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

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)

Community-acquired pneumonia as an emergency condition

Despite the improvements in its management, community-acquired pneumonia (CAP) still exhibits high global morbidity and mortality rates, especially in elderly patients. This review focuses on the most recent findings on the epidemiology, cause, diagnosis and management of CAP.There is consistent evidence that the trend in CAP mortality has declined over time. However, the mortality of pneumococcal CAP has not changed in the last two decades, with an increase in the rate of hospitalization and more severe forms of CAP. Streptococcus pneumoniae remains the most frequent cause of CAP in all settings, age groups and regardless of comorbidities. However, the implementation of molecular diagnostic tests in the last years has identified respiratory viruses as a common cause of CAP too. The emergency of multidrug-resistance pathogens is a worldwide concern. An improvement in our ability to promptly identify the causative cause of CAP is required in order to provide pathogen-directed antibiotic therapy, improve antibiotic stewardship programs and implement appropriate vaccine strategies.It is time to apply all the knowledge generated in the last decade in order to optimize the management of CAP

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

El régimen tributario minero y la situación actual de la minería en el país

En la presente entrevista, la Dra. Blume responde a nuestras interrogantes respecto a la situación tributaria minera en el país; actividad en la que competimos con países como Chile y Canadá. Al respecto, la ponente señala que a pesar de los conflictos sociales de nuestro país, “competimos negativamente” en el mundo. De la misma forma, desarrolla la importancia que ha tenido la minería en el Perú, criticando la creación de normas especiales para dicha actividad, cuando existen otras que no cuentan con normas de promoción. Finalmente, nos brinda su opinión acerca de qué mecanismo considera más efectivo entre el Aporte Voluntario Minero o el Nuevo Régimen Tributario

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

New antimicrobial approaches to gram positive respiratory infections

Nowadays, we face growing resistance among gram-positive and gram-negative pathogens that cause respiratory infection in the hospital and in the community. The spread of penicillin- and macrolide-resistant pneumococci, Community-acquired methicillin-resistant staphylococcus aureus (Ca-MRSA), the emergence of glycopeptide-resistant staphylococci underline the need for underline the need for therapeutic alternatives. A number of new therapeutic agents, with activity against the above Gram (+) respiratory pathogens, as ceftaroline, ceftopibrole, telavancin, tedizolid have become available, either in clinical trials or have been approved for clinical use. Especially, the development of new oral antibiotics, as nemonaxacin, omadacyclin, cethromycin and solithromycin will give a solution to the lack of oral drugs for outpatient treatment. In the future the clinician needs to optimize the use of old and new antibiotics to treat gram (+) respiratory serious infections

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

La Calidad de Servicio en la Corte Superior de Justicia de La Libertad, 2018.

La presente investigación se realizó teniendo como objetivo general el Determinar el Nivel de La Calidad de Servicio de La Corte Superior de La Libertad, 2018. Tiene como variable de estudio La Calidad de Servicio, es de diseño no experimental y de acuerdo a la temporalidad de corte transversal, se utilizó la técnica de la encuesta y como instrumento de recolección de datos el cuestionario, se trabajó con una población compuesta por todos los usuarios de la Corte Superior de Justicia de La Libertad, es decir población desconocida y una muestra de 197 usuarios, con un margen de error de 7% y la principal conclusión fue que respecto a la Calidad de Servicio en la corte Superior de La Libertad en 2018, encontramos que para más del 50% de los usuarios es de Mala Calidad, lo que indica que existe una enorme deficiencia en la atención del usuario en todos sus estamentos, y se corrobora con lo indicado en la realidad problemática respecto a los estudios del INE que señalan que el Poder Judicial es una de las instituciones menos confiables