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PubMed2005

[Microbiologic diagnosis of acute upper respiratory tract infections].

The main aim of the microbiological diagnosis is to detect the etiologic agent of an infection. In case of bacteria it means to check the susceptibility to antibiotics. It can be difficult to find the etiological agent of respiratory tract infections due to wide range of potential pathogens both viral and bacterial. Culture methods are the most frequently used while in case of atypical and viral pathogens rather serological methods based on specific antibody level checking are recommended. In high standard level laboratories molecular biology methods are more widely used. They allow to detect in short time the existence of typical bacteria like Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, atypical ones like Mycoplasma, Chlamydia, and viral pathogens like influenza virus, parainfluenza virus, adenovirus, RSV and rhinovirus. In fact it is very difficult in Poland to get access to high level laboratories for primary care physicians. This is the reason why the treatment of respiratory tract infections is mainly empirical and based on guidelines developed by experts.

Acute Disease↗
PubMed1994

Diffuse alveolar hemorrhage associated with Mycoplasma hominis respiratory tract infection in a bone marrow transplant recipient.

An 18-year-old woman developed respiratory distress and diffuse pulmonary infiltrates after allogeneic bone marrow transplantation. Bronchoalveolar lavage findings indicated diffuse alveolar hemorrhage. Cultures of the lavage fluid and the pharynx grew Mycoplasma species; the pharyngeal isolate was identified as Mycoplasma hominis. Mycoplasma hominis infection may have an etiologic role in diffuse alveolar hemorrhage.

Adolescent↗
PubMed2004

Serotypes of Haemophilus influenzae strains isolated from pediatric patients with respiratory tract infections.

Capsular serotypes of 122 respiratory Haemophilus influenzae strains were identified utilizing antigenic examinations (Slide Agglutination Test [SAT] and counter immuno-electrophoresis [CIE]), and PCR method. Results of the two methods were compared to find disagreement. Clinical and bacteriological characteristics of encapsulated strains were analyzed. By utilizing PCR assay, 3 (2.5%) serotype b, 1 (0.8%) serotype f and 118 (96.7%) non-typeable strains were found among 122 tested strains. Discrepancy between the results of antigenic examinations and PCR assay was found in one strain. That strain gave positive results by antigenic tests with capsular type c antiserum but it was determined to be capsular type f by PCR. No serotype b- strain was detected. All the encapsulated strains displayed biotype I. All the serotype b strains produced beta-lactamase, but none of those was sulbactam/ampicillin and amoxicillin/clavulanic acid resistant. The serotype f strain was beta-lactamase non-producing ampicillin susceptible. The patients suffered from respiratory infections due to encapsulated strains displayed safe clinical manifestations and good clinical responses to antibiotic treatments using beta-lactams. In pre-vaccination era, PCR is considered to be a useful method for determination of serotypes of respiratory H. influenzae, which may contribute to reducing a possibility of clonal transmission of serotype b strains among children community, which is one of the potential risk factors for pediatric invasive infections.

Adolescent↗
PubMed1981

[Clinical studies of cefoxitin for the treatment of chronic respiratory tract infections (author's transl)].

1. Serum and sputum concentrations of cefoxitin were measured at fixed intervals following a one hour drip infusion of 2 g to a total of three patients with chronic respiratory tract diseases. The peak levels in serum were found to be 142.1-273.6 microgram/ml at the end of the infusion and those in sputum were found to be 0.92-2.30 microgram/ml at 2 to 4 hours after initiation of the infusion. 2. Cefoxitin was administered to a total of five patients with chronic respiratory tract infections who had failed to respond to the previous treatments with conventional antibiotics. The results were that in one case the therapeutic effect was judged as excellent, in three cases as good, and in one case it was difficult to evaluate. In all cases, there was no significant abnormality indicative of side effects regarding clinical symptoms and laboratory tests of renal and hepatic functions. In a view of the findings stated above, it is considered that cefoxitin is a new antibiotic which can be used for the treatment of chronic respiratory tract infections.

Aged↗
PubMed2005

Human metapneumovirus-associated respiratory tract infections in the Republic of Ireland during the influenza season of 2003-2004.

