Annals of the American Thoracic Society
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Editorial Comment
Video laryngoscopy in the intensive care unit. A clearer view?
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Review Multicenter Study
Diagnoses of early and late readmissions after hospitalization for pneumonia. A systematic review.
Pneumonia is a frequent cause of hospitalization, yet drivers of post-pneumonia morbidity remain poorly characterized. Causes of hospital readmissions may elucidate important sources of morbidity and are of particular interest given the U.S. Hospital Readmission Reductions Program. ⋯ Pneumonia, heart failure/cardiovascular disease, and chronic obstructive pulmonary disease/pulmonary disease are the most common readmission diagnoses after pneumonia hospitalization. Although pneumonia was the most common readmission diagnosis, it accounted for only a minority of all readmissions. Late readmission diagnoses are less thoroughly described, and further research is needed to understand how hospitalization for pneumonia fits within the broader context of patients' health trajectory.
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Despite significant advances in treatment strategies targeting the underlying defect in cystic fibrosis (CF), airway infection remains an important cause of lung disease. In this two-part series, we review recent evidence related to the complexity of CF airway infection, explore data suggesting the relevance of individual microbial species, and discuss current and future treatment options. In Part I, the evidence with respect to the spectrum of bacteria present in the CF airway, known as the lung microbiome is discussed. ⋯ Pseudomonas aeruginosa plays a prominent role in CF lung disease, but many other nonfermenting gram-negative bacteria are also found in the CF airway. Many new inhaled antibiotics specifically targeting P. aeruginosa have become available with the hope that they will improve the quality of life for patients. Part I concludes with a discussion of how best to treat patients with multiple coinfections.
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Multicenter Study Comparative Study
Environmental risks for nontuberculous mycobacteria. Individual exposures and climatic factors in the cystic fibrosis population.
Persons with cystic fibrosis are at high risk of pulmonary nontuberculous mycobacterial infection, with a national prevalence estimated at 13%. The risk of nontuberculous mycobacteria associated with specific environmental exposures, and the correlation with climatic conditions in this population has not been described. ⋯ Atmospheric conditions explain more of the variation in disease prevalence than individual behaviors. The risk of specific exposures may vary by geographic region due to differences in conditions favoring mycobacterial growth and survival. However, because exposure to these organisms is ubiquitous and behaviors are similar among persons with and without pulmonary nontuberculous mycobacteria, genetic susceptibility beyond cystic fibrosis is likely to be important for disease development. Common individual risk factors in high-risk populations remain to be identified.