scholarly journals Comprehensive Description of Pathogens and Antibiotic Treatment Guidance in Children With Community-Acquired Pneumonia Using Combined Mass Spectrometry Methods

2021 ◽  
Vol 11 ◽  
Author(s):  
Liying Sun ◽  
Chi Zhang ◽  
Shuhua An ◽  
Xiangpeng Chen ◽  
Yamei Li ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Community Acquired Pneumonia ◽  
Molecular Testing ◽  
Respiratory Pathogens ◽  
National Guidelines ◽  
Culture Methods ◽  
Identification Rate ◽  
Infection Pattern

The objective of this study was to evaluate the value of molecular methods in the management of community-acquired pneumonia (CAP) in children. Previously developed mass spectrometry (MS)-based methods combined with quantitative real-time PCR (combined-MS methods) were used to describe the aetiology and evaluate antibiotic therapy in the enrolled children. Sputum collected from 302 children hospitalized with CAP were analyzed using the combined-MS methods, which can detect 19 viruses and 12 bacteria related to CAP. Based on the results, appropriate antibiotics were determined using national guidelines and compared with the initial empirical therapies. Respiratory pathogens were identified in 84.4% of the patients (255/302). Co-infection was the predominant infection pattern (51.7%, 156/302) and was primarily a bacterial-viral mixed infection (36.8%, 111/302). Compared with that using culture-based methods, the identification rate for bacteria using the combined-MS methods (61.8%, 126/204) increased by 28.5% (p <0.001). Based on the results of the combined-MS methods, the initial antibiotic treatment of 235 patients was not optimal, which mostly required switching to β-lactam/β-lactamase inhibitor combinations or reducing unnecessary macrolide treatments. Moreover, using the combined-MS methods to guide antibiotic therapy showed potential to decrease the length of stay in children with severe CAP. For children with CAP, quantitative molecular testing on sputum can serve as an important complement to traditional culture methods. Early aetiology elucidated using molecular testing can help guide the antibiotic therapy.

scholarly journals Comprehensive Molecular Testing for Respiratory Pathogens in Community-Acquired Pneumonia

2016 ◽  
Vol 62 (7) ◽  
pp. 817-823 ◽  
Author(s):  
Naomi J. Gadsby ◽  
Clark D. Russell ◽  
Martin P. McHugh ◽  
Harriet Mark ◽  
Andrew Conway Morris ◽  
...  
Keyword(s):  
Community Acquired Pneumonia ◽  
Molecular Testing ◽  
Respiratory Pathogens

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

2020 ◽  
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 ◽  
Community Acquired Pneumonia ◽  
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.

scholarly journals Clinical Factors Associated with a Shorter or Longer Course of Antibiotic Treatment in Patients with Exacerbations of Bronchiectasis: A Prospective Cohort Study

2019 ◽  
Vol 8 (11) ◽  
pp. 1950
Author(s):  
Giulia Scioscia ◽  
Rosanel Amaro ◽  
Victoria Alcaraz-Serrano ◽  
Albert Gabarrús ◽  
Patricia Oscanoa ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Prospective Observational Study ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Clinical Factors ◽  
Treatment Results ◽  
Factors Associated ◽  
Long Term Oxygen Therapy

Background: Bronchiectasis exacerbations are often treated with prolonged antibiotic use, even though there is limited evidence for this approach. We therefore aimed to investigate the baseline clinical and microbiological findings associated with long courses of antibiotic treatment in exacerbated bronchiectasis patients. Methods: This was a bi-centric prospective observational study of bronchiectasis exacerbated adults. We compared groups receiving short (≤14 days) and long (15–21 days) courses of antibiotic treatment. Results: We enrolled 191 patients (mean age 72 (63, 79) years; 108 (56.5%) females), of whom 132 (69%) and 59 (31%) received short and long courses of antibiotics, respectively. Multivariable logistic regression of the baseline variables showed that long-term oxygen therapy (LTOT), moderate–severe exacerbations, and microbiological isolation of Pseudomonas aeruginosa were associated with long courses of antibiotic therapy. When we excluded patients with a diagnosis of community-acquired pneumonia (n = 49), in the model we found that an etiology of P. aeruginosa remained as factor associated with longer antibiotic treatment, with a moderate and a severe FACED score and the presence of arrhythmia as comorbidity at baseline. Conclusions: Decisions about the duration of antibiotic therapy should be guided by clinical and microbiological assessments of patients with infective exacerbations.

The impact of national recommendations on antibiotic treatment of community acquired pneumonia. Do pediatricians follow the national guidelines?

2017 ◽  
Author(s):  
Grażyna Kraj ◽  
Katarzyna Krenke ◽  
Joanna Peradzyńska ◽  
Julita Chądzyńska ◽  
Krystian Wołoszyn ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Community Acquired Pneumonia ◽  
National Guidelines ◽  
The Impact

scholarly journals Molecular Testing of Serial Blood Specimens from Patients with Early Lyme Disease during Treatment Reveals Changing Coinfection with Mixtures ofBorrelia burgdorferiGenotypes

2019 ◽  
Vol 63 (7) ◽  
Author(s):  
Michael R. Mosel ◽  
Heather E. Carolan ◽  
Alison W. Rebman ◽  
Steven Castro ◽  
Christian Massire ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Lyme Disease ◽  
Antibiotic Therapy ◽  
Electrospray Ionization ◽  
Direct Detection ◽  
Molecular Testing ◽  
Ionization Mass ◽  
Content Type ◽  
Blood Specimens ◽  
Over Time

ABSTRACTBorrelia burgdorferiis the etiological agent of Lyme disease. In the current study, we used direct-detection PCR and electrospray ionization mass spectrometry to monitor and genotypeB. burgdorferiisolates from serially collected whole-blood specimens from patients clinically diagnosed with early Lyme disease before and during 21 days of antibiotic therapy.B. burgdorferiisolates were detected up to 3 weeks after the initiation of antibiotic treatment, with ratios of coinfectingB. burgdorferigenotypes changing over time.

