Community-Acquired Pneumonia

Key clinical point: Serum IL-17 levels show a positive correlation with the severity and poor prognostic outcomes in patients with community-acquired pneumonia (CAP).

Main finding: In patients with CAP, serum IL-17 levels at admission increased in parallel with CAP severity scores, such as pneumonia severity index, and, after adjusting for confounding factors, showed a positive correlation with intensive care unit (ICU) admission (adjusted odds ratio [aOR] 1.01; P = .01), mechanical ventilation (aOR 1.10; P = .02), death (aOR, 1.05; P < .01), and hospital stay of 14 days or more (aOR 1.21; P = .01).

Study details: This was a prospective cohort study including 239 patients who were hospitalized for CAP.

Disclosures: The National Natural Science Foundation of China, Anhui Provincial Natural Science Foundation, National Natural Science Foundation Incubation Program of the Second Affiliated Hospital of Anhui Medical University, and Scientific Research of Health Commission in Anhui Province sponsored the study. None of the authors declared any conflict of interests.

Source: Feng CM et al. BMC Pulm Med. 2021;21:393 (Dec 2). Doi: 10.1186/s12890-021-01770-6.

Key clinical point: Serum IL-17 levels show a positive correlation with the severity and poor prognostic outcomes in patients with community-acquired pneumonia (CAP).

Main finding: In patients with CAP, serum IL-17 levels at admission increased in parallel with CAP severity scores, such as pneumonia severity index, and, after adjusting for confounding factors, showed a positive correlation with intensive care unit (ICU) admission (adjusted odds ratio [aOR] 1.01; P = .01), mechanical ventilation (aOR 1.10; P = .02), death (aOR, 1.05; P < .01), and hospital stay of 14 days or more (aOR 1.21; P = .01).

Study details: This was a prospective cohort study including 239 patients who were hospitalized for CAP.

Disclosures: The National Natural Science Foundation of China, Anhui Provincial Natural Science Foundation, National Natural Science Foundation Incubation Program of the Second Affiliated Hospital of Anhui Medical University, and Scientific Research of Health Commission in Anhui Province sponsored the study. None of the authors declared any conflict of interests.

Source: Feng CM et al. BMC Pulm Med. 2021;21:393 (Dec 2). Doi: 10.1186/s12890-021-01770-6.

Key clinical point: Serum IL-17 levels show a positive correlation with the severity and poor prognostic outcomes in patients with community-acquired pneumonia (CAP).

Main finding: In patients with CAP, serum IL-17 levels at admission increased in parallel with CAP severity scores, such as pneumonia severity index, and, after adjusting for confounding factors, showed a positive correlation with intensive care unit (ICU) admission (adjusted odds ratio [aOR] 1.01; P = .01), mechanical ventilation (aOR 1.10; P = .02), death (aOR, 1.05; P < .01), and hospital stay of 14 days or more (aOR 1.21; P = .01).

Study details: This was a prospective cohort study including 239 patients who were hospitalized for CAP.

Disclosures: The National Natural Science Foundation of China, Anhui Provincial Natural Science Foundation, National Natural Science Foundation Incubation Program of the Second Affiliated Hospital of Anhui Medical University, and Scientific Research of Health Commission in Anhui Province sponsored the study. None of the authors declared any conflict of interests.

Source: Feng CM et al. BMC Pulm Med. 2021;21:393 (Dec 2). Doi: 10.1186/s12890-021-01770-6.

Key clinical point: In patients hospitalized for community-acquired pneumonia (CAP), the least risk of acute kidney injury (AKI) can be achieved by empiric treatment with a third-generation cephalosporin ± macrolide or a respiratory fluoroquinolone.

Main finding: Barring fluoroquinolones (adjusted odds ratio [aOR] 1.06; 95% CI 0.98-1.14), all regimens offered a higher risk for AKI than a third-generation cephalosporin ± macrolide, with piperacillin/tazobactam + vancomycin being associated with the highest AKI odds (aOR 1.89; 95% CI 1.73-2.06).

Study details: Findings are from a retrospective cohort study consisting of 449,535 adult patients hospitalized for CAP, of whom 3.1% developed AKI.

Disclosures: The study was sponsored by the Agency for Healthcare Research and Quality. The authors declared no conflict of interests.

Source: Le P et al. Curr Med Res Opin. 2021 (Nov 15). Doi: 10.1080/03007995.2021.2000716.

Key clinical point: In patients hospitalized for community-acquired pneumonia (CAP), the least risk of acute kidney injury (AKI) can be achieved by empiric treatment with a third-generation cephalosporin ± macrolide or a respiratory fluoroquinolone.

Main finding: Barring fluoroquinolones (adjusted odds ratio [aOR] 1.06; 95% CI 0.98-1.14), all regimens offered a higher risk for AKI than a third-generation cephalosporin ± macrolide, with piperacillin/tazobactam + vancomycin being associated with the highest AKI odds (aOR 1.89; 95% CI 1.73-2.06).

Study details: Findings are from a retrospective cohort study consisting of 449,535 adult patients hospitalized for CAP, of whom 3.1% developed AKI.

Disclosures: The study was sponsored by the Agency for Healthcare Research and Quality. The authors declared no conflict of interests.

Source: Le P et al. Curr Med Res Opin. 2021 (Nov 15). Doi: 10.1080/03007995.2021.2000716.

Key clinical point: In patients hospitalized for community-acquired pneumonia (CAP), the least risk of acute kidney injury (AKI) can be achieved by empiric treatment with a third-generation cephalosporin ± macrolide or a respiratory fluoroquinolone.

Main finding: Barring fluoroquinolones (adjusted odds ratio [aOR] 1.06; 95% CI 0.98-1.14), all regimens offered a higher risk for AKI than a third-generation cephalosporin ± macrolide, with piperacillin/tazobactam + vancomycin being associated with the highest AKI odds (aOR 1.89; 95% CI 1.73-2.06).

