Author's response to 'CAP and HCAP are different? An unresolved question

Dear Editor, We thank the authors for the interest in our recent publication and for their useful comments. Unfortunately we consider the comparison with the publication from Giannella et al1 poorly appropriate in many aspects. The main strength of our work is the multicentre prospective case–control study design (match by age, gender and period of hospitalisation). Although severity scores were not used for matching, we considered this design the most appropriate to describe healthcare-associated pneumonia (HCAP) features. In fact, the Giannella group performed an observational prospective study only on patients admitted to internal medicine departments: these elements (study design and patients) could justify a different population composition and, consequently, different microbiological and clinical findings. In fact, in comparison..

Understanding mortality in bacteremic pneumococcal pneumonia

Community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae is one of the major causes of morbidity and mortality in children and the elderly (adults over 60 years of age) worldwide.(1,2) Data from community-based studies show that the estimated overall annual incidence of pneumococcal bacteremia in the United States is 15-30 cases per 100,000 population; the rate is higher for persons > 65 years of age (50-83 cases per 100,000 population) and for children < 2 years of age (160 cases per 100,000 population), with an overall case fatality rate ranging from 20% (in young adults) to 60% (in the elderly). Associated comorbidities also play an important role.(3) Among adults, 60-87% of all cases of pneumococcal bacteremia are attributed to pneumonia; among young children, the primary site of infection is frequently unidentified

The War against Bad Bugs: Fighting the Resistance

Multidrug-resistant (MDR) microorganisms have become a growing concern, especially in regions with high prevalence. Both the increase in antibiotic consumption and rapid spread of highly-resistant strains have contributed to a surge inMDRmicroorganismrates. Such a rise is significant, given thatMDR organisms may also result in increased mortality and elevated healthcare costs. In fact, high mortality attributable to multidrug-resistant microorganisms for 2050 is expected in developing countries, mainly in Asia and Africa, followed by Latin America [1]. E orts should therefore center around developing antimicrobial stewardship programs, control measures and new antibiotics

New aspects in the management of pneumonia

Despite improvements in the management of community-acquired pneumonia (CAP), morbidity and mortality are still high, especially in patients with more severe disease. Early and appropriate antibiotics remain the cornerstone in the treatment of CAP. However, two aspects seem to contribute to a worse outcome: an uncontrolled inflammatory reaction and an inadequate immune response. Adjuvant treatments, such as corticosteroids and intravenous immunoglobulins, have been proposed to counterbalance these effects. The use of corticosteroids in patients with severe CAP and a strong inflammatory reaction can reduce the time to clinical stability, the risk of treatment failure, and the risk of progression to acute respiratory distress syndrome. The administration of intravenous immunoglobulins seems to reinforce the immune response to the infection in particular in patients with inadequate levels of antibodies and when an enriched IgM preparation has been used; however, more studies are needed to determinate their impact on outcome and to define the population that will receive more benefit

Treating HIV-Positive/Non-AIDS Patients for Community-Acquired Pneumonia with ART

Purpose of Review: This article reviews the most recent publications on community-acquired pneumonia (CAP) in the HIV-infected population on antiretroviral therapy (ART), focusing on epidemiology, prognostic factors, etiology, and antimicrobial therapy. The data discussed here were mainly obtained from a non-systematic review using Medline and references from relevant articles. Recent Findings: CAP remains a major cause of morbidity and mortality among HIV-infected patients and incurs high health costs despite the introduction of ART. Summary: HIV-infected patients are generally known to be more susceptible to bacterial pneumonia. Streptococcus pneumoniae is the most frequently reported pathogen in HIV-infected patients on ART, who present a higher rate of bacteremia than non-HIV-infected patients. Several studies have also examined microbial etiology and prognostic factors of CAP in HIV-infected patients on ART. Despite the high rate of bacterial pneumonia in these patients, mortality rates are not higher than in patients without HIV infection

Ceftobiprole for the treatment of pneumonia: a European perspective

Ceftobiprole, a new broad spectrum, parenteral cephalosporin, exhibits potent in vitro activity against a number of Gram-positive pathogens, including methicillin-resistant Staphylococcus aureus and penicillin-resistant Streptococcus pneumoniae, and Gram-negative pathogens associated with hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP). Ceftobiprole has demonstrated noninferiority in two large-scale pivotal studies comparing it to ceftriaxone with or without linezolid in CAP, with clinical cure rates 86.6% versus 87.4%, or ceftazidime in HAP, with clinical cure rates of 77% versus 76%, respectively. However, ceftobiprole was inferior in the subgroup of patients undergoing mechanical ventilation. Ceftobiprole has so far demonstrated a good safety profile in preliminary studies, with similar tolerability to comparators. The most commonly observed adverse events of ceftobiprole included headache and gastrointestinal upset. It is the first cephalosporin monotherapy approved in the EU for the treatment of both CAP and HAP (excluding ventilator-associated pneumonia)

