The Infectious Diseases Society of America (IDSA) Foundation recently hosted a webinar on the continuous challenges of non-COVID respiratory tract infections as part of their Dr. John G. Bartlett Memorial Education Series. The World Health Organization (WHO) reports respiratory tract infections as the leading cause of disease burden and lower respiratory tract infection (LRTI) as the third leading cause of death worldwide .
The webinar, available on-demand here, focuses on lower respiratory tract infections and is divided into three presentations. In the first talk of the webinar, Dr. Donna Wolk discusses screening and diagnosis of lower respiratory tract infections and surveillance options. In the second presentation Dr. Leila Hojat discusses the pathogenesis, etiology and clinical manifestation of pneumonia. The third topic covers antibiotic decision-making and the importance of vaccines, presented by Dr. Maryrose Laguio-Vila.
This blog summarizes the highlights from the third talk. The first and second talk of the webinar is covered here and here.
Antimicrobial resistance (AMR) is considered a major concern for global public health. Not only can inadequate antibiotic therapy result in worsening clinical conditions, the overuse of antibiotics also leads to an increase of antibiotic resistance. With antibiotics becoming less effective, treatment of even common bacterial infectious diseases like pneumonia can be extremely challenging. Antibiotic stewardship is a crucial effort to drive proper use of antibiotics.
“Most upper respiratory tract infections do not need antibiotics” – Dr. Laguio-Vila
Dr. Laguio-Vila starts her presentation by emphasizing that most upper respiratory tract infections do not need antibiotics. To emphasize the importance of antibiotic stewardship, she cites a recent study highlighting that over 40% of prescribed antibiotics by primary care providers for the treatment of upper respiratory infections were unnecessary. Dr. Laguio-Vila admits that it remains very difficult clinically to tell if someone has a respiratory tract infection that is bacterial or viral in origin. She highlights that pneumonia is a clinical diagnosis and should be based on a combination of the patient’s symptomatology, objective markers of infections (such as fever and leukocytosis), and new radiographic changes to rule out other non-infectious conditions.
“Every antibiotic day counts” – Dr. Laguio-Vila
To ensure proper patient management for those diagnosed with a bacterial respiratory tract infection such as community-acquired pneumonia (CAP), clinical predictions scoring systems are helpful. For example, the Pneumonia Severity Index (PSI) and the CURB-65 are both scoring systems that can help providers to determine the best triage location and antibiotic therapy for their patients. Dr. Laguio-Vila explicitly points out the results from the GLIMP study, which showed low incidence of methicillin-resistant Staphylococcus aureus (MRSA) among patients with community acquired pneumonia. Besides choosing the proper antibiotic regimen, following the guideline for treatment duration is equally important.
Dr. Laguio-Vila summarizes the role of vaccines using a quote from Benjamin Franklin: “An ounce of prevention is worth a pound of cure.”
Vaccines play a critical role in stopping the spread of pathogens and support antibiotic stewardship. The presentation summarizes currently available vaccines and highlights their importance by using Pneumococcal vaccines as an example. Vaccine-induced immunity protects the general public from potential infections and reduces the severity during an infection. Moreover, vaccination helps contribute to herd immunity.
In summary, Dr. Laguio-Vila emphasizes that most respiratory tract infections are viral and do not need antibiotics. For conditions that need antibiotic treatments, guidelines help healthcare providers to determine the regimen and duration. Vaccines have been proven to reduce disease burden of respiratory tract infections.
A blog summarizing the highlights of the first and the second talks is available here and here.
The webinar is available on-demand here to learn more about antibiotic stewardship as well as etiology, clinical manifestation, and diagnosis.
About the Speaker
Maryrose Laguio-Vila, MD, is an infectious diseases physician and Chief of the Infectious Diseases Division at Rochester General Hospital (RGH) in Rochester, NY. She established and is the Medical Director of the RGH Antimicrobial Stewardship Program. She is also the physician leader for developing the Rochester Regional Health System hospital stewardship collaborative. She is also Associate Program Director of the RGH Internal Medicine Residency Program and core faculty in the Rochester Regional Health System Infectious Diseases fellowship program, serving as a mentor and preceptor in the fields of infectious diseases and antibiotic stewardship.
 Avendaño Carvajal L, Perret Pérez C. Epidemiology of Respiratory Infections. Pediatric Respiratory Diseases. 2020 Feb 1:263–72. doi: 10.1007/978-3-030-26961-6_28. PMCID: PMC7120591.