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Søgeord (pneumoni) valgt. Opdateret for 6 timer siden.280 emner vises.
Stoesser, N., Phan, H. T. T., Seale, A. C., Aiken, Z., Thomas, S., Smith, M., Wyllie, D., George, R., Sebra, R., Mathers, A. J., Vaughan, A., Peto, T. E. A., Ellington, M. J., Hopkins, K. L., Crook, D. W., Orlek, A., Welfare, W., Cawthorne, J., Lenney, C., Dodgson, A., Woodford, N., Walker, A. S., the TRACE Investigators' Group
Carbapenem resistance in Enterobacterales is a public health threat. Klebsiella pneumoniae carbapenemase (encoded by alleles of the blaKPC family) is one of the commonest transmissible carbapenem resistance mechanisms worldwide. The dissemination of blaKPC has historically been associated with distinct K. pneumoniae lineages (clonal group 258 [lsqb]CG258[rsqb]), a particular plasmid family (pKpQIL), and a composite transposon (Tn4401). In the UK, blaKPC has represented a large-scale, persistent, management challenge for some hospitals, particularly in North-West England. The dissemination of blaKPC has evolved to be polyclonal and poly-species, but the genetic mechanisms underpinning this evolution have not been elucidated in detail; this study used short-read whole genome sequencing of 604 blaKPC-positive isolates (Illumina) and long-read assembly (PacBio)/polishing (Illumina) of 21 isolates for characterisation. We observed the dissemination of blaKPC (predominantly blaKPC-2; 573/604 [lsqb]95%[rsqb] isolates) across eight species and more than 100 known sequence types. Although there was some variation at the transposon level (mostly Tn4401a, 584/604 (97%) isolates; predominantly with ATTGA-ATTGA target site duplications, 465/604 [lsqb]77%[rsqb] isolates), blaKPC spread appears to have been supported by highly fluid, modular exchange of larger genetic segments amongst plasmid populations dominated by IncFIB (580/604 isolates), IncFII (545/604 isolates) and IncR replicons (252/604 isolates). The subset of reconstructed plasmid sequences (21 isolates, 77 plasmids) also highlighted modular exchange amongst non-blaKPC and blaKPC plasmids, and the common presence of multiple replicons within blaKPC plasmid structures (>60%). The substantial genomic plasticity observed has important implications for our understanding of the epidemiology of transmissible carbapenem resistance in Enterobacterales, for the implementation of adequate surveillance approaches, and for control.
Dubois, J., Dubois, M., Martel, J.-F.
Omadacycline is an aminomethylcycline antibiotic with in vitro activity against pathogens causing community-acquired bacterial pneumonia (CABP). This study investigated the activity of omadacycline against Legionella pneumophila strains isolated between 1995 and 2014 from nosocomial or community-acquired respiratory infections. Omadacycline exhibited extracellular activity similar to comparator antibiotics; intracellular penetrance was found by day 3 of omadacycline exposure. These results support the utility of omadacycline as an effective antibiotic for the treatment of CABP caused by L. pneumophila.
Elaine Y P Lee, Ming-Yen Ng, Pek-Lan Khong
In late December, 2019, a cluster of cases of viral pneumonia was linked to a seafood market in Wuhan (Hubei, China), and was later determined to be caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; previously known as 2019-nCoV).1 The genome sequence of SARS-CoV-2 is similar to, but distinct from, those of two other coronaviruses responsible for large-scale outbreaks in the past: severe acute respiratory syndrome coronavirus (SARS-CoV; about 79% sequence identity) and Middle East respiratory syndrome coronavirus (MERS-CoV; about 50%).
Heshui Shi, Xiaoyu Han, Nanchuan Jiang, Yukun Cao, Osamah Alwalid, Jin Gu, Yanqing Fan, Chuansheng Zheng
COVID-19 pneumonia manifests with chest CT imaging abnormalities, even in asymptomatic patients, with rapid evolution from focal unilateral to diffuse bilateral ground-glass opacities that progressed to or co-existed with consolidations within 1–3 weeks. Combining assessment of imaging features with clinical and laboratory findings could facilitate early diagnosis of COVID-19 pneumonia.
Even though enterococci can cause serious infections in multiple sites, they are a rare cause of pneumonia. We reported a uremic patient with vancomycin-resistant E. faecium (VRE-fm) pneumonia, possibly related to epileptic seizures.
A 57-year old man with uremia on hemodialysis was admitted to the hospital with complaint of recurrent epileptic seizures, followed by a two-week history of recurrent fever and cough with purulent sputum. Chest CT demonstrated multiple exudation of both lungs. He was diagnosed as community acquired pneumonia. Despite antibiotic combination therapy, abnormal chest shadows aggravated. Sputum and blood cultures were initially negative, but later blood culture grew VRE-fm. We suspected aspiration of gastrointestinal content induced by epilepsy as the most likely mechanism. The patient was successfully treated with a four-week course of linezolid according to the antibiotic susceptibility testing.
Physicians should consider multi-drug resistant organisms such as VRE in uremic patients with pneumonia that fails to resolve with broad-spectrum antibiotics, especially in the cases with aspiration induced by epilepsy, immunocompromised conditions, and repeated or prolonged hospitalizations.
In this study, we evaluated the genetic relatedness of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KPN) isolates from an outbreak in a neonatal intensive care unit (NICU) in August 2017, We implemented an active countermeasure to control this outbreak successfully.
The incidence of healthcare-associated ESBL-KPN bacteremia was evaluated before and after initiating enhanced infection control (IC) practices in January 2018. Surveillance cultures were set up and monitored for neonates, medical personnel, and NICU environments. Molecular analyses, including pulse-field gel electrophoresis (PFGE), sequence typing, and ESBL genotyping, were performed for the isolated KPN strains.
After implementing the enhanced IC procedures, the healthcare-associated bacteremia rate decreased from 6.0 to 0.0 per 1000 patient-days. Samples from neonates (n = 11/15, 73.3%), medical personnel (n = 1/41, 2.4%), and medical devices and the environments (6/181, 3.3%) tested positive for ESBL-KPN in the surveillance cultures in December 2017. Active surveillance cultures revealed that 23 of 72 neonates who were screened (31.9%) were colonized with ESBL-KPN between January and March 2018. All the isolates demonstrated closely related PFGE patterns and were identified as ST307 strain carrying the CTX-M-15 gene.
Contaminated NICU environments and medical devices, as well as transmission by medical personnel, appeared to be the source of the outbreak of ESBL-KPN infection. We employed an enhanced IC strategy during January–March 2018 and successfully controlled the clonal outbreak of CTX-M-15-positive KPN. ST307 has emerged as an important bacteremia-causing pathogen in the NICU and should be carefully monitored.
