scholarly journals Peculiarities of community-acquired pneumonia treatment in patients with COVID-19

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Carolina Catcov ◽  
◽  
Svetlana Chislaru ◽  
Ina Pogonea ◽  
Nicolae Bacinschi ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Picture ◽  
Bacterial Pneumonia ◽  
Bacterial Flora ◽  
Blood Parameters ◽  
Community Acquired Pneumonia ◽  
Antibacterial Treatment ◽  
Beta Lactams ◽  
Gram Negative ◽  
Radiological Data

The clinical picture (fever, cough, sputum, auscultatory changes), peripheral blood parameters (leukocytosis, ESR) and radiological data are currently the criteria for suspecting bacterial pneumonia in patients with SARS CoV-2 infection and for indication of antibacterial treatment. The initiation of antibiotic therapy is empirical by taking into account the pathogens most likely involved in community-acquired pneumonia (Str pneumoniae, St. aureus, Kl. pneumoniae, Haemofillus influenzae, Mecoplasma pneumoniae, Chlamydia, Ps. aeruginosa). Beta-lactams (cephalosporins, carbapenems), protected beta-lactams, macrolides and fluoroquinolones are the most commonly administered groups, and the combinations of cephalosporins + macrolides and cephalosporins + fluoroquinolones constitute the most used groups of antibacterial treatment in order to include bacterial flora, gram-positive or gram-negative, and atypical.

scholarly journals Procalcitonin to Distinguish Viral From Bacterial Pneumonia: A Systematic Review and Meta-analysis

2019 ◽  
Vol 70 (3) ◽  
pp. 538-542 ◽  
Author(s):  
Ishan S Kamat ◽  
Vignesh Ramachandran ◽  
Harish Eswaran ◽  
Danielle Guffey ◽  
Daniel M Musher
Keyword(s):  
Antibiotic Therapy ◽  
Sensitivity And Specificity ◽  
Bacterial Pneumonia ◽  
Meta Analysis ◽  
Outcome Data ◽  
Community Acquired Pneumonia ◽  
Therapy Outcome ◽  
Essential Question ◽  
Diagnostic Modalities ◽  
Guided Therapy

Abstract Because of the diverse etiologies of community-acquired pneumonia (CAP) and the limitations of current diagnostic modalities, serum procalcitonin levels have been proposed as a novel tool to guide antibiotic therapy. Outcome data from procalcitonin-guided therapy trials have shown similar mortality, but the essential question is whether the sensitivity and specificity of procalcitonin levels enable the practitioner to distinguish bacterial pneumonia, which requires antibiotic therapy, from viral pneumonia, which does not. In this meta-analysis of 12 studies in 2408 patients with CAP that included etiologic diagnoses and sufficient data to enable analysis, the sensitivity and specificity of serum procalcitonin were 0.55 (95% confidence interval [CI], .37–.71; I2 = 95.5%) and 0.76 (95% CI, .62–.86; I2 = 94.1%), respectively. Thus, a procalcitonin level is unlikely to provide reliable evidence either to mandate administration of antibiotics or to enable withholding such treatment in patients with CAP.

scholarly journals Characteristics of Bacterial Microflora Isolated from Sputum of Patients with Pneumonia Registered in Khabarovsk City and Khabarovsk Territory in the Initial Period of COVID-19 Pandemic in May–June, 2020

2020 ◽  
pp. 43-49
Author(s):  
A. P. Bondarenko ◽  
V. A. Shmylenko ◽  
O. E. Trotsenko ◽  
V. O. Kotova ◽  
L. V. Butakova ◽  
...  
Keyword(s):  
Initial Period ◽  
Bacterial Flora ◽  
Test System ◽  
Community Acquired Pneumonia ◽  
Resistant Bacteria ◽  
Candida Spp ◽  
Scientific Center ◽  
Gram Negative ◽  
Detection Frequency ◽  
Microbial Associations

