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He YY, Sun J, Wu YE, Wang YB, van den Anker J, Hao GX, Sun DQ, Zhao W. Population pharmacokinetics and dose optimization of levofloxacin in elderly patients with pneumonia. Br J Clin Pharmacol 2024; 90:1213-1221. [PMID: 38317382 DOI: 10.1111/bcp.16003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/28/2023] [Accepted: 01/01/2024] [Indexed: 02/07/2024] Open
Abstract
AIMS Levofloxacin is a quinolone antibiotic with a broad antibacterial spectrum. It is frequently used in elderly patients with pneumonia. The pharmacokinetic profile of elderly patients changes with age, but data on the pharmacokinetics of levofloxacin in these patients are limited. The aim of this study was to establish a population pharmacokinetic model of levofloxacin in elderly patients with pneumonia and to optimize individualized dosing regimens based on this newly developed model. METHODS This is a prospective, open-label pharmacokinetic study in elderly patients with pneumonia. Blood samples were collected using an opportunistic approach. The plasma concentrations of levofloxacin were determined by high-performance liquid chromatography. A population pharmacokinetic model was established using nonlinear mixed-effect model software. Monte Carlo simulations were used for dose simulation and dose optimization. RESULTS Data from 51 elderly patients with pneumonia were used for the population pharmacokinetic analysis. A one-compartment model with first-order elimination was most suitable for describing the data, and the estimated glomerular filtration rate was the only covariate that had a significant impact on the model. The final model estimated that the mean clearance of levofloxacin in elderly patients with pneumonia was 5.26 L/h. Monte Carlo simulation results showed that the optimal dosing regimen for levofloxacin was 750 mg once a day in elderly patients with pneumonia, with a minimum inhibitory concentration of 2 mg/L. CONCLUSIONS The population pharmacokinetic model of levofloxacin in elderly patients with pneumonia was established, and the dose optimization of levofloxacin was completed through Monte Carlo simulation.
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Affiliation(s)
- Yun-Ying He
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jing Sun
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Pharmacy, The Second Hospital of Shandong University, Jinan, China
| | - Yue-E Wu
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yong-Bin Wang
- Department of Respiratory, The Second Hospital of Shandong University, Jinan, China
| | - John van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington, District of Columbia, USA
- Departments of Pediatrics, Pharmacology & Physiology, Genomics and Precision Medicine, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
- Department of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Guo-Xiang Hao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - De-Qing Sun
- Department of Pharmacy, The Second Hospital of Shandong University, Jinan, China
| | - Wei Zhao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Pharmacy, The Second Hospital of Shandong University, Jinan, China
- Department of Clinical Pharmacy, Clinical Trial Center, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, Shandong, China
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Yamanaka M, Yamaguchi K, Muramatsu M, Miura H, Ochi M. Using the Oral Assessment Guide to Predict the Onset of Pneumonia in Residents of Long-Term Care and Welfare Facilities: A One-Year Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13731. [PMID: 36360610 PMCID: PMC9654310 DOI: 10.3390/ijerph192113731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Appropriate oral health care, depending on oral assessments, reduces the onset of pneumonia. However, the relationship between risk evaluation using an oral assessment tool and pneumonia in residents of long-term care facilities has not been fully elucidated. In the present study, we aim to examine the relationship between the total scores of the Oral Assessment Guide (OAG) and the incidence of pneumonia after a one-year baseline study of residents in long-term care facilities. The settings for sampling include nine long-term care facilities in Hokkaido. At baseline, there were 267 study subjects. A total of 72 individuals dropped out and 11 individuals met the exclusion criteria. Therefore, the subject sample included 184 individuals. Among the subjects included in our analyses, eight individuals developed pneumonia (six males and two females). A multiple logistic regression analysis was performed with the risk factors for developing pneumonia. Evaluations were performed based on the odds ratio (OR) and 95% confidence interval (CI). We observed that the OR for pneumonia onset was 2.29 (CI: 1.27-4.14) after being adjusted for pneumonia risk factors. Therefore, it was suggested that the total scores of the OAG could be used to screen for the risk of pneumonia onset in residents of long-term care and welfare facilities.
