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At least 397 records · Page 22Linked to original sources
PubMed1985

The emergence of resistance to beta-lactam antibiotics during treatment of Pseudomonas aeruginosa lower respiratory tract infections: is combination therapy the solution?

Treatment of Pseudomonas aeruginosa lower respiratory tract infections with beta-lactam antibiotics alone (beta-lactam monotherapy) has been thought to result in a high incidence of therapeutic failure due to the emergence of multiply-resistant strains on the basis of induction of a chromosomal beta-lactamase. Review of published experience in patients without granulocytopenia or cystic fibrosis suggests that favorable clinical responses can be obtained in 80-90% of cases, and bacteriological cures in 45-55%, using any of the newer beta-lactam antipseudomonal agents alone (data from cefsulodin, cefoperazone, azlocillin and piperacillin). Resistance develops in 30-40% of the infecting organisms, and is associated with treatment failure in 10-20% of cases (data from cefsulodin, ticarcillin and carbenicillin). Cross-resistance to other beta-lactams and to aminoglycosides can occur but seems unlikely to be on the basis of induction of a chromosomal beta-lactamase (data from cefsulodin). The addition of an aminoglycoside antibiotic (combination therapy) has been recommended to prevent these outcomes. Retrospective comparison with results obtained using combination therapy in patients without granulocytopenia or cystic fibrosis suggests that the addition of an aminoglycoside cannot be expected to prevent either the development of resistance or therapeutic failure (which are frequently unassociated). Treating every patient with a Pseudomonas aeruginosa lower respiratory tract infection with combination therapy will expose all of them to the toxicity of an aminoglycoside but will rarely repay this risk with the prevention of a multiply resistant strain or the salvage of a patient destined to fail beta-lactam monotherapy.

Aminoglycosides↗
PubMed1998

Upper respiratory tract infections in family practice.

The causative pathogens in the majority of mild to moderate upper respiratory tract infections are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Bacterial infections of the respiratory tract are often treated empirically; however, the recent increase in serious infections caused by S. pneumoniae and rising antimicrobial resistance rates have prompted experts to reevaluate the therapeutic approaches to treatment of these infections. Although amoxicillin continues to be considered a first line therapy, some situations warrant alternative therapies. Antimicrobial therapy must provide effective coverage of the potential pathogens, yet issues of compliance must also be addressed to ensure clinical success. Ease of administration, taste and the potential for adverse events are important considerations for the pediatric population. Clinical trials support the use of alternative therapies in the treatment of patients with upper respiratory tract infections.

Anti-Bacterial Agents↗
PubMed1990

Viral lower respiratory tract infections in Filipino children.

Viral causes of acute lower respiratory tract infection were studied prospectively between 15 June and 31 October 1984 in 312 Filipino children less than 5 years old living in periurban slums and middle-class housing. The cause was based on viral antigen detection, virus isolation, and antibody assays. There were 131 children (41.2%) who were admitted to the hospital, and 150 (47%) had an infiltrate on chest radiograph. A total of 198 viral infections were confirmed in 162 patients (51.9%), 42.3% with single viral infection and 9.6% with mixed (two or more) infection. The infections were measles (21.4%), influenza A (15.9%), parainfluenza types 1, 2, and 3 (8.8%), respiratory syncytial virus (7.1%), influenza B (5.8%), enteroviruses (5.1%), adenoviruses (3.9%), herpes simplex virus (1.6%), and cytomegalovirus (1.3%). Viral infections other than measles were seen in 39.7% of the cases. The presence of viral infection correlated with better nutritional status. Influenza A or B diagnosis was associated with mild forms of acute respiratory tract infection, measles and a preceding rash with severe disease.

Acute Disease↗
PubMed1996

Secretory immunoglobulin A increases during relaxation in children with and without recurrent upper respiratory tract infections.

