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Boix-Palop L, Arranz MJ, Sangil A, Dietl B, Xercavins M, Pérez J, Calbo E. Host genetic variants associated with susceptibility and severity of pneumococcal pneumonia in adult patients. Pneumonia (Nathan) 2023; 15:18. [PMID: 38143267 PMCID: PMC10749500 DOI: 10.1186/s41479-023-00120-w] [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: 08/31/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Pneumococcal community-acquired pneumonia (P-CAP) is a major cause of morbidity and hospitalization. Several host genetics factors influencing risk of pneumococcal disease have been identified, with less information about its association with P-CAP. The aim of the study was to assess the influence of single nucleotide polymorphisms (SNP) within key genes involved in the innate immune response on the susceptibility to P-CAP and to study whether these polymorphic variants were associated with the severity and outcome of the episodes in a cohort of adult Caucasian patients. METHODS Seventeen SNPs from 7 genes (IL-R1, IL-4, IL-10, IL-12B, NFKBIA, NFKBIE, NFKBIZ) were analyzed. For susceptibility, a case-control study including a cohort of 57 adult with P-CAP, and 280 ethnically matched controls was performed. Genetic influence on clinical severity and outcome was evaluated in a prospective observational study including all consecutive adult P-CAP patients from November 2015 to May 2017. RESULTS The NFKBIA polymorphism rs696 and a haplotype combination were associated with susceptibility to P-CAP (OR = 0.62, p = 0.005 and OR = 0.63, p = 0.008, respectively). The SNP IL4 rs2227284 was associated with severe P-CAP (OR = 2.17, p = 0.04). IL-R1 (rs3917267) and IL-10 (rs3024509) variants were related with respiratory failure (OR = 3.31, p = 0.001 and OR = 0.18, p = 0.003, respectively) as well as several haplotype combinations in NFKBIA, NFKBIZ, IL-R1 and IL-10 (p = 0,02, p = 0,01, p = 0,001, p = 0,03, respectively). CURB-65 values were associated with the IL-10 rs3024509 variant (beta = - 0.4, p = 0.04), and with haplotype combinations of NFKBIZ and IL-10 (p = 0.05, p = 0.04, respectively). Genetic variants in IL-10 (rs3024509) and in IL-12B (rs730691) were associated with PSI values (beta = - 0.54, p = 0.01, and beta = - 0.28, p = 0.04, respectively), as were allelic combinations in IL-R1 (p = 0.02) and IL-10 (p = 0.01). Finally, several polymorphisms in the IL-R1 gene (rs13020778, rs2160227, & rs3917267) were associated with the time elapsed until clinical stability (beta = - 0.83, p = 0.03; beta = - 1, p = 0.02 and beta = 1.07, p = 0.008, respectively). CONCLUSIONS A genetic variant in NFKBIA was associated with susceptibility to P-CAP in adult Caucasian patients and genetic variants from key cytokines of the innate immune response (Il-4, IL-10, IL-R1 and IL-12B) and NF-κB inhibitors were associated with different phenotypes of severe P-CAP. If validated, these SNPs may help to identify people at risk of P-CAP or severe P-CAP on which preventive measures could be applied.
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Affiliation(s)
- Lucía Boix-Palop
- Infectious Diseases Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain.
- Universitat Internacional de Catalunya, Barcelona, Spain.
- Universitat de Barcelona, Barcelona, Spain.
| | - María J Arranz
- Fundació Docència i Recerca Mútua Terrassa, Barcelona, Spain
| | - Anna Sangil
- Internal Medicine Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Beatriz Dietl
- Infectious Diseases Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | | | - Josefa Pérez
- Microbiology Department, CatLab, Barcelona, Spain
| | - Esther Calbo
- Infectious Diseases Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain.
- Universitat Internacional de Catalunya, Barcelona, Spain.
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Guo L, Zhang Q, Lv C, Ma X, Song X, Huang J, Chen W, Li C, Ding Q. A novel biomarker for pleural effusion diagnosis: Interleukin-36γ in pleural fluid. J Clin Lab Anal 2022; 37:e24799. [PMID: 36478612 PMCID: PMC9833963 DOI: 10.1002/jcla.24799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Numerous studies have described the critical importance of interleukin (IL) -36γ in host defense against lung infections, but it is unknown whether it plays a role in infectious pleural effusion (IPE). This study aimed to examine the levels of IL-36γ in pleural effusions of different etiologies and evaluate the diagnostic accuracy of IL-36γ in the differential diagnosis of IPE. METHODS A total of 112 individuals was enrolled in this research. IL-36γ levels in pleural fluids of all 112 patients were measured by enzyme-linked immunosorbent assay (ELISA). We also characterized these markers' diagnostic values across various groups. RESULTS Patients with tuberculous pleural effusion (TPE) and parapneumonic effusion (PPE) had exhibited markedly higher IL-36γ levels in their pleural fluid than the malignant pleural effusion (MPE) and transudative effusion patients. Furthermore, the IL-36γ concentrations in TPE patients were evidently higher than in uncomplicated parapneumonic effusion (UPPE) patients but significantly lower than in complicated parapneumonic effusion (CPPE)/empyema patients. Pleural fluid IL-36γ is a useful marker to differentiate TPE from UPPE, at a cut-off value for 657.5 pg/ml (area under the curve = 0.904, p < 0.0001) with 70.0% sensitivity and 95.7% specificity. CONCLUSIONS The elevated IL-36γ in pleural effusion may be used as a novel biomarker for infectious pleural effusion diagnosis, particularly in patients with CPPE/empyema, and is a potentially promising biomarker to differentiate between TPE and UPPE.
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Affiliation(s)
- Lun Guo
- School of MedicineNingbo UniversityNingboChina,Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Qipan Zhang
- School of MedicineNingbo UniversityNingboChina,Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Chengna Lv
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Xudan Ma
- School of MedicineNingbo UniversityNingboChina,Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Xuxiang Song
- School of MedicineNingbo UniversityNingboChina,Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Jing Huang
- Department of Pharmacy, The Affiliated Hospital of Medical CollegeNingbo UniversityNingboChina
| | - Weili Chen
- School of MedicineNingbo UniversityNingboChina,Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Chaofen Li
- Department of laboratory medicineNingbo Ninth HospitalNingboChina
| | - Qunli Ding
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
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Global Perspective of Legionella Infection in Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031907. [PMID: 35162928 PMCID: PMC8835084 DOI: 10.3390/ijerph19031907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/11/2021] [Accepted: 01/20/2022] [Indexed: 01/27/2023]
Abstract
Legionnaires’ disease (LD) (Legionella) is a common cause of community-acquired pneumonia (CAP) in those requiring hospitalization. Geographical variation in the importance of Legionella species as an aetiologic agent of CAP is poorly understood. We performed a systematic review and meta-analysis of population-based observational studies that reported the proportion of Legionella infection in patients with CAP (1 January 1990 to 31 May 2020). Using five electronic databases, articles were identified, appraised and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality of the included studies was assessed using the Newcastle–Ottawa Scale. Univariate and multivariate meta-regression analyses were conducted using study design, WHO region, study quality and healthcare setting as the explanatory variables. We reviewed 2778 studies, of which 219 were included in the meta-analysis. The mean incidence of CAP was 46.7/100,000 population (95% CI: 46.6–46.8). The mean proportion of Legionella as the causative agent for CAP was 4.6% (95% CI: 4.4 to 4.7). Consequently, the mean Legionella incidence rate was 2.8/100,000 population (95% CI: 2.7–2.9). There was significant heterogeneity across all studies I2 = 99.27% (p < 0.0001). After outliers were removed, there was a decrease in the heterogeneity (I2 = 43.53%). Legionella contribution to CAP has a global distribution. Although the rates appear highest in high income countries in temperate regions, there are insufficient studies from low- and middle-income countries to draw conclusions about the rates in these regions. Nevertheless, this study provides an estimate of the mean incidence of Legionella infection in CAP, which could be used to estimate the regional and global burden of LD to support efforts to reduce the impact of this infection as well as to fill important knowledge gaps.
