1
|
Waterer G. Macrolides in community-acquired pneumonia. THE LANCET. RESPIRATORY MEDICINE 2024; 12:260-262. [PMID: 38184007 DOI: 10.1016/s2213-2600(23)00434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Grant Waterer
- University of Western Australia, Royal Perth Hospital, WA 6000, Australia.
| |
Collapse
|
2
|
Davis D, Thadhani J, Choudhary V, Nausheem R, Vallejo-Zambrano CR, Mohammad Arifuddin B, Ali M, Carson BJ, Kanwal F, Nagarajan L. Advancements in the Management of Severe Community-Acquired Pneumonia: A Comprehensive Narrative Review. Cureus 2023; 15:e46893. [PMID: 37954793 PMCID: PMC10638673 DOI: 10.7759/cureus.46893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Pneumonia, classified as a lower respiratory tract illness, affects different parts of the bronchial system as well as alveoli and can present with varying severities depending on co-morbidities and causative pathogens. It can be broadly classified using the setting in which it was acquired, namely the community or hospital setting, the former being more common and spreading through person-to-person droplet transmission. Community-acquired pneumonia (CAP) is currently the fourth leading cause of death worldwide, and its high mortality makes continual insight into the management of the condition worthwhile. This review explores the literature specifically for severe CAP (sCAP) and delves into the diagnosis, various modalities of treatment, and management of the condition. This condition can be defined as pneumonia requiring mechanical ventilation in the ICU and/or presenting with sepsis and organ failure due to pneumonia. The disease process is characterized by inflammation of the lung parenchyma, initiated by a combination of pathogens and lowered local defenses. Acute diagnosis of the condition is vital in reducing negative patient outcomes, namely through clinical presentation, blood/sputum cultures, imaging modalities such as computed tomography scan, and inflammatory markers, identifying common causative pathogens such as Streptococcus pneumoniae, rhinovirus, Legionella, and viral influenza. Pathogens such as Escherichia coli should also be investigated in patients with chronic obstructive pulmonary disease. The mainstay of treating sCAP includes rapid ICU admission once a diagnosis has been confirmed, initiating sepsis protocol, and treatment with combined empiric antibiotic regimens consisting of beta-lactams and macrolides. Corticosteroid use alongside antibiotics shows promise in reducing inflammation, but its use has to be judged on a case-by-case basis. New drugs such as omadacycline, delafloxacin, and zabofloxacin have shown valid evidence for the treatment of resistant causative organisms. The main guidelines for preventing sCAP include maintaining a healthy lifestyle, and annual pneumococcal and influenza vaccines are recommended for the most vulnerable patient groups, such as those with COPD and immunosuppression.
Collapse
Affiliation(s)
- Don Davis
- Medicine, Medical University of Varna, Varna, BGR
| | - Jainisha Thadhani
- Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Manama, BHR
| | | | | | | | | | - Mujahaith Ali
- Medicine, Ternopil National Medical University, Ternopil, UKR
| | - Bryan J Carson
- Emergency Medicine, Northern Health and Social Care Trust, Coleraine, GBR
| | - Fnu Kanwal
- Medical College, Chandka Medical College, Larkana, PAK
| | - Lavanya Nagarajan
- Department of Medicine, The Tamilnadu Dr.M.G.R. Medical University, Chennai, IND
| |
Collapse
|
3
|
Bouras M, Rello J, Roquilly A. Steroids in severe community-acquired pneumonia: dangerous, worthless, or miracle cure? The roller coaster of clinical trials. Anaesth Crit Care Pain Med 2023:101253. [PMID: 37245688 PMCID: PMC10214762 DOI: 10.1016/j.accpm.2023.101253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Marwan Bouras
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France; CHU Nantes, INSERM, Nantes Université, Anesthesie Reanimation, CIC 1413, F-44000 Nantes, France.
| | - Jordi Rello
- CHU Nîmes, FOREVA Recherche Group, Nîmes, France; Vall d'Hebron Institut of Research, Clinical Research in Pneumonia & Sepsis /CRIPS), 08035 Barcelona, Spain
| | - Antoine Roquilly
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France; CHU Nantes, INSERM, Nantes Université, Anesthesie Reanimation, CIC 1413, F-44000 Nantes, France
| |
Collapse
|
4
|
Baranov AA, Kozlov RS, Namazova-Baranova LS, Andreeva IV, Bakradze MD, Vishneva EA, Karaseva MS, Kuznetsova TA, Kulichenko TV, Lashkova YS, Lyutina EI, Manerov FK, Mayanskiy NA, Platonova MM, Polyakova AS, Selimzyanova LR, Tatochenko VK, Starovoytova EV, Stetsiouk OU, Fedoseenko MV, Chashchina IL, Kharkin AV. Modern approaches at the management of children with community-acquired pneumonia. PEDIATRIC PHARMACOLOGY 2023. [DOI: 10.15690/pf.v20i1.2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Experts of The Union of Pediatricians of Russia have developed current clinical guidelines for management of children with community-acquired pneumonia, which were approved by the Scientific and Practice Council of Ministry of Public Health of the Russian Federation in January 2022. Particular attention is paid to the etiological structure, modern classification, diagnostic tests and flagship approaches to antibacterial therapy of community-acquired pneumonia in children based on the principles of evidentiary medicine.
Collapse
Affiliation(s)
- Aleksander A. Baranov
- Sechenov First Moscow State Medical University;
Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | - Leyla S. Namazova-Baranova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
| | | | | | - Elena A. Vishneva
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
| | - Mariya S. Karaseva
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | | | - Yulia S. Lashkova
- Pirogov Russian National Research Medical University;
National Medical Research Center of Children’s Health
| | | | | | | | - Mariya M. Platonova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | - Lilia R. Selimzyanova
- Sechenov First Moscow State Medical University;
Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
| | | | | | | | - Marina V. Fedoseenko
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
| | | | | |
Collapse
|
5
|
Waterer G, Donaldson G. Can Electronic Decision Support Tools Really Reduce Mortality from Community-acquired Pneumonia? Am J Respir Crit Care Med 2022; 205:1267-1268. [PMID: 35320063 PMCID: PMC9873109 DOI: 10.1164/rccm.202202-0358ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Grant Waterer
- University of Western AustraliaRoyal Perth HospitalPerth, Western Australia, Australia
| | - Gavin Donaldson
- National Heart and Lung InstituteImperial College LondonLondon, United Kingdom
| |
Collapse
|
6
|
Sakakibara T, Shindo Y, Kobayashi D, Sano M, Okumura J, Murakami Y, Takahashi K, Matsui S, Yagi T, Saka H, Hasegawa Y. A prediction rule for severe adverse events in all inpatients with community-acquired pneumonia: a multicenter observational study. BMC Pulm Med 2022; 22:34. [PMID: 35022026 PMCID: PMC8753951 DOI: 10.1186/s12890-022-01819-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Prediction of inpatients with community-acquired pneumonia (CAP) at high risk for severe adverse events (SAEs) requiring higher-intensity treatment is critical. However, evidence regarding prediction rules applicable to all patients with CAP including those with healthcare-associated pneumonia (HCAP) is limited. The objective of this study is to develop and validate a new prediction system for SAEs in inpatients with CAP. Methods Logistic regression analysis was performed in 1334 inpatients of a prospective multicenter study to develop a multivariate model predicting SAEs (death, requirement of mechanical ventilation, and vasopressor support within 30 days after diagnosis). The developed ALL-COP-SCORE rule based on the multivariate model was validated in 643 inpatients in another prospective multicenter study. Results The ALL-COP SCORE rule included albumin (< 2 g/dL, 2 points; 2–3 g/dL, 1 point), white blood cell (< 4000 cells/μL, 3 points), chronic lung disease (1 point), confusion (2 points), PaO2/FIO2 ratio (< 200 mmHg, 3 points; 200–300 mmHg, 1 point), potassium (≥ 5.0 mEq/L, 2 points), arterial pH (< 7.35, 2 points), systolic blood pressure (< 90 mmHg, 2 points), PaCO2 (> 45 mmHg, 2 points), HCO3− (< 20 mmol/L, 1 point), respiratory rate (≥ 30 breaths/min, 1 point), pleural effusion (1 point), and extent of chest radiographical infiltration in unilateral lung (> 2/3, 2 points; 1/2–2/3, 1 point). Patients with 4–5, 6–7, and ≥ 8 points had 17%, 35%, and 52% increase in the probability of SAEs, respectively, whereas the probability of SAEs was 3% in patients with ≤ 3 points. The ALL-COP SCORE rule exhibited a higher area under the receiver operating characteristic curve (0.85) compared with the other predictive models, and an ALL-COP SCORE threshold of ≥ 4 points exhibited 92% sensitivity and 60% specificity. Conclusions ALL-COP SCORE rule can be useful to predict SAEs and aid in decision-making on treatment intensity for all inpatients with CAP including those with HCAP. Higher-intensity treatment should be considered in patients with CAP and an ALL-COP SCORE threshold of ≥ 4 points. Trial registration This study was registered with the University Medical Information Network in Japan, registration numbers UMIN000003306 and UMIN000009837. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01819-0.
