Posts filed under ‘Infecciones respiratorias’

Emergence of Bordetella holmesii as a Causative Agent of Whooping Cough, Barcelona, Spain

Emerging Infectious Diseases November 2017 V.23 N.11

Alba Mir-Cros, Gema Codina, M. Teresa Martín-Gómez, Anna Fàbrega, Xavier Martínez, Mireia Jané, Diego Van Esso, Thais Cornejo, Carlos Rodrigo, Magda Campins, Tomàs Pumarola, and Juan José González-LópezComments to Author

Hospital Universitari Vall d’Hebron, Barcelona, Spain (A. Mir-Cros, G. Codina, M.T. Martín-Gómez, A. Fàbrega, X. Martínez, T. Cornejo, C. Rodrigo, M. Campins, T. Pumarola, J.J. González-López); Universitat Autònoma de Barcelona, Barcelona (A. Mir-Cros, G. Codina, C. Rodrigo, M. Campins, T. Pumarola, J.J. González-López); Public Health Agency of Catalonia, Barcelona (M. Jané); Primary Care Health Centre Service ‘Muntanya,’ Barcelona (D. Van Esso)

We describe the detection of Bordetella holmesii as a cause of whooping cough in Spain. Prevalence was 3.9% in 2015, doubling to 8.8% in 2016. This emergence raises concern regarding the contribution of B. holmesii to the reemergence of whooping cough and the effectiveness of the pertussis vaccine.

PDF

https://wwwnc.cdc.gov/eid/article/23/11/pdfs/17-0960.pdf

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October 18, 2017 at 8:24 am

Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.

Clin Infect Dis. 2016 Sep 1;63(5):e61-e111.

Kalil AC1, Metersky ML2, Klompas M3, Muscedere J4, Sweeney DA5, Palmer LB6, Napolitano LM7, O’Grady NP8, Bartlett JG9, Carratalà J10, El Solh AA11, Ewig S12, Fey PD13, File TM Jr14, Restrepo MI15, Roberts JA16, Waterer GW17, Cruse P18, Knight SL18, Brozek JL19.

Author information

1 Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha.

2 Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington.

3 Brigham and Women’s Hospital and Harvard Medical School Harvard Pilgrim Health Care Institute, Boston, Massachusetts.

4 Department of Medicine, Critical Care Program, Queens University, Kingston, Ontario, Canada.

5 Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego.

6 Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, State University of New York at Stony Brook.

7 Department of Surgery, Division of Trauma, Critical Care and Emergency Surgery, University of Michigan, Ann Arbor.

8 Department of Critical Care Medicine, National Institutes of Health, Bethesda.

9 Johns Hopkins University School of Medicine, Baltimore, Maryland.

10 Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Spanish Network for Research in Infectious Diseases, University of Barcelona, Spain.

11 Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, Veterans Affairs Western New York Healthcare System, New York.

12 Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Germany.

13 Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha.

14 Summa Health System, Akron, Ohio.

15 Department of Medicine, Division of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System and University of Texas Health Science Center at San Antonio.

16 Burns, Trauma and Critical Care Research Centre, The University of Queensland Royal Brisbane and Women’s Hospital, Queensland.

17 School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.

18 Library and Knowledge Services, National Jewish Health, Denver, Colorado.

19 Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Abstract

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations.

IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.

These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia.

The panel’s recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981759/pdf/ciw353.pdf

October 13, 2017 at 3:54 pm

International ERS/ESICM/ESCMID/ALAT Guidelines for the Management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT)

Eur Respir Journal  September 2017 V.50 N.3

ERS/ESICM/ESCMID/ALAT guidelines

Antoni Torres, Michael S. Niederman, Jean Chastre, Santiago Ewig, Patricia Fernandez-Vandellos, Hakan Hanberger, Marin Kollef, Gianluigi Li Bassi, Carlos M. Luna, Ignacio Martin-Loeches, J. Artur Paiva, Robert C. Read, David Rigau, Jean François Timsit, Tobias Welte and Richard Wunderink

The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.

The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.

A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).

Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population–intervention–comparison–outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention.

PDF

http://erj.ersjournals.com/content/erj/50/3/1700582.full.pdf

October 5, 2017 at 9:28 am

Prevention of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

Eur Respir Journal  September 2017 V.50 N.3

ERS/ATS guidelines

Jadwiga A. Wedzicha (ERS co-chair)1, Peter M.A. Calverley2, Richard K. Albert3, Antonio Anzueto4, Gerard J. Criner5, John R. Hurst6, Marc Miravitlles 7, Alberto Papi 8, Klaus F. Rabe9, David Rigau10, Pawel Sliwinski11, Thomy Tonia12, Jørgen Vestbo13, Kevin C. Wilson14 and Jerry A. Krishnan(ATS co-chair)15

Affiliations:

1 Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK.

