Antoni Torres, Catia Cillóniz. Clinical Management of Bacterial Pneumonia

Antoni Torres, Catia Cillóniz Clinical Management of Bacterial Pneumonia

Antoni Torres, Catia Cillóniz Clinical Management of Bacterial Pneumonia

Authors Professor Antoni Torres MD, PhD, FERS Director Pulmonary Intensive Care Unit Department of Pulmonary Medicine Hospital Clinic of Barcelona CIBERES. IDIBAPS. University of Barcelona Spain Catia Cillóniz PhD Department of Pulmonary Medicine Hospital Clinic of Barcelona CIBERES. IDIBAPS Spain ISBN 978-3-319-22061-1 ISBN 978-3-319-22062-8 (ebook) DOI 10.1007/978-3-319-22062-8 Springer Cham Heidelberg New York Dordrecht London Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Adis is a brand of Springer Springer is part of Springer Science+Business Media (www.springer.com) Project editor: Mia Cahill

Contents Author biographies Abbreviations Preface vii ix xi 1 Introduction to pneumonia 1 Introduction 1 Overview of bacterial pneumonia 1 References 4 2 Epidemiology, etiology, and risk factors of bacterial 7 pneumonia Epidemiology 7 Microbial etiology 11 Antibiotic resistance 15 Risk factors 19 Summary points 23 References 23 3 Pathology and clinical features of pneumonia 29 Pathophysiology of pneumonia 29 Pathogenesis of pneumonia 34 Signs and symptoms of pneumonia 34 Prognosis of pneumonia 35 Summary points 36 References 36 4 Diagnosis and classification of pneumonia 39 Diagnosis and classification of hospital-acquired and 39 ventilator-associated pneumonia Diagnosis of community-acquired pneumonia 40 v

vi CONTENTS Summary points 54 References 54 5 Methods for preventing pneumonia 57 Guidelines for the prevention of pneumonia 57 Preventative strategies to reduce the risk of community-acquired 58 pneumonia in adults Nonpharmacological prevention of hospital-acquired 61 and ventilator-associated pneumonia Vaccination 63 New vaccines 68 Summary points 68 References 69 6 Management of pneumonia 75 Guidelines for management and treatment of pneumonia 75 Medical management of pneumonia 77 Guidelines for the antimicrobial treatment of community-acquired 80 pneumonia Guidelines for the antimicrobial treatment of hospital-acquired/ 81 ventilator-associated pneumonia Emerging therapies for the treatment of community-acquired 84 pneumonia Emerging therapies for the treatment of hospital-acquired/ 88 ventilator-associated pneumonia Management of pneumonia in special populations 89 Summary points 94 References 94

Author biographies Antoni Torres, MD, is a Professor of Medicine at the University of Barcelona. Born in Barcelona in 1954, he is Full Professor of Medicine at the University of Barcelona and Head of the Respiratory Intensive Care Unit at Hospital Clínic Barcelona. He is considered a physician of reference both nationally and internationally in lung infections, including pneumonia, chronic obstructive pulmonary disease, bronchiectasis, immunocompromised patients, ventilation weaning, noninvasive ventilation, and acute respiratory distress syndrome. He leads the research group on Applied Research in Respiratory Diseases of the Institut d Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), from where he facilitates translational research studies. He also coordinates a CIBER group on respiratory diseases (Ciberes) and takes part in several European projects. He is co-author of more than 300 scientific publications, has supervised 24 PhD theses, and his H-Index is 97. Professor Torres has been the recipient of several awards, including the Edward Shanoff award (1988), the Josep Trueta Award (2001), the Fundación de Ciencias de la Salud (2001) award for the 10 best biomedical researchers in the last 4 years, the Lilly Foundation Award (2007) and the Award EUROPE ASPIRE (2011). He was awarded to the professional excellence in Investigation of the COMB (College of Physicians), 2013 and received the ICREA Academia award from the University of Barcelona (2013). He also holds a Fellowship of the ERS (European Respiratory Society) for the contribution to research in the respiratory field (2014). He is also member of several societies and is the President of the area of tuberculosis and respiratory infections of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) and President of the area of respiratory infections of the Latin American Thorax Association (ALAT). vii

