Respiratory Tract Infections In Patients Research Articles

Illumina and Nanopore sequencing in culture-negative samples from suspected lower respiratory tract infection patients.

To evaluate the diagnostic value of metagenomic sequencing technology based on Illumina and Nanopore sequencing platforms for patients with suspected lower respiratory tract infection whose pathogen could not be identified by conventional microbiological tests. Patients admitted to the Respiratory and Critical Care Medicine in Shanghai Ruijin Hospital were retrospectively studied from August 2021 to March 2022. Alveolar lavage or sputum was retained in patients with clinically suspected lower respiratory tract infection who were negative in conventional tests. Bronchoalveolar lavage fluid (BALF) samples were obtained using bronchoscopy. Sputum samples were collected, while BALF samples were not available due to bronchoscopy contraindications. Samples collected from enrolled patients were simultaneously sent for metagenomic sequencing on both platforms. Thirty-eight patients with suspected LRTI were enrolled in this study, consisting of 36 parts of alveolar lavage and 2 parts of sputum. According to the infection diagnosis, 31 patients were confirmed to be infected with pathogens, while 7 patients were diagnosed with non-infectious disease. With regard to the diagnosis of infectious diseases, the sensitivity and specificity of Illumina and Nanopore to diagnose infection in patients were 80.6% vs. 93.5% and 42.9 vs. 28.6%, respectively. In patients diagnosed with bacterial, Mycobacterium, and fungal infections, the positive rates of Illumina and Nanopore sequencer were 71.4% vs. 78.6%, 36.4% vs. 90.9%, and 50% vs. 62.5%, respectively. In terms of pathogen diagnosis, the sensitivity and specificity of pathogens detected by Illumina and Nanopore were 55.6% vs. 77.8% and 42.9% vs. 28.6%, respectively. Among the patients treated with antibiotics in the last 2 weeks, 61.1% (11/18) and 77.8% (14/18) cases of pathogens were accurately detected by Illumina and Nanopore, respectively, among which 8 cases were detected jointly. The consistency between Illumina and diagnosis was 63.9% (23/36), while the consistency between Nanopore and diagnosis was 83.3% (30/36). Between Illumina and Nanopore sequencing methods, the consistency ratio was 55% (22/42) based on pathogen diagnosis. Both platforms play a certain value in infection diagnosis and pathogen diagnosis of CMT-negative suspected LRTI patients, providing a theoretical basis for clinical accurate diagnosis and symptomatic treatment. The Nanopore platform demonstrated potential advantages in the identification of Mycobacterium and could further provide another powerful approach for patients with suspected Mycobacterium infection.

Etiologies, risk factors, and antibiotic pattern of lower respiratory tract infection in patients coming to Deccan College of Medical Sciences, Hyderabad, South India

Background. Lower Respiratory Tract Infections (LRTI) impose a huge problem on society due to their tenacious and unescapable health problems, and they were the reasons for consultation and hospitalization. Patients with LRTI were present with a wide spectrum of diseases that range from life-threatening infections to minor self-limiting illnesses. Materials and methods. Sputum samples from 310 patients with complaints of lower respiratory tract infections were collected and analyzed. After microscopic analysis, 30 were excluded from the study. Of the 280 that were included in the study, 171 were males and 109 were females. The age group between 56 and 65 years comprised the highest number of patients in the study. Different antibiotics were used to check antibiotic sensitivity patterns against isolated Gram-positive and negative bacteria. Results. Of the 280 samples processed, 122 (43.5%) were culture-positive. Among the 122 bacterial isolates, the predominant organism was Klebsiella pneumoniae 55 (45%). The most common predisposing factor identified in 115 (37%) patients was smoking. Using the Double Disk Synergy Test, 11 (20%) out of a total of 55 K. pneumoniae isolates and 4 (30.7%) out of 13 Pseudomonas isolates showed Extended Spectrum Beta Lactamases (ESBL). The Klebsiella and Pseudomonas isolates showed resistance to 2nd and 3rd generation Cephalosporins. Conclusion. Because of different geographical regions and conditions, the etiology and the antibiotic sensitivity patterns of LRTI vary, so the etiology, predisposing factors, and the antibiotic sensitivity pattern of LRTI need to be updated regularly. The diagnostic facilities for early and rapid identification of LRTI also need to be improved.