2 Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.

3 Dept of Medicine, University of Colorado, Denver, Aurora, CO, USA.

4 University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, TX, USA.

5 Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.

6 UCL Respiratory, University College London, London, UK.

7 Pneumology Dept, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.

8 Respiratory Medicine, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.

9 Dept of Internal Medicine, Christian-Albrechts University, Kiel and LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany.

10 Iberoamerican Cochrane Center, Barcelona, Spain.

11 2nd Dept of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.

12 Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

13Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.

14Dept of Medicine, Boston University School of Medicine, Boston, MA, USA. 15University of Illinois Hospital and Health Sciences System, Chicago, IL, USA

This document provides clinical recommendations for the prevention of chronic obstructive pulmonary disease (COPD) exacerbations. It represents a collaborative effort between the European Respiratory Society and the American Thoracic Society. Comprehensive evidence syntheses were performed to summarise all available evidence relevant to the Task Force’s questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts. After considering the balance of desirable (benefits) and undesirable consequences (burden in the form of adverse effects and cost), quality of evidence, feasibility, and acceptability of various interventions, the Task Force made recommendations for mucolytic, long-acting muscarinic antagonist, phosphodiesterase-4 inhibitor (roflumilast) and macrolide therapy, as well as a conditional recommendation against fluoroquinolone therapy. All of the recommendations were conditional, except for a strong recommendation for the use of a long-acting antimuscarinic agent versus a long-acting β2-adrenergic, indicating that there was uncertainty about the balance of desirable and undesirable consequences of the intervention, and that well-informed patients may make different choices regarding whether to have or not have the specific intervention. The guideline summarises the evidence and provides recommendations for pharmacological therapy for the prevention of COPD exacerbations.

PDF

http://erj.ersjournals.com/content/erj/50/3/1602265.full.pdf

October 5, 2017 at 9:27 am

Antibiotic Prescribing for Adults Hospitalized in the Etiology of Pneumonia in the Community Study

Open Forum Infectious Diseases April 2017 V.4 N.2

Sara Tomczyk; Seema Jain; Anna M Bramley; Wesley H Self; Evan J Anderson …

Background

Community-acquired pneumonia (CAP) 2007 guidelines from the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recommend a respiratory fluoroquinolone or beta-lactam plus macrolide as first-line antibiotics for adults hospitalized with CAP. Few studies have assessed guideline-concordant antibiotic use for patients hospitalized with CAP after the 2007 IDSA/ATS guidelines. We examine antibiotics prescribed and associated factors in adults hospitalized with CAP.

Methods

From January 2010 to June 2012, adults hospitalized with clinical and radiographic CAP were enrolled in a prospective Etiology of Pneumonia in the Community study across 5 US hospitals. Patients were interviewed using a standardized questionnaire, and medical charts were reviewed. Antibiotics prescribed were classified according to defined nonrecommended CAP antibiotics. We assessed factors associated with nonrecommended CAP antibiotics using logistic regression.

Results

Among enrollees, 1843 of 1874 (98%) ward and 440 of 446 (99%) ICU patients received ≥1 antibiotic ≤24 hours after admission. Ward patients were prescribed a respiratory fluoroquinolone alone (n = 613; 33%), or beta-lactam plus macrolide (n = 365; 19%), beta-lactam alone (n = 240; 13%), among other antibiotics, including vancomycin (n = 235; 13%) or piperacillin/tazobactam (n = 157; 8%) ≤24 hours after admission. Ward patients with known risk for healthcare-associated pneumonia (HCAP), recent outpatient antibiotic use, and in-hospital antibiotic use <6 hours after admission were significantly more likely to receive nonrecommended CAP antibiotics.

Conclusions

Although more than half of ward patients received antibiotics concordant with IDSA/ATS guidelines, a number received nonrecommended CAP antibiotics, including vancomycin and piperacillin/tazobactam; risk factors for HCAP, recent outpatient antibiotic, and rapid inpatient antibiotic use contributed to this. This hypothesis-generating descriptive epidemiology analysis could help inform antibiotic stewardship efforts, reinforces the need to harmonize guidelines for CAP and HCAP, and highlights the need for improved diagnostics to better equip clinicians.

PDF

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September 3, 2017 at 6:54 pm

Carbapenem-Resistant Enterobacteriaceae Infections: Results From a Retrospective Series and Implications for the Design of Prospective Clinical Trials

Open Forum Infectious Diseases April 2017 V.4 N.2

Elizabeth L. Alexander; Jeffery Loutit; Mario Tumbarello; Richard Wunderink; Tim Felton …

Background.