Human metapneumovirus (hMPV) is a newly identified paramyxovirus that has been associated with respiratory tract illness in children aged < 5 years, the elderly, and immunocompromised patients. This study determined the frequency of respiratory tract infections (RTIs) associated with hMPV in the Republic of Ireland. Bronchoalveolar lavage (BAL) samples from 168 adult patients and respiratory specimens from 122 children aged < 5 years were collected between September 2003 and May 2004. The virus was detected by reverse-transcription (RT)-PCR using hMPV polymerase (L) and matrix (M)-specific primers in four (2.4%) of 171 BAL specimens obtained from 168 adults. No other respiratory virus was detected in these specimens, and no hMPV RNA was detected in respiratory specimens from children during the same time period. In all four adult cases, two of whom had underlying disease, hMPV was associated with mild, self-limiting upper RTIs. The most common clinical findings included fever (3/4 patients), cough (4/4) and rhinorrhoea (3/4). No patient died as a result of these RTI episodes. Phylogenetic analysis was performed using the amplified regions of the M and fusion (F) genes of hMPV. The Irish isolates belonged to cluster 1B, and did not show a separate Irish sub-lineage.

Adult↗
PubMed1999

Chlamydia trachomatis lower respiratory tract infection in infants.

Chlamydia trachomatis may be an important cause of lower respiratory tract infection (LRTI) in infants born to mothers amongst whom there is a high prevalence of sexually transmitted disease. A study of 100 ambulatory infants with signs of LRTI in South Africa showed that 6% had C. trachomatis infection. The majority of the infected infants had received chloramphenicol eye ointment as prophylaxis. Half had previously visited a health facility for the same illness but the infection has been misdiagnosed. Infants with C. trachomatis infection were According to the Centers for Disease Control (CDC) guidelines, 85% were younger than uninfected infants (mean (SD) age of 3.8 weeks (3.2) vs 8.7 weeks (5.4); p=0.03). Clinical signs significantly associated with chlamydial infection were the presence of eye discharge (p = 0.02) or conjunctivitis (p = 0.01). There was a greater rate of rhinorrhoea (p = 0.06) and wheeze (p = 0.03) amongst patients without chlamydial infection. H. influenzae, M. catarrhalis, S. pneumoniae, S. aureus and N. gonorrhoeae were cultured from five different patients infected with chlamydia. The majority of infants with chlamydial infection had mild disease requiring only outpatient anti- biotic therapy.

Chlamydia Infections↗
PubMed2004

Physician behaviour for antimicrobial prescribing for paediatric upper respiratory tract infections: a survey in general practice in Trinidad, West Indies.

BACKGROUND: Upper respiratory tract infections (URTIs) are among the most frequent reasons for physician office visits in paediatrics. Despite their predominant viral aetiology, URTIs continue to be treated with antimicrobials. We explored general practitioners' (GPs) prescribing behaviour for antimicrobials in children (< or = 16 years) with URTIs in Trinidad, using the guidelines from the Centers for Disease Control and Prevention (CDC) as a reference. METHODS: A cross-sectional study was conducted on 92 consenting GPs from the 109 contacted in Central and East Trinidad, between January to June 2003. Using a pilot-tested questionnaire, GPs identified the 5 most frequent URTIs they see in office and reported on their antimicrobial prescribing practices for these URTIs to trained research students. RESULTS: The 5 most frequent URTIs presenting in children in general practice, are the common cold, pharyngitis, tonsillitis, sinusitis and acute otitis media (AOM) in rank order. GPs prescribe at least 25 different antibiotics for these URTIs with significant associations for amoxicillin, co-amoxiclav, cefaclor, cefuroxime, erythromycin, clarithromycin and azithromycin (p < 0.001). Amoxicillin alone or with clavulanate was the most frequently prescribed antibiotic for all URTIs. Prescribing variations from the CDC recommendations were observed for all URTIs except for AOM (50%), the most common condition for antibiotics. Doctors practicing for >30 years were more likely to prescribe antibiotics for the common cold (p = 0.014). Severity (95.7%) and duration of illness (82.5%) influenced doctors' prescribing and over prescribing in general practice was attributed to parent demands (75%) and concern for secondary bacterial infections (70%). Physicians do not request laboratory investigations primarily because they are unnecessary (86%) and the waiting time for results is too long (51%). CONCLUSIONS: Antibiotics are over prescribed for paediatric URTIs in Trinidad and amoxicillin with co-amoxiclav were preferentially prescribed. Except for AOM, GPs' prescribing varied from the CDC guidelines for drug and duration. Physicians recognise antibiotics are overused and consider parents expecting antibiotics and a concern for secondary bacterial infections are prescribing pressures. Guidelines to manage URTIs, ongoing surveillance programs for antibiotic resistance, public health education on non-antibiotic strategies, and postgraduate education for rational pharmacotherapy in general practice would decrease inappropriate antibiotic use in URTIs.