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Affiliation(s)
- Masahiro Yamanaka
- Division of Fixed Prosthodontics and Oral Implantology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-gun 061-0293, Japan
| | - Kanetaka Yamaguchi
- Division of Fixed Prosthodontics and Oral Implantology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-gun 061-0293, Japan
| | - Masumi Muramatsu
- School of Nursing, Sapporo City University, Sapporo 060-0011, Japan
| | - Hiroko Miura
- Division of Disease Control and Epidemiology, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-gun 061-0293, Japan
| | - Morio Ochi
- Division of Fixed Prosthodontics and Oral Implantology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-gun 061-0293, Japan
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Chen L, Huang H, Chen X. Distribution of Pathogens in Elderly Chinese Patients With Pneumonia: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:584066. [PMID: 34381791 PMCID: PMC8350134 DOI: 10.3389/fmed.2021.584066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 06/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To summarize the distribution of pathogenic bacteria in elderly Chinese patients with pneumonia and provide guidance for the clinical application of antibiotics. Methods: The electronic databases of PubMed, Embase, Cochrane library, and China National Knowledge Infrastructure were searched. The primary outcomes included the prevalence of gram-positive cocci, gram-negative bacilli, and fungus. The summary prevalence and 95% confidence interval (CI) were calculated using the random-effects model. Results: A total of 17 retrospective studies reporting a total of 5,729 elderly patients with pneumonia were selected for final analysis. The summary prevalence of gram-positive cocci was 25% (95% CI: 20-30%; p < 0.001), whereas the prevalence of gram-negative bacilli was 56% (95% CI: 46-67%; p < 0.001). Moreover, the pooled prevalence of fungus in elderly patients with pneumonia was 11% (95% CI: 8-14%; p < 0.001). The most common gram-positive cocci were Staphylococcus aureus (ES: 8%; 95% CI: 6-11%; p <0.001), Streptococcus hemolyticus (ES: 7%; 95% CI: 6-8%; p < 0.001), and Streptococcus pneumoniae (ES: 5%; 95% CI: 3-7%; p < 0.001). Pseudomonas aeruginosa (ES: 18%; 95% CI: 14-22%; p <0.001) and Klebsiella pneumoniae (ES: 14%; 95% CI: 11-18%; p <0.001) were most common gram-negative bacilli. Furthermore, the pooled prevalence of Candida albicans in elderly patients with pneumonia was 6% (95% CI: 5-8%; p < 0.001). Conclusions: The findings demonstrated the comprehensive distribution of pathogenic bacteria in elderly Chinese patients with pneumonia, which could guide further antibiotic therapies.
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Affiliation(s)
- Luming Chen
- Department of Geriatrics, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Hongqiang Huang
- Department of Geriatrics, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Xiaolin Chen
- Department of Geriatrics, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
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Lourdesamy Anthony AI, Zam Z, Hussin N. A Hospital-based Study on the Local Epidemiology of Pneumonia Including the Contribution of Legionella Pneumonia. Malays J Med Sci 2021; 27:79-88. [PMID: 33447136 PMCID: PMC7785258 DOI: 10.21315/mjms2020.27.6.8] [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: 03/24/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background In real-life practice, only 20% of hospitalised pneumonia cases have an identified etiology. The usage of Legionella urine antigen test (LUAT) in developed nations revolutionised case detection rates. Accordingly, our objectives were to study the microbiological etiology for hospitalised pneumonia patients and the diagnosis of Legionella pneumonia. Methods A prospective, observational single-centre study was conducted where all 504 cases that were consecutively admitted for pneumonia were enrolled. Blood and sputum samples obtained were used to identify pathogens using standard microbiological culture methods. The urine samples collected were tested using the ImmunocatchTMLegionella immunochromatographic (ICT) urine antigen test. Results A microbiological diagnosis was only achieved in 104 cases (20.6%) and a Gram-negative infection predominance was observed. Culture-positive cases required longer hospitalisation (8.46 days versus 5.53 days; P < 0.001) and the higher usage of antipseudomonal antibiotics (23.1% versus 8.3%; P < 0.001). Only 3 cases (0.6%) were diagnosed with Legionella pneumonia. Conclusion The local pathogen distribution is diverse compared to other regions. Culture-negative pneumonia is common and significantly differs from culture-positive pneumonia. Legionella pneumophila serotype 1 is not a common cause of pneumonia and LUAT did not help demystify the cause of culture-negative pneumonia.
