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Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, Todi SK, Mohan A, Hegde A, Jagiasi BG, Krishna B, Rodrigues C, Govil D, Pal D, Divatia JV, Sengar M, Gupta M, Desai M, Rungta N, Prayag PS, Bhattacharya PK, Samavedam S, Dixit SB, Sharma S, Bandopadhyay S, Kola VR, Deswal V, Mehta Y, Singh YP, Myatra SN. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024; 28:S104-S216. [PMID: 39234229 PMCID: PMC11369928 DOI: 10.5005/jp-journals-10071-24677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/20/2024] [Indexed: 09/06/2024] Open
Abstract
How to cite this article: Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, et al. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024;28(S2):S104-S216.
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Affiliation(s)
- Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
| | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Subhash K Todi
- Department of Critical Care, AMRI Hospital, Kolkata, West Bengal, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Ashit Hegde
- Department of Medicine & Critical Care, P D Hinduja National Hospital, Mumbai, India
| | - Bharat G Jagiasi
- Department of Critical Care, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, Maharashtra, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St John's Medical College and Hospital, Bengaluru, India
| | - Camila Rodrigues
- Department of Microbiology, P D Hinduja National Hospital, Mumbai, India
| | - Deepak Govil
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Divya Pal
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mukesh Desai
- Department of Immunology, Pediatric Hematology and Oncology Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Narendra Rungta
- Department of Critical Care & Anaesthesiology, Rajasthan Hospital, Jaipur, India
| | - Parikshit S Prayag
- Department of Transplant Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Pradip K Bhattacharya
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Srinivas Samavedam
- Department of Critical Care, Ramdev Rao Hospital, Hyderabad, Telangana, India
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Sudivya Sharma
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Susruta Bandopadhyay
- Department of Critical Care, AMRI Hospitals Salt Lake, Kolkata, West Bengal, India
| | - Venkat R Kola
- Department of Critical Care Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Vikas Deswal
- Consultant, Infectious Diseases, Medanta - The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Yogendra P Singh
- Department of Critical Care, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Ruiz-Spinelli A, Waterer G, Rello J. Severe community-acquired pneumonia in the post COVID-19 era. Curr Opin Crit Care 2023; 29:400-406. [PMID: 37641523 DOI: 10.1097/mcc.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW The aim was to examine and summarize the most recent published literature in the last years stating the advances for treatment options and adjunctive therapies in patients hospitalized with severe community-acquired pneumonia (sCAP). Search was performed in PubMed, including observational studies, randomized controlled trials, systematic reviews and meta-analyses, and international guidelines. RECENT FINDINGS Regardless of a large number of published CAP guidelines, most of their recommendations are based on low-level evidence.Viruses have an increasing role as sCAP etiology with an impact on mortality. Accordingly, it is imperative to strengthen the demand for vaccines and newer antivirals. Considering an early monitoring of the immune response in patients with severe Influenza, may help to evaluate a personalized immunomodulatory strategy. Despite growing evidence, the use of corticosteroids as an adjunctive therapy in bacterial sCAP continues to be controversial. SUMMARY Mortality due to sCAP still remains undesirably high. This fact strengthens the need for more high-quality research to increase evidence. It also highlights the need for clinicians to be aware of the level of evidence of the stated recommendations, taking this into consideration before decision making.
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Affiliation(s)
- Alfonsina Ruiz-Spinelli
- Intensive Care Unit, Department of Critical Care, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Department of Medicine, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Grant Waterer
- Respiratory Department, University of Western Australia, Royal Perth Hospital, Perth, Australia
| | - Jordi Rello
- Global Health eCore, Vall d'Hebron Institute of Research (VHIR), Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Unité de Recherche FOVERA, Réanimation Douleur Urgences, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
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Fujikura Y, Somekawa K, Manabe T, Horita N, Takahashi H, Higa F, Yatera K, Miyashita N, Imamura Y, Iwanaga N, Mukae H, Kawana A. Aetiological agents of adult community-acquired pneumonia in Japan: systematic review and meta-analysis of published data. BMJ Open Respir Res 2023; 10:e001800. [PMID: 37751988 PMCID: PMC10533802 DOI: 10.1136/bmjresp-2023-001800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE Epidemiological information is essential in providing appropriate empiric antimicrobial therapy for pneumonia. This study aimed to clarify the epidemiology of community-acquired pneumonia (CAP) by conducting a systematic review of published studies in Japan. DESIGN Systematic review. DATA SOURCE PubMed and Ichushi web database (January 1970 to October 2022). ELIGIBILITY CRITERIA Clinical studies describing pathogenic micro-organisms in CAP written in English or Japanese, excluding studies on pneumonia other than adult CAP, investigations limited to specific pathogens and case reports. DATA EXTRACTION AND SYNTHESIS Patient setting (inpatient vs outpatient), number of patients, concordance with the CAP guidelines, diagnostic criteria and methods for diagnosing pneumonia pathogens as well as the numbers of each isolate. A meta-analysis of various situations was performed to measure the frequency of each aetiological agent. RESULTS Fifty-six studies were included and 17 095 cases of CAP were identified. Pathogens were undetectable in 44.1% (95% CI 39.7% to 48.5%). Streptococcus pneumoniae was the most common cause of CAP requiring hospitalisation or outpatient care (20.0% (95% CI 17.2% to 22.8%)), followed by Haemophilus influenzae (10.8% (95% CI 7.3% to 14.3%)) and Mycoplasma pneumoniae (7.5% (95% CI 4.6% to 10.4%)). However, when limited to CAP requiring hospitalisation, Staphylococcus aureus was the third most common at 4.9% (95% CI 3.9% to 5.8%). Pseudomonas aeruginosa was more frequent in hospitalised cases, while atypical pathogens were less common. Methicillin-resistant S. aureus accounted for 40.7% (95% CI 29.0% to 52.4%) of S. aureus cases. In studies that used PCR testing for pan-respiratory viral pathogens, human enterovirus/human rhinovirus (9.4% (95% CI 0% to 20.5%)) and several other respiratory pathogenic viruses were detected. The epidemiology varied depending on the methodology and situation. CONCLUSION The epidemiology of CAP varies depending on the situation, such as in the hospital versus outpatient setting. Viruses are more frequently detected by exhaustive genetic searches, resulting in a significant variation in epidemiology.
