Archive for June 4, 2009

Prospective Comparison of Severity Scores for Predicting Clinically Relevant Outcomes for Patients Hospitalized With Community-Acquired Pneumonia

Chest  June 2009  V.135  N.6  p.1572-1579

Pedro Pablo España Yandiola, MD*, Alberto Capelastegui, MD, José Quintana, MD, Rosa Diez, RN, Inmaculada Gorordo, MD, Amaia Bilbao, MSc, Rafael Zalacain, MD, Rosario Menendez, MD and Antonio Torres, MD

*From the Service of Pneumology (Drs. España Yandiola, Capelastegui, and Gorordo, and Ms. Diez) and Research Unit (Dr. Quintana), Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain; Basque Foundation for Health Innovation and Research (BIOEF) [Ms. Bilbao], Sondika, Bizkaia, Spain; Cruces Hospital (Dr. Zalacain), Vizcaya, Spain; Service of Pneumonology (Dr. Menendez), Hospital Universitario La Fe, Valencia, Spain; and Hospital Clinic Institut d’Investigacions Biomédiques August Pi i Sunyer (Dr. Torres), Universita de Barcelona, Barcelona, Spain.

Background: The comparative accuracy and discriminatory power of three validated rules for predicting clinically relevant outcomes other than mortality in patients hospitalized with community-acquired pneumonia (CAP) are unknown.

Methods: We prospectively compared the newly developed severe community-acquired pneumonia (SCAP) score, pneumonia severity index (PSI), and the British Thoracic Society confusion, urea > 7 mmol/L, respiratory rate ≥ 30 breaths/min, BP < 90 mm Hg systolic or < 60 mm Hg diastolic, age ≥ 65 years (CURB-65) rule in an internal validation cohort of 1,189 consecutive adult inpatients with CAP from one hospital and an external validation cohort of 671 consecutive adult inpatients from three other hospitals. Major adverse outcomes were admission to ICU, need for mechanical ventilation, progression to severe sepsis, or treatment failure. Mean hospital length of stay (LOS) was also evaluated. The rules were compared based on sensitivity, specificity, and area under the curve (AUC) of the receiver operating characteristic.

Results: The rate of all adverse outcomes and hospital LOS increased directly with increasing SCAP, PSI, or CURB-65 scores (p < 0.001) in both cohorts. Patients classified as high risk by the SCAP score showed higher rates of adverse outcomes (ICU admission, 35.8%; mechanical ventilation, 16.4%; severe sepsis, 98.5%; treatment failure, 22.4%) than PSI and CURB-65 high-risk classes. The discriminatory power of SCAP, as measured by AUC, was 0.75 for ICU admission, 0.76 for mechanical ventilation, 0.79 for severe sepsis, and 0.61 for treatment failure in the external validation cohort. AUC differences with PSI or CURB-65 were found.

Conclusions: The SCAP score is as accurate or better than other current scoring systems in predicting adverse outcomes in patients hospitalized with CAP while helping classify patients into different categories of increasing risk for potentially closer monitoring.


June 4, 2009 at 3:53 pm Leave a comment

Effect of Linezolid Compared With Glycopeptides in Methicillin-Resistant Staphylococcus aureus Severe Pneumonia in Piglets

Chest  June 2009  V.135  N.6  p.1564-1571

Carlos M. Luna, MD, PhD, FCCP*, Didier A. Bruno, MD, Joaquín García-Morato, MD, Keli C. Mann, MD, Juan Risso Patrón, MD, Judith Sagardía, MD, Rubén Absi, PhD, Milagros García Bottino, PhD, Diana Marchetti, PhD, Angela Famiglietti, PhD, Mónica Baleztena, MD and Cesar Biancolini, MD

*From the Department of Medicine (Drs. Luna, Bruno, and Risso Patrón), Experimental Surgery University Center (Drs. García-Morato, Sagardía, and Biancolini), and the Department of Pathology (Dr. Baleztena), Hospital de Clínicas, and the Facultad de Farmacia y Bioguímica (Drs. Absi, García Bottino, Marchetti, and Famiglietti), Universidad de Buenos Aires, Buenos Aires, Argentina; and the Department of Pulmonary Medicine (Dr. Mann), Universidade Federal do Rio Grande Do Sul, Porto Alegre, Brazil.

