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The aetiology and antibiotic management of community-acquired pneumonia in adults in Europe: a literature review

Abstract

The purpose of this paper was to generate up-to-date information on the aetiology of community-acquired pneumonia (CAP) and its antibiotic management in adults across Europe. Structured searches of PubMed identified information on the aetiology of CAP and its antibiotic management in individuals aged >15 years across Europe. We summarise the data from 33 studies published between January 2005 and July 2012 that reported on the pathogens identified in patients with CAP and antibiotic treatment in patients with CAP. Streptococcus pneumoniae was the most commonly isolated pathogen in patients with CAP and was identified in 12.0–85.0 % of patients. Other frequently identified pathogens found to cause CAP were Haemophilus influenzae, Gram-negative enteric bacilli, respiratory viruses and Mycoplasma pneumoniae. We found several age-related trends: S. pneumoniae, H. influenzae and respiratory viruses were more frequent in elderly patients aged ≥65 years, whereas M. pneumoniae was more frequent in those aged <65 years. Antibiotic monotherapy was more frequent than combination therapy, and beta-lactams were the most commonly prescribed antibiotics. Hospitalised patients were more likely than outpatients to receive combination antibiotic therapy. Limited data on antibiotic resistance were available in the studies. Penicillin resistance of S. pneumoniae was reported in 8.4–20.7 % of isolates and erythromycin resistance was reported in 14.7–17.1 % of isolates. Understanding the aetiology of CAP and the changing pattern of antibiotic resistance in Europe, together with an increased awareness of the risk factors for CAP, will help clinicians to identify those patients most at risk of developing CAP and provide guidance on the most appropriate treatment.

Prevalence and risk of viral infection in patients with acute exacerbation of chronic obstructive pulmonary disease: a meta-analysis

Exacerbations of chronic obstructive pulmonary disease (COPD) lead to substantial morbidity and mortality. Viral infections could be an important cause of acute exacerbations of COPD (AECOPD) and only a few studies report the prevalence of respiratory viruses on this disease.

We aimed to update the review on the prevalence of respiratory viral infection in patients with AECOPD with a meta-analysis.

We reviewed the prevalence of respiratory viruses on this disease by searching PubMed systematically to identify primary studies published from Jan 1990 to March 2012. Studies met with seven criteria were extracted for meta-analysis. A total of 17 studies were eligible for the meta-analysis.

Weighted overall prevalence of respiratory viruses in patients with AECOPD was 39.3 % (95 % CI 36.9–41.6) with a high degree of a heterogeneity (I 2 > 75 %). In contrast, the rate in stable COPD patients from four studies was 13.6 % (95 % CI 9.0–18.2) without any apparent heterogeneity. Pooled risk ratio for respiratory viral infection was 4.1 (95 % CI 2.0–8.5) for AECOPD as compared with stable COPD. Rhinovirus was the most common virus and with a weighted prevalence of 14.8 % (95 % CI 13.3–16.5).

Respiratory viruses probably are important etiological agents in patients with AECOPD as compared with the stable COPD patients. This result would help to provide better strategies for management of AECOPD and health-care planning.

Pharmacological Treatment of Depression in Older Patients with Chronic Obstructive Pulmonary Disease: Impact on the Course of the Disease and Health Outcomes

Over 40 % of older chronic obstructive pulmonary disease (COPD) patients suffer from clinically significant depressive symptoms, which may interfere with their daily activities. Untreated depression may increase physical disability, social isolation, hopelessness and healthcare utilization.

This review examined the impact of depression on the course of COPD, and the efficacy of antidepressant drug therapy and its implications for clinical practice. The efficacy of antidepressants in published trials in patients with COPD has been inconclusive. Specifically, there has been no clear evidence that antidepressants can induce remission of depression or ameliorate dyspnoea or physiological indices of COPD. Both selective serotonin reuptake inhibitor (SSRI) and tricyclic antidepressant (TCA) studies conducted in depressed COPD patients have been significantly limited by methodological weaknesses including small sample size, sample heterogeneity and variability in the scales used to diagnose and monitor the treatment of depression. For this reason, it remains unclear which SSRIs or TCAs should be favoured in the treatment of depressed COPD patients and what are appropriate dosages and duration ranges. Simply offering antidepressant drugs to older depressed COPD patients is unlikely to improve their condition.

