Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
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Clin. Microbiol. Infect. · Nov 2009
Clinical response to ertapenem in severe community-acquired pneumonia: a retrospective series in an elderly population.
To evaluate in routine hospital practice the clinical response to ertapenem in comparison with other parenteral antibiotics in the treatment of community-acquired pneumonia (CAP), clinical records from patients with severe CAP treated with ertapenem from July 2002 to June 2006 in seven Spanish hospitals were retrospectively reviewed. Patients were classified according to the Pneumonia Severity Index (PSI). Each ertapenem-treated patient was matched with two patients in the same hospital treated with other antibiotics, according to age (difference
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Little is known about procalcitonin (PCT) levels in patients with community-acquired pneumonia (CAP) caused by Legionella pneumophila. The aim of the present study was to investigate this infection marker in patients admitted with L. pneumophila pneumonia in relation to conventional inflammatory parameters, severity of pneumonia upon admission and clinical outcome. Eighteen patients admitted with CAP caused by L. pneumophila serogroup 1 were retrospectively examined. ⋯ Persistently increased PCT levels during treatment were indicative of unfavourable clinical outcome. Conventional inflammatory parameters (CRP and WBC) and the CURB-65 score lacked this discriminatory capacity in our study population. PCT may therefore be a valuable tool in the initial clinical assessment and follow-up of patients with L. pneumophila pneumonia.
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There has been concern about the performance of CURB-65 in older patients with community-acquired pneumonia (CAP) and that younger patients who subsequently die are initially misclassified as having non-severe CAP. The purpose of this study was to evaluate the effect of age on the performance of CURB-65. We analysed data prospectively, collected in two UK hospitals. ⋯ The AUROC was significantly higher for the <65-year cohort in comparison with older patients (0.93 vs. 0.7, p <0.05). Clinicians should interpret the CURB-65 score with care in older patients referred to hospital with CAP. In those aged <65 years, however, CURB-65 appears to be able to identify a cohort of patients (CURB-65 score of 0 or 1) with very low mortality.
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Clin. Microbiol. Infect. · Sep 2009
Comparative StudySeverity of illness scoring systems in patients with bacteraemic pneumococcal pneumonia: implications for the intensive care unit care.
Severity of illness scoring systems are useful for decisions on the management of patients with community-acquired pneumonia (CAP), including assessing the need for intensified therapy and monitoring, or for intensive care unit (ICU) admission. We compared the accuracy of the Pneumonia Severity Index (PSI), the CURB-65 and CRB-65 score, the modified-American Thoracic Society score (ATS), the IDSA/ATS guidelines and the Pitt Bacteraemia score (PBS) in evaluating severity of illness in 766 patients with bacteraemic pneumococcal pneumonia. We evaluated the sensitivity and specificity, the positive predictive value (PPV) and the negative predictive value (NPV) and the accuracy of the classification in predicting 14-day mortality. ⋯ Both the modified-ATS and the PBS scoring systems identified those patients who might benefit most from intensified care and monitoring. The PBS and modified-ATS proved superior to the IDSA/ATS guidelines, CURB-65 and CRB-65 with respect to their specificity and PPV. The low PPV of the PSI rendered it not usable as a parameter for decision-making in severely-ill patients with pneumococcal bacteraemia.
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Clin. Microbiol. Infect. · Aug 2009
The molecular epidemiology and evolution of the Panton-Valentine leukocidin-positive, methicillin-resistant Staphylococcus aureus strain USA300 in Western Australia.
Between 2003 and 2008, 76 clinical isolates of the Panton-Valentine leukocidin-positive Staphylococcus aureus strain 'West Australian methicillin-resistant Staphylococcus aureus (MRSA)-12' (WA MRSA-12) were recovered from 72 patients living in the Perth area in Western Australia. These isolates were found to belong to multilocus sequence type 8, and had a USA300-like pulsed-field gel electrophoresis pulsotype. All isolates were genotyped using diagnostic DNA arrays covering species markers, resistance factors, virulence-associated, as well as MSCRAMM (microbial surface components recognizing adhesive matrix molecules) genes to prove the identity between WA MRSA-12 and the pandemic strain USA300, as well as to detect possible genetic variability. ⋯ Notably, the arginine catabolic mobile element (ACME) was absent in 12 isolates (15.8%). The mercury resistance (mer) operon, which is usually associated with SCCmec type III elements, was found in several ACME-negative isolates. The present study emphasises the importance of genotyping in detecting the introduction and evolution of significant MRSA strains within a community.