Current Issues of Empirical Therapy of Severe Bacterial Community-Acquired Pneumonia During the Season of Respiratory Viral Infections

Progredient growth of morbidity and mortality of patients with community-acquired pneumonia (CAP) requires optimization of treatment including antibacterial therapy. Implementation of molecular-genetic methods of diagnostics of viral and viral-bacterial infections in clinical practice has significantly augmented the conception of etiology of community-acquired pneumonia. Seasonal fluctuation of CAP prevalence corresponds with growth of morbidity of acute respiratory infections and influenza which contribute to the etiological structure of CAP by increasing the risk of infection caused by staphylococci. The synergy between influenza A virus and S.aureus has been shown; it is associated with an increase of virus replication in the presence of specific staphylococcal proteases and the ability of viruses to increase adhesion of S.aureusin the respiratory tract, to decrease phagocytosis of S.aureus by macrophages/neutrophils and production of antimicrobial peptides, as well as to increase the probability of secondary bacterial co-infection. Therefore, the most important requirement for the empiric therapy agents of CAP is high streptococcal and staphylococcal activity. According to the current guidelines on antimicrobial therapy of severe CAP, antipneumococcic cephalosporins, macrolides, and fluoroquinolones are the basic treatment agents, but none of them have the combined high antistaphylococcal and antipneumococcal activity inherent in ceftaroline. The advantages of ceftaroline over ceftriaxone and levofloxacin in terms of the probability of reaching target concentrations for clinically relevant pharmacokinetic/pharmacodynamic parameters are shown. Meta-analysis of randomized clinical trials showed the higher clinical efficacy of ceftaroline in comparison to ceftriaxone with similar adverse event rate. Summarized analysis of antibiotic susceptibility data, pharmacokinetic/pharmacodynamic and clinical data, as well as negative epidemiological trends confirms the necessity of optimization of antimicrobial therapy of CAP for implementation of ceftaroline advantages against pneumococci and staphylococci in comparison to other β-lactams. Therefore, empiric treatment with ceftaroline is the most rational option for the therapy of CAP in critically ill patients during the season of respiratory viral infection.

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Ceftobiprole Perspective: Current and Potential Future Indications

Antibiotics ◽

10.3390/antibiotics10020170 ◽

2021 ◽

Vol 10 (2) ◽

pp. 170 ◽

Cited By ~ 1

Author(s):

Tommaso Lupia ◽

Carlo Pallotto ◽

Silvia Corcione ◽

Lucio Boglione ◽

Francesco Giuseppe De Rosa

Keyword(s):

Bacterial Infections ◽

Life Experiences ◽

Real Life ◽

Empirical Therapy ◽

Bloodstream Infections ◽

Clinical Situation ◽

Community Acquired Pneumonia ◽

Severe Infections ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired

Ceftobiprole combines an excellent spectrum for community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) pathogens, with a low/medium MDR risk, and the β-lactams’ safety in frail patients admitted to the hospital in internal medicine wards which may be at high risk of adverse events by anti-MRSA coverage as oxazolidinones or glycopeptides. We aimed to report the available evidence regarding ceftobiprole use in pneumonia and invasive bacterial infections, shedding light on ceftobiprole stewardship. The clinical application and real-life experiences of using ceftobiprole for bloodstream infections, including infective endocarditis, are limited but nevertheless promising. In addition, extended-spectrum ceftobiprole activity, including Enterococcus faecalis, Enterobacteriaceae, and Pseudomonas aeruginosa, has theoretical advantages for use as empirical therapy in bacteremia potentially caused by a broad spectrum of microorganisms, such as catheter-related bacteremia. In the future, the desirable approach to sepsis and severe infections will be administered to patients according to their clinical situation, the intrinsic host characteristics, the susceptibility profile, and local epidemiology, while the “universal antibiotic strategy” will no longer be adequate.