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Peñaloza HF, van der Geest R, Ybe JA, Standiford TJ, Lee JS. Interleukin-36 Cytokines in Infectious and Non-Infectious Lung Diseases. Front Immunol 2021; 12:754702. [PMID: 34887860 PMCID: PMC8651476 DOI: 10.3389/fimmu.2021.754702] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/14/2021] [Indexed: 12/26/2022] Open
Abstract
The IL-36 family of cytokines were identified in the early 2000’s as a new subfamily of the IL-1 cytokine family, and since then, the role of IL-36 cytokines during various inflammatory processes has been characterized. While most of the research has focused on the role of these cytokines in autoimmune skin diseases such as psoriasis and dermatitis, recent studies have also shown the importance of IL-36 cytokines in the lung inflammatory response during infectious and non-infectious diseases. In this review, we discuss the biology of IL-36 cytokines in terms of how they are produced and activated, as well as their effects on myeloid and lymphoid cells during inflammation. We also discuss the role of these cytokines during lung infectious diseases caused by bacteria and influenza virus, as well as other inflammatory conditions in the lungs such as allergic asthma, lung fibrosis, chronic obstructive pulmonary disease, cystic fibrosis and cancer. Finally, we discuss the current therapeutic advances that target the IL-36 pathway and the possibility to extend these tools to treat lung inflammatory diseases.
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Affiliation(s)
- Hernán F Peñaloza
- Acute Lung Injury Center of Excellence, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rick van der Geest
- Acute Lung Injury Center of Excellence, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joel A Ybe
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Theodore J Standiford
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Janet S Lee
- Acute Lung Injury Center of Excellence, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
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5
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Boix-Palop L, Obradors M, Xercavins M, Picó-Plana E, Canales L, Dietl B, Pérez J, Garau J, Calbo E. Improvement of pneumococcal pneumonia diagnosis using quantitative real-time PCR targeting lytA in adult patients: a prospective cohort study. Clin Microbiol Infect 2021; 28:138.e1-138.e7. [PMID: 34116202 DOI: 10.1016/j.cmi.2021.05.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of the study was to assess the performance of real-time PCR targeting the lytA gene (rtPCR-lytA) in plasma, urine and nasopharyngeal (NP) samples for the diagnosis of pneumococcal community-acquired pneumonia (P-CAP). METHODS Prospective observational study including all consecutive adults with CAP from November 2015 to May 2017. P-CAP was defined if pneumococcus was identified using conventional methods (CM) and/or a positive rtPCR-lytA was detected in blood, urine or NP samples (NP cut-off ≥8000 copies/mL). Diagnostic performance of each test was calculated. RESULTS A total of 133 individuals with CAP were included. Of these, P-CAP was diagnosed in 62 (46.6%). The proportion of P-CAP diagnosed by rtPCR-lytA methods was significantly higher than that diagnosed by CM (87.1% versus 59.7%, p 0.005). The rtPCR-lytA identified Streptococcus pneumoniae in 25 patients (40.3% of all individuals with P-CAP) whose diagnosis would have been missed by CM. NP-rtPCR-lytA allowed diagnosis of 62.3% of P-CAP. A nasopharyngeal colonization density ≥2351 copies/mL predicted P-CAP diagnosis (area under the curve = 0.82, sensitivity 83.3%, specificity 80.9%). There was a positive correlation between increasing bacterial load in blood and CURB-65 score (Spearman correlation coefficient r = 0.4, p 0.001), pneumonia severity index (r = 0.3, p 0.02) and time to clinical stability (r = 0.33, p 0.01). Median bacterial load in blood was higher in P-CAP patients with bacteraemia (0.65 × 103 versus 0 × 103 copies/mL, p 0.002), intensive care unit admission (0.68 × 103 versus 0 × 103 copies/mL, p 0.04) or mechanical ventilation (7.45 × 103 versus 0 × 103 copies/mL, p 0.04). CONCLUSIONS The use of rtPCR-lytA methods significantly increased the diagnosis of P-CAP compared with CM. Nasopharyngeal swabs rtPCR-lytA detection, with an accurate cut-off value, was the most promising among molecular methods for the diagnosis of P-CAP.
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Affiliation(s)
- Lucía Boix-Palop
- Infectious Diseases Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Meritxell Obradors
- Infectious Diseases Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | | | | | - Lydia Canales
- Radiology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Beatriz Dietl
- Infectious Diseases Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Josefa Pérez
- Microbiology Department, CatLab, Barcelona, Spain
| | - Javier Garau
- Infectious Diseases Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain; Service of Internal Medicine, Clínica Rotger, Palma de Mallorca, Spain
| | - Esther Calbo
- Infectious Diseases Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain.
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6
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Dietl B, Henares D, Boix-Palop L, Muñoz-Almagro C, Garau J, Calbo E. Related Factors to Streptococcus pneumoniae Invasive Infection and Clinical Manifestations: The Potential Role of Nasopharyngeal Microbiome. Front Med (Lausanne) 2021; 8:650271. [PMID: 33996857 PMCID: PMC8117960 DOI: 10.3389/fmed.2021.650271] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/22/2021] [Indexed: 12/15/2022] Open
Abstract
Infections of the lower respiratory tract, such as pneumonia, are one of the leading causes of death worldwide. Streptococcus pneumoniae might colonize the upper respiratory tract and is the main aetiological agent of community-acquired pneumonia (CAP). In the last decades, several factors related to the host, the microorganism and the antibiotic therapy have been investigated to identify risk factors associated with the development of invasive pneumococcal disease (IPD). Nevertheless, these factors themselves do not explain the risk of developing disease or its severity. Recently, some studies have focused on the importance of nasopharyngeal (NP) microbiome and its relation to respiratory health. This review presents existing evidence of the potential role of NP microbiome in the development of IPD.
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Affiliation(s)
- Beatriz Dietl
- Infectious Diseases Unit, Hospital Universitari Mútua Terrassa, Terrassa, Spain.,Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Desirée Henares
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.,Center for Epidemiology and Public Health, CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Lucía Boix-Palop
- Infectious Diseases Unit, Hospital Universitari Mútua Terrassa, Terrassa, Spain.,Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.,Center for Epidemiology and Public Health, CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Garau
- Internal Medicine Department, Clínica Rotger, Palma de Mallorca, Spain
| | - Esther Calbo
- Infectious Diseases Unit, Hospital Universitari Mútua Terrassa, Terrassa, Spain.,Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
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7
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López‐Alcalde J, Rodriguez‐Barrientos R, Redondo‐Sánchez J, Muñoz‐Gutiérrez J, Molero García JM, Rodríguez‐Fernández C, Heras‐Mosteiro J, Marin‐Cañada J, Casanova‐Colominas J, Azcoaga‐Lorenzo A, Hernandez Santiago V, Gómez‐García M. Short-course versus long-course therapy of the same antibiotic for community-acquired pneumonia in adolescent and adult outpatients. Cochrane Database Syst Rev 2018; 9:CD009070. [PMID: 30188565 PMCID: PMC6513237 DOI: 10.1002/14651858.cd009070.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a lung infection that can be acquired during day-to-day activities in the community (not while receiving care in a hospital). Community-acquired pneumonia poses a significant public health burden in terms of mortality, morbidity, and costs. Shorter antibiotic courses for CAP may limit treatment costs and adverse effects, but the optimal duration of antibiotic treatment is uncertain. OBJECTIVES To evaluate the efficacy and safety of short-course versus longer-course treatment with the same antibiotic at the same daily dosage for CAP in non-hospitalised adolescents and adults (outpatients). We planned to investigate non-inferiority of short-course versus longer-term course treatment for efficacy outcomes, and superiority of short-course treatment for safety outcomes. SEARCH METHODS We searched CENTRAL, which contains the Cochrane Acute Respiratory Infections Group Specialised Register, MEDLINE, Embase, five other databases, and three trials registers on 28 September 2017 together with conference proceedings, reference checking, and contact with experts and pharmaceutical companies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing short- and long-courses of the same antibiotic for CAP in adolescent and adult outpatients. DATA COLLECTION AND ANALYSIS We planned to use standard Cochrane methods. MAIN RESULTS Our searches identified 5260 records. We did not identify any RCTs that compared short- and longer-courses of the same antibiotic for the treatment of adolescents and adult outpatients with CAP.We excluded two RCTs that compared short courses (five compared to seven days) of the same antibiotic at the same daily dose because they evaluated antibiotics (gemifloxacin and telithromycin) not commonly used in practice for the treatment of CAP. In particular, gemifloxacin is no longer approved for the treatment of mild-to-moderate CAP due to its questionable risk-benefit balance, and reported adverse effects. Moreover, the safety profile of telithromycin is also cause for concern.We found one ongoing study that we will assess for inclusion in future updates of the review. AUTHORS' CONCLUSIONS We found no eligible RCTs that studied a short-course of antibiotic compared to a longer-course (with the same antibiotic at the same daily dosage) for CAP in adolescent and adult outpatients. The effects of antibiotic therapy duration for CAP in adolescent and adult outpatients remains unclear.
