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47 papers 0 to 25 followers Community-Acquired Pneumonia
By B M
Elena Prina, Adrian Ceccato, Antoni Torres
Despite improvements in the management of community-acquired pneumonia (CAP), morbidity and mortality are still high, especially in patients with more severe disease. Early and appropriate antibiotics remain the cornerstone in the treatment of CAP. However, two aspects seem to contribute to a worse outcome: an uncontrolled inflammatory reaction and an inadequate immune response. Adjuvant treatments, such as corticosteroids and intravenous immunoglobulins, have been proposed to counterbalance these effects. The use of corticosteroids in patients with severe CAP and a strong inflammatory reaction can reduce the time to clinical stability, the risk of treatment failure, and the risk of progression to acute respiratory distress syndrome...
October 1, 2016: Critical Care: the Official Journal of the Critical Care Forum
Fiona Havers, Anna M Bramley, Lyn Finelli, Carrie Reed, Wesley H Self, Christopher Trabue, Sherene Fakhran, Robert Balk, D Mark Courtney, Timothy D Girard, Evan J Anderson, Carlos G Grijalva, Kathryn M Edwards, Richard G Wunderink, Seema Jain
BACKGROUND: Prior retrospective studies suggest that statins may benefit patients with community-acquired pneumonia (CAP) due to antiinflammatory and immunomodulatory effects. However, prospective studies of the impact of statins on CAP outcomes are needed. We determined whether statin use was associated with improved outcomes in adults hospitalized with CAP. METHODS: Adults aged ≥18 years hospitalized with CAP were prospectively enrolled at 3 hospitals in Chicago, Illinois, and 2 hospitals in Nashville, Tennessee, from January 2010-June 2012...
June 15, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Catia Cillóniz, Albert Gabarrús, Miquel Ferrer, Jorge Puig de la Bellacasa, Mariano Rinaudo, Josep Mensa, Michael S Niederman, Antoni Torres
BACKGROUND: Pseudomonas aeruginosa is not a frequent pathogen in community-acquired pneumonia (CAP). However, in patients with severe CAP, P aeruginosa can be the etiology in 1.8% to 8.3% of patients, with a case-fatality rate of 50% to 100%. We describe the prevalence, clinical characteristics, outcomes, and risk factors associated with CAP resulting from multidrug-resistant (MDR) and non-MDR P aeruginosa. METHODS: Prospective observational study of 2,023 consecutive adult patients with CAP with definitive etiology...
August 2016: Chest
Raquel K Belforti, Tara Lagu, Sarah Haessler, Peter K Lindenauer, Penelope S Pekow, Aruna Priya, Marya D Zilberberg, Daniel Skiest, Thomas L Higgins, Mihaela S Stefan, Michael B Rothberg
BACKGROUND: Fluoroquinolones have equivalent oral and intravenous bioavailability, but hospitalized patients with community-acquired pneumonia (CAP) generally are treated intravenously. Our objectives were to compare outcomes of hospitalized CAP patients initially receiving intravenous vs oral respiratory fluoroquinolones. METHODS: This was a retrospective cohort study utilizing data from 340 hospitals involving CAP patients admitted to a non-intensive care unit (ICU) setting from 2007 to 2010, who received intravenous or oral levofloxacin or moxifloxacin...
July 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Jonathan S Lee, Daniel L Giesler, Walid F Gellad, Michael J Fine
IMPORTANCE: Antibiotic therapy is the cornerstone of medical management for community-acquired pneumonia. OBJECTIVE: To assess the associations between 3 key aspects of antibiotic therapy (optimal time to antibiotic initiation, initial antibiotic selection, and criteria for the transition from intravenous to oral therapy) and short-term mortality in adults hospitalized with community-acquired pneumonia. EVIDENCE REVIEW: Bibliographic databases of MEDLINE, EMBASE, and the Cochrane Collaboration were searched for studies of adults hospitalized with radiographically confirmed community-acquired pneumonia published from January 1, 1995, until November 5, 2015...
