Pulmonary Infections: Pathogenesis and Antimicrobial Treatment

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: closed (15 November 2024) | Viewed by 9777

Special Issue Editor


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Guest Editor
The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
Interests: acute illness; ARDS; COPD; lung function

Special Issue Information

Dear Colleagues,

Pulmonary infections remain a leading cause of morbidity and mortality worldwide, yet their underlying mechanisms are not completely understood. The severity of clinical presentation depends on a complex host–microbe interaction, immune resistance, tissue resilience, and changes in microbiome. In the last two years, we have witnessed a dramatic worldwide increase in hospitalizations for pneumonia caused by SARS-CoV-2 infection with high mortality rates. SARS-CoV-2 as well as other viral infections may also predispose patients to potentially fatal secondary bacterial or fungal infections. Furthermore, the increasing antimicrobial resistance is a major challenge as respiratory infections caused by multidrug-resistant bacteria are associated with a greater likelihood of inappropriate antimicrobial therapy and poor clinical outcomes. This Special Issue welcomes submissions of original and review articles that investigate the etiologies, pathogenesis, immunology, treatments, and outcomes of respiratory infections.

Dr. Marija Vukoja
Guest Editor

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Keywords

  • respiratory infections
  • pathogenesis
  • antibiotics
  • treatment
  • outcomes

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Published Papers (5 papers)