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Affiliation(s)
| | - Zarifah Zam
- Microbiology Unit, Hospital Taiping, Taiping, Malaysia
| | - Narwani Hussin
- Clinical Research Centre, Hospital Taiping, Taiping, Malaysia
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Kawakami N, Namkoong H, Ohata T, Sakaguchi S, Saito F, Yuki H. Clinical features of Mycoplasma pneumoniae pneumonia in older adults. Geriatr Gerontol Int 2019; 18:814-816. [PMID: 29722163 DOI: 10.1111/ggi.13278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/03/2018] [Accepted: 01/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Naoki Kawakami
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Ho Namkoong
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan.,Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Ohata
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Shinji Sakaguchi
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Fumitake Saito
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Hideki Yuki
- Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
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Abstract
Pneumonia remains the main cause of morbidity and mortality from infectious diseases in the world. The important reason for the increased global mortality is the impact of pneumonia on chronic diseases especially in the elderly population and the virulence factors of the causative microorganisms. Because elderly individuals present with comorbidities, particular attention should be paid for multidrug-resistant pathogens. Streptococcus pneumoniae remains the most frequently encountered pathogen. Enteric gram-negative rods, as well as anaerobes, should be considered in patients with aspiration pneumonia. Interventions for modifiable risk factors will reduce the risk of this infection. The adequacy of the initial antimicrobial therapy and determination of patients’ follow-up place is a key factor for prognosis. Also, vaccination is one of the most important preventive measures. In this section it was focused on several aspects, including the atypical presentation of pneumonia in the elderly, the methods to evaluate the severity of illness, the appropriate take care place and the management with prevention strategies.
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Girón Ortega J, Pérez Galera S, Girón González J. Diagnóstico y tratamiento empírico de la neumonía adquirida en la comunidad en situaciones especiales: pacientes inmunocomprometidos sin infección por el VIH y ancianos. MEDICINE - PROGRAMA DE FORMACIÓN MÉDICA CONTINUADA ACREDITADO 2018; 12:3168-3173. [PMID: 32287904 PMCID: PMC7144516 DOI: 10.1016/j.med.2018.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
La neumonía en el anciano tiene con frecuencia una presentación clínica menos florida que en el adulto de menor edad y que a menudo se complica por la descompensación de patologías concomitantes. En el anciano existen particularidades relativas a los gérmenes implicados en la neumonía, entre otros motivos por el mayor riesgo de infecciones por gérmenes multirresistentes al tratarse de enfermos con un contacto frecuente con los servicios de asistencia sanitaria. Las infecciones pulmonares en el individuo inmunodeprimido presentan causas diferentes en función del déficit inmune del que se trate. Tras una estratificación del riesgo, se decidirá el ingreso hospitalario o el tratamiento ambulatorio; tratamiento este determinado por las particularidades del momento de aparición de la neumonía, la situación epidemiológica local referida al porcentaje de resistencias a antibióticos en el área y las particularidades clínicas.
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Toledo D, Soldevila N, Torner N, Pérez-Lozano MJ, Espejo E, Navarro G, Egurrola M, Domínguez Á. Factors associated with 30-day readmission after hospitalisation for community-acquired pneumonia in older patients: a cross-sectional study in seven Spanish regions. BMJ Open 2018; 8:e020243. [PMID: 29602852 PMCID: PMC5884368 DOI: 10.1136/bmjopen-2017-020243] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Hospital readmission in patients admitted for community-acquired pneumonia (CAP) is frequent in the elderly and patients with multiple comorbidities, resulting in a clinical and economic burden. The aim of this study was to determine factors associated with 30-day readmission in patients with CAP. DESIGN A cross-sectional study. SETTING The study was conducted in patients admitted to 20 hospitals in seven Spanish regions during two influenza seasons (2013-2014 and 2014-2015). PARTICIPANTS We included patients aged ≥65 years admitted through the emergency department with a diagnosis compatible with CAP. Patients who died during the initial hospitalisation and those hospitalised more than 30 days were excluded. Finally, 1756 CAP cases were included and of these, 200 (11.39%) were readmitted. MAIN OUTCOME MEASURES 30-day readmission. RESULTS Factors associated with 30-day readmission were living with a person aged <15 years (adjusted OR (aOR) 2.10, 95% CI 1.01 to 4.41), >3 hospital visits during the 90 previous days (aOR 1.53, 95% CI 1.01 to 2.34), chronic respiratory failure (aOR 1.74, 95% CI 1.24 to 2.45), heart failure (aOR 1.69, 95% CI 1.21 to 2.35), chronic liver disease (aOR 2.27, 95% CI 1.20 to 4.31) and discharge to home with home healthcare (aOR 5.61, 95% CI 1.70 to 18.50). No associations were found with pneumococcal or seasonal influenza vaccination in any of the three previous seasons. CONCLUSIONS This study shows that 11.39% of patients aged ≥65 years initially hospitalised for CAP were readmitted within 30 days after discharge. Rehospitalisation was associated with preventable and non-preventable factors.