The value of multiplex PCR in describing the microbial ecology of respiratory infections during the COVID 19 pandemic

Respiratory infections constitute a frequent reason for consultation and hospitalization and their emergence means that the identification of pathogens is important for the implementation of appropriate treatment for effective patient care. Multiplex PCR is a diagnostic tool developed for the identification of the microbial agent and the detection of resistance mechanisms. The objective of this study was to highlight and identify by multiplex PCR the bacteria and viruses responsible for respiratory infections in patients presenting clinical signs, and in whom biological examinations did not identify germs in cause during the COVID 19 pandemic, to be able to follow the epidemiology and microbial ecology of lower respiratory infections which has undergone changes, due to hygiene rules as well as current measures and methods of controlling this pandemic.

Microbiological profile of long COVID and associated clinical and radiological findings: a prospective cross-sectional study.

To study the frequency of microbiological etiology of respiratory infections in patients with long COVID and their associated clinical and radiological findings. Nasopharyngeal swabs and sputum specimens were collected from 97 patients with respiratory illness stemming from long COVID. The specimens were assessed for their microbiological profile (bacteria and virus) and their association with the overall clinical and radiological picture. In total, 23 (24%) patients with long COVID had viral infection (n = 12), bacterial infection (n = 9), or coinfection (n = 2). Microorganisms were detected at significantly higher rates in hospitalized patients, patients with moderate COVID-19, and patients with asthma (P < .05). Tachycardia (65%) was the most common symptom at presentation. A statistically significant number of patients with long COVID who had viral infection presented with cough and myalgia; and a statistically significant number of patients with long COVID who had bacterial infection presented with productive coughing (P < .05). Post-COVID fibrotic changes were found in 61% of cohort patients (31/51). A decreasing trend of respiratory pathogens (enveloped viruses and bacteria) was found in long COVID. An analysis including a larger group of viral- or bacterial-infected patients with long COVID is needed to obtain high-level evidence on the presenting symptoms (cough, myalgia) and their association with the underlying comorbidities and severity.

Evaluation of clinical characteristics and risk factors associated with Chlamydia psittaci infection based on metagenomic next-generation sequencing

IntroductionPsittacosis is a zoonosis caused by Chlamydia psittaci, the clinical manifestations of Psittacosis range from mild illness to fulminant severe pneumonia with multiple organ failure. This study aimed to evaluate the clinical characteristics of Chlamydia psittaci infection diagnosed based on metagenomic next-generation sequencing(mNGS), as well as the risk factors affecting the progress of Chlamydia psittaci infection, in order to improve the effect of therapeutics.MethodsWe retrospectively analyzed the clinical data of patients infected with chlamydia psittaci in the First Affiliated Hospital of Nanchang University from January 2021 to December 2021. The patient’s past medical history, clinical manifestations, laboratory examinations, chest CT results, treatment status, and prognosis data were collected. we also investigated both the pathogenic profile characteristics and the lower respiratory tract microbiota of patients with Chlamydia psittaci pneumonia using mNGS.ResultsAll cases of Chlamydia psittaci in our research have been confirmed by mNGS. Among 46 cases of Chlamydia psittaci pneumonia, Poultry exposure was reported in 35 cases. In severe cases of Chlamydia psittaci pneumonia, Neutrophils, Procalcitonin (PCT), Lactate Dehydrogenase (LDH), Hydroxybutyrate Dehydrogenase (HBDH), Creatine Kinase Isoenzymes-B (CK-MB) and D-Dimer levels were remarkably higher than that of non-severe cases, except for lymphocytes (all P < 0.05). Chest CT scans showed Bilateral (77.8%), multiple lobar lungs (85.2%), pleural effusions (44.4%) involvement in those suffering from severe Chlamydia psittaci pneumonia, whereas its incidence was 0%, 21.1% and 10.5% in non-severe patients, respectively (P < 0.05). Multivariate analysis revealed that higher lymphocyte concentrations (OR 0.836, 95% CI 0.714–0.962, P = 0.041) were the only protective factor for survival. mNGS results indicated that 41.3% of patients (19/46) had suspected coinfections with a coinfection rate of 84.2% (16/19) in the severe group, much higher than that in the non severe group (p < 0.05). No significantly different profiles of lower respiratory tract microbiota diversity were found between non severe group and severe group.ConclusionA history of poultry exposure in patients can serve as an important basis for diagnosing Chlamydia psittaci pneumonia, and patients with severe Chlamydia psittaci pneumonia are more likely to develop elevated inflammatory biomarkers as well as elevated cardiac markers. Higher lymphocyte concentrations are protective factors associated with severe C. psittaci pneumonia. The higher proportion of patients with coinfections in our study supports the use of mNGS for comprehensive early detection of respiratory infections in patients with C. psittaci pneumonia.

