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Background: The incidence of hypermucoviscous Klebsiella pneumoniae (hmvKp), which complicates communityacquired pneumonia, has been increasing recently. This study aimed to detect hypermucoviscous K. pneumoniae and determine its antimicrobial susceptibility pattern in adult patients with community-acquired pneumonia in Northwest Ethiopia. Methods: This cross-sectional study included 39 K. pneumoniae isolates identified by using Gram stain, culture, and biochemical tests from 312 adult patients with community-acquired pneumonia at the University of Gondar Comprehensive Specialized Referral Hospital from April to June 2021. The hypermucoviscous strains were identified by using the string test. Antimicrobial susceptibility testing was performed by using the Kirby-Bauer disk diffusion method. Data were entered by using EPI data version 4.6 and were analyzed by using SPSS version 20. A pvalue ≤ 0.05 at a 95% confidence interval was considered statistically significant. Results: Overall, 35.9% (n = 14) of the 39 K. pneumoniae isolates were hypermucoviscous phenotype. The mean age of the hmvKp group was lower than of the cKp group (36.93 ± 12.573 vs. 53.52 ± 19.556 years, p = 0.007). All hmvKp isolates were resistant to amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. Azithromycin resistance in the hmvKp strains was significantly higher than in the cKp group (p = 0.012). Conclusions: This study demonstrates that the hmvKp phenotype causes community-acquired pneumonia and a full resistance to amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. Antimicrobial resistance was higher in the hmvKp strain than in the classic strains. Further detection of resistance genes, capsular serotypes, hypermucoviscosity-related genes, and virulence genes is necessary. [ABSTRACT FROM AUTHOR]

Сeftaroline fosamil is a fifth-generation cephalosporin and a unique β-lactam and the only currently registered in the Russian Federation cephalosporin with activity against MRSA. Сeftaroline is approved for use in pediatric practice for the treatment of children with community-acquired pneumonia and complicated skin and soft tissue infections, including cases of patients with concomitant bacteremia. The place of ceftaroline in the treatment of severe and life-threatening infections in children is primarily due to its high activity against the key causative agents of community-acquired pneumonia and skin and soft tissue infections (first of all, S. pneumoniae and S. aureus, including MRSA), bactericidal mechanism of action, creation of effective concentrations and penetration into the infection’s site, low potential for resistance development, proven significant development of clinical effect, high clinical efficacy in these infections and favorable tolerability and safety profile. The review presents the results of the program of clinical evaluation of ceftaroline in children, analyzes current data on etiology and antimicrobial resistance of the key pathogens of community-acquired pneumonia and skin and soft tissue infections in the Russian Federation, defines the place of ceftaroline in clinical recommendations in children, and characterizes the patient’s profile to whom the prescription of ceftaroline in hospital is indicated.

Oral 3rd generation cephalosporin cefpodoxime proxetil has been available in the antibiotic armamentarium for more than 30 years, however, unlike other oral cephalosporins (e.g. cefixime), it has not been given due recognition in clinical practice in Russia due to its low availability on the domestic pharmaceutical market. At the same time, the high activity of cefpodoxime against respiratory pathogens (S. pneumoniae, H. influenzae and S. pyogenes), pharmacological characteristics, results of clinical trials of its safety and efficacy, allow us to discuss the inclusion of this antimicrobial into Russian clinical guidelines for the treatment of community-acquired respiratory infections, primarily in outpatients, as well as for stepdown therapy of these infections in the hospital. In addition, cefpodoxime is a reliable option to replace parenteral therapy, in particular with ceftriaxone, which is unreasonably often prescribed in outpatient practice in Russia, without the threat of loss of the treatment efficacy.

Background: Severe community-acquired pneumonia (sCAP) is life-threatening and characterized by intensive care unit (ICU) admission and high mortality. And they are vulnerable to hospital-acquired infection. In such a severe condition, metagenomic next-generation sequencing (mNGS) outperforms for short turnaround time and broad detection spectrum. Case presentation: A 15-year-old male with severe influenza and methicillinresistant Staphylococcus aureus (MRSA) pneumonia progressed rapidly, initially misdiagnosed as influenza co-infected with Aspergillus for misleading bronchoscopy manifestations. The turnaround time of mNGS is 13 h, which has the potential to expedite the clinical medication process. With the powerful support of mNGS and extracorporeal membrane oxygenation (ECMO), antiinfective therapy was adjusted accordingly, and vital signs gradually stabilized. After tortuous treatment and unremitting efforts, the patient recovered well. Conclusions: Rapid mNGS applications, timely medication adjustments, strong ECMOsupport and active family compliance contribute to this miracle of life. Falsenegative or false-positive results are alarming, anti-infectivemedications should be adjusted after a comprehensive review of physical status and other indicators. [ABSTRACT FROM AUTHOR]