Use of the BioFire Film Array Blood Culture Identification(BCID) Panel(BioFire Diagnostics, Salt Lake City, Utah) on Pleural Fluid Samples in Pediatric Patients Hospitalized for Community Acquired Pneumonia(CAP)

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S141-S141
Author(s):  
D M Drehner ◽  
A Nazario ◽  
G Franco ◽  
S Riggins ◽  
A Cadilla ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Blood Culture ◽  
Antibiotic Therapy ◽  
Pleural Fluid ◽  
Antibiotic Treatment ◽  
Bacterial Culture ◽  
Bacterial Pathogens ◽  
Community Acquired Pneumonia ◽  
Radiographic Findings ◽  
Viral Respiratory

Abstract Introduction/Objective CAP accounts for approximately 124,000 pediatric hospitalizations annually. Those patients often have received antibiotics prior to admission. Many have concurrent viral infections. Bacterial infections accompanying viral respiratory infections are known to increase morbidity and mortality. Traditional bacterial culture methods are often negative because of previous antibiotic therapy. The BCID, a multiplex polymerase chain reaction(PCR) assay, can identify 19 bacterial pathogens in approximately 90 minutes. It is FDA approved for blood culture isolates. We hypothesized it would detect bacterial pathogens in pleural effusions. Methods BCID panels were done on residual pleural fluid samples from 10 patients with severe community acquired pneumonia during the period 5/2018 – 12/2019. The patients had positive radiographic findings of pneumonia, were inpatients, had intact immune systems by clinical history and had received antibiotic therapy for more than 8 hours before specimen collection. Treatment required 133 inpatient days. 6 of 10 were diagnosed with viral respiratory pathogens. 1 of 9 had a positive blood culture. 1 of 10 had a positive pleural fluid culture. Results 10 of 10 pleural fluid specimens were positive for a pathogen on the BCID panel – 8, Streptococcus pneumoniae, 1, Staphylococcus aureus and I, Streptococcus pyogens. Two of ten had confirmatory positive cultures. Also, one pleural fluid gram stain showed gram positive cocci in chains and clusters. The BCID detected Streptococcus pyogens. Anti Streptolysin O was strongly positive, 964(0 – 70) IU/mL. Conclusion The yield of bacterial culture plummets with previous antibiotic treatment. FDA approved multiplex PCR panels have narrowly defined specimen requirements. That increases the cost and decreases test applicability. Despite a history of appropriate immunizations in the sample population Streptococcus pneumoniae may be prevalent in the complex pediatric pneumonia population. The BCID may be effective at pathogen detection in cases of complex pneumonia where patients have received prior antibiotic treatment.

scholarly journals Impact of comprehensive molecular testing to reduce antibiotic use in community-acquired pneumonia (RADICAP): a randomised, controlled, phase IV clinical trial protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e038957
Author(s):  
Gabriela Abelenda-Alonso ◽  
Alexander Rombauts ◽  
Carlota Gudiol ◽  
Yolanda Meije ◽  
Mercedes Clemente ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Antibiotic Therapy ◽  
Treatment Time ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Molecular Testing ◽  
Open Label ◽  
Major Health Problem ◽  
Microbiological Testing ◽  
Randomised Controlled

IntroductionCommunity-acquired pneumonia (CAP) continues to be a major health problem worldwide and is one of the main reasons for prescribing antibiotics. However, the causative agent is often not identified, resulting in antibiotic overtreatment, which is a key driver of antimicrobial resistance and adverse events. We aim to test the hypothesis that comprehensive molecular testing, compared with routine microbiological testing, would be effective in reducing antibiotic use in patients with CAP.Methods and analysisWe will perform a randomised, controlled, open-label clinical trial with two parallel groups (1:1) at two tertiary hospitals between 2020 and 2022. Non-severely immunosuppressed adults hospitalised for CAP will be considered eligible. Patients will be randomly assigned to receive either the experimental diagnosis (comprehensive molecular testing plus routine microbiological testing) or standard diagnosis (only microbiological routine testing). The primary endpoint will be antibiotic consumption measured as days of antibiotic therapy per 1000 patient-days. Secondary endpoints will be de-escalation to narrower antibiotic treatment, time to switch from intravenous to oral antibiotics, days to reaching an aetiological diagnosis, antibiotic-related side effects, length of stay, days to clinical stability, intensive care unit admission, days of mechanical ventilation, hospital readmission up to 30 days after randomisation and death from any cause by 48 hours and 30 days after randomisation. We will need to include 440 subjects to be able to reject the null hypothesis that both groups have equal days of antibiotic therapy per 1000 patient-days with a probability >0.8.Ethics and disseminationEthical approval has been obtained from the Ethics Committee of Bellvitge Hospital (AC028/19) and from the Spanish Medicines and Medical Devices Agency, and it is valid for all participating centres under existing Spanish legislation. Results will be presented at international meetings and will be made available to patients, their caregivers and funders.Trial registration numberClinicalTrials: NCT04158492. EudraCT: 2018-004880-29.

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