Respiratory tract infection (RTI) in young children is a leading cause of morbidity and hospitalization worldwide. There are few studies assessing the performance for bronchoalveolar lavage fluid (BALF) versus oropharyngeal swab (OPS) specimens in microbiological findings for children with RTI. The primary purpose of this study was to compare the detection rates of OPS and paired BALF in detecting key respiratory pathogens using suspension microarray.
We collected paired OPS and BALF specimens from 76 hospitalized children with respiratory illness. The samples were tested simultaneously for 8 respiratory viruses and 5 bacteria by suspension microarray.
Of 76 paired specimens, 62 patients (81.6%) had at least one pathogen. BALF and OPS identified respiratory pathogen infections in 57 (75%) and 49 (64.5%) patients, respectively (P > 0.05). The etiology analysis revealed that viruses were responsible for 53.7% of the patients, whereas bacteria accounted for 32.9% and Mycoplasma pneumoniae for 13.4%. The leading 5 pathogens identified were respiratory syncytial virus, Streptococcus pneumoniaee, Haemophilus influenzae, Mycoplasma pneumoniae and adenovirus, and they accounted for 74.2% of etiological fraction. For detection of any pathogen, the overall detection rate of BALF (81%) was marginally higher than that (69%) of OPS (p = 0.046). The differences in the frequency distribution and sensitivity for most pathogens detected by two sampling methods were not statistically significant.
In this study, BALF and OPS had similar microbiological yields. Our results indicated the clinical value of OPS testing in pediatric patients with respiratory illness.
Cancer and sepsis comorbidity is a major public health problem in most parts of the world including Zimbabwe. The microbial aetiologies of sepsis and their antibiograms vary with time and locations. Knowledge on local microbial aetiologies of sepsis and their susceptibility patterns is critical in guiding empirical antimicrobial treatment choices.
This was a descriptive cross-sectional study which determined the microbial aetiologies of sepsis from blood cultures of paediatric and adult cancer patients obtained between July 2016 and June 2017. The TDR-X120 blood culture system and TDR 300B auto identification machine were used for incubation of blood culture bottles and identification plus antimicrobial susceptibility testing, respectively.
A total of 142 participants were enrolled; 50 (35.2%) had positive blood cultures, with 56.0% Gram positive, 42.0% Gram-negative bacteria and 2.0% yeast isolated. Common species isolated included coagulase negative Staphylococcus spp. (CoNS) (22.0%), E. coli (16.0%), K. pneumoniae (14.0%), E. faecalis (14.0%) and S. aureus (8.0%). Gram-negative isolates exhibited high resistance to gentamicin (61.9%) and ceftriaxone (71.4%) which are the empiric antimicrobial agents used in our setting. Amikacin and meropenem showed 85.7 and 95.2% activity respectively against all Gram-negative isolates, whilst vancomycin and linezolid were effective against 96.2 and 100.0% of all Gram-positive isolates respectively. We isolated 10 (66.7%) extended spectrum β-lactamase (ESBL) amongst the E. coli and K. pneumoniae isolates. Ten (66.7%) of the Staphylococcus spp. were methicillin resistant.
CoNS, E. coli, K. pneumoniae, E. faecalis and S. aureus were the major microbial drivers of sepsis amongst cancer patients in Zimbabwe. Most isolates were found to be resistant to commonly used empirical antibiotics, with isolates exhibiting high levels of ESBL and methicillin resistance carriage. A nationwide survey on microbial aetiologies of sepsis and their susceptibility patterns would assist in the guidance of effective sepsis empiric antimicrobial treatment among patients with cancer.
Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted with fever.
This prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100 °F (37.7 °C) or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled.
A total of 302 children were included in the study, out of which 47% (95% CI 41.4–52.7%) presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous 1 week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI.
The study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.
Sabrina, Araujo de Franca; Tavares, Wagner M.; Salinet, Angela S. M.; Paiva, Wellingson S.; Teixeira, Manoel J.
To elucidate the impact of early tracheostomy on hospitalization outcomes in patients with traumatic brain injury.
Lilacs, PubMed, and Cochrane databases were searched. The close-out date was August 8, 2018.
Studies written in English, French, Spanish, or Portuguese with traumatic brain injury as the base trauma, clearly formulated question, patient’s admission assessment, minimum follow-up during hospital stay, and minimum of two in-hospital outcomes were selected. Retrospective studies, prospective analyses, and case series were included. Studies without full reports or abstract, commentaries, editorials, and reviews were excluded.
The study design, year, patient’s demographics, mean time between admission and tracheostomy, neurologic assessment at admission, confirmed ventilator-assisted pneumonia, median ICU stay, median hospital stay, mortality rates, and ICU and hospital costs were extracted.
A total of 4,219 studies were retrieved and screened. Eight studies were selected for the systematic review; of these, seven were eligible for the meta-analysis. Comparative analyses were performed between the early tracheostomy and late tracheostomy groups. Mean time for early tracheostomy and late tracheostomy procedures was 5.59 days (SD, 0.34 d) and 11.8 days (SD, 0.81 d), respectively. Meta-analysis revealed that early tracheostomy was associated with shorter mechanical ventilation duration (–4.15 [95% CI, –6.30 to –1.99]) as well as ICU (–5.87 d [95% CI, –8.74 to –3.00 d]) and hospital (–6.68 d [95% CI, –8.03 to –5.32 d]) stay durations when compared with late tracheostomy. Early tracheostomy presented less risk difference for ventilator-associated pneumonia (risk difference, 0.78; 95% CI, 0.70–0.88). No statistical difference in mortality was found between the groups.
The findings from this meta-analysis suggest that early tracheostomy in severe traumatic brain injury patients contributes to a lower exposure to secondary insults and nosocomial adverse events, increasing the opportunity of patient’s early rehabilitation and discharge.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Drs. Sabrina and Tavares disclosed that this research was supported by the nonprofit organization Instituto Paulista de Saude para Alta Complexidade. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Address requests for reprints to: Araujo de Franca Sabrina, BaSN, Department of Research of IPSPAC - Instituto Paulista de Saúde para a Alta Complexidade, 199 Padre Anchieta Avenue - Room 2, Jardim, Santo Andre, SP, 09090-710, Brazil. E-mail: firstname.lastname@example.org
Copyright © by 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Yanping Bao, Yankun Sun, Shiqiu Meng, Jie Shi, Lin Lu
A novel coronavirus (2019-nCoV) has been identified as originating in Wuhan, Hubei Province, China. It has widely and rapidly spread in China and several other countries, causing an outbreak of acute infectious pneumonia. According to the official website of the National Health Commission,1 as of Feb 4, 2020, 24 324 people have been confirmed to have a 2019-nCoV infection and 490 deaths have resulted from 2019-nCoV in 31 provinces in mainland China.1 16 678 confirmed cases were in Hubei province.
