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Ringshausen FC, Shapiro AJ, Nielsen KG, Mazurek H, Pifferi M, Donn KH, van der Eerden MM, Loebinger MR, Zariwala MA, Leigh MW, Knowles MR, Ferkol TW. Safety and efficacy of the epithelial sodium channel blocker idrevloride in people with primary ciliary dyskinesia (CLEAN-PCD): a multinational, phase 2, randomised, double-blind, placebo-controlled crossover trial. Lancet Respir Med 2024; 12:21-33. [PMID: 37660715 DOI: 10.1016/s2213-2600(23)00226-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Mucociliary clearance is dysfunctional in people with primary ciliary dyskinesia, resulting in the accumulation of dehydrated mucus in the airways that is difficult to clear. We undertook a study to assess the benefit on lung function of treatment with a nebulised epithelial sodium channel (ENaC) blocker, idrevloride, with or without hypertonic saline, in people with primary ciliary dyskinesia. METHODS The CLEAN-PCD trial was a phase 2, randomised, double-blind, placebo-controlled crossover trial conducted at 32 tertiary adult and paediatric care centres and university hospitals in Canada, Denmark, Germany, Italy, the Netherlands, Poland, the UK, and the USA. People with a confirmed diagnosis of primary ciliary dyskinesia, aged 12 years or older, with a percentage of predicted FEV1 (ppFEV1) in the range of 40% to <90%, were randomly assigned in a 2:2:1:1 ratio (block size=6), stratified by ppFEV1 at screening, to one of four sequences: (1) idrevloride in hypertonic saline in treatment period 1 then hypertonic saline in treatment period 2; (2) hypertonic saline in treatment period 1 then idrevloride in hypertonic saline in treatment period 2; (3) idrevloride in treatment period 1 then placebo in treatment period 2; and (4) placebo in treatment period 1 then idrevloride in treatment period 2. The idrevloride dose was 85 μg and hypertonic saline was 4·2% NaCl. 3 mL of each study treatment was nebulised twice daily for 28 days in treatment periods 1 and 2; the two 28-day treatment periods were separated by a 28-day washout period. The primary endpoint was absolute change from baseline in ppFEV1 after 28 days. Safety assessments and reports of adverse events were made at clinic visits during each treatment period and by a follow-up telephone call 28 days after the last dose of study drug. Additionally, adverse events could be reported at a follow-up telephone call 3 days after the start of dosing and as they arose. Participants who received at least one dose of study drug were included in the safety analyses (safety set), and those who also had spirometry data were included in the efficacy analyses (full analysis set). The completed study is registered (EudraCT 2015-004917-26; ClinicalTrials.govNCT02871778). FINDINGS Between Sep 14, 2016, and May 31, 2018, 216 patients were screened and 123 were randomly assigned to one of four crossover sequences. Across the two treatment periods, treatment with idrevloride in hypertonic saline was initiated in 80 patients and completed in 78 patients (all 78 had data available and were included in the analysis); hypertonic saline initiated in 81 patients and completed in 76 patients (75 had data available and were included in the analysis); idrevloride initiated in 37 patients and completed in 35 patients (34 had data available and were included in the analysis); and placebo initiated in 36 patients and completed in 34 patients (all 34 had data available and were included in the analysis). Greater absolute increases in ppFEV1 from baseline to 28 days of treatment were seen with idrevloride in hypertonic saline (least-squares mean absolute change from baseline 1·0 percentage points, 95% CI -0·4 to 2·4) than with hypertonic saline alone (least-squares mean absolute change from baseline of -0·5 percentage points, -2·0 to 0·9; difference 1·5 percentage points, 95% CI <0·1 to 3·0; p=0·044). There was no significant difference in ppFEV1 for the parallel comparison of idrevloride in hypertonic saline compared with placebo or the crossover comparison of idrevloride with placebo. Adverse events were similar across treatments (57 to 65% of patients). Cough occurred in a greater proportion of participants during treatments that contained idrevloride or hypertonic saline compared with placebo, and oropharyngeal pain occurred in a greater proportion of participants during idrevloride treatments than during treatment with hypertonic saline alone or placebo, whereas chest discomfort was more common during treatments that included hypertonic saline. INTERPRETATION In this phase 2 crossover study, idrevloride in hypertonic saline was safe and associated with improved lung function over a 28-day period in people with primary ciliary dyskinesia compared with hypertonic saline alone. Larger, longer clinical studies are warranted to explore the potential benefits of idrevloride in combination with hypertonic saline in people with primary ciliary dyskinesia. FUNDING Parion Sciences, under agreement with Vertex Pharmaceuticals.
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Affiliation(s)
- Felix C Ringshausen
- Department of Respiratory Medicine and Infectious Diseases, German Center for Lung Research and European Reference Network for Rare and Complex Lung Diseases, Hannover Medical School, Hannover, Germany.
| | - Adam J Shapiro
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Kim G Nielsen
- Danish Primary Ciliary Dyskinesia Centre, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henryk Mazurek
- Department of Pneumonology and Cystic Fibrosis, National Institute of Tuberculosis and Lung Disorders, Rabka-Zdroj, Poland
| | - Massimo Pifferi
- Department of Paediatrics, University Hospital of Pisa, Pisa, Italy
| | | | | | - Michael R Loebinger
- Host Defence Unit and National Heart and Lung Institute, Royal Brompton Hospital and Imperial College London, London, UK
| | - Maimoona A Zariwala
- Department of Pathology and Laboratory Medicine, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Margaret W Leigh
- Department of Pediatrics, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael R Knowles
- Department of Medicine, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas W Ferkol
- Department of Pediatrics, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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van der Veer T, de Koning Gans JM, Braunstahl GJ, Pieters ALP, van den Berg JMW, Hoek RAS, Kamphuis LSJ, Bakker M, Dubois AVF, Aerts JGJV, van der Eerden MM. The effect of beclomethasone-formoterol versus placebo on chronic cough in patients with non-CF bronchiectasis: the FORZA randomised controlled trial. Eur Respir J 2023; 61:2300186. [PMID: 37263749 DOI: 10.1183/13993003.00186-2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/10/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Tjeerd van der Veer
- Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
- Shared first authorship
| | - Johanna Margaretha de Koning Gans
- Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Shared first authorship
| | - Gerrit J Braunstahl
- Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | | | | | - Rogier A S Hoek
- Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - Lieke S J Kamphuis
- Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Marleen Bakker
- Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Alain V F Dubois
- Department of Respiratory Medicine, Admiraal De Ruyter Ziekenhuis, Goes, The Netherlands
| | - Joachim G J V Aerts
- Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
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3
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Beekman RRAL, Duijkers RR, Snijders DD, van der Eerden MM, Kross MM, Boersma WWG. Validating a clinical prediction score for Legionella-related community acquired pneumonia. BMC Infect Dis 2022; 22:442. [PMID: 35534798 PMCID: PMC9081661 DOI: 10.1186/s12879-022-07433-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/13/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Legionella-related community acquired pneumonia (CAP) is a disease with an increasing incidence and a high mortality rate, especially if empirical antibiotic therapy is inadequate. Antibiotic treatment highly relies on clinical symptoms, although proven non-specific, because currently available diagnostic techniques provide insufficient accuracy for detecting Legionella CAP on admission. This study validates a diagnostic scoring system for detection of Legionella-related CAP, based on six items on admission (Legionella prediction score). METHODS We included patients with Legionella-related CAP admitted to five large Dutch hospitals between 2006 and 2016. Controls were non-Legionella-related CAP patients. The following six conditions were rewarded one point if present: fever > 39.4 °C; dry cough; hyponatremia (sodium) < 133 mmol/L; lactate dehydrogenase (LDH) > 225 mmol/L; C-reactive protein (CRP) > 187 mg/L and platelet count < 171 × 109/L. The accuracy of the prediction score was assessed by calculating the area under the curve (AUC) through logistic regression analysis. RESULTS We included 131 cases and 160 controls. A score of 0 occurred in non-Legionella-related CAP patients only, a score of 5 and 6 in Legionella-related CAP patients only. A cut-off ≥ 4 resulted in a sensitivity of 58.8% and a specificity of 93.1%. The AUC was 0.89 (95% CI 0.86-0.93). The strongest predictors were elevated LDH, elevated CRP and hyponatremia. CONCLUSIONS This multi-centre study validates the Legionella prediction score, an easily applicable diagnostic scoring system, in a large group of patients and finds high diagnostic accuracy. The score shows promise for future prospective validation and could contribute to targeted antibiotic treatment of suspected Legionella CAP.