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Affiliation(s)
- Diana Toledo
- Epidemiología y Salud Pública, (CIBERESP), Consorcio Centro de Investigación Biomédica en Red, M.P, Madrid, Spain
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Núria Soldevila
- Epidemiología y Salud Pública, (CIBERESP), Consorcio Centro de Investigación Biomédica en Red, M.P, Madrid, Spain
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Núria Torner
- Epidemiología y Salud Pública, (CIBERESP), Consorcio Centro de Investigación Biomédica en Red, M.P, Madrid, Spain
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- Servei de Control Epidemiològic, Agència de Salut Pública de Catalunya, Barcelona, Spain
| | | | - Elena Espejo
- Unitat de Malalties Infeccioses, Hospital de Terrassa, Barcelona, Spain
| | - Gemma Navarro
- Unitatd'Epidemiologia i Avaluació, Parc Tauli Hospital Universitari, Barcelona, Spain
| | - Mikel Egurrola
- Serviciode Neumología, Hospital de Galdakao, Usansolo, Spain
| | - Ángela Domínguez
- Epidemiología y Salud Pública, (CIBERESP), Consorcio Centro de Investigación Biomédica en Red, M.P, Madrid, Spain
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
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Abstract
The incidence of pneumonia increases with age, and is particularly high in patients who reside in long-term care facilities (LTCFs). Mortality rates for pneumonia in older adults are high and have not decreased in the last decade. Atypical symptoms and exacerbation of underlying illnesses should trigger clinical suspicion of pneumonia. Risk factors for multidrug-resistant organisms are more common in older adults, particularly among LTCF residents, and should be considered when making empiric treatment decisions. Monitoring of clinical stability and underlying comorbid conditions, potential drug-drug interactions, and drug-related adverse events are important factors in managing elderly patients with pneumonia.
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Affiliation(s)
- Oryan Henig
- Division of Infectious Diseases, Department of Medicine, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI 48109-5680, USA
| | - Keith S Kaye
- Division of Infectious Diseases, Department of Medicine, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI 48109-5680, USA.
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Yanagi S, Tsubouchi H, Miura A, Matsuo A, Matsumoto N, Nakazato M. The Impacts of Cellular Senescence in Elderly Pneumonia and in Age-Related Lung Diseases That Increase the Risk of Respiratory Infections. Int J Mol Sci 2017; 18:ijms18030503. [PMID: 28245616 PMCID: PMC5372519 DOI: 10.3390/ijms18030503] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/10/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Shigehisa Yanagi
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki; Kihara 5200, Kiyotake, Miyazaki 889-1692, Japan.
| | - Hironobu Tsubouchi
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki; Kihara 5200, Kiyotake, Miyazaki 889-1692, Japan.
| | - Ayako Miura
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki; Kihara 5200, Kiyotake, Miyazaki 889-1692, Japan.
| | - Ayako Matsuo
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki; Kihara 5200, Kiyotake, Miyazaki 889-1692, Japan.
| | - Nobuhiro Matsumoto
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki; Kihara 5200, Kiyotake, Miyazaki 889-1692, Japan.
| | - Masamitsu Nakazato
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki; Kihara 5200, Kiyotake, Miyazaki 889-1692, Japan.
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Sauce D, Dong Y, Campillo-Gimenez L, Casulli S, Bayard C, Autran B, Boddaert J, Appay V, Elbim C. Reduced Oxidative Burst by Primed Neutrophils in the Elderly Individuals Is Associated With Increased Levels of the CD16bright/CD62LdimImmunosuppressive Subset. J Gerontol A Biol Sci Med Sci 2016; 72:163-172. [DOI: 10.1093/gerona/glw062] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/16/2016] [Indexed: 12/28/2022] Open
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Abstract
Influenza A virus (IAV) is a serious global health problem worldwide due to frequent and severe outbreaks. IAV causes significant morbidity and mortality in the elderly population, due to the ineffectiveness of the vaccine and the alteration of T cell immunity with ageing. The cellular and molecular link between ageing and virus infection is unclear and it is possible that damage associated molecular patterns (DAMPs) may play a role in the raised severity and susceptibility of virus infections in the elderly. DAMPs which are released from damaged cells following activation, injury or cell death can activate the immune response through the stimulation of the inflammasome through several types of receptors found on the plasma membrane, inside endosomes after endocytosis as well as in the cytosol. In this review, the detriment in the immune system during ageing and the links between influenza virus infection and ageing will be discussed. In addition, the role of DAMPs such as HMGB1 and S100/Annexin in ageing, and the enhanced morbidity and mortality to severe influenza infection in ageing will be highlighted.
