Search

Whole slide imaging (WSI) allows pathologists to view virtual versions of slides on computer monitors. With increasing adoption of digital pathology, laboratories have begun to validate their WSI systems for diagnostic purposes according to reference guidelines. Among these the College of American Pathologists (CAP) guideline includes three strong recommendations (SRs) and nine good practice statements (GPSs). To date, the application of WSI to cytopathology has been beyond the scope of the CAP guideline due to limited evidence. Herein we systematically reviewed the published literature on WSI validation studies in cytology. A systematic search was carried out in PubMed-MEDLINE and Embase databases up to November 2021 to identify all publications regarding validation of WSI in cytology. Each article was reviewed to determine if SRs and/or GPSs recommended by the CAP guideline were adequately satisfied. Of 3963 retrieved articles, 25 were included. Only 4/25 studies (16%) satisfied all three SRs, with only one publication (1/25, 4%) fulfilling all three SRs and nine GPSs. Lack of a suitable validation dataset was the main missing SR (16/25, 64%) and less than a third of the studies reported intra-observer variability data (7/25, 28%). Whilst the CAP guideline for WSI validation in clinical practice helped the widespread adoption of digital pathology, more evidence is required to routinely employ WSI for diagnostic purposes in cytopathology practice. More dedicated validation studies satisfying all SRs and/or GPSs recommended by the CAP are needed to help expedite the use of WSI for primary diagnosis in cytopathology.

Community-acquired pneumonia (CAP) is the leader among respiratory tract infections. The severity of CAP varies from mild forms (outpatient treatment) to severe, requiring hospitalization. A signifi cant number of negative clinical outcomes, including lethal, actualize regular analysis of patient’s management strategies with a focus on a rational antibiotic therapy. The purpose of the review is to evaluate a rational approach to the choice of an empirical drug for antibiotic therapy of CAP in diff erent patient populations. This review includes an analysis of modern clinical guidelines for CAP antibiotic therapy in pediatric patients and adults, considering current data on the resistance of the main pathogens and the results of clinical effi cacy trials involving antimicrobials listed in the given guidelines. Analysis of the prevalence of causative agents of CAP reveals leading positions of Streptococcus pneumoniae and atypical microfl ora with a tendency to increase of the role of potentially resistant microorganisms — Staphylococcus aureus and Gram-negatives (Pseudomonas aeruginosa, Haemophilus infl uenzae, family of Enterobacteriaceae). The schemes of CAP empiric antibiotic therapy in adults and children according to the clinical guidelines in Europe, USA, and Russia include β-lactams, macrolides, respiratory fl uoroquinolones and doxycycline. In Russian Federation, a suffi ciently high level of sensitivity of major CAP pathogens is detected for β-lactams (inhibitorprotected aminopenicillins, third-generation cephalosporins), respiratory fl uoroquinolones and macrolides (azithromycin, clarithromycin). Analysis of clinical effi cacy trials of empiric antibiotic therapy revealed benefi ts of aminopenicillins in treatment of outpatients, except in cases caused by atypical microfl ora macrolides are the drug of choice. The combination of β-lactam antibiotic plus macrolide is indicated for patients with increased CAP severity rates and risks of atypical microfl ora. Inhibitor-protected β-lactams, cephalosporins II and III generations, and respiratory fl uoroquinolones are essential to treat severe CAP.

Внебольничная пневмония (ВП) является лидирующим заболеванием в группе инфекций дыхательных путей. Тяжесть ВП варьирует от нетяжёлых форм, подлежащих амбулаторному лечению, до тяжёлых, требующих госпитализации. Значимое количество отрицательных исходов, включая летальный, делает актуальным регулярный анализ терапевтических тактик ведения пациентов с данной патологией, c фокусом на рациональной антибиотикотерапии. Цель обзорной статьи состоит в оценке рационального подхода к выбору эмпирического препарата для антибиотикотерапии ВП в различных популяциях пациентов. Представленный обзор включает анализ современных клинических рекомендаций по антибиотикотерапии ВП у пациентов детского возраста и взрослых с учётом текущих данных о резистентности основных возбудителей ВП и результатов клинических исследований, посвящённых эффективности применения указанных в клинических рекомендациях антимикробных препаратов. Анализ распространённости возбудителей ВП позволяет сделать вывод о сохранении лидирующих позиций Streptococcus pneumoniae и атипичной микрофлоры с тенденцией к возрастанию роли потенциально резистентных микроорганизмов — Staphylococcus aureus и грамотрицательных микроорганизмов (Pseudomonas aeruginosa, Haemophilus influenzae, представители семейства Enterobacteriaceae). Схемы эмпирической антибиотикотерапии ВП у взрослых и детей, согласно клиническим руководствам стран Европы, США и России, включают β-лактамы, макролиды, респираторные фторхинолоны и доксициклин. В РФ сохранён достаточно высокий уровень чувствительности основных возбудителей ВП по отношению к β-лактамам (прежде всего ингибитор-защищённым аминопенициллинам, цефалоспоринам III поколения), респираторным фторхинолонам и макролидам. Анализ клинических исследований эффективности эмпирической антибиотикотерапии свидетельствует о сохранении преимуществ аминопенициллинов в терапии амбулаторных пациентов за исключением случаев, вызванной атипичной микрофлорой, где препаратом выбора являются макролиды. Комбинация β-лактамный антибиотик плюс макролид показана пациентам с увеличением степени тяжести ВП на фоне риска атипичной микрофлоры. Ингибитор-защищённые β-лактамы, цефалоспорины II и III поколений и респираторные фторхинолоны необходимы для терапии тяжёлой ВП., Community-acquired pneumonia (CAP) is the leader among respiratory tract infections. The severity of CAP varies from mild forms (outpatient treatment) to severe, requiring hospitalization. A signifi cant number of negative clinical outcomes, including lethal, actualize regular analysis of patient’s management strategies with a focus on a rational antibiotic therapy. The purpose of the review is to evaluate a rational approach to the choice of an empirical drug for antibiotic therapy of CAP in diff erent patient populations. This review includes an analysis of modern clinical guidelines for CAP antibiotic therapy in pediatric patients and adults, considering current data on the resistance of the main pathogens and the results of clinical efficacy trials involving antimicrobials listed in the given guidelines. Analysis of the prevalence of causative agents of CAP reveals leading positions of Streptococcus pneumoniae and atypical microfl ora with a tendency to increase of the role of potentially resistant microorganisms — Staphylococcus aureus and Gram-negatives (Pseudomonas aeruginosa, Haemophilus infl uenzae, family of Enterobacteriaceae). The schemes of CAP empiric antibiotic therapy in adults and children according to the clinical guidelines in Europe, USA, and Russia include β-lactams, macrolides, respiratory fl uoroquinolones and doxycycline. In Russian Federation, a sufficiently high level of sensitivity of major CAP pathogens is detected for β-lactams (inhibitorprotected aminopenicillins, third-generation cephalosporins), respiratory fluoroquinolones and macrolides (azithromycin, clarithromycin). Analysis of clinical efficacy trials of empiric antibiotic therapy revealed benefits of aminopenicillins in treatment of outpatients, except in cases caused by atypical microfl ora macrolides are the drug of choice. The combination of β-lactam antibiotic plus macrolide is indicated for patients with increased CAP severity rates and risks of atypical microfl ora. Inhibitor-protected β-lactams, cephalosporins II and III generations, and respiratory fluoroquinolones are essential to treat severe CAP.