Pre- and in-hospital management of community-acquired pneumonia in southern France, 1998-99

Kidney disease and mortality in patients with respiratory tract infections: a systematic review and meta-analysis

BACKGROUND

Respiratory tract infections (RTIs) are a common reason for people to seek medical care. RTIs are associated with high short-term mortality. Inconsistent evidence exists in the association between the presence of kidney disease and the risk of death in patient with RTIs.

METHODS

We searched the PubMed, Cochrane Library and Embase databases from inception through April 2019 for cohort and case-control studies investigating the presence of kidney disease (defined as medical diagnosis of kidney disease, reduced estimated glomerular filtration rate or creatinine clearance, elevated serum creatinine and proteinuria) on mortality in adults with RTIs in different settings including community, inpatient and intensive care units. We assessed the quality of the included studies using Cochrane Collaboration's tool and conducted a meta-analysis on the relative risk (RR) of death.

RESULTS

Of 5362 records identified, 18 studies involving 16 676 participants met the inclusion criteria, with 15 studies investigating pneumonia and 3 studies exploring influenza. The risk of bias in the available evidence was moderate. Most [17/18 (94.5%)] of studies reported positive associations of underlying chronic kidney disease with mortality. The pooled adjusted risk for all-cause mortality in patients with RTIs almost doubled [RR 1.96 (95% confidence interval 1.48-2.59)] in patients with kidney disease. Associations were consistent across different timings of kidney disease assessment and provenances of RTIs (community-acquired or healthcare-associated).

CONCLUSIONS

The presence of kidney disease is associated with higher mortality among people with RTIs, especially in those with pneumonia. The presence of kidney disease might be taken into account when considering admission for patients who present with RTIs.

Aetiology and risk factors of community-acquired pneumonia in hospitalized patients in Norway

BACKGROUND AND AIMS

In Norway, data on the aetiology of community-acquired pneumonia (CAP) in hospitalized patients are limited. The aims of this study were to investigate the bacterial aetiology of CAP in hospitalized patients in Norway, risk factors for CAP and possible differences in risk factors between patients with Legionnaire's disease and pneumonia because of other causes.

METHODS

Adult patients with radiologically confirmed CAP admitted to hospital were eligible for the study. Routine aerobic and Legionella culture of sputum, blood culture, urinary antigen test for Legionella pneumophila and Streptococcus pneumoniae, polymerase chain reaction detection of Chlamydophila pneumoniae, Mycoplasma pneumoniae and Bordetella pertussis from throat specimens, and serology for L. pneumophila serogroup 1-6 were performed. A questionnaire, which included demographic and clinical data, risk factors and treatment, was completed.

RESULTS

We included 374 patients through a 20-month study period in 2007-2008. The aetiological agent was detected in 37% of cases. S. pneumoniae (20%) was the most prevalent agent, followed by Haemophilus influenzae (6%) and Legionella spp. (6%). Eight Legionella cases were diagnosed by urinary antigen test, of which four also had positive serology. In addition, 13 Legionella cases were diagnosed by serology. The degree of comorbidity was high. An increased risk of hospital-diagnosed Legionella pneumonia was found among patients with a diagnosis of chronic congestive heart failure.

CONCLUSION

Our results indicate that S. pneumoniae is the most common bacterial cause of pneumonia in hospitalized patients, and the prevalence of Legionella pneumonia is probably higher in Norway than recognized previously.

[Managing lower respiratory tract infections in immunocompetent patients. Definitions, epidemiology, and diagnostic features]

Les infections respiratoires basses sont une des principales cause de mortalité dans le monde et les pneumopathies représentent en France la première cause de décès d'origine infectieuse. Trois entités nosologiques distinctes sont habituellement isolées en fonction de la localisation infectieuse : la bronchite aiguë, la pneumopathie et la bronchopneumopathie (atteignant les bronches et le parenchyme pulmonaire). En cas d'infections de l'arbre bronchique dans le cadre d'une bronchopathie chronique on parle de décompensation infectieuse de la maladie bronchique. Les deux principales difficultés diagnostiques de ces infections sont de déterminer la présence d'une participation alvéolaire au processus infectieux et de définir l'agent (ou les agents) pathogènes. Ces deux éléments vont conditionner la prise en charge thérapeutique. En dehors de l'examen physique, indispensable dans ce contexte, seule la radiographie thoracique pourra, en cas de persistance d'un doute, permettre de confirmer la présence d'une participation alvéolaire. Le diagnostic microbiologique pose la question de sa nécessité systématique et celui de sa valeur. Il n'est pas indispensable de réaliser un diagnostic microbiologique de certitude dans tous les cas. La décision de documentation doit répondre à deux impératifs : faisabilité et valeur diagnostique. La valeur d'un prélèvement dépend de son aptitude à mettre en évidence l'agent pathogène et dans certains cas de la possibilité d'en déterminer le profil de sensibilité (qui reste une indication majeure à la réalisation de ces prélèvements).

Disease, temporal and sociodemographic influences on initial treatment of community-acquired pneumonia in Manitoba, Canada

Reimbursement restrictions on newer antibiotics, common to many drug plans, may result in unnecessary hospitalisation when patients are unable to pay 'out of pocket' for recommended antibiotics. We examined the effect of income, among other subject characteristics, on the likelihood of hospitalisation or receipt of restricted antibiotics for initial treatment of community-acquired pneumonia (CAP). A retrospective cross-sectional review of healthcare claims from the province of Manitoba, Canada, from 1 May 1996 to 1 March 2002 was conducted. Of 36969 subjects with a diagnosis of CAP, 13.6% were initially hospitalised and 86.4% were treated as outpatients. Independent predictors of initial hospitalisation included: age (for every 10-year increase) (odds ratio (OR)=1.42); male gender (OR=1.22); urban residence (OR=0.52); presentation to the emergency department (OR=5.14); and level of co-morbidity (high versus low) (OR=1.66). The effect of income level on hospitalisation was modified by co-morbidity status. Among subjects lacking CAP-specific co-morbidities, the probability of initial hospitalisation was greater in the lowest versus the highest income quintile (OR=1.87). Among outpatients, restricted antibiotics were widely received and differences in use by income were modest.