Medline ® Abstracts for References 2,76,81
of 'Treatment of community-acquired pneumonia in adults who require hospitalization'
Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG, Infectious Diseases Society of America, American Thoracic Society
Clin Infect Dis. 2007;44 Suppl 2:S27.
McMaster University Medical School, Hamilton, Ontario, Canada. firstname.lastname@example.org
Impact of antibiotics on expression of virulence-associated exotoxin genes in methicillin-sensitive and methicillin-resistant Staphylococcus aureus.
Stevens DL, Ma Y, Salmi DB, McIndoo E, Wallace RJ, Bryant AE
J Infect Dis. 2007;195(2):202.
Extracellular protein toxins contribute to the pathogenesis of a wide variety of Staphylococcus aureus infections. The present study investigated the effects that cell-wall active antibiotics and protein-synthesis inhibitors have on transcription and translation of genes for Panton-Valentine leukocidin, alpha-hemolysin, and toxic-shock syndrome toxin 1, in both methicillin-sensitive and methicillin-resistant S. aureus. Subinhibitory concentrations of nafcillin induced and prolonged mRNA for Panton-Valentine leukocidin, alpha-toxin, and toxic-shock syndrome toxin 1 and increased toxin production. In contrast, clindamycin and linezolid markedly suppressed translation, but not transcription, of toxin genes. These results suggest (1) that protein-synthesis inhibition is an important consideration in the selection of antimicrobial agents to treat serious infections caused by toxin-producing gram-positive pathogens and (2) that, by inducing and enhancing toxin production, inadvertent use of beta-lactam antibiotics to treat methicillin-resistant S. aureus infections may contribute to worse outcomes.
Veterans Affairs Medical Center, Boise, ID 83702, USA. email@example.com
Time to first antibiotic and mortality in adults hospitalised with community-acquired pneumonia: a matched-propensity analysis.
Daniel P, Rodrigo C, Mckeever TM, Woodhead M, Welham S, Lim WS, British Thoracic Society
Thorax. 2016 Jun;71(6):568-70. Epub 2015 Nov 11.
A matched-propensity analysis of national data from the British Thoracic Society community-acquired pneumonia audit was conducted (n=13 725). Overall, time to first antibiotic (TFA) was≤4 h in 63%. Adjusted 30-day inpatient (IP) mortality was lower for adults with TFA≤4 h compared with TFA>4 h (adjusted OR 0.84, 95% CI 0.74 to 0.94; p=0.003). Increasing TFA was associated with greater OR of 30-day IP mortality (p value for trend=0.001), but no TFA threshold was evident. Although we found an association between TFA and mortality, we cannot say whether this is causal or whether TFA might just be a quality measure for overall or other processes of care.
Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.