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Epidemiological and clinical features of acute respiratory infections occurring in St. Petersburg during the 2017–2018 and 2018–2019 epidemic seasons

Journal Infectology ◽

10.22625/2072-6732-2021-13-2-53-60 ◽

2021 ◽

Vol 13 (2) ◽

pp. 53-60

Author(s):

D. A. Guzhov ◽

E. A. Elpaeva ◽

M. A. Egorova ◽

V. A. Eder ◽

I. L. Baranovskya ◽

...

Keyword(s):

Clinical Features ◽

Respiratory Infection ◽

Acute Respiratory Infection ◽

Influenza A ◽

Bacterial Infections ◽

Respiratory Infections ◽

Influenza B Virus ◽

Influenza B ◽

Acute Respiratory Infections ◽

Pharyngeal Wall

Objective: to analyze the epidemiological and clinical features of acute respiratory infections occurring during the St. Petersburg 2017-2018 and 2018-2019 epidemic seasons.Materials and methods: the study included 457 patients, treated in St. Petersburg clinics from 2017-2019, displaying symptoms of acute respiratory infection (ARI), including evaluation of their clinical histories. Pathogen types were determined by polymerase chain reaction (PCR). Data analysis was carried out using mathematical statistics methods using the Statistica 10 software package (StatSoft Inc.).Results: in this study, we examined the epidemiological and clinical features of acute respiratory infections in St. Petersburg occurring during two epidemic seasons, 2017-2018 and 2018-2019. The 2017-2018 season was characterized by a prevalence of infections caused by influenza B viruses and influenza A subtype H3N2 viruses. In the 2018-2019 season, there was a greater number of acute respiratory viral infections (ARVIs) and infections caused by influenza A subtype H1N1pdm; influenza B virus was detected only in isolated cases. In the 2017-2018 sore throats and muscle aches were a characteristic symptom of influenza A H1N1pdm infections, of bacterial infections – only sore throats. It was shown that throat pain and vasodilation of the scleral and soft palate vessels were significantly more frequent in the 2017-2018 season, compared to the 2018-2019 season. Cough and redness of the posterior pharyngeal wall were hallmark signs of ARVIs in the 2018-2019 season.Conclusion: according to the data, each epidemic season is characterized not only by its own type-specific acute respiratory infection frequencies, but also by different clinical manifestation frequencies. For global monitoring, treatment effectiveness evaluation, and refined study of acute respiratory infection clinical features, it is advisable to use approaches which incorporate accurate, specific, and rapid molecular biological methods capable of identifying a broad range of pathogens.

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Epidemiological and clinical features of acute respiratory infections occurring in St. Petersburg during the 2017–2018 and 2018–2019 epidemic seasons

Journal Infectology ◽

10.22625/2072-6732-2020-12-4-65-71 ◽

2020 ◽

Vol 12 (4) ◽

pp. 65-71

Author(s):

D. A. Guzhov ◽

E. A. Elpaeva ◽

M. A. Egorova ◽

V. A. Eder ◽

I. L. Baranovskaya ◽

...

Keyword(s):

Clinical Features ◽

Respiratory Infection ◽

Acute Respiratory Infection ◽

Influenza A ◽

Bacterial Infections ◽

Respiratory Infections ◽

Influenza B Virus ◽

Influenza B ◽

Acute Respiratory Infections ◽

Pharyngeal Wall

Objective: to analyze the epidemiological and clinical features of acute respiratory infections occurring during the St. Petersburg 2017–2018 and 2018–2019 epidemic seasons.Materials and methods: the study included 457 patients, treated in St. Petersburg clinics from 2017–2019, displaying symptoms of acute respiratory infection (ARI), including evaluation of their clinical histories. Pathogen types were determined by polymerase chain reaction (PCR). Data analysis was carried out using mathematical statistics methods using the Statistica 10 software package (StatSoft Inc.).Results: in this study, we examined the epidemiological and clinical features of acute respiratory infections in St. Petersburg occurring during two epidemic seasons, 2017–2018 and 2018–2019. The 2017–2018 season was characterized by a prevalence of infections caused by influenza B viruses and influenza A subtype H3N2 viruses. In the 2018–2019 season, there was a greater number of acute respiratory viral infections (ARVIs) and infections caused by influenza A subtype H1N1pdm; influenza B virus was detected only in isolated cases. In the 2017–2018 sore throats and muscle aches were a characteristic symptom of influenza A H1N1pdm infections, of bacterial infections – only sore throats. It was shown that throat pain and vasodilation of the scleral and soft palate vessels were significantly more frequent in the 2017–2018 season, compared to the 2018–2019 season. Cough and redness of the posterior pharyngeal wall were hallmark signs of ARVIs in the 2018–2019 season.Conclusion: according to the data, each epidemic season is characterized not only by its own type-specific acute respiratory infection frequencies, but also by different clinical manifestation frequencies. For global monitoring, treatment effectiveness evaluation, and refined study of acute respiratory infection clinical features, it is advisable to use approaches which incorporate accurate, specific, and rapid molecular biological methods capable of identifying a broad range of pathogens.