Objective: to study the bacterial microflora in the sputum of patients with pneumonia caused by SARSCoV-2 or other pathogens.Materials and methods. The bacterial microflora of sputum of 173 patients with pneumonia admitted to hospitals in Khabarovsk and the Khabarovsk Territory in May – June 2020 was examined. Detection of RNA of the SARS-CoV-2 virus was carried out by PCR with the Vector-PCRRV-2019-nCoV-RG test system (manufactured by the State Scientific Center of VB “Vector”, Koltsovo). Determination of the DNA of mycoplasmosis agents and chlamydia was carried out with the test system “AmpliSens® Mycoplasma pneumoniae/Chlamydophila pneumonia” (manufactured by CRIE). Statistical data processing was performed using the Excel program. Results and discussion. Both groups of patients (Covid-19+ and Covid-19–) had high levels of bacterial flora isolation (81.4 and 74.7 %) including common pathogens for community-acquired pneumonia as well as notable detection frequency of Candida spp. and microbial associations. The group of Covid-19+ patients demonstrated a wider range of detected pathogens, was positive for poly-resistant gram-negative Enterobacteriaceae, non-fermenting gram-negative poly-resistant bacteria, with more expressed manifestation of microbial associations. In the group of Covid-19– participants drug-resistant microflora was presented only by MRSA and MRSE  staphylococci.

Preliminary Study of the Bacterial Flora and Indications for Antibiotic Therapy in Cancer Patients

1973 ◽  
Vol 59 (2) ◽  
pp. 151-162
Author(s):  
Emilio Bajetta ◽  
Silvio Monfardini ◽  
Marco Gasparini ◽  
Renzo Dettori
Keyword(s):  
Urinary Tract Infection ◽  
Clinical Practice ◽  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Bacterial Flora ◽  
Retrospective Evaluation ◽  
Gram Positive ◽  
Gram Negative ◽  
New Antibiotics ◽  
Preliminary Study

A retrospective evaluation of infections that occurred at the National Cancer Institute of Milan during 1971 showed that the majority of them were still produced by gram-positive bacilli, even in myelosuppressed patients with leukemia and lymphoma. Only in patients with urinary tract infection and in febrile patients with bronchogenic carcinoma was the incidence of gram-negative higher than that of gram-positive infections. The persistence of the predominance of gram-positive versus gram-negative bacilli could be partly due to the fact some new antibiotics have been introduced into clinical practice later in Italy then in other countries. The incidence of fungi positive cultures was comparable to that reported in other centers. The importance of knowing the bacterial ecology in a given center or ward in order to choose the appropriate initial antibiotic therapy is discussed.

scholarly journals β-Lactam and Fluoroquinolone Combination Antibiotic Therapy for Bacteremia Caused by Gram-Negative Bacilli

2009 ◽  
Vol 53 (4) ◽  
pp. 1386-1394 ◽  
Author(s):  
Majdi N. Al-Hasan ◽  
John W. Wilson ◽  
Brian D. Lahr ◽  
Kristine M. Thomsen ◽  
Jeanette E. Eckel-Passow ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Antibiotic Therapy ◽  
Cox Regression ◽  
Receive Combination Therapy ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Gram Negative ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
First Time

ABSTRACT The role of combination antibiotic therapy with a beta-lactam and a fluoroquinolone for bacteremia caused by gram-negative bacilli, to our knowledge, has not been previously described. Much of the previous study of combination therapy has included beta-lactams and aminoglycosides. We conducted a large retrospective cohort study to evaluate 28-day all-cause mortality in patients with monomicrobial bacteremia due to aerobic gram-negative bacilli who received either a combination of beta-lactams and fluoroquinolones or beta-lactam monotherapy. We enrolled adult patients admitted to Mayo Clinic hospitals from 1 January 2001 to 31 October 2006 in the study. After stratification of patients by Pitt bacteremia scores, we used Cox regression models to estimate the hazard ratios (HR) for 28-day all-cause mortality after adjusting for the propensity to receive combination therapy. We identified 398 and 304 unique patients with bacteremia caused by gram-negative bacilli who received single and combination antibiotic therapy, respectively. In less severely ill patients with Pitt bacteremia scores of <4, combination therapy was associated with lower 28-day mortality than single therapy (4.2% [9 of 214] versus 8.8% [28 of 319]; adjusted HR, 0.44; 95% confidence interval [CI], 0.20 to 0.98; P = 0.044). In critically ill patients with Pitt bacteremia scores of ≥4, there was no difference in 28-day mortality between combination and single therapy (25.6% [23 of 90] versus 27.8% [22 of 79]; adjusted HR, 0.87; 95% CI, 0.47 to 1.62; P = 0.660). These findings were consistent for 14-day all-cause mortality. In this large cohort, we found for the first time that combination therapy with beta-lactams and fluoroquinolones was associated with a reduction in 28-day all-cause mortality among less severely ill patients with bacteremia caused by gram-negative bacilli.

scholarly journals Diagnosis and antibacterial treatment for community-acquired pneumonia in children during the COVID-19 pandemic

2021 ◽  
Vol 4 (1) ◽  
pp. 70-76
Author(s):  
S.V. Zaitseva ◽  
◽  
O.V. Zaitseva ◽  
E.E. Lokshina ◽  
◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Bacterial Pneumonia ◽  
Laboratory Tests ◽  
Community Acquired Pneumonia ◽  
Antibacterial Treatment ◽  
Causative Agents ◽  
Heavy Burden ◽  
Reasonable Use ◽  
And Child Health

During the COVID-19 pandemic, the reasonable use of antibiotics became an important issue of practical health care. This fact is accounted for by the heavy burden of COVID-19 on healthcare system, difficulties with interpreting respiratory disorders and verifying communityacquired pneumonia using instrumental and laboratory tests. Therefore, the risk of unnecessary prescription of antibiotics and, as a result, the prevalence of antibiotic resistance significantly increase. This paper addresses current ideas about the role of the most common causative agents of community-acquired pneumonia in children, the milestones of the diagnosis of community-acquired pneumonia, differential diagnosis of viral and bacterial pneumonia, the algorithms of the choice of basic antibacterial treatment in out-patient settings. The authors emphasize that only the use of limited antibiotic spectrum (i.e., amoxicillin, inhibitor-protected aminopenicillins), their rational dosing and course treatment recommended for community-acquired pneumonia will prevent the loss of antibacterial efficacy for infectious diseases. KEYWORDS: community-acquired pneumonia, children, SARS-CoV-2, antibiotic therapy, antibiotic resistance, inhibitor-protected aminopenicillins. FOR CITATION: Zaitseva S.V., Zaitseva O.V., Lokshina E.E. Diagnosis and antibacterial treatment for community-acquired pneumonia in children during the COVID-19 pandemic. Russian Journal of Woman and Child Health. 2021;4(1):70–76. DOI: 10.32364/2618-8430- 2021-4-1-70-76.

scholarly journals An AI-based auxiliary empirical antibiotic therapy model for children with bacterial pneumonia using low-dose chest CT images

2021 ◽  
Author(s):  
Mudan Zhang ◽  
Siwei Yu ◽  
Xuntao Yin ◽  
Xianchun Zeng ◽  
Xinfeng Liu ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Pneumonia ◽  
Low Dose ◽  
Ct Images ◽  
Chest Ct ◽  
Classification Model ◽  
Empirical Antibiotic Therapy ◽  
Gram Positive ◽  
Gram Negative ◽  
Multi Class Classification

Abstract Purpose To construct an auxiliary empirical antibiotic therapy (EAT) multi-class classification model for children with bacterial pneumonia using radiomics features based on artificial intelligence and low-dose chest CT images. Materials and methods Data were retrospectively collected from children with pathogen-confirmed bacterial pneumonia including Gram-positive bacterial pneumonia (122/389, 31%), Gram-negative bacterial pneumonia (159/389, 41%) and atypical bacterial pneumonia (108/389, 28%) from January 1 to June 30, 2019. Nine machine-learning models were separately evaluated based on radiomics features extracted from CT images; three optimal submodels were constructed and integrated to form a multi-class classification model. Results We selected five features to develop three radiomics submodels: a Gram-positive model, a Gram-negative model and an atypical model. The comprehensive radiomics model using support vector machine method yielded an average area under the curve (AUC) of 0.75 [95% confidence interval (CI), 0.65–0.83] and accuracy (ACC) of 0.58 [sensitivity (SEN), 0.57; specificity (SPE), 0.78] in the training set, and an average AUC of 0.73 (95% CI 0.61–0.79) and ACC of 0.54 (SEN, 0.52; SPE, 0.75) in the test set. Conclusion This auxiliary EAT radiomics multi-class classification model was deserved to be researched in differential diagnosing bacterial pneumonias in children.

