The Modern Diagnostic Approach to Community-Acquired Pneumonia in Adults
Semin Respir Crit Care Med 2016; 37: 876-885 DOI: 10.1055/s-0036-1592125Respiratory tract infections, the majority of which are community acquired, are among the leading causes of death worldwide and a leading indication for hospital admission. The burden of disease demonstrates a “U”-shaped distribution, primarily affecting young children as the immune system matures, and older adults as the process of immunosenescence and accumulation of comorbidities leads to increased susceptibility to infection. Diagnosis of community-acquired pneumonia (CAP) is traditionally based on demonstration of a new infiltrate on a chest radiograph in a patient presenting with an acute respiratory illness or sepsis. Advances in diagnosis have been slow, and although there are increasing data on the value of computed tomography or lung ultrasound as more sensitive diagnostic methodologies, they are not widely used as initial diagnostic tests. There are a wide range of differential diagnoses and pneumonia “mimics” which should be considered in patients presenting with CAP. Once the diagnosis of CAP has been made, identifying the causative microorganism is the next stage in the diagnostic process. Traditional culture-based approaches are relatively insensitive and achieve a positive diagnosis in only 30 to 70% of cases, even when rigorously applied. Urinary antigen tests, polymerase chain reaction assays, and even next-generation sequencing technologies have become available ...
ConclusionsHAI and antimicrobial use prevalence remained stable in comparison with the previous PPS (7.1% and 27.4% in 2011 and 2015, respectively). Belgian hospitals should be further stimulated to set local targets to improve antibiotic prescribing and reduce HAI.
ConclusionsMost Dutch hospitals report regular use of recommended practices for preventing CLABSI and CDI. Several specific practices to prevent CAUTI and VAP were less frequently used, however, providing an opportunity for improvement.
ConclusionPneumonia caused byK. pneumoniae was associated with a high mortality. Importantly, multi-drug resistant strains were also detected in patients with CAP. Hypervirulent strains were prevalent in all 3 groups of pneumonia patients, even in those with HAP.
ConclusionsMultiple resistance genes are located in a complex class 1 integron within a 42-kb T. pyogenes genomic island (TGI1), leading TP1 multiple drug resistance. In comparison with SG1 families, TGI1 possesses versatile gene distribution and specific gene context for its upstream and downstream, and it represents a new lineage of genomic resistance islands.
Abstract Acinetobacter baumannii has emerged as an important nosocomial pathogen due to its ability to survive in hospital settings and its antimicrobial resistance. It is one of the key pathogens in ventilator-associated pneumonia (VAP). The aim of this study was to characterize the mechanisms of quinolone resistance among A. baumannii isolates causing VAP and to investigate the presence of the novel abaQ gene among them. Quinolone-resistant A. baumannii isolates causing VAP were collected over a period of 4 months. Mutations within gyrA and parC were analyzed and the presence of qnrA, qnrB, qnrS, and abaQ w...
Condition: Antibiotic Reaction Intervention: Diagnostic Test: urine culture Sponsor: Batool Mutar Completed
The World Health Organization earlier this year called antimicrobial resistance—pathogens’ ability to evade medical interventions—one of the 10 largest threats to global health. In the U.S. alone, according to a recent Centers for Disease Control and Prevention (CDC) report, 35,000 people die each year due to antibiotic-resistant infections. A new study published in the BMJ points to one major propagator of the problem: doctors are prescribing antibiotics when they shouldn’t. In fact, up to 43% of U.S. antibiotic prescriptions may be “inappropriate,” according to the research. Antibioti...
ConclusionsLevels of antibiotic knowledge varied between ethnic groups, but a lower level of antibiotic knowledge did not correspond with a higher number of antibiotic prescriptions.
ConclusionsA high prevalence of antibiotic use was observed in the 18 Brazilian hospitals. The antibiotics were prescribed mainly empirically. Intravenous broad-spectrum antibiotics were the most frequent antimicrobials used, showing that reinforcement of de-escalation strategy is needed. The Global-PPS data can be very useful for monitoring stewardship programmes and intervention.