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Affiliation(s)
- Yuji Fujikura
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
- Department of Medical Risk Management and Infection Control, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan
| | - Kohei Somekawa
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Toshie Manabe
- Graduate School of Medical Science, Nagoya City University, Nagoya, Aichi, Japan
- West Medical Center, Nagoya City University, Nagoya, Aichi, Japan
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Hiroshi Takahashi
- Department of Respiratory Medicine, Saka General Hospital, Shiogama, Miyagi, Japan
| | - Futoshi Higa
- Division of Respiratory Medicine, National Hospital Organization Okinawa National Hospital, Ginowan, Okinawa, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan
| | - Naoyuki Miyashita
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yoshifumi Imamura
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki, Nagasaki, Japan
| | - Naoki Iwanaga
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Nagasaki, Japan
| | - Akihiko Kawana
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
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Hu C, Zeng Y, Zhong Z, Yang L, Li H, Zhang HM, Xia H, Jiang MY. Clinical characteristics and severity prediction score of Adenovirus pneumonia in immunocompetent adult. PLoS One 2023; 18:e0281590. [PMID: 36795764 PMCID: PMC9934457 DOI: 10.1371/journal.pone.0281590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 01/26/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Compared with children and immunocompromised patients, Adenovirus pneumonia in immunocompetent adults is less common. Evaluation of the applicability of severity score in predicting intensive care unit (ICU) admission of Adenovirus pneumonia is limited. METHODS We retrospectively reviewed 50 Adenovirus pneumonia inpatients in Xiangtan Central Hospital from 2018 to 2020. Hospitalized patients with no pneumonia or immunosuppression were excluded. Clinical characteristics and chest image at the admission of all patients were collected. Severity scores, including Pneumonia severity index (PSI), CURB-65, SMART-COP, and PaO2/FiO2 combined lymphocyte were evaluated to compare the performance of ICU admission. RESULTS Fifty inpatients with Adenovirus pneumonia were selected, 27 (54%) non-ICU and 23 (46%) ICU. Most patients were men (40 [80.00%]). Age median was 46.0 (IQR 31.0-56.0). Patients who required ICU care (n = 23) were more likely to report dyspnea (13[56.52%] vs 6[22.22%]; P = 0.002) and have lower transcutaneous oxygen saturation ([90% (IQR, 90-96), 95% (IQR, 93-96)]; P = 0.032). 76% (38/50) of patients had bilateral parenchymal abnormalities, including 91.30% (21/23) of ICU patients and 62.96% (17/27) of non-ICU patients. 23 Adenovirus pneumonia patients had bacterial infections, 17 had other viruses, and 5 had fungi. Coinfection with virus was more common in non-ICU patients than ICU patients (13[48.15%]VS 4[17.39%], P = 0.024), while bacteria and fungi not. SMART-COP exhibited the best ICU admission evaluation performance in Adenovirus pneumonia patients (AUC = 0.873, p < 0.001) and distributed similar in coinfections and no coinfections (p = 0.26). CONCLUSIONS In summary, Adenovirus pneumonia is not uncommon in immunocompetent adult patients who are susceptible to coinfection with other etiological illnesses. The initial SMART-COP score is still a reliable and valuable predictor of ICU admission in non-immunocompromised adult inpatients with adenovirus pneumonia.
