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Invasive fungal infections are common, and severe complications can occur in immunocompromised patients, especially in patients with hematologic malignancies who require intensive care unit (ICU) admission (2,2). Invasive fusariosis is [...]

Purpose Lower respiratory tract infections (LRTI) are the most frequent infectious complication in patients admitted to the intensive care unit (ICU). We aim to report the clinical characteristics of ICU-admitted patients due to nosocomial LRTI and to describe their microbiology and clinical outcomes. Methods A prospective observational study was conducted in 13 countries over two continents from 9th May 2016 until 16th August 2019. Characteristics and outcomes of ventilator-associated pneumonia (VAP), ventilator-associated tracheobronchitis (VAT), ICU hospital-acquired pneumonia (ICU-HAP), HAP that required invasive ventilation (VHAP), and HAP in patients transferred to the ICU without invasive mechanical ventilation were collected. The clinical diagnosis and treatments were per clinical practice and not per protocol. Descriptive statistics were used to compare the study groups. Results 1060 patients with LRTI (72.5% male sex, median age 64 [50-74] years) were included in the study; 160 (15.1%) developed VAT, 556 (52.5%) VAP, 98 (9.2%) ICU-HAP, 152 (14.3%) HAP, and 94 (8.9%) VHAP. Patients with VHAP had higher serum procalcitonin (PCT) and Sequential Organ Failure Assessment (SOFA) scores. Patients with VAP or VHAP developed acute kidney injury, acute respiratory distress syndrome, multiple organ failure, or septic shock more often. One thousand eight patients had microbiological samples, and 711 (70.5%) had etiological microbiology identified. The most common microorganisms were Pseudomonas aeruginosa (18.4%) and Klebsiella spp (14.4%). In 382 patients (36%), the causative pathogen shows some antimicrobial resistance pattern. ICU, hospital and 28-day mortality were 30.8%, 37.5% and 27.5%, respectively. Patients with VHAP had the highest ICU, in-hospital and 28-day mortality rates. Conclusion VHAP patients presented the highest mortality among those admitted to the ICU. Multidrug-resistant pathogens frequently cause nosocomial LRTI in this multinational cohort study., Author(s): Ignacio Martin-Loeches [sup.1] [sup.37], Luis Felipe Reyes [sup.2] [sup.3] [sup.4], Saad Nseir [sup.5], Otavio Ranzani [sup.6], Pedro Povoa [sup.7], Emili Diaz [sup.8], Marcus J. Schultz [sup.9] [sup.10] [sup.40], Alejandro [...]

Purpose Duration of antibiotic therapy for ventilator-associated pneumonia (VAP) due to non-fermenting Gram-negative bacilli (NF-GNB), including Pseudomonas aeruginosa (PA) remains uncertain. We aimed to assess the non-inferiority of a short duration of antibiotics (8 days) vs. prolonged antibiotic therapy (15 days) in VAP due to PA (PA-VAP). Methods We conducted a nationwide, randomized, open-labeled, multicenter, non-inferiority trial to evaluate optimal duration of antibiotic treatment in PA-VAP. Eligible patients were adults with diagnosis of PA-VAP and randomly assigned in 1:1 ratio to receive a short-duration treatment (8 days) or a long-duration treatment (15 days). A pre-specified analysis was used to assess a composite endpoint combining mortality and PA-VAP recurrence rate during hospitalization in the intensive care unit (ICU) within 90 days. Results The study was stopped after 24 months due to slow inclusion rate. In intention-to-treat population (n = 186), the percentage of patients who reached the composite endpoint was 25.5% (N = 25/98) in the 15-day group versus 35.2% (N = 31/88) in the 8-day group (difference 9.7%, 90% confidence interval (CI) -1.9%-21.2%). The percentage of recurrence of PA-VAP during the ICU stay was 9.2% in the 15-day group versus 17% in the 8-day group. The two groups had similar median days of mechanical ventilation, of ICU stay, number of extra pulmonary infections and acquisition of multidrug-resistant (MDR) pathogens during ICU stay. Conclusions Our study failed to show the non-inferiority of a short duration of antibiotics in the treatment of PA-VAP, compared to a long duration. The short duration strategy may be associated to an increase of PA-VAP recurrence. However, the lack of power limits the interpretation of this study., Author(s): Adrien Bouglé [sup.1], Sophie Tuffet [sup.2], Laura Federici [sup.3], Marc Leone [sup.4], Antoine Monsel [sup.5], Thomas Dessalle [sup.1], Julien Amour [sup.1], Claire Dahyot-Fizelier [sup.6], François Barbier [sup.7], Charles-Edouard Luyt [...]