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Respiratory Viruses in Pediatric Necropsies: An Immunohistochemical Study

Pediatric and Developmental Pathology ◽

10.2350/07-02-0229.1 ◽

2009 ◽

Vol 12 (3) ◽

pp. 211-216 ◽

Cited By ~ 13

Author(s):

Débora C. C hong ◽

Sonia M. Raboni ◽

Karla Bueno Abujamra ◽

Daniele M. Marani ◽

Meri B. Nogueira ◽

...

Keyword(s):

Lung Tissue ◽

Influenza A ◽

Bacterial Infections ◽

Pediatric Patients ◽

Respiratory Infections ◽

Epidemiological Data ◽

Respiratory Viruses ◽

Tissue Samples ◽

Histopathological Findings ◽

Positive Results

Infections of the respiratory system are responsible for the majority of hospitalizations and deaths in pediatric patients in developing countries. We selected 177 necropsies of pediatric patients who died as a result of serious respiratory infections. The histopathological findings and epidemiological data were reviewed, and lung tissue samples were separated for immunohistochemistry testing. Conventional immunohistochemistry techniques were used to detect viral antigens in formalin-fixed, paraffin-embedded (FF-PE) lung tissue samples using a pool of monoclonal antibodies against respiratory viruses (respiratory syncytial virus, influenza A and B, adenovirus, and parainfluenza 1, 2, and 3 viruses) as primary antibodies. The histopathological findings were classified into bronchopneumonia (BCP) and interstitial pneumonitis (IP) patterns. The immunohistochemistry results were compared with histopathological patterns and epidemiological data. Positive results for viruses were found in 34% and 62.5% of the BCP and IP cases, respectively. Males and infants below 1 year of age were more frequent in the group that had positive results for viruses. Acute enteritis was the main cause of hospitalization and sepsis the most frequent cause of death in this group. A clear seasonal distribution was observed, with the majority of cases occurring in the 2nd and 3rd trimesters (autumn and winter) of each year in the period studied. Immunohistochemistry is an affordable and easy-to-perform method for viral-antigen detection in FF-PE tissue samples. Although BCP is a classic histopathological pattern found in bacterial infections, it is possible that children with serious respiratory infections had concomitant viral and bacterial infections, regardless of their previous immunologic state.

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La polmonite acquisita in comunità

Medico e Bambino ◽

10.53126/meb40515 ◽

2021 ◽

Vol 40 (8) ◽

pp. 515-518

Author(s):

Alessandra Iacono ◽

Angela Troisi ◽

Federico Marchetti

Keyword(s):

Clinical Practice ◽

Practice Guidelines ◽

Antimicrobial Therapy ◽

Standard Care ◽

Current Practice ◽

Respiratory Infections ◽

Community Acquired Pneumonia ◽

Healthy Children ◽

Short Course ◽

Serious Infections

Community-acquired pneumonia (CAP) is one of the most common serious infections in children. The appropriate duration of antimicrobial therapy is unclear. In current practice antibiotic treatment courses of 10 days are prescribed in mild-moderate CAP, while up to 14-21-day courses in severe and complicated cases. The results of the SAFER (Short-Course Antimicrobial Therapy for Paediatric Respiratory Infections) study found that the “short therapy” appeared to be comparable to standard care for the treatment of previously healthy children with CAP not requiring hospitalization. Clinical practice guidelines should recommend 5 days of amoxicillin for paediatric pneumonia management in accordance with antimicrobial stewardship principles.