Collapse
|
7
|
Serrano Fernández L, Ruiz Iturriaga LA, España Yandiola PP, Méndez Ocaña R, Pérez Fernández S, Tabernero Huget E, Uranga Echeverria A, Gonzalez Jimenez P, García Hontoria P, Torres Martí A, Menendez Villanueva R, Zalacain Jorge R. Bacteraemic pneumococcal pneumonia and SARS-CoV-2 pneumonia: differences and similarities. Int J Infect Dis 2021; 115:39-47. [PMID: 34800689 PMCID: PMC8598257 DOI: 10.1016/j.ijid.2021.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To analyse differences in clinical presentation and outcome between bacteraemic pneumococcal community-acquired pneumonia (B-PCAP) and sSvere Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pneumonia. METHODS This observational multi-centre study was conducted on patients hospitalized with B-PCAP between 2000 and 2020 and SARS-CoV-2 pneumonia in 2020. Thirty-day survival, predictors of mortality, and intensive care unit (ICU) admission were compared. RESULTS In total, 663 patients with B-PCAP and 1561 patients with SARS-CoV-2 pneumonia were included in this study. Patients with B-PCAP had more severe disease, a higher ICU admission rate and more complications. Patients with SARS-CoV-2 pneumonia had higher in-hospital mortality (10.8% vs 6.8%; P=0.004). Among patients admitted to the ICU, the need for invasive mechanical ventilation (69.7% vs 36.2%; P<0.001) and mortality were higher in patients with SARS-CoV-2 pneumonia. In patients with B-PCAP, the predictive model found associations between mortality and systemic complications (hyponatraemia, septic shock and neurological complications), lower respiratory reserve and tachypnoea; chest pain and purulent sputum were protective factors in these patients. In patients with SARS-CoV-2 pneumonia, mortality was associated with previous liver and cardiac disease, advanced age, altered mental status, tachypnoea, hypoxaemia, bilateral involvement, pleural effusion, septic shock, neutrophilia and high blood urea nitrogen; in contrast, ≥7 days of symptoms was a protective factor in these patients. In-hospital mortality occurred earlier in patients with B-PCAP. CONCLUSIONS Although B-PCAP was associated with more severe disease and a higher ICU admission rate, the mortality rate was higher for SARS-CoV-2 pneumonia and deaths occurred later. New prognostic scales and more effective treatments are needed for patients with SARS-CoV-2 pneumonia.
Collapse
Affiliation(s)
- Leyre Serrano Fernández
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain.
| | - Luis Alberto Ruiz Iturriaga
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain.
| | | | - Raúl Méndez Ocaña
- Pneumology Service, Hospital Universitari i politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - Silvia Pérez Fernández
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo. Bizkaia, Spain.
| | - Eva Tabernero Huget
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.
| | - Ane Uranga Echeverria
- Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
| | - Paula Gonzalez Jimenez
- Pneumology Service, Hospital Universitari i politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | | | - Antoni Torres Martí
- Pneumology Service, Hospital Clinic/Institut D´Investigacions Biomediques August Pi I Sunyer, University of Barcelona, Barcelona, Spain.
| | - Rosario Menendez Villanueva
- Pneumology Service, Hospital Universitari i politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | | |
Collapse
|
8
|
Ewig S, Kolditz M, Pletz M, Altiner A, Albrich W, Drömann D, Flick H, Gatermann S, Krüger S, Nehls W, Panning M, Rademacher J, Rohde G, Rupp J, Schaaf B, Heppner HJ, Krause R, Ott S, Welte T, Witzenrath M. [Management of Adult Community-Acquired Pneumonia and Prevention - Update 2021 - Guideline of the German Respiratory Society (DGP), the Paul-Ehrlich-Society for Chemotherapy (PEG), the German Society for Infectious Diseases (DGI), the German Society of Medical Intensive Care and Emergency Medicine (DGIIN), the German Viological Society (DGV), the Competence Network CAPNETZ, the German College of General Practitioneers and Family Physicians (DEGAM), the German Society for Geriatric Medicine (DGG), the German Palliative Society (DGP), the Austrian Society of Pneumology Society (ÖGP), the Austrian Society for Infectious and Tropical Diseases (ÖGIT), the Swiss Respiratory Society (SGP) and the Swiss Society for Infectious Diseases Society (SSI)]. Pneumologie 2021; 75:665-729. [PMID: 34198346 DOI: 10.1055/a-1497-0693] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The present guideline provides a new and updated concept of the management of adult patients with community-acquired pneumonia. It replaces the previous guideline dating from 2016.The guideline was worked out and agreed on following the standards of methodology of a S3-guideline. This includes a systematic literature search and grading, a structured discussion of recommendations supported by the literature as well as the declaration and assessment of potential conflicts of interests.The guideline has a focus on specific clinical circumstances, an update on severity assessment, and includes recommendations for an individualized selection of antimicrobial treatment.The recommendations aim at the same time at a structured assessment of risk for adverse outcome as well as an early determination of treatment goals in order to reduce mortality in patients with curative treatment goal and to provide palliation for patients with treatment restrictions.
Collapse
Affiliation(s)
- S Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, EVK Herne und Augusta-Kranken-Anstalt Bochum
| | - M Kolditz
- Universitätsklinikum Carl-Gustav Carus, Klinik für Innere Medizin 1, Bereich Pneumologie, Dresden
| | - M Pletz
- Universitätsklinikum Jena, Institut für Infektionsmedizin und Krankenhaushygiene, Jena
| | - A Altiner
- Universitätsmedizin Rostock, Institut für Allgemeinmedizin, Rostock
| | - W Albrich
- Kantonsspital St. Gallen, Klinik für Infektiologie/Spitalhygiene
| | - D Drömann
- Universitätsklinikum Schleswig-Holstein, Medizinische Klinik III - Pulmologie, Lübeck
| | - H Flick
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Klinische Abteilung für Lungenkrankheiten, Graz
| | - S Gatermann
- Ruhr Universität Bochum, Abteilung für Medizinische Mikrobiologie, Bochum
| | - S Krüger
- Kaiserswerther Diakonie, Florence Nightingale Krankenhaus, Klinik für Pneumologie, Kardiologie und internistische Intensivmedizin, Düsseldorf
| | - W Nehls
- Helios Klinikum Erich von Behring, Klinik für Palliativmedizin und Geriatrie, Berlin
| | - M Panning
- Universitätsklinikum Freiburg, Department für Medizinische Mikrobiologie und Hygiene, Freiburg
| | - J Rademacher
- Medizinische Hochschule Hannover, Klinik für Pneumologie, Hannover
| | - G Rohde
- Universitätsklinikum Frankfurt, Medizinische Klinik I, Pneumologie und Allergologie, Frankfurt/Main
| | - J Rupp
- Universitätsklinikum Schleswig-Holstein, Klinik für Infektiologie und Mikrobiologie, Lübeck
| | - B Schaaf
- Klinikum Dortmund, Klinik für Pneumologie, Infektiologie und internistische Intensivmedizin, Dortmund
| | - H-J Heppner
- Lehrstuhl Geriatrie Universität Witten/Herdecke, Helios Klinikum Schwelm, Klinik für Geriatrie, Schwelm
| | - R Krause
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Klinische Abteilung für Infektiologie, Graz
| | - S Ott
- St. Claraspital Basel, Pneumologie, Basel, und Universitätsklinik für Pneumologie, Universitätsspital Bern (Inselspital) und Universität Bern
| | - T Welte
- Medizinische Hochschule Hannover, Klinik für Pneumologie, Hannover
| | - M Witzenrath
- Charité, Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Berlin
| |
Collapse
|
9
|
Abstract
While the world is grappling with the consequences of a global pandemic related to SARS-CoV-2 causing severe pneumonia, available evidence points to bacterial infection with Streptococcus pneumoniae as the most common cause of severe community acquired pneumonia (SCAP). Rapid diagnostics and molecular testing have improved the identification of co-existent pathogens. However, mortality in patients admitted to ICU remains staggeringly high. The American Thoracic Society and Infectious Diseases Society of America have updated CAP guidelines to help streamline disease management. The common theme is use of timely, appropriate and adequate antibiotic coverage to decrease mortality and avoid drug resistance. Novel antibiotics have been studied for CAP and extend the choice of therapy, particularly for those who are intolerant of, or not responding to standard treatment, including those who harbor drug resistant pathogens. In this review, we focus on the risk factors, microbiology, site of care decisions and treatment of patients with SCAP.
Collapse
Affiliation(s)
- Girish B Nair
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA.
| | - Michael S Niederman
- Weill Cornell Medical College, Pulmonary and Critical Care, New York Presbyterian/ Weill Cornell Medical Center, New York, NY, USA.
| |
Collapse
|
10
|
Serrano L, Ruiz LA, Martinez-Indart L, España PP, Gómez A, Uranga A, García M, Santos B, Artaraz A, Zalacain R. Non-bacteremic pneumococcal pneumonia: general characteristics and early predictive factors for poor outcome. Infect Dis (Lond) 2020; 52:603-611. [PMID: 32552142 DOI: 10.1080/23744235.2020.1772991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Purpose: Nowadays, most cases of pneumococcal community-acquired pneumonia (PCAP) are diagnosed by positive urinary antigen. Our aims were to analyse process of care in patients hospitalised with non-bacteremic PCAP (NB-PCAP) and identify factors associated with poor outcome (PO) in this population.Methods: We conducted a prospective study, including patients hospitalised for NB-PCAP (positive urinary antigen and negative blood culture) over a 15 year period. We performed multivariate analysis of predisposing factors for PO, defined as need for mechanical ventilation and/or shock and/or in-hospital death.Results: Of the 638 patients included, 4.1% died in hospital and 12.8% had PO. Host-related factors were similar in patients with and without PO, but patients with PO had higher illness severity on admission. Adjusted analysis revealed the following independent factors associated with PO: being a nursing home resident (OR: 6.156; 95% CI: 1.827-20.750; p = .003), respiratory rate ≥30 breaths/min (OR: 3.030; 95% CI: 1.554-5.910; p = .001), systolic blood pressure <90 mmHg (OR: 4.789; 95% CI: 1.967-11.660; p = .001), diastolic blood pressure <60 mmHg (OR: 2.820; 95% CI: 1.329-5.986; p = .007), pulse rate ≥125 beats/min (OR: 3.476; 95% CI: 1.607-7.518; p = .002), pH <7.35 (OR: 9.323; 95% CI: 3.680-23.622; p < .001), leukocytes <4000/µL (OR: 10.007; 95% CI: 2.960-33.835; p < .001), and severe inflammation (OR: 2.364; 95% CI 1.234-4.526; p = .009). The area under the curve for predicting PO was 0.890 (95% CI: 0.851-0.929).Conclusions: Since patients with PO seem different and had worse in-hospital course, we identified eight independent risk factors for PO measurable on admission.
