Nosocomial Pneumonia in the Era of Multidrug-Resistance: Updates in Diagnosis and Management

Nosocomial pneumonia (NP), including hospital-acquired pneumonia in non-intubated patients and ventilator-associated pneumonia, is one of the most frequent hospital-acquired infections, especially in the intensive care unit. NP has a significant impact on morbidity, mortality and health care costs, especially when the implicated pathogens are multidrug-resistant ones. This narrative review aims to critically review what is new in the field of NP, specifically, diagnosis and antibiotic treatment. Regarding novel imaging modalities, the current role of lung ultrasound and low radiation computed tomography are discussed, while regarding etiological diagnosis, recent developments in rapid microbiological confirmation, such as syndromic rapid multiplex Polymerase Chain Reaction panels are presented and compared with conventional cultures. Additionally, the volatile compounds/electronic nose, a promising diagnostic tool for the future is briefly presented. With respect to NP management, antibiotics approved for the indication of NP during the last decade are discussed, namely, ceftobiprole medocaril, telavancin, ceftolozane/tazobactam, ceftazidime/avibactam, and meropenem/vaborbactam.

Download Full-text

Acinetobacter baumanniiInfection and IL-17 Mediated Immunity

Mediators of Inflammation ◽

10.1155/2016/9834020 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Zihe Yan ◽

Junjun Yang ◽

Renjing Hu ◽

Xichi Hu ◽

Kong Chen

Keyword(s):

Immune Response ◽

Acinetobacter Baumannii ◽

Military Personnel ◽

Potential Role ◽

Multidrug Resistant ◽

Interleukin 17 ◽

Hospital Acquired Infections ◽

Host Pathogen Interaction ◽

Hospital Acquired

Acinetobacter baumanniiis a significant cause of severe hospital-acquired infections with a recent rise in multidrug-resistant infections involving traumatic wounds of military personnel. The interleukin-17 (IL-17) pathway is essential for neutrophil recruitment in response to a variety of pathogens, while the control ofA. baumanniiinfection is known to be dependent on neutrophils. This suggests that IL-17 may play an important role inA. baumanniiinfection; however, this has yet to be studied. Here, we summarize the recent advances in understanding the host-pathogen interaction ofA. baumanniiand propose a potential role of the IL-17 pathway in generating a protective immune response.

Download Full-text

Adaptation to Adversity: the Intermingling of Stress Tolerance and Pathogenesis in Enterococci

Microbiology and Molecular Biology Reviews ◽

10.1128/mmbr.00008-19 ◽

2019 ◽

Vol 83 (3) ◽

Cited By ~ 4

Author(s):

Anthony O. Gaca ◽

José A. Lemos

Keyword(s):

Gastrointestinal Tract ◽

Immune Responses ◽

Stress Tolerance ◽

Molecular Mechanisms ◽

Multidrug Resistant ◽

Innate Immune ◽

Innate Immune Responses ◽

Hospital Acquired Infections ◽

Hospital Acquired

SUMMARY Enterococcus is a diverse and rugged genus colonizing the gastrointestinal tract of humans and numerous hosts across the animal kingdom. Enterococci are also a leading cause of multidrug-resistant hospital-acquired infections. In each of these settings, enterococci must contend with changing biophysical landscapes and innate immune responses in order to successfully colonize and transit between hosts. Therefore, it appears that the intrinsic durability that evolved to make enterococci optimally competitive in the host gastrointestinal tract also ideally positioned them to persist in hospitals, despite disinfection protocols, and acquire new antibiotic resistances from other microbes. Here, we discuss the molecular mechanisms and regulation employed by enterococci to tolerate diverse stressors and highlight the role of stress tolerance in the biology of this medically relevant genus.

Download Full-text

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 ◽

Community Acquired Pneumonia ◽

Traditional Classification ◽

Hospital Acquired Pneumonia ◽

Health Care Associated Pneumonia ◽

Hospital Acquired

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

Download Full-text

Prospective, comparative clinical study between high-dose colistin monotherapy and colistin–meropenem combination therapy for treatment of hospital-acquired pneumonia and ventilator-associated pneumonia caused by multidrug-resistant Klebsiella pneumoniae

Journal of Global Antimicrobial Resistance ◽

10.1016/j.jgar.2018.07.003 ◽

2018 ◽

Vol 15 ◽

pp. 127-135 ◽

Cited By ~ 6

Author(s):

Mohamed Farouk Ahmed Abdelsalam ◽

Maged Salah Abdalla ◽

Hanan Salah El-Din El-Abhar

Keyword(s):

Clinical Study ◽

Combination Therapy ◽

Klebsiella Pneumoniae ◽

Multidrug Resistant ◽

High Dose ◽

Ventilator Associated Pneumonia ◽

Comparative Clinical Study ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired

Download Full-text

Complete Genome Sequence of Klebsiella pneumoniae Phage Sweeny

Microbiology Resource Announcements ◽

10.1128/mra.01047-19 ◽

2019 ◽

Vol 8 (39) ◽

Cited By ~ 1

Author(s):

Nicholas Martinez ◽

Eric Williams ◽

Heather Newkirk ◽

Mei Liu ◽

Jason J. Gill ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Complete Genome Sequence ◽

Protein Level ◽

Multidrug Resistant ◽

Content Type ◽

Hospital Acquired Infections ◽

Multidrug Resistant Bacterium ◽

Protein Encoding ◽

Hospital Acquired ◽

Encoding Genes

Klebsiella pneumoniae is a multidrug-resistant bacterium causing many severe hospital-acquired infections. Here, we describe siphophage Sweeny that infects K. pneumoniae. Of its 78 predicted protein-encoding genes, a functional assignment was given to 36 of them. Sweeny is most closely related to T1-like phages at the protein level.

