The epidemiology of respiratory tract infections.
80 and over; Adolescent; Adult; Age Factors; Aged; Child; Community-Acquired Infections/epidemiology; Cross Infection/epidemiology; Drug Resistance; Female; Humans; Incidence; Infant; Male; Microbial; Middle Aged; Newborn; Preschool; Respiratory Tract Diseases/*epidemiology/mortality/prevention & control; Risk Factors; United States/epidemiology
Respiratory tract infections (RTIs) are the most common, and potentially most severe, of infections treated by health care practitioners. Lower RTIs along with influenza, are the most common cause of death by infection in the United States. Risk factors for pneumonia and other respiratory tract infections include: extremes of age (very young and elderly), smoking, alcoholism, immunosuppression, and comorbid conditions. The microbial cause of RTIs vary depending on the infection (i.e., pneumonia compared with acute bacterial sinusitis), setting (i.e., community-acquired compared with nosocomial), and other factors. The causative pathogens associated with CAP have changed in prevalence over time. Although Streptococcus pneumoniae remains the most common causative pathogen, a number of newer pathogens, such as Chlamydia pneumoniae and sin nombre virus, have been recognized in recent years. The emerging antimicrobial resistance of respiratory pathogens (most notably S. pneumoniae) has also increased the challenge for appropriate management of RTI. An awareness of the epidemiology and cause of specific respiratory infections should optimize care.
File T M
Seminars in respiratory infections
2000
2000-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1053/srin.2000.18059" target="_blank" rel="noreferrer noopener">10.1053/srin.2000.18059</a>
Predisposing factors and antibiotic use in nosocomial infections caused by Xanthomonas maltophilia.
*Xanthomonas/isolation & purification; Anti-Bacterial Agents/*therapeutic use; Cross Infection/*drug therapy/microbiology; Gram-Negative Bacterial Infections/*drug therapy/microbiology; Humans; Risk Factors
Hulisz D T; File T M
Infection control and hospital epidemiology
1992
1992-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1086/646579" target="_blank" rel="noreferrer noopener">10.1086/646579</a>
Pharmacokinetics of imipenem in serum and skin window fluid in healthy adults after intramuscular or intravenous administration.
Adult; Biological Availability; Cilastatin/administration & dosage/pharmacokinetics; Humans; Imipenem/administration & dosage/blood/*pharmacokinetics; Infusions; Injections; Intramuscular; Intravenous; Male; Middle Aged; Skin/*metabolism
The pharmacokinetic profiles of imipenem after intramuscular (i.m.) and intravenous injections were examined in adult volunteers. Levels of imipenem in serum after i.m. injection of a microcrystalline suspension of imipenem-cilastatin (500 mg each) reached a peak (8.0 micrograms/ml) at 1.5 h after administration, and concentrations were maintained in excess of 1.5 micrograms/ml for 6 h. Serum elimination half-life (1.3 h), volume of distribution (14.5 liters), and area under the curve (AUC; 27.8 micrograms.h/ml) after i.m. injection did not significantly differ from those of a comparable dose given by intravenous infusion. Bioavailability after i.m. injection was 89%. Imipenem levels in skin window fluid after i.m. administration were maximal (4.3 micrograms/ml) at 4 h after injection, at which time imipenem concentrations exceeded those produced by intravenous infusion. The AUCskin window/AUCserum ratio for skin window fluid after i.m. injection was 68%, indicating good penetration of the drug into skin fluid. This study shows that i.m. injection of 500 mg of imipenem-cilastatin results in concentrations of imipenem in serum and skin fluid that are, for at least 6 h, consistent with antimicrobial activity against susceptible organisms.
Signs S A; Tan J S; Salstrom S J; File T M
Antimicrobial agents and chemotherapy
1992
1992-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1128/aac.36.7.1400" target="_blank" rel="noreferrer noopener">10.1128/aac.36.7.1400</a>
The Science of Selecting Antimicrobials for Community-Acquired Pneumonia (CAP)
Antibiotics; Human; Practice Guidelines; Drug Resistance; Pneumonia; Drug Therapy; Microbial; Combination; Microbial Culture and Sensitivity Tests; Antiinfective Agents; Streptococcus; Gram-Negative Bacteria; Antibiotics – Therapeutic Use; Community-Acquired Infections – Drug Therapy; Bacterial – Drug Therapy; Macrolide – Therapeutic Use; Quinolone – Therapeutic Use; Lactam – Therapeutic Use; Legionnaires' Disease – Drug Therapy
File T M
Journal of Managed Care Pharmacy
2009
2009-03-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.18553/jmcp.2009.15.s2.5" target="_blank" rel="noreferrer noopener">10.18553/jmcp.2009.15.s2.5</a>
Highlights From Clinical Practice Guidelines by the Infectious Diseases Society of America for the Diagnosis and Treatment of Seasonal Influenza
antiviral; Diagnosis; guideline; Immunology; Infectious Diseases; influenza
Seasonal influenza remains a significant cause of morbidity and mortality. The Infectious Diseases Society of America has published an update of the clinical practice guideline for the diagnosis and treatment of seasonal influenza. The guideline provides new recommendations for management of this infection. Clinicians should use rapid molecular assays for diagnosis. Antiviral therapy of patients with severe or progressive illness should be started regardless of illness duration.
