DANIEL MUSHER
Baylor College of Medicine, Internal Medicine, Faculty Member
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BackgroundWhen Candida is found in a sputum culture, clinicians generally dismiss it as a contaminant. We sought to identify cases of community-acquired pneumonia (CAP) in which Candida might play a contributory etiologic role.MethodsIn a... more
BackgroundWhen Candida is found in a sputum culture, clinicians generally dismiss it as a contaminant. We sought to identify cases of community-acquired pneumonia (CAP) in which Candida might play a contributory etiologic role.MethodsIn a convenience sample of patients hospitalized for CAP, we screened for “high-quality sputum” by Gram stain (>20 WBC/epithelial cell) and performed quantitative sputum cultures. Criteria for a potential etiologic role for Candida included the observation of large numbers of yeast forms on Gram stain and the finding of >106 CFU/ml Candida in sputum. We gathered clinical information on cases that met these criteria for possible Candida infection.ResultsSputum from 6 of 154 consecutive CAP patients had large numbers of extra- and intracellular yeast forms on Gram stain, with >106 CFU/ml Candida albicans, glabrata, or tropicalis on quantitative culture. In all 6 patients, the clinical diagnoses at admission included chronic aspiration. Greater th...
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Background The etiology of community-acquired pneumonia (CAP) has evolved since the beginning of the antibiotic era. Recent guidelines encourage immediate empiric antibiotic treatment once a diagnosis of CAP is made. Concerns about... more
Background The etiology of community-acquired pneumonia (CAP) has evolved since the beginning of the antibiotic era. Recent guidelines encourage immediate empiric antibiotic treatment once a diagnosis of CAP is made. Concerns about treatment recommendations, on the one hand, and antibiotic stewardship, on the other, motivated this review of the medical literature on the etiology of CAP. Methods We conducted a systematic review of English-language literature on the etiology of CAP using methods defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed using a combination of the keywords ‘pneumonia’, ‘CAP’, ‘etiology’, ‘microbiology’, ‘bacteriology’, and ‘pathogen’. We examined articles on antibiotics that were develop to treat pneumonia. We reviewed all ‘related articles’ as well as studies referenced by those that came up in the search. After we excluded articles that did not give sufficient microbiological data or fail...
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Background Background: Recent guidelines recommend immediate empiric antibiotic treatment for patients (pts) with community-acquired pneumonia (CAP). Concerns about treatment recommendations and antibiotic stewardship motivated a... more
Background Background: Recent guidelines recommend immediate empiric antibiotic treatment for patients (pts) with community-acquired pneumonia (CAP). Concerns about treatment recommendations and antibiotic stewardship motivated a systematic literature review of the etiology of CAP. Methods We reviewed English-language literature using PRISMA guidelines. Data were stratified into diagnostic categories according to the microbiologic studies that were done (Table1). Fig.1. Flowchart of systematic literature review and study selection Table 1. Characteristics of studies reporting the etiology of community-acquired pneumonia Results 146 articles with 82,674 CAP pts met criteria for inclusion; 63,938 (77.3%) were inpatients, 16,532 (20.0%) were in- or outpatients, and 2,204 (2.7%) were outpatients. Pneumococcus was the most common cause of CAP without regard to which microbiological techniques were used (33-50% of all cases). The proportion due to this organism declined with time, much mo...
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In most cases of community-acquired pneumonia (CAP), an etiologic agent is not determined; the most common report from the microbiological evaluation of sputum cites "normal respiratory flora." Non-diphtheria spp. a component of... more
In most cases of community-acquired pneumonia (CAP), an etiologic agent is not determined; the most common report from the microbiological evaluation of sputum cites "normal respiratory flora." Non-diphtheria spp. a component of this flora, is commonly viewed as a contaminant, but it may be the cause of pneumonia and the frequency with which it causes CAP may be underestimated. This report present 3 cases of CAP in which spp. was clearly the predominant isolate; identification was confirmed by matrix-assisted laser desorption ionization time of flight (MALDI-TOF) mass spectrometry. Two cases were caused by and one by Two patients had a tracheostomy and one was on hemodialysis. Patients who received an appropriate antibiotic responded well. When identified as the predominant isolate in sputum from a patient with CAP, spp. should be considered as a potential cause of the infection. In cases with patients who have compromised airway clearance or who are immunocompromised, mic...
