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Ostermann L, Seeliger B, David S, Flasche C, Maus R, Reinboth MS, Christmann M, Neumann K, Brand K, Seltmann S, Bühling F, Paton JC, Roth J, Vogl T, Viemann D, Welte T, Maus UA. S100A9 is indispensable for survival of pneumococcal pneumonia in mice. PLoS Pathog 2023; 19:e1011493. [PMID: 37467233 DOI: 10.1371/journal.ppat.1011493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/18/2023] [Indexed: 07/21/2023] Open
Abstract
S100A8/A9 has important immunomodulatory roles in antibacterial defense, but its relevance in focal pneumonia caused by Streptococcus pneumoniae (S. pneumoniae) is understudied. We show that S100A9 was significantly increased in BAL fluids of patients with bacterial but not viral pneumonia and correlated with procalcitonin and sequential organ failure assessment scores. Mice deficient in S100A9 exhibited drastically elevated Zn2+ levels in lungs, which led to bacterial outgrowth and significantly reduced survival. In addition, reduced survival of S100A9 KO mice was characterized by excessive release of neutrophil elastase, which resulted in degradation of opsonophagocytically important collectins surfactant proteins A and D. All of these features were attenuated in S. pneumoniae-challenged chimeric WT→S100A9 KO mice. Similarly, therapy of S. pneumoniae-infected S100A9 KO mice with a mutant S100A8/A9 protein showing increased half-life significantly decreased lung bacterial loads and lung injury. Collectively, S100A9 controls central antibacterial immune mechanisms of the lung with essential relevance to survival of pneumococcal pneumonia. Moreover, S100A9 appears to be a promising biomarker to distinguish patients with bacterial from those with viral pneumonia. Trial registration: Clinical Trials register (DRKS00000620).
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Affiliation(s)
- Lena Ostermann
- Division of Experimental Pneumology, Hannover Medical School, Hannover, Germany
| | - Benjamin Seeliger
- Clinic for Pneumology, Hannover Medical School, Hannover, Germany
- German Center for Lung Research, Hannover, Germany
| | - Sascha David
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Carolin Flasche
- Division of Experimental Pneumology, Hannover Medical School, Hannover, Germany
| | - Regina Maus
- Division of Experimental Pneumology, Hannover Medical School, Hannover, Germany
| | - Marieke S Reinboth
- Division of Experimental Pneumology, Hannover Medical School, Hannover, Germany
| | - Martin Christmann
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Konstantin Neumann
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Korbinian Brand
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | | | - Frank Bühling
- Labopart Medical Laboratories, Dresden and Chemnitz, Germany
| | - James C Paton
- Research Centre for Infectious Diseases, Department of Molecular and Biomedical Science, University of Adelaide, Adelaide, Australia
| | - Johannes Roth
- Institute of Immunology, University of Münster, Münster, Germany
| | - Thomas Vogl
- Institute of Immunology, University of Münster, Münster, Germany
| | - Dorothee Viemann
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Translational Pediatrics, Department of Pediatrics, University Hospital Würzburg, Germany
- Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
- Center for Infection Research, University Würzburg, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, Hannover, Germany
- German Center for Lung Research, Hannover, Germany
| | - Ulrich A Maus
- Division of Experimental Pneumology, Hannover Medical School, Hannover, Germany
- German Center for Lung Research, Hannover, Germany
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Ozbay S, Ayan M, Ozsoy O, Akman C, Karcioglu O. Diagnostic and Prognostic Roles of Procalcitonin and Other Tools in Community-Acquired Pneumonia: A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13111869. [PMID: 37296721 DOI: 10.3390/diagnostics13111869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Community-acquired pneumonia (CAP) is among the most common causes of death and one of the leading healthcare concerns worldwide. It can evolve into sepsis and septic shock, which have a high mortality rate, especially in critical patients and comorbidities. The definitions of sepsis were revised in the last decade as "life-threatening organ dysfunction caused by a dysregulated host response to infection". Procalcitonin (PCT), C-reactive protein (CRP), and complete blood count, including white blood cells, are among the most commonly analyzed sepsis-specific biomarkers also used in pneumonia in a broad range of studies. It appears to be a reliable diagnostic tool to expedite care of these patients with severe infections in the acute setting. PCT was found to be superior to most other acute phase reactants and indicators, including CRP as a predictor of pneumonia, bacteremia, sepsis, and poor outcome, although conflicting results exist. In addition, PCT use is beneficial to judge timing for the cessation of antibiotic treatment in most severe infectious states. The clinicians should be aware of strengths and weaknesses of known and potential biomarkers in expedient recognition and management of severe infections. This manuscript is intended to present an overview of the definitions, complications, and outcomes of CAP and sepsis in adults, with special regard to PCT and other important markers.
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Affiliation(s)
- Sedat Ozbay
- Department of Emergency Medicine, Sivas Numune Education and Research Hospital, Sivas 58040, Turkey
| | - Mustafa Ayan
- Department of Emergency Medicine, Sivas Numune Education and Research Hospital, Sivas 58040, Turkey
| | - Orhan Ozsoy
- Department of Emergency Medicine, Sivas Numune Education and Research Hospital, Sivas 58040, Turkey
| | - Canan Akman
- Department of Emergency Medicine, Canakkale Onsekiz Mart University, Canakkale 17100, Turkey
| | - Ozgur Karcioglu
- Department of Emergency Medicine, University of Health Sciences, Taksim Education and Research Hospital, Beyoglu, Istanbul 34098, Turkey
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Hori S, Yamamoto Y, Ushida K, Shirai Y, Shimizu M, Kato Y, Shimizu A, Momosaki R. Impact of Frailty Risk on Oral Intake and Length of Hospital Stay in Older Patients with Pneumonia: A Historical Cohort Study. J Clin Med 2022; 12:jcm12010077. [PMID: 36614878 PMCID: PMC9821132 DOI: 10.3390/jcm12010077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to examine the association between frailty risk and outcomes in older patients with pneumonia. For this purpose, the JMDC multi-center database was used, and a historical cohort study was conducted to examine the association between the Hospital Frailty Risk Score (HFRS) and oral intake prognosis and length of hospital stay in older patients hospitalized with pneumonia. Patients were classified into low-risk (HFRS < 5), intermediate-risk (HFRS = 5−15), and high-risk (HFRS > 15) groups based on their HFRS scores, and outcomes were defined as the number of days from admission to the start of oral intake and length of hospital stay. A total of 98,420 patients with pneumonia (mean age 82.2 ± 7.2) were finally included. Of these patients, 72,207 (73.4%) were in the low-risk group, 23,136 (23.5%) were in the intermediate-risk group, and 3077 (3.1%) were in the high-risk group. The intermediate- and high-risk groups had a higher number of days to the start of oral intake than the low-risk group (intermediate-risk group: coefficient 0.705, 95% confidence interval [CI] 0.642−0.769; high-risk group: coefficient 0.889, 95% CI 0.740−1.038). In addition, the intermediate- and high-risk groups also had longer hospital stays than the low-risk group (intermediate-risk group: coefficient 5.743, 95% CI 5.305−6.180; high-risk group: coefficient 7.738, 95% CI 6.709−8.766). Overall, we found that HFRS is associated with delayed initiation of oral intake and prolonged hospital stay in older patients with pneumonia. Therefore, evaluation based on HFRS could be helpful in making clinical decisions regarding the selection of feeding strategies and when to discharge older patients with pneumonia.
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Affiliation(s)
- Shinsuke Hori
- Department of Rehabilitation, Mie University Hospital, Tsu 514-8507, Japan
| | - Yoshinori Yamamoto
- Department of Rehabilitation, Mie University Hospital, Tsu 514-8507, Japan
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Kenta Ushida
- Department of Rehabilitation, Mie University Hospital, Tsu 514-8507, Japan
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Yuka Shirai
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
- Department of Nutrition, Hamamatsu Medicine University Hospital, Hamamatsu 431-3192, Japan
| | - Miho Shimizu
- Department of Rehabilitation, Mie University Hospital, Tsu 514-8507, Japan
| | - Yuki Kato
- Department of Rehabilitation, Mie University Hospital, Tsu 514-8507, Japan
| | - Akio Shimizu
- Department of Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano 380-8525, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
- Correspondence: ; Tel.: +81-59-232-1111
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Are Undernutrition and Obesity Associated with Post-Discharge Mortality and Re-Hospitalization after Hospitalization with Community-Acquired Pneumonia? Nutrients 2022; 14:nu14224906. [PMID: 36432592 PMCID: PMC9697837 DOI: 10.3390/nu14224906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Undernutrition is associated with increased mortality after hospitalization with community-acquired pneumonia (CAP), whereas obesity is associated with decreased mortality in most studies. We aimed to determine whether undernutrition and obesity are associated with increased risk of re-hospitalization and post-discharge mortality after hospitalization. This study was nested within the Surviving Pneumonia cohort, which is a prospective cohort of adults hospitalized with CAP. Patients were categorized as undernourished, well-nourished, overweight, or obese. Undernutrition was based on diagnostic criteria by the European Society for Clinical Nutrition and Metabolism. Risk of mortality was investigated using multivariate logistic regression and re-hospitalization with competing risk Cox regression where death was the competing event. Compared to well-nourished patients, undernourished patients had a higher risk of 90-day (OR 3.0, 95% CI 1.0; 21.4) mortality, but a similar 30-day and 180-day mortality risk. Obese patients had a similar re-hospitalization and mortality risk as well-nourished patients. In conclusion, among patients with CAP, undernutrition was associated with increased risk of mortality. Undernourished patients are high-risk patients, and our results indicate that in-hospital screening of undernutrition should be implemented to identify patients at mortality risk. Studies are required to investigate whether nutritional therapy after hospitalization with CAP would improve survival.
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Anar C, Biçmen C, Güldaval F, Atay T, Gayaf M, Balcı G, Onur Alıcı I, Doğan Bİ, Büyükşirin M, Ayrancı A, Karadeniz G, Polat G. Antibiotic resistance rates and penicillin MIC distribution in patients with streptococcal pneumonia between 2013-2019, and use of antibiotics in clinical practice. Indian J Med Microbiol 2022; 40:577-581. [PMID: 36028454 DOI: 10.1016/j.ijmmb.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/17/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of the present study is to investigate the antibiotic resistance rates and use of antibiotics in patients with streptococcal pneumonia in a reference tertiary care hospital for pulmonary diseases in Izmir, Turkey. METHODS A total of 1224 cases with streptococcal pneumonia between 2013 and 2019 were included in the study, retrospectively. Drug susceptibility testing for penicillin and other antibiotics were performed according to the recommendations of EUCAST criteria. Clinical data and general characteristics were collected and evaluated for each patient in accordance with the susceptibility testing report. RESULTS Totally, resistance rates for trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, tetracycline, clindamycin and levofloxacin resistance were 63.5%, 39.8%, 37.7%, 37.6%, 28.8%, and 4.8%, respectively. Antibiotic resistance was not detected against vancomycin,teicoplanin and linezolid. Multidrug resistance rate was found to be 27.1%. It was observed that there was a statistically significant decrease in trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, clindamycin and levofloxacin resistance rates by years (p: 0.000, 0.004, 0.000, 0.001, 0.010, respectively). The penicillin MIC distribution was higher at the range of 0.12-2 μg/mL and there was statistical difference among the ranges of MIC values for the representative years (p:0.033). Among the antibiotics investigated, the most commonly used antibiotic was moxifloxacin. CONCLUSIONS Trimethophrim-sulfamethoxazole resistance rate has been found higher than other antibiotics. As penicillin MIC values were at the range of 0.12-2 μg/mL frequently, high doses of penicillin treatment might be required in some patients. It is noteworthy that significant decrease in resistance rates in penicillin, erythromycin, clindamycin and tetracycline could be due to the vaccination programme carried out since 2008 in Turkey. As the empiric use of quinolones is high it would be more appropriate to use it according to the susceptibility testing. It is important to determine the regional antimicrobial susceptibility for Streptococcus pneumoniae to select appropriate empirical antimicrobials in the clinical practice.
