Pulmonary Infections

Clinical Perspective ◽

Immunosuppressed Patients ◽

Healthcare Associated ◽

Pneumonia can be classified as: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), healthcare-associated pneumonia (HCAP), and pneumonia in immunosuppressed patients. Although the above are similar pathologically, they are very different from a clinical perspective. Chest radiography is often performed to support the diagnosis and to determine the extent of involvement prior to the onset of therapy. Radiography should not be performed in the short term in patients who are improving clinically as it can lead to the misdiagnosis of treatment failure. Chest radiography in patients treated for pneumonia should only be obtained before 4-6 weeks after the onset of therapy if there is a failure of clinical response or if complications of pneumonia are clinically suspected. The majority of pneumonias will resolve after 6 weeks of appropriate antibiotic therapy.

Clinical characteristics of patients with pneumonia caused by Klebsiella pneumoniae in Taiwan and prevalence of antimicrobial-resistant and hypervirulent strains: a retrospective study

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0660-x ◽

2020 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Chih-Han Juan ◽

Shih-Yu Fang ◽

Chia-Hsin Chou ◽

Tsung-Ying Tsai ◽

Yi-Tsung Lin

Keyword(s):

Retrospective Study ◽

Klebsiella Pneumoniae ◽

Clinical Characteristics ◽

Drug Resistant ◽

Resistant Strains ◽

Healthcare Associated ◽

Drug Resistant Strains ◽

Abstract Background We aimed to compare the clinical characteristics of patients with community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), and hospital-acquired pneumonia (HAP) caused by Klebsiella pneumoniae and analyze the antimicrobial resistance and proportion of hypervirluent strains of the microbial isolates. Methods We conducted a retrospective study on patients with pneumonia caused by K. pneumoniae at the Taipei Veterans General Hospital in Taiwan between January 2014 and December 2016. To analyze the clinical characteristics of these patients, data was extracted from their medical records. K. pneumoniae strains were subjected to antimicrobial susceptibility testing, capsular genotyping and detection of the rmpA and rmpA2 genes to identify hypervirulent strains. Results We identified 276 patients with pneumonia caused by K. pneumoniae, of which 68 (24.6%), 74 (26.8%), and 134 (48.6%) presented with CAP, HCAP, and HAP, respectively. The 28-day mortality was highest in the HAP group (39.6%), followed by the HCAP (29.7%) and CAP (27.9%) groups. The HAP group also featured the highest proportion of multi-drug resistant strains (49.3%), followed by the HCAP (36.5%) and CAP groups (10.3%), while the CAP group had the highest proportion of hypervirulent strains (79.4%), followed by the HCAP (55.4%) and HAP groups (41.0%). Conclusion Pneumonia caused by K. pneumoniae was associated with a high mortality. Importantly, multi-drug resistant strains were also detected in patients with CAP. Hypervirulent strains were prevalent in all 3 groups of pneumonia patients, even in those with HAP.

Community-Acquired Pneumonia and Hospital-Acquired Pneumonia in Adult Patients with Idiopathic Inflammatory Myopathy: Outcome and Antibiotic Therapy

Rheumatology and Therapy ◽

10.1007/s40744-020-00268-7 ◽

2020 ◽

Author(s):

Junyu Liang ◽

Chuanyin Sun ◽

Liqin Xu ◽

Guanhua Xu ◽

Heng Cao ◽

...

Keyword(s):

Antibiotic Therapy ◽

Inflammatory Myopathy ◽

Idiopathic Inflammatory Myopathy ◽

Adult Patients ◽

Which regimen is most effective at improving outcomes in critically ill adults with hospital-acquired pneumonia: short-course or prolonged-course antibiotic therapy?