Neuroimaging of tuberculosis- modalities, imaging protocols and radiomics: a review

Background and Objective:&#x0D; A large number of review and research articles exists in literature which describe the radiological appearance of various manifestations of nervous system tuberculosis, however there is paucity of text which describes the application of each and every imaging modality in the workup of the entire spectrum of this pathology. The intent of this article is to review the existing literature on the role of different radiological modalities in the stepwise work up of CNS TB. The article focuses on the role of plain radiograph, fluoroscopy, computed tomography, magnetic resonance imaging along with its advanced sequences and nuclear medicine in imaging of the many faces of tuberculosis in CNS. The article also aims to review the existing literature on the role of MR based textural analysis (Radiomics) as a problem-solving tool in various nervous system pathologies.&#x0D; Methods:&#x0D; We searched PubMed central databases for articles published in English from January 1 2000 to February 28 2021 along with references from the relevant articles. The search terms included “imaging in central nervous system tuberculosis” “Radiomics in tuberculosis “, “Radomics in central nervous system ”. In total 95 articles including case reports, case series, original articles and review articles were included in this review.&#x0D; Results:&#x0D; Conventional imaging modalities including radiograph and fluoroscopy are becoming extinct in work up of tuberculosis in the nervous system itself, however a plain radiograph still holds a key position in screening the chest for presence of subclinical respiratory tract infection in patients presenting with brain tuberculosis. In addition, it is a sensitive tool as baseline investigation in workup of spinal tuberculosis (T.B). Fluoroscopy is a useful tool in image guided procedures for collection of samples for histopathology and CSF analysis.&#x0D; Cross sectional imaging modalities including computed tomography and magnetic resonance imaging have revolutionized imaging of central nervous system pathologies in particular tuberculosis. Computed tomography acts as a screening tool to identify the presence of intracranial tuberculosis and recognize its complications. In addition it is an important tool to determine the extent of spinal T.B. Magnetic Resonance Imaging (MRI) along with its advanced sequences including spectroscopy, Magnetization transfer T1 sequence (MT T1), perfusion imaging, and magnetic resonance angiography (MRA) and magnetic resonance venography (MRV) is an ideal imaging method to work up CNS TB. It can identify numerous manifestations of tuberculosis in the brain, work up its associated complication, and explain the extent of neurological symptoms. Moreover, it has the capability to differentiate TB from other nervous system infections. Furthermore, it can differentiate neoplastic and inflammatory brain disorders from CNS TB. Radiomics, particularly the textural features based on MR imaging is the future of neuroimaging. Its role is getting established in the work up of several intracranial pathologies including brain tumors and neurodegenerative disorders. Certainly, it has significant potential in the imaging work up of CNS tuberculosis, which is underexplored and therefore requires the central attention of upcoming researchers focusing on this topic.&#x0D; Conclusion:&#x0D; Cross sectional imaging is the mainstay of imaging workup. Nuclear imaging is becoming an essential adjuvant to determine the burden of the disease. Role of radiomics is evolving in intracranial pathologies and certainly needs the central attention of future researches to establish its role in CNS TB imaging.

Respiratory Syncytial Virus Vaccines for the Prevention of Lower Respiratory Tract Infections in Patients Living with Chronic Obstructive Pulmonary Disease: A Rapid Review

Background: Patients living with chronic obstructive pulmonary disease (COPD) are at risk for lower respiratory tract infections caused by respiratory syncytial virus (RSV). The first RSV vaccines were approved in 2023 for adults ages 60 years and older. The safety and efficacy of the RSV vaccines and their clinical implications in patients living with COPD, apart from composite comorbidity results, are under-reported. Methods: This rapid review aimed to collect and report data pertaining to RSV vaccine safety and efficacy in patients living with COPD. Resources searched included Ovid MEDLINE, EMBASE, International Pharmaceutical Abstracts, published peer-reviewed abstracts, ClinicalTrials.gov, and the United States Food and Drug Administration (FDA) website. Results: Seven records were included: five research manuscripts and two ongoing clinical trials. Patients living with COPD were included in RSV vaccine clinical trials, but outcomes of RSV vaccine safety and efficacy in patients living with COPD were grossly unreported. Conclusions: Future clinical trials of patients living with COPD and subgroup analyses of patients living with COPD within existing studies evaluating RSV vaccine safety and efficacy are necessary to substantiate outcomes in this population.