Objective. To estimate prevalence and antimicrobial susceptibility of circulated S. pneumoniae serotypes in adult population in different regions of the Russian Federation. Materials and Methods. A total of 500 isolates of S. pneumoniae obtained from patients with invasive pneumococcal disease (IPD), community-acquired pneumonia (CAP), sinusitis/acute otitis media (AOM) and healthy carriers from 29 centers were included in the study from 01 June 2019 to 15 January 2020. Re-identification, typing using real-time PCR with 27 primer pairs and antimicrobial susceptibility testing were performed in the central laboratory by standardized methods. Results. Among 50 isolates from patients with IPD, the following serotypes were detected: 3 (20.0%), 23F (10.0%), 6ABCD (8.0%), 19F (6.0%), 12ABF, 4, 7AF, 8, 9NL, 9VA, 15B (4.0% each), 1, 10A, 11AD, 14, 15AF, 18ABCF, 22AF, 33F/33A/37 (2.0% each). PCV-13 and PPV-23 covered 62.0% and 86.0% of those serotypes, respectively. Among 357 isolates from patients with CAP, the following serotypes were detected: 19F (12.3%), 6ABCD (11.5%), 3 (10.1%), 23F (5.9%), 14 (5.3%), 22AF (5.0%), 11AD (4.8%), 9NL (3.4%), 15AF (2.8%), 9VA (2.2%), 18ABCF (2.0%), 19A (1.7%), 12ABF (1.4%), 17F (0.8%), 16, 33F/33A/37, 7AF and 8 (0.6% each), 10A and 4 (0,3% each); serotypes were not specified due to the PCR typing protocol limitations for 106 (29.8%) isolates. PCV-13 and PPV-23 covered 51.9% and 68.7% of those serotypes, respectively. In patients with sinusitis/AOM (n = 48), serotypes were: 19F (18.8%), 6ABCD (16.7%), 23F (12.5%), 3 (12.5%), 18ABCF (6.3%), 11AD (4.2%), 14 (4.2%), 22AF (4.2%), 15AF, 4, 9VA (2.1% each). PCV-13 and PPV-23 covered 75.0% and 83.3% of those serotypes, respectively. In healthy nasopharyngeal carriers (n = 45), the following serotypes were detected: 19F (24.4%), 3 (17.8%), 6ABCD (17.8%), 11AD (13.3%), 23F (8.9%), 22AF (6.7%), 14 and 15AF (2.2% each). PCV-13 and PPV-23 covered 71.1% and 91.1% of those serotypes, respectively. Serotypes 14, 19F, and 19A were frequently resistant to three antibiotics – penicillin, erythromycin, and tetracycline. Resistance to respiratory quinolones was very low (0.7%) and detected among serotypes 14 and 9NL only. The majority of non-vaccine serotypes did not have substantial antimicrobial resistance problems. Conclusions. Despite the relatively low number of isolates in all but CAP group and limitations of PCR typing protocol, results of our study support the use of pneumococcal vaccines (PPV-23 and PCV-13) in Russian adult population, with some advantages of PPV-23 over PCV-13.

This paper discusses an etiology, patient characteristics, and antimicrobial resistance surveillance data, as well as other factors which help to determine indications for administration and choice of antibiotics for the treatment of patients with lower respiratory tract infections, such as acute bronchitis, communityacquired pneumonia and COPD exacerbation, based on the principles of appropriate antimicrobial therapy.

The aim of the study was to determine the correlation between blood levels of Nterminal portion of the inactive precursor of natriuretic peptide of Btype (NTproBNP) and hemodynamic, clinical and laboratory parameters in the course of intensive treatment of patients with severe communityacquired pneumonia (CAP).Materials and methods. The study included 12 patients (10 men and 2 women) with severe CAP, age 25—88 (51.5 (41.25; 69)) years. The severity of the condition was as follows (averages and percentiles): on a scale of CURB65 — 3—5 (4; 4,5) scores, APACHE II — 16—33 (23 (18.75; 25)) scores, SOFA — 6—16 (10 (9; 12.75)) points. Concentartions of NTproBNP in venous blood 24—36 h post admission and on day 5 of treatment were determined by analyzer Dimension Xpand Plus (Siemens).Results. Within 24—36 hours after the admission concentration of NTproBNP was 783.5 (460.75; 4150.25) pg/ml. The content of the biomarker remained higher than in norm in 66.7% of patients. By the 5th day the concentration of the biomarker was 537 (376.25, 1334) pg/ml. In surviving patients (66.7%), the concentration of NT proBNP was decreasing (P=0.008) to day 5 of treatment from 918 (560, 8501) to 391 (341, 1010) pg/ml. CAP patients who did not survived later (32.3%) exhibited no decrease of the biomarker concentration. Significant correlation between NTproBNP on admission to ISU and index of total peripheral vascular resistance on day 2 of intensive treatment (r=0.63; p

