Update on the pathogenesis and management of pneumonia in the elderly-roles of aspiration pneumonia

Teramoto, Shinji; Yoshida, Kazufumi; Hizawa, Nobuyuki

doi:10.1016/j.resinv.2015.01.003

Cited by 68 publications

(51 citation statements)

References 66 publications

(73 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…reviewed ways to prevent aspiration pneumonia and concluded that few data were available to guide an evidence-based approach to the prevention using drugs such as angiotensin-converting enzyme inhibitors or capsaicin78. The evidence relating to non-pharmacologic approaches; swallowing rehabilitation, thickening feeds, oral hygiene, gastroesophageal reflux management, and a head-up position are also limited, but the combination approach using pharmacologic and non-pharmacologic methods may be of value in high risk patients7980.…”

Section: Discussionmentioning

confidence: 99%

Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis

Komiya

Rubin

Kadota

et al. 2016

Sci Rep

View full text Add to dashboard Cite

Aspiration pneumonia is thought to be associated with a poor outcome in patients with community acquired pneumonia (CAP). However, there has been no systematic review regarding the impact of aspiration pneumonia on the outcomes in patients with CAP. This review was conducted using the MOOSE guidelines: Patients: patients defined CAP. Exposure: aspiration pneumonia defined as pneumonia in patients who have aspiration risk. Comparison: confirmed pneumonia in patients who were not considered to be at high risk for oral aspiration. Outcomes: mortality, hospital readmission or recurrent pneumonia. Three investigators independently identified published cohort studies from PubMed, CENTRAL database, and EMBASE. Nineteen studies were included for this systematic review. Aspiration pneumonia increased in-hospital mortality (relative risk, 3.62; 95% CI, 2.65–4.96; P < 0.001, seven studies) and 30-day mortality (3.57; 2.18–5.86; P < 0.001, five studies). In contrast, aspiration pneumonia was associated with decreased ICU mortality (relative risk, 0.40; 95% CI, 0.26–0.60; P < 0.00001, four studies). Although there are insufficient data to perform a meta-analysis on long-term mortality, recurrent pneumonia, and hospital readmission, the few reported studies suggest that aspiration pneumonia is also associated with these poor outcomes. In conclusion, aspiration pneumonia was associated with both higher in-hospital and 30-day mortality in patients with CAP outside ICU settings.

show abstract

Section: Discussionmentioning

confidence: 99%

Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis

Komiya

Rubin

Kadota

et al. 2016

Sci Rep

View full text Add to dashboard Cite

show abstract

“…The elderly, the fastest growing segment of the population in developed countries, are more susceptible to many infections due to changes in their immune responses over time that make them less efficacious at controlling pathogens (113,114). The elderly are the patient cohort associated with the highest risk of mortality caused by K. pneumoniae, with some estimates suggesting a mortality rate of 30% in these patients following hospitalization due to K. pneumoniae CAPs (113,115). Both HAPs and CAPs in the elderly are predominantly initiated through aspiration of oropharyngeal flora.…”

Section: Patient Risk Factorsmentioning

confidence: 99%

“…Both HAPs and CAPs in the elderly are predominantly initiated through aspiration of oropharyngeal flora. Based on several studies where the mean patient age was at least 60 years, K. pneumoniae was the causative agent of 17.2% of all CAPs and 6.5 to 11.6% of all HAPs observed (115).…”

Section: Patient Risk Factorsmentioning

confidence: 99%

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Paczosa

Mecsas

2016

Microbiol Mol Biol Rev

1,290

1,345

View full text Add to dashboard Cite

SUMMARYKlebsiella pneumoniaecauses a wide range of infections, including pneumonias, urinary tract infections, bacteremias, and liver abscesses. Historically,K. pneumoniaehas caused serious infection primarily in immunocompromised individuals, but the recent emergence and spread of hypervirulent strains have broadened the number of people susceptible to infections to include those who are healthy and immunosufficient. Furthermore,K. pneumoniaestrains have become increasingly resistant to antibiotics, rendering infection by these strains very challenging to treat. The emergence of hypervirulent and antibiotic-resistant strains has driven a number of recent studies. Work has described the worldwide spread of one drug-resistant strain and a host defense axis, interleukin-17 (IL-17), that is important for controlling infection. Four factors, capsule, lipopolysaccharide, fimbriae, and siderophores, have been well studied and are important for virulence in at least one infection model. Several other factors have been less well characterized but are also important in at least one infection model. However, there is a significant amount of heterogeneity inK. pneumoniaestrains, and not every factor plays the same critical role in all virulentKlebsiellastrains. Recent studies have identified additionalK. pneumoniaevirulence factors and led to more insights about factors important for the growth of this pathogen at a variety of tissue sites. Many of these genes encode proteins that function in metabolism and the regulation of transcription. However, much work is left to be done in characterizing these newly discovered factors, understanding how infections differ between healthy and immunocompromised patients, and identifying attractive bacterial or host targets for treating these infections.

show abstract

“…The most frequent microorganisms involved in aspiration are anaerobic bacteria and microaerophilic streptococci from the oral flora. Aspiration pneumonia may be the second most common etiology of CAP in the subset of patients over 80 years old [32]. …”

Section: Microbial Etiology Of Community-acquired Pneumonia (Cap)mentioning

confidence: 99%

Microbial Etiology of Pneumonia: Epidemiology, Diagnosis and Resistance Patterns

Cillóniz

Martín‐Loeches

García-Vidal

et al. 2016

IJMS

211

161

View full text Add to dashboard Cite

Globally, pneumonia is a serious public health concern and a major cause of mortality and morbidity. Despite advances in antimicrobial therapies, microbiological diagnostic tests and prevention measures, pneumonia remains the main cause of death from infectious disease in the world. An important reason for the increased global mortality is the impact of pneumonia on chronic diseases, along with the increasing age of the population and the virulence factors of the causative microorganism. The increasing number of multidrug-resistant bacteria, difficult-to-treat microorganisms, and the emergence of new pathogens are a major problem for clinicians when deciding antimicrobial therapy. A key factor for managing and effectively guiding appropriate antimicrobial therapy is an understanding of the role of the different causative microorganisms in the etiology of pneumonia, since it has been shown that the adequacy of initial antimicrobial therapy is a key factor for prognosis in pneumonia. Furthermore, broad-spectrum antibiotic therapies are sometimes given until microbiological results are available and de-escalation cannot be performed quickly. This review provides an overview of microbial etiology, resistance patterns, epidemiology and microbial diagnosis of pneumonia.

show abstract

Update on the pathogenesis and management of pneumonia in the elderly-roles of aspiration pneumonia

Cited by 68 publications

References 66 publications

Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis

Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Microbial Etiology of Pneumonia: Epidemiology, Diagnosis and Resistance Patterns

Contact Info

Product

Resources

About