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Affiliation(s)
- Jesús López‐Alcalde
- Universidad Francisco de Vitoria (UFV) MadridFaculty of MedicineCtra. Pozuelo‐Majadahonda km. 1,800MadridSpain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS)Clinical Biostatistics UnitCtra. Colmenar, km. 9.100MadridSpain28034
| | - Ricardo Rodriguez‐Barrientos
- Gerencia Asistencial de Atención Primaria, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)Unidad de apoyo a la InvestigaciónJátiva Nº23 2ºcMadridSpain28007
| | - Jesús Redondo‐Sánchez
- Gerencia Asistencial Atención PrimariaCentro de Salud Ramon y CajalJabonería 67MadridSpain28921
| | - Javier Muñoz‐Gutiérrez
- Gerencia Asistencial Atención PrimariaCentro de Salud Buenos AiresPio FelipeMadridSpain28038
| | - José María Molero García
- Gerencia Asistencial Atención PrimariaCentro de Salud San AndrésAlberto Palacios, nº 22MadridMadridSpain28021
| | | | - Julio Heras‐Mosteiro
- Rey Juan Carlos UniversityDepartment of Preventive Medicine and Public Health & Immunology and MicrobiologyAvda. Atenas s/nAlcorcónMadridSpain28922
| | - Jaime Marin‐Cañada
- Gerencia Asistencial Atencion Primaria de MadridCentro de Salud Villarejo de SalvanesCalle Hospital 7Villarejo de SalvanesMadridSpain28590
| | - Jose Casanova‐Colominas
- Gerencia Asistencial de Atención PrimariaCentro de Salud Ciudad de los PeriodistasValencia de don Juan 1028034 MadridMadridSpain28034
| | - Amaya Azcoaga‐Lorenzo
- Gerencia Asistencial Atención PrimariaCentro de Salud Los PintoresC/Prolongación Cordoba s/nParlaMadridSpain29981
| | - Virginia Hernandez Santiago
- University of St AndrewsDivision of Population and Behavioural Sciences, School of MedicineNorth HaughDundeeUKKY16 9TF
| | - Manuel Gómez‐García
- Gerencia Asistencial Atención PrimariaCentro de Salud MirasierraC/ Mirador de la Reina nº 117MadridSpain28035
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Kishore AK, Vail A, Jeans AR, Chamorro A, Di Napoli M, Kalra L, Langhorne P, Roffe C, Westendorp W, Nederkoorn PJ, Garau J, van de Beek D, Montaner J, Woodhead M, Meisel A, Smith CJ. Microbiological Etiologies of Pneumonia Complicating Stroke. Stroke 2018; 49:1602-1609. [DOI: 10.1161/strokeaha.117.020250] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/02/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Amit K. Kishore
- From the Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, United Kingdom (A.K.K., C.J.S.)
- Division of Cardiovascular Sciences (A.K.K., C.J.S.)
| | - Andy Vail
- Centre for Biostatistics, Salford Royal Foundation Trust (A.V.)
| | - Adam R. Jeans
- University of Manchester, United Kingdom; Department of Microbiology, Salford Royal NHS Foundation Trust, United Kingdom (A.R.J.)
| | - Angel Chamorro
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, Spain (A.C.)
| | - Mario Di Napoli
- Neurological Service and Stroke Unit, San Camillo de’ Lellis General Hospital, Rieti, Italy (M.D.N.)
| | - Lalit Kalra
- Clinical Neurosciences, King’s College Hospital NHS Foundation Trust London, United Kingdom (L.K.)
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, Glasgow Royal Infirmary, University of Glasgow, United Kingdom (P.L.)
| | - Christine Roffe
- Keele University Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Stoke-on-Trent, United Kingdom (C.R.)
| | - Willeke Westendorp
- Department of Neurology, Academic Medical Center, Amsterdam Neuroscience, University of Amsterdam, Netherlands (W.W., P.J.N., D.v.d.B.)
| | - Paul J. Nederkoorn
- Department of Neurology, Academic Medical Center, Amsterdam Neuroscience, University of Amsterdam, Netherlands (W.W., P.J.N., D.v.d.B.)
| | - Javier Garau
- Department of Medicine, Hospital Universitari Mutua de Terrassa, Barcelona, Spain (J.G.)
| | - Diederik van de Beek
- Department of Neurology, Academic Medical Center, Amsterdam Neuroscience, University of Amsterdam, Netherlands (W.W., P.J.N., D.v.d.B.)
| | - Joan Montaner
- From the Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, United Kingdom (A.K.K., C.J.S.)
- Neurovascular Research Lab, Vall d’Hebron Research Institute, Barcelona, Spain (J.M.)
| | - Mark Woodhead
- Department of Respiratory Medicine, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester University NHS Foundation Trust, United Kingdom (M.W.)
| | - Andreas Meisel
- Department of Neurology, NeuroCure Clinical Research Center, Center for Stroke Research Berlin, Charité Universitaetsmedizin Berlin, Germany (A.M.)
| | - Craig J. Smith
- From the Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, United Kingdom (A.K.K., C.J.S.)
- Division of Cardiovascular Sciences (A.K.K., C.J.S.)
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9
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Bonniaud P, Fabre A, Frossard N, Guignabert C, Inman M, Kuebler WM, Maes T, Shi W, Stampfli M, Uhlig S, White E, Witzenrath M, Bellaye PS, Crestani B, Eickelberg O, Fehrenbach H, Guenther A, Jenkins G, Joos G, Magnan A, Maitre B, Maus UA, Reinhold P, Vernooy JHJ, Richeldi L, Kolb M. Optimising experimental research in respiratory diseases: an ERS statement. Eur Respir J 2018; 51:13993003.02133-2017. [PMID: 29773606 DOI: 10.1183/13993003.02133-2017] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/02/2018] [Indexed: 12/15/2022]
Abstract
Experimental models are critical for the understanding of lung health and disease and are indispensable for drug development. However, the pathogenetic and clinical relevance of the models is often unclear. Further, the use of animals in biomedical research is controversial from an ethical perspective.The objective of this task force was to issue a statement with research recommendations about lung disease models by facilitating in-depth discussions between respiratory scientists, and to provide an overview of the literature on the available models. Focus was put on their specific benefits and limitations. This will result in more efficient use of resources and greater reduction in the numbers of animals employed, thereby enhancing the ethical standards and translational capacity of experimental research.The task force statement addresses general issues of experimental research (ethics, species, sex, age, ex vivo and in vitro models, gene editing). The statement also includes research recommendations on modelling asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, lung infections, acute lung injury and pulmonary hypertension.The task force stressed the importance of using multiple models to strengthen validity of results, the need to increase the availability of human tissues and the importance of standard operating procedures and data quality.