Ensheng Dong, Hongru Du, Lauren Gardner
In December, 2019, a local outbreak of pneumonia of initially unknown cause was detected in Wuhan (Hubei, China), and was quickly determined to be caused by a novel coronavirus,1 namely severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The outbreak has since spread to every province of mainland China as well as 27 other countries and regions, with more than 70 000 confirmed cases as of Feb 17, 2020.2 In response to this ongoing public health emergency, we developed an online interactive dashboard, hosted by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University, Baltimore, MD, USA, to visualise and track reported cases of coronavirus disease 2019 (COVID-19) in real time.
Xingfei Pan, Dexiong Chen, Yong Xia, Xinwei Wu, Tangsheng Li, Xueting Ou, Liyang Zhou, Jing Liu
Since December, 2019, an outbreak of pneumonia caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a serious epidemic in China and other countries, resulting in worldwide concern.1 Family clusters of infected individuals have been reported, and this phenomenon could present a serious threat to public health if not strictly controlled. In a previously reported family cluster, most infected individuals had clinical symptoms, decreased lymphocyte counts, and abnormal chest CT images, and were positive for the virus on quantitative RT-PCR (qRT-PCR) analysis.
Kalina W, Souza V, Wu K, et al.
AbstractBackgroundIdentifying Streptococcus pneumoniae (Sp) serotypes by urinary antigen detection assay (UAD) is the most sensitive way to evaluate the epidemiology of non-bacteremic community acquired pneumonia (CAP). We first described a UAD to detect the Sp serotypes 1,-3,-4,-5,-6A,-6B,-7F,-9V,-14,-18C,-19A,-19F,-23F covered by the licensed 13-valent Sp conjugate vaccine PCV13. To assess the substantial remaining pneumococcal disease burden after introduction of several pneumococcal vaccines, a UAD-2 assay was developed to detect 11 additional serotypes (-2,-8,-9N,-10A,-11A,-12F,-15B,-17F,-20,-22F,-33F) in individuals with radiographically-confirmed CAP.MethodsUAD-2 specificity was achieved by capturing pneumococcal polysaccharides with serotype-specific monoclonal antibodies using Luminex technology. Assay qualification assessed accuracy, precision, sample linearity. Serotype positivity was based on cutoffs determined by non-parametric statistical evaluation of urine samples from individuals without pneumococcal disease. Sensitivity and specificity of the positivity cutoffs were assessed in a clinical validation using urine samples obtained from a large study that measured the proportion of radiographically-confirmed CAP caused by Sp serotypes in hospitalized US adults.ResultsThe UAD-2 was shown to be specific and reproducible. Clinical validation demonstrated assay sensitivity and specificity of 92.2% and 95.9% against a gold standard of bacteremic pneumonia. Additionally, the UAD-2 assay identified a Sp serotype in 3.72% of non-bacteremic CAP cases obtained from hospitalized US adults. When combined with bacteremic CAP cases, the percent of pneumonias with a UAD-2 serotype was 4.33%.ConclusionsThe qualified/clinically validated UAD-2 method has applicability in understanding the epidemiology of non-bacteremic Sp CAP and utility to assess vaccine efficacy of future pneumococcal conjugate vaccines that are under development.
Stabler S, Giovannelli J, Launay D, et al.
AbstractBackgroundRituximab (RTX) is widely administered to patients with autoimmune diseases (AID). This study aimed to estimate the incidence of serious infectious events (SIE) after RTX initiation in patients with AID. We also described the characteristics and risk factors of SIE, and immunoglobulin replacement therapy (IgRT) strategies.MethodsPatients treated between 2005 and 2016 were included in this retrospective monocentric cohort study. An RTX-course was defined as the complete RTX treatment regimen received by a given patient for AID. SIE and IgRT were right-censored at 24 months after RTX initiation.ResultsTwo hundred and twenty-one patients were included (corresponding to 276 RTX-courses). Reasons for RTX initiation included connective tissue disease (38%), systemic vasculitis (36%), and autoimmune cytopenia (22%). The 1- and 2-year incidences of SIE were 17.3 (12.0-22.5) and 11.3 (8.1-14.5) per 100 person-years, respectively. Forty-seven SIE were observed, mostly comprising pneumonias (45%) and bacteremias (21%). When documented, the microorganisms were bacterial (55%) and fungal (12%). Identified risk factors of SIE were age, history of diabetes, history of cancer, concomitant steroid treatment and low CD4 lymphocyte count at RTX initiation. IgRT was started in 22 RTX-courses (8%).ConclusionIn patients with AID treated with RTX, the 1- and 2-year incidence of SIE were 17.3 and 11.3 per 100 person-years, respectively. Reports of SIE characteristics, risk factors and IgRT strategies highlights the need for an appropriate and individualized assessment prior to and following RTX to prevent SIE, particularly in patients with comorbidities.
Xuejiao Chen, Junzhang Tian, Guanming Li, Guowei Li
In December, 2019, a group of patients with pneumonia of unknown origin, most of whom had been exposed to the Huanan seafood wholesale market in Wuhan, China, was first reported.1 Using deep sequencing analysis, Chinese authorities identified a new betacoronavirus (severe acute respiratory syndrome coronavirus 2; SARS-CoV-2) as the cause of the outbreak, and found that SARS-CoV-2 belongs to a clade within the subgenus sarbecovirus, orthocoronavirinae subfamily.2 As of Feb 10, 2020, the ongoing outbreak of coronavirus disease 2019 (COVID-19) originating in Wuhan had caused 42 638 confirmed cases and 1016 deaths, with 32 provinces and regions of China affected.
Rice TW, Kripalani S, Lindsell CJ.
Among critically ill patients in the intensive care unit (ICU), complications are frequent, including stress ulcers in the upper gastrointestinal tract. To help prevent the development of ulcers, antagonism of gastric acid (with antacids historically) or inhibition of the production of acid (with histamine-2 receptor blockers more recently) were implemented as part of routine critical care. The introduction of proton pump inhibitors, with data demonstrating improved ulcer prevention and recovery compared with histamine-2 receptor blockers in non–critically ill patients, led many physicians who provide care for critically ill patients to incorporate proton pump inhibitors for routine stress ulcer prophylaxis. However, the lack of randomized clinical trials (RCTs) that directly compared histamine-2 receptor blockers with proton pump inhibitors for stress ulcer prophylaxis in critically ill patients, combined with decreasing incidence of significant gastrointestinal bleeding in these patients and emerging evidence of an association between proton pump inhibitor use and adverse events, including Clostridioides difficile (Clostridium difficile) infection, cognitive decline, and nosocomial pneumonia, made the optimal choice of routine stress ulcer prophylaxis less clear.
