ABSTRACT
The purpose of the study was to compare the clinical characteristics and outcomes of bacteraemic pneumococcal pneumonia (BPP) in chronic obstructive pulmonary disease (COPD) and non-COPD patients. A case-control study was conducted. Cases were any adult with BPP and forced expiratory volume in 1 second (FEV(1)) <80% and FEV(1)/forced expiratory vital capacity (FVC) <70%. Controls were patients with BPP without clinical diagnosis of COPD matched 1:2 by age, gender and date of isolation. Variables included co-morbidities, serotypes, pneumonia severity index (PSI), treatment and mortality. There were 45 cases and 90 controls. No significant differences were found in Charlson scores, antibiotic treatment, serotype distribution and severity. Malignancy, shock and mechanical ventilation were less frequent in COPD patients. One patient died vs 14 controls (p = 0.02). In univariate analysis, shock, multilobar involvement, Charlson score, heart failure and absence of COPD were associated with mortality. After adjustment for the presence of shock there were no differences in mortality. BPP presents less frequently with shock and has a lower mortality rate in COPD patients than in non-COPD patients.
Subject(s)
Bacteremia/epidemiology , Bacteremia/microbiology , Pneumonia, Pneumococcal/complications , Pneumonia, Pneumococcal/epidemiology , Pulmonary Disease, Chronic Obstructive/complications , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/physiopathology , Case-Control Studies , Female , Humans , Male , Middle Aged , Pneumonia, Pneumococcal/drug therapy , Pneumonia, Pneumococcal/physiopathology , Risk Factors , Serotyping , Severity of Illness Index , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/isolation & purification , Survival Analysis , Treatment OutcomeABSTRACT
BACKGROUND: Information on patterns of resistance to and cross-resistance between antiretroviral agents is increasingly available and may be important for decisions on how to combine drugs to achieve an optimum antiviral effect in future therapeutic strategies. The increasing number of heavily pre-treated patients have changed the approach to assist therapeutic decision-making in patients failing therapy. Recent studies give us a more comprehensive analysis of the link of such mutations with a rebound in viral load and appearance of drug resistance. However, not all sites of mutations are known and the effects of interactions between them at different codons has not yet been well understood. Moreover, the interpretation is made from generalisations based on drug testing in vitro and there are scarce clinical data available. OBJECTIVE: This work tries to summarize the most important studies to date, in order to know the significance of drug resistance as well as their potential use in everyday clinical practice.