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Affiliation(s)
- Philippe Bonniaud
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre Hospitalo-Universitaire de Bourgogne, Dijon, France.,Faculté de Médecine et Pharmacie, Université de Bourgogne-Franche Comté, Dijon, France.,INSERM U866, Dijon, France
| | - Aurélie Fabre
- Dept of Histopathology, St Vincent's University Hospital, UCD School of Medicine, University College Dublin, Dublin, Ireland
| | - Nelly Frossard
- Laboratoire d'Innovation Thérapeutique, Université de Strasbourg, Strasbourg, France.,CNRS UMR 7200, Faculté de Pharmacie, Illkirch, France.,Labex MEDALIS, Université de Strasbourg, Strasbourg, France
| | - Christophe Guignabert
- INSERM UMR_S 999, Le Plessis-Robinson, France.,Université Paris-Sud and Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Mark Inman
- Dept of Medicine, Firestone Institute for Respiratory Health at St Joseph's Health Care MDCL 4011, McMaster University, Hamilton, ON, Canada
| | - Wolfgang M Kuebler
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tania Maes
- Dept of Respiratory Medicine, Laboratory for Translational Research in Obstructive Pulmonary Diseases, Ghent University Hospital, Ghent, Belgium
| | - Wei Shi
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute of Children's Hospital Los Angeles, Los Angeles, CA, USA.,Dept of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Martin Stampfli
- Dept of Medicine, Firestone Institute for Respiratory Health at St Joseph's Health Care MDCL 4011, McMaster University, Hamilton, ON, Canada.,Dept of Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University
| | - Stefan Uhlig
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Aachen, Germany
| | - Eric White
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Martin Witzenrath
- Dept of Infectious Diseases and Respiratory Medicine And Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pierre-Simon Bellaye
- Département de Médecine nucléaire, Plateforme d'imagerie préclinique, Centre George-François Leclerc (CGFL), Dijon, France
| | - Bruno Crestani
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Service de Pneumologie A, Paris, France.,INSERM UMR 1152, Paris, France.,Université Paris Diderot, Paris, France
| | - Oliver Eickelberg
- Division of Pulmonary Sciences and Critical Care Medicine, Dept of Medicine, University of Colorado, Aurora, CO, USA
| | - Heinz Fehrenbach
- Priority Area Asthma & Allergy, Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany.,Member of the Leibniz Research Alliance Health Technologies
| | - Andreas Guenther
- Justus-Liebig-University Giessen, Universitary Hospital Giessen, Agaplesion Lung Clinic Waldhof-Elgershausen, German Center for Lung Research, Giessen, Germany
| | - Gisli Jenkins
- Nottingham Biomedical Research Centre, Respiratory Research Unit, City Campus, University of Nottingham, Nottingham, UK
| | - Guy Joos
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Antoine Magnan
- Institut du thorax, CHU de Nantes, Université de Nantes, Nantes, France
| | - Bernard Maitre
- Hôpital H Mondor, AP-HP, Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie et de Pathologie Professionnelle, DHU A-TVB, Université Paris Est - Créteil, Créteil, France
| | - Ulrich A Maus
- Hannover School of Medicine, Division of Experimental Pneumology, Hannover, Germany
| | - Petra Reinhold
- Institute of Molecular Pathogenesis at the 'Friedrich-Loeffler-Institut' (Federal Research Institute for Animal Health), Jena, Germany
| | - Juanita H J Vernooy
- Dept of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), AZ Maastricht, The Netherlands
| | - Luca Richeldi
- UOC Pneumologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Martin Kolb
- Dept of Medicine, Firestone Institute for Respiratory Health at St Joseph's Health Care MDCL 4011, McMaster University, Hamilton, ON, Canada
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10
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O'Flaherty BM, Li Y, Tao Y, Paden CR, Queen K, Zhang J, Dinwiddie DL, Gross SM, Schroth GP, Tong S. Comprehensive viral enrichment enables sensitive respiratory virus genomic identification and analysis by next generation sequencing. Genome Res 2018; 28:869-877. [PMID: 29703817 PMCID: PMC5991510 DOI: 10.1101/gr.226316.117] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 04/10/2018] [Indexed: 01/01/2023]
Abstract
Next generation sequencing (NGS) technologies have revolutionized the genomics field and are becoming more commonplace for identification of human infectious diseases. However, due to the low abundance of viral nucleic acids (NAs) in relation to host, viral identification using direct NGS technologies often lacks sufficient sensitivity. Here, we describe an approach based on two complementary enrichment strategies that significantly improves the sensitivity of NGS-based virus identification. To start, we developed two sets of DNA probes to enrich virus NAs associated with respiratory diseases. The first set of probes spans the genomes, allowing for identification of known viruses and full genome sequencing, while the second set targets regions conserved among viral families or genera, providing the ability to detect both known and potentially novel members of those virus groups. Efficiency of enrichment was assessed by NGS testing reference virus and clinical samples with known infection. We show significant improvement in viral identification using enriched NGS compared to unenriched NGS. Without enrichment, we observed an average of 0.3% targeted viral reads per sample. However, after enrichment, 50%–99% of the reads per sample were the targeted viral reads for both the reference isolates and clinical specimens using both probe sets. Importantly, dramatic improvements on genome coverage were also observed following virus-specific probe enrichment. The methods described here provide improved sensitivity for virus identification by NGS, allowing for a more comprehensive analysis of disease etiology.
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Affiliation(s)
- Brigid M O'Flaherty
- Centers for Disease Control and Prevention, NCIRD, DVD, Atlanta, Georgia 30329, USA.,Oak Ridge Institute for Science Education, Oak Ridge, Tennessee 37830, USA
| | - Yan Li
- Centers for Disease Control and Prevention, NCIRD, DVD, Atlanta, Georgia 30329, USA
| | - Ying Tao
- Centers for Disease Control and Prevention, NCIRD, DVD, Atlanta, Georgia 30329, USA
| | - Clinton R Paden
- Centers for Disease Control and Prevention, NCIRD, DVD, Atlanta, Georgia 30329, USA.,Oak Ridge Institute for Science Education, Oak Ridge, Tennessee 37830, USA
| | - Krista Queen
- Centers for Disease Control and Prevention, NCIRD, DVD, Atlanta, Georgia 30329, USA.,Oak Ridge Institute for Science Education, Oak Ridge, Tennessee 37830, USA
| | - Jing Zhang
- Centers for Disease Control and Prevention, NCIRD, DVD, Atlanta, Georgia 30329, USA.,IHRC Incorporated, Atlanta, Georgia 30346, USA
| | - Darrell L Dinwiddie
- Department of Pediatrics, Clinical Translational Science Center, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | | | - Gary P Schroth
- Illumina, Incorporated, San Diego, California 92122, USA
| | - Suxiang Tong
- Centers for Disease Control and Prevention, NCIRD, DVD, Atlanta, Georgia 30329, USA
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11
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van der Lee L, Hill AM, Patman S. A survey of clinicians regarding respiratory physiotherapy intervention for intubated and mechanically ventilated patients with community-acquired pneumonia. What is current practice in Australian ICUs? J Eval Clin Pract 2017; 23:812-820. [PMID: 28345309 DOI: 10.1111/jep.12722] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 12/31/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Community-acquired pneumonia (CAP) is a common cause for intensive care unit (ICU) admission resulting in high morbidity and mortality. There is a paucity of evidence regarding respiratory physiotherapy for intubated and mechanically ventilated patients with CAP, and anecdotally clinical practice is variable in this cohort. The aims of this study were to identify the degree of variability in physiotherapy practice for intubated adult patients with CAP and to explore ICU physiotherapist perceptions of current practice for this cohort and factors that influence physiotherapy treatment mode, duration, and frequency. METHOD A survey was developed based on common aspects of assessment, clinical rationale, and intervention for intubated and mechanically ventilated patients. Senior ICU physiotherapists across 88 Australian public and private hospitals were recruited. RESULTS The response rate was 72%. Respondents (n = 75) stated their main rationale for providing a respiratory intervention were improved airway clearance (98%, n = 60/61), alveolar recruitment (74%, n = 45/61), and gas exchange (33%, n = 20/61). Respondents estimated that average intervention lasted between 16 and 30 minutes (70% of respondents, n = 41/59) and would be delivered once (44%) or twice (44%) daily. Results indicated large variability in reported practice; however, trends existed regarding positioning in alternate side-lying (81%, n = 52/64) or affected lung uppermost (83%, n = 53/64) and use of hyperinflation techniques (81%, 52/64). Decisions regarding duration were reported to be based on sputum volume (95%), viscosity (93%) and purulence (88%), cough effectiveness (95%), chest X-ray (87%), and auscultation (84%). Sixty percent reported that workload and staffing affected intervention duration and frequency. Intervention time was more likely increased when there was greater staffing (P = .03). CONCLUSION Respiratory physiotherapy treatment varies for intubated patients with CAP. Further research is required to determine what is considered best practice for this patient population.