Study details: Findings are from a retrospective cohort study consisting of 449,535 adult patients hospitalized for CAP, of whom 3.1% developed AKI.

Disclosures: The study was sponsored by the Agency for Healthcare Research and Quality. The authors declared no conflict of interests.

Source: Le P et al. Curr Med Res Opin. 2021 (Nov 15). Doi: 10.1080/03007995.2021.2000716.

Key clinical point: Quick sequential (sepsis-related) organ failure assessment (qSOFA) is better than the Infectious Disease Society of America/American Thoracic Society minor criteria and worse than confusion, urea, respiratory rate, blood pressure, and age ≥ 65 years (CURB-65) in predicting mortality in community-acquired pneumonia (CAP).

Main finding: The predictive validity of qSOFA for mortality (area under the receiver operating characteristic curve [AUROC] 0.868; 95% CI 0.853-0.882) was higher than that of minor criteria (AUROC 0.824; P < .0001) and lower than that of CURB-65 (AUROC 0.919; P < .0001).

Study details: The data come from an observational prospective cohort study consisting of 2,116 adult patients with CAP.

Disclosures: The study was sponsored by the Medical Science and Technology Foundation of Guangdong Province, Planned Science and Technology Project of Shenzhen Municipality, and Nonprofit Scientific Research Project of Futian District. The authors declared no conflict of interests.

Source: Guo Q et al. Am J Emerg Med. 2022(Feb);52:1-7 (Nov 24). Doi: 10.1016/j.ajem.2021.11.029.

Key clinical point: Quick sequential (sepsis-related) organ failure assessment (qSOFA) is better than the Infectious Disease Society of America/American Thoracic Society minor criteria and worse than confusion, urea, respiratory rate, blood pressure, and age ≥ 65 years (CURB-65) in predicting mortality in community-acquired pneumonia (CAP).

Main finding: The predictive validity of qSOFA for mortality (area under the receiver operating characteristic curve [AUROC] 0.868; 95% CI 0.853-0.882) was higher than that of minor criteria (AUROC 0.824; P < .0001) and lower than that of CURB-65 (AUROC 0.919; P < .0001).

Study details: The data come from an observational prospective cohort study consisting of 2,116 adult patients with CAP.

Disclosures: The study was sponsored by the Medical Science and Technology Foundation of Guangdong Province, Planned Science and Technology Project of Shenzhen Municipality, and Nonprofit Scientific Research Project of Futian District. The authors declared no conflict of interests.

Source: Guo Q et al. Am J Emerg Med. 2022(Feb);52:1-7 (Nov 24). Doi: 10.1016/j.ajem.2021.11.029.

Key clinical point: Quick sequential (sepsis-related) organ failure assessment (qSOFA) is better than the Infectious Disease Society of America/American Thoracic Society minor criteria and worse than confusion, urea, respiratory rate, blood pressure, and age ≥ 65 years (CURB-65) in predicting mortality in community-acquired pneumonia (CAP).

Main finding: The predictive validity of qSOFA for mortality (area under the receiver operating characteristic curve [AUROC] 0.868; 95% CI 0.853-0.882) was higher than that of minor criteria (AUROC 0.824; P < .0001) and lower than that of CURB-65 (AUROC 0.919; P < .0001).

Study details: The data come from an observational prospective cohort study consisting of 2,116 adult patients with CAP.

Disclosures: The study was sponsored by the Medical Science and Technology Foundation of Guangdong Province, Planned Science and Technology Project of Shenzhen Municipality, and Nonprofit Scientific Research Project of Futian District. The authors declared no conflict of interests.

Source: Guo Q et al. Am J Emerg Med. 2022(Feb);52:1-7 (Nov 24). Doi: 10.1016/j.ajem.2021.11.029.

Key clinical point: A positive association exists between blood glucose levels at hospital admission for community-acquired pneumonia (CAP) and 28-day mortality, and the strength of this association decreases with age.

Main finding: After adjusting for confounding factors, all patients exhibited a significant association between blood glucose levels at hospitalization and 28-day mortality (hazard ratio [HR] 2.08; P < .01). After age stratification, this association was evidenced in both middle-aged (HR 4.48; P < .01) and elderly (HR 1.52; P = .05) patients, but was stronger in the former (P = .01).

Study details: This was a retrospective observational study including 1,656 patients aged ≥45 years who were hospitalized for CAP, of which 592 were middle-aged (45-64 years) and 1,064 were elderly (>65 years).

Disclosures: The authors declared no conflict of interests.

Source: Shen Y et al. Int J Gen Med. 2021;14:7775-7781 (Nov 6). Doi: 10.2147/IJGM.S331082.

Key clinical point: A positive association exists between blood glucose levels at hospital admission for community-acquired pneumonia (CAP) and 28-day mortality, and the strength of this association decreases with age.

Main finding: After adjusting for confounding factors, all patients exhibited a significant association between blood glucose levels at hospitalization and 28-day mortality (hazard ratio [HR] 2.08; P < .01). After age stratification, this association was evidenced in both middle-aged (HR 4.48; P < .01) and elderly (HR 1.52; P = .05) patients, but was stronger in the former (P = .01).

Study details: This was a retrospective observational study including 1,656 patients aged ≥45 years who were hospitalized for CAP, of which 592 were middle-aged (45-64 years) and 1,064 were elderly (>65 years).

Disclosures: The authors declared no conflict of interests.

Source: Shen Y et al. Int J Gen Med. 2021;14:7775-7781 (Nov 6). Doi: 10.2147/IJGM.S331082.

Key clinical point: A positive association exists between blood glucose levels at hospital admission for community-acquired pneumonia (CAP) and 28-day mortality, and the strength of this association decreases with age.

