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Μικροβιακή πνευμονία: Υπάρχει κάτι νεώτερο ; PowerPoint PPT Presentation


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Μικροβιακή πνευμονία: Υπάρχει κάτι νεώτερο ;. Βάνα Σπούλου Eπίκουρη Καθηγήτρια Παιδιατρικής Λοιμωξιολογίας Α′ Παιδιατρική Κλινική Πανεπιστημίου A θηνών Αθηνών. Πνευμονία μια «παλαιά» λοίμωξη με μεγάλη θνησιμότητα. Ba κτηριακή πνευμονία: Νεώτερα σε. Επιδημιολογία Διάγνωση

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: ;

E

A


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Ba :

  • 2011 IDSA GUIDELINES

    British Thoracic Society Guidelines: update 2011


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Bacterial (single) 14%

Unknown 14%

Bacterial (multiple) 5%

Viral (single) 21%

Mixed 33%

Viral (multiple) 12%

  • Severity of the disease may be linked to aetiology

  • Bacterial pneumonia usually causes children to become severely ill

  • Cevey-Macherel M., et al. 2009 . Eur J.


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Bacterial isolates in lung aspirate samples from children

N=255(66%)

N=240(34%)

N=885(44%)

N=949(66%)

N=674(51%)

N=101(58%)

Vuori-Holopainene E Clin Infect Dis 2001; 32: 71526


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2014

[b] 1/3 <2 []

[].

3 []

1-5 [].

[]


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Cochrane review impact of pcvs on clinical pneumonia in hiv negative children 24 months old

Cochrane review: Impact of PCVs on clinical pneumonia in HIV negative children <24 months old

Risk Ratio

N, Random, 95% CI

The impact is considerably lower for clinical pneumonia relative to X-ray defined pneumonia but still significant

Madhi et al 2005 (PCV9)

Black et al 2000 (PCV7)

Cutts et al 2005 (PCV9)

Lucero et al 2009 (PCV11)

Pooled RR = 0.94 (95% CI 0.91 to 0.98, p = 0.0006)

Pooled VE = 6% (95% CI 2% to 9%).

0.5

0.7

1

1.5

2

Favours PCV

Favours Control

Intent to treat (ITT) analysis (random effects model)

RR= Risk ratio; VE = vaccine efficacy

Cochrane database System Rev 2009; Oct 7(4):


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(2006-2012)

2011


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Ba :

  • 2011 IDSA GUIDELINES

    British Thoracic Society Guidelines: update 2011


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;/

  • , CRP, : . (+)

  • WBC: ()

  • () (C)

    ( <2 %)


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PCR

9

B

C

W/Y

L.m

N.m

19A, 14, 3,1

4,18C, 6, 23F,19F

Tzanakaki et al , CMI, 2005 , Drakopoulou et al FEMS 2008, Soulama et al CMI 2008


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PCR /

PCR


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2014

!

.


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: , , (90mg mg/kg kg/day 3 ) (-)

: (E)

( (+)

: (-)


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  • (150 mg/kg/day div q6h)! G: ( , (-)

  • :

  • , (D)

  • 3 . A MRSA, (D)

    - ( ) (D)


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10 (-).

, p.o , 2-3

CA-MRSA : >10 (-)

: 7-10 4-6 (B)

-


Antibiotic resistance in i pd in greece

Antibiotic resistance in IPD in Greece

Syriopoulou V et al. ESPID, 2010, Nice.

20


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: PCV 13 CAP

PNEUMOCOCCAL PNEUMONIA IN CHILDREN: A FRENCH PROSPECTIVE STUDY IN THE ERA OF 13 VALENT PNEUMOCOCCAL CONJUGATE VACCINES IMPLEMENTATION IN FRANCE

  • (CAP):

  • 1 15 , ,

  • - 8

  • - 2009 2012 3 1 :

  • -PCV13, - -PCV13.

  • .

Angoulvant F et al. Presented at ESPID 2013, Milan


2002 2011 579

, (. 2002-2011, =579)

V. Syriopoulou et al. Poster presentation ISPPD 2012, Brasil


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3 V

Farmaki et al ISPPD2014


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  • <5 :6,96 100.0001

  • >64 : 12,1 100.0001


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60%

60

50

35%

40

29%

Carriage rate (%)

25%

30

20

6%

10

0

Preschool

Grammar school

Jr. HighSchool

Households

with children

Householdswithout children

.

1 Presentation by Mark A. Fletcher, M.D.,on Epidemiology of Streptococcus pneumoniae: Pneumococcus


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Centers for Disease Control and Prevention, 2010. Active Bacterial Core Surveillance (ABCs) Report, Emerging Infections Program Network, Streptococcus pneumoniae, 2009.

Available at: http://www.cdc.gov/abcs/reports-findings/survreports/spneu09.pdf


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  • )

:

  • 75

  • PCV13 & Placebo

  • 85.000 (42.500 group

  • PCV13 CAP 65 .

Hak, et al. Rationale and design of Community-Acquired Pneumonia Immunization Trial in Adults, 2008.


Ppv23 65

PPV23 > 65

PCV13

4

6B

9V

14

18C

19F

23F

1

5

7F

3

19A

6A

CRM197


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, ! .....

!


2 nd generation cephalosporins vs amoxicilline for s pneumoniae

In vitro

Optimal bactericidal activity vs. S. pneumoniae achieved at lower concentrations (relative to MIC) for amoxicillin than cefuroxime

In vivo(animal models)

Mice infected with penicillin-resistant S. pneumoniae

Time above MIC

>40% for amoxicillin

6% for cefuroxime

Time above optimal bactericidalconcentration

>40% for amoxicillin

3% for cefuroxime

2nd Generation Cephalosporins vs.amoxicilline for S. pneumoniae

Perez-Trallero E, et al. J Antimicro Chemother 1998;41:629-634; Perez-Trallero E, et al. J Chemother 2001;13:118-125


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