistance, accompanying chronic diseases, malnutrition, reduced pulmonary function and abuse of antibiotics are the main risk factors for HAP in the elderly. Improvement of immune function, adequate nutrition and air sterilization in the wards are the central strategies for prevention and treatment.

  6. Clinical significance of combined detection of Mycoplasma pneumoniae and Chlamydia pneumoniae in patients with community acquired pneumonia%社区获得性肺炎患者联合监测肺炎支原体与肺炎衣原体的临床意义

    Institute of Scientific and Technical Information of China (English)

    杨宏生; 许锡荣; 沈琪

    2016-01-01

    Objective To discuss the clinical significance of combined detection of Mycoplasma pneumoniae (Mp) and Chlamydia pneumoniae (Cp) in patients with community acquired pneumonia (CAP). Methods Mp and Cp were monitored in throat swab specimens from 1 580 patients with CAP admitted in our hospital from Feb. 2012 to Oct. 2014. The main pathogenic bacteria were cultured and identified, and the clinical effects of different anti-infective treat-ment plans were compared. Results Pathogens of CAP mainly included Mp (30.0%), Streptococcus pneumoniae (15.9%), Haemophilus influenzae (12.9%) and Cp (10.1%), and co-infection of 2 kinds of pathogens infection was com-mon (10.1%). In the treatment, the use frequency of β-Lactam antibiotics was the highest (76.71%). The cure rate ofβ-Lactam antibiotics combined with Macrolide antibiotics or Fluoroquinolone antibiotics (66.72%) was significantly higher than separate application of β-Lactam antibiotics (56.73%, P0.05), but the cure rate of β-Lactam antibiotics combined with Macrolide antibiotics or Fluoroquinolone antibiotics (69.7%) was significantly higher than separate application ofβ-Lactam antibiotics (44.4%) in the treatment of bacterial infection combined with Mp or Cp infection (P0.05),而在细菌合并Mp或Cp感染时,联合用药治愈率(69.7%)明显高于单用β-内酰胺类药物(44.4%),差异有统计学意义(P<0.05).结论 CAP患者感染Mp与Cp较多见,β-内酰胺类药物是常用治疗药物,β-内酰胺类联合大环内酯类或氟喹诺酮类药物可提高患者治愈率,Mp与Cp联合检测对于敏感抗生素的选择及疗效的提高具有重要临床意义.

  7. 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

  8. Immunocompromised host: from the early events until the impact of acquired immunodeficiency syndrome

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    Costa Sylvio Celso Gonçalves da

    2000-01-01

    Full Text Available The concept that microorganisms can modulate the host resistance was historically reviewed in the present article. The importance of African trypanosomiasis in the development of the research on immunosuppression as well as the impact of human immunodeficiency virus infection are discussed. Each day new opportunistic organisms establish a constant challenge for the correct diagnosis of concomitant infections in acquired immunodeficiency syndrome. The importance of parasite infection in the balance of host resistance in the third world was emphasized. Finally, some aspects of Leishmania as opportunistic organisms were presented.

  9. 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 ...

  10. Transmission dynamics of carbapenemase-producing Klebsiella pneumoniae and anticipated impact of infection control strategies in a surgical unit.

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    Vana Sypsa

    Full Text Available BACKGROUND: Carbapenemase-producing Klebsiella pneumoniae (CPKP has been established as important nosocomial pathogen in many geographic regions. Transmission from patient to patient via the hands of healthcare workers is the main route of spread in the acute-care setting. METHODOLOGY/PRINCIPAL FINDINGS: Epidemiological and infection control data were recorded during a prospective observational study conducted in a surgical unit of a tertiary-care hospital in Greece. Surveillance culture for CPKP were obtained from all patients upon admission and weekly thereafter. The Ross-Macdonald model for vector-borne diseases was applied to obtain estimates for the basic reproduction number R(0 (average number of secondary cases per primary case in the absence of infection control and assess the impact of infection control measures on CPKP containment in endemic and hyperendemic settings. Eighteen of 850 patients were colonized with CPKP on admission and 51 acquired CPKP during hospilazation. R(0 reached 2 and exceeded unity for long periods of time under the observed hand hygiene compliance (21%. The minimum hand hygiene compliance level necessary to control transmission was 50%. Reduction of 60% to 90% in colonized patients on admission, through active surveillance culture, contact precautions and isolation/cohorting, in combination with 60% compliance in hand hygiene would result in rapid decline in CPKP prevalence within 8-12 weeks. Antibiotics restrictions did not have a substantial benefit when an aggressive control strategy was implemented. CONCLUSIONS/SIGNIFICANCE: Surveillance culture on admission and isolation/cohorting of colonized patients coupled with moderate hand hygiene compliance and contact precautions may lead to rapid control of CPKP in endemic and hyperendemic healthcare settings.

  11. Influencing factor of gram negative bacteria for adult patients with community-acquired pneumonia%社区获得性肺炎革兰氏阴性菌感染的影响因素

    Institute of Scientific and Technical Information of China (English)

    边喜明

    2016-01-01

    目的:探讨社区获得性肺炎( CAP)成年患者革兰氏阴性细菌感染的影响因素。方法选取确诊为社区获得性肺炎的成人患者186例。采集患者痰标本检测致病菌;对患者一般资料进行统计分析。结果186例CAP患者中,60例患者检测出92株细菌,占32.26%;其中革兰氏阳性菌19株(14例),革兰氏阴性菌73株(46例),分别占20.65%和79.35%。46革兰氏阴性菌CAP患者与186例CAP患者在年龄、入院前应用抗生素、合并基础疾病、白细胞异常、中性粒细胞、营养不良、总胆红素、CD4+和CD4+/CD8+比值存在显著性差异(P<0.05或P<0.01)。分析显示,入院前应用抗生素、合并基础疾病、白细胞异常、中性粒细胞、营养不良、总胆红素和CD4+/CD8+比值为CAP成年患者革兰氏阴性细菌感染的独立影响因素( P<0.05或P<0.01)。结论入院前应用抗生素、合并基础疾病、白细胞异常、中性粒细胞、营养不良、总胆红素和 CD4+/CD8+比值为CAP成年患者革兰氏阴性细菌感染的独立影响因素。%Objective To investigate the influencing factor of gram negative bacteria for adult patients with community-acquired pneumonia. Methods 186 adult patients with community acquired pneumonia were selected. The sputum samples were detected for pathogenic bacterium, and their general data were analyzed. Results Among 60 patients, 92 strains were detected, accounting for 32. 26%. There were 19 strains of gram positive strains (14 ca-ses) and 73 strains of gram negative strains (46 cases), accounting for 20. 65% and 79. 35%, respectively. There were significant differences in age, antibiotics use before admission, underlying disease, leukocyte disorder, neutro-phile granulocyte, malnutrition, total bilirubin, CD4+ and CD4+ /CD8+ between gram negative strains infected commu-nity acquired pneumonia and total community acquired pneumonia ( P <0. 05 or P <0. 01 ) . Logistic regression showed that

  12. 浅议老年社区获得性肺炎的诊断及抗菌治疗%Diagnosis and antibacterial therapy of elderly community-acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    田茂良; 王英

    2013-01-01

    随着我国人口的老年化,社区获得性肺炎成为影响老年人健康的主要问题.因此对老年社区获得性肺炎的准确诊断,以及合理地应用抗生素治疗显得尤为重要.通过检索、查阅大量文献和依据临床经验,对老年社区获得性肺炎的诊断、抗生素经验性治疗、病原菌治疗、抗菌药物的联合应用、抗菌药物的序贯法和降阶梯治疗、抗菌药物疗程等方面进行了综述,以便做到有的放矢,避免滥用抗生素.%With the aging of population in China,the community-acquired pneumonia in the old becomes the main problems,which affects their health.So it is important to have an accurate diagnosis and to have a rational use of antibiotic treatment on the elderly community-acquired pneumonia.Through searching and consulting a lot of documents and in accordance with the clinical experience,this article reviews the diagnosis of elderly community-acquired pneumonia,antibiotics empirical treatment,pathogen treatment,antibacterial drug combined application,antibacterial drug sequential method and drop step therapy in order to prevent abusing antibiotics.

  13. Glucocorticoid Acquired Character Pneumonia Application in Community%糖皮质激素在社区获得性肺炎中应用的初步研究

    Institute of Scientific and Technical Information of China (English)

    史家欣; 李家树

    2014-01-01

    Objective To explore the ef ect of corticosteroids on community-acquired pneumonia.Methods 24 patients with community-acquired pneumonia were divided into the corticosteroids group (9 cases)and the control group (15 cases).The time of symptoms improvement,the duration of antibiotics and the relapse rate were analyzed.Results Corticosteroids significantly improved the symptoms and reduced the duration of antibiotics therapy(P0.05).Conclusion Corticosteroids could improve the symptoms and reduce the duration of antibiotics therapy.Further studies are needed to validate the role of corticosteroids in community-acquired pneumonia.%目的:探讨糖皮质激素对社区获得性肺炎(CAP)的影响。方法回顾分析2012年10月~2014年5月在我科住院的 CAP患者24例,分为糖皮质激素组(9例)和对照组(15例)。比较两组患者的症状改善时间、抗生素疗程和疾病复发率。结果糖皮质激素组的症状改善时间和抗生素疗程均短于对照组(P<0.05),两组间疾病复发率无显著差异(P>0.05)。结论糖皮质激素能显著改善CAP症状和缩短抗生素疗程,需要进一步确定其在CAP中的应用价值。

  14. 老年社区获得性肺炎细菌分布及耐药性分析%Analysis of Distribution of Bacteria and Drug Resistance in Elderly Community-Acquired Pneumonia

    Institute of Scientific and Technical Information of China (English)

    谢宝元; 乜庆荣; 王京

    2016-01-01

    Objective To study the distribution of bacteriology and bacterial drug resistance in elderly community-acquired pneumonia(CAP) of Liang Xiang Hospital.Methods Recruit the 111 elderly patients with community-acquired pneumonia from January 2013 to August 2015 were treated in Liang Xiang Hospital whose sputum culture results were positive,and the sputum culture results were statistically analyzed.ResultsThe hospital elderly CAP bacterial infection Gram-positive bacteria accounted for 63(53.8%), mainly Streptococcus pneumoniae 37(31.6%); G- bacteria accounted for 54(46.2%),Klebsiella pneumoniae 20(17.1%),Escherichia coli 16(13.7%). The resistance rate of streptococcus pneumoniae to ampicillin, cefazolin is 51.4%. The resistance rate of klebsiella to ampicillin, cefazolin, erythromycin, sulfamethoxazole is 100%. The resistance rate of escherichia coli to cefazolin, erythromycin, sulfamethoxazole resistance rate is 100%.Conclusions In Liang Xiang Hospital,the elderly community-acquired bacterial pneumonia infection mainly include streptococcus pneumoniae, klebsiella pneumonia and escherichia coli, and them has been produce a certain amount of resistance. In order to prevent drug-resistant strains effectively, clinicians must pay attention to the results of bacterial culture and rational use of antibiotics based on culture results.%目的:探讨某院老年社区获得性肺炎(CAP)的细菌学分布及细菌耐药情况。方法选取某院呼吸内科2013年1月至2015年8月收治的111例痰细菌培养结果阳性的老年社区获得性肺炎患者,将痰培养结果进行统计分析。结果某院老年CAP细菌感染革兰阳性菌占63株(53.8%),主要为肺炎链球菌37株(31.6%);G-菌占54株(46.2%),主要为肺炎克雷伯菌20株(17.1%)、大肠埃希菌16株(13.7%)。肺炎链球菌对氨苄青霉素、头孢唑林耐药率达51.4%。肺炎克雷伯菌对氨苄青霉素、头孢唑林、红霉素、复方新诺明耐药率达100%。大肠

  15. 儿童社区获得性肺炎323例病原菌分布与耐药性研究%Detection of pathogenic bacteria and antibiotic resistance in 323 children with community acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    王军; 郭丽萍; 汤进; 马维维

