جستجوی مقالات مرتبط با کلیدواژه « community-acquired pneumonia » در نشریات گروه « پزشکی »

Pneumonia is one of the common infectious diseases in the community and hospital, which can cause complications and death if not treated. Correct treatment of this disease is important. Therefore, in this study, we aimed to evaluate antibiotic stewardship for pneumonia with the American Thoracic Society (ATS) guidelines in Loghman Hakim Hospital in 2021.

In this descriptive study, all patients admitted to Loghman Hakim Hospital in 2021 with pneumonia were evaluated. Age, gender, type of pneumonia (healthcare-associated pneumonia, community-acquired pneumonia, community-acquired aspiration pneumonia, early-onset and late-onset hospital-acquired pneumonia, ventilator-associated pneumonia, and hospital-acquired aspiration pneumonia), antibiotic type and dose, and renal dose adjustment of antibiotics were recorded. Then, the antibiotic prescription protocol in patients with pneumonia was compared with the ATS guidelines.

72 people were included in the study; 11 (15.28%) had healthcare-associated pneumonia (HCAP), 24(33.33%) community-acquired pneumonia (CAP), 20(27.78%) community-acquired aspiration pneumonia (CAAP), 7(9.72%) hospital-acquired pneumonia (HAP), 4(5.56%) hospital-acquired aspiration pneumonia (HAAP), and 6 (8.33%) patients had ventilator-associated pneumonia (VAP). 31.94% did not receive antibiotics according to the protocol. 13.88% of patients received antibiotics correctly, but with the wrong dose, and in 18.06% of patients, the type of antibiotic was wrong (P-value=0.102).

Monitoring antibiotic stewardship in the hospital for patients with pneumonia is necessary.

The objective of this study was to investigate the prevalence of Mycoplasma pneumoniae and Chlamydophila pneumoniae infections in patients with community-acquired pneumonia (CAP) admitted to Beheshti hospital in Kashan.

A descriptive cross-sectional study was conducted on 160 CAP patients admitted to Beheshti hospital in Kashan. Serological tests were performed using the ELISA method to evaluate IgG and IgM antibodies for Mycoplasma and Chlamydia pneumoniae. A questionnaire was also completed, which included demographic data, hospitalization time, and clinical and paraclinical findings. The data were analyzed using SPSS software (version 20).

The study found that 19 (11.9%) cases tested positive for M. pneumoniae IgM antibodies, while 132 (82.5%) cases tested positive for M. pneumoniae IgG antibodies. For C. pneumoniae, 16 (10%) cases tested positive for IgM antibodies, and 151 (94.4%) cases tested positive for IgG antibodies. There was no significant association between M. pneumoniae and Chlamydia pneumoniae infections with sex, underlying illness, pneumonia severity, ICU admission, hospital death, hospitalization time, CRP, hematocrit, and platelet count. However, a significant relationship was observed between M. pneumoniae and chief complaint (p<0.001), as well as age (p = 0.122). Additionally, a significant relationship was found between C. pneumoniae and white blood cell count (p = 0.001), as well as changes in chest radiography (p = 0.001).

Given the significant incidence of atypical infections in CAP patients and the difficulties in laboratory detection, effective antibiotics targeting Mycoplasma pneumoniae and Chlamydophila pneumoniae are strongly suggested in the empirical therapy of CAP.

Community-acquired pneumonia (CAP) is one of the most common life-threatening infec- tions, occurring in the community or within the first 48 hours of a patient's hospitalization. The present study aimed to investigate the frequency of pathogenic bacteria and their antibiotic resistance pattern in the sputum of patients with commu- nity-acquired pneumonia in Yasuj from 2018 to 2019.

In the present study, 128 patients with CAP were included. Under aseptic conditions clinical samples including sputum collected from each patient were sent to the Microbiology Laboratory. Specific culture media and biochemical tests were used to identify the bacteria. Antimicrobial resistance patterns of the isolates were examined by disc diffusion. DNA was extracted from sputum using the phenol-chloroform method. The PCR method was used for the molec- ular detection of bacteria. Data were analyzed using SPSS software version 22 and the chi-square test.

The most common clinical symptoms in patients were sputum (68.8%), fever (64.1%), shortness of breath (60.2%), cough (50.8%), and chest pain (24.2%). A total of 133 bacteria were identified by culture and 117 bacteria by PCR. In the current study, the most prevalent organisms were Streptococcus pneumoniae (24.1%), Hemophilus influenzae (18%), Staph- ylococcus aureus (13.5%), and Moraxella catarrhalis (11.4%). Antibiogram test showed that most of the Gram-negative bacteria were resistant to levofloxacin (22.6%), rifampin (20.8%) and ceftriaxone (17%), and the highest resistance rate to clindamycin (43.1%), ciprofloxacin (43.1%) and amoxicillin (41.4%) were detected in the Gram-positive bacteria. Cefepime was the most effective antibiotic against Gram negative bacteria.

