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Yagi Y, Yanagisawa N, Higuchi S, Okazaki M, Kawada K, Ishida T, Jobu K, Arakawa Y, Kadota T, Kawanishi Y, Fukuda H, Ueba T, Yamagishi Y, Hamada Y. Outcome evaluation of pharmacist-physician collaborative protocol-based antimicrobial treatment for hospitalized stroke patients with aspiration pneumonia. J Infect Chemother 2024:S1341-321X(24)00269-1. [PMID: 39313149 DOI: 10.1016/j.jiac.2024.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVES To evaluate the efficacy and patient outcomes of pharmacist-physician collaborative protocol-based antimicrobial treatment regimens for antimicrobial stewardship. METHODS Patients treated for aspiration pneumonia due to stroke within 48 h after admission to Kochi Medical School Hospital (January 2019 to December 2022) were included. Primary outcomes were the cumulative number of days of antimicrobial treatment and length of hospital stay. Secondary outcomes included the percentage of patients under-dosed with first-choice antimicrobial agents and inpatient mortality. RESULTS Group A (66 patients) did not receive the antimicrobial treatment protocol, whereas group B (46 patients) did. There were no differences in the patient backgrounds. Group B had a significantly lower percentage of patients who were undertreated with the first-choice antimicrobial agent (9.1 % vs. 42.9 %). There was no significant difference in inpatient mortality between group A and group B (6.1 % vs. 4.3 %). The cumulative number of days of antimicrobial administration and the length of hospital stay were significantly lower in group B: 7.0 days (95 % CI, 6.0-8.0) vs. 9.0 days (95 % CI, 8.0-11.0) for antimicrobial administration, and 28.5 days (95 % CI, 22.0-35.0) vs. 43.0 days (95 % CI, 28.0-55.0) for hospital stay. CONCLUSIONS Protocol-based antimicrobial treatment for aspiration pneumonia supports appropriate antimicrobial usage and improves patient quality of life. These findings will assist in the effective treatment of aspiration pneumonia in an aging society.
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Affiliation(s)
- Yusuke Yagi
- Department of Infection Prevention and Control, Kochi Medical School Hospital, Japan; Department of Pharmacy, Kochi Medical School Hospital, Japan
| | - Narika Yanagisawa
- Department of Infection Prevention and Control, Kochi Medical School Hospital, Japan; Department of Pharmacy, Kochi Medical School Hospital, Japan
| | - Shinya Higuchi
- Department of Neurosurgery, Kochi Medical School, Kochi University, Japan
| | - Moemi Okazaki
- Department of Infection Prevention and Control, Kochi Medical School Hospital, Japan; Department of Pharmacy, Kochi Medical School Hospital, Japan
| | - Kei Kawada
- Department of Clinical Pharmacy Practice Pedagogy, Tokushima University Graduate School of Biomedical Sciences, Japan; Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Tomoaki Ishida
- Department of Pharmacy, Kochi Medical School Hospital, Japan
| | - Kohei Jobu
- Department of Pharmacy, Kochi Medical School Hospital, Japan
| | - Yu Arakawa
- Department of Infection Prevention and Control, Kochi Medical School Hospital, Japan; Department of Clinical Infectious Diseases, Kochi Medical School, Kochi University, Japan
| | - Tomohito Kadota
- Department of Neurosurgery, Kochi Medical School, Kochi University, Japan
| | - Yu Kawanishi
- Department of Neurosurgery, Kochi Medical School, Kochi University, Japan
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kochi Medical School, Kochi University, Japan
| | - Tetsuya Ueba
- Department of Neurosurgery, Kochi Medical School, Kochi University, Japan
| | - Yuka Yamagishi
- Department of Infection Prevention and Control, Kochi Medical School Hospital, Japan; Department of Clinical Infectious Diseases, Kochi Medical School, Kochi University, Japan
| | - Yukihiro Hamada
- Department of Pharmacy, Kochi Medical School Hospital, Japan.
