Streptococcus anginosus lung infection and empyema: A case report and review of the literature

Streptococcus milleri group (SMG) also referred to as the Streptococcus anginosus group. These are Gram-positive, variable hemolysis, catalase negative, microaerophilic, non-motile facultative anaerobes which have been known to cause abscesses in humans. We report a case of empyema caused by Streptococcus anginosus in a patient with an unresolved pneumonia for over a month. In early October 2018, the patient presented to an emergency room with the complaints of shortness of air, productive cough, chills, subjective fever and weight loss for 4 weeks. A chest X-ray revealed a left lower lobe pneumonia. He was treated with 250 mg of azithromycin for 4 days. During a follow-up visit in November 2018, he reported having persistent symptoms. The chest CT revealed a localized pleural fluid collection at the left lower chest highly suggestive of empyema. He was prescribed 100mg of doxycycline for a month. However, he was admitted to the hospital a week later due to worsening symptoms. The microbiological cultures for sputum and blood were negative; however, pleural fluid cultures grew Streptococcus anginosus resistant to clindamycin and erythromycin. The patient was treated with broad spectrum antimicrobial regimen in conjunction with surgical management. Initially, the patient underwent CT guided placement of chest tube with instillation of Tissue Plasminogen Activator (TPA) for the drainage of pleural fluid followed Video-assisted Thoracoscopy with lateral decortication and drainage of empyema of the left lung due to persistence of complicated effusion. There was remarkable improvement in his symptoms, and he recovered subsequently. Our case highlights the infections caused by the Streptococcus milleri group (SMG) in individuals with an unresolved pneumonia. Such patients should be diagnosed accurately and treated aggressively with rapid and effective interventions

Adult Patients Living with Human Immunodeficiency Virus Hospitalized for Community-Acquired Pneumonia in the United States: Incidence and Outcomes

Background: Community-acquired pneumonia (CAP) is a common infectious reason for hospitalization of adults in the United States (US), including those with Human Immunodeficiency Virus (HIV). While there are studies detailing the incidence and outcomes for all adults with CAP we are not aware of a recent study detailing incidence and outcomes in adult HIV patients hospitalized with CAP. The objectives of this study were (1) to define the current incidence and outcomes of adult HIV patients hospitalized with CAP in Louisville, Kentucky, and (2) to estimate the burden of CAP in the US HIV adult population. Methods: This was a secondary analysis of The University of Louisville Pneumonia Study; a prospective population-based cohort study of all hospitalized adults with CAP who were residents of Louisville, Kentucky, from 1 June 2014 to 31 May 2016. Results: A total of 110 unique patients living with HIV were hospitalized with CAP during our two-year study. The annual incidence of adults living with HIV hospitalized with CAP is estimated to be 1,950 per 100,000. Of the estimated 1.1 million adults living with HIV in the US currently we predict that 21,450 will be hospitalized with CAP annually. The median time to clinical stability in adult patients living with HIV hospitalized with CAP was 2 (IQR: [1, 3]) days. The median length of stay for adult patients living with HIV hospitalized with CAP was 4 (IQR: [3, 7]) days. Mortality occurred as follows; in-hospital: 1.8%, 30-day 6.8%, 6-month 15.5%, and 1 year 20.2%. Conclusion: The estimated annual incidence of adult patients living with HIV and hospitalized with CAP was found to be 1,950 per 100,000 suggesting that 21,450 adults living with HIV will be admitted with CAP yearly across the US. This is a similar incidence to that recently predicted for the elderly. Mortality occurred as follows; in-hospital: 1.8%, 30-day 6.8%, 6-month 15.5%, and 1 year 20.2%. Our 30-day mortality rate for adult patients living with HIV hospitalized for CAP was similar to other figures in the literature

Potential role of intermittent fasting on decreasing cardiovascular disease in human immunodeficiency virus patients receiving antiretroviral therapy

Cardiovascular disease (CVD) has become one of the commonest causes of comorbidity and mortality among People living with human immunodeficiency virus (HIV) (PLWH) on antiretroviral therapy (ART). Nearly 50% of PLWH are likely to have an increased risk of developing CVD, including coronary heart disease, cerebrovascular disease, peripheral artery disease and aortic atherosclerosis. Aside from the common risk factors, HIV infection itself and side effects of antiretroviral therapy contribute to the pathophysiology of this entity. Potential non-pharmacological therapies are currently being tested worldwide for this purpose, including eating patterns such as Intermittent fasting (IF). IF is a widespread practice gaining high level of interest in the scientific community due to its potential benefits such as improvement in serum lipids and lipoproteins, blood pressure (BP), platelet-derived growth factor AB, systemic inflammation, and carotid artery intima-media thickness among others cardiovascular benefits. This review will focus on exploring the potential role of intermittent fasting as a non-pharmacological and cost-effective strategy in decreasing the burden of cardiovascular diseases among HIV patients on ART due to its intrinsic properties improving the main cardiovascular risk factors and modulating inflammatory pathways related to endothelial dysfunction, lipid peroxidation and aging. Intermittent fasting regimens need to be tested in clinical trials as an important, cost-effective, and revolutionary coadjutant of ART in the fight against the increased prevalence of cardiovascular disease in PLWH.Revisión por pare