    2011-01-01

    目的 了解2008-2010年于本院住院的儿童社区获得性肺炎(community acquired pneumonia,CAP)病原菌分布及耐药情况 方法 采用法国梅里埃ATB expression鉴定及药敏仪,对儿童CAP患儿进行痰细菌培养、鉴定及药物敏感试验 结果 被检出的323株细菌结果中,G+球菌占38 4%,其中主要为肺炎链球菌(streptococcus pneumoniae,SP)(27 9%),金黄色葡萄球菌(staphylococcus aureus,SA)(10 5%);G-杆菌占61 6%,最常见的是大肠埃希菌(escherichia coli,E coli) (24 5%),肺炎克雷伯杆菌(klebsiella pneumoniae,K pn)(13 9%),流感嗜血杆菌(haemophilus influenzae,HI)(8%) SP感染率>6月患儿与<6月患儿有非常显著差异,且在>6月患儿各年龄组居首位 E coli和K pn感染率随着年龄增长下降,<6月与>6月患儿之间有显著差异 产ESBLs株的K pn和E coli检出率高达71 1%和77 2%;HI对氨苄西林的耐药率为66 7%;而SP对红霉素的耐药率高达98 9% 结论 本地区下呼吸道感染的细菌病原学的分布及变化,耐药情况,对合理选择抗生素,减缓耐药菌产生具有重要意义.%[Objective] To provide reference for the treatment for clinicians during the recent two years investigation of bacterial and antibiotic resistance analysis of hospitalized children with community acquired pneumonia(CAP)in some are-as of Hanzhong. [Method] The sputum bacterial culture, identification and drug sensitive test were made for children with CAP by rench Merieux ATB expression identification and susceptibility meter. [Results] Of the 323 strains of bacterial pathogens, 11 kinds of bacterial pathogens were isolated. Gram-positive cocci accounted for 38. 4%. Of them were streptococcus pneumoniae (SP) (27. 9%) and staphylococcus aureus (SA) (10. 5%). Gram-negative bacilli accounted for 61.6%, the predominant isolate was Escherichia coll (E. Coli) (24. 5%), followed by klebsiella pneumoniae (K. Pn) (13. 9%) and haemophilus influenzae (HI) (8

  16. 3岁以下小儿社区获得性肺炎细菌病原学监测分析%The bacterial etiology pattern of community - acquired pneumonia in children under 3 years old in Yiwu area

    Institute of Scientific and Technical Information of China (English)

    何成川; 赵耀

    2011-01-01

    目的 了解当地3岁以下小儿社区获得性肺炎(CAP)的细菌病原学流行情况.方法 对2006年6月至2010年5月间3岁以下CAP住院患儿的细菌病原学监测资料进行回顾性分析.结果 细菌总检出率为32.1%,其中金黄色葡萄球菌、大肠埃希菌、肺炎链球菌、肺炎克雷伯菌、阴沟肠杆菌占80.7%.金黄色葡萄球菌、肺炎链球菌、肺炎克雷伯菌和阴沟肠杆菌的检出与患儿年龄有关(P值均<0.05),金黄色葡萄球菌的检出与发病季节有关(P<0.05),金黄色葡萄球菌、肺炎克雷伯菌的检出与患儿来源有关(P值均<0.01).结论 当地3岁以下小儿CAP细菌病原学以金黄色葡萄球菌、大肠埃希菌、肺炎链球菌、肺炎克雷伯菌、阴沟肠杆菌为主,并受患儿年龄、发病季节、患儿来源影响.%Objective To investigate the bacterial etiology pattern of community - acquired pneumonia ( CAP ) in children under 3 years old in Yiwu area.Methods The pathogenic bacteria isolated from hospitalized children under 3 years old with CAP between June 2006 and May 2010 were retrospectively analyzed.Results Bacteria pathogens were determined in 649 of 2019 cases ( 32.1% ).The isolates of Staphylococcus aureas, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Eenterabacter cloacae accounted for 80.7 %.The detection rates of Staphylococcus aureas, Streptococcus pneumoniae, Klebsiella pneumoniae, and Eenterabacter cloacae were associated with the age of children (P < 0.01, P < 0.05 ).The detection rate of Staphylolcoccus aureas was associated with the season ( P < 0.05 ).The detection rate of Staphylolcoccus aureas, Streptococcus pneumoniae were associated with the source of children ( P < 0.01, P < 0.05 ).Conclusion The main pathegenic bacteria responsible for community - acquired pneumonia in children under 3 years old in Yiwu area includes Staphylolcoccus aureas, Eecherichia coli, Straptococcus pneumonias

  17. 优质护理在老年社区获得性肺炎患者中的应用%Application of high quality nursing care to old patients with community-acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    王革亚; 丁叶霞

    2013-01-01

    目的:探讨优质护理在老年社区获得性肺炎患者中的应用及临床效果.方法:将 2010年4~9月老年社区获得性肺炎患者60例作为对照组,给予常规护理;将2010年10月~2011年3月老年社区获得性肺炎患者60例作为实验组,实施优质护理.观察比较两组生命体征改善、住院指标、护理质量指标变化情况.结果:两组生命体征改善、平均住院日、患者满意度、护理质量指标等比较差异有统计学意义(P<0.05,P<0.01).结论:优质护理可减少老年社区获得性肺炎患者住院天数,提高护理质量和患者满意度.%Objective:To explore the application of high quality nursing care to old patients with community -acquired pneumonia and investigate its clinical effect. Methods :60 old patients who developed community - acquired pneumonia from April to September 2010 were taken as the control group and other 60 old patients who suffered from community - acquired pneumonia from October 2010 to March 2011 were taken as the experimental group. The patients in the control group received routine nursing care and the patients in the experimental group were given high quality nursing care. The improvement of vital signs, the change of hospitalization indicators and nursing quality indexes were observed and compared between the two groups. Results: There were statistically significant differences in the comparison of the improvement of vital signs,the average hospitalization days,the degree of patient satisfaction and nursing quality indexes between the two groups ( P < 0. 05 ,P < 0. 01 ). Conclusion:The high quality nursing care can reduce the hospitalization days of old patients with community - acquired pneumonia and improve nursing quality and patient satisfaction.

  18. Klebsiella pneumoniae Siderophores Induce Inflammation, Bacterial Dissemination, and HIF-1α Stabilization during Pneumonia

    Science.gov (United States)

    Holden, Victoria I.; Breen, Paul; Houle, Sébastien; Dozois, Charles M.

    2016-01-01

    ABSTRACT Klebsiella pneumoniae is a Gram-negative pathogen responsible for a wide range of infections, including pneumonia and bacteremia, and is rapidly acquiring antibiotic resistance. K. pneumoniae requires secretion of siderophores, low-molecular-weight, high-affinity iron chelators, for bacterial replication and full virulence. The specific combination of siderophores secreted by K. pneumoniae during infection can impact tissue localization, systemic dissemination, and host survival. However, the effect of these potent iron chelators on the host during infection is unknown. In vitro, siderophores deplete epithelial cell iron, induce cytokine secretion, and activate the master transcription factor hypoxia inducible factor-1α (HIF-1α) protein that controls vascular permeability and inflammatory gene expression. Therefore, we hypothesized that siderophore secretion by K. pneumoniae directly contributes to inflammation and bacterial dissemination during pneumonia. To examine the effects of siderophore secretion independently of bacterial growth, we performed infections with tonB mutants that persist in vivo but are deficient in siderophore import. Using a murine model of pneumonia, we found that siderophore secretion by K. pneumoniae induces the secretion of interleukin-6 (IL-6), CXCL1, and CXCL2, as well as bacterial dissemination to the spleen, compared to siderophore-negative mutants at an equivalent bacterial number. Furthermore, we determined that siderophore-secreting K. pneumoniae stabilized HIF-1α in vivo and that bacterial dissemination to the spleen required alveolar epithelial HIF-1α. Our results indicate that siderophores act directly on the host to induce inflammatory cytokines and bacterial dissemination and that HIF-1α is a susceptibility factor for bacterial invasion during pneumonia. PMID:27624128

  19. Klebsiella pneumoniae Siderophores Induce Inflammation, Bacterial Dissemination, and HIF-1α Stabilization during Pneumonia

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    Victoria I. Holden

    2016-09-01

    Full Text Available Klebsiella pneumoniae is a Gram-negative pathogen responsible for a wide range of infections, including pneumonia and bacteremia, and is rapidly acquiring antibiotic resistance. K. pneumoniae requires secretion of siderophores, low-molecular-weight, high-affinity iron chelators, for bacterial replication and full virulence. The specific combination of siderophores secreted by K. pneumoniae during infection can impact tissue localization, systemic dissemination, and host survival. However, the effect of these potent iron chelators on the host during infection is unknown. In vitro, siderophores deplete epithelial cell iron, induce cytokine secretion, and activate the master transcription factor hypoxia inducible factor-1α (HIF-1α protein that controls vascular permeability and inflammatory gene expression. Therefore, we hypothesized that siderophore secretion by K. pneumoniae directly contributes to inflammation and bacterial dissemination during pneumonia. To examine the effects of siderophore secretion independently of bacterial growth, we performed infections with tonB mutants that persist in vivo but are deficient in siderophore import. Using a murine model of pneumonia, we found that siderophore secretion by K. pneumoniae induces the secretion of interleukin-6 (IL-6, CXCL1, and CXCL2, as well as bacterial dissemination to the spleen, compared to siderophore-negative mutants at an equivalent bacterial number. Furthermore, we determined that siderophore-secreting K. pneumoniae stabilized HIF-1α in vivo and that bacterial dissemination to the spleen required alveolar epithelial HIF-1α. Our results indicate that siderophores act directly on the host to induce inflammatory cytokines and bacterial dissemination and that HIF-1α is a susceptibility factor for bacterial invasion during pneumonia.

  20. Clinical effect of 3g/day administration of meropenem on severe pneumonia

    OpenAIRE

    OKIMOTO, Niro; KATOH, Tadashi; TANAKA, Hisataka; Hayashi, Toshikiyo; KURIHARA, Takeyuki; Miyashita, Naoyuki

    2013-01-01

    We examined the clinical effect of Meropenem (MEPM) on severe pneumonia. We administered 3g of Meropenem daily to 20 patients with severe pneumonia: 8 communityacquired pneumonia patients, 9 nursing and healthcare-associated pneumonia patients, and 3 hospital-acquired pneumonia patients. It was effective in 15 of the 20 patients (75%): 8 of 8 community-acquired pneumonia patients (100%), 6 of 9 nursing and healthcare-associated pneumonia patients (66.6%), and 1 of 3 hospital-acquired pneumoni...

  1. 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

  2. [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.

  3. Risk of pneumonia and urinary tract infection within the first week after total hip arthroplasty and the impact on survival

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    Glassou EN

    2017-01-01

    Full Text Available Eva N Glassou,1,2 Torben B Hansen,1,3 Alma B Pedersen2 1University Clinic of Hand, Hip and Knee Surgery, Department of Orthopedic Surgery, Regional Hospital West Jutland, Aarhus University, 2Department of Clinical Epidemiology, Aarhus University Hospital, 3The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Aarhus University, Aarhus, Denmark Background: Pneumonia and urinary tract infections (UTIs increase morbidity and mortality. There is little epidemiological evidence from large population-based studies on risk factors for these infections and subsequent mortality in total hip arthroplasty (THA patients.Aim: To examine the risk factors of postoperative pneumonia and UTI after THA and their impact on survival.Patients and methods: We used the Danish Hip Arthroplasty Register to identify THAs due to osteoarthritis registered from 2000 to 2013. We collected data about comorbidities, mortality and infections in relation to primary hospitalization and potential predictive variables from administrative databases. Regression models were used to estimate associations between potential risk factors and infection, and subsequently, between infection and mortality.Results: In total 84,812 THAs were included. The cumulative incidence of pneumonia and UTI within 7 days of the primary procedure were 0.21 (95% confidence interval [CI]: 0.18–0.25 and 0.29 (95% CI: 0.26–0.33, respectively. Patient-related risk factors for infection were being 80 years or older, gender and a comorbidity burden at time of surgery. The hazard ratio (HR of dying within 90 days of the primary THA was 10.67 (95% CI: 5.79–19.57 compared to patients without pneumonia. For patients with UTIs, the HR was 1.64 (95% CI: 0.41–6.59 compared to those without a UTI.Conclusion: Pneumonia was associated with an increased short-term risk of dying, despite adjustment for coexisting comorbidity and other potential confounders. Age, gender and comorbidity were the most

  4. 老年社区获得性肺炎42例临床分析%Clinical analysis of 42 cases of elderly patients with community acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    王上伟

    2012-01-01

    目的探讨老年社区获得性肺炎(CAP)的临床特点及治疗效果.方法对42例老年CAP患者的临床资料进行回顾性分析.结果42例老年CAP病原学检测阳性率为50.0%,肺炎链球菌占阳性患者的57.1%,支原体占阳性患者的28.6%,混合感染占阳性患者的19.0%.先经验治疗,根据痰培养+药敏结果和病情变化再调整治疗方案.疗程7~14d.39例达到痊愈或显效,治疗有效率为92.9%.结论肺炎链球菌仍是引起老年CAP最常见的病原体,不典型致病菌感染日益增多,同时有部分为混合感染.头孢他啶联合阿奇霉素或莫西沙星治疗效果好,不良反应少.%Objective To investigate the clinical characteristics and treatment effects of elderly community acquired pneumonia. Methods A retrospective analysis was done in 42 cases of elderly patients with community acquired pneumonia. Results From 42 cases of patients 50.0% were with positive pathogen, 57.1%(12 patients) were with streptococcus pneumoniae, 28.6%(6 cases) were mycoplasma pneumoniae and 19.0%(4 cases) were with mixed infections. We chose antibiotics according to clinical experience at first,then changed according to the result of sputum culture and pathogenetic condition.Through clinical treatment of 7-14 days,39 patients(92.9%)had distinct improvement.Conclusion Streptococcus pneumonia is still the most common pathogen caused elderly CAP, non-typical pathogenic bacteria are increasing and mixed infections accounting for a certain proportion. The effect of ceftazidime combined with azithromycin or moxifloxacin in treatment of elderly CAP is satisfied with less adverse reactions.