Collapse
Affiliation(s)
- Leyre Serrano
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Luis A Ruiz
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Lorea Martinez-Indart
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Pedro P España
- Unit of Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Ainhoa Gómez
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Ane Uranga
- Unit of Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Marta García
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Borja Santos
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Amaia Artaraz
- Unit of Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Rafael Zalacain
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| |
Collapse
|
11
|
Impact of time to antibiotic therapy on clinical outcome in patients with bacterial infections in the emergency department: implications for antimicrobial stewardship. Clin Microbiol Infect 2020; 27:175-181. [PMID: 32120032 DOI: 10.1016/j.cmi.2020.02.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/15/2020] [Accepted: 02/23/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Rapid initiation of antibiotic treatment is considered crucial in patients with severe infections such as septic shock and bacterial meningitis, but may not be as important for other infectious syndromes. A better understanding of which patients can tolerate a delay in start of therapy is important for antibiotic stewardship purposes. OBJECTIVES To explore the existing evidence on the impact of time to antibiotics on clinical outcomes in patients presenting to the emergency department (ED) with bacterial infections of different severity of illness and source of infection. SOURCES A literature search was performed in the PubMed/MEDLINE database using combined search terms for various infectious syndromes (sepsis/septic shock, bacterial meningitis, lower respiratory tract infections, urinary tract infections, intra-abdominal infections and skin and soft tissue infections), time to antibiotic treatment, and clinical outcome. CONTENT The literature search generated 8828 hits. After screening titles and abstracts and assessing potentially relevant full-text papers, 60 original articles (four randomized controlled trials, 43 observational studies) were included. Most articles addressed sepsis/septic shock, while few studies evaluated early initiation of therapy in mild to moderate disease. The lack of randomized trials and the risk of confounding factors and biases in observational studies warrant caution in the interpretation of results. We conclude that the literature supports prompt administration of effective antibiotics for septic shock and bacterial meningitis, but there is no clear evidence showing that a delayed start of therapy is associated with worse outcome for less severe infectious syndromes. IMPLICATIONS For patients presenting with suspected bacterial infections, withholding antibiotic therapy until diagnostic results are available and a diagnosis has been established (e.g. by 4-8 h) seems acceptable in most cases unless septic shock or bacterial meningitis are suspected. This approach promotes the use of ecologically favourable antibiotics in the ED, reducing the risks of side effects and selection of resistance.
Collapse
|
12
|
Trent SA, Jarou ZJ, Havranek EP, Ginde AA, Haukoos JS. Variation in Emergency Department Adherence to Treatment Guidelines for Inpatient Pneumonia and Sepsis: A Retrospective Cohort Study. Acad Emerg Med 2019; 26:908-920. [PMID: 30343515 DOI: 10.1111/acem.13639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Evidence-based clinical practice guidelines (CPGs) for the treatment of pneumonia and sepsis have existed for many years with multiple studies suggesting improved patient outcomes. Despite their importance, little is known about variation in emergency department (ED) adherence to these CPGs. Our objectives were to estimate variation in ED adherence across CPGs for pneumonia and sepsis and identify patient, provider, and environmental factors associated with adherence. METHODS This was a multicenter retrospective study using standard medical record review methods. The population consisted of consecutive adults hospitalized for pneumonia or sepsis (identified by discharge ICD-9 codes) at five Colorado hospitals (two academic, three community) who were admitted to the hospital from the ED and for whom the ED diagnosed or initiated treatment. The outcome measured was ED adherence to the CPG (primary) and in-hospital mortality (secondary). Hierarchical generalized linear models were used for analysis. RESULTS Among 827 patients, ED care was 57% adherence to CPGs with significant variation in adherence across CPGs (sepsis 50%, pneumonia 64%, p < 0.001). Patients were less likely to receive adherent care if they presented with chief complaints that were associated but not typical of the diagnosis (odds ratio [OR] = 0.6, 95% confidence interval [CI] = 0.4-0.8), received an ED diagnosis that was not specific to the CPG (associated diagnosis OR = 0.3 [95% CI = 0.2-0.5]; unrelated diagnosis OR = 0.4 [95% CI = 0.2-0.6]) or presented to a community hospital (OR = 0.6, 95% CI = 0.4-0.9). ED CPG nonadherence was associated with higher in-hospital mortality (OR = 2.4, 95% CI = 1.2-4.8). CONCLUSION Adherence to ED infectious CPGs for pneumonia and sepsis varies significantly across diseases and types of institutions with significant room for improvement, especially in light of a significant association with in-hospital mortality.
Collapse
Affiliation(s)
- Stacy A. Trent
- Department of Emergency Medicine Denver Health Medical Center Denver CO
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Zachary J. Jarou
- Department of Emergency Medicine Denver Health Medical Center Denver CO
- Department of Emergency Medicine University of Chicago School of Medicine Chicago IL
| | - Edward P. Havranek
- Department of Medicine Denver Health Medical Center Denver CO
- Division of Cardiology University of Colorado School of Medicine Aurora CO
| | - Adit A. Ginde
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Jason S. Haukoos
- Department of Emergency Medicine Denver Health Medical Center Denver CO
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
- Department of Epidemiology Colorado School of Public Health Aurora CO
| |
Collapse
|
13
|
Suzuki J, Sasabuchi Y, Hatakeyama S, Matsui H, Sasahara T, Morisawa Y, Yamada T, Yasunaga H. Azithromycin plus β-lactam versus levofloxacin plus β-lactam for severe community-acquired pneumonia: A retrospective nationwide database analysis. J Infect Chemother 2019; 25:1012-1018. [PMID: 31227381 DOI: 10.1016/j.jiac.2019.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/22/2019] [Accepted: 05/26/2019] [Indexed: 11/25/2022]
Abstract
Previous studies showed potential benefits of macrolide combined with β-lactam for severe community-acquired pneumonia (CAP). However, it remains inconclusive whether macrolide plus β-lactam is superior to respiratory fluoroquinolone plus β-lactam for patients with severe CAP. Using a nationwide inpatient database in Japan, we performed propensity score matching and inverse probability of treatment weighting (IPTW) to compare 28-day mortality and in-hospital mortality between azithromycin plus β-lactam and levofloxacin plus β-lactam for severe CAP patients admitted to hospital between July 2010 and March 2015. We identified 1,999 patients with severe pneumonia who received azithromycin plus β-lactam (n = 840) or levofloxacin plus β-lactam (n = 1,159) within 2 days after admission. Five-hundred sixty propensity score-matched pairs showed no significant differences between azithromycin plus β-lactam and levofloxacin plus β-lactam in 28-day mortality and in-hospital mortality (19.3% vs. 20.7%, p = 0.601 and 24.8% vs. 26.8%, p = 0.495, respectively). IPTW analysis also showed no significant differences between azithromycin plus β-lactam and levofloxacin plus β-lactam in 28-day mortality (risk difference, -3.5% [95% confidence interval, -8.8% to 1.7%] and in-hospital mortality (risk difference, -3.6%; 95% confidence interval, -9.4% to 2.1%). In conclusion, there were no significant differences in 28-day mortality and in-hospital mortality between azithromycin plus β-lactam and levofloxacin plus β-lactam for severe CAP patients.
Collapse
Affiliation(s)
- Jun Suzuki
- Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Shuji Hatakeyama
- Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan; Division of General Internal Medicine/Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan.
| | - Teppei Sasahara
- Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan; Department of Infection and Immunity, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
| | - Yuji Morisawa
- Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Toshiyuki Yamada
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan.
| |
Collapse
|
14
|
Abstract
Few guidelines have greater acceptance than that for management of community-acquired pneumonia (CAP). Despite this, areas remain controversial, and new challenges continue to emerge. Current guidelines differ from those of northern European countries predominantly in need for macrolide combination with β-lactams for hospitalized, non-intensive care unit patients. A preponderance of evidence favors combination therapy. Challenges for current and future CAP guidelines include new antibiotic classes, emergence of viruses as major causes for CAP, new diagnostic modalities, alternative risk stratification for pathogens resistant to usual CAP antibiotics, and evidence-based management of severe CAP, including immunomodulatory therapy such as corticosteroids.
Collapse
Affiliation(s)
- Richard G Wunderink
- Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, 240 East Huron Street, McGaw M-336, Chicago, IL 60611, USA.
| |
Collapse
|
15
|
Cillóniz C, Dominedò C, Nicolini A, Torres A. PES Pathogens in Severe Community-Acquired Pneumonia. Microorganisms 2019; 7:microorganisms7020049. [PMID: 30759805 PMCID: PMC6406253 DOI: 10.3390/microorganisms7020049] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/09/2019] [Accepted: 02/09/2019] [Indexed: 12/16/2022] Open
Abstract
Worldwide, there is growing concern about the burden of pneumonia. Severe community-acquired pneumonia (CAP) is frequently complicated by pulmonary and extra-pulmonary complications, including sepsis, septic shock, acute respiratory distress syndrome, and acute cardiac events, resulting in significantly increased intensive care admission rates and mortality rates. Streptococcus pneumoniae (Pneumococcus) remains the most common causative pathogen in CAP. However, several bacteria and respiratory viruses are responsible, and approximately 6% of cases are due to the so-called PES (Pseudomonas aeruginosa, extended-spectrum β-lactamase Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus) pathogens. Of these, P. aeruginosa and methicillin-resistant Staphylococcus aureus are the most frequently reported and require different antibiotic therapy to that for typical CAP. It is therefore important to recognize the risk factors for these pathogens to improve the outcomes in patients with CAP.