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Mikamo H, Nagashima M, Kusachi S, Fujimi S, Oshima N, De Anda C, Takase A. Efficacy and safety of tedizolid for the treatment of ventilated gram-positive hospital-acquired or ventilator-associated bacterial pneumonia in Japanese patients: Results from a subgroup analysis of a phase 3, randomized, double-blind study comparing tedizolid and linezolid. J Infect Chemother 2022; 28:1235-1241. [PMID: 35718656 DOI: 10.1016/j.jiac.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/13/2022] [Accepted: 04/27/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The results from the phase 3 study that evaluated the efficacy and safety of tedizolid phosphate, an oxazolidinone drug, for the treatment of gram-positive ventilated hospital-acquired bacterial pneumonia (vHABP)/ventilator-associated bacterial pneumonia (VABP) compared with linezolid (VITAL study), have been previously reported. We conducted a subgroup analysis to report the data obtained from Japanese patients enrolled in this study. METHODS Patients aged ≥18 years with vHABP/VABP likely to be caused by gram-positive cocci were randomized 1:1 to tedizolid phosphate 200 mg once daily for 7 days or linezolid 600 mg twice daily for 10 days. In both treatment groups, patients with concurrent gram-positive bacteremia were treated for 14 days. Primary efficacy endpoints were day 28 all-cause mortality (ACM) and investigator-assessed clinical response at test-of-cure (TOC) in the intention-to-treat population. Safety outcomes included assessment of treatment-emergent adverse events. RESULTS Fifty-three Japanese patients were randomized at received study drug (tedizolid, n = 28; linezolid, n = 25). Demographics and characteristics were generally similar between treatment groups. Rates of day 28 ACM were 10.7% and 20.0% with tedizolid and linezolid, respectively (difference, 9.3%; 95% CI, -10.1 to 28.7). Rates of investigator-assessed clinical cure at TOC were 78.6% and 72.0% with tedizolid and linezolid, respectively (difference, 6.6%; 95% CI, -16.7 to 29.8). Tedizolid phosphate was generally well tolerated and no new safety concerns were observed in the Japanese subgroup. CONCLUSION The results from this subgroup analysis suggest generally favorable efficacy and safety of tedizolid in adult Japanese patients with vHABP/VABP. (ClinicalTrials.gov identifier: NCT02019420).
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Affiliation(s)
- Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Makoto Nagashima
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Shinya Kusachi
- Department of Surgery, Toho Kamagaya Hospital, 594 Awano, Kamagaya, Chiba, 273-0132, Japan
| | - Satoshi Fujimi
- Department of Emergency Medicine, Osaka General Medical Center, 3-1-56 Bandai Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Nobuyuki Oshima
- Japan Development, MSD K.K., 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, 102-8667, Japan
| | - Carisa De Anda
- Global Clinical Development, Merck & Co., Inc., Rahway, NJ, USA
| | - Akiko Takase
- Japan Development, MSD K.K., 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, 102-8667, Japan.