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Affiliation(s)
- Chao Hu
- Department of Respiratory and Critical Medicine, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
| | - Ying Zeng
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
| | - Zhi Zhong
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
| | - Li Yang
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
| | - Hui Li
- Department of Respiratory and Critical Medicine, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
| | - Huan Ming Zhang
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
| | - Hong Xia
- Department of Orthopedics, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
- * E-mail: (MYJ); (HX)
| | - Ming Yan Jiang
- Department of Respiratory and Critical Medicine, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
- * E-mail: (MYJ); (HX)
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Gu X, Gao R, Li Y, Liu J, Wu Y, Xu H. Combination effect of azithromycin with TCM preparation Xiyanping injection against Klebsiella pneumoniae infection in rats. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 104:154332. [PMID: 35853301 DOI: 10.1016/j.phymed.2022.154332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/03/2022] [Accepted: 07/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Klebsiella pneumoniae is known as one of the most principal opportunistic human pathogens. Although antibiotics such as the first-line agent azithromycin (AZM) usually are efficient for the treatment of K. pneumonia-related infections, growing threat from antibiotic resistance has become a major challenge. Various preparations based on traditional Chinese medicine (TCM) clinical experience have been developed to help combat such a global public health threat, including Xiyanping injection (XYP) that is made from the natural product andrographolide with potent heat-clearing and toxin-resolving functions. PURPOSE The present study aimed to demonstrate the therapeutic potential, as well as the action of mechanism of AZM in combination with XYP against K. pneumonia infection in rats. METHODS Pneumonia model of K. pneumoniae infection in rats was established and subjected to various treatments. The lung histopathological lesions were evaluated. ELISA and Griess techniques were used to determine the level of crucial cytokines. The protein expressions of MAPKs and NF-κB pathways were analyzed by Western blotting. RESULTS The combination in vivo could significantly inhibit the proliferation of K. pneumoniae in lung, improve the pathological changes of lung and reduce inflammatory factors in lung homogenate and bronchoalveolar lavage fluid, mainly by inactivating MAPKs and NF-κB signaling pathways. Combination therapy caused one-fold increase in apparent distribution volume of AZM in rats after multiple dosing, along with a significant increase of AZM level in lungs but obvious decrease in livers. CONCLUSION The combination therapy of AZM and XYP showed increased antibacterial and anti-inflammatory properties, indicating that it might be used to treat K. pneumoniae infection.
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Affiliation(s)
- Xuejing Gu
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Yantai University, Yantai 264005, China
| | - Rongrong Gao
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Yantai University, Yantai 264005, China
| | - Yanli Li
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Yantai University, Yantai 264005, China; Department of Pharmacy, Binzhou Hospital of Traditional Chinese Medicine, Binzhou 256601, China
| | - Jiali Liu
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Yantai University, Yantai 264005, China
| | - Yan Wu
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Yantai University, Yantai 264005, China
| | - Hui Xu
- School of Pharmacy, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Key Laboratory of Molecular Pharmacology and Drug Evaluation, Yantai University, Yantai 264005, China.
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Darie AM, Stolz D. Multiplex bacterial PCR for antibiotic stewardship in pneumonia - Author's reply. THE LANCET. RESPIRATORY MEDICINE 2022; 10:e79. [PMID: 35926546 DOI: 10.1016/s2213-2600(22)00269-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Andrei M Darie
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel 4031, Switzerland
| | - Daiana Stolz
- Department of Clinical Research, University Hospital Basel, Basel 4031, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Gómez-Zorrilla S, Sendra E, Horcajada JP. A profile of delafloxacin in the treatment of adults with community-acquired bacterial pneumonia. Expert Rev Clin Pharmacol 2022; 15:671-688. [PMID: 35838033 DOI: 10.1080/17512433.2022.2100346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Community-acquired bacterial pneumonia (CABP) is the most common infectious cause of hospital admission in adults, and poses a significant clinical and economic burden. At the same time, antimicrobial resistance is increasing worldwide with only a few new antibiotics developed in recent years. Delafloxacin is an anionic fluoroquinolone available in intravenous and oral formulations and with a broad spectrum of activity targeting Gram-positives, including methicillin-resistant Staphylococcus aureus (MRSA), gram-negative organisms, and atypical and anaerobic organisms. It also has a better adverse event profile compared to other fluoroquinolones. AREAS COVERED This article reviews the current epidemiology of CABP, etiologic agents and current resistance rates, current treatment guidelines, characteristics of delafloxacin (chemistry, microbiology, PK/PD), clinical efficacy and safety in pneumonia and other indications, and regulatory affairs. EXPERT OPINION : Delafloxacin's susceptibility profile against respiratory pathogens, bioequivalent intravenous and oral formulations and favorable safety profile, support its use for the treatment of CABP. It could be useful as empirical treatment in countries with high rates of penicillin-resistant S. pneumoniae and in patients with suspected or documented pneumonia due to MRSA. In post-influenza staphylococcal bacterial pneumonia, MRSA could be also considered an important pathogen.
