Treatment Failure In Community-acquired Pneumonia Research Articles

Impact of mental illness on outcomes of outpatients with community-acquired pneumonia.

According to the National Alliance on Mental Illness, one in five adults experience a mental health condition yearly. Community-acquired pneumonia (CAP) is often treated with QTc prolonging antibiotics. The primary outcome assessed is if psychiatric diagnosis contributed to treatment failure in CAP. Outpatients with International Statistical Classification of Diseases and Related Health Problems 9 and 10 codes for CAP from January 2008 to January 2018 were analyzed retrospectively by descriptive statistics. Bivariate analysis was used to compare baseline characteristics, treatment regimens, and outcomes between those with a psychiatric diagnosis and those without. A χ-test was used for analysis of categorical variables and either the independent Student's t-test or one-way analysis of variance was used was used for analysis of continuous variables. Criteria were met by 518 patients, of which, 49% had a psychiatric diagnosis. Patients with psychiatric comorbidity were not more likely to experience treatment failure, subsequent admission, or mortality. There was no statistically significant difference between patients with a psychiatric diagnosis and those without in early or late CAP treatment failure (P=0.34 and 0.12), 30-day subsequent admission rates (P=0.41), 30-day mortality (P=0.34), or 90-day mortality (P=0.38). Psychiatric diagnosis increased the likelihood of a concomitant QTc prolonging psychiatric medication (51.78 vs. 3.40% P<0.0001), however, the prescribing rate of a QTc prolonging antibiotic was not statistically significantly different (85.3 vs. 83.4% P=0.54). Outpatients with mental illness can be treated for CAP without fear of increased risk of treatment failure compared with those without such diagnosis. This study emphasizes the necessity to consider the full patient history and diagnosis when treating patients with outpatient infections.

Predictors of treatment failure and clinical stability in patients with community acquired pneumonia.

Community acquired pneumonia (CAP) is the leading infectious cause of mortality worldwide with approximately 10% of patients hospitalized requiring intensive care unit (ICU) admission. The ability to predict clinical stability (CS) and treatment failure (TF) enables the clinician to alter antibiotics appropriately, facilitate a timely ICU admission, or arrange a suitable discharge. The detection of CS and TF can be difficult and changes in clinical signs may be subtle or delayed. Thus clinical scores and biomarkers are routinely used to identify severity and monitor clinical progression. The evidence, however, is vast and the definitive role of these systems is at times difficult to elucidate. The aim of this review is to analyse the current literature and to provide a rational and clinically focused view of the predictive utility of various systems used to identify CS and TF in CAP.

Falla de tratamiento en neumonía adquirida en la comunidad: coccidioidomicosis en un viajero

Treatment failure in community-acquired pneumonia is defined as a clinical condition with inadequate response to antimicrobial therapy. Resistant and unusual microorganisms and noninfectious causes are responsible for treatment failure. Coccidioides immitis is a fungus that causes pneumonia in the northern hemisphere, especially in the United States and northern Mexico. We report a case of pulmonary coccidioidomycosis imported from Mexico to Chile. After a comprehensive study, histopathology was able to establish Coccidiodes immitis as the causative agent, achieving clinical and radiological improvement with antifungal therapy.

Comparative antibiotic failure rates in the treatment of community-acquired pneumonia: Results from a claims analysis

Introduction|Antibiotic treatment failure contributes to the economic and humanistic burdens of community-acquired pneumonia (CAP) by increasing morbidity, mortality, and healthcare costs. This study compared treatment failure rates of levofloxacin with those of other antibiotics in a large US sample.Methods|Medical and pharmacy claims in the nationally representative SDI database were used to identify adults with a new outpatient diagnosis of CAP receiving a study antibiotic (levofloxacin, amoxicillin/clavulanate, azithromycin, moxifloxacin) between September 1, 2005 and March 31, 2008. Treatment failure was defined as ≥1 of the following events ≤30 days after index date: a refill for the index antibiotic after completed days of therapy, a different antibiotic dispensed >1 day after the index prescription, or hospitalization with a pneumonia diagnosis or emergency department visit >3 days postindex. Cohorts were propensity score matched for demographic and clinical characteristics. Treatment failure rates were compared between pairs of cohorts for the full sample and for high-risk patients (age ≥65 and/or on Medicaid).Results|Among the 3994 study patients, the numbers of dispensed index prescriptions were 268 for amoxicillin/clavulanate, 1609 for azithromycin, 1460 for levofloxacin, and 657 for moxifloxacin. Unadjusted treatment failure rates for the sample were 20.8% for levofloxacin, 23.9% for amoxicillin/clavulanate, 23.9% for azithromycin, and 19.9% for moxifloxacin. For high-risk patients, unadjusted treatment failure rates were 19.1% for levofloxacin, 26.1% for amoxicillin/clavulanate, 26.3% for azithromycin, and 24.3% for moxifloxacin. Propensity score-matched treatment failure rates were significantly lower with levofloxacin than azithromycin (19.8% vs. 24.5%, odds ratio [OR] comparator vs. levofloxacin 1.38; 95% CI: 1.14, 1.67), a difference amplified in high-risk patients (19.0% vs. 26.4%, OR 1.61; 95% CI: 1.22, 2.13). No significant differences were observed for other paired comparisons.Conclusion|In a large US sample, treatment failure in CAP appeared to be less likely with quinolones (such as levofloxacin) than azithromycin, an effect particularly marked in high-risk patients (age ≥65 and/or on Medicaid).

