Antimicrobial Treatment of Lower Respiratory Tract Infections

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 23443

Special Issue Editors


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Guest Editor
First Department of Critical Care Medicine & Pulmonary Services, Medical School of National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
Interests: inflammation; endothelial injury; ventilator associated pneumonia; critical care medicine; critical care infections; SARS-CoV-2

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Guest Editor
Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
Interests: infections; emerging pathogens; inflammation; immunology; public health; respiratory infections; MDR organisms; viral pathogens

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Guest Editor
Attikon University Hospital, Athens, Greece
Interests: viral infections; immunopathogenesis of viral disease
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Guest Editor Assistant
Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
Interests: HIV infection; viral infection; emerging pathogens; MDR organisms; respiratory infections; infections in immunocompromised; host immune responses
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are pleased to invite you to contribute to this Special Issue, entitled “Antimicrobial Treatment of Lower Respiratory Tract Infections”. Lower respiratory tract infections (LRTIs) are highly prevalent. However, severe LRTIs are associated with significant mortality and morbidity worldwide. Pneumonia remains among the main causes of morbidity and mortality in adults and represents the leading cause of death in children under the age of five. Pneumonia, and specifically severe community-acquired pneumonia and nosocomial pneumonia, as well as other severe LRTIs, are associated with huge socioeconomic and healthcare costs. Antimicrobials remain the mainstay of bacterial LRTI treatment, although their use in viral LRTIs may be associated with significant side effects. Prompt initiation of pathogen-specific antimicrobials is crucial for improving the prognosis and outcome of LRTIs and plays a pivotal role in reducing their global healthcare and socioeconomic burden.

This Special Issue aims to delineate the latest pre-clinical (experimental), animal and clinical research and clinic-epidemiological data on the role of old and newer antimicrobials in the progress, prognosis and the outcome of pneumonia. Ultimately, this issue aims to expand our understanding and generate in-depth knowledge on the management of community- and healthcare-associated bacterial LRTIs through gathering current evidence and addressing potential gaps in the literature.

Original research articles and reviews are welcome. Research areas may include (but are not limited to) the following: antimicrobial treatment in community-acquired pneumonia/lower respiratory tract infection; antimicrobial treatment in healthcare-associated pneumonia; epidemiology and mechanisms of antibiotic resistance of pneumonia pathogens; novel antibiotics for lower respiratory tract infections; use of antimicrobials for lower respiratory tract infections in specific populations, such as immunocompromised and critically ill patients, those with COVID-19 and other severe viral LRTIs and elderly, pediatric, cystic fibrosis, COPD and asthma patients.

We look forward to receiving your contributions.

Prof. Dr. Anastasia Kotanidou
Prof. Dr. Sotirios Tsiodras
Dr. Paraskevi C. Fragkou
Guest Editors

Dr. Charalampos D. Moschopoulos
Guest Editor Assistant

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • lower respiratory tract infection
  • community-acquired pneumonia
  • nosocomial pneumonia
  • ventilator-associated pneumonia
  • antibiotics
  • antimicrobial resistance

Published Papers (10 papers)

