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Fluoroquinolones with increased activity against Streptococcus pneumoniae are a treatment option for bacterial exacerbations in the COPD patients. Several epidemiological studies show that resistance to levofloxacin or moxifloxacin remains low, despite their wild clinical use. However, efflux pumps may reduce the susceptibility of clinical isolates to these fluoroquinolones in a way that cannot be detected when using the clinical breakpoints of susceptibility .proposed by European Committee for Antimicrobial susceptibility testing (EUCAST) or the American Clinical and Laboratory Standard Institute (CLSI) European on anti Institute of Clinical Laboratory Standard (NCCLS). The aim of this work was to study the prevalence of efflux and to identify the pump responsible for this efflux in S. pneumoniae isolates from COPD patients. We collected 106 strains of patients with episodes of exacerbation of COPD from 2007 to 2009. We measured the MIC of ciprofloxacin (CIP), norfloxacin (NOR), acriflavine (ACR) and ethidium bromide (BET) in the presence and absence of an inhibitor of efflux pumps, reserpine, to phenotypically determine the presence of efflux pump. In the presence of reserpine, the distributions of ciprofloxacin and norfioxacin were significantly shifted to lower values. Aller inactivation of the genes coding for efflux pumps PatA and PatB. The data therefore suggest that PatA/PatB are involved in resistance to fluoroquinolones in S. pneumoniae. Ciprofloxacin has never been included in treatment guidelines for the treatment of streptococcal infections in Belgium. One may suspects that its widespread use for other indications has triggered the emergence of resistance in S. pneumoniae can develop resistance to ciprofloxacin efflux by repeated exposure to subinhibitory concentrations of this antibiotic. Our data should be taken as a warning to the development of resistance by efflux to fluoroquinolones when used to treat pneumococcal infections Les fluoroquinolones ayant une activité accrue contre le Streptococcus pneumoniae sont décrites comme une option de traitement pour les exacerbations de BPCO dans les directives thérapeutiques en cas de surinfection bactérienne. Plusieurs enquêtes épidémiologiques montrent qué la résistance à la lévofloxacine ou la moxifloxacine reste apparemment faible, malgré avec une utilisation importante de ces antibiotiques. Cependant, chez S. pneumoniae ont été découvertes des pompes à efflux pouvant réduire la susceptibilité des isolats cliniques à ces fluoroqulnolones d’une manière qui ne peut être détectée si on ne se rapporte qu’aux critères de sensibilité et de résistance proposés, par les instances de référence telles que le CLSI’ et 1’EUCAST2. Le but de ce travail était de déterminer la prévalence de résistance par efflux et d’identifier la pompe responsable de cet efflux dans une collection d’ isolats cliniques obtenus chez des patients atteints de BPCO. Nous avons collecté 106 souches chez des patients souffrant d’épisodes d’exacerbation de BPCO de 2007 à 2009. Nous avons mesuré les CMI de la ciprofloxacine (CIP), norfioxacine (NOR), acriflavine (ACR) et du bromure d’éthidium (BET) en présence et en absence d’un inhibiteur de pompes à efflux, la réserpine, afin de déterminer phénotypiquement la présence d’une résistance par efflux. En présence de réserpine, les distributions de la ciprofloxacine et norfloxacine étaient nettement déplacées vers des valeurs plus faibles. Par ailleurs, l’inactivation des gènes codant pour les protéines PatA et PatB restaure la sensibilité des souches. Les données suggèrent fortement que la ciprofloxacine et la norfioxacine sont sujettes à l’efflux médié par PatA/PatB chez S. pneumoniae. La ciprofloxacine n’est pas inclue dans les recommandations thérapeutiques pour le traitement der infections à pneumocoques en Belgique. On peut soupçonner que son utilisation à grande échelle pour d’autres indications peut avoir entraîné l’émergence de souches de S. pneumoniae capables de développer une résistance par efflux à la ciprofloxacine par une exposition répétée à des concentrations subinhibitrices de cet antibiotique