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Bacteria and Viral Profile of Severe Acute Respiratory Infections of Children Attending Yangon Children’s Hospital and Yankin Children’s Hospital

Myanmar Health Sciences Research Journal ◽

10.34299/mhsrj.00921 ◽

2019 ◽

Vol 31 (1) ◽

pp. 44-51

Keyword(s):

Influenza A ◽

Respiratory Infections ◽

Antibiotic Sensitivity ◽

Parainfluenza Virus ◽

Sensitivity Testing ◽

E Coli ◽

Children's Hospital ◽

Severe Acute Respiratory Infection ◽

Children’S Hospital ◽

Syncytial Virus

Objectives of study are (1) to reinforce the national capacity for diagnosis and antibiogram of some infectious diseases causing severe acute respiratory infection (SARI) and (2) to build a network between hospital and laboratory for the diagnosis and surveillance of SARI in Yangon. This study is a crosssectional hospital- and laboratory-based descriptive study. A total of 825 samples including respiratory samples and blood samples from 511 children attending Yangon Children’s Hospital and Yankin Children’s Hospital from December 2014 to April 2016 for treatment of SARI were included. Identification and antibiotic sensitivity testing were done using Vitek 2. Out of 129 gram-negative bacilli (GNB), K. pneumoniae 32%, P. aeruginosa 18%, A. baumannii 13%, E. coli 9% were mostly isolated. Among 35 gram-positive cocci (GPC), S. aureus 42% and S. pneumoniae 6% were mostly isolated. Multidrug resistance rates were E. coli 100%, K. pneumoniae 95%, A. baumanii 82% and P. aeruginosa 17%. Extended-spectrum beta-latamase (ESBL)-producing K. pneumoniae and E. coli was 6 out of 10 tested organisms. Carbarpenemase-producing GNB and methicillin-resistant Staphylococcus aureus (MRSA) were 21% and 33%, respectively. Virology section tested 529 samples of 490 patients using the FTD33 Multiplex PCR method which can detect 33 pathogens including 20 viruses, 12 bacteria and 1 fungus. Out of 490 patients, 374 were PCR positive. Different types of samples including nasopharyngeal, throat, endotracheal and laryngeal swab, tracheal secretion and bronchoalveolar lavage, were tested. Out of 566 viruses, respiratory syncytial virus (RSV) (19.3%), rhinovirus (17.0%), parechovirus (14.3%), bocavirus (11.1%), adenovirus (10.2%), metapneumo-virus A and B (10.2%), parainfluenza virus (5.7%), enterovirus (3.0%), influenza A virus (2.8%), coronavirus (4%), parainfluenza virus (0.9%) and influenza C virus (0.4%) were detected. This study highlighted the etiological agents of bacteria, viruses and drug-resistant bacterial pathogens in SARI.

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Community acquired pneumonia-current scenario among immunocompromised patients in a tertiary care hospital

International Journal of Bioassays ◽

10.21746/ijbio.2016.01.004 ◽

2016 ◽

Vol 5 (01) ◽

pp. 4715

Author(s):

A. V. Sowmya* ◽

G. Jayalakshmi ◽

David Agatha

Keyword(s):

