1
|
Hovind MJ, Berdal JE, Dalgard O, Lyngbakken MN. Impact of antibiotic therapy in patients with respiratory viral infections: a retrospective cohort study. Infect Dis (Lond) 2024; 56:1031-1039. [PMID: 39042560 DOI: 10.1080/23744235.2024.2375592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/17/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVES The impact of antibiotics in patients with positive polymerase chain reaction (PCR) for respiratory viruses without evidence of a respiratory bacterial co-infection is largely unknown. The aim of this study was to assess the association of antibiotics on 30-day mortality and length of hospital stay in patients with an acute respiratory infection and PCR documented presence of respiratory viruses. METHODS We conducted a retrospective cohort study of adult patients admitted to hospital between 2012 and 2021 with positive PCR for influenza virus (H3N2, H1N1, influenza B), respiratory syncytial virus, human metapneumovirus or severe acute respiratory syndrome coronavirus 2. We used logistic regression, the Kaplan-Meier estimator and Poisson's regression to assess the impact of antibiotic therapy on outcomes. RESULTS Among 3979 patients, 67.7% received antibiotics. In adjusted analyses, antibiotics initiated in the emergency department (adjusted OR 1.23, 95% CI 0.77-1.96) and days of antibiotic therapy (adjusted OR per day of therapy 0.98, 95% CI 0.95-1.00) had no significant impact on mortality, whereas antibiotics initiated later during admission (adjusted OR 2.25, 95% CI 1.26-4.02) was associated with increased mortality. Patients prescribed antibiotics had longer duration of hospital admission. CONCLUSIONS We observed no protective association between in-hospital antibiotic therapy and outcomes, suggesting overuse of antibiotics in respiratory infections with proven respiratory viruses. A restrictive antibiotic strategy may be warranted.
Collapse
Affiliation(s)
- M J Hovind
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - J E Berdal
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - O Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - M N Lyngbakken
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
2
|
Al-Dorzi HM, Alsafwani ZA, Alsalahi E, Aljulayfi AS, Alshaer R, Alanazi S, Aldossari MA, Alsahoo DA, Khan R. Patients with influenza admitted to a tertiary-care hospital in Riyadh between 2018 and 2022: characteristics, outcomes and factors associated with ICU admission and mortality. BMC Pulm Med 2024; 24:464. [PMID: 39300448 DOI: 10.1186/s12890-024-03281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Influenza is a common cause of hospital admissions globally with regional variations in epidemiology and clinical profile. We evaluated the characteristics and outcomes of patients with influenza admitted to a tertiary-care center in Riyadh, Saudi Arabia. METHODS This was a retrospective cohort of adult patients admitted with polymerase chain reaction-confirmed influenza to King Abdulaziz Medical City-Riyadh between January 1, 2018, and May 31, 2022. We compared patients who required intensive care unit (ICU) admission to those who did not and performed multivariable logistic regression to assess the predictors of ICU admission and hospital mortality. RESULTS During the study period, 675 adult patients were hospitalized with influenza (median age 68.0 years, females 53.8%, hypertension 59.9%, diabetes 55.1%, and chronic respiratory disease 31.1%). Most admissions (83.0%) were in the colder months (October to March) in Riyadh with inter-seasonal cases even in the summertime (June to August). Influenza A was responsible for 79.0% of cases, with H3N2 and H1N1 subtypes commonly circulating in the study period. Respiratory viral coinfection occurred in 12 patients (1.8%) and bacterial coinfection in 42 patients (17.4%). 151 patients (22.4%) required ICU admission, of which 62.3% received vasopressors and 48.0% mechanical ventilation. Risk factors for ICU admission were younger age, hypertension, bilateral lung infiltrates on chest X-ray, and Pneumonia Severity Index. The overall hospital mortality was 7.4% (22.5% for ICU patients, p < 0.0001). Mortality was 45.0% in patients with bacterial coinfection, 30.9% in those requiring vasopressors, and 29.2% in those who received mechanical ventilation. Female sex (odds ratio [OR], 2.096; 95% confidence interval [CI] 1.070, 4.104), ischemic heart disease (OR, 3.053; 95% CI 1.457, 6.394), immunosuppressed state (OR, 7.102; 95% CI 1.803, 27.975), Pneumonia Severity Index (OR, 1.029; 95% CI, 1.017, 1.041), leukocyte count and serum lactate level (OR, 1.394; 95% CI, 1.163, 1.671) were independently associated with hospital mortality. CONCLUSIONS Influenza followed a seasonal pattern in Saudi Arabia, with H3N2 and H1N1 being the predominant circulating strains during the study period. ICU admission was required for > 20%. Female sex, high Pneumonia Severity Index, ischemic heart disease, and immunosuppressed state were associated with increased mortality.