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Affiliation(s)
- Ceyda Anar
- Department of Chest Diseases, İzmir Katip Çelebi Üniversity, Atatürk Training and Research Hospital, Turkey.
| | - Can Biçmen
- Department of Medical Microbiyology Laboratory, Health Sciences University İzmir Dr.Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Turkey
| | - Filiz Güldaval
- Department of Chest Diseases, Health Sciences University İzmir Dr.Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Turkey
| | - Tuba Atay
- Department of Medical Microbiyology Laboratory, Health Sciences University İzmir Dr.Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Turkey
| | - Mine Gayaf
- Department of Chest Diseases, Health Sciences University İzmir Dr.Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Turkey
| | - Günseli Balcı
- Department of Chest Diseases, Health Sciences University İzmir Dr.Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Turkey
| | - Ibrahim Onur Alıcı
- Department of Chest Diseases, İzmir Bakırçay Üniversity Çiğli Training and Research Hospital, Turkey
| | - Betül İkbal Doğan
- Department of Chest Diseases, İzmir Katip Çelebi Üniversity, Atatürk Training and Research Hospital, Turkey
| | - Melih Büyükşirin
- Department of Chest Diseases, Health Sciences University İzmir Dr.Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Turkey
| | - Aysu Ayrancı
- Department of Chest Diseases, İzmir Bakırçay Üniversity Çiğli Training and Research Hospital, Turkey
| | - Gülistan Karadeniz
- Department of Chest Diseases, Health Sciences University İzmir Dr.Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Turkey
| | - Gülru Polat
- Department of Chest Diseases, Health Sciences University İzmir Dr.Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Turkey
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Kurokawa Y, Watanabe S, Miyabe S, Ishibashi K, Yamamoto S, Goto M, Hasegawa S, Miyachi H, Kohei F, Nagao T. Oral hygiene status and factors related to oral health in hospitalized patients with schizophrenia. Int J Dent Hyg 2022; 20:658-663. [PMID: 35920084 DOI: 10.1111/idh.12605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/17/2022] [Accepted: 07/31/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to elucidate the oral hygiene status and the factors associated with poor oral hygiene among patients with schizophrenia. METHODS The relationships of oral hygiene status (calculus index [CI], debris index [DI]), the mean number of decayed-missing-filled teeth (mean DMFT), and Revised Oral Assessment Guide (ROAG) with related factors (hospitalization, chlorpromazine equivalents [CPZE], age, Barthel Index [BI], frequency of cleaning teeth, and self-oral hygiene ability) among 249 hospitalized schizophrenic patients were investigated. RESULTS The results for oral hygiene status were as follows: median (range); CI 0.5 (0-6.0), DI 1.7 (0-6.0), ROAG 10.0 (7.0-15.0); and mean DMFT 21.7±7.3. The average CPZE was 524.4±353.6 mg (mean ± SD), and the BI was 76.4±30.7. There was a negative correlation between BI and DI (r = -0.34) and a positive correlation between age and mean DMFT (r=0.57). Male patients tended to have worse oral conditions (ROAG) than females. The least-squares multiple regression analysis revealed that BI for DI, age for mean DMFT, sex for ROAG, and self-oral hygiene ability for CI, DI, and mean DMFT were factors related to oral health status. CONCLUSION Patients with schizophrenia tended to have poor oral hygiene. BI, being male, and low activities of daily living were associated with poor oral hygiene. Furthermore, advanced age was associated with an increased risk of dental caries.
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Affiliation(s)
- Yoshiya Kurokawa
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Satoshi Watanabe
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Satoru Miyabe
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Kenichiro Ishibashi
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan.,Department of Maxillofacial Surgery, Ogaki Municipal Hospital, Gifu, Japan
| | - Satoshi Yamamoto
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan.,Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, Division of Surgical Pathology, University of Fukui Hospital, Fukui, Japan
| | - Mitsuo Goto
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Shogo Hasegawa
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Hitoshi Miyachi
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Fujita Kohei
- Hinaga General Center for Mental Care, Mie, Japan
| | - Toru Nagao
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi, Japan
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Huang CP, Tsai CS, Su PL, Huang TH, Ko WC, Lee NY. Respiratory etiological surveillance among quarantined patients with suspected lower respiratory tract infection at a medical center in southern Taiwan during COVID-19 pandemic. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:428-435. [PMID: 34509393 PMCID: PMC8423990 DOI: 10.1016/j.jmii.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023]
Abstract
Background A comprehensive study of respiratory pathogens was conducted in an area with a low prevalence of COVID-19 among the adults quarantined at a tertiary hospital. Methods From March to May 2020, 201 patients suspected lower respiratory tract infection (LRTI) were surveyed for etiologies by multiplex polymerase chain reaction (PCR: FilmArray TM Respiratory Panel) test combination with cultural method, viral antigen detection and serologic surveys. Results Total 201 patients tested with FilmArray TM Respiratory Panel were enrolled, of which 68.2% had sputum bacterial culture, 86.1% had pneumococcus and Legionella urine antigen test. Their median age was 72.0 year-old with multiple comorbidities, and 11.4% were nursing home residents. Bacteria accounted for 59.7% of identified pathogens. Atypical pathogens were identified in 31.3% of total pathogens, of which viruses accounted for 23.9%. In comparison to patients with bacterial infection, patients with atypical pathogens were younger (median= 77.2 vs 67.1, years, P = 0.017) and had shorter length of hospital (8.0 vs 4.5, days, P = 0.007). Conclusions Patients with LRTI caused by atypical pathogens was indistinguishable from those with bacterial pathogens by clinical manifestations or biomarkers. Multiplex PCR providing rapid diagnosis of atypical pathogens enhance patient care and decision making when rate of sputum culture sampling was low in quarantine ward during pandemic.
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Affiliation(s)
- Chien-Ping Huang
- Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Shiang Tsai
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital Douliu Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan; Infection Control Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Lan Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tang-Hsiu Huang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Infection Control Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Infection Control Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Mills MT, Al-Mohammad A, Warriner DR. Changes and advances in the field of infective endocarditis. Br J Hosp Med (Lond) 2022; 83:1-11. [DOI: 10.12968/hmed.2021.0510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infective endocarditis is a rare but deadly disease, with a highly variable presentation. The clinical manifestations of the condition are often multisystemic, ranging from dermatological to ophthalmic, and cardiovascular to renal. Thus, patients with infective endocarditis may first present to the acute or general physician, who may have a variable knowledge of the condition. The diagnosis of infective endocarditis can be challenging, relying on clinical, imaging and microbiological features. Recent decades have seen a transformation in the epidemiology and microbiology of infective endocarditis and yet, despite advances in diagnostics and therapeutics, mortality rates remain high. This review outlines the emerging studies and guidelines on the assessment and management of infective endocarditis, focusing on the evolving epidemiology of the condition, the role of new imaging modalities, updated diagnostic criteria, the latest on antimicrobial and surgical management, and the role of a multidisciplinary approach in the management of patients with infective endocarditis.
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Affiliation(s)
- Mark T Mills
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Abdallah Al-Mohammad
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David R Warriner
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Department of Cardiology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Impact of 7-valent versus 10-valent pneumococcal conjugate vaccines on primary care consultations across various age groups in the Netherlands, 5 years after the switch: A time-series analysis. Vaccine 2021; 40:334-343. [PMID: 34969546 DOI: 10.1016/j.vaccine.2021.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND In 2011, 10-valent pneumococcal conjugate vaccine (PCV10) replaced PCV7 in The Netherlands. We aimed to assess the impact of this switch on non-invasive pneumococcal disease in primary care across various age-groups, including pneumonia-bronchitis, otitis media (OM) and sinusitis with and without considering pre-PCV10 secular trends. METHODS Electronic records of 397,441 individuals included in a regional primary care database from July 2006 to June 2016 were extracted (2,408,762 person-years). We fitted interrupted time-series on annual incidence rates (IR) of primary care diagnosed pneumonia-bronchitis, OM and sinusitis episodes per age-group. We performed these two types of analyses, comparing; 1) the post-PCV10 observed versus expected trend if PCV10 had not been implemented and pre-PCV10 secular trends had continued 2), the pre- versus post-PCV10 observed, model fitted trend. The latter assumes no secular trend. Incidence rate ratios (IRR) were calculated using both methods. RESULTS We found significant reductions following PCV10 introduction with both analysis methods for pneumonia-bronchitis in the pediatric and adult age-groups, for sinusitis in the age-group 20-50 years and for OM, the effect across various age-groups are uncertain given contradictory results. For other outcomes and age-groups, the effect estimates were not consistent across the two-method used and heavily depended on the strength of the underlying trend. No consistent effects were observed in the elderly population, considering the two methods used. CONCLUSION Our study supports some direct and indirect-effect of PCV10 introduction on non-IPD, mainly on pneumonia-bronchitis, but estimates heavily depend on the method of analysis used. Estimates from the two different approaches may differ substantially if underlying trends are strong.
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Ishimaru N, Suzuki S, Shimokawa T, Akashi Y, Takeuchi Y, Ueda A, Kinami S, Ohnishi H, Suzuki H, Tokuda Y, Maeno T. Predicting Mycoplasma pneumoniae and Chlamydophila pneumoniae in community-acquired pneumonia (CAP) pneumonia: epidemiological study of respiratory tract infection using multiplex PCR assays. Intern Emerg Med 2021; 16:2129-2137. [PMID: 33983474 PMCID: PMC8116829 DOI: 10.1007/s11739-021-02744-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/04/2021] [Indexed: 01/22/2023]
Abstract
Community-acquired pneumonia (CAP) is a common illness that can lead to mortality. β-lactams are ineffective against atypical pathogen including Mycoplasma pneumoniae. We used molecular examinations to develop a decision tree to predict atypical pathogens with CAP and to examine the prevalence of macrolide resistance in Mycoplasma pneumoniae. We conducted a prospective observational study of patients aged ≥ 18 years who had fever and respiratory symptoms and were diagnosed with CAP in one of two community hospitals between December 2016 and October 2018. We assessed combinations of clinical variables that best predicted atypical pathogens with CAP by classification and regression tree (CART) analysis. Pneumonia was defined as respiratory symptoms and new infiltration recognized on chest X-ray or chest computed tomography. We analyzed 47 patients (21 females, 44.7%, mean age: 47.6 years). Atypical pathogens were detected in 15 patients (31.9%; 12 Mycoplasma pneumoniae, 3 Chlamydophila pneumoniae). Ten patients carried macrolide resistant Mycoplasma pneumoniae (macrolide resistant rate 83.3%). CART analysis suggested that factors associated with presence of atypical pathogens were absence of crackles, age < 45 years, and LD ≥ 183 U/L (sensitivity 86.7% [59.5, 98.3], specificity 96.9% [83.8, 99.9]). ur simple clinical decision rules can be used to identify primary care patients with CAP that are at risk for atypical pathogens. Further research is needed to validate its usefulness in various populations.Trial registration Clinical Trial (UMIN trial ID: UMIN000035346).
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Affiliation(s)
- Naoto Ishimaru
- Department of General Internal Medicine, Akashi Medical Center, 743-33, Ohkubo-Cho Yagi, Akashi, Hyogo, 674-0063, Japan.
| | - Satoshi Suzuki
- Department of General Medicine, Tone Chuo Hospital, Numata, Gunma, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | - Yusaku Akashi
- Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Yuto Takeuchi
- Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Atsuo Ueda
- Department of Clinical Laboratory, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Saori Kinami
- Department of General Internal Medicine, Akashi Medical Center, 743-33, Ohkubo-Cho Yagi, Akashi, Hyogo, 674-0063, Japan
| | - Hisashi Ohnishi
- Department of Respiratory Medicine, Akashi Medical Center, Akashi, Hyogo, Japan
| | - Hiromichi Suzuki
- Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | | | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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11
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Navarro-Torné A, Montuori EA, Kossyvaki V, Méndez C. Burden of pneumococcal disease among adults in Southern Europe (Spain, Portugal, Italy, and Greece): a systematic review and meta-analysis. Hum Vaccin Immunother 2021; 17:3670-3686. [PMID: 34106040 PMCID: PMC8437551 DOI: 10.1080/21645515.2021.1923348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/07/2021] [Accepted: 04/23/2021] [Indexed: 12/18/2022] Open
Abstract
The aim was to summarize pneumococcal disease burden data among adults in Southern Europe and the potential impact of vaccines on epidemiology. Of 4779 identified studies, 272 were selected. Invasive pneumococcal disease (IPD) incidence was 15.08 (95% CI 11.01-20.65) in Spain versus 2.56 (95% CI 1.54-4.24) per 100,000 population in Italy. Pneumococcal pneumonia incidence was 19.59 (95% CI 10.74-35.74) in Spain versus 2.19 (95% CI 1.36-3.54) per 100,000 population in Italy. Analysis of IPD incidence in Spain comparing pre-and post- PCV7 and PCV13 periods unveiled a declining trend in vaccine-type IPD incidence (larger and statistically significant for the elderly), suggesting indirect effects of childhood vaccination programme. Data from Portugal, Greece and, to a lesser extent, Italy were sparse, thus improved surveillance is needed. Pneumococcal vaccination uptake, particularly among the elderly and adults with chronic and immunosuppressing conditions, should be improved, including shift to a higher-valency pneumococcal conjugate vaccine when available.