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Research

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11 pages, 1066 KiB  
Article
Association between Empirical Anti-Pseudomonal Antibiotics and Progression to Thoracic Surgery and Death in Empyema: Database Research
by Akihiro Shiroshita, Kentaro Tochitani, Yohei Maki, Takero Terayama and Yuki Kataoka
Antibiotics 2024, 13(5), 383; https://doi.org/10.3390/antibiotics13050383 - 24 Apr 2024
Viewed by 550
Abstract
Evidence on the optimal antibiotic strategy for empyema is lacking. Our database study aimed to evaluate the effectiveness of empirical anti-pseudomonal antibiotics in patients with empyema. We utilised a Japanese real-world data database, focusing on patients aged ≥40 diagnosed with empyema, who underwent [...] Read more.
Evidence on the optimal antibiotic strategy for empyema is lacking. Our database study aimed to evaluate the effectiveness of empirical anti-pseudomonal antibiotics in patients with empyema. We utilised a Japanese real-world data database, focusing on patients aged ≥40 diagnosed with empyema, who underwent thoracostomy and received intravenous antibiotics either upon admission or the following day. Patients administered intravenous vasopressors were excluded. We compared thoracic surgery and death within 90 days after admission between patients treated with empirical anti-pseudomonal and non-anti-pseudomonal antibiotics. Cause-specific hazard ratios for thoracic surgery and death were estimated using Cox proportional hazards models, with adjustment for clinically important confounders. Subgroup analyses entailed the same procedures for patients exhibiting at least one risk factor for multidrug-resistant organisms. Between March 2014 and March 2023, 855 patients with empyema meeting the inclusion criteria were enrolled. Among them, 271 (31.7%) patients received anti-pseudomonal antibiotics. The Cox proportional hazards models indicated that compared to empirical non-anti-pseudomonal antibiotics, empirical anti-pseudomonal antibiotics were associated with higher HRs for thoracic surgery and death within 90 days, respectively. Thus, regardless of the risks of multidrug-resistant organisms, empirical anti-pseudomonal antibiotics did not extend the time to thoracic surgery or death within 90 days. Full article
(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)
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9 pages, 1039 KiB  
Article
Antibiotic Treatment for Lower Respiratory Tract Infections in Primary Care: A Register-Based Study Examining the Role of Radiographic Imaging
by Sara Carlsson, Katarina Hedin, Olof Cronberg and Anna Moberg
Antibiotics 2023, 12(7), 1165; https://doi.org/10.3390/antibiotics12071165 - 9 Jul 2023
Cited by 2 | Viewed by 1198
Abstract
When imaging (i.e., chest-x-ray or computed tomography) is used to differentiate between acute bronchitis and pneumonia, many patients are being prescribed antibiotics despite the absence of radiographic pneumonia signs. This study of lower respiratory tract infections (LRTIs) with negative chest imaging compares cases [...] Read more.
When imaging (i.e., chest-x-ray or computed tomography) is used to differentiate between acute bronchitis and pneumonia, many patients are being prescribed antibiotics despite the absence of radiographic pneumonia signs. This study of lower respiratory tract infections (LRTIs) with negative chest imaging compares cases where antibiotics were prescribed and not prescribed to find characteristics that could explain the prescription. Data were extracted from the regional electronic medical record system in Kronoberg County, Sweden, for patients aged 18–79 years diagnosed with acute bronchitis or pneumonia and who had any chest radiologic imaging between 2007–2014. Of 696 cases without evidence of pneumonia on imaging, 55% were prescribed antibiotics. Age, sex, and co-morbidity did not differ between those with or without antibiotics. The median level of C-reactive protein was low in both groups but differed significantly (21 vs. 10 mg/L; p < 0.001). Resident physicians prescribed antibiotics more frequently than interns or specialists (p < 0.001). It is unclear what features prompted the antibiotic prescribing in those with negative imaging indicating overuse of antibiotics for LRTIs. Full article
(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)
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10 pages, 255 KiB  
Article
Evaluation of a Pediatric Community-Acquired Pneumonia Antimicrobial Stewardship Intervention at an Academic Medical Center
by Lauren Puzz, Emily A. Plauche, David A. Cretella, Virginia A. Harrison and Mary Joyce B. Wingler
Antibiotics 2023, 12(4), 780; https://doi.org/10.3390/antibiotics12040780 - 19 Apr 2023
Cited by 1 | Viewed by 1563
Abstract
(1) Background: Pneumonia is the leading diagnosis associated with antibiotic use in hospitalized children. The Infectious Diseases Society of America published pediatric community-acquired pneumonia (CAP) guidelines in 2011, but adherence to recommendations varies across institutions. The purpose of this study was to evaluate [...] Read more.
(1) Background: Pneumonia is the leading diagnosis associated with antibiotic use in hospitalized children. The Infectious Diseases Society of America published pediatric community-acquired pneumonia (CAP) guidelines in 2011, but adherence to recommendations varies across institutions. The purpose of this study was to evaluate the impact of an antimicrobial stewardship intervention on antibiotic prescribing in pediatric patients admitted to an academic medical center. (2) Methods: This single-center pre/post-intervention evaluation included children admitted for CAP during three time periods (pre-intervention and post-intervention groups 1 and 2). The primary outcomes were changes in inpatient antibiotic selection and duration following the interventions. Secondary outcomes included discharge antibiotic regimens, length of stay, and 30-day readmission rates. (3) Results: A total of 540 patients were included in this study. Most patients were under five years of age (69%). Antibiotic selection significantly improved, with prescriptions for ceftriaxone decreasing (p < 0.001) and ampicillin increasing (p < 0.001) following the interventions. Antibiotic duration decreased from a median of ten days in the pre-intervention group and post-intervention group 1 to eight days in post-intervention group 2. (4) Conclusions: Our antibiotic stewardship intervention directed at pediatric CAP treatment resulted in improved antibiotic prescriptions and provides data that can be used to further educate providers at our institution. Full article