  5. 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

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    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

  6. 社区获得性嗜肺军团菌肺炎治疗的抗菌药物使用分析%Analysis of the antibacterial use in community-acquired pneumonia due to Legionella pneumophila

    Institute of Scientific and Technical Information of China (English)

    薛洪源; 葛向华; 蔡长春; 闫成

    2012-01-01

    Objective To evaluate the clinical efficacy of antibacterial agents in the sequential therapy of 38 cases of community-acquired pneumonia due to Legionella pneumophila and provide supporting data for the treatment of Legionella pneumonia. Methods The clinical data and outcomes of the 38 patients following sequential therapy with levofloxacin and macrolides were reviewed retrospectively. Results All the 38 patients were cured after the diagnosis was confirmed as community-acquired pneumonia due to Legionella pneumophila. The temperature was normalized 2. 2 ± 1. 1 days after antimicrobial therapy. No serious adverse reaction was identified. The total duration of treatment in the hospital was 23. 5 + 13. 5 days. Conclusions Sequential therapy with levofloxacin and macrolides is safe and effective for the community- acquired pneumonia caused by Legionella pneumophila.%目的 探讨社区获得性嗜肺军团菌肺炎抗菌治疗的疗效,为临床治疗嗜肺军团菌感染提供依据.方法 调查38例确诊嗜肺军团菌肺炎患者使用左氧氟沙星联合大环内酯类抗生素治疗后的转归及临床特点,分析联合用药、疗程、不良反应等情况.结果38例患者治疗后痊愈,给药后(2.2±1.1)d体温降为正常,总住院时间(23.5±13.5)d,治疗后未出现严重不良反应.结论选用左氧氟沙星联合大环内酯类抗生素序贯治疗社区获得性嗜肺军团菌肺炎,疗效确切,不良反应少.

  7. Pharmacokinetic/pharmacodynamic analysis to evaluate ceftaroline fosamil dosing regimens for the treatment of community-acquired bacterial pneumonia and complicated skin and skin-structure infections in patients with normal and impaired renal function.

    Science.gov (United States)

    Canut, A; Isla, A; Rodríguez-Gascón, A

    2015-04-01

    In this study, the probability of pharmacokinetic/pharmacodynamic target attainment (PTA) of ceftaroline against clinical isolates causing community-acquired bacterial pneumonia (CABP) and complicated skin and skin-structure infection (cSSSI) in Europe was evaluated. Three dosing regimens were assessed: 600 mg every 12 h (q12 h) as a 1-h infusion (standard dose) or 600 mg every 8 h (q8 h) as a 2-h infusion in virtual patients with normal renal function; and 400 mg q12 h as a 1-h infusion in patients with moderate renal impairment. Pharmacokinetic and microbiological data were obtained from the literature. The PTA and the cumulative fraction of response (CFR) were calculated by Monte Carlo simulation. In patients with normal renal function, the ceftaroline standard dose (600 mg q12 h as a 1-h infusion) can be sufficient to treat CABP due to ceftazidime-susceptible (CAZ-S) Escherichia coli, CAZ-S Klebsiella pneumoniae, meticillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis (CFR>90%). However, against meticillin-resistant S. aureus (MRSA), the CFR was 72%. In cSSSI, the CFR was also <80% for MRSA. Administration of ceftaroline 600 mg q8 h as a 2-h infusion or 400 mg q12 h as a 1-h infusion in patients with moderate renal insufficiency provided a high probability of treatment success (CFR ca. 100%) for most micro-organisms causing CABP and cSSSI, including MRSA and penicillin-non-susceptible S. pneumoniae. These results suggest that in patients with normal renal function, ceftaroline 600 mg q8 h as a 2-h infusion may be a better option than the standard dose, especially if the MRSA rate is high.

  8. Relationship between hospital-acquired pneumonia and transfusion and its mechanisms%危重患者医院获得性肺炎与输血的关系及机制探讨

    Institute of Scientific and Technical Information of China (English)

    王婕; 瞿介明

    2014-01-01

    Anemia is a common problem in critically ill patients admitted to intensive care units.Liberal and inappropriate transfusion not only can not correct the state of hypoxia,but also increases the risk of developing hospital-acquired pneumonia,deteriorates the disease,and aggravates the burden of health care.Transfusion-related immunomodulation bears the primary responsibility.In clinical practice,it is recommended to take individualized therapy for critically ill patients and avoid the overtreatment of transfusion,which contributes to the prevention of hospital-acquired pneumonia.%ICU内患者普遍存在贫血情况,宽松、不合理的输血治疗不但不能纠正患者缺氧状态,反而增加院内肺部感染的风险,恶化病情,加重医疗负担.这个过程主要是通过输血相关性免疫调节介导.在临床实践中,对危重患者进行个体化治疗,避免过度、过量输血,以预防感染并发症的发生.

  9. Detection of antibody responses against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis proteins in children with community-acquired pneumonia: effects of combining pneumococcal antigens, pre-existing antibody levels, sampling interval, age, and duration of illness.

    Science.gov (United States)

    Borges, I C; Andrade, D C; Vilas-Boas, A-L; Fontoura, M-S H; Laitinen, H; Ekström, N; Adrian, P V; Meinke, A; Cardoso, M-R A; Barral, A; Ruuskanen, O; Käyhty, H; Nascimento-Carvalho, C M

    2015-08-01

    We evaluated the effects of combining different numbers of pneumococcal antigens, pre-existing antibody levels, sampling interval, age, and duration of illness on the detection of IgG responses against eight Streptococcus pneumoniae proteins, three Haemophilus influenzae proteins, and five Moraxella catarrhalis proteins in 690 children aged pneumonia. Serological tests were performed on acute and convalescent serum samples with a multiplexed bead-based immunoassay. The median sampling interval was 19 days, the median age was 26.7 months, and the median duration of illness was 5 days. The rate of antibody responses was 15.4 % for at least one pneumococcal antigen, 5.8 % for H. influenzae, and 2.3 % for M. catarrhalis. The rate of antibody responses against each pneumococcal antigen varied from 3.5 to 7.1 %. By multivariate analysis, pre-existing antibody levels showed a negative association with the detection of antibody responses against pneumococcal and H. influenzae antigens; the sampling interval was positively associated with the detection of antibody responses against pneumococcal and H. influenzae antigens. A sampling interval of 3 weeks was the optimal cut-off for the detection of antibody responses against pneumococcal and H. influenzae proteins. Duration of illness was negatively associated with antibody responses against PspA. Age did not influence antibody responses against the investigated antigens. In conclusion, serological assays using combinations of different pneumococcal proteins detect a higher rate of antibody responses against S. pneumoniae compared to assays using a single pneumococcal protein. Pre-existing antibody levels and sampling interval influence the detection of antibody responses against pneumococcal and H. influenzae proteins. These factors should be considered when determining pneumonia etiology by serological methods in children.

  10. Identification of diagnosis markers for community acquired pneumonia by proteomic finger-printing%社区获得性肺炎蛋白指纹图谱诊断技术研究

    Institute of Scientific and Technical Information of China (English)

    翁丽珍; 陈力舟; 黄明翔; 陈晓红; 李学玲; 林剑东; 刘坦业

    2015-01-01

    目的 探索社区获得性肺炎蛋白指纹图谱的特点. 方法 从本院临床病例中,选择社区获得性细菌性肺炎患者与健康者各60例,进行血清蛋白指纹图谱检测,分析其相关蛋白峰值并进行统计学处理.结果 对60例社区获得性细菌性肺炎患者与60例健康者的血清蛋白指纹图谱数据进行比较,发现有3个蛋白峰(1028. 49、4796. 56、7564. 77m/z)存在显著的差异(P<0. 01). 由此3个蛋白峰组成的诊断模型判别社区获得性细菌性肺炎的总有效率为95. 8%(115/120),特异度为92. 3%(60/65)、灵敏度为100%(55/55)、阳性预测值为91. 7%(55/60)、阴性预测值为100%(60/60). 结论 蛋白质指纹图谱技术具有方法简便、检测快速,标本用量少等优点,可能成为社区获得性肺炎早期诊断的辅助指标.%Objective To explore the characteristics of community acquired pneumonia using proteinfingerprinting technology. Method 60 patients with community acquired bacterial pneumonia, and 60 healthy volunteers were se-lected from known clinical cases. Serum protein fingerprint studies were used to analyze their protein peaks and per-form statistical processing. Result Comparison of the serum protein fingerprinting data from the pool of 60 patients and 60 healthy volunteers, Significant difference in 3 protein peaks(1028. 49、4796. 56、7564. 77 m/z)identified be-tween community acquired bacterial pneumonia and healthy volunteers (P<0. 01). The total effective rate of the 3 protein peaks as a diagnosis model for differential diagnosis of community acquired bacterial pneumonia and healthy volunteers was 95. 8%(115/120), The specificity was 92. 3%(60/65),the sensitivity was 100%(55/55), The positive predictive value was 91. 7%(55/60), the negative predictive value was 100%(60/60). Conclusion Pro-tein fingerprinting technology is advantageous of being a simple method, quick detection, and requires less amount of sample. It is expected to become the early

  11. Impact of ventilator associated pneumonia on outcome in patients with chronic obstructive pulmonary disease exacerbation

    Directory of Open Access Journals (Sweden)

    Vijay Hadda

    2014-01-01

    Full Text Available Background and Objective: There are sparse data regarding the impact of ventilator-associated pneumonia (VAP on outcome among patients with chronic obstructive pulmonary disease (COPD exacerbation. Materials and Methods: This retrospective study included patients with COPD exacerbation requiring endotracheal intubation for more than 48 h admitted in a single respiratory unit from January 2008 to December 2009. Records of these patients were checked for the occurrence of VAP. Results: One hundred and fifty-three patients required endotracheal intubation for COPD exacerbation during this period. The mean age of this cohort was 61.46 ± 11.3 years. The median duration of COPD was 6 years (range: 1-40. A total of 35 (22.8% patients developed VAP (early: 9 and late: 26. The risk of mortality was comparable between two groups, that is, patients with and without VAP [odd′s ratio (OR−1.125; 95% confidence interval (CI, 0.622-2.035]. The duration of mechanical ventilation and hospital stay (median ± standard error, 95% CI was 32 ± 10 (95% CI, 13-51 versus 10 ± 2 (95% CI, 6-14 days; P ≤ 0.001 and 53 ± 26 (95% CI, 3-103 versus 18 ± 7 (95% CI, 5-31 days; P = 0.031, respectively was higher among patients with VAP. Conclusions: Our study has shown that VAP leads to increased duration of mechanical ventilation and hospital stay; however, the mortality is not affected.

  12. Exploring hotspots of pneumococcal pneumonia and potential impacts of ejecta dust exposure following the Christchurch earthquakes.

    Science.gov (United States)

    Pearson, Amber L; Kingham, Simon; Mitchell, Peter; Apparicio, Philippe

    2013-12-01

    The etiology of pneumococcal pneumonia (PP) is well-known. Yet, some events may increase its incidence. Natural disasters may worsen air quality, a risk factor for PP. We investigated spatial/spatio-temporal clustering of PP pre- and post-earthquakes in Christchurch, New Zealand. The earthquakes resulted in deaths, widespread damage and liquefaction ejecta (a source of air-borne dust). We tested for clusters and associations with ejecta, using 97 cases (diagnosed 10/2008-12/2011), adjusted for age and area-level deprivation. The strongest evidence to support the potential role of ejecta in clusters of PP cases was the: (1) geographic shift in the spatio-temporal cluster after deprivation adjustment to match the post-earthquake clusters and; (2) increased relative risk in the fully-adjusted post-earthquake compared to the pre-earthquake cluster. The application of spatial statistics to study PP and ejecta are novel. Further studies to assess the long-term impacts of ejecta inhalation are recommended particularly in Christchurch, where seismic activity continues.

  13. 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

  14. 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

  15. Diagnóstico microbiológico de la neumonía del adulto adquirida en la comunidad OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS MICROBIOLOGIC DIAGNOSIS

    Directory of Open Access Journals (Sweden)

    Patricio Jiménez P.