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13
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Welte T. Managing CAP patients at risk of clinical failure. Respir Med 2015; 109:157-69. [DOI: 10.1016/j.rmed.2014.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 10/07/2014] [Accepted: 10/27/2014] [Indexed: 12/11/2022]
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Growing Antibiotic Resistance in Fatal Cases of Staphylococcal Pneumonia in the Elderly. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 905:39-56. [DOI: 10.1007/5584_2015_184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Acute Pneumonia. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7151914 DOI: 10.1016/b978-1-4557-4801-3.00069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Simonetti AF, Viasus D, Garcia-Vidal C, Carratalà J. Management of community-acquired pneumonia in older adults. Ther Adv Infect Dis 2014; 2:3-16. [PMID: 25165554 DOI: 10.1177/2049936113518041] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Community-acquired pneumonia (CAP) is an increasing problem among the elderly. Multiple factors related to ageing, such as comorbidities, nutritional status and swallowing dysfunction have been implicated in the increased incidence of CAP in the older population. Moreover, mortality in patients with CAP rises dramatically with increasing age. Streptococcus pneumoniae is still the most common pathogen among the elderly, although CAP may also be caused by drug-resistant microorganisms and aspiration pneumonia. Furthermore, in the elderly CAP has a different clinical presentation, often lacking the typical acute symptoms observed in younger adults, due to the lower local and systemic inflammatory response. Several independent prognostic factors for mortality in the elderly have been identified, including factors related to pneumonia severity, inadequate response to infection, and low functional status. CAP scores and biomarkers have lower prognostic value in the elderly, and so there is a need to find new scales or to set new cut-off points for current scores in this population. Adherence to the current guidelines for CAP has a significant beneficial impact on clinical outcomes in elderly patients. Particular attention should also be paid to nutritional status, fluid administration, functional status, and comorbidity stabilizing therapy in this group of frail patients. This article presents an up-to-date review of the main aspects of CAP in elderly patients, including epidemiology, causative organisms, clinical features, and prognosis, and assesses key points for best practices for the management of the disease.
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Affiliation(s)
- Antonella F Simonetti
- Department of Infectious Diseases, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Diego Viasus
- Department of Infectious Diseases, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain and Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain and Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
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de Moraes TP, Olandoski M, Caramori JCT, Martin LC, Fernandes N, Divino-Filho JC, Pecoits-Filho R, Barretti P. Novel predictors of peritonitis-related outcomes in the BRAZPD cohort. Perit Dial Int 2014; 34:179-87. [PMID: 24385333 DOI: 10.3747/pdi.2012.00333] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Peritonitis remains the main cause of peritoneal dialysis (PD) technique failure worldwide, despite significant reductions in infection rates observed over the past decades. Several studies have described risk factors for peritonitis, technique failure and mortality. However, there are scarce data regarding predictors of complications during and after a peritonitis episode. The aim of our study was to analyze predictors of peritonitis-related outcome in the Brazilian Peritoneal Dialysis study (BRAZPD) cohort. METHODS All adult incident patients recruited in the BRAZPD Study between December 2004 and October 2007, who remained at least 90 days on PD and presented their first peritonitis episode (n = 474 patients) were included in the study. The endpoints analyzed were non-resolution, death due to a peritonitis episode and long-term technique survival after a peritonitis episode. RESULTS In the multivariable regression, non-resolution was independently associated with older age (odds ratio (OR) 1.02; p < 0.01), collagenosis as the primary renal disease (OR 4.6; p < 0.05) and Pseudomonas spp as etiological agent (OR 2.9; p < 0.05). Patients who were transferred from APD to CAPD during peritonitis therapy presented a higher risk of non-response (OR 2.5; p < 0.05). The only factor associated with death during a peritonitis episode was older age (OR 1.04; p < 0.05). Exposure to vancomycin and male gender were the independent predictors of long-term technique failure (OR 2.2; p < 0.01). CONCLUSION Apart from confirming previous observations of the negative impact of older age and Pseudomonas spp peritonitis on outcomes, we observed that collagenosis may negatively impact response to treatment and exposure to vancomycin may possibly reduce long-term technique survival. It is important to emphasize that the association of vancomycin with technique failure does not prove causality. These findings shed light on new factors predicting outcome when peritonitis is diagnosed.
