The Changing Microbiologic Epidemiology of Community-Acquired Pneumonia

Aliberti, Stefano; Kaye, Keith S.

doi:10.3810/pgm.2013.11.2710

Cited by 27 publications

(19 citation statements)

References 90 publications

(153 reference statements)

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“…real-time reversetranscriptase polymerase chain reaction) has revealed a very different picture. Nowadays viral etiologies per se are responsible for one-third of all cases of communityacquired pneumonias (CAP) [62,63]. These etiologies include influenza, parainfluenza, coronavirus, rhinovirus, metapneumovirus, adenovirus, respiratory syncytial virus, and other less frequent microorganisms.…”

Section: Role Of Viral-bacterial Co-infections and Their Effect On Oumentioning

confidence: 99%

Influenza virus-related critical illness: pathophysiology and epidemiology

2019

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Influenza virus affects the respiratory tract by direct viral infection or by damage from the immune system response. In humans, the respiratory epithelium is the only site where the hemagglutinin (HA) molecule is effectively cleaved, generating infectious virus particles. Virus transmission occurs through a susceptible individual’s contact with aerosols or respiratory fomites from an infected individual. The inability of the lung to perform its primary function of gas exchange can result from multiple mechanisms, including obstruction of the airways, loss of alveolar structure, loss of lung epithelial integrity from direct epithelial cell killing, and degradation of the critical extracellular matrix. Approximately 30–40% of hospitalized patients with laboratory-confirmed influenza are diagnosed with acute pneumonia. These patients who develop pneumonia are more likely to be < 5 years old, > 65 years old, Caucasian, and nursing home residents; have chronic lung or heart disease and history of smoking, and are immunocompromised. Influenza can primarily cause severe pneumonia, but it can also present in conjunction with or be followed by a secondary bacterial infection, most commonly by Staphylococcus aureus and Streptococcus pneumoniae . Influenza is associated with a high predisposition to bacterial sepsis and ARDS. Viral infections presenting concurrently with bacterial pneumonia are now known to occur with a frequency of 30–50% in both adult and pediatric populations. The H3N2 subtype has been associated with unprecedented high levels of intensive care unit (ICU) admission. Influenza A is the predominant viral etiology of acute respiratory distress syndrome (ARDS) in adults. Risk factors independently associated with ARDS are age between 36 and 55 years old, pregnancy, and obesity, while protective factors are female sex, influenza vaccination, and infections with Influenza A (H3N2) or Influenza B viruses. In the ICU, particularly during the winter season, influenza should be suspected not only in patients with typical symptoms and epidemiology, but also in patients with severe pneumonia, ARDS, sepsis with or without bacterial co-infection, as well as in patients with encephalitis, myocarditis, and rhabdomyolysis.

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Section: Role Of Viral-bacterial Co-infections and Their Effect On Oumentioning

confidence: 99%

Influenza virus-related critical illness: pathophysiology and epidemiology

2019

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“…Community‐acquired pneumonia (CAP) has been associated with significant mortality among hospitalized patients . Appropriate antibiotic treatment is challenged by the emergence of resistant strains, including those of Streptococcus pneumoniae . Treatment recommendations are based on randomized controlled trials (RCTs) comparing monotherapy regimens in hospitalized patients with low mortality probability and on observational studies evaluating more severely ill patients than those enrolled in RCTs .…”

Section: Introductionmentioning

confidence: 99%

“…1 Appropriate antibiotic treatment is challenged by the emergence of resistant strains, including those of Streptococcus pneumoniae. 2,3 Treatment recommendations 1,[4][5][6][7][8][9] are based on randomized controlled trials (RCTs) comparing monotherapy regimens in hospitalized patients with low mortality probability and on observational studies evaluating more severely ill patients than those enrolled in RCTs. 10,11 Monotherapy and combination regimens are recommended for mild or moderate CAP; combination regimens are mainly recommended for severe CAP.…”

Section: Introductionmentioning

confidence: 99%

The dilemma of monotherapy or combination therapy in community‐acquired pneumonia

Vardakas

Trigkidis

Apiranthiti

et al. 2017

Eur J Clin Investigation

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Scope: To study the factors associated with mortality in hospitalized patients with community-acquired pneumonia treated with monotherapy or combination therapy. Methods: PubMed and Scopus were searched. Patients receiving macrolides, blactams and fluoroquinolones, as monotherapy or in combination, were included.Meta-analyses and meta-regressions were performed. Results: Fifty studies were included. Overall, monotherapy was not associated with higher mortality than combination (RR 1.14, 95% CI 0.99-1.32, I 2 84%).Monotherapy was associated with higher mortality than combination in North American and retrospective studies. b-lactam monotherapy was associated with higher mortality than b-lactam/macrolide combination in the primary (1.32, 1.12-1.56, I 2 85%) and most sensitivity analyses. There was no difference in mortality between fluoroquinolone monotherapy and b-lactam/macrolide combination (0.98, 0.78-1.23, I 2 73%). In meta-regressions, the moderators that could partially explain the observed statistical heterogeneity were the frequency of cancer patients (P = .03) and Pneumonia Severity Index score IV (P = .008). Conclusion: Due to the considerable heterogeneity and inclusion of unadjusted data, it is difficult to recommend a specific antibiotic regimen over another.Specific antibiotic regimens, study design and the characteristics of the population under study seem to influence the reported outcomes.

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“…The most common pathogens implicated in pneumonia are Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Haemophilus influenzae, Legionella species, and respiratory viruses. 19,20 In addition, multiple studies have shown Staphylococcus aureus to be one of the most common pneumonia pathogens behind S pneumoniae. 21 Regarding HAP, the largest report on the microbiology of HAP showed that most culture-positive cases were due to S aureus and gramnegative pathogens.…”

Section: What Pathogens Are Responsible For Causing Pneumonia?mentioning

confidence: 99%