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Research

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11 pages, 726 KiB  
Article
Impact of Empirical Antimicrobial Treatment on Patients with Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia
by Pirawan Khunkit, Pisud Siripaitoon, Yongyut Lertsrisatit, Dissaya Watthanapaisal, Narongdet Kositpantawong, Siripen Kanchanasuwan, Nadia Cheh-oh, Sorawit Chittrakarn, Tanapat Jaroenmark, Natnicha Poonchuay and Sarunyou Chusri
Antibiotics 2024, 13(8), 729; https://doi.org/10.3390/antibiotics13080729 - 3 Aug 2024
Viewed by 1128
Abstract
This retrospective study was conducted to evaluate the characteristics and outcomes of patients with ventilator-associated pneumonia (VAP) caused by Stenotrophomonas maltophilia (S. maltophilia), focusing on the impact of appropriate empirical antimicrobial treatment. Of the enrolled 240 patients with VAP due to [...] Read more.
This retrospective study was conducted to evaluate the characteristics and outcomes of patients with ventilator-associated pneumonia (VAP) caused by Stenotrophomonas maltophilia (S. maltophilia), focusing on the impact of appropriate empirical antimicrobial treatment. Of the enrolled 240 patients with VAP due to S. maltophilia (median age: 45 years) in a tertiary-care hospital in southern Thailand between January 2010 and December 2021, 90% had medical comorbidities and 91% had previously received carbapenems. In addition, only 45% of the patients were initially admitted to the intensive care unit. Patients administered appropriate empirical antimicrobial treatment including colistin alone and colistin plus TMP-SMX or fluoroquinolone-based regimens had significantly lower 14-day, 30-day, and in-hospital mortalities, compared with those who did not receive appropriate empirical antimicrobial treatment (21% and 2% vs. 31%; 30% and 5% vs. 44%; and 30% and 12% vs. 53%, respectively). Thus, the use of appropriate empirical antimicrobial treatments led to a significantly reduced length of hospital stay, duration of ventilation, and hospital costs. The current study suggests that the use of appropriate empirical antimicrobial treatment based on susceptibility testing without considering pharmacokinetic properties and administration dosages improves the outcomes of patients with VAP due to S. maltophilia. Full article
(This article belongs to the Special Issue Pulmonary Infections: Pathogenesis and Antimicrobial Treatment)
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13 pages, 2164 KiB  
Article
Improvement in Diagnosis and Management of Nosocomial Pneumonias in a Cardiovascular Surgery Intensive Care Unit: A Multidisciplinary Approach
by Kirstin J. Kooda, Alejandra A. Zambrano, Dylan L. Kosaski, Leah Higbe, William Brian B. Beam, J. Kyle K. Bohman, Erica D. Wittwer, Steven D. Brady, Allison M. LeMahieu, Madiha Fida and Aditya Shah
Antibiotics 2024, 13(7), 590; https://doi.org/10.3390/antibiotics13070590 - 26 Jun 2024
Viewed by 1554
Abstract
Background: While criteria for the diagnosis of nosocomial pneumonias exist, objective definitions are a challenge and there is no gold standard for diagnosis. We analyzed the impact of the implementation of a logical, consensus-based diagnostic and treatment protocol for managing nosocomial pneumonias in [...] Read more.
Background: While criteria for the diagnosis of nosocomial pneumonias exist, objective definitions are a challenge and there is no gold standard for diagnosis. We analyzed the impact of the implementation of a logical, consensus-based diagnostic and treatment protocol for managing nosocomial pneumonias in the cardiovascular surgery intensive care unit (CVS-ICU). Methods: We conducted a quasi-experimental, interrupted time series analysis to evaluate the impact of a diagnostic and treatment protocol for nosocomial pneumonias in the CVS-ICU. Impacts were measured relative to patient outcomes, diagnostic processes, and antimicrobial stewardship improvement. Descriptive statistics were used to analyze results. Results: Overall, 35 pre-protocol and 39 post-protocol patients were included. Primary clinical variables suggesting pneumonia in pre- and post-protocol patients were new lung consolidation (50% vs. 71%), new leukocytosis (59% vs. 64%), and positive culture (32% vs. 55%). Appropriate diagnostic testing improved (23% vs. 54%, p = 0.008) after protocol implementation. The proportion of patients meeting the criteria for nosocomial pneumonia (77% vs. 87%) was not statistically significant, though more patients in the post-protocol group met probable diagnostic criteria (51% vs. 77%). Duration of therapy was not significantly different (6 days [IQR = 5.0, 10.0] vs. 7 days [IQR = 6.0, 9.0]). Conclusions: The implementation of a diagnostic and treatment protocol for management of nosocomial pneumonias in the CVS-ICU resulted in improved diagnostic accuracy, advanced antimicrobial and diagnostic stewardship efforts, and laboratory cost savings without an adverse impact on patient-centered outcomes. Full article
(This article belongs to the Special Issue Pulmonary Infections: Pathogenesis and Antimicrobial Treatment)
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12 pages, 998 KiB  
Article
A Multicentric Observational Study to Determine Myocardial Injury in Severe Community-Acquired Pneumonia (sCAP)
by Ignacio Martin-Loeches, Giampaolo Maggi, Emili Diaz, Judith Marín-Corral, Alfonso Guedea, Marcos I. Restrepo, Luis F. Reyes and Alejandro Rodríguez
Antibiotics 2023, 12(12), 1710; https://doi.org/10.3390/antibiotics12121710 - 8 Dec 2023
Viewed by 1510
Abstract
Background: Severe community-acquired pneumonia (sCAP) is the most frequent admission for acute respiratory failure in intensive care medicine. Observational studies have found a correlation between patients who were admitted with CAP and the development of cardiovascular events. The risk of acute myocardial damage [...] Read more.
Background: Severe community-acquired pneumonia (sCAP) is the most frequent admission for acute respiratory failure in intensive care medicine. Observational studies have found a correlation between patients who were admitted with CAP and the development of cardiovascular events. The risk of acute myocardial damage in patients with CAP is particularly high within the first 30 days of hospitalization. Research design and methods: Multicenter prospective cohort analysis conducted in consecutive patients admitted to an ICU with microbiologically confirmed diagnoses of sCAP. The aim was to determine any structural cardiac damage detected by advanced imagining techniques (cardiac MRI) and cardiac biomarkers in patients with sCAP. The patients were stratified, according to their etiology, into pneumococcal or not-pneumococcal sCAP. The primary outcome was cardiac damage at day 5 and 7 of clinical presentation. Results: A total of 23 patients were consecutively and prospectively enrolled for two winter periods. No significant differences were observed between the median troponin when comparing the pneumococcal vs. non-pneumococcal. The incidence of myocardial damage was numerically higher in the pneumococcal subgroup (70% vs. 50%, p = 0.61) on day 5 and on day 7 (53% vs. 40%, p = 0.81) but did not achieve significance. Confirming a correlation between the biomarkers of cell damage and the biomarkers of myocardial damage, only a positive and significant correlation was observed between h-FABP and DNA on day 1 (r = 0.74; p < 0.01) and day 3 (r = 0.83; p < 0.010). Twenty cardiac MRIs were performed on the 23 patients (87%). No presence of fibrosis was observed in any of the studies carried out within the first 15 days of admission. Conclusions: No significant myocardial damage was found in patients with sCAP independent of the bacterial etiology in accordance with biomarker alterations (Troponin and/or h-FABP) or cardiac MRI. Using cardiac MRI, we could not find any presence of myocardial fibrosis within the first 15 days of admission. Full article
(This article belongs to the Special Issue Pulmonary Infections: Pathogenesis and Antimicrobial Treatment)
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14 pages, 1426 KiB  
Article
Impact of the SARS-CoV-2 Virus Pandemic on Patients with Bronchiectasis: A Multicenter Study
by Adrián Martínez-Vergara, Rosa Mª Girón Moreno, Casilda Olveira, María Victoria Girón, Adrián Peláez, Julio Ancochea, Grace Oscullo and Miguel Ángel Martínez-García
Antibiotics 2022, 11(8), 1096; https://doi.org/10.3390/antibiotics11081096 - 12 Aug 2022
Cited by 8 | Viewed by 2215
Abstract
Background: Infection by SARS-CoV-2 has unquestionably had an impact on the health of patients with chronic respiratory airway diseases, such as COPD and asthma, but little information is available about its impact on patients with bronchiectasis. The objective of the present study was [...] Read more.
Background: Infection by SARS-CoV-2 has unquestionably had an impact on the health of patients with chronic respiratory airway diseases, such as COPD and asthma, but little information is available about its impact on patients with bronchiectasis. The objective of the present study was to analyze the effect of the SARS-CoV-2 pandemic on the state of health, characteristics, and clinical severity (including the number and severity of exacerbations) of patients with non-cystic fibrosis bronchiectasis. Methods: This study was multicenter, observational, and ambispective (with data collected before and during the SARS-CoV-2 pandemic), and included 150 patients diagnosed with non-cystic fibrosis bronchiectasis. Results: A significant drop was observed in the number and severity of the exacerbations (57% in all exacerbations and 50% in severe exacerbations) in the E-FACED and BSI multidimensional scores, in the pandemic, compared with the pre-pandemic period. There was also a drop in the percentage of sputum samples positive for pathogenic microorganisms in general (from 58% to 44.7%) and, more specifically, Pseudomonas aeruginosa (from 23.3% to 13.3%) and Haemophilus influenzae (from 21.3% to 14%). Conclusions: During the SARS-CoV-2 period, a significant reduction was observed in the exacerbations, severity, and isolations of pathogenic microorganisms in patients with bronchiectasis. Full article
(This article belongs to the Special Issue Pulmonary Infections: Pathogenesis and Antimicrobial Treatment)
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Review