Collapse
Affiliation(s)
- Hasan M Al-Dorzi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, ICU2, Mail Code 1425, PO Box 22490, Riyadh, 11426, Saudi Arabia.
| | - Zahra A Alsafwani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Elham Alsalahi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Alaa S Aljulayfi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Roa Alshaer
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Salam Alanazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Munira A Aldossari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Deem A Alsahoo
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Raymond Khan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, ICU2, Mail Code 1425, PO Box 22490, Riyadh, 11426, Saudi Arabia
| |
Collapse
|
3
|
Zhao M, Zhang B, Yan M, Zhao Z. Development and validation of a nomogram to predict severe influenza. Immun Inflamm Dis 2024; 12:e70026. [PMID: 39340342 PMCID: PMC11437489 DOI: 10.1002/iid3.70026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 09/09/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Influenza is an acute respiratory disease posing significant harm to human health. Early prediction and intervention in patients at risk of developing severe influenza can significantly decrease mortality. METHOD A comprehensive analysis of 146 patients with influenza was conducted using the Gene Expression Omnibus (GEO) database. We assessed the relationship between severe influenza and patients' clinical information and molecular characteristics. First, the variables of differentially expressed genes were selected using R software. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analysis were performed to investigate the association between clinical information and molecular characteristics and severe influenza. A nomogram was developed to predict the presence of severe influenza. At the same time, the concordance index (C-index) is adopted area under the receiver operating characteristic (ROC), area under the curve (AUC), decision curve analysis (DCA), and calibration curve to evaluate the predictive ability of the model and its clinical application. RESULTS Severe influenza was identified in 47 of 146 patients (32.20%) and was significantly related to age and duration of illness. Multivariate logistic regression demonstrated significant correlations between severe influenza and myloperoxidase (MPO) level, haptoglobin (HP) level, and duration of illness. A nomogram was formulated based on MPO level, HP level, and duration of illness. This model produced a C-index of 0.904 and AUC of 0.904. CONCLUSIONS A nomogram based on the expression levels of MPO, HP, and duration of illness is an efficient model for the early identification of patients with severe influenza. These results will be useful in guiding prevention and treatment for severe influenza disease.
Collapse
Affiliation(s)
- Mingzhen Zhao
- Pulmonary and Critical Care MedicineAffiliated Hospital of Chengde Medical UniversityChengdeHebeiChina
| | - Bo Zhang
- Pulmonary and Critical Care MedicineAffiliated Hospital of Chengde Medical UniversityChengdeHebeiChina
| | - Mingjun Yan
- Pulmonary and Critical Care MedicineAffiliated Hospital of Chengde Medical UniversityChengdeHebeiChina
| | - Zhiwei Zhao
- Pulmonary and Critical Care MedicineAffiliated Hospital of Chengde Medical UniversityChengdeHebeiChina
| |
Collapse
|
4
|
Tang S, De Jesus AC, Chavez D, Suthakaran S, Moore SK, Suthakaran K, Homami S, Rathnasinghe R, May AJ, Schotsaert M, Britto CJ, Bhattacharya J, Hook JL. Rescue of alveolar wall liquid secretion blocks fatal lung injury due to influenza-staphylococcal coinfection. J Clin Invest 2023; 133:e163402. [PMID: 37581936 PMCID: PMC10541650 DOI: 10.1172/jci163402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/10/2023] [Indexed: 08/17/2023] Open
Abstract
Secondary lung infection by inhaled Staphylococcus aureus (SA) is a common and lethal event for individuals infected with influenza A virus (IAV). How IAV disrupts host defense to promote SA infection in lung alveoli, where fatal lung injury occurs, is not known. We addressed this issue using real-time determinations of alveolar responses to IAV in live, intact, perfused lungs. Our findings show that IAV infection blocked defensive alveolar wall liquid (AWL) secretion and induced airspace liquid absorption, thereby reversing normal alveolar liquid dynamics and inhibiting alveolar clearance of inhaled SA. Loss of AWL secretion resulted from inhibition of the cystic fibrosis transmembrane conductance regulator (CFTR) ion channel in the alveolar epithelium, and airspace liquid absorption was caused by stimulation of the alveolar epithelial Na+ channel (ENaC). Loss of AWL secretion promoted alveolar stabilization of inhaled SA, but rescue of AWL secretion protected against alveolar SA stabilization and fatal SA-induced lung injury in IAV-infected mice. These findings reveal a central role for AWL secretion in alveolar defense against inhaled SA and identify AWL inhibition as a critical mechanism of IAV lung pathogenesis. AWL rescue may represent a new therapeutic approach for IAV-SA coinfection.