(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)
12 pages, 290 KiB  
Article
Pulse Oximetry as an Aid to Rule Out Pneumonia among Patients with a Lower Respiratory Tract Infection in Primary Care
by Chloé Fischer, José Knüsli, Loïc Lhopitallier, Estelle Tenisch, Marie-Garance Meuwly, Pauline Douek, Jean-Yves Meuwly, Valérie D’Acremont, Andreas Kronenberg, Isabella Locatelli, Yolanda Mueller, Nicolas Senn and Noémie Boillat-Blanco
Antibiotics 2023, 12(3), 496; https://doi.org/10.3390/antibiotics12030496 - 2 Mar 2023
Cited by 1 | Viewed by 1580
Abstract
Guidelines recommend chest X-rays (CXRs) to diagnose pneumonia and guide antibiotic treatment. This study aimed to identify clinical predictors of pneumonia that are visible on a chest X-ray (CXR+) which could support ruling out pneumonia and avoiding unnecessary CXRs, including oxygen saturation. A [...] Read more.
Guidelines recommend chest X-rays (CXRs) to diagnose pneumonia and guide antibiotic treatment. This study aimed to identify clinical predictors of pneumonia that are visible on a chest X-ray (CXR+) which could support ruling out pneumonia and avoiding unnecessary CXRs, including oxygen saturation. A secondary analysis was performed in a clinical trial that included patients with suspected pneumonia in Swiss primary care. CXRs were reviewed by two radiologists. We evaluated the association between clinical signs (heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, abnormal auscultation, and oxygen saturation < 95%) and CXR+ using multivariate analysis. We also calculated the diagnostic performance of the associated clinical signs combined in a clinical decision rule (CDR), as well as a CDR derived from a large meta-analysis (at least one of the following: heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, or abnormal auscultation). Out of 469 patients from the initial trial, 107 had a CXR and were included in this study. Of these, 26 (24%) had a CXR+. We found that temperature and oxygen saturation were associated with CXR+. A CDR based on the presence of either temperature ≥ 37.8 °C and/or an oxygen saturation level < 95% had a sensitivity of 69% and a negative likelihood ratio (LR−) of 0.45. The CDR from the meta-analysis had a sensitivity of 92% and an LR− of 0.37. The addition of saturation < 95% to this CDR increased the sensitivity (96%) and decreased the LR− (0.21). In conclusion, this study suggests that pulse oximetry could be added to a simple CDR to decrease the probability of pneumonia to an acceptable level and avoid unnecessary CXRs. Full article
(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)
10 pages, 870 KiB  
Article
Overruling of Procalcitonin-Guided Antibiotics for Lower Respiratory Tract Infections in Primary Care: Ancillary Study of a Randomized Controlled Trial
by José Knüsli, Loïc Lhopitallier, Andreas Kronenberg, Jean-Yves Meuwly, Onya Opota, Marc-Antoine Perrenoud, Marie-Anne Page, Kevin C. Kain, Aline Mamin, Valérie D’Acremont, Nicolas Senn, Yolanda Mueller, Isabella Locatelli and Noémie Boillat-Blanco
Antibiotics 2023, 12(2), 377; https://doi.org/10.3390/antibiotics12020377 - 12 Feb 2023
Viewed by 1783
Abstract
Background: Lower respiratory tract infections (LRTIs) in primary care are a promising target for antibiotic stewardship. A clinical trial in Switzerland showed a large decrease in antibiotic prescriptions with procalcitonin guidance (cut-off < 0.25 µg/L) compared with usual care. However, one-third of patients [...] Read more.
Background: Lower respiratory tract infections (LRTIs) in primary care are a promising target for antibiotic stewardship. A clinical trial in Switzerland showed a large decrease in antibiotic prescriptions with procalcitonin guidance (cut-off < 0.25 µg/L) compared with usual care. However, one-third of patients with low procalcitonin at baseline received antibiotics by day 28. Aim: To explore the factors associated with the overruling of initial procalcitonin guidance. Design and Setting: Secondary analysis of a cluster randomized trial in which patients with an LRTI were included. Method: Using the characteristics of patients, their disease, and general practitioners (GPs), we conducted a multivariate logistic regression, adjusted for clustering. Results: Ninety-five out of 301 (32%) patients with low procalcitonin received antibiotics by day 28. Factors associated with an overruling of procalcitonin guidance were: a history of chest pain (adjusted OR [aOR] 1.81, 95% confidence interval 1.03–3.17); a prescription of chest X-ray by the GP (aOR 4.65, 2.32–9.34); a C-reactive protein measured retrospectively above 100 mg/L (aOR 7.48, 2.34–23.93, reference ≤ 20 mg/L); the location of the GP practice in an urban setting (aOR 2.27, 1.18–4.37); and the GP’s number of years of experience (aOR per year 1.05, 1.01–1.09). Conclusions: Overruling of procalcitonin guidance was associated with GPs’ socio-demographic characteristics, pointing to the general behavioral problem of overprescription by physicians. Continuous medical education and communication training might support the successful implementation of procalcitonin point-of-care tests aimed at antibiotic stewardship. Full article
(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)
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15 pages, 1404 KiB  
Article
Intravenous Polymyxin B as Adjunctive Therapy to High-Dose Tigecycline for the Treatment of Nosocomial Pneumonia Due to Carbapenem-Resistant Acinetobacter baumannii and Klebsiella pneumoniae: A Propensity Score-Matched Cohort Study
by Lei Zha, Xue Zhang, Yusheng Cheng, Qiancheng Xu, Lingxi Liu, Simin Chen, Zhiwei Lu, Jun Guo and Boris Tefsen