VIII AUTHOR BIOGRAPHIES Catia Cillóniz Campos, PhD, is a Doctor in Medicine at the University of Barcelona. She holds a degree in Biology from the San Luis Gonzaga National University in Peru and has a Masters in Advanced Microbiology and Masters in SIDA from University of Barcelona. She is a researcher within the Applied Research in Respiratory Diseases team, where she coordinates the research line of community-acquired pneumonia (CAP). Her research and clinical interests are in the microbial etiology of CAP, determining the direct or indirect relationship of the different microorganisms with the severity and course of the infection, or describing the course of the different etiologic agents, the type of presentation observed in hospitals and associated comorbidities. She also works on hospitalacquired pneumonia, where she records and monitors the epidemiology, clinical presentation, etiology, and outcome factors of disease. Her research goal is to determine the etiology of CAP, its clinical presentation, severity, resistance, and to contribute to evolving diagnostic tests to identify the etiologic agents with greater accuracy. Dr. Cillóniz has been awarded with the University of Barcelona Extraordinary Doctorate Prize for the academic year 2011/2012. This award recognizes the quality of some of the theses developed and approved at the University of Barcelona which have obtained the Excellent Cum Laude qualification. She has published over 40 articles on CAP in peerreview journals since 2007 and is a member of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Spanish Society of Pneumology and Thoracic Surgery (SEPAR), and the European Respiratory Society (ERS).

Abbreviations ARDS ATS BAL BAS BLI Bpm br BTS CABP CA-MRSA CAP CFU COPD Acute respiratory distress syndrome American Thoracic Society Bronchoalveolar lavage Bronchial aspirate β-lactamase inhibitor Beats per minute Breaths British Thoracic Society Community-acquired bacterial pneumonia Community-acquired methicillin-resistant Staphylococcus aureus Community-acquired pneumonia Colony-forming units Chronic obstructive pulmonary disease CRM 197 Cross-reactive material 197 CRP C-reactive protein CT Computerized tomography CXR Chest X-ray DRSP Drug resistant Streptococcus pneumoniae Erm(B) Erythromycin ribosome methylation ERS European Respiratory Society ESBL Extended spectrum β-lactamases ESCMID European Society of Clinical Microbiology and Infectious Diseases FiO 2 Fraction of inspired oxygen HAP Hospital-acquired pneumonia HIV Human immunodeficiency virus ICU Intensive care unit IDSA Infectious Diseases Society of America IgM Immunoglobulin M IPD Invasive pneumococcal disease IRVS Intensive respiratory or vasopressor support ix

x ABBREVIATIONS IV MDR MIC mprf MRSA MRSE MSSA MSSE MV NBP NP NV-ICUAP OR PaO 2 PBPs PcpA PCV PhtD PLT PORT PPSV PSB PSI PTC PVL QRDR RR VAP VE-VAP VISA VRSA WBC yo Intravenous Multidrug-resistant Mean inhibitory concentration Multipeptide resistance factor Methicillin-resistant Staphylococcus aureus Methicillin-resistant Staphylococcus epidermidis Methicillin-sensitive Staphylococcus aureus Methicillin-sensitive Staphylococcus epidermidis Mechanical ventilation Nosocomial bacterial pneumonia Nosocomial pneumonia Nonventilated ICU-acquired pneumonia Odds ratio Partial arterial oxygen pressure Penicillin-binding proteins Pneumococcal choline-binding protein A Pneumococcal conjugate vaccine Pneumococcal histidine triad protein D Platelets Pneumonia Patient Outcomes Research Team Pneumococcal polysaccharide vaccine Protected specimen brushing Pneumonia Severity Index Protected telescoping catheter Panton-Valentine leukocidin Quinolone resistance determinant region Respiratory rate Ventilator-associated pneumonia Very early-onset ventilator-associated pneumonia Vancomycin intermediate Staphylococcus aureus Vancomycin-resistant Staphylococcus aureus White blood cell Years old

Preface Despite many advances in antibiotic therapies, diagnostic tools and strategies for prevention, pneumonia is still the primary cause of death from infectious disease worldwide. The key factor for the increased mortality is the effect of pneumonia on comorbidities and underlying diseases, along with the rising age of the population and the virulence of the pathogens. The increasing number of antibiotic-resistant bacteria is a matter of concern for clinicians when choosing antibiotic treatment in patients with pneumonia. In general, the management of pneumonia presents a major challenge for the clinicians. The optimum outcome for pneumonia can be achieved by careful risk stratification, accurate assessment of severity, and appropriate antibiotic therapy. In the last decade several international and national societies have released guidelines for the management of pneumonia (community- and hosptial-acquired pneumonia), including recommendations for initial antibiotic treatment, microbiological testing, decision to hospitalize and admit to the intensive care unit, and management of non-responding patients. Recent studies show that implementation of guidelines for the management of pneumonia is followed by improvement in outcomes, including mortality. This handbook summarizes important features and management issues of bacterial pneumonia, including the latest information on microbiological etiology, clinical course, diagnostic testing, and antimicrobial treatment and prevention. xi