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20 pages, 808 KiB  
Review
Obstructive Sleep Apnea and Acute Lower Respiratory Tract Infections: A Narrative Literature Review
by Marko Nemet and Marija Vukoja
Antibiotics 2024, 13(6), 532; https://doi.org/10.3390/antibiotics13060532 - 6 Jun 2024
Viewed by 2468
Abstract
Both obstructive sleep apnea (OSA) and acute lower respiratory tract infections (LRTIs) are important global health issues. The pathophysiological links between OSA and LRTIs include altered immune responses due to chronic intermittent hypoxia and sleep fragmentation, increased aspiration risk, and a high burden [...] Read more.
Both obstructive sleep apnea (OSA) and acute lower respiratory tract infections (LRTIs) are important global health issues. The pathophysiological links between OSA and LRTIs include altered immune responses due to chronic intermittent hypoxia and sleep fragmentation, increased aspiration risk, and a high burden of comorbidities. In this narrative review, we evaluated the current evidence on the association between OSA and the incidence and outcomes of acute LRTIs in adults, specifically community-acquired pneumonia and viral pneumonia caused by influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Studies have demonstrated that OSA patients are more likely to develop bacterial pneumonia and exhibit a higher risk of invasive pneumococcal disease. The risk intensifies with the severity of OSA, influencing hospitalization rates and the need for intensive care. OSA is also associated with an increased risk of contracting influenza and suffering more severe disease, potentially necessitating hospitalization. Similarly, OSA contributes to increased COVID-19 disease severity, reflected by higher rates of hospitalization, longer hospital stays, and a higher incidence of acute respiratory failure. The effect of OSA on mortality rates from these infections is, however, somewhat ambiguous. Finally, we explored antibiotic therapy for OSA patients with LRTIs, addressing care settings, empirical regimens, risks, and pharmacokinetic considerations. Given the substantial burden of OSA and its significant interplay with acute LRTIs, enhanced screening, targeted vaccinations, and optimized management strategies for OSA patients should be prioritized. Full article
(This article belongs to the Special Issue Pulmonary Infections: Pathogenesis and Antimicrobial Treatment)
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