Antibiotics 2023, 12(2), 273; https://doi.org/10.3390/antibiotics12020273 - 30 Jan 2023
Cited by 4 | Viewed by 2381
Abstract
Although the combination of polymyxin and tigecycline is widely used in treating carbapenem-resistant bacterial infections, the benefit of this combination is still uncertain. To assess whether adding polymyxin B to the high-dose tigecycline regimen would result in better clinical outcomes than the high-dose [...] Read more.
Although the combination of polymyxin and tigecycline is widely used in treating carbapenem-resistant bacterial infections, the benefit of this combination is still uncertain. To assess whether adding polymyxin B to the high-dose tigecycline regimen would result in better clinical outcomes than the high-dose tigecycline therapy in patients with pneumonia caused by carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii, we conducted a propensity score-matched cohort study in a single center between July 2019 and December 2021. Of the 162 eligible patients, 102 were included in the 1:1 matched cohort. The overall 14-day mortality in the matched cohort was 24.5%. Compared with high-dose tigecycline, the combination therapy was not associated with better clinical outcomes, and showed similar 14-day mortality (OR, 0.72, 95% CI 0.27–1.83, p = 0.486), clinical cure (OR, 1.09, 95% CI 0.48–2.54, p = 0.823), microbiological cure (OR, 0.96, 95% CI 0.39–2.53, p = 0.928) and rate of nephrotoxicity (OR 0.85, 95% CI 0.36–1.99, p = 0.712). Subgroup analyses also did not demonstrate any statistical differences. Based on these results, it is reasonable to recommend against adding polymyxin B to the high-dose tigecycline regimen in treating pneumonia caused by carbapenem-resistant K. pneumoniae and A. baumannii. Full article
(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)
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14 pages, 1894 KiB  
Article
Pragmatic Comparison of Piperacillin/Tazobactam versus Carbapenems in Treating Patients with Nosocomial Pneumonia Caused by Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae
by Lei Zha, Xiang Li, Zhichu Ren, Dayan Zhang, Yi Zou, Lingling Pan, Shirong Li, Shanghua Chen and Boris Tefsen
Antibiotics 2022, 11(10), 1384; https://doi.org/10.3390/antibiotics11101384 - 10 Oct 2022
Cited by 4 | Viewed by 4284
Abstract
The effectiveness of piperacillin/tazobactam for managing nosocomial pneumonia caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is unknown. To answer this question, we conducted a retrospective cohort study in two tertiary teaching hospitals of patients admitted between January 2018 and July 2021 with a diagnosis [...] Read more.
The effectiveness of piperacillin/tazobactam for managing nosocomial pneumonia caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is unknown. To answer this question, we conducted a retrospective cohort study in two tertiary teaching hospitals of patients admitted between January 2018 and July 2021 with a diagnosis of nosocomial pneumonia caused by ESBL-producing K. pneumoniae receiving either piperacillin/tazobactam or carbapenems within 24 h from the onset of pneumonia for at least 72 h. Clinical outcomes, including 28-day mortality and 14-day clinical and microbiological cure, were analyzed. Of the 136 total patients, 64 received piperacillin/tazobactam and 72 received carbapenems. The overall 28-day mortality was 19.1% (26/136). In the inverse probability of treatment weighted cohort, piperacillin/tazobactam therapy was not associated with worse clinical outcomes, as the 28-day mortality (OR, 0.82, 95% CI, 0.23–2.87, p = 0.748), clinical cure (OR, 0.94, 95% CI, 0.38–2.35, p = 0.894), and microbiological cure (OR, 1.10, 95% CI, 0.53–2.30, p = 0.798) were comparable to those of carbapenems. Subgroup analyses also did not demonstrate any statistical differences. In conclusion, piperacillin/tazobactam could be an effective alternative to carbapenems for treating nosocomial pneumonia due to ESBL-producing K. pneumoniae when the MICs are ≤8 mg/L. Full article
(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)
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8 pages, 1618 KiB  
Article
Comparison between Ceftriaxone and Sulbactam-Ampicillin as Initial Treatment of Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis
by Hideo Kato, Mao Hagihara, Nobuhiro Asai, Jun Hirai, Yuka Yamagishi, Takuya Iwamoto and Hiroshige Mikamo
Antibiotics 2022, 11(10), 1291; https://doi.org/10.3390/antibiotics11101291 - 22 Sep 2022
Cited by 2 | Viewed by 5615
Abstract
Current guidelines recommend the use of ceftriaxone and sulbactam-ampicillin for the initial treatment of community-acquired pneumonia (CAP). However, there are no clear data on these guidelines. Therefore, this systematic review and meta-analysis aims to evaluate the effectiveness of ceftriaxone and sulbactam-ampicillin in the [...] Read more.
Current guidelines recommend the use of ceftriaxone and sulbactam-ampicillin for the initial treatment of community-acquired pneumonia (CAP). However, there are no clear data on these guidelines. Therefore, this systematic review and meta-analysis aims to evaluate the effectiveness of ceftriaxone and sulbactam-ampicillin in the initial treatment of CAP. The Embase, Scopus, PubMed, Ichushi, and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched from inception to July 2022. The studies included patients who received ceftriaxone or sulbactam-ampicillin as the initial antibiotic therapy for CAP. The mortality and clinical cure rates were evaluated. Of the 2152 citations identified for screening, four studies were included. Results of the pooled analysis indicated no significant differences in the mortality and clinical cure rates between patients treated with ceftriaxone and those treated with sulbactam-ampicillin (mortality, odds ratio [OR]: 1.85, 95% confidence interval [CI]: 0.57–5.96; clinical cure rate, OR: 1.08, 95% CI: 0.18–6.44). This study supports the guidelines for CAP treatment, though further studies are needed to obtain a deeper understanding. Full article
(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)
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Review