Emerging antibiotics for community-acquired pneumonia

Introduction: Community-acquired pneumonia is the most common infection leading to hospitalization and death in all age groups, especially in elderly populations. Increasing antibiotic resistance among the common bacterial pathogens associated with community-acquired pneumonia, especially Streptococcus pneumoniae and staphylococci, has made its empirical treatment increasingly problematic, highlighting the need for effective antibiotic therapy. Areas covered: We searched PubMed and ClinicalTrials.gov for English-language reports of phase III clinical trials conducted between 2000 and 2019 concerning the antibiotic treatment of community-acquired pneumonia. We provide a summary of the latest approved drugs for this indication and highlight emerging drugs with a potential indication. Expert opinion: Ceftaroline (a new cephalosporine) and omadacycline (a cycline alternative), either parenterally or orally, are the only two new antibiotics to have been approved by the FDA for the treatment of community-acquired pneumonia in the last five years. Among the antimicrobials in development, Lefamulin (the first pleuromutilin), is currently in phase III development. Among the known antibiotic classes, solithromycin (a macrolide), nemonoxacin (a quinolone), and delafloxacin and zabofloxacin (both fluoroquinolones), have been studied in phase II and III in clinical trials. The availability of these new antibiotics may offer opportunities to improve the empirical treatment for community-acquired pneumonia

Management of severe acute exacerbations of COPD: an updated narrative review

Background: Patients with chronic obstructive pulmonary disease (COPD) may experience an acute worsening of respiratory symptoms that results in additional therapy; this event is defined as a COPD exacerbation (AECOPD). Hospitalization for AECOPD is accompanied by a rapid decline in health status with a high risk of mortality or other negative outcomes such as need for endotracheal intubation or intensive care unit (ICU) admission. Treatments for AECOPD aim to minimize the negative impact of the current exacerbation and to prevent subsequent events, such as relapse or readmission to hospital. Main body: In this narrative review, we update the scientific evidence about the in-hospital pharmacological and non-pharmacological treatments used in the management of a severe AECOPD. We review inhaled bronchodilators, steroids, and antibiotics for the pharmacological approach, and oxygen, high flow nasal cannulae (HFNC) oxygen therapy, non-invasive mechanical ventilation (NIMV) and pulmonary rehabilitation (PR) as non-pharmacological treatments. We also review some studies of non-conventional drugs that have been proposed for severe AECOPD. Conclusion: Several treatments exist for severe AECOPD patients requiring hospitalization. Some treatments such as steroids and NIMV (in patients admitted with a hypercapnic acute respiratory failure and respiratory acidosis) are supported by strong evidence of their efficacy. HFNC oxygen therapy needs further prospective studies. Although antibiotics are preferred in ICU patients, there is a lack of evidence regarding the preferred drugs and optimal duration of treatment for non-ICU patients. Early rehabilitation, if associated with standard treatment of patients, is recommended due to its feasibility and safety. There are currently few promising new drugs or new applications of existing drugs

Ceftobiprole for the treatment of pneumonia

Ceftobiprole is a fifth-generation cephalosporin with potent antimicrobial activity against Gram positive and Gram-negative bacteria. It has been approved in major European countries for the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), excluding ventilator-associated pneumonia (VAP). Ceftobiprole is currently in a phase 3 clinical program for registration in the U.S. In 2015, it was designated as an infectious disease product qualified for the treatment of lung and skin infections by the FDA. The efficacy of ceftobiprole in pneumonia has been demonstrated in two-phase III clinical trials conducted in patients with CAP and HAP. The recommended dose in the adult with pneumonia is 500 mg every 8 h infused in 2 h; in case of renal failure, the regimen of administration must be adjusted according to the patient's renal function. It is not necessary to adjust the dose according to gender, age, body weight or liver failure. In case of hyperfiltration, an extension to 4 h infusion of the 500mg TID is required

Clinical management of community acquired pneumonia in the elderly patient

Introduction: Community acquired pneumonia (CAP) is a major health problem in elderly persons and is associated with high morbidity and mortality. Areas covered: This article reviews the most recent publications relative to CAP in the elderly population, with a focus on epidemiology, prognostic factors, microbial etiology, therapy and prevention. The data discussed in this review were mainly obtained from a non-systematic review using Medline, and references from relevant articles. Expert commentary: CAP can occur at any age, but its incidence and risk of death are linked to increasing age. Age-related changes in the immune system make this population more vulnerable to CAP. Mortality in hospitalized patients with CAP ranges from 10% to 12%. However, in the case of elderly patients, several studies have reported mortality rates of up to 25%. Pneumococcal and influenza vaccination comprise one of the most important preventive approaches for CAP in the elderly