An increasing prevalence of pneumonia caused by drug-resistant pathogens (DRPs) has been identifi ed. The 2005 American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) guidelines proposed the health care-associated pneumonia (HCAP) model in order to identify an increased risk of DRPs in patients coming from the community. These patients are known to have a worse prognosis, mostly due to poor functional status and treatment restrictions. New useful scores have been developed to help physicians in predicting DRPs. This manuscript is a review of currently published literature concerning the impact of CAP caused by DRPs and the different predictive models available.

Community-acquired pneumonia (CAP) is a frequent infectious disease that can be usually treated in an ambulatory setting. A small percentage of these cases require hospitalization and yet it is the leading infectious cause of hospitalization and death in some countries. A number of these infections is caused by gram-negative bacteria (GNB), which have repeatedly been found to bear an adverse prognostic potential. Its incidence is variable (0-9%) and some species carry a special pathogenicity. Enterobacteriaceae in these studies were more commonly isolated than P. aeruginosa while Acinetobacter spp. and B. cepacia were only occasionally described. The present review has the aim to update the current knowledge about the etiology, classifi cation, antimicrobial resistance, diagnosis, and therapy in CAP due to GNB.

Intravenous drug use (IDU), initially confined to developed countries, specifically the western countries is no more bound by boundaries. In last few decades, the prevalence has been increased several fold and is a matter of serious concern. IDUs indulge in high-risk activities like sharing of the needle and unprotected sexual activities, which make them more vulnerable to acquired human immunodeficiency virus (HIV) infection (acquired immune deficiency syndrome [AIDS]). They silently spread the infection in the community (other IDUs, spouses and sexual partners). There is an increasing trend of HIV infection/AIDS among intravenous drug abusers across the world including India being no exception. The article highlights the global epidemiological data, specific focus of India.

In its strongest resurgence since the pandemic of 2009, the influenza type A virus, known as H1N1, has broken out in different parts of India with deaths surpassing 1000 mark and number of affected cases exceeding 18,000 by the end of February 2015. Swine influenza spreads from person to person, either by inhaling the virus or by touching surfaces contaminated with the virus, then touching the mouth or nose. Symptoms occurring in infected human by H1N1 are like any other flu symptoms. Treatment is largely supportive and consists of bed rest, increased fluid consumption, cough suppressants, antipyretics and analgesics for fever and myalgias. Management largely includes the potential use of antiviral agents for patients presenting with illness due to influenza virus infection. If the illness is known or suspected to be due to a zoonotic influenza A virus, oseltamivir or zanamivir are treatment options. For known or suspected infection with avian influenza H5N1 virus, antiviral treatment should follow the World Health Organization (WHO) rapid advice guidelines on pharmacological management of humans infected with highly pathogenic avian influenza A (H5N1) virus. WHO also recommends vaccination of the high-risk group with seasonal influenza vaccine. Vaccination is recommended for health care workers working in close proximity to influenza patients are at higher risk of acquiring the disease. Since swine flu can directly be transmitted from one person to another through air droplets, people who fail to follow proper hygiene, especially in crowded places are at a high risk of contracting the virus. Proper preventive and control measures thus must be ensured. We have only limited treatment options, so rational use of the antiviral agent is very essential to avoid resistance and future complications. Health education and awareness among citizens should be transferred by proper mechanism.

In the last few years, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) has become the new gold standard method for the identification of microorganisms. Nevertheless, other useful applications of mass spectrometry have recently been demonstrated including the detection of resistance mechanisms. The MALDI-TOF-MS hydrolysis assay allows rapid detection of β-lactamase activity with results available within a few hours. Rapid detection of β-lactamases is important since β-lactam antibiotics remains as the mainstay of the treatment of several community-acquired and nosocomial infections, and a steady increase has been observed of resistant microorganisms associated with the production of extended spectrum β-lactamases (ESBLs) and carbapenemases. Several studies have reported the high sensitivity and specificity of the MALDI-TOF-MS antibiotic hydrolysis assay for the detection of ESBLs - or carbapenemase-producing Gram-negative bacilli. In addition, this technique can be performed directly from positive blood culture, significantly shortening the time of resistance detection. However, the standardization of assay conditions as well as automatic analysis of the spectra obtained is required. The aim of this review was to summarize the currently available data regarding the accuracy of the detection of β-lactamase activity using the MALDI-TOF-MS antibiotic hydrolysis assay.