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Affiliation(s)
- Silvia Gómez-Zorrilla
- Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Elena Sendra
- Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Juan P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
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Utility of Polymerase Chain Reaction in Nasopharyngeal Swabs for Identifying Respiratory Bacteria Causing Community-Acquired Pneumonia. Microbiol Spectr 2022; 10:e0037922. [PMID: 35583335 PMCID: PMC9241648 DOI: 10.1128/spectrum.00379-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Timely identification of a pathogen in lower respiratory tract infections (LRTI) can support appropriate antibiotics use. The difficulty of obtaining lower respiratory tract (LRT) samples limits the utility of point-of-care syndromic molecular assays. We assessed the performance of the FilmArray Pneumonia plus panel (FilmArray PP) in nasopharyngeal (NP) swab for detection of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Patients in the study included retrospectively consenting adults who attended the emergency department of Lausanne University Hospital between February 2019 and August 2020 for a community-acquired LRTI, with available NP swab and a high-quality LRT sample. These samples were tested with the FilmArray PP (cutoff of ≥104 copies/mL). Positive (PPA) and negative percent agreement (NPA) of FilmArray PP in NP swab were calculated, using (i) FilmArray PP in LRT sample and (ii) standard microbiological tests as reference standards. To assess the performance of a lower detection cutoff, NP samples were also tested with an in-house PCR (cutoff of ≥10 copies/mL) for S. pneumoniae and H. influenzae. Overall, 118 patients were included. FilmArray PP in LRT sample and standard microbiology tests detected S. pneumoniae in 19/118 and 12/118, H. influenzae in 44/118 and 19/118, and M. catarrhalis in 14/118 and 0/118, respectively. Using LRT FilmArray PP as reference, PPA and NPA of FilmArray PP on NP were 58% and 100% for S. pneumoniae, 61% and 100% for H. influenzae, and 57% and 99% for M. catarrhalis. Using standard diagnostic tests as reference, PPA and NPA were 58% and 96% for S. pneumoniae, 74% and 87% for H. influenzae, and indefinite and 92% for M. catarrhalis. Using a lower cutoff on NP (≥102 copies/mL), PPA was 68% for S. pneumoniae and 77% for H. influenzae with LRT FilmArray PP as reference. FilmArray PP in NP swabs has a limited PPA for identifying the most common etiologies of community-acquired LRTI irrespective of the reference standard, preventing its use for withholding antibiotics. The PCR detection cutoff does not explain the low PPA. The excellent NPA suggests the use of NP PCR results for rapidly targeted antimicrobial therapy. IMPORTANCE Timely identification of a pathogen in patients with lower respiratory tract infections is of paramount importance to avoid inappropriate antibiotic prescription. We aimed to evaluate the performance of a rapid syndromic molecular assay in nasopharyngeal swabs for identifying the most common bacterial causes of lower respiratory tract infections in adults (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis). Our data show that nasopharyngeal molecular assay has a good concordance with lower respiratory tract sample when positive but not when negative. A positive result is therefore concordant with a lower respiratory tract infection and can be used to target antibiotics. Nevertheless, a negative result does not have a good concordance, so it cannot be used to withhold antibiotics. Our findings illustrate the potential utility of these easily collected samples for the management of patients with lower respiratory tract infections.
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Abstract
PURPOSE OF REVIEW Community-acquired pneumonia (CAP) is known as a major worldwide health concern considering it has been shown to account for 78% of infection-related deaths in the USA. It is a common cause for hospitalization with a continued incidence rise in the elderly, high mortality rate and long-term sequelae in critically ill patients. Severe CAP (sCAP) is an accepted terminology used to describe ICU admitted patients with CAP. The aim of this review is to further report on the major advances in treatment for patients with sCAP including new antibiotic treatments despite macrolide resistance as seen in the ICU, and multifaceted antibiotic stewardship interventions that may lead to the reduction broad-spectrum antibiotic use in CAP. RECENT FINDINGS We aim to examine the most recent findings in order to determine appropriate empirical antibiotic choices, timing regimens and evidence for clinical effectiveness. This will be addressed by focusing on the use combination therapies, the usefulness of severity scores and the difficulty to treat multidrug-resistant pathogens, including gram negatives such as Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. Relevant reports referenced within included randomized controlled trials, meta-analyses, observational studies, systematic reviews and international guidelines where applicable. SUMMARY New antibiotics have been recently launched with direct agent-specific properties that have been shown to avoid the overuse of previous broad-spectrum antibiotics when treating patients sCAP. Although narrow-spectrum antibiotics are now recommended and imperative in improving a patients' prognosis, there are also some considerations when prescribing antibiotics that are beyond the spectrum. There is a need to implement effective policies of de-escalation to avoid antibiotic resistance and the risk for developing subsequent infections by combining informed clinical judgement and the application of biomarkers. Reaching clinical stability and avoidance of treatment failure are the most important pillars in treatment success.