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Affiliation(s)
- Lisa van der Lee
- School of Physiotherapy, The University of Notre Dame Australia, 19 Mouat Street, Fremantle, Western Australia, 6959, Australia.,Allied Health, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Kent St, Bentley, Perth, Western Australia, 6845, Australia
| | - Shane Patman
- School of Physiotherapy, The University of Notre Dame Australia, 19 Mouat Street, Fremantle, Western Australia, 6959, Australia
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12
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van der Lee L, Hill AM, Patman S. Efficacy of a respiratory physiotherapy intervention for intubated and mechanically ventilated adults with community acquired pneumonia: a systematic review protocol. ACTA ACUST UNITED AC 2017. [PMID: 28628508 DOI: 10.11124/jbisrir-2016-003145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
REVIEW OBJECTIVES The objective of the review is to map evidence on the efficacy of a respiratory physiotherapy intervention for intubated and mechanically ventilated adults with community acquired pneumonia (CAP). Specifically, the review seeks to investigate if respiratory physiotherapy interventions can achieve the following for intubated and mechanically ventilated adults with CAP.
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Affiliation(s)
- Lisa van der Lee
- 1School of Physiotherapy, The University of Notre Dame, Fremantle, Australia 2School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia 3Department of Allied Health, Fiona Stanley Hospital, Murdoch, Australia 4The Western Australian Group for Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence, Perth, Australia
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13
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Tomczyk S, Jain S, Bramley AM, Self WH, Anderson EJ, Trabue C, Courtney DM, Grijalva CG, Waterer GW, Edwards KM, Wunderink RG, Hicks LA. Antibiotic Prescribing for Adults Hospitalized in the Etiology of Pneumonia in the Community Study. Open Forum Infect Dis 2017; 4:ofx088. [PMID: 28730159 PMCID: PMC5510457 DOI: 10.1093/ofid/ofx088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/04/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) 2007 guidelines from the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recommend a respiratory fluoroquinolone or beta-lactam plus macrolide as first-line antibiotics for adults hospitalized with CAP. Few studies have assessed guideline-concordant antibiotic use for patients hospitalized with CAP after the 2007 IDSA/ATS guidelines. We examine antibiotics prescribed and associated factors in adults hospitalized with CAP. METHODS From January 2010 to June 2012, adults hospitalized with clinical and radiographic CAP were enrolled in a prospective Etiology of Pneumonia in the Community study across 5 US hospitals. Patients were interviewed using a standardized questionnaire, and medical charts were reviewed. Antibiotics prescribed were classified according to defined nonrecommended CAP antibiotics. We assessed factors associated with nonrecommended CAP antibiotics using logistic regression. RESULTS Among enrollees, 1843 of 1874 (98%) ward and 440 of 446 (99%) ICU patients received ≥1 antibiotic ≤24 hours after admission. Ward patients were prescribed a respiratory fluoroquinolone alone (n = 613; 33%), or beta-lactam plus macrolide (n = 365; 19%), beta-lactam alone (n = 240; 13%), among other antibiotics, including vancomycin (n = 235; 13%) or piperacillin/tazobactam (n = 157; 8%) ≤24 hours after admission. Ward patients with known risk for healthcare-associated pneumonia (HCAP), recent outpatient antibiotic use, and in-hospital antibiotic use <6 hours after admission were significantly more likely to receive nonrecommended CAP antibiotics. CONCLUSIONS Although more than half of ward patients received antibiotics concordant with IDSA/ATS guidelines, a number received nonrecommended CAP antibiotics, including vancomycin and piperacillin/tazobactam; risk factors for HCAP, recent outpatient antibiotic, and rapid inpatient antibiotic use contributed to this. This hypothesis-generating descriptive epidemiology analysis could help inform antibiotic stewardship efforts, reinforces the need to harmonize guidelines for CAP and HCAP, and highlights the need for improved diagnostics to better equip clinicians.
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Affiliation(s)
- Sara Tomczyk
- Epidemic Intelligence Service
- Respiratory Diseases Branch
| | | | | | | | | | - Chris Trabue
- University of Tennessee Health Science Center, Nashville, Tennessee
| | - D Mark Courtney
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
| | | | - Grant W Waterer
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
- University of Western Australia, Perth, Australia
| | | | | | - Lauri A Hicks
- Respiratory Diseases Branch
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, and
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14
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Increase in fitness of Streptococcus pneumoniae is associated with the severity of necrotizing pneumonia. Pediatr Infect Dis J 2015; 34:499-505. [PMID: 25461475 DOI: 10.1097/inf.0000000000000631] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of necrotizing pneumococcal pneumonia has increased during the past 2 decades. We hypothesized that increased pneumococcal load or augmented inflammatory cytokine production might lead to destructive pneumococcal lung disease. METHODS This study enrolled prospectively 0- to 18-year-old children with a diagnosis of community-acquired pneumonia with pleural effusion admitted to 6 medical centers from March 2010 to April 2012. Children were diagnosed with pneumococcal empyema if the pleural fluid tested positive for quantitative pneumococcal (lytA) detection by real-time polymerase chain reaction. Pneumococcal empyema cases were further divided into 4 groups according to necrosis severity: (0) nonnecrosis, (1) mild necrosis, (2) cavitation and (3) bronchopleural fistula. Nasopharyngeal and pleural pneumococcal load, as well as levels of proinflammatory cytokines (TNF-α, IL-1β, IL-6, IL-8), Th1-(IL-2, IFN-γ), Th2-(IL-4, IL-10) and Th17-cytokines (IL-17), in the pleural fluid was measured. RESULTS Serotypes 19A and 3 accounted for 69.4% and 12.5%, respectively, of 72 cases of pneumococcal empyema. Pleural pneumococcal load was significantly higher in serotypes 19A and 3 infection than in the other strains causing infection (P = 0.006). There was a correlation between nasopharyngeal and pleural pneumococcal load (ρ = 0.35; P = 0.05). In multivariate ordinal logistic regression analysis, pleural pneumococcal load (adjusted odds ratio: 1.79; 95% confidence interval: 1.03-3.06) and IL-8 (adjusted odds ratio: 2.64; 95% confidence interval: 1.21-5.75) were independent factors associated with the severity of lung necrosis. CONCLUSIONS Evolution of Streptococcus pneumoniae toward increased fitness in their interaction with host and exaggerated IL-8 expression may be responsible for the increase of necrotizing pneumococcal pneumonia.
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15
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Impact of the glpQ2 gene on virulence in a Streptococcus pneumoniae serotype 19A sequence type 320 strain. Infect Immun 2014; 83:682-92. [PMID: 25422269 DOI: 10.1128/iai.02357-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Glycerophosphodiester phosphodiesterase (GlpQ) metabolizes glycerophosphorylcholine from the lung epithelium to produce free choline, which is transformed into phosphorylcholine and presented on the surfaces of many respiratory pathogens. Two orthologs of glpQ genes are found in Streptococcus pneumoniae: glpQ, with a membrane motif, is widespread in pneumococci, whereas glpQ2, which shares high similarity with glpQ in Haemophilus influenzae and Mycoplasma pneumoniae, is present only in S. pneumoniae serotype 3, 6B, 19A, and 19F strains. Recently, serotype 19A has emerged as an epidemiological etiology associated with invasive pneumococcal diseases. Thus, we investigated the pathophysiological role of glpQ2 in a serotype 19A sequence type 320 (19AST320) strain, which was the prevalent sequence type in 19A associated with severe pneumonia and invasive pneumococcal disease in pediatric patients. Mutations in glpQ2 reduced phosphorylcholine expression and the anchorage of choline-binding proteins to the pneumococcal surface during the exponential phase, where the mutants exhibited reduced autolysis and lower natural transformation abilities than the parent strain. The deletion of glpQ2 also decreased the adherence and cytotoxicity to human lung epithelial cell lines, whereas these functions were indistinguishable from those of the wild type in complementation strains. In a murine respiratory tract infection model, glpQ2 was important for nasopharynx and lung colonization. Furthermore, infection with a glpQ2 mutant decreased the severity of pneumonia compared with the parent strain, and glpQ2 gene complementation restored the inflammation level. Therefore, glpQ2 enhances surface phosphorylcholine expression in S. pneumoniae 19AST320 during the exponential phase, which contributes to the severity of pneumonia by promoting adherence and host cell cytotoxicity.
