Combination antibiotic therapy for community-acquired pneumonia

Community-acquired pneumonia (CAP) is a common and potentially serious illness that is associated with morbidity and mortality. Although medical care has improved during the past decades, it is still potentially lethal. Streptococcus pneumoniae is the most frequent microorganism isolated. Treatment includes mandatory antibiotic therapy and organ support as needed. There are several antibiotic therapy regimens that include β-lactams or macrolides or fluoroquinolones alone or in combination. Combination antibiotic therapy achieves a better outcome compared with monotherapy and it should be given in the following subset of patients with CAP: outpatients with comorbidities and previous antibiotic therapy, nursing home patients with CAP, hospitalized patients with severe CAP, bacteremic pneumococcal CAP, presence of shock, and necessity of mechanical ventilation. Better outcome is associated with combination therapy that includes a macrolide for wide coverage of atypical pneumonia, polymicrobial pneumonia, or resistant Streptococcus pneumoniae. Macrolides have shown different properties other than antimicrobial activity, such as anti-inflammatory properties. Although this evidence comes from observational, most of them retrospective and nonblinded studies, the findings are consistent. Ideally, a prospective, multicenter, randomized trial should be performed to confirm these findings

Severe pneumococcal pneumonia: impact of new quinolones on prognosis

<p>Abstract</p> <p>Background</p> <p>Most guidelines have been proposing, for more than 15 years, a β-lactam combined with either a quinolone or a macrolide as empirical, first-line therapy of severe community acquired pneumonia (CAP) requiring ICU admission. Our goal was to evaluate the outcome of patients with severe CAP, focusing on the impact of new rather than old fluoroquinolones combined with β-lactam in the empirical antimicrobial treatments.</p> <p>Methods</p> <p>Retrospective study of consecutive patients admitted in a 16-bed general intensive care unit (ICU), between January 1996 and January 2009, for severe (Pneumonia Severity Index > or = 4) community-acquired pneumonia due to non penicillin-resistant <it>Streptococcus pneumoniae </it>and treated with a β-lactam combined with a fluoroquinolone.</p> <p>Results</p> <p>We included 70 patients of whom 38 received a β-lactam combined with ofloxacin or ciprofloxacin and 32 combined with levofloxacin. Twenty six patients (37.1%) died in the ICU. Three independent factors associated with decreased survival in ICU were identified: septic shock on ICU admission (AOR = 10.6; 95% CI 2.87-39.3; p = 0.0004), age > 70 yrs. (AOR = 4.88; 95% CI 1.41-16.9; p = 0.01) and initial treatment with a β-lactam combined with ofloxacin or ciprofloxacin (AOR = 4.1; 95% CI 1.13-15.13; p = 0.03).</p> <p>Conclusion</p> <p>Our results suggest that, when combined to a β-lactam, levofloxacin is associated with lower mortality than ofloxacin or ciprofloxacin in severe pneumococcal community-acquired pneumonia.</p

Identification of volatiles generated by potato tubers (Solanum tuberosum CV: Maris piper) infected by Erwinia carotovora, Bacillus polymyxa and Arthrobacter sp.

Bacteria were isolated from internal tissues of surface sterilized healthy tubers of Solanum tuberosum cv. Maris Piper (8 different isolates) and from tubers inoculated with Erwinia carotovora ssp. carotovora showing soft-rot symptoms (3 different isolates), and identified by fatty acid profiling. Bacillus polymyxa and an Arthrobacter sp. were isolated from both sources, E. carotovora only from the soft-rotted tubers. The volatile organic compounds (VOCs) generated by tubers inoculated with E. carotovora, B. polymyxa and the Arthrobacter sp. were identified. Inoculated tubers of cv. Maris Piper were incubated under controlled humidity (95% relative humidity) and temperature (10°C) to simulate typical storage conditions. B. polymyxa and Arthrobacter sp. did not cause symptoms, whilst E. carotovora caused limited soft-rot infections after 4weeks at the low temperatures typically associated with potatoes in storage. The VOCs released to the headspace around these tubers were collected using an adsorbent system and analysed by Gas Chromatography-Mass Spectrometry (GC-MS). Twenty-two volatiles unique to E. carotovora infection of potato tubers were found, including 10 alkanes, four alkenes, two aldehydes, one sulphide, one ketone, one alcohol, one aromatic, one acid and one heterocyclic compound. B. polymyxa generated three unique volatiles: N,N-dimethylformamide, 1-pentadecene and 1-hexadecane. Only one volatile, 2,3-dihydrofuran, was unique to the Arthrobacter infection. Production of volatile nitrogen species from E. carotovora-infected tubers increased with time, whereas none were detected in the headspace above uninfected tubers. Further analysis using a modified GC-MS method established that ammonia, trimethylamine and several volatile sulphides were evolved from tubers infected by E. carotovora. No specific volatile was useful as a marker associated with any of the three bacterial species but in the case of E. carotovora-infected potato tubers a significant increase in the volume of compounds evolved was clearly observed. The results are discussed in relation to the use of sensors to detect VOCs evolved from infected tubers in order to provide an early warning system for the control of soft rot in potato stores

Biochar application reduces nodulation but increases nitrogenase activity in clover

Background and aims: Biochar is produced from the pyrolysis of organic materials, and when buried in soil can act as a long term soil carbon (C) store. Evidence suggests that biochar can also increase crop yields, reduce nutrient leaching and increase biological nitrogen fixation in leguminous plants. However, the potential for increasing biological N2 fixation in agroecosystems is poorly understood, with inconsistent reports of root nodulation following biochar application. Therefore, the aim of this study was to determine the effect of biochar application rate and time since application on nodulation and nitrogenase activity in nodules of clover grown in a temperate agricultural soil. Methods: We used replicated field plots with three biochar application rates (0, 25 and 50 t ha-1). Three years after biochar amendment, the plots were further split and fresh biochar added at two different rates (25 and 50 t ha-1) resulting in double-loaded reapplications of 25&thinsp;+&thinsp;25 and 50&thinsp;+&thinsp;50 t ha-1. Results: Three years after biochar application, there was no significant difference in the total number of root nodules between biochar-amended and unamended soil, regardless of the application rate. However, despite clover root nodules being of a similar number and size the level of nitrogenase activity of individual nodules in biochar-amended soil was significantly higher than in unamended soil. Reapplication of biochar resulted in decreased nodulation, although the rate of nitrogenase activity per nodule remained unaffected. Conclusion: In the short term, biochar influences root nodule number and localised N2 fixation per nodule; however, total nitrogenase activity for the whole root system remained unaffected by the application rate of biochar or time since its application. These results emphasise the importance of long-term field studies, with a variety of applications rates for determining the influence of biochar applications on N2-fixing organisms and in providing data that can meaningfully inform agronomic management decisions and climate change mitigation strategies