Journal Article↗
PubMedDate not supplied

Severity assessment of lower respiratory tract infection in elderly patients in primary care.

BACKGROUND: Simple markers for evaluating the severity of lower respiratory tract infections (LRTI) in primary care are lacking. It is of value to examine whether the information available to the primary care physician during a patient's initial visit can be used to assess the severity of LRTI. METHODS: The associations between different baseline variables and outcomes (survival within or more than 30 days) were investigated prospectively in a series of 950 home-living patients 65 years or older with severe LRTI that their primary care physicians suspected to be pneumonia. RESULTS: Twenty-one men and 17 women died (4.1%) within 30 days. According to univariate analysis, the following parameters differed (P < .01) between the fatalities and survivors: acute aggravation of a coexisting illness, age, respiratory rate, white blood cell count, and C-reactive protein (CRP) level. According to Cox forward stepwise regression analysis (P = .01 for entry and.05 for removal), acute aggravation of a concurrent illness, respiratory rate (> or = 25/min), and CRP concentration (> or = 100 mg/L) were independently associated with death. The mortality rate was 2.2% if the patients had none or only 1 of the independent risk factors and 20% if they had all 3 risk factors. CONCLUSIONS: Preceding aggravation of a concurrent illness and respiratory rate of 25/min or higher, together with an elevated serum CRP level (> or = 100 mg/L), can be used as simple markers for identifying patients with the highest risk for LRTI and improve management decisions among elderly people in primary care.

Aged↗
PubMed2000

Bacterial agents of lower respiratory tract infections (LRTIs), beta-lactamase production, and resistance to antibiotics in elderly people. DEDALO Study Group.

This study determined the etiology of lower respiratory tract infections in the elderly and assessed whether the growth of beta-lactamase producing bacteria is particularly favoured in these patients. Between December 1998 and May 1999, 187 patients with community-acquired pneumonia (CAP), and 887 patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) were enrolled. The mean age was 74 years (range of 65-94 year). Sputum and bronchial aspirate for microbiological investigation were obtained. Besides organisms commonly involved in bacterial infections of the lower respiratory tract (i.e. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis), Enterobacteriaceae and Pseudomonas spp. were also found. A high percentage of these bacteria were beta-lactamase producers. These data along with the clinical presentation, severity of infection, and epidemiological knowledge, might represent a guide for the choice of empiric antimicrobial treatment.

Aged↗
PubMed1984

Upper respiratory tract infections and airway reactivity in normal and asthmatic subjects.

To assess the effect of an upper respiratory tract infection (URTI) on airway reactivity, histamine inhalation tests (HITs) were performed prospectively in 44 nonsmoking asthmatic (14) and nonasthmatic (30) volunteers. Fifteen of the subjects developed an URTI during the following 4 months. Pulmonary function-forced expiratory volume in one second (FEV1), maximal midexpiratory flow rates (MMEFR) and maximal flow at 50% vital capacity (V50), and HITs, were studied at onset and 2, 3, and 4 wk after infection. There were no significant changes in pulmonary function during the total study period. For the 15 subjects, the mean provocative concentration of histamine causing a 20% fall in FEV1, (PC20H) was 8.73 mg/ml prior to onset of URTI, and at 1, 2, 3, and 4 wk after URTI was 7.97, 8.68, 8.13, and 8.61 mg/ml. These were not significantly different for the group as a whole, nor for the subgroups of asthmatics and nonasthmatics. Small changes in PC20H outside the normal range of variability occurred in 5 of 15 subjects. These were short-lived and no predictive factor for change in PC20H was identified in this group. Thus, URTI was not associated with significant changes in PC20H in this group of asthmatic and nonasthmatic subjects.

