scholarly journals Normal Respiratory Flora as a Cause of Community-Acquired Pneumonia

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Daniel M Musher ◽  
Sirus J Jesudasen ◽  
Joseph W Barwatt ◽  
Daniel N Cohen ◽  
Benjamin J Moss ◽  
...  
Keyword(s):  
Respiratory Virus ◽  
Bacterial Pathogens ◽  
Community Acquired Pneumonia ◽  
Etiologic Agent ◽  
High Quality ◽  
Bacterial Speciation ◽  
Colony Forming Units ◽  
Genetic Features ◽  
Reaction Thresholds ◽  
Time Of Admission

Abstract Background Intensive studies have failed to identify an etiologic agent in >50% cases of community-acquired pneumonia (CAP). Bacterial pneumonia follows aspiration of recognized bacterial pathogens (RBPs) such as Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus after they have colonize the nasopharynx. We hypothesized that aspiration of normal respiratory flora (NRF) might also cause CAP. Methods We studied 120 patients hospitalized for CAP who provided a high-quality sputum specimen at, or soon after admission, using Gram stain, quantitative sputum culture, bacterial speciation by matrix-assisted laser desorption ionization time-of-flight, and viral polymerase chain reaction. Thresholds for diagnosis of bacterial infection were ≥105 colony-forming units (cfu)/mL sputum for RBPs and ≥106 cfu for NRF. Results Recognized bacterial pathogens were found in 68 of 120 (56.7%) patients; 14 (20.1%) of these had a coinfecting respiratory virus. Normal respiratory flora were found in 31 (25.8%) patients; 10 (32.2%) had a coinfecting respiratory virus. Infection by ≥2 RBPs occurred in 10 cases and by NRF together with RBPs in 13 cases. Among NRF, organisms identified as Streptococcus mitis, which share many genetic features of S pneumoniae, predominated. A respiratory virus alone was found in 16 of 120 (13.3%) patients. Overall, an etiologic diagnosis was established in 95.8% of cases. Conclusions Normal respiratory flora, with or without viral coinfection, appear to have caused one quarter of cases of CAP and may have played a contributory role in an additional 10.8% of cases caused by RBPs. An etiology for CAP was identified in >95% of patients who provided a high-quality sputum at, or soon after, the time of admission.

Respiratory viral testing and antibacterial treatment in patients hospitalized with community-acquired pneumonia

2020 ◽  
pp. 1-9
Author(s):  
Michael Klompas ◽  
Peter B. Imrey ◽  
Pei-Chun Yu ◽  
Chanu Rhee ◽  
Abhishek Deshpande ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Respiratory Virus ◽  
Respiratory Viruses ◽  
Community Acquired Pneumonia ◽  
Blood Cultures ◽  
Antibacterial Treatment ◽  
Viral Pathogens ◽  
Antimicrobial Utilization ◽  
Viral Testing ◽  
Virus Testing

Abstract Objective: Viruses are more common than bacteria in patients hospitalized with community-acquired pneumonia. Little is known, however, about the frequency of respiratory viral testing and its associations with antimicrobial utilization. Design: Retrospective cohort study. Setting: The study included 179 US hospitals. Patients: Adults admitted with pneumonia between July 2010 and June 2015. Methods: We assessed the frequency of respiratory virus testing and compared antimicrobial utilization, mortality, length of stay, and costs between tested versus untested patients, and between virus-positive versus virus-negative patients. Results: Among 166,273 patients with pneumonia on admission, 40,787 patients (24.5%) were tested for respiratory viruses, 94.8% were tested for influenza, and 20.7% were tested for other viruses. Viral assays were positive in 5,133 of 40,787 tested patients (12.6%), typically for influenza and rhinovirus. Tested patients were younger and had fewer comorbidities than untested patients, but patients with positive viral assays were older and had more comorbidities than those with negative assays. Blood cultures were positive for bacterial pathogens in 2.7% of patients with positive viral assays versus 5.3% of patients with negative viral tests (P < .001). Antibacterial courses were shorter for virus-positive versus -negative patients overall (mean 5.5 vs 6.4 days; P < .001) but varied by bacterial testing: 8.1 versus 8.0 days (P = .60) if bacterial tests were positive; 5.3 versus 6.1 days (P < .001) if bacterial tests were negative; and 3.3 versus 5.2 days (P < .001) if bacterial tests were not obtained (interaction P < .001). Conclusions: A minority of patients hospitalized with pneumonia were tested for respiratory viruses; only a fraction of potential viral pathogens were assayed; and patients with positive viral tests often received long antibacterial courses.

scholarly journals Predictive Factors of the Responses to Treatment of Mycoplasma pneumoniae Pneumonia

