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Background Probabilistic scores have been recently suggested to identify pneumonia caused by multidrug-resistant (MDR) bacteria. The aim of the study was to validate both Aliberti and Shorr scores in predicting MDR pneumonia, comparing them with healthcare associated pneumonia (HCAP) classification. Methods Two independent European cohorts of consecutive patients hospitalised with pneumonia were prospectively evaluated in Barcelona, Spain (BC) and Edinburgh, UK (EC). Data on admission and during hospitalisation were collected. The predictive value of the three scores was explored for correctly indicating the presence of MDR pneumonia via a receiver-operating characteristic (ROC) curve. Results A total of 1591 patients in the BC and 1883 patients in the EC were enrolled. The prevalence of patients with MDR pathogen among those with isolated bacteria was 7.6% in the BC and 3.3% in the EC. The most common MDR pathogen found in both cohorts was MRSA, followed by MDR P aeruginosa . A significantly higher prevalence of MDR bacteria was found among patients in the intensive care unit (ICU). The two probabilistic scores, and particularly the Aliberti one, showed an area under the ROC curve higher than the HCAP classification in predicting MDR pneumonia, especially in the ICU. Conclusions Risk scores able to identify MDR pneumonia could help in developing strategies for antimicrobial stewardship.

Background: Cysteinyl leukotrienes (Cys-LTs) and isoprostanes are inflammatory metabolites derived from arachidonic acid whose levels are increased in the airways of asthmatic patients. Isoprostanes are relatively stable and specific for lipid peroxidation, which makes them potentially reliable biomarkers for oxidative stress. A study was undertaken to evaluate the effect of a course of oral steroids on Cys-LT and 8-isoprostane levels in exhaled breath condensate of children with an asthma exacerbation. Methods: Exhaled breath condensate was collected and fractional exhaled nitric oxide (FENO) and spirometric parameters were measured before and after a 5 day course of oral prednisone (1 mg/kg/day) in 15 asthmatic children with an asthma exacerbation. Cys-LT and 8-isoprostane concentrations were measured using an enzyme immunoassay. FENO was measured using a chemiluminescence analyser. Exhaled breath condensate was also collected from 10 healthy children. Results: Before prednisone treatment both Cys-LT and 8-isoprostane concentrations were higher in asthmatic subjects (Cys-LTs, 12.7 pg/ml (IQR 5.4–15.6); 8-isoprostane, 12.0 pg/ml (9.4–29.5)) than in healthy children (Cys-LTs, 4.3 pg/ml (2.0–5.7), p=0.002; 8-isoprostane, 2.6 pg/ml (2.1–3.0), p

Background—Nitric oxide (NO) plays an important role as an inflammatory mediator in the airways. Since chronic obstructive pulmonary disease (COPD) is characterised by airway inflammation, a study was undertaken to determine NO levels in the exhaled air of patients with COPD. Methods—Two groups of patients with clinically stable COPD were studied, 10 current smokers and 10 ex-smokers. Two control groups of healthy subjects consisting of 10 current smokers and 20 nonsmokers were also studied. Exhaled NO levels were measured by the collection bag technique and NO chemiluminescence analyser. Results—Mean (SE) levels of exhaled NO in ex-smokers and current smokers with COPD (25.7 (3.0) ppb and 10.2 (1.4) ppb, respectively) were significantly higher than in non-smoker and current smoker control subjects (9.4 (0.8) ppb and 4.6 (0.4) ppb, respectively). In current smokers with COPD exhaled levels of NO were significantly lower than in ex-smokers. In this latter group of patients there was a significant negative correlation between smoking history (pack years) and levels of exhaled NO (r = ‐0.8, p = 0.002). A positive correlation was seen between forced expiratory volume in one second (FEV1) and levels of exhaled NO (r = 0.65, p = 0.001) in patients with COPD. Conclusions—These data show that exhaled NO is increased in patients with stable COPD, both current and exsmokers, compared with healthy control subjects. (Thorax 1999;54:572‐575)

Introduction There are no risk stratification tools for morbidity and mortality in bronchiectasis. As more treatments become available, it is important to identify patients at risk of exacerbations, hospital admissions and mortality to target novel therapies. Methods A prospective observational study at a specialist bronchiectasis clinic in Edinburgh, UK was used to derive a bronchiectasis severity index using cox-proportional hazards regression to identify independent predictors of mortality and hospital admission over 4 years follow-up. Averaged s-coefficients were used to award points for each independent variable and the discrimination of a derived score was tested using the area under the receiver operator characteristic curve (AUC). The score was validated in independent cohorts from Dundee, UK (N = 218), Leuven, Belgium (N = 253), Monza, Italy (N = 105) and Newcastle, UK (N = 126). Results 608 patients were included in the derivation cohort. Independent predictors of future hospital admissions were prior hospital admissions hazard ratio (HR) 13.5 (9.40–19.46), MRC dyspnoea score > 4, HR 2.42 (1.66–3.52), FEV 1 Pseudomonas aeruginosa colonisation HR 2.16 (1.36–3.43), colonisation with other organisms HR 1.66 (1.12–2.44) and > 3 lobes involved on HRCT HR 1.48 (1.02–2.15). In the model for mortality, independent predictors were Age >70 years 8.57 (1.15–63.63), FEV 1 The bronchiectasis severity index derived from these models was composed of prior hospitalisation (5 points), MRC dyspnoea score (0–3 points), FEV 1 (0–3 points), bacterial colonisation (0- 3 points) Age (0–6 points) BMI In the validation cohorts, the AUC for mortality ranged from 0.81–0.84 and for hospitalisation was AUC 0.80–0.88. Conclusions The bronchiectasis severity index identifies patients at risk of future mortality, hospital admissions and exacerbations.