Journal of Medical Virology, Volume 0, Issue ja, -Not available-.
Pfaller, M. A., Huband, M. D., Shortridge, D., Flamm, R. K.
Omadacycline is a broad-spectrum aminomethylcycline approved in October 2018 by the United States Food and Drug Administration for treating acute bacterial skin and skin structure infections and community-acquired pneumonia as both an oral and intravenous once-daily formulation. In this report, omadacycline and comparators were tested against 49,000 non-duplicate bacterial isolates collected prospectively during 2016-2018 from medical centers in Europe (24,500 isolates; 40 medical centers [19 countries]) and the United States (24,500 isolates; 33 medical centers [23 states and all 9 United States Census Divisions]). Omadacycline was tested by broth microdilution following Clinical and Laboratory Standards Institute M07 (2018) methods.Omadacycline (MIC50/90, 0.12/0.25 mg/L) inhibited 98.6% of Staphylococcus aureus isolates at ≤0.5 mg/L including 96.3% of methicillin-resistant S. aureus and 99.8% of methicillin-susceptible S. aureus. Omadacycline potency was comparable for Streptococcus pneumoniae (MIC50/90, 0.06/0.12 mg/L), viridans group streptococci (MIC50/90, 0.06/0.12 mg/L) and β-hemolytic streptococci (MIC50/90, 0.12/0.25 mg/L) regardless of species and susceptibility to penicillin, macrolides or tetracycline. Omadacycline was active against Enterobacterales (MIC50/90, 1/8 mg/L; 87.5% inhibited at ≤4 mg/L) except Proteus mirabilis (MIC50/90, 16/>32 mg/L) and Indole-positive Proteus spp. (MIC50/90, 8/32 mg/L) and was most active against Escherichia coli (MIC50/90, 0.5/2 mg/L), Klebsiella oxytoca (MIC50/90, 1/2 mg/L) and Citrobacter spp. (MIC50/90, 1/4 mg/L). Omadacycline inhibited 92.4% of Enterobacter cloacae species complex and 88.5% of Klebsiella pneumoniae isolates at ≤4 mg/L. Omadacycline was active against Haemophilus influenzae (MIC50/90, 0.5/1 mg/L) regardless of β-lactamase status and against Moraxella catarrhalis (MIC50/90, ≤0.12/0.25 mg/L). The potent activity of omadacycline against Gram-positive and -negative bacteria indicates that omadacycline merits further study in serious infections in which multidrug resistance and mixed Gram-positive and -negative infections may be a concern.
Stone, G. G., Bradford, P. A., Tawadrous, M., Taylor, D., Cadatal, M. J., Chen, Z., Chow, J. W.
Nosocomial pneumonia (NP), including ventilator-associated pneumonia (VAP), is increasingly associated with multidrug-resistant Gram-negative pathogens. This study describes the in vitro activity of ceftazidime-avibactam, ceftazidime, and relevant comparator agents against bacterial pathogens isolated from patients with NP, including VAP, enrolled in a ceftazidime-avibactam phase 3 trial (ClinicalTrials.gov identifier NCT01808092). Gram-positive pathogens were included if co-isolated with a Gram-negative pathogen. In vitro susceptibility was determined at a central laboratory using Clinical and Laboratory Standards Institute broth microdilution methods. Of 817 randomized patients, 457 (55.9%) had ≥1 Gram-negative bacterial pathogen isolated at baseline, and 149 (18.2%) had ≥1 Gram-positive pathogen co-isolated. The most common isolated pathogens were Klebsiella pneumoniae (18.8%), Pseudomonas aeruginosa (15.8%), and Staphylococcus aureus (11.5%). Ceftazidime-avibactam was highly active in vitro against 370 isolates of Enterobacteriaceae, with 98.6% susceptible (MIC90 0.5 μg/ml) compared with 73.2% susceptible for ceftazidime (MIC90 >64 μg/ml). The percent susceptibility values for ceftazidime-avibactam and ceftazidime against 129 P. aeruginosa isolates were 88.4% and 72.9% (MIC90 values of 16 μg/ml and 64 μg/ml) respectively. Among ceftazidime-nonsusceptible Gram-negative isolates, ceftazidime-avibactam percent susceptibility values were 94.9% for 99 Enterobacteriaceae and 60.0% for 35 P. aeruginosa. MIC90 values for linezolid and vancomycin (permitted per-protocol for Gram-positive coverage) were within their respective MIC susceptibility breakpoints against the Gram-positive pathogens isolated. This analysis demonstrates that ceftazidime-avibactam was active in vitro against the majority of Enterobacteriaceae and P. aeruginosa isolated from patients with NP, including VAP, in a phase 3 trial.
Yu P, Zhu J, Zhang Z, et al.
AbstractAn ongoing outbreak of pneumonia associated with 2019 novel coronavirus (2019-nCoV) was reported in China. It is unclear if the infectivity exists during the incubation period, although a person-to-person transmission has been reported in previous studies. We report the epidemiological features of a familial cluster of four patients in Shanghai, of which one was 88 years old man with moving difficulties and was only exposed to his asymptomatic family members who developed symptoms later. The epidemiological evidence has shown a potential transmission of the 2019-nCoV during the incubation period.
Montoya-Ferrer A, Sanosyan A, Fayd'herbe De Maudave A, et al.
AbstractBackgroundImmune control of Epstein-Barr virus (EBV) infection is impaired in HIV-infected individuals. We explored maternal factors associated with EBV acquisition in HIV-exposed uninfected (HEU) infants and the relationship between EBV infection and serious adverse events (SAE) during the first year of life.MethodsTwo hundred and one HEU infants from Uganda enrolled in the ANRS12174 trial were tested for anti-viral capsid antigen (VCA) antibodies at week 50 of life. The date of infection was estimated by testing of EBV DNA at weeks 1, 6, 14, 26, 38 and 50 postpartum on dried blood spot (DBS).ResultsEighty-seven (43%) infants were tested positive for anti-VCA IgG at week 50. Among the 59 infants positive for EBV DNA, 25% were infected within the first 26 weeks. Almost half of them (12%) were infected before week 14. Shedding of EBV in breast milk was associated with EBV DNA in maternal plasma (P=.009), HIV RNA detection (P=.039), lower CD4 count (P=.001) and was correlated with plasma EBV DNA levels (P=.002). EBV infant infection at week 50 was associated with shedding of EBV in breast milk (P=.009) and young maternal age (P=.029). Occurrence of a clinical SAE, including malaria and pneumonia, was associated with higher levels of EBV DNA in infants (P=.010).ConclusionsBy assessing EBV infection in HEU infants we observed that infection during the first year of life is determined by HIV and EBV maternal factors and that EBV DNA levels was higher among infants with clinical SAE.
