Archive for May 25, 2015

Management of community-acquired pneumonia in older adults.

Ther Adv Infect Dis. 2014 Feb;2(1):3-16.

Simonetti AF1, Viasus D2, Garcia-Vidal C2, Carratalà J3.

1Department of Infectious Diseases, Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain.

2Department of Infectious Diseases, Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain and Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain.

3Department of Infectious Diseases, Hospital Universitari de Bellvitge – IDIBELL, L’Hospitalet de Llobregat, Feixa Llarga s/n, 08907, L’Hospitalet de Llobregat, Barcelona, Spain.

Abstract

Community-acquired pneumonia (CAP) is an increasing problem among the elderly. Multiple factors related to ageing, such as comorbidities, nutritional status and swallowing dysfunction have been implicated in the increased incidence of CAP in the older population.

Moreover, mortality in patients with CAP rises dramatically with increasing age.

Streptococcus pneumoniae is still the most common pathogen among the elderly, although CAP may also be caused by drug-resistant microorganisms and aspiration pneumonia.

Furthermore, in the elderly CAP has a different clinical presentation, often lacking the typical acute symptoms observed in younger adults, due to the lower local and systemic inflammatory response.

Several independent prognostic factors for mortality in the elderly have been identified, including factors related to pneumonia severity, inadequate response to infection, and low functional status.

CAP scores and biomarkers have lower prognostic value in the elderly, and so there is a need to find new scales or to set new cut-off points for current scores in this population.

Adherence to the current guidelines for CAP has a significant beneficial impact on clinical outcomes in elderly patients. Particular attention should also be paid to nutritional status, fluid administration, functional status, and comorbidity stabilizing therapy in this group of frail patients.

This article presents an up-to-date review of the main aspects of CAP in elderly patients, including epidemiology, causative organisms, clinical features, and prognosis, and assesses key points for best practices for the management of the disease.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4072047/pdf/10.1177_2049936113518041.pdf

Advertisements

May 25, 2015 at 7:38 pm

Rapid urine antigen testing for Streptococcus pneumoniae in adults with community-acquired pneumonia: clinical use and barriers.

Diagn Microbiol Infect Dis. 2014 Aug;79(4):454-7.

Harris AM1, Beekmann SE2, Polgreen PM2, Moore MR3.

1Respiratory Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: ieo9@cdc.gov  

2University of Iowa Carver College of Medicine, Iowa City, Iowa.

3Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.

Abstract

Streptococcus pneumoniae (pneumococcus) is the most common bacterial etiology of community-acquired pneumonia (CAP) in adults, a leading cause of death.

The majority of pneumococcal CAP is diagnosed by blood culture, which likely underestimates the burden of disease.

The 2007 CAP guidelines recommend routine use of the rapid pneumococcal urinary antigen (UAg) test.

To assess the how pneumococcal UAg testing is being used among hospitalized adult CAP patients and what barriers restrict its use, a Web-based survey was distributed in 2013 to 1287 infectious disease physician members of the Emerging Infectious disease Network of the Infectious Disease Society of America. Of 493 eligible responses, 65% use the pneumococcal UAg test.

The primary barrier to UAg use was availability (46%). UAg users reported ordering fewer other diagnostic tests and tailoring antibiotic therapy. Increased access to UAg tests could improve pneumonia management and pneumococcal CAP surveillance.

PDF

http://www.dmidjournal.com/article/S0732-8893(14)00200-4/pdf

May 25, 2015 at 7:35 pm

Guidelines for the management of community-acquired pneumonia in the elderly patient.

Rev Esp Quimioter. 2014 Mar;27(1):69-86.

González-Castillo J1, Martín-Sánchez FJ, Llinares P, Menéndez R, Mujal A, Navas E, Barberán J; Spanish Society of Emergency Medicine and Emergency Care; Spanish Society of Geriatrics and Gerontology; Spanish Society of Chemotherapy; Spanish Society of Pneumology and Thoracic Surgery; Spanish Society of Home Hospitalization.

1Juan González-Castillo, Servicio de Urgencias. Hospital Clínico San Carlos, Calle Profesor Martín-Lagos s/n, 28040 Madrid, Spain. jgonzalezcast@gmail.com   

Abstract

The incidence of community-acquired pneumonia (CAP) increases with age and is associated with an elevated morbimortality due to the physiological changes associated with aging and a greater presence of chronic disease.

Taking into account the importance of this disease from an epidemiological and prognostic point of view, and the enormous heterogeneity described in the clinical management of the elderly, we believe a specific consensus document regarding this patient profile is necessary.