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17
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Obed M, García-Vidal C, Pessacq P, Mykietiuk A, Viasus D, Cazzola L, Domínguez MA, Calmaggi A, Carratalà J. [Clinical features and outcome of community-acquired methicillin-resistant Staphylococcus aureus pneumonia]. Enferm Infecc Microbiol Clin 2013; 32:23-7. [PMID: 23473825 DOI: 10.1016/j.eimc.2013.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 01/16/2013] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The aim of this study is to describe the epidemiological and clinical features, treatment and prognosis of community-acquired pneumonia (CAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) in two different geographic regions where community-acquired MRSA (CA-MRSA) infections have different frequencies. METHODS Observational study of patients admitted to two hospitals (one in Argentina, the other in Spain) between March 2008 and June 2012. RESULTS We documented 16 cases of CAP caused by MRSA. MRSA accounted for 15 of 547 (2.7%) cases of CAP in Hospital Rodolfo Rossi and 1 of 1258 (0,08%) cases at the Hospital Universitari de Bellvitge (P ≤ .001). Most patients were young and previously healthy. Multilobar infiltrates, cavitation and skin and soft tissue involvement were frequent. All patients had positive blood cultures. Five patients required admission to the intensive care unit. Early mortality (≤ 48 hours) was 19%, and overall mortality (≤ 30 days) was 25%. CONCLUSION CAP caused by MRSA causes high morbidity and mortality rates. It should be suspected in areas with a high prevalence of CA-MRSA infections, and especially in young and healthy patients who present with multilobar pneumonia with cavitation. Mortality is mainly related to septic shock and respiratory failure and occurs early in most cases.
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Affiliation(s)
- Mora Obed
- Servicio de Enfermedades Infecciosas, Hospital Rodolfo Rossi, La Plata, Argentina
| | - Carolina García-Vidal
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge-IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España; REIPI (Red Española de Investigación en Patología Infecciosa), Instituto de Salud Carlos III, Madrid, España.
| | - Pedro Pessacq
- Servicio de Enfermedades Infecciosas, Hospital Rodolfo Rossi, La Plata, Argentina
| | - Analia Mykietiuk
- Servicio de Enfermedades Infecciosas, Hospital Rodolfo Rossi, La Plata, Argentina
| | - Diego Viasus
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge-IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España; REIPI (Red Española de Investigación en Patología Infecciosa), Instituto de Salud Carlos III, Madrid, España
| | - Laura Cazzola
- Laboratorio de Microbiología, Hospital Rodolfo Rossi, La Plata, Argentina
| | - M Angeles Domínguez
- REIPI (Red Española de Investigación en Patología Infecciosa), Instituto de Salud Carlos III, Madrid, España; Servicio de Microbiología, Hospital Universitario de Bellvitge, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Anibal Calmaggi
- Servicio de Enfermedades Infecciosas, Hospital Rodolfo Rossi, La Plata, Argentina
| | - Jordi Carratalà
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge-IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España; REIPI (Red Española de Investigación en Patología Infecciosa), Instituto de Salud Carlos III, Madrid, España
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18
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Fujisaki R, Yamaoka T, Yamamura M, Kawakami S, Ono Y, Miyazawa Y, Teramoto T, Nishiya H. Usefulness of gram-stained sputum obtained just after administration of antimicrobial agents as the earliest therapeutic indicator for evaluating the effectiveness of empiric therapy in community-acquired pneumonia caused by pneumococcus or Moraxella catarrhalis. J Infect Chemother 2012; 19:517-23. [PMID: 23073648 DOI: 10.1007/s10156-012-0475-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/04/2012] [Indexed: 10/27/2022]
Abstract
We present here three cases in which morphological changes and/or a decreased number of Streptococcus pneumoniae or Moraxella catarrhalis could be observed in gram-stained sputum obtained just after the first administration of an antimicrobial agent. Case 1 was a 53-year-old man with pneumonia caused by gram-positive diplococcus, identified as S. pneumoniae, who was administered 2 g of ampicillin over a period of 1 h. Gram-stained sputum showed smaller or gram-negative pneumococci at the completion of administration of the agent, a decreased number of cocci at 1 h after administration, and almost no cocci at 12 h after the completion of administration. Case 2 was a 72-year-old woman with pneumonia caused by diplococcus, identified as S. pneumoniae, who was administered 2 g of ampicillin over a period of 1 h. Gram-stained sputum showed weakly stained, small cocci at the completion of administration of the agent and few cocci at 1 h after the completion of administration. Case 3 was a 58-year-old woman with pneumonia caused by a gram-negative diplococcus, identified as Moraxella catarrhalis, who was administered 1 g of cefotaxime over a period of 30 min. Gram-stained sputum showed few extracellular cocci and some intracellular cocci inside neutrophils 1 h after administration and no cocci 2 h after the completion of administration. These three cases showed that gram-stained sputum obtained just after and/or 1 h after administration of the first antimicrobial agent were suitable as the quickest therapeutic indicator of the effectiveness of empiric therapy, with the effectiveness of the agent being shown much earlier than with markers such as the white blood cell count and C-reactive protein level.
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Affiliation(s)
- Ryuichi Fujisaki
- Department of Internal Medicine, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, 173-8605, Japan
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19
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Morrissey I, Leakey A. Activity of ceftaroline against serotyped Streptococcus pneumoniae isolates from Europe and South Africa associated with community-acquired bacterial pneumonia (2007-08). J Antimicrob Chemother 2012; 67:1408-12. [PMID: 22357801 DOI: 10.1093/jac/dks038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Abstract
OBJECTIVES To determine the activity of ceftaroline (the active metabolite of the prodrug ceftaroline fosamil), a new cephalosporin recently approved in the USA for the treatment of community-acquired bacterial pneumonia, against serotyped Streptococcus pneumoniae causing community-acquired bacterial pneumonia from Europe and South Africa. METHODS During 2007-08, 74 centres submitted 857 isolates of S. pneumoniae from patients with community-acquired bacterial pneumonia. These were re-identified and serotyped. MICs of ceftaroline and 12 comparators were determined by CLSI broth microdilution at a central laboratory. RESULTS Ceftaroline was very active against all 857 S. pneumoniae isolates (MIC(90) 0.12 mg/L). The MIC(50) for South African isolates was 0.06 mg/L compared with 0.004 or 0.008 mg/L for isolates from elsewhere. Antibiotic resistance was also higher in South Africa than other countries. Serotypes 3, 1, 7 and 11 were more susceptible to ceftaroline (MIC(90) = 0.008 mg/L) and the reference antibiotics than the population as a whole. Ceftaroline showed a biphasic MIC distribution (associated with cefuroxime susceptibility), the extent of which differed between isolate populations. Nevertheless, the highest ceftaroline MIC observed was only 0.5 mg/L (two isolates: one from the UK and one from South Africa). CONCLUSIONS These data from a large collection of S. pneumoniae isolates during 2007-08 from Europe and South Africa with varying serotype and antibiotic susceptibility, confirm the excellent in vitro activity of ceftaroline against S. pneumoniae causing community-acquired bacterial pneumonia in both adults and children.
