Five-Year Outcomes among U.S. Bronchiectasis and NTM Research Registry Patients.

Rationale: Nontuberculous mycobacteria (NTM) are prevalent among patients with bronchiectasis. However, the long-term natural history of patients with NTM and bronchiectasis is not well described. Objectives: To assess the impact of NTM on 5-year clinical outcomes and mortality in patients with bronchiectasis. Methods: Patients in the Bronchiectasis and NTM Research Registry with ⩾5 years of follow-up were eligible. Data were collected for all-cause mortality, lung function, exacerbations, hospitalizations, and disease severity. Outcomes were compared between patients with and without NTM at baseline. Mortality was assessed using Cox proportional hazards models and the log-rank test. Measurements and Main Results: In total, 2,634 patients were included: 1,549 (58.8%) with and 1,085 (41.2%) without NTM at baseline. All-cause mortality (95% confidence interval) at Year 5 was 12.1% (10.5%, 13.7%) overall, 12.6% (10.5%, 14.8%) in patients with NTM, and 11.5% (9.0%, 13.9%) in patients without NTM. Independent predictors of 5-year mortality were baseline FEV1 percent predicted, age, hospitalization within 2 years before baseline, body mass index, and sex (all P < 0.01). The probabilities of acquiring NTM or Pseudomonas aeruginosa were approximately 4% and 3% per year, respectively. Spirometry, exacerbations, and hospitalizations were similar, regardless of NTM status, except that annual exacerbations were lower in patients with NTM (P < 0.05). Conclusions: Outcomes, including exacerbations, hospitalizations, rate of loss of lung function, and mortality rate, were similar across 5 years in patients with bronchiectasis with or without NTM.

SCCM issued recommendations for corticosteroid use in acutely ill adults with sepsis, ARDS, or CAP.

SOURCE CITATION: Chaudhuri D, Nei AM, Rochwerg B, et al. 2024 focused update: guidelines on use of corticosteroids in sepsis, acute respiratory distress syndrome, and community-acquired pneumonia. Crit Care Med. 2024;52:e219-e233. 38240492.

COVID-19 vs. non-COVID-19 related nosocomial pneumonias: any differences in etiology, prevalence, and mortality?

PURPOSE OF REVIEW: This review explores the similarities and differences between coronavirus disease 2019 (COVID-19)-related and non-COVID-related nosocomial pneumonia, particularly hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). It critically assesses the etiology, prevalence, and mortality among hospitalized patients, emphasizing the burden of these infections during the period before and after the severe acute respiratory syndrome coronavirus 2 pandemic. RECENT FINDINGS: Recent studies highlight an increase in nosocomial infections during the COVID-19 pandemic, with a significant rise in cases involving severe bacterial and fungal superinfections among mechanically ventilated patients. These infections include a higher incidence of multidrug-resistant organisms (MDROs), complicating treatment and recovery. Notably, COVID-19 patients have shown a higher prevalence of VAP than those with influenza or other respiratory viruses, influenced by extended mechanical ventilation and immunosuppressive treatments like corticosteroids. SUMMARY: The findings suggest that COVID-19 has exacerbated the frequency and severity of nosocomial infections, particularly VAP. These complications not only extend hospital stays and increase healthcare costs but also lead to higher morbidity and mortality rates. Understanding these patterns is crucial for developing targeted preventive and therapeutic strategies to manage and mitigate nosocomial infections during regular or pandemic care.

Severe aspiration pneumonia in the elderly.

The global population is aging at an unprecedented rate, resulting in a growing and vulnerable elderly population in need of efficient comprehensive healthcare services that include long-term care and skilled nursing facilities. In this context, severe aspiration pneumonia, a condition that carries substantial morbidity, mortality, and financial burden, especially among elderly patients requiring admission to the intensive care unit, has attracted greater concern. Aspiration pneumonia is defined as a pulmonary infection related to aspiration or dysphagia in etiology. Prior episodes of coughing on food or liquid intake, a history of relevant underlying conditions, abnormalities on videofluoroscopy or water swallowing, and gravity-dependent shadow distribution on chest imaging are among the clues that suggest aspiration. Patients with aspiration pneumonia tend to be elderly, frail, and suffering from more comorbidities than those without this condition. Here, we comprehensively address the epidemiology, clinical characteristics, diagnosis, treatment, prevention, and prognosis of severe aspiration community-acquired pneumonia in the elderly to optimize care of this high-risk demographic, enhance outcomes, and minimize the healthcare costs associated with this illness. Emphasizing preventive measures and effective management strategies is vital in ensuring the well-being of our aging population.

A Multicentric Observational Study to Determine Myocardial Injury in Severe Community-Acquired Pneumonia (sCAP).

