Epidemiology of pneumonia in hospitalized adults ≥18 years old in four districts of Ulaanbaatar, Mongolia, 2015-2019

Assessment of diaphragmatic thickness as a predictor for intubation in pneumonia patients

Pneumonia, one of the major contributors to morbidity and mortality globally, often leads to serious complications such as respiratory failure. Diaphragmatic dysfunction, detected through ultrasound, may predict the need for intubation in patients with pneumonia. This study aimed to evaluate the roles of diaphragmatic thickness fraction (DTF) and diaphragmatic excursion (DE) as predictors of intubation in pneumonia patients. This follow-up cohort study involved 53 participants diagnosed with pneumonia. Diaphragmatic ultrasonography was performed to measure DTF and DE within 24 hours of admission. The mean age of the patients was 51.8±20.4 years, with 66% being male. Diabetes mellitus (DM) (p=0.000) and hypertension (HTN) (p=0.003) were significantly associated with the need for intubation. DE was significantly correlated with intubation (p=0.001). At a cut-off of 2.9 cm, DE demonstrated 100% sensitivity and 56% specificity for predicting intubation. DTF exhibited 92% sensitivity and 60% specificity at a cut-off of 0.52, with a positive predictive value of 85% and a negative predictive value of 54%. Diaphragmatic parameters, particularly DE and DTF, are significant predictors of intubation in pneumonia patients. Comorbidities such as DM and HTN also play a critical role, underscoring the importance of early identification of high-risk patients for timely intervention.

Pneumococcal vaccines for prevention of adult pneumonia

Streptococcus pneumoniae, pneumococcus, is one of most important bacterial pathogens in adult community-acquired pneumonia. Although it can cause a variety of illness including invasive diseases (IPD), pneumonia has a greater impact than IPD from the perspective of health economics. 23 valent pneumococcal polysaccharide vaccine (PPSV23) and 13 valent pneumococcal conjugate vaccine (PCV13) have been recommended for people ≥65 years old until recently based on evidence in preventing IPD and pneumonia. Because the introduction and dissemination of PCVs for infants and its effects on herd immunity have led 'serotype replacement' in adult IPD and pneumococcal pneumonia since the 2000s, serotypes targeted by vaccines have sifted accordingly. With the availability of PCV21 this year, in addition to PCV15 and PCV20, vaccine prevention strategies for adult pneumococcal pneumonia need to be reconsidered. In this narrative review, we discuss current and future challenges regarding pneumococcal vaccines to prevent adult pneumococcal pneumonia.

Clozapine and Pneumonia: Synthesizing the Link by Reviewing Existing Reports-A Systematic Review and Meta-Analysis

Background and Objectives: Clozapine is a highly effective antipsychotic used for treating treatment-refractory psychotic and mood disorders. However, clozapine also has a serious risk of side effects leading to mortality, particularly its potentiated risk of leading to pneumonia. This review aims to overview the demographic and health-related risk factors leading to pneumonia to better inform risk assessment for clozapine users and to summarise current theories on the mechanisms for clozapine-associated pneumonia. This paper will highlight the need to prioritise pneumococcal vaccination in this population group. Materials and Method: We conducted a literary search of five online databases conforming to PRISMA. Our review includes all peer-reviewed papers with original data that discuss clozapine and pneumonia and excludes case reports. Baseline information of participants, pneumonia-related information and information regarding risk factors and mechanisms causing pneumonia were also extracted. Results: Clozapine was found to have an increased risk of pneumonia compared to other antipsychotic medications. Factors included comorbidities, higher clozapine dosages, and concurrent use of other antipsychotic medications. Key mechanisms for clozapine-associated pneumonia include clozapine-induced hyper sedation, sialorrhea and neutropoenia. Conclusions: While clozapine improves overall mortality for patients, our review confirms clozapine has the highest risk of pneumonia of all antipsychotics. The review also highlights the prevalent underuse of pneumococcal vaccines among clozapine users and the urgent need to increase uptake.

Impacts of environmental factors on the aetiological diagnosis and disease severity of community-acquired pneumonia in China: a multicentre, hospital-based, observational study

Environmental exposures are known to be associated with pathogen transmission and immune impairment, but the association of exposures with aetiology and severity of community-acquired pneumonia (CAP) are unclear. A retrospective observational study was conducted at nine hospitals in eight provinces in China from 2014 to 2019. CAP patients were recruited according to inclusion criteria, and respiratory samples were screened for 33 respiratory pathogens using molecular test methods. Sociodemographic, environmental and clinical factors were used to analyze the association with pathogen detection and disease severity by logistic regression models combined with distributed lag nonlinear models. A total of 3323 CAP patients were included, with 709 (21.3%) having severe illness. 2064 (62.1%) patients were positive for at least one pathogen. More severe patients were found in positive group. After adjusting for confounders, particulate matter (PM) 2.5 and 8-h ozone (O3-8h) were significant association at specific lag periods with detection of influenza viruses and Klebsiella pneumoniae respectively. PM10 and carbon monoxide (CO) showed cumulative effect with severe CAP. Pollutants exposures, especially PM, O3-8h, and CO should be considered in pathogen detection and severity of CAP to improve the clinical aetiological and disease severity diagnosis.

Prevalence and Etiology of Community- and Hospital-Acquired Pneumonia in Saudi Arabia and Their Antimicrobial Susceptibility Patterns: A Systematic Review

(1) Background and Objectives: Pneumonia is a major cause of morbidity and mortality worldwide, including in Saudi Arabia, and the prevalence and etiology of the disease varies depending on the setting. The development of effective strategies can help reduce the adverse impact of this disease. Therefore, this systematic review was conducted to explore the prevalence and etiology of community-acquired and hospital-acquired pneumonia in Saudi Arabia, as well as their antimicrobial susceptibility. (2) Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 recommendations were followed for this systematic review. Several databases were used to perform a thorough literature search, and papers were then assessed for eligibility by two independent reviewers. The Newcastle-Ottawa Scale (NOS) was used to extract the data from the relevant research and evaluate its quality. (3) Results: This systematic review included 28 studies that highlighted the fact that gram-negative bacteria, particularly Acinetobacter spp. and Pseudomonas aeruginosa, were the common cause of hospital-acquired pneumonia, while Staphylococcus aureus and Streptococcus spp. were responsible for community-acquired pneumonia in children. The study also found that bacterial isolates responsible for pneumonia showed high resistance rates against several antibiotics, including cephalosporins and carbapenems. (4) Conclusions: In conclusion, the study found that different bacteria are responsible for community- and hospital-acquired pneumonia in Saudi Arabia. Antibiotic resistance rates were high for several commonly used antibiotics, highlighting the need for rational antibiotic use to prevent further resistance. Moreover, there is a need to conduct more regular multicenter studies to assess etiology, resistance, and susceptibility patterns of pneumonia-causing pathogens in Saudi Arabia.