Diabetes Mellitus ◽

Antimicrobial Therapy ◽

Tertiary Care ◽

Community Acquired Pneumonia ◽

Polymicrobial Infection ◽

Resistance Pattern ◽

Care Hospital ◽

Immunocompromised Patients ◽

Drug Resistant ◽

Etiologic Agents

Pneumonia is a common illness accounting for majority of hospitalizations worldwide with significant mortality and morbidity. Antimicrobial therapy, being the main stay of treatment, the choices of antibiotics depends on the nature of the etiologic agents and the host factors. The current study was aimed to identify the bacterial & fungal etiologic agents of Community Acquired Pneumonia (CAP) in Immunocompromised (IC) patients, with their antimicrobial resistant pattern and to analyze the associated immunocompromised states. Various respiratory samples from study group of 75 immunocompromised patients with features of pneumonia were collected, processed and the isolates were identified with their antimicrobial susceptibility& resistance pattern according to CLSI guidelines. The results were analyzed statistically. Diabetes mellitus is the most common immunocompromised state (48%) associated with CAP. Monomicrobial and polymicrobial infection rates were 80.36% and 19.64% respectively. Gram negative pathogens and fungal pathogens were identified in 60% and 25.37% of culture positive cases respectively. Diabetes mellitus is commonly found in association with polymicrobial infection (19.44%) and fungal infection (16.66%). Drug resistant strains comprise about 75% of MRSA strains, 72.72 % of ESBL producers and 3.44% of Amp C producers. As the number of elderly people with associated IC state is on rise, with change in the pattern of microbial etiologic agents causing CAP, a prior knowledge of the host and microbial factors will help in formulating empirical antimicrobial therapy and proper treatment thereby curbing the spread of infections by drug resistant pathogens and the associated morbidity and mortality.

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The lung–gut axis during viral respiratory infections: the impact of gut dysbiosis on secondary disease outcomes

Mucosal Immunology ◽

10.1038/s41385-020-00361-8 ◽

2021 ◽

Author(s):

Valentin Sencio ◽

Marina Gomes Machado ◽

François Trottein

Keyword(s):

Gut Microbiota ◽

Bacterial Infections ◽

Respiratory Infections ◽

Critical Role ◽

Good Health ◽

Disease Outcomes ◽

And Function ◽

Viral Respiratory Infections ◽

The Impact ◽

Viral Respiratory

AbstractBacteria that colonize the human gastrointestinal tract are essential for good health. The gut microbiota has a critical role in pulmonary immunity and host’s defense against viral respiratory infections. The gut microbiota’s composition and function can be profoundly affected in many disease settings, including acute infections, and these changes can aggravate the severity of the disease. Here, we discuss mechanisms by which the gut microbiota arms the lung to control viral respiratory infections. We summarize the impact of viral respiratory infections on the gut microbiota and discuss the potential mechanisms leading to alterations of gut microbiota’s composition and functions. We also discuss the effects of gut microbial imbalance on disease outcomes, including gastrointestinal disorders and secondary bacterial infections. Lastly, we discuss the potential role of the lung–gut axis in coronavirus disease 2019.

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Multiplexed detection of SARS-CoV-2 and other respiratory infections in high throughput by SARSeq

Nature Communications ◽

10.1038/s41467-021-22664-5 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Ramesh Yelagandula ◽

◽

Aleksandr Bykov ◽

Alexander Vogt ◽

Robert Heinen ◽

...

Keyword(s):

Influenza A ◽

Respiratory Infections ◽

High Sensitivity ◽

Cost Effective ◽

Massively Parallel ◽

Rt Pcr ◽

Viral Spread ◽

Saliva Analysis ◽

Double Blinded ◽

Generation Sequencing

AbstractThe COVID-19 pandemic has demonstrated the need for massively-parallel, cost-effective tests monitoring viral spread. Here we present SARSeq, saliva analysis by RNA sequencing, a method to detect SARS-CoV-2 and other respiratory viruses on tens of thousands of samples in parallel. SARSeq relies on next generation sequencing of multiple amplicons generated in a multiplexed RT-PCR reaction. Two-dimensional, unique dual indexing, using four indices per sample, enables unambiguous and scalable assignment of reads to individual samples. We calibrate SARSeq on SARS-CoV-2 synthetic RNA, virions, and hundreds of human samples of various types. Robustness and sensitivity were virtually identical to quantitative RT-PCR. Double-blinded benchmarking to gold standard quantitative-RT-PCR performed by human diagnostics laboratories confirms this high sensitivity. SARSeq can be used to detect Influenza A and B viruses and human rhinovirus in parallel, and can be expanded for detection of other pathogens. Thus, SARSeq is ideally suited for differential diagnostic of infections during a pandemic.

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