Collapse
Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)-SGR 911-Ciber de Enfermedades Respiratorias (Ciberes), 08036 Barcelona, Spain.
| | - Cristina Dominedò
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
| | - Antonello Nicolini
- Respiratory Diseases Unit, Hospital of Sestri Levante, 16039 Sestri Levante, Italy.
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)-SGR 911-Ciber de Enfermedades Respiratorias (Ciberes), 08036 Barcelona, Spain.
| |
Collapse
|
16
|
Bedos JP, Varon E, Porcher R, Asfar P, Le Tulzo Y, Megarbane B, Mathonnet A, Dugard A, Veinstein A, Ouchenir K, Siami S, Reignier J, Galbois A, Cousson J, Preau S, Baldesi O, Rigaud JP, Souweine B, Misset B, Jacobs F, Dewavrin F, Mira JP. Host-pathogen interactions and prognosis of critically ill immunocompetent patients with pneumococcal pneumonia: the nationwide prospective observational STREPTOGENE study. Intensive Care Med 2018; 44:2162-2173. [PMID: 30456466 DOI: 10.1007/s00134-018-5444-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the relative importance of host and bacterial factors associated with hospital mortality in patients admitted to the intensive care unit (ICU) for pneumococcal community-acquired pneumonia (PCAP). METHODS Immunocompetent Caucasian ICU patients with PCAP documented by cultures and/or pneumococcal urinary antigen (UAg Sp) test were included in this multicenter prospective study between 2008 and 2012. All pneumococcal strains were serotyped. Logistic regression analyses were performed to identify risk factors for hospital mortality. RESULTS Of the 614 patients, 278 (45%) had septic shock, 270 (44%) had bacteremia, 307 (50%) required mechanical ventilation at admission, and 161 (26%) had a diagnosis based only on the UAg Sp test. No strains were penicillin-resistant, but 23% had decreased susceptibility. Of the 36 serotypes identified, 7 accounted for 72% of the isolates, with different distributions according to age. Although antibiotics were consistently appropriate and were started within 6 h after admission in 454 (74%) patients, 116 (18.9%) patients died. Independent predictors of hospital mortality in the adjusted analysis were platelets ≤ 100 × 109/L (OR, 7.7; 95% CI, 2.8-21.1), McCabe score ≥ 2 (4.58; 1.61-13), age > 65 years (2.92; 1.49-5.74), lactates > 4 mmol/L (2.41; 1.27-4.56), male gender and septic shock (2.23; 1.30-3.83 for each), invasive mechanical ventilation (1.78; 1-3.19), and bilateral pneumonia (1.59; 1.02-2.47). Women with platelets ≤ 100 × 109/L had the highest mortality risk (adjusted OR, 7.7; 2.8-21). CONCLUSIONS In critically ill patients with PCAP, age, gender, and organ failures at ICU admission were more strongly associated with hospital mortality than were comorbidities. Neither pneumococcal serotype nor antibiotic regimen was associated with hospital mortality.
Collapse
Affiliation(s)
- Jean-Pierre Bedos
- Réanimation Médico-Chirurgicale, Hôpital A. Mignot, CH Versailles, 177 Rue de Versailles, 78157, Le Chesnay, France.
| | - Emmanuelle Varon
- Laboratoire de Microbiologie, Centre National de Référence des Pneumocoques, AP-HP Hôpital Européen Georges-Pompidou, 75908, Paris Cedex 15, France.,Centre National de Référence des Pneumocoques, Centre Hospitalier Interrcommunal de Créteil, 94000, Créteil, France
| | - Raphael Porcher
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS-UMR1153), Inserm/Université Paris Descartes, Centre d'épidémiologie clinique, Centre Equator France, Hôpital Hôtel-Dieu, 75004, Paris, France
| | - Pierre Asfar
- CHU Angers, Réanimation Médicale, 49933, Angers Cedex 9, France
| | | | - Bruno Megarbane
- Hôpital Lariboisière, Réanimation Médicale et Toxicologique, 75010, Paris, France
| | - Armelle Mathonnet
- Hôpital de La Source, Réanimation Polyvalente, 45067, Orléans Cedex 2, France
| | - Anthony Dugard
- CHU Dupuytren, Réanimation Polyvalente, 87042, Limoges, France
| | - Anne Veinstein
- CHU Jean Bernard, Réanimation, 86021, Poitiers Cedex, France
| | - Kader Ouchenir
- Hôpital Louis Pasteur, Réanimation, 28018, Chartres Cedex, France
| | - Shidasp Siami
- CH Sud Essonne, Réanimation Polyvalente, 91152, Etampes Cedex 02, France
| | - Jean Reignier
- CHU Nantes, Réanimation Médicale, 44093, Nantes Cedex 1, France
| | - Arnaud Galbois
- Hôpital St Antoine, Réanimation Médicale, 75012, Paris, France
| | - Joël Cousson
- Hôpital Robert Debré, Réanimation Polyvalente, 51092, Reims Cedex, France
| | - Sébastien Preau
- Hôpital A. Calmette, Réanimation, 59037, Lille Cedex, France
| | - Olivier Baldesi
- CH du Pays d'Aix, Réanimation, 13616, Aix En Provence, France
| | | | - Bertrand Souweine
- CHU Gabriel Montpied, Réanimation Médicale, 63000, Clermont Ferrand, France
| | - Benoit Misset
- Hôpital Saint Joseph, Réanimation, 75014, Paris, France
| | - Frederic Jacobs
- Hôpital Antoine Béclère, Réanimation Médicale, 92140, Clamart, France
| | | | - Jean-Paul Mira
- Hôpital Cochin, Réanimation Médicale, 75679, Paris Cedex 14, France
| |
Collapse
|
17
|
Berger S, Goekeri C, Gupta SK, Vera J, Dietert K, Behrendt U, Lienau J, Wienhold SM, Gruber AD, Suttorp N, Witzenrath M, Nouailles G. Delay in antibiotic therapy results in fatal disease outcome in murine pneumococcal pneumonia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:287. [PMID: 30382866 PMCID: PMC6211394 DOI: 10.1186/s13054-018-2224-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/09/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) remains a major cause of death worldwide. Mechanisms underlying the detrimental outcome despite adequate antibiotic therapy and comorbidity management are still not fully understood. METHODS To model timely versus delayed antibiotic therapy in patients, mice with pneumococcal pneumonia received ampicillin twice a day starting early (24 h) or late (48 h) after infection. Clinical readouts and local and systemic inflammatory mediators after early and late antibiotic intervention were examined. RESULTS Early antibiotic intervention rescued mice, limited clinical symptoms and restored fitness, whereas delayed therapy resulted in high mortality rates. Recruitment of innate immune cells remained unaffected by antibiotic therapy. However, both early and late antibiotic intervention dampened local levels of inflammatory mediators in the alveolar spaces. Early treatment protected from barrier breakdown, and reduced levels of vascular endothelial growth factor (VEGF) and perivascular and alveolar edema formation. In contrast, at 48 h post infection, increased pulmonary leakage was apparent and not reversed by late antibiotic treatment. Concurrently, levels of VEGF remained high and no beneficial effect on edema formation was evident despite therapy. Moreover, early but not late treatment protected mice from a vast systemic inflammatory response. CONCLUSIONS Our data show that only early antibiotic therapy, administered prior to breakdown of the alveolar-capillary barrier and systemic inflammation, led to restored fitness and rescued mice from fatal streptococcal pneumonia. The findings highlight the importance of identifying CAP patients prior to lung barrier failure and systemic inflammation and of handling CAP as a medical emergency.
Collapse
Affiliation(s)
- Sarah Berger
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Cengiz Goekeri
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Shishir K Gupta
- Department of Dermatology, Laboratory of Systems Tumor Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Julio Vera
- Department of Dermatology, Laboratory of Systems Tumor Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Kristina Dietert
- Department of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Ulrike Behrendt
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Jasmin Lienau
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Sandra-Maria Wienhold
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Achim D Gruber
- Department of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Witzenrath
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Geraldine Nouailles
- Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| |
Collapse
|
18
|
Garnacho-Montero J, Barrero-García I, Gómez-Prieto MDG, Martín-Loeches I. Severe community-acquired pneumonia: current management and future therapeutic alternatives. Expert Rev Anti Infect Ther 2018; 16:667-677. [DOI: 10.1080/14787210.2018.1512403] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jose Garnacho-Montero
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Irene Barrero-García
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ignacio Martín-Loeches
- Department of Anaesthesia and Critical Care, St James University Hospital, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Ireland
| |
Collapse
|
19
|
Corrêa RDA, Costa AN, Lundgren F, Michelin L, Figueiredo MR, Holanda M, Gomes M, Teixeira PJZ, Martins R, Silva R, Athanazio RA, da Silva RM, Pereira MC. 2018 recommendations for the management of community acquired pneumonia. J Bras Pneumol 2018; 44:405-423. [PMID: 30517341 PMCID: PMC6467584 DOI: 10.1590/s1806-37562018000000130] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 09/11/2018] [Indexed: 12/17/2022] Open
Abstract
Community-acquired pneumonia (CAP) is the leading cause of death worldwide. Despite the vast diversity of respiratory microbiota, Streptococcus pneumoniae remains the most prevalent pathogen among etiologic agents. Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent decades, CAP ranks third as a cause of death in Brazil. Since the latest Guidelines on CAP from the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) were published (2009), there have been major advances in the application of imaging tests, in etiologic investigation, in risk stratification at admission and prognostic score stratification, in the use of biomarkers, and in the recommendations for antibiotic therapy (and its duration) and prevention through vaccination. To review these topics, the SBPT Committee on Respiratory Infections summoned 13 members with recognized experience in CAP in Brazil who identified issues relevant to clinical practice that require updates given the publication of new epidemiological and scientific evidence. Twelve topics concerning diagnostic, prognostic, therapeutic, and preventive issues were developed. The topics were divided among the authors, who conducted a nonsystematic review of the literature, but giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. All authors had the opportunity to review and comment on all questions, producing a single final document that was approved by consensus.