Main finding: After adjusting for confounding factors, all patients exhibited a significant association between blood glucose levels at hospitalization and 28-day mortality (hazard ratio [HR] 2.08; P < .01). After age stratification, this association was evidenced in both middle-aged (HR 4.48; P < .01) and elderly (HR 1.52; P = .05) patients, but was stronger in the former (P = .01).

Study details: This was a retrospective observational study including 1,656 patients aged ≥45 years who were hospitalized for CAP, of which 592 were middle-aged (45-64 years) and 1,064 were elderly (>65 years).

Disclosures: The authors declared no conflict of interests.

Source: Shen Y et al. Int J Gen Med. 2021;14:7775-7781 (Nov 6). Doi: 10.2147/IJGM.S331082.

Key clinical point: Lefamulin is suitable as monotherapy against common community-acquired bacterial pneumonia (CABP)-causing pathogens, both typical and atypical, including drug-resistant strains and those causing polymicrobial infections.

Main finding: Lefamulin was as effective as moxifloxacin in the microbiological intent-to-treat (microITT) population, exhibiting a similar early clinical response rate (89.3% vs. 93.0%; difference ‒3.7; 95% CI ‒7.9 to 0.5) and investigator assessment of clinical response success rate (83.2% vs. 86.7%; difference ‒3.3; 95% CI ‒8.6 to 2.0).

Study details: The study analyzed pooled data from the phase 3 noninferiority Lefamulin Evaluation Against Pneumonia 1 and 2 trials, including a total of 1,289 adult patients with CABP (Pneumonia Outcomes Research Team risk classes II-V) who were randomly assigned to receive lefamulin or moxifloxacin. Of these, a baseline CABP pathogen was detected in 709 patients (microITT population).

Disclosures: Nabriva Therapeutics plc (Fort Washington, PA, USA) sponsored the study. Some of the authors, including the lead author, are former or current employees of or stockholders in Nabriva Therapeutics. A few others received research grants/consultation fees from various sources including Nabriva Therapeutics.

Source: Paukner S et al. J Glob Antimicrob Resist. 2021 (Nov 14). Doi: 10.1016/j.jgar.2021.10.021.

Key clinical point: Lefamulin is suitable as monotherapy against common community-acquired bacterial pneumonia (CABP)-causing pathogens, both typical and atypical, including drug-resistant strains and those causing polymicrobial infections.

Main finding: Lefamulin was as effective as moxifloxacin in the microbiological intent-to-treat (microITT) population, exhibiting a similar early clinical response rate (89.3% vs. 93.0%; difference ‒3.7; 95% CI ‒7.9 to 0.5) and investigator assessment of clinical response success rate (83.2% vs. 86.7%; difference ‒3.3; 95% CI ‒8.6 to 2.0).

Study details: The study analyzed pooled data from the phase 3 noninferiority Lefamulin Evaluation Against Pneumonia 1 and 2 trials, including a total of 1,289 adult patients with CABP (Pneumonia Outcomes Research Team risk classes II-V) who were randomly assigned to receive lefamulin or moxifloxacin. Of these, a baseline CABP pathogen was detected in 709 patients (microITT population).

Disclosures: Nabriva Therapeutics plc (Fort Washington, PA, USA) sponsored the study. Some of the authors, including the lead author, are former or current employees of or stockholders in Nabriva Therapeutics. A few others received research grants/consultation fees from various sources including Nabriva Therapeutics.

Source: Paukner S et al. J Glob Antimicrob Resist. 2021 (Nov 14). Doi: 10.1016/j.jgar.2021.10.021.

Key clinical point: Lefamulin is suitable as monotherapy against common community-acquired bacterial pneumonia (CABP)-causing pathogens, both typical and atypical, including drug-resistant strains and those causing polymicrobial infections.

Main finding: Lefamulin was as effective as moxifloxacin in the microbiological intent-to-treat (microITT) population, exhibiting a similar early clinical response rate (89.3% vs. 93.0%; difference ‒3.7; 95% CI ‒7.9 to 0.5) and investigator assessment of clinical response success rate (83.2% vs. 86.7%; difference ‒3.3; 95% CI ‒8.6 to 2.0).

Study details: The study analyzed pooled data from the phase 3 noninferiority Lefamulin Evaluation Against Pneumonia 1 and 2 trials, including a total of 1,289 adult patients with CABP (Pneumonia Outcomes Research Team risk classes II-V) who were randomly assigned to receive lefamulin or moxifloxacin. Of these, a baseline CABP pathogen was detected in 709 patients (microITT population).

Disclosures: Nabriva Therapeutics plc (Fort Washington, PA, USA) sponsored the study. Some of the authors, including the lead author, are former or current employees of or stockholders in Nabriva Therapeutics. A few others received research grants/consultation fees from various sources including Nabriva Therapeutics.

Source: Paukner S et al. J Glob Antimicrob Resist. 2021 (Nov 14). Doi: 10.1016/j.jgar.2021.10.021.

Key clinical point: Reinforcement of antibiotic stewardship by forming large multihospital collaboratives increases adherence to the appropriate 5-day therapy for uncomplicated community-acquired pneumonia (CAP) while decreasing adverse events.

Main finding: After adjusting for hospital clustering, the 20.9% predicted probability of patients receiving a 5-day antibiotic therapy increased to 45.9% (P < .001) over the study period, with the odds of this duration increasing (adjusted odds ratio [aOR] 1.10; 95% CI 1.07-1.14) and composite adverse events decreasing (aOR 0.98; 95% CI 0.96-0.99) with each successive quarter.

Study details: This study included 6,553 patients eligible for a 5-day therapy for uncomplicated CAP who were admitted to any of the 41 hospitals that participated in a state-wide collaborative quality initiative, Michigan Hospital Medicine Safety Consortium, for the entire 3-year study period.

Disclosures: The study was sponsored by Blue Cross Blue Shield of Michigan and a career development award from the Agency for Healthcare Research and Quality to the lead author who, along with other authors, also declared receiving salary, research grants, or speaker honoraria from additional sources.