Adult↗
PubMed1981

A combination of amoxicillin and clavulanic acid in the treatment of respiratory tract infections caused by amoxicillin-resistant haemophilus influenzae.

This study was undertaken to evaluate the efficacy of a fixed combination of amoxicillin and clavulanic acid in 33 patients with chronic or recurrent respiratory tract infections (R.T.I.), mainly bronchitis. In two patients bronchopneumonia was diagnosed, and in one cystic fibrosis. The patients were treated with 750 mg of the drug combination (500 mg amoxicillin/250 mg clavulanic acid) t. i. d. for seven or ten days. Good clinical success was obtained in 17 patients and a clear improvement in another eight. The most frequently isolated micro-organism was Haemophilus influenzae; of the 22 strains isolated, 20 were resistant to 2 mg/l amoxicillin but sensitive to the combination of 2 mg/l amoxicillin and 1 mg/l clavulanic acid. Side-effects were reported in nine patients; two patients discontinued treatment for this reason. Amoxicillin/clavulanic acid is a useful therapeutic addition to the existing forms of treatment for amoxicillin-resistant respiratory tract infections.

Aged↗
PubMed1997

Health care resource utilization and antimicrobial use in elderly patients with community-acquired lower respiratory tract infection who develop Clostridium difficile-associated diarrhoea.

We conducted a prospective observational study on the medical management and health service resource utilization associated with the hospital care of patients with community-acquired lower respiratory tract infection. Between January 1994 and June 1995, 28 such patients developed Clostridium difficile-associated diarrhoea; these 28 patients were matched with 56 age-matched patients, who were used as a control group in a comparative study. Progress during the first week after admission was similar as measured by fever days and pathology or radiology use. The use of iv cephalosporins (g/day) during the first week was greater in the group who developed C. difficile-associated diarrhoea than in controls. The length of hospital stay was 36.4 +/- 21.6 days in patients with C. difficile-associated diarrhoea compared with 19.8 +/- 13.3 days in controls. Cases also required more pathological and radiological tests and greater use of antimicrobials and other drugs; however, if pathology and radiology use was calculated per day of patient stay there was no difference between the two groups. When antimicrobial use was compared, controlling for the time taken until found to be C. difficile toxin positive, patients with C. difficile infection received more iv cefuroxime as well as more total cephalosporins, beta-lactams and macrolides measured in g/day. Interestingly, in this study we could not show an increased mortality associated with C. difficile diarrhoea despite obvious evidence of morbidity. The development of C. difficile-associated diarrhoea substantially increases health care resource utilization for individual patients who are admitted to hospital with lower respiratory tract infection.

Aged↗
PubMed1994

Intranasal monoclonal immunoglobulin A against respiratory syncytial virus protects against upper and lower respiratory tract infections in mice.

The role of secretory antibody in protection against respiratory syncytial virus (RSV) infection was examined by using monoclonal immunoglobulin A (IgA) antibody for intranasal passive immunization of mice. Eight anti-RSV IgA hybridomas were produced by fusing myeloma cells with lung lymphocytes from RSV-immunized mice. Five IgA antibodies recognized RSV strains of both the A and the B subgroups, and two of these neutralized virus in a plaque reduction assay. Monoclonal IgA antibody HNK20, which bound to F glycoprotein, was most effective, reducing plaques by 50% at a concentration of 0.1 microgram/ml for both subgroup A and subgroup B strains. HNK20 also neutralized all of eight clinical isolates of RSV tested. When delivered intranasally to mice 24 h prior to RSV challenge, HNK20 reduced virus titers in the lungs by nearly 100-fold. Maximal protection occurred at a dose of 0.5 mg/kg of body weight. Significant protection against lung infection was seen when the interval between antibody treatment and challenge was as long as 72 h. HNK20 also decreased virus titers in the nose approximately 10-fold when given 1 h, but not 24 h, before challenge. When mice were treated with HNK20 intranasally 3 days after challenge, viral titers were reduced in the lungs but not the nose. The results indicate that topical application of relatively small amounts of monoclonal IgA can protect against both upper and lower respiratory tract infections caused by RSV.