Collapse
Affiliation(s)
- Ricardo de Amorim Corrêa
- . Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Andre Nathan Costa
- . Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP) Brasil
| | | | - Lessandra Michelin
- . Faculdade de Medicina, Universidade de Caxias do Sul, Caxias do Sul (RS) Brasil
| | | | - Marcelo Holanda
- . Faculdade de Medicina, Universidade Federal do Ceará - UFC - Fortaleza (CE) Brasil
| | - Mauro Gomes
- . Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo (SP) Brasil
| | | | - Ricardo Martins
- . Faculdade de Medicina, Universidade de Brasília - UnB - Brasília (DF) Brasil
| | - Rodney Silva
- . Faculdade de Medicina, Universidade Federal do Paraná - UFPR - Curitiba (PR) Brasil
| | | | | | - Mônica Corso Pereira
- . Faculdade de Medicina, Universidade Estadual de Campinas - Unicamp - Campinas (SP) Brasil
| |
Collapse
|
20
|
|
21
|
Feldman C, Richards G. Appropriate antibiotic management of bacterial lower respiratory tract infections. F1000Res 2018; 7:F1000 Faculty Rev-1121. [PMID: 30079235 PMCID: PMC6058472 DOI: 10.12688/f1000research.14226.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2018] [Indexed: 01/05/2023] Open
Abstract
Lower respiratory tract infections are the leading cause of infectious disease deaths worldwide and are the fifth leading cause of death overall. This is despite conditions such as pneumococcal infections and influenza being largely preventable with the use of appropriate vaccines. The mainstay of treatment for the most important bacterial lower respiratory tract infections, namely acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and community-acquired pneumonia (CAP), is the use of antibiotics. Yet despite a number of recent publications, including clinical studies as well as several systematic literature reviews and meta-analyses, there is considerable ongoing controversy as to what the most appropriate antibiotics are for the empiric therapy of CAP in the different settings (outpatient, inpatient, and intensive care unit). Furthermore, in the case of AECOPD, there is a need for consideration of which of these exacerbations actually need antibiotic treatment. This article describes these issues and makes suggestions for appropriately managing these conditions, in the setting of the need for antimicrobial stewardship initiatives designed to slow current emerging rates of antibiotic resistance, while improving patient outcomes.
Collapse
Affiliation(s)
- Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Guy Richards
- Division of Critical Care, Charlotte Maxeke Johannesburg Academic Hospital, and Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| |
Collapse
|
22
|
Cillóniz C, Liapikou A, Martin-Loeches I, García-Vidal C, Gabarrús A, Ceccato A, Magdaleno D, Mensa J, Marco F, Torres A. Twenty-year trend in mortality among hospitalized patients with pneumococcal community-acquired pneumonia. PLoS One 2018; 13:e0200504. [PMID: 30020995 PMCID: PMC6051626 DOI: 10.1371/journal.pone.0200504] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is only limited information on mortality over extended periods in hospitalized patients with pneumococcal community-acquired pneumonia (CAP). We aimed to evaluate the 30-day mortality and whether is changed over a 20-year period among immunocompetent adults hospitalized with pneumococcal CAP. METHODS We conducted a retrospective observational study of data that were prospectively collected at the Hospital Clinic of Barcelona of all adult patients hospitalized with diagnosis of pneumococcal CAP over a 20-year period. To aid analysis, results were divided into four periods of 5 years each (1997-2001, 2002-2006, 2007-2011, 2012-2016). The primary outcome was 30-day mortality, but secondary outcomes included intensive care unit (ICU) admission, lengths of hospital and ICU-stays, ICU-mortality, and need of mechanical ventilation. RESULTS From a cohort of 6,403 patients with CAP, we analyzed the data for 1,120 (17%) adults with a diagnosis of pneumococcal CAP. Over time, we observed decreases in the rates of alcohol consumption, smoking, influenza vaccination, and older patients (age ≥65 years), but increases in admissions to ICU and the need for non-invasive mechanical ventilation. The overall 30-day mortality rate was 8% (95% confidence interval, 6%-9%; 84 of 1,120 patients) and did not change significantly between periods (p = 0.33). Although, we observed a decrease in ICU-mortality comparing the first period (26%) to the second one (10%), statistical differences disappeared with adjustment (p0.38). CONCLUSION Over time, 30-day mortality of hospitalized pneumococcal CAP did not change significantly. Nor did it change in the propensity-adjusted multivariable analysis. Since mortality in pneumococcal pneumonia has remained unaltered for many years despite the availability of antimicrobial agents with proven in vitro activity, other non-antibiotic strategies should be investigated.
Collapse
Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona—Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)—SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Adamantia Liapikou
- Respiratory Department, Sotiria Chest Diseases Hospital, Mesogion, Athens, Greece
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), St James's University Hospital, Department of Clinical Medicine, Trinity College, Dublin, Ireland
| | | | - Albert Gabarrús
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona—Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)—SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Adrian Ceccato
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona—Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)—SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Daniel Magdaleno
- Superior Medical School of the National Polytechnic Institute Mexico City, Mexico City, Mexico
| | - Josep Mensa
- Department of Infectious Disease, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Francesc Marco
- Department of Microbiology, Biomedical Diagnostic Center (CDB), ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Antoni Torres
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona—Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)—SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| |
Collapse
|
23
|
Anderson R, Nel JG, Feldman C. Multifaceted Role of Pneumolysin in the Pathogenesis of Myocardial Injury in Community-Acquired Pneumonia. Int J Mol Sci 2018; 19:E1147. [PMID: 29641429 PMCID: PMC5979279 DOI: 10.3390/ijms19041147] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/14/2018] [Accepted: 03/21/2018] [Indexed: 12/14/2022] Open
Abstract
Pneumolysin (PLY), a member of the family of Gram-positive bacterial, cholesterol-dependent, β-barrel pore-forming cytolysins, is the major protein virulence factor of the dangerous respiratory pathogen, Streptococcus pneumoniae (pneumococcus). PLY plays a major role in the pathogenesis of community-acquired pneumonia (CAP), promoting colonization and invasion of the upper and lower respiratory tracts respectively, as well as extra-pulmonary dissemination of the pneumococcus. Notwithstanding its role in causing acute lung injury in severe CAP, PLY has also been implicated in the development of potentially fatal acute and delayed-onset cardiovascular events, which are now recognized as being fairly common complications of this condition. This review is focused firstly on updating mechanisms involved in the immunopathogenesis of PLY-mediated myocardial damage, specifically the direct cardiotoxic and immunosuppressive activities, as well as the indirect pro-inflammatory/pro-thrombotic activities of the toxin. Secondly, on PLY-targeted therapeutic strategies including, among others, macrolide antibiotics, natural product antagonists, cholesterol-containing liposomes, and fully humanized monoclonal antibodies, as well as on vaccine-based preventive strategies. These sections are preceded by overviews of CAP in general, the role of the pneumococcus as the causative pathogen, the occurrence and types of CAP-associated cardiac complication, and the structure and biological activities of PLY.
Collapse
Affiliation(s)
- Ronald Anderson
- Department of Immunology and Institute for Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa.
| | - Jan G Nel
- Department of Haematology, Faculty of Health Sciences, University of Pretoria and Tshwane Academic Division of the National Health Laboratory Service, Pretoria 0001, South Africa.
| | - Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 0002, South Africa.
| |
Collapse
|
24
|
Restrepo MI, Reyes LF. Pneumonia as a cardiovascular disease. Respirology 2018; 23:250-259. [PMID: 29325222 DOI: 10.1111/resp.13233] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/05/2017] [Indexed: 01/08/2023]
Abstract
Community-acquired pneumonia (CAP) is an important cause of death around the globe. Up to 30% of patients admitted to hospital for CAP develop cardiovascular complications (i.e. new/worsening heart failure, new/worsening arrhythmias, myocardial infarctions and/or strokes), acutely and up to 10 years thereafter. Cardiac complications result from complex interactions between preexisting conditions, relative ischaemia, upregulation of the sympathetic system, systemic inflammation and direct pathogen-mediated damage to the cardiovascular system. The exact mechanisms underlying the direct host-pathogen interactions are of great interest to identify potential therapeutic and preventative targets for CAP. In this review, we summarize the epidemiological data, risk factors and the pathogen-driven cardiovascular damage affecting patients with CAP.
Collapse
Affiliation(s)
- Marcos I Restrepo
- Division of Pulmonary Diseases and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Luis F Reyes
- Division of Pulmonary Diseases and Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW Community-acquired pneumonia (CAP) is the leading cause of mortality among infectious diseases. Several efforts have been implemented to achieve better outcomes, but an important proportion of patients continue dying. This review focuses on the newest research on prognostic factors and diagnostics, opening new perspectives in the management of CAP. RECENT FINDINGS CAP survival improved in recent years despite an increasing incidence of severe presentations. Appropriateness of antimicrobial choice, combination therapy and early administration of antibiotics has proved to be decisive. Novel biomarkers, as monocyte human leukocyte antigen-DR, presepsin and proadrenomedullin, have been explored for the prediction of severe CAP; moreover, the application of new techniques in metabolomics, genomics and microbiomics in the field of infections may contribute to predicting clinical instability and worse outcomes, showing that precise individual phenotypes are key factors for survival. CAP with unidentified organism is still an issue of concern, but new rapid molecular tests improve yield rates, revealing an unexpected high prevalence of viral detection and proving their usefulness also in the recognition of bacterial causes. SUMMARY Precision medicine applied to risk stratification and diagnosis, together with rapid microbiologic molecular testing, may contribute to optimizing the management of CAP, with potential additional reduction of mortality rates.
