Community acquired pneumonia: assessment and treatment

Patterson, Caroline; Loebinger, Michael R.

doi:10.7861/clinmedicine.12-3-283

Cited by 12 publications

(5 citation statements)

References 19 publications

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“…Many infectious processes vary in terms of presentation between young and older subjects, but the differences we observed exceed the expected variations due to age alone. For instance, radiological findings in pneumonia are usually similar at all ages [ 22 ]; however, we observed substantial radiological differences, notably regarding pleural effusion, pneumothorax and unilateral involvement that were all more frequent in toddlers. In addition, it was unexpected to observe a lower mortality in very young children compared to young adults without underlying conditions.…”

Section: Discussionmentioning

confidence: 64%

Prognostic factors of severe community-acquired staphylococcal pneumonia in France

et al. 2021

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PurposeStaphylococcus aureus causes severe forms of community-acquired pneumonia (CAP), namely staphylococcal pleuropneumonia in young children and staphylococcal necrotising pneumonia in older patients. Methicillin resistance, the Panton-Valentine leukocidin (PVL) toxin, as well as less specific factors have been associated with poor outcome in severe CAP, but their respective roles are unclear.MethodsA prospective multicentre cohort study of severe staphylococcal CAP was conducted in 77 paediatric and adult intensive care units in France between January 2011 and December 2016. After age-clustering, risk factors for mortality, including pre-existing conditions, clinical presentation, laboratory features, strain genetic lineage, PVL, other virulence factors, and methicillin resistance were assessed using univariate and multivariable Cox and LASSO regressions.ResultsOf 163 included patients, aged one month to 87 years, 85 (52.1%) had PVL-positive CAP; there were 20 (12.3%) patients aged <3 years (hereafter “toddlers”), among whom 19 (95%) had PVL-positive CAP. The features of PVL-positive CAP in toddlers matched with the historical description of staphylococcal pleuropneumonia, with a lower mortality (n=3/19, 15%) compared to PVL-positive CAP in older patients (n=31/66, 47%). Mortality in older patients was independently predicted by PVL-positivity (hazard ratio 1.81, 95% CI, 1.03 to 3.17) and methicillin resistance (2.37, 95% CI 1.29 to 4.34) independently from S. aureus lineages and the presence of other virulence determinants.ConclusionPVL was associated with staphylococcal pleuropneumonia in toddlers and was a risk factor for mortality in older patients with severe CAP, independently of methicillin resistance, S. aureus genetic background and other virulence factors.

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Section: Discussionmentioning

confidence: 64%

Prognostic factors of severe community-acquired staphylococcal pneumonia in France

et al. 2021

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“…For most CAP patients, clinical symptoms can be improved 72 h after the initial therapy, while radiographic improvement lags behind clinical symptoms . Disease status should be assessed 72 h after initial therapy.…”

Section: Section 6 Assessment After Initial Therapy and The Criteriamentioning

confidence: 99%

Diagnosis and treatment of community‐acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association

Cao

Huang

She

et al. 2017

Clinical Respiratory J

187

181

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Community‐acquired pneumonia (CAP) in adults is an infectious disease with high morbidity in China and the rest of the world. With the changing pattern in the etiological profile of CAP and advances in medical techniques in diagnosis and treatment over time, Chinese Thoracic Society of Chinese Medical Association updated its CAP guideline in 2016 to address the standard management of CAP in Chinese adults. Extensive and comprehensive literature search was made to collect the data and evidence for experts to review and evaluate the level of evidence. Corresponding recommendations are provided appropriately based on the level of evidence. This updated guideline covers comprehensive topics on CAP, including aetiology, antimicrobial resistance profile, diagnosis, empirical and targeted treatments, adjunctive and supportive therapies, as well as prophylaxis. The recommendations may help clinicians manage CAP patients more effectively and efficiently. CAP in pediatric patients and immunocompromised adults is beyond the scope of this guideline. This guideline is only applicable for the immunocompetent CAP patients aged 18 years and older. The recommendations on selection of antimicrobial agents and the dosing regimens are not mandatory. The clinicians are recommended to prescribe and adjust antimicrobial therapies primarily based on their local etiological profile and results of susceptibility testing, with reference to this guideline.

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“…Many infectious processes vary in terms of presentation between young and older subjects, but the differences we observed exceed the expected variations due to age alone. For instance, radiological findings in pneumonia are usually similar at all ages, 21 however, we observed substantial radiological differences, notably regarding pleural effusion, pneumothorax and unilateral involvement that were more frequent in toddlers. It was also unexpected to observe a lower mortality in very young children compared to young adults without underlying conditions.…”

Section: Discussionmentioning

confidence: 54%

Risk factors of severity in community-acquired staphylococcal pneumonia

Gillet

Tristan

Rasigade

et al. 2020

Preprint

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Background Staphylococcus aureus causes severe forms of community-acquired pneumonia (CAP), namely staphylococcal pleuropneumonia in young children and staphylococcal necrotizing pneumonia in older patients. Methicillin resistance and the Panton-Valentine leukocidin (PVL) toxin have both been associated with poor outcome in severe CAP, but their respective roles are unclear. Methods Prospective multicenter cohort study of severe staphylococcal CAP conducted in 77 pediatric and adult intensive care units in France between January 2011 and December 2016. Clinical features and outcomes were compared between toddlers (<3 years of age) and older patients with PVL-positive CAP; and between older patients with PVL-negative or PVL-positive CAP. Risk factors for mortality were identified using multivariate Cox regression. Results Of 163 included patients, aged one month to 87 years, 85 (52.1%) had PVL-positive CAP; there were 20 (12.3%) toddlers, among whom 19 (95%) had PVL-positive CAP. The features of PVL-positive CAP in toddlers matched with the historical description of staphylococcal pleuropneumonia, with a lower mortality (n = 3/19, 15%) compared to PVL-positive CAP in older patients (n=31/66, 47%). Mortality in older patients was independently predicted by PVL-positivity (hazard ratio 1.81, 95% CI, 1.03 to 3.17) and methicillin resistance (2.37, 95% CI 1.29 to 4.34). As genetic diversity was comparably high in PVL-positive and PVL-negative isolates, confounding by microbial population structure was unlikely. Conclusion PVL was associated with staphylococcal pleuropneumonia in toddlers and was a risk factor for mortality in older patients with severe CAP, independently of methicillin resistance. Funded by the French ministry of Health (PHRC 2010-A01132-37)

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Community acquired pneumonia: assessment and treatment

Cited by 12 publications

References 19 publications

Prognostic factors of severe community-acquired staphylococcal pneumonia in France

Prognostic factors of severe community-acquired staphylococcal pneumonia in France

Diagnosis and treatment of community‐acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association

Risk factors of severity in community-acquired staphylococcal pneumonia

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