scholarly journals Pharmacokinetic/Pharmacodynamic Dosage Individualization of Suppressive Beta-Lactam Therapy Administered by Subcutaneous Route in Patients With Prosthetic Joint Infection

2021 ◽  
Vol 8 ◽  
Author(s):  
Sylvain Goutelle ◽  
Anne Conrad ◽  
Cécile Pouderoux ◽  
Evelyne Braun ◽  
Frédéric Laurent ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Case Series ◽  
Therapeutic Drug ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Gram Negative ◽  
Prosthetic Joint

Suppressive parenteral antibiotic therapy with beta-lactams may be necessary in patients with Gram-negative bone and joint infection (BJI). Subcutaneous drug administration can facilitate this therapy in outpatient setting, but there is limited information about this practice. We have developed an original approach for drug dosing in this context, based on therapeutic drug monitoring (TDM) and pharmacokinetic/pharmacodynamic (PK/PD) principles. The objective of this study was to describe our approach and its first results in a case series. We analyzed data from patients who received suppressive antibiotic therapy by subcutaneous (SC) route with beta-lactams as salvage therapy for prosthetic joint infection (PJI) and had TDM with PK/PD-based dose adjustment. Ten patients (six women and four men with a mean age of 77 years) were included from January 2017 to May 2020. The drugs administered by SC route were ceftazidime (n = 4), ertapenem (n = 4), and ceftriaxone (n = 2). In each patient, PK/PD-guided dosage individualization was performed based on TDM and minimum inhibitory concentration (MIC) measurements. The dose interval could be prolonged from twice daily to thrice weekly in some patients, while preserving the achievement of PK/PD targets. The infection was totally controlled by the strategy in nine out the 10 patients during a median follow-up of 1,035 days (~3 years). No patient acquired carbapenem-resistant Gram-negative bacteria during the follow-up. One patient presented treatment failure with acquired drug resistance under therapy, which could be explained by late MIC determination and insufficient exposure, retrospectively. To conclude, our innovative approach, based on model-based TDM, MIC determination, and individualized PK/PD goals, facilitates, and optimizes suppressive outpatient beta-lactam therapy administered by SC route for PJI. These encouraging results advocate for larger clinical evaluation.

scholarly journals Analysis of the consumption of antibacterial medications in community-acquired pneumonia in children

2019 ◽  
pp. 36-38
Author(s):  
A. I. Chepurnova ◽  
E. V. Eliseeva ◽  
Yu. V. Feoktistova ◽  
A. V. Kropotov
Keyword(s):  
Antibiotic Therapy ◽  
Average Duration ◽  
Descriptive Study ◽  
Community Acquired Pneumonia ◽  
Antibacterial Treatment ◽  
Study Objective ◽  
Pediatric Pulmonology ◽  
Medication Selection ◽  
Antibacterial Medication

Objective: The study objective is to analyze the efficacy of antibacterial medication selection to treat community-acquired pneumonia (CAP) in children in an out-patient clinic and in a pulmonology department of an in-patient hospital.Methods: Retrospective descriptive study for 2009–2017 in day-patient departments of pediatric clinics and pediatric pulmonology departments of in-patient hospitals of Primorskiy territory (760 cases).Results: 50 % of children took antibiotics at pre-hospital stage (self-treatment). Penicillins were the most popular – 50.1 % (218 prescriptions), cephalosporins were used in 129 (29.7 %), macrolides – in 86 (18.8 %) of cases. The average duration of antibacterial treatment course of CAP was 10 days at pre-hospital stage. Both in the out-patient clinic and in the in-patient hospital, cephalosporins (58.4 and 58.3 %), macrolides (34.8 and 37.4 %) and aminoglycosides (6.3 and 3.4 %) were used more often.Conclusions: The positive dynamics in the protocols of antibiotic therapy of CAP should be noted. The improvement of regulatory framework has led to the increase of rational prescriptions. It is necessary to continue improving of clinical guidelines and implementing pulmonology hospitals of microbiological monitoring that will allow improving the quality of antibacterial treatment.

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