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Affiliation(s)
| | - Ruud R Duijkers
- Department of Pulmonology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands. .,Department of Pulmonology, Medisch Centrum Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, Netherlands.
| | | | | | - Martijn M Kross
- Department of Pulmonology, Slotervaartziekenhuis, Amsterdam, Netherlands
| | - Wim W G Boersma
- Department of Pulmonology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
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4
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Muilwijk D, de Poel E, van Mourik P, Suen SWF, Vonk AM, Brunsveld JE, Kruisselbrink E, Oppelaar H, Hagemeijer MC, Berkers G, de Winter-de Groot KM, Heida-Michel S, Jans SR, van Panhuis H, van der Eerden MM, van der Meer R, Roukema J, Dompeling E, Weersink EJM, Koppelman GH, Vries R, Zomer-van Ommen DD, Eijkemans MJC, van der Ent CK, Beekman JM. Forskolin-induced Organoid Swelling is Associated with Long-term CF Disease Progression. Eur Respir J 2022; 60:13993003.00508-2021. [PMID: 35086832 PMCID: PMC9386333 DOI: 10.1183/13993003.00508-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022]
Abstract
Rationale Cystic fibrosis (CF) is a monogenic life-shortening disease associated with highly variable individual disease progression which is difficult to predict. Here we assessed the association of forskolin-induced swelling (FIS) of patient-derived organoids with long-term CF disease progression in multiple organs and compared FIS with the golden standard biomarker sweat chloride concentration (SCC). Methods We retrieved 9-year longitudinal clinical data from the Dutch CF Registry of 173 people with mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Individual CFTR function was defined by FIS, measured as the relative size increase of intestinal organoids after stimulation with 0.8 µM forskolin, quantified as area under the curve (AUC). We used linear mixed-effect models and multivariable logistic regression to estimate the association of FIS with long-term forced expiratory volume in 1 s % predicted (FEV1pp) decline and development of pancreatic insufficiency, CF-related liver disease and diabetes. Within these models, FIS was compared with SCC. Results FIS was strongly associated with longitudinal changes of lung function, with an estimated difference in annual FEV1pp decline of 0.32% (95% CI 0.11–0.54%; p=0.004) per 1000-point change in AUC. Moreover, increasing FIS levels were associated with lower odds of developing pancreatic insufficiency (adjusted OR 0.18, 95% CI 0.07–0.46; p<0.001), CF-related liver disease (adjusted OR 0.18, 95% CI 0.06–0.54; p=0.002) and diabetes (adjusted OR 0.34, 95% CI 0.12–0.97; p=0.044). These associations were absent for SCC. Conclusion This study exemplifies the prognostic value of a patient-derived organoid-based biomarker within a clinical setting, which is especially important for people carrying rare CFTR mutations with unclear clinical consequences. Forskolin-induced swelling of patient-derived intestinal organoids is associated with long-term cystic fibrosis disease progression, expressed as FEV1pp decline and development of pancreatic insufficiency, CF-related liver disease and CF-related diabeteshttps://bit.ly/3tjjJzU
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Affiliation(s)
- Danya Muilwijk
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands.,These authors contributed equally to this work
| | - Eyleen de Poel
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands.,Regenerative Medicine Utrecht, University Medical Center, Utrecht University, Utrecht, The Netherlands.,These authors contributed equally to this work
| | - Peter van Mourik
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Sylvia W F Suen
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands.,Regenerative Medicine Utrecht, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Annelotte M Vonk
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands.,Regenerative Medicine Utrecht, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Jesse E Brunsveld
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands.,Regenerative Medicine Utrecht, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Evelien Kruisselbrink
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands.,Regenerative Medicine Utrecht, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Hugo Oppelaar
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands.,Regenerative Medicine Utrecht, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Marne C Hagemeijer
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands.,Regenerative Medicine Utrecht, University Medical Center, Utrecht University, Utrecht, The Netherlands.,Current affiliation: Center for Lysosomal and Metabolic Diseases, Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gitte Berkers
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Karin M de Winter-de Groot
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Sabine Heida-Michel
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Stephan R Jans
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Hannah van Panhuis
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Menno M van der Eerden
- Department of Pulmonology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Jolt Roukema
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Edward Dompeling
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Els J M Weersink
- Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Gerard H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - Robert Vries
- Hubrecht Organoid Technology (HUB), Utrecht, The Netherlands
| | | | - Marinus J C Eijkemans
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Cornelis K van der Ent
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands.,These authors contributed equally to this work and are both corresponding authors
| | - Jeffrey M Beekman
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, The Netherlands .,Regenerative Medicine Utrecht, University Medical Center, Utrecht University, Utrecht, The Netherlands.,These authors contributed equally to this work and are both corresponding authors
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5
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van der Veer T, Dallinga MA, van der Valk JPM, Kappen JH, In 't Veen JCCM, van der Eerden MM, Braunstahl GJ. Reduced exacerbation frequency and prednisone dose in patients with ABPA and asthma treated with dupilumab. Clin Transl Allergy 2021; 11:e12081. [PMID: 34962725 PMCID: PMC8805688 DOI: 10.1002/clt2.12081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Tjeerd van der Veer
- Department of Pulmonary Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Marloes A Dallinga
- Department of Pulmonary Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | | | - Jasper H Kappen
- Department of Pulmonary Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Allergy and Clinical Immunology, Immunomodulation and Tolerance Group, Inflammation Repair and Development, Imperial College, National Heart and Lung Institute, London, UK
| | - Johannes C C M In 't Veen
- Department of Pulmonary Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Gert-Jan Braunstahl
- Department of Pulmonary Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
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6
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van der Veer T, van der Sar-van der Brugge S, Paats MS, van Nood E, de Backer IC, Aerts JGJV, van der Eerden MM. Do-not-intubate status and COVID-19 mortality in patients admitted to Dutch non-ICU wards. Eur J Clin Microbiol Infect Dis 2021; 40:2207-2209. [PMID: 33713005 PMCID: PMC7954520 DOI: 10.1007/s10096-021-04223-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/08/2021] [Indexed: 12/29/2022]
Abstract
Mortality from COVID-19 has been particularly high in elderly patients on mechanical ventilation. Treatment outcomes for patients with do-not-intubate (DNI) status are unknown. One hundred patients admitted to the non-ICU ward during the “first wave” were retrospectively analyzed. Mortality rate was 49% in patients with a DNI order. This subgroup was characterized by significantly higher age, more comorbidity, and care dependency. Mortality among DNI patients was three times higher than other patients, but not higher than some of the published mortality rates for elderly mechanically ventilated patients. Advanced care planning is essential in COVID-19 to assist patient autonomy and prevent non-beneficial medical interventions.
