Prevalence and etiology of community-acquired pneumonia in immunocompromised patients

Background. The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. Methods. We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. Results. At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non\u2013community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P < .001). Conclusions. Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses

Microbiological testing of adults hospitalised with community-acquired pneumonia: An international study

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p&lt;0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p&lt;0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations

Atypical pathogens in hospitalized patients with community-acquired pneumonia: A worldwide perspective

Background: Empirical antibiotic coverage for atypical pathogens in community-acquired pneumonia (CAP) has long been debated, mainly because of a lack of epidemiological data. We aimed to assess both testing for atypical pathogens and their prevalence in hospitalized patients with CAP worldwide, especially in relation with disease severity. Methods: A secondary analysis of the GLIMP database, an international, multicentre, point-prevalence study of adult patients admitted for CAP in 222 hospitals across 6 continents in 2015, was performed. The study evaluated frequency of testing for atypical pathogens, including L. pneumophila, M. pneumoniae, C. pneumoniae, and their prevalence. Risk factors for testing and prevalence for atypical pathogens were assessed through univariate analysis. Results: Among 3702 CAP patients 1250 (33.8%) underwent at least one test for atypical pathogens. Testing varies greatly among countries and its frequency was higher in Europe than elsewhere (46.0% vs. 12.7%, respectively, p &lt; 0.0001). Detection of L. pneumophila urinary antigen was the most common test performed worldwide (32.0%). Patients with severe CAP were less likely to be tested for both atypical pathogens considered together (30.5% vs. 35.0%, p = 0.009) and specifically for legionellosis (28.3% vs. 33.5%, p = 0.003) than the rest of the population. Similarly, L. pneumophila testing was lower in ICU patients. At least one atypical pathogen was isolated in 62 patients (4.7%), including M. pneumoniae (26/251 patients, 10.3%), L. pneumophila (30/1186 patients, 2.5%), and C. pneumoniae (8/228 patients, 3.5%). Patients with CAP due to atypical pathogens were significantly younger, showed less cardiovascular, renal, and metabolic comorbidities in comparison to adult patients hospitalized due to non-atypical pathogen CAP. Conclusions: Testing for atypical pathogens in patients admitted for CAP in poorly standardized in real life and does not mirror atypical prevalence in different settings. Further evidence on the impact of atypical pathogens, expecially in the low-income countries, is needed to guidelines implementation

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

Introduction to breeding service of crossbred in cross-bred dual purpose heifers

This study evaluated 21,667 observations of age (EI) and weight (PI) of introduction to service in heifers from 47 dual purpose bovine herds, located in four areas of dry and humid tropical forest environments. Effects studied were those of geographic area (Laberinto, Perija, Costa Oriental and Sur del Lago); management system: traditional (ST) and improved (SM); breed predominance (Holstein, Brown Swiss, Brahman and Carora); season of birth and of introduction to service; birth weight (PN); and weaning age (ED) and weight (PD). Mean EI was 30.9 ± 5.9 m and was earlier (P<0.001) in Laberinto and Perija than in the other regions, in SM than ST (27.3 ± 02 vs.31.6 ± 0.01 m), and in Brown Swiss and Brahman than in Holsteins (32.0 ± 01 m). Mean PI was 353.3 ± 31.9 kg and was heavier (P<0.001) in Laberinto to (383.4± 1.5 kg), in SM than ST (364.6± 1.0 vs. 349.7 ± 0.5 kg), and Holstein and Brown Swiss (354.3 ± 0.7 and 357.6 ± 1.2 kg). EI was related to PI and dependent on daily weight gain (GDP); 48% of the heifers had GDP of 251 to 350 g/d an only 9.2% gained > 350 g/d. A GDP of > 350 g/d resulted in earliest EI (24.4 ± 0.4 m) and heaviest PI (375.8 ± 1.8 kg). Birth and weaning in dry season delayed EI. Lower EI and higher PI during rainy season were related to grazing conditions. At ED of 10 m, EI increased (29.2 ± 0.4 to 34.6 ± 0.4 m) and PI decreased (366.2 ± 2.0 to 358.6 ± 2.0 kg); while in heifers with PD 180 kg, EI was 29.9 ± 0.2 and 27.8 ± 0.2 m, and PI was 353.5 ± 0.9 and 359.1 ± 1.1 kg (P<0.001). Adequate feeding management improved EI and PI results

Avaliação de programas hormonais para a indução e sincronização do estro em caprinos Evaluation of hormonal programs to induce and synchronize estrus in goats

O objetivo deste trabalho foi estabelecer alternativas para indução e sincronização do estro em cabras leiteiras manejadas semi-intensivamente. Foram conduzidos quatro experimentos com 411 cabras na Embrapa-Centro Nacional de Pesquisa deCaprinos, Sobral, CE. No protocolo básico, utilizaram-se esponjas intra-vaginais com 50 mg de acetato de medroxiprogesterona (MAP) por dez dias e aplicação intra-muscular de 100 mig de cloprostenol e 200 UI de gonadotropina coriônica eqüina (eCG) no 8º dia; a inseminação artificial (IA), com sêmen congelado foi feita 38 horas após remoção da esponja. No experimento1 substituiu-se a e CG pelo "efeito macho"; no experimento 2 substituiu-se a dose de MAP para 60 mg; no experimento3 compararam-se diferentes momentos de IA: 38, 44 e 50 horas e no experimento 4 substituiu-se a eCG pela gonadotropina humana (hCG). Nenhuma das alternativas testadas modificou (P>0,05) a prolificidade. A IA em cio natural gerou maior (P<0,05) índice de parição no experimento2(67,7%) e no experimento 4 (73,3%). A dose de 60 mg de MAP permitiu realizar a IA mais tarde (44 horas apósretirar a esponja) sem detrimento da fertilidade. A hCG equivaleu a eCG, se aplicada 48 horas antes de retirar a esponja.<br>The objective of this study was to establish alternatives to induce and synchronize estrus in dairy goats managed under semi-intensive conditions. Four experiments were carried out using 411 goats at the Embrapa-Centro Nacional de Pesquisa de Caprinos, Sobral, CE, Brazil. In the basic protocol, intra-vaginal sponges were used with 50 mg of medroxyprogesterone acetate (MAP) over ten days, associated with intra-muscular shots of cloprostenol, and equine corionic gonadotropin (eCG) at the 8th day. Artificial insemination (AI) with frozen semen took place 38 hours after sponge withdrawal. In the first experiment, eCG was replaced by "buck effect"; in the second experiment, 60 mg MAP replaced the usual dose; the third experiment compared different pre-fixed time for AI: 38, 44 and 50 hours and in the fourth experiment, hCG (human corionic gonadotropin) given at different moments, replaced eCG. Prolificacy was not influenced (P>0.05) by any changes of basic protocol.After natural estrus, AIprovided higher (P<0.05) parturition rates in the second (67.7%) and fourth experiment (73.3%). Sponge with 60mg MAP allowed to inseminate later (44 hours after removal) without impairing fertility. As long as hCG is given 48 hours before sponge removal it results equals to eCG ones