Animals↗
PubMed2005

Moxifloxacin in respiratory tract infections.

Moxifloxacin is a fourth-generation fluoroquinolone that has been shown to be effective against respiratory pathogens, including Gram-positive (Streptococcus pneumoniae), Gram-negative (Haemophilus influenzae, Moraxella catarrhalis), and atypical strains (Chlamydia pneumoniae, Mycoplasma pneumoniae), as well as multi-drug resistant S. pneumoniae, including strains resistant to penicillin, macrolides, tetracyclines, trimethoprim/sulfamethoxazole and some fluoroquinolones. Moxifloxacin is highly concentrated in lung tissue, and has demonstrated rapid eradication rates. The bioavailability and half-life of moxifloxacin provides potent bactericidal effects at a dose of 400mg/day. The ratio of the area under the concentration-time curve to MIC of moxifloxacin is the highest among the fluoroquinolones against S. pneumoniae. The clinical efficacy of moxifloxacin has been shown in controlled studies of community-acquired pneumonia (CAP), exacerbations of chronic bronchitis (CB) and acute bacterial rhinosinusitis. Moxifloxacin has demonstrated a faster resolution of symptoms in CAP and exacerbations of CB patients compared with first-line therapy. It has also demonstrated better eradication in exacerbations of CB compared with standard therapy, in particular the macrolides. Treatment guidelines should take into account the results of clinical trials with moxifloxacin in order to establish the role of this antimicrobial in the therapeutic arsenal against respiratory tract infections.

Aza Compounds↗
PubMed1997

[Etiology of acute lower respiratory tract infections among children younger than 5 years old in Santa Fe].

The etiology of acute lower respiratory tract infections (ARI) and nasopharyngeal bacterial carriage in children less than 5 years old living in Santa Fe city, Argentina, was studied. A total of 518 children were included in the study: 450 suffering from ARI and 68 asymptomatic children. Blood samples, pleural effusions and nasopharyngeal secretions (NS) were obtained from children for bacterial isolations. NS was also used for fluorescent antibody techniques, and serum samples were employed for detecting IgM anti Chlamydia trachomatis. A bacterial pathogen was isolated from blood in 6.2% (14/224) of the children with ARI. A total of 11 Streptococcus pneumoniae (five of them oxacillin resistant), two Haemophilus influenzae and one Staphylococcus aureus strains were isolated. The most frequently detected pathogen in the ARI group was respiratory syncytial virus (RSV). It was found in 23.3% (105/450) of the children with ARI. Among children with risk of Chlamydia trachomatis infection, 24% presented high titters of specific IgM antibodies. Main bacteria carried in NS in the ARI group were H.influenzae (31.6%) and S. pneumoniae (23.4%) while viridans streptococci (26.5%), H.influenzae (23.5%) and Moraxella catarrhalis (22.1%) were more frequently isolated from controls. The most common pneumococcal types were 14 and 7 and the main type of H.influenzae was b biotype I. During the period of this study, the susceptibility of the pneumococcal isolates to oxacillin decreased from 60% to 50.8%, and the H.influenzae susceptibility to ampicillin fell from 92.3% to 79%. All the H.influenzae type b isolations were susceptible to ampicillin.

Acute Disease↗
PubMedDate not supplied

Feasibility of a primary care intervention to decrease oral antibiotics for acute upper respiratory tract infections: A pilot study.