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Aetiology of community-acquired pneumonia among adults in an H1N1 pandemic year: the role of respiratory viruses. Eur J Clin Microbiol Infect Dis 2012; 31:2765-72. [PMID: 22549730 PMCID: PMC7088264 DOI: 10.1007/s10096-012-1626-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 04/06/2012] [Indexed: 01/10/2023]
Abstract
This study aimed to determine the aetiology of community-acquired pneumonia (CAP) by adding polymerase chain reaction (PCR) to conventional methods and to describe the clinical and laboratory features between patients with bacterial pneumonia (BP) and viral pneumonia (VP). Adults with CAP admitted from November 2009 to October 2010 were included. Demographics, comorbidities, severity and clinical features were recorded. Conventional microbiological methods included blood and sputum cultures, acute and convalescent serologic samples, and antigen urinary detection. New methods included multiplex PCR for Mycoplasma pneumoniae, Legionella pneumophila, Chlamydophila pneumoniae, Bordetella pertussis and 15 respiratory viruses. A total of 169 patients were included. Using conventional methods, we identified a pathogen in 51 % of cases. With PCR, up to 70 % of cases had an aetiological diagnosis. Forty-five patients had BP (34 %), 22 had VP (17 %) and 25 (19 %) had co-infection (BP and VP). Pneumococci and respiratory syncytial virus (RSV) were the most frequently identified pathogens. Procalcitonin (PCT) and C-reactive protein (CRP) median values were significantly higher in BP than in VP patients. Shaking chills, higher CURB score and shock were significantly more frequent in BP. A viral infection was identified in more than one-third of patients with CAP. Clinical and laboratory features could help to differentiate between VP and BP and to guide empirical therapy.
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Simonetti A, Viasus D, Garcia-Vidal C, Adamuz J, Roset A, Manresa F, Dorca J, Gudiol F, Carratalà J. Timing of antibiotic administration and outcomes of hospitalized patients with community-acquired and healthcare-associated pneumonia. Clin Microbiol Infect 2011; 18:1149-55. [PMID: 22115052 DOI: 10.1111/j.1469-0691.2011.03709.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The effects of antibiotic timing on outcomes of patients with community-acquired pneumonia (CAP) are controversial. Moreover, no information is available regarding this issue in healthcare-associated pneumonia (HCAP). We aimed to determine the impact of antibiotic timing on 30-day mortality of patients with CAP and HCAP. Non-immunocompromised adults admitted to hospital through the emergency department (ED) with community-onset pneumonia were prospectively observed from 2001 to 2009. Patients who received prior antibiotics were excluded. Of 1593 patients with pneumonia who were analyzed, 1274 had CAP and 319 HCAP. The mean time from patient arrival at the ED until antibiotic administration was 5.8 h (standard deviation (SD) 3.5) in CAP and 6.1 h (SD 3.8) in HCAP (p 0.30). Mortality was higher in patients with HCAP (5.5% vs. 13.5%; p <0.001). After adjusting for confounding factors in a logistic regression analysis, the antibiotic administration ≤4 h was not associated with decreased 30-day mortality in patients with CAP (odds ratio (OR) 1.12, 95% confidence interval (CI) 0.57-2.21) and in patients with HCAP (OR 0.59, 95% CI 0.19-1.83). Similarly, antibiotic administration ≤8 h was not associated with decreased 30-day mortality in CAP (OR 1.58, 95% CI 0.64-3.88) and HCAP patients (OR 0.59, 95% CI 0.19-1.83). In conclusion, antibiotic administration within 4 or 8 h of arrival at the ED did not improve 30-day survival in hospitalized adults for CAP or HCAP.
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Affiliation(s)
- A Simonetti
- Service of Infectious Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona, Spain
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Doshi SM, Rueda AM, Corrales-Medina VF, Musher DM. Anemia and community-acquired pneumococcal pneumonia. Infection 2011; 39:379-83. [PMID: 21556973 DOI: 10.1007/s15010-011-0122-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 04/14/2011] [Indexed: 11/25/2022]
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Rodriguez-Barrientos R, López-Alcalde J, Rodríguez-Fernández C, Muñoz-Gutiérrez J, Gómez-García M, Molero-García JM, Casanova-Colominas J, Marin-Cañada J, Redondo-Sánchez J, Vila-Méndez ML. Short-course versus long-course therapy of the same antibiotic for community-acquired pneumonia in adolescent and adult outpatients. Hippokratia 2011. [DOI: 10.1002/14651858.cd009070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Jesús López-Alcalde
- CIBER Epidemiología y Salud Pública (CIBERESP) - Universitat Autònoma de Barcelona; Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau); Barcelona Catalunya Spain 08041
| | | | | | - Manuel Gómez-García
- Madrid Health Service; Centro de Salud Mirasierra; C/ Mirador de la Reina nº 117 Madrid Spain 28035
| | - José María Molero-García
- Madrid Health Service; Centro de Salus San Andrés; Alberto Palacios, nº 22 Madrid Madrid Spain 28021
| | - Jose Casanova-Colominas
- Madrid Health Service; Primary Care; Llano Castellano Av. number 3 Centro de Salud Virgen de Begoña Madrid Madrid Spain 28034
| | - Jaime Marin-Cañada
- Madrid Health Service; Centro de Salud Jaime Vera; Av. España Madrid Spain 28822
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Rozenbaum MH, Hak E, van der Werf TS, Postma MJ. Results of a cohort model analysis of the cost-effectiveness of routine immunization with 13-valent pneumococcal conjugate vaccine of those aged > or =65 years in the Netherlands. Clin Ther 2010; 32:1517-32. [PMID: 20728764 DOI: 10.1016/j.clinthera.2010.06.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Community-acquired pneumonia and invasive pneumococcal disease are common among older people (ie, those aged > or =65 years). A new 13-valent pneumococcal conjugate vaccine (PCV-13) is under study in the Netherlands. OBJECTIVE The aim of this work was to model the cost-effectiveness of PCV-13 vaccination among those aged > or =65 years in the Netherlands, both in the total population and in those at increased risk for pneumonia, for various levels of efficacy (30%-90%) assumed. METHODS Our previously published cost-effectiveness model was updated to include age-specific epidemiologic data and health-care utilization and costs for a hypothetical cohort of adults aged > or =65 years in the Netherlands. This cohort was followed twice-once as unvaccinated and once as vaccinated-over a time period of 5 years, with differences between both analyses reported. Outcome measures included costs, life-years gained (LYGs), quality-adjusted life-years, and incremental cost-effectiveness ratios (ICERs). All analyses were performed from a societal perspective. RESULTS In the model, the ICER for vaccination remained below euro80,000/LYG, except when the vaccine was assumed to protect only against bacteremic pneumonia, with a relatively low effectiveness (40%) in combination with a high vaccine price (euro65), and indirect effects of serotype replacement would largely offset the direct effect of vaccination. For various assumptions, introduction of widespread PCV-13 vaccination (assuming a 60% efficacy against invasive and noninvasive disease because of vaccine serotypes, and a cost of euro50 per vaccinated person) was associated with the ICERs varying from cost-saving to euro50,676/LYG. CONCLUSIONS In this model analysis of a hypothetical cohort in the Netherlands, vaccination with PCV-13 might be considered cost-effective, both for the total population and for the high-risk population aged > or =65 years, from a societal perspective, over a 5-year time horizon. The main limitation of this study was uncertainty regarding how great a proportion of pneumonia could be attributed to pneumococcal disease.
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Affiliation(s)
- Mark H Rozenbaum
- Department of Pharmacy, University of Groningen, the Netherlands.
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25
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Mermond S, Berlioz-Arthaud A, Estivals M, Baumann F, Levenes H, Martin PMV. Aetiology of community-acquired pneumonia in hospitalized adult patients in New Caledonia. Trop Med Int Health 2010; 15:1517-24. [PMID: 20955369 DOI: 10.1111/j.1365-3156.2010.02653.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the aetiology of community-acquired pneumonia (CAP) in hospitalized adult patients in New Caledonia, a French archipelago in the South Pacific. METHODS Confirmed CAP patients (n=137) were enrolled prospectively. Pathogens were detected by culture, molecular methods, serology on paired sera, immunofluorescence on nasopharyngeal swabs and antigen detection in urine. RESULTS The aetiology of CAP was determined in 82 of 137 cases (59.8%), of which 31 exhibited two or more pathogens (37.8%). Hundred and seventeen pathogens were detected: Streptococcus pneumoniae was the most common one (41.0%), followed by influenza virus A (22.1%) and Haemophilus influenzae (10.2%). The frequency of atypical bacteria was low (6.0%). The most frequent and significant coinfection was S. pneumoniae with influenza A virus (P=0.004). Influenza virus was detected from nasopharyngeal swabs in four patients (15.4% of patients tested for influenza) and by PCR from pulmonary specimens in 15 patients (57.7%). CONCLUSIONS : Pneumoniae is the leading cause of CAP in New Caledonian adults. Viral-bacterial co-infections involving S. pneumoniae and influenza virus are very common during the winter. Such adult patients hospitalized with CAP are a clear sentinel group for surveillance of influenza. Vaccination against influenza and S. pneumoniae should be strengthened when risk factors are identified.