File T M
Infectious Diseases in Clinical Practice
2019
2019-07
<a href="http://doi.org/10.1097/ipc.0000000000000742" target="_blank" rel="noreferrer noopener">10.1097/ipc.0000000000000742</a>
Factors associated with antimicrobial resistance and mortality in pneumococcal bacteremia
antibiotic resistance; azithromycin; bacteremia; clarithromycin; community-acquired pneumonia; Emergency Medicine; erythromycin; macrolide resistance; mortality; outpatients; penicillin; Streptococcus pneumoniae; streptococcus-pneumoniae bacteremia; surveillance; united-states
We conducted a multicenter, retrospective cohort study of patients with Streptococcus pneumoniae bacteremia to determine factors associated with antibiotic resistance and mortality. Risk factors were identified using multivariate logistic regression. There were 1574 patients at 34 sites enrolled. Compared to isolates from patients not receiving an antibiotic before the index blood culture, patients receiving an antibiotic were less likely to harbor an antibiotic susceptible organism. Susceptibility to penicillin decreased from 78% (95% confidence interval [CI] 75-80) to 49% (95% CI 39-59); to cefotaxime/ceftriaxone, from 92% (95% CI 90-93) to 82% (95% CI 72-89); and to macrolide, from 84% (95% CI 82-87) to 55% (95% CI 41-68). Factors associated with macrolide non-susceptibility include: > 24 h of antibiotic therapy at time of the index culture (odds ratio [OR] 4.0), residing in southern U.S. (OR 1.7), and having an antibiotic allergy (OR 1.7). Harboring an antibiotic non-susceptible strain (OR 1.4) and male sex (OR 1.4) were associated with increased risk of mortality, whereas black race (OR 0.6) and evidence of focal infection (OR 0.6) were associated with decreased risk. (c) 2007 Elsevier Inc.
Neuman M I; Kelley M; Harper M B; File T M; Camargo C A; Investigators E MNet
Journal of Emergency Medicine
2007
2007-05
Journal Article
<a href="http://doi.org/10.1016/j.jemermed.2006.08.014" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2006.08.014</a>
Emergence of methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of late-onset nosocomial pneumonia in intensive care patients in the USA
blood-stream infections; CA-MRSA; community-acquired pneumonia; Community-associated methicillin-resistant Staphylococcus aureus; Community-associated MRSA; disease; epidemiology; Infectious Diseases; Intensive care; molecular; mortality; MRSA; mrsa strains; Nosocomial pneumonia; outcomes; panton-valentine leukocidin; risk-factors; ventilator-associated pneumonia
Objective: To compare demographic and clinical characteristics, and methicillin-resistant Staphylococcus aureus (MRSA) strain characteristics, in patients with early-onset (EO) and late-onset (LO) MRSA nosocomial pneumonia. Methods: This was a retrospective analysis of data from a multicenter observational study of nosocomial pneumonia patients admitted between November 2008 and July 2010. Laboratory analyses performed on MRSA isolates included confirmation of antimicrobial susceptibility and heteroresistance to vancomycin, USA typing, staphylococcal cassette chromosome (SCC) mec typing, and detection of Panton-Valentine leukocidin (PVL) genes. Results: We identified 134 patients; 42 (31%) had EO MRSA pneumonia and 92 (69%) had LO MRSA pneumonia. The patients in the LO group were more likely to have risk factors for multidrug-resistant pathogens (98% vs. 76%, p < 0.001). The MRSA USA300 strain was found with equal frequency in the EO and LO groups. Likewise, both groups had similar frequencies of isolates exhibiting PVL and SCCmec type IV. Conclusions: Our findings provide further evidence of the continued migration of community-associated MRSA into the healthcare setting in the USA. MRSA USA300 genotype has emerged as a significant cause of LO nosocomial pneumonia in intensive care units. Appropriate anti-MRSA antimicrobial therapy should be considered for both EO and LO hospital-acquired pneumonia and ventilator-associated pneumonia. (C) 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Pasquale T R; Jabrocki B; Salstrom S J; Wiemken T L; Peyrani P; Haque N Z; Scerpella E G; Ford K D; Zervos M J; Ramirez J A; File T M; Grp Impact-Hap Study
International Journal of Infectious Diseases
2013
2013-06
Journal Article
<a href="http://doi.org/10.1016/j.ijid.2012.12.013" target="_blank" rel="noreferrer noopener">10.1016/j.ijid.2012.12.013</a>
Value of noninvasive studies in community-acquired pneumonia
antimicrobial resistance; colonization; diagnosis; gram stain; Immunology; Infectious Diseases; prediction rule; requiring hospitalization; sputum; Streptococcus pneumoniae; surveillance; united-states
Noninvasive diagnostic studies, i.e., sputum gram stain, sputum culture, blood culture and antigen detection assays will assist the clinician in the selection of initial antimicrobial therapy in some patients. These tests may be even more valuable in adjusting treatment regimens to prevent the use of broad spectrum antimicrobial agents as routine therapy.
Plouffe J F; McNally C; File T M
Infectious Disease Clinics of North America
1998
1998-09
Journal Article
<a href="http://doi.org/10.1016/s0891-5520(05)70205-1" target="_blank" rel="noreferrer noopener">10.1016/s0891-5520(05)70205-1</a>
Safety of Intravenous Infusion of Doripenem
antibiotics; carbapenems; ertapenem; history; hypersensitivity; imipenem; Immunology; Infectious Diseases; meropenem; Microbiology; penicillin allergy; seizures
Carbapenems remain a mainstay for the empirical treatment of serious nosocomial infection. Although the tolerance and safety profile of the carbapenems as a class is favorable, the primary safety concern is the potential for treatment-emergent seizures. In preclinical testing, doripenem, a new carbapenem antibiotic, showed negligible neurotoxic effects. The safety and tolerability of intravenous doripenem was evaluated in 1 phase 2 and in 6 phase 3 clinical trials conducted with patients with nosocomial pneumonia, including ventilator-associated pneumonia; complicated intra-abdominal infection; and complicated urinary tract infection. Safety data were available from 1817 patients who received doripenem and 1325 patients who received 1 of 4 active comparator drugs as part of this development program. Overall, intravenous doripenem was found to be safe and well tolerated, demonstrating a safety profile comparable to that of comparator agents and a limited propensity to induce seizures, including when administered via 1-h or 4-h infusion.