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Affiliation(s)
| | | | - Marthe S Paats
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Els van Nood
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - Ingrid C de Backer
- Department of Pulmonary Medicine, Amphia Hospital, Breda, the Netherlands
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van Kampen JJA, van de Vijver DAMC, Fraaij PLA, Haagmans BL, Lamers MM, Okba N, van den Akker JPC, Endeman H, Gommers DAMPJ, Cornelissen JJ, Hoek RAS, van der Eerden MM, Hesselink DA, Metselaar HJ, Verbon A, de Steenwinkel JEM, Aron GI, van Gorp ECM, van Boheemen S, Voermans JC, Boucher CAB, Molenkamp R, Koopmans MPG, Geurtsvankessel C, van der Eijk AA. Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19). Nat Commun 2021. [PMID: 33431879 DOI: 10.1101/2020.06.08.20125310] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Key questions in COVID-19 are the duration and determinants of infectious virus shedding. Here, we report that infectious virus shedding is detected by virus cultures in 23 of the 129 patients (17.8%) hospitalized with COVID-19. The median duration of shedding infectious virus is 8 days post onset of symptoms (IQR 5-11) and drops below 5% after 15.2 days post onset of symptoms (95% confidence interval (CI) 13.4-17.2). Multivariate analyses identify viral loads above 7 log10 RNA copies/mL (odds ratio [OR] of 14.7 (CI 3.57-58.1; p < 0.001) as independently associated with isolation of infectious SARS-CoV-2 from the respiratory tract. A serum neutralizing antibody titre of at least 1:20 (OR of 0.01 (CI 0.003-0.08; p < 0.001) is independently associated with non-infectious SARS-CoV-2. We conclude that quantitative viral RNA load assays and serological assays could be used in test-based strategies to discontinue or de-escalate infection prevention and control precautions.
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Affiliation(s)
| | | | - Pieter L A Fraaij
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision Infectious Diseases and Immunology, Erasmus MC - Sophia, Rotterdam, The Netherlands
| | - Bart L Haagmans
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Mart M Lamers
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Nisreen Okba
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | | | - Henrik Endeman
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Rogier A S Hoek
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | | | - Dennis A Hesselink
- Erasmus MC Transplant Institute, Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, Rotterdam, The Netherlands
| | - Herold J Metselaar
- Erasmus MC Transplant Institute, Rotterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
| | - Annelies Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | | | - Georgina I Aron
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
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8
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van Kampen JJA, van de Vijver DAMC, Fraaij PLA, Haagmans BL, Lamers MM, Okba N, van den Akker JPC, Endeman H, Gommers DAMPJ, Cornelissen JJ, Hoek RAS, van der Eerden MM, Hesselink DA, Metselaar HJ, Verbon A, de Steenwinkel JEM, Aron GI, van Gorp ECM, van Boheemen S, Voermans JC, Boucher CAB, Molenkamp R, Koopmans MPG, Geurtsvankessel C, van der Eijk AA. Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19). Nat Commun 2021; 12:267. [PMID: 33431879 PMCID: PMC7801729 DOI: 10.1038/s41467-020-20568-4] [Citation(s) in RCA: 477] [Impact Index Per Article: 159.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022] Open
Abstract
Key questions in COVID-19 are the duration and determinants of infectious virus shedding. Here, we report that infectious virus shedding is detected by virus cultures in 23 of the 129 patients (17.8%) hospitalized with COVID-19. The median duration of shedding infectious virus is 8 days post onset of symptoms (IQR 5-11) and drops below 5% after 15.2 days post onset of symptoms (95% confidence interval (CI) 13.4-17.2). Multivariate analyses identify viral loads above 7 log10 RNA copies/mL (odds ratio [OR] of 14.7 (CI 3.57-58.1; p < 0.001) as independently associated with isolation of infectious SARS-CoV-2 from the respiratory tract. A serum neutralizing antibody titre of at least 1:20 (OR of 0.01 (CI 0.003-0.08; p < 0.001) is independently associated with non-infectious SARS-CoV-2. We conclude that quantitative viral RNA load assays and serological assays could be used in test-based strategies to discontinue or de-escalate infection prevention and control precautions.
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Affiliation(s)
| | | | - Pieter L A Fraaij
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision Infectious Diseases and Immunology, Erasmus MC - Sophia, Rotterdam, The Netherlands
| | - Bart L Haagmans
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Mart M Lamers
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Nisreen Okba
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | | | - Henrik Endeman
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Rogier A S Hoek
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
- Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | | | - Dennis A Hesselink
- Erasmus MC Transplant Institute, Rotterdam, The Netherlands
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, Rotterdam, The Netherlands
| | - Herold J Metselaar
- Erasmus MC Transplant Institute, Rotterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
| | - Annelies Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | | | - Georgina I Aron
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
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9
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Sieswerda E, de Boer MGJ, Bonten MMJ, Boersma WG, Jonkers RE, Aleva RM, Kullberg BJ, Schouten JA, van de Garde EMW, Verheij TJ, van der Eerden MM, Prins JM, Wiersinga WJ. Recommendations for antibacterial therapy in adults with COVID-19 - an evidence based guideline. Clin Microbiol Infect 2021; 27:61-66. [PMID: 33010444 PMCID: PMC7527308 DOI: 10.1016/j.cmi.2020.09.041] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023]
Abstract
SCOPE The Dutch Working Party on Antibiotic Policy constituted a multidisciplinary expert committee to provide evidence-based recommendation for the use of antibacterial therapy in hospitalized adults with a respiratory infection and suspected or proven 2019 Coronavirus disease (COVID-19). METHODS We performed a literature search to answer four key questions. The committee graded the evidence and developed recommendations by using Grading of Recommendations Assessment, Development, and Evaluation methodology. QUESTIONS ADDRESSED BY THE GUIDELINE AND RECOMMENDATIONS We assessed evidence on the risk of bacterial infections in hospitalized COVID-19 patients, the associated bacterial pathogens, how to diagnose bacterial infections and how to treat bacterial infections. Bacterial co-infection upon admission was reported in 3.5% of COVID-19 patients, while bacterial secondary infections during hospitalization occurred up to 15%. No or very low quality evidence was found to answer the other key clinical questions. Although the evidence base on bacterial infections in COVID-19 is currently limited, available evidence supports restrictive antibiotic use from an antibiotic stewardship perspective, especially upon admission. To support restrictive antibiotic use, maximum efforts should be undertaken to obtain sputum and blood culture samples as well as pneumococcal urinary antigen testing. We suggest to stop antibiotics in patients who started antibiotic treatment upon admission when representative cultures as well as urinary antigen tests show no signs of involvement of bacterial pathogens after 48 hours. For patients with secondary bacterial respiratory infection we recommend to follow other guideline recommendations on antibacterial treatment for patients with hospital-acquired and ventilator-associated pneumonia. An antibiotic treatment duration of five days in patients with COVID-19 and suspected bacterial respiratory infection is recommended upon improvement of signs, symptoms and inflammatory markers. Larger, prospective studies about the epidemiology of bacterial infections in COVID-19 are urgently needed to confirm our conclusions and ultimately prevent unnecessary antibiotic use during the COVID-19 pandemic.