Promising treatment strategies such as a collaborative treatment approach and cognitive behavioural therapy should be considered for depressed COPD patients, with or without antidepressant drug therapy. Further studies are needed, including large, randomized, controlled trials with long-term follow-up, to examine the efficacy of antidepressants in patients with COPD.

Bronchial microbiome of severe COPD patients colonised by Pseudomonas aeruginosa

human-microbiomeThe bronchial microbiome in severe COPD during stability and exacerbation in patients chronically colonised by Pseudomonas aeruginosa (PA), has not been defined. Our objective was to determine the characteristics of the bronchial microbiome of severe COPD patients colonised and not colonised by P. aeruginosa and its changes during exacerbation.

COPD patients with severe disease and frequent exacerbations were categorised according to chronic colonisation by P. aeruginosa. Sputum samples were obtained in stability and exacerbation, cultured, and analysed by 16S rRNA gene amplification and pyrosequencing. Sixteen patients were included, 5 of them showing chronic colonisation by P. aeruginosa. Pseudomonas genus had significantly higher relative abundance in stable colonised patients (p = 0.019), but no significant differences in biodiversity parameters were found between the two groups (Shannon, 3 (2–4) vs 3 (2–3), p = 0.699; Chao1, 124 (77–159) vs 140 (115–163), p = 0.364).

In PA-colonised patients bronchial microbiome changed to a microbiome similar to non-PA-colonised patients during exacerbations. An increase in the relative abundance over 20 % during exacerbation was found for Streptococcus, Pseudomonas, Moraxella, Haemophilus, Neisseria, Achromobacter and Corynebacterium genera, which include recognised potentially pathogenic microorganisms, in 13 patients colonised and not colonised by P. aeruginosa with paired samples. These increases were not identified by culture in 5 out of 13 participants (38.5 %).

Stable COPD patients with severe disease and PA-colonised showed a similar biodiversity to non-PA-colonised patients, with a higher relative abundance of Pseudomonas genus in bronchial secretions. Exacerbation in severe COPD patients showed the same microbial pattern, independently of previous colonisation by P. aeruginosa.

Pulmonary Function After Lobectomy Versus Segmentectomy in Patients with Stage I Non-Small Cell Lung Cancer

lobectomySeveral reports have shown that segmentectomy is superior to lobectomy for preservation of postoperative pulmonary function. The purpose of this study was to characterize the relationship between pulmonary function and the volume of the resected lung in patients undergoing segmentectomy or lobectomy.

Methods :Patients undergoing open lobectomy (n = 126) and open segmentectomy (n = 52) for stage I non-small cell lung cancer were analyzed retrospectively. Pulmonary function testing, including vital capacity (VC) and forced expiratory volume in 1 second (FEV1), was performed preoperatively and at 1 and 6 months postoperatively.

Results :The postoperative reduction of VC and FEV1, as indicated by the postoperative value/preoperative value, at 6 months after surgery was significantly less in the segmentectomy group than in the lobectomy group. However, the standardized functional loss ratio, as expressed by [(measured postoperative value)–(predicted postoperative value)] / (predicted postoperative value) × 100 (%), at 1 month after surgery was significantly lower in the segmentectomy group than in the lobectomy group. No significant difference in the standardized functional loss ratio was seen at 6 months postoperatively.

Conclusions : Pulmonary function at 6 months after surgery is better after segmental resection than after lobectomy. However, the absolute value of pulmonary function did not reach the predicted-postoperative value at 1 month after surgery. Thus, when segmentectomy is performed, clinicians should be aware that early postoperative pulmonary function may be significantly less than the expected value.

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