Cefepime versus ceftriaxone for empiric treatment of hospitalized patients with community-acquired pneumonia

Cefepime resistance and associated risk factors among Escherichia coli strains isolated from clinical specimens

Cefepime is active against bacteria producing chromosomally and plasmid-mediated extended broad-spectrum β-lactamase enzymes. The aim of this study was to evaluate risk factors for acquisition of cefepime resistance in Escherichia coli strains among hospitalized patients in a university hospital in Sanandaj, Iran. The study was a case-control investigation. A case patient was defined as a patient who had one isolate of a cefepime-resistant E. coli strain. A control patient was defined as a patient who had one isolate of a cefepime-sensitive E. coli strain. Cefepime resistance was determined by HiComb MIC tests (HIMEDIA, India). Out of the 255 total isolates, 73 (28.6%) were resistant to cefepime. The previous treatment of cefepime was a risk factor for acquisition of a cefepime-resistant isolate (OR = 6.32, 95% CI: 1.5-25.19, p < 0.007). The use of a ventilator was considered to be a risk for acquisition of a cefepime-resistant isolate (OR = 6.25, 95% CI: 1.86-21.02, p <0.002). The use of a catheter was also found to be a risk factor for acquisition of cefepime resistance (OR = 6.28, 95% CI: 1.86-21.02, p <0.001). There was a significant correlation between days of stay in hospital wards and cefepime resistance (p < 0.003). The main risk factors associated with cefepime resistance were previous treatment with cefepime, use of ventilator, use of catheter and days of stay in ward. More studies are needed to evaluate the role of these factors in order to control the spread of drug resistance.

Immunoglobulin G Fc(gamma) receptor expression on polymorphonuclear cells in bronchoalveolar lavage fluid of HIV-infected and HIV-seronegative patients with bacterial pneumonia

This study was designed to test the hypothesis that impaired neutrophil function might contribute to the development of bacterial pneumonia in patients with HIV-infection. Numbers of inflammatory cells and immunoglobulin G Fcgamma receptor (IgG FcgammaR) I, II, III levels were investigated in bronchoalveolar lavage (BAL) fluid of HIV-seronegative and HIV-infected patients with bacterial pneumonia. The 99 patients were classified into three groups: I: HIV-seronegative and pneumonia (n = 40); II: HIV-infected and pneumonia (n = 19); III: HIV-seronegative with other pulmonary diseases than pneumonia (n = 40). The results of groups I and II, II and III, and I and III were compared. The percentage of alveolar macrophages was significantly lower (group II vs. III: p = 0.005, group I vs. III: p = 0.001), that of neutrophils increased significantly in patients with pneumonia (group II vs. III: p = 0.02, group I vs. III: p = 0.01). Lymphocytes differed only between groups I and III (p = 0.04). Although only the expression of FcgammaRI was significantly higher in HIV-seronegative pneumonia patients compared to those without pneumonia (p = 0.01), the mean expression of all three receptors was lower in the HIV-infected group, with that of FcgammaRI approaching statistical significance. This report provides first evidence that altered FcgammaR expression on BAL neutrophils might contribute to the increased susceptibility of HIV-infected patients to bacterial pneumonia.