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12
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Huang HK, Wang JH, Kao SL. Risk of developing pneumonia associated with clinically diagnosed hypothyroidism: a nationwide population-based cohort study. Fam Pract 2021; 38:630-636. [PMID: 33904923 DOI: 10.1093/fampra/cmab027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hypothyroidism has a detrimental effect on the immune system, which may predispose patients to infection. However, evidence about the risk of developing either community- or hospital-acquired pneumonia in patients with hypothyroidism is scarce. OBJECTIVE To evaluate the association between hypothyroidism and the risk of developing pneumonia. METHODS This was a retrospective population-based cohort study from Taiwan's National Health Insurance Research Database. After 1:1 propensity score matching, 9749 patients (age ≥20 years) newly diagnosed with hypothyroidism between 2001 and 2014 and 9749 patients without hypothyroidism or other thyroid diseases were included in the hypothyroidism and non-hypothyroidism cohorts, respectively, and followed up until 2015. The development of pneumonia was defined as the primary outcome. Cox proportional hazards regression models were used to calculate the hazard ratios (HRs) of developing pneumonia between hypothyroidism and non-hypothyroidism cohorts after adjusting for age, sex and baseline comorbidities. To evaluate whether thyroxine replacement therapy (TRT) modified the risk for pneumonia, we divided patients with hypothyroidism into subgroups: patients who received TRT and those who did not. RESULTS Hypothyroidism was associated with a higher risk of pneumonia [adjusted HR (aHR) 1.38, 95% confidence interval (CI) 1.29-1.49, P < 0.001]. Patients with hypothyroidism who received TRT had a lower risk of pneumonia than patients who did not (aHR 0.85, 95% CI 0.76-0.93, P = 0.001). Similar results were obtained in the age- and sex-stratified analyses. CONCLUSIONS Clinically diagnosed hypothyroidism was independently associated with the risk of pneumonia. In patients with hypothyroidism, TRT was associated with a lower risk of pneumonia.
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Affiliation(s)
- Huei-Kai Huang
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Sheng-Lun Kao
- Division of Geriatric Medicine, Department of Family Medicine, Hualien Tzu Chi Hospital and Tzu Chi University, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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13
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Voiriot G, Fartoukh M, Durand-Zaleski I, Berard L, Rousseau A, Armand-Lefevre L, Verdet C, Argaud L, Klouche K, Megarbane B, Patrier J, Richard JC, Reignier J, Schwebel C, Souweine B, Tandjaoui-Lambiotte Y, Simon T, Timsit JF. Combined use of a broad-panel respiratory multiplex PCR and procalcitonin to reduce duration of antibiotics exposure in patients with severe community-acquired pneumonia (MULTI-CAP): a multicentre, parallel-group, open-label, individual randomised trial conducted in French intensive care units. BMJ Open 2021; 11:e048187. [PMID: 34408046 PMCID: PMC8375718 DOI: 10.1136/bmjopen-2020-048187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION At the time of the worrying emergence and spread of bacterial resistance, reducing the selection pressure by reducing the exposure to antibiotics in patients with community-acquired pneumonia (CAP) is a public health issue. In this context, the combined use of molecular tests and biomarkers for guiding antibiotics discontinuation is attractive. Therefore, we have designed a trial comparing an integrated approach of diagnosis and treatment of severe CAP to usual care. METHODS AND ANALYSIS The multiplex PCR and procalcitonin to reduce duration of antibiotics exposure in patients with severe-CAP (MULTI-CAP) trial is a multicentre (n=20), parallel-group, superiority, open-label, randomised trial. Patients are included if adult admitted to intensive care unit for a CAP. Diagnosis of pneumonia is based on clinical criteria and a newly appeared parenchymal infiltrate. Immunocompromised patients are excluded. Subjects are randomised (1:1 ratio) to either the intervention arm (experimental strategy) or the control arm (usual strategy). In the intervention arm, the microbiological diagnosis combines a respiratory multiplex PCR (mPCR) and conventional microbiological investigations. An algorithm of early antibiotic de-escalation or discontinuation is recommended, based on mPCR results and the procalcitonin value. In the control arm, only conventional microbiological investigations are performed and antibiotics de-escalation remains at the clinician's discretion. The primary endpoint is the number of days alive without any antibiotic from the randomisation to day 28. Based on our hypothesis of 2 days gain in the intervention arm, we aim to enrol a total of 450 patients over a 30-month period. ETHICS AND DISSEMINATION The MULTI-CAP trial is conducted according to the principles of the Declaration of Helsinki, is registered in Clinical Trials and has been approved by the Committee for Protection of Persons and the National French Drug Safety Agency. Written informed consents are obtained from all the patients (or representatives). The results will be disseminated through educational institutions, submitted to peer-reviewed journals for publication and presented at medical congresses. TRIAL REGISTRATION NUMBER NCT03452826; Pre-results.
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Affiliation(s)
- Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Muriel Fartoukh
- Service de Médecine Intensive Réanimation, Assistance Publique-Hopitaux de Paris, Paris, France
| | | | - Laurence Berard
- Unité de Recherche Clinique de l'Est Parisien, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Alexandra Rousseau
- Unité de Recherche Clinique de l'Est Parisien, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Laurence Armand-Lefevre
- Département de Microbiologie, Hôpital Bichat, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Charlotte Verdet
- Département de Microbiologie, Hôpital Saint-Antoine, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Laurent Argaud
- Service de Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Université de Lyon, Lyon, France
| | - Kada Klouche
- Intensive Care Medicine Department, Universite de Montpellier, Montpellier, France
| | - Bruno Megarbane
- Service de Médecine Intensive Réanimation, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Juliette Patrier
- Service de Réanimation Infectieuse, Hôpital Bichat, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Jean-Christophe Richard
- Service de Médecine Intensive Réanimation, Hôpital de la Croix-Rousse, Université de Lyon, Lyon, France
| | - Jean Reignier
- Médecine intensive réanimation, CHU Nantes, Nantes, Pays de la Loire, France
| | - Carole Schwebel
- Service de Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
| | - Bertrand Souweine
- Medical Intensive Care Unit, CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - Yacine Tandjaoui-Lambiotte
- Service de Réanimation médico-chirurgicale, Hôpital Avicennes, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
| | - Tabassome Simon
- Clinical Research Platform (URC-CRB-CRC), Assistance Publique-Hôpitaux de Paris, Saint Antoine Hospital, Paris, France
- Clinical Pharmacology-Research Platform, Université Pierre et Marie Curie, Paris, France
| | - Jean-François Timsit
- Service de Réanimation Infectieuse, Hôpital Bichat, Assistance Publique-Hopitaux de Paris, Paris, Île-de-France, France
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Almirall J, Boixeda R, de la Torre MC, Torres A. Aspiration pneumonia: A renewed perspective and practical approach. Respir Med 2021; 185:106485. [PMID: 34087609 DOI: 10.1016/j.rmed.2021.106485] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
Aspiration pneumonia (AP) is a sub-type of community-acquired pneumonia (CAP) still poorly recognized especially in the absence of an aspiration event. A further difficulty is the differentiation between AP and aspiration pneumonitis. From a clinical perspective, AP is becoming increasingly relevant as a potential cause of severe and life-threatening respiratory infection among frail and very old patients, particularly among those with CAP requiring inpatient care. Moreover, AP is frequently underdiagnosed and a clear-cut definition of this pathological entity is lacking. There are different factors that increase the risk for aspiration, but other common factors influencing oral colonization such as malnutrition, smoking, poor oral hygiene or dry mouth, are also important in the pathogenesis of AP and should be considered. While there is no doubt in the diagnosis of AP in cases of a recent witnessed aspiration of oropharyngeal or gastric content, we here proposed a definition of AP that also includes silent unobserved aspirations. For this reason, the presence of one or more risk factors of oropharyngeal aspiration is required together with one or more risk factors for oral bacterial colonization. This proposed definition based on expert opinion not only unifies the diagnostic criteria of AP, but also provides the possibility to devise easily applicable strategies to prevent oral colonization.
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Affiliation(s)
- Jordi Almirall
- Intensive Care Unit, Hospital de Mataró, Universitat Autònoma de Barcelona, Consorci Sanitari Del Maresme, Mataró, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Ramon Boixeda
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Service of Internal Medicine, Hospital de Mataró, Consorci Sanitari Del Maresme, Mataró, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Mari C de la Torre
- Intensive Care Unit, Hospital de Mataró, Universitat Autònoma de Barcelona, Consorci Sanitari Del Maresme, Mataró, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Antoni Torres
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Universitat de Barcelona, Barcelona, Spain; Service of Pneumology, Institut Clínic Del Torax, Institut D'Investigació Biomédica Agustí Pi I Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain.
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15
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Zare MA, Mizani M, Sameti A, Bahmani A, Fathi M. Emergency Physicians Performing Point-of-Care Lung Sonography to Diagnose Pneumonia: A Prospective Multicenter Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479320983248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: There has always been some issues in the accurate diagnosis of pneumonia, a common cause of emergency department (ED) visits and revisits, which is typically made based on the patient’s clinical syndrome. This is made more difficult due to the traditional chest radiography having limited accuracy. This prospective multicenter study was conducted to determine the diagnostic accuracy of a point-of-care lung sonography performed by emergency physicians for the diagnosis of pneumonia in an acute care setting. This was compared with chest computed tomography (CT), the diagnostic gold standard. Methods: ED patients who presented with signs and symptoms of pneumonia were eligible to enroll in the study. After enrollment, point-of-care lung sonography was performed on patients by emergency physicians who had passed a focused teaching course on lung sonographic findings of pneumonia. All enrolled patients were followed up. Patients who underwent a chest CT during their hospital admission course were finally included and analyzed. Results: Emergency physicians who performed a point-of-care lung sonography had a sensitivity of 100%, specificity of 75%, positive predictive value of 88.88%, negative predictive value of 100%, and an overall accuracy of 90% in the diagnosis of pneumonia. Conclusion: These emergency physicians could accurately diagnose pneumonia, with a point-of-care lung sonography, after completing a focused sonography course.
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Affiliation(s)
- Mohammad Amin Zare
- Emergency Medicine Department, Iran University of Medical Sciences, Tehran, Iran
| | - Mahtab Mizani
- Emergency Medicine Specialist, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Sameti
- Emergency Medicine Specialist, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Bahmani
- Emergency Medicine Department, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Marzieh Fathi
- Emergency Medicine Specialist, Iran University of Medical Sciences, Tehran, Iran
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16
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Sistani SS, Parooie F. Diagnostic Performance of Ultrasonography in Patients With Pneumonia: An Updated Comparative Systematic Review and Meta-analysis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479321992348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: A chest radiograph (CXR) is still the preferred diagnostic method when pneumonia is suspected, although the sensitivity is relatively low. The aim of this study was to compare the diagnostic sensitivity, specificity, and accuracy of ultrasonography (US) for the diagnosis of community-acquired pneumonia (CAP), compared with CXR. Materials and Methods: A principled search was conducted to identify original English articles using PubMed, EMBASE, Web of Science, Scopus, and the Cochrane library, with the end date of October 2020. A combination of keywords, such as “ultrasound” or “ultrasonography,” “pneumonia,” “sensitivity,” and “specificity,” was used. Methodologic quality was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 criteria. Statistical analysis was completed on the resulting study data. Results: The search produced 16 eligible articles that reported on 2040 patients. The overall pooled sensitivity for US and CXR, to diagnose pneumonia, was 0.96 and 0.65, respectively. The overall pooled specificity for US and CXR was 0.85 and 0.81, respectively. The overall pooled positive likelihood ratio for US and CXR was 9.74 and 3.67, respectively. The negative likelihood ratio for US and CXR was 0.05 and 0.42, respectively. In addition, summary receiver operative characteristics areas under the curve were 0.98 for US and 0.77 for CXR. Conclusion: This review demonstrated that lung US is a useful technique for the diagnosis of pneumonia. This diagnostic method can be used by emergency physicians with high accuracy, sensitivity, and specificity. Among an elderly population, this diagnostic method may be a better choice than CXR. The rapid performance of lung US may facilitate a quick, cost-effective, and safe diagnosis of this potentially fatal disease.
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Abstract
Pneumonia is a common acute respiratory infection that affects the alveoli and distal airways; it is a major health problem and associated with high morbidity and short-term and long-term mortality in all age groups worldwide. Pneumonia is broadly divided into community-acquired pneumonia or hospital-acquired pneumonia. A large variety of microorganisms can cause pneumonia, including bacteria, respiratory viruses and fungi, and there are great geographical variations in their prevalence. Pneumonia occurs more commonly in susceptible individuals, including children of <5 years of age and older adults with prior chronic conditions. Development of the disease largely depends on the host immune response, with pathogen characteristics having a less prominent role. Individuals with pneumonia often present with respiratory and systemic symptoms, and diagnosis is based on both clinical presentation and radiological findings. It is crucial to identify the causative pathogens, as delayed and inadequate antimicrobial therapy can lead to poor outcomes. New antibiotic and non-antibiotic therapies, in addition to rapid and accurate diagnostic tests that can detect pathogens and antibiotic resistance will improve the management of pneumonia.