Redman R; File T M
Clinical Infectious Diseases
2009
2009-08
Journal Article
<a href="http://doi.org/10.1086/599813" target="_blank" rel="noreferrer noopener">10.1086/599813</a>
Higher Pneumococcal Disease Vaccination Rates Needed to Protect More At-Risk US Adults
changing epidemiology; community-acquired; community-acquired pneumonia; conjugate vaccine; General & Internal Medicine; H1N1 influenza; invasive pneumococcal disease; meningitis; older-adults; pneumococcal disease; pneumonia; PPSV23; united-states
Pneumococcal disease, which includes pneumococcal pneumonia, meningitis, and bacteremia, is associated with substantial morbidity, mortality, and health care costs in adults. Advanced age, chronic lung or cardiovascular disease, immunosuppressive conditions, and smoking increase the risk for infection. Despite the availability of an effective pneumococcal polysaccharide vaccine (PPSV23), vaccination rates among adults remain suboptimal. This is of immediate concern given the current H1N1 pandemic, since secondary bacterial infection with Streptococcus pneumoniae is common and can contribute to morbidity and mortality. The Centers for Disease Control and Prevention has recently called for increased efforts to vaccinate recommended persons against pneumococcal disease. Long-term trends including the growth of the elderly population and an increase in the number of patients with chronic conditions also underscore the importance of improving pneumococcal vaccination rates. It is important for health care providers, public health officials, and policy makers to recognize the serious health impact of pneumococcal disease in adults and to ensure increased coverage; at present, this is the best way to protect against invasive pneumococcal infection and its consequences.
Rehm S J; Farley M M; File T M; Hall W J; Hopkins R; Levine O S; Nichol K L; Nuorti P; Zimmerman R K; Schaffner W
Postgraduate Medicine
2009
2009-11
Journal Article
<a href="http://doi.org/10.3810/pgm.2009.11.2069" target="_blank" rel="noreferrer noopener">10.3810/pgm.2009.11.2069</a>
Identifying Barriers to Adult Pneumococcal Vaccination: An NFID Task Force Meeting
adult vaccination; care; disease; General & Internal Medicine; influenza; pneumococcal disease; pneumococcal vaccine; pneumonia; Streptococcus pneumoniae; united-states
Pneumococcal infection is common in adults, and invasive disease is associated with a high mortality rate. Pneumococcal polysaccharide vaccine can prevent invasive pneumococcal disease and is recommended for people aged >= 65 years and for younger adults with high-risk chronic conditions; however, vaccination rates are suboptimal in all of these groups. A multidisciplinary task force meeting examined ways to increase vaccination rates in the target populations. Barriers to vaccination include lack of awareness of the disease or vaccine among vaccination candidates and health care providers, failure to assume responsibility for vaccination, competing priorities, incomplete or inaccessible documentation of previous vaccines, and health care system delivery challenges. Efforts to address these barriers should use appropriate methods. For example, potential vaccine recipients might be motivated by a message from a community leader, whereas health care providers are more apt to offer a vaccine when reminded that it is a recommended best practice. All health care providers need to accept responsibility for vaccination so that this preventive measure becomes a high priority in the care of patients at risk for serious pneumococcal infection.
Rehm S J; File T M; Metersky M; Nichol K L; Schaffner W; Natl Fdn Infect Dis Pneumococcal D
Postgraduate Medicine
2012
2012-05
Journal Article
<a href="http://doi.org/10.3810/pgm.2012.05.2550" target="_blank" rel="noreferrer noopener">10.3810/pgm.2012.05.2550</a>
INFECTIONS DUE TO CORYNEBACTERIUM GROUP-D2 - REPORT OF A CASE
General & Internal Medicine
Roncikoenig T J; Tan J S; File T M; Thomson R B
Archives of Internal Medicine
1990
1990-09
Journal Article
<a href="http://doi.org/10.1001/archinte.150.9.1965" target="_blank" rel="noreferrer noopener">10.1001/archinte.150.9.1965</a>
How long should we treat community-acquired pneumonia?
antibacterial response; antibiotic-therapy; antimicrobial therapy; azithromycin; clinical-efficacy; community-acquired pneumonia; double-blind; duration of therapy; Infectious Diseases; practice guidelines; respiratory-tract infections; short-duration therapy; Streptococcus pneumoniae
Purpose of review: The studies, reviewed in this article suggest that a shorter duration of antibiotic therapy is comparable to standard therapy in the treatment of community-acquired pneumonia and promotes reduction of adverse events, microbial resistance, cost, and improved patient compliance. Recent findings: Community-acquired pneumonia has traditionally been treated with a 7-14-day course of antimicrobial therapy. Since there have been few well controlled trials regarding the optimal duration of therapy, however, there has been no consensus on length of therapy among different organizational guidelines. Several recent studies have demonstrated that shorter course antibiotic regimens are effective in the treatment of community-acquired pneumonia. Summary: Short-course antibiotic therapy is equivalent to standard length of therapy for clinical cure and bacterial eradication. Minimization of drug exposure, however, reduces selection pressure for resistant strains, strengthens patient compliance, and potentially reduces adverse events such as Clostridium difficile infections.
Scalera N M; File T M
Current Opinion in Infectious Diseases
2007
2007-04
Journal Article
<a href="http://doi.org/10.1097/QCO.0b013e3280555072" target="_blank" rel="noreferrer noopener">10.1097/QCO.0b013e3280555072</a>
Performance measure of urinary antigen in patients with Streptococcus pneumoniae bacteremia
adults; assay binax; bacteremia; community-acquired pneumonia; diagnosis; etiologic diagnosis; infections; Infectious Diseases; management; Microbiology; pneumococcal pneumonia; rapid diagnosis; severity; sputum culture; Streptococcus pneumoniae; Urinary antigen
The Streptococcus pneumoniae (SP) urinary antigen (UAg) test is a commonly used assay. The purpose cif this study was to evaluate the test's actual performance in the clinical setting and determine the effects of renal function, grade of bacteremia, and severity-of-illness scores on its outcome. Patients with pneumococcal bacteremia were retrospectively identified and stratified on the basis of glomerular filtration rates, number of positive blood cultures, and CURB-65 scores. Logistic regression was used to determine the effect that these 3 variables had on test outcomes. SP UAg testing was performed in 65 of 129 patients with pneumococcal bacteremia and was positive in 42 of 65 (64.5%). Impaired renal function was the only variable to have a significant effect on test outcome (P = 0.03). Test performance was less sensitive than prospective studies indicate. Patients with impaired renal function were significantly more likely to have positive UAg tests. (C) 2010 Elsevier Inc. All rights reserved.