2021 ◽  
Vol 10 (6) ◽  
pp. 1154
Author(s):  
Eun Lee ◽  
Yun Young Lee
Keyword(s):  
Pleural Effusion ◽  
Mycoplasma Pneumoniae ◽  
Predictive Factors ◽  
Respiratory Virus ◽  
Clinical Laboratory ◽  
Poor Response ◽  
Response To Treatment ◽  
Slow Response ◽  
Response Group ◽  
Time Of Admission

The prevalence of refractory Mycoplasma pneumoniae (MP) pneumonia is increasing. The present study aimed to identify the predictive factors of responses to treatment of MP pneumonia in children. A total of 149 children were diagnosed with MP pneumonia, of whom 56 were included in the good response group, 75 children in the slow response group, and 18 children in no response or progression group. Data on the clinical, laboratory, and radiologic features were retrospectively obtained through medical chart reviews. The severity of pneumonia, based on the extent of pneumonic lesions on chest x-ray (adjusted odds ratio (aOR), 10.573; 95% confidence intervals (CIs), 2.303−48.543), and lactate dehydrogenase (LDH) levels (aOR, 1.002; 95% CIs, 1.000–1.004) at the time of admission were associated with slow response to treatment of MP pneumonia. Pleural effusion (aOR, 5.127; 95% CIs, 1.404–18.727), respiratory virus co-infection (aOR, 4.354; 95% CIs, 1.374–13.800), and higher LDH levels (aOR, 1.005; 95% CIs, 1.002–1.007) as well as MP-specific IgM titer (aOR, 1.309; 95% CIs, 1.095–1.564) were associated with no response or progression of MP pneumonia. The area under the curve for the prediction of no or poor response in MP pneumonia using pleural effusion, respiratory virus co-infection, LDH levels, and MP-specific IgM titer at the time of admission was 0.8547. This study identified the predictive factors of responses to treatment of MP pneumonia in children, which would be helpful in establishing a therapeutic plan and predicting the clinical course of MP pneumonia in children.

scholarly journals Assessment of Analysis of Urinary Pneumococcal Antigen by Immunochromatography for Etiologic Diagnosis of Community-Acquired Pneumonia in Adults

2006 ◽  
Vol 13 (10) ◽  
pp. 1092-1097 ◽  
Author(s):  
Maria Luisa Briones ◽  
José Blanquer ◽  
David Ferrando ◽  
Maria Luisa Blasco ◽  
Concepción Gimeno ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Diagnostic Techniques ◽  
Community Acquired Pneumonia ◽  
Etiologic Agent ◽  
Chronic Obstructive ◽  
Pneumococcal Infections ◽  
Obstructive Pulmonary Disease ◽  
Pneumococcal Antigen ◽  
A Prospective Study ◽  
Etiologic Diagnosis

ABSTRACT The limitations of conventional microbiologic methods (CMM) for etiologic diagnosis of community pneumococcal pneumonia have made faster diagnostic techniques necessary. Our aim was to evaluate the usefulness of the immunochromatography (ICT) technique for detecting urinary Streptococcus pneumoniae antigen in the etiologic diagnosis of community-acquired pneumonias (CAP). This was a prospective study on in-patients with CAP in a tertiary hospital conducted from October 2000 to March 2004. Apart from using CMM to reach an etiologic diagnosis, we determined pneumococcal antigen in concentrated urine by ICT. We also determined the urinary pneumococcal antigen (UPA) content in patients from two control groups to calculate the specificity of the technique. One group was comprised of in-patients diagnosed with chronic obstructive pulmonary disease (COPD) or asthma, with respiratory infection, and without pneumonia; the other group included fractures. We studied 959 pneumonia patients and determined UPA content in 911 (95%) of them. We diagnosed the etiology of 253 cases (28%) using CMM; S. pneumoniae was the most common etiologic agent (57 cases). ICT analysis was positive for 279 patients (31%). Using this technique, the percentage of diagnoses of pneumococcal pneumonias increased by 26%, while the overall etiologic diagnosis increased from 28 to 49%. The technique sensitivity was 81%; the specificity oscillated between 80% in CAP with nonpneumococcal etiology and 99% for patients with fractures without infections. Determination of UPA is a rapid, simple analysis with good sensitivity and specificity, which increased the percentage of etiologic diagnoses. Positive UPA may persist in COPD patients with probable pneumococcal colonization or recent pneumococcal infections.