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Affiliation(s)
- Elske Sieswerda
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Mark G J de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - Marc M J Bonten
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Wim G Boersma
- Department of Pulmonary Diseases, Northwest Hospital Group, Alkmaar, the Netherlands
| | - René E Jonkers
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Roel M Aleva
- Department of Pulmonary Diseases, Máxima Medisch Centrum, Eindhoven, the Netherlands
| | - Bart-Jan Kullberg
- Radboud Center for Infectious Diseases and Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jeroen A Schouten
- Department of Intensive Care, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ewoudt M W van de Garde
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Theo J Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - W Joost Wiersinga
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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10
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Djamin RS, Talman S, Schrauwen EJA, von Wintersdorff CJH, Wolffs PF, Savelkoul PHM, Uzun S, Kerstens R, van der Eerden MM, Kluytmans JAJW. Prevalence and abundance of selected genes conferring macrolide resistance genes in COPD patients during maintenance treatment with azithromycin. Antimicrob Resist Infect Control 2020; 9:116. [PMID: 32723393 PMCID: PMC7389634 DOI: 10.1186/s13756-020-00783-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/14/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Maintenance treatment with macrolide antibiotics has shown to be effective in reducing exacerbations in COPD patients. A major concern with prolonged treatment with antibiotics is the development of bacterial resistance. In this study we determined the effect of azithromycin on the development and acquisition of resistance to macrolides in the nasopharyngeal flora in COPD patients. Methods This study was part of the COLUMBUS trial, a randomised, double-blind, placebo-controlled trial to measure the effect of maintenance treatment with azithromycin in 92 COPD patients on the exacerbation rates during a 12-month period. In order to determine resistance to macrolides, we used a targeted metagenomic approach to measure the presence and relative abundance of specific macrolide resistance genes ermB, ermF and mefA in throat samples collected at different time-points during this 12-month period. Results There was no increased risk for acquisition of macrolide resistance genes in the azithromycin group compared to the placebo group in COPD patients. However, loss of the macrolide resistance gene ermB was increased overtime in the placebo treated group compared to the azithromycin group (n = 5 for the placebo group versus n = 0 for the azithromycin group at 12 months; p = 0.012). The change in relative abundance of the three macrolide-resistance genes showed that all but one (ermF) increased during treatment with azithromycin. Conclusions The acquisition rate of macrolide resistance genes in COPD patients treated with azithromycin maintenance therapy was limited, but the relative abundance of macrolide resistance genes increased significantly over time compared to placebo. This study was part of the COLUMBUS trial (Clinicaltrials.gov, NCT00985244).
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Affiliation(s)
- Remco S Djamin
- Department t of Respiratory Medicine, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Sander Talman
- Department t of Respiratory Medicine, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands.
| | - Eefje J A Schrauwen
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands.,Academy for Technology and Environmental Health, Avans University of Applied Sciences, Breda, the Netherlands
| | | | - Petra F Wolffs
- Department of Medical Microbiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Paul H M Savelkoul
- Department of Medical Microbiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sevim Uzun
- Department t of Respiratory Medicine, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - René Kerstens
- Orion Statistical Consulting BV, Hilvarenbeek, The Netherlands
| | | | - Jan A J W Kluytmans
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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11
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Tiddens HAWM, Meerburg JJ, van der Eerden MM, Ciet P. The radiological diagnosis of bronchiectasis: what's in a name? Eur Respir Rev 2020; 29:29/156/190120. [PMID: 32554759 PMCID: PMC9489191 DOI: 10.1183/16000617.0120-2019] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 01/02/2020] [Indexed: 12/31/2022] Open
Abstract
Diagnosis of bronchiectasis is usually made using chest computed tomography (CT) scan, the current gold standard method. A bronchiectatic airway can show abnormal widening and thickening of its airway wall. In addition, it can show an irregular wall and lack of tapering, and/or can be visible in the periphery of the lung. Its diagnosis is still largely expert based. More recently, it has become clear that airway dimensions on CT and therefore the diagnosis of bronchiectasis are highly dependent on lung volume. Hence, control of lung volume is required during CT acquisition to standardise the evaluation of airways. Automated image analysis systems are in development for the objective analysis of airway dimensions and for the diagnosis of bronchiectasis. To use these systems, clear and objective definitions for the diagnosis of bronchiectasis are needed. Furthermore, the use of these systems requires standardisation of CT protocols and of lung volume during chest CT acquisition. In addition, sex- and age-specific reference values are needed for image analysis outcome parameters. This review focusses on today's issues relating to the radiological diagnosis of bronchiectasis using state-of-the-art CT imaging techniques. Bronchiectasis diagnosis is expert based. Clear definitions, standardisation of lung volume and CT protocols, and reference values are needed to allow automated image analysis for its diagnosis and to be used for clinical management and clinical studies.http://bit.ly/35vASqz
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Affiliation(s)
- Harm A W M Tiddens
- Dept of Paediatric Pulmonology and Allergology, Erasmus Medical Centre (MC)-Sophia Children's Hospital, Rotterdam, The Netherlands .,Dept of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jennifer J Meerburg
- Dept of Paediatric Pulmonology and Allergology, Erasmus Medical Centre (MC)-Sophia Children's Hospital, Rotterdam, The Netherlands.,Dept of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Pierluigi Ciet
- Dept of Paediatric Pulmonology and Allergology, Erasmus Medical Centre (MC)-Sophia Children's Hospital, Rotterdam, The Netherlands.,Dept of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
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12
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Meerburg JJ, Albasri M, van der Wiel EC, Andrinopoulou ER, van der Eerden MM, Majoor CJ, Arets HGM, Heijerman HGM, Tiddens HAWM. Home videos of cystic fibrosis patients using tobramycin inhalation powder: Relation of flow and cough. Pediatr Pulmonol 2019; 54:1794-1800. [PMID: 31393073 PMCID: PMC6852538 DOI: 10.1002/ppul.24467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/05/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Many cystic fibrosis (CF) patients chronically infected with Pseudomonas aeruginosa are on maintenance tobramycin inhalation therapy. Cough is reported as a side effect of tobramycin inhalation powder (TIP) in 48% of the patients. Objectives of this study were to investigate the association between the inspiratory flow of TIP and cough and to study the inhalation technique. We hypothesized that cough is related to a fast inhalation. MATERIALS AND METHODS In this prospective observational study, CF patients ≥ 6 years old on TIP maintenance therapy from four Dutch CF centers were visited twice at home. Video recordings were obtained and peak inspiratory flow (PIF) was recorded while patients inhaled TIP. Between the two home visits, the patients made three additional videos. CF questionnaire-revised, spirometry data, and computed tomography scan were collected. Two observers scored the videos for PIF, cough, and mistakes in inhalation technique. The associations between PIF and cough were analyzed using a logistic mixed-effects model accounting for FEV1 % predicted and capsule number. RESULTS Twenty patients were included, median age 22 (18-28) years. No significant associations were found between PIF and cough. The risk of cough was highest after inhalation of the first capsule when compared to the second, third, and fourth capsule (P ≤ .015). Fourteen patients (70%) coughed at least once during TIP inhalation. A breath-hold of less than 5 seconds after inhalation and no deep expiration before inhalation were the most commonly observed mistakes. CONCLUSION PIF is not related to cough in CF patients using TIP.
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Affiliation(s)
- Jennifer J Meerburg
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mehdi Albasri
- Department of Paediatric Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Els C van der Wiel
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | | | - Christof J Majoor
- Department of Pulmonology, Amsterdam University Medical Center, AMC, Amsterdam, The Netherlands
| | - Hubertus G M Arets
- Department of Pediatric Pulmonology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harry G M Heijerman
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harm A W M Tiddens
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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13
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van der Eerden MM. [Use of antibiotics for asthma and COPD exacerbation]. Ned Tijdschr Geneeskd 2019; 163:D4252. [PMID: 31449361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most patients with asthma do not receive antibiotics when they experience an exacerbation. In contrast, most patients with COPD exacerbations do indeed receive antibiotics. However, studies have shown that while some subgroups of patients with asthma or COPD may benefit from antibiotics, others do not. In this era of antibiotic stewardship, it is of crucial importance to use objective criteria when deciding whether or not to give antibiotics. Biomarkers, such as procalcitonin, could be helpful when making this decision. There is a clear need for well-designed and high-quality studies with enough power to evaluate the usage of these kinds of biomarkers.