Selickman J; Paxos M; File T M; Seltzer R; Bonilla H
Diagnostic Microbiology and Infectious Disease
2010
2010-06
Journal Article
<a href="http://doi.org/10.1016/j.diagmicrobio.2010.01.005" target="_blank" rel="noreferrer noopener">10.1016/j.diagmicrobio.2010.01.005</a>
Managing patients with recurrent acute exacerbations of chronic bronchitis: a common clinical problem
acute exacerbation; acute otitis media; airway inflammation; antimicrobial resistance; chronic bronchitis; chronic obstructive; community-acquired pneumonia; disease; empiric therapy; General & Internal Medicine; haemophilus-influenzae; moraxella-catarrhalis; obstructive-pulmonary-disease; pneumococcal; pneumonia; pulmonary; Research & Experimental Medicine; resistance; resistant streptococcus-pneumoniae; surveillance program
Chronic obstructive pulmonary disease (COPD) affects 15 million people and is the fourth leading cause of death in the United States. It places a considerable burden on the healthcare system, with exacerbations contributing to a significant proportion of this burden. Patients with recurrent exacerbation, who experience more than 2 exacerbations per year, are especially difficult to manage. Several potential host, pathogen, and treatment factors can be identified that contribute to recurrent exacerbation. Patients with recurrent exacerbations are often exposed to frequent courses of antimicrobials. Therefore, antimicrobial resistance among common bacterial pathogens is likely to be prevalent in this group of patients, and further complicates therapy in this already difficult-to-treat patient population. In the management of patients with recurrent exacerbation, one goal should be to decrease the frequency of exacerbations, for which several strategies are suggested. In this article, we will review available literature identified through an extensive search of Medline and PubMed on the characteristics and approach to management of these difficult-to-treat patients. There is a substantial need for more research to understand the etiology and identify efficacious interventions to reduce the frequency of exacerbations of COPD.
Sethi S; File T M
Current Medical Research and Opinion
2004
2004-10
Journal Article
<a href="http://doi.org/10.1185/030079904x3096" target="_blank" rel="noreferrer noopener">10.1185/030079904x3096</a>
Distribution of 13-Valent Pneumococcal Conjugate Vaccine Streptococcus pneumoniae Serotypes in US Adults Aged >= 50 Years With Community-Acquired Pneumonia
13-valent pneumococcal; care-associated pneumonia; cohort; community-acquired pneumonia; conjugate vaccine; disease; efficacy; epidemiology; healthcare-associated pneumonia; immunization; Immunology; Infectious Diseases; Microbiology; older-adults; pneumococcal serotypes; polysaccharide vaccine; population; serotype distribution; Streptococcus pneumoniae; united-states; urinary antigen detection assay
Background. Streptococcus pneumoniae causes a substantial proportion of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) in the United States. Limited data are available regarding the pneumococcal serotypes causing CAP and HCAP. Methods. Adults aged >= 50 years presenting to participating US hospitals with radiographically confirmed pneumonia between February 2010 and September 2011 were screened for inclusion. S. pneumoniae was identified using microbiological cultures, BinaxNOW (R) S. pneumoniae assay, or urine antigen detection (UAD) assay capable of detecting 13-valent pneumococcal conjugate vaccine (PCV13)-associated serotypes. Results. Among 710 subjects enrolled, the median age was 65.4 years; 54.2% of subjects were male, 22.4% of radiographically confirmed pneumonia cases were considered HCAP, and 96.6% of subjects were hospitalized. S. pneumoniae was detected in 98 subjects (13.8%) by any test, and PCV13-associated serotype(s) were identified by UAD in 78 (11.0%). Serotype 19A was most prevalent, followed by 7F/A, 3, and 5. Serotypes associated with 7-valent pneumococcal conjugate vaccine (PCV7) accounted for 25% of UAD-positive isolates. Conclusions. Pneumococcal serotypes causing noninvasive pneumonia in adults may differ significantly from those causing invasive disease, with PCV7-associated serotypes overrepresented. Serotype 5, rarely seen in contemporary surveillance of invasive disease in the United States, substantially contributed to the observed cases of S. pneumoniae-positive CAP or HCAP.
Sherwin R L; Gray S; Alexander R; McGovern P C; Graepel J; Pride M W; Purdy J; Paradiso P; File T M
Journal of Infectious Diseases
2013
2013-12
Journal Article
<a href="http://doi.org/10.1093/infdis/jit506" target="_blank" rel="noreferrer noopener">10.1093/infdis/jit506</a>
HIGH-PRESSURE LIQUID-CHROMATOGRAPHIC METHOD FOR ANALYSIS OF CEPHALOSPORINS
Microbiology; Pharmacology & Pharmacy
Signs S A; File T M; Tan J S
Antimicrobial Agents and Chemotherapy
1984
1984
Journal Article
<a href="http://doi.org/10.1128/aac.26.5.652" target="_blank" rel="noreferrer noopener">10.1128/aac.26.5.652</a>
A clinician's guide to the appropriate and accurate use of antibiotics: the Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria
acute exacerbations; antibiotic therapy resistance; antibiotics; antimicrobials; cefuroxime axetil; chronic bronchitis; clarithromycin; community-acquired pneumonia; double-blind; efficacy; General & Internal Medicine; pharmacodynamics; respiratory-tract infections; Streptococcus pneumoniae
In response to the overuse and misuse of antibiotics, leading to increasing bacterial resistance and decreasing development of new antibiotics, the Council for Appropriate and Rational Antibiotic Therapy (CARAT) has developed criteria to guide appropriate and accurate antibiotic selection. The criteria, which are aimed at optimizing antibiotic therapy, include evidence-based results, therapeutic benefits, safety, optimal drug for the optimal duration, and cost-effectiveness. (C) 2005 Elsevier Inc. All rights reserved.