S. pneumoniae was the most prevalent bacteria identified by culture and PCR methods in patients with CAP, indicating an important role of this bacterium in the pathogenesis of CAP. According to the results, cefepime can be used to treat patients with CAP with Gram-negative bacteria. In the present study, S. pneumoniae, S. aureus, P. aeruginosa, H. influenzae, M. catarrhalis, and K. pneumoniae have been isolated from the CAP patient population with varying frequencies. This is consistent with various studies in different parts of the world.

Community-acquired pneumonia (CAP) refers to pneumonia attained outside the hospital or less than 48 hours before admission, which is a significant cause of mortality and morbidity, especially in major comorbidities and older age. Several microorganisms contribute to developing CAP, primarily Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis, and atypical pathogens, e.g., Mycoplasma pneumonia. The incidence of these microorganisms depends on outpatient or inpatient settings. Administering appropriate treatment among available antibiotics is a critical issue affecting patient survival.

With a multidisciplinary panel expert, this document offers evidence-based recommendations for managing CAP in Iran.

The document evaluated the availability of antimicrobial agents and local antibiotic resistance patterns based on 94 relevant published studies from Google Scholar, Scopus, PubMed, Scientific Information Database (SID), Iran Medex, Iran doc, Mag Iran, PubMed, and expert opinions.

The panel addressed two main parts of rational recommendations for managing outpatients or hospitalized patients with CAP.

One of the most dangerous respiratory diseases is pneumonia, one of the ten leading causes of death globally. Hospital-acquired pneumonia (HAP) is a common infection in hospitals, which is the second most common nosocomial infection and causes inflammation parenchyma. In Community-acquired pneumonia (CAP), we have various risk factors, including age and gender, and also some specific risk factors. Ventilator-associated pneumonia (VAP) is one of the deadliest nosocomial infections. According to the Centers for Disease Control and Prevention, VAP is pneumonia that develops about 48 hours of an artificial airway. Bacteria, viruses, parasites, fungi, and other microorganisms can cause these diseases. This review article discusses microbial agents associated with pneumonia. Our goal is to gather information about HAP, CAP, and VAP to give people specific information. In this study, these three issues have been examined together, but in similar studies, each of them has been examined separately, and our type of study will be more helpful in diagnosis and treatment.

We aimed to evaluate the characteristics of a stress injury in community-acquired pneumonia (CAP) patients in the respiratory intensive care unit (RICU) and analyze the risk factors, to provide evidence for clinical prevention and treatment.

This retrospective study was conducted in RICU at Qilu Hospital of Shandong University, China. We selected 85 patients with traumatic CAP who were brought in from January 2019 to December 2020 as the case group and 167 patients without traumatic CAPhospitalized in the same period as the control group.Mul-tivariate binary Logistic regression analysis was used to explore the influencing factors.

The incidence rate of a stress injury in 252 patients was 33.73%. The most affected region found in these patients was the sacrococcygeal region (24.26%). Most of the patients were presented in stage one (49.50%). Factors associated with a stress-induced injury in RICU, CAP patients were CURB-65 combined with cerebrovascular disease, fever combined with heart disease and albumin was found as an independent risk factor.

Attempts to improvestress injury in CAP patients through setting measurable process of care standards are to be encouraged. An approach including the patient’sclothes and bedding should be changed frequently, nutrition should be managed and the skin of the patientshould be kept clean and dry. The occur-rence of stress can further be reduced by the use of protective tools and the timely participation of the family members in patient management.

Community-acquired pneumonia (CAP) remains one of the leading causes of hospital admissions and a common cause of death. Population-based studies assessing the etiology and incidence of CAP are lacking in developing countries. In this prospective study, we assessed the incidence, etiology, and outcomes of CAP in the Iranian population.

This five-year hospital based cross-sectional and descriptive study included 357 patients with CAP, between 18 and 95 years of age. Demographic criteria and clinical data of CAP including fever, cough, sputum, dyspnea, hemoptysis, gastrointestinal symptoms and loss of consciousness were recorded. Laboratory findings and prescribed antibiotics were retrieved from the patients’ records. Results of bronchoalveolar lavage fluid and sputum specimens and also culture results were recorded.
Paired t-test, independent-samples T Test and chi-square were used to examine the relationships among different variables. P<0.05 was considered significant.