Atypical bacterial pathogens in community-acquired pneumonia in children: a hospital-based study

2009 ◽  
Vol 39 (2) ◽  
pp. 109-111 ◽  
Author(s):  
Jyotsna Agarwal ◽  
Shally Awasthi ◽  
Anuradha Rajput ◽  
Manoj Tiwari ◽  
Amita Jain
Keyword(s):  
Bacterial Pathogens ◽  
Community Acquired Pneumonia

scholarly journals AMOXYCILLIN FOR COMMUNITY-ACQUIRED PNEUMONIA IN CHILDREN

2017 ◽  
pp. 52-55
Author(s):  
A. B. MALAKHOV ◽  
N. G. KOLOSOVA
Keyword(s):  
Respiratory Diseases ◽  
Adverse Reactions ◽  
Bacterial Pathogens ◽  
Community Acquired Pneumonia ◽  
Haemophilus Influenza ◽  
Cost Of Treatment ◽  
Global Challenge ◽  
Beta Hemolytic Streptococcus ◽  
Group A ◽  
The Cost

The majority of respiratory diseases have viral etiology, and they do not require antibacterial therapy since it does not affect the course of the disease, does not reduce the incidence of bacterial complications. The causes of tonsillitis, epiglottitis, pneumonia are bacterial pathogens, such as Streptococcus pyogenes (group A beta-hemolytic streptococcus), Streptococcus pneumoniae,Haemophilus influenza, S. aureus and Moraxella catarrhalis. Home treatment of children remains a global challenge, as it may be the cause of an unfavorable outcome in young children, and, therefore, the issues of diagnostics and rational antibiotic therapy are still relevant. Irrational use of antibiotics can promote growth of resistance of bacterial pathogens, increase the frequency of adverse reactions of therapy and increase the cost of treatment

Abstract P134: ASSOCIATION OF HYPERTENSION WITH MORTALITY RISK IN PATIENTS WITH COVID 19 PNEUMONIA IN A HOSPITAL IN MEXICO CITY

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
José Martín Alanís Naranjo ◽  
Gabriela Olguín Contreras ◽  
Cristo Raymundo Ibarra Jaimes
Keyword(s):  
Severe Pneumonia ◽  
Ground Glass Opacity ◽  
Cross Sectional Study ◽  
Community Acquired Pneumonia ◽  
P Value ◽  
Cross Sectional ◽  
Risk Of Mortality ◽  
Chest X Ray ◽  
Time Of Admission ◽  
First Time

Introduction: The world is currently suffering from the outbreak of a pandemic caused by the SARS-CoV-2 coronavirus, which causes the disease called COVID-19. This disease was reported for the first time in Wuhan, Hubei Province, China, on December 31, 2019. Hypertension, diabetes and cardiovascular disease are common among patients with COVID-19. In Mexico, information on the association between COVID-19 and hypertension is scarce. Methods: This investigation was a descriptive, observational and cross-sectional study that included patients over 18 years of age who had been hospitalized with laboratory-confirmed COVID-19 between April 6, 2020, and May 6, 2020, and exhibited chest X-ray abnormalities (ground-glass opacity, interstitial alterations and/or multilobar infiltrate). Severity of pneumonia (severe vs. nonsevere) at the time of admission was defined using the community-acquired pneumonia guidelines of the American Thoracic Society (ATS). Results: Information was collected from 89 patients with COVID-19 pneumonia, 34 of whom (38.2%) were hypertensive. When studying risk factors in hypertensive patients and their degree of statistical association with risk of mortality, only the severity of pneumonia stood out. The association between severe pneumonia and mortality was statistically significant (OR: 10.9, CI 1.19-99.6, p value = 0.034). Conclusions: Severity of pneumonia upon admission can be regarded as a marker of adverse clinical outcome in hypertensive COVID-19 patients. Among hypertensive COVID-19 patients, in-hospital mortality was high (68%); such mortality was higher in our study than has been reported in other series worldwide.

Pneumonia

2012 ◽  
pp. 256-266
Author(s):  
Priya Sampathkumar
Keyword(s):  
Health Care ◽  
Nosocomial Pneumonia ◽  
Acute Infection ◽  
Care Facility ◽  
Health Care Facility ◽  
Failure To Thrive ◽  
Community Acquired Pneumonia ◽  
Immunosuppressed Patients ◽  
Pulmonary Parenchyma ◽  
Time Of Admission

There are 2 basic types of pneumonia: community-acquired pneumonia and nosocomial pneumonia. Community-acquired pneumonia is an acute infection of the pulmonary parenchyma acquired while the patient was in the community rather than in a hospital. Older or immunosuppressed patients with CAP may present with nonrespiratory symptoms: confusion, failure to thrive, worsening of an underlying chronic illness, or falls. Nosocomial pneumonia: pneumonia that develops more than 48 hours after admission to a health care facility and which was not incubating at the time of admission. Prevention, diagnosis, and treatment are also reviewed.

Respiratory Virus Detection Rate in Patients with Severe or Atypical Community-acquired Pneumonia

2011 ◽  
Vol 71 (5) ◽  
pp. 335
Author(s):  
Ji Won Park ◽  
Sun Young Jung ◽  
Hyuk Soo Eun ◽  
Shinhye Cheon ◽  
Seok Woo Seong ◽  
...  
Keyword(s):  
Detection Rate ◽  
Respiratory Virus ◽  
Virus Detection ◽  
Community Acquired Pneumonia
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