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

Experimental assessment of the liquefaction resistance of calcareous biogenous sands

ABSTRACTLiquefaction is a phenomenon in which soils, typically sands, suddenly loose a substantial amount of their shear strength and stiffness, this often triggered by large-magnitude earthquakes. Most liquefaction research has focused on silicate-based sands and not on other sand types, such as calcareous biogenous sands Calcareous sands are usually composed of skeletal or non-skeletal remains of marine organisms, with unique characteristics in terms of their mineralogy surface roughness, particle shape, crushability, and intraparticle porosity. The unique characteristics of calcareous sands suggest that their geotechnical engineering behaviour can be substantially different compared to that of terrigenous sands, including their behaviour under seismic loading, which have not been very well studiedThis paper presents the results of an experimental programme aimed at studying the cyclic liquefaction resistance of uncemented calcareous biogenous sands retrieved from south-western Puerto Rico Evaluation of liquefaction potential involved a comprehensive set of isotropically consolidated undrained cyclic triaxial tests on reconstituted samples of this calcareous sand. The programme also included tests on Ottawa terrigenous silica sand samples prepared and tested in similar conditions for comparison purposes.In general, the experimental results showed that Cabo Rojo calcareous sands had higher liquefaction resistance compared to Ottawa silica sands tested under similar conditions. Important differences between calcareous and silica sands regarding pore pressure generation characteristics and axial strain accumulation were also observedRESUMENLa licuación es un fenómeno en el cual los suelos, típicamente arenas, pierden una cantidad importante de su rigidez y resistencia al esfuerzo cortante, generalmente por causa de sismos de gran magnitud . La mayoría de investigaciones sobre licuación se han enfocado en arenas terrígenas con base de sílice o cuarzo, y no sobre otro tipo de arenas, como las arenas calcáreas biogénicas . Las arenas calcáreas están usualmente compuestas por residuos de organismos marinos esqueléticos y no esqueléticos, con características específicas en términos de su mineralogía, rugosidad superficial, forma de partículas, susceptibilidad al rompimiento y porosidad interna de los granos Las características particulares de las arenas calcáreas, hacen suponer que su comportamiento ingenieril geotécnico puede ser considerablemente diferente comparado con el de arenas terrígenas, incluyendo su comportamiento bajo carga sísmica, el cual no ha sido estudiado en detalleEste artículo presenta los resultados de un programa experimental desarrollado con el fin de estudiar la resistencia a licuación cíclica de una arena calcárea biogénica no cementada, extraída del suroeste de Puerto Rico La evaluación del potencial de licuación incluyó una extensa cantidad de ensayos triaxiales cíclicos no drenados consolidados isotrópicamente, sobre muestras no cementadas de esta arena calcárea Para fines de comparación, el programa también incluyó ensayos sobre la arena terrígena de Ottawa bajo condiciones de prueba similaresEn general, los resultados experimentales mostraron que las arenas calcáreas de Cabo Rojo tuvieron mayor resistencia a licuación, comparada con las arenas de Ottawa para condiciones de prueba similares También se observaron diferencias importantes en cuanto a las características de generación de presiones de poros y acumulación de deformaciones axiale

Influencia del origen y la mineralogía de las arenas en la resistencia a licuación.

Los métodos disponibles en la literatura para evaluar la resistencia a licuación de arenas se basan principalmente en investigaciones sobre arenas de origen terrígeno con mineralogía de sílice o cuarzo. Esto es debido en parte a que las arenas terrígenas son las más abundantes. Sin embargo existen otros tipos de arenas en términos de origen, mineralogía y forma de sus granos, cuya susceptibilidad a licuación no ha sido estudiada en mayor detalle. Este artículo busca contribuir a llenar este vacío, al presentar resultados de un programa experimental detallado para determinar la resistencia a licuación de arenas calcáreas no cementadas. El estudio involucró caracterización mineralógica, determinación de propiedades índice principales, línea de estado crítico y ensayos triaxiales cíclicos no drenados con consolidación isotrópica, sobre una arena calcárea no cementada. Con fines de comparación, se realizaron pruebas similares sobre la arena de sílice estándar de Ottawa. Los resultados mostraron que las arenas calcáreas tuvieron mayor resistencia a licuación que las arenas de sílice, cuando fueron probadas bajo condiciones similares. También se encontraron diferencias importantes en la generación de presiones de poros y en la acumulación de deformaciones axiales durante la fase de carga cíclica en los ensayos triaxiales

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–community-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 &lt; .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

International prevalence and risk factors evaluation for drug-resistant Streptococcus pneumoniae pneumonia

Objective: Streptococcus pneumoniae is the most frequent bacterial pathogen isolated in subjects with Community-acquired pneumonia (CAP) worldwide. Limited data are available regarding the current global burden and risk factors associated with drug-resistant Streptococcus pneumoniae (DRSP) in CAP subjects. We assessed the multinational prevalence and risk factors for DRSP-CAP in a multinational point-prevalence study. Design: The prevalence of DRSP-CAP was assessed by identification of DRSP in blood or respiratory samples among adults hospitalized with CAP in 54 countries. Prevalence and risk factors were compared among subjects that had microbiological testing and antibiotic susceptibility data. Multivariate logistic regressions were used to identify risk factors independently associated with DRSP-CAP. Results: 3,193 subjects were included in the study. The global prevalence of DRSP-CAP was 1.3% and continental prevalence rates were 7.0% in Africa, 1.2% in Asia, and 1.0% in South America, Europe, and North America, respectively. Macrolide resistance was most frequently identified in subjects with DRSP-CAP (0.6%) followed by penicillin resistance (0.5%). Subjects in Africa were more likely to have DRSP-CAP (OR: 7.6; 95%CI: 3.34-15.35, p<0.001) when compared to centres representing other continents. Conclusions: This multinational point-prevalence study found a low global prevalence of DRSP-CAP that may impact guideline development and antimicrobial policies