Cochrane Clinical Answers ◽

10.1002/cca.1174 ◽

2016 ◽

Author(s):

Elie Mulhem ◽

Karen Pettersen

Keyword(s):

Antibiotic Therapy ◽

Critically Ill ◽

Short Course ◽

Critically Ill Adults ◽

Hospital Acquired ◽

Ill Adults

Management of Health-Care Associated Pneumonia (HCAP)

Italian Journal of Medicine ◽

10.4081/itjm.2012.87 ◽

2013 ◽

pp. 87-90

Author(s):

Alessia Rosato ◽

Claudio Santini

Keyword(s):

Health Care ◽

Treatment Approach ◽

Multidrug Resistant ◽

Outpatient Setting ◽

Traditional Classification ◽

Health Care Associated Pneumonia ◽

Introduction The traditional classification of Pneumonia as either community acquired (CAP) or hospital acquired (HAP) reflects deep differences in the etiology, pathogenesis, approach and prognosis between the two entities. Health-Care Associated Pneumonia (HCAP) develops in a heterogeneous group of patients receiving invasive medical care or surgical procedures in an outpatient setting. For epidemiology and outcomes, HCAP closely resembles HAP and possibly requires an analogous therapeutic regimen effective against multidrug-resistant pathogens. Materials and methods We reviewed the pertinent literature and the guidelines for the diagnosis and management of HCAP to analyze the evidence for the recommended approach. Results Growing evidence seems to confirm the differences in epidemiology and outcome between HCAP and CAP but fails to confirm any real advantage in pursuing an aggressive treatment for all HCAP and CAP patients. Discussion Further investigations are needed to establish the optimal treatment approach according to the different categories of patients and the different illness severities. Keywords Health Care Associated Pneumonia (HCAP); Community Acquired Pneumonia (CAP); Hospital Acquired Pneumonia (HAP); Multidrug-resistant (MDR) Pathogens

The Association of Antibiotic Duration With Successful Treatment of Community-Acquired Pneumonia in Children

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa055 ◽

2020 ◽

Cited By ~ 2

Author(s):

Rebecca G Same ◽

Joe Amoah ◽

Alice J Hsu ◽

Adam L Hersh ◽

Daniel J Sklansky ◽

...

Keyword(s):

Antibiotic Therapy ◽

Treatment Failure ◽

Propensity Score Analysis ◽

Day Treatment ◽

Hospital Readmissions ◽

Emergency Department Visits ◽

Johns Hopkins Hospital ◽

National Guidelines ◽

Short Course

Abstract Background National guidelines recommend 10 days of antibiotics for children with community-acquired pneumonia (CAP), acknowledging that the outcomes of children hospitalized with CAP who receive shorter durations of therapy have not been evaluated. Methods We conducted a comparative effectiveness study of children aged ≥6 months hospitalized at The Johns Hopkins Hospital who received short-course (5–7 days) vs prolonged-course (8–14 days) antibiotic therapy for uncomplicated CAP between 2012 and 2018 using an inverse probability of treatment weighted propensity score analysis. Inclusion was limited to children with clinical and radiographic criteria consistent with CAP, as adjudicated by 2 infectious diseases physicians. Children with tracheostomies; healthcare-associated, hospital-acquired, or ventilator-associated pneumonia; loculated or moderate to large pleural effusion or pulmonary abscess; intensive care unit stay >48 hours; cystic fibrosis/bronchiectasis; severe immunosuppression; or unusual pathogens were excluded. The primary outcome was treatment failure, a composite of unanticipated emergency department visits, outpatient visits, hospital readmissions, or death (all determined to be likely attributable to bacterial pneumonia) within 30 days after completing antibiotic therapy. Results Four hundred and thirty-nine patients met eligibility criteria; 168 (38%) patients received short-course therapy (median, 6 days) and 271 (62%) received prolonged-course therapy (median, 10 days). Four percent of children experienced treatment failure, with no differences observed between patients who received short-course vs prolonged-course antibiotic therapy (odds ratio, 0.48; 95% confidence interval, .18–1.30). Conclusions A short course of antibiotic therapy (approximately 5 days) does not increase the odds of 30-day treatment failure compared with longer courses for hospitalized children with uncomplicated CAP.