February 9, 2016: JAMA: the Journal of the American Medical Association
Carlos M Barrera, Analia Mykietiuk, Hristo Metev, Mimi Floarea Nitu, Najumuddin Karimjee, Pablo Alexis Doreski, Ismail Mitha, Cristina Mihaela Tanaseanu, Joseph McDermott Molina, Yuri Antonovsky, Dirkie Johanna Van Rensburg, Brian H Rowe, Jose Flores-Figueroa, Barbara Rewerska, Kay Clark, Kara Keedy, Amanda Sheets, Drusilla Scott, Gary Horwith, Anita F Das, Brian Jamieson, Prabhavathi Fernandes, David Oldach
BACKGROUND: Community-acquired bacterial pneumonia (CABP) is a leading cause of morbidity and mortality, and treatment recommendations, each with specific limitations, vary globally. We aimed to compare the efficacy and safety of solithromycin, a novel macrolide, with moxifloxacin for treatment of CABP. METHODS: We did this global, double-blind, double-dummy, randomised, active-controlled, non-inferiority trial at 114 centres in North America, Latin America, Europe, and South Africa...
April 2016: Lancet Infectious Diseases
Naomi J Gadsby, Clark D Russell, Martin P McHugh, Harriet Mark, Andrew Conway Morris, Ian F Laurenson, Adam T Hill, Kate E Templeton
BACKGROUND: The frequent lack of a microbiological diagnosis in community-acquired pneumonia (CAP) impairs pathogen-directed antimicrobial therapy. This study assessed the use of comprehensive multibacterial, multiviral molecular testing, including quantification, in adults hospitalized with CAP. METHODS: Clinical and laboratory data were collected for 323 adults with radiologically-confirmed CAP admitted to 2 UK tertiary care hospitals. Sputum (96%) or endotracheal aspirate (4%) specimens were cultured as per routine practice and also tested with fast multiplex real-time polymerase-chain reaction (PCR) assays for 26 respiratory bacteria and viruses...
April 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Forest W Arnold, Jose Bordon, Rafael Fernandez-Botran, Madhavi J Rane, Silvia M Uriarte, Robert Kelley, Timothy L Wiemken, Paula Peyrani, Julio A Ramirez
PURPOSE: The objective of this study was to measure plasma cytokine levels and blood neutrophil functions as well as clinical outcomes in hospitalized patients with community-acquired pneumonia (CAP) treated with or without macrolide use--a known modulator of inflammatory response. METHODS: Subjects with CAP had peripheral blood analyzed for some neutrophil functions (degranulation of secretory vesicles and specific granules, respiratory burst response and phagocytosis) and ten cytokine levels measured in serum and sputum supernatants...
February 2016: Lung
You-Dong Wan, Tong-Wen Sun, Zi-Qi Liu, Shu-Guang Zhang, Le-Xin Wang, Quan-Cheng Kan
BACKGROUND: Corticosteroids are an option in the treatment of community-acquired pneumonia (CAP). However, the benefits and adverse effects of corticosteroids, especially in severe CAP, have not been well assessed. METHODS: PubMed, Embase, and Cochrane library databases from inception to May 2015 were searched. Randomized controlled trials (RCTs) and cohort studies that evaluated use of corticosteroids in adult patients with CAP were included. The quality of outcomes was evaluated using Grading of Recommendations Assessment, Development and Evaluation methodology...
January 2016: Chest
Ricardo José, Andrew Williams, Michal Sulikowski, David Brealey, Jeremy Brown, Rachel Chambers
BACKGROUND: Community-acquired pneumonia is commonly caused by Streptococcus pneumoniae, which is associated with excessive neutrophilic inflammation. The high-affinity thrombin receptor, proteinase-activated receptor 1 (PAR1), has been implicated in mediating the interplay between coagulation and inflammation. However, its role during S pneumoniae-induced neutrophilic inflammation, and the mechanisms for neutrophil recruitment in this context are poorly understood. We aimed to investigate the role of neutrophilic inflammation and PAR1 in S pneumoniae-induced pneumonia...