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14
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Pieters A, Bakker M, Hoek RAS, Altenburg J, van Westreenen M, Aerts JGJV, van der Eerden MM. The clinical impact of Pseudomonas aeruginosa eradication in bronchiectasis in a Dutch referral centre. Eur Respir J 2019; 53:13993003.02081-2018. [PMID: 30635292 DOI: 10.1183/13993003.02081-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/24/2018] [Indexed: 11/05/2022]
Affiliation(s)
| | - Marleen Bakker
- Dept of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rogier A S Hoek
- Dept of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Josje Altenburg
- Pulmonary Diseases, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Mireille van Westreenen
- Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joachim G J V Aerts
- Dept of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Abrahamian FM, Aldape MJ, Aldasoro E, Allen UD, Al-Sum H, Anadkat MJ, Anders K, Angelakis E, Angus BJ, Antoniadou A, Arena F, Arends JE, Arribas JR, Artenstein AW, Atherton JC, Aucott JN, Aw TC, Babcock HM, Bailey R, Bailey TC, Banks AZ, Barillo DJ, Barrette EP, Bauer MP, Bayston R, Beard CB, Beardsley J, Beeching NJ, Bégué RE, Beldi G, Benson CA, Berbari EF, Berenger JM, Berger C, Bernardino JI, Bille J, Billioux AC, Bitnun A, Blair I, Blanche S, Bleck TP, Bleeker-Rovers CP, Bleijenberg G, Bloch KC, Blum J, Blumberg EA, Bonomo RA, Bonten MJ, Bourayou R, Bouza E, Brandt KA, Bretelle F, Brisse S, Britton WJ, Brook I, Brouwer MC, Browne SK, Bryant AE, Bühler S, Bulger EM, Buller RML, Burke LA, Burri C, Butler MW, Calandra T, Calfee DP, Calvo-Cano A, Cameron DW, Carcillo JA, Carson G, Chambers ST, Charrel RN, Nguyen VCV, Chevaliez S, Chiller TM, Christaki E, Chung KK, Clifford DB, Clumeck N, Cohen J, Collinge J, Conlon CP, Conrad C, Cooke FJ, Cope JR, Corey GR, Cross JH, Cunha BA, Cunha CB, D'Journo B, Daikos GL, Daniels JM, Davidson RN, Day NP, De Cock KM, de Silva TI, de Vries HJ, de Wit S, Delaloye J, Denning DW, Dennis DT, Dhanireddy S, Dielubanza EJ, Diemert DJ, Doganay M, Doherty T, Dolecek C, Dondorp AM, Douglas A, Drancourt M, Dubourg G, Dudley MN, Durand G, Eckhardt BJ, Efstratiou A, Ekkelenkamp MB, Eranki A, Erdem H, Escota GV, Evans HL, Eziefula AC, Fenollar F, Fenwick A, Fierer J, Finch RG, Fleckenstein JM, Forstner C, Foschi F, Fournier PE, French MA, Gage KL, Garcia LS, Gascon J, Gastañaduy AS, Gautret P, Geisler WM, Ghanem KG, Giani T, Giannella M, Gilliam BL, Gilliet M, Glaser CA, Glupczynski Y, Gnann JW, Goldstein EJ, Gottstein B, Gouriet F, Gravitt PE, Green MD, Green ST, Groll AH, Gulick RM, Gupta A, Habib G, Harbarth S, Harris M, Hayden FG, Hetem DJ, Hill PC, Hirschel B, Hodowanec AC, Hoffart L, Hoffmann C, Holland SM, Horby PW, Horne DJ, Hraiech S, Hull MW, Huttner A, Ingram RJ, Islam J, Ison MG, James SH, Jenkins C, Jenkins SG, Jensen JS, Johnston C, Jones TB, Jordan SJ, Julian KG, Kato Y, Kauffman CA, Kaye KS, Keane MP, Keeney J, Kelly P, Kent SJ, Kern WV, Keynan Y, Kim AA, Koné-Paut I, Kosmidis C, Kroes AC, Kroon FP, Ksiazek TG, Kuhlmann FM, Kuijper EJ, Kwon JH, Kyei GB, Lacombe K, Lagacé-Wiens P, Lagier JC, Lamagni T, Landraud L, Lanternier F, LaPlante KL, Lawn SD, Lawrence SJ, Leblebicioglu H, Lee N, Leggett JE, Lehours P, Levy PY, Leyh RG, Lillis RA, Limmathurotsakul D, Lin J, Lindquist HA, Lipsky BA, Liscynesky C, Looney D, Lortholary O, Lowy FD, Luft BJ, Mackowiak PA, MacPherson PA, Maghraoui-Slim V, Mallon PW, Mangino JE, Manuel O, Marchetti O, Marks KM, Marr KA, Marrazzo J, Marschall J, Martin DH, Matonti F, Matulewicz RS, Mayer KH, McCulloh RJ, McGready R, Mdodo R, Mead S, Mégraud F, Meintjes G, Metcalf SC, Michaels MG, Migliori GB, Miles MA, Miller A, Mimiaga MJ, Mingeot-Leclercq MP, Misch EA, Mitreva M, Montaner JS, Moore CB, Muñoz P, Muñoz J, Murray CK, Musso D, Mutengo M, Mutizwa MM, Naber KG, Natarajan P, Neme S, Newton PN, Nichols RA, Nicolle LE, Nosten F, Notarangelo LD, Nutman TB, Nyirjesy P, O'Connell PR, Opal SM, Ormerod LP, Osmon DR, Pankert MB, Pantaleo G, Papazian L, Parente DM, Parola P, Parsaei S, Pascual MA, Patel R, Patrozou E, Pawlotsky JM, Peacock SJ, Pechère JC, Pelegrin I, Peters BS, Peters EJ, Petersen JM, Petersen LR, Petraitis V, Pham LL, Picado A, Pilatz A, Pilmis B, Pinazo MJ, Pletz MW, Pogue JM, Polgreen EL, Polgreen PM, Posfay-Barbe KM, Powderly WG, Presti R, Prod'hom G, Puolakkainen M, Quinn TC, Raoult D, Razonable RR, Read RC, Redfield RR, Rentenaar RJ, Reynolds SJ, Ribi C, Richardson MD, Ritter ML, Roch A, Rockstroh JK, Rojek A, Romero JR, Rooijakkers SH, Rosenbluth D, Rosenzweig SD, Rossolini GM, Rubinstein E, Ryan G, Safren SA, Sahasrabuddhe VV, Saikku PA, Sajadi MM, Salvaggio MR, Santos CA, Satlin MJ, Schaeffer AJ, Schimmer C, Schooley RT, Schumacher RF, Sha BE, Shapiro DS, Sheehan G, Shlaes DM, Shoham S, Simmons CP, Simon DW, Simon MS, Simonsen KA, Slack MP, Smith TT, Sobel JD, Souli M, Sridhar S, Steckelberg JM, Stevens DL, Strah H, Sturm AW, Sungkanuparph S, Tabrizi SJ, Tacconelli E, Tan CS, Taplitz RA, Thomas G, Thomas LD, Thuny F, Thwaites G, Tissot F, Tønjum T, Torriani FJ, Toso C, Tulkens PM, Tunkel AR, Turner CE, Ustianowski AP, van Bambeke F, van Crevel R, van de Beek D, van Delden C, van der Eerden MM, van der Meer JW, van der Poll T, van Ingen J, van Putten J, Vaudaux BP, Vermund SH, Viscidi RP, Visvanathan K, Visvesvara GS, von Seidlein L, Wagenlehner FM, Wald A, Walsh TJ, Warhurst DC, Warnock DW, Warrell DA, Warrell MJ, Warris A, Watkins RR, Weatherall DJ, Weber R, Weidner W, White JR, White PJ, Whitehorn J, Whitley RJ, Whitty CJ, Wiersinga WJ, Wilcox MH, Williams TN, Wilson CC, Wilson ME, Wisplinghoff H, Wood R, Wunderink RG, Wyles D, Yang ZT, Yoder JS, Zaidi NA, Zimmer AJ, Zuckerman JN, Zumla A. List of Contributors. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00234-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Pieters ALP, Maat APWM, Hoogsteden HC, van der Eerden MM. [Surgical management of bronchiectasis]. Ned Tijdschr Geneeskd 2015; 159:A8928. [PMID: 26173665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Exacerbations of bronchiectasis can result in a decline in lung function, a poorer prognosis and a reduction in quality of life. Three female patients aged 57, 41 and 40 presented with recurrent exacerbations of bronchiectasis despite optimal conservative and antibiotic (maintenance) treatment. In one patient the underlying cause of the bronchiectasis could not be identified; in the other two patients there was a post infectious cause. Surgical procedures were performed on account of the presence of localised bronchiectasis. No major complications were observed. All three patients experienced an impressive reduction in symptoms and exacerbations. Moreover, there was only a slight decline in lung function in two patients and an improvement in lung function in one patient. In patients with localised bronchiectasis, recurrent exacerbations and persistent symptoms despite optimal conservative and antibiotic treatment, surgical resection of affected areas could reduce the number of exacerbations and improve quality of life.
