Frequency and clinical significance of Herpes simplex virus type 1/2 reactivation in adult patients with mild to moderately severe community-acquired pneumonia: a multicentre cohort study.

PURPOSE: This study assessed the frequency, clinical significance, and risk factors for Herpes simplex virus (HSV) reactivation in immunocompetent patients with community-acquired pneumonia (CAP). METHODS: The study included adult CAP-patients who were enrolled in the CAPNETZ study between 2007 and 2017 and had a residual sputum sample available for analysis. In addition to routine diagnostics, sputum and blood samples were tested for HSV-1/2 using PCR. Demographics, comorbidities, and CRB-65 score were compared between HSV-positive and negative patients using Fisher exact or Mann Whitney test. Logistic regression analyses investigated the influence of HSV reactivation on a modified hospital recovery scale (HRS) until day 7, divided into 3 categories (no oxygen therapy, oxygen therapy, ICU admission or death). RESULTS: Among 245 patients, HSV-1 and HSV-2 were detected in 30 patients (12.2%, 95%CI 8.7-16.9) and 0 patients, respectively. All HSV-positive patients were hospitalized, had a CRB-65 severity score of 0-2 and survived the first 28 day. In the HSV-positive group, patients had a non-significantly higher median age (70.5 versus 66 years) and a higher rate of oncological comorbidities (16.7% versus 8.8%) compared to the HSV-negative group. Distribution of co-pathogens and outcome parameters did not significantly differ between both groups. In a multivariate logistic regression model, age (AOR 1.029, p = 0.012) and CRB-65 score (AOR 1.709, p = 0.048), but not HSV-1 as single or co-pathogen were independently associated with higher HRS. CONCLUSION: Our study suggests that HSV-1 reactivation is common in CAP but might not be associated with specific risk factors or a complicated disease course.

Efficacy and Safety of Nemonoxacin in Outpatients with Community-Acquired Pneumonia.

PURPOSE: To evaluate the efficacy and safety of 500 mg of nemonoxacin administered orally once daily to outpatients with community-acquired pneumonia (CAP). PATIENTS AND METHODS: Patients with CAP who received nemonoxacin monotherapy were selected from outpatients who visited the Department of Pulmonary and Critical Care Medicine of Shengjing Hospital of China Medical University between July and December 2018. Their characteristics, pneumonia-related symptoms, treatment effects, and adverse reactions were recorded. RESULTS: In total, 337 patients with CAP were administered 500 mg of nemonoxacin orally once daily for 8.24 ± 3.73 days. Fourteen patients were lost during the follow-up period. At the end of the follow-up period, information on 323 patients (132 males and 191 females) with a median age of 52 (P25, P75: 34, 61) years was collected. On the basis of CRB-65 scores, 273 and 50 cases were classified to have low and intermediate risks, respectively. After 3 days of treatment, the symptom improvement rate was 61.3% (198 patients). Improved symptoms or cures were evident in 98.14% (317 patients) of the patients after treatment was completed. Five (1.55%) patients were hospitalized for poor treatment efficacy, and one (0.31%) patient was diagnosed with lung cancer despite improved symptoms. During oral therapy, there were three cases of skin and three cases of gastrointestinal adverse events, an incidence of 1.86%. Based on subsequent re-examinations and telephonic follow-ups, 93.50% (302 cases) of patients were satisfied with treatment effects. CONCLUSION: In treating outpatients with mild-to-moderate CAP, nemonoxacin can effectively control symptoms, reducing medical costs and saving patient time. Importantly, this is a safe and effective therapeutic approach as it is well tolerated with few side effects.

Rebounds after discharge from the emergency department for community-acquired pneumonia: focus on the usefulness of severity scoring systems.

BACKGROUND: Community-acquired pneumonia (CAP) is common cause of hospital admission and leading cause of morbidity and mortality. Severity scoring systems are used to predict risk profile, outcome and mortality, and to help decisions about management strategies. Aim of the work and Methods: To critically analyze pneumonia "rebound" cases, once discharged from the emergency department (ED) and afterwards admitted. We conducted an observational clinical study in the acute setting of a university teaching hospital, prospectively analyzing, in a 1 year period, demographic, medical, clinical and laboratory data, and the outcome. RESULTS: 249 patients were discharged home with diagnosis of CAP; 80 cases (32.1%) resulted in the high-intermediate risk class according to CURB-65 or CRB-65. Twelve patients (4.8%) presented to the ED twice and were then admitted. At their first visit 5 were in the high-intermediate risk group; just 4 of them were in the non-low risk group at the time of their admission. The rebound cohort showed some peculiar abnormalities in laboratory parameters (coagulation and renal function) and severe chest X-rays characteristics. None died in 30 days. CONCLUSIONS: The power of CURB-65 to correctly predict mortality for CAP patients discharged home from the ED is not confirmed by our results; careful clinical judgement seems to be irreplaceable in the management process. Many patients with a high-intermediate risk according to CURB-65 can be safely treated as outpatients, according to adequate welfare conditions; we identified a subgroup of cases that should worth a special attention and, therefore, a brief observation period in the ED before the final decision to safely discharge or admit.