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Affiliation(s)
- Sylvain Mermond
- Institut Pasteur de Nouvelle-Calédonie, Nouméa, CHT Gaston Bourret, Nouméa, New Caledonia.
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How CK, Hou SK, Shih HC, Yen DHT, Huang CI, Lee CH, Tang GJ. Usefulness of triggering receptor expressed on myeloid cells-1 in differentiating between typical and atypical community-acquired pneumonia. Am J Emerg Med 2010; 29:626-31. [PMID: 20825846 DOI: 10.1016/j.ajem.2010.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 12/31/2009] [Accepted: 01/02/2010] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The purpose of this study is to investigate the clinical use of inflammatory marker triggering receptor expressed on myeloid cells (TREM)-1 at admission for differentiating between typical and atypical bacterial community-acquired pneumonia (CAP). METHODS A prospective, noninterventional study of patients with CAP hospitalized through the emergency department was performed. Surface expression of TREM-1 was analyzed using flow cytometry on peripheral blood cells, and soluble TREM-1 (sTREM-1) concentration was determined in plasma. RESULTS Eighty-eight patients with clinical suspicion of CAP were eligible. The causative pathogen was identified in 39 patients (44.3%). After excluding 4 mixed pneumonia cases, 21 typical and 14 atypical bacterial infections were enrolled. Patients with typical bacterial CAP demonstrated increased TREM-1 surface expression on monocytes and neutrophils. Median plasma sTREM-1 levels at admission were 65.2 pg/mL (range, 17.6-138.1 pg/mL) in patients with typical CAP and 25.9 pg/mL (range, 11.5-54.8 pg/mL) in patients with atypical CAP (P < .001). Soluble TREM-1 had good discriminative value to differentiate typical from atypical pathogens with an area under the receiver operating characteristic curve of 0.87 (95% confidence interval, 0.75-0.98). At a cutoff level of 44.2 pg/mL, sTREM-1 yielded a sensitivity of 81%, a specificity of 79%, a positive likelihood ratio of 3.79, and a negative likelihood ratio of 0.24. CONCLUSIONS In newly admitted patients with CAP, determination of the TREM-1 levels may provide useful additional diagnostic information on the bacterial etiology.
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Hagan JB, Park MA, Kita H, Campeau NG. Reduced immunoglobulin M is associated with sinus mucosal thickening, osteitis and sinus surgery in patients with common variable immunodeficiency. Int Arch Allergy Immunol 2009; 152:81-6. [PMID: 19940510 DOI: 10.1159/000260088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 07/29/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although common variable immunodeficiency (CVID) is associated with sinopulmonary disease, there are no previous systematic evaluations comparing computed tomographic (CT) sinus imaging with immunoglobulin measurements in patients with this condition. METHODS We performed a retrospective review by a blinded observer using the Lund-Mackay numerical scoring scale as well as a visual scale for remodeling changes in the paranasal sinus bone on CT scans in CVID patients. RESULTS The sinus CT scans of 19 subjects (9 males, 10 females; median age at diagnosis 34 years) are described. There was an inverse relationship between serum IgM and sinus mucosal thickening as described by the Lund-Mackay scale (R = -0.6398; p = 0.0032). Osteitis of the paranasal sinus bone was almost exclusively found in patients with a reduced serum IgM level of less than 25 mg/dl (p = 0.0074). CONCLUSION This is the first study to show that sinus mucosal thickening on CT in patients with CVID is inversely related to serum IgM levels.
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Affiliation(s)
- John B Hagan
- Department of Medicine, Division of Allergic Diseases, Mayo Clinic and Foundation, Rochester, Minn., USA
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28
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Rello J, Lisboa T, Lujan M, Gallego M, Kee C, Kay I, Lopez D, Waterer GW. Severity of Pneumococcal Pneumonia Associated With Genomic Bacterial Load. Chest 2009; 136:832-840. [DOI: 10.1378/chest.09-0258] [Citation(s) in RCA: 158] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Garcia-Vidal C, Carratalà J, Fernández-Sabé N, Dorca J, Verdaguer R, Manresa F, Gudiol F. Aetiology of, and risk factors for, recurrent community-acquired pneumonia. Clin Microbiol Infect 2009; 15:1033-8. [PMID: 19673961 DOI: 10.1111/j.1469-0691.2009.02918.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recurrent community-acquired pneumonia (CAP) requiring hospitalization is a matter of particular concern. However, current information on its prevalence, aetiology and risk factors is lacking. To address these issues, we performed an observational analysis of a prospective cohort of hospitalized adults with CAP. Recurrence was defined as two or more episodes of CAP 1 month apart within 3 years. Patients with severe immunosuppression or local predisposing factors were excluded. Of the 1556 patients, 146 (9.4%) had recurrent CAP. The most frequent causative organism was Streptococcus pneumoniae, both in patients with recurrent CAP and in those without recurrence. Haemophilus influenzae, other Gram-negative bacilli and aspiration pneumonia were more frequent among patients with recurrent CAP, whereas Legionella pneumophila was rarely identified in this group. Independent factors associated with recurrent CAP were greater age, lack of pneumococcal vaccination, chronic obstructive pulmonary disease (COPD) and corticosteroid therapy. In a sub-analysis of 389 episodes of pneumococcal pneumonia, the only independent risk factor for recurrence was lack of pneumococcal vaccination. Recurrence of CAP is not a rare clinical problem and it occurs mainly in the elderly, patients with COPD, and those receiving corticosteroids. Our study provides support for recommending pneumococcal vaccination for adults at risk of pneumonia, including those with a first episode of CAP.
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Affiliation(s)
- C Garcia-Vidal
- Infectious Disease, Institut d'Investigació Biomèdica de Bellvitge-Hospital Universitari de Bellvitge (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Abstract
PURPOSE OF REVIEW The issue of whether the outcome of bacteremic pneumococcal infections is improved with the use of combination antibiotic therapy versus monotherapy is still not resolved. This review highlights recent studies that have addressed this issue. RECENT FINDINGS Some studies have indicated benefit of combination antibiotic therapy in severely ill patients with community-acquired pneumonia of all-cause. Conversely, in less severely ill hospitalized patients, fluoroquinolone monotherapy was as effective as fluoroquinolone combination regimens and a propensity analysis failed to show benefit of beta-lactam/macrolide combination over beta-lactam monotherapy. Studies across the world have shown a more favorable outcome in patients with community-acquired pneumonia treated with guideline-compliant therapy, mostly beta-lactam/macrolide combination regimens. The only recent study of patients with bacteremic pneumococcal pneumonia failed, however, to show benefit of combination therapy. A large number of investigations have yielded observations that address possible mechanisms by which combination therapy may have benefit, investigating issues such as cover for atypical pathogens, attenuation of pneumococcal virulence factors, and anti-inflammatory activity of the macrolide group of antibiotics. SUMMARY Despite a number of recent studies, the definitive decision regarding the need for combination antibiotic therapy for the effective management of bacteremic pneumococcal infections has not yet been formally resolved.
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Kilpatrick DC, Chalmers JD, MacDonald SL, Murray M, Mohammed A, Hart SP, Matsushita M, Hill A. Stable bronchiectasis is associated with low serum L-ficolin concentrations. CLINICAL RESPIRATORY JOURNAL 2009; 3:29-33. [DOI: 10.1111/j.1752-699x.2008.00105.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marimón JM, Cilla G, Pérez-Trallero E. Biología molecular en el diagnóstico de la infección respiratoria aguda de origen bacteriano. Enferm Infecc Microbiol Clin 2008; 26 Suppl 9:26-32. [DOI: 10.1016/s0213-005x(08)76538-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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