Author(s): Adrien Bouglé [sup.1], Sophie Tuffet [sup.2], Laura Federici [sup.3], Marc Leone [sup.4], Antoine Monsel [sup.5], Thomas Dessalle [sup.1], Julien Amour [sup.1], Claire Dahyot-Fizelier [sup.6], François Barbier [sup.7], Charles-Edouard Luyt [...]

Background Chronic obstructive pulmonary disease (COPD) typically includes neutrophilic airway inflammation and eosinophilic inflammation in some cases. Inhaled corticosteroid (ICS) suppresses eosinophilic inflammation of the airway and reduces acute exacerbation (AE). The present study investigated the relationship between ICS and AE in patients with COPD classified by blood eosinophil counts. Methods Overall, 244 patients with COPD were retrospectively evaluated between 2014 and 2017 and classified into two groups based on blood eosinophil counts ([greater than or equal to] 300/[mu]L and < 300/[mu]L). These patients were then reclassified into subgroups of those with and without ICS. Differences in the characteristics and incidence of AE and pneumonia with AE in each subgroup were evaluated retrospectively. Results All patients with ICS used 320 [mu]g budesonide twice daily. In the group with blood eosinophil counts [greater than or equal to] 300/[mu]L, patients with ICS had a significantly lower incidence of AE than those without ICS (P = 0.023). Meanwhile, no significant differences were observed in incidence of AE in the group with blood eosinophil counts < 300/[mu]L. In the group with blood eosinophil counts < 300/[mu]L, patients with ICS had a higher incidence of pneumonia with AE (P = 0.009). Conversely, no significant differences were observed in the group with blood eosinophil counts [greater than or equal to] 300/[mu]L. Conclusions ICS significantly reduced AE in COPD patients with blood eosinophil counts [greater than or equal to] 300/[mu]L. Meanwhile, ICS significantly increased pneumonia rate in patients with blood eosinophil count < 300/[mu]L. Blood eosinophil count may be a useful indicator to identify the benefits and risks of ICS in COPD., Author(s): Zenya Saito [sup.1], Masahiro Yoshida [sup.1], Ayako Kojima [sup.1], Kentaro Tamura [sup.1], Tsukasa Hasegawa [sup.1], Kazuyoshi Kuwano [sup.2] Author Affiliations: (1) Division of Respiratory Diseases, Department of Internal Medicine, [...]

Human coronaviruses (hCoVs) cause severe respiratory illness in the elderly. Age-related impairments in innate immunity and suboptimal virus-specific T cell and antibody responses are believed to cause severe disease upon respiratory virus infections. This phenomenon has recently received increased attention, as elderly patients are at substantially elevated risk for severe COVID-19 disease and experience increased rates of mortality following SARS-CoV-2 infection compared with younger populations. However, the basis for age-related fatal pneumonia following pathogenic hCoVs is not well understood. In this Review, we provide an overview of our current understanding of hCoV-induced fatal pneumonia in the elderly. We describe host immune response to hCoV infections derived from studies of young and aged animal models and discuss the potential role of age-associated increases in sterile inflammation (inflammaging) and virus-induced dysregulated inflammation in causing age-related severe disease. We also highlight the existing gaps in our knowledge about virus replication and host immune responses to hCoV infection in young and aged individuals., Introduction Prior to 2002, human coronaviruses (hCoVs) were best known as causes of the common cold. Two CoVs, HCoV-229E and HCoV-OC43, were identified in the 1960s and caused upper respiratory [...]