scholarly journals Current microbiological aspects of community respiratory infection beyond COVID-19

2021 ◽  
Vol 34 (2) ◽  
pp. 81-92
Author(s):  
Rafael Cantón ◽  
Keyword(s):  
Respiratory Infection ◽  
Ecological Impact ◽  
Antimicrobial Treatment ◽  
The State ◽  
Intrinsic Activity ◽  
Chronic Obstructive ◽  
Beta Lactam ◽  
Bacterial Populations ◽  
Vaccination Programs ◽  
Mutant Prevention Concentration

From a microbiological point of view, both empirical and targeted antimicrobial treatment in respiratory infection is based on the sensitivity profile of isolated microorganisms and the possible resistance mechanisms that they may present. The latter may vary in different geographic areas according to prescription profiles and vaccination programs. Beta-lactam antibiotics, fluoroquinolones, and macrolides are the most commonly used antimicrobials during the exacerbations of chronic obstructive pulmonary disease and community-acquired pneumonia. In their prescription, different aspects such as intrinsic activity, bactericidal effect or their ability to prevent the development of resistance must be taken into account. The latter is related to the PK/PD parameters, the mutant prevention concentration and the so-called selection window. More recently, the potential ecological impact has grown in importance, not only on the intestinal microbiota, but also on the respiratory one. Maintaining the state of eubiosis requires the use of antimicrobials with a low profile of action on anaerobic bacteria. With their use, the resilience of the bacterial populations belonging to the microbiota, the state of resistance of colonization and the collateral damage related to the emergence of resistance to the antimicrobials in pathogens causing the infections and in the bacterial populations integrating the microbiota.

scholarly journals Bacterial superinfections among persons with coronavirus disease 2019:A comprehensive review of data from postmortem studies

2021 ◽  
Author(s):  
Cornelius J Clancy ◽  
Ilan S Schwartz ◽  
Brittany Kula ◽  
M Hong Nguyen
Keyword(s):  
Rank Order ◽  
Diffuse Alveolar Damage ◽  
Antimicrobial Treatment ◽  
Beta Lactam ◽  
Quality Of Data ◽  
Major Objective ◽  
Postmortem Studies ◽  
Lung Infections ◽  
Histopathologic Findings

Abstract Background Limited clinical data suggest ~16% prevalence of bacterial superinfections among critically ill patients with coronavirus disease 2019 (COVID-19). Methods We reviewed postmortem studies of patients with COVID-19 published in English through 26 September 2020 for histopathologic findings consistent with bacterial lung infections. Results Worldwide, 621 patients from 75 studies were included. The quality of data was uneven, likely because identifying superinfections was not a major objective in 96% (72/75) of studies. Histopathology consistent with potential lung superinfection was reported in 32% (200/621) of patients (22-96 years old; 66% men). Types of infections were pneumonia (95%), abscesses or empyema (3.5%), and septic emboli (1.5%). Seventy-three percent of pneumonias were focal rather than diffuse. Predominant histopathologic findings were intra-alveolar neutrophilic infiltrations that were distinct from those typical of COVID-19-associated diffuse alveolar damage. In studies with available data, 79% of patients received antimicrobial treatment; most common agents were beta-lactam/beta-lactamase inhibitors (48%), macrolides (16%), cephalosoprins (12%), and carbapenems (6%). Superinfections were proven by direct visualization or recovery of bacteria in 25.5% (51/200) of potential cases, and 8% of all patients in postmortem studies. In rank order, pathogens included Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella pneumoniae. Lung superinfections were causes of death in 16% of potential cases, and 3% of all patients with COVID-19. Conclusions Potential bacterial lung superinfections were evident at postmortem examination in 32% of persons who died with COVID-19 (proven, 8%; possible, 24%), but they were uncommonly the cause of death.

scholarly journals Seroprevalence of Antibodies against Diphtheria, Tetanus and Pertussis in Adult At-Risk Patients