BACKGROUND: Antimicrobial resistance in common respiratory tract pathogens is a growing public health threat, especially in the southeastern United States. The excessive use of antibiotics for common infections is a major contributing factor in the emergence of antibiotic resistance. We report results from a multi-site outpatient pilot project in North Carolina to reduce antibiotic prescriptions for acute nonbacterial upper respiratory tract infections (URIs). METHODS: Primary care practices were provided education and symptom therapy kits for patients with URIs, as an alternative to antibiotics, in a project to reduce the overuse of antimicrobial therapy The feasibility of this approach was evaluated with interviews and surveys. A methodology for claims-based evaluation of intervention efficacy in reduction of antibiotics use was developed as part of this project. RESULTS: Of eight contacted practices, four agreed to participate and three participated fully. Physicians reported that symptom therapy kits were useful for patients with URIs and resulted in a meaningful change in antibiotic prescribing behaviors. A claims-based approach is a feasible and promising method to evaluate efficacy in subsequent post-pilot large-scale implementations. LIMITATIONS: Due to the small number of outpatient practices and the lack of controls in this pilot study, the efficacy of the intervention in reducing antibiotic use could not be determined. CONCLUSIONS: Education combined with symptom therapy kits as an alternative to oral antibiotics is a feasible intervention that warrants additional studies to evaluate the efficacy of this approach in the reduction of antibiotic use for URIs.

Administration, Oral↗
PubMed2006

Prevalence and influence of diagnostic tests for acute respiratory tract infections in primary care.

BACKGROUND: General practitioners (GPs) use diagnostic tests to help distinguish between viral and bacterial acute respiratory tract infections (ARTI). We investigated the prevalence of these tests, and how tests are associated with diagnosis, treatment and patient satisfaction. METHODS: As part of a clinical trial, 45 GPs screened 1108 patients with ARTI and collected information on signs and symptoms, diagnostic test results, and subsequent diagnosis and treatment. A sample of 636 patients was interviewed after 7 days and their opinions recorded. We used multivariate mixed models to estimate associations between the use of tests and (1) baseline characteristics, (2) subsequent antibiotic treatment, and (3) patient satisfaction. RESULTS: GPs carried out at least one test in 42% of the 1108 patients screened. The tests used were (percentage of patients): CRP (35%), leucocyte count (17%), rapid Strep A (9%), chest X-ray (5%), sinus X-ray (1%), and throat culture (1%). The use of tests was associated with increasing patient age, education, and degree of discomfort. Antibiotic therapy was strongly associated with a positive test, with odds ratios of 26 (95% CI, 10-67) for a CRP above 50 mg/l; 9.6 (95% CI, 3.6-26) for a leucocyte count above 10,000/microl; and 122 (4.4-3435) for a positive StrepA test. There was no evidence of an association between the use of tests and patient satisfaction. CONCLUSIONS: Nearly half of these patients with ARTI received a diagnostic test. Older patients, those with higher education and those in more discomfort were more likely to get tests. A positive test was strongly associated with antibiotic treatment.

Acute Disease↗
PubMed1999

Emergence of antibiotic resistance in upper and lower respiratory tract infections.

The increase in antibiotic resistance is of great concern to the medical community. The treatment of respiratory tract infections are significantly impacted by resistance, as 67% of antibiotic use in adults and 87% in children is for the treatment of such infections. The most common pathogens implicated in these infections are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, and isolates of all 3 have developed resistance to some of the antibiotics currently on the market. In 1997, one third of S. pneumoniae strains were classified as penicillin resistant, up to 50% of H. influenzae strains produced beta-lactamase, and all M. catarrhalis strains produced beta-lactamase. As resistance can vary with geographic region and specific populations, one way to determine the-most effective antibiotic for an infection is to ascertain the resistance pattern of these pathogens from local laboratories or national surveillance studies. Breakpoints using pharmacodynamic data based on drug concentration present for at least 40% of the dosing interval, or area under the serum concentration curve:minimum inhibitory concentration ratios have been valuable for comparing the activities of oral agents. Of the currently available beta-lactams and macrolides, only amoxicillin/clavulanate and daily intramuscular ceftriaxone are active against more than 90% of all 3 respiratory pathogens. Newer quinolones are also active against these pathogens, but overuse is very likely to result in rapid development of resistance, and their use should be reserved for patients with treatment failure or significant drug allergies.

Adult↗