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Tony S Brar, Neeka Akhavan
This is a 78 year old male with a past medical history of coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), hypertension (HTN), and gastroesophageal reflux disorder (GERD) who presented to the emergency room with worsening shortness of breath (SOB) and low-grade fevers for one week prior to admission. He was originally diagnosed with healthcare associated pneumonia (HCAP) and an acute on chronic COPD exacerbation and treated with prednisone, inhalers, ipratropium/albuterol, and broad-spectrum antibiotics...
2016: Respiratory Medicine Case Reports
Dae Young Hong, Sang O Park, Jong Won Kim, Kyeong Ryong Lee, Kwang Je Baek, Ji Ung Na, Pil Cho Choi, Young Hwan Lee
BACKGROUND: Early prediction of the clinical outcomes for health care-associated pneumonia (HCAP) patients is challenging. OBJECTIVES: This is the first study to evaluate procalcitonin (PCT) as a predictor of outcomes in HCAP patients. METHODS: We conducted an observational study based on data for HCAP patients prospectively collected between 2011 and 2014. Outcome variables were intensive care unit (ICU) admission and 30-day mortality. PCT was categorized into three groups: <0...
2016: Respiration; International Review of Thoracic Diseases
D Sousa, J M Bravo-Ferrer, T Seoane-Pillado, P Vázquez-Rodríguez, L Ramos-Merino, J M Gutiérrez-Urbón, S Pita, P Llinares
OBJECTIVE: The clinical response to ertapenem in community-acquired pneumonia (CAP) at the setting of routine hospital practice has been scarcely evaluated. METHODS: We retrospectively compared CAP cases treated with ertapenem or with other standard antimicrobials (controls) at a tertiary 1,434-bed center from 2005 to 2014. RESULTS: Out of 6,145 patients hospitalized with CAP, 64 (1%) ertapenem-treated and 128 controls were studied (PSI IV-V 72%, mean age 73 years...
October 2016: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
Russell T Attridge, Christopher R Frei, Mary Jo V Pugh, Kenneth A Lawson, Laurajo Ryan, Antonio Anzueto, Mark L Metersky, Marcos I Restrepo, Eric M Mortensen
PURPOSE: Recent data have not demonstrated improved outcomes when guideline-concordant (GC) antibiotics are given to patients with health care-associated pneumonia (HCAP). This study was designed to evaluate the relationship between health outcomes and GC therapy in patients admitted to an intensive care unit (ICU) with HCAP. MATERIALS AND METHODS: We performed a population-based cohort study of patients admitted to greater than 150 hospitals in the US Veterans Health Administration system to compare baseline characteristics, bacterial pathogens, and health outcomes in ICU patients with HCAP receiving GC-HCAP therapy, GC community-acquired pneumonia (GC-CAP) therapy, or non-GC therapy...
August 11, 2016: Journal of Critical Care
Shanshan Xie, Laura Spelmink, Mario Codemo, Karthik Subramanian, Katrin Pütsep, Birgitta Henriques-Normark, Marie Olliver
The traditional Chinese medicine Chan-Su is widely used for treatment of cancer and cardiovascular diseases, but also as a remedy for infections such as furunculosis, tonsillitis and acute pharyngitis. The clinical use of Chan-Su suggests that it has anti-infective effects, however, the mechanism of action is incompletely understood. In particular, the effect on the human immune system is poorly defined. Here, we describe previously unrecognized immunomodulatory activities of cinobufagin (CBG), a major bioactive component of Chan-Su...
2016: PloS One
Karl J Madaras-Kelly, Muriel Burk, Christina Caplinger, Jefferson G Bohan, Melinda M Neuhauser, Matthew Bidwell Goetz, Rongping Zhang, Francesca E Cunningham
OBJECTIVE: Practice guidelines recommend the shortest duration of antimicrobial therapy appropriate to treat uncomplicated pneumonia be prescribed to reduce the emergence of resistant pathogens. A national evaluation was conducted to assess the duration of therapy for pneumonia. DESIGN: Retrospective medication utilization evaluation. SETTING: Thirty Veterans Affairs medical centers. PATIENTS: Inpatients discharged with a diagnosis of pneumonia...
August 16, 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Ping-Huai Wang, Hao-Chien Wang
BACKGROUND: After the concept of healthcare associated pneumonia (HCAP) was introduced in 2005 by the American Thoracic Society/Infectious Disease Society of America (ATS/IDSA), pneumonia in hemodialysis patients has been classified as HCAP. Even though there are several risk factors and scoring systems of drug-resistant pathogens (DRPs) in HCAP, the risk factors for DRPs in hemodialysis-associated pneumonia are unclear. METHODS: Patients who were admitted to our tertiary care hospital from January 2005 to December 2010 were screened by a discharge diagnosis of pneumonia...