Refugee-Centered Medical Home:A New Approach to Care at the University of Louisville Global Health Center

Refugees arrive to the United States with a full spectrum of health conditions, many of which involve intense case management requiring significant financial investments and use of healthcare resources. Kentucky receives more than 3,000 new refugees each year and ranked 10th in the nation for numbers of new arrivals resettled during 2015. These refugees arrive from diverse countries representing different cultures and speaking different languages. In addition, they arrive with diverse health conditions and medical needs. The aims of this paper are to share experiences from the University of Louisville Global Health Center regarding conceptualization, implementation and evaluation of a new care model. This model focuses on the complexities of caring for refugees from diverse populations and backgrounds. The foundation for this model aligns with the patient-centered medical home approach outlined by the Agency for Healthcare Research and Quality. Recognizing the need for a new paradigm for care, a refugee-centered medical home model was designed and implemented as an ideal approach

Do Antiplatelet Medications Prevent Poor Clinical Outcomes in Patients With Community-Acquired Pneumonia? Results From the Community-Acquired Pneumonia Organization International Cohort Study

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Correlation of Obesity With Outcomes in Hospitalized Patients With Community-Acquired Pneumonia: Results From the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study

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COPD exacerbation caused by SARS-CoV-2: A Case Report from the Louisville COVID-19 Surveillance Program

A 53-year-old male with a history of chronic obstructive pulmonary disease (COPD) on home oxygen presented to the hospital with worsening shortness of breath plus cough. He was admitted to the intensive care unit for COPD exacerbation and respiratory failure. A routine evaluation was performed including a nasopharyngeal swab for a respiratory viral panel, which was negative. His symptoms improved over 48 hours at which time a surveillance test for SARS-CoV-2 returned as positive. After clinical improvement, he was discharged to home isolation

Clinical Characteristics and Outcomes of Patients With Community-Acquired Pneumonia—Real-Life Versus Food and Drug Administration (FDA) Trials: Results From the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study

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Antimicrobial Stewardship in Hospitalized Patients with Respiratory Infections: Ten-Year Experience from the Robley Rex Louisville VA Medical Center

Rationale: Antibiotic stewardship has been defined as coordinated interventions designed to improve and measure the appropriate use of antibiotic agents. Respiratory infections are the most common infectious reason for hospitalization in the United States. Therefore, one could extrapolate that respiratory infections are then also the most common reason for hospital antibiotic use and possess the highest potential for hospital antibiotic misuse. The primary objective of this article was to evaluate the role of antimicrobial stewardship on improving antibiotic use for respiratory infections in hospitalized patients on intravenous (IV) antibiotics at the Robley Rex Louisville VAMC over a 10-year period. Methods: This was a retrospective review of the Robley Rex Louisville VAMC ASP Switch Therapy and Antimicrobial Review database. The study included all Robley Rex Louisville VAMC patients admitted to the hospital and placed on IV antibiotics between January 1st 2007 and December 31st 2016. Results: Recommendations from an antimicrobial stewardship team (AST) improve hospital IV antibiotic use in respiratory infections to a level above 90%. Conclusion: AST recommendations regarding antibiotic use for respiratory infections improve compliance with hospital guidelines. There is an ongoing role for antimicrobial stewardship programs overtime

Sepsis in Patients with Ventilator Associated Pneumonia due to Methicillin- Resistant Staphylococcus aureus: Incidence and Impact on Clinical outcomes

Background: Sepsis is a clinical syndrome associated with organ dysfunction due to a dysregulated host response to infection. Methicillin-resistant Staphylococcus aureus (MRSA) Ventilator-associated pneumonia (VAP) is a serious infection frequently associated with sepsis. The objectives of this study were to define the incidence of sepsis and clinical failure in patients with MRSA VAP. Methods: This was a secondary analysis of the Improving Medicine through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study database. VAP was defined according to CDC criteria. MRSA VAP was considered when MRSA was isolated from a tracheal aspirate or bronchoalveolar lavage. We used the 3rd International Consensus Definitions for sepsis. The presence of clinical failure was evaluated at the 14-day follow-up and defined as: 1) progression of baseline signs and symptoms of pneumonia, or 2) death. The Chi- Square Trend Test was utilized to determine the association between the level of organ dysfunction and clinical failure. Results: MRSA VAP was diagnosed in 205 patients with 138 (67%) presenting with sepsis. Clinical failure occurred in 14% (8/57) of patients without sepsis. Clinical failure occurred in 18% (13/73) of patients with sepsis and 1 organ dysfunction, in 28% (12/43) of patients with sepsis and 2 organ dysfunction, in 28% (5/18) of patients with sepsis and 3 organ dysfunction, and in 100% (4/4) of patients with sepsis and 4 organ dysfunction (p= 0.01). Conclusions: Sepsis is a frequent complication of MRSA VAP and the number of organ dysfunction correlates with clinical failure in these patients. Effective prevention and treatment of sepsis and associated organ dysfunction is essential to avoid cumulative burden of disease in MRSA VAP