Reported antibiotic use among patients in the multicenter ANDEMIA infectious diseases surveillance study in sub-saharan Africa

BackgroundExposure to antibiotics has been shown to be one of the drivers of antimicrobial resistance (AMR) and is critical to address when planning and implementing strategies for combatting AMR. However, data on antibiotic use in sub-Saharan Africa are still limited. Using hospital-based surveillance data from the African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA), we assessed self-reported antibiotic use in multiple sub-Saharan African countries.MethodsANDEMIA included 12 urban and rural health facilities in Côte d’Ivoire, Burkina Faso, Democratic Republic of the Congo, and Republic of South Africa. Patients with acute respiratory infection (RTI), acute gastrointestinal infection (GI) and acute febrile disease of unknown cause (AFDUC) were routinely enrolled, and clinical, demographic, socio-economic and behavioral data were collected using standardized questionnaires. An analysis of ANDEMIA data from February 2018 to May 2022 was conducted. Reported antibiotic use in the ten days prior to study enrolment were described by substance and by the WHO AWaRe classification (“Access”, “Watch”, “Reserve”, and “Not recommended” antibiotics). Frequency of antibiotic use was stratified by location, disease syndrome and individual patient factors.ResultsAmong 19,700 ANDEMIA patients, 7,258 (36.8%) reported antibiotic use. A total of 9,695 antibiotics were reported, including 54.7% (n = 5,299) from the WHO Access antibiotic group and 44.7% (n = 4,330) from the WHO Watch antibiotic group. The Watch antibiotic ceftriaxone was the most commonly reported antibiotic (n = 3,071, 31.7%). Watch antibiotic use ranged from 17.4% (56/322) among RTI patients in Côte d’Ivoire urban facilities to 73.7% (630/855) among AFDUC patients in Burkina Faso urban facilities. Reported antibiotic use included WHO Not recommended antibiotics but no Reserve antibiotics.ConclusionsReported antibiotic use data from this multicenter study in sub-Saharan Africa revealed a high proportion of WHO Watch antibiotics. Differences in Watch antibiotic use were found by disease syndrome, country and health facility location, which calls for a more differentiated approach to antibiotic use interventions including further evaluation of accessibility and affordability of patient treatment.

Clinical predictors of hypoxemia in patients of acute lower respiratory tract infections: A hospital-based study

Aim: The aim of this study was to study clinical predictors of hypoxemia in patients of acute lower respiratory infections in children. Materials and Methods: An observational prospective study was conducted for 8 months in the General Pediatric Ward and Pediatric Intensive Care Unit of Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, a tertiary care hospital in Rohilkhand region. This is a hospital-based study. All children admitted with acute lower respiratory tract infections between the age group of 1 month to 59 months of age and diagnosed with pneumonia and bronchiolitis were enrolled and oxygen saturation of patients was recorded and compared with arterial blood gas. Results: A total of 40 patients were enrolled in the study. More than 90% cases of pneumonia and bronchiolitis presented with difficulty in breathing followed by rapid breathing as the next most common symptom. The least common symptom was noisy breathing and pain in abdomen. The most common signs observed were tachypnea which was present in 100% cases of mild, moderate, and severe hypoxemia. Tachypnea (91%), pallor (89%) and nasal flaring (84%), crepitations (added sounds), and subcostal retractions had better sensitivity for detecting hypoxemia. Conclusion: It was observed that a combination of clinical signs and symptoms can be used to predict hypoxemia when facilities of pulse oximetry and arterial blood gas analysis are not available, especially in low-resource settings.

Nitric oxide-releasing prodrug for the treatment of complex Mycobacterium abscessus infections.

Non-tuberculosis mycobacteria (NTM) can cause severe respiratory infection in patients with underlying pulmonary conditions, and these infections are extremely difficult to treat. In this report, we evaluate a nitric oxide (NO)-releasing prodrug [methyl tris diazeniumdiolate (MD3)] against a panel of NTM clinical isolates and as a treatment for acute and chronic NTM infections in vivo. Its efficacy in inhibiting growth or killing mycobacteria was explored in vitro alongside evaluation of the impact to primary human airway epithelial tissue. Airway epithelial tissues remained viable after exposure at concentrations of MD3 needed to kill mycobacteria, with no inherent toxic effect from drug scaffold after NO liberation. Resistance studies conducted via serial passage with representative Mycobacterium abscessus isolates demonstrated no resistance to MD3. When administered directly into the lung via intra-tracheal administration in mice, MD3 demonstrated significant reduction in M. abscessus bacterial load in both acute and chronic models of M. abscessus lung infection. In summary, MD3 is a promising treatment for complex NTM pulmonary infection, specifically those caused by M. abscessus, and warrants further exploration as a therapeutic.