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13 pages, 1032 KiB  
Review
The Role of the Respiratory Microbiome in the Pathogenesis of Aspiration Pneumonia: Implications for Diagnosis and Potential Therapeutic Choices
by Natalia G. Vallianou, Alexandros Skourtis, Dimitris Kounatidis, Evangelia Margellou, Fotis Panagopoulos, Eleni Geladari, Angelos Evangelopoulos and Edison Jahaj
Antibiotics 2023, 12(1), 140; https://doi.org/10.3390/antibiotics12010140 - 10 Jan 2023
Cited by 5 | Viewed by 1932
Abstract
Although the lungs were considered to be sterile until recently, the advent of molecular biology techniques, such as polymerase chain reaction, 16 S rRNA sequencing and metagenomics has led to our expanding knowledge of the lung microbiome. These methods may be particularly useful [...] Read more.
Although the lungs were considered to be sterile until recently, the advent of molecular biology techniques, such as polymerase chain reaction, 16 S rRNA sequencing and metagenomics has led to our expanding knowledge of the lung microbiome. These methods may be particularly useful for the identification of the causative agent(s) in cases of aspiration pneumonia, in which there is usually prior administration of antibiotics. The most common empirical treatment of aspiration pneumonia is the administration of broad-spectrum antibiotics; however, this may result in negative cultures from specimens taken from the respiratory tract. Therefore, in such cases, polymerase chain reaction or metagenomic next-generation sequencing may be life-saving. Moreover, these modern molecular methods may assist with antimicrobial stewardship. Based upon factors such as age, altered mental consciousness and recent hospitalization, there is a shift towards the predominance of aerobes, especially Gram-negative bacteria, over anaerobes in aspiration pneumonia. Thus, the therapeutic choices should be expanded to cover multi-drug resistant Gram-negative bacteria in selected cases of aspiration pneumonia. Full article
(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)
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Other