Background: Severe community-acquired pneumonia (sCAP) is the most frequent admission for acute respiratory failure in intensive care medicine. Observational studies have found a correlation between patients who were admitted with CAP and the development of cardiovascular events. The risk of acute myocardial damage in patients with CAP is particularly high within the first 30 days of hospitalization. Research design and methods: Multicenter prospective cohort analysis conducted in consecutive patients admitted to an ICU with microbiologically confirmed diagnoses of sCAP. The aim was to determine any structural cardiac damage detected by advanced imagining techniques (cardiac MRI) and cardiac biomarkers in patients with sCAP. The patients were stratified, according to their etiology, into pneumococcal or not-pneumococcal sCAP. The primary outcome was cardiac damage at day 5 and 7 of clinical presentation. Results: A total of 23 patients were consecutively and prospectively enrolled for two winter periods. No significant differences were observed between the median troponin when comparing the pneumococcal vs. non-pneumococcal. The incidence of myocardial damage was numerically higher in the pneumococcal subgroup (70% vs. 50%, p = 0.61) on day 5 and on day 7 (53% vs. 40%, p = 0.81) but did not achieve significance. Confirming a correlation between the biomarkers of cell damage and the biomarkers of myocardial damage, only a positive and significant correlation was observed between h-FABP and DNA on day 1 (r = 0.74; p < 0.01) and day 3 (r = 0.83; p < 0.010). Twenty cardiac MRIs were performed on the 23 patients (87%). No presence of fibrosis was observed in any of the studies carried out within the first 15 days of admission. Conclusions: No significant myocardial damage was found in patients with sCAP independent of the bacterial etiology in accordance with biomarker alterations (Troponin and/or h-FABP) or cardiac MRI. Using cardiac MRI, we could not find any presence of myocardial fibrosis within the first 15 days of admission.

Medidas farmacológicas para la prevención de la neumonía asociada a la ventilación mecánica / Pharmacologic measures for the prevention of mechanical ventilation-associated pneumonia

La neumonía asociada a la ventilación mecánica (NAV) es la complicación infecciosa que representa la mayor causa de morbimortalidad en las unidades de cuidados intensivos. Debido a su complicado diagnóstico y tratamiento, la prevención de la NAV es una tarea prioritaria. La interrupción diaria de la sedación, la descontaminación oral y digestiva, el uso profiláctico de antibióticos sistémicos o inhalados, el control de la glucemia, la profilaxis de la úlcera de estrés, el protocolo de transfusión y el tiempo y la adecuación del tratamiento antimicrobiano son las principales intervenciones clásicamente indicadas.Esta revisión de la bibliografía discute críticamente las principales medidas farmacológicas para la prevención de la NAV y focaliza en su nivel de evidencia y en la idoneidad de aplicarlas en la práctica clínica habitual (AU)

Ventilator associated pneumonia is the principal infectious complication in the Intensive Care Unit (ICU), and represents the main infectious cause of morbidity and mortality. Its diagnosis and management is complex. Consequently, its prevention becomes a cornerstone in daily clinical practice. Daily interruption of sedation, oral and digestive decontamination, prophylactic administration of systemic and/or inhaled antibiotics, glycemic control, stress ulcer prophylaxis, transfusion policy and timing and adequacy of antibiotic treatment are the main suggested pharmacologic interventions.The aim of this review is to critically describe the principal pharmacologic interventions for the prevention of ventilator associated pneumonia, focusing on the degree of the evidence and the appropriateness for daily clinical practice (AU)

Prevención no farmacológica de la neumonía asociada a ventilación mecánica / Non-Pharmacological Prevention of Ventilator Associated Pneumonia

La neumonía asociada a ventilación mecánica es la primera causa de mortalidad por infecciones nosocomiales en la unidad de cuidados intensivos. Su incidencia oscila entre el 9 y el 67% de los pacientes que requieren ventilación mecánica. Hay múltiples factores de riesgo asociados y aumenta significativamente la estancia en la unidad de cuidados intensivos y en el hospital. El coste adicional por cada neumonía asociada a ventilación mecánica oscila entre 9.000 y 31.000 €.Por tanto, su prevención debe considerarse una prioridad. Ésta podría disminuir tanto la morbimortalidad asociada como el coste de la atención, y mejorar la seguridad del paciente(AU)

Ventilator-associated pneumonia (VAP) is the first cause of mortality due to nosocomial infections in the intensive care unit. Its incidence ranges from 9% to 67% of patients on mechanical ventilation. Risk factors are multiple and are associated with prolonged stays in hospital and intensive care units. Additional costs for each episode of VAP range from 9,000 € to 31,000 €.Thus, its prevention should be considered as a priority. This prevention could decrease associated morbidity, mortality, costs, and increase patient safety(AU)

Gripe A (H1N1). Experiencia de Estados Unidos / Infl uenza A (H1N1). Experience in the United States