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Cantón R, Barberán J, Linares M, Molero JM, Rodríguez-González-Moro JM, Salavert M, González Del Castillo J. Decalogue for the selection of oral antibiotics for lower respiratory tract infections. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:16-29. [PMID: 35041328 PMCID: PMC8790641 DOI: 10.37201/req/172.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/12/2022] [Indexed: 12/28/2022]
Abstract
Lower respiratory tract infections, including chronic obstructive pulmonary disease exacerbations (COPD-E) and community acquired pneumonia (CAP), are one of the most frequent reasons for consultation in primary care and hospital emergency departments, and are the cause of a high prescription of antimicrobial agents. The selection of the most appropriate oral antibiotic treatment is based on different aspects and includes to first consider a bacterial aetiology and not a viral infection, to know the bacterial pathogen that most frequently cause these infections and the frequency of their local antimicrobial resistance. Treatment should also be prescribed quickly and antibiotics should be selected among those with a quicker mode of action, achieving the greatest effect in the shortest time and with the fewest adverse effects (toxicity, interactions, resistance and/or ecological impact). Whenever possible, antimicrobials should be rotated and diversified and switched to the oral route as soon as possible. With these premises, the oral treatment guidelines for mild or moderate COPD-E and CAP in Spain include as first options beta-lactam antibiotics (amoxicillin and amoxicillin-clavulanate and cefditoren), in certain situations associated with a macrolide, and relegating fluoroquinolones as an alternative, except in cases where the presence of Pseudomonas aeruginosa is suspected.
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Affiliation(s)
- R Cantón
- Rafael Cantón. Servicio de Microbiología. Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). Madrid. Spain.
| | | | | | | | | | | | - J González Del Castillo
- Juan Gonzalez del Castillo. Servicio de Urgencias, Hospital Clínico San Carlos and Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
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Kyriazopoulou E, Karageorgos A, Liaskou-Antoniou L, Koufargyris P, Safarika A, Damoraki G, Lekakis V, Saridaki M, Adamis G, Giamarellos-Bourboulis EJ. BioFire ® FilmArray ® Pneumonia Panel for Severe Lower Respiratory Tract Infections: Subgroup Analysis of a Randomized Clinical Trial. Infect Dis Ther 2021; 10:1437-1449. [PMID: 34120316 PMCID: PMC8197784 DOI: 10.1007/s40121-021-00459-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The epidemiology of severe lower respiratory tract infections (LRTI) is constantly changing. We aimed to describe it using the BioFire® FilmArray® Pneumonia plus (PNplus) Panel. METHODS In a sub-study of the PROGRESS trial, sputum samples of 90 patients with sepsis and LRTI were retrospectively studied. The primary endpoint was the comparative detection rate of pathogens between conventional microbiology and PNplus Panel; secondary endpoints were microbiology and the association with the inflammatory host response. RESULTS Fifty-six patients with community-acquired pneumonia without risk factors for multidrug-resistant (MDR) pathogens and another 34 patients with risk factors for MDR were studied; median pneumonia severity index (PSI) was 113 (88-135). PNplus detection rate was 72.2% compared to 10% by conventional microbiology (p < 0.001); Streptococcus pneumoniae was the most common pathogen. PSI and procalcitonin were greater among patients with bacterial pathogens than viral pathogens. Median procalcitonin was 0.49 ng/ml and 0.18 ng/ml among patients with ≥ 105 and < 105 copies/ml of detected bacteria, respectively (p = 0.004). Resistance reached 14.4%. CONCLUSION PNplus detects severe pneumonia pathogens at a greater rate than conventional microbiology. High levels of inflammation accompany bacterial detection. TRIAL REGISTRATION PROGRESS, ClinicalTrials.gov NCT03333304, 06/11/2017.
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Affiliation(s)
- Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, Medical School, ATTIKON University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Athanasios Karageorgos
- 4th Department of Internal Medicine, Medical School, ATTIKON University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Lydia Liaskou-Antoniou
- 4th Department of Internal Medicine, Medical School, ATTIKON University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Panagiotis Koufargyris
- 4th Department of Internal Medicine, Medical School, ATTIKON University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Asimina Safarika
- 4th Department of Internal Medicine, Medical School, ATTIKON University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Georgia Damoraki
- 4th Department of Internal Medicine, Medical School, ATTIKON University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Vasileios Lekakis
- 4th Department of Internal Medicine, Medical School, ATTIKON University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Maria Saridaki
- 4th Department of Internal Medicine, Medical School, ATTIKON University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - George Adamis
- 1st Department of Internal Medicine, G. Gennimatas General Hospital, Athens, Greece
| | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Medical School, ATTIKON University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece.