February 26, 2015: Lancet
Elena Prina, Otavio T Ranzani, Antoni Torres
Community-acquired pneumonia causes great mortality and morbidity and high costs worldwide. Empirical selection of antibiotic treatment is the cornerstone of management of patients with pneumonia. To reduce the misuse of antibiotics, antibiotic resistance, and side-effects, an empirical, effective, and individualised antibiotic treatment is needed. Follow-up after the start of antibiotic treatment is also important, and management should include early shifts to oral antibiotics, stewardship according to the microbiological results, and short-duration antibiotic treatment that accounts for the clinical stability criteria...
September 12, 2015: Lancet
Reed A C Siemieniuk, Maureen O Meade, Pablo Alonso-Coello, Matthias Briel, Nathan Evaniew, Manya Prasad, Paul E Alexander, Yutong Fei, Per O Vandvik, Mark Loeb, Gordon H Guyatt
BACKGROUND: Community-acquired pneumonia (CAP) is common and often severe. PURPOSE: To examine the effect of adjunctive corticosteroid therapy on mortality, morbidity, and duration of hospitalization in patients with CAP. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through 24 May 2015. STUDY SELECTION: Randomized trials of systemic corticosteroids in hospitalized adults with CAP...
October 6, 2015: Annals of Internal Medicine
Antoni Torres, Francesco Blasi, Nathalie Dartois, Murat Akova
Pneumococcal disease (including community-acquired pneumonia and invasive pneumococcal disease) poses a burden to the community all year round, especially in those with chronic underlying conditions. Individuals with COPD, asthma or who smoke, and those with chronic heart disease or diabetes mellitus have been shown to be at increased risk of pneumococcal disease compared with those without these risk factors. These conditions, and smoking, can also adversely affect patient outcomes, including short-term and long-term mortality rates, following pneumonia...
October 2015: Thorax
Yann-Erick Claessens, Marie-Pierre Debray, Florence Tubach, Anne-Laure Brun, Blandine Rammaert, Pierre Hausfater, Jean-Marc Naccache, Patrick Ray, Christophe Choquet, Marie-France Carette, Charles Mayaud, Catherine Leport, Xavier Duval
RATIONALE: Clinical decision making relative to community-acquired pneumonia (CAP) diagnosis is difficult. Chest radiograph is key in establishing parenchymal lung involvement. However, radiologic performance may lead to misdiagnosis, rendering questionable the use of chest computed tomography (CT) scan in patients with clinically suspected CAP. OBJECTIVES: To assess whether early multidetector chest CT scan affects diagnosis and management of patients visiting the emergency department with suspected CAP...
October 15, 2015: American Journal of Respiratory and Critical Care Medicine
Brendon P Scicluna, Peter M C Klein Klouwenberg, Lonneke A van Vught, Maryse A Wiewel, David S Y Ong, Aeilko H Zwinderman, Marek Franitza, Mohammad R Toliat, Peter Nürnberg, Arie J Hoogendijk, Janneke Horn, Olaf L Cremer, Marcus J Schultz, Marc J Bonten, Tom van der Poll
RATIONALE: Community-acquired pneumonia (CAP) accounts for a major proportion of intensive care unit (ICU) admissions for respiratory failure and sepsis. Diagnostic uncertainty complicates case management, which may delay appropriate cause-specific treatment. OBJECTIVES: To characterize the blood genomic response in patients with suspected CAP and identify a candidate biomarker for the rapid diagnosis of CAP on ICU admission. METHODS: The study comprised two cohorts of consecutively enrolled patients treated for suspected CAP on ICU admission...