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Uzun S, Djamin RS, Kluytmans JAJW, Mulder PGH, van't Veer NE, Ermens AAM, Pelle AJ, Hoogsteden HC, Aerts JGJV, van der Eerden MM. Azithromycin maintenance treatment in patients with frequent exacerbations of chronic obstructive pulmonary disease (COLUMBUS): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med 2014; 2:361-8. [PMID: 24746000 DOI: 10.1016/s2213-2600(14)70019-0] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Macrolide resistance is an increasing problem; there is therefore debate about when to implement maintenance treatment with macrolides in patients with chronic obstructive pulmonary disease (COPD). We aimed to investigate whether patients with COPD who had received treatment for three or more exacerbations in the previous year would have a decrease in exacerbation rate when maintenance treatment with azithromycin was added to standard care. METHODS We did a randomised, double-blind, placebo-controlled, single-centre trial in The Netherlands between May 19, 2010, and June 18, 2013. Patients (≥18 years) with a diagnosis of COPD who had received treatment for three or more exacerbations in the previous year were randomly assigned, via a computer-generated randomisation sequence with permuted block sizes of ten, to receive 500 mg azithromycin or placebo three times a week for 12 months. Randomisation was stratified by use of long-term, low-dose prednisolone (≤10 mg daily). Patients and investigators were masked to group allocation. The primary endpoint was rate of exacerbations of COPD in the year of treatment. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00985244. FINDINGS We randomly assigned 92 patients to the azithromycin group (n=47) or the placebo group (n=45), of whom 41 (87%) versus 36 (80%) completed the study. We recorded 84 exacerbations in patients in the azithromycin group compared with 129 in those in the placebo group. The unadjusted exacerbation rate per patient per year was 1·94 (95% CI 1·50-2·52) for the azithromycin group and 3·22 (2·62-3·97) for the placebo group. After adjustment, azithromycin resulted in a significant reduction in the exacerbation rate versus placebo (0·58, 95% CI 0·42-0·79; p=0·001). Three (6%) patients in the azithromycin group reported serious adverse events compared with five (11%) in the placebo group. During follow-up, the most common adverse event was diarrhoea in the azithromycin group (nine [19%] patients vs one [2%] in the placebo group; p=0·015). INTERPRETATION Maintenance treatment with azithromycin significantly decreased the exacerbation rate compared with placebo and should therefore be considered for use in patients with COPD who have the frequent exacerbator phenotype and are refractory to standard care. FUNDING SoLong Trust.
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Affiliation(s)
- Sevim Uzun
- Department of Respiratory Medicine, Amphia Hospital, Breda, Netherlands
| | - Remco S Djamin
- Department of Respiratory Medicine, Amphia Hospital, Breda, Netherlands
| | | | | | | | - Anton A M Ermens
- Laboratory for Clinical Chemistry and Haematology, Amphia Hospital, Breda, Netherlands
| | - Aline J Pelle
- Centre of Research on Psychology in Somatic Diseases, University of Tilburg, Tilburg, Netherlands
| | - Henk C Hoogsteden
- Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Joachim G J V Aerts
- Department of Respiratory Medicine, Amphia Hospital, Breda, Netherlands; Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
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Paats MS, Bergen IM, Bakker M, Hoek RAS, Nietzman-Lammering KJ, Hoogsteden HC, Hendriks RW, van der Eerden MM. Cytokines in nasal lavages and plasma and their correlation with clinical parameters in cystic fibrosis. J Cyst Fibros 2013; 12:623-9. [PMID: 23751406 DOI: 10.1016/j.jcf.2013.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 04/24/2013] [Accepted: 05/13/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND Because persistent inflammation plays a dominant role in cystic fibrosis (CF), we assessed systemic and local upper airway responses during and after pulmonary exacerbation. METHODS We followed a cohort of Pseudomonas aeruginosa-infected adult CF patients (n=16) over time in pulmonary exacerbation and in stable disease. Interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-17A, IL-22, interferon-γ and TNFα levels were measured in sputum, nasal lavages and plasma. RESULTS In CF patients IL-6 and IL-10 levels in nasal lavages were significantly increased in exacerbation compared with stable disease. Systemic IL-6 significantly correlated with CRP levels and FEV1 (%predicted), independently of disease status. Systemic IL-10 also correlated significantly with CRP and FEV1 (%predicted), but only in exacerbation. Other cytokines tested did not discriminate between exacerbation and stable disease. CONCLUSIONS Determination of IL-6 and IL-10 in nasal lavages may provide a minimally invasive tool in the assessment of an exacerbation in CF.
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Affiliation(s)
- Marthe S Paats
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Paats MS, Bergen IM, Hanselaar WEJJ, Groeninx van Zoelen EC, Hoogsteden HC, Hendriks RW, van der Eerden MM. Local and systemic cytokine profiles in nonsevere and severe community-acquired pneumonia. Eur Respir J 2013; 41:1378-85. [PMID: 23258791 DOI: 10.1183/09031936.00060112] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Local inflammatory responses in community-acquired pneumonia (CAP) remain insufficiently elucidated, especially in patients with nonsevere CAP. In this study we determined local and systemic cytokine responses in CAP patients and correlated these with disease severity and other clinical parameters. Levels of interleukin (IL)-6, IL-8, IL-10, IL-1β, tumour necrosis factor-α, interferon (IFN)-γ, IL-22, IL-17A and IL-4 were determined in bronchoalveolar lavage fluid and serum of 20 CAP patients upon admission and 10 healthy individuals. Systemic cytokine levels were also measured on days 7 and 30. In bronchoalveolar lavage fluid of CAP patients, levels of IL-6, IL-8 and IFN-γ were significantly increased compared with healthy individuals, but no correlations with disease severity were found. Systemic levels of IL-6, IL-10 and IFN-γ were significantly higher in severe CAP patients than in nonsevere CAP patients and healthy individuals. Moreover, these cytokines showed a significant correlation with the pneumonia severity index. In the total group of CAP patients, systemic IL-8 and IL-22 levels were also increased compared with healthy individuals. We therefore conclude that IL-6, IL-10 and IFN-γ are important cytokines in CAP, although differences in disease severity upon admission are only reflected by systemic levels of these cytokines.