A diminished mucosal concentration of secretory immunoglobulin A (sIgA) in the upper respiratory tract may increase susceptibility to colds and flu. The aim of the present study was to determine whether sIgA increases during relaxation in children aged between 8 and 12 years with recurrent upper respiratory tract infections. Forty-five healthy children and 45 children with 10 or more upper respiratory tract infections in the previous year were randomly assigned to one of three experimental conditions: relaxation with suggestions to increase immune system proteins, relaxation alone, or a control condition. Samples of saliva were obtained before and after each condition. The concentration of sIgA in the saliva samples was later determined by measuring the rate of precipitation of antigen-antibody complexes to known concentration of sIgA antigen. The concentration of sIgA increased in the relaxation conditions but not in the control condition. The sIgA/albumin ratio (a more specific measure of local mucosal immunity than concentration) increased during the relaxation-suggestion condition but not during the relaxation or control conditions; however, both the concentration of sIgA and the sIgA/albumin ratio increased in proportion to subjective relaxation ratings. Neither response differed between healthy children and children with recurrent infections. The findings indicate that a disturbance in mucosal immunity in children with recurrent colds and flu does not limit increases in sIgA during relaxation. Higher preinfection levels of sIgA correlate with resistance to upper respiratory tract infection, so enhancing the sIgA concentration with relaxation techniques may help children with recurrent infection problems.

Albumins↗
PubMed1992

[A study on in vitro antibacterial activity and clinical usefulness in respiratory tract infections of panipenem/betamipron, a newly synthesized carbapenem antibiotic].

Panipenem/betamipron (PAPM/BP) is a combination drug of PAPM, a new parenteral carbapenem antibiotic and BP, an amino acid derivative at a weight ratio of 1:1. Its in vitro antibacterial activities against clinically isolated respiratory pathogenic bacteria were determined. It was superior to imipenem (IPM) in the in vitro antibacterial activities against Haemophilus influenzae, Haemophilus parainfluenzae, Branhamella catarrhalis, Staphylococcus aureus including MRSA, Klebsiella pneumoniae, Serratia marcescens and Escherichia coli. PAPM had antibacterial activities almost equal to those of IPM against Streptococcus pneumoniae and Enterococcus spp. Against Pseudomonas aeruginosa, however, its antibacterial activity was about 1/4 that of IPM. The clinical usefulness of PAPM/BP was studied by dissolving it in a solution containing lactate and administering the solution by intravenous drip infusion to 12 cases of respiratory tract infections. Out of 11 cases with respiratory tract infections excluding cytomegalovirus pneumonia, the efficacy rate was 90.9%, with 4 cases of excellent and 6 cases of good responses. In terms of its bacteriological efficacies, eradication of pathogenic bacteria including super-infection were observed in 2 out of 4 strains, but 2 strains of P. aeruginosa remained unchanged. Six strains appeared as superinfected bacteria during and after administration of this preparation substituting original pathogens. Side-effects were not observed in the 12 cases, and in laboratory tests, slight transient increases of S-GOT and S-GPT were found in 1 case. In conclusion, PAPM/BP is a very useful parenteral antibiotic against respiratory tract infections and can be one of the drugs of the first choice.

Adult↗
PubMed2001

[Analysis of the risk factors and drug resistance of lower respiratory tract infection by Flavobacteria].

OBJECTIVE: To investigate risk factors of 26 cases with lower respiratory tract infection caused by Flavobacteria and its antimicrobial susceptibility in vitro. METHODS: Retrospective study of the clinical materials of 26 cases of lower respiratory tract infection caused by Flavobacteria. Antimicrobial susceptibility (MIC) was determined with the method of agar dilution. RESULTS: All of 26 cases suffered from underlying diseases, among them malignant tumors were most common (31%) illness. 50% of the cases were mixed infections. Risk factors of infections were application of multiple antibiotics (81%), host immune suppression (77%), invasive manasements (31%), and prolonged hospitalization. No specific clinical manifestations and chest X-ray appearance revealed. Isolates were highly resistant to most of antimicrobial agents. Ciprofloxacin, trimethoprim-sulfamethoxazole and piperacillin are the most sensitive agents. CONCLUSIONS: Lower respiratory tract infection caused by Flavobacteria developed most commonly in patients who suffered from various underlying diseases, immunodeficiency, and longtime antibiotic overuse. Clinical isolates were highly resistant to most kinds of antimicrobial agents.