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Mazloomirad F, Hasanzadeh S, Sharifi A, Nikbakht G, Roustaei N, Khoramrooz SS. Identification and detection of pathogenic bacteria from patients with hospital-acquired pneumonia in southwestern Iran; evaluation of biofilm production and molecular typing of bacterial isolates. BMC Pulm Med 2021; 21:408. [PMID: 34886838 PMCID: PMC8662843 DOI: 10.1186/s12890-021-01773-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/29/2021] [Indexed: 12/01/2022] Open
Abstract
Background Hospital-acquired pneumonia (HAP) is the second most common nosocomial infection in intensive care units (ICUs). The present study aims to determine the prevalence of pathogenic bacteria, their biofilm formation, and molecular typing from patients with HAP in southwestern Iran. Methods Fifty-eight patients with HAP participated in this cross-sectional study. Sputum and endotracheal aspirate were collected from each patient for isolation and detection of bacteria. Biofilm formation was evaluated using Congo red agar or Microtiter plate assay. The antimicrobial susceptibility patterns of the isolates were investigated. The multiplex polymerase chain reaction (M-PCR) technique was used to determine the Staphylococcal Cassette Chromosome mec (SCCmec) types of methicillin-resistant Staphylococcus aureus (MRSA) strains. All S. aureus isolates were typed using the agr typing method. A repetitive element sequence-based PCR (rep-PCR) typing method was used for typing of Gram-negative bacteria. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 15 and the chi-square test. Results Bacteria were isolated in 52 (89.7%) of patients. Acinetobacter baumannii (A. baumannii) was the most prevalent organism (37%), followed by S. aureus, Pseudomonas aeruginosa (P. aeruginosa), and Escherichia coli (E. coli). Using the PCR method, 56 bacteria were detected. A. baumannii was the most prevalent (35.7%) organism. A. baumannii and P. aeruginosa were biofilm-producing. All Gram-negative isolates were colistin-sensitive, and most of the A. baumannii isolates were multidrug-resistant (MDR). MRSA was identified in 12 (80%) S. aureus isolates, and 91.6% of MRSA were SCCmec type III. The agr type III was the most predominant. The rep-PCR analysis showed seven different patterns in 20 A. baumannii, six patterns in 13 P. aeruginosa, and four patterns in 6 E. coli. Conclusion A. baumannii was more prevalent than S. aureus in ventilator-associated pneumonia (VAP), while S. aureus is a major pathogen in non-ventilator hospital-acquired pneumonia (NV-HAP), possibly due to the tendency of the former to aquatic environments. Based on the rep-PCR typing method, it was concluded that bacteria were transmitted from patients or healthcare workers among different wards. Colistin can be used as a treatment in Gram-negative MDR isolates.
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Affiliation(s)
- Farzad Mazloomirad
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Sajad Hasanzadeh
- Department of Internal Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Asghar Sharifi
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Gordafarin Nikbakht
- Department of Infectious Diseases, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Narges Roustaei
- Department of Epidemiology and Biostatistics, School of Health and Nutrition Sciences, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Seyed Sajjad Khoramrooz
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran. .,Department of Microbiology, Yasuj University of Medical Sciences, Yasuj, Iran.
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Jiao J, Li Z, Wu X, Cao J, Liu G, Liu Y, Li F, Zhu C, Song B, Jin J, Liu Y, Wen X, Cheng S, Wan X. Risk factors for 3-month mortality in bedridden patients with hospital-acquired pneumonia: A multicentre prospective study. PLoS One 2021; 16:e0249198. [PMID: 33784317 PMCID: PMC8009424 DOI: 10.1371/journal.pone.0249198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 03/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mortality among patients with hospital-acquired pneumonia (HAP) is quite high; however, information on risk factors for short-term mortality in this population remains limited. The aim of the current study was to identify the risk factors for mortality in bedridden patients with HAP during a 3-month observation period. METHODS A secondary data analysis was conducted. In total, 1141 HAP cases from 25 hospitals were included in the analysis. Univariate and multilevel regression analyses were performed to identify the risk factors for mortality. RESULTS During the 3-month observation period, there were 189 deaths among bedridden patients with HAP. The mortality rate in this study was 16.56%. Multilevel regression analysis showed that ventilator-associated pneumonia (OR = 2.034, 95%CI: 1.256, 3.296, p = 0.004), pressure injuries (OR = 2.202, 95%CI: 1.258, 3.852, p = 0.006), number of comorbidities (OR = 1.076, 95%CI: 1.016,1.140, p = 0.013) and adjusted Charlson Comorbidity Index score (OR = 1.210, 95%CI: 1.090, 1.343, p<0.001) were associated with an increased risk of mortality, while undergoing surgery with general anaesthesia (OR = 0.582, 95%CI: 0.368, 0.920, p = 0.021) was associated with a decreased risk of mortality. CONCLUSIONS The identification of risk factors associated with mortality is an important step towards individualizing care plans. Our findings may help healthcare workers select high-risk patients for specific interventions. Further study is needed to explore whether appropriate interventions against modifiable risk factors, such as reduced immobility complications or ventilator-associated pneumonia, could improve the prognoses.