Objectives: To investigate if compared with glycopeptides, antimicrobial therapy (AMT) with linezolid (LZD) improves the outcome in methicillin-resistant Staphylococcus aureus (MRSA) experimental pneumonia in mechanically ventilated piglets.

Methods: The MRSA minimal inhibitory concentration (MIC) was 0.5 for vancomycin (VAN), 0.25 for teicoplanin (TEI), and 2.0 μg/mL for LZD was inoculated in Largewhite-Landrace piglets divided into five groups. One group (n = 6) did not receive mechanical ventilation (MV) or AMT. Those in the remaining groups received MV and VAN (n = 9), TEI (n = 7), LZD (n = 9), or no AMT (n = 7). Plasma and BAL tumor necrosis factor-α, interleukin-6, and C-reactive protein (CRP) concentrations, postmortem lung pathology, cultures (lung, blood, and BAL) and plasma, epithelial lining fluid (ELF), and lung antibiotic concentrations were evaluated.

Measurements and main results: All piglets developed severe pneumonia; lung pathology score was lower in those receiving LZD vs those receiving glycopeptides (p = 0.049) or no AMT (p = 0.037). Serum CRP and serum and BAL cytokines increased; there were no differences between the groups. Fourteen died spontaneously at 44.4 ± 16.8 h; the remaining 24 were killed after 72 to 96 h. The concentrations of the antimicrobial agents tested in 15 piglets were higher than the MIC for the three antimicrobial agents in peak and trough plasma, ELF, and lung specimens. Survival at 72 h was higher in the LZD comparing with the no-AMT group.

Conclusions: Inoculation produced severe MRSA pneumonia. LZD AMT was associated with lower pathology score, better survival, and a trend to better clearance of MRSA, not attributable exclusively to pharmacokinetic or pharmacodynamic reasons.


June 4, 2009 at 3:51 pm Leave a comment

Influenza in patients with human immunodeficiency virus infection.

Chest  July 1, 1990  V.98  N.1  p.33-37

S Safrin, J D Rush, and J Mills

Department of Medicine, University of California, San Francisco

Although patients infected with human immunodeficiency virus (HIV) might be expected to have more severe illness due to influenza virus infection than normal persons, the course of influenza in such patients has not been well delineated. We describe six consecutive HIV-infected patients at San Francisco General Hospital in whom influenza virus was isolated from induced sputum or bronchoalveolar lavage specimens between December 1988 and March 1989. Although neither clinical presentation of influenza nor rate of secondary complications appeared to be altered from that in healthy individuals, our power of comparison was limited by small sample size. However, a high prevalence of hypoxemia and a trend toward prolonged duration of illness were identified. Larger, controlled studies are needed to define the course of influenza virus infection in HIV-infected patients as compared with nonimmunosuppressed patients.



June 4, 2009 at 3:50 pm Leave a comment

Prognosis after West Nile Virus Infection

Annals of Internal Medicine  19 August 2008  V.149  N.4  p.232-241

Mark Loeb, MD, MSc; Steven Hanna, PhD; Lindsay Nicolle, MD; John Eyles, PhD; Susan Elliott, PhD; Michel Rathbone, MD; Michael Drebot, PhD; Binod Neupane, MSc; Margaret Fearon, MD; and James Mahony, PhD

From McMaster University, Hamilton, Ontario; University of Manitoba and the Public Health Agency of Canada, Winnipeg, Manitoba; and Ontario Provincial Laboratory, Toronto, Ontario, Canada.

Background: The long-term prognosis of patients infected with West Nile virus is not well understood.

Objective: To describe the patterns of physical and mental function after infection with West Nile virus and to determine factors associated with recovery.

Design: Longitudinal cohort study.

Setting: Data were collected during home visits and from ambulatory clinics in 4 Canadian provinces.

Participants: 156 persons with West Nile virus infection.