Source: Vaughn VM et al. Clin Infect Dis. 2021:ciab950 (Nov 13). Doi: 10.1093/cid/ciab950.

Key clinical point: Reinforcement of antibiotic stewardship by forming large multihospital collaboratives increases adherence to the appropriate 5-day therapy for uncomplicated community-acquired pneumonia (CAP) while decreasing adverse events.

Main finding: After adjusting for hospital clustering, the 20.9% predicted probability of patients receiving a 5-day antibiotic therapy increased to 45.9% (P < .001) over the study period, with the odds of this duration increasing (adjusted odds ratio [aOR] 1.10; 95% CI 1.07-1.14) and composite adverse events decreasing (aOR 0.98; 95% CI 0.96-0.99) with each successive quarter.

Study details: This study included 6,553 patients eligible for a 5-day therapy for uncomplicated CAP who were admitted to any of the 41 hospitals that participated in a state-wide collaborative quality initiative, Michigan Hospital Medicine Safety Consortium, for the entire 3-year study period.

Disclosures: The study was sponsored by Blue Cross Blue Shield of Michigan and a career development award from the Agency for Healthcare Research and Quality to the lead author who, along with other authors, also declared receiving salary, research grants, or speaker honoraria from additional sources.

Source: Vaughn VM et al. Clin Infect Dis. 2021:ciab950 (Nov 13). Doi: 10.1093/cid/ciab950.

Key clinical point: Reinforcement of antibiotic stewardship by forming large multihospital collaboratives increases adherence to the appropriate 5-day therapy for uncomplicated community-acquired pneumonia (CAP) while decreasing adverse events.

Main finding: After adjusting for hospital clustering, the 20.9% predicted probability of patients receiving a 5-day antibiotic therapy increased to 45.9% (P < .001) over the study period, with the odds of this duration increasing (adjusted odds ratio [aOR] 1.10; 95% CI 1.07-1.14) and composite adverse events decreasing (aOR 0.98; 95% CI 0.96-0.99) with each successive quarter.

Study details: This study included 6,553 patients eligible for a 5-day therapy for uncomplicated CAP who were admitted to any of the 41 hospitals that participated in a state-wide collaborative quality initiative, Michigan Hospital Medicine Safety Consortium, for the entire 3-year study period.

Disclosures: The study was sponsored by Blue Cross Blue Shield of Michigan and a career development award from the Agency for Healthcare Research and Quality to the lead author who, along with other authors, also declared receiving salary, research grants, or speaker honoraria from additional sources.

Source: Vaughn VM et al. Clin Infect Dis. 2021:ciab950 (Nov 13). Doi: 10.1093/cid/ciab950.

Key clinical point: Patients with severe community-acquired pneumonia (SCAP) who also have type 2 diabetes mellitus (T2DM) have poorer clinical outcomes than those without T2DM.

Main finding: Compared with patients with SCAP but without T2DM, those with both exhibited higher rates of hospital mortality (35.2% vs. 31.0%; P = .009), 14-day mortality (15.0% vs. 10.8%; P < .001), 30-day mortality (25.7% vs. 22.7%; P = .046), and intensive care unit (ICU) mortality (30.8% vs. 26.5%; P = .005) along with a longer ICU length of stay (13 days vs. 12 days; P = .016).

Study details: Findings are from a retrospective, single-center, observational study including 3,786 adult patients admitted to an ICU for SCAP, among whom 1,262 patients with T2DM were matched to 2,524 patients without T2DM.

Disclosures: The study received funding from the National Natural Science Foundation of China, Science and Technology Department of Sichuan Province, and National Key Research and Development Program of China. The authors declared having no conflict of interests.

Source: Huang D et al. Crit Care. 2021;25:419 (Dec 7). Doi: 10.1186/s13054-021-03841-w.

Key clinical point: Patients with severe community-acquired pneumonia (SCAP) who also have type 2 diabetes mellitus (T2DM) have poorer clinical outcomes than those without T2DM.

Main finding: Compared with patients with SCAP but without T2DM, those with both exhibited higher rates of hospital mortality (35.2% vs. 31.0%; P = .009), 14-day mortality (15.0% vs. 10.8%; P < .001), 30-day mortality (25.7% vs. 22.7%; P = .046), and intensive care unit (ICU) mortality (30.8% vs. 26.5%; P = .005) along with a longer ICU length of stay (13 days vs. 12 days; P = .016).

Study details: Findings are from a retrospective, single-center, observational study including 3,786 adult patients admitted to an ICU for SCAP, among whom 1,262 patients with T2DM were matched to 2,524 patients without T2DM.

Disclosures: The study received funding from the National Natural Science Foundation of China, Science and Technology Department of Sichuan Province, and National Key Research and Development Program of China. The authors declared having no conflict of interests.

Source: Huang D et al. Crit Care. 2021;25:419 (Dec 7). Doi: 10.1186/s13054-021-03841-w.

Key clinical point: Patients with severe community-acquired pneumonia (SCAP) who also have type 2 diabetes mellitus (T2DM) have poorer clinical outcomes than those without T2DM.

Main finding: Compared with patients with SCAP but without T2DM, those with both exhibited higher rates of hospital mortality (35.2% vs. 31.0%; P = .009), 14-day mortality (15.0% vs. 10.8%; P < .001), 30-day mortality (25.7% vs. 22.7%; P = .046), and intensive care unit (ICU) mortality (30.8% vs. 26.5%; P = .005) along with a longer ICU length of stay (13 days vs. 12 days; P = .016).

Study details: Findings are from a retrospective, single-center, observational study including 3,786 adult patients admitted to an ICU for SCAP, among whom 1,262 patients with T2DM were matched to 2,524 patients without T2DM.