    2005-04-01

    . Antibiotic treatment directed against a known pathogen enables us to narrow antibacterial spectrum of action, and to reduce costs, drug adverse effects risk and antibiotic resistance. However it is unnecessary to perform extended microbiological studies in all patients with community acquired pneumonia (CAP. Etiological studies must be based in pneumonia severity, epidemiological risk factors and clinical response to empirical treatment. Routine microbiological analysis for ambulatory patients is not recommended. In patients with persistent cough and worsening in their general conditions, a sputum sample must be obtained to perform an acid-fast smear and Mycobacterium culture. The risk of complications and death of patients hospitalized with CAP justifies basic microbiological exploration (sputum Gram staining and culture, blood cultures, pleural fluid culture intending to obtain a more accurate etiology of pulmonary infection and to guide specific antibiotic treatment. Paired serum samples obtained to document atypical pathogen infections (Mycoplasma pneumoniae, Chlamydia pneumoniae and urine sample to detect Legionella pneumophila antigenuria are recommended in all CAP severely ill patients that are admitted to ICU, in those not responding to betalactamic drug treatment and in selected patients with specific epidemiological risks. A microbiological study would be useful in management of patients with severe CAP pneumonia outbreaks with clinical-epidemiological particular characteristics, and in-patients with empirical antimicrobial treatment failure

  16. 社区获得性肺炎病原体分离相关因素探讨%Related factors of pathogens distribution of community acquired pneumonia

    Institute of Scientific and Technical Information of China (English)

    魏丽; 胡必杰; 何礼贤; 李华茵; 陈雪华; 谢红梅; 高晓东

    2009-01-01

    Objective To study the related factors of pathogens distribution of community acquired pneumonia.Methods All 320 patients were recorded information of onset, at the time of enrollment. Sputum cultures were performed. The first and convalescent serum are collected for MP, CP and LP antibody test. Statistical analyses are performed using the SPSS 12.0 software. Results A total of 186 bacterial pathogens were isolated from 320 patients. SP(25.8% ) was the most fre-quent isolate,followed by HI(21. 5% ) ,KP(9.7% ) and Staphylococcus aureus (4.3% ). Serological detection of atypi-cal pathogens indicate that 130(40.6% ) patients were confirmed of MP infection,46 (14.4% ) of CP infection and 13 (4.1% ) of LP infection. Bacteria and atypical pathogens mixed infection was common in this study. 30.8% MP and 21.7% CP were concumently infected with bacterial pathogens. The patients who were &65 years old,having COPD his-tory purulent sputum,leukocytosis > 10×10~9 cells/L,and PORT score >70 were easier to isolate bacterial pathogens. SP was more common in patients with purulent sputum,leukocytosis>10×10~9 cells/L,and PORT score >70.But MP was more common in patients <65 years old.non COPD,not having purulent sputum,leukocytosis 4 ~ 10×10~9 cells/L,and PORT score≤70.The difference was significant between the groups (P<0.05). Conclusion The top three bacteria pathogen of CAP in China is SP, HI and KP. There was a high prevalence of atypical pathogens of CAP in China. Patients' some symptoms,disease history and lab investigation can be used to diagnose special pathogens infection.%目的 研究社区获得性肺炎(CAP)病原体分离的相关因素.方法 收集2003年11月至2005年6月中国22个城市的36所医院CAP患者320例,记录患者的临床资料,取患者痰标本进行常规细菌培养,留取急性期和恢复期血清,测定肺炎支原体(MP)抗体、肺炎衣原体(CP)抗体和嗜肺军团菌(LP)抗体.分析cAP病原体分离的相关因素.结果 320

  17. Aerosolised pentamidine for Pneumocystis carinii pneumonia in patients with acquired immunodeficiency syndrome Aerosol de pentamidina no tratamento da pneumonia por Pneumocystis carinii em pacientes com a síndrome da imunodeficiência adquirida

    Directory of Open Access Journals (Sweden)

    Adriana Weinberg

    1990-08-01

    Full Text Available The goal of this study was to evaluate inhaled pentamidine for the treatment of patients with mild and moderate Pneumocystis carinii pneumonitis. Eight adults with AIDS and pneumocystis pneumonia (4 with a first episode and 4 with a repeat pneumocystosis received daily inhalations of aerosol pentamidine isethionate for 21 days. Six patients were treated with doses of 300 mg of pentamidine and the remaining 2 received 600 mg every day. In the 300 mg treatment group, 2 individuals showed discrete and transient neutropenia. However, both subjects that received 600 mg of aerosol pentamidine daily developed leukopenia. One of them had major toxicity (overall severe intolerance of 12.5% that required drug discontinuation and did not allow any analysis of the treatment efficacy. Of the 7 evaluable patients, 6 (88% completed the treatment successfuly. One subject of the 300 mg regimen experienced an early recurrence. In conclusion, inhaled pentamidine is an effective treatment for mild and moderate cases of P. carinii pneumonia. It is less toxic than standard anti-pneumocystis therapy and is suitable for outpatient use.O objetivo deste estudo consistiu em avaliar pentamidina inalatória para o tratamento de pneumonia leve a moderada, causada por Pneumocystis carinii. Oito adultos com a síndrome da imunodeficiência humana e pneumocistose (4 apresentando o primeiro episódio e 4 na vigência de pneumocistose de repetição receberam inalações diárias de isetionato de pentamidina por 21 dias. Seis pacientes foram tratados com doses de 300 mg de pentamidina e os 2 restantes receberam 600 mg diariamente. No grupo de 300 mg, 2 indivíduos desenvolveram neutropenia leve e transitória. Porém, ambos os pacientes recebendo 600 mg de pentamidina aerosol apresentaram leucopenia. Um deles teve toxicidade importante (intolerância global de 12,5%, que levou a suspensão da droga e impediu a avaliação da sua eficácia. Entre os 7 pacientes que puderam ser

  18. Diagnostic value of procalcitonin for hospital-acquired pneumonia in patients receiving surgical critical care%降钙素原对重症患者医院获得性肺炎的诊断价值

    Institute of Scientific and Technical Information of China (English)

    孙广正; 周其林; 戴华卫

    2014-01-01

    目的:研究降钙素原(PC T )对外科重症患者医院获得性肺炎的病情评估作用,为临床治疗提供参考依据。方法前瞻性纳入2011-2012年60例外科重症患者,入院后给予PCT、C‐反应蛋白(CRP)等检查,根据肺炎严重程度和预后分成发生肺炎组34例与未发生肺炎组26例,分别比较重症组与轻症组PC T 表达水平的差异,分析PCT与医院获得性肺炎发生的相关性,采用SPSS 12.0进行统计处理。结果纳入的60例患者中死亡8例,病死率13.33%;发生医院获得性肺炎患者共34例,发生率为56.66%;发生医院获得性肺炎的患者PC T峰值平均为(136.56±57.6)μg/L ,病程中的平均值为(66.59±20.9)μg/L ;未发生医院获得性肺炎的患者PC T峰值平均为(34.21±11.5)μg/L,病程中的平均值为(14.7±6.91)μg/L ;两组相比,差异有统计学意义(P<0.05)。结论 PC T可以有效的用于外科重症患者医院获得性肺炎的诊断,具有临床推广价值。%OBJECTIVE To study procalcitonin (PCT ) for evaluation of hospital‐acquired pneumonia in patients with severe diseases in the surgical department and to provide reference for clinical treatment .METHODS Totally 60 patients with severe diseases in the surgical department were prospectively enrolled ,and given PCT ,CRP and other tests after admission .They were divided into the pneumonia group (n=34) and the non‐pneumonia group (n=26) according to the pneumonia severity and prognosis .The differences in the expression levels of PCT between the two groups were compared .The correlation of PCT and the occurrence of hospital‐acquired pneumonia were analyzed .RESULTS Among the total of 60 patients ,8 patients died ,the mortality rate was 13 .33% .Hospital‐ac‐quired pneumonia occurred in a total of 34 cases ,the rate was 56 .66% .The average PCT peak value for patients with hospital‐acquired

  19. Draft Genome Sequences of Streptococcus pneumoniae with High-Level Resistance to Respiratory Fluoroquinolones

    OpenAIRE

    Keness, Yoram; Bisharat, Naiel

    2016-01-01

    Streptococcus pneumoniae is the leading cause of community-acquired pneumonia. Levofloxacin is a fluoroquinolone used for treatment of severe community-acquired pneumonia. Here, we describe the draft genome sequences of S. pneumoniae with emerging resistance to levofloxacin, resulting in failure of treatment of pneumococcal pneumonia.

  20. 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.

  1. 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。

  2. 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.

  3. Analysis of causes and factors associated with antimicrobial treatment failure in hospitalized patients with community-acquired pneumonia%社区获得性肺炎治疗失败的原因和危险因素分析

    Institute of Scientific and Technical Information of China (English)

    杨丹榕; 唐洁; 张云娇; 徐凌; 沈策

    2010-01-01

    Objective To determine the causes and risk factors of antimicrobial treatment failure in patients with community-acquired pneumonia(CAP). Methods Hospitalized adults with CAP from January 2006 to December 2006 were analyzed retrospectively. Treatment failure was defined as appearance of nonresponding pneumonia and progressive pneumonia. Patient's clinical features were analyzed. Results All of 378 patients were involved in this study. Total antimicrobial treatment failure was happened in 50 patients(32 patients with non-responding pneumonia and 18 patients with progressive pneumonia). The causes were infectious (35 patients,70% ), non-infectious (11 patients,22% ) and undetermined (4 patients,8% ).Mortality of antimicrobial treatment failure was 18%(9/50, 8 patients died of infectious cause, 1 patient had no clear cause of death). Stepwise Logistic regression analysis showed that C-reactive protein, multilobar pneumonia,albumin < 30 g/L,renal function lesion,liver function lesion were related with antimicrobial treatment failure. Independent factors of treatment failure were multilobar pneumonia (P= 0.002) ,albumin <30 g/L(P = 0.001 ) and renal function lesion (P = 0.000). Conclusion The major challenge associated with antimicrobial treatment failure in hospitalized patients with CAP is infection, most of which is infection of drug resistant strain.%目的 探讨社区获得性肺炎(CAP)治疗失败的原因和危险因素.方法 回顾性分析2006年1-12月拟诊CAP入院病例378例,以无反应性肺炎及进展性肺炎定义治疗失败,以此分析治疗失败CAP患者的临床特征,探讨治疗失败的原因,并进行高危因素分析.结果 378例CAP患者中,治疗失败50例,其中无反应性肺炎32例,进展性肺炎18例.分析失败原因:感染性原因35例,占70%;非感染性原因11例,占22%;无法明确原因4例,占8%.50例患者中共有9例死亡(18%),8例为感染性原因,1例为无法明确原因.C反应蛋

  4. 胸外科手术后医院获得性肺炎的前瞻性监测与干预研究%Prospective monitoring of hospital acquired pneumonia in thoracic surgical patients and intervention measures

    Institute of Scientific and Technical Information of China (English)

    仝宇红; 钱雪松; 郑颖; 刘冰慧; 张金梁; 刘维伟; 田春风; 邢江涛

    2014-01-01

    Objective To study the prevention and control measures for hospital acquired pneumonia in thoracic surgical patients.Methods Using the prospective monitoring,morbidity rate of hospital acquired pneumonia in thoracic surgical patients was monitored.The cluster intervention measures were taken,such as education training,strictly disinfecting the respirator duct,raising up the patients'bedside 30°,conducting oral cavity nursing with hlorhexidine,making assessment everyday to determine the withdrawal of the respirator,and strict hand hygiene.Results By cluster intervention measures,the implementation of hand hygienc of the medical staff was significantly improved; intervention measures including raising up the patients' bedside 30°,conducting oral cavity nursing with hlorhexidine,making assessment everyday to determine the withdrawal of the respirator were enforced well.The morbidity rate of hospital acquired pneumonia in thoracic surgical patients fell from 25.87% to 9.02% (P <0.05).Conclusions It is a positive significance for the prevention and control of the hospital acquired pneumonia in thoracic surgical patients through cluster intervention measures.%目的 探讨胸外科手术后医院获得性肺炎的预防控制措施.方法 采用前瞻性监测方法,通过集束干预包括加强培训、呼吸机管路的严格消毒、床头抬高30°、洗必泰口腔护理、每天评估是否撤机、加强手卫生等综合措施,监测胸外科手术后医院获得性肺炎发病率.结果 通过集束干预措施,手卫生依从率明显提高,床头抬高30°、洗必泰口腔护理每2~6小时1次、每天评估是否撤机干预措施执行情况优于干预前,胸外科手术后医院获得性肺炎发病率由监测前的25.87%下降至9.02%,差异有统计学意义(x2 =44.956,P<0.05).结论 开展前瞻性监测,实施集束干预措施,对控制胸外科手术后医院获得性肺炎有积极意义,降低了手术后医院获得性肺炎的发病率.

  5. 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)

  6. 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.