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Affiliation(s)
- Marthe S Paats
- Dept of Pulmonary Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
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20
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Paats MS, Bergen IM, Hanselaar WEJJ, van Zoelen ECG, Verbrugh HA, Hoogsteden HC, van den Blink B, Hendriks RW, van der Eerden MM. T helper 17 cells are involved in the local and systemic inflammatory response in community-acquired pneumonia. Thorax 2013; 68:468-74. [PMID: 23315492 DOI: 10.1136/thoraxjnl-2012-202168] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Recent findings in mouse models suggest that T helper (Th)17 cells, characterised by production of interleukin (IL)-17A and IL-22, are involved in the immunopathogenesis of pneumonia. OBJECTIVE In this study, we aimed to identify the involvement of Th17 cells in human community-acquired pneumonia (CAP). DESIGN Within 24 h of admission, T cells from peripheral blood (n=39) and bronchoalveolar lavage (BAL, n=20) of CAP patients and of 10 healthy individuals were analysed by intracellular flow cytometry for the production of various cytokines, including IL-17A and IL-22. Peripheral blood T cells were also analysed 7 and 30 days after admission. Th17 cytokine profiles were correlated with pneumonia severity index and microbial aetiology. RESULTS In the BAL of CAP patients, proportions of IL-17A and IL-22 single positive, as well as IL-17A/IL-22 double positive CD4 T cells were significantly increased compared with healthy individuals. Significantly increased proportions of IL-17A/IL-22 double positive CD4 T cells in BAL were found in non-severe and severe CAP patients, as well as in pneumococcal and non-pneumococcal CAP. In the peripheral blood of CAP patients upon admission, we found significantly increased proportions of IL-17A/IL-22 double positive CD4 T cells. One week after admission, the proportions of these double positive cells were still significantly increased in CAP patients compared with healthy individuals. CONCLUSIONS These data indicate that Th17 cells are engaged in the local and systemic immune response in human pneumonia. Especially, IL-17A/IL-22 double positive Th17 cells may be involved in the immunopathogenesis of CAP.
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Affiliation(s)
- Marthe S Paats
- Department of Pulmonary Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands
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21
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Said MA, Johnson HL, Nonyane BAS, Deloria-Knoll M, O'Brien KL, Andreo F, Beovic B, Blanco S, Boersma WG, Boulware DR, Butler JC, Carratalà J, Chang FY, Charles PGP, Diaz AA, Domínguez J, Ehara N, Endeman H, Falcó V, Falguera M, Fukushima K, Garcia-Vidal C, Genne D, Guchev IA, Gutierrez F, Hernes SS, Hoepelman AIM, Hohenthal U, Johansson N, Kolek V, Kozlov RS, Lauderdale TL, Mareković I, Masiá M, Matta MA, Miró Ò, Murdoch DR, Nuermberger E, Paolini R, Perelló R, Snijders D, Plečko V, Sordé R, Strålin K, van der Eerden MM, Vila-Corcoles A, Watt JP. Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques. PLoS One 2013; 8:e60273. [PMID: 23565216 PMCID: PMC3615022 DOI: 10.1371/journal.pone.0060273] [Citation(s) in RCA: 306] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 02/26/2013] [Indexed: 12/17/2022] Open
Abstract
Background Pneumococcal pneumonia causes significant morbidity and mortality among adults. Given limitations of diagnostic tests for non-bacteremic pneumococcal pneumonia, most studies report the incidence of bacteremic or invasive pneumococcal disease (IPD), and thus, grossly underestimate the pneumococcal pneumonia burden. We aimed to develop a conceptual and quantitative strategy to estimate the non-bacteremic disease burden among adults with community-acquired pneumonia (CAP) using systematic study methods and the availability of a urine antigen assay. Methods and Findings We performed a systematic literature review of studies providing information on the relative yield of various diagnostic assays (BinaxNOW® S. pneumoniae urine antigen test (UAT) with blood and/or sputum culture) in diagnosing pneumococcal pneumonia. We estimated the proportion of pneumococcal pneumonia that is bacteremic, the proportion of CAP attributable to pneumococcus, and the additional contribution of the Binax UAT beyond conventional diagnostic techniques, using random effects meta-analytic methods and bootstrapping. We included 35 studies in the analysis, predominantly from developed countries. The estimated proportion of pneumococcal pneumonia that is bacteremic was 24.8% (95% CI: 21.3%, 28.9%). The estimated proportion of CAP attributable to pneumococcus was 27.3% (95% CI: 23.9%, 31.1%). The Binax UAT diagnosed an additional 11.4% (95% CI: 9.6, 13.6%) of CAP beyond conventional techniques. We were limited by the fact that not all patients underwent all diagnostic tests and by the sensitivity and specificity of the diagnostic tests themselves. We address these resulting biases and provide a range of plausible values in order to estimate the burden of pneumococcal pneumonia among adults. Conclusions Estimating the adult burden of pneumococcal disease from bacteremic pneumococcal pneumonia data alone significantly underestimates the true burden of disease in adults. For every case of bacteremic pneumococcal pneumonia, we estimate that there are at least 3 additional cases of non-bacteremic pneumococcal pneumonia.
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Affiliation(s)
- Maria A Said
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
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Hoek RAS, Paats MS, Pas SD, Bakker M, Hoogsteden HC, Boucher CAB, van der Eerden MM. Incidence of viral respiratory pathogens causing exacerbations in adult cystic fibrosis patients. ACTA ACUST UNITED AC 2012; 45:65-9. [DOI: 10.3109/00365548.2012.708942] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Paats MS, Bergen IM, Hoogsteden HC, van der Eerden MM, Hendriks RW. Systemic CD4+ and CD8+ T-cell cytokine profiles correlate with GOLD stage in stable COPD. Eur Respir J 2012; 40:330-7. [PMID: 22183488 DOI: 10.1183/09031936.00079611] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with pulmonary and systemic inflammation. Both CD4+ and CD8+ T-lymphocytes play a key role in COPD pathogenesis, but cytokine profiles in circulating T-lymphocytes have not been well characterised. Here we report the analysis of peripheral blood T-cells from 30 stable COPD patients and 10 healthy never-smokers for interferon (IFN)-γ, interleukin (IL)-4, tumour necrosis factor (TNF)-α and the T-helper 17 cytokines IL-17A, IL-17F and IL-22 by intracellular flow cytometry. We found significantly increased proportions of IFN-γ+ and TNF-α+ CD8+ T-cells in COPD patients, when compared with healthy controls. This was most evident in patients with less severe disease. In contrast, expression profiles in circulating CD4+ T-cells were similar in COPD patients and healthy controls for all cytokines tested, except for IL-17F. COPD patients with more severely reduced diffusing capacity had lower proportions of IL-17A+ CD4+ T-cells. Proportions of IL-22+ cells in the CD4+ memory T-cell population were significantly increased in active smokers, when compared with past smokers. Collectively, this comprehensive cytokine analysis of circulating T-cells in COPD patients revealed a correlation for CD8+ T-cells between Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage and IFN-γ or TNF-α expression, but not for CD4+ T-cells.
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Affiliation(s)
- Marthe S Paats
- Dept of Pulmonary Medicine, Erasmus MC Rotterdam, PO Box 2040, NL 3000 CA Rotterdam, The Netherlands.