Kaur R, Pham M, Yu K, et al.
AbstractAbstractImportanceAntibiotic-resistant S. pneumoniae strains may cause infections that fail to respond to antimicrobial-therapy. Results reported from hospitalized patients with invasive, bacteremic infections may not be the same as those observed in a primary-care setting where young children receive care for non-invasive infections. Young children experience the highest burden of pneumococcal disease.ObjectivesTo determine the antibiotic susceptibility of S. pneumoniae strains isolated from children in a primary-care setting in the post-13-valent pneumococcal conjugate vaccine (PCV-13) era.Design, Setting, and ParticipantsProspective collection of 1201 isolates of S. pneumoniae from 2006-2016 in a primary-care setting. Antibiotic susceptibility testing to 16 different antibiotics of ten classes performed. Participants were children age 6 to 36 months old. Nasopharyngeal swabs were obtained from patients during acute otitis media (AOM) visits and routine healthy visits. Middle ear fluid obtained by tympanocentesis.ResultsAfter introduction of PCV-13, antibiotic susceptibility of pneumococci, especially to penicillin, initially improved largely due to disappearance of serotype 19A, included in PCV-13. However, beginning in 2013, antibiotic susceptibility among pneumococcal strains began decreasing due to new serotypes not included in PCV-13. In addition to reduced susceptibility to penicillin, the most recent isolates show reduced susceptibility to third generation cephalosporins, fluoroquinolones and carbapenems, antibiotics commonly used to treat life-threatening, invasive pneumococcal diseases.Conclusions and relevanceIn recent years, pneumococcal nasopharyngeal and AOM isolates from children exhibit reduced susceptibility to penicillin, third generation cephalosporin, fluoroquinolone and carbapenem antibiotics. The new strains have a different profile of resistance compared to the pre-PCV-13 era.
Bingjie Wang, Fen Pan, Chun Wang, Wantong Zhao, Yan Sun, Tiandong Zhang, Yingying Shi, Hong Zhang
Akihito Okazaki, Yoshihiro Takeda, Yasuhiko Matsuda, Kazuhiko Shibata, Kazuo Kasahara
American Journal of Respiratory and Critical Care Medicine, Volume 201, Issue 4, Page e12-e12, February 15, 2020.
Charles Langelier, Monica Fung, Saharai Caldera, Thomas Deiss, Amy Lyden, Brian C. Prince, Paula Hayakawa Serpa, Farzad Moazed, Peter Chin-Hong, Joseph L. DeRisi, Carolyn S. Calfee
American Journal of Respiratory and Critical Care Medicine, Volume 201, Issue 4, Page 491-495, February 15, 2020.
Chen Wang, Peter W Horby, Frederick G Hayden, George F Gao
In December, 2019, Wuhan, Hubei province, China, became the centre of an outbreak of pneumonia of unknown cause, which raised intense attention not only within China but internationally. Chinese health authorities did an immediate investigation to characterise and control the disease, including isolation of people suspected to have the disease, close monitoring of contacts, epidemiological and clinical data collection from patients, and development of diagnostic and treatment procedures. By Jan 7, 2020, Chinese scientists had isolated a novel coronavirus (CoV) from patients in Wuhan.
Nanshan Chen, Min Zhou, Xuan Dong, Jieming Qu, Fengyun Gong, Yang Han, Yang Qiu, Jingli Wang, Ying Liu, Yuan Wei, Jia'an Xia, Ting Yu, Xinxin Zhang, Li Zhang
The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection.
Jasper Fuk-Woo Chan, Shuofeng Yuan, Kin-Hang Kok, Kelvin Kai-Wang To, Hin Chu, Jin Yang, Fanfan Xing, Jieling Liu, Cyril Chik-Yan Yip, Rosana Wing-Shan Poon, Hoi-Wah Tsoi, Simon Kam-Fai Lo, Kwok-Hung Chan, Vincent Kwok-Man Poon, Wan-Mui Chan, Jonathan Daniel Ip, Jian-Piao Cai, Vincent Chi-Chung Cheng, Honglin Chen, Christopher Kim-Ming Hui, Kwok-Yung Yuen
Our findings are consistent with person-to-person transmission of this novel coronavirus in hospital and family settings, and the reports of infected travellers in other geographical regions.
Satlin M, Lewis J, II, Weinstein M, et al.
AbstractRecent data on polymyxin pharmacokinetics (PK), pharmacodynamics (PD), toxicity and clinical outcomes suggest these agents have limited clinical utility. PK-PD data show a steady state concentration of 2 ug/mL is required for killing bacteria with colistin minimum inhibitory concentrations (MICs) of 2 ug/mL. Less than 50% of patients with normal renal function achieve this exposure and it is associated with high risk of nephrotoxicity. This exposure does not achieve bacterial stasis in pneumonia models. Randomized and observational studies consistently demonstrate increased mortality for polymyxins compared to alternative agents. CLSI and EUCAST are two global organizations that establish interpretive criteria for in vitro susceptibility data. CLSI has recently taken the step to eliminate the “susceptible” interpretive category for the polymyxins, whereas EUCAST maintains this interpretive category. This viewpoint describes the opinions of the two organizations and the data that were used to inform their perspectives.
Ali Khalid, Alicia Fajardo Lubián, Li Ma, Ruby CY Lin, Jonathan R. Iredell
Elisa Antinori, Ilaria Unali, Anna Bertoncelli, Annarita Mazzariol
Klebsiella pneumoniae producing KPC is a great health concern and therapy with ceftazidime-avibactam represent a choice for the treatment of infections supported by these strains. We report a ceftazidime-avibactam resistant strain by a deletion of 6 nucleotides in the blaKPC gene sequence.
Community–acquired pneumonia (CAP) is one of the leading worldwide causes of childhood morbidity and mortality. Its disease burden varies by age and etiology and is time dependent. We aimed to investigate the annual and seasonal patterns in etiologies of pediatric CAP requiring hospitalization.
