Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective

Gramegna, Andrea; Sotgiu, Giovanni; Pasquale, Marta Di; Radovanovic, Dejan; Terraneo, Silvia; Reyes, Luis Felipe; Vendrell, Ester; Neves, João; Menzella, Francesco; Blasi, Francesco; Aliberti, Stefano; Restrepo, Marcos I.

doi:10.1186/s12879-018-3565-z

Cited by 37 publications

(31 citation statements)

References 24 publications

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“…Widespread use of macrolides has contributed to the expansion of macrolide-resistant S. pneumoniae. Pneumococci and atypical pathogens of CAP have become increasingly resistant to these drugs [66].…”

Section: Antimicrobial Resistancementioning

confidence: 99%

Community-Acquired Bacterial Pneumonia—Changing Epidemiology, Resistance Patterns, and Newer Antibiotics: Spotlight on Delafloxacin

et al. 2020

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Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality both in the USA and globally. As the burden of CAP continues to increase due to several factors, the advances in its diagnosis, prevention, and treatment have taken on even greater interest and importance. The majority of CAP patients are treated empirically, and selection of appropriate antibiotic treatment is increasingly difficult because the epidemiology of CAP is changing, in part due to antimicrobial resistance, and the causative CAP pathogens differ between countries and regions. There is also an increasing prevalence of chronic co-morbid diseases among CAP patients. Treatment of CAP has become challenging because of these factors along with the varying safety profiles and efficacy of well-established antibiotics, as well as limited new therapeutic options. Recently, however, new antibiotics have been approved, which will expand the treatment options for CAP, particularly in those patients with underlying complications. Recently approved delafloxacin, an anionic fluoroquinolone, has a unique structure and distinct chemical characteristics; it demonstrated non-inferiority to moxifloxacin in a phase III clinical trial, but was shown to be superior to moxifloxacin at early clinical response in CAP patients who also have chronic obstructive pulmonary disease (COPD) or asthma as a co-morbidity, and in CAP patients who may have severe illness. Delafloxacin could offer an additional therapy against resistant isolates and among these difficult-to-treat patients. This review summarizes the development, latest research, and safety profile of the new antibiotic delafloxacin, and its potential future role in the treatment of CAP.

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Section: Antimicrobial Resistancementioning

confidence: 99%

Community-Acquired Bacterial Pneumonia—Changing Epidemiology, Resistance Patterns, and Newer Antibiotics: Spotlight on Delafloxacin

et al. 2020

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“…Nocardia is an intracellular bacteria 16 and the host's immune reaction against infection broadly relies on macrophage activity 17 . In contrast to nocardiosis, pneumonia in hospitalized patients is usually caused by typical, extracellular bacteria 18 . Individuals with chronic pulmonary diseases were found to have a higher rate of macrophage dysfunction 19 .…”

Section: Discussionmentioning

confidence: 99%

Clinical correlates of nocardiosis

Margalit

Goldberg

Ari

et al. 2020

Sci Rep

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Nocardia is an opportunistic pathogen that most frequently affects the lungs. Evidence is limited regarding the risk factors for nocardiosis. The current study assessed clinical correlates of nocardiosis. A retrospective study was conducted based on medical records of consecutive adult patients (N = 60) with nocardiosis hospitalized during 2007-2018 at a tertiary hospital in central Israel. A matched comparison group of 120 patients was randomly selected among hospitalized patients with community-acquired pneumonia. Multivariable conditional logistic regression models were fitted. Immunosuppressive pharmacotherapy was positively associated with nocardiosis (matched odds ratio [OR] 4.40, 95% confidence interval [CI] 2.25-8.62, p < 0.001), particularly corticosteroid therapy (matched OR 4.69, 95% CI 2.45-8.99, p < 0.001). Systemic corticosteroid therapy was strongly associated with pulmonary nocardiosis (matched OR 5.90, 95% CI 2.75-12.66, p < 0.001). The positive association between solid organ transplantation and nocardiosis was attenuated following adjustment for systemic corticosteroids in a multivariable model. The association between corticosteroid therapy and nocardiosis appeared stronger in patients with chronic pulmonary disease (OR 5.74, 95% CI 2.75-12.66, p < 0.001) than in the pooled analysis of all nocardiosis cases. In conclusion, corticosteroid therapy was strongly correlated with nocardiosis, particularly among individuals with chronic pulmonary disease and in pulmonary nocardiosis. Nocardiosis is an opportunistic infection that typically occurs in individuals with a history of solid organ transplantation (SOT) 1 , malignancy 2 , human immunodeficiency virus infection 3 or chronic pulmonary diseases 4. Evidence on the independent contribution of each of these conditions to nocardiosis risk remains limited, since most studies were case-series and lacked a comparison group. It is also unclear if the likelihood of nocardiosis is related to the underlying disease itself or to the immunosuppression therapy administered against it. Corticosteroid therapy is prevalent amongst individuals diagnosed with nocardiosis 5,6. A European multicenter case-control study conducted among SOT recipients (SOTR) showed that corticosteroid dosage was related to the risk of nocardiosis (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.03-1.22 for each milligram increase in corticosteroid dose), and a strong positive association was found between high calcineurin inhibitor and nocardiosis (OR 6.11, 95% CI 2.58-14.51) 1. As corticosteroid therapy is the standard of care for many conditions that might be also associated with nocardiosis, such as SOT, chronic pulmonary diseases and cancer, the independent role of each factor, warrant further investigation. As Nocardia is mostly transmitted by inhalation or aspiration 7 , the lungs are the primary site of infection in more than two-thirds of the nocardiosis cases 3. However, evidence on the risk factors for nocardiosis, beyond the general propensity to develop bacterial pne...

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“…First, the current study was only conducted in two Japanese teaching hospitals across a period of approximately one and a half years. The epidemiology of atypical pathogens differs based on country, 26 season, [27][28][29] and year. 27,30 Therefore, the findings of the current study may not be generalizable to other settings.…”

Section: Discussionmentioning

confidence: 99%

Physicians' prediction for the assessment of atypical pathogens in respiratory tract infections

Suzuki

Ishimaru

Akashi

et al. 2020

J of Gen and Family Med

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Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective

Cited by 37 publications

References 24 publications

Community-Acquired Bacterial Pneumonia—Changing Epidemiology, Resistance Patterns, and Newer Antibiotics: Spotlight on Delafloxacin

Community-Acquired Bacterial Pneumonia—Changing Epidemiology, Resistance Patterns, and Newer Antibiotics: Spotlight on Delafloxacin

Clinical correlates of nocardiosis

Physicians' prediction for the assessment of atypical pathogens in respiratory tract infections

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