Collapse
|
26
|
Waterer G. Empiric antibiotics for community-acquired pneumonia: A macrolide and a beta-lactam please! Respirology 2017; 23:450-451. [PMID: 29278281 DOI: 10.1111/resp.13248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 12/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Grant Waterer
- School of Medicine, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
27
|
Vardakas KZ, Trigkidis KK, Apiranthiti KN, Falagas ME. The dilemma of monotherapy or combination therapy in community-acquired pneumonia. Eur J Clin Invest 2017; 47. [PMID: 29027205 DOI: 10.1111/eci.12845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 10/09/2017] [Indexed: 11/26/2022]
Abstract
SCOPE To study the factors associated with mortality in hospitalized patients with community-acquired pneumonia treated with monotherapy or combination therapy. METHODS PubMed and Scopus were searched. Patients receiving macrolides, β-lactams and fluoroquinolones, as monotherapy or in combination, were included. Meta-analyses and meta-regressions were performed. RESULTS Fifty studies were included. Overall, monotherapy was not associated with higher mortality than combination (RR 1.14, 95% CI 0.99-1.32, I2 84%). Monotherapy was associated with higher mortality than combination in North American and retrospective studies. β-lactam monotherapy was associated with higher mortality than β-lactam/macrolide combination in the primary (1.32, 1.12-1.56, I2 85%) and most sensitivity analyses. There was no difference in mortality between fluoroquinolone monotherapy and β-lactam/macrolide combination (0.98, 0.78-1.23, I2 73%). In meta-regressions, the moderators that could partially explain the observed statistical heterogeneity were the frequency of cancer patients (P = .03) and Pneumonia Severity Index score IV (P = .008). CONCLUSION Due to the considerable heterogeneity and inclusion of unadjusted data, it is difficult to recommend a specific antibiotic regimen over another. Specific antibiotic regimens, study design and the characteristics of the population under study seem to influence the reported outcomes.
Collapse
Affiliation(s)
- Konstantinos Z Vardakas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.,Department of Medicine, Henry Dunant Hospital Center, Athens, Greece
| | - Kyriakos K Trigkidis
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.,Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
| | - Katerina N Apiranthiti
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.,Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
| | - Matthew E Falagas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.,Department of Medicine, Henry Dunant Hospital Center, Athens, Greece.,Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
28
|
|
29
|
Pereira JM, Gonçalves-Pereira J, Ribeiro O, Baptista JP, Froes F, Paiva JA. Impact of antibiotic therapy in severe community-acquired pneumonia: Data from the Infauci study. J Crit Care 2017; 43:183-189. [PMID: 28915392 DOI: 10.1016/j.jcrc.2017.08.048] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/23/2017] [Accepted: 08/31/2017] [Indexed: 11/17/2022]
Abstract
Antibiotic therapy (AT) is the cornerstone of the management of severe community-acquired pneumonia (CAP). However, the best treatment strategy is far from being established. To evaluate the impact of different aspects of AT on the outcome of critically ill patients with CAP, we performed a post hoc analysis of all CAP patients enrolled in a prospective, observational, multicentre study. Of the 502 patients included, 76% received combination therapy, mainly a β-lactam with a macrolide (80%). AT was inappropriate in 16% of all microbiologically documented CAP (n=177). Hospital and 6months mortality were 34% and 35%. In adjusted multivariate logistic regression analysis, combination AT with a macrolide was independently associated with a reduction in hospital (OR 0.17, 95%CI 0.06-0.51) and 6months (OR 0.21, 95%CI 0.07-0.57) mortality. Prolonged AT (>7days) was associated with a longer ICU (14 vs. 7days; p<0.001) and hospital length of stay (LOS) (25 vs. 17days; p<0.001). Combination AT with a macrolide may be the most suitable AT strategy to improve both short and long term outcome of severe CAP patients. AT >7days had no survival benefit and was associated with a longer LOS.
Collapse
Affiliation(s)
- J M Pereira
- Emergency and Intensive Care Department, Centro Hospitalar S. João, Porto, Portugal; Department of Medicine, University of Porto Medical School, Porto, Portugal; Grupo de Infecção e Sepsis, Portugal.
| | - J Gonçalves-Pereira
- Intensive Care Unit, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal; Nova Medical School, Lisboa, Portugal
| | - O Ribeiro
- Department of Health Information and Decision Sciences, Center for Research in Health Technologies and Information Systems, CINTESIS, University of Porto Medical School, Porto, Portugal
| | - J P Baptista
- Intensive Care Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - F Froes
- Intensive Care Unit, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - J A Paiva
- Emergency and Intensive Care Department, Centro Hospitalar S. João, Porto, Portugal; Department of Medicine, University of Porto Medical School, Porto, Portugal; Grupo de Infecção e Sepsis, Portugal
| |
Collapse
|
30
|
Blot M, Pivot D, Bourredjem A, Salmon-Rousseau A, de Curraize C, Croisier D, Chavanet P, Binquet C, Piroth L. Effectiveness of and obstacles to antibiotic streamlining to amoxicillin monotherapy in bacteremic pneumococcal pneumonia. Int J Antimicrob Agents 2017; 50:359-364. [DOI: 10.1016/j.ijantimicag.2017.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/08/2017] [Accepted: 03/22/2017] [Indexed: 12/15/2022]
|
31
|
Boyles TH, Brink A, Calligaro GL, Cohen C, Dheda K, Maartens G, Richards GA, van Zyl Smit R, Smith C, Wasserman S, Whitelaw AC, Feldman C. South African guideline for the management of community-acquired pneumonia in adults. J Thorac Dis 2017; 9:1469-1502. [PMID: 28740661 DOI: 10.21037/jtd.2017.05.31] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Tom H Boyles
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Adrian Brink
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa
| | - Greg L Calligaro
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Guy A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard van Zyl Smit
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | | | - Sean Wasserman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Andrew C Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Charles Feldman
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | |
Collapse
|
32
|
Anderson R, Feldman C. Pneumolysin as a potential therapeutic target in severe pneumococcal disease. J Infect 2017; 74:527-544. [PMID: 28322888 DOI: 10.1016/j.jinf.2017.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/09/2017] [Accepted: 03/11/2017] [Indexed: 12/13/2022]
Abstract
Acute pulmonary and cardiac injury remain significant causes of morbidity and mortality in those afflicted with severe pneumococcal disease, with the risk for early mortality often persisting several years beyond clinical recovery. Although remaining to be firmly established in the clinical setting, a considerable body of evidence, mostly derived from murine models of experimental infection, has implicated the pneumococcal, cholesterol-binding, pore-forming toxin, pneumolysin (Ply), in the pathogenesis of lung and myocardial dysfunction. Topics covered in this review include the burden of pneumococcal disease, risk factors, virulence determinants of the pneumococcus, complications of severe disease, antibiotic and adjuvant therapies, as well as the structure of Ply and the role of the toxin in disease pathogenesis. Given the increasing recognition of the clinical potential of Ply-neutralisation strategies, the remaining sections of the review are focused on updates of the types, benefits and limitations of currently available therapies which may attenuate, directly and/or indirectly, the injurious actions of Ply. These include recently described experimental therapies such as various phytochemicals and lipids, and a second group of more conventional agents the members of which remain the subject of ongoing clinical evaluation. This latter group, which is covered more extensively, encompasses macrolides, statins, corticosteroids, and platelet-targeted therapies, particularly aspirin.
Collapse
Affiliation(s)
- Ronald Anderson
- Department of Immunology and Institute of Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
33
|
Prise en charge des infections à Streptococcus pneumoniae : ce qui a changé en 15 ans. MEDECINE INTENSIVE REANIMATION 2017. [DOI: 10.1007/s13546-017-1265-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
34
|
Abstract
Acute pneumonia is an active infection of the lungs that results when an individual at risk gets exposed to a particular microbiological pathogen. Acute pneumonia is the leading cause of death in the United States that is attributable to an infection. The risk factors, pathogenesis, and microbiological organisms involved differ if the pneumonia develops in the community versus health care-associated environment. The development of concise and comprehensive guidelines has led to an improvement in the management of the problem. However, the emergence of multidrug-resistant organisms and the increase in the percentage of elderly population keep mortality risk very substantial.
Collapse
|
35
|
Sakamoto Y, Yamauchi Y, Yasunaga H, Takeshima H, Hasegawa W, Jo T, Matsui H, Fushimi K, Nagase T. Guidelines-concordant empiric antimicrobial therapy and mortality in patients with severe community-acquired pneumonia requiring mechanical ventilation. Respir Investig 2016; 55:39-44. [PMID: 28012492 DOI: 10.1016/j.resinv.2016.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/24/2016] [Accepted: 08/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) has high morbidity and mortality among adults. Several clinical guidelines recommend prompt administration of combined antimicrobial therapy. However, the association between guidelines concordance and mortality in patients with severe pneumonia remains unclear. The present study aimed to examine the impact of guidelines-concordant empiric antimicrobial therapy on 7-day mortality in patients with extremely severe pneumonia who required mechanical ventilation at admission, using a nationwide inpatient database in Japan. METHODS Data of CAP patients aged over 20 years who required mechanical ventilation at admission between April 2012 and March 2014 were retrospectively analyzed. Multivariable logistic regression analysis was performed to examine the association between guidelines-concordant empiric antimicrobial therapy and all-cause 7-day mortality, with adjustment for patient backgrounds and pneumonia severity. RESULTS There were a total of 3719 eligible patients, 836 (22.5%) of whom received guidelines-concordant combination therapy. Overall, 7-day mortality was 29.5%. Higher 7-day mortality was associated with advanced age, confusion, lower systolic blood pressure, malignant tumor or immunocompromised state, and C-reactive protein ≥20mg/dl or infiltration occupying two-thirds of one lung on chest radiography. After adjustment for these variables, guidelines-concordant combined antimicrobial therapy was associated with significantly lower 7-day mortality (odds ratio: 0.78; 95% confidence interval: 0.65-0.95; P=0.013). CONCLUSIONS Adherence to initial empiric treatment as recommended by the guidelines was associated with better short-term prognosis in patients with extremely severe pneumonia who required mechanical ventilation on hospital admission.