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Lourdesamy Anthony AI, Zam Z, Hussin N. A Hospital-based Study on the Local Epidemiology of Pneumonia Including the Contribution of Legionella Pneumonia. Malays J Med Sci 2021; 27:79-88. [PMID: 33447136 PMCID: PMC7785258 DOI: 10.21315/mjms2020.27.6.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background In real-life practice, only 20% of hospitalised pneumonia cases have an identified etiology. The usage of Legionella urine antigen test (LUAT) in developed nations revolutionised case detection rates. Accordingly, our objectives were to study the microbiological etiology for hospitalised pneumonia patients and the diagnosis of Legionella pneumonia. Methods A prospective, observational single-centre study was conducted where all 504 cases that were consecutively admitted for pneumonia were enrolled. Blood and sputum samples obtained were used to identify pathogens using standard microbiological culture methods. The urine samples collected were tested using the ImmunocatchTMLegionella immunochromatographic (ICT) urine antigen test. Results A microbiological diagnosis was only achieved in 104 cases (20.6%) and a Gram-negative infection predominance was observed. Culture-positive cases required longer hospitalisation (8.46 days versus 5.53 days; P < 0.001) and the higher usage of antipseudomonal antibiotics (23.1% versus 8.3%; P < 0.001). Only 3 cases (0.6%) were diagnosed with Legionella pneumonia. Conclusion The local pathogen distribution is diverse compared to other regions. Culture-negative pneumonia is common and significantly differs from culture-positive pneumonia. Legionella pneumophila serotype 1 is not a common cause of pneumonia and LUAT did not help demystify the cause of culture-negative pneumonia.
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Affiliation(s)
| | - Zarifah Zam
- Microbiology Unit, Hospital Taiping, Taiping, Malaysia
| | - Narwani Hussin
- Clinical Research Centre, Hospital Taiping, Taiping, Malaysia
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Abstract
Community-acquired pneumonia (CAP) is a common cause for admission to the hospital and contributes significantly to patient morbidity and healthcare cost. We present a review of the epidemiology, pathophysiology, risk factors, symptoms, diagnosis, presentations, risk-stratification, markers, and management of CAP in the United States (US). The overall incidence of CAP is 16 to 23 cases per 1000 persons per year, and the rate increases with age. Some of the risk factors for CAP include comorbidities such as, chronic obstructive pulmonary disease (COPD), asthma, and heart failure. CAP symptoms vary, and typically include productive cough, dyspnea, pleuritic pain, abnormal vital signs (e.g., fever, tachycardia), and abnormal lung examination findings. A diagnosis can be made by radiography, which has the additional benefit of helping to identify patterns associated with typical and atypical CAP. There are risk-stratification calculators that can be used routinely by physicians to triage patients, and to determine adequate management. The Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) developed the Pneumonia Severity Index (PSI) which incorporates 20 risk factors to place patients into 5 classes correlated with mortality risk. In addition, the British Thoracic Society (BTS) established the original severity score CURB (confusion, uremia, respiratory rate, low blood pressure) to identify patients with CAP who may be candidates for outpatient vs. inpatient treatment. Inflammatory markers, such as procalcitonin (PCT), can be used to guide management throughout hospital stay. Antibiotic coverage will vary depending on whether outpatient vs. inpatient management is required.
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Chizhova OY, Ruslyakova IA, Baculin IG, Vinnichuk SA, Sakharov VI. [Viruso-bacterial pneumonia, complicated by lightness pulmonary bleeding with death]. TERAPEVT ARKH 2020; 92:57-61. [PMID: 33720605 DOI: 10.26442/00403660.2020.11.000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 12/25/2020] [Indexed: 11/22/2022]
Abstract
Despite the significant achievements and successes of medical science, the incidence of influenza, its complications and socio-economic damage do not decrease, remaining at a high level. In the clinic of Mechnikov North-Western State Medical University from December 2018 to February 2019, from 89 hospitalized patients with pneumonia/acute bronchitis viral etiology was determined in 29 (32%). In 27 (97%) patients it was virus A (H1N1), in 2 cases A (H3N2). 9 (31%) patients were sever and were hospitalized in intensive care unit. The case of severe viral pneumonia caused by A (H3N2) complicated by fulminant pulmonary hemorrhage with a lethal outcome is presented.
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Affiliation(s)
- O Y Chizhova
- Mechnikov North-Western State Medical University
| | | | - I G Baculin
- Mechnikov North-Western State Medical University
| | | | - V I Sakharov
- Mechnikov North-Western State Medical University
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Farghly S, Abd-Elkader R, El Zohne RA, Abd El-Kareem DM. Mean platelet volume change (∆MPV) and red blood cell distribution width (RDW) as promising markers of community-acquired pneumonia (CAP) outcome. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [PMCID: PMC7439238 DOI: 10.1186/s43168-020-00024-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Prognostic markers play an essential role in the proper management of community-acquired pneumonia. This research work aimed to evaluate the association of RDW and /or MPV with mortality and morbidity in patients with CAP to improve the yield of already used prognostic scores.
Results
The current study enrolled 153 patients with community-acquired pneumonia (CAP). Out of them, 101 (64%) patients improved while 52 (36%) died. It was noticed that each of delta MPV and RDW (P < 0.001) had positive significant correlation with PSI and CURB-65. Delta MPV and RDW was significantly higher in patients who died (2.61 ± 1.01 vs. 1.78 ± 0.76; P = 0.01 for delta MPV and 16.50 ± 3.54 vs. 15.50 ± 2.81; P = 0.02 for RDW).
Conclusion
Initial RDW and rising MPV during hospitalization for CAP is associated with more severe clinical characteristics and high mortality. Moreover, the use of RDW and delta MPV in patients admitted with CAP can improve the performance of prognostic scales.
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Arnaíz de Las Revillas F, Sousa D, Ardunay C, García-Vidal C, Montejo M, Rodríguez-Álvarez R, Pasquau J, Bouza E, Oteo JA, Balseiro C, Méndez C, Lwoff N, Llinares P, Fariñas MC. Healthcare-associated pneumonia: a prospective study in Spain. REVISTA ESPANOLA DE QUIMIOTERAPIA 2020; 33:358-368. [PMID: 32693555 PMCID: PMC7528418 DOI: 10.37201/req/067.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The aim of the study was to describe the epidemiological characteristics and factors related to outcome in Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated pneumonia (HCAP). Patients and method A 3-year prospective observational epidemiological case study of HCAP was conducted in seven Spanish hospitals. Microbiological and patient characteristics and outcomes were collected and classified by causative pathogen into 4 categories: “S. pneumoniae”, “MRSA”, “Others” and “Unknown”. Patients were followed up 30 days after discharge. Results A total of 258 (84.6%) patients were enrolled (170 were men [65.9%]). Mean age was 72.4 years ± 15 years (95% CI [70.54-74.25]). The etiology of pneumonia was identified in 73 cases (28.3%):S. pneumoniae in 35 patients (13.6%), MRSA in 8 (3.1%), and other microorganisms in 30 patients (11.6%). Significant differences in rates of chronic obstructive pulmonary disease (p < 0.05), previous antibiotic treatment (p < 0.05), other chronic respiratory diseases, inhaled corticosteroids (p < 0.01), and lymphoma (p < 0.05) were observed among the four groups. Patients with MRSA pneumonia had received more previous antibiotic treatment (87.5%). Thirty-three (12.8%) patients died during hospitalisation; death in 27 (81.2%) was related to pneumonia. Conclusions The etiology of HCAP was identified in only one quarter of patients, with S. pneumoniae being the most prevalent microorganism. Patients with chronic respiratory diseases more frequently presented HCAP due to MRSA than to S. pneumoniae. Death at hospital discharge was related in most cases to pneumonia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - M C Fariñas
- María Carmen Fariñas. Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008 Santander, Cantabria, Spain.
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Species Identification and Antibiotic Resistance Prediction by Analysis of Whole-Genome Sequence Data by Use of ARESdb: an Analysis of Isolates from the Unyvero Lower Respiratory Tract Infection Trial. J Clin Microbiol 2020; 58:JCM.00273-20. [PMID: 32295890 PMCID: PMC7315026 DOI: 10.1128/jcm.00273-20] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/04/2020] [Indexed: 12/12/2022] Open
Abstract
Whole-genome sequencing (WGS) is now routinely performed in clinical microbiology laboratories to assess isolate relatedness. With appropriately developed analytics, the same data can be used for prediction of antimicrobial susceptibility. We assessed WGS data for identification using open-source tools and antibiotic susceptibility testing (AST) prediction using ARESdb compared to matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) identification and broth microdilution phenotypic susceptibility testing on clinical isolates from a multicenter clinical trial of the FDA-cleared Unyvero lower respiratory tract infection (LRTI) application (Curetis). Whole-genome sequencing (WGS) is now routinely performed in clinical microbiology laboratories to assess isolate relatedness. With appropriately developed analytics, the same data can be used for prediction of antimicrobial susceptibility. We assessed WGS data for identification using open-source tools and antibiotic susceptibility testing (AST) prediction using ARESdb compared to matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) identification and broth microdilution phenotypic susceptibility testing on clinical isolates from a multicenter clinical trial of the FDA-cleared Unyvero lower respiratory tract infection (LRTI) application (Curetis). For the trial, more than 2,000 patient samples were collected from intensive care units across nine hospitals and tested for LRTI. The isolate subset used in this study included 620 clinical isolates originating from 455 LRTI culture-positive patient samples. Isolates were sequenced using the Illumina Nextera XT protocol and FASTQ files with raw reads uploaded to the ARESdb cloud platform (ares-genetics.cloud; released for research use in 2020). The platform combines Ares Genetics’ proprietary database ARESdb with state-of-the-art bioinformatics tools and curated public data. For identification, WGS showed 99 and 93% concordance with MALDI-TOF MS at the genus and species levels, respectively. WGS-predicted susceptibility showed 89% categorical agreement with phenotypic susceptibility across a total of 129 species-compound pairs analyzed, with categorical agreement exceeding 90% in 78 species-compound pairs and reaching 100% in 32. Results of this study add to the growing body of literature showing that, with improvement of analytics, WGS data could be used to predict antimicrobial susceptibility.
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Cavallazzi R, Furmanek S, Arnold FW, Beavin LA, Wunderink RG, Niederman MS, Ramirez JA. The Burden of Community-Acquired Pneumonia Requiring Admission to ICU in the United States. Chest 2020; 158:1008-1016. [PMID: 32298730 DOI: 10.1016/j.chest.2020.03.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/31/2020] [Accepted: 03/14/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A paucity of studies have assessed the epidemiology of community-acquired pneumonia (CAP) that require ICU admission. We conducted a study on this group of patients with the primary objective of defining the incidence, epidemiology, and mortality rate of CAP in the ICUs in Louisville, Kentucky. The secondary objective was to estimate the number of patients who were hospitalized and the number of deaths that were associated with CAP in ICU in the United States. RESEARCH QUESTIONS What is epidemiology of CAP in the ICU in Louisville, Kentucky, and the projected incidence in the United States? STUDY DESIGN AND METHODS This was a secondary analysis of a prospective population-based cohort study. The setting was all nine adult hospitals in Louisville, Kentucky. The annual incidence of CAP in the ICU per 100,000 adults was calculated for the whole adult population of Louisville. The number of patients who were hospitalized because of CAP in ICU in the United States was estimated by multiplying the Louisville incidence rate of CAP in ICU by the 2014 US adult population. RESULTS From a total of 7,449 unique patients who were hospitalized with CAP, 1,707 patients (23%) were admitted to the ICU. The incidence of CAP in the ICU was 145 cases per 100,000 population of adults. Cases of CAP in the ICU were clustered in patients from areas of the city with high poverty. The mortality rate of patients with CAP in ICU was 27% at 30 days and 47% at one year. In the United States, the estimated number of patients who were hospitalized with CAP requiring the ICU was 356,326 per year, and the estimated number of deaths at 30 days and one year were 96,206 and 167,474, respectively. INTERPRETATION Almost one in five patients who are hospitalized with CAP requires intensive care. Poverty is associated with CAP in the ICU. Nearly one-half of patients with CAP in the ICU will die within one year. Because of its significant burden, CAP in the ICU should be a high priority in research agenda and health policy.
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Affiliation(s)
- Rodrigo Cavallazzi
- Divisions of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, KY.
| | - Stephen Furmanek
- Divisions of Infectious Diseases, University of Louisville, Louisville, KY
| | - Forest W Arnold
- Divisions of Infectious Diseases, University of Louisville, Louisville, KY
| | - Leslie A Beavin
- Divisions of Infectious Diseases, University of Louisville, Louisville, KY
| | - Richard G Wunderink
- Pulmonary and Critical Care Division, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY
| | - Julio A Ramirez
- Divisions of Infectious Diseases, University of Louisville, Louisville, KY
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Ferreira-Coimbra J, Sarda C, Rello J. Burden of Community-Acquired Pneumonia and Unmet Clinical Needs. Adv Ther 2020; 37:1302-1318. [PMID: 32072494 PMCID: PMC7140754 DOI: 10.1007/s12325-020-01248-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Indexed: 12/26/2022]
Abstract
Community-acquired pneumonia (CAP) is the leading cause of death among infectious diseases and an important health problem, having considerable implications for healthcare systems worldwide. Despite important advances in prevention through vaccines, new rapid diagnostic tests and antibiotics, CAP management still has significant drawbacks. Mortality remains very high in severely ill patients presenting with respiratory failure or shock but is also high in the elderly. Even after a CAP episode, higher risk of death remains during a long period, a risk mainly driven by inflammation and patient-related co-morbidities. CAP microbiology has been altered by new molecular diagnostic tests that have turned viruses into the most identified pathogens, notwithstanding uncertainties about the specific role of each virus in CAP pathogenesis. Pneumococcal vaccines also impacted CAP etiology and thus had changed Streptococcus pneumoniae circulating serotypes. Pathogens from specific regions should also be kept in mind when treating CAP. New antibiotics for CAP treatment were not tested in severely ill patients and focused on multidrug-resistant pathogens that are unrelated to CAP, limiting their general use and indications for intensive care unit (ICU) patients. Similarly, CAP management could be personalized through the use of adjunctive therapies that showed outcome improvements in particular patient groups. Although pneumococcal vaccination was only convincingly shown to reduce invasive pneumococcal disease, with a less significant effect in pneumococcal CAP, it remains the best therapeutic intervention to prevent bacterial CAP. Further research in CAP is needed to reduce its population impact and improve individual outcomes.