Slama T G; Amin A; Brunton S A; File T M; Milkovich G; Rodvold K A; Sahm D F; Varon J; Weiland D; Carat
American Journal of Medicine
2005
2005-07
Journal Article
<a href="http://doi.org/10.1016/j.amjmed.2005.05.007" target="_blank" rel="noreferrer noopener">10.1016/j.amjmed.2005.05.007</a>
Risk factors for domestic acquisition of Legionnaires disease
community-acquired pneumonia; cooling-tower; evaporative condenser; General & Internal Medicine; hot; legionella-pneumophila serogroup-1; monoclonal-antibody; outbreak; potable water; tap water; united-states; water-systems
Background: Legionnaires disease is a common cause of adult pneumonia. Outbreaks of legionnaires disease have been well described, but little is known about sporadically occurring legionnaires disease, which accounts for most infections. Exposure to contaminated residential water sources is 1 plausible means of disease acquisition. Methods: Employing a matched case-control study design in 15 hospitals in 2 Ohio counties, we prospectively enrolled 146 adults diagnosed as having nonepidemic, community-acquired legionnaires disease and compared each with 2 hospital-based control patients, matched for age, sex, and underlying illness category. An interview regarding potential exposures was followed by a home survey that included sampling residential sources for Legionella. Interview and home survey data were analyzed to estimate the risk of acquiring legionnaires disease associated with various exposures. Results: Multivariate analysis showed that a nonmunicipal water supply (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.17-4.37), recent residential plumbing repair (OR, 2.39; 95% CI, 1.10-5.18), and smoking (OR, 3.48; 95% CI, 2.09-5.79) were independent risk factors for legionnaires disease. Univariate analysis suggested that electric (vs gas) water heaters (OR, 1.97; 95% CI, 1.10-3.52), working more than 40 hours weekly (OR, 2.13; 95% CI, 1.12-4.07), and spending nights away from home before illness (OR, 1.68; 95% CI, 1.03-2.74) were additional possible risk factors. Lower chlorine concentrations in potable water and lower water heater temperatures were associated with residential Legionella colonization. Conclusions: A proportion of sporadic cases of legionnaires disease may be residentially acquired and are associated with domestic potable water and disruptions in residential plumbing systems. Potential strategies to reduce legionnaires disease risk include consistent chlorination of potable water, increasing water heater temperatures, and limiting exposure to aerosols after domestic plumbing repairs.
Straus W L; Plouffe J F; File T M; Lipman H B; Hackman B H; Salstrom S J; Benson R F; Breiman R F; Baird I; Emerick J; Gianakopoulos G; Herbert M; Parsons J; Anderson C J; Bollin G E; Farkas S A; Francis S J; Gardner W G; Myers J P; Signs D J; Tan J S; Thomson R B; Barbaree J; Fields B; Morrill W; Moyenuddin M; Pruckler J; StJohn A
Archives of Internal Medicine
1996
1996-08
Journal Article
<a href="http://doi.org/10.1001/archinte.156.15.1685" target="_blank" rel="noreferrer noopener">10.1001/archinte.156.15.1685</a>
CEFMENOXIME VERSUS CEFOXITIN IN THE TREATMENT OF SERIOUS BACTERIAL-INFECTIONS
General & Internal Medicine
Tan J S; File T M
American Journal of Medicine
1984
1984
Journal Article
<a href="http://doi.org/10.1016/s0002-9343(84)80075-3" target="_blank" rel="noreferrer noopener">10.1016/s0002-9343(84)80075-3</a>
DIAGNOSIS AND TREATMENT OF STAPHYLOCOCCAL DISEASES
Orthopedics
Tan J S; File T M
Journal of the American Podiatric Medical Association
1989
1989-10
Journal Article
<a href="http://doi.org/10.7547/87507315-79-10-492" target="_blank" rel="noreferrer noopener">10.7547/87507315-79-10-492</a>
Legionnaires disease with bacteremic coinfection
adults; community-acquired pneumonia; criteria; Immunology; infection; Infectious Diseases; influenza; legionella-pneumophila; measles; Microbiology; risk-factors; surveillance
We describe 6 patients who had bacteremic community-acquired pneumonia and unsuspected Legionella pneumophila coinfection. We reviewed case records of patients who were diagnosed as having a recent Legionella infection on the basis of either the presence of L. pneumophila serogroup 1 antigen in urine or a 4-fold increase in L. pneumophila antibody level and with a blood culture that yielded a bacterium other than L. pneumophila. Three patients were diagnosed with legionellosis on the basis of the presence of antigen in urine, and 3 were diagnosed on the basis of a 4-fold increase in antibody titer. Of these 6 patients, 4 were infected with Streptococcus pneumoniae, 1 with Streptococcus pyogenes, and 1 with Enterobacter cloacae. L. pneumophila infection in these patients may have predisposed them to concomitant bacteremia. Initial empiric antimicrobial therapy for patients who live in areas of endemicity and who are smokers should be treated with antimicrobial agents that have activity against pneumococcus and Legionella species.
Tan M J; Tan J S; File T M
Clinical Infectious Diseases
2002
2002-09
Journal Article
<a href="http://doi.org/10.1086/341771" target="_blank" rel="noreferrer noopener">10.1086/341771</a>
Persistently positive culture results in a patient with community-acquired pneumonia due to Legionella pneumophila
azithromycin; clarithromycin; erythromycin; hospitalized-patients; Immunology; Infectious Diseases; legionnaires-disease; macrolides; Microbiology; pcr; pharmacokinetics; time
We describe a patient with community-acquired pneumonia due to Legionella pneumophila serogroup 6. This patient was found to have bronchoalveolar carcinoma of the lung by means of cytologic testing in 1 of 2 bronchoalveolar lavage samples, but no lesions were visible on bronchoscopy. Despite intravenous administration of azithromycin to the patient, repeat culture and polymerase chain reaction showed persistence of Legionella; the isolates remained susceptible to azithromycin. The patient did not respond to 14 doses of daily intravenously administered azithromycin. The poor outcome may have been partially due to the suspected underlying lung malignancy, as shown by cytologic examination, and by a delay in seeking medical attention.