Collapse
Affiliation(s)
- Yukiyo Sakamoto
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Yasuhiro Yamauchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Hideyuki Takeshima
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Wakae Hasegawa
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Taisuke Jo
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| |
Collapse
|
36
|
Abstract
PURPOSE OF REVIEW Community-acquired pneumonia (CAP) is a pervasive disease that is encountered in outpatient and inpatient settings. CAP is the leading cause of death from an infectious disease and accounts for significant worldwide morbidity and mortality. This update reviews current advances that can be used to promote improved outcomes in CAP. RECENT FINDINGS Early recognition of CAP and its severe presentations, with appropriate site of care decisions, leads to reduced patient mortality. In addition to traditional prognostic tools, certain serum biomarkers can assist in defining disease severity and guide treatment and management strategies. The use of macrolides as part of combination antibiotic therapy has shown beneficial mortality effects across the CAP disease spectrum, especially for those with severe illness. When treating community-associated, methicillin-resistant Staphylococcus aureus pneumonia, use of an antitoxin antibiotic is likely to be valuable. Adjunctive therapy with corticosteroids may prevent delayed clinical resolution in selected patients with severe CAP. Recent data expand on the interaction of CAP with comorbid disease, particularly cardiovascular disease, and its impact on mortality in CAP patients. SUMMARY Improved diagnostic tools, optimized treatment regimens, and enhanced understanding of CAP-induced perturbations in comorbid disease states hold promise to improve patient outcomes.
Collapse
|
37
|
|
38
|
Rello J, Diaz E, Mañez R, Sole-Violan J, Valles J, Vidaur L, Zaragoza R, Gattarello S. Improved survival among ICU-hospitalized patients with community-acquired pneumonia by unidentified organisms: a multicenter case-control study. Eur J Clin Microbiol Infect Dis 2016; 36:123-130. [PMID: 27655267 DOI: 10.1007/s10096-016-2779-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
Abstract
A retrospective analysis from prospectively collected data was conducted in intensive care units (ICUs) at 33 hospitals in Europe comparing the trend in ICU survival among adults with severe community-acquired pneumonia (CAP) due to unknown organisms from 2000 to 2015. The secondary objective was to establish whether changes in antibiotic policies were associated with different outcomes. ICU mortality decreased (p = 0.02) from 26.9 % in the first study period (2000-2002) to 15.7 % in the second period (2008-2015). Demographic data and clinical severity at admission were comparable between groups, except for age over 65 years and incidence of cardiomyopathy. Over time, patients received higher rates of combination therapy (94.3 vs. 77.2 %; p < 0.01) and early (<3 h) antibiotic delivery (72.9 vs. 50.3 %; p < 0.01); likewise, the 2008-2015 group was more likely to receive adequate antibiotic prescription [as defined by the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines] than the 2000-2002 group (70.7 vs. 48.2 %; p < 0.01). Multivariate analysis showed an independent association between decreased ICU mortality and early (<3 h) antibiotic administration [odds ratio (OR) 3.48 [1.70-7.15], p < 0.01] or adequate antibiotic prescription according to guidelines (OR 2.22 [1.11-4.43], p = 0.02). In conclusion, our findings suggest that ICU mortality in severe CAP due to unidentified organisms has decreased in the last 15 years. Several changes in management and better compliance with guidelines over time were associated with increased survival.
Collapse
Affiliation(s)
- J Rello
- Universitat Autonoma de Barcelona, Barcelona, Spain. .,CIBERES, Barcelona, Spain.
| | - E Diaz
- CIBERES, Barcelona, Spain.,Hospital Joan XXIII, Tarragona, Spain
| | - R Mañez
- Hospital de Bellvitge, Barcelona, Spain
| | - J Sole-Violan
- CIBERES, Barcelona, Spain.,Hospital Negrin, Las Palmas de Gran Canaria, Spain
| | - J Valles
- CIBERES, Barcelona, Spain.,Hospital Parc Tauli, Sabadell, Spain
| | - L Vidaur
- CIBERES, Barcelona, Spain.,Hospital de Donostia, Donostia, Spain
| | | | | | | |
Collapse
|
39
|
Abstract
Pneumococcal infections continue to cause significant morbidity and mortality in patients throughout the world. This microorganism remains the most common bacterial cause of community-acquired pneumonia and is associated with a considerable burden of disease and health-care costs in both developed and developing countries. Emerging antibiotic resistance has been a concern because of its potential negative impact on the outcome of patients who receive standard antibiotic therapy. However, there have been substantial changes in the epidemiology of this pathogen in recent years, not least of which has been due to the use of pneumococcal conjugate vaccines in children, with subsequent herd protection in unvaccinated adults and children. Furthermore, much recent research has led to a better understanding of the virulence factors of this pathogen and their role in the pathogenesis of severe pneumococcal disease, including the cardiac complications, as well as the potential role of adjunctive therapy in the management of severely ill cases. This review will describe recent advances in our understanding of the epidemiology, virulence factors, and management of pneumococcal community-acquired pneumonia.
Collapse
Affiliation(s)
- Charles Feldman
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand Medical School, Johannesburg, South Africa
| | - Ronald Anderson
- Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
40
|
Pneumonies aiguës communautaires (PAC) de l’adulte : focus sur les PAC virales. REVUE DES MALADIES RESPIRATOIRES ACTUALITÉS 2016; 8:263-267. [PMID: 32288906 PMCID: PMC7140245 DOI: 10.1016/s1877-1203(16)30108-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
|
41
|
Phua J, Dean NC, Guo Q, Kuan WS, Lim HF, Lim TK. Severe community-acquired pneumonia: timely management measures in the first 24 hours. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:237. [PMID: 27567896 PMCID: PMC5002335 DOI: 10.1186/s13054-016-1414-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Mortality rates for severe community-acquired pneumonia (CAP) range from 17 to 48 % in published studies.In this review, we searched PubMed for relevant papers published between 1981 and June 2016 and relevant files. We explored how early and aggressive management measures, implemented within 24 hours of recognition of severe CAP and carried out both in the emergency department and in the ICU, decrease mortality in severe CAP.These measures begin with the use of severity assessment tools and the application of care bundles via clinical decision support tools. The bundles include early guideline-concordant antibiotics including macrolides, early haemodynamic support (lactate measurement, intravenous fluids, and vasopressors), and early respiratory support (high-flow nasal cannulae, lung-protective ventilation, prone positioning, and neuromuscular blockade for acute respiratory distress syndrome).While the proposed interventions appear straightforward, multiple barriers to their implementation exist. To successfully decrease mortality for severe CAP, early and close collaboration between emergency medicine and respiratory and critical care medicine teams is required. We propose a workflow incorporating these interventions.
Collapse
Affiliation(s)
- Jason Phua
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University Health System, Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nathan C Dean
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Qi Guo
- Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China.,Guangzhou Institute of Respiratory Diseases (State Key Laboratory of Respiratory Diseases), First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Win Sen Kuan
- Department of Emergency Medicine, National University Hospital, National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui Fang Lim
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University Health System, Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tow Keang Lim
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University Health System, Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| |
Collapse
|
42
|
Chronic obstructive pulmonary disease: A guide for the primary care physician. Dis Mon 2016; 62:164-87. [DOI: 10.1016/j.disamonth.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
43
|
Ricard JD, Messika J. Low-dose corticosteroids during severe community-acquired pneumonia: end of the story. Eur Respir J 2016; 45:305-7. [PMID: 25653260 DOI: 10.1183/09031936.00225414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jean-Damien Ricard
- AP-HP, Service de Réanimation Médico-chirurgicale, Hôpital Louis Mourier, Colombes, France INSERM, IAME, 1137, Paris, France Univ Paris Diderot, IAME, 1137, Sorbonne Paris Cité, Paris, France
| | - Jonathan Messika
- AP-HP, Service de Réanimation Médico-chirurgicale, Hôpital Louis Mourier, Colombes, France INSERM, IAME, 1137, Paris, France Univ Paris Diderot, IAME, 1137, Sorbonne Paris Cité, Paris, France
| |
Collapse
|
44
|
|
45
|
Simonetti AF, Garcia-Vidal C, Viasus D, García-Somoza D, Dorca J, Gudiol F, Carratalà J. Declining mortality among hospitalized patients with community-acquired pneumonia. Clin Microbiol Infect 2016; 22:567.e1-7. [PMID: 27021421 DOI: 10.1016/j.cmi.2016.03.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/25/2016] [Accepted: 03/13/2016] [Indexed: 11/15/2022]
Abstract
Little information is available on the changes over time in community-acquired pneumonia (CAP) management and their impact on 30-day mortality in hospitalized patients. We performed a prospective, observational study of non-severely immunosuppressed hospitalized adults with CAP from 1995 to 2014. A total of 4558 patients were included. Thirty-day mortality decreased from 9.6% in the first study period (1995-99) to 4.1% in the last period (2010-14); with a progressive downward trend (-0.2% death/year; p for trend = 0.003). Over time, patients were older (p 0.02), had more co-morbidities (p 0.037), more frequently presented severe illness according to the Pneumonia Severity Index (p <0.001) and septic shock (p <0.001), and more often required intensive care unit admission (p <0.001). Combination antibiotic therapy (p <0.001) and fluoroquinolone use (p <0.001) increased. Factors independently associated with 30-day mortality were increasing age (OR 1.04; 95% CI 1.03-1.05), co-morbidities (OR 1.48; 95% CI 1.04-2.11), shock at admission (OR 4.95; 95% CI 3.49-7.00), respiratory failure (OR 1.89; 95% CI 1.42-2.52), bacteraemia (OR 2.16; 95% CI 1.58-2.96), Gram-negative bacilli aetiology (OR 4.79; 95% CI 2.52-9.10) and fluoroquinolone use (OR 0.45; 95% CI 0.29-0.71). When we adjusted for a propensity score to receive fluoroquinolones, the protective effect of fluoroquinolone use was not confirmed. In conclusion, 30-day mortality decreased significantly over time in hospitalized patients with CAP in spite of an upward trend in patient age and other factors associated with poor outcomes. Several changes in the management of CAP and a general improvement in global care over time may have caused the observed outcomes.