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Affiliation(s)
- Jing Jiao
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Zhen Li
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Jing Cao
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Ge Liu
- Department of Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Ying Liu
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Fangfang Li
- Department of Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College Hospital, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People’s Hospital, Zhengzhou, Henan Province, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Wuhan, Hubei Province, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People’s Hospital, Chengdu, Sichuan Province, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
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Suaya JA, Fletcher MA, Georgalis L, Arguedas AG, McLaughlin JM, Ferreira G, Theilacker C, Gessner BD, Verstraeten T. Identification of Streptococcus pneumoniae in hospital-acquired pneumonia in adults. J Hosp Infect 2020; 108:146-157. [PMID: 33176175 DOI: 10.1016/j.jhin.2020.09.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/29/2022]
Abstract
Hospital-acquired pneumonia (HAP) is often more severe and life-threatening than community-acquired pneumonia (CAP). The role of Streptococcus pneumoniae in CAP is well-understood, but its role in HAP is unclear. The objective of this study was to summarize the available literature on the prevalence of S. pneumoniae in HAP episodes. We searched MEDLINE for peer-reviewed articles on the microbiology of HAP in individuals aged ≥18 years, published between 2008 and 2018. We calculated pooled estimates of the prevalence of S. pneumoniae in episodes of HAP using a random-effects, inverse-variance-weighted meta-analysis. Forty-seven of 1908 articles met the inclusion criteria. Bacterial specimen isolation techniques for microbiologically defined HAP episodes included bronchoalveolar lavage, protective specimen brush, tracheobronchial aspirate and sputum, as well as blood culture. Culture was performed in all studies; five studies also used urine antigen detection (5/47; 10.6%). S. pneumoniae was identified in 5.1% (95% confidence interval (CI): 3.8-6.6%) of microbiologically defined HAP episodes (N = 20), with 5.4% (95% CI: 4.3-6.7%, N = 29) in ventilator-associated HAP and 6.0% (95% CI: 4.1-8.8%, N = 6) in non-ventilator-associated HAP. S. pneumoniae was identified in 5.3% (95% CI: 4.5-6.3%) of HAP occurring in the intensive care unit (ICU, N = 41) and in 5.6% (95% CI: 3.3-9.5%, N = 5) outside the ICU. A higher proportion of early-onset HAP (10.3%; 95% CI: 8.3-12.8%, N = 16) identified S. pneumoniae as compared with late-onset HAP (3.3%; 95% CI: 2.5-4.4%, N = 16). In conclusion, S. pneumoniae was identified by culture in 5.1% of microbiologically defined HAP episodes. The importance of HAP as part of the disease burden caused by S. pneumoniae merits further research.
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Affiliation(s)
- J A Suaya
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc., New York, NY, USA.
| | - M A Fletcher
- Emerging Markets Medical Affairs, Vaccines, Pfizer Inc., Paris, France
| | - L Georgalis
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - A G Arguedas
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc., New York, NY, USA
| | - J M McLaughlin
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc., New York, NY, USA
| | - G Ferreira
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - C Theilacker
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc., New York, NY, USA
| | - B D Gessner
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc., New York, NY, USA
| | - T Verstraeten
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
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Factors influencing mortality in hospital-acquired pneumonia caused by Gram-negative bacteria in China. J Infect Public Health 2019; 12:630-633. [PMID: 30824328 DOI: 10.1016/j.jiph.2019.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/17/2019] [Accepted: 02/06/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hospital-acquired pneumonia (HAP) remains an important cause of morbidity and mortality despite advances in antimicrobial therapy. The emergence of Gram-negative bacteria (GNB) is of major concern. The objective of this study was to describe the epidemiology, microbiology, and predictors of infection-related 30-day mortality in HAP with GNB. METHODS We performed a retrospective, single-center analysis of HAP patients with GNB occurring from January 2014 and December 2017. Univariate and multivariate analyses were performed to identify the risk factors for mortality. RESULTS During the observational period, there were 1472 cases of HAP; 314 cases were bacterial culture-positive, 269 cases were caused by GNB, with a predominance of Acinetobacter baumannii and Pseudomonas aeruginosa. The mortality related to GNB was 14.5% (39 deaths).In the multivariate logistic regression analysis, the risk factors for mortality were age >70 years, intensive care unit (ICU) admission, blood lymphocyte count < 0.8 × 109/L, multidrug-resistant Gram-negative bacteria(MDR-GNB) infection, and elevation of blood urea nitrogen(BUN) level. We identified these factors as significant predictors of GNB related mortality; the area under the receiver operating characteristic (ROC) curves was 0.836. CONCLUSION The results provided can help clinicians in identifying individuals who are at risk of infection-related 30-day mortality in HAP with GNB.
