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Community-acquired pneumonia: Pathogenesis of acute cardiac events and potential adjunctive therapies.
Chest. 2015 May 7;
Authors: Feldman C, Anderson R
Abstract
ABSTRACT: Despite advances in antimicrobial chemotherapy and access to sophisticated intensive care facilities, bacterial community-acquired pneumonia (CAP) continues to carry an unacceptably high mortality rate of 10-15% in hospitalized cases. CAP, considered by many to be the most under-estimated disease worldwide, poses a particular threat to the elderly whose numbers are steadily increasing in developed countries. Indeed elderly patients with severe CAP, as well as those with other risk factors, are at significant risk for development of inflammation-mediated acute cardiac events which may undermine the success of antimicrobial therapy. Adjunctive anti-inflammatory strategies are therefore of considerable potential benefit in this setting. Currently, the most promising of these are the macrolides, corticosteroids, and, more recently, statins, all of which target immune/inflammatory cells. In addition, recent insights into the immunopathogenesis of acute coronary events in patients with CAP have revealed a probable pivotal role of platelet activation, potentially modifiable by agents which possess anti-inflammatory and/or platelet-targeted activities. Statins, which not only possess anti-inflammatory activity, but which also appear to target several pathways involved in platelet activation, seem particularly well-suited as adjuncts to antibiotic therapy in bacterial CAP. Following a brief consideration of the immunopathogenesis of bacterial CAP, this review is focused on mechanisms of platelet activation by CAP pathogens, as well as the pharmacological control thereof, with emphasis on statins.
PMID: 25951315 [PubMed - as supplied by publisher]