The increasing incidence of multidrug-resistant Gram negatives, such as carbapenem-resistant Enterobacteriaceae (CRE), has resulted in a critical need for new antimicrobials. Most studies of new antimicrobials have been performed in patients with nondrug-resistant pathogens. We performed a retrospective analysis of patients with CRE infections to inform the design of phase 3 clinical trials.

Methods.

This was a retrospective study at 22 centers in 4 countries. Baseline data, treatment, and outcomes were collected in patients with complicated urinary tract infection (cUTI)/acute pyelonephritis (AP), hospital-acquired bacterial pneumonia (HABP), ventilator-associated bacterial pneumonia (VABP), and bacteremia due to CRE.

Results.

Two hundred fifty-six cases of CRE infection were identified: 75 cUTI/AP, 21 HABP, 20 VABP, and 140 bacteremia. The patient population had significant comorbidities: 32.8% had chronic renal insufficiency, and 26.2% were immunocompromised. Illness severity at presentation was high: 29.3% presented with septic shock. Treatment regimens varied widely; however, a majority of patients received combination therapy. Outcomes were universally poor (28-day mortality was 28.1%) across all sites of infection, particularly in dialysis patients and those with sepsis.

Conclusions.

The CRE infections occured in patients with substantial comorbidities and were associated with high mortality and low rates of clinical cure with available antibiotics. Patients with these comorbidities are often excluded from enrollment in clinical trials for registration of new drugs. These results led to changes in the inclusion/exclusion criteria of a phase 3 trial to better represent the patient population with CRE infections and enable enrollment. Observational studies may become increasingly important to guide clinical trial design, inform on the existing standard of care, and provide an external control for subsequent trials.

PDF

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September 3, 2017 at 6:51 pm

Current and Future Considerations for the Treatment of Hospital-Acquired Pneumonia.

Adv Ther. 2016 Feb;33(2):151-66.

Montravers P1,2, Harpan A3, Guivarch E3,4.

Author information

1 Département d’Anesthésie-Réanimation, CHU Bichat Claude-Bernard-HUPNVS, Assistance Publique-Hôpitaux de Paris, University Denis Diderot, PRESS Sorbonne Cité, 46 Rue Henri-Huchard, 75018, Paris, France. philippe.montravers@aphp.fr

2 University Denis Diderot, PRESS Sorbonne Cité, Paris, France. philippe.montravers@aphp.fr

3 Département d’Anesthésie-Réanimation, CHU Bichat Claude-Bernard-HUPNVS, Assistance Publique-Hôpitaux de Paris, University Denis Diderot, PRESS Sorbonne Cité, 46 Rue Henri-Huchard, 75018, Paris, France.

4 University Denis Diderot, PRESS Sorbonne Cité, Paris, France.

Abstract

Hospital-acquired pneumonia (HAP) and health-care-associated pneumonia (HCAP) are leading causes of death, morbidity, and resource utilization in hospitalized patients, and are associated with a broad range of Gram-positive and Gram-negative pathogens.

Here, we discuss the different definitions of HAP and HCAP, review current guidelines regarding the treatment of these conditions, highlight the shortcomings of current therapeutic options, and discuss new antibiotic treatments.

To optimize therapeutic outcomes in patients with HAP/HCAP, initial antimicrobial treatment must be appropriate and should be given as soon as possible; inappropriate or delayed therapy greatly increases morbidity and mortality.

Selection of the most appropriate antimicrobial agent depends on the causative pathogen(s); initial broad-spectrum therapy is commonly recommended and should cover all pathogens that may be present.

Treatment selection should also take into consideration the following factors: knowledge of underlying local risk factors for antimicrobial resistance, disease staging, and risk factors related to specific pathogens such as Pseudomonas aeruginosa, Acinetobacter spp., and methicillin-resistant Staphylococcus aureus (MRSA).

Guidelines consistently emphasize the importance of treating HAP and HCAP with early and appropriate broad-spectrum antibiotics, and recent developments in this field have resulted in the availability of several additional treatment options.

Telavancin shows potent activity against Gram-positive bacteria including MRSA and can be administered once daily; it was approved in the USA and European Union for the treatment of HAP after demonstrating non-inferiority to vancomycin.

Ceftobiprole medocaril exhibits rapid antimicrobial activity against a broad range of both Gram-positive and Gram-negative pathogens, including MRSA.

It was approved for the treatment of HAP (excluding ventilator-associated pneumonia) and community-acquired pneumonia in Europe in 2013.

These new treatments may offer effective alternative therapeutic options for the management of HAP.

FUNDING:

Basilea Pharmaceutica Ltd., Basel, Switzerland.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769724/pdf/12325_2016_Article_293.pdf

August 1, 2017 at 9:09 pm

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