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Kumeliauskas L, Fruetel K, Holroyd-Leduc JM. Evaluation of older adults hospitalized with a diagnosis of failure to thrive. Can Geriatr J 2013; 16:49-53. [PMID: 23737929 PMCID: PMC3671012 DOI: 10.5770/cgj.16.64] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND older adults are sometimes hospitalized with the admission diagnosis of failure to thrive (FTT), often because they are not felt safe to be discharged back to their current living arrangement. It is unclear if this diagnosis indicates primarily a social admission or suggests an acute medical deterioration. The objective of this study was to explore the level of acuity and medical investigations commonly conducted among older hospitalized adults with a diagnosis of FTT. METHODS We conducted a retrospective cohort study at three hospitals in Calgary, Alberta. Data were extracted from the electronic medical records of the 603 admissions of patients 65 years or older with a diagnosis of FTT between January 2010 and January 2011. Markers of medical acuity were evaluated. RESULTS The vast majority of patients had short hospital stays. Specialist physicians were consulted for 323 cases (54%). Allied health-care professionals were consulted in 151 cases (25%). While in hospital, patients underwent extensive investigations, including CT scans, ultrasounds, and echo-cardiograms. Many patients received IV fluids (71%) and IV antibiotics (35%). CONCLUSIONS The data suggest that acute illnesses, and not social factors, were the primary reason for admission among those given a diagnosis of FTT.
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Sousa D, Justo I, Domínguez A, Manzur A, Izquierdo C, Ruiz L, Nebot M, Bayas JM, Celorrio JM, Varona W, Llinares P, Miguez E, Sánchez E, Carratalá J. Community-acquired pneumonia in immunocompromised older patients: incidence, causative organisms and outcome. Clin Microbiol Infect 2012; 19:187-92. [PMID: 22390624 DOI: 10.1111/j.1469-0691.2012.03765.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The number of elderly patients in the community with immunosuppressive conditions has increased progressively over recent decades. We sought to determine the incidence, causative organisms and outcome of community-acquired pneumonia (CAP) occurring in immunocompromised older patients. We prospectively compared cases of CAP in immunocompromised and non-immunocompromised patients admitted to five public hospitals in three Spanish regions. Of 320 cases studied, 115 (36%) occurred in immunocompromised patients, including: solid or hematological malignancy (97), corticosteroids or other immunosuppressive drugs (44), solid organ or stem cell transplant (five), and other conditions (eight). The etiology was established in 44% of immunocompromised patients vs. 32% of non-immunocompromised patients (p 0.03). Streptococcus pneumoniae was the most common causative organism in both groups (29% vs. 21%; p 0.08), followed by Legionella pneumophila (3% vs. 6%; p 0.01). Gram-negative bacilli were more frequent among immunocompromised patients (5% vs. 0.5%; p <0.01), particularly Pseudomonas aeruginosa (3% vs. 0%; p 0.04). Nocardiosis was only observed in immunocompromised patients (two cases). Bacteremia occurred similarly in the two groups. No significant differences were found with respect to ICU admission (8%, in both groups) or the length of stay (12.5 vs. 10.4 days). The early (<48 h) (3.5 vs. 0.5%; p 0.04) and overall case-fatality rates (12% vs. 3%; p <0.01) were higher in immunocompromised patients. In conclusion, a substantial number of older patients hospitalized for CAP are immunocompromised. Although relatively uncommon, CAP due to gram-negative bacilli, including P. aeruginosa, is more frequent among these patients. CAP occurring in immunocompromised patients causes significant morbidity and mortality.
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Affiliation(s)
- D Sousa
- Department of Infectious Diseases, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
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Akgün KM, Crothers K, Pisani M. Epidemiology and management of common pulmonary diseases in older persons. J Gerontol A Biol Sci Med Sci 2012; 67:276-91. [PMID: 22337938 DOI: 10.1093/gerona/glr251] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Pulmonary disease prevalence increases with age and contributes to morbidity and mortality in older patients. Dyspnea in older patients is often ascribed to multiple etiologies such as medical comorbidities and deconditioning. Common pulmonary disorders are frequently overlooked as contributors to dyspnea in older patients. In addition to negative impacts on morbidity and mortality, quality of life is reduced in older patients with uncontrolled, undertreated pulmonary symptoms. The purpose of this review is to discuss the epidemiology of common pulmonary diseases, namely pneumonia, chronic obstructive pulmonary disease, asthma, lung cancer, and idiopathic pulmonary fibrosis in older patients. We will review common clinical presentations for these diseases and highlight differences between younger and older patients. We will also briefly discuss risk factors, treatment, and mortality associated with these diseases. Finally, we will address the relationship between comorbidities, pulmonary symptoms, and quality of life in older patients with pulmonary diseases.
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Affiliation(s)
- Kathleen M Akgün
- Pulmonary and Critical Care Section, Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, USA.
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Wispelwey B, Schafer KR. Fluoroquinolones in the management of community-acquired pneumonia in primary care. Expert Rev Anti Infect Ther 2011; 8:1259-71. [PMID: 21073291 DOI: 10.1586/eri.10.110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Brian Wispelwey
- Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia Health Center, P.O. Box 801337, Charlottesville, VA 22908-1337, USA.