In a post hoc analysis of the Community-Acquired Pneumonia (CAP) immunization Trial in Adults the model-predicted 13-valent pneumococcal conjugate vaccine efficacy for preventing vaccine-type specific CAP and Invasive Pneumococcal Disease declined from 65% to 40% for subjects being 65 and 75 year olds at the time of vaccination, respectively. [ABSTRACT FROM AUTHOR]

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an important cause of not only hospital acquired pneumonia, but also non-nosocomial pneumonia. However, the risk factors for non-nosocomial MRSA pneumonia are not clearly defined. Our objective was to identify risk factors at admission that were associated with non-nosocomial MRSA pneumonia.Methods: We evaluated 943 patients admitted to a university-affiliated hospital with culture-positive bacterial pneumonia developed outside the hospital from January 2008 to December 2011. We compared the clinical characteristics between MRSA and non-MRSA pneumonia, and identified risk factors associated with MRSA pneumonia.Results: Of 943 patients, MRSA was identified in 78 (8.2%). Higher mortality was observed in MRSA than in non-MRSA patients (33.3% vs. 21.5%; P = 0.017). In a logistic regression analysis, MRSA pneumonia was observed more frequently in patients with a previous history of MRSA infection (OR = 6.05; P < 0.001), a PSI score ≥120 (OR = 2.40; P = 0.015), intravenous antibiotic treatment within 30 days of pneumonia (OR = 2.23; P = 0.018). By contrast, non-MRSA pneumonia was observed more often in patients with a single infiltrate on chest radiography (OR = 0.55; P = 0.029).Conclusions: Anti-MRSA antibiotics could be considered in hospitalized non-nosocomial patients with several risk factors identified herein. The presence or absence of these factors would provide useful guidance in selecting initial empirical antibiotics. [ABSTRACT FROM AUTHOR]

Background and objective: Patients with community-acquired Acinetobacter baumannii (AB) pneumonia have been reported from subtropical countries. We investigated the epidemiology, clinical and microbiological characteristics of community-acquired pneumonia (CAP) due to AB in Singapore. Method: A retrospective case series was performed over a 21-month period at two institutions. Results: From 1 January 2007 to 30 September 2008, eight patients were diagnosed with CAP due to AB. Seven had bacteraemia and five were sputum culture-positive. The median age at presentation was 58.5 years (range 45–76 years). Five patients (71.4%) acquired the pneumonia in the warmer months of June to September. Presentation was acute, with a median duration of 2.5 days (range 1–7 days). The median Acute Physiology and Chronic Health Evaluation II score was 28.5 (range 6–36). Six patients presented with septic shock, lactic acidosis, acute kidney injury and respiratory failure, necessitating ICU care; five of thesepatients eventually died. All patients received empirical antibiotics, including third-generation cephalosporins, which were inactive against the organism. All isolates were susceptible to ampicillin/sulbactam, ciprofloxacin, co-trimoxazole, aminoglycosides and imipenem. Conclusions: Community-acquired AB pneumonia have a fulminant course. In a region endemic for melioidosis and severe community-acquired Klebsiella pneumoniae, the challenge lies in rapid identification and initiation of appropriate empirical antibiotics to improve the survival of patients with AB CAP. [ABSTRACT FROM AUTHOR]

Legionella pneumophila is increasingly recognized as a cause of both sporadic and epidemic community-acquired pneumonia. Clinical manifestations of Legionnaires' disease are not specific and current diagnostic scores are of limited use. Urinary antigen detection is an effective test for rapid diagnosis of infection caused by L. pneumophila serogroup 1. Improved outcomes regarding the time to defervescence, development of complications and length of stay, have been recently observed for patients treated with levofloxacin monotherapy. Current case-fatality rates for hospitalized patients with community-acquired Legionella pneumonia are lower than those traditionally reported for this infection. Effective preventive strategies are needed. [ABSTRACT FROM AUTHOR]

Clin Microbiol Infect 2010; 16: 909–911 To investigate the safety and practicability of conducting transthoracic fine-needle aspiration (TFNA) in a general hospital setting, we applied the TFNA procedure to 20 patients hospitalized with community-acquired pneumonia (CAP) within 36 h of admission. Also, a preliminary assessment was made of the potential value of adding TFNA to conventional methods of diagnostic microbiology. TFNA was easy to perform and caused little discomfort, and no serious adverse events were observed. In spite of ongoing antimicrobial treatment, a likely aetiological diagnosis was established for 14 of 20 (70%) of the patients. TFNA may provide important additional information on the aetiology of CAP. [ABSTRACT FROM AUTHOR]