Fulminant community‐acquired pneumonia probably caused by Acinetobacter lwoffii

We describe a case of fulminant community‐acquired pneumonia probably caused by Acinetobacter lwoffii. A 63‐year‐old woman was admitted with an acute respiratory illness and consolidation in the right upper lobe. She deteriorated rapidly despite antibiotic therapy, and required ventilatory support. The patient died of multiple organ failure and intractable shock, 7 days after admission to hospital; her disease was probably caused by A. lwoffii.     

Polymicrobial community‐acquired pneumonia: An emerging entity

Polymicrobial aetiology in community‐acquired pneumonia (CAP) is more common than previously recognized. This growing new entity can influence inflammation, host immunity and disease outcomes in CAP patients. However, the true incidence is complicated to determine and probably underestimated due mainly to many cases going undetected, particularly in the outpatient setting, as the diagnostic yield is restricted by the sensitivity of currently available microbiologic tests and the ability to get certain types of clinical specimens. The observed rate of polymicrobial cases may also lead to new antibiotic therapy considerations. In this review, we discuss the pathogenesis, microbial interactions in pneumonia, epidemiology, biomarkers and antibiotic therapy for polymicrobial CAP.     

Coagulation and inflammation biomarkers may help predict the severity of community‐acquired pneumonia

Background and objective: There are limited data on the relationship between the severity of community‐acquired pneumonia (CAP) and biomarkers of inflammation and coagulation. The aim of this study was to evaluate the association between the severity of CAP and serum levels of antithrombin III (AT‐III), protein C (P‐C), D‐dimers (D‐D) and CRP, at hospital admission. Methods: This was a prospective observational study in 77 adults (62.3% men), who were hospitalized for CAP. The severity of CAP was assessed using the confusion, uraemia, respiratory rate ≥30 breaths/min, low blood pressure, age ≥65 years (CURB‐65) score. Results: Forty patients (52%) had severe CAP (CURB‐65 score 3–5). Serum levels of AT‐III were lower and levels of D‐D and CRP were higher in patients with severe CAP than in patients with mild CAP (CURB‐65 score 0–2) (P < 0.001 for all comparisons). Levels of P‐C were lower in patients with severe CAP compared with those with mild CAP, but the difference was not significant (P = 0.459). At a cut‐off point of 85%, AT‐III showed a sensitivity of 80% and a specificity of 75%, as a determinant of the need for hospitalization. At a cut‐off point of 600 ng/mL, D‐D showed a sensitivity of 90% and a specificity of 75% and at a cut‐off point of 110 mg/L, CRP showed a sensitivity of 83% and a specificity of 79%, as determinants of the need for hospitalization. Conclusions: Serum levels of AT‐III, D‐D and CRP at admission appear to be useful biomarkers for assessing the severity of CAP.     

Viral and bacterial aetiology of community‐acquired pneumonia in adults

Please cite this paper as: Huijskens et al. (2012) Viral and bacterial aetiology of community‐acquired pneumonia in adults. Influenza and Other Respiratory Viruses 7(4), 567–573. Background Modern molecular techniques reveal new information on the role of respiratory viruses in community‐acquired pneumonia. In this study, we tried to determine the prevalence of respiratory viruses and bacteria in patients with community‐acquired pneumonia who were admitted to the hospital. Methods Between April 2008 and April 2009, 408 adult patients (aged between 20 and 94 years) with community‐acquired pneumonia were tested for the presence of respiratory pathogens using bacterial cultures, real‐time PCR for viruses and bacteria, urinary antigen testing for Legionella and Pneumococci and serology for the presence of viral and bacterial pathogens. Results Pathogens were identified in 263 (64·5%) of the 408 patients. The most common single organisms in these 263 patients were Streptococcus pneumoniae (22·8%), Coxiella burnetii (6·8%) and influenza A virus (3·8%). Of the 263 patients detected with pathogens, 117 (44·5%) patients were positive for one or more viral pathogens. Of these 117 patients, 52 (44·4%) had no bacterial pathogen. Multiple virus infections (≥2) were found in 16 patients. Conclusion In conclusion, respiratory viruses are frequently found in patients with CAP and may therefore play an important role in the aetiology of this disease.     

Predictors of length of stay between the young and aged in hospitalized community‐acquired pneumonia patients

Aim: To determine the factors that may prolong the length of stay (LOS) for older patients hospitalized for community‐acquired pneumonia (CAP) and also to see if they are applicable to the younger patients. Methods: A retrospective case record review was conducted of all adult patients who were discharged from the general medical service or the geriatric medicine service of an acute care hospital over 6 months. Results: During the study period, 393 patients were discharged with the diagnosis of pneumonia. Based on the study criteria, 200 patients were included in the study. Of the elderly patients, 39% had severe pneumonia compared to 9.3% in the younger group (P < 0.001), resulting in a higher mortality rate. All patients with severe pneumonia had serum albumin levels of less than 3.7 g/dL. The median LOS was significantly shorter in the younger patients (4 days) compared to the elderly patients (9 days, P < 0.001). Severe pneumonia, dysphagia, chronic renal disease, hypoalbuminemia and older age group were found to be significantly associated with longer LOS. Conclusion: Compared to younger patients, older subjects aged 65 years and above hospitalized with CAP were more likely to have severe pneumonia and longer LOS. Presence of severe pneumonia, dysphagia, chronic renal disease, hypoalbuminaemia and age of more than 65 years were significantly associated with longer LOS for all patients. However, in the younger group, only hypoalbuminaemia remained a significant factor. In the elderly patients, severe pneumonia, dysphagia and type of residence were important factors predicting longer LOS.