October 1, 2015: American Journal of Respiratory and Critical Care Medicine
Dean T Eurich, Thomas J Marrie, Jasjeet K Minhas-Sandhu, Sumit R Majumdar
RATIONALE: Information on the long-term prognosis after community-acquired pneumonia (CAP) is limited. OBJECTIVES: To determine if CAP increases adverse long-term outcomes relative to a control population. METHODS: Between 2000 and 2002, 6,078 adults with CAP from six hospitals and seven emergency departments in Edmonton (AB, Canada) were prospectively recruited and matched on age, sex, and site of treatment with five control subjects without pneumonia (n = 29,402)...
September 1, 2015: American Journal of Respiratory and Critical Care Medicine
Charles Feldman, Ronald Anderson
Despite advances in antimicrobial chemotherapy and access to sophisticated intensive care facilities, bacterial community-acquired pneumonia (CAP) continues to carry an unacceptably high mortality rate of 10% to 15% in hospitalized cases. CAP, considered by many to be the most underestimated disease worldwide, poses a particular threat to the elderly whose numbers are steadily increasing in developed countries. Indeed, elderly patients with severe CAP, as well as those with other risk factors, are at significant risk for development of inflammation-mediated acute cardiac events that may undermine the success of antimicrobial therapy...
August 2015: Chest
Douwe F Postma, Cornelis H van Werkhoven, Leontine J R van Elden, Steven F T Thijsen, Andy I M Hoepelman, Jan A J W Kluytmans, Wim G Boersma, Clara J Compaijen, Eva van der Wall, Jan M Prins, Jan J Oosterheert, Marc J M Bonten
BACKGROUND: The choice of empirical antibiotic treatment for patients with clinically suspected community-acquired pneumonia (CAP) who are admitted to non-intensive care unit (ICU) hospital wards is complicated by the limited availability of evidence. We compared strategies of empirical treatment (allowing deviations for medical reasons) with beta-lactam monotherapy, beta-lactam-macrolide combination therapy, or fluoroquinolone monotherapy. METHODS: In a cluster-randomized, crossover trial with strategies rotated in 4-month periods, we tested the noninferiority of the beta-lactam strategy to the beta-lactam-macrolide and fluoroquinolone strategies with respect to 90-day mortality, in an intention-to-treat analysis, using a noninferiority margin of 3 percentage points and a two-sided 90% confidence interval...
April 2, 2015: New England Journal of Medicine
Jiu-Xin Qu, Li Gu, Zeng-Hui Pu, Xiao-Min Yu, Ying-Mei Liu, Ran Li, Yi-Min Wang, Bin Cao, Chen Wang
BACKGROUND: Better knowledge of distribution of respiratory viruses (RVs) in adolescents and adults with community-acquired pneumonia (CAP) is needed. METHODS: To investigate the RVs etiology among adolescents and adults with CAP, according to age and pneumonia severity index (PSI), a multi-center, prospective study was conducted from November 2010 to April 2012. Fifteen RVs were tested by polymerase chain reaction (PCR). Bacteria were detected by urinary antigen, conventional culture and PCR...
2015: BMC Infectious Diseases
Roger Dumke, Christiane Schnee, Mathias W Pletz, Jan Rupp, Enno Jacobs, Konrad Sachse, Gernot Rohde
Mycoplasma pneumoniae and Chlamydia spp., which are associated with community-acquired pneumonia (CAP), are difficult to propagate, and can cause clinically indistinguishable disease patterns. During 2011-2012, we used molecular methods to test adult patients in Germany with confirmed CAP for infection with these 2 pathogens. Overall, 12.3% (96/783) of samples were positive for M. pneumoniae and 3.9% (31/794) were positive for Chlamydia spp.; C. psittaci (2.1%) was detected more frequently than C. pneumoniae (1...
March 2015: Emerging Infectious Diseases
2016-07-11 01:06:29
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