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29 pages, 17265 KiB  
Systematic Review
Echinacea Reduces Antibiotics by Preventing Respiratory Infections: A Meta-Analysis (ERA-PRIMA)
by Giuseppe Gancitano, Nicola Mucci, Rainer Stange, Mercedes Ogal, Selvarani Vimalanathan, Mahfuza Sreya, Anthony Booker, Bushra Hadj-Cherif, Werner C. Albrich, Karin Woelkart-Ardjomand, Samo Kreft, Wim Vanden Berghe, Godehard Hoexter, Andreas Schapowal and Sebastian L. Johnston
Antibiotics 2024, 13(4), 364; https://doi.org/10.3390/antibiotics13040364 - 16 Apr 2024
Viewed by 1574
Abstract
Respiratory tract infections (RTIs) are the leading cause of antibiotic prescriptions, primarily due to the risk for secondary bacterial infections. In this study, we examined whether Echinacea could reduce the need for antibiotics by preventing RTIs and their complications, and subsequently investigated its [...] Read more.
Respiratory tract infections (RTIs) are the leading cause of antibiotic prescriptions, primarily due to the risk for secondary bacterial infections. In this study, we examined whether Echinacea could reduce the need for antibiotics by preventing RTIs and their complications, and subsequently investigated its safety profile. A comprehensive search of EMBASE, PubMed, Google Scholar, Cochrane DARE and clinicaltrials.gov identified 30 clinical trials (39 comparisons) studying Echinacea for the prevention or treatment of RTIs in 5652 subjects. Echinacea significantly reduced the monthly RTI occurrence, risk ratio (RR) 0.68 (95% CI 0.61–0.77) and number of patients with ≥1 RTI, RR = 0.75 [95% CI 0.69–0.81] corresponding to an odds ratio 0.53 [95% CI 0.42–0.67]. Echinacea reduced the risk of recurrent infections (RR = 0.60; 95% CI 0.46–0.80), RTI complications (RR = 0.44; 95% CI 0.36–0.54) and the need for antibiotic therapy (RR = 0.60; 95% CI 0.39–0.93), with total antibiotic therapy days reduced by 70% (IRR = 0.29; 95% CI 0.11–0.74). Alcoholic extracts from freshly harvested Echinacea purpurea were the strongest, with an 80% reduction of antibiotic treatment days, IRR 0.21 [95% CI 0.15–0.28]. An equal number of adverse events occurred with Echinacea and control treatment. Echinacea can safely prevent RTIs and associated complications, thereby decreasing the demand for antibiotics. Relevant differences exist between Echinacea preparations. Full article
(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: The role of the respiratory microbiome in the pathogenesis of aspiration pneumonia: implications for diagnosis and potential therapeutic choices
Author: Vallianou
Highlights: * The lungs of human beings are not sterile. * The human lung microbiome can be determined by the use of sophisticated molecular techniques. * It seems that the human lung microbiome could play a crucial role in aspiration pneumonia. *Therapeutic choices should be expanded to cover multi-drug resistant gram negative bacteria in selected cases of aspiration pneumonia.

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