The following guidelines are based on a systematic analysis of the literative which has been discussed by members of the ESOCAP committee and by external reviewers. The literature review and detailed methods of guideline development will be published in the European Respiratory Review, along with the list of external reviewers Initial clinical assessment and decision on hospital referralThe management of a community-acquired lower respiratory tract infection (LRTI) should follow a systematic step-by-step process ( fig. 1), beginning with a detailed history and clinical examination. Attempts to identify the type of LRTI (pneumonia, acute bronchitis, superinfection of chronic bronchitis, or viral infection) are probably unhelpful outside hospital, since several studies have demonstrated that the sensitivity and specificity of clinical signs and symptoms are low for establishing such a classification. Therefore, the main goal of initial clinical evaluation is to determine whether the patient can be managed at home or whether there is evidence that suggests potential or immediate severity, or that the illness will follow a complicated course (table 1, fig. 2). All these features will guide the decision on hospital referral and admission ( fig. 2).

Abstract:The clinical impact of viral factors (types and viral loads) during respiratory syncytial virus (RSV) infection is still controversial, especially regarding newly described genotypes. In this study, infants with RSV bronchiolitis were recruited to describe the association of these viral factors with severity of infection. RSV antigenic types, genotypes, and viral loads were determined from hospitalized patients at Hospital Roberto del Río, Santiago, Chile. Cases were characterized by demographic and clinical information, including days of lower respiratory symptoms and severity. A total of 86 patients were included: 49 moderate and 37 severe cases. During 2013, RSV-A was dominant (86%). RSV-B predominated in 2014 (92%). Phylogenetic analyses revealed circulation of GA2, Buenos Aires (BA), and Ontario (ON) genotypes. No association was observed between severity of infection and RSV group (p = 0.69) or genotype (p = 0.87). After a clinical categorization of duration of illness, higher RSV genomic loads were detected in infants evaluated earlier in their disease (p < 0.001) and also in infants evaluated later, but coursing a more severe infection (p = 0.04). Although types and genotypes did not associate with severity in our children, higher RSV genomic loads and delayed viral clearance in severe patients define a group that might benefit from new antiviral therapies.

Objetivo: Describir el apoyo social de las personas que padecen cáncer y la relación con la calidad de vida. Metodología: Estudio descriptivo correlacional de alcance transversal, muestreo no probabilístico, en 132 personas diagnosticadas con cáncer, a quienes se les aplicó el cuestionario de Apoyo Social en Pacientes con Cáncer y el instrumento de Evaluación Subjetiva de la Calidad de Vida. Resultados: La edad promedio de los adultos con cáncer fue de 50.49 años ± 13.65, predomino el género femenino (76%). Los tipos de cáncer, fueron cáncer de mama (40%), cáncer cervicouterino (19%), otros tipos de cáncer (41%). El 65% estuvo con tratamiento de quimioterapia. La media del apoyo social fue 72.51±21.01 y de 66.55±14.64 para la calidad de calidad. El apoyo social y la calidad presentaron una relación débil, (r=.28**, p=.001), positiva y significativa. Conclusión: El cáncer afecta más a mujeres, sobresaliendo el cáncer de mama. Se encontró relación entre el apoyo social y la calidad de vida. Debido muy probablemente a que los adultos se ven fortalecidos por la redes de apoyos social (seguridad social, familiares y amigos), y refieren buena su calidad de vida. Lo que indica que a mayor apoyo social mayor calidad de vida.

The fluctuations in the number of some intestinal bacterial lineages may be associated with increased antimicrobial resistance and disease. Adaptation to a given environment may select bacterial mutants that have reduced ability to adapt to new environments and changes in diet have been associated with alterations in microbiome taxon composition. We wanted to see the effect of diet change in linage composition and antimicrobial resistance profiles of numerically dominant E. coli. We subjected 50 chickens from an industrial operation (under corn-based diet supplemented with antimicrobials) to 2 antimicrobial-free diets; one based on corn and the other based on alfalfa. Fecal samples were obtained from all animals at arrival and after five weeks under different diets. Five E. coli colonies (from each sample) were subjected to genetic typing and antimicrobial susceptibility testing. We observed high diversity and high turnover rate of numerically dominant E. coli strains from animals from both diet groups. We did not find differences in antimicrobial resistance profiles in isolates from different diet groups. Our results suggest that there is high diversity and high turnover rate of E. coli strains in the intestines regardless of the diet. Chicken intestines seemed to contain many E. coliThe fluctuations in the number of some intestinal bacterial lineages may be associated with increased antimicrobial resistance and disease. Adaptation to a given environment may select bacterial mutants that have reduced ability to adapt to new environments and changes in diet have been associated with alterations in microbiome taxon composition. We wanted to see the effect of diet change in linage composition and antimicrobial resistance profiles of numerically dominant E. coli. We subjected 50 chickens from an industrial operation (under corn-based diet supplemented with antimicrobials) to 2 antimicrobial-free diets; one based on corn and the other based on alfalfa. Fecal samples were obtained from all animals at arrival and after five weeks under different diets. Five E. coli colonies (from each sample) were subjected to genetic typing and antimicrobial susceptibility testing. We observed high diversity and high turnover rate of numerically dominant E. coli strains from animals from both diet groups. We did not find differences in antimicrobial resistance profiles in isolates from different diet groups. Our results suggest that there is high diversity and high turnover rate of E. coli strains in the intestines regardless of the diet. Chicken intestines seemed to contain many E. coli lineages able to thrive in different substrates. The absence of differences in antimicrobial resistance among bacteria, from animals in different diets, may indicate that the carriage of antimicrobial resistance genes does not affect the bacterial ability to adapt to different substrates. lineages able to thrive in different substrates. The absence of differences in antimicrobial resistance among bacteria, from animals in different diets, may indicate that the carriage of antimicrobial resistance genes does not affect the bacterial ability to adapt to different substrates.

Background: The use of antimicrobials in the animal industry has increased the prevalence of antibiotic resistant bacteria and antimicrobial-resistance genes which can be transferred to human microbiota through the food chain or the environment. To reduce the influx of antibiotic-resistance to the human microbiota, restrictions on antimicrobials (in food animals) have been implemented in different countries. We investigated the impact of an antimicrobial restriction on the frequency of antimicrobial-resistant bacteria in pigs (PCI 1050) from an Ecuadorian farm. Results: No differences in antimicrobial resistant coliforms or antimicrobial resistance genes (richness and abundance) were found when we compared animals fed with or without antibiotics. Nevertheless, the absence of antimicrobials in pigs didn’t impact the productive performance of animals. Conclusion: Fitness costs of antimicrobial resistance in bacteria within intestinal microbiota of animals seems to be overestimated. Avoiding antimicrobials as prophylactics in pigs fed is not enough to control maintenance and spread of antimicrobial resistance.