Strong evidence supports the use of noninvasive ventilation (NIV) in acute respiratory failure (ARF) to prevent endotracheal intubation (ETI) in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary edema, and immunocompromised patients. However, weaker evidence supports NIV used in acute respiratory distress syndrome (ARDS) and ARF due to community-acquired pneumonia (CAP) in immunocompetent patients owing to high rates of treatment failure. In all patients, NIV should be applied under close monitoring for signs of treatment failure and, in such case, ETI should be promptly available. A trained team, at an appropriate location, with careful patient selection and optimal choice of devices can optimize NIV outcome. In this short review we examine past and more recent literature regarding the use of NIV in ARF due to CAP, discussing the application of both continuous positive airway pressure (CPAP) and pressure support ventilation (PSV).

Ophthalmic infections of fungal origin, namely mycotic keratitis, mycoticendophthalmitis, etc., are commonly encountered in the tropical and sub-tropical countries including India. Mycotic keratitis, in particular, presents an important ophthalmic problem causing visual disability due to its protracted course and unfavorable responses. Determination of various host and environmental factors that put an individual at risk for development of fungal infections in the eye may reduce the time to their diagnosis. Even though Aspergillus and Fusarium are the most common species causing keratitis, pigmented dematiaceous fungi remain an important cause of mycotic keratitis. Majority of fungal keratitis responds to medical therapy if diagnosed on time and treatment started immediately. Failure of medical therapy may be due to infection of the cornea by certain pathogens or late presentation, which requires surgical treatment in conjunction with anti-fungal therapy post-operative. We, therefore, searched for literatures using the keywords "pigmented fungi, pheohyphomycosis, keratitis, ophthalmology" through GoogleScholar and reviewed the microbiology of pheohyphomycosis of the eye and its treatment in the light of improved culture and diagnostic methods.

Community-acquired pneumonia (CAP) remains an important cause of morbidity and mortality in developed countries. The disease is one of the top 10 causes of death and up to the present time, standard aggressive medical care has not resulted in a decrease in mortality. Knowledge of risk factors for CAP is essential to the design of preventive measures to reduce its incidence. Preventive strategies promoting effective vaccines or identifying and acting on modifiable risk factors are of paramount importance in reducing CAP-related death. Most studies have been performed in patients referred for inpatient care or in CAP cases in which a specific pathogen has been identified, but data from population-based studies are scarcer. We present a review of the main risk factors for CAP in adults, classified in the following categories: (a) Comorbidities and their treatments, (b) demographic and socioeconomic factors, (c) lifestyle factors and (d) environmental factors. We conclude with some brief recommendations on preventive measures and vaccination.

The presence of chronic infections in patients with respiratory diseases has led to an increased interest in inhaled antibiotics. Their utility has been demonstrated in cystic fibrosis (CF) and extended their use to chronic obstructive pulmonary disease and non-CF bronchiectasis (BE). We have seen a development of new inhaled formulations and nebulizers in the last years. The main objective is to reduce the airway bacterial load, symptoms and the rate and severity of exacerbations. Actual BE guidelines recommend inhaled antibiotics when a patient has 3 or more exacerbations per year. Recent meta-analysis shows an overall benefit for BE patients with inhaled antibiotics. Nowadays, there are different nebulizer systems such as ultrasonic nebulization, "jet" nebulizer, and vibrating mesh system. In addition, there are several antibiotic formulations for nebulization and some dry powder formulations. We review the current evidence available for inhaled antibiotics in BE patients and the systems designed for the inhalation of antibiotics.

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. "Severe CAP'' (sCAP) identifies a group of patients who have severe disease and require Intensive Care Unit admission. Recommendations for antibiotic treatment for sCAP are based on illness severity, frequency of specific pathogens and local microbial resistance patterns. The challenges to patient management include the emergence of the high prevalence of multidrug-resistant in CAP, mainly from institutionalizing patients. A new approach is the evaluation of biomarkers as C-reactive protein, procalcitonin on the diagnosis, prognosis and therapy duration of sCAP with promising results . Implementation of guidelines for CAP treatment should be emphasized in order to increase survival. The benefits of steroid use in patients with severe pneumonia have not been proven yet by current literature.