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Ishikawa S, Igari H, Yamagishi K, Takayanagi S, Yamagishi F. Microorganisms isolated at admission and treatment outcome in sputum smear-positive pulmonary tuberculosis. J Infect Chemother 2018; 25:45-49. [PMID: 30414723 DOI: 10.1016/j.jiac.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 10/27/2022]
Abstract
Cured or completed cases in newly diagnosed sputum smear-positive pulmonary tuberculosis (TB) is 47.7% in Japan in 2016. Aging of TB patients and their underlying conditions could affect treatment outcome. We analyzed the association between the isolation of microorganisms from sputum at admission and the 180-day mortality rate of the sputum smear-positive pulmonary TB patients in Chiba-East Hospital in Japan. Total subjects were 761 (median age: 63 years). Sputum test for microorganisms was conducted in 708 patients. Microorganisms other than the normal oral flora were isolated in 128 cases (18.1%). Details of the isolated microorganisms were as follows: methicillin-resistant Staphylococcus aureus 23 cases, Klebsiella pneumoniae 17 cases, Pseudomonas aeruginosa 16 cases. Mortality was significantly elevated in the patients with those microorganisms than the others (39.8% vs. 10.2%) (P < 0.01). Fifty-one of 128 patients with those microorganisms died, and 10 of them died of infectious disease, which is the most frequent cause of deaths. The factors associated with the isolation of those microorganisms were as follows: respiratory failure (adjusted odds ratio (aOR):2.5 [95% confidence interval (CI) 1.3-4.7]), performance status 3 or 4 (aOR:2.9 [95% CI 1.6-5.4]), serum albumin <3.0 mg/dL (aOR:2.1 [95% CI 1.3-3.6], age of 65 years or older (aOR:2.0 [95% CI 1.2-3.4]). Those strains were isolated from one of sixth patients. Patients with those microorganisms did not always develop infectious diseases; however, treatment outcomes were poor, with higher mortality. The isolations of microorganisms were associated with various underlying conditions, leading to death. Thus, attention should be paid to TB patients with the above factors.
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Affiliation(s)
- Satoru Ishikawa
- National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; Japan Community Health Care Organization Funabashi Central Hospital, Department of Internal Medicine, 6-13-10 Kaijin, Funabashi, Chiba 273-8556, Japan.