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Research Interests: Incidence Geometry, Medicine, Streptococcus pneumoniae, Biological Sciences, Humans, and 15 moreInternal Medicine, Female, Pneumonia, Male, Incidence, Lung, Aged, Middle Aged, Adult, Necrosis, Bacteremia, Clinical Infectious Diseases, Serotyping, Severity of Illness Index, and Medical and Health Sciences
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Research Interests: Medicine, Streptococcus pneumoniae, Biological Sciences, Humans, Pneumonia, and 13 morePhenazines, Antibiotics, Anti-Bacterial Agents, Retrospective Studies, Bacteremia, Gram, Sputum, Staining, Sensitivity and Specificity, Gram Staining, Blood Culture, Clinical Infectious Diseases, and Medical and Health Sciences
Research Interests: Cardiology, Medicine, Comorbidity, Biological Sciences, Heart Failure, and 15 moreHumans, Internal Medicine, Female, Pneumonia, Male, Confidence intervals, Atrial Fibrillation, Incidence, Myocardial Infarction, Cardiovascular Diseases, Hypoxemia, Clinical Infectious Diseases, Acute Disease, Medical and Health Sciences, and Age distribution
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Research Interests: Immunology, Medicine, Streptococcus pneumoniae, Biological Sciences, Humans, and 12 morePneumonia, Middle Aged, Immune system, Antibody, Adult, Convalescence, Pneumolysin, Sensitivity and Specificity, Enzyme Linked Immunosorbent Assay, Clinical Infectious Diseases, immunoglobulin G, and Medical and Health Sciences
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Research Interests: Treatment, Treatment Outcome, Medicine, Biological Sciences, Humans, and 10 morePneumonia, Antimicrobial, Antibiotics, Anti-Bacterial Agents, Intensive Care Medicine, Biological markers, Food and Drug Administration, Clinical Infectious Diseases, Clinical Trials as Topic, and Medical and Health Sciences
Background Intensive studies have failed to identify an etiologic agent in >50% cases of community-acquired pneumonia (CAP). Bacterial pneumonia follows aspiration of recognized bacterial pathogens (RBPs) such as Streptococcus... more
Background Intensive studies have failed to identify an etiologic agent in >50% cases of community-acquired pneumonia (CAP). Bacterial pneumonia follows aspiration of recognized bacterial pathogens (RBPs) such as Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus after they have colonize the nasopharynx. We hypothesized that aspiration of normal respiratory flora (NRF) might also cause CAP. Methods We studied 120 patients hospitalized for CAP who provided a high-quality sputum specimen at, or soon after admission, using Gram stain, quantitative sputum culture, bacterial speciation by matrix-assisted laser desorption ionization time-of-flight, and viral polymerase chain reaction. Thresholds for diagnosis of bacterial infection were ≥105 colony-forming units (cfu)/mL sputum for RBPs and ≥106 cfu for NRF. Results Recognized bacterial pathogens were found in 68 of 120 (56.7%) patients; 14 (20.1%) of these had a coinfecting respiratory virus. Normal respirator...
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In patients with pneumococcal community-acquired pneumonia (CAP), the risk factors for bacteraemia and its impact on outcomes are not fully elucidated. We aimed to compare characteristics of patients with blood-culture-positive versus... more
In patients with pneumococcal community-acquired pneumonia (CAP), the risk factors for bacteraemia and its impact on outcomes are not fully elucidated. We aimed to compare characteristics of patients with blood-culture-positive versus blood-culture-negative pneumococcal CAP, and to characterise bacteraemic serotypes.We describe a prospective, observational study on nonimmunocompromised patients with pneumococcal CAP, from 1996 to 2013. We define severe pneumonia according to American Thoracic Society/Infectious Diseases Society of America guidelines.Of a total of 917 patients with pneumococcal CAP, 362 had blood-culture-positive pneumococcal pneumonia (BCPPP; 39%). High C-reactive protein (CRP) (≥20 mg·dL(-1)) (odds ratio (OR) 2.36, 95% CI 1.45-3.85), pleural effusion (OR 2.03, 95% CI 1.13-3.65) and multilobar involvement (OR 1.69, 95% CI 1.02-2.79) were independently associated with bacteraemic CAP, while nursing home resident (OR 0.12, 95% CI 0.01-1.00) was found as a protective f...
Research Interests: Medicine, Multivariate Analysis, Humans, Internal Medicine, Nursing Homes, and 15 moreHospitalization, Female, Male, Aged, Middle Aged, C reactive protein, Adult, Odds ratio, Bacteremia, Community Acquired Pneumonia, Intensive Care Units, Pleural Effusion, Blood Culture, Pneumococcal Vaccines, and Medical and Health Sciences
Research Interests: Gastroenterology, Medicine, Biological Sciences, Humans, Internal Medicine, and 15 moreHospitalization, Female, Animals, Pneumonia, Male, Aged, Middle Aged, Prognosis, Community Acquired Pneumonia, Procalcitonin, Calcitonin, Intensive Care Units, Clinical Infectious Diseases, Medical and Health Sciences, and leukocytosis
Research Interests: Medicine, Streptococcus pneumoniae, Multivariate Analysis, Prospective studies, Humans, and 13 moreInternal Medicine, Female, Pneumonia, Male, Aged, Middle Aged, Anti-Bacterial Agents, Urinary System, Prognosis, Community Acquired Pneumonia, Sensitivity and Specificity, Pleural Effusion, and Logistic Models
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Hemophilus influenzae pneumonia was diagnosed in 41 adult patients based on cultures of blood, pleural fluid or transtracheal aspirate. Bacteremia occurred in all age groups, but was most frequent in patients over the age of 50 years with... more
Hemophilus influenzae pneumonia was diagnosed in 41 adult patients based on cultures of blood, pleural fluid or transtracheal aspirate. Bacteremia occurred in all age groups, but was most frequent in patients over the age of 50 years with severe underlying pulmonary disease. Chest films usually demonstrated multisegmental or multilobar infiltrates without evidence of cavitation. Pleural involvement was evident in half of the patients, although empyema occurred infrequently. Mortality was almost always associated with serious underlying diseases and bacteremia. Encapsulated strains of H. influenzae (usually type B) were identified in 18 of 22 (82 per cent) patients. The use of transtracheal aspirations and the adoption of routine subculturing of blood cultures on chocolate agar appear to be important factors in our increased recognition of this disease.