  7. Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Clinical and Hypoxemic Childhood Pneumonia over Three Years in Central Malawi: An Observational Study

    Science.gov (United States)

    McCollum, Eric D.; Nambiar, Bejoy; Deula, Rashid; Zadutsa, Beatiwel; Bondo, Austin; King, Carina; Beard, James; Liyaya, Harry; Mankhambo, Limangeni; Lazzerini, Marzia; Makwenda, Charles; Masache, Gibson; Bar-Zeev, Naor; Kazembe, Peter N.; Mwansambo, Charles; Lufesi, Norman; Costello, Anthony; Armstrong, Ben

    2017-01-01

    Background The pneumococcal conjugate vaccine’s (PCV) impact on childhood pneumonia during programmatic conditions in Africa is poorly understood. Following PCV13 introduction in Malawi in November 2011, we evaluated the case burden and rates of childhood pneumonia. Methods and Findings Between January 1, 2012-June 30, 2014 we conducted active pneumonia surveillance in children 75% three-dose PCV13 coverage (post). We also used multivariable time-series regression, adjusting for autocorrelation and exploring seasonal variation and alternative model specifications in sensitivity analyses. The early versus post analysis showed an increase in cases and rates of total, fast breathing, and indrawing pneumonia and a decrease in danger sign and hypoxemic pneumonia, and pneumonia mortality. At 76% three-dose PCV13 coverage, versus 0%, the time-series model showed a non-significant increase in total cases (+47%, 95% CI: -13%, +149%, p = 0.154); fast breathing cases increased 135% (+39%, +297%, p = 0.001), however, hypoxemia fell 47% (-5%, -70%, p = 0.031) and hospital deaths decreased 36% (-1%, -58%, p = 0.047) in children <5 years. We observed a shift towards disease without danger signs, as the proportion of cases with danger signs decreased by 65% (-46%, -77%, p<0.0001). These results were generally robust to plausible alternative model specifications. Conclusions Thirty months after PCV13 introduction in Malawi, the health system burden and rates of the severest forms of childhood pneumonia, including hypoxemia and death, have markedly decreased. PMID:28052071

  8. 神经疾病并发医院获得性肺炎的危险因素及其干预%Risk factors for neurological diseases complicated with hospital-acquired pneumonia and their intervention

    Institute of Scientific and Technical Information of China (English)

    范琳琳; 宿英英

    2012-01-01

    Hospital-acquired pneumonia (HAP) is a very common complication in patients with neurological diseases.Its incidence and mortality are very high and result in a prolonged hospital stay and an increase in hospitalization costs.Therefore,how to effectively prevent HAP has become the focus of attention by neurologists.There are many risk factors for HAP,such as advanced age,conscious disorders,dysphagia,body position,oropharyngeal colonization,mechanical ventilation,enteral nutrition,and stress ulcer prevention drugs,etc.Clearing the risk factors for HAP and taking appropriate measures to strengthen protection may reduce the occurrence of HAP and improve the prognosis of patients.%医院获得性肺炎(hospital-acquired pneumonia,HAP)是神经疾病患者的常见并发症,其发生率和病死率都很高,并导致住院时间延长和住院费用增加.因此,如何有效预防HAP应成为神经内科医生关注的重点.HAP的危险因素众多,如高龄、意识障碍、吞咽困难、体位、口咽部细菌定植、机械通气、肠内营养、应激性溃疡预防药物等.明确HAP的危险因素并采取相应措施加强防护,可减少HAP发生并改善患者预后.

  9. 银川地区儿童社区获得性肺炎病原学研究%Etiology Characteristics of Community Acquired Pneumonia in Children of Yinchuan

    Institute of Scientific and Technical Information of China (English)

    张永平; 张永红; 赵永华; 徐锦华

    2012-01-01

    Objective To investigate the pathogenic bacteria distribution of community - acquired pneumonia ( CAP) in children of Yinchuan area and its clinical significance, so as to provide suggestion for optimal usage of antibiotics clinically. Methods Specimens of deep respiratory secretions of 309 children with CAP were collected with negative pressure by sterile disposable collector for bacterial culture, bacterial identification and drug sensitivity test. Results 87 strains of pathogenic bacteria were isolated (total positive rate 28. 16% ) as follows: Streptococcus pneumoniae (32. 18%), Klebsiella pneumoniae (22.99%), Staphylococcus aureus (10. 34%), Hemophilies influenzae (10. 34%), Escherichia coli (9. 52%), Bauman Acinetobacter (4. 59% ) , Enterobacter cloacae (4. 59% ) , Enterobacter aerogenes (1. 19% ) and Pseudomonas aeruginosa ( 1. 19% ). Streptococcus pneumoniae mainly occured in children between 3 months to 5 years old while Kleb-siella pneumoniae, Staphylococcus aureus, Bauman Acinetobacter and Enterobacter cloacae were more common in infants within their first year of life. Hemophilies influenzae occured mainly in children over 1 year old, and Escherichia coli were mainly found in infants within three months. Streptococcus pneumoniae and Klebsiella pneumoniae had multiple drug resistance to commonly used antibiotics. Conclusion The pathogenic bacteria of CAP in children in Yinchuan area are mainly Streptococcus pneumoniae, Klebsiella pneumoniae, Staphylococcus aureus, Hemophilies influenzae and Escherichia coli. Pathogenic bacteria are different in different age groups. The most common seen Streptococcus pneumonia and Klebsiella pneumonia are strongly resistant to multiple antibiotics so clinicians should choose rational antibiotics according to the results of bacte-rial culture and drug sensitive test.%目的 分析银川地区儿童社区获得性肺炎(CAP)的病原菌分布特点及其与临床的关系,为合理使用抗菌药物提供依据.方法

  10. ‘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

  11. A Correlative Study of Different Pathogens Caused by Community Acquired Pneumonia in Association with Helico-bacter Pylori Infection%社区获得性肺炎致病原与幽门螺杆菌的相关性研究

    Institute of Scientific and Technical Information of China (English)

    洪丽月; 洪原城; 黄种杰; 金润女

    2016-01-01

    Objective To explore the correlation of helicobacter pylori (Hp) and community-acquired pneumonia with different pathogens. Methods 206 patients with community acquired pneumonia were randomly selected between March 2012 and January 2015 in respiratory department of our hospital inpatient department and outpatient department. Sputum spec-imen of patients was used for pathogenic bacteria culture, and 40 healthy controls were selected. Both groups used the routine blood test for Hp concentrations and comparative analysis. Results Different pathogens of community acquired pneumonia in Hp antibody positive rate was higher than that of control group ( P0. 05 ) . Haemophilus influenzae, Streptococcus pneumoniae, and Hp antibody positive rates were significantly higher than those of Chlamydia trachomatis and pneumonia mycoplasma (P0.05),而感染流感嗜血杆菌和肺炎链球菌Hp抗体阳性率均显著高于衣原体与肺炎支原体(P<0.05)。结论社区获得性肺炎患者血清Hp抗体阳性率高,提示Hp感染可能增加感染社区获得性肺炎的概率。

  12. 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.

  13. The Detection of Bacteria and Resistance in Children Community-acquired Pneumonia%小儿社区获得性肺炎的细菌学检测和耐药性分析

    Institute of Scientific and Technical Information of China (English)

    李树青; 沈玲; 徐风芝; 韩炳鑫

    2013-01-01

    Objective To analysis the bacterial etiology and resistance in children community-acquired pneumonia in Weifang . Methods 2526 children were included in this study since January 2005.The standard operation procedure of clinical test and VITEK-60 were used to separate and indentify bacteria .And disk diffusion method was used for the antibiotics sensitive test .Results ①Pathogens were detected in 52.90% of study patients.Bacteria accounted for 1417 isolates,Gram positive coccus for 61.75% and Gram negative bacilli ( G-) for 38.2%.Eight bacteria such as Group A streptococcus ,Streptococcus pneumoniae ,E.coli,Staphylococcus aureus ,Epidermis staphy-lococcus,Klebsiella pneumoniae ,Group D streptococcus and Pseudomonas aeruginosa represented the greatest proportion with 79.1%.②Group A streptococcus was sensitive to β-lactam antibiotics ,and 62.34%resistance to erythromycin .For Streptococcus pneumoniae ,the rate of resistance to penicillin was 21.5%,and to cefuroxime,ceftriaxone,amoxicillin,piperacillin/tazobactam were 7.6%~13.0%.For Staphy-lococcus aureus and Epidermis staphylococcus ,the rates of resistance to penicillin and erythromycin were 81%~90%,and to other β-lactam antibiotics were 30%.For E.coli,the rate of resistance to ampicillin was 92.4%,and to otherβ-lactam antibiotics and amikacin were 20%~30%.Klebsiella pneumoniae was resist to most antibiotics ,except ciprofloxacin ,cefoperazone/sulbactam ,piperacillin/tazobactam .For Pseudo-monas aeruginosa,the rate of resistance to ceftriaxone was 46.5%,to cefoperazone/sulbactam,piperacillin/tazobactam,amikacin,ceftazidime, ciprofloxacin were 0 ~4.2%.Conclusion Group A streptococcus , Streptococcus pneumoniae , E.coli, Staphylococcus aureus , Epidermis staphylococcus ,Klebsiella pneumoniae ,Group D streptococcus and Pseudomonas aeruginosa arewere the common pathogens of community -ac-quired pneumonia in children in Weifang .Streptococcus pneumoniae iswas resistance to penicillin .Gram negative bacilli iswas

  14. Etiology of hospital-acquired pneumonia in elderly patients and risk factors for prognosis%老年医院获得性肺炎病原学及预后危险因素分析

    Institute of Scientific and Technical Information of China (English)

    田甜; 刘长庭; 方向群; 张晓军

    2012-01-01

    目的 了解并探讨老年医院获得性肺炎(HAP)的临床特点、病原学分布、影响预后因素等.方法 回顾性分析2002年1月-2011年12月老年病房中669例,年龄≥65岁老年HAP患者的临床资料;通过单因素与多因素分析方法研究影响老年HAP的多种预后因素.结果 总共培养出的1130株病原菌,其中革兰阴性菌1000株,占88.5%,革兰阳性菌130株,占11.5%,居前3位的病原菌为铜绿假单胞菌、鲍氏不动杆菌及嗜麦芽寡养单胞菌,占61.9%、9.4%及6.1%;机械通气、受累肺叶数、胸腔积液情况及APACHEⅡ评分是影响老年患者HAP预后的因素.结论 老年医院获得性肺炎病原菌分布广、患者病情重、机械通气比例较高,加之需要多种侵入性操作和治疗导致其死亡率较高.%OBJECTIVE To investigate the clinical characteristics, etiologic distribution, and impact factors for prognosis of the hospital-acquired pneumonia( HAP) in the senile patients. METHODS A cohort of 669 elderly patients from geriatric wards which were diagnosed as HAP from Jan 2002 to Dec 2011 were retrospectively studied. All the enrolled patients were with the age above 65 years. By means of the univariate analysis and multivariate logistic regression analysis, the multiple factors for the prognosis of the elderly patients with HAP were observed. RESULTS A total of 1130 strains of pathogens were isolated, including 1000 (88. 5%) strains of gram-negative bacteria and 130 (11. 5%) strains of gram-negative bacteria. The top three species of pathogens were Pseudomonas aeruginosa (61.9%), Acinetobacter baumannii (9.4%), and Stenotrophomonas maltophilia (6. 1%). The mechanical ventilation, number of affected lung lobes, pleural effusion and APACHE Ⅱ score are the impact factors for the prognosis of the patients with HAP. CONCLUSION The pathogens causing HAP in the elderly patients distribute widely, the condition is severe, with high proportion of mechanical

  15. 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.

  16. 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

  17. 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.

  18. TARGETed surveillance: susceptibility of Streptococcus pneumoniae isolated from community-acquired respiratory tract infections in 2003 to fluoroquinolones and other agents.

    Science.gov (United States)

    Morrissey, I; Colclough, A; Northwood, J

    2007-10-01

    We assessed antibiotic resistance in Streptococcus pneumoniae collected worldwide in 2003. Resistance to clarithromycin was the highest overall (34.1%) followed by penicillin G (22.1%). Patient age and/or country of origin had the greatest effect on susceptibility. Resistance was highest in childrenFluoroquinolone resistance was very low overall, but 3.0% levofloxacin resistance (2.6% gatifloxacin and 0.4% moxifloxacin) was observed in Italy. Interestingly, many isolates with minimum inhibitory concentrations (MICs) at the top of the fluoroquinolone susceptibility breakpoints possessed single quinolone resistance-determining region (QRDR) mutations. Care should be taken when treating fluoroquinolone-susceptible isolates with a higher MIC, which are likely to harbour QRDR mutations and may become fully resistant and cause treatment failure. We concur with the conclusions of other recent studies that suggest fluoroquinolone breakpoints should be lowered to ensure these isolates are categorised as resistant. Fluoroquinolones would still remain an important alternative treatment for respiratory tract infections (albeit for adults only), with moxifloxacin being the most potent fluoroquinolone tested in this study.