Early and Late Treatment Failure in Community-Acquired Pneumonia

Treatment failure is a matter of great concern in the management of community-acquired pneumonia (CAP). Defined generally as lack of response or clinical deterioration, failure is considered early when it occurs within the first 72 hours and late when it occurs after 72 hours. The reported incidence of treatment failure among hospitalized patients with CAP ranges from 2.4 to 31% for early failure and from 3.9 to 11% for late failure. Most cases of early failure occur because of inadequate host-pathogen responses. Factors associated with treatment failure include high-risk pneumonia, liver disease, multilobar infiltrates, Legionella pneumonia, gram-negative pneumonia, pleural effusion, cavitation, leucopenia, and discordant antimicrobial therapy. Conversely, influenza vaccination, initial treatment with fluoroquinolones, and chronic obstructive pulmonary disease have been linked with a lower risk of failure. Treatment failure is associated with high morbidity and mortality rates. Its detection and management require careful clinical assessment. Certain serum biological markers may be helpful to identify patients with a higher risk of deterioration and poor prognosis. Because inadequate host-pathogen responses are responsible for a significant number of failures, strategies aimed at modulating the inflammatory response should be investigated. Discordant therapy can be prevented by rational application of the current antibiotic guidelines.

Treatment Failure in Community-Acquired Pneumonia

Treatment failure (TF) is defined as a clinical condition with inadequate response to antimicrobial therapy. Clinical response should be evaluated within the first 72 h of treatment, whereas infiltrate images may take up to 6 weeks to resolve. Early failure is considered when ventilatory support and/or septic shock appear within the first 72 h. The incidence of treatment failure in community-acquired pneumonia is 10 to 15%, and the mortality is increased nearly fivefold. Resistant and unusual microorganisms and noninfectious causes are responsible for TF. Risk factors are related to the initial severity of the disease, the presence of comorbidity, the microorganism involved, and the antimicrobial treatment implemented. Characteristics of patients and factors related to inflammatory response have been associated with delayed resolution and poor prognosis. The diagnostic approach to TF depends on the degree of clinical impact, host factors, and the possible cause. Initial reevaluation should include a confirmation of the diagnosis of pneumonia, noninvasive microbiological samples, and new radiographic studies. A conservative approach of clinical monitoring and serial radiographs may be recommended in elderly patients with comorbid conditions that justify a delayed response. Invasive studies with bronchoscopy to obtain protected brush specimen and BAL are indicated in the presence of clinical deterioration or failure to stabilize. BAL processing should include the study of cell patterns to rule out other noninfectious diseases and complete microbiological studies. The diagnostic yield of imaging procedures with noninvasive and invasive samples is up to 70%. After obtaining microbiological samples, an empirical change in antibiotic therapy is required to cover a wider microbial spectrum.

Bacteremic pneumococcal pneumonia associated with macrolide failure

Despite rising rates of macrolide resistance to Streptococcus pneumoniae, the current guidelines for outpatient treatment of community-acquired pneumonia include a macrolide as initial empiric therapy. There have only been a few previously documented cases of macrolide treatment failure in community-acquired pneumonia and there is controversy as to whether macrolide resistance in S. pneumoniae is clinically important. Reported here are two cases of community-acquired pneumonia caused by S. pneumoniae, one of which was fatal, that failed to respond to clarithromycin.

Macrolide Treatment Failure in Community-acquired Pneumonia and Associated Clinical Consequences

Macrolide Treatment Failure in Community-acquired Pneumonia and Associated Clinical Consequences

Community-acquired pneumonia: causes of treatment failure in patients enrolled in clinical trials

In order to determine the causes of treatment failure in community-acquired pneumonia (CAP) clinical trials, a MEDLINE search for all CAP studies published between 1990 and 1997 was performed. Prospective, randomized studies comparing the efficacy of two or more antibiotics in CAP were selected. Treatment failure was defined as persistent fever, deterioration of patient's condition, or a change in the prescribed antibiotic regimen. In 16% of the cases included in the clinical trials, the treatment of CAP is unsuccessful. A significant number of identified failure cases were owing to antibiotic side-effects. Resistant pathogens are an unusual cause of failure whatever the antibiotic used.

Azithromycin treatment failure in community-acquired pneumonia caused by Streptococcus pneumoniae resistant to macrolides by a 23S rRNA mutation

In this report, we describe an azithromycin treatment failure in community-acquired pneumonia. During the first three days of azithromycin, the patient’s symptoms worsened, and she was subsequently admitted to the hospital. Blood cultures were positive for a penicillin-susceptible, macrolide-resistant S. pneumoniae. DNA sequencing revealed an A2059G mutation in domain V of the 23S rRNA. To our knowledge, this is the first clinical report of an azithromycin failure in the treatment of S. pneumoniae resistant to macrolides by this mechanism.