The total number of patients in the study was 384 patients, of which 55.2% were male and 44.8% were female (P value = 0.2). The most common underlying disease was community-acquired pneumonia (35.9%). The most common symptom was productive cough, which was observed in 85.2% of the patients. The most common microorganisms isolated from culture were Staphylococcus aureus (9.1%) and Acinetobacter (8.9%). The most commonly used antibiotic in this study was ceftriaxone (43.3). In addition, Acinetobacter species were the most common pathogen in exudative pleural effusion (51.5%). Among the people with higher than normal ESR, 62.2% were male and 37.8% were female, which showed a significant difference (P = 0.03). Out of 89 deaths following pneumonia, 43.8% were under 65 and 56.2% were over 65 years of age, which was significant (P= 0.01).

Considering the high prevalence of Staphylococcus aureus and higher mortality in the elderly and patients with decreased level of consciousness or underlying obstructive pulmonary disease, it is necessary to conduct detailed examinations for sputum culture at the beginning and administer appropriate treatment, based on the identified pathogen as soon as possible in order to reduce drug resistance.

 Lower respiratory tract infections (LRTIs) are prevalent diseases and a major cause of referral to primary healthcare centers. The present study aimed to identify the bacterial etiology of LRTIs to determine the trend changes within the past three decades and help ascertain the new scenarios of empirical LRTI therapy in Turkey.

Data Sources:

 This systematic review was conducted by searching various electronic databases based on specified criteria. In total, 2,670 articles were identified, which had been published during 1990 - 2020 and could be potentially used, and 46 scientific studies that met the eligibility criteria were selected for the review.

 The most frequently isolated bacteria in the reviewed studies were Acinetobacter spp. (31.68%), P. aeruginosa (16.59%), H. influenzae (14.30%), and S. pneumoniae (13.80%). Data analysis also indicated that the most frequent reports of LRTI agents were in Aegean region in Turkey during 2014-2020.

 This systematic review reflected the changes in LRTI agents over the past three decades in Turkey. Knowledge of the frequency of LRTI bacterial agents specific to each country could help healthcare professionals in reporting laboratory results and prescribing/selecting the most effective antibiotics for the treatment of the disease.

We aimed to review relevant randomized controlled trials to assess the relative clinical effects of antibiotic treatment of patients with community-acquired pneumonia (CAP).

In this meta-analysis, we identified relevant studies from PubMed, Cochrane, and Embase using appropriate keywords. Key pertinent sources in the literature were also reviewed and all articles published through Oct 2019 were considered for inclusion. For each study, we assessed the risk ratios (RRs) or mean difference combined with the 95% confidence interval (CI) to assess and synthesize outcomes.

Overall, 36 studies were consistent with the meta-analysis, involving 17,076 patients. There was no significant difference in the mortality after subgroup analysis: individualized treatment vs. standard treatment; β-lactams plus macrolides vs. β-lactam and/or fluoroquinolone; ceftaroline fosamil vs. ceftriaxone; combination therapy vs. monotherapy or high-dose vs. low-dose. The drug-related adverse event incidence was significantly higher in the ceftriaxone group than in the other drug groups (P<0.05) and also higher in the tigecyline group than in the levofloxacin group (P<0.05). Compared with ceftriaxone, ceftaroline fosamil significantly increased the clinical cure rate at the test-of-cure (TOC) visit in the clinically evaluable population, modified intent-to-treat efficacy (MITTE) population, microbiologically evaluable (ME) population and the microbiological MITTE (mMITTE) population (all P<0.05). Compared with ceftriaxone, ceftaroline fosamil significantly increased the clinical cure rate at the TOC visit in the mMITTE population of Gram positive-Streptococcus pneumoniae (P<0.05) and multidrug-resistant S. pneumoniae (P<0.05).

There was a limited number of included studies in the subgroup analysis, but it will still be necessary to conduct more high-quality randomized controlled trials to confirm the clinical efficacy of different antibiotics used to treat CAP.

The spread of antimicrobial resistance (AMR) is a serious public health threat complicating treatment and resulting in prolonged hospitalization. The prevalence of AMR threat is not well defined due to the dearth of appropriate surveillance systems. This study sought to assess the prevalence of AMR among bacterial isolates from sputum specimens obtained from patients with pneumonia presenting at two secondary healthcare facilities in Zaria from June 1 to August 31, 2018.   Standard methodology was followed in processing sputum samples that met the acceptance criteria. The antibiotic susceptibility patterns of bacterial pathogens cultured from sputum specimens obtained from June 1 to August 31, 2018) were evaluated using the recommendation of the Clinical and Laboratory Standards Institute. Finally, data were analyzed using descriptive statistics.   Acinetobacter spp. were the predominant pathogens accounting for 32% of recovered isolates, followed by Staphylococcus spp. (18%) and Klebsiella spp. (17%), respectively. AMR was found in 91% of the isolates. Most isolates were resistant to erythromycin (ERY) (80%) and amoxicillin (83.3%). Eventually, the multiple antibiotic resistance index ≥0.3 was observed in 76% of the isolates.   Based on the findings, AMR rates were observed to be high, and may display a serious therapeutic challenge to the management of community-acquired pneumonia. Concerted efforts are needed to combat the worrisome AMR trends revealed in this study.

