Healthcare-Associated Atypical Pneumonia

Forgie, Sarah; Marrie, Thomas J.

doi:10.1055/s-0028-1119811

Cited by 50 publications

(42 citation statements)

References 188 publications

(209 reference statements)

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“…Screening for all HCoVs in a multi-year population sampling is infrequent so studies that directly compare the impact of HCoV infections are rare [19,25,26,27,28,29,30,31]. Despite a sizable historical role in the common cold [32] the HCoVs are also found in patients with more severe cases of ARI [26,33,34,35] including LRTI and pneumonia in adults and the elderly [9,36,37]. HCoVs are also found in cases of bronchial hyper-responsiveness in susceptible individuals [38,39] and nosocomial respiratory viral infections [40,41,42].…”

Section: Introductionmentioning

confidence: 99%

Co-circulation of Four Human Coronaviruses (HCoVs) in Queensland Children with Acute Respiratory Tract Illnesses in 2004

Mackay

Arden

Speicher

et al. 2012

Viruses

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Acute respiratory illnesses (ARIs) with unconfirmed infectious aetiologies peak at different times of the year. Molecular diagnostic assays reduce the number of unconfirmed ARIs compared to serology- or culture-based techniques. Screening of 888 inpatient and outpatient respiratory specimens spanning late autumn through to early spring, 2004, identified the presence of a human coronavirus (HCoV) on 74 occasions (8.3% of all specimens and 26.3% of all respiratory virus detections). Prevalence peaked in August (late winter in the southern hemisphere) when they were detected in 21.9% of specimens tested. HCoV-HKU1 and HCoV-OC43 comprised 82.4% of all HCoVs detected. Positive specimens were used to develop novel reverse transcriptase real-time PCRs (RT-rtPCRs) for HCoV detection. An objective clinical severity score was assigned to each positive HCoV patient. Severity scores were similar to those from a random selection of young children who were positive for respiratory syncytial virus at a different time but from the same specimen population. During the cooler months of 2004, sensitive and specific RT-rtPCRs identified the concurrent circulation of all four HCoVs, a quarter of which co-occurred with another virus and most of which were from children under the age of two years.

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Section: Introductionmentioning

confidence: 99%

Co-circulation of Four Human Coronaviruses (HCoVs) in Queensland Children with Acute Respiratory Tract Illnesses in 2004

Mackay

Arden

Speicher

et al. 2012

Viruses

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“…Legionella pneumophila has been identified as the culprit in <1% to 2·4% of HCAP cases . Infection with Legionella pneumophila may be more likely in patients receiving immunosuppressive therapy and in areas where the water supply is colonized by the organism . In contrast to other atypical pathogens, Legionella is more likely to cause severe cases of HCAP necessitating ICU admission or mechanical ventilation …”

Section: Resultsmentioning

confidence: 99%

The role of azithromycin in healthcare-associated pneumonia treatment

et al. 2015

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Summary What is known and objective Healthcare‐associated pneumonia (HCAP) is an important presentation among hospitalized patients. Standardized definitions of this entity are almost a decade old, and practice patterns have shifted from published guidelines to include empiric coverage with a macrolide, such as azithromycin. Azithromycin is oftentimes included in the empiric treatment regimen for HCAP because of the importance of appropriate empiric antimicrobial coverage, the perceived concern regarding atypical organisms, potential anti‐inflammatory effects of the medication, and positive clinical data among patients with Streptococcal bacteremia. Methods In this review, we systematically investigate data for each of these topics along with clinical data examining the role of azithromycin in HCAP. Results and discussion Our findings indicate that atypical organisms are rare in HCAP, that the anti‐inflammatory actions of azithromycin – although promising – have not produced consistently positive effects in many chronic or acute conditions, and that the data available for azithromycin use in bacteremia are of low quality. A single‐centre cohort indicated that the clinical benefits of azithromycin did not extend to HCAP compared to community‐acquired pneumonia. What is new and conclusion Additionally, there are newer data emphasizing the potential cardiotoxicity of azithromycin, particularly among patients at high risk. All of these data indicate that azithromycin should not be part of the standard empiric treatment for HCAP.

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“…Studies on HCAP published since the release of the ATS/IDSA guidelines in 2005 have been analysed in several reviews to determine whether they are in support of the HCAP concept as outlined in the guidelines. Several reviews have suggested that the HCAP concept is now commonly accepted . Other reviews have raised concerns about qualitative aspects of some studies on HCAP and have questioned the key assumption of the HCAP concept that increased frequency of MDR pathogens leads to inadequate antibiotic cover and thus increased mortality .…”

Section: The Controversy Over Hcapmentioning

confidence: 99%

Healthcare‐associated pneumonia: A US disease or relevant to the Asia Pacific, too?

Dobler

Waterer

2013

Respirology

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The term 'health care-associated pneumonia' (HCAP) was introduced by the American Thoracic Society and the Infectious Diseases Society of America in 2005 to describe a distinct entity of pneumonia that resembles hospital-acquired pneumonia rather than communityacquired pneumonia (CAP) in terms of occurrence of drug-resistant pathogens and mortality in patients that-while not hospitalized in the traditional sensehave been in recent contact with the health-care system. It was proposed that HCAP should be treated empirically with therapy for drug-resistant pathogens. Over the last few years, there has been increasing controversy over whether HCAP is a helpful definition, or leads to unnecessary and potentially problematic overtreatment. The term HCAP has been extensively criticized in Europe. While most studies have shown that HCAP is associated with more frequent drug-resistant pathogens and higher mortality than CAP, there is no clear evidence that this is due to inappropriate antibiotic therapy. Therapy consistent with HCAP treatment guidelines has also not been found to improve mortality. Based on current evidence, we suggest broadspectrum antibiotic therapy to treat possible pathogens not usually covered in CAP be based on assessment of individual risk factors rather than applying a HCAP classification system in the Asia-Pacific Region.

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Healthcare-Associated Atypical Pneumonia

Cited by 50 publications

References 188 publications

Co-circulation of Four Human Coronaviruses (HCoVs) in Queensland Children with Acute Respiratory Tract Illnesses in 2004

Co-circulation of Four Human Coronaviruses (HCoVs) in Queensland Children with Acute Respiratory Tract Illnesses in 2004

The role of azithromycin in healthcare-associated pneumonia treatment

Healthcare‐associated pneumonia: A US disease or relevant to the Asia Pacific, too?

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