The purpose of the present work was to perform a review of the evidence related to the risk factors for the etiology, the clinical presentation, the management and the treatment of CAP in elderly patients with the aim of elaborating a series of specific recommendations based on critical analysis of the literature.

This document is the fruit of the collaboration of different specialists representing the Spanish Society of Emergency Medicine and Emergency Care (SEMES), the Spanish Society of Geriatrics and Gerontology (SEGG), the Spanish Society of Chemotherapy (SEQ), the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) and the Spanish Society of Home Hospitalization (SEHAD).

PDF

http://seq.es/seq/0214-3429/27/1/gonzalez.pdf

May 25, 2015 at 7:32 pm

Acute bacterial skin infections: developments since the 2005 Infectious Diseases Society of America (IDSA) guidelines.

J Emerg Med. 2013 Jun;44(6):e397-412.

Moran GJ1, Abrahamian FM, Lovecchio F, Talan DA.

1Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, USA.

Abstract

BACKGROUND:

Patients with acute bacterial skin and skin structure infections (ABSSSI) commonly present to Emergency Departments (EDs) where physicians encounter a wide spectrum of disease severity. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has increased in the past decade, and CA-MRSA is now a predominant cause of purulent ABSSSI in the United States (US).

OBJECTIVES:

This article reviews significant developments since the most recent Infectious Diseases Society of America (IDSA) guidelines for the management of ABSSSI in the CA-MRSA era, focusing on recent studies and recommendations for managing CA-MRSA, newer antimicrobials with improved MRSA activity, new diagnostic technologies, and options for outpatient parenteral antimicrobial therapy (OPAT).

DISCUSSION:

The increasing prevalence of CA-MRSA has led the IDSA and other organizations to recommend empiric coverage of CA-MRSA for purulent ABSSSI. The availability of rapid MRSA detection assays from skin and soft tissue swabs could potentially facilitate earlier selection of targeted antimicrobial therapy. Several newer intravenous antibiotics with expanded MRSA coverage, including ceftaroline fosamil, daptomycin, linezolid, and telavancin, may be utilized for treatment of ABSSSI. OPAT may be an option for intravenous administration of antibiotics in selected patients and may prevent or shorten hospitalizations, decrease readmission rates, and reduce nosocomial infections and complications.

CONCLUSION:

The growing prevalence of CA-MRSA associated with ABSSSI in the US has a significant impact on clinical management decisions in the ED. Recent availability of new diagnostic testing and therapeutic options may help meet the demand for effective antistaphylococcal agents.

PDF

http://www.jem-journal.com/article/S0736-4679(12)01574-0/pdf

May 25, 2015 at 4:13 pm

Ceftaroline, a new broad-spectrum cephalosporin in the era of multiresistance.

Enferm Infecc Microbiol Clin. 2014 Mar;32 Suppl 2:1-7.

Horcajada JP1, Cantón R2.

1Servicio de Enfermedades Infecciosas, Hospital Universitario del Mar, Institut Hospital del Mar d’Investigació Mèdica (IMIM), Barcelona, España.

2Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España. Electronic address: rafael.canton@salud.madrid.org

Abstract

Antimicrobial resistance has increased during the last few years, representing a public health concern.

Among Gram-positive organisms, methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pneumoniae are paradigms of resistance and of the dispersion of multiresistant clones.

Ceftaroline, a broad-spectrum cephalosporin that includes MRSA and penicillin-resistant S. pneumoniae, is the first β-lactam antibiotic useful in infections due to MRSA.

Phase-III clinical trials have demonstrated its efficacy in the treatment of community-acquired pneumonia and in skin and soft tissue infections, which are the current indications for ceftaroline.

Due to its microbiological and pharmacological (PK/PD) profiles, these indications could be expanded to include bacteremia, endocarditis, and even osteoarticular infections.

Another notable feature is the activity of this drug against Gram-negative bacilli susceptible to third generation cephalosporins, indicating that ceftaroline could be useful when these organisms are suspected or demonstrated in polymicrobial infections.

Clinical follow-up of ceftaroline use will more clearly define future ceftaroline indications.

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90295887&pident_usuario=0&pcontactid=&pident_revista=28&ty=21&accion=L&origen=zonadelectura&web=www.elsevier.es&lan=es&fichero=28v32nSupl.2a90295887pdf001.pdf

 

May 25, 2015 at 2:36 pm


Calendar

May 2015
M T W T F S S
« Apr   Jun »
 123
45678910
11121314151617
18192021222324
25262728293031

Posts by Month

Posts by Category