2016: BMC Infectious Diseases
Amrollah Sharifi, Mohammad Javad Hosseinzadeh-Attar, Homayoon Vahedi, Saharnaz Nedjat
BACKGROUND: Inflammatory bowel disease (IBD) is an intestinal chronic inflammatory condition and includes Crohn's disease (CD) and ulcerative colitis (UC). It has been proposed that Vitamin D supplementation may have a beneficial role in IBD. AIM: To characterize the effects of Vitamin D on cathelicidin (hCAP/LL37) gene expression, ESR, and serum hs-CRP levels. MATERIALS AND METHODS: Ninety UC patients on remission were randomized to receive 300,000 IU intramuscular Vitamin D or 1 mL normal saline as placebo, respectively...
July 2016: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
Daniel Svensson, Daniel Nebel, Ulrikke Voss, Eva Ekblad, Bengt-Olof Nilsson
The biologically active form of vitamin D, 1α,25-dihydroxyvitamin D3 (1,25D3), has been reported to positively regulate the human cathelicidin anti-microbial peptide (CAMP) gene coding for LL-37, but the mechanisms are not completely understood. We have determined the expression of CAMP, vitamin D receptor (VDR), and the retinoid X receptor (RXR) isoforms in human skin and gingival tissue biopsies and investigated the signaling pathways involved in 1,25D3-induced upregulation of CAMP. Human skin and gingival biopsies exhibited few VDR-immunoreactive cells within the stratum basale, whereas rat colon enterocytes (positive control) possessed abundant VDR immunoreactivity...
June 30, 2016: Cell and Tissue Research
Hiroyuki Tada, Takamitsu Shimizu, Isao Nagaoka, Haruhiko Takada
Maxacalcitol (22-oxacalcitriol: OCT) is a synthetic vitamin D3 analog with a limited calcemic effect. In this study, we investigated whether OCT increases the production of LL-37/CAP-18, a human cathelicidin antimicrobial peptide, in human gingival/oral epithelial cells. A human gingival epithelial cell line (Ca9-22) and human oral epithelial cell lines (HSC-2, HSC-3, and HSC-4) exhibited the enhanced expression of LL-37 mRNA upon stimulation with OCT as well as active metabolites of vitamins D3 and D2. Among the human epithelial cell lines, Ca9-22 exhibited the strongest response to these vitamin D-related compounds...
2016: Biomedical Research
Raymond Farah, Jonathan Bleier, Peter Gilbey, Rola Khamisy-Farah
BACKGROUND AND OBJECTIVES: The correct diagnosis of healthcare-associated pneumonia (HCAP) as opposed to community-acquired pneumonia is essential for the selection of a correct empirical antimicrobial approach, reserving the broad-spectrum or highly potent antimicrobial therapies for resistant strains most commonly present in HCAP, whereas treating the less resistant strains, most commonly associated with community and long-term care facility-acquired infections, with a more targeted empirical approach...
June 27, 2016: Journal of Clinical Laboratory Analysis
Masafumi Seki, Ryota Fuke, Nozomi Oikawa, Maya Hariu, Yuji Watanabe
UNLABELLED: We presented three cases of influenza-related severe pneumonia/empyema that occurred in one season. CASE 1: A 76-year-old diabetic man, developed empyema as a result of severe community-acquired pneumonia (CAP) secondary to Haemophilus influenzae, as confirmed on sputum culture. Nasal swab was positive for influenza A antigen. After drainage of empyema, intravenous peramivir and piperacillin/tazobactam were administered for 3 days and 2 weeks, respectively, followed by oral levofloxacin for 2 weeks...
2016: Respiratory Medicine Case Reports
Brooke K Decker, Patricia L Harris, Robert R Muder, Jae H Hong, Nina Singh, Ali F Sonel, Cornelius J Clancy
RATIONALE: Legionella testing is not recommended for all patients with pneumonia, but rather for particular patient subgroups. As a result, the overall incidence of Legionella pneumonia may be underestimated. OBJECTIVES: To determine the incidence of Legionella pneumonia in a veteran population in an endemic area after introduction of a systematic infectious diseases consultation and testing program. METHODS: In response to a 2011-2012 outbreak, the VA Pittsburgh Healthcare System mandated infectious diseases consultations and testing for Legionella by urine antigen and sputum culture in all patients with pneumonia...