We conducted a retrospective study in 30,994 children (aged 0–18 years) with CAP between 2010 and 2015 at 23 nationwide hospitals in South Korea. Mycoplasma pneumoniae (MP) pneumonia was clinically classified as macrolide-sensitive MP, macrolide-less effective MP (MLEP), and macrolide-refractory MP (MRMP) based on fever duration after initiation of macrolide treatment, regardless of the results of in vitro macrolide sensitivity tests.
MP and respiratory syncytial virus (RSV) were the two most commonly identified pathogens of CAP. With the two epidemics of MP pneumonia (2011 and 2015), the rates of clinical MLEP and MRMP pneumonia showed increasing trends of 36.4% of the total MP pneumonia. In children
Pneumocystis pneumonia (PCP) is increasingly being diagnosed in patients with systemic lupus erythematosus (SLE), and hydroxychloroquine (HCQ) has been found to possess antifungal activities. We hence aimed to investigate the association between HCQ and PCP risk among patients with SLE.
Using the 1997–2013 nationwide claim data, we identified 24,343 newly-diagnosed SLE patients. We then identified 58 PCP cases and selected 348 non-PCP controls matching (1:6) by age, sex, disease duration and the year of PCP diagnosis date. The risk of PCP was assessed by determing odds ratios (ORs) with 95% confidence intervals (CIs) by using multivariable conditional logistic regression.
The risk of PCP was associated with moderate to severe renal disease (OR 6.73, 95% CI 1.98–22.92), higher doses of glucocorticoids (≤5 mg/day, reference; 5–10 mg/day, OR 25.88, 95% CI 2.97–225.33; > 10 mg/day, OR 286.58, 95% CI 28.58–> 999), higher 3-month cumulative dose of cyclophosphamide (not use, reference; ≤1.4 g, OR 0.64, 95% CI 0.14–3.01; > 1.4 g, OR 11.52, 95% CI 1.97–67.39) and use of mycophenolate mofetil/mycophenolic acid (OR 50.79, 95% CI 5.32–484.77), whereas 3-month cumulative dose of HCQ was associated with a reduced risk of PCP among patients with SLE (not use, reference; ≤14 g, OR 0.69, 95% CI 0.21–2.24; > 14 g, OR 0.20, 95% CI 0.05–0.71).
This study demonstrated incident PCP was associated with mycophenolate mofetil/mycophenolic acid use and higher doses of cyclophosphamide or glucocorticoid, whereas the use of a higher dose of HCQ was associated with a reduced risk of PCP in lupus patients.
We analyzed the results of a 3-year surveillance study on the epidemiological and clinical characteristics of healthcare associated-infections (HAIs) in elderly inpatients in a large tertiary hospital in China.
Real-time surveillance was performed from January 1, 2015 to December 31, 2017. All HAIs were identified by infection control practitioners and doctors. Inpatient data were collected with an automatic surveillance system.
A total of 134,637 inpatients including 60,332 (44.8%) elderly ≥60 years were included. The overall incidence of HAI was 2.0%. The incidence of HAI in elderly patients was significantly higher than that in non-elderly patients (2.6% vs. 1.5%, χ2 = 202.421, P
Meyer Sauteur P, Trück J, van Rossum A, et al.
AbstractBackgroundWe recently demonstrated that the measurement of Mycoplasma pneumoniae (Mp)-specific IgM antibody-secreting cells (ASCs) improved diagnosis of Mp infection. Here, we aimed to describe Mp ASC kinetics and duration in comparison to conventional measures such as pharyngeal Mp DNA and serum antibodies.MethodsProspective longitudinal study of 63 community-acquired pneumonia (CAP) patients and 21 healthy controls (HCs), 3–18 years of age, from 2016–2017. Mp ASCs measured by enzyme-linked immunospot (ELISpot) were assessed alongside Mp DNA and antibodies during 6-month follow-up.ResultsMp ASCs of the isotype IgM were found in 29 (46%), IgG in 27 (43%), and IgA in 27 (43%) CAP patients. Mp ASCs were detected from 2 days to maximum 6 weeks after symptom onset, while Mp DNA and antibodies persisted until 4 months (p=0.03) and 6 months (p
Na Zhu, Dingyu Zhang, Wenling Wang, Xingwang Li, Bo Yang, Jingdong Song, Xiang Zhao, Baoying Huang, Weifeng Shi, Roujian Lu, Peihua Niu, Faxian Zhan, Xuejun Ma, Dayan Wang, Wenbo Xu, Guizhen Wu, George F. Gao, Wenjie Tan
New England Journal of Medicine, Ahead of Print.
Qun Li, Xuhua Guan, Peng Wu, Xiaoye Wang, Lei Zhou, Yeqing Tong, Ruiqi Ren, Kathy S.M. Leung, Eric H.Y. Lau, Jessica Y. Wong, Xuesen Xing, Nijuan Xiang, Yang Wu, Chao Li, Qi Chen, Dan Li, Tian Liu, Jing Zhao, Man Liu, Wenxiao Tu, Chuding Chen, Lianmei Jin, Rui Yang, Qi Wang, Suhua Zhou, Rui Wang, Hui Liu, Yinbo Luo, Yuan Liu, Ge Shao, Huan Li, Zhongfa Tao, Yang Yang, Zhiqiang Deng, Boxi Liu, Zhitao Ma, Yanping Zhang, Guoqing Shi, Tommy T.Y. Lam, Joseph T. Wu, George F. Gao, Benjamin J. Cowling, Bo Yang, Gab
Fu-Sheng Wang, Chao Zhang
The 2019 novel coronavirus (2019-nCoV) infection can lead to acute resolved or fatal pneumonia. On the basis of knowledge of other coronaviruses, the main route of human-to-human transmission of 2019-nCoV is probably through respiratory droplets. As of Feb 4, 2020, statistical data show that the outbreak constitutes an epidemic threat in China, where the exponential increase in patients has reached 20 438 confirmed cases, with 2788 (13·64%) patients in critical condition and 425 (2·08%) deaths; 23 214 additional suspected cases have also been identified so far.
Y. Chen et al.
Justin M Oldham
When a thorough evaluation of interstitial lung disease (ILD) fails to yield a diagnosis, patients are diagnosed with unclassifiable ILD. The definitions of unclassifiable ILD used in early studies have been variable;1 however, an international working group has proposed that unclassifiable ILD characterises patients for whom an ILD diagnosis cannot be assigned with more than 50% confidence.2 This scenario commonly occurs in patients with overlapping features of idiopathic pulmonary fibrosis (IPF), chronic hypersensitivity pneumonitis, and connective tissue disease-associated ILD.