Fluoroquinolones --- Pulmonary Disease, Chronic Obstructive --- Cyprofloxacin

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Chronic Obstructive Pulmonary Disease (COPD) refers to a group of closely related diseases recognized by irreversibly impaired lung function and airflow obstructions. The World Health Organization (WHO) has estimated that COPD will be found on the list of the six most frequent causes of death worldwide by 2020. More than 200 000 Norwegians are now diagnosed with COPD, and the prevalence is increasing. Thus, COPD constitutes a major future challenge for health services, and it is important to promote effective prevention and treatment of the disease. The Norwegian Directorate of Health has appointed a working group to develop national guidelines for COPD treatment, and as a part of this process the Norwegian Knowledge Centre for Health Services was commissioned to evaluate the efficacy of treatment of acute exacerbations of COPD in intermediate units or 'hospital at home" as compared to traditional hospital care. 1. Treatment of acute exacerbation of COPD in "hospital at home" may lead to fewer readmissions when compared to conventional treatment in hospital.2. Treatment of acute exacerbation of COPD in "hospital at home" may show a trend for lowering of mortality rate when compared to conventional treatment in hospital, these results did not reach significant differences3. It is uncertain whether patients, as well as their relative, seem to prefer treatment in "hospital at home" rather than conventional hospital treatment.4. No studies met the inclusion criteria when it came to evaluate the efficacy of intermediate care units for treatment of acute exacerbation of COPD.

Home care services. --- Pulmonary Disease, Chronic Obstructive.

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Personen met chronisch longlijden kunnen soms thuis behoefte hebben aan extra zuurstoftoediening. In België kan zulke zuurstoftherapie zonder enige beperking door elke arts worden voorgeschreven, en de laatste jaren ziet men een grote stijging van de uitgaven. Bij de organisatie van de therapie zijn verschillende beleidsinstanties en privé- en beroepsorganisaties betrokken, waardoor een globale visie ontbreekt. Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) pleit voor het herbekijken van de prijzen en voor de minst dure methodes om de zuurstof toe te dienen, vermits ze toch een gelijkwaardig medisch effect hebben. Verder wordt de langdurige therapie best voorbehouden voor patiënten bij wie het wetenschappelijk bewezen is dat ze er baat bij hebben: mensen met zeer ernstige ademnood door COPD, mucoviscidose, hartfalen en bepaalde longziekten.

2009-14 --- 2009-14 --- 2009-14 --- Belgium --- Belgium --- Belgium --- Cost-Benefit Analysis --- Cost-Benefit Analysis --- Cost-Benefit Analysis --- Costs and Cost Analysis --- Costs and Cost Analysis --- Costs and Cost Analysis --- Cystic Fibrosis --- Cystic Fibrosis --- Cystic Fibrosis --- Heart Failure --- Heart Failure --- Heart Failure --- Lung Diseases, Interstitial --- Lung Diseases, Interstitial --- Lung Diseases, Interstitial --- Meta-Analysis [Publication Type] --- Meta-Analysis [Publication Type] --- Meta-Analysis [Publication Type] --- Oxygen Inhalation Therapy --- Oxygen Inhalation Therapy --- Oxygen Inhalation Therapy --- Palliative Care --- Palliative Care --- Palliative Care --- Pulmonary Disease, Chronic Obstructive --- Pulmonary Disease, Chronic Obstructive --- Pulmonary Disease, Chronic Obstructive --- R156 --- R156 --- R156 --- Technology Assessment, Biomedical --- Technology Assessment, Biomedical --- Technology Assessment, Biomedical --- WF 145 Respiratory System - - Therapeutics --- WF 145 Respiratory System - - Therapeutics --- WF 145 Respiratory System - - Therapeutics

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Managing COPD is an in-depth guide on the management of patients with COPD concentrating on the impact of COPD on a patient as well as how healthcare professionals can intervene and educate the patient at an early stage and thereby slow the onset of severe symptoms. This book has been designed to increase physician awareness of the pathological processes involved in the aetiology of COPD which underpins effective disease management.

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