Healthcare-Associated Pneumonia and Hospital-Acquired Pneumonia: Bacterial Aetiology, Antibiotic Resistance and Treatment Outcomes: A Study From North India

Lung ◽

10.1007/s00408-018-0117-7 ◽

2018 ◽

Vol 196 (4) ◽

pp. 469-479

Author(s):

Sandeep Kumar ◽

Rafi Ahmed Jan ◽

Bashir Ahmad Fomda ◽

Roohi Rasool ◽

Parvaiz Koul ◽

...

Keyword(s):

Antibiotic Resistance ◽

Treatment Outcomes ◽

North India ◽

Bacterial Aetiology ◽

Healthcare Associated ◽

Pneumonia

10.1093/med/9780199568741.003.0129 ◽

2018 ◽

Author(s):

Pippa Newton

Keyword(s):

Nosocomial Pneumonia ◽

Acute Infection ◽

Healthcare Setting ◽

Pulmonary Parenchyma ◽

Post Intubation ◽

Hospital Acquired ◽

Symptoms And Signs

Pneumonia is defined as acute infection of the pulmonary parenchyma, presenting with consistent symptoms and signs and associated with new radiographic shadowing. It may be acute or chronic in onset and involve either one area of a lung (e.g. lobar pneumonia) or be multifocal in nature. It may be community acquired or hospital acquired. Community- acquired pneumonia is defined as pneumonia occurring in an individual with no recent contact with a healthcare setting, or in a patient admitted to hospital with development of symptoms and/or signs of pneumonia within 48 hours of admission. Hospital-acquired pneumonia or nosocomial pneumonia occurs when a patient develops symptoms or signs of pneumonia after 48 hours of admission to a healthcare setting or in the context of a long-term nursing home resident. A subtype of nosocomial pneumonia is ventilator-associated pneumonia, defined as pneumonia occurring at least 48–72 hours post intubation.

Incidence and outcomes of hospitalization for community-acquired, ventilator-associated and non-ventilator hospital-acquired pneumonias in patients with type 2 diabetes mellitus in Spain

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001447 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001447

Author(s):

Ana Lopez-de-Andres ◽

Romana Albadalejo-Vicente ◽

Javier de Miguel-Diez ◽

Valentin Hernandez-Barrera ◽

Zichen Ji ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Incidence Rates ◽

Older Age ◽

Design And Methods ◽

IntroductionTo describe the incidence and compare in-hospital outcomes of community-acquired pneumonia (CAP), ventilator-associated pneumonia (VAP) and non-ventilator hospital-acquired pneumonia (NV-HAP) among patients with or without type 2 diabetes mellitus (T2DM) using propensity score matching.Research design and methodsThis was a retrospective observational epidemiological study using the 2016–2017 Spanish Hospital Discharge Records.ResultsOf 245 221 admissions, CAP was identified in 227 524 (27.67% with T2DM), VAP was identified in 2752 (18.31% with T2DM) and NV-HAP was identified in 14 945 (25.75% with T2DM). The incidence of pneumonia was higher among patients with T2DM (CAP: incidence rate ratio (IRR) 1.44, 95% CI 1.42 to 1.45; VAP: IRR 1.24, 95% CI 1.12 to 1.37 and NV-HAP: IRR 1.38, 95% CI 1.33 to 1.44). In-hospital mortality (IHM) for CAP was 12.74% in patients with T2DM and 14.16% in matched controls (p<0.001); in patients with VAP and NV-HAP, IHM was not significantly different between those with and without T2DM (43.65% vs 41.87%, p=0.567, and 29.02% vs 29.75%, p=0.484, respectively). Among patients with T2DM, older age and dialysis were factors associated with IHM for all types of pneumonia. In patients with VAP, the risk of IHM was higher in females (OR 1.95, 95% CI 1.28 to 2.96).ConclusionThe incidence rates of all types of pneumonia were higher in patients with T2DM. Higher mortality rates in patients with T2DM with any type of pneumonia were associated with older age, comorbidities and dialysis.