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12
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Niederman MS, Baron RM, Bouadma L, Calandra T, Daneman N, DeWaele J, Kollef MH, Lipman J, Nair GB. Initial antimicrobial management of sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:307. [PMID: 34446092 PMCID: PMC8390082 DOI: 10.1186/s13054-021-03736-w] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 02/08/2023]
Abstract
Sepsis is a common consequence of infection, associated with a mortality rate > 25%. Although community-acquired sepsis is more common, hospital-acquired infection is more lethal. The most common site of infection is the lung, followed by abdominal infection, catheter-associated blood steam infection and urinary tract infection. Gram-negative sepsis is more common than gram-positive infection, but sepsis can also be due to fungal and viral pathogens. To reduce mortality, it is necessary to give immediate, empiric, broad-spectrum therapy to those with severe sepsis and/or shock, but this approach can drive antimicrobial overuse and resistance and should be accompanied by a commitment to de-escalation and antimicrobial stewardship. Biomarkers such a procalcitonin can provide decision support for antibiotic use, and may identify patients with a low likelihood of infection, and in some settings, can guide duration of antibiotic therapy. Sepsis can involve drug-resistant pathogens, and this often necessitates consideration of newer antimicrobial agents.
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Affiliation(s)
- Michael S Niederman
- Pulmonary and Critical Care Medicine, New York Presbyterian/Weill Cornell Medical Center, 425 East 61st St, New York, NY, 10065, USA.
| | - Rebecca M Baron
- Harvard Medical School; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Lila Bouadma
- AP-HP, Bichat Claude Bernard, Medical and Infectious Diseas ICU, University of Paris, Paris, France
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lusanne University Hospital, University of Lusanne, Lusanne, Switzerland
| | - Nick Daneman
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jan DeWaele
- Department of Critical Care Medicine, Surgical Intensive Care Unit, Ghent University, Ghent, Belgium
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey Lipman
- Royal Brisbane and Women's Hospital and Jamieson Trauma Institute, The University of Queensland, Brisbane, Australia.,Nimes University Hospital, University of Montpelier, Nimes, France
| | - Girish B Nair
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
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13
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Christensen MA, Nevers M, Ying J, Haroldsen C, Stevens V, Jones MM, Yarbrough PM, Goetz MB, Restrepo MI, Madaras-Kelly K, Samore MH, Jones BE. Simulated Adoption of 2019 Community-Acquired Pneumonia Guidelines Across 114 Veterans Affairs Medical Centers: Estimated Impact on Culturing and Antibiotic Selection in Hospitalized Patients. Clin Infect Dis 2021; 72:S59-S67. [PMID: 33512530 DOI: 10.1093/cid/ciaa1604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/20/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The 2019 American Thoracic Society/Infectious Diseases Society of America guidelines for community-acquired pneumonia (CAP) revised recommendations for culturing and empiric broad-spectrum antibiotics. We simulated guideline adoption in Veterans Affairs (VA) inpatients. METHODS For all VA acute hospitalizations for CAP from 2006-2016 nationwide, we compared observed with guideline-expected proportions of hospitalizations with initial blood and respiratory cultures obtained, empiric antibiotic therapy with activity against methicillin-resistant Staphylococcus aureus (anti-MRSA) or Pseudomonas aeruginosa (antipseudomonal), empiric "overcoverage" (receipt of anti-MRSA/antipseudomonal therapy without eventual detection of MRSA/P. aeruginosa on culture), and empiric "undercoverage" (lack of anti-MRSA/antipseudomonal therapy with eventual detection on culture). RESULTS Of 115 036 CAP hospitalizations over 11 years, 17 877 (16%) were admitted to an intensive care unit (ICU). Guideline adoption would slightly increase respiratory culture (30% to 36%) and decrease blood culture proportions (93% to 36%) in hospital wards and increase both respiratory (40% to 100%) and blood (95% to 100%) cultures in ICUs. Adoption would decrease empiric selection of anti-MRSA (ward: 27% to 1%; ICU: 61% to 8%) and antipseudomonal (ward: 25% to 1%; ICU: 54% to 9%) therapies. This would correspond to greatly decreased MRSA overcoverage (ward: 27% to 1%; ICU: 56% to 8%), slightly increased MRSA undercoverage (ward: 0.6% to 1.3%; ICU: 0.5% to 3.3%), with similar findings for P. aeruginosa. For all comparisons, P < .001. CONCLUSIONS Adoption of the 2019 CAP guidelines in this population would substantially change culturing and empiric antibiotic selection practices, with a decrease in overcoverage and slight increase in undercoverage for MRSA and P. aeruginosa.