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Affiliation(s)
- João Ferreira-Coimbra
- Internal Medicine Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Cristina Sarda
- Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jordi Rello
- Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institute of Research, Barcelona, Spain
- CIBERES-Centro de investigación en red de enfermedades respiratorias, Madrid, Spain
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Hu WP, Zhang FY, Zhang J, Hang JQ, Zeng YY, Du CL, Jie ZJ, Jin XY, Zheng CX, Luo XM, Huang Y, Cheng QJ, Qu JM. Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai. J Thorac Dis 2020; 12:1417-1426. [PMID: 32395279 PMCID: PMC7212141 DOI: 10.21037/jtd.2020.03.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Despite the release of a national guideline in 2016, the actual practices with respect to adult community-acquired pneumonia (CAP) remain unknown in China. We aimed to investigate CAP patient management practices in Shanghai to identify potential problems and provide evidence for policy making. Methods A short-period, 5-day prospective cross-sectional study was performed with sampled pulmonologists from 36 hospitals, encompassing all the administrative districts of Shanghai, during January 8–12, 2018. The medical information was recorded and analyzed for the patients with the diagnosis of CAP who were cared for by 46 pulmonologists during the study period. Results Overall, 435 patients were included in the final analysis, and 94.3% had a low risk of death in terms of CRB-65 criteria (C: disturbance of consciousness, R: respiratory rate, B: blood pressure, 65: age). When diagnosed with CAP, 70.1% of patients were not evaluated using the CURB-65 score (CRB-65 + U: urea nitrogen), but most patients (95.4%) were evaluated using CRB-65. Time to achieve clinical stability was longer in patients with hypoxemia than in those without hypoxemia (8.42±6.36 vs. 5.53±4.12 days, P=0.004). Overall, 84.4% of patients with a CRB-65 score of 0 were administered antibiotics intravenously, and 19.4% were still hospitalized after excluding hypoxemia and comorbidities. The average duration of antibiotic treatment was 10.4±4.9 days. Overall, 72.6% of patients received antibiotics covering atypical pathogens whose time to clinical stability was significantly shortened compared with those without coverage, but the antibiotic duration was similar and not correspondingly shortened. Conclusions CRB-65 seems to be more practical than CURB-65 for the initial evaluation of CAP in the context of local practice, and oxygenation assessment should be included in the evaluation of severity. Overtreatment may be relatively common in patients at low risk of death, including unreasonable hospitalization, intravenous administration, and antibiotic duration.
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Affiliation(s)
- Wei-Ping Hu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Feng-Ying Zhang
- Department of Respiratory Medicine, Shanghai Putuo District People's Hospital, Shanghai 200060, China
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jing-Qing Hang
- Department of Respiratory Medicine, Shanghai Putuo District People's Hospital, Shanghai 200060, China
| | - Ying-Ying Zeng
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Chun-Ling Du
- Department of Respiratory Medicine, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai 201700, China
| | - Zhi-Jun Jie
- Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, China
| | - Xiao-Yan Jin
- Department of Respiratory Medicine, Tong Ren Hospital, Shanghai Jiao Tong University, Shanghai 200050, China
| | - Cui-Xia Zheng
- Department of Respiratory Medicine, Shanghai Yangpu District Central Hospital, Tongji University, Shanghai 200090, China
| | - Xu-Ming Luo
- Department of Respiratory Medicine, Shanghai Putuo District Central Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
| | - Yi Huang
- Department of Pulmonary and Critical Care Medicine, Changhai Hospital of Shanghai, Navy Medical University, Shanghai 200433, China
| | - Qi-Jian Cheng
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Pulmonary Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
| | - Jie-Ming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Pulmonary Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
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Influence of Pneumonia on the Survival of Patients with COPD. J Clin Med 2020; 9:jcm9010230. [PMID: 31952326 PMCID: PMC7020011 DOI: 10.3390/jcm9010230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Pneumonia is a frequent infection. Chronic obstructive pulmonary disease (COPD) can present with comorbidities, including pneumonia. It is known that COPD worsens the evolution of pneumonia, but few studies describe the impact of pneumonia on COPD evolution. This study analyzes the influence of pneumonia on the survival of COPD patients. Methods: Observational study of a cohort of 273 patients with COPD who attended spirometry in 2011, with a prospective follow-up of six years. Patients were divided into two groups according to their acquisition of pneumonia during follow-up. The difference in survival between the two groups was analyzed. Results: Survival was lower in the group with pneumonia compared with that without pneumonia (p = 0.000), both globally and after stratification by COPD phenotype. Pneumonia (Hazard Ratio -HR- 2.65; 95% Confidence Interval -CI- 1.57–4.48), advanced age (HR 1.08; 95% CI 1.03–1.09), and high Charlson index (HR 1.31; 95% CI 1.17–1.47) were identified as risk factors independently associated with mortality, while a high body mass index (HR 0.92; 95% CI 0.87–0.96) was identified as a protective factor. Conclusions: Pneumonia is associated with worse prognosis in COPD patients. It is important to take into account this comorbidity for a comprehensive care of these patients.
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Antibiothérapie courte au cours de la pneumonie aiguë communautaire : revue de la littérature et perspectives. Rev Mal Respir 2020; 37:26-33. [DOI: 10.1016/j.rmr.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 12/05/2018] [Indexed: 11/18/2022]
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Haque MA. Seasonal Incidence of Community-acquired Pneumonia: A Retrospective Study in a Tertiary Care Hospital in Kathmandu, Nepal. Cureus 2019; 11:e6417. [PMID: 31988818 PMCID: PMC6970104 DOI: 10.7759/cureus.6417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Community-acquired pneumonia (CAP) is the major cause of death in adult and elderly persons with a variety of presentations. Seasonal variation in the incidence of the disease is essential for clinicians and epidemiologists who deal with such diseases. The study was aimed at analysing the clinical profile and outcomes of community-acquired pneumonia during different seasons of the year in a tertiary care hospital, Manmohan Memorial Teaching Hospital (MMTH), of Kathmandu, Nepal. Method The aetiology and clinical profile of 378 patients with CAP who were admitted to MMTH over a period of one year were taken into account in this retrospective cross-sectional hospital-based study. Data were retrieved from the hospital medical records section and the Department of Pathology. All patients with a primary diagnosis of CAP admitted to the hospital were included in the study. Monthly and seasonal trends, aetiology, comorbidities, and mortality rates were analysed. Results Of 378 patients with CAP, 160 patients (42.3%) had associated chronic obstructive pulmonary disease (COPD), 92 patients (24.3%) had hypertension (HTN), 59 patients (15.6%) had diabetes, 12 patients (3.1%) had active pulmonary tuberculosis, seven patients (1.85%) had kidney disease, and the remaining 48 patients (12.6%) had only CAP. Seasonal variation of CAP was noted in 131 patients (35%) in the winter, 98 (26%) in autumn, 86 (23%) in spring, and 63 patients (16%) in summer seasons. None of the patients were vaccinated against influenza and pneumococcus. The most common organism isolated in CAP was Acinetobacter calcoaceticus baumannii (ACB) complex (4.7%), which was more distinguished in the winter season. The second most isolated organism was Pseudomonas aeruginosa (2.6%). The most common clinical presentation was fever (63%), followed by cough (47%) and shortness of breath (47%). Sputum culture was found to be positive in 51 cases (13.4%). Among 378 patients, 78 patients (20.6%) received treatment in the Intensive Care Unit (ICU) and the rest of the patients received treatment in the general medical ward. The mortality rate was found to be 6.6%. Conclusion An incidence of sputum-positive CAP was found in 51 cases (13.4%). The most common organism was ACB complex, followed by Pseudomonas aeruginosa, which were sensitive to polymyxins. Both of them were predominant in the winter and spring.
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König R, Cao X, Oswald M, Forstner C, Rohde G, Rupp J, Witzenrath M, Welte T, Kolditz M, Pletz M. Macrolide combination therapy for patients hospitalised with community-acquired pneumonia? An individualised approach supported by machine learning. Eur Respir J 2019; 54:13993003.00824-2019. [PMID: 31537702 DOI: 10.1183/13993003.00824-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/05/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The role of macrolide/β-lactam combination therapy in community-acquired pneumonia (CAP) of moderate severity is a matter of debate. Macrolides expand the coverage to atypical pathogens and attenuate pulmonary inflammation, but have been associated with cardiovascular toxicity and drug interactions. We developed a decision tree based on aetiological and clinical parameters, which are available ex ante to support a personalised decision for or against macrolides for the best clinical outcome of the individual patient. METHODS We employed machine learning in a cross-validation scheme based on a well-balanced selection of 4898 patients after propensity score matching to data available on admission of 6440 hospitalised patients with moderate severity (non-intensive care unit patients) from the observational, prospective, multinational CAPNETZ study. We aimed to improve the primary outcome of 180-day survival. RESULTS We found a simple decision tree of patient characteristics comprising chronic cardiovascular and chronic respiratory comorbidities as well as leukocyte counts in the respiratory secretion at enrolment. Specifically, we found that patients without cardiovascular or patients with respiratory comorbidities and high leukocyte counts in the respiratory secretion benefit from macrolide treatment. Patients identified to be treated in compliance with our treatment suggestion had a lower mortality of 27% (OR 1.83, 95% CI 1.48-2.27; p<0.001) compared to the observed standard of care. CONCLUSION Stratifying macrolide treatment in patients following a simple treatment rule may lead to considerably reduced mortality in CAP. A future randomised controlled trial confirming our result is necessary before implementing this rule into the clinical routine.
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Affiliation(s)
- Rainer König
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.,Network Modelling, Hans Knöll Institut Jena, Jena, Germany.,These authors contributed equally
| | - Xueqi Cao
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.,Network Modelling, Hans Knöll Institut Jena, Jena, Germany.,These authors contributed equally
| | - Marcus Oswald
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.,Network Modelling, Hans Knöll Institut Jena, Jena, Germany.,These authors contributed equally
| | - Christina Forstner
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.,Dept of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Gernot Rohde
- Dept of Respiratory Medicine, Medical Clinic I, Goethe University Hospital, Frankfurt/Main, Germany.,CAPNETZ STIFTUNG, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL)
| | - Jan Rupp
- CAPNETZ STIFTUNG, Hannover Medical School, Hannover, Germany.,Dept of Infectious Diseases and Microbiology, University-Hospital Schleswig-Holstein/Campus Lübeck, University of Lübeck, Lübeck, Germany
| | - Martin Witzenrath
- CAPNETZ STIFTUNG, Hannover Medical School, Hannover, Germany.,Division of Pulmonary Inflammation, and Dept of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tobias Welte
- CAPNETZ STIFTUNG, Hannover Medical School, Hannover, Germany.,Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Martin Kolditz
- Division of Pulmonology, Medical Dept I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Mathias Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany .,CAPNETZ STIFTUNG, Hannover Medical School, Hannover, Germany
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Abstract
PURPOSE OF REVIEW The first guidelines on community-acquired pneumonia (CAP) were published in 1993, but since then many of the challenges regarding the outpatient management of CAP persist. These include the difficulty in establishing the initial clinical diagnosis, its risk stratification, which will dictate the place of treatment, the empirical choice of antibiotics, the relative scarcity of novel antibiotics and the importance of knowing local microbiological susceptibility patterns. RECENT FINDINGS New molecular biology methods have changed the etiologic perspective of CAP, especially the contribution of virus. Lung ultrasound and biomarkers might aid diagnosis and severity stratification in the outpatient setting. Antibiotic resistance is a growing problem that reinforces the importance of novel antibiotics. And finally, prevention and the use of anti-pneumococcal vaccine are instrumental in reducing the burden of disease. SUMMARY Most of CAP cases are managed in the community; however, most research comes from hospitalized severe patients. New and awaited advances might contribute to aid diagnosis, cause and assessment of patients with CAP in the community. This knowledge might prove decisive in the execution of stewardship programmes that maintain current antibiotics, safeguard future ones and reinforce prevention.