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Age-associated alteration in naive and memory Th17 cell response in humans. Clin Immunol 2011; 140:84-91. [PMID: 21489886 DOI: 10.1016/j.clim.2011.03.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 03/04/2011] [Accepted: 03/22/2011] [Indexed: 12/21/2022]
Abstract
Th17 cells produce IL-17 that plays an important role in host defense. However, little is known about whether aging affects human Th17 cells. Here we demonstrated that healthy elderly people (age ≥ 65) had a decreased frequency of IL-17-producing cells in memory CD4(+) T cells compared to healthy young people (age ≤ 40) while both groups had similar frequencies of IFN-γ-producing cells in the same memory cell subset as measured by flow cytometry. In contrast, the healthy elderly had increased differentiation of IL-17-producing effector cells but not IFN-γ-producing cells from naive CD4(+) T cells compared to the healthy young. The results of ELISA also showed similar findings with increased IL-17 production from naive CD4(+) T cells and decreased IL-17 production from memory CD4(+) T cells in the elderly compared to the young. These findings indicate that aging differentially affects naive and memory Th17 cell responses in humans.
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Intrapulmonary administration of leukotriene B4 enhances pulmonary host defense against pneumococcal pneumonia. Infect Immun 2010; 78:2264-71. [PMID: 20231413 DOI: 10.1128/iai.01323-09] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Leukotriene B(4) (LTB(4)) is a potent lipid mediator of inflammation formed by the 5-lipoxygenase (5-LO)-catalyzed oxidation of arachidonic acid. We have previously shown that (i) LTB(4) is generated during infection, (ii) its biosynthesis is essential for optimal antimicrobial host defense, (iii) LT deficiency is associated with clinical states of immunocompromise, and (iv) exogenous LTB(4) augments antimicrobial functions in phagocytes. Here, we sought to determine whether the administration of LTB(4) has therapeutic potential in a mouse model of pneumonia. Wild-type and 5-LO knockout mice were challenged with Streptococcus pneumoniae via the intranasal route, and bacterial burdens, leukocyte counts, and cytokine levels were determined. LTB(4) was administered via the intraperitoneal, intravenous, and intranasal routes prior to pneumococcal infection and by aerosol 24 h following infection. Leukocytes recovered from mice given S. pneumoniae and treated with aerosolized LTB(4) were evaluated for expression levels of the p47phox subunit of NADPH oxidase. Intrapulmonary but not systemic pretreatment with LTB(4) significantly reduced the lung S. pneumoniae burden in wild-type mice. Aerosolized LTB(4) was effective at improving lung bacterial clearance when administered postinoculation in animals with established infection and exhibited greater potency in 5-LO knockout animals, which also exhibited greater baseline susceptibility. Augmented bacterial clearance in response to LTB(4) was associated with enhanced monocyte recruitment and leukocyte expression of p47phox. The results of the current study in an animal model serve as a proof of concept for the potential utility of treatment with aerosolized LTB(4) as an immunostimulatory strategy in patients with bacterial pneumonia.
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Sakamoto N, Sugihara E, Boku S, Fukuda H, Isonuma H, Aiba M, Dambara T. [Clinical analysis of mortality in elderly patients with community-acquired pneumonia]. Nihon Ronen Igakkai Zasshi 2010; 47:47-51. [PMID: 20339205 DOI: 10.3143/geriatrics.47.47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM Community-acquired pneumonia remains a common and serious disease for elderly persons. The incidence and mortality rates of pneumonia are higher in the elderly. We analyzed the mortality and prognostic factors in 200 elderly patients with community-acquired pneumonia. METHODS The subjects were 200 elderly patients aged 65 years or older who needed hospitalization after initial visit to Geriatric Medicine, Juntedo Tokyo Koto Geriatric Medical Center, between January 2005 and December 2006. The subjects were divided into two groups, those who died, and those who survived on admission, we examined mortality rates and compared the background, underlying disease, laboratory data, chest X-ray findings, severity classification using A-DROP, between the two groups. RESULTS The mortality rate was 15.0%. Circulating diseases, cerebrovacscular diseases and dementia were the most common underlying diseases. It took a longer period to enter the hospital in the cases that died. In laboratory findings, total protein, serum albumin and percutaneous oxygen saturation were lower, and BUN was higher in the fatality group. There were many more patients who had extending infiltration shadow on chest X-ray films and severe condition on A-DROP classification in the fatality group. CONCLUSIONS We concluded that delay of diagnosis and treatment, dehydration, low levels of protein and albumin were important prognostic factors. The extent of infiltration shadow in chest X-ray findings was also important. A-DROP might be useful for estimating the prognosis in elderly patients with community-acquired pneumonia. We should consider the prognostic factors and severity at the initial stage when treating elderly patients with pneumonia.
