Therapeutic Implications of Antibacterial Resistance in Community-Acquired Respiratory Tract Infections in Children

Abstract. The global spread of antibacterial resistance has important implications for the current and future management of bacterial respiratory tract infections in children. Data suggest that emerging resistance to commonly prescribed antibacterials, such as macrolides and trimethoprim-sulfamethoxazole, is beginning to impact the treatment of these infections, which include acute otitis media, tonsillitis/pharyngitis and community-acquired pneumonia. There is, therefore, a need for additional agents that are active against common respiratory tract pathogens, including resistant strains and are suitable for use in children. Infection control measures to curb the clonal spread of antibacterial resistance are also extremely important.     

Viral Infections of the Lower Respiratory Tract

Lower respiratory tract infections (LRTIs) are a global burden to public health and are frequently caused by respiratory viruses. Advances in molecular diagnostic techniques have allowed the identification of previously undetected viral pathogens and have improved our understanding of respiratory virus infections. Here we review the epidemiological and clinical characteristics of recently identified viruses including human metapneumovirus, human coronaviruses NL63 and HKU1, human rhinovirus C, bocavirus, WU and KI polyomaviruses, and parechovirus. The roles of these viruses in LRTIs in children and adults are discussed.     

85例老年患者医院下呼吸道感染病例分析

目的:探讨影响老年下呼吸道感染相关因素从而为临床检查及治疔提供帮助.方法:对85例老年下呼吸道感染患者进行回顾性调查分析,讨论了老年下呼吸道感染与年龄、季节、原发病、病原菌、治疗方法的相关性.结果:老年患者医院下呼吸道感染的感染率随着年龄增长而增大,多发于冬季,脑卒中和冠心病合并下呼吸道感染的几率较高;致病菌主要是革兰阴性杆菌;侵入性治疗方法易导致下呼吸道感染.结论:提高免疫力,合理使用抗生素,注意病房环境消毒,护理人员应规范操作,加强营养支持治疗.     

The Role of Adenovirus in Respiratory Tract Infections

Adenovirus plays a significant role in respiratory tract disease in pediatric and adult patients. It has been linked to outbreaks and epidemics in various patient populations, resulting in considerable morbidity and mortality. In this article, we discuss the epidemiology, pathogenesis, respiratory tract illnesses and complications, and roles of potential treatment options. The role of the past oral adenovirus vaccine and the military implications of its withdrawal from routine use in military recruits is discussed as well.     

Resistant Pathogens in Respiratory Tract Infections in Older People

Bronchitis, bronchiectasis, and pneumonia are the most common respiratory tract infections observed in older people and are the leading causes of morbidity and mortality associated with infection. Accurate diagnosis of respiratory tract infections in older people is problematic because of the lack of clear symptoms and signs that are usually seen in younger patients. In addition, the increasing prevalence of bacterial resistance to antibiotic therapy highlights the importance of appropriate therapy. The following review examines the issues associated with the accurate diagnosis of respiratory tract infections, optimal therapy for older patients, and the mechanisms of emerging bacterial resistance to antibiotic therapy.     

下呼吸道感染金葡菌耐药性分析

目的调查我院住院病人下呼吸道感染金黄色葡萄球菌（SA）的耐药现状。方法对101例下呼吸道感染sA的住院病人临床资料进行分析,并比较甲氧西林敏感金黄色葡萄球菌（MSSA）与耐甲氧西林金黄色葡萄球菌（MRSA）对抗生素的耐药性差异。结果共101例下呼吸道感染患者,分离出MRSA71例,分离率70．30％。下呼吸道sA感染发生于基础疾病较多,接受侵入性操作,长时间使用抗生素的患者;药敏结果显示,MRSA对多种抗菌药物的产生高度耐药,且耐药率明显高于MSSA（P〈0．01）,但对替加环素、万古霉素、利奈唑胺敏感率为100％。结论下呼吸道感染sA多发生于危险因素较多的患者;MRSA分离率高,对常用抗菌药物呈多重耐药。     

Phage Therapy for Multi-Drug Resistant Respiratory Tract Infections

The emergence of multi-drug resistant (MDR) bacteria is recognised today as one of the greatest challenges to public health. As traditional antimicrobials are becoming ineffective and research into new antibiotics is diminishing, a number of alternative treatments for MDR bacteria have been receiving greater attention. Bacteriophage therapies are being revisited and present a promising opportunity to reduce the burden of bacterial infection in this post-antibiotic era. This review focuses on the current evidence supporting bacteriophage therapy against prevalent or emerging multi-drug resistant bacterial pathogens in respiratory medicine and the challenges ahead in preclinical data generation. Starting with efforts to improve delivery of bacteriophages to the lung surface, the current developments in animal models for relevant efficacy data on respiratory infections are discussed before finishing with a summary of findings from the select human trials performed to date.     

Efficacy and Tolerability of Once-Daily Telithromycin Compared with High-Dose Amoxicillin for Treatment of Community-Acquired Pneumonia