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Abstract
Pneumonia, including community-acquired bacterial pneumonia, hospital-acquired bacterial pneumonia, and ventilator-acquired bacterial pneumonia, carries unacceptably high morbidity and mortality. Despite advances in antimicrobial therapy, emergence of multidrug resistance and high rates of treatment failure have made optimization of antibiotic efficacy a priority. This review focuses on pharmacokinetic and pharmacodynamic approaches to antibacterial optimization within the lung environment and in the setting of critical illness. Strategies for including these approaches in drug development programs as well as clinical practice are described and reviewed.
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Affiliation(s)
- Ana Motos
- Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA; Division of Animal Experimentation, Department of Pulmonary and Critical Care, Hospital Clinic, 170 Villarroel Street, Barcelona 08036, Spain
| | - James M Kidd
- Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA; Division of Infectious Diseases, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
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Voiriot G, Philippot Q, Elabbadi A, Elbim C, Chalumeau M, Fartoukh M. Risks Related to the Use of Non-Steroidal Anti-Inflammatory Drugs in Community-Acquired Pneumonia in Adult and Pediatric Patients. J Clin Med 2019; 8:jcm8060786. [PMID: 31163625 PMCID: PMC6617416 DOI: 10.3390/jcm8060786] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/22/2019] [Accepted: 05/27/2019] [Indexed: 12/22/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to alleviate symptoms during community-acquired pneumonia (CAP), while neither clinical data nor guidelines encourage this use. Experimental data suggest that NSAIDs impair neutrophil intrinsic functions, their recruitment to the inflammatory site, and the resolution of inflammatory processes after acute pulmonary bacterial challenge. During CAP, numerous observational data collected in hospitalized children, hospitalized adults, and adults admitted to intensive care units (ICUs) support a strong association between pre-hospital NSAID exposure and a delayed hospital referral, a delayed administration of antibiotic therapy, and the occurrence of pleuropulmonary complications, even in the only study that has accounted for a protopathic bias. Other endpoints have been described including a longer duration of antibiotic therapy and a greater hospital length of stay. In all adult series, patients exposed to NSAIDs were younger and had fewer comorbidities. The mechanisms by which NSAID use would entail a complicated course in pneumonia still remain uncertain. The temporal hypothesis and the immunological hypothesis are the two main emerging hypotheses. Current data strongly support an association between NSAID intake during the outpatient treatment of CAP and a complicated course. This should encourage experts and scientific societies to strongly advise against the use of NSAIDs in the management of lower respiratory tract infections.
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Affiliation(s)
- Guillaume Voiriot
- Assistance Publique-Hôpitaux de Paris, Service de Réanimation médico-chirurgicale, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, 75020 Paris, France.
- Sorbonne Université, UFR Médecine, 75006 Paris, France.
- Faculté de Médecine, GRC CARMAS, Université Paris Est, 94000 Créteil, France.
| | - Quentin Philippot
- Assistance Publique-Hôpitaux de Paris, Service de Réanimation médico-chirurgicale, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, 75020 Paris, France.
| | - Alexandre Elabbadi
- Assistance Publique-Hôpitaux de Paris, Service de Réanimation médico-chirurgicale, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, 75020 Paris, France.
| | - Carole Elbim
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, Team "Immune System, Neuroinflammation and Neurodegenerative Diseases", Hôpital Saint-Antoine, 75012 Paris, France.
| | - Martin Chalumeau
- UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris Descartes University, 75014 Paris, France.
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, 75015 Paris, France.
| | - Muriel Fartoukh
- Assistance Publique-Hôpitaux de Paris, Service de Réanimation médico-chirurgicale, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, 75020 Paris, France.
- Sorbonne Université, UFR Médecine, 75006 Paris, France.
- Faculté de Médecine, GRC CARMAS, Université Paris Est, 94000 Créteil, France.
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Impact of Lymphocyte and Neutrophil Counts on Mortality Risk in Severe Community-Acquired Pneumonia with or without Septic Shock. J Clin Med 2019; 8:jcm8050754. [PMID: 31137863 PMCID: PMC6572378 DOI: 10.3390/jcm8050754] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 01/30/2023] Open
Abstract
Background: Community-acquired pneumonia (CAP) is a frequent cause of death worldwide. As recently described, CAP shows different biological endotypes. Improving characterization of these endotypes is needed to optimize individualized treatment of this disease. The potential value of the leukogram to assist prognosis in severe CAP has not been previously addressed. Methods: A cohort of 710 patients with CAP admitted to the intensive care units (ICUs) at Hospital of Mataró and Parc Taulí Hospital of Sabadell was retrospectively analyzed. Patients were split in those with septic shock (n = 304) and those with no septic shock (n = 406). A single blood sample was drawn from all the patients at the time of admission to the emergency room. ICU mortality was the main outcome. Results: Multivariate analysis demonstrated that lymphopenia <675 cells/mm3 or <501 cells/mm3 translated into 2.32- and 3.76-fold risk of mortality in patients with or without septic shock, respectively. In turn, neutrophil counts were associated with prognosis just in the group of patients with septic shock, where neutrophils <8850 cells/mm3 translated into 3.6-fold risk of mortality. Conclusion: lymphopenia is a preserved risk factor for mortality across the different clinical presentations of severe CAP (sCAP), while failing to expand circulating neutrophils counts beyond the upper limit of normality represents an incremental immunological failure observed just in those patients with the most severe form of CAP, septic shock.
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Mahendra M, Jayaraj BS, Limaye S, Chaya SK, Dhar R, Mahesh PA. Factors influencing severity of community-acquired pneumonia. Lung India 2018; 35:284-289. [PMID: 29970765 PMCID: PMC6034384 DOI: 10.4103/lungindia.lungindia_334_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in India. There is a need to understand the risk factors associated with severity of CAP in our population. This study was part of the international global initiative for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia study to evaluate MRSA. METHODS A total of 100 consecutive cases of pneumonia admitted to the Department of Pulmonary Medicine in a tertiary care hospital were recruited in the study during March-July 2015. The severity of pneumonia was assessed based on the CURB-65 score. Individuals with pneumonia and CURB-65 score >2 were compared with subjects with CURB-65 score ≤2. Individuals were also evaluated for the causative organism and its resistance pattern with specific reference to the presence of MRSA. RESULTS Mean age of patients was 54.03 years, 66% were men. Patients were managed either in the intensive care unit (42%) or wards/high dependency unit (58%), 22% needed noninvasive ventilation and 18% needed mechanical ventilation within 24 h of admission. On multivariate analysis, prior respiratory infection (within last 1 year), obesity (body mass index >30), and alcoholism, old age (>60 years) were independently associated risk factors for severe pneumonia. There were no cases of MRSA. In 34% of cases, organisms could be identified. Most common organisms were Klebsiella (8%), influenza (8%), and Pseudomonas (5%). CONCLUSION Prior respiratory infection, obesity, alcoholism, and old age (>60 years) were observed to be important risk factors for severe CAP. Prospective studies should evaluate effect of weight reduction and cessation of alcohol consumption on recurrences of pneumonia in this population and on the severity of pneumonia.
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Affiliation(s)
- M Mahendra
- Department of Pulmonary Medicine, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India
| | - BS Jayaraj
- Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - Sneha Limaye
- Department of Clinical Trials, Respiratory Research Network of India(CRF), Pune, Maharashtra, India
| | - SK Chaya
- Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - Raja Dhar
- Department Of Respiratory Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - PA Mahesh
- Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
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Musher DM, Abers MS, Bartlett JG. Evolving Understanding of the Causes of Pneumonia in Adults, With Special Attention to the Role of Pneumococcus. Clin Infect Dis 2018; 65:1736-1744. [PMID: 29028977 PMCID: PMC7108120 DOI: 10.1093/cid/cix549] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 09/05/2017] [Indexed: 01/18/2023] Open
Abstract
Before 1945, Streptococcus pneumoniae caused more than 90% of cases of pneumonia in adults. After 1950, the proportion of pneumonia caused by pneumococcus began to decline. Pneumococcus has continued to decline; at present, this organism is identified in fewer than fewer10%-15% of cases. This proportion is higher in Europe, a finding likely related to differences in vaccination practices and smoking. Gram-negative bacilli, Staphylococcus aureus, Chlamydia, Mycoplasma, and Legionella are each identified in 2%-5% of patients with pneumonia who require hospitalization. Viruses are found in 25% of patients, up to one-third of these have bacterial coinfection. Recent studies fail to identify a causative organism in more than 50% of cases, which remains the most important challenge to understanding lower respiratory infection. Our findings have important implications for antibiotic stewardship and should be considered as new policies for empiric pneumonia management are developed.
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Affiliation(s)
- Daniel M Musher
- Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Michael S Abers
- Massachusetts General Hospital.,Harvard Medical School, Boston, Massachusetts
| | - John G Bartlett
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Voiriot G, Chalumeau M, Messika J, Basille D, Philippe B, Ricard JD, Andrejak C, Jounieaux V, Sanchez O, Fartoukh M. [Risks associated with the use of non-steroidal anti-inflammatory drugs during pneumonia]. Rev Mal Respir 2018; 35:430-440. [PMID: 29754841 DOI: 10.1016/j.rmr.2017.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/10/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Outpatient treatment of community-acquired pneumonia (CAP) patients with non-steroidal anti-inflammatory drugs (NSAIDs) is frequent, although this is not based on clinical recommendations and there is no scientific evidence supporting better symptom relief in comparison to acetaminophen. STATE OF THE ART Experimental data suggest that NSAIDs alter the intrinsic functions of neutrophils, limit their locoregional recruitment, alter bacterial clearance and delay the resolution of inflammatory processes during acute bacterial pulmonary challenge. In hospitalized children and adults with CAP, observational data suggest a strong and independent association between the outpatient exposure to NSAIDs and the occurrence of pleuropulmonary complications (pleural empyema, excavation, and abscess). In the only study taking into account possible protopathic bias, the association still persists. Other markers of morbidity have been described, including delay in hospital management, prolonged antibiotic therapy, and higher transfer rate to an intensive care unit. PERSPECTIVES Data describing the role of self-medication and the biological mechanisms involved are needed. CONCLUSIONS Intake of NSAIDs during outpatient treatment of CAP is probably the second modifiable factor of morbidity after inadequate antibiotic therapy. In light of existing data in children and adults, health authorities should urgently reassess the risk-benefit ratio of NSAIDS in CAP.
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Affiliation(s)
- G Voiriot
- Service de réanimation médico-chirurgicale, hôpital Tenon, hôpitaux universitaires de l'Est-Parisien, Assistance publique-hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France.
| | - M Chalumeau
- Service de pédiatrie générale et maladies infectieuses, hôpital universitaire Necker-Enfants-Malades, Assistance publique-hôpitaux de Paris, 75015 Paris, France; Faculté de médecine, université Paris-Descartes-Paris-V, 75006 Paris, France
| | - J Messika
- Service de réanimation médico-chirurgicale, hôpital Louis-Mourier, hôpitaux universitaires Paris-Nord-Val-de-Seine, Assistance publique-hôpitaux de Paris, 92700 Colombes, France
| | - D Basille
- Service de pneumologie et réanimation respiratoire, centre hospitalier universitaire Amiens-Picardie, 80080 Amiens, France
| | - B Philippe
- Service de pneumologie, centre hospitalier René-Dubos, 95300 Pontoise, France
| | - J-D Ricard
- Service de réanimation médico-chirurgicale, hôpital Louis-Mourier, hôpitaux universitaires Paris-Nord-Val-de-Seine, Assistance publique-hôpitaux de Paris, 92700 Colombes, France; Faculté de médecine, université Paris-Diderot-Paris-VII, 75013 Paris, France
| | - C Andrejak
- Service de pneumologie et réanimation respiratoire, centre hospitalier universitaire Amiens-Picardie, 80080 Amiens, France; Faculté de médecine, université de Picardie-Jules-Verne, 80025 Amiens, France
| | - V Jounieaux
- Service de pneumologie et réanimation respiratoire, centre hospitalier universitaire Amiens-Picardie, 80080 Amiens, France; Faculté de médecine, université de Picardie-Jules-Verne, 80025 Amiens, France
| | - O Sanchez
- Faculté de médecine, université Paris-Descartes-Paris-V, 75006 Paris, France; Service de pneumologie, soins intensifs et endoscopies bronchiques, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, Assistance Publique-hôpitaux de Paris, 75015 Paris, France
| | - M Fartoukh
- Service de réanimation médico-chirurgicale, hôpital Tenon, hôpitaux universitaires de l'Est-Parisien, Assistance publique-hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université Paris, 75013 Paris, France
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Heo JY, Seo YB, Choi WS, Lee J, Yoon JG, Lee SN, Choi MJ, Noh JY, Ahn JY, Jeong HW, Cheong HJ, Kim WJ, Lee HY, Song JY. Incidence and case fatality rates of community-acquired pneumonia and pneumococcal diseases among Korean adults: Catchment population-based analysis. PLoS One 2018; 13:e0194598. [PMID: 29596444 PMCID: PMC5875769 DOI: 10.1371/journal.pone.0194598] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 02/20/2018] [Indexed: 11/21/2022] Open
Abstract
Background Pneumonia is a leading infectious cause of morbidity and mortality among adults. Pneumococcal pneumonia (PP) is the most common vaccine-preventable bacterial etiology of pneumonia. In this study, we estimated the incidence of community-acquired pneumonia (CAP) and pneumococcal diseases among Korean adults. Methods Clinical and microbiological databases from three hospitals were retrospectively reviewed to determine the incidence and case fatality rates of CAP and pneumococcal diseases in Korean adults aged ≥19 years from 2011 to 2014. Incidence and case fatality rates of CAP, PP and invasive pneumococcal diseases (IPD) were evaluated based on the catchment population. Catchment population was calculated using national health insurance data, estimating the proportion of patients with pneumonia that were medically attended at each hospital. Results Among 5,783 patients with medically attended CAP, 833 (14.4%) had PP. For IPD, a total of 91 culture-confirmed cases were identified. The overall incidence of CAP was 307.7 cases per 100,000 persons per year with an in-hospital mortality rate of 6.2%. The estimated annual incidence of pneumococcal pneumonia was 42.2–49.4 cases per 100,000 persons per year, increasing with age to >280 per 100,000 persons per year in older patients over 70 years. The annual incidence of IPD had a range of 4.1–6.5 cases per 100,000 persons per year. The overall case fatality rate for invasive pneumococcal diseases was 30.8% with the highest rate of 66.7% in patients over 80 years. Conclusion Over the study period, incidences of CAP, PP and IPD were consistently high, particularly in older people. These results provide baseline data to establish healthcare strategies and estimate their impact among Korean adults.
