rifampin and Pneumonia--Pneumococcal

The inflammatory response in pneumococcal infection is primarily driven by immunoreactive bacterial cell wall components [lipoteichoic acid (LTA)]. An acute release of these components occurs when pneumococcal infection is treated with β-lactam antibiotics.. We hypothesized that non-lytic rifampicin compared with lytic β-lactam antibiotic treatment would attenuate the inflammatory response in patients with pneumococcal pneumonia.. In the PRISTINE (Pneumonia treated with RIfampicin aTtenuates INflammation) trial, a randomized, therapeutic controlled, exploratory study in patients with community-acquired pneumococcal pneumonia, we looked at LTA release and inflammatory and clinical response during treatment with both rifampicin and β-lactam compared with treatment with β-lactam antibiotics only. The trial is registered in the Dutch trial registry, number NTR3751 (European Clinical Trials Database number 2012-003067-22).. Forty-one patients with community-acquired pneumonia were included; 17 of them had pneumococcal pneumonia. LTA release, LTA-mediated inflammatory responses, clinical outcomes, inflammatory biomarkers and transcription profiles were not different between treatment groups.. The PRISTINE study demonstrated the feasibility of adding rifampicin to β-lactam antibiotics in the treatment of community-acquired pneumococcal pneumonia, but, despite solid in vitro and experimental animal research evidence, failed to demonstrate a difference in plasma LTA concentrations and subsequent inflammatory and clinical responses. Most likely, an inhibitory effect of human plasma contributes to the low immune response in these patients. In addition, LTA plasma concentration could be too low to mount a response via Toll-like receptor 2 in vitro, but may nonetheless have an effect in vivo.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactams; Community-Acquired Infections; Female; Humans; Inflammation; Lipopolysaccharides; Male; Middle Aged; Netherlands; Plasma; Pneumonia, Pneumococcal; Rifampin; Teichoic Acids; Treatment Outcome; Young Adult

We performed urinary antigen tests for pneumococcus and Legionella for patients with community-acquired pneumonia (CAP), to prescribe a documented antibiotic therapy. We report the efficiency of low-spectrum antibiotic treatment, illustrating the inappropriateness of bacteriological respiratory sampling.. Patients with CAP were enrolled from three different units; the pneumonia severity index was used to assess the disease. Respiratory samples were also listed. Low-spectrum antibiotic therapy was amoxicillin for pneumococcal infection, and macrolides or non-anti-pneumococcal fluoroquinolone for legionellosis.. Six hundred and seventy-five CAP were diagnosed during the study period,, 150 with positive urinary antigen tests (23%), among which 108 pneumococcal infections (73%), 40 legionellosis (26%), and two mixed infections. The pneumonia severity index was 106+/-38. Amoxicillin was prescribed in 108 cases, fluoroquinolone in 24 cases, macrolide in 18 cases. The outcome was favourable for 138 patients (92%). Eighty three respiratory samples allowed identification of a bacterium for 58 patients (39%), among which 24 strains were not in the antibiotic spectrum: Haemophilus influenzae and Pseudmomonas aeruginosa in six cases, Staphylococcus aureus in five cases, Klebsiella pneumoniae in two cases, and another Gram negative bacillus in five cases. These strains were resistant in vitro to the prescribed treatment in 19/24 cases (79%). One out of 12 patients who died had a respiratory sample positive for Enterobacter spp strain resistant to the ongoing antibiotic treatment.. The low-spectrum antibiotic therapy based on urinary antigen tests is efficient, and demonstrates respiratory tract colonisation with bacteriological strains usually considered as pathogenic.

Topics: Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Antigens, Bacterial; Cohort Studies; Community-Acquired Infections; Comorbidity; Erythromycin; Female; France; Hospital Mortality; Hospitals, University; Humans; Legionella; Legionnaires' Disease; Lung Diseases, Fungal; Male; Middle Aged; Ofloxacin; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Rifampin; Severity of Illness Index; Streptococcus pneumoniae; Treatment Outcome

A case of Streptococcus pneumoniae meningitis in a possibly immune-compromised child with a ventriculoatrial shunt is described. The infection was successfully eradicated by treatment with intravenous ceftriaxone and rifampicin, without removal of the shunt.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid Shunts; Drug Therapy, Combination; Female; Humans; Infant; Meningitis, Pneumococcal; Pneumonia, Pneumococcal; Prosthesis-Related Infections; Rifampin

Two elderly residents of a care home were hospitalised with pneumonia over a period of one month. They had bacteraemia with penicillin non-susceptible Streptococcus pneumoniae (PNSP) and both died. All residents and staff of the care home were screened for PNSP using nasopharyngeal swabs, with one resident and one member of staff found to be asymptomatic carriers. Oral rifampicin was given to the carriers. All four strains were found to be serotype 14, and multilocus sequence typing (MLST) showed ST2652, not previously detected in Scotland. Review of care home residents showed that pneumococcal vaccination coverage was low (63%). This is similar to rates found in those aged > or =65 years in the general population and needs to be improved upon.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Typing Techniques; Carrier State; Cross Infection; Female; Genotype; Humans; Male; Nasopharynx; Nursing Homes; Penicillin Resistance; Pneumonia, Pneumococcal; Rifampin; Scotland; Serotyping; Streptococcus pneumoniae

Penicillin-resistant pneumococcal strains continue to spread. Some strains are also resistant to other antibiotics, including the cephalosporins. Better utilization of the 23-valent pneumococcal vaccine, which covers the serotypes responsible for 90% of pneumococcal infections, is an important step in combating resistance.

Topics: Aged; Algorithms; Bacterial Vaccines; Cefotaxime; Cephalosporin Resistance; Chest Tubes; Combined Modality Therapy; Decision Trees; Diagnosis, Differential; Drug Resistance, Multiple; Drug Therapy, Combination; Humans; Male; Microbial Sensitivity Tests; Penicillin Resistance; Pleural Effusion; Pneumococcal Vaccines; Pneumonia, Pneumococcal; Rifampin; Streptococcus pneumoniae; Vancomycin

Topics: Cephalosporins; Humans; Male; Penicillin G Procaine; Pneumonia, Pneumococcal; Rifampin

Topics: Adolescent; Adult; Aged; Bronchitis; Bronchopneumonia; Enterobacteriaceae; Feeding and Eating Disorders; Female; Haemophilus influenzae; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Nausea; Neoplasm Metastasis; Pleural Neoplasms; Pleurisy; Pleuropneumonia; Pneumonia, Pneumococcal; Pulmonary Emphysema; Rifampin; Sputum; Staphylococcus

Topics: Acute Disease; Bronchitis; Bronchopneumonia; Humans; Lung Abscess; Pneumonia, Pneumococcal; Rifampin