Vaccines ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 18
Author(s):  
Lise Boey ◽  
Eline Bosmans ◽  
Liane Braz Ferreira ◽  
Nathalie Heyvaert ◽  
Melissa Nelen ◽  
...  
Keyword(s):  
At Risk ◽  
Chronic Diseases ◽  
Age Groups ◽  
Chronic Obstructive ◽  
Solid Organ ◽  
Recent Infection ◽  
Vaccination Programs ◽  
Vaccine Preventable Diseases ◽  
Increased Risk ◽  
Risk Patients

Patients with chronic diseases are at increased risk of complications following infection. It remains, however, unknown to what extend they are protected against vaccine-preventable diseases. We assessed seroprevalence of antibodies against diphtheria, tetanus and pertussis to evaluate whether current vaccination programs in Belgium are adequate. Antibody titers were assessed with a bead-based multiplex assay in serum of 1052 adults with chronic diseases. We included patients with diabetes mellitus type 1 (DM1) (n = 172), DM2 (n = 77), chronic kidney disease (n = 130), chronic obstructive pulmonary disease (COPD) (n = 170), heart failure (n = 77), HIV (n = 196) and solid organ transplant (SOT) recipients (n = 230). Factors associated with seroprevalence were analysed with multiple logistic regression. We found seroprotective titers in 29% for diphtheria (≥0.1 IU/mL), in 83% for tetanus (≥0.1 IU/mL) and 22% had antibodies against pertussis (≥5 IU/mL). Seroprotection rates were higher (p < 0.001) when vaccinated within the last ten years. Furthermore, diphtheria seroprotection decreased with age (p < 0.001). Tetanus seroprotection was less reached in women (p < 0.001) and older age groups (p < 0.001). For pertussis, women had more often a titer suggestive of a recent infection or vaccination (≥100 IU/mL, p < 0.01). We conclude that except for tetanus, the vast majority of at-risk patients remains susceptible to vaccine-preventable diseases such as diphtheria and pertussis.

scholarly journals Adult Patient Care Plan: Management of the Febrile Neutropenic Cancer Patient on an Outpatient Basis

2000 ◽  
Vol 11 (suppl d) ◽  
pp. 27D-33D ◽  
Author(s):  
Coleman Rotstein ◽  
Eric J Bow ◽  
Keyword(s):  
Performance Status ◽  
Single Agent ◽  
Dose Intensity ◽  
Underlying Disease ◽  
Antimicrobial Treatment ◽  
The State ◽  
Care Plan ◽  
Invasive Infection ◽  
Outpatient Basis ◽  
Comorbid Conditions

Invasive infection may complicate the course of neutropenic cancer patients receiving intensive chemotherapy. The rate of complications is related to prognostic factors including the underlying malignant diagnosis, the state of responsiveness of the underlying disease to treatment, the dose-intensity of the cytotoxic therapy, the duration of neutropenia, the performance status of the patient and comorbid conditions. The pathogens involved are usually the patients’ endogenous microflora, and the sites of infection are those anatomic sites colonized with the endogenous microflora. The approach to the febrile neutropenic episode requires a sequence of steps including the recognition of the febrile state (oral temperature higher than 38°C), the depth and duration of the neutropenia (absolute neutrophil count less than 0.5×109/L), the identification of a clinical focus of infection and a potential pathogen, the administration of empirical antibacterial therapy, and finally, an assessment of the outcome. Management decisions about whether to treat with oral or parenteral antibacterial agents, with a combination or single agent therapy, or as an inpatient or an outpatient can be based on an assessments of risks of the severity of the patient’s comorbid conditions and the patient’s risk of developing medical complications that would require inpatient management. The duration of antimicrobial treatment depends on the recovery from the state of neutropenia and the origin of the infectious process.

scholarly journals Mycoplasma pneumoniae may cause dyspnoea and hospitalisations in young healthy adults

2021 ◽  
Author(s):  
Riku Metsälä ◽  
Solja Ala-Korpi ◽  
Juha Rannikko ◽  
Merja Helminen ◽  
Marjo Renko
Keyword(s):  
Respiratory Tract ◽  
Mycoplasma Pneumoniae ◽  
Hospital Setting ◽  
Health Condition ◽  
Clinical Findings ◽  
Antimicrobial Treatment ◽  
University Hospital ◽  
Upper Respiratory Tract ◽  
Beta Lactam ◽  
Beta Lactam Antibiotics