Disclosures: The study received funding from the National Natural Science Foundation of China, Science and Technology Department of Sichuan Province, and National Key Research and Development Program of China. The authors declared having no conflict of interests.

Source: Huang D et al. Crit Care. 2021;25:419 (Dec 7). Doi: 10.1186/s13054-021-03841-w.

Key clinical point: Owing to a similar clinical efficacy and safety profile to piperacillin-tazobactam (PIP-TAZ), cefoperazone-sulbactam (CFP-SUL) could be used as an alternative for treating severe community-acquired pneumonia (SCAP) in elderly patients.

Main finding: The odds for clinical cure (adjusted odds ratio [aOR] 1.10; 95% CI 0.71-1.70), clinical effectiveness (aOR 0.99; 95% CI 0.62-1.59), all-cause mortality (aOR 0.95; 95% CI 0.60-1.48), and pneumonia-related mortality (aOR 0.88; 95% CI 0.51-1.53) were similar between patients with SCAP receiving CFP-SUL and those receiving PIP-TAZ. Both drug combinations were equally well tolerated.

Study details: Based on the retrospective multicenter registry BATTLE, the study included 624 patients with SCAP among 317 others with hospital- or ventilator-acquired pneumonia who were aged ≥65 years when diagnosed with pneumonia.

Disclosures: The authors disclosed receiving no financial support for the study. None of the authors declared any conflict of interests.

Source: Huang CT et al. Int J Antimicrob Agents. 2021;106491 (Dec 4). Doi: 10.1016/j.ijantimicag.2021.106491.

Key clinical point: Owing to a similar clinical efficacy and safety profile to piperacillin-tazobactam (PIP-TAZ), cefoperazone-sulbactam (CFP-SUL) could be used as an alternative for treating severe community-acquired pneumonia (SCAP) in elderly patients.

Main finding: The odds for clinical cure (adjusted odds ratio [aOR] 1.10; 95% CI 0.71-1.70), clinical effectiveness (aOR 0.99; 95% CI 0.62-1.59), all-cause mortality (aOR 0.95; 95% CI 0.60-1.48), and pneumonia-related mortality (aOR 0.88; 95% CI 0.51-1.53) were similar between patients with SCAP receiving CFP-SUL and those receiving PIP-TAZ. Both drug combinations were equally well tolerated.

Study details: Based on the retrospective multicenter registry BATTLE, the study included 624 patients with SCAP among 317 others with hospital- or ventilator-acquired pneumonia who were aged ≥65 years when diagnosed with pneumonia.

Disclosures: The authors disclosed receiving no financial support for the study. None of the authors declared any conflict of interests.

Source: Huang CT et al. Int J Antimicrob Agents. 2021;106491 (Dec 4). Doi: 10.1016/j.ijantimicag.2021.106491.

Key clinical point: Owing to a similar clinical efficacy and safety profile to piperacillin-tazobactam (PIP-TAZ), cefoperazone-sulbactam (CFP-SUL) could be used as an alternative for treating severe community-acquired pneumonia (SCAP) in elderly patients.

Main finding: The odds for clinical cure (adjusted odds ratio [aOR] 1.10; 95% CI 0.71-1.70), clinical effectiveness (aOR 0.99; 95% CI 0.62-1.59), all-cause mortality (aOR 0.95; 95% CI 0.60-1.48), and pneumonia-related mortality (aOR 0.88; 95% CI 0.51-1.53) were similar between patients with SCAP receiving CFP-SUL and those receiving PIP-TAZ. Both drug combinations were equally well tolerated.

Study details: Based on the retrospective multicenter registry BATTLE, the study included 624 patients with SCAP among 317 others with hospital- or ventilator-acquired pneumonia who were aged ≥65 years when diagnosed with pneumonia.

Disclosures: The authors disclosed receiving no financial support for the study. None of the authors declared any conflict of interests.

Source: Huang CT et al. Int J Antimicrob Agents. 2021;106491 (Dec 4). Doi: 10.1016/j.ijantimicag.2021.106491.

Key clinical point: In patients with chronic obstructive pulmonary disease (COPD), the occurrence of SARS-CoV-2 community-acquired pneumonia (CAP) leads to poorer clinical outcomes than non-SARS-CoV-2 CAP.

Main finding: After adjustment for inverse propensity weighting (IPW) and pneumonia severity index, patients with COPD and SARS-CoV-2 CAP had higher odds of intensive care unit (ICU) admission during hospitalization (IPW-odds ratio [OR] 2.41), invasive mechanical ventilation requirement (IPW-OR 2.23), a cardiovascular event (IPW-OR 4.98), and in-hospital mortality (IPW-OR 7.31) and a longer length of hospital stay (all P < .001) than patients with COPD  who were non-SARS-CoV-2 CAP.

Study details: The analysis compared 96 hospitalized patients with COPD and SARS-CoV-2 CAP with 1,129 patients with COPD and non-SARS-CoV-2 CAP included in the Burden of COVID-19 study and the University of Louisville Pneumonia Study, 2 large observational retrospective and prospective studies, respectively.

Disclosures: The study was sponsored by the Division of Infectious Diseases, University of Louisville. None of the authors reported any conflict of interests.

Source: Sheikh D et al. Respir Med. 2021’191:106714 (Dec 8). Doi: 10.1016/j.rmed.2021.106714.

Key clinical point: In patients with chronic obstructive pulmonary disease (COPD), the occurrence of SARS-CoV-2 community-acquired pneumonia (CAP) leads to poorer clinical outcomes than non-SARS-CoV-2 CAP.

Main finding: After adjustment for inverse propensity weighting (IPW) and pneumonia severity index, patients with COPD and SARS-CoV-2 CAP had higher odds of intensive care unit (ICU) admission during hospitalization (IPW-odds ratio [OR] 2.41), invasive mechanical ventilation requirement (IPW-OR 2.23), a cardiovascular event (IPW-OR 4.98), and in-hospital mortality (IPW-OR 7.31) and a longer length of hospital stay (all P < .001) than patients with COPD  who were non-SARS-CoV-2 CAP.