  19. 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

  20. 烟台市成人社区获得性肺炎病毒病原学分类的研究%Etiological classification of virus in adult community-acquired pneumonia in Yantai

    Institute of Scientific and Technical Information of China (English)

    于红霞; 陈永芹; 蒲增惠; 赵茂茂

    2014-01-01

    To employ multiplex polymerase chain reaction (PCR) to classify the types of virus in 128 patients of community-acquired pneumonia and analyze the relationship between type of virus,age and seasons.The positive rate of viral pneumonia was 34.4% (44/128).In 44 virus positive patients,the rates of influenza A virus,rhinovirus,adenovirus,parainfluenza type 1,human metapneumovirus virus,influenza B virus,parainfluenza type 2,parainfluenza type 3 and enterovirus were 22.7% (10/44),15.9% (7/44),15.9% (7/44),9.1% (4/44),9.1% (4/44)6.8% (3/44),2.3% (1/44),2.3% (1/44) and 2.3% (1/44) respectively.And other 6(13.6%) patients were at least infected by one virus.The viral pneumonia had a high positive rate in spring and winter.And the age group of 20 to 29 years had a high positive rate.The major pathogen contributing to adult community-acquired pneumonia in Yantai were influenza A virus,rhinovirus and adenovirus.%对128例确诊为社区获得性肺炎患者的咽拭子采用多重PCR方法进行病毒分类,分析病毒分类与年龄和季节的关系.病毒性肺炎占34.4% (44/128).44例病毒阳性患者中,甲型流感病毒占22.7%(10/44),鼻病毒、腺病毒各占15.9%(各7/44),副流感病毒1型和人偏肺病毒各占9.1%(各4/44),乙型流感病毒占6.8% (3/44),副流感病毒2型、副流感病毒3型及肠道病毒各占2.3%(各1/44),另有6例为多重病毒感染(13.6%).病毒性肺炎在冬春季节发病高,发病人群中20~ 29岁所占比例高.在烟台市成人社区获得性肺炎病原构成中,病毒性肺炎所占比例较大,尤其以甲型流感病毒、鼻病毒和腺病毒为主.

  1. 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

  2. Drug resistance of pathogens causing community-acquired pneumonia in children%儿童社区获得性肺炎病原菌耐药性分析

    Institute of Scientific and Technical Information of China (English)

    吕菊红; 刘胜利; 王玉

    2012-01-01

    OBJECTIVE To investigate the drug resistance of the pathogens isolated from children with communityacquired pneumonia in Baoji area, which will contribute to the proposing of coping strategies and guiding rational use of antibiotics. METHODS The sputum samples from 1240 hospitalized children with community-acquired pneumonia from Jan 2008 to Dec 2010 were isolated and cultured; identification and susceptibility testing were performed. RESULTS In 612 strains, gram-negative bacteria accounted for 63. 6%, gram-positive bacteria accounted for 26. 1 % , and fungi accounted for 10. 3%. The main gram-negative bacteria included Escherichia coli and Klebsiella pneumoniae, which had the highest resistance rate to ampicillin, but susceptible to imipenem, ciprofloxacin and piperacillin-sodium. The main gram-positive bacteria included Streptococcus pneumoniae and Staphylococcus aureus. The resistance rate of S. Pneumoniae was 74. 5% to penicillin and 96. 4% to macrolides. CONCLUSION Since p-lactam and macrolide antibiotics are used widely in pediatrics, the distribution and drug resistance of the pathogens isolated from children are different from adults. ESBLs and AmpC enzymes produced by pathogens in children are higher than in adults. Comprehensive measures should be taken for scientific and reasonable use of antibiotics.%目的 调查分析宝鸡地区儿童社区获得性肺炎病原菌的分布及耐药性,指导临床合理使用抗菌药物.方法 对2008年1月-2010年12月儿科住院符合社区获得性肺炎1240例患儿,送痰液标本进行分离培养,做菌株鉴定和药敏试验.结果 共分离出病原菌612株,其中革兰阴性菌占63.6%;革兰阳性菌占26.1%;真菌占10.3%,革兰阴性菌以大肠埃希菌、肺炎克雷伯菌为主,对氨苄西林耐药率最高,敏感的抗菌药物为亚胺培南、环丙沙星、哌拉西林/他唑巴坦;革兰阳性菌中以肺炎链球菌和金黄色葡萄球菌为主,肺炎链球菌对

  3. In vitro activities of tedizolid compared with other antibiotics against Gram-positive pathogens associated with hospital-acquired pneumonia, skin and soft tissue infection and bloodstream infection collected from 26 hospitals in China.

    Science.gov (United States)

    Li, Shuguang; Guo, Yu; Zhao, Chunjiang; Chen, Hongbin; Hu, Bijie; Chu, Yunzhuo; Zhang, Zhijie; Hu, Yunjian; Liu, Zhiyong; Du, Yan; Gui, Qiaodi; Ji, Ping; Zeng, Ji; Cao, Bin; Fu, Quan; Zhang, Rong; Wang, Zhongxin; Zhuo, Chao; Feng, Xianju; Jia, Wei; Jin, Yan; Xu, Xuesong; Liao, Kang; Ni, Yuxing; Yu, Yunsong; Xu, Xiuli; Hu, Zhidong; Lei, Jin-E; Yang, Qing; Wang, Hui

    2016-10-01

    To evaluate the in vitro antimicrobial activities of tedizolid, linezolid and other comparators against clinically significant Gram-positive cocci isolates from hospital-acquired pneumonia (HAP), skin and soft tissue infection (SSTI) and bloodstream infection (BSI), 2140 nonduplicate isolates (23.7 % isolated from HAP, 46.8 % from SSTI and 29.5 % from BSI) were consecutively collected in 26 hospitals in 17 cities across China during 2014. These pathogens included 632 methicillin-resistant Staphylococcus aureus, 867 methicillin-sensitive Staphylococcusaureus, 299 coagulase-negative Staphylococcus (CoNS), 104 Enterococcus faecalis, 99 Enterococcusfaecium, 13 Streptococcus pneumoniae, 23 α-haemolytic Streptococcus and 103 β-haemolytic Streptococcus. MICs of routine clinical antibiotics were determined by broth microdilution method according to the Clinical and Laboratory Standards Institute guidelines 2015. Tedizolid, linezolid, vancomycin, daptomycin, teicoplanin and tigecycline showed high in vitro activity against Gram-positive pathogens (≥98.0 % susceptible), and tedizolid exhibited four- to eight fold greater activity than linezolid against the pathogens tested, with MIC90s of methicillin-resistant Staphylococcus aureus, α-haemolytic Streptococcus and β-haemolytic Streptococcus (0.25 vs 2 µg ml-1); methicillin-sensitive Staphylococcu saureus, E. faecalis and E. faecium (0.5 vs 2 µg ml-1); methicillin-resistant CoNS and methicillin-sensitive CoNS (0.25 vs 1 µg ml-1); and Streptococcuspneumoniae (0.125 vs 0.5 µg ml-1). Tedizolid MIC90s associated with different infections did not show significant differences, and the drug exhibited excellent activity against surveyed Gram-positive pathogens associated with HAP, SSTI and BSI, including linezolid-nonsusceptible strains. These data suggest that tedizolid could be an alternative to linezolid for the treatment of infections caused by Gram-positive organisms.

  4. The clinical study on the combined detection of mycoplasma pneumoniae and chlamydia pneumoniae of the patients with community acquired pneumonia%社区获得性肺炎患者联合检测肺炎支原体和衣原体的临床研究

    Institute of Scientific and Technical Information of China (English)

    陈雪莹; 张卫星

    2014-01-01

    目的:观察分析联合检测肺炎支原体(Mp)和肺炎衣原体(Cp)对社区获得性肺炎(CAP)患者的临床意义。方法选取1500例 CAP 患者作为研究对象,对其咽拭子标本中的 Mp 和 Cp DNA 进行检测,对主要病原菌进行培养和鉴定,观察比较患者的抗感染治疗方案和治愈率。结果本组 CAP 患者的病原体分布以 Mp、肺炎链球菌、流感嗜血杆菌和 Cp 的比例最大,而感染类型以2种病原体感染的比例最多;在本组患者的治疗过程中,β-内酰胺类抗菌药物的使用频率最高,应用β-内酰胺类联合大环内酯类或氟喹诺酮类药物治疗的患者的治愈率显著高于单独应用β-内酰胺类药物的患者(P <0.05);在治疗Mp 或 Cp 单纯感染时,单独应用β-内酰胺类药物与应用β-内酰胺类联合大环内酯类或氟喹诺酮类药物治疗的患者治愈率无显著性差异(P >0.05);在治疗细菌合并 Mp 或 Cp 感染时,应用β-内酰胺类联合大环内酯类或氟喹诺酮类药物的患者治愈率显著高于单独应用β-内酰胺类药物者(P <0.05)。结论 Mp 和 Cp 感染在 CAP 患者中比较多见,患者的主要感染类型是2种病原体的混合性感染,β-内酰胺类药物是治疗过程中常用药物,应用β-内酰胺类联合大环内酯类或氟喹诺酮类药物的抗感染方案可提高患者的治愈率,特别是在有细菌合并 Mp 或 Cp 感染时,可发挥显著疗效,临床医生应根据 Mp 或 Cp 的检测结果合理、有效地选择抗感染治疗方案。%Objective To observe and analyze the clinical significance of the combined de-tection of Mycoplasma pneumoniae (Mp)and Chlamydia pneumoniae (Cp)for the patients with community acquired pneumonia (CAP).Methods 1500 CAP patients were selected as the re-search objects.DNA of Mp and Cp in the throat swab specimens of the patients were detected and the main pathogenic bacteria were

  5. 老年医院获得性肺炎病原学、耐药性以及预后危险因素分析%The Geriatric Hospital Acquired Pneumonia Resistance Prognostic Risk Factors

    Institute of Scientific and Technical Information of China (English)

    葛新; 周磊; 张驰明; 李晓锋; 王长征

    2013-01-01

    Objective:To investigate the Geriatric Hospital Acquired Pneumonia,resistance and prognostic risk factors.Methods:the etiology,susceptibility and prognostic risk factors of elderly patients with HAP received by our hospital in January 2007-2012 in December were analyzed.Results:Pseudomonas aemginosa,and E.coli had the highest detection rate in pathogenic G-bacteria,and the G cocci with the highest detection rate were Staphylococcus aureus and Streptococcus pneumoniae; all pathogens had certain resistances to antibiotics,the prognosis of patients Logistic analysis showed combined underlying disease,age,outside the city of population exposure to patients with pneumonia as well as smoking,alcohol consumption were risk factors affected the prognosis of patients with HAP.Conclusion:By the detection of pathogens and resistance in the elderly HAP analysis,to choice a reasonable of antimicrobial drugs to improve the prognosis of patients.%目的:探讨老年医院获得性肺炎病原学、耐药性以及预后危险因素.方法:对我院2007年1月-2012年12月收治的老年HAP患者进行病原学、药敏分析以及对预后的危险因素进行分析.结果:在G-杆菌中铜绿假单胞菌以及大肠埃希菌是检出率最高的致病菌,G+球菌中金黄色葡萄球菌以及肺炎链球菌检出率最高;所有致病菌均对常规抗生素均有一定的耐药性,对患者的预后的Logistic分析其中合并基础疾病、年龄、外市人口、接触肺炎患者以及吸烟、饮酒是影响HAP患者预后的危险因素.结论:对于老年HAP中进行检测病原菌以及耐药性进行分析,继而合理选择抗菌药物,提高患者的预后.

  6. Distribution and resistance of Streptococcus pneumoniae causing hospital and community-acquired infections%医院感染与社区感染肺炎链球菌分布与耐药性分析

    Institute of Scientific and Technical Information of China (English)

    谢朝云; 熊芸; 孙静; 胡杨; 杨忠玲

    2015-01-01

    OBJECTIVE To compare the differences in resistance of Streptococcus pneumoniae causing hospital in‐fections and community‐acquired infections ,so as to provide reference for the clinical treatment of S .pneumoniae infections .METHODS A comparative analysis was conducted on 140 clinical strains of S . pneumoniae isolated from clinical infection specimens during Jun .2011 to Apr .2014 .The strains were identified by VITEK‐2 Com‐pact and VITEK GP identification card .The Kirby‐Bauer method was used for drug sensitivity test .The SPSS 19 .0 software was used for statistical analysis .RESULTS The resistance of isolated S . pneumoniae to penicillin G ,oxacillin ,clindamycin ,erythromycin ,azithromycin was respectively 46 .43% ,76 .43% ,87 .14% ,92 .14% , 89 .29% .The drug resistance rate of hospital infections and community‐acquired infections to penicillin G ,oxacil‐lin ,erythromycin ,amikacin and ciprofloxacin was respectively 70 .77% ,25 .33% ;93 .85% ,61 .33% ;98 .46% , 86 .67% ;100 .00% ,66 .67% ;10 .77% ,0 .The resistance rate of S .pneumoniae was significeatly higher for hos‐pital infections than for community‐acquired infections (P<0 .05) .CONCLUSION The resistance rate of S .pneu‐moniae to commonly used antimicrobial drugs continues to rise ,especially for hospital infection .Clinicians should pay attention to strengthening drug sensitivity monitoring and the changes of clinical infection bacteria as well as bacterial resistance ,make targeted selection of drugs with high sensitivity ,perform inoculation of S .pneumoniae vaccine ,so as to effective control and slow dow n the increase of bacterial resistance .%目的:分析医院感染与社区感染肺炎链球菌的耐药性差异,为临床治疗肺炎链球菌感染提供参考依据。方法对2011年6月-2014年4月临床感染标本中分离的肺炎链球菌140株比较分析,用VITEK‐2 Compact及VITEK GP鉴定卡鉴定,药敏试验用K‐B法,数据采用SPSS 19.0软