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Affiliation(s)
- Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Jin Gu Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Saem Na Lee
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Joo Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Asian Pacific Influenza Institute (APII), Korea University Guro Hospital, Seoul, Korea
| | - Jin-Young Ahn
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hye Won Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- Division of Infectious Diseases, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Asian Pacific Influenza Institute (APII), Korea University Guro Hospital, Seoul, Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Asian Pacific Influenza Institute (APII), Korea University Guro Hospital, Seoul, Korea
| | - Hee Young Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- * E-mail: (HYL); (JYS)
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Asian Pacific Influenza Institute (APII), Korea University Guro Hospital, Seoul, Korea
- * E-mail: (HYL); (JYS)
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Pérez-Deago B, Alonso-Porcel C, Elvira-Menendez C, Murcia-Olagüenaga A, Martínez-Ibán M. [Epidemiology and management of community acquired pneumonia: more than 10 years experience]. Semergen 2018; 44:389-394. [PMID: 29574009 DOI: 10.1016/j.semerg.2018.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/24/2018] [Accepted: 01/29/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the characteristics of patients diagnosed with Community Acquired Pneumonia in this basic health area, their management, outcomes, and use of prognostic scales driven by the few studies carried out from Primary Care on these aspects. MATERIAL AND METHODS Descriptive cross-sectional study on a population diagnosed with Community Acquired Pneumonia if three urban health centres, during the period January 2000 to 31 July 2103. RESULTS Out of a sample of 1,290 patients obtained, 56.1% were men, and the mean age of the population was 61.9 years. There were 22.7% smokers. More than half (59.9%) had a disease in the prognostic scales, with Diabetes Mellitus present in 20%, and 36.1% with pulmonary disease (17.6% COPD, 11.8% asthma). Just under half (43.2%) of the total patients were diagnosed in Primary Care. There was a diagnostic X-ray in 92.7% of the cases, and a follow-up X-ray in 59.4%. Prognostic scales were recorded in 2% of the cases. The most commonly used antibiotics were amoxicillin-clavulanic (30.7%) and levofloxacin (30.4%). Having prior disease increases the risk of re-treatment by 1.6 (95% CI; 1.1-2.2)]. The mortality risk is multiplied by 5.3 on having a previous disease (95% CI; 1.3-19.2). CONCLUSIONS In the Primary Care setting, Community Acquired Pneumonia is a common and potentially serious disease which, in half the cases, occurs in patients with associated comorbidity. As regards treatment and management, is highlighted the wide use made of amoxicillin-clavulanic, compared to the low use of amoxicillin, combined therapy, and prognostic scales.
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Affiliation(s)
- B Pérez-Deago
- Servicio de Urgencias, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | - C Alonso-Porcel
- Servicio de Urgencias, Hospital Universitario de Cabueñes, Gijón, Asturias, España.
| | - C Elvira-Menendez
- Servicio de Urgencias, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | - A Murcia-Olagüenaga
- Servicio de Urgencias, Hospital Universitario de Cabueñes, Gijón, Asturias, España
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Torres A, Cillóniz C, Blasi F, Chalmers JD, Gaillat J, Dartois N, Schmitt HJ, Welte T. Burden of pneumococcal community-acquired pneumonia in adults across Europe: A literature review. Respir Med 2018; 137:6-13. [PMID: 29605214 DOI: 10.1016/j.rmed.2018.02.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The burden of community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae (pneumococcus) among adults in Europe is poorly defined. METHODS Structured searches of PubMed were conducted to identify the incidence of pneumococcal CAP among adults across Europe. RESULTS The overall incidence rates for CAP was 68-7000 per 100,000 and the incidence in hospitalised CAP cases of all causes was 16-3581 per 100,000. In general the incidence of CAP increased consistently with age. Available data indicated higher burdens of pneumococcal CAP caused in groups with more comorbidities. Most cases of pneumococcal CAP (30%-78%) were caused by serotypes covered by PCV13 vaccine; the incidence of PCV13-related pneumonia decreased after the introduction of childhood vaccination. CONCLUSIONS We observed a high burden adult pneumococcal CAP in Europe despite use of the 23-valent pneumococcal polysaccharide vaccine, particularly in elderly patients with comorbidities. CAP surveillance presented wide variations across Europe. Pneumococcal CAP has to be monitored very carefully due to the possible effect of current vaccination strategies.
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Affiliation(s)
- Antoni Torres
- Department of Pulmonology, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, Spain.
| | - Catia Cillóniz
- Department of Pulmonology, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milanoand Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center Fondazione IRCCS Cà Granda Ospedale, Maggiore Policlinico, Milano, Italy
| | - James D Chalmers
- College of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Jacques Gaillat
- Infectious Diseases Department Centre Hospitalier Annecy Genevois, 1 avenue de l'Hôpital, 74374 Pringy, France
| | - Nathalie Dartois
- Pfizer Vaccines, Medical and Scientific Affairs, 23-25 avenue du Dr. Lannelongue, F-75668 Paris Cedex 14, France
| | - Heinz-Josef Schmitt
- Pfizer Vaccines, Medical and Scientific Affairs, 23-25 avenue du Dr. Lannelongue, F-75668 Paris Cedex 14, France
| | - Tobias Welte
- Department of Respiratory Medicine, Medizinische Hochschule, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Tokgoz Akyil F, Yalcinsoy M, Hazar A, Cilli A, Celenk B, Kilic O, Sayiner A, Kokturk N, Sakar Coskun A, Filiz A, Cakir Edis E. Prognosis of hospitalized patients with community-acquired pneumonia. Pulmonology 2018; 24:S2173-5115(17)30156-2. [PMID: 29463455 DOI: 10.1016/j.rppnen.2017.07.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/09/2017] [Accepted: 07/13/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The long-term prognosis of patients with community-acquired pneumonia (CAP) has attracted increasing interest in recent years. The objective of the present study is to investigate the short and long-term outcomes in hospitalized patients with CAP and to identify the predictive factors associated with mortality. PATIENTS AND METHODS The study was designed as a retrospective, multicenter, observational study. Hospitalized patients with CAP, as recorded in the pneumonia database of the Turkish Thoracic Society between 2011 and 2013, were included. Short-term mortality was defined as 30-day mortality and long-term mortality was assessed from those who survived 30 days. Predictive factors for short- and long-term mortality were analyzed. RESULTS The study included 785 patients, 68% of whom were male and the mean age was 67±16 (18-92). The median duration of follow-up was 61.2±11.8 (37-90) months. Thirty-day mortality was 9.2% and the median survival of patients surviving 30 days was 62.8±4.4 months. Multivariate analysis revealed that advanced age, the absence of fever, a higher Charlson comorbidity score, higher blood urea nitrogen (BUN)/albumin ratios and lower alanine aminotransferase (ALT) levels were all predictors of long-term mortality. CONCLUSION Long-term mortality following hospitalization for CAP is high. Charlson score and lack of fever are potential indicators for decreased long-term survival. As novel parameters, baseline BUN/albumin ratios and ALT levels are significantly associated with late mortality. Further interventions and closer monitoring are necessary for such subgroups of patients.
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Affiliation(s)
- F Tokgoz Akyil
- Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, İstanbul, Turkey.
| | - M Yalcinsoy
- Inonu University, Faculty of Medicine, Department of Chest Diseases, Battalgazi/Malatya, Turkey
| | - A Hazar
- Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, İstanbul, Turkey
| | - A Cilli
- Akdeniz University, Faculty of Medicine, Department of Chest Diseases, Konyaaltı/Antalya, Turkey
| | - B Celenk
- Akdeniz University, Faculty of Medicine, Department of Chest Diseases, Konyaaltı/Antalya, Turkey
| | - O Kilic
- Dokuz Eylul University, Faculty of Medicine, Department of Chest Diseases, Konak/İzmir, Turkey
| | - A Sayiner
- Ege University, Faculty of Medicine, Department of Chest Diseases, Bornova/İzmir, Turkey
| | - N Kokturk
- Gazi University, Faculty of Medicine, Department of Chest Diseases, Yenimahalle/Ankara, Turkey
| | - A Sakar Coskun
- Celal Bayar University, Faculty of Medicine, Department of Chest Diseases, Yunusemre - Manisa, Turkey
| | - A Filiz
- Gaziantep University, Faculty of Medicine, Department of Chest Diseases, Şehitkamil/Gaziantep, Turkey
| | - E Cakir Edis
- Trakya University, Faculty of Medicine, Department of Chest Diseases, İskender Köyü/Edirne Merkez/Edirne, Turkey
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Chen L, Zhou F, Li H, Xing X, Han X, Wang Y, Zhang C, Suo L, Wang J, Yu G, Wang G, Yao X, Yu H, Wang L, Liu M, Xue C, Liu B, Zhu X, Li Y, Xiao Y, Cui X, Li L, Uyeki TM, Wang C, Cao B. Disease characteristics and management of hospitalised adolescents and adults with community-acquired pneumonia in China: a retrospective multicentre survey. BMJ Open 2018; 8:e018709. [PMID: 29449294 PMCID: PMC5829872 DOI: 10.1136/bmjopen-2017-018709] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To describe the clinical characteristics and management of patients hospitalised with community-acquired pneumonia (CAP) in China. DESIGN This was a multicentre, retrospective, observational study. SETTING 13 teaching hospitals in northern, central and southern China from 1 January 2014 to 31 December 2014 PARTICIPANTS: Information on hospitalised patients aged ≥14 years with radiographically confirmed pneumonia with illness onset in the community was collected using standard case report forms. PRIMARY AND SECONDARY OUTCOME MEASURES Resource use for CAP management. RESULTS Of 14 793 patients screened, 5828 with radiographically confirmed CAP were included in the final analysis. Low mortality risk patients with a CURB-65 score 0-1 and Pneumonia Severity Index risk class I-II accounted for 81.2% (4434/5594) and 56.4% (2034/3609) patients, respectively. 21.7% (1111/5130) patients had already achieved clinical stability on admission. A definite or probable pathogen was identified only in 12.7% (738/5828) patients. 40.9% (1575/3852) patients without pseudomonal infection risk factors received antimicrobial overtreatment regimens. The median duration between clinical stability to discharge was 5.0 days with 30-day mortality of 4.2%. CONCLUSIONS These data demonstrated the overuse of health resources in CAP management, indicating that there is potential for improvement and substantial savings to healthcare systems in China. TRIAL REGISTRATION NUMBER NCT02489578; Results.