Tan J S; File T M; DiPersio J R; DiPersio L P; Hamor R; Saravolatz L D; Stout J E
Clinical Infectious Diseases
2001
2001-06
Journal Article
<a href="http://doi.org/10.1086/320526" target="_blank" rel="noreferrer noopener">10.1086/320526</a>
PHARMACOKINETICS OF INTRAVENOUS CEFMETAZOLE WITH EMPHASIS ON COMPARISON BETWEEN PREDICTED THEORETICAL LEVELS IN TISSUE AND ACTUAL SKIN WINDOW FLUID LEVELS
Microbiology; Pharmacology & Pharmacy
Tan J S; Salstrom S J; Signs S A; Hoffman H E; File T M
Antimicrobial Agents and Chemotherapy
1989
1989-06
Journal Article
<a href="http://doi.org/10.1128/aac.33.6.924" target="_blank" rel="noreferrer noopener">10.1128/aac.33.6.924</a>
Respiratory infections unique to Asia
adult patients; avian influenza; community-acquired pneumonia; eosinophilia; h5n1; hong-kong; influenza; management; negative pulmonary tuberculosis; parasite; pneumonia; randomized controlled-trial; respiratory syndrome; Respiratory System; scrub typhus; severe acute; syndrome sars; tropical infection
Asia is a highly heterogeneous region with vastly different cultures, social constitutions and populations affected by a wide spectrum of respiratory diseases caused by tropical pathogens. Asian patients with community-acquired pneumonia differ from their Western counterparts in microbiological aetiology, in particular the prominence of Gram-negative organisms, Mycobacterium tuberculosis, Burkholderia pseudomallei and Staphylococcus aureus. In addition, the differences in socioeconomic and health-care infrastructures limit the usefulness of Western management guidelines for pneumonia in Asia. The importance of emerging infectious diseases such as severe acute respiratory syndrome and avian influenza infection remain as close concerns for practising respirologists in Asia. Specific infections such as melioidosis, dengue haemorrhagic fever, scrub typhus, leptospirosis, salmonellosis, penicilliosis marneffei, malaria, amoebiasis, paragonimiasis, strongyloidiasis, gnathostomiasis, trinchinellosis, schistosomiasis and echinococcosis occur commonly in Asia and manifest with a prominent respiratory component. Pulmonary eosinophilia, endemic in parts of Asia, could occur with a wide range of tropical infections. Tropical eosinophilia is believed to be a hyper-sensitivity reaction to degenerating microfilariae trapped in the lungs. This article attempts to address the key respiratory issues in these respiratory infections unique to Asia and highlight the important diagnostic and management issues faced by practising respirologists.
Tsang K W; File T M
Respirology
2008
2008-11
Journal Article
<a href="http://doi.org/10.1111/j.1440-1843.2008.01409.x" target="_blank" rel="noreferrer noopener">10.1111/j.1440-1843.2008.01409.x</a>
Azithromycin vs cefuroxime plus erythromycin for empirical treatment of community-acquired pneumonia in hospitalized patients - A prospective, randomized, multicenter trial
adults; chlamydia-pneumoniae; diagnosis; epidemiology; etiology; General & Internal Medicine; guidelines; in-vitro activities; management; resistant streptococcus-pneumoniae; therapy
Objective: To compare the efficacy and safety of azithromycin dihydrate monotherapy with those of a combination of cefuroxime axetil plus erythromycin as empirical therapy for community-acquired pneumonia in hospitalized patients. Methods: Patients were enrolled in a prospective, randomized, multicenter study. The standard therapy of cefuroxime plus erythromycin was consistent with the American Thoracic Society, Canadian Community-Acquired Pneumonia Consensus Group, and Infectious Disease Society of America consensus guidelines. The doses were intravenous azithromycin (500 mg once daily) followed by oral azithromycin (500 mg once daily), intravenous cefuroxime (750 mg every 8 hours), followed by oral cefuroxime axetil (500 mg twice daily), and erythromycin (500-1000 mg) intravenously or orally every 6 hours. Randomization was stratified by severity of illness and age. Patients who were immunosuppressed or residing in nursing homes were excluded. Results: Data from 145 patients (67 received azithromycin and 78 received cefuroxime plus erythromycin) were evaluable. Streptococcus pneumoniae and Haemophilus influenzae were isolated in 19% (28/145) and 13% (19/145), respectively. The atypical pathogens accounted for 33% (48/145) of the etiologic diagnoses; Legionella pneumophila, Chlamydia pneumoniae, and Mycoplasma pneumoniae were identified in 14% (20/ 145), 10%;, (15/145), and 9% (13/145), respectively. Clinical cure was achieved in 91% (61/67) of the patients in the azithromycin group and 91% (71/78) in the cefuroxime plus erythromycin group. Adverse events (intravenous catheter site reactions, gastrointestinal tract disturbances) were significantly more common in patients who received cefuroxime plus erythromycin (49% [30/78]) than in patients who received azithromycin (12% [8/67]) (P<.001). Conclusions: Treatment with azithromycin was as effective as cefuroxime plus erythromycin in the empirical management of community-acquired pneumonia in immunocompetent patients who were hospitalized. Azithromycin was well tolerated.