  7. Analysis on risk factors for community-acquired pneumonia in the elderly%老年人社区获得性肺炎的相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    阮婷; 徐晓

    2015-01-01

    Objective To explore the risk factors for community-acquired pneumonia (CAP) in the elderly,in order to provide the basis for clinical prevention and treatment.Methods 168 elderly patients with CAP (observation group) and 100 elderly patients without CAP (control group) were chosen from our hospital from Jan.2013 to Dec.2014.The clinical data were investigated,and the risk factors for CAP were analyzed.Results Single factor analysis showed that there were significant differences between the two groupsin serum protein level,pets-raising,smoking,dust exposure,bronchial disease,renal dysfunction and diabetes mellitus (all P<0.05).Multivariate logistic regression analysis showed that serum protein level,pets-raising,smoking,bronchial disease and diabetes were the independent risk factors for CAP in the elderly (OR=2.793,2.578,3.017,3.168 and 2.643,all P<0.05).Conclusions The community-acquired pneumonia is related with many risk factors in the elderly.The clinical corresponding prevention and treatment for the risk factors should be developed,which have an important significance in the early diagnosis,early treatment and prognostic improvement in community-acquired pneumonia.%目的 探讨老年人发生社区获得性肺炎的相关危险因素,为临床防治提供依据. 方法 选择我院2013年1月至2014年12月收治的168例老年社区获得性肺炎患者作为观察组,另外选择同期医院就诊的100例非社区获得性肺炎老年患者为对照组;调查其临床资料,分析其发生社区获得性肺炎的相关危险因素. 结果 单因素分析结果显示,两组患者在血清白蛋白水平、是否饲养宠物、吸烟史、粉尘接触史、支气管疾病、肾功能异常和糖尿病史等因素间差异有统计学意义(均P<0.05);多因素Logistic回归分析结果显示,血清白蛋白水平、是否饲养宠物、吸烟史、患有支气管疾病和糖尿病为社区获得性肺炎的独立危险因素(OR=2.793、2.578、3.017

  8. Analysis study of bacterial pathogen characteristics of children with community-acquired pneumonia%儿童社区获得性肺炎细菌病原学特点分析研究

    Institute of Scientific and Technical Information of China (English)

    谢庆玲; 李伟伟; 包增兰; 覃敏; 谭颖; 韦玉华; 甄宏; 唐晓燕; 陈泓伶; 温志红; 农生洲; 贺海兰; 庞智东; 梁卓信

    2014-01-01

    Objective To study the bacterial pathogen characteristics of children with community-acquired pneumonia(CAP) and antimicrobial susceptibility for clinical pneumonia treatment .Methods The clinical features, bacterial pathogen characteristics and microbial sensitivity test of 956 cases of hospitalized children with CAP were systematically analyzed.Results Gram-negative(G-) bacteria was detected in sputum culture from 653 of 956 cases of children with CAP, accounting for 68.3%;Gram-positive(G+) cocci in 303 cases, accounting for 31.7%.A-mong them, E.coli was detected in 253 cases(26.5%), klebsiella pneumoniae in 166 cases(17.4%), haemophilus influenzae in 78 cases(8.2%), acinetobacter baumannii in 53 cases(5.5%), Pseudomonas aeruginosa in 41 cases ( 4.3%), Streptococcus pneumoniae in 47 cases(4.9%) and staphylococcus aureus in 41 cases(4.3%).Common original pathogen of children with CAP in the secondary hospital were haemophilus influenzae , moraxelle catarrhalis and Streptococcus pneumoniae .While those in the tertiary hospitals were E .coli, klebsiella pneumoniae , acineto-bacter baumannii and coagulase negative staphylococcus aureus .Klebsiella pneumoniae were partly resistant to Tien-am and Meiluopeinan , and acinetobacter baumannii were also resistant to Tienam .Streptococcus pneumoniae were generally resistant to penicillin , and sulfamethoxazole , clindamycin and erythromycin and azithromycin .Staphylococ-cus aureus was completely resistant to penicillin and also highly resistant to sulfamethoxazole , ampicillin, erythromy-cin, azithromycin and tetracycline .Conclusion G-bacteria in children with CAP were not uncommon , while there be likely needed to pay seriously attention to higher antimicrobial resistance to bacteria .%目的:探讨儿童社区获得性肺炎( CAP )细菌病原学特点及药敏情况,指导临床肺炎诊治。方法系统分析956例住院CAP患儿的临床特征,细菌病原学特点和微生物

  9. The Impacts of Cellular Senescence in Elderly Pneumonia and in Age-Related Lung Diseases That Increase the Risk of Respiratory Infections

    Directory of Open Access Journals (Sweden)

    Shigehisa Yanagi

    2017-02-01

    Full Text Available Pneumonia generates considerable negative impacts on the elderly. Despite the widespread uses of vaccines and appropriate antibiotics, the morbidity and mortality of elderly pneumonia are significantly higher compared to the counterparts of young populations. The definitive mechanisms of high vulnerability in the elderly against pathogen threats are unclear. Age-associated, chronic low-grade inflammation augments the susceptibility and severity of pneumonia in the elderly. Cellular senescence, one of the hallmarks of aging, has its own characteristics, cell growth arrest and senescence-associated secretory phenotype (SASP. These properties are beneficial if the sequence of senescence–clearance–regeneration is transient in manner. However, persisting senescent cell accumulation and excessive SASP might induce sustained low-grade inflammation and disruption of normal tissue microenvironments in aged tissue. Emerging evidence indicates that cellular senescence is a key component in the pathogenesis of chronic obstructive pulmonary disease (COPD and idiopathic pulmonary fibrosis (IPF, which are known to be age-related and increase the risk of pneumonia. In addition to their structural collapses, COPD and IPF might increase the vulnerability to pathogen insults through SASP. Here, we discuss the current advances in understanding of the impacts of cellular senescence in elderly pneumonia and in these chronic lung disorders that heighten the risk of respiratory infections.

  10. The Impacts of Cellular Senescence in Elderly Pneumonia and in Age-Related Lung Diseases That Increase the Risk of Respiratory Infections.

    Science.gov (United States)

    Yanagi, Shigehisa; Tsubouchi, Hironobu; Miura, Ayako; Matsuo, Ayako; Matsumoto, Nobuhiro; Nakazato, Masamitsu

    2017-02-25

    Pneumonia generates considerable negative impacts on the elderly. Despite the widespread uses of vaccines and appropriate antibiotics, the morbidity and mortality of elderly pneumonia are significantly higher compared to the counterparts of young populations. The definitive mechanisms of high vulnerability in the elderly against pathogen threats are unclear. Age-associated, chronic low-grade inflammation augments the susceptibility and severity of pneumonia in the elderly. Cellular senescence, one of the hallmarks of aging, has its own characteristics, cell growth arrest and senescence-associated secretory phenotype (SASP). These properties are beneficial if the sequence of senescence-clearance-regeneration is transient in manner. However, persisting senescent cell accumulation and excessive SASP might induce sustained low-grade inflammation and disruption of normal tissue microenvironments in aged tissue. Emerging evidence indicates that cellular senescence is a key component in the pathogenesis of chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF), which are known to be age-related and increase the risk of pneumonia. In addition to their structural collapses, COPD and IPF might increase the vulnerability to pathogen insults through SASP. Here, we discuss the current advances in understanding of the impacts of cellular senescence in elderly pneumonia and in these chronic lung disorders that heighten the risk of respiratory infections.

  11. Effect of Health Education on Nursing Effect of Community Acquired Pneu-monia in Elderly%健康教育对老年人社区获得性肺炎护理效果的影响

    Institute of Scientific and Technical Information of China (English)

    王丽林

    2016-01-01

    目的:探讨健康教育对老年人社区获得性肺炎护理效果的影响。方法以2015年12月-2016年5月在该院接受治疗的社区获得性肺炎的老年患者97例作为研究对象,通过心理教育、饮食指导、作息指导、用药教育、特殊教育、口腔护理教育和出院指导等方面进行健康教育,观察治疗的总有效率。结果观察组通过心理教育、饮食指导、作息指导、用药教育、特殊教育、口腔护理教育和出院指导等方面进行健康教育。结果显示:对照组的总有效率为71.13%,观察组的总有效率为94.85%,观察组明显优于对照组,两组比较差异有统计学意义(字2=10.72,P<0.05)。结论良好的健康教育能够提高治疗的效果,减轻并发症的反应几率。%Objective To study the effect of health education on nursing effect of community acquired pneumonia in elderly. Methods 97 cases of senile patients with community acquired pneumonia in our hospital from December, 2015 to April, 2016 were selected as the research objects, After health education such as mental education, diet guidance, work-rest guidance, medication education, special education, oral nursing education and discharge guidance,and the total effective rate of treatment was observed. Results Observation group through psychological education, dietary advice, guidance and rest, medication education, special education, and oral care education discharge guidance in areas such as health education. The results showed that:the control group total effective rate 71.13%, the total effective rate of the observation group 94.85% in the observation group than the control group, the difference was statistically significant (χ²= 10.72, P<0.05). Conclusion The good health education can improve the treatment effect, relieve the reaction probability of complications.

  12. 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 ...

  13. Toxocara canis: impact of preweaning nutritional deprivation on the pathogenesis of pneumonia in the mouse.

    Science.gov (United States)

    Moreira, Daniela S; Rocha, Gutemberg M

    2005-08-01

    The present study was conducted to better understand the immure response to Toxocara canis pneumonia in mice with preweaning nutritional deprivation. Breast-fed Swiss mice, undernourished due to large litter size (up to 15 pups) and paired controls with only 5-8 pups were used. At 21 days old, both groups were infected with T. canis larvae. Liver retinol, retinyl palmitate, and inflammatory infiltrate in lungs were compared in both groups. Significantly lower levels of retinol and retinyl palmitate in liver tissue confirmed the hypovitaminosis A (P nutritionally deprived animals. Histological analysis showed similar eosinophilic infiltration in both groups at day 3 but was significantly more severe in undernourished mice at day 20 post-infection (P = 0.01). The present findings indicate that preweaning undernourishment is associated with a more severe inflammation in response to T. canis pneumonia. It suggests that vitamin A deficiency that persists after nutritional rehabilitation, may contribute to the severity of T. canis infection. The authors suggest that nutritional status should be carefully investigated in patients with more severe clinical findings.

  14. Clinical observation and experience of cefotaxime sodium in treating community acquired pneumonia%头孢噻肟钠治疗社区获得性肺炎的观察及体会

    Institute of Scientific and Technical Information of China (English)

    周乐山

    2004-01-01

    目的探讨头孢噻肟钠(cefotaxime sodium)治疗社区获得性肺炎(community acquired pneumonia,CAP)的临床疗效及安全性.方法90例社区获得性肺炎病人,随机分为治疗组和对照组,每组45例.治疗组:静脉注射头孢噻肟钠,每次1.0~2.0g,每8 h静注1次,疗程7~14d;对照组:静脉滴注青霉素G(benzylpenicillin),每次240~480wu,每6h静注1次,疗程7~14d.结果头孢噻肟钠和青霉素G的临床有效率分别为93.3%和66.7%,细菌清除率为95.6%和71.1%,两组差异具有统计学意义(P<0.05),治疗期间两组均未出现明显不良反应.结论头孢噻肟钠疗效肯定,安全性好,可作为治疗社区获得性肺炎的首选药.

  15. Effect of targeted monitoring on control of hospital-acquired pneumonia after neurosurgical operation%目标性监测对控制神经外科手术后 医院获得性肺炎的效果分析

    Institute of Scientific and Technical Information of China (English)

    许缤; 陈红岩; 孙嫣; 仝宇红; 朱丽丽; 陈岩; 陈大华

    2011-01-01

    摘要:目的 研究目标性监测对预防控制神经外科手术后患者医院获得性肺炎的意义.方法开展神经外科手术后医院获得性肺炎的目标性监测,通过教育培训、严格呼吸机管道的消毒、减少外源性污染、患者床头抬高30~45度、氯己定口腔护理、严格的手卫生及每天评估是否可以撤机等综合措施,监测神经外科手术后医院获得性肺炎发病率.结果开展目标性监测后,神经外科手术后医院获得性肺炎发病率由监测前24.57%下降至监测后的8.24%,差异有统计学意义(P<0.05).结论开展目标性监测对控制神经外科手术后医院获得性肺炎发病率具有显著效果,对预防控制医院外科手术后肺炎具有积极意义.%OBJECTIVE To explore the significance of targeted monitoring on the prevention and control hospital acquired pneumonia after neurosurgical operation. METHODS The method of targeted monitoring was applied to the hospital acquired pneumonia after neurosurgical operation. By taking such comprehensive measures as education training, strictly disinfecting the respirator duct, reducing exogenous contamination, raising the patients' bedside 35-40°up, conducting oral cavity nursing with chlorhexidine, strict hand hygiene, and making assessment everyday to determine the withdrawal of the respirator, morbidity rates of hospital acquired pneumonia after neurosurgical operation were monitored. RESULTS By using targeted monitoring, the morbidity rates of hospital acquired pneumonia after neurosurgical operation decreased from 24. 57% to 8. 24%, and there were significant differences(P<0. 05). CONCLUSION Targeted monitoring can effectively control the morbidity rates of hospital acquired pneumonia after neurosurgical operation, and it is of positive significance for the prevention and control of the hospital acquired pneumonia after surgical operation.