Sarah B Doernberg
Over 50% of patients in critical care settings receive antibiotics on any given day.1 Because of the high incidence of resistant organisms, risk of inadequate empirical therapy in patients who are critically ill, and uncertainty of diagnosis in this setting, de-escalation of antibiotics poses a unique challenge. Therefore, clinicians tend to prescribe antibiotics expansively, even in the face of data suggesting appropriateness of narrower antibiotic courses or shorter durations.2 Ventilator-associated pneumonia, a common indication for antibiotics in the intensive care unit, poses a major diagnostic challenge, often leading to indiscriminate antibiotic use.
At the age of 41 years and having never smoked, Julie Swedberg, based in Minnesota (USA), was stunned to be diagnosed with stage 4 lung cancer in 2016. Her husband Eric and two young sons, aged 8 and 10 years at the time, were all devastated. “I'd been coughing a lot, and also had a history of allergies, so went to my doctor”, she explains. Multiple visits, antibiotics, and steroids did nothing to reduce her symptoms, so Julie requested a CT scan. “There was a spot on my lung in three different x-rays that was diagnosed as pneumonia.
Thomas P Hellyer, Daniel F McAuley, Timothy S Walsh, Niall Anderson, Andrew Conway Morris, Suveer Singh, Paul Dark, Alistair I Roy, Gavin D Perkins, Ronan McMullan, Lydia M Emerson, Bronagh Blackwood, Stephen E Wright, Kallirroi Kefala, Cecilia M O'Kane, Simon V Baudouin, Ross L Paterson, Anthony J Rostron, Ashley Agus, Jonathan Bannard-Smith, Nicole M Robin, Ingeborg D Welters, Christopher Bassford, Bryan Yates, Craig Spencer, Shondipon K Laha, Jonathan Hulme, Stephen Bonner, Vanessa Linnett, Julian Sonkse
Antibiotic use remains high in patients with suspected ventilator-associated pneumonia. Antibiotic stewardship was not improved by a rapid, highly sensitive rule-out test. Prescribing culture, rather than poor test performance, might explain this absence of effect.
Ofman G, Pradarelli B, Caballero M, et al.
AbstractBackgroundEfforts to better understand the risk factors associated with respiratory failure (RF) and fatal LRTI in premature children in developing countries are necessary to elaborate evidenced-based preventive interventions. We aim to characterize the burden of RSV and hMPV LRTI in premature children and determine risk factors for RF and fatal illness in a vulnerable population.MethodsA prospective, population-based, cross-sectional study. Subjects with severe LRTI were enrolled during respiratory season. Risk factors for RF and death in premature infants were investigated.Results664 premature children participated. Infant’s hospitalization rate due to LRTI was 82.6/1,000 (95% confidence interval (CI), 68.6-96.7/1,000). Infant’s RSV and hMPV rates were 40.9/1,000 (36.3–45.6 /1,000) and 6.6/1,000 (3.9-9.2 /1,000), respectively. The RF rate was 8.2/1,000 (4.9-11.5 /1,000). LRTI mortality was 2.2/1,000 (0.7-3.7 /1,000); for RSV was 0.8/1,000 (0-1.7 /1,000) with a case fatality ratio of 1.8%. Never breastfeeding, malnutrition, younger than 6 months, congenital heart disease and lower hematocrit were risk factors for RF. Experiencing pneumonia, pneumothorax, sepsis or apnea were clinical determinants of poor outcomes.ConclusionsPremature children under 2 years old in vulnerable environments experience RF and death more often than term counterparts. Modifiable risk factors associated with poor outcomes should prompt evidence-based interventions.
Cavallazzi, Rodrigo; Ramirez, Julio
Purpose of review
The aim of this study was to discuss the literature on community-acquired pneumonia (CAP) in patients with chronic obstructive pulmonary disease (COPD).
Well designed studies show that COPD is the strongest risk factor for development of CAP. Lung microbiome, abnormal lung immunity and pathogen virulence are important components of the pathogenesis of CAP in COPD. The cause of CAP in patients with COPD is similar to that of non-COPD patients. However, patients with COPD are at an increased risk of infection by Gram-negative bacilli, including Pseudomonas aeruginosa. Empiric treatment regimens for CAP in COPD should contemplate the most common pathogens, and consideration should be given for the coverage of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus depending on the severity of CAP, severity of COPD or prior isolation of these pathogens. COPD has not been consistently shown to be an independent risk factor for worse short-term outcomes in patients with CAP. In a long-term study, COPD is associated with worse outcomes in these patients.
Research focused on lung microbiome and abnormal lug immunity in patients with COPD should be prioritized. Further clinical research should try to consolidate the role of additional treatment approaches such as immunomodulating medications in COPD patients with CAP.
Correspondence to Rodrigo Cavallazzi, MD, 550 S. Jackson St., 3rd Floor, Ste. A3R35, Louisville, KY 40202, USA. E-mail: email@example.com
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Jabbour, Jean-Francois; Sharara, Sima L.; Kanj, Souha S.
Purpose of review
The increase in skin and soft tissue infections (SSTI) because of multidrug-resistant (MDR) pathogens is a global concern. Although MDR Gram-negative bacteria (GNB) are often overlooked as a cause of SSTIs, their burden on the morbidity of many subgroups of patients is high. There is a paucity in the available treatment options and guidelines on how to treat these pathogens. This manuscript reviews the management of SSTIs caused by carbapenem-resistant Enterobacteriaceae (CRE), Pseudomonas aeruginosa (CRPA), Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia. We also highlight a few novel antibiotics that show promise in the future management of MDR-GNB SSTIs.
Studies on treatment options of MDR-GNB SSTIs are scarce. Most clinical trials investigating new antibiotics have addressed conditions such as complicated intraabdominal infections, complicated urinary infections, and respiratory infections. CREs are a heterogenous group of pathogens with various mechanisms of resistance dictating susceptibility to different antimicrobial agents. Ceftazidime--avibactam, and meropenem--vaborbactam have potent activity against some of the CREs, especially Klebsiella pneumoniae carbapenemase (KPC) producers. Several novel antibiotics have potent activity against CRPA SSTIs, such as ceftazidime--avibactam, ceftolozane--tazobactam, cefiderocol, delafloxacin, finafloxacin, and murepavadin. Cefiderocol may also play an important role in the management of CRAB SSTIs, along with plazomicin and eravacycline.
MDR-GNB play a major role in SSTIs in patients with underlying immunodeficiency, as well as burn or trauma-related injuries. With the alarming global rise in MDR-GNB resistance, antibiotic therapy for SSTIs is challenging and must be guided by in-vitro susceptibility results. Currently, data extrapolated from other indications and combination therapy can be used empirically pending microbiological data and susceptibilities. Novel antibiotics are currently under development. It is hoped that future clinical trials will be designed to address MDR-GNB SSTIs.