Measurements: Scores on the Physical Component Summary and Mental Component Summary of the Short Form-36, Depression Anxiety Stress Scale, and Fatigue Severity Scale.

Results: Physical and mental function, as well as mood and fatigue, seemed to return to normal within 1 year of symptom onset. Participants with neuroinvasive disease took slightly longer to recover. Maximum predicted recovery or rate of recovery in any domain did not differ between participants with meningoencephalitis and those with encephalitis. Lack of preexisting comorbid conditions was associated with faster recovery of physical function, whereas lack of comorbid conditions and male sex were associated with faster recovery of mental function.

Limitations: The analysis excluded 7 patients who died shortly after diagnosis, so the study’s estimates of prognosis may be overoptimistic. The authors did not formally assess neuropsychological difficulties. The estimates of recovery are relative to the U.S. population, not to participants’ function levels before West Nile virus infection.

Conclusion: Physical and mental outcome measures seem to normalize within approximately 1 year in patients with West Nile virus. The presence of preexisting comorbid conditions is associated with longer recovery.



June 4, 2009 at 12:52 am Leave a comment

Epidemiological aspects of major opportunistic infections of the respiratory tract in persons with AIDS: Europe, 1993-2000

AIDS  Sept. 26, 2003  V.17  N.14  p.2109-2116

Serraino, Diego; Puro, Vincenzo; Boumis, Evangelo a; Angeletti, Claudio; Girardi, Enrico; Petrosillo, Nicola a; Ippolito, Giuseppe


Objective(s): To describe the epidemiology of Pneumocystis carinii pneumonia (PCP), pulmonary tuberculosis (PTB) and recurrent bacterial pneumonia (RBP) as AIDS-defining illnesses (ADI) in Europe.

Design: Analysis of AIDS surveillance data collected in the World Health Organization European region by EuroHIV, Saint Maurice, France.

Methods: Adult AIDS cases notified between 1993 and 2000 were studied. Since AIDS diagnosis may be constituted by up to four concurrent illnesses, polytomous logistic regression odds ratios (OR) and 95% confidence intervals (CI) were computed. Time trends and correlates of PCP, PTB or RBP were assessed.

Results: There were 181 296 ADI among the 142 447 AIDS cases included in this study. PCP was the commonest ADI in western Europe (17.8%) and PTB (20.4%) was the commonest ADI in eastern Europe. Within western Europe, PTB was more common in the south than in the north (OR, 1.5) and increased steadily over time. RBP increased until 1998 (from 1.9% to 3.7%) and thereafter declined. Young age was associated with an excess risk for PTB and, in comparison with heterosexuals, homosexual men were at higher risk for PCP (OR, 1.3). Injecting drug users (IDU) (OR, 2.8; 95% CI, 2.6-3.1) and recipients of blood (OR, 1.7; 95% CI, 1.4-2.2) were at increased risk for RBP.

Conclusions: This analysis highlighted the continuing importance of PCP and the increasing importance of PTB as an ADI in western Europe, and it emphasized the need to investigate more thoroughly the vast epidemic of AIDS-associated PTB in eastern Europe. IDU and recipients of blood should be considered as target groups for vaccination against RBP.



June 4, 2009 at 12:50 am Leave a comment

HIV-associated community-acquired pneumonia in the highly active antiretroviral therapy era

AIDS  Nov. 22, 2002  V.16  N.17  p.2361-2362


Viale, Pierluigia,b; Scudeller, Luigiac; Signorini, Lianab; Cadeo, Barbarab; Petrosillo, Nicolad; Pagani, Leonardoa,e; Carosi, Giampierob; for the POP-HIV Study Group

aInstitute of Infectious Diseases, University of Udine, Udine, Italy; bClinic of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy; cClinical Epidemiology Unit, IRCCS San Matteo, Pavia, Italy; dIRCCS ‘L. Spallanzani’, Rome, Italy; and eDivision of Infectious Diseases, Hospital of Bolzano, Bolzano, Italy.

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June 4, 2009 at 12:48 am Leave a comment


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