Carbocysteine as Adjuvant Therapy in Acute Respiratory Tract Infections in Patients without Underlying Chronic Conditions: Systematic Review and Meta-Analysis

Carbocysteine as Adjuvant Therapy in Acute Respiratory Tract Infections in Patients without Underlying Chronic Conditions: Systematic Review and Meta-Analysis

Microbiological and Clinical Characteristics of Lower Respiratory Tract Infections in Patients from the Pediatric Ward, Adult Respiratory Ward, and Medicine Intensive Care Unit at a University Hospital in Northern India

Abstract Background: Respiratory infections are common infections reported among human beings. Infections involving the respiratory tract can be mild and transient and people tend to neglect them. The chief cause of lower respiratory tract infections (LRTIs) can be attributed to hospitalization. Materials and Methods: We conducted a retrospective, cross-sectional study from January 2021 to April 2021. The clinical, demographic, and microbiological characteristics of the patients admitted to adult respiratory ward (ARW), pediatric ward (PW), and medicine intensive care unit (MICU) were extracted from the electronic records and laboratory registers for this study. Results: We included 788 patients in this study from January 2021 to April 2021. The mean age of patients was 52.67 ± 20.15 years with a male predominance in ARW (248/383, 64.75%) and MICU (252/369, 68.29%) and a female predominance in PW (28/36, 77.78%). Most patients were admitted to the ARW (383/788, 48.60%) followed by the MICU (369/788, 46.83%). Bacterial growth was seen in 358 (358/788, 38.89%) respiratory samples. Blood culture was positive in 188 (188/788, 23.86%) samples. The most common microorganism causing LRTI and bloodstream infection was Klebsiella pneumoniae with an infection rate of 32.68% (117/358, 32.68%) and 25.53% (48/188, 25.53%), respectively. Total leukocyte count (P &lt; 0.0001) and procalcitonin (P = 0.0113) were statistically significant diagnostic parameters associated with MDR isolates. Conclusion: This study establishes the range of bacteria obtained from the respiratory samples of LRTI patients and guides the clinicians in the administration of appropriate antibiotics according to the antibiotic susceptibility pattern to eliminate MDR.

Ensemble of explainable artificial intelligence predictions through discriminate regions: A model to identify COVID-19 from chest X-ray images

Abstract In 2019, lung disease severely affected human health and was later renamed coronavirus disease 2019 (COVID-2019). Since then, several research methods have been proposed, such as reverse transcription polymerase chain reaction (RT-PCR), and disease identification through chest X-rays and computed tomography (CT) scans, to help the healthcare sector. RT-PCR was time-consuming when more patients were present, and a CT scan was costly. Several deep-learning (DL) methods were used to identify diseases using computer-aided tools. Among those convolutional neural networks (CNNs), the state of the art was adopted in the machinery to predict cancer. However, there is a lack of explainability (XAI) in how CNN predicts the disease. In this article, we construct XAI ensembles with Local Interpretation Model Agnostic Explanation(LIME), Grad CAM, and a Saliency map. It provides a visual explanation for a DL prognostic model that predicts COVID-19 respiratory infection in patients. Our quantitative experimental results have shown that ensemble XAI with an accuracy of 98.85%, although individual LIME has scored an accuracy of 99.62% on test data, is more reliable since it is the combination of models.

Performance of the FebriDx Rapid Point-of-Care Test for Differentiating Bacterial and Viral Respiratory Tract Infections in Patients with a Suspected Respiratory Tract Infection in the Emergency Department.

FebriDx is a rapid point-of-care test combining qualitative measurements of C-reactive protein (CRP) and Myxovirus Resistance Protein A (MxA) using a disposable test device to detect and differentiate acute bacterial from viral respiratory tract infections. The goal of this study was to investigate the diagnostic accuracy of FebriDx in patients with suspected respiratory tract infections in the emergency department (ED). This was an observational cohort study, performed in the ED of an academic hospital. Patients were included if they had a suspected infection. The primary outcome was the presence of a bacterial or viral infection, determined by clinical adjudication by an expert panel. The sensitivity, specificity, and positive and negative predictive value of FebriDx for the presence of bacterial versus non-bacterial infections, and viral versus non-viral infections were calculated. Between March 2019 and November 2020, 244 patients were included. A bacterial infection was present in 41%, viral infection was present in 24%, and 4% of the patients had both viral and bacterial pathogens. FebriDx demonstrated high sensitivity in the detection of bacterial infection (87%), high NPV (91%) to rule out bacterial infection, and high specificity (94%) for viral infection in patients with a suspected infection in the ED.