Vergis E N; Indorf A; File T M; Phillips J; Bates J; Tan J; Sarosi G A; Grayston J T; Summersgill J; Yu V L
Archives of Internal Medicine
2000
2000-05
Journal Article
<a href="http://doi.org/10.1001/archinte.160.9.1294" target="_blank" rel="noreferrer noopener">10.1001/archinte.160.9.1294</a>
What caused cough and hemoptysis in a patient recently treated for exudative tonsillitis?
arcanobacterium-haemolyticum; corynebacterium-hemolyticum; Infectious Diseases; pharyngitis
Prabhakar K; File T M; Baumgarten K L
Infections in Medicine
2008
2008-03
Journal Article
n/a
CEFADROXIL, CEFACLOR, CEFUROXIME - INTERSTITIAL FLUID CONCENTRATIONS DETERMINED THROUGH A SKIN WINDOW
cefaclor; cefadroxil; cefuroxime; interstitial fluid; pharmacokinetics; Pharmacology & Pharmacy; Research & Experimental Medicine; skin window
The complex interaction between plasma and tissue concentrations of drug has significant implications for therapies that use beta-lactam antibiotics. This comparative, triple-crossover, open-label study enrolled 12 healthy adult male volunteers to determine interstitial fluid concentrations of cefadroxil, cefaclor, and cefuroxime. Each participant, by random assignment, received therapeutically equivalent (in skin and skin-structure infections) single oral doses of cefadroxil 500 mg, cefaclor 250 mg, and cefuroxime axetil 250 mg on separate occasions 1 week apart. Serum and interstitial fluid (by skin-window technique) concentrations were assayed sequentially to determine persistence and magnitude of antibiotic penetration into interstitial fluid. Statistically higher concentrations of cefadroxil (5.5 mug/mL) than of cefaclor (1.2 mug/mL) and cefuroxime (1.1 mug/mL) were documented in interstitial fluid. Cefadroxil (0.63) also demonstrated a tissue fluid:blood area under the curve ratio significantly greater than that achieved by cefaclor (0.48) and comparable to that of cefuroxime axetil (0.60). No significant adverse events occurred with any study medication. The distribution to interstitial fluids and reliable tissue penetration are fundamental principles of successful antibacterial therapy of skin and skin-structure infections. The excellent tissue and interstitial fluid penetration of cefadroxil may contribute to its high degree of efficacy when administered once daily.
Tan J S; Salstrom S J M; File T M
Advances in Therapy
1994
1994-05
Journal Article
n/a
A COMPARISON OF AMPICILLIN-SULBACTAM WITH CEFOXITIN IN THE TREATMENT OF LOWER RESPIRATORY-TRACT INFECTIONS OF BACTERIAL ETIOLOGY
ampicillin sulbactam; cefoxitin; lower respiratory tract infection; Pharmacology & Pharmacy; Research & Experimental Medicine
Ampicillin/sulbactam (1.0-2.0 g ampicillin and 0.5-1.0 g sulbactam) and cefoxitin (1.0-2.0 g), both administered intravenously once every 6 hours, were compared in patients with lower respiratory tract infections. Thirty-two of the 51 ampicillin/sulbactam-treated patients and 24 of the 49 patients who received cefoxitin were evaluable. No significant differences were noted in the clinical and bacteriologic responses to the two antimicrobials (P = .349 and P = .473, respectively). Twenty-two (68.8%) of the ampicillin/sulbactam-treated patients were cured and 9 (28.1%) were improved; there was 1 failure. Thirteen (54.2%) patients who received cefoxitin were cured and 10 (41.7%) were improved; clinical outcome in 1 patient was not able to be determined. All isolates were eradicated in 28 (87.5%) of the patients who received ampicillin/sulbactam. The original pathogen persisted in 2 (6.3%) others. The bacteriologic response was not determined in 2 (6.3%) patients. All initial isolates were eradicated in 20 (83.3%) cefoxitin-treated patients and partially eradicated in 1 (4.2%) additional patient. In 2 (8.3%) patients, the original pathogen persisted. The bacteriologic response was not determined in 1 (4.2%) patient. Adverse reactions occurred with approximately equal frequency in both groups.
Tan J; File T M
Advances in Therapy
1994
1994-01
Journal Article
n/a
HOSPITAL-BASED PULMONARY PATHOGENS - EVOLVING BACTERIAL-RESISTANCE
antimicrobial resistance; ceftazidime; drug-resistance; gram-negative bacteria; Immunology; Infectious Diseases; nosocomial infections; pneumococcal bacteremia; resistance; spectrum beta-lactamases; staphylococcus-aureus infections; Streptococcus pneumoniae; therapy
Tan J S; File T M
Infectious Diseases in Clinical Practice
1995
1995-09
Journal Article
n/a
REPEAT ANTIMICROBIAL SUSCEPTIBILITY TESTING OF IDENTICAL ISOLATES
Microbiology
Thomson R B; File T M; Burgoon R A
Journal of Clinical Microbiology
1989
1989-05
Journal Article
n/a
YIELD, CLINICAL-SIGNIFICANCE, AND COST OF A COMBINATION BACTEC PLUS SEPTI-CHEK BLOOD CULTURE SYSTEM
Microbiology
Thomson R B; File T M; Tan J S; Evans B L
Journal of Clinical Microbiology
1987
1987-05
Journal Article
n/a
MULTICENTER STUDY OF THE CLINICAL EFFICACY OF IMIPENEM CILASTATIN FOR TREATMENT OF SERIOUS INFECTIONS
Immunology; Microbiology
Trumbore D; Pontzer R; Levison M E; Kaye D; Cynamon M; Liu C; Hinthorn D R; Tan J S; File T M
Reviews of Infectious Diseases
1985
1985
Journal Article
n/a
Consensus on early intervention in community-acquired pneumonia: Panel discussion
Infectious Diseases; Immunology
Bartlett J G; Andriole V T; Arno P; Brown R B; Etchason J; File T M; Hadlock C; Hillman A L; Niederman M S; Rush D; Schwartz S; Stelmach W J; Tice A D
Infectious Diseases in Clinical Practice
1996
1996-12
Journal Article or Conference Abstract Publication
n/a
Community-acquired pneumonia in adults: Guidelines for management
Infectious Diseases; Microbiology; united-states; Immunology; polymerase chain-reaction; resistant streptococcus-pneumoniae; legionnaires-disease; chlamydia-pneumoniae; aspiration; diagnostic fiberoptic bronchoscopy; hantavirus pulmonary syndrome; pneumococcal polysaccharide vaccine; pneumocystis-carinii pneumonia; transtracheal
This is part of the series of practice guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. The purpose of this guideline is to provide assistance to clinicians in the diagnosis and treatment of community-acquired pneumonia, The targeted providers are internists and family practitioners. The targeted groups are immunocompetent adult patients. Criteria are specified for determining whether the inpatient or outpatient setting is appropriate for treatment. Differences from other guidelines written on this topic include use of laboratory criteria for diagnosis and approach to antimicrobial therapy. Panel members and consultants are experts in adult infectious diseases. The guidelines are evidence based where possible. A standard ranking system is used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary and tables highlight the major recommendations. The guidelines will be listed on the IDSA home page at http://www.idsociety.org.