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Affiliation(s)
- Naoharu Sakamoto
- Department of General Medicine, Juntendo University School of Medicine
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Tsai WD, Chen HT, Chang WH. Discordant Chest Radiographs—A Pitfall in Febrile Elderly Patients With Pneumonia. INT J GERONTOL 2009. [DOI: 10.1016/s1873-9598(09)70045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Stupka JE, Mortensen EM, Anzueto A, Restrepo MI. Community-acquired pneumonia in elderly patients. AGING HEALTH 2009; 5:763-774. [PMID: 20694055 PMCID: PMC2917114 DOI: 10.2217/ahe.09.74] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Community-acquired pneumonia continues to have a significant impact on elderly individuals, who are affected more frequently and with more severe consequences than younger populations. As the population ages it is expected that the medical and economic impact of this disease will increase. Despite these concerns, little progress has been made in research specifically focusing on community-acquired pneumonia in the elderly. Data continue to show that a high index of suspicion, early antimicrobial therapy and appropriate medications to cover typical pathogens are extremely important in treating community-acquired pneumonia in older individuals. This review is designed to serve as an update to our previous work published in Aging Health in 2006, with specific emphasis on the most recent evidence published since that time.
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Affiliation(s)
- John E Stupka
- The University of Texas Health Science Center at San Antonio, Department of Medicine, Division of Pulmonary & Critical Care Medicine, San Antonio, TX, USA, Tel.: +1 210 617 5256, Fax: +1 210 567 4423,
| | - Eric M Mortensen
- The University of Texas Health Science Center at San Antonio, Department of Medicine, Division of General Medicine, San Antonio, TX, USA and VERDICT (11C6) at the South Texas Veterans Health Care System, Audie L Murphy Division, San Antonio, TX, USA, Tel.: +1 210 617 5300, Fax: +1 210 567 4423,
| | - Antonio Anzueto
- The University of Texas Health Science Center at San Antonio, Department of Medicine, Division of Pulmonary & Critical Care Medicine, San Antonio, TX, USA and South Texas Veterans Health Care System, Audie L Murphy Division, TX, USA, Tel.: +1 210 617 5256, Fax: +1 210 567 4423,
| | - Marcos I Restrepo
- The University of Texas Health Science Center at San Antonio, Department of Medicine, Division of Pulmonary & Critical Care Medicine, San Antonio, TX, USA and VERDICT (11C6) at the South Texas Veterans Health Care System, Audie L Murphy Division, San Antonio, TX, USA, Tel.: +1 210 617 5300 ext. 15413, Fax: +1 210 567 4423,
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Morbidity and mortality of elderly patients with zoonotic Salmonella and Campylobacter: A population-based study. J Infect 2008; 57:214-22. [DOI: 10.1016/j.jinf.2008.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 06/02/2008] [Accepted: 06/13/2008] [Indexed: 11/23/2022]
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Bassim CW, Gibson G, Ward T, Paphides BM, Denucci DJ. Modification of the Risk of Mortality from Pneumonia with Oral Hygiene Care. J Am Geriatr Soc 2008; 56:1601-7. [PMID: 18691286 DOI: 10.1111/j.1532-5415.2008.01825.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Carol W Bassim
- Dental Service, Washington, DC, Veterans Affairs Medical Center, Washington, District of Columbia, USA.
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Abstract
This article examines the bacteriology, clinical features, therapy for, and prevention of pneumonia in older patients. The discussion focuses on patients who develop pneumonia out of the hospital, including individuals with community-acquired pneumonia and health care-associated pneumonia. Health care-associated pneumonia incorporates patients who live in nursing homes when they develop pneumonia and in many instances requires management similar to nosocomial pneumonia. We have chosen not to discuss nosocomial pneumonia in older patients because it does not have distinctive features or a different management approach than when this illness arises in younger patients.
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Affiliation(s)
- Michael S Niederman
- Department of Medicine, Winthrop-University Hospital, 222 Station Plaza North, Suite 509, Mineola, NY 11550, USA.
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Unexpected induction of resistant Pseudomonas aeruginosa biofilm to fluoroquinolones by diltiazem: A new perspective of microbiological drug–drug interaction. J Infect Public Health 2008; 1:105-12. [DOI: 10.1016/j.jiph.2008.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 10/21/2008] [Accepted: 10/22/2008] [Indexed: 11/22/2022] Open
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