Severe community-acquired pneumonia

Niederman, Michael S.; Torres, Antoni

doi:10.1183/16000617.0123-2022

Cited by 44 publications

(31 citation statements)

References 70 publications

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“…The possibility to rapidly detect mecA and mecC genes in S. aureus, extended-spectrum beta-lactamases (ESBL) producing and carbapenem-resistant strains of Enterobacteriacae, and multidrug-resistant (MDR) such as Acinetobacter baumannii could reduce the the time required to prescribe targeted therapy, with a potential benefit in terms of survivorship. 14 However, data on these types of techniques show a very high sensitivity against a lower specificity, being able to represent situations of colonization rather than infection, or even the presence of genetic material belonging to nonliving strains, with an increase of overtreatment which has also been associated with adverse outcomes. 15,16 Potential harms from an excess of antibiotics used in these patients may determine inappropriate escalation of antibiotic therapy, side effects due to drug toxicity, selection for more antibiotic-resistant pathogens, and increased rate of Clostridium difficile infection, not to mention the impact on the society due to increased burden of antibiotic resistance and the associated costs.…”

Section: Role Of Rapid Diagnostic Techniquesmentioning

confidence: 99%

“…NIV delivers positive pressure ventilation through various interfaces (e.g., nasal mask, face mask, helmet), while HFNO involves the delivery of heated and humidified oxygen at rates of up to 60 L/minute through nasal cannula, providing a small amount of positive end-expiratory pressure (PEEP) and generating a washout of dead space. 56 The choice of NIV rather than HFNO in AHRF is controversial, as the benefits and harms of spontaneous ventilation in these patients must be carefully weighed 14 and in the future, unanimous criteria for defining treatment failure in these patients should also be defined.…”

Section: Respiratory Failure Managementmentioning

confidence: 99%

Section: Role Of Rapid Diagnostic Techniquesmentioning

confidence: 99%

“…The choice of NIV rather than HFNO in AHRF is controversial, as the benefits and harms of spontaneous ventilation in these patients must be carefully weighed 14 and in the future, unanimous criteria for defining treatment failure in these patients should also be defined.…”

Section: Respiratory Failure Managementmentioning

confidence: 99%

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New Guidelines for Severe Community-acquired Pneumonia

Calabretta,

Martìn-Loeches,

Torres

2024

Semin Respir Crit Care Med

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In 2023, the new European guidelines on severe community-acquired pneumonia, providing clinical practice recommendations for the management of this life-threatening infection, characterized by a high burden of mortality, morbidity, and costs for the society. This review article aims to summarize the principal evidence related to eight different questions covered in the guidelines, by also highlighting the future perspectives for research activity.

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Section: Role Of Rapid Diagnostic Techniquesmentioning

confidence: 99%

Section: Respiratory Failure Managementmentioning

confidence: 99%

Section: Role Of Rapid Diagnostic Techniquesmentioning

confidence: 99%

Section: Respiratory Failure Managementmentioning

confidence: 99%

See 2 more Smart Citations

New Guidelines for Severe Community-acquired Pneumonia

Calabretta,

Martìn-Loeches,

Torres

2024

Semin Respir Crit Care Med

Self Cite

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“…Disease progression may result in severe CAP, defined by acute respiratory failure and the need for mechanical ventilation (4)(5)(6). Acute lung injury is characterized by hypoxemia, enhanced pulmonary vascular permeability and inflammation-mediated lung injury (7,8).…”

Section: Introductionmentioning

confidence: 99%

Enzymatic modulation of the pulmonary glycocalyx alters susceptibility toStreptococcus pneumoniae

Goekeri,

Linke,

Hoffmann

et al. 2024

Preprint

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The pulmonary epithelial glycocalyx is rich in glycosaminoglycans such as hyaluronan and heparan sulfate. Despite their presence, the precise role of these glycosaminoglycans in bacterial lung infections remains elusive. To address this, we intranasally inoculated mice with Streptococcus pneumoniae in the presence or absence of enzymes targeting pulmonary hyaluronan and heparan sulfate, followed by characterization of subsequent disease pathology, pulmonary inflammation, and lung barrier dysfunction. Enzymatic degradation of hyaluronan and heparan sulfate exacerbated pneumonia in mice, as evidenced by increased disease scores and alveolar neutrophil recruitment. However, targeting epithelial hyaluronan further exacerbated systemic disease, indicated by elevated splenic bacterial load and plasma levels of pro-inflammatory cytokines. In contrast, enzymatic cleavage of heparan sulfate resulted in increased bronchoalveolar bacterial burden, lung damage and pulmonary inflammation in mice infected with Streptococcus pneumoniae. Accordingly, heparinase-treated mice also exhibited disrupted lung barrier integrity as evidenced by higher alveolar edema scores and vascular protein leakage into the airways. This finding was corroborated in a human alveolus-on-a-chip platform, confirming that heparinase treatment also disrupts the human lung barrier. Notably, enzymatic pre-treatment with either hyaluronidase or heparinase also rendered human epithelial cells more sensitive to pneumococcal-induced barrier disruption, as determined by transepithelial electrical resistance measurements, consistent with our findings in murine pneumonia. Taken together, these findings demonstrate the importance of intact hyaluronan and heparan sulfate in controlling pneumococcal virulence, pulmonary inflammation, and epithelial barrier function.

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Corticosteroids in critically ill patients: A narrative review

Haan,

Blackmon,

Cobb

et al. 2024

Pharmacotherapy

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Corticosteroids have been utilized in modern medicine for decades. Many indications have been investigated across various treatment settings with both benefit and harm observed. Given the instability of critically ill patients, the increased risk of corticosteroid‐related complications, and the pervasive comorbidities, patients who receive corticosteroids must be carefully managed. Common critical care disease states in which corticosteroids have been studied and are routinely utilized include acute respiratory distress syndrome, adrenal insufficiency, angioedema, asthma, chronic obstructive pulmonary disease, community‐acquired pneumonia, coronavirus disease 2019, septic shock, and spinal cord injury. Benefits of corticosteroids include an improvement in disease state‐specific outcomes, decreased hospital length of stay, decreased mechanical ventilatory support, and decreased mortality. The harm of corticosteroids is well documented through adverse effects that include, but are not limited to, hyperglycemia, tachycardia, hypertension, agitation, delirium, anxiety, immunosuppression, gastrointestinal bleeding, fluid retention, and muscle weakness. Furthermore, corticosteroids are associated with increased health care costs through adverse effects as well as drug acquisition and administration costs. Given the assortment of agents, dosing, benefits, risks, and utilization in the critical care setting, there may be difficulty with identifying the appropriate places for use of corticosteroids in therapy. There currently exists no comprehensive report detailing the use of corticosteroids in the aforementioned disease states within the critical care setting. This narrative review sets out to describe these in detail.

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Severe community-acquired pneumonia

Cited by 44 publications

References 70 publications

New Guidelines for Severe Community-acquired Pneumonia

New Guidelines for Severe Community-acquired Pneumonia

Enzymatic modulation of the pulmonary glycocalyx alters susceptibility toStreptococcus pneumoniae

Corticosteroids in critically ill patients: A narrative review

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