Collapse
Affiliation(s)
- A F Simonetti
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain
| | - C Garcia-Vidal
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain.
| | - D Viasus
- Division of Health Sciences, Faculty of Medicine, Universidad del Norte, and Hospital Universidad del Norte, Barranquilla, Colombia
| | - D García-Somoza
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Dorca
- Department of Respiratory Diseases, Hospital Universitari de Bellvitge Barcelona, Spain
| | - F Gudiol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| |
Collapse
|
46
|
|
47
|
Grau I, Ardanuy C, Cubero M, Benitez MA, Liñares J, Pallares R. Declining mortality from adult pneumococcal infections linked to children's vaccination. J Infect 2016; 72:439-49. [PMID: 26868606 DOI: 10.1016/j.jinf.2016.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 01/14/2016] [Accepted: 01/22/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine changes in mortality among adults with invasive pneumococcal disease (IPD) after introducing pneumococcal conjugate vaccines (PCVs) in children. METHODS An active surveillance of adults with culture-proven IPD in Barcelona. Serotype-specific mortality and rates of disease and death were analysed in three periods: baseline (1994-2001), PCV7 (2002-2009) and PCV13 (2010-2013). RESULTS Overall, IPD caused by PCV7 serotypes was associated with increased case fatality rate (24 percent). In patients 18-64 years (baseline vs. PCV7 vs. PCV13 periods), case fatality rate from IPD decreased (22 vs.14 vs. 12 percent), and it was associated with a decline in PCV7 serotypes (3.56 vs. 2.80 vs. 1.49 cases/10(5) person-years) and in PCV7 serotypes-specific death (0.74 vs. 0.53 vs. 0.09 deaths/10(5) person-years). In patients ≥65 years, case fatality rate did not change (24 vs. 22 vs. 24 percent); however, there was a decline in PCV7 serotypes-specific death (4.94 vs. 3.58 vs. 2.45 deaths/10(5) person-years), and an increase in non-PCV serotypes-specific death (2.55 vs. 3.70 vs. 4.09 deaths/10(5) person-years). CONCLUSIONS The use of PCVs for children was associated with a reduction of mortality from IPD in adults 18-64 years, through the indirect effect of herd protection. In older adults, age-related factors could play a role in IPD mortality.
Collapse
Affiliation(s)
- Imma Grau
- Infectious Diseases Department, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, Barcelona, Spain.
| | - Carmen Ardanuy
- Microbiology Department, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, Barcelona, Spain.
| | - Meritxell Cubero
- Microbiology Department, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, Barcelona, Spain.
| | - Miguel A Benitez
- Microbiology Department, Hospital Moises Broggi, Sant Joan Despi, Barcelona, Spain.
| | - Josefina Liñares
- Microbiology Department, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, Barcelona, Spain.
| | - Roman Pallares
- Infectious Diseases Department, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
48
|
Community-Acquired Pneumonia in Elderly Patients With Diabetes Mellitus. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000302] [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]
|
49
|
Vallés J, Diaz E, Martín-Loeches I, Bacelar N, Saludes P, Lema J, Gallego M, Fontanals D, Artigas A. Evolution over a 15-year period of the clinical characteristics and outcomes of critically ill patients with severe community-acquired pneumonia. Med Intensiva 2015; 40:238-45. [PMID: 26391738 DOI: 10.1016/j.medin.2015.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/05/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To study the characteristics and outcomes of patients in the ICU with severe community-acquired pneumonia (SCAP) over a 15-year surveillance period. METHODS We conducted a retrospective cohort study of episodes of SCAP, and assessed the epidemiology, etiology, treatment and outcomes of patients admitted to the ICU, comparing three periods (1999-2003, 2004-2008 and 2009-2013). RESULTS A total of 458 patients were diagnosed with SCAP. The overall cumulative incidence was 37.4 episodes/1000 admissions, with a progressive increase over the three periods (P<0.001). Patients fulfilling the two major IDSA/ATS criteria at admission increased from 64.2% in the first period to 82.5% in the last period (P=0.005). Streptococcus pneumoniae was the prevalent pathogen. The incidence of bacteremia was 23.1%, and a progressive significant reduction in overall incidence was observed over the three periods (P=0.02). Globally, 91% of the patients received appropriate empiric antibiotic treatment, increasing from 78.3% in the first period to 97.7% in the last period (P<0.001). Combination antibiotic therapy (betalactam+macrolide or fluoroquinolone) increased significantly from the first period (61%) to the last period (81.3%) (P<0.001). Global ICU mortality was 25.1%, and decreased over the three periods (P=0.001). CONCLUSIONS Despite a progressively higher incidence and severity of SCAP in our ICU, crude ICU mortality decreased by 18%. The increased use of combined antibiotic therapy and the decreasing rates of bacteremia were associated to improved patient prognosis.
Collapse
Affiliation(s)
- J Vallés
- Critical Care Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain; Universidad Autonoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER Enfermedades Respiratorias, Spain.
| | - E Diaz
- Critical Care Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain
| | - I Martín-Loeches
- CIBER Enfermedades Respiratorias, Spain; Critical Care Department, Hospital St. James, Dublin, Ireland
| | - N Bacelar
- Critical Care Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain
| | - P Saludes
- Critical Care Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain
| | - J Lema
- Critical Care Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain
| | - M Gallego
- Respiratory Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain
| | - D Fontanals
- Universidad Autonoma de Barcelona, Bellaterra, Barcelona, Spain; Microbiology Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain
| | - A Artigas
- Critical Care Department, Hospital Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain; Universidad Autonoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER Enfermedades Respiratorias, Spain
| |
Collapse
|
50
|
Gattarello S, Lagunes L, Vidaur L, Solé-Violán J, Zaragoza R, Vallés J, Torres A, Sierra R, Sebastian R, Rello J. Improvement of antibiotic therapy and ICU survival in severe non-pneumococcal community-acquired pneumonia: a matched case-control study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:335. [PMID: 26369551 PMCID: PMC4570589 DOI: 10.1186/s13054-015-1051-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/26/2015] [Indexed: 11/10/2022]
Abstract
INTRODUCTION We aimed to compare intensive care unit mortality due to non-pneumococcal severe community-acquired pneumonia between the periods 2000-2002 and 2008-2014, and the impact of the improvement in antibiotic strategies on outcomes. METHODS This was a matched case-control study enrolling 144 patients with non-pneumococcal severe pneumonia: 72 patients from the 2000-2002 database (CAPUCI I group) were paired with 72 from the 2008-2014 period (CAPUCI II group), matched by the following variables: microorganism, shock at admission, invasive mechanical ventilation, immunocompromise, chronic obstructive pulmonary disease, and age over 65 years. RESULTS The most frequent microorganism was methicillin-susceptible Staphylococcus aureus (22.1%) followed by Legionella pneumophila and Haemophilus influenzae (each 20.7%); prevalence of shock was 59.7%, while 73.6% of patients needed invasive mechanical ventilation. Intensive care unit mortality was significantly lower in the CAPUCI II group (34.7% versus 16.7%; odds ratio (OR) 0.78, 95% confidence interval (CI) 0.64-0.95; p = 0.02). Appropriate therapy according to microorganism was 91.5% in CAPUCI I and 92.7% in CAPUCI II, while combined therapy and early antibiotic treatment were significantly higher in CAPUCI II (76.4 versus 90.3% and 37.5 versus 63.9%; p < 0.05). In the multivariate analysis, combined antibiotic therapy (OR 0.23, 95% CI 0.07-0.74) and early antibiotic treatment (OR 0.07, 95% CI 0.02-0.22) were independently associated with decreased intensive care unit mortality. CONCLUSIONS In non-pneumococcal severe community-acquired pneumonia , early antibiotic administration and use of combined antibiotic therapy were both associated with increased intensive care unit survival during the study period.
Collapse
Affiliation(s)
- Simone Gattarello
- Critical Care Department, Vall d'Hebron Hospital, Ps. Vall d'Hebron, 119-129, Anexe AG-5a planta, 08035, Barcelona, Spain. .,Department of Medicine of the Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
| | - Leonel Lagunes
- Critical Care Department, Vall d'Hebron Hospital, Ps. Vall d'Hebron, 119-129, Anexe AG-5a planta, 08035, Barcelona, Spain.,Department of Medicine of the Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Loreto Vidaur
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Intensive Care Department, Donostia University Hospital, Donostia, Spain
| | - Jordi Solé-Violán
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Intensive Care Department, Dr. Negrin University Hospital, Las Palmas de Gran Canaria, Spain
| | - Rafael Zaragoza
- Intensive Care Department, Dr. Peset University Hospital, Valencia, Spain
| | - Jordi Vallés
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Critical Care Centre, Sabadell Hospital, Consorci Hospitalari Universitari Parc Taulí, Sabadell, Spain
| | - Antoni Torres
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Respiratory Disease Department, Hospital Clinic i Provincial de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rafael Sierra
- Critical Care Unit, Puerta del Mar University Hospital, Cadiz, Spain
| | - Rosa Sebastian
- Intensive Care Department, Donostia University Hospital, Donostia, Spain
| | - Jordi Rello
- Critical Care Department, Vall d'Hebron Hospital, Ps. Vall d'Hebron, 119-129, Anexe AG-5a planta, 08035, Barcelona, Spain.,Department of Medicine of the Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| |
Collapse
|