Download Full-text

Hospital-acquired infections due to multidrug-resistant organisms in Hungary, 2005-2010

Eurosurveillance ◽

10.2807/ese.18.02.20352-en ◽

2013 ◽

Vol 18 (2) ◽

Author(s):

S Caini ◽

A Hajdu ◽

A Kurcz ◽

K Böröcz

Keyword(s):

Infection Control ◽

Multidrug Resistant ◽

Special Focus ◽

Gram Negative ◽

Hospital Acquired Infections ◽

Health Authorities ◽

Multidrug Resistant Organisms ◽

Public Health Authorities ◽

Gram Negative Organisms ◽

Hospital Acquired

Healthcare-associated infections caused by multidrug-resistant organisms are associated with prolonged medical care, worse outcome and costly therapies. In Hungary, hospital-acquired infections (HAIs) due to epidemiologically important multidrug-resistant organisms are notifiable by law since 2004. Overall, 6,845 case-patients (59.8% men; median age: 65 years) were notified in Hungary from 2005 to 2010. One third of case-patients died in hospital. The overall incidence of infections increased from 5.4 in 2005 to 14.7 per 100,000 patient-days in 2010. Meticillin-resistant Staphylococcus aureus (MRSA) was the most frequently reported pathogen (52.2%), but while its incidence seemed to stabilise after 2007, notifications of multidrug-resistant Gram-negative organisms have significantly increased from 2005 to 2010. Surgical wound and bloodstream were the most frequently reported sites of infection. Although MRSA incidence has seemingly reached a plateau in recent years, actions aiming at reducing the burden of HAIs with special focus on Gram-negative multidrug-resistant organisms are needed in Hungary. Continuing promotion of antimicrobial stewardship, infection control methodologies, reinforced HAI surveillance among healthcare and infection control practitioners, and engagement of stakeholders, hospital managers and public health authorities to facilitate the implementation of existing guidelines and protocols are essential.

Download Full-text

Hospital-Acquired Pneumonia = Nosocomial Pneumonia

Encyclopedia of Intensive Care Medicine ◽

10.1007/978-3-642-00418-6_1710 ◽

2012 ◽

pp. 1152-1152

Author(s):

Jeffrey N. Harr ◽

Philip F. Stahel ◽

Phillip D. Levy ◽

Antoine Vieillard-Baron ◽

Yang Xue ◽

...

Keyword(s):

Nosocomial Pneumonia ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired

Download Full-text

Abstract WP366: Readmission for an Infection After a Stroke Admission: The Role of Hospital Acquired Infections

Stroke ◽

10.1161/str.50.suppl_1.wp366 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Amelia K Boehme ◽

Maitreyi Oka ◽

Bevin Cohen ◽

Barun Mathema ◽

Elaine Larson

Keyword(s):

Hospital Acquired Infections ◽

Hospital Acquired

Download Full-text

In Vitro Antifungal Combination of Flucytosine with Amphotericin B, Voriconazole, or Micafungin against Candida auris Shows No Antagonism

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01393-19 ◽

2019 ◽

Vol 63 (12) ◽

Cited By ~ 8

Author(s):

A. L. Bidaud ◽

F. Botterel ◽

A. Chowdhary ◽

E. Dannaoui

Keyword(s):

Amphotericin B ◽

Inhibitory Concentration ◽

Geometric Mean ◽

Multidrug Resistant ◽

Candida Auris ◽

Content Type ◽

Hospital Acquired Infections ◽

Resistant Mutants ◽

Hospital Acquired

ABSTRACT Candida auris is an emerging, multidrug-resistant pathogen responsible for invasive hospital-acquired infections. Flucytosine is an effective anti-Candida species drug, but which cannot be used as a monotherapy because of the risk of development of resistant mutants during treatment. It is, therefore, noteworthy to test possible combinations with flucytosine that may have a synergistic interaction. In this study, we determined the in vitro interaction between flucytosine and amphotericin B, micafungin, or voriconazole. These combinations have been tested against 15 C. auris isolates. The MIC ranges (geometric mean [Gmean]) of flucytosine, amphotericin B, micafungin, and voriconazole were 0.125 to 1 μg/ml (0.42 μg/ml), 0.25 to 1 μg/ml (0.66 μg/ml), 0.125 to 0.5 μg/ml (0.3 μg/ml), and 0.03 to 4 μg/ml (1.05 μg/ml), respectively. When tested in combination, indifferent interactions were mostly observed with fractional inhibitory concentration index values from 0.5 to 1, 0.31 to 1.01, and 0.5 to 1.06 for the combinations of flucytosine with amphotericin B, micafungin, and voriconazole, respectively. A synergy was observed for the strain CBS 10913 from Japan. No antagonism was observed for any combination. The combination of flucytosine with amphotericin B or micafungin may be relevant for the treatment of C. auris infections.

Download Full-text