Correspondence to Souha S. Kanj, Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh 2020, 1107 Beirut, Lebanon. Tel: +961 3 835 845; e-mail: firstname.lastname@example.org
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Dominedò, Cristina; Ceccato, Adrian; Torres, Antoni
Purpose of review
Ventilator-associated pneumonia (VAP) is a serious event in critically ill patients. We aim to review the most recent evidences about VAP, including its cause, the main differences between the American and European guidelines in the definition of risk factors for multidrug-resistant pathogens, the main principles guiding empirical antibiotic treatment, and the potential role of molecular diagnostic tests.
The 2016 ATS/IDSA and the 2017 ERS/ESICM/ESCMID/ALAT guidelines provide different approaches for the management of VAP. Both guidelines highlight the need to use local epidemiological data for antibiotic choice; however, they identify different risk factors that can assist with decision making when local data are not available. Nevertheless, validation studies of the American guidelines suggest that empiric antibiotic therapy based on risk factors may lead to an overuse of broad-spectrum antibiotics. Rapid diagnostic tests may allow a faster identification of VAP cause, resulting in more adequate antimicrobial therapy and reduced exposition to broad-spectrum antibiotics.
Clinical studies should be conducted to evaluate the benefits of implementing guidelines and new approaches such as combinations of clinical data with rapid diagnostic tests; meantime adaptations of guidelines to local settings should be carried out by a local multidisciplinary expert team.
Correspondence to Antoni Torres, Department of Pulmonary Medicine, Hospital Clinic of Barcelona, C/ Villarroel 170, 08036 Barcelona, Spain. Tel: +34 93 227 5779; fax: + 34 93 227 9813; e-mail: email@example.com
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Howard L, Edwards K, Zhu Y, et al.
AbstractBackgroundHuman metapneumovirus (HMPV) is a leading cause of respiratory tract infections. Few studies have compared the clinical characteristics and severity of HMPV-associated pneumonia with other pathogens.MethodsActive population-based surveillance was previously conducted for radiographically-confirmed community-acquired pneumonia hospitalizations among children and adults in eight United States hospitals. Clinical data and specimens for pathogen detection were systematically collected. We described clinical features of all HMPV-associated pneumonia, and after excluding co-detections with other pathogen types, we compared features of HMPV-associated pneumonia with other viral, atypical, and bacterial pneumonia and modeled severity (mild, moderate, severe) and length of stay using multivariable proportional odds regression.ResultsHMPV was detected in 298/2358 (12.6%) children and 88/2320 (3.8%) adults hospitalized with pneumonia and was commonly co-detected with other pathogens (125/298 [42%] children and 21/88 [24%] adults). Fever and cough were the most common presenting symptoms of HMPV-associated pneumonia and were also common symptoms of other pathogens. After excluding co-detections, in children (n=1778), compared to HMPV (reference), bacterial pneumonia exhibited increased severity (OR 3.66 [95% CI 1.43-9.40]), RSV (0.76 [0.59-0.99]) and atypical (0.39 [0.19-0.81]) infections exhibited decreased severity, and other viral pneumonia exhibited similar severity (0.88 [0.55-1.39]). In adults (n=2145), bacterial (3.74 [1.87-7.47]) and RSV pneumonia (1.82 [1.32-2.50]) were more severe than HMPV (reference), but all other pathogens had similar severity.ConclusionsClinical features did not reliably distinguish HMPV-associated pneumonia from other pathogens. HMPV-associated pneumonia was less severe than bacterial and adult RSV pneumonia but otherwise as or more severe than other common pathogens.
Arcari, G., Di Lella, F. M., Bibbolino, G., Mengoni, F., Beccaccioli, M., Antonelli, G., Faino, L., Carattoli, A.
In this study we investigated VIM-1-producing Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, Citrobacter freundii, and Enterobacter cloacae strains, isolated in 2019 during a period of active surveillance of carbapenem resistant Enterobacterales in a large university hospital in Italy. VIM-1-producing strains colonized the gut of patients, with up to three different VIM-1-positive bacterial species isolated from a single rectal swab, but also caused bloodstream infection to one colonized patient. In the multi-species cluster the blaVIM-1 was identified in a 5-gene cassette class 1 integron, associated with several genetic determinants, including the blaSHV-12, qnrS1 and mph(A) genes, located on a highly conjugative and broad-host range IncA plasmid. Characteristics and origin of this IncA plasmid were studied.
Dansk Selskab for Intern Medicin (DSIM) årsmøde og overrækkelse af Hagedorn prisen 2020
Novo Nordisk Fonden, Tuborg Havnevej 19, 2900 Hellerup
Conference on Retroviruses and Opportunistic Infections (CROI) 2020
Boston, Massachusetts, USA
8.03.2020 - 11.03.2020
Når CROI går i fisk - med transmissioner fra CROI 2020
10.03.2020 - 11.03.2020
World TB day 2020
Specialespecifikt kursus om kardiopulmonale infektioner og TB
26.03.2020 - 27.03.2020
National handlingsplan for antibiotika til mennesker (2017)
Retningslinjer til sundhedsprofessionelle vedr. håndtering af infektion med zikavirus (2019)
Antiviral behandling af hiv smittede personer (2019)
Varicella Zoster Virus encephalitis in Denmark from 2015 to 2019- A nationwide prospective cohort study
27.02.2020Clinical Infectious Diseases Advance Access
Inflammatory Phenotypes Predict Changes in Arterial Stiffness following ART Initiation
27.02.2020Clinical Infectious Diseases Advance Access
The cause of death in bacterial meningitis
27.02.2020Latest Results for BMC Infectious Diseases
Leptospirosis in Indonesia: diagnostic challenges associated with atypical clinical manifestations and limited laboratory capacity
27.02.2020Latest Results for BMC Infectious Diseases
Eliminating viral hepatitis C in Belgium: the micro-elimination approach
27.02.2020Latest Results for BMC Infectious Diseases
Hvad synes Professor Jens Lundgren om"Dolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIV."?
Hvorfor anbefaler Professor Troels Lillebæk artiklen"The global prevalence of latent tuberculosis: a systematic review and meta-analysis."?
Hvad tænker Professor Lars Østergaard om"Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial."?
Hvorfor anbefaler Professor Thomas Benfield artiklen"Oral versus Intravenous Antibiotics for Bone and Joint Infection."?
Hvad mener Professor Niels Obel om artiklen"Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis."?
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