Background: This randomized, double-blind study compared the efficacy and tolerability of the new ketolide antimicrobial telithromycin with that of high-dose amoxicillin in the treatment of community-acquired pneumonia (CAP). Patients and Methods: Adult patients (n = 404), with signs and symptoms of CAP and radiologic confirmation were randomized to receive telithromycin 800 mg once daily (n = 199) or amoxicillin 1,000 mg three times a day (n = 205) for 10 days. Clinical and bacteriologic outcomes were assessed at post-therapy test-of-cure (days 17–24) and late post therapy (days 31–36). Results: The clinical cure rate for telithromycin-treated patients (per protocol) pst therapy (days 17–24) was 141/149 (94.6%) and compared well with that for amoxicillin (137/152 (90.1%)). Subset analysis of patients (per protocol) showed high clinical cure rates for patients aged ≥ 65 years (telithromycin 21/24, 87.5%; amoxicillin 22/29, 75.9%); those with documented pneumococcal bacteremia (telithromycin 10/10, 100%; amoxicillin 7/9, 77.8%); and patients with a Fine score ≥ III (telithromycin 31/34, 91.2%; amoxicillin 38/47, 80.9%). Bacterial eradication rates were comparable between treatments (telithromycin 42/48, 87.5%; amoxicillin 39/45, 86.7%), with 22/23 vs 18/21 Streptococcus pneumoniae strains 9/12 vs 11/13 Haemophilus influenzae strains and all Moraxella catarrhalis isolates (five and three patients, respectively) eradicated at the test-of-cure ivsit. Both treatments were generally well tolerated. Conclusion: Telithromycin 800 mg once daily is a convenient, optimal-spectrum, first-line treatment for CAP in adults, at least as effective and well tolerated as high-dose amoxicillin. Received: August 24, 2001 · Revision accepted: July 5, 2002 L. Hagberg (corresponding author)     

Enterococcal-associated Lower Respiratory Tract Infections: A Case Report and Literature Review

Abstract   We report a rare case of bacteremic enterococcal pneumonia in an 81-year-old man, with an indolent disease course. We reviewed the literature concerning lower respiratory tract infections associated with enterococci for the burden, the pathogenesis and the clinical characteristics of these unusual infections.     

Allergies, Upper Respiratory Tract Infections, and Asthma

The aims of this study were (1) to quantify the prevalence of aeroallergen hypersensitivity in presentations for emergency treatment of asthma and (2) to determine the strength of association between viral upper respiratory tract infections (URTIs) and admission for treatment of asthma. A series of 209 asthmatic patients presenting to the Emergency Department (ED) of the Alfred Hospital over 6 months underwent skin prick testing and venipuncture for serum IgE and rye grass pollen (RGP) RAST. A case-control study of 38 asthmatic inpatients and 90 controls admitted for road trauma or endoscopy underwent nasopharyngeal aspiration for viral culture and immunofluorescence (IF). Eighty-four percent of ED asthmatic patients had one or more positive skin tests to common aeroallergens, 57% had a positive skin test, and 45% had a positive RAST to RGP. Viral cultures or IF studies were positive in 8 asthmatic patients and 2 controls. Asthmatic inpatients were 6 times more likely to have a viral URTI than were controls. It is concluded that aeroallergen hy-persensitivity is present in most asthmatic patients presenting to the ED, and that there is a strong association between viral URTIs and admission for asthma.     

Community-Acquired Acinetobacter Meningitis in Adults

Summary Community-acquired Acinetobacter meningitis in adults is an extremely rare infection of the central nervous system (CNS). Here we report one adult case of this rare CNS infection and review the clinical data of another seven cases reported in the English language literature. In total, eight patients (6 men and two women) aged between 19 and 63 years were studied. The causative pathogen in our patient was Acinetobacter baumannii; in the other reported cases they were most likely Acinetobacter lwoffli, Acinetobacter johnsonii, Acinetobacter junii, a genomic species 3 or 6. No underlying disease was found in seven of the eight cases and six of the eight patients acquired the infections before the age of 30 years. Fever and consciousness disturbance were the most common clinical manifestations. Waterhouse-Friderichsen syndrome (WFS) was found in two cases. Unlike the Acinetobacter strains found in nosocomial infections, the strain of Acinetobacter meningitis in the community-acquired case did not show multiple antibiotic resistance. Most adult patients with community-acquired Acinetobacter meningitis can be saved by timely therapy with appropriate antibiotics before deterioration of the systemic condition and impairment of consciousness. Received: March 27, 2000 · Revision accepted: October 9, 2000     

Treatment Duration of Febrile Urinary Tract Infections

Although febrile urinary tract infections (UTIs) are relatively common in adults, data on optimal treatment duration are limited. Randomized controlled trials specifically addressing the elderly and patients with comorbidities have not been performed. This review highlights current available evidence. Premenopausal, non-pregnant women without comorbidities can be treated with a 5–7 day regimen of fluoroquinolones in countries with low levels of fluoroquinolone resistance, or, if proven susceptible, with 14 days of trimethoprim-sulfamethoxazole. Oral β-lactams are less effective compared with fluoroquinolones and trimethoprim-sulfamethoxazole. In men with mild to moderate febrile UTI, a 2-week regimen of an oral fluoroquinolone is likely sufficient. Although data are limited, this possibly holds even in the elderly patients with comorbidities or bacteremia.     

Treatment of Resistant Enterococcal Urinary Tract Infections

Enterococcus spp have emerged as important pathogens in urinary tract infection (UTI), especially in hospitalized patients. Resistance to multiple antibiotics, including vancomycin, has become common, particularly in infections involving Enterococcus faecium. The management of UTIs caused by Enterococcus spp has become challenging given the presence of underlying comorbidities in these patients and the limited therapeutic options available to treat multidrug-resistant (MDR) Enterococcus. Routine therapy for asymptomatic bacteriuria with MDR-Enterococcus is not recommended. Removal of indwelling urinary catheters should be considered. Appropriate antibiotic therapy selection should be guided by urine culture and susceptibility results. Data are limited on the treatment of UTIs caused by MDR-Enterococcus. Potential oral agents active against MDR-Enterococcus that may be considered for acute uncomplicated UTI include nitrofurantoin, fosfomycin, and fluoroquinolones. Potential parenteral agents for the treatment of pyelonephritis and complicated UTIs caused by MDR-Enterococcus include daptomycin, linezolid, and quinipristin-dalfopristin. Aminoglycosides or rifampin may be considered as adjunctive therapy in serious infections.