AbstractPolymerase chain reaction (PCR)-based diagnostics for Mycoplasma pneumoniae (M. pneumoniae) from the respiratory tract has become widely available, but the interpretation of the results remains unclear. M. pneumoniae has been suggested to cause mainly mild and self-limiting infections or asymptomatic carriage. However, systematic analyses of the association between PCR results and clinical findings are scarce. This study aimed to clarify the clinical features of PCR-positive M. pneumoniae infections in a hospital setting. We reviewed 103 PCR-positive patients cared for in a university hospital during a 3-year period. Data on age, sex, health condition, acute symptoms, other pathogens found, laboratory and X-ray results and treatments were collected. Over 85% of the patients had a triad of typical symptoms: fever, cough and shortness of breath. Symptoms in the upper respiratory tract were rare. In 91% of the cases, M. pneumoniae was the only pathogen found. The highest incidence was found in the age group of 30–40 years, and 68% of the patients did not have any underlying diseases. Most patients were initially empirically treated with beta-lactam antibiotics and needed 2–4 changes in their treatment. Only 6% were discharged without an antibiotic effective against M. pneumoniae. This study shows that M. pneumoniae often led to hospitalisation and that patients needed appropriate antimicrobial treatment to recover. Mixed infections were rare, and situations that could be interpreted as carriage did not occur.

Bronchodilator and anti-inflammatory therapy of chronic obstructive pulmonary disease from the position of interchangeability

2021 ◽  
Vol 31 (4) ◽  
pp. 518-529
Author(s):  
E. A. Orlova ◽  
I. P. Dorfman ◽  
M. A. Orlov ◽  
A. K. Andreeva ◽  
M. A. Abdullaev
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Generic Drugs ◽  
The State ◽  
Chronic Obstructive ◽  
Anticholinergic Drugs ◽  
Adherence To Treatment ◽  
Obstructive Pulmonary Disease ◽  
State Register ◽  
Anti Inflammatory

The choice of drugs used to treat patients with chronic obstructive pulmonary disease (COPD) (inhaled β-agonists, M-anticholinergic drugs, inhaled corticosteroids (ICS)) in view of their interchangeability is reviewed in this article. This aspect is especially important for clinicians when choosing an effective and safe treatment for COPD and for increasing patient adherence to treatment.The aim of this study was to assess the ratio of the number of reference (original), interchangeable, and generic drugs used in COPD.Methods. In accordance with the Russian clinical guidelines 2018 and GOLD 2019, modern drugs for the treatment of COPD with bronchodilator and anti-inflammatory activity were selected. All trade names of the corresponding drugs for each international non-proprietary name (INN) In the State Register of Medicines website were considered. The information on the availability of reference (original) drugs and the corresponding interchangeable products, as well as their presence in the List of vital and essential drugs was analyzed.Results. A large number of generic prodcuts are registered in the State Register of Medicines, and only a few of them are interchangeable with the corresponding reference (original) drug.Conclusion. The analysis will help widen the doctors’ choice of interchangeable drugs in treatment of COPD with an equivalent effect and safety of reference drugs, as well as to increase the patients’ adherence to treatment.

scholarly journals Combination antibiotic therapy versus monotherapy in the treatment of acute exacerbations of chronic obstructive pulmonary disease: an open-label randomized trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Phuong Nguyen Thi Thu ◽  
Minh Ngo Thị Huong ◽  
Ngan Tran Thi ◽  
Hoi Nguyen Thanh ◽  
Khue Pham Minh
Keyword(s):  
Clinical Success ◽  
Chronic Obstructive ◽  
Gram Negative Bacteria ◽  
Beta Lactam ◽  
Open Label ◽  
Obstructive Pulmonary Disease ◽  
Gram Negative ◽  
Copd Exacerbations ◽  
Beta Lactam Antibiotics ◽  
Acute Exacerbations