La neumonía e influenza estacional tienen consecuencias importantes en la mortalidad, morbilidad y costede pacientes alrededor del mundo. A fi nales del mes de marzo de 2009 se reportó un brote de infl uenza A(H1N1) en México, que se extendió rápidamente alrededor del mundo, incluyendo Estados Unidos, llegandoa nivel de pandemia. La actividad de infl uenza A (H1N1) ha alcanzado niveles más altos que los reportadosen años anteriores, afectando principalmente a la población pediátrica menor de 18 años. Adicionalmente,un grupo de condiciones comórbidas fue más frecuentemente asociado en los pacientes con infl uenza A(H1N1) grave, que incluye: enfermedad pulmonar crónica, inmunosupresión, enfermedad cardíaca, obesidady embarazo. La pandemia actual ha tenido un impacto bastante importante en salud pública de EstadosUnidos y en muchos otros países alrededor del mundo. Por lo tanto, esta revisión pretende dar una mirada ala experiencia norteamericana sobre la epidemia por el virus de la infl uenza A (H1N1), enfocándose cronológicamenteen la epidemiología, grupos de alto riesgo, diagnóstico, vacunación y manejo(AU)

Pneumonia and seasonal infl uenza have major repercussions on mortality, morbidity and costs worldwide.At the end of March 2009, an outbreak of infl uenza A (H1N1) was reported in Mexico that rapidly spreadthroughout the world, including the United States, reaching pandemic proportions. The activity of infl uenzaA (H1N1) has reached levels higher than those reported in previous years, mainly affecting the pediatricpopulation aged less than 18 years old. In addition, a group of comorbid conditions were more frequentlyassociated in patients with severe infl uenza A (H1N1), including chronic pulmonary disease,immunosuppression, heart disease, obesity and pregnancy.The current pandemic has had a substantial impact on public health in the United States and in many othercountries worldwide. Therefore, the present review aims to examine the North American experience of theinfl uenza A (H1N1) epidemic, focussing chronologically on the epidemiology of the virus, high risk groups,diagnosis, vaccination and management(AU)

Humoral immune response to the anti-malaria vaccine SPf66 in the Colombian Atrato river region

The immunogenicity of anti-malaria synthetic vaccine SPf66 was tested in a region of the Colombian middle Atrato river. The specific serum antibodies against SPf66 were quantified in vaccinees and placebo injected controls for a two-years period post-immunization. The frequency of individuals showing seroconversion of anti-SPf66 antibodies three months after completion of the immunization schedule was higher in vaccinees than in controls (52.7 per cent and 25.5 per cent, respectively, p<0.01). However, an over than four-fold increase of the specific anti-SPf66 antibody titers was observed only in 1.4 per cent of vaccinees and 0.2 per cent of the controls (p<0.01). The anti-SPf66 antibody titers augmented in vaccinees from first dose application to three months after the thrid dose, continuously decreasing thereafter to reach below baseline values two years after completion of the immunization schedule. The results show that SPf66 has very low immunogenicity and induces a short term humoral immune response (six months).

Standardization and evaluation of ELISA for the serodiagnosis of amoebic liver abscess

An ELISA test for the serological diagnosisof amoebic liver abscess (ALA) was standardized and evaluated in sera from three groups of patients: (1) three patients with diagnosis confirmed by isolation of the parasite,(2) thirty seven patients with diagnosis established by clinical findings and ultrasound studies and (3) seven patients whose diagnosis were established by clinical findings and a positive double immunodifusion test. Ninety one serum samples from healthy subjects and 22 from patients with other liver or parasitic diseases were also included in the study. the optimum concentration of Entamoeba histolytica antigen was 1.25 µg/ml and optimum dilutions of serum and anti-human IgG-alkaline phosphatase conjugate were 1:400 and 1:4000 respectively. The cut-off point of the ELISA test in this study was an absorbance value of 0.34. The test parameters were: sensitivity = 95.7 per cent, specificty = 100 per cent, positive predictive value = 100 per cent and negative predictive value = 98.2 per cent.The ELISA test was found to be of great use as a diagnostic tool for the establishment of amoebic etiology in patients with clinical supposition of ALA. The test could also be used for seroepidemiological surveys of the prevalence of invasive amoebiasis in a given population, since it allows the processing of a greater number of samples at a lower cost tahn other serological tests

Diagnostic tests for amoebic liver abscess: comparison of enzyme-linked immunosorbent assay (ELISA) and counterimmunoelectrophoresis (CIE)

The liver abscess is the most frequent extraintestinal complication of intestinal amoebiasis: its diagnosis is suggested by the clinical picture but it must be confirmed by paraclinic tests. Themost stringent diagnosis requires identification of E. histolytica. But this is possible only in a few cases. Serological tests greatly improve the diagnosis of this severe complication of amoebiasis. We compared the Enzyme Linfed Immunosorbent Assay and the Counterimmunoelectrophoresis techniques. Both techniques were used to detect amoebic antibodies in 50 control patients, 30 patients with liver abscess and 30 patients with intestinal amoebiasis. All the sera from control patients gave negative results in both techniques. When analysing the sera from patients with intestinal amoebiasis, 10 per cent of them were positive by ELISA but non by CIE. The sera of patients with liver abscess, we found that 90 per cent were positive by the ELISA method and 66.6 per cent by the CIE technique. In patients with amoebic liver abscess, the results showed that the ELISA was more sensitive than the CIE, as it presented a higher sensitivity (100 per cent) than that of the CIE technique (66 per cent).