Archive for January 21, 2016

Clinical Characteristics of Community-Acquired Viridans Streptococcal Pneumonia.

Tuberc Respir Dis (Seoul). 2015 Jul;78(3):196-202.

Choi SH1, Cha SI1, Choi KJ1, Lim JK2, Seo H1, Yoo SS1, Lee J1, Lee SY1, Kim CH1, Park JY1.

Author information

1Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.

2Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea.

Abstract

BACKGROUND:

Viridans streptococci (VS) are a large group of streptococcal bacteria that are causative agents of community-acquired respiratory tract infection. However, data regarding their clinical characteristics are limited. The purpose of the present study was to investigate the clinical and radiologic features of community-acquired pneumonia (CAP) with or without parapneumonic effusion caused by VS.

METHODS:

Of 455 consecutive CAP patients with or without parapneumonic effusion, VS were isolated from the blood or pleural fluid in 27 (VS group, 5.9%) patients. Streptococcus pneumoniae was identified as a single etiologic agent in 70 (control group) patients. We compared various clinical parameters between the VS group and the control group.

RESULTS:

In univariate analysis, the VS group was characterized by more frequent complicated parapneumonic effusion or empyema and bed-ridden status, lower incidences of productive cough, elevated procalcitonin (>0.5 ng/mL), lower age-adjusted Charlson comorbidity index score, and more frequent ground glass opacity (GGO) or consolidation on computed tomography (CT) scans. Multivariate analysis demonstrated that complicated parapneumonic effusion or empyema, productive cough, bed-ridden status, and GGO or consolidation on CT scans were independent predictors of community-acquired respiratory tract infection caused by VS.

CONCLUSION:

CAP caused by VS commonly presents as complicated parapneumonic effusion or empyema. It is characterized by less frequent productive cough, more frequent bed-ridden status, and less common CT pulmonary parenchymal lesions. However, its treatment outcome and clinical course are similar to those of pneumococcal pneumonia

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499586/pdf/trd-78-196.pdf

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January 21, 2016 at 7:32 pm

Predictors of Pseudomonas and methicillin-resistant Staphylococcus aureus in hospitalized patients with healthcare-associated pneumonia

Respirology 2016 Jan 21:157

Mark L. Metersky1,*, Christopher R. Frei2,3 andEric M. Mortensen4

1The Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA

2Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, USA

3Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center School of Medicine, San Antonio, USA

4VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, USA

*Correspondence: Mark L. Metersky, Division of Pulmonary and Critical Care Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1321, USA. Email: metersky@uchc.edu

Conflict of Interest Statement: CRF has received research grants to his institution for investigator-initiated cancer and infectious diseases research from Bristol Myers Squibb, Forest, Ortho-McNeil Janssen and Pfizer in the past three years.

Abstract

Background and objective

Patients with healthcare-associated pneumonia (HCAP) are at high risk of infection with multidrug-resistant (MDR) pathogens. Factors discriminating infection with MDR Gram-negative (MDR-GN) organism from infection with methicillin-resistant Staphylococcus aureus (MRSA) are not well understood and patients are often treated for both organisms. This study was performed to determine risk factors predicting pneumonia due to Pseudomonas versus MRSA.

Methods

Veterans age ≥65 hospitalized with HCAP between 2002 and 2012 were identified from the Veterans Affairs administrative databases. Patients were identified with Pseudomonas pneumonia, MRSA pneumonia or neither according to the International Classification of Diseases, 9th Revision, Clinical Modification codes. We assessed unadjusted and adjusted associations of patient characteristics and HCAP due to Pseudomonas or MRSA.

Results

Of the 61651 patients with HCAP, 1156 (1.9%) were diagnosed with Pseudomonas pneumonia, 641 (1.0%) with MRSA pneumonia and 59 854 (97.1%) with neither. MRSA pneumonia was positively associated with male gender, age >74, diabetes, chronic obstructive pulmonary disease (COPD), recent nursing home or hospital stay, recent exposure to fluoroquinolone or antibiotics treating Gram-positive organisms, and severe pneumonia. MRSA pneumonia was negatively associated with complicated diabetes. Pseudomonas pneumonia was positively associated with recent hospital stay, immunocompromise, COPD, hemiplegia, recent exposure to inhaled corticosteroids, β-lactam/cephalosporin/carbapenem antibiotics, antibiotics against Gram-positive organisms, ‘other antibiotics’ and severe pneumonia. Pseudomonas pneumonia was negatively associated with age >84, higher socioeconomic status, drug abuse and diabetes.

Conclusions

Patient characteristics may assist in identifying patients at risk for HCAP due to Pseudomonas or MRSA.

abstract

http://onlinelibrary.wiley.com/doi/10.1111/resp.12651/abstract

PDF se adjunta

http://onlinelibrary.wiley.com/doi/10.1111/resp.12651/epdf

January 21, 2016 at 8:32 am


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