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Uzun S, Djamin RS, Kluytmans J, Van’t Veer NE, Ermens AAM, Pelle AJ, Mulder P, van der Eerden MM, Aerts J. Influence of macrolide maintenance therapy and bacterial colonisation on exacerbation frequency and progression of COPD (COLUMBUS): study protocol for a randomised controlled trial. Trials 2012; 13:82. [PMID: 22682323 PMCID: PMC3478173 DOI: 10.1186/1745-6215-13-82] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 06/09/2012] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is characterised by progressive development of airflow limitation that is poorly reversible. Because of a poor understanding of COPD pathogenesis, treatment is mostly symptomatic and new therapeutic strategies are limited. There is a direct relationship between the severity of the disease and the intensity of the inflammatory response. Besides smoking, one of the hypotheses for the persistent airway inflammation is the presence of recurrent infections. Macrolide antibiotics have bacteriostatic as well as anti-inflammatory properties in patients with cystic fibrosis and other inflammatory pulmonary diseases. There is consistent evidence that macrolide therapy reduces infectious exacerbations, decreases the requirement for additional antibiotics and improves nutritional measures. Because of these positive effects we hypothesised that maintenance macrolide therapy may also have beneficial effects in patients with COPD who have recurrent exacerbations. The effects on development of bacterial resistance to macrolides due to this long-term treatment are unknown. Until now, studies investigating macrolide therapy in COPD are limited. The objective of this study is to assess whether maintenance treatment with macrolide antibiotics in COPD patients with three or more exacerbations in the previous year decreases the exacerbation rate in the year of treatment and to establish microbial resistance due to the long-term treatment. METHODS/DESIGN The study is set up as a prospective randomised double-blind placebo-controlled single-centre trial. A total of 92 patients with COPD who have had at least three exacerbations of COPD in the previous year will be included. Subjects will be randomised to receive either azithromycin 500 mg three times a week or placebo. Our primary endpoint is the reduction in the number of exacerbations of COPD in the year of treatment. DISCUSSION We investigate whether long-term therapy with macrolide antibiotics can prevent exacerbations in patients with COPD. Additionally, our study aims to assess the effect of long-term use of macrolide on the development of antimicrobial resistance and on inflammatory parameters related to COPD. We believe this study will provide more data on the effects of macrolide treatment in patients in COPD and will add more knowledge on its working mechanisms. TRIAL REGISTRATION http://www.clinicaltrials.gov NCT00985244.
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Affiliation(s)
- Sevim Uzun
- Department of Respiratory Medicine, Amphia Ziekenhuis, Breda, The Netherlands
| | - Remco S Djamin
- Department of Respiratory Medicine, Amphia Ziekenhuis, Breda, The Netherlands
| | - JanAJW Kluytmans
- Department of Microbiology, Amphia Ziekenhuis, Breda, The Netherlands
| | | | - Anton A M Ermens
- Laboratory for Clinical Chemistry and Hematology, Amphia Ziekenhuis, Breda, The Netherlands
| | - Aline J Pelle
- Center of Research on Psychology in Somatic Diseases, University of Tilburg, Tilburg, The Netherlands
| | - Paul Mulder
- Department of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - JoachimGJV Aerts
- Department of Respiratory Medicine, Amphia Ziekenhuis, Breda, The Netherlands
- Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
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Jones BE, Jones J, Bewick T, Lim WS, Aronsky D, Brown SM, Boersma WG, van der Eerden MM, Dean NC. CURB-65 pneumonia severity assessment adapted for electronic decision support. Chest 2010; 140:156-163. [PMID: 21163875 DOI: 10.1378/chest.10-1296] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Accurate severity assessment is crucial to the initial management of community-acquired pneumonia (CAP). The CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) score contains data that are entered routinely in electronic medical records and are, thus, electronically calculable. The aim of this study was to determine whether an electronically generated severity estimate using CURB-65 elements as continuous and weighted variables better predicts 30-day mortality than the traditional CURB-65. METHODS In a retrospective cohort study at a US university-affiliated community teaching hospital, we identified 2,069 patients aged 18 years or older with CAP confirmed by radiographic findings in the ED. CURB-65 elements were extracted from the electronic medical record, and 30-day mortality was identified with the Utah Population Database. Performance of a severity prediction model using continuous and weighted CURB-65 variables was compared with the traditional CURB-65 in the US derivation population and validated in the original 1,048 patients from the CURB-65 international derivation study. RESULTS The traditional, binary CURB-65 score predicted mortality in the US cohort with an area under the curve (AUC) of 0.82. Our severity prediction model generated from continuous, weighted CURB-65 elements was superior to the traditional CURB-65, with an out-of-bag AUC of 0.86 (P < .001). This finding was validated in the international database, with an AUC of 0.85 for the electronic model compared with 0.80 for the traditional CURB-65 (P = .01). CONCLUSIONS Using CURB-65 elements as continuous and weighted data improved prediction of 30-day mortality and could be used as a real-time, electronic decision support tool or to adjust outcomes by severity when comparing processes of care.
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Affiliation(s)
- Barbara E Jones
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT.
| | - Jason Jones
- Department of Medical Informatics, Intermountain Medical Center, Murray, UT
| | - Thomas Bewick
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | - Wei Shen Lim
- Nottingham University Hospitals NHS Trust, Nottingham, England
| | - Dominik Aronsky
- Department of Biomedical Informatics and Emergency Medicine, Vanderbilt Hospital, Nashville, TN
| | - Samuel M Brown
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT; Department of Medical Informatics, Intermountain Medical Center, Murray, UT
| | - Wim G Boersma
- Department of Pulmonary Disease, Medical Centre Alkmaar, The Netherlands
| | | | - Nathan C Dean
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT; Department of Medical Informatics, Intermountain Medical Center, Murray, UT
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Hoek RAS, van der Eerden MM. [A man with exercise related shortness of breath]. Ned Tijdschr Geneeskd 2010; 154:A1102. [PMID: 20735868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 51-year old male was admitted to the hospital with complaints of fever, a productive cough and exercise-related shortness of breath. These complaints were caused by a pneumatocele, which was successfully treated with antibiotics.
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Affiliation(s)
- Rogier A S Hoek
- Afd. Longziekten en Tuberculose, Erasmus Medisch Centrum, Rotterdam, the Netherlands.
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van der Eerden MM, de Graaff CS, Vlaspolder F, Bronsveld W, Jansen HM, Boersma WG. Evaluation of an algorithm for switching from IV to PO therapy in clinical practice in patients with community-acquired pneumonia. Clin Ther 2004; 26:294-303. [PMID: 15038952 DOI: 10.1016/s0149-2918(04)90028-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND In patients with community-acquired pneumonia (CAP), switching from IV to PO antibiotics offers advantages over IV therapy alone, including improved cost-effectiveness through reductions in the length of hospital stay and treatment costs. OBJECTIVE The aim of this study was to determine whether a method for switching therapy in clinical practice could be used in patients with CAP and whether differences were found in the duration of IV treatment and length of hospital stay between the 5 risk classes of the Pneumonia Severity Index (PSI) after the therapy switch. METHODS This was a prospective, observational study of patients aged >/=18 years presenting with CAP at our teaching hospital between December 1998 and November 2000. Microbiological and serological tests were performed, and signs and symptoms of CAP, C-reactive protein levels, and white blood cell counts were assessed throughout treatment and at the 1-month follow-up. Patients were stratified by PSI risk class. When the patient's temperature had been normalized for 72 hours and respiratory symptoms (dyspnea, coughing, and thoracal pain) had improved, patients were switched from IV to PO therapy (same drug). RESULTS The study included 180 patients with CAP Clinical cure was seen in 174 (97%) patients. No significant difference between the 5 risk classes was found in duration of therapy. Patients in risk class V remained hospitalized for a significantly longer period than patients in risk classes I through IV (P < 0.001). Furthermore, after patients were switched to PO antibiotics, the level of C-reactive protein decreased in patients in all risk classes and was normalized by follow-up. CONCLUSIONS In the population studied, use of specific criteria (ie, absence of fever for 72 hours and reduction in respiratory symptoms) allowed successful switch from IV to PO antibiotic therapy for the treatment of CAP Duration of therapy was not affected by PSI risk class, but those in risk class V were hospitalized longer than other risk classes.
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