Clinical utility of metagenomic next-generation sequencing in pathogen detection for lower respiratory tract infections and impact on clinical outcomes in southernmost China.

Today, metagenomic next-generation sequencing (mNGS) has emerged as a diagnostic tool for infections. However, since Hainan has a complicated pathogen spectrum, the diagnostic value and impact on patient outcomes of mNGS in Hainan are to be explored. From April 2020 to October 2021, 266 suspected lower respiratory tract infections (LRTIs) patients in Hainan were enrolled, and specimens were collected before antibiotic treatment. Bronchoalveolar lavage fluid (BALF) samples were subjected to mNGS and culture to compare the diagnostic performance. Other conventional microbiological tests (CMT) were also performed. Patients' treatments and clinical outcomes were recorded, and the antibiotic resistance genes (ARGs) were detected via mNGS workflow. The positive rate of mNGS outperformed that of culture (87.55% vs. 39.30%, p<0.001) and CMT (87.12% vs. 52.65%, p<0.001). Specifically, mNGS detected more P. aeruginosa (12.03% vs 9.02%, p<0.05), H. influenzae (9.77% vs 2.26%, p<0.001), Aspergillus fumigatus (3.00% vs 0.75%, p<0.05), Candida albicans (26.32% vs 7.52%, p<0.001) and uncommon pathogens. It also demonstrated great diagnostic advantages in Mycobacterium tuberculosis with 80% sensitivity and 97.4% specificity. Over half of the patients (147, 55.26%) had modified empirical treatment according to mNGS results and 89.12% of them responded well. For three deaths with modified treatment, multiple drug resistance was predicted by mNGS and confirmed by antibiotic susceptibility test. The application of mNGS can benefit clinics in pathogen identification and antimicrobial treatment stewardship. Physicians should be alert to some emerging uncommon pathogens, including Chlamydia Psittaci, Nocardia otitidiscaviarum, and rare NTM.

2127. In vitro Activities of Ceftaroline and Comparator Agents against Bacterial Pathogens Frequently Causing Community-Acquired Respiratory Tract Infections in Patients from a Global Population: ATLAS Surveillance Program 2018-2021

Abstract Background Community-acquired bacterial pneumonia (CABP) is a frequent cause of patient morbidity and mortality. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are frequent etiologic agents of CABP. Ceftaroline fosamil is a parenteral cephem approved treatment of patients with CABP caused by S. pneumoniae (including cases with concurrent bacteremia), methicillin-susceptible Staphylococcus aureus (MSSA), H. influenzae, and some species of Enterobacterales. In this study we report the in vitro activity of ceftaroline and comparators against isolates from community-acquired respiratory tract infections (CARTI) collected through a global surveillance program. Methods Clinically relevant, non-duplicate, isolates cultured from respiratory specimens by clinical laboratories in 54 countries in 2018-2021 were collected by the ATLAS Surveillance Program central laboratory (IHMA, Schaumburg, IL, USA). Community-acquired infections were defined as those from patients &amp;lt; 48 hours in hospital. In total, 7,886 isolates of S. pneumoniae, H. influenzae, M. catarrhalis, MSSA, and methicillin-resistant S. aureus (MRSA) were tested. The isolates (n/percent of total) originated from Asia/South Pacific (1,893/24.0%); Europe (4,283/54.3%); Latin America (671/8.5%); Middle East/Africa (659/8.4%); and North America (Canada only) (380/4.8%). Ceftaroline and comparator agent MICs were determined by CLSI M07 broth microdilution methodology. MICs were interpreted using 2023 CLSI M100 MIC breakpoints. Results The in vitro activity of ceftaroline and comparator agents is summarized in the table. Greater than 99% of S. pneumoniae and 100% of MSSA were susceptible to ceftaroline, including penicillin-nonsusceptible S. pneumoniae based on a dosage of 600 mg every 12h. Sixty-two (9.6%) MRSA were ceftaroline-susceptible-dose-dependent (MIC 2-4 µg/mL) based on a dosage of 600 mg every 8h administered over 2h, with the majority from (n) Thailand (9), S. Korea (7), and China (6). Four isolates, from S. Korea (2), China (1), and Ukraine (1) were resistant to CPT (MIC of ≥8 µg/mL). 99.6% of H. influenzae were susceptible to ceftaroline. Conclusion Ceftaroline demonstrated potent in vitro activity against current pathogens associated with CABP from a global collection. Disclosures Meredith Hackel, PhD, Pfizer Inc.: Honoraria|Venatorx: Paid fees for conducting the study and abstract preparation Gregory Stone, PhD, Pfizer: Stocks/Bonds Daniel F. Sahm, PhD, Merck &amp; Co., Inc.: Honoraria|Pfizer Inc.: Honoraria|Venatorx: Paid fees for conducting the study and abstract preparation