Terapéutica antimicrobiana en la neumonía adquirida en la comunidad / Antibiotic treatment in community acquired pneumonia

Introducción: la neumonía adquirida en la comunidad constituye una infección frecuente en nuestro medio, con elevada mortalidad en pacientes ancianos. Objetivo: determinar la efectividad de los tratamientos antimicrobianos utilizados en los pacientes con neumonía adquirida en la comunidad. Material y Métodos: estudio observacional, descriptivo, retrospectivo, en pacientes hospitalizados en el Hospital Comandante Manuel Fajardo con neumonía adquirida en la comunidad, durante los primeros 3 trimestres del año 2008. Las variables utilizadas fueron: los parámetros del score CRB-65, los esquemas de tratamiento utilizados y la evolución final del paciente. Resultados: el 88 por ciento de los pacientes tenían más de 65 años. La mortalidad general fue de 39.44 por ciento, independientemente del esquema de tratamiento utilizado. En los grupos de III y IV del CRB-65 la mortalidad fue de 70.6 por ciento. Conclusiones: la efectividad de los esquemas terapéuticos utilizados fue similar. La mortalidad fue mayor en los grupos III y IV del CRB-65(AU)

Introduction: the Community-Acquired Pneumonia is one of the most frequents infections in our environment, with high mortality in patient of the third age. Objective: to determine the effectiveness of the antibiotics treatments used in the patients with Community-Acquired Pneumonia. Methods: Observational, retrospective and descriptive study was conducted in in 208 patients admitted at Internal Medicine service of Manuel Fajardo Hospital, during the first 3 trimesters of 2008. The variables studied were the parameters of CRB-65 score, the patients´s final evolution and the antimicrobial regimen used. Results: the 88 percent of patients were more than 65 years old. The global mortality was 39.44 percent, independently of the antimicrobial regimen used. The mortality in the III and IV groups of CRB-65 was 70.6 percent. Conclusions: the effectiveness of the three antimicrobial regimens was similar. The mortality was bigger in the patients of the groups III and IV of the CRB-65(AU)

Terapéutica antimicrobiana en la neumonía adquirida en la comunidad / Antibiotic treatment in community acquired pneumonia

Introducción: la neumonía adquirida en la comunidad constituye una infección frecuente en nuestro medio, con elevada mortalidad en pacientes ancianos. Objetivo: determinar la efectividad de los tratamientos antimicrobianos utilizados en los pacientes con neumonía adquirida en la comunidad. Material y Métodos: estudio observacional, descriptivo, retrospectivo, en pacientes hospitalizados en el Hospital «Comandante Manuel Fajardo¼ con neumonía adquirida en la comunidad, durante los primeros 3 trimestres del año 2008. Las variables utilizadas fueron: los parámetros del score CRB-65, los esquemas de tratamiento utilizados y la evolución final del paciente. Resultados: el 88% de los pacientes tenían más de 65 años. La mortalidad general fue de 39.44%, independientemente del esquema de tratamiento utilizado. En los grupos de III y IV del CRB-65 la mortalidad fue de 70.6%. Conclusiones: la efectividad de los esquemas terapéuticos utilizados fue similar. La mortalidad fue mayor en los grupos III y IV del CRB-65.

Introduction: the Community-Acquired Pneumonia is one of the most frequents infections in our environment, with high mortality in patient of the third age. Objective: to determine the effectiveness of the antibiotics treatments used in the patients with Community-Acquired Pneumonia. Methods: Observational, retrospective and descriptive study was conducted in in 208 patients admitted at Internal Medicine service of Manuel Fajardo Hospital, during the first 3 trimesters of 2008. The variables studied were the parameters of CRB-65 score, the patients´s final evolution and the antimicrobial regimen used. Results: the 88% of patients were more than 65 years old. The global mortality was 39.44%, independently of the antimicrobial regimen used. The mortality in the III and IV groups of CRB-65 was 70.6%. Conclusions: the effectiveness of the three antimicrobial regimens was similar. The mortality was bigger in the patients of the groups III and IV of the CRB-65.