  16. Bacteremia with Streptococcus pneumoniae

    DEFF Research Database (Denmark)

    Christensen, J S; Jensen, T G; Kolmos, H J

    2012-01-01

    We conducted a hospital-based cohort study among adult patients with first-time Streptococcus pneumoniae bacteremia (SPB) from 2000 through 2008. Patients were identified in a population-based bacteremia database and followed up for mortality through the Danish Civil Registration System (CRS...... age of the patients was 65 years. The focal diagnosis of the SPB was pneumonia in 381 (79 %) patients, followed in frequency by meningitis in 33 (7 %) patients. Of the 481 patients, 390 (81 %) had community-acquired SPB. Of these, 23 (6 %) did not have sepsis, 132 (34 %) had sepsis, 224 (57 %) had...

  17. 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

  18. Relationship of pneumonia severity index with serum levels of NT?proBNP and D?Dimer in elderly patients with community?acquired pneumonia%老年社区获得性肺炎患者PSI分级与NT-proBNP及血清D-二聚体的关系

    Institute of Scientific and Technical Information of China (English)

    邱建凯; 尹占良; 张芳芳; 李令娟; 姚海珍

    2016-01-01

    目的 探讨老年社区获得性肺炎(CAP)患者肺炎严重度指数(PSI)分级与血清N末端脑钠肽前体(NT-proBNP)和D-二聚体(D-Dimer)水平的关系.方法 选择本院收治的162例老年CAP患者为老年肺炎组,正常对照组为50例无基础疾病的健康体检人群.患者入院后24 h内进行临床数据收集,评估PSI,根据入院后28 d内是否死亡分为存活组与死亡组.同时检测老年肺炎组及正常对照组血清NT-proBNP与D-Dimer浓度,分析并比较CAP患者PSI分级与血清NT-proBNP及D-Dimer水平的关系.结果 (1)老年肺炎组血清NT-proBNP、D-Dimer水平明显高于正常对照组(P<0.05).(2)老年肺炎组患者血清NT-proBNP及D-Dimer水平随PSI分级增加而升高.不同PSI分级患者间NT-proBNP及D-Dimer水平比较,差异均有统计学意义(P<0.05).CAP患者死亡率随PSI分级增加而上升(P<0.05).(3)死亡组在入院时PSI评分、血清NT-proBNP及D-Dimer水平均明显高于存活组,差异有统计学意义(P<0.05).结论 NT-proBNP、D-Dimer不仅可作为诊断老年CAP的有效指标,而且与老年CAP患者PSI分级有一定的关系.%Objective To explore the relationship of pneumonia severity index(PSI) with serum levels of NT-proBNP and D-Dimer in elderly patients with community-acquired pneumonia ( CAP ) . Methods 162 elderly cases of CAP in our hospital were chosen as senile pneumonia group from March 2012 to July 2015. Fifty cases of healthy people without basic diseases were selected as normal control group. Clinical data of CAP patients were collected within 24 h after admission and PSI was assessed. All the patients were divided into survival group and death group within 28 d after admission. Serum levels of NT-proBNP and D-Dimer were detected in two groups. The relationship of PSI with serum levels of NT-proBNP, D-Dimer was analyzed. Results ( 1) Serum levels of NT-proBNP and D-Dimer in senile pneumonia group were significantly higher than those in normal control group( P

  19. 老年人医院内获得性肺炎的危险因素分析%A multicenter prospective cohort study on risk factors for hospital-acquired pneumonia in the elderly

    Institute of Scientific and Technical Information of China (English)

    邓至; 胡必杰; 何礼贤; 高晓东; 李华茵; 陈雪华; 王文娟; 任金兰; 韩红妹

    2008-01-01

    目的 了解老年人医院内获得性肺炎(HAP)的发病率,筛查并确定老年人HAP发病危险因素尤其是高危因素.方法 多中心前瞻性队列研究.选2004年3-6月上海市31所二、三级医院新入院的老年患者为研究对象,统计HAP发病率及分析相关危险因素.结果 (1)共入组5299例老年患者,年龄65~96(74.3±5.9)岁.合并慢性疾病的老年患者占28.5%.APACHE Ⅱ评分为5~31(8.3±3.4)分.确诊为HAP者255例(4.81%),发病率46.75/1000住院日,粗病死率为14.90%.(2)HAP发病率较高的科室依次为ICU(21.43%)、血液科(12.17%)、胸外科(11.41%)、呼吸科(7.92%).(3)多因素logistic回归分析显示,入住二级医院或ICU、慢性阻塞性肺疾病病程≥10年、心肺功能不全、肝硬化失代偿期、卒中或脑外伤、免疫抑制、入院后使用抗菌药物或制酸剂、鼻胃管留置、机械通气、意识障碍、活动受限、血清白蛋白<35g/L为老年人HAP发病的独立危险因素.结论 老年人HAP发病的独立危险因素众多,需要综合防治才能有效控制HAP的发生.%Objective To investigate the incidence and the risk factors for hospital-acquired pneumonia(HAP)in the elderly in Shanghai.Methods This was a muhicenter prospective clinical cohort study.A total of 5299 patients more than 65 years old.admitted into 31 secondary or tertiary hospitals in Shanghai,were enrolled.Measurements of the demographic and potential risk factors reflecting illness severity,nutrition,drug exposure,surgery and ventilation were performed.Pneumonia was classified by the definition of Chinese Medical Association.Risk factors were analyzed by univariate Pearson Chi-squared test and multivariable logistic regression analysis with backward(Likelihood ratio).Resuits Of the enrolled patients,2805 male and 2494 female,255(4.81%)developed hospital-acquired pneumonia.The incidence was 46.75/1000 hospitalizations.Among them 38 died:and the rough mortality was 14.90%.The

  20. The Preliminary Study of the Vitamin A Level and Children with Community-acquired Pneumonia%血清维生素A水平与儿童社区获得性肺炎相关性的初步研究

    Institute of Scientific and Technical Information of China (English)

    姚夏娟; 顾岚

    2016-01-01

    Objective:To analyze the vitamin A concentration in the acute and recovery phase of younger children with the community-acquired pneumonia,discuss the relationship of vitamin A concentration with different pathogens.Method:152 cases of children with community-acquired pneumonia aged from six months to five years(60 months) were selected as the research group and 50 healthy children of the same age were selected as the control group.The serum level of retinol was measured to analyze the vitamin A concentration.Result:The serum level of VA in the acute phase of pneumonia children was lower than the normal children[(0.87±0.34)μmol/ vs (1.18±0.23)μmol/L,P<0.05] and different pathogens of acute pneumonia were at different levels,viral pneumonia was (0.89±0.17)μmol/L,bacterial pneumonia was (0.84±0.19)μmol/L,mycoplasma pneumonia was (0.73±0.15)μmol/L.Mycoplasma pneumonia in which the serum level of VA was relatively lower,compared with bacterial pneumonia and viral pneumonia,the differences were significant(P<0.05).Conclusion:The serum level of VA in community-acquired pneumonia children decreases compared with normal group and children with mycoplasma pneumonia are more likely to occur subclinical vitamin A deficiency.%目的:本研究旨在评估社区获得性肺炎患儿急性期、恢复期血清维生素A状况,探讨不同病原体肺炎患儿体内维生素A水平。方法:选择年龄为6个月~5岁(60个月)的不同病原体住院肺炎患儿152例为研究对象,并选择同期同一年龄门诊健康体检儿童50例为正常对照组,分别采用测定血清视黄醇(retinol)浓度的方法来评估患儿体内维生素A状况。结果:肺炎患儿血清VA低于正常对照组儿童[(0.87±0.34)μmol/L vs (1.18±0.23)μmol/L,P<0.05];不同病原体肺炎急性期血清VA水平不同,病毒性肺炎为(0.89±0.17)μmol/L、细菌性肺炎为(0.84±0.19)μmol/L、肺炎支原体肺炎为(0.73±0.15)μmol/L,其中肺炎

  1. 重庆地区婴幼儿社区获得性肺炎病原学分析%Etiology of Children with Community Acquired Pneumonia in Chongqing Area

    Institute of Scientific and Technical Information of China (English)

    冯英; 罗征秀; 符州; 罗健; 刘恩梅

    2011-01-01

    目的:了解重庆地区婴幼儿社区获得性肺炎(CAP)病原学分布特点.方法:回顾性分析重庆医科大学附属儿童医院呼吸病房2009年3月~2010年2月住院治疗的1 106例CAP患儿鼻咽抽吸物细菌培养、呼吸道7种病毒、MP-PCR、CP-PCR及MP、CP血清学检测结果.结果:(1)1 106例患儿病毒检出阳性540例(48.8%),最常见病毒为RSV,共398例,占检出病毒病例的73.7%.(2)细菌检出阳性590例(53.3%),检出的最常见细菌为肺炎链球菌,共126例,占检出细菌病例的21.4%.(3)MP检出阳性67例(6.1%),CP检出阳性126例(11.4%),≤12月组MP和CP检出率低于1~3岁组(P<0.05).(4)病原体混合检出阳性共427例(38.6%),以细菌-病毒混合检出多见(占检出混合病原体病例的55.7%).结论:RSV是重庆地区住院治疗的婴幼儿CAP第一位病毒病原体,肺炎链球菌是检出的首位细菌病原体,病毒-细菌混合检出率较高.%Objective; To study the distribution of etiology of children under 3 years old with community acquired pneumonia (CAP) in Chongqing area. Methods; We collected nasopharyngeal specimen by negative pressure suction from 1,106 children with CAP. The specimens were tested for respiratory pathogen by direct immunofluorescence respectively, bacterial culture and polymerase chain reaction (PCR). Antibodies against Mycoplasma ( MP) and Chlamydia ( CP) were detected by Enzyme Linked Immunosorbent Assay (ELISA) in sera. Results; (1) The overall positive rate of respiratory viruses was 48. 8% , among the viruses,the top detected virus was RSV (73. 7% ). (2) The overall positive rate of bacteria was 53. 3% , among the bacteria, the top detected bacteria was Streptococcus pneumoniae (SP) (21.4%). (3) MP and CP were positive in 67 cases (6. 1%) and 126 cases (11.4%), respectively. Mycoplasma and Chlamydia pneumoniae infections were more common in children older than 1 year. (4) Compound infections 427 cases (38. 6% ) , the mixed infections of bacteria and

  2. 社区获得性肺炎看似违反常规的抗感染治疗一例%Anti-infection Treatment of Community Acquired Pneumonia That Seems Unconventional:A Case Study

    Institute of Scientific and Technical Information of China (English)

    王希明

    2016-01-01

    社区获得性肺炎患者初始经验治疗失败时,临床常规根据痰培养及药敏试验结果选择抗生素,尤其是多次痰培养均为同一种细菌生长时,临床常把该结果作为选择抗生素的风向标。然而,受送检的痰液质量及实验室技术人员主观因素的影响,痰培养检出的优势菌不一定是致病菌。本文报道1例社区获得性肺炎患者,痰培养结果提示存在多种革兰阴性杆菌,但抗革兰阴性杆菌治疗无效,综合患者临床特征后,改为抗球菌治疗,患者体温恢复正常。当患者痰培养结果与临床特征不符时,临床医生不能盲目信任检查结果。如不存在误诊、特殊病原体感染、并发症、免疫抑制等情况,且充分抗杆菌(已覆盖耐药菌)治疗无效时,可实施抗球菌治疗。%When initial experiential therapy of community acquired pneumonia patients fails,we routinely choose drugs according to sputum culture and drug susceptibility results;especially when multiple sputum cultures showed the same kind of bacteria growing,we often take this result as the indicator of choosing antibiotics. However,influenced by the quality of sputum inspected and subjective factors of laboratory staff,the dominant bacteria cultured may not be pathogenic bacteria. The paper reported a case of community acquired pneumonia patients. In this case,the sputum culture results suggest many kinds of gram negative bacteria,and the anti gram negative bacilli treatment showed no efficacy;referring to clinical features of patients, the treatment was transferred to anti - coccus treatment,after which the body temperature of the patient returned to normal. When unconformity occurs between sputum culture and clinical features,clinical doctors should not strictly follow diagnosis results. If no misdiagnosis,special pathogenic infection,complication and immunosupression exist and the full anti - bacillus treatment(covering drug

  3. 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 h