2162. In Vitro Antimicrobial Activity of Ceftobiprole against Streptococcus pneumoniae Isolates from the United States (2016–2020)

Abstract Background Ceftobiprole (BPR) is an advanced-generation cephalosporin approved in Europe and many non-European countries for the treatment of community-acquired pneumonia and non–ventilator-associated hospital-acquired pneumonia in adults caused by indicated species, including Streptococcus pneumoniae (SPN). This study evaluated the in vitro antimicrobial activity of BPR and comparator agents against recent SPN isolates causing lower respiratory tract infections in patients at medical centers in the United States (US). Methods A total of 2,793 SPN isolates from 32 US medical centers (2016–2020) were collected from patients with lower respiratory tract infections. Isolates were tested for antimicrobial susceptibility using the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method. MIC interpretations for BPR and comparators utilized European Committee on Antimicrobial Susceptibility Testing (EUCAST) or CLSI criteria, respectively. The EUCAST BPR susceptibility breakpoint for SPN was 0.5 mg/L. Results BPR inhibited 99.5% of all SPN isolates at the EUCAST breakpoint (MIC50/90, 0.015/0.25 mg/L). The MIC50/90 values were stable over all 5 surveillance years. The following comparator agents displayed lower activity against the isolate set: clindamycin (85.5% susceptible [S]), erythromycin (53.2% S), penicillin (63.2% S using oral breakpoints), tetracycline (79.4% S), and trimethoprim-sulfamethoxazole (72.8% S). BPR maintained excellent in vitro activity against each of the isolate subsets resistant to these comparator antimicrobials (95.4–98.8% S to BPR depending on the comparator antimicrobial; 95.4% of the penicillin-resistant isolates were S to BPR). This SPN isolate set was also 99.4% S to levofloxacin, 97.4% S to ceftriaxone (using non-meningitis breakpoints), and 100% S to linezolid and vancomycin. Conclusion BPR exhibited potent in vitro antimicrobial activity against recent SPN clinical isolates collected in US medical centers (2016–2020). These data indicate that BPR merits further investigation as a potential option for the treatment of lower respiratory tract infections caused by SPN in the US. Disclosures Leonard R. Duncan, PhD, AbbVie: Grant/Research Support|Basilea: Grant/Research Support|CorMedix: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support Mariana Castanheira, PhD, AbbVie: Grant/Research Support|Basilea: Grant/Research Support|bioMerieux: Grant/Research Support|Cipla: Grant/Research Support|CorMedix: Grant/Research Support|Entasis: Grant/Research Support|Melinta: Grant/Research Support|Paratek: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support Jennifer Smart, PhD, Basilea Pharmaceutica International Ltd, Allschwil, Switzerland: Stocks/Bonds Mark E. Jones, PhD, Astellas Pharma Global Development, Inc: Support for the present publication|Basilea Pharmaceutica International Ltd: Employee of Basilea Pharmaceutica International Ltd|Basilea Pharmaceutica International Ltd: Stocks/Bonds Rodrigo E. Mendes, PhD, AbbVie: Grant/Research Support|Basilea: Grant/Research Support|Cipla: Grant/Research Support|Entasis: Grant/Research Support|GSK: Grant/Research Support|Paratek: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support

The economic burden of viral severe acute respiratory infections in the Kingdom of Saudi Arabia: A nationwide cost-of-illness study

ObjectivesThe authors conducted a study to estimate the rising disease and economic burden of viral severe acute respiratory infections and their management, including COVID-19, respiratory syncytial virus, and influenza types A and B, in early and delayed diagnosis scenarios in the Kingdom of Saudi Arabia from a national perspective. MethodsThis cross-sectional study was conducted in May 2022 using a de novo Excel-based universal cost-of-illness calculator model. The study used primary data, such as expert interviews, as well as secondary data from a thorough literature search. ResultsThe total economic burden of viral severe acute respiratory infections in patients with an early diagnosis was lower than those with a delayed diagnosis among patients with complications, both from the payer's (United States dollar [USD] 3846 million vs USD 4726 million) and societal (USD 4048 million vs USD 5020 million, respectively) perspectives. The major cost driver of the total economic burden for both early and delayed diagnosis was disease management costs: 49% (USD 1880 million) and 58% (USD 2730 million), respectively. ConclusionsIn the Kingdom of Saudi Arabia, the total economic burden for COVID-19, influenza (epidemic phase), and respiratory syncytial virus was higher with a delayed diagnosis vs an early diagnosis, emphasizing the importance of using a broader diagnostic method.