Adolescent↗
PubMed1991

Upper respiratory tract infections in young children: duration of and frequency of complications.

This study was performed to determine the usual duration of community-acquired viral upper respiratory tract infections and the incidence of complications (otitis media/sinusitis) of these respiratory tract infections in infancy and early childhood. Children in various forms of child-care arrangements (home care, group care, and day care) were enrolled at birth and observed for 3 years. Families were telephoned every 2 weeks to record on a standardized form the type and severity of illnesses experienced during the previous interval. Only children remaining in their original child-care group for the entire study period were compared. The mean duration of an upper respiratory tract infection varied between 6.6 days (for 1- to 2-year-old children in home care) and 8.9 days (for children younger than 1 year in day care). The percentage of apparently simple upper respiratory tract infections that lasted more than 15 days ranged from 6.5% (for 1- to 3-year-old children in home care) to 13.1% (for 2- to 3-year-old children in day care). Children in day care were more likely than children in home care to have protracted respiratory symptoms. Of 2741 respiratory tract infections recorded for the 3-year period, 801 (29.2%) were complicated by otitis media. During the first 2 years of life, children in any type of day care were more likely than children in home care to have otitis media as a complication of upper respiratory tract infection. In year 3, the risk of otitis media was similar in all types of child care.

Age Factors↗
PubMed2005

Anesthetic management of the child with an upper respiratory tract infection.

PURPOSE OF REVIEW: The decision to proceed with anesthesia for the child with an upper respiratory tract infection is often difficult. Whereas most studies suggest that children who present for elective procedures with an upper respiratory tract infection are at increased risk of perioperative adverse events, these events are typically easy to recognize and treat. This review will discuss the current literature regarding outcome in children who present for elective surgery with an upper respiratory tract infection and suggests approaches to optimize their perioperative management. RECENT FINDINGS: Although the literature regarding this important topic has been slow to evolve, recent large-scale outcome studies have identified a number of factors that increase the risk of perioperative adverse events among children with upper respiratory tract infections. The significance of these findings will be discussed. SUMMARY: An understanding of the risk factors associated with administering anesthesia to the child with an upper respiratory tract infection is important in identifying elements of the preoperative assessment that merit attention and in optimizing the anesthetic plan as a means to limit any perioperative complications.

Journal Article↗
PubMed1997

Impact of HIV on mortality from acute lower respiratory tract infection in rural Zambia.

AIMS: To establish the prevalence and clinical correlates of HIV among children with acute lower respiratory tract infection. METHODS: Children admitted to a rural Zambian hospital were studied over an eight month period. The diagnosis of acute lower respiratory tract infection was made clinically, according to World Health Organisation (WHO) criteria. Clinicians, who were unaware of the children's HIV status, prescribed antibiotic and supportive treatment according to WHO guidelines. HIV status was established using the polymerase chain reaction (Amplicor HIV1, Roche) applied to dried blood spots. RESULTS: Acute lower respiratory tract infection was diagnosed in 132 children (median age 8 months, range 1 month to 4 years). The WHO criteria for severe or very severe pneumonia were met by 96/132 patients (73%) and 21 patients (16%) died. HIV dried blood spot PCR was positive in 14 cases (11%), of whom four fulfilled the WHO clinical case definition for paediatric AIDS and five died. The group as a whole were malnourished, but the HIV positive children were more severely malnourished (mean z score for weight = -3.01) than the HIV negative children (mean z score = -1.73, p < 0.001). The relative risk of death was 2.6 in the HIV positive group but this was not significant (p = 0.079). CONCLUSIONS: An important minority of children with acute lower respiratory tract infection in rural Zambia will be infected with HIV. However, most HIV positive children presenting with respiratory infection will survive given simple antibiotic and supportive treatment.

AIDS-Related Opportunistic Infections↗
PubMed1987

Serum IgG subclasses in patients with an increased susceptibility to respiratory tract infections.