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Affiliation(s)
- Liang Chen
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Infectious Disease, 4th Medical College of Peking University, Beijing Jishuitan Hospital, Beijing, China
| | - Fei Zhou
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hui Li
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiqian Xing
- Department of Respiratory Medicine, Yan’an Hospital, Kunming Medical University, Kunming, China
| | - Xiudi Han
- Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Yiming Wang
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Chunxiao Zhang
- Department of Respiratory Medicine, Beijing Huimin Hospital, Beijing, China
| | - Lijun Suo
- Department of Respiratory Medicine, Linzi District People’s Hospital, Zibo, China
| | - Jingxiang Wang
- Department of Respiratory Medicine, Beijing Luhe Hospital, Capital Medical University, Weifang, China
| | - Guohua Yu
- Department of Pulmonary and Critical Care Medicine, Weifang NO.2 People’s Hospital, Weifang, China
| | - Guangqiang Wang
- Department of Respiratory Medicine, Qilu Hospital Of Shandong University (Qindao), Qingdao, China
| | - Xuexin Yao
- Department of Respiratory Medicine, The 2nd Hospital of Beijing Corps, Chinese Armed Police Forces, Beijing, China
| | - Hongxia Yu
- Department of Infectious Disease, Yantai Yuhuangding Hospital, Yantai, China
| | - Lei Wang
- Department of Respiratory Medicine, Rizhao Chinese Medical Hospital, Shandong Chinese Medical University, Rizhao, China
| | - Meng Liu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chunxue Xue
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Bo Liu
- Department of Respiratory Medicine, Linzi District People’s Hospital, Zibo, China
| | - Xiaoli Zhu
- Occupational Medicine and Toxicology Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yanli Li
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Xiao
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaojing Cui
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Lijuan Li
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Departmentof Pulmonary Medicine, Capital Medical University, Beijing, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Departmentof Pulmonary Medicine, Capital Medical University, Beijing, China
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Uranga A, Quintana JM, Aguirre U, Artaraz A, Diez R, Pascual S, Ballaz A, España PP. Predicting 1-year mortality after hospitalization for community-acquired pneumonia. PLoS One 2018; 13:e0192750. [PMID: 29444151 PMCID: PMC5812619 DOI: 10.1371/journal.pone.0192750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/30/2018] [Indexed: 12/27/2022] Open
Abstract
Background Community-acquired pneumonia (CAP) is a major public health problem with high short- and long-term mortality. The main aim of this study was to develop and validate a specific prognostic index for one-year mortality in patients admitted for CAP. Methods This was an observational, prospective study of adults aged ≥18 years admitted to Galdakao-Usansolo Hospital (Bizkaia, Spain) from January 2001 to July 2009 with a diagnosis of CAP surviving the first 15 days. The entire cohort was divided into two parts, in order to develop a one-year mortality predictive model in the derivation cohort, before validation using the second cohort. Results A total of 2351 patients were included and divided into a derivation and a validation cohort. After deaths within 15 days were excluded, one-year mortality was 10.63%. A predictive model was created in order to predict one-year mortality, with a weighted score that included: aged over 80 years (4 points), congestive heart failure (2 points), dementia (6 points), respiratory rate ≥30 breaths per minute (2 points) and blood urea nitrogen >30 mg/dL (3 points) as predictors of higher risk with C-index of 0.76. This new model showed better predictive ability than current risk scores, PSI, CURB65 and SCAP with C-index of 0.73, 0.69 and 0.70, respectively. Conclusions An easy-to-use score, called the one-year CAPSI, may be useful for identifying patients with a high probability of dying after an episode of CAP.
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Affiliation(s)
- Ane Uranga
- Department of Respiratory Medicine, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
- * E-mail:
| | - Jose M. Quintana
- Research Unit, Galdakao-Usansolo Hospital - Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
| | - Urko Aguirre
- Research Unit, Galdakao-Usansolo Hospital - Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain
| | - Amaia Artaraz
- Department of Respiratory Medicine, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
| | - Rosa Diez
- Department of Respiratory Medicine, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
| | - Silvia Pascual
- Department of Respiratory Medicine, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
| | - Aitor Ballaz
- Department of Respiratory Medicine, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
| | - Pedro P. España
- Department of Respiratory Medicine, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
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45
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Daniel P, Bewick T, McKeever TM, Roberts M, Ashton D, Smith D, Latip L, Lim WS. Healthcare reconsultation in working-age adults following hospitalisation for community-acquired pneumonia. Clin Med (Lond) 2018; 18:41-46. [PMID: 29436438 PMCID: PMC6330906 DOI: 10.7861/clinmedicine.18-1-41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Community-acquired pneumonia (CAP) is associated with prolonged symptom persistence during recovery. However, the effect of the residual symptom load on healthcare utilisation is unknown. The aim of this study was to quantify healthcare reconsultation within 28 days of hospital discharge for an index episode of CAP, and explore reasons for these reconsultations. Adults of working age admitted to any of four hospitals in the UK, with a primary diagnosis of CAP, were prospectively studied. Of 108 patients, 71 (65.7%) reconsulted healthcare services within 28 days of discharge; of these, 90.1% consulted their GP. Men were less likely to reconsult than women (adjusted odds ratio [aOR] 0.34, 95% confidence interval 0.13-0.91, p=0.032). Persistence of respiratory symptoms accounted for the majority of these reconsultations. Healthcare utilisation is high in working-age adults after an episode of hospitalised CAP and, in most cases, is due to failure to resolve index symptoms.
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Affiliation(s)
- Priya Daniel
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Thomas Bewick
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | | | - Mark Roberts
- Department of Respiratory Medicine, King's Mill Hospital, Mansfield, UK
| | - Deborah Ashton
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Daniel Smith
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Lenny Latip
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Dai RX, Kong QH, Mao B, Xu W, Tao RJ, Wang XR, Kong QY, Xu JF. The mortality risk factor of community acquired pneumonia patients with chronic obstructive pulmonary disease: a retrospective cohort study. BMC Pulm Med 2018; 18:12. [PMID: 29357862 PMCID: PMC5778745 DOI: 10.1186/s12890-018-0587-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/15/2018] [Indexed: 11/26/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is one of the most common comorbidities in community acquired pneumonia (CAP) patients. We aimed to investigate the characteristics and mortality risk factors of COPD patients hospitalized with CAP. Methods A retrospective cohort study was conducted at Shanghai Pulmonary Hospital and Shanghai Dahua Hospital. Clinical and demographic data in patients diagnosed with CAP were collected between January 2015 and June 2016. Logistic regression analysis was performed to screen mortality risk factors of COPD patients hospitalized with CAP. Results Of the total 520 CAP patients, 230 (44.2%) patients had been diagnosed comorbid with COPD (COPD-CAP). CAP patients comorbid with COPD patients had higher rate of need for ICU admission (18.3% vs 13.1%) and need for NIMV (26.1% vs 1.4%) than without COPD (nCOPD-CAP). The PSI, CURB-65 and APACHE-II scores in COPD-CAP patients were higher than that in nCOPD-CAP patients (95 vs 79, P < 0.001; 1 vs 1, P < 0.001; 13 vs 8, P < 0.001, respectively). Logistic regression analysis indicated that aspiration, D-dimer > 2.0 μg/mL and CURB-65 ≥ 3 were risk factors associated with in-hospital mortality ((odd ratio) OR = 5.678, OR = 4.268, OR = 20.764, respectively) in COPD-CAP patients. The risk factors associated with 60-day mortality in COPD-CAP patients were comorbid with coronary heart disease, aspiration, need for NIMV (non-invasive mechanical ventilation) and CURB-65 ≥ 3 (OR = 5.206, OR = 7.921, OR = 3.974, OR = 18.002, respectively). Conclusions COPD patients hospitalized with CAP had higher rate of need for NIMV, need for ICU admission and severity scores than those without COPD. Aspiration, D-dimer > 2.0 μg/mL, comorbid with coronary heart disease, need for NIMV and CURB-65 ≥ 3 were mortality risk factors in CAP patients comorbid with COPD. Electronic supplementary material The online version of this article (10.1186/s12890-018-0587-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruo-Xuan Dai
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China
| | - Qing-Hua Kong
- Department of Respiratory and Critical Care Medicine, Shanghai Dahua Hospital, No. 901 Old Humin Road, Shanghai, China
| | - Bei Mao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China
| | - Wen Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China
| | - Ru-Jia Tao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China
| | - Xiao-Ru Wang
- Department of Respiratory and Critical Care Medicine, Shanghai Dahua Hospital, No. 901 Old Humin Road, Shanghai, China
| | - Qing-Yao Kong
- Department of Anesthesia and Critical Care, the University of Chicago, Chicago, IL, USA
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China.
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Melgaard D, Baandrup U, Bøgsted M, Bendtsen MD, Hansen T. Rehospitalisation and mortality after hospitalisation for orapharyngeal dysphagia and community-acquired pneumonia: A 1-year follow-up study. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2017.1417668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Dorte Melgaard
- Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ulrik Baandrup
- Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Martin Bøgsted
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Dahl Bendtsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Tina Hansen
- Department of Physical and Occupational Therapy, Metropolitan University College, Copenhagen, Denmark
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48
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Unluer EE, Karagoz A, Senturk GO, Karaman M, Olow KH, Bayata S. Bedside lung ultrasonography for diagnosis of pneumonia. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000205] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The aim of this study was to investigate the accuracy of bedside lung ultrasound (BUS) in the diagnosis of community-acquired pneumonia (CAP) in patients with dyspnoea presenting to the emergency department (ED) and to analyse the characteristic sonographic findings of CAP. Methods After a six-hour training program, BUS procedures were performed between October 2011 and February 2012 to prospectively evaluate patients presenting to the ED with dyspnoea. Chest X-ray (CXR) or computerised tomography (CT) were ordered, depending on the presence of consolidation signs on CXR. The outcome was determined by consolidation findings on CXR or CT. BUS results were compared using Chi-squared testing. Results Of the 112 enrolled patients with dyspnoea, 40 patients were excluded and 72 were included in the study. Thirty-four patients were BUS positive. Of these, CXR or CT findings agreed with the BUS findings in 27 patients. In 38 cases, BUS was negative, and one patient was diagnosed with pneumonia based on the CT report. The sensitivity, specificity, PPV, NPV, and the positive and negative likelihood ratios for BUS were 96.4%, 84.1%, 79.4%, 97.4%, 6.1 and 0.042, respectively. The diagnostic accuracy of BUS was 89%. The presence of consolidation signs, either shred or hepatisation, were the most frequent sonographic findings in our study. Conclusions Acute alveolar consolidation can be diagnosed easily by performing BUS with high degree of accuracy in EDs.
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Affiliation(s)
| | | | | | | | - KH Olow
- Benadir University, Faculty of Medicine and Surgery, Mogadishu/Somalia
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49
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Athlin S, Lidman C, Lundqvist A, Naucler P, Nilsson AC, Spindler C, Strålin K, Hedlund J. Management of community-acquired pneumonia in immunocompetent adults: updated Swedish guidelines 2017. Infect Dis (Lond) 2017; 50:247-272. [PMID: 29119848 DOI: 10.1080/23744235.2017.1399316] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Based on expert group work, Swedish recommendations for the management of community-acquired pneumonia in adults are here updated. The management of sepsis-induced hypotension is addressed in detail, including monitoring and parenteral therapy. The importance of respiratory support in cases of acute respiratory failure is emphasized. Treatment with high-flow oxygen and non-invasive ventilation is recommended. The use of statins or steroids in general therapy is not found to be fully supported by evidence. In the management of pleural infection, new data show favourable effects of tissue plasminogen activator and deoxyribonuclease installation. Detailed recommendations for the vaccination of risk groups are afforded.
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Affiliation(s)
- Simon Athlin
- a Department of Infectious Diseases , Örebro University Hospital , Örebro , Sweden.,b Faculty of Medicin and Health , Örebro University , Örebro , Sweden
| | - Christer Lidman
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Anders Lundqvist
- e Department of Infectious Diseases , Södra Älvsborgs Hospital , Borås , Sweden
| | - Pontus Naucler
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Anna C Nilsson
- f Infectious Disease Research Unit, Department of Translational Medicine , Lund University , Malmö , Sweden
| | - Carl Spindler
- d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Kristoffer Strålin
- b Faculty of Medicin and Health , Örebro University , Örebro , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,g Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Jonas Hedlund
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
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50
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Richter J, Mazurenko O, Kazley AS, Ford EW. How Differences Between Manager and Clinician Perceptions of Safety Culture Impact Hospital Processes of Care. J Patient Saf 2017; 16:289-293. [PMID: 29112031 DOI: 10.1097/pts.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evidenced-based processes of care improve patient outcomes, yet universal compliance is lacking, and perceptions of the quality of care are highly variable. The purpose of this study is to examine how differences in clinician and management perceptions on teamwork and communication relate to adherence to hospital processes of care. METHODS Hospitals submitted identifiable data for the 2012 Hospital Survey on Patient Safety Culture and the Centers for Medicare and Medicaid Services' Hospital Compare. The dependent variable was a composite, developed from the scores on adherence to acute myocardial infarction, heart failure, and pneumonia process of care measures. The primary independent variables reflected 4 safety culture domains: communication openness, feedback about errors, teamwork within units, and teamwork between units. We assigned each hospital into one of 4 groups based on agreement between managers and clinicians on each domain. Each hospital was categorized as "high" (above the median) or "low" (below) for clinicians and managers in communication and teamwork. RESULTS We found a positive relationship between perceived teamwork and communication climate and processes of care measures. If managers and clinicians perceived the communication openness as high, the hospital was more likely to adhere with processes of care. Similarly, if clinicians perceived teamwork across units as high, the hospital was more likely to adhere to processes of care. CONCLUSIONS Manager and staff perceptions about teamwork and communications impact adherence to processes of care. Policies should recognize the importance of perceptions of both clinicians and managers on teamwork and communication and seek to improve organizational climate and practices. Clinician perceptions of teamwork across units are more closely linked to processes of care, so managers should be cognizant and try to improve their perceptions.
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Affiliation