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Affiliation(s)
| | - McKenna Nevers
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Jian Ying
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Candace Haroldsen
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Vanessa Stevens
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Makoto M Jones
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Peter M Yarbrough
- Department of Internal Medicine, Veterans Affairs Salt Lake City Health Care System and University of Utah, Salt Lake City, Utah, USA
| | - Matthew Bidwell Goetz
- Division of Infectious Disease, Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Marcos I Restrepo
- Division of Pulmonary and Critical Care, South Texas Veterans Health Care System and UT Health San Antonio, San Antonio, Texas, USA
| | - Karl Madaras-Kelly
- Pharmacy Service, Veterans Affairs Boise Idaho and Idaho State University, Boise, Idaho, USA
| | - Matthew H Samore
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Barbara Ellen Jones
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Pulmonary and Critical Care, University of Utah, Salt Lake City, Utah, USA
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14
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Oh H, Heo ST, Kim M, Kim YR, Yoo JR. Antimicrobial Susceptibility Trends of Streptococcus pneumoniae by Age Groups Over Recent 10 Years in a Single Hospital in South Korea. Yonsei Med J 2021; 62:306-314. [PMID: 33779084 PMCID: PMC8007430 DOI: 10.3349/ymj.2021.62.4.306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/26/2020] [Accepted: 01/11/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Streptococcus pneumoniae (S. pneumoniae) causes respiratory tract infections. Its non-vaccine serotypes and multidrug-resistant pneumococcal diseases have increased during the post-pneumococcal vaccination era. Therefore, it is important to understand the regional and age-related antimicrobial susceptibility of S. pneumoniae to select appropriate empirical antimicrobials. MATERIALS AND METHODS We retrospectively studied trends in the antimicrobial resistance of S. pneumoniae to commonly prescribed antibiotics in patient groups of various ages at a single teaching hospital in Jeju Island from 2009 to 2018. RESULTS In total, 1460 S. pneumoniae isolates were obtained during the study period. The overall antimicrobial resistance rates of S. pneumoniae to penicillin, erythromycin, ceftriaxone, levofloxacin, and vancomycin were 16.2%, 84.7%, 25.9%, 3.3%, and 0.0%, respectively, and the MDR rate was 6.7%. Erythromycin and ceftriaxone resistance rates increased by years; however, they were significantly reduced in adult groups. Levofloxacin resistance and MDR rates were also higher in adult groups. Overall, the MDR rate significantly increased during the recent 10 years, as well as in patients with a history of hospitalization within 90 days [odds ratio (OR)=3.58, 95% confidence interval (CI)=1.91-6.71] and sinusitis (OR=4.98, 95% CI=2.07-11.96). CONCLUSION Erythromycin and ceftriaxone resistance rates and the MDR rate of S. pneumoniae significantly increased during the recent 10 years; the trends in individual antimicrobial resistance rates significantly differed between the age groups. This study indicates the need for caution when using ceftriaxone as an empirical antimicrobial against pneumococcal infections.
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Affiliation(s)
- Hyunjoo Oh
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
| | - Sang Taek Heo
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Misun Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
| | - Young Ree Kim
- Department of Laboratory Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jeong Rae Yoo
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
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15
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Dessie T, Jemal M, Maru M, Tiruneh M. Multiresistant Bacterial Pathogens Causing Bacterial Pneumonia and Analyses of Potential Risk Factors from Northeast Ethiopia. Int J Microbiol 2021; 2021:6680343. [PMID: 33763137 PMCID: PMC7964111 DOI: 10.1155/2021/6680343] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Pneumonia is the most common cause of morbidity and mortality in developing countries, mostly caused by different species of bacterial pathogens. Hence, patient management needs awareness of the pathogens and antimicrobial susceptibility testing (AST). This study was aimed to assess the type of bacterial isolates and their antimicrobial susceptibility patterns among pneumonia suspected patients at Dessie Referral Hospital, Northeast Ethiopia. Potential risk factors were also assessed to apply preventive measures accordingly. MATERIALS AND METHODS A cross-sectional study design was employed among pneumonia suspected patients from February to April 2020 at Dessie Referral Hospital. Sociodemographic characteristics and associated risk factors were collected using a pretested questionnaire, and clinical data were extracted by reviewing medical records. Sputum specimens were collected and inoculated into chocolate agar, blood agar, mannitol salt agar, and MacConkey agar which are then incubated at 35°C or 37°C for 24-48 hours. Bacterial species were identified based on Gram stain, colony characteristics, and biochemical techniques. The data were entered in to Epi-Info version 7.1.5 and analyzed with SPSS software version 20. p value <0.05 at 95% CI was considered as statistically significant. RESULTS A total of 406 sputum specimens were collected and cultured, among which 157 (38.7%) were positive for different bacterial pathogens. The predominant pathogens were Klebsiella pneumoniae (28.0%), Streptococcus pneumoniae (24.8%), Staphylococcus aureus (18.5%), and Pseudomonas aeruginosa (14.0%). Majority of the isolates exhibited resistance to ampicillin with 81.5% followed by penicillin with 75.9% and amoxicillin-clavulanate with 61.2%. Multivariable logistic regression showed a significant association of culture positivity with older age (AOR = 2.43, CI: 1.12-5.28, p value = 0.025), cigarette smoking (AOR = 4.67, CI: 2.39-9.20, p value <0.001), and alcohol use (AOR = 5.58, CI: 3.14-9.92, p value <0.001). Resistance to ampicillin and penicillin was associated with repeated prescription and use. CONCLUSIONS This study found high prevalence of bacterial pneumonia in the study area, and high rate of bacterial resistance was observed in ampicillin, penicillin, and amoxicillin-clavulanate. Repeated prescriptions and use of antimicrobials were significantly independent factors of bacterial resistance. Therefore, patient management needs identification of bacteria by routine culture with antimicrobial susceptibility testing.