Microbial Characteristics of Lower Respiratory Tract Infections in Patients Referred from Primary Care Hospitals

Objective: This study investigated the microbiological characteristics of severe lower respiratory tract infection patients not respond to initial treatment, and were transferred to a tertiary-level hospital.Material and Methods: This was a multicenter, prospective study conducted across four hospitals: Cho Ray, Pham Ngoc Thach, Gia Dinh People’s Hospital, and Can Tho Central General Hospital. Sputum specimens were collected shortly after admission and subjected to culture and real-time PCR testing.Results: Out of the 252 patients, 170 (67.4%) met the criteria for analysis and identification of pathogenic microorganisms. The most frequently isolated pathogens were Streptococcus pneumoniae (S. pneumonia) and Haemophilus influenzae (H. influenzae), comprising of 27.0% and 13.1%, respectively. Antibiotic susceptibility testing was conducted on 55 patients (32.3%). Among these cases, there were 16 instances of S. pneumoniae, 10 cases of Staphylococcus aureus (S. aureus), 10 cases of Pseudomonas aeruginosa (P. aeruginosa), 14 cases of gram-negative enteric bacteria, 2 cases of H. influenzae, 1 case of Moraxella catarrhalis (M. catarrhalis), 1 case of Enterococcus faecium, and 1 case of M. pneumoniae. The antibiogram results revealed significant findings; including a 70% prevalence of extended-spectrum beta-lactamase and 90% occurrence of Methicillin-Resistant Staphylococcus aureus. The data also indicated high resistance rates; such as 90% resistance to erythromycin, 40-80% to ciprofloxacin, 30-80% to ceftazidime, and 30-40% to imipenem.Conclusion: Pathogens associated with LRTIs referred from primary care hospitals encompass S. pneumonia, H. influenza, and S. aureus. At our facility, piperacillin, imipenem, amikacin, vancomycin, and linezolid emerged as the most effective antibiotics for addressing these LRTIs.

Bacterial respiratory infections in patients with COVID-19: A retrospective study from a tertiary care center in Lebanon

BackgroundDespite multiple reports of increased incidence of bacterial respiratory tract infections following COVID-19 globally, the microbiology is not yet fully elucidated. In this study, we describe the microbiology of bacterial infections and the prevalence of multidrug resistant organisms (MDROs) in hospitalized COVID-19 patients with community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP) which includes both non-ventilated hospital acquired pneumonia (NVHAP) and ventilator-associated pneumonia (VAP). To our knowledge, this is the first study that compares the microbiology of VAP and NVHAP in COVID-19 patients. MethodsThis is a longitudinal retrospective cohort study conducted at the American University of Beirut Medical Center (AUBMC), a tertiary-care centre in Lebanon. Adult patients with confirmed COVID-19 and concurrent bacterial respiratory infections with an identifiable causative organism who were hospitalized between March 2020 and September 2021 were included. Bacterial isolates identified in hospital-acquired pneumonia (HAP) were divided into 3 groups based on the time of acquisition of pneumonia after admission: hospital day 3–14, 15–28 and 29–42. ResultsOut of 1674 patients admitted with COVID-19, 159 (9.5%) developed one or more respiratory infections with an identifiable causative organism. Overall, Gram-negative bacteria were predominant (84%) and Stenotrophomonas maltophilia was the most common pathogen, particularly in HAP. Among 231 obtained isolates, 59 (26%) were MDROs, seen in higher proportion in HAP, especially among patients with prolonged hospital stay (> 4 weeks). Non-fermenter Gram-negative bacilli (NFGNB) (OR = 3.52, p-value<0.001), particularly S. maltophilia (OR = 3.24, p-value = 0.02), were significantly more implicated in VAP compared to NVHAP. ConclusionsNFGNB particularly S. maltophilia were significantly associated with COVID-19 VAP. A high rate of bacterial resistance (25%), especially among Gram-negative bacteria, was found which may compromise patients’ outcomes and has important implications in guiding therapeutic decisions in COVID-19 patients who acquire bacterial respiratory infections.