Collapse
Affiliation(s)
- Stephanie Tang
- Lung Imaging Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
- Graduate School of Biomedical Sciences
| | - Ana Cassandra De Jesus
- Lung Imaging Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
| | - Deebly Chavez
- Lung Imaging Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
| | - Sayahi Suthakaran
- Lung Imaging Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
- Graduate School of Biomedical Sciences
| | - Sarah K.L. Moore
- Lung Imaging Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
| | - Keshon Suthakaran
- Lung Imaging Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
| | - Sonya Homami
- Lung Imaging Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
- Graduate School of Biomedical Sciences
| | - Raveen Rathnasinghe
- Graduate School of Biomedical Sciences
- Global Health and Emerging Pathogens Institute, Department of Microbiology
| | - Alison J. May
- Department of Cell, Developmental and Regenerative Biology
- Department of Otolaryngology, and
- Institute of Regenerative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Schotsaert
- Global Health and Emerging Pathogens Institute, Department of Microbiology
| | - Clemente J. Britto
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jahar Bhattacharya
- Departments of Medicine and Physiology and Cellular Biophysics, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Jaime L. Hook
- Lung Imaging Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
- Global Health and Emerging Pathogens Institute, Department of Microbiology
| |
Collapse
|
5
|
Ruiz-Spinelli A, Waterer G, Rello J. Severe community-acquired pneumonia in the post COVID-19 era. Curr Opin Crit Care 2023; 29:400-406. [PMID: 37641523 DOI: 10.1097/mcc.0000000000001083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW The aim was to examine and summarize the most recent published literature in the last years stating the advances for treatment options and adjunctive therapies in patients hospitalized with severe community-acquired pneumonia (sCAP). Search was performed in PubMed, including observational studies, randomized controlled trials, systematic reviews and meta-analyses, and international guidelines. RECENT FINDINGS Regardless of a large number of published CAP guidelines, most of their recommendations are based on low-level evidence.Viruses have an increasing role as sCAP etiology with an impact on mortality. Accordingly, it is imperative to strengthen the demand for vaccines and newer antivirals. Considering an early monitoring of the immune response in patients with severe Influenza, may help to evaluate a personalized immunomodulatory strategy. Despite growing evidence, the use of corticosteroids as an adjunctive therapy in bacterial sCAP continues to be controversial. SUMMARY Mortality due to sCAP still remains undesirably high. This fact strengthens the need for more high-quality research to increase evidence. It also highlights the need for clinicians to be aware of the level of evidence of the stated recommendations, taking this into consideration before decision making.
Collapse
Affiliation(s)
- Alfonsina Ruiz-Spinelli
- Intensive Care Unit, Department of Critical Care, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Department of Medicine, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Grant Waterer
- Respiratory Department, University of Western Australia, Royal Perth Hospital, Perth, Australia
| | - Jordi Rello
- Global Health eCore, Vall d'Hebron Institute of Research (VHIR), Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Unité de Recherche FOVERA, Réanimation Douleur Urgences, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| |
Collapse
|
6
|
Little JS, Tandon M, Hong JS, Nadeem O, Sperling AS, Raje N, Munshi N, Frigault M, Barmettler S, Hammond SP. Respiratory infections predominate after day 100 following B-cell maturation antigen-directed CAR T-cell therapy. Blood Adv 2023; 7:5485-5495. [PMID: 37486599 PMCID: PMC10514400 DOI: 10.1182/bloodadvances.2023010524] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023] Open
Abstract
Infections are an important complication after B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T-cell therapy and risks may differ between the early and late periods. We evaluated infections in 99 adults who received a first BCMA-directed CAR T-cell therapy (commercial and investigational autologous BCMA CAR T-cell products at the recommended phase 2 dose) for relapsed/refractory multiple myeloma between November 2016 and May 2022. Infections were recorded until day 365, if patients experienced symptoms with a microbiologic diagnosis, or for symptomatic site-specific infections treated with antimicrobials. One-year cumulative incidence functions were calculated based on time to first respiratory infection using dates of infection-free death and receipt of additional antineoplastic therapies as competing risks. Secondary analysis evaluated risk factors for late respiratory infections using univariate and multivariable Cox regression models. Thirty-seven patients (37%) experienced 64 infectious events over the first year after BCMA-directed CAR T-cell therapy, with 42 early infectious events (days, 0-100), and 22 late infectious events (days, 101-365). Respiratory infections were the most common site-specific infection and the relative proportion of respiratory infections increased in the late period (31% of early events vs 77% of late events). On multivariable analysis, hypogammaglobulinemia (hazard ratio [HR], 6.06; P = .044) and diagnosis of an early respiratory viral infection (HR, 2.95; P = .048) were independent risk factors for late respiratory infection. Respiratory infections predominate after BCMA CAR T-cell therapy, particularly after day 100. Hypogammaglobulinemia and diagnosis of an early respiratory infection are risk factors for late respiratory infections that may be used to guide targeted preventive strategies.
Collapse
Affiliation(s)
- Jessica S. Little
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Megha Tandon
- Harvard Medical School, Boston, MA
- Division of Allergy and Immunology, Massachusetts General Hospital, Boston, MA
| | - Joseph Seungpyo Hong
- Harvard Medical School, Boston, MA
- Division of Allergy and Immunology, Massachusetts General Hospital, Boston, MA
| | - Omar Nadeem
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | - Adam S. Sperling
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
- Division of Hematology, Brigham and Women’s Hospital, Boston, MA
| | - Noopur Raje
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Nikhil Munshi
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | - Matthew Frigault
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Sara Barmettler
- Harvard Medical School, Boston, MA
- Division of Allergy and Immunology, Massachusetts General Hospital, Boston, MA
| | - Sarah P. Hammond
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
- Massachusetts General Hospital Cancer Center, Boston, MA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
7
|
Li Y, Yang Y, Chen D, Wang Y, Zhang X, Li W, Chen S, Wong SM, Shen M, Akerley BJ, Shen H. Memory Th17 cell-mediated protection against lethal secondary pneumococcal pneumonia following influenza infection. mBio 2023; 14:e0051923. [PMID: 37222516 PMCID: PMC10470593 DOI: 10.1128/mbio.00519-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/11/2023] [Indexed: 05/25/2023] Open
Abstract
Streptococcus pneumoniae (Sp) frequently causes secondary pneumonia after influenza A virus (IAV) infection, leading to high morbidity and mortality worldwide. Concomitant pneumococcal and influenza vaccination improves protection against coinfection but does not always yield complete protection. Impaired innate and adaptive immune responses have been associated with attenuated bacterial clearance in influenza virus-infected hosts. In this study, we showed that preceding low-dose IAV infection caused persistent Sp infection and suppression of bacteria-specific T-helper type 17 (Th17) responses in mice. Prior Sp infection protected against subsequent IAV/Sp coinfection by improving bacterial clearance and rescuing bacteria-specific Th17 responses in the lungs. Furthermore, blockade of IL-17A by anti-IL-17A antibodies abrogated the protective effect of Sp preinfection. Importantly, memory Th17 responses induced by Sp preinfection overcame viral-driven Th17 inhibition and provided cross-protection against different Sp serotypes following coinfection with IAV. These results indicate that bacteria-specific Th17 memory cells play a key role in providing protection against IAV/Sp coinfection in a serotype-independent manner and suggest that a Th17-based vaccine would have excellent potential to mitigate disease caused by coinfection. IMPORTANCE Streptococcus pneumoniae (Sp) frequently causes secondary bacterial pneumonia after influenza A virus (IAV) infection, leading to increased morbidity and mortality worldwide. Current pneumococcal vaccines induce highly strain-specific antibody responses and provide limited protection against IAV/Sp coinfection. Th17 responses are broadly protective against Sp single infection, but whether the Th17 response, which is dramatically impaired by IAV infection in naïve mice, might be effective in immunization-induced protection against pneumonia caused by coinfection is not known. In this study, we have revealed that Sp-specific memory Th17 cells rescue IAV-driven inhibition and provide cross-protection against subsequent lethal coinfection with IAV and different Sp serotypes. These results indicate that a Th17-based vaccine would have excellent potential to mitigate disease caused by IAV/Sp coinfection.
Collapse
Affiliation(s)
- Yong Li
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Shanghai Institute of Immunology, Shanghai Jiaotong University, Shanghai, China
| | - Ying Yang
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dafan Chen
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Wang
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Xinyun Zhang
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenchao Li
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Shengsen Chen
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Sandy M. Wong
- Department of Microbiology and Immunology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Mengwen Shen
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Emergency Medical, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Brian J. Akerley
- Department of Cell and Molecular Biology, Center for Immunology and Microbial Research, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Hao Shen
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
8
|
Earnhardt EY, Tipper JL, D’Mello A, Jian MY, Conway ES, Mobley JA, Orihuela CJ, Tettelin H, Harrod KS. Influenza A-induced cystic fibrosis transmembrane conductance regulator dysfunction increases susceptibility to Streptococcus pneumoniae. JCI Insight 2023; 8:e170022. [PMID: 37318849 PMCID: PMC10443798 DOI: 10.1172/jci.insight.170022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/13/2023] [Indexed: 06/17/2023] Open
Abstract
Influenza A virus (IAV) infection is commonly complicated by secondary bacterial infections that lead to increased morbidity and mortality. Our recent work demonstrates that IAV disrupts airway homeostasis, leading to airway pathophysiology resembling cystic fibrosis disease through diminished cystic fibrosis transmembrane conductance regulator (CFTR) function. Here, we use human airway organotypic cultures to investigate how IAV alters the airway microenvironment to increase susceptibility to secondary infection with Streptococcus pneumoniae (Spn). We observed that IAV-induced CFTR dysfunction and airway surface liquid acidification is central to increasing susceptibility to Spn. Additionally, we observed that IAV induced profound transcriptional changes in the airway epithelium and proteomic changes in the airway surface liquid in both CFTR-dependent and -independent manners. These changes correspond to multiple diminished host defense pathways and altered airway epithelial function. Collectively, these findings highlight both the importance of CFTR function during infectious challenge and demonstrate a central role for the lung epithelium in secondary bacterial infections following IAV.
Collapse
Affiliation(s)
- Erin Y. Earnhardt
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer L. Tipper
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adonis D’Mello
- Department of Microbiology and Immunology, Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ming-Yuan Jian
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elijah S. Conway
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James A. Mobley
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Carlos J. Orihuela
- Department of Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hervé Tettelin
- Department of Microbiology and Immunology, Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kevin S. Harrod
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
9
|
Gao CA, Pickens CI, Morales-Nebreda L, Wunderink RG. Clinical Features of COVID-19 and Differentiation from Other Causes of CAP. Semin Respir Crit Care Med 2023; 44:8-20. [PMID: 36646082 DOI: 10.1055/s-0042-1759889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality, one of the most common reasons for infection-related death worldwide. Causes of CAP include numerous viral, bacterial, and fungal pathogens, though frequently no specific organism is found. Beginning in 2019, the COVID-19 pandemic has caused incredible morbidity and mortality. COVID-19 has many features typical of CAP such as fever, respiratory distress, and cough, and can be difficult to distinguish from other types of CAP. Here, we highlight unique clinical features of COVID-19 pneumonia such as olfactory and gustatory dysfunction, lymphopenia, and distinct imaging appearance.
Collapse
Affiliation(s)
- Catherine A Gao
- Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Chiagozie I Pickens
- Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Luisa Morales-Nebreda
- Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
10
|
Song J, Zhao J, Cai X, Qin S, Chen Z, Huang X, Li R, Wang Y, Wang X. Lianhuaqingwen capsule inhibits non-lethal doses of influenza virus-induced secondary Staphylococcus aureus infection in mice. JOURNAL OF ETHNOPHARMACOLOGY 2022; 298:115653. [PMID: 35995276 DOI: 10.1016/j.jep.2022.115653] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/07/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Lianhuaqingwen capsule (LH-C) is a traditional Chinese medicine (TCM), consisting of two prescriptions, Ma-xing-shi-gan-tang (MXSGT) and Yinqiao San. It has been proven to have antiviral, antibacterial, and immunomodulatory effects in recent years. Clinically, it is commonly used in the treatment of respiratory tract infections. AIM OF THE STUDY It was demonstrated in our previous studies that LH-C has an effect of antivirus and inhibits influenza virus-induced bacterial adhesion to respiratory epithelial cells through down-regulation of cell adhesion molecules in vitro. However, LH-C's effect against influenza-induced secondary bacterial infection in animal studies remains unclear. Therefore, in the present study, we established a mouse model of infection with non-lethal doses of influenza virus(H1N1) and secondary infection of Staphylococcus aureus (S. aureus), to investigate the potential effects of LH-C. METHODS Experiments were carried out on BALB/c mice infecting non-lethal doses of H1N1 and non-lethal doses of S. aureus, and the viral, and bacterial doses were determined by observing and recording changes in the body weight, mortality, and pathological changes. Moreover, after LH-C treatment, the survival rate, body weight, lung index, viral titers, bacterial colonies, pathological changes, and the inflammatory cytokines in the mouse model have all been systematically determined. RESULTS In the superinfection models of H1N1 and S. aureus, the mortality rate was 100% in groups of mice infected with 20 PFU/50 μL of H1N1 and 105 CFU/mL of S. aureus, 20 PFU/50 μL of H1N1 and 106 CFU/mL of S. aureus, 4 PFU/50 μL of H1N1 and 106 CFU/mL of S. aureus. The mortality rate was 50% in the group of mice infected with 4 PFU/50 μL of H1N1 and 105 CFU/mL of S. aureus. The mortality rate was 37.5% in the group of mice infected with 20 PFU/50 μL of H1N1 alone and in the group of mice infected with 2 PFU/50 μL of H1N1 and 106 CFU/mL of S. aureus. The mortality rate in the group of mice infected with 2 PFU/50 μL of H1N1 and 106 CFU/mL of S. aureus was 30%. The infected mice of 2 PFU/50 μL of H1N1 and 106 CFU/mL of S. aureus had a weight loss of nearly 10%. About the histopathological changes in the lung tissue of infection mice, severe lung lesions were found in the superinfection models. LH-C improved survival in the superinfected mice, significantly reduced lung index, lowered viral titers and bacterial loads, and alleviated lung damage. It reduced lung inflammation by down-regulating mRNA expression levels of inflammatory mediators like IL-6, IL-1β, IL-10, TNF-α, IFN-β, MCP-1, and RANTES. CONCLUSIONS We found that superinfection from non-lethal doses of S. aureus following non-lethal doses of H1N1 was equally fatal in mice, confirming the severity of secondary infections. The ability of LH-C to alleviate lung injury resulting from secondary S. aureus infection induced by H1N1 was confirmed. These findings provided a further assessment of LH-C, suggesting that LH-C may have good therapeutic efficacy in influenza secondary bacterial infection disease.
Collapse
Affiliation(s)
- Jian Song
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jin Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xuejun Cai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shengle Qin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zexin Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaodong Huang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Runfeng Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yutao Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Xinhua Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China; Institute of Integration of Traditional and Western Medicine, Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
11
|
Weidmann MD, Berry GJ, Green DA, Wu F. Prevalence and clinical disease severity of respiratory co-infections during the COVID-19 pandemic. ADVANCES IN MOLECULAR PATHOLOGY 2022. [PMCID: PMC9364747 DOI: 10.1016/j.yamp.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
Şencan İ, Çağ Y, Karabay O, Kurtaran B, Güçlü E, Öğütlü A, Demirbaş Z, Bulut D, Karlıdağ GE, Sefa Sayar M, Şibar EG, Eren Kutsoylu OÖ, Kul G, Erol S, Bektaş B, Ünver Ulusoy T, Kuzi S, Tasbakan M, Yiğit Ö, Ceran N, İnal AS, Ergen P, Yamazhan T, Uzar H, Ağalar C. Antibiotic use and Influencing Factors Among Hospitalized Patients with COVID-19: A Multicenter Point-Prevalence Study from Turkey. Balkan Med J 2022; 39:209-217. [PMID: 35611705 PMCID: PMC9136543 DOI: 10.4274/balkanmedj.galenos.2022.2021-11-62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Broad-spectrum empirical antimicrobials are frequently prescribed for patients with coronavirus disease 2019 (COVID-19) despite the lack of evidence for bacterial coinfection. Aims We aimed to cross-sectionally determine the frequency of antibiotics use, type of antibiotics prescribed, and the factors influencing antibiotics use in hospitalized patients with COVID-19 confirmed by polymerase chain reaction. Study Design The study was a national, multicenter, retrospective, and single-day point prevalence study. Methods This was a national, multicenter, retrospective, and single-day point-prevalence study, conducted in the 24-h period between 00:00 and 24:00 on November 18, 2020, during the start of the second COVID-19 peak in Turkey. Results A total of 1500 patients hospitalized with a diagnosis of COVID-19 were included in the study. The mean age ± standard deviation of the patients was 65.0 ± 15.5, and 56.2% (n = 843) of these patients were men. Of these hospitalized patients, 11.9% (n = 178) were undergoing invasive mechanical ventilation or ECMO. It was observed that 1118 (74.5%) patients were receiving antibiotics, of which 416 (37.2%) were prescribed a combination of antibiotics. In total, 71.2% of the patients had neither a clinical diagnosis nor microbiological evidence for prescribing antibiotics. In the multivariate logistic regression analysis, hospitalization in a state hospital (p < 0.001), requiring any supplemental oxygen (p = 0.005), presence of moderate/diffuse lung involvement (p < 0.001), C-reactive protein > 10 ULT coefficient (p < 0.001), lymphocyte count < 800 (p = 0.007), and clinical diagnosis and/or confirmation by culture (p < 0.001) were found to be independent factors associated with increased antibiotic use. Conclusion The necessity of empirical antibiotics use in patients with COVID-19 should be reconsidered according to their clinical, imaging, and laboratory findings.
Collapse
Affiliation(s)
- İrfan Şencan
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Health Practice and Research Center, İstanbul, Turkey
| | - Yasemin Çağ
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Oğuz Karabay
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Behice Kurtaran
- Department of Infectious Diseases and Clinical Microbiology, Çukurova University, Adana, Turkey
| | - Ertuğrul Güçlü
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Aziz Öğütlü
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Zehra Demirbaş
- Department of Infectious Diseases and Clinical Microbiology, Elbistan State Hospital, Kahramanmaraş, Turkey
| | - Dilek Bulut
- Department of Infectious Diseases and Clinical Microbiology, Van Training and Research Hospital, Van, Turkey
| | - Gülden Eser Karlıdağ
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Turkey, Elazığ City Hospital, Elazığ, Turkey
| | - Merve Sefa Sayar
- Department of Infectious Diseases and Clinical Microbiology, Van Training and Research Hospital, Van, Turkey
| | - Ezgi Gizem Şibar
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Health Practice and Research Center, İstanbul, Turkey
| | - Oya Özlem Eren Kutsoylu
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Gülnur Kul
- Department of Infectious Diseases and Clinical Microbiology, Dörtyol State Hospital, Hatay, Turkey
| | - Serpil Erol
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Turkey, Haydarpaşa Training and Research Hospital Health Practice and Research Center, İstanbul, Turkey
| | - Begüm Bektaş
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Tülay Ünver Ulusoy
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Health Practice and Research Center, İstanbul, Turkey
| | - Semanur Kuzi
- Department of Infectious Diseases and Clinical Microbiology, Ünye State Hospital, Ordu, Turkey
| | - Meltem Tasbakan
- Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Özge Yiğit
- Department of Infectious Diseases and Clinical Microbiology, Ünye State Hospital, Ordu, Turkey
| | - Nurgül Ceran
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Turkey, Haydarpaşa Training and Research Hospital Health Practice and Research Center, İstanbul, Turkey
| | - Ayşe Seza İnal
- Department of Infectious Diseases and Clinical Microbiology, Çukurova University, Adana, Turkey
| | - Pınar Ergen
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Tansu Yamazhan
- Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Hanife Uzar
- Department of Infectious Diseases and Clinical Microbiology, Viranşehir State Hospital, Şanlıurfa, Turkey
| | - Canan Ağalar
- Department of Infectious Diseases and Clinical Microbiology, Fenerbahçe University, Medicana Ataşehir Hospital, İstanbul, Turkey
| |
Collapse
|
13
|
Abstract
Community-acquired pneumonia is an important cause of morbidity and mortality. It can be caused by bacteria, viruses, or fungi and can be prevented through vaccination with pneumococcal, influenza, and COVID-19 vaccines. Diagnosis requires suggestive history and physical findings in conjunction with radiographic evidence of infiltrates. Laboratory testing can help guide therapy. Important issues in treatment include choosing the proper venue, timely initiation of the appropriate antibiotic or antiviral, appropriate respiratory support, deescalation after negative culture results, switching to oral therapy, and short treatment duration.
Collapse
|
14
|
Fjelltveit EB, Cox RJ, Kittang BR, Blomberg B, Buanes EA, Langeland N, Mohn KGI. Lower antibiotic prescription rates in hospitalized COVID-19 patients than influenza patients, a prospective study. Infect Dis (Lond) 2021; 54:79-89. [PMID: 34525895 DOI: 10.1080/23744235.2021.1974539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND COVID-19 patients are extensively treated with antibiotics despite few bacterial complications. We aimed to study antibiotic use in hospitalized COVID-19 patients compared to influenza patients in two consecutive years. Furthermore, we investigated changes in antibiotic use from the first to second pandemic wave. METHODS This prospective study included both patients from two referral hospitals in Bergen, Norway, admitted with influenza (n = 215) during the 2018/2019 epidemic and with COVID-19 (n = 82) during spring/summer 2020, and national data on registered Norwegian COVID-19 hospital admissions from March 2020 to January 2021 (n = 2300). Patient characteristics were compared, and logistic regression analysis was used to identify risk factors for antibiotic use. RESULTS National and local COVID-19 patients received significantly less antibiotics (53% and 49%) than influenza patients (69%, p < .001). Early antibiotics contributed to >90% of antibiotic prescriptions in the two local hospitals, and >70% of prescriptions nationally. When adjusted for age, comorbidities, symptom duration, chest X-ray infiltrates and oxygen treatment, local COVID-19 patients still had significantly lower odds of antibiotic prescription than influenza patients (aOR 0.21, 95%CI 0.09-0.50). At the national level, we observed a significant reduction in antibiotic prescription rates in the second pandemic wave compared to the first (aOR 0.35, 95% CI 0.29-0.43). CONCLUSION Fewer COVID-19 patients received antibiotics compared to influenza patients admitted to the two local hospitals one year earlier. The antibiotic prescription rate was lower during the second pandemic wave, possibly due to increased clinical experience and published evidence refuting the efficacy of antibiotics in treating COVID-19 pneumonia.
Collapse
Affiliation(s)
- Elisabeth B Fjelltveit
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Rebecca Jane Cox
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Bård Reiakvam Kittang
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Bjørn Blomberg
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Eirik A Buanes
- Norwegian Intensive Care and Pandemic Registry (NIPaR), Haukeland University Hospital, Bergen, Norway.,Helse Bergen Health Trust, Haukeland University Hospital, Bergen, Norway
| | | | - Nina Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Kristin G-I Mohn
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|