 Pneumonia has high rates of morbidity and mortality in Indonesia. Infections caused by multidrug-resistant (MDR) pathogens are not only found in patients with nosocomial pneumonia but are also reported in patients with community-acquired pneumonia (CAP). Only a few studies have analyzed the factors associated with MDR pathogenic infections, especially in developing countries such as Indonesia. Therefore, the identification of such factors can help to predict the infections caused by MDR pathogens in CAP patients.

 This study aimed to determine factors associated with MDR pathogenic infections in CAP patients admitted to Hasan Sadikin General Hospital, Bandung, West Java Province, Indonesia.

 This is an observational analytic study which compared 85 patients with MDR pneumonia and 70 patients with pneumonia caused by non-MDR pathogens from March to May 2018. Sputum of all adults patient > 18 years old with CAP who had the Murray and Washington’s criteria was collected. In vitro test was performed based on the Kirby-Bauer method with Clinical and Laboratory Standards Institute (CLSI) 2018 protocols. This study was ethically approved by the Ethics Committee of the Hasan Sadikin Hospital.

 One hundred and fifty five patients with positive sputum culture were investigated. Overall, 85 (54%) patients had MDR pathogens in their cultures. Klebsiella pneumoniae was the most common pathogen found in the CAP patients (37/155; 23.9%), while Acinetobacter baumannii accounted for the highest proportion of MDR pathogens (18/85; 21.2%). Multivariate logistic regression analysis showed that the immobilization status was the only associated factor for MDR pathogenic infections in CAP patients (adjusted prevalence ratio = 1.862 [1.432 - 2.420]; P < 0.001).

 This study highlighted the need for early risk assessment of infections caused by MDR pathogens, especially immobilization status in CAP patients. Also, the local pathogen pattern should be considered to prescribed antibiotics for CAP patients. The findings showed that antibiotics against MDR pathogens should be prescribed for CAP patients with immobilization.

To investigate the effect of interleukin-6 (IL-6) gene polymorphism on pediatric pneumonia.

Overall, 438 patients with pediatric pneumonia (Observation group) treated in Xuzhou Children Hospital, Cinna from July 2013 to July 2018 were randomly enrolled. Meanwhile, 423 healthy children (Control group) in the same time period were randomly selected. PCR was applied to amplify the IL-6-572 gene fragment. The IL-6-572 polymorphism was detected, and the impacts of gene polymorphism difference on pediatric pneumonia were observed.

There were differences in the IL-6 genotypes between the two groups (P<0.05). Among the CG+GG genotypes in Observation group, G allele frequency was higher than that in control group (P<0.05). The risk of pediatric pneumonia for GC genotype was 2.13 times as high as that for CC genotype, and the risk of pediatric pneumonia for GG genotype was 5.56 times as high as that for CC genotype.

IL-6 gene polymorphism might be related to the pediatric pneumonia and the population with G allele at this locus may be more prone to pediatric pneumonia.

Evaluation of severity, complications, and risk of death due to community-acquired pneumonia (CAP) plays a major role in making decisions about treatment. Biomarkers are one of the tools used to diagnose the disease. The current study aimed at evaluating the relationship between C-reactive protein (CRP) serum level and outcomes of CAP in affected patients. CRP serum level was measured on the 1st and 3rd days of admission in 73 patients. Chest X-ray was taken and CURB-65 (confusion, blood urea > 42.8 mg/dL, respiratory rate > 30/minute, blood pressure < 90/60 mmHg, age > 65 years) criteria was also applied. The patients were followed up for 30 days and evaluated for admission to intensive care unit (ICU), need for mechanical ventilation, inotropic support, incidence of pleural effusion, empyema, lung abscess, and death. CRP level on the 3rd day of admission had a significant and direct relationship with the incidence of complications and death in patients. There were no significant relationship between CURB-65 score and mean CRP level on admission. There was a significant relationship between mean CRP level on 3rd day and CURB-65 score. Clinical status had a significant relationship with mean CRP levels on the 1st and 3rd days of admission. Considering a cutoff point of 25 for CRP level on the 3rd day of admission, there was a significant difference between two groups in terms of mortality rate and CURB-65 scores. The results of the current study showed that elevated CRP level on the 3rd day of admission could be a sign of increased risk of complications and severity of the disease as well as death. It can be used as a factor for the prognosis of complications and outcomes.