Community-acquired pneumonia (CAP) should be treated with antibiotics of increasingly shorter duration and using a scoring scale such as 60-BrI-NG, which can help identify the pathogen causing the infection. For help choosing the ideal antibiotic treatment, consider Dr. David de la Rosa, a pulmonologist and researcher at the Barcelona Respiratory Network (BRN), which promotes collaborative research in the field of respiratory health.
As we celebrate World Pneumonia Day on 12 November, BRN highlights the most significant advances in research into this respiratory infection, as CAP is one of the leading causes of morbidity and mortality in older adults.The most common disease-causing pathogens identified include Streptococcus pneumoniae (pneumococcus), as well as other respiratory bacteria and viruses.
Despite microbiological testing, no pathogen was detected in more than 62% of cases, and empiric antibiotic therapy was administered as recommended by clinical guidelines, although the specific etiology was unknown. Regarding the use of antibiotics in pneumococcal infections, a study published last October in the scientific journal PLoS One, which reviewed more than 436,000 episodes of CAP, “underscores the current trend of prescribing antibiotics for CAP for shorter periods of time.” Five days is probably enough in most cases,” explained David de la Rosa. “Nevertheless, this article shows that a large proportion of the population still accepts guidelines that are inconsistent with treatment guideline recommendations,” he lamented.
Another important aspect of CAP management is the identification of patients with pneumonia whose causative organisms are at higher risk of becoming resistant to commonly used antibiotics, e.g. Pseudomonas aeruginosa. Last month, another Thai study, published in BMC Infectious Drugs, established a 60-BrI-NG risk score (the first letter of four risk factors) indicating that pneumonia is caused by this pathogen: patients Have bronchiectasis; other respiratory diseases such as atelectasis, pulmonary fibrosis, or pulmonary blisters; immunocompromised conditions; and feeding through the nasogastric area.
Risk of CAP in patients with COPD using inhaled corticosteroids
There has also been debate in the scientific community about the risk of pneumonia caused by the use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD). In this regard, a Danish observational study published in September in the journal Open Breath Research that looked at more than 35,000 COPD patients in Danish outpatient clinics concluded that COPD patients treated with ultrafine particle IC had a lower risk of hospitalization for pneumonia than COPD patients treated with ultrafine particle IC. Standard size IC particles.
“This article shows that not all corticosteroids are associated with a higher risk of pneumonia and that some forms of corticosteroids, such as ultrafine particles, may also reduce this risk,” David de la Rosa said.
Risk factors for pleural effusion in elderly patients with CAP
Another retrospective case-control study conducted in China and published in BMC Pulmonary Medicine in September described factors associated with an increased risk of parapneumonic effusion (PPE), a relatively common case of pneumonia in older adults. complications, complicating the condition. These patients were treated with CAP. The study identified chest tightness, persistent fever, low serum albumin and sodium levels as risk factors and concluded that early identification and prompt treatment of these patients could prevent inappropriate treatment and reduce morbidity and mortality .
“While this study deals with a very specific topic, it is important to emphasize that it has identified factors that contribute to pleural effusion (a complication of typical pneumonia in older patients), duration of fever, and low albumin levels in the body.” David “This finding reinforces the idea that you should not wait until many days after having a fever before seeking medical attention,” de la Rosa explained. Likewise, malnourished patients should be monitored more closely. “