Abstract Background The role of antibiotics in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations and their effectiveness in combination have not been clearly established. To determine whether using a combination of fluoroquinolones and beta-lactams improves the clinical and microbiological efficacy of antibiotics on day 20 of treatment, we conducted an open-label randomized trial based on clinical outcomes, microbiological clearance, spirometry tests, and signs of systemic inflammation in patients hospitalized with acute exacerbations of COPD. Methods We enrolled 139 subjects with COPD exacerbations, defined as acute worsening of respiratory symptoms leading to additional treatment. Patients were divided randomly into two groups: 79 patients using beta-lactam antibiotics alone and 60 using beta-lactam antibiotics plus fluoroquinolones. Clinical and microbiological responses, spirometry tests, symptom scores, and serum C-reactive protein (CRP) levels were evaluated. Results Clinical success, lung function, and symptoms were similar in patients with or without fluoroquinolone administration on days 10 and 20. Combination therapy was superior in terms of microbiological outcomes and reduction in serum CRP value. Although equivalent to monotherapy in terms of clinical success, the combination showed superiority in terms of microbiological success and a decrease in CRP. The combination therapy group had a higher microbiological success rate with gram-negative bacteria than the monotherapy group with Pseudomonas aeruginosa (100% vs. 33.3%, respectively) and Acinetobacter baumanii (100% vs. 20%, respectively) (P < 0.05). Conclusions Concomitant use of fluoroquinolone and beta-lactam antibiotics for bacterial infections during COPD exacerbations caused by gram-negative bacteria appear to be effective and should be applied in clinical practice.

Clinical, Radiological and Laboratory Profile of Covid-19 Patients Admitted to a Dedicated Covid-19 Hospital in Odisha

2021 ◽  
Vol 8 (15) ◽  
pp. 989-993
Author(s):  
Mohan Rao C ◽  
Nipa Singh ◽  
Kinshuk Sarbhai ◽  
Saswat Subhankar ◽  
Sanghamitra Pati ◽  
...  
Keyword(s):  
Laboratory Data ◽  
Ct Images ◽  
The State ◽  
Viral Clearance ◽  
Clinical Profile ◽  
Chronic Obstructive ◽  
Laboratory Findings ◽  
Obstructive Pulmonary Disease ◽  
Reactive Protein ◽  
Set Up

BACKGROUND The Covid-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a public health challenge being faced by the world currently. International and national responses to combat the Covid-19 pandemic have been very prompt with the setting up of dedicated Covid-19 hospitals. In the state of Odisha, situated in the eastern part of India, Kalinga Institute of Medical Sciences (KIMS), set up the first dedicated Covid hospital of the state. This study intends to chronicle the clinical profile, radiological presentations, laboratory findings, and clinical outcome of patients admitted to the KIMS Covid hospital. METHODS A retrospective analysis of the clinical and laboratory data of patients admitted with Covid-19 diagnosis at the dedicated Covid-19 hospital from 5th April 2020 to 4th June 2020 was done. RESULTS A total number of 272 Covid-19 cases were included in this study. Majority of the patients were males (83.57 %) and most of the patients (79.04 %) were asymptomatic. The mortality rate was 1.9 %. Fever (18.38 %), cough (17.27 %), dyspnoea (16.91 %) and myalgia (14.7 %) were the major symptoms observed. Severity was mild in 78.94 % cases. Delayed viral clearance was seen in 13 % cases. The typical features of novel SARS-CoV-2 infection was seen in 12 - 13 % cases in computed tomography (CT) images of thorax. c-reactive protein (CRP) was raised as a biomarker of inflammation. Of the 5 deaths encountered, 2 had diabetes mellitus, 2 were hypertensive and 1 had chronic obstructive pulmonary disease (COPD). CONCLUSIONS Covid-19 may have a delayed viral clearance beyond two weeks. A discordance between CT images and the clinical condition may also be observed. Diabetes, hypertension, and high blood CRP levels were significantly associated with mortality. KEYWORDS Covid-19, SARS-CoV-2, Clinical Profile, Radiological Findings, Comorbidities, Fatality

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