Study details: The analysis compared 96 hospitalized patients with COPD and SARS-CoV-2 CAP with 1,129 patients with COPD and non-SARS-CoV-2 CAP included in the Burden of COVID-19 study and the University of Louisville Pneumonia Study, 2 large observational retrospective and prospective studies, respectively.

Disclosures: The study was sponsored by the Division of Infectious Diseases, University of Louisville. None of the authors reported any conflict of interests.

Source: Sheikh D et al. Respir Med. 2021’191:106714 (Dec 8). Doi: 10.1016/j.rmed.2021.106714.

Key clinical point: In patients with chronic obstructive pulmonary disease (COPD), the occurrence of SARS-CoV-2 community-acquired pneumonia (CAP) leads to poorer clinical outcomes than non-SARS-CoV-2 CAP.

Main finding: After adjustment for inverse propensity weighting (IPW) and pneumonia severity index, patients with COPD and SARS-CoV-2 CAP had higher odds of intensive care unit (ICU) admission during hospitalization (IPW-odds ratio [OR] 2.41), invasive mechanical ventilation requirement (IPW-OR 2.23), a cardiovascular event (IPW-OR 4.98), and in-hospital mortality (IPW-OR 7.31) and a longer length of hospital stay (all P < .001) than patients with COPD  who were non-SARS-CoV-2 CAP.

Study details: The analysis compared 96 hospitalized patients with COPD and SARS-CoV-2 CAP with 1,129 patients with COPD and non-SARS-CoV-2 CAP included in the Burden of COVID-19 study and the University of Louisville Pneumonia Study, 2 large observational retrospective and prospective studies, respectively.

Disclosures: The study was sponsored by the Division of Infectious Diseases, University of Louisville. None of the authors reported any conflict of interests.

Source: Sheikh D et al. Respir Med. 2021’191:106714 (Dec 8). Doi: 10.1016/j.rmed.2021.106714.

The virtual elimination of Haemophilus influenzae type B as a respiratory pathogen, recognition of Mycoplasma  pneumoniae as a common cause of pneumonia in older children and young adults, and atypical pathogens in elderly adults have recently changed our selection of initial empiric antimicrobial therapy for lower respiratory tract infections in some patients. It is increasingly important to use such information since  narrow-spectrum antibiotics for empiric therapy of moderately severe community acquired pneumonia (CAP) should be standard therapy.¹ On the other hand, the addition of doxycycline to a beta-lactam antibiotic has recently been shown to improve outcomes of CAP in elderly adults.² Along with advanced age, male gender is also a risk factor for treatment failure of moderately severe CAP,³ so should be taken into consideration in management decisions.

If a patient with mild CAP does not respond to initial antibacterial therapy, the most likely explanation is a viral cause.  Other  bacterial causes might also be considered, such as Staphylococcus aureus, multi-resistant pneumococcus, coliforms, ampicillin-resistant H. influenzae, fungi, or anaerobes depending on clinical and laboratory factors.

New, rapid diagnostic tests are also useful in making clinical decisions and are particularly important for children who are unable to produce sputum for examination and whose small airways limit use of bronchoscopy. Recent studies have shown that heparin-binding protein (HBP) predicts disease progression in children with severe CAP, directing the physician to do further testing of microbiologic etiology.⁴

Treatment of pneumonia is usually empiric. If Chlamydia pneumoniae or M. pneumoniae is suspected as the responsible pathogen, azithromycin should be used as primary therapy. Quinolones or tetracycline-based antibiotics can be considered when macrolides are not tolerated. In children with community-acquired pneumonia (CAP) discharged from emergency departments or inpatient wards, findings from a trial including 814 children > 6 months old with CAP found that a lower dose and shorter course of amoxicillin was not inferior compared to higher doses and longer courses. The children were randomly assigned 1:1 after hospital discharge to receive one of the 4 possible combinations of amoxicillin dose (35-50 or 70-90 mg/kg) and duration (3 or 7 days). The results indicated that further outpatient treatment with amoxicillin at the lower dose was not inferior to a higher dose, and a 3-day treatment course was not inferior to a 7-day treatment course.⁵

Pneumococcal urinary antigen testing (PUAT) has recently been shown to direct narrow spectrum antibiotic therapy when positive in children or allow earlier de-escalation from broad spectrum antibiotics.⁶

When Staphylococcus aureus is suspected, methicillin resistance (MRSA) must be considered. Vancomycin has been standard therapy for this pathogen unless clindamycin susceptibility is documented. A recent study showed that the newer cephalosporin, ceftaroline, used as monotherapy or in combination with a macrolide or quinolone resulted in a lower hospital mortality rate than standard therapy with vancomycin or combination antibiotics.⁷

              Other data used to determine probable causes of CAP include associated clinical signs and symptoms, chest x-ray findings, and diagnostic laboratory tests. Sputum is rarely produced by children during episodes of pneumonia, so the usual common step in the management of adult severe pneumonias, Gram stain examination of sputum is eliminated.

              Antibiotics are selected primarily on the basis of age and severity of illness.  Duration of therapy is 7 to 10 days for uncomplicated CAP.  Once the causative agent is identified by culture or with one of the rapid antigen detection assays, specific therapy may be readily selected.

      Treatment of pneumonia is usually empiric but the preference for narrow spectrum antibiotics should be emphasized .¹  Amoxicillin for children and a quinolone for adults is the usual therapy.