Bartlett J G; Breiman R F; Mandell L A; File T M
Clinical Infectious Diseases
1998
1998-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1086/513953" target="_blank" rel="noreferrer noopener">10.1086/513953</a>
Community-Acquired Pneumonia in Older Adults
community-acquired pneumonia; Geriatrics & Gerontology; Elderly; Vaccine; Antimicrobial therapy; Nursing home-acquired pneumonia; Respiratory pathogens
Community-acquired pneumonia (CAP) is a common disorder with significant morbidity and mortality, particularly for older adults. Risk factors include comorbid conditions commonly found in older patients as well as immunocompromising conditions such as steroid use or administration of anti-TNF agents. While Streptococcus pneumoniae remains the most common cause of CAP in older patients, the microbiology of pneumonia differs somewhat from that of young adults with increased incidence of Staphylococcus aureus and gram-negative bacilli (especially for patients who are residents of nursing homes). The classic features of infections such as fever may not be present in older patients. Antimicrobial therapy is similar to that of younger patients and based on recent guidelines; however, there is an increased need to adjust doses based on the pharmacokinetics of the older population. Prevention includes administration of preventive vaccines and control of comorbid conditions.
Breen T R; File T M
Current Geriatrics Reports
2015
2015-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1007/s13670-014-0112-7" target="_blank" rel="noreferrer noopener">10.1007/s13670-014-0112-7</a>
Executive Summary: IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults
Infectious Diseases; Microbiology; Immunology; quality; grade; consensus; recommendations
Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed.
Chow A W; Benninger M S; Brook I; Brozek J L; Goldstein E J C; Hicks L A; Pankey G A; Seleznick M; Volturo G; Wald E R; File T M
Clinical Infectious Diseases
2012
2012-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1093/cid/cir1043" target="_blank" rel="noreferrer noopener">10.1093/cid/cir1043</a>
IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults
Infectious Diseases; Microbiology; randomized; Immunology; community-acquired pneumonia; controlled-trial; streptococcus-pneumoniae; infections; acute otitis-media; placebo-controlled trial; acute maxillary sinusitis; diagnosed acute; general-practice population; pneumococcal conjugate vaccine; resistant; respiratory-tract; rhinosinusitis
Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed.
Chow A W; Benninger M S; Brook I; Brozek J L; Goldstein E J C; Hicks L A; Pankey G A; Seleznick M; Volturo G; Wald E R; File T M
Clinical Infectious Diseases
2012
2012-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1093/cid/cis370" target="_blank" rel="noreferrer noopener">10.1093/cid/cis370</a>
Ventilator-associated pneumonia: gearing towards shorter-course therapy
pneumonia; Infectious Diseases; trial; infection; antibiotic-therapy; resolution; Antimicrobial therapy; duration of therapy; pseudomonas-aeruginosa; ventilator-associated
Purpose of review The studies that are reviewed in this article have all concluded that a shorter duration of antibiotic therapy (7-8 days) may be adequate in the treatment of the majority of patients with ventilator-associated pneumonia, and does not confer an increased incidence of mortality. Recent findings Ventilator-associated pneumonia has traditionally been treated with at least 2 weeks of antimicrobial therapy. With the increasing emergence of multi-drug-resistant pathogens, however, efforts have been directed at minimizing the duration of therapy. Several studies have emerged over the last few years aiming to shorten the duration of antimicrobial therapy for ventilator-associated pneumonia. Summary The minimum effective duration of antibiotic therapy, however, remains unclear. Further studies geared towards determining this are needed.
Chua T D; File T M
Current Opinion in Infectious Diseases
2006
2006-04
Journal Article or Conference Abstract Publication
n/a
Etiology and management of community-acquired pneumonia in Asia
Infectious Diseases
The causative organisms of community-acquired pneumonia, especially in Japan and Korea, are essentially similar to those in Western countries. If there are any differences, these are due to the laboratory tests and criteria used to define pathogenicity. Overall, Streptococcus pneumoniae is the most frequently occurring pathogen and Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae and viruses follow. Legionella spp. look likely to be low frequency pathogens in Asian countries, but a reason for this might be limitations of the laboratory tests used. A high frequency of Gram-negative bacilli as pathogens of community-acquired pneumonia in some Asian countries may be due to different criteria used to identify disease-causing organisms. A small number of papers about antibiotic resistance have shown no large differences between Asian countries, but considerable differences to Western countries, such as frequency of macrolide-resistant S. pneumoniae. Some Asian countries have their own guidelines for community-acquired pneumonia, but these are written in their own languages. Curr Opin Infect Dis 15:157-162. (C) 2002 Lippincott Williams Wilkins.
Matsushima T; Miyashita N; File T M
Current Opinion in Infectious Diseases
2002
2002-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00001432-200204000-00010" target="_blank" rel="noreferrer noopener">10.1097/00001432-200204000-00010</a>