| | - Hidetoshi Igari
- National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; Chiba University Hospital, Division of Infection Control and Treatment, 1-8-1 Inohana, Chuoh-ku, Chiba 260-8677, Japan
| | - Kazutaka Yamagishi
- National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; Chiba University Hospital, Division of Infection Control and Treatment, 1-8-1 Inohana, Chuoh-ku, Chiba 260-8677, Japan
| | - Shin Takayanagi
- National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; Chiba University Hospital, Division of Infection Control and Treatment, 1-8-1 Inohana, Chuoh-ku, Chiba 260-8677, Japan
| | - Fumio Yamagishi
- National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan
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Parrott G, Nebeya D, Kinjo T, Miyagi K, Haranaga S, Higa F, Tateyama M, Fujita J. Etiological analysis and epidemiological comparison among adult CAP and NHCAP patients in Okinawa, Japan. J Infect Chemother 2017; 23:452-458. [PMID: 28431934 DOI: 10.1016/j.jiac.2017.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/03/2017] [Accepted: 03/30/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Etiological epidemiology and diagnosis are important issues for CAP and NHCAP. Despite the availability of effective therapies, significant morbidity and mortality ensues. METHODS We retrospectively analyzed the etiology of 200 pneumonia patients at the University of the Ryukyus Hospital. Patients were categorized into CAP (n = 97) or NHCAP (n = 103), according to the Japanese Respiratory Society guidelines. Diagnoses were made using clinical tests including, Gram stain, bacterial culture, serum and urinary tests. RESULTS Pathogens were detected in 71% of patients, and identified as the source of infection in 52% (104/200). The majority of patients suffered from Streptococcus pneumoniae (32/200), Haemophilus influenzae (22/200), and Moraxella catarrhalis (16/200). Gram stain guided pathogen-oriented therapy decisions for 38 of 96 patients with unknown pathogens. Atypical pathogens were only diagnosed in CAP patients (n = 5). Severity of pneumonia was related to male sex (p = 0.006), and preexisting conditions, such as chronic heart failure (p < 0.001) and COPD (p < 0.001). Risk factors associated with increased length of stay included chronic heart failure, chronic renal failure, other pulmonary diseases and diabetes. Mortality for NHCAP patients was associated with lung cancer and bronchiectasis. CAP patients were more frequently admitted during winter months, while NHCAP patients were admitted during all other seasons. Seasonal patterns for individual pathogens could not be determined. CONCLUSION Gram staining remains useful to guiding diagnostics. Pathogens affecting CAP and NHCAP patients were not significantly different; as such, attention should be focused on the management of underlying conditions. Clinical outcomes were not affected by guideline discordant therapy.
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Affiliation(s)
- Gretchen Parrott
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Japan.
| | - Daijiro Nebeya
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Japan
| | - Takeshi Kinjo
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Japan
| | - Kazuya Miyagi
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Japan
| | - Shusaku Haranaga
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Japan
| | - Futoshi Higa
- Department of Respiratory Medicine, National Hospital Organization Okinawa National Hospital, Japan
| | - Masao Tateyama
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Japan
| | - Jiro Fujita
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Japan
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Abstract
PURPOSE OF REVIEW Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) continue to present very significant diagnostic and management challenges. The development, introduction and use of a wider range of immunosuppressive therapies are leading to a broader spectrum of microorganisms causing HAP and VAP. The persistent clinical dilemma regarding their cause is that detection of a microorganism from a respiratory tract sample does not necessarily signify it is the causative agent of the pneumonia. The ever-increasing antibiotic resistance problem means that HAP and VAP are becoming progressively more difficult to treat. In this article, we review the cause, antimicrobial resistance, diagnosis and treatment of HAP and VAP and encapsulate recent developments and concepts in this rapidly moving field. RECENT FINDINGS Although the microbial causes of HAP and VAP remain at present similar to those identified in previous studies, there are marked geographical differences. Resistance rates among Gram-negative bacteria are continually increasing, and for any species, multiresistance is the norm rather than the exception. The development and introduction of rapid point-of-care diagnostics may improve understanding of the cause of HAP and VAP and has immense potential to influence the treatment and clinical outcomes in HAP/VAP, with patients likely to receive much faster, microorganism-specific treatment with obvious downstream improvements to clinical outcome and antimicrobial stewardship. SUMMARY We describe recent trends in aetiology of HAP and VAP and recent trends in antimicrobial resistance, including resistance mechanisms causing particular concern. The potential for novel molecular diagnostics to revolutionize the diagnosis and treatment of HAP/VAP is discussed.
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Methicillin-Resistant Staphylococcus aureus Pneumonia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e318282630e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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