      If a patient with mild CAP does not respond to initial antibacterial therapy, the most likely explanation is a viral cause but for severely ill patients, other bacterial etiologies should also be considered, particularly MRSA where the addition of caftaroline would be considered.⁷   

References

1. Schweitzer VA et al. Narrow-spectrum antibiotics for community-acquired pneumonia in Dutch adults (CAP-PACT): a cross-sectional, stepped-wedge, cluster-randomised, non-inferiority, antimicrobial stewardship intervention trial. Lancet Infect Dis. 2021(Oct 7).
2. Uddin M et al. Effectiveness of Beta-Lactam plus Doxycycline for Patients Hospitalized with Community-Acquired Pneumonia Clin Infect Dis. 2021;ciab863 (Nov 9).
3. Dinh A et al. Factors Associated With Treatment Failure in Moderately Severe Community-Acquired Pneumonia: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2021;4(10):e2129566 (Oct 15).
4. Huang C et al. Heparin-Binding Protein in Critically Ill Children With Severe Community-Acquired Pneumonia. Front Pediatr. 2021 (Oct 28).
5. Bielicki JA et al. Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial. JAMA. 2021;326(17):1713-1724 (Nov 2).
6. Greenfield A et al. Impact of Streptococcus pneumoniae Urinary Antigen Testing in Patients with Community-acquired Pneumonia Admitted within a Large Academic Health System. Open Forum Infect Dis. 2021;ofab522 (Oct 22).
7. Cilloniz C et al. Impact on in-hospital mortality of ceftaroline versus standard of care in community-acquired pneumonia: a propensity-matched analysis. Eur J Clin Microbiol Infect Dis. 2021 (Nov 12).

The virtual elimination of Haemophilus influenzae type B as a respiratory pathogen, recognition of Mycoplasma  pneumoniae as a common cause of pneumonia in older children and young adults, and atypical pathogens in elderly adults have recently changed our selection of initial empiric antimicrobial therapy for lower respiratory tract infections in some patients. It is increasingly important to use such information since  narrow-spectrum antibiotics for empiric therapy of moderately severe community acquired pneumonia (CAP) should be standard therapy.¹ On the other hand, the addition of doxycycline to a beta-lactam antibiotic has recently been shown to improve outcomes of CAP in elderly adults.² Along with advanced age, male gender is also a risk factor for treatment failure of moderately severe CAP,³ so should be taken into consideration in management decisions.

If a patient with mild CAP does not respond to initial antibacterial therapy, the most likely explanation is a viral cause.  Other  bacterial causes might also be considered, such as Staphylococcus aureus, multi-resistant pneumococcus, coliforms, ampicillin-resistant H. influenzae, fungi, or anaerobes depending on clinical and laboratory factors.

New, rapid diagnostic tests are also useful in making clinical decisions and are particularly important for children who are unable to produce sputum for examination and whose small airways limit use of bronchoscopy. Recent studies have shown that heparin-binding protein (HBP) predicts disease progression in children with severe CAP, directing the physician to do further testing of microbiologic etiology.⁴

Treatment of pneumonia is usually empiric. If Chlamydia pneumoniae or M. pneumoniae is suspected as the responsible pathogen, azithromycin should be used as primary therapy. Quinolones or tetracycline-based antibiotics can be considered when macrolides are not tolerated. In children with community-acquired pneumonia (CAP) discharged from emergency departments or inpatient wards, findings from a trial including 814 children > 6 months old with CAP found that a lower dose and shorter course of amoxicillin was not inferior compared to higher doses and longer courses. The children were randomly assigned 1:1 after hospital discharge to receive one of the 4 possible combinations of amoxicillin dose (35-50 or 70-90 mg/kg) and duration (3 or 7 days). The results indicated that further outpatient treatment with amoxicillin at the lower dose was not inferior to a higher dose, and a 3-day treatment course was not inferior to a 7-day treatment course.⁵

Pneumococcal urinary antigen testing (PUAT) has recently been shown to direct narrow spectrum antibiotic therapy when positive in children or allow earlier de-escalation from broad spectrum antibiotics.⁶

When Staphylococcus aureus is suspected, methicillin resistance (MRSA) must be considered. Vancomycin has been standard therapy for this pathogen unless clindamycin susceptibility is documented. A recent study showed that the newer cephalosporin, ceftaroline, used as monotherapy or in combination with a macrolide or quinolone resulted in a lower hospital mortality rate than standard therapy with vancomycin or combination antibiotics.⁷

              Other data used to determine probable causes of CAP include associated clinical signs and symptoms, chest x-ray findings, and diagnostic laboratory tests. Sputum is rarely produced by children during episodes of pneumonia, so the usual common step in the management of adult severe pneumonias, Gram stain examination of sputum is eliminated.

              Antibiotics are selected primarily on the basis of age and severity of illness.  Duration of therapy is 7 to 10 days for uncomplicated CAP.  Once the causative agent is identified by culture or with one of the rapid antigen detection assays, specific therapy may be readily selected.

      Treatment of pneumonia is usually empiric but the preference for narrow spectrum antibiotics should be emphasized .¹  Amoxicillin for children and a quinolone for adults is the usual therapy.

      If a patient with mild CAP does not respond to initial antibacterial therapy, the most likely explanation is a viral cause but for severely ill patients, other bacterial etiologies should also be considered, particularly MRSA where the addition of caftaroline would be considered.⁷   

References

1. Schweitzer VA et al. Narrow-spectrum antibiotics for community-acquired pneumonia in Dutch adults (CAP-PACT): a cross-sectional, stepped-wedge, cluster-randomised, non-inferiority, antimicrobial stewardship intervention trial. Lancet Infect Dis. 2021(Oct 7).
2. Uddin M et al. Effectiveness of Beta-Lactam plus Doxycycline for Patients Hospitalized with Community-Acquired Pneumonia Clin Infect Dis. 2021;ciab863 (Nov 9).
3. Dinh A et al. Factors Associated With Treatment Failure in Moderately Severe Community-Acquired Pneumonia: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2021;4(10):e2129566 (Oct 15).
4. Huang C et al. Heparin-Binding Protein in Critically Ill Children With Severe Community-Acquired Pneumonia. Front Pediatr. 2021 (Oct 28).
5. Bielicki JA et al. Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial. JAMA. 2021;326(17):1713-1724 (Nov 2).
6. Greenfield A et al. Impact of Streptococcus pneumoniae Urinary Antigen Testing in Patients with Community-acquired Pneumonia Admitted within a Large Academic Health System. Open Forum Infect Dis. 2021;ofab522 (Oct 22).
7. Cilloniz C et al. Impact on in-hospital mortality of ceftaroline versus standard of care in community-acquired pneumonia: a propensity-matched analysis. Eur J Clin Microbiol Infect Dis. 2021 (Nov 12).

