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Suaya JA, Fletcher MA, Georgalis L, Arguedas AG, McLaughlin JM, Ferreira G, Theilacker C, Gessner BD, Verstraeten T. Identification of Streptococcus pneumoniae in hospital-acquired pneumonia in adults. J Hosp Infect 2020; 108:146-157. [PMID: 33176175 DOI: 10.1016/j.jhin.2020.09.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/29/2022]
Abstract
Hospital-acquired pneumonia (HAP) is often more severe and life-threatening than community-acquired pneumonia (CAP). The role of Streptococcus pneumoniae in CAP is well-understood, but its role in HAP is unclear. The objective of this study was to summarize the available literature on the prevalence of S. pneumoniae in HAP episodes. We searched MEDLINE for peer-reviewed articles on the microbiology of HAP in individuals aged ≥18 years, published between 2008 and 2018. We calculated pooled estimates of the prevalence of S. pneumoniae in episodes of HAP using a random-effects, inverse-variance-weighted meta-analysis. Forty-seven of 1908 articles met the inclusion criteria. Bacterial specimen isolation techniques for microbiologically defined HAP episodes included bronchoalveolar lavage, protective specimen brush, tracheobronchial aspirate and sputum, as well as blood culture. Culture was performed in all studies; five studies also used urine antigen detection (5/47; 10.6%). S. pneumoniae was identified in 5.1% (95% confidence interval (CI): 3.8-6.6%) of microbiologically defined HAP episodes (N = 20), with 5.4% (95% CI: 4.3-6.7%, N = 29) in ventilator-associated HAP and 6.0% (95% CI: 4.1-8.8%, N = 6) in non-ventilator-associated HAP. S. pneumoniae was identified in 5.3% (95% CI: 4.5-6.3%) of HAP occurring in the intensive care unit (ICU, N = 41) and in 5.6% (95% CI: 3.3-9.5%, N = 5) outside the ICU. A higher proportion of early-onset HAP (10.3%; 95% CI: 8.3-12.8%, N = 16) identified S. pneumoniae as compared with late-onset HAP (3.3%; 95% CI: 2.5-4.4%, N = 16). In conclusion, S. pneumoniae was identified by culture in 5.1% of microbiologically defined HAP episodes. The importance of HAP as part of the disease burden caused by S. pneumoniae merits further research.
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Affiliation(s)
- J A Suaya
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc., New York, NY, USA.
| | - M A Fletcher
- Emerging Markets Medical Affairs, Vaccines, Pfizer Inc., Paris, France
| | - L Georgalis
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - A G Arguedas
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc., New York, NY, USA
| | - J M McLaughlin
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc., New York, NY, USA
| | - G Ferreira
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - C Theilacker
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc., New York, NY, USA
| | - B D Gessner
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc., New York, NY, USA
| | - T Verstraeten
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
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Takada H, Hifumi T, Nishimoto N, Kanemura T, Yoshioka H, Okada I, Kiriu N, Inoue J, Koido Y, Kato H. Linezolid versus vancomycin for nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus in the elderly: A retrospective cohort analysis: Effectiveness of linezolid in the elderly. Am J Emerg Med 2016; 35:245-248. [PMID: 27832976 DOI: 10.1016/j.ajem.2016.10.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/21/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Several reports have compared the efficacy of linezolid (LZD) in Methicillin-resistant Staphylococcus aureus (MRSA) infections with that of vancomycin (VCM); however, these two antibiotics for the treatment of nosocomial MRSA pneumonia in elderly patients has not been well evaluated. The purpose of this study is to evaluate the efficacy and safety of LZD compared with VCM for the treatment of elderly patients with nosocomial MRSA pneumonia in a retrospective chart review of a cohort. METHODS We included 28 consecutive patients aged ≥65years hospitalized with a confirmed diagnosis of MRSA pneumonia and treated with LZD (n=11) or VCM (n=17) between November 2010 and May 2015. We collected patient, disease, and laboratory data. The primary outcome was 30-day mortality. The secondary outcomes were the sequential organ failure assessment (SOFA) total, respiratory, renal, coagulation, hepatic, cardiovascular, and central nervous system scores on days 1, 3, 7, and 14. RESULTS There were no significant differences between the two groups with regard to baseline characteristics. The 30-day mortality rate was significantly lower in the LZD group than in the VCM group (0% vs. 41%, P=.02). The SOFA total score on days 3, 7, and 14 were significantly lower those at baseline in the LZD group (P<.05). The SOFA respiratory score on days 14 was also significantly lower than baseline in the LZD group (P<.05). CONCLUSION LZD may be more efficacious than VCM for treating elderly patients with nosocomial MRSA pneumonia.
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Affiliation(s)
- Hiroaki Takada
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori, Tachikawa, Tokyo 190-0014, Japan
| | - Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan.
| | - Naoki Nishimoto
- Clinical research support center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan
| | - Takashi Kanemura
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori, Tachikawa, Tokyo 190-0014, Japan
| | - Hayato Yoshioka
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori, Tachikawa, Tokyo 190-0014, Japan
| | - Ichiro Okada
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori, Tachikawa, Tokyo 190-0014, Japan
| | - Nobuaki Kiriu
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori, Tachikawa, Tokyo 190-0014, Japan
| | - Junichi Inoue
- Division of Critical Care Medicine and Trauma, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506, Japan
| | - Yuichi Koido
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori, Tachikawa, Tokyo 190-0014, Japan
| | - Hiroshi Kato
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori, Tachikawa, Tokyo 190-0014, Japan
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