August 2016: Annals of the American Thoracic Society
Kentaro Akata, Kazuhiro Yatera, Kei Yamasaki, Toshinori Kawanami, Keisuke Naito, Shingo Noguchi, Kazumasa Fukuda, Hiroshi Ishimoto, Hatsumi Taniguchi, Hiroshi Mukae
BACKGROUND: Aspiration pneumonia has been a growing interest in an aging population. Anaerobes are important pathogens, however, the etiology of aspiration pneumonia is not fully understood. In addition, the relationship between the patient clinical characteristics and the causative pathogens in pneumonia patients with aspiration risk factors are unclear. To evaluate the relationship between the patient clinical characteristics with risk factors for aspiration and bacterial flora in bronchoalveolar lavage fluid (BALF) in pneumonia patients, the bacterial floral analysis of 16S ribosomal RNA gene was applied in addition to cultivation methods in BALF samples...
2016: BMC Pulmonary Medicine
Joachim Lorenz, Santiago Ewig
Community acquired pneumonia (CAP) is an infection with a limited spectrum of pathogens. Pneumonias acquired in a hospital or under immunoincompetence are being treated according to different algorithms. The concept of health care associated pneumonia (HCAP) is discarted. It is not capable to predict a high probability of multiresistant pathogens.
April 2016: Deutsche Medizinische Wochenschrift
Huang-Pin Wu, Chien-Ming Chu, Chun-Yao Lin, Chung-Chieh Yu, Chung-Ching Hua, Teng-Jen Yu, Yu-Chih Liu
BACKGROUND: The risk factors for Staphylococcus aureus (S. aureus) pneumonia are not fully identified. The aim of this work was to find out the clinical characteristics associated with S. aureus infection in patients with healthcare-associated pneumonia (HCAP) and hospital-acquired pneumonia (HAP), which may be applicable for more appropriate selection of empiric antibiotic therapy. METHODS: From July 2007 to June 2010, patients who were admitted to the intensive care unit with severe HCAP/HAP and severe sepsis were enrolled in this study...
2016: Pulmonary Medicine
Jin-liang Liu, Feng Xu, Hui Zhou, Xue-jie Wu, Ling-xian Shi, Rui-qing Lu, Alessio Farcomeni, Mario Venditti, Ying-li Zhao, Shu-ya Luo, Xiao-jun Dong, Marco Falcone
Aim of this study was to develop a new simpler and more effective severity score for community-acquired pneumonia (CAP) patients. A total of 1640 consecutive hospitalized CAP patients in Second Affiliated Hospital of Zhejiang University were included. The effectiveness of different pneumonia severity scores to predict mortality was compared, and the performance of the new score was validated on an external cohort of 1164 patients with pneumonia admitted to a teaching hospital in Italy. Using age ≥ 65 years, LDH > 230 u/L, albumin < 3...
2016: Scientific Reports
Zeynep Kubilay, A Joseph Layon, Herman Baer, Lennox K Archibald
Healthcare-associated pneumonia (HCAP) represents a major diagnostic challenge because of the relatively low sensitivity and specificity of clinical criteria, radiological findings, and microbiologic culture results. It is often difficult to distinguish between pneumonia, underlying pulmonary disease, or conditions with pulmonary complications; this is compounded by the often-subjective clinical diagnosis of pneumonia. We conducted this study to determine the utility of post-mortem lung biopsies for diagnosing pneumonia in tissue donors diagnosed with pneumonia prior to death...
June 2016: Cell and Tissue Banking
Hongyeul Lee, Ji Young Park, Taehoon Lee, Yeon Joo Lee, Hyo-Jeong Lim, Jong Sun Park, Ho Il Yoon, Jae-Ho Lee, Choon-Taek Lee, Young-Jae Cho
BACKGROUND/AIMS: Healthcare-associated pneumonia (HCAP) was proposed asa new pneumonia category in 2005, and treatment recommendations includebroad-spectrum antibiotics directed at multidrug-resistant (MDR) pathogens.However, this concept continues to be controversial, and microbiological data arelacking for HCAP patients in the intensive care unit (ICU). This study was conductedto determine the rate and type of antibiotic-resistant organisms and theclinical outcomes in patients with HCAP in the ICU, compared to patients withcommunity-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP)...
May 2016: Korean Journal of Internal Medicine
Oriol Sibila, Ana Rodrigo-Troyano, Yuichiro Shindo, Stefano Aliberti, Marcos I Restrepo
PURPOSE OF REVIEW: Identification of patients with multidrug-resistant (MDR) pathogens at initial diagnosis is essential for the appropriate selection of empiric treatment of patients with pneumonia coming from the community. The term Healthcare-Associated Pneumonia (HCAP) is controversial for this purpose. Our goal is to summarize and interpret the data addressing the association of MDR pathogens and community-onset pneumonia. RECENT FINDINGS: Most recent clinical studies conclude that HCAP risk factor does not accurately identify resistant pathogens...
May 2016: Current Opinion in Pulmonary Medicine
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