The virtual elimination of Haemophilus influenzae type B as a respiratory pathogen, recognition of Mycoplasma  pneumoniae as a common cause of pneumonia in older children and young adults, and atypical pathogens in elderly adults have recently changed our selection of initial empiric antimicrobial therapy for lower respiratory tract infections in some patients. It is increasingly important to use such information since  narrow-spectrum antibiotics for empiric therapy of moderately severe community acquired pneumonia (CAP) should be standard therapy.¹ On the other hand, the addition of doxycycline to a beta-lactam antibiotic has recently been shown to improve outcomes of CAP in elderly adults.² Along with advanced age, male gender is also a risk factor for treatment failure of moderately severe CAP,³ so should be taken into consideration in management decisions.

If a patient with mild CAP does not respond to initial antibacterial therapy, the most likely explanation is a viral cause.  Other  bacterial causes might also be considered, such as Staphylococcus aureus, multi-resistant pneumococcus, coliforms, ampicillin-resistant H. influenzae, fungi, or anaerobes depending on clinical and laboratory factors.

New, rapid diagnostic tests are also useful in making clinical decisions and are particularly important for children who are unable to produce sputum for examination and whose small airways limit use of bronchoscopy. Recent studies have shown that heparin-binding protein (HBP) predicts disease progression in children with severe CAP, directing the physician to do further testing of microbiologic etiology.⁴

Treatment of pneumonia is usually empiric. If Chlamydia pneumoniae or M. pneumoniae is suspected as the responsible pathogen, azithromycin should be used as primary therapy. Quinolones or tetracycline-based antibiotics can be considered when macrolides are not tolerated. In children with community-acquired pneumonia (CAP) discharged from emergency departments or inpatient wards, findings from a trial including 814 children > 6 months old with CAP found that a lower dose and shorter course of amoxicillin was not inferior compared to higher doses and longer courses. The children were randomly assigned 1:1 after hospital discharge to receive one of the 4 possible combinations of amoxicillin dose (35-50 or 70-90 mg/kg) and duration (3 or 7 days). The results indicated that further outpatient treatment with amoxicillin at the lower dose was not inferior to a higher dose, and a 3-day treatment course was not inferior to a 7-day treatment course.⁵

Pneumococcal urinary antigen testing (PUAT) has recently been shown to direct narrow spectrum antibiotic therapy when positive in children or allow earlier de-escalation from broad spectrum antibiotics.⁶

When Staphylococcus aureus is suspected, methicillin resistance (MRSA) must be considered. Vancomycin has been standard therapy for this pathogen unless clindamycin susceptibility is documented. A recent study showed that the newer cephalosporin, ceftaroline, used as monotherapy or in combination with a macrolide or quinolone resulted in a lower hospital mortality rate than standard therapy with vancomycin or combination antibiotics.⁷

              Other data used to determine probable causes of CAP include associated clinical signs and symptoms, chest x-ray findings, and diagnostic laboratory tests. Sputum is rarely produced by children during episodes of pneumonia, so the usual common step in the management of adult severe pneumonias, Gram stain examination of sputum is eliminated.

              Antibiotics are selected primarily on the basis of age and severity of illness.  Duration of therapy is 7 to 10 days for uncomplicated CAP.  Once the causative agent is identified by culture or with one of the rapid antigen detection assays, specific therapy may be readily selected.

      Treatment of pneumonia is usually empiric but the preference for narrow spectrum antibiotics should be emphasized .¹  Amoxicillin for children and a quinolone for adults is the usual therapy.

      If a patient with mild CAP does not respond to initial antibacterial therapy, the most likely explanation is a viral cause but for severely ill patients, other bacterial etiologies should also be considered, particularly MRSA where the addition of caftaroline would be considered.⁷   

References

1. Schweitzer VA et al. Narrow-spectrum antibiotics for community-acquired pneumonia in Dutch adults (CAP-PACT): a cross-sectional, stepped-wedge, cluster-randomised, non-inferiority, antimicrobial stewardship intervention trial. Lancet Infect Dis. 2021(Oct 7).
2. Uddin M et al. Effectiveness of Beta-Lactam plus Doxycycline for Patients Hospitalized with Community-Acquired Pneumonia Clin Infect Dis. 2021;ciab863 (Nov 9).
3. Dinh A et al. Factors Associated With Treatment Failure in Moderately Severe Community-Acquired Pneumonia: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2021;4(10):e2129566 (Oct 15).
4. Huang C et al. Heparin-Binding Protein in Critically Ill Children With Severe Community-Acquired Pneumonia. Front Pediatr. 2021 (Oct 28).
5. Bielicki JA et al. Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial. JAMA. 2021;326(17):1713-1724 (Nov 2).
6. Greenfield A et al. Impact of Streptococcus pneumoniae Urinary Antigen Testing in Patients with Community-acquired Pneumonia Admitted within a Large Academic Health System. Open Forum Infect Dis. 2021;ofab522 (Oct 22).
7. Cilloniz C et al. Impact on in-hospital mortality of ceftaroline versus standard of care in community-acquired pneumonia: a propensity-matched analysis. Eur J Clin Microbiol Infect Dis. 2021 (Nov 12).