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Affiliation(s)
- Tewodros Dessie
- Amhara Public Health Institute, Dessie Branch, P.O. Box 686, Dessie, Ethiopia
| | - Mohabaw Jemal
- University of Gondar, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, P.O. Box 196, Gondar, Ethiopia
| | - Minwuyelet Maru
- Amhara Public Health Institute, Dessie Branch, P.O. Box 686, Dessie, Ethiopia
| | - Moges Tiruneh
- University of Gondar, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, P.O. Box 196, Gondar, Ethiopia
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16
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Gupta V, Yu KC, Schranz J, Gelone SP. A Multicenter Evaluation of the US Prevalence and Regional Variation in Macrolide-Resistant S. pneumoniae in Ambulatory and Hospitalized Adult Patients in the United States. Open Forum Infect Dis 2021; 8:ofab063. [PMID: 34250183 PMCID: PMC8266646 DOI: 10.1093/ofid/ofab063] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/29/2021] [Indexed: 01/16/2023] Open
Abstract
Macrolide resistance was found in 39.5% of 3626 nonduplicate Streptococcus pneumoniae isolates from adult ambulatory and inpatient settings at 329 US hospitals (2018–2019). Macrolide resistance was significantly higher for respiratory vs blood isolates and ambulatory vs inpatient settings. Despite geographic variation, S. pneumoniae macrolide resistance was >25% in most regions.
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Affiliation(s)
- Vikas Gupta
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Kalvin C Yu
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
| | - Jennifer Schranz
- Nabriva Therapeutics US, Inc., King of Prussia, Pennsylvania, USA
| | - Steven P Gelone
- Nabriva Therapeutics US, Inc., King of Prussia, Pennsylvania, USA
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17
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Rattani S, Farooqi J, Jabeen G, Chandio S, Kash Q, Khan A, Jabeen K. Evaluation of semi-quantitative compared to quantitative cultures of tracheal aspirates for the yield of culturable respiratory pathogens - a cross-sectional study. BMC Pulm Med 2020; 20:284. [PMID: 33121470 PMCID: PMC7594958 DOI: 10.1186/s12890-020-01311-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background Diagnosis of lower respiratory tract infections (LRTI) depends on the presence of clinical, radiological and microbiological findings. Endotracheal suction aspirate (ETSA) is the commonest respiratory sample sent for culture from intubated patients. Very few studies have compared quantitative and semi-quantitative processing of ETSA cultures for LRTI diagnosis. We determined the diagnostic accuracy of quantitative and semi-quantitative ETSA culture for LRTI diagnosis, agreement between the quantitative and semi quantitative culture techniques and the yield of respiratory pathogens with both methods. Methods This was a cross-sectional study conducted at the Aga Khan University clinical laboratory, Karachi, Pakistan. One hundred and seventy-eight ETSA samples sent for routine bacteriological cultures were processed quantitatively as part of regular specimen processing method and semi-quantitatively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for both methods using clinical diagnosis of pneumonia as reference standard. Agreement between the quantitative and semi quantitative methods was assessed via the kappa statistic test. Pathogen yield between the two methods was compared using Pearson’s chi-square test. Results The quantitative and semi-quantitative methods yielded pathogens in 81 (45.5%) and 85 (47.8%) cases respectively. There was complete concordance of both techniques in 155 (87.1%) ETSA samples. No growth was observed in 45 (25.3%) ETSA specimens with quantitative culture and 37 (20.8%) cases by semi-quantitative culture. The diagnostic accuracy of both techniques were comparable; 64.6% for quantitative and 64.0% for semi-quantitative culture. The kappa agreement was found to be 0.84 (95% CI, 0.77–0.91) representing almost perfect agreement between the two methods. Although semi-quantitative cultures yielded more pathogens (47.8%) as compared to quantitative ETSA cultures (45.5%), the difference was only 2.3%. However, this difference achieved statistical (chi-square p-value < 0.001) favoring semi-quantitative culture methods over quantitative culture techniques for processing ETSA. Conclusion In conclusion, there is a strong agreement between the performances of both methods of processing ETSA cultures in terms of accuracy of LRTI diagnosis. Semi-quantitative cultures of ETSA yielded more pathogens as compared to quantitative cultures. Although both techniques were comparable, we recommend processing of ETSA using semi-quantitative technique due to its ease and reduced processing time.
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Affiliation(s)
- Salima Rattani
- Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Joveria Farooqi
- Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Ghazala Jabeen
- Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Saeeda Chandio
- Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Qaiser Kash
- Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Aijaz Khan
- Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Kauser Jabeen
- Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
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