Serum IgG subclass concentrations were assayed in 45 patients with chronic respiratory tract infections and 16 patients with recurrent acute respiratory tract infections. Eleven of these 61 patients, all but one with recurrent acute infections, were IgA-deficient but the remainder had normal or high serum immunoglobulin concentrations. Only 4% of patients with chronic infections were IgG2-deficient. The prevalence of IgG2 deficiency amongst patients with recurrent acute infections was greater (31%), but in most cases this appeared to be due to an association with IgA deficiency. Owing to the limits of assay sensitivity it was not possible to determine whether any patient was IgG4-deficient, but the number of sera with undetectable IgG4 was greater in patients with recurrent acute infections than in controls (37.5% vs 10%, p less than 0.01), although such patients were mainly those with IgA and IgG2 deficiency. None of the patients had IgG1 or IgG3 deficiency; in fact IgG3 concentrations were higher than those of controls in both groups of patients (p less than 0.001) and IgG1 concentrations were higher than those of controls in patients with recurrent infections (p less than 0.01). Thus, unequivocal IgG subclass deficiency is uncommon in non-IgA-deficient patients, but those with IgG2 deficiency may have an immune defect requiring further investigation.

Adult↗
PubMed2004

Seasonality of long term wheezing following respiratory syncytial virus lower respiratory tract infection.

BACKGROUND: It is well known that respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) is associated with subsequent wheezing episodes, but the precise natural course of wheezing following RSV LRTI is not known. This study aimed to determine the continuous development of wheezing following RSV LRTI in children up to the age of 3 years. METHODS: A prospective cohort study was performed in 140 hospitalised infants with RSV LRTI. Continuous follow up data were obtained with a unique log in which parents noted daily respiratory symptoms. RESULTS: A marked decrease in wheezing was seen during the first year of follow up. The burden of wheezing following RSV LRTI was observed during the winter season. Signs of airflow limitation during RSV LRTI were strongly associated with wheezing during the follow up period. Total and specific serum immunoglobulin E levels, patient eczema, and parental history of atopy were not associated with wheezing. CONCLUSIONS: Airway morbidity following RSV LRTI has a seasonal pattern, which suggests that viral upper respiratory tract infections are the predominant trigger for wheezing following RSV LRTI. There is a significant decrease in airway symptoms during the first 12 months after admission to hospital. Simple clinical variables, but not allergic risk factors, can predict the development of wheezing following RSV LRTI.

Child, Preschool↗
PubMed1984

[Clinical use of cefoxitin in respiratory tract infections].

Cefoxitin (CFX) was used in 9 patients who had respiratory tract infections and following results were obtained: CFX was used in 2 patients with acute pneumonia, 2 with lung abscess, 3 with a mixed infection of lung cancer, 1 with a mixed infection of pulmonary tuberculosis and 1 with empyema. The overall efficacy rate was 77.8%; results were excellent in 2, good in 5 and poor in 2. Bacteriologically, all strains except P. aeruginosa were eradicated after treatment. No side effects were observed. A slight transient elevation of transaminase was observed in 1 patient after doses of 4 approximately 8 g daily. From the above, CFX seems to be a useful and safe drug as an initial choice in the treatment of respiratory tract infections.

Adult↗
PubMed1999

What is the place of fluoroquinolones in the treatment of community-acquired respiratory tract infections?

The newest (third generation) fluoroquinolones are potentially useful agents in the management of community-acquired respiratory tract infections. This is mainly due to their increased activity against Streptococcuspneumoniae, a pathogen poorly susceptible to the second-generation compounds, and playing a major role in upper and lower respiratory tract infections. Also, their spectrum includes the other main pathogens involved in those infections, comprising Haemophilus influenzae and intracellular agents, against which the newest fluoroquinolones exhibit a similar activity to that of the previous compounds. The pharmacokinetic and pharmacodynamic properties of the newest quinolones make them suitable for effective therapy of lower respiratory tract infections. However, careful attention should be paid to the dose and dosing regimen of each compound in clinical usage in order to select the most adapted drug. In clinical trials, the fluoroquinolones have been shown to be at least as effective as the comparators in the treatment of community-acquired pneumonia, acute exacerbations of chronic bronchitis (AECB) or sinusitis, including documented pneumococcal infections. Their tolerance is generally considered to be good. The main question regarding the fluoroquinolones in the treatment of community-acquired respiratory tract infections is their role as first-line agents used in single drug therapy. Cost-effectiveness studies are needed to define this role further. Identification of subpopulations of patients at risk of being infected by penicillin-resistant pneumococci or Gram-negative bacilli who could benefit from a fluoroquinolone could be useful. Also, it must be considered that a large use of fluoroquinolones as first-line agents in very common infections such as AECB or sinusitis could contribute to the selection of bacteria, including S. pneumoniae, resistant to this class of antibiotics. Careful control of fluoroquinolone usage and development of bacterial resistance is of great importance.

Anti-Infective Agents↗
PubMed2002

The value of polymerase chain reaction for the diagnosis of viral respiratory tract infections in lung transplant recipients.

BACKGROUND: Respiratory viruses cause severe infections in lung transplant recipients, which require rapid and accurate diagnosis for appropriate management. OBJECTIVES: To evaluate the added benefit of a multiplex PCR for respiratory viruses (influenza [FLU] A and B, respiratory syncytial virus [RSV] A and B and parainfluenza virus [PIV] 1, 2, and 3) complementing rapid respiratory viral culture (RRV) and FLU-A antigen detection (EIA) in this transplant population. RESULTS: Over 6 months, 116 nasal washes and bronchoalveolar lavages, obtained from 72 lung transplant recipients with symptoms of upper or lower respiratory tract infections, were tested in real time by RRV and FLU-A EIA, and batched frozen by PCR. One or more methods recognized a respiratory virus in 31 (27%) specimens, including 15 FLU-A, nine RSV and seven PIV. PCR identified 26 of 31 positive samples demonstrating a sensitivity of 84%, higher than RRV (67%) or EIA (54%). PCR, RRV and EIA detected 60, 80 and 54%, respectively, FLU-A samples. PCR and RRV were equivalent for RSV-A, PIV-2 and 3, but PCR found a significantly higher number of RSV-B and PIV-1. CONCLUSIONS: These data indicate that routine use of PCR will enhance the number and speed with which viral respiratory tract infections are diagnosed in lung transplant recipients.

Adult↗
PubMed1985

Economic costs of respiratory tract infections in the United States.

To evaluate one aspect of the impact of respiratory tract infections in the United States, national survey data were used to estimate direct and indirect economic costs. Overall, upper and lower respiratory tract infections are estimated to be responsible for approximately $15 billion in direct treatment costs. Physician charges account for about one half and hospital care accounts for approximately one quarter of these costs. An estimated 1.25 million patients are hospitalized yearly for community-acquired respiratory tract infections, and charges for their care are projected to exceed $4 billion. Almost 300 thousand patients acquire nosocomial respiratory infections yearly, and charges for treating these infections are approximately $470 million. Although costs associated with hospital care are substantial, approximately $10 billion (67 percent of the total estimated cost of these infections) results from treatment of patients in ambulatory settings. It is not possible to calculate the full magnitude of the indirect costs of respiratory infections, but losses in income of employed persons who miss work because of infection are calculated to be more than $9 billion per year.

Ambulatory Care↗
PubMed1986

Use of bacterial antigen detection in the diagnosis of pediatric lower respiratory tract infections.

Two immunochemical methods were used to identify Haemophilus influenzae and Streptococcus pneumoniae capsular antigens in the urine and serum of 162 children with acute lower respiratory tract infection. These methods were compared with standard bacterial blood culture. Viral and mycoplasma cultures of respiratory secretions were obtained simultaneously to determine the frequency of antigenuria at the time of nonbacterial acute lower respiratory tract infection. Urine from groups of well children and children with acute otitis media was tested for capsular antigens to determine the incidence of antigenuria. Antigenuria was found in 24% of children 2 months to 18 years of age with acute lower respiratory tract infection compared with a 2% incidence of bacteremia. Antigenuria was found in 4% of asymptomatic children and 16% of children with acute otitis media. One third of children with symptoms of acute lower respiratory tract infection and viral isolates from the oropharynx had bacterial antigenuria. The sixfold increase in frequency of bacterial antigenuria in children at the time of lower respiratory symptoms suggests that bacterial acute lower respiratory tract infection may be more common than identified by traditional culture techniques. Because bacterial antigen may come from other sites such as the middle ear, further studies are needed to determine the role of antigen detection in the diagnosis of pediatric acute lower respiratory tract infection.

Acute Disease↗
PubMed2003

Infectious aetiologies in elderly patients hospitalised with non-pneumonic lower respiratory tract infection.

OBJECTIVE: to identify the infectious aetiologies of non-pneumonic lower respiratory tract infections in hospitalised elderly patients, and to characterise the patients in terms of demographic, clinical and therapeutic variables. DESIGN: a prospective, non-interventional, purely serologically based diagnostic study. SETTING: a tertiary university hospital in southern Israel. SUBJECTS: 133 elderly patients hospitalised for non-pneumonic lower respiratory tract infections. METHODS: paired sera were obtained for each of the hospitalisations and were tested using immunofluorescence or enzyme immunoassay methods to identify 13 different pathogens. Only significant changes in antibody titers or levels between the paired sera were considered diagnostic. RESULTS: at least one infectious aetiology was identified in 77 patients (58%). At least one of seven viral aetiologies was identified in 52 patients (39%). A bacterial aetiology was identified in 27 patients (20%) including Streptococcus pneumoniae in 24 (18%). An atypical bacterium was found in 27 patients (20%) including Mycoplasma pneumoniae in 15 (11%) and Legionella spp. in nine (7%). More than one aetiology was found in 23 patients (17%). One hundred and twenty nine patients (96%) suffered from serious chronic co-morbidity. One hundred and twenty one patients received antibiotics during their hospitalisation, 106 (80%) with a beta-lactam and 42 (31%) with another antibiotic. CONCLUSIONS: non-pneumonic lower respiratory tract infection is caused in hospitalised elderly patients by a broad spectrum of aetiological agents, primarily respiratory viruses with a significant, though lesser, prevalence of classical and atypical bacteria. Despite this distribution of aetiologies, most patients are treated with beta-lactam antibiotics. The indication for antibiotic therapy in these patients and the choice of antibiotic preparation should be addressed in further studies.

Aged↗
PubMed1995

[Evaluation of conventional and new generation tests for testing the humeral response to Mycoplasma pneumoniae antigens in natural infections in humans. II. Occurrence and level of mycoplasma antibodies in patients with respiratory tract infections].

The aim of the study was to observe the frequency of occurrence of mycoplasmal antibodies detected by the complement fixation test (CFT), immunoelectroprecipitation test (IEPT) and ELISA in selected groups of patients with respiratory tract infections and to determine the dependence of these antibodies on the age of patients and length of illness. 521 serum samples collected from 404 persons were examined; 378 samples were obtained from 276 patients with pneumonia and 143 from 128 patients with upper respiratory tract infections. Additionally, serum samples from 50 patients with B. pertussis were investigated in this section of the study as a control test to demonstrate the specificity of the tests. It was established that in patients with pneumonia mycoplasmal antibodies are, as a rule, detected in much higher titers than in patients with upper respiratory tract infections. On with age, the level of mycoplasmal antibodies detected in all the three tests rose in the examined patients. In the highest titers antibodies against M. pneumoniae were detected in adults within the age 21-50. As a rule mycoplasmal IgM antibodies reached a level 2-3 times higher than IgG antibodies. It was also shown that already during the first week of illness antibodies against M. pneumoniae determined by the CFT, IEPT and ELISA in the sera of the examined persons are higher than the level known to be diagnostically significant. During the second week of illness IgA and IgM antibodies have a particularly high titer while the growth of titer of IgG antibodies is relatively small. A very high level of IgM, along with progressive growth of IgG antibodies and the related gradual decrease of the index value IgM/IgG, was observed in the serum of patients up to the 4th week of illness. In some cases, in titer known to be diagnostically significant, this high level was present even many months after the appearance of disease symptoms. Antibodies against M. pneumoniae in class of immunoglobulin A disappeared the fastest. Thus it is believed that demonstrating their characteristics dynamics or detecting these antibodies in the patient's serum in the titer assumed to be diagnostically significant can indicate an acute stage of illness.

Adolescent↗