Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia:a Multinational Point Prevalence Study of Hospitalised Patients

Pseudornonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aeruginosa-CAP are limited. We assessed the multinational burden and specific risk factors associated with P. aeruginosa-CAP. We enrolled 3193 patients in 54 countries with confirmed diagnosis of CAP who underwent microbiological testing at admission. Prevalence was calculated according to the identification of P. aeruginosa. Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant P. aeruginosa-CAP. The prevalence of P. aeruginosa and antibiotic-resistant P. aeruginosa-CAP was 4.2% and 2.0%, respectively. The rate of P. aeruginosa CAP in patients with prior infection/colonisation due to P. aeruginosa and at least one of the three independently associated chronic lung diseases (i.e. tracheostomy, bronchiectasis and/or very severe chronic obstructive pulmonary disease) was 67%. In contrast, the rate of P. aeruginosa-CAP was 2% in patients without prior P. aeruginosa infection/colonisation and none of the selected chronic lung diseases. The multinational prevalence of P. aeruginosa-CAP is low. The risk factors identified in this study may guide healthcare professionals in deciding empirical antibiotic coverage for CAP patients

Contribuições do solo e dossel em modelo de estimativa de biomassa aérea no Bioma Pampa Soil and canopy contributions in a predictive model of aerial biomass in the Pampa Biome

O objetivo deste trabalho foi avaliar o desempenho preditivo do submodelo espectral do modelo JONG, com a inserção de variáveis espectrais que considerassem a densidade de biomassa do dossel e as contribuições dos diferentes solos subjacentes. Índices calculados pela diferença e razão simples - entre as bandas 4 e 3, 4 e 5, 4 e 7, do sensor orbital ETM+/Landsat 7 - foram sugeridos para representar a contribuição espectral dos solos subjacentes e a influência das diferenças estruturais dos dosséis. A parametrização da componente espectral foi implementada por regressão linear múltipla e, em seguida, foi comparada aos dados de biomassa obtidos em campo. As variáveis espectrais que melhor expressaram as variações da disponibilidade inicial de forragem foram a fração solo (modelo linear de mistura espectral) e a razão entre as bandas 4 e 7. A componente espectral do modelo JONG, com a nova parametrização, apresenta sensibilidade para eliminar as influências do solo e dossel na disponibilidade inicial de biomassa e facilita a interpretação dos resultados, em razão da relação entre as variáveis espectrais selecionadas.<br>The objective of this work was to evaluate the predictive performance of the JONG model's spectral submodel, with the insertion of variables considering contributions of different underlying soils and canopy densities. Indices calculated by subtraction and simple ratio between 4 and 3, 4 and 5, 4 and 7 bands, of Landsat 7/ETM+ sensor - were suggested in order to represent the spectral contribution of the different underlying soils and the influence of canopy structural differences. The spectral component parameterization was implemented by multiple linear regression and, then, it was compared to the biomass data measured in the field. Spectral variables that better describe the variations of initial biomass availability and soil spectral contributions were the soil fraction (spectral mixture linear model), and ratio between 4 and 7 bands. The spectral component of the JONG model, with the new parameterization, showed sensibility in eliminating the canopy and soil influences in the biomass initial availability and, also, improved the interpretation of results due to the relationship between selected spectral variables

Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia

Background and objective Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. Methods We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when &gt;= 3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. Results Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) &lt; 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. Conclusion This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP