| 1. |
- Athlin, Simon, 1971-, et al.
(författare)
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Management of community-acquired pneumonia in immunocompetent adults : updated Swedish guidelines 2017
- 2018
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Ingår i: Infectious Diseases. - : Informa UK Limited. - 2374-4235 .- 2374-4243. ; 50:4, s. 247-272
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Forskningsöversikt (refereegranskat)abstract
- Based on expert group work, Swedish recommendations for the management of community-acquired pneumonia in adults are here updated. The management of sepsis-induced hypotension is addressed in detail, including monitoring and parenteral therapy. The importance of respiratory support in cases of acute respiratory failure is emphasized. Treatment with high-flow oxygen and non-invasive ventilation is recommended. The use of statins or steroids in general therapy is not found to be fully supported by evidence. In the management of pleural infection, new data show favourable effects of tissue plasminogen activator and deoxyribonuclease installation. Detailed recommendations for the vaccination of risk groups are afforded.
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| 2. |
- Athlin, Simon, 1971-, et al.
(författare)
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Pneumococcal urinary antigen testing for antimicrobial guidance in community-acquired pneumonia : A register-based cohort study
- 2022
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Ingår i: Journal of Infection. - : Elsevier. - 0163-4453 .- 1532-2742. ; 85:2, s. 167-173
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate the effect of pneumococcal urinary antigen test (UAT) usage on broad-spectrum antibiotic treatment in community-acquired pneumonia (CAP).METHODS: Patients admitted to 32 Swedish hospitals between 2011 and 2014 were retrospectively included from the Swedish National Quality Register of CAP. Using propensity score matched data, stratified by CRB-65 score, we studied the effect of performing UAT and of positive test results on treatment with broad-spectrum β-lactam monotherapy (BSBM) and antibiotics with coverage for atypical bacteria compared to narrow-spectrum β-lactam monotherapy (NSBM).RESULTS: UAT was performed for 4,995/14,590 (34.2%) patients, 603/4,995 (12.1%) of whom had positive test results. At day three, performing UAT was not associated with decreased use of BSBM (OR 1.07, 95% CI 0.94-1.23) but was associated with increased atypical coverage among patients with CRB-65 score 2 (OR 1.47, 95% CI 1.06-2.02). A positive UAT was associated with decreased BSBM use (OR 0.39, 95% CI 0.25-0.60) and decreased atypical coverage (OR 0.25, 95% CI 0.16-0.37), predominantly in non-severe CAP. At day one, performing UAT was associated with atypical coverage among patients with CRB-65 scores 2 (OR 2.60, 95% CI 1.69-3.98) and 3-4 (OR 3.69, 95% CI 1.55-8.79), and a positive test reduced the odds of BSBM treatment among CRB-65 score 3-4 patients (OR 3.49, 95% CI 1.02-12.0).CONCLUSIONS: Performing UAT had no overall effect on decreasing the use of BSBM treatment by day three of hospitalization, yet non-severely ill patients with positive UAT results were less likely to be treated with BSBM and antibiotics with atypical coverage.
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| 3. |
- Browall, Sarah, et al.
(författare)
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Clinical manifestations of invasive pneumococcal disease by vaccine and non-vaccine types
- 2014
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 44:6, s. 1646-1657
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Tidskriftsartikel (refereegranskat)abstract
- Pneumococcal conjugated vaccines (PCVs) have shown protection against invasive pneumococcal disease by vaccine serotypes, but an increase in non-vaccine serotype disease has been observed. Type-specific effects on clinical manifestation need to be explored.Clinical data from 2096 adults and 192 children with invasive pneumococcal disease were correlated to pneumococcal molecular serotypes. Invasive disease potential for pneumococcal serotypes were calculated using 165 invasive and 550 carriage isolates from children.The invasive disease potential was lower for non-PCV13 compared to vaccine-type strains. Patients infected with non-PCV13 strains had more underlying diseases, were less likely to have pneumonia and, in adults, tended to have a higher mortality. Furthermore, patients infected with pneumococci belonging to clonal serotypes only expressing non-PCV13 capsules had a higher risk for septicaemia and mortality.PCV vaccination will probably lead to a decrease in invasive pneumococcal disease but an alteration in the clinical manifestation of invasive pneumococcal disease. Genetic lineages causing invasive pneumococcal disease in adults often express non-vaccine serotypes, which can expand after vaccination with an increased risk of infection in patients with underlying diseases.
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| 4. |
- Spindler, Carl
(författare)
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Diagnosis, prognosis and prevention of severe pneumococcal disease
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Streptococcus pneumoniae also known as pneumococcus is a major contributor to the disease burden in the world. Infections caused by this bacterium include a wide spectrum of different disease types, from non-severe upper respiratory tract infections to invasive disease forms like bacteremic pneumococcal pneumonia or meningitis, conditions attributed with a high rate of severe disease and mortality. An important feature of this bacterium is that it only causes disease under certain circumstances, and the most common outcome upon contact with this bacterium is transient nasopharyngeal colonization rather than disease from it. Some patient groups such as young children and older people are however at a substantially increased risk of severe disease from the pneumococcus. The aim of this thesis is to increase the understanding of factors of importance to severe pneumococcal disease. The first paper addresses the difficulties in obtaining an etiological diagnosis in pneumonias, which potentially would delay an optimal care and treatment of these patients. We were able to demonstrate that our RQ-PCR method targeting specific gene sequences within the bacteria S. pneumoniae, H. influenzae and M. catarrhalis, increased the diagnostic yield from sputum samples significantly and also that this method seemed especially valuable in finding the causative bacterium when the patient had received antibiotics prior to specimen sampling. The second paper addresses the issue of how to identify patients that are at special risk for a severe outcome from pneumococcal pneumonia. We investigated this by analysing the ability of three different severity score systems, initially developed for the assessment of severity in all cause community acquired pneumonia, to predict mortality and need of ICU admission in bacteraemic pneumococcal pneumonia. We concluded that these severity scores worked fairly well also in this subgroup of patients, but also identified the CURB-65 as the best score system since it was the most practical to use. The third paper addresses whether specific pneumococcal properties are able to influence the severity and outcome of invasive pneumococcal disease (IPD). We investigated the relationship between clonal affiliation / serotypes of pneumococci and patient characteristics and outcome of IPD. We concluded that some clones and serotypes seem more prone to cause severe disease among older patients burdened by comorbidities, and are thus behaving like opportunistic pathogens, while other clones and serotype tended to cause milder disease among younger and previously healthy individuals, thus behaving as primary pathogens. The fourth paper addresses the issue of preventing invasive pneumococcal disease. We investigated the effects of the large scale vaccination campaign with the 23-valent pneumococcal polysaccharide vaccine directed towards all elderly persons in Stockholm County between 1997 and 2001. We studied the effects on incidence and serotype distribution of IPD, and concluded that a substantial decrease in vaccine-type IPD was seen among the vaccinated population, but not among other age groups, and also that no serotype replacement occurred during the 5 year study period.
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| 5. |
- Spindler, Carl, et al.
(författare)
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Effects of a large-scale introduction of the pneumococcal polysaccharide vaccine among elderly persons in Stockholm, Sweden
- 2008
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Ingår i: Vaccine. - : Elsevier BV. - 1873-2518 .- 0264-410X. ; 26:43, s. 5541-5546
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Tidskriftsartikel (refereegranskat)abstract
- In October 1998 Stockholm County launched a 3-year vaccination campaign with the 23-valent pneumococcal polysaccharide vaccine (PPV-23) directed towards all elderly persons. We analysed the impact of this campaign on the incidence and serotype distribution of invasive pneumococcal disease (IPD) in Stockholm County, where the vaccine coverage was 36%, as compared to Skane County, where no vaccination campaign was performed. The incidence of vaccine-type IPD in Stockholm declined significantly during the study period (1997-2001) in elderly persons, from 50 to 28.9/100,000, hot not in other age groups in Stockholm, nor in any age group in Skane. (C) 2008 Elsevier Ltd. All rights reserved.
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| 6. |
- Spindler, Carl, et al.
(författare)
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Swedish guidelines on the management of community-acquired pneumonia in immunocompetent adults-Swedish Society of Infectious Diseases 2012
- 2012
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa Healthcare. - 0036-5548 .- 1651-1980. ; 44:12, s. 885-902
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Forskningsöversikt (refereegranskat)abstract
- This document presents the 2012 evidence based guidelines of the Swedish Society of Infectious Diseases for the in-hospital management of adult immunocompetent patients with community-acquired pneumonia (CAP). The prognostic score CRB-65 is recommended for the initial assessment of all CAP patients, and should be regarded as an aid for decision-making concerning the level of care required, microbiological investigation, and antibiotic treatment. Due to the favourable antibiotic resistance situation in Sweden, an initial narrow-spectrum antibiotic treatment primarily directed at Streptococcus pneumoniae is recommended in most situations. The recommended treatment for patients with severe CAP (CRB-65 score 2) is penicillin G in most situations. In critically ill patients (CRB-65 score 3-4), combination therapy with cefotaxime/macrolide or penicillin G/fluoroquinolone is recommended. A thorough microbiological investigation should be undertaken in all patients, including blood cultures, respiratory tract sampling, and urine antigens, with the addition of extensive sampling for more uncommon respiratory pathogens in the case of severe disease. Recommended measures for the prevention of CAP include vaccination for influenza and pneumococci, as well as smoking cessation.
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