Genetic variation in MYLK and lung injury in children and adults with community-acquired pneumonia.

Objective: To investigate whether selected single nucleotide polymorphisms in the myosin light chain kinase gene are associated with more severe lung injury in children and adults with community-acquired pneumonia. Previous studies have demonstrated an association between single nucleotide polymorphisms in the myosin light chain kinase gene and increased severity of acute lung injury in adults.

Design: Prospective, case-control genetic association study.

Severe community-acquired pneumonia and PIRO: a new paradigm of management.

Appropriate antibiotic management and aggressive supportive therapy is not enough to improve survival in severe community-acquired pneumonia (sCAP), a systemic syndrome involving infectious organisms, inflammation, and coagulation systems. A sepsis severity staging system focused on predisposition, insult, deleterious response, and organ failure (PIRO) provides a useful basis for risk stratification and therapy. A new paradigm of management is suggested based on early identification of patients at risk, aggressive management, modulation of host response, and need for adjunctive therapy.

Respiratory infections: a current and future threat.

Despite all the medical progress in the last 50 years pulmonary infections continue to exact and extremely high human and economic cost. This review will focus on the human, pathogen and environmental factors that contribute to the continued global burden or respiratory diseases with a particular focus on areas where we might hope to see some progress in the coming decades.

Adjunctive therapy in community-acquired pneumonia.

Despite potent antibiotics, community-acquired pneumonia (CAP) remains the most common cause of death from infection and the seventh overall leading cause of death in the United States. For this reason, interest has been redirected into non-antibiotic therapeutic measures. Despite theoretical benefits, the existing literature does not suggest a clear benefit for corticosteroid treatment, but large prospective randomized trials are needed.

A clinical evaluation committee assessment of recombinant human tissue factor pathway inhibitor (tifacogin) in patients with severe community-acquired pneumonia.

Introduction: The purpose of this analysis was to determine the potential efficacy of recombinant human tissue factor pathway inhibitor (tifacogin) in a subpopulation of patients with community-acquired pneumonia (CAP) from a phase III study of severe sepsis.

Methods: A retrospective review of patients with suspected pneumonia was conducted by an independent clinical evaluation committee (CEC) blinded to treatment assignment. The CEC reanalyzed data from patients enrolled in an international multicenter clinical trial of sepsis who had a diagnosis of pneumonia as the probable source of sepsis.

The role of MRSA in healthcare-associated pneumonia.

An important continued trend in healthcare-associated infection, including healthcare-associated pneumonia (HCAP), is the rise of methicillin-resistant Staphylococcus aureus (MRSA). The emergence of community-acquired strains of MRSA has complicated the management further. We review likely risk factors for MRSA HCAP, which include prior antibiotic therapy, nasal colonization, poor infection control practices, and antecedent viral infection.

PIRO score for community-acquired pneumonia: a new prediction rule for assessment of severity in intensive care unit patients with community-acquired pneumonia.

Objective: To develop a severity assessment tool to predict mortality in community-acquired pneumonia (CAP) patients in intensive care unit (ICU), comparing its performance with Acute Physiology and Chronic Health Evaluation (APACHE) II score and American Thoracic Society/Infectious Disease Society of America (ATS/IDSA) criteria as a prognostic index in CAP patients requiring ICU admission.

Design: Secondary analysis of prospective observational cohort study.

Setting: Thirty-three ICUs.

Scenario 2: community-acquired pneumonia requiring hospitalization but not requiring admission to an intensive care unit.

The patient is a 65-year-old woman with community-acquired pneumonia of sufficient severity to require hospitalization. Factors important for consideration in clinical trials are illustrated.

Health care-associated infection (HAI): a critical appraisal of the emerging threat-proceedings of the HAI Summit.

During the Health Care-Associated Pneumonia Summit conducted in June 2007, it was found that there is a need for educational efforts in several areas of health care-associated infections (HAI) that extend beyond pneumonia. This supplement to Clinical Infectious Diseases represents the proceedings of the HAI Summit, a diverse panel of clinical investigators whose goal was to assess the quality of evidence regarding issues surrounding HAI and to discuss potential implications for its diagnosis and treatment in the future.

Early microbiological response to linezolid vs vancomycin in ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of ventilator-associated pneumonia (VAP). This prospective, open-label, multicenter clinical trial compared the early microbiological efficacy of linezolid (LZD) therapy with that of vancomycin (VAN) therapy in patients with MRSA VAP.

Methods: A total of 149 patients with suspected MRSA VAP were randomized to receive either LZD, 600 mg, or VAN, 1 g every 12 h.

Efficacy and safety of intravenous infusion of doripenem versus imipenem in ventilator-associated pneumonia: a multicenter, randomized study.

Objective: Doripenem is an investigational carbapenem with broad-spectrum activity against gram-negative and gram-positive pathogens, including multidrug-resistant strains, commonly responsible for ventilator-associated pneumonia (VAP). This large, phase III study compared doripenem with imipenem for the treatment of ventilator-associated pneumonia.

Design: Prospective, multicenter, parallel randomized, active-controlled, open-label study.

Derivation of a triage algorithm for chest radiography of community-acquired pneumonia patients in the emergency department.

Background: Community-acquired pneumonia (CAP) accounts for 1.5 million emergency department (ED) patient visits in the United States each year.

Objectives: To derive an algorithm for the ED triage setting that facilitates rapid and accurate ordering of chest radiography (CXR) for CAP.

A double-blind placebo-controlled study to evaluate the safety and efficacy of L-2-oxothiazolidine-4-carboxylic acid in the treatment of patients with acute respiratory distress syndrome.

Objective: Acute respiratory distress syndrome is an abrupt inflammatory illness that involves damage from reactive oxygen species. We examined the efficacy and safety of oxothiazolidine-4-carboxylic acid (OTZ), a free radical scavenger, in treating acute respiratory distress syndrome.

Design: Double-blind, placebo-controlled trial.

4G/5G plasminogen activator inhibitor-1 polymorphisms and haplotypes are associated with pneumonia.

Rationale: Plasminogen activator inhibitor (PAI)-1 inhibits urokinase and tissue plasminogen activator, required for host response to infection. Whether variation within the PAI-1 gene is associated with increased susceptibility to infection is unknown.

Objectives: To ascertain the role of the 4G/5G polymorphism and other genetic variants within the PAI-1 gene.

Severe pseudomonal infections.

Purpose Of Review: To review the most recent data on severe Pseudomonas aeruginosa infections. The focus will be on clinical studies with an emphasis on the critically ill.

Recent Findings: The frequency of P.

Genetic polymorphisms that predict outcome and need for treatment in cardiovascular disease.

Purpose Of Review: Interest in the genetic determinants of complications of cardiovascular disease, and the resultant influence on management, has increased. We have therefore reviewed the literature in the last 12-16 months for studies documenting genetic risk of complications. The focus is on risk of complications or differences in management, rather than only susceptibility to cardiovascular disease itself.

[Assessment of patients with poor resolution of HAP].

Emphasis in VAP management is now shifting to the effectiveness of antibiotic therapy and its effect on subsequent mortality. As many as 62% of patients with VAP meet a set of objective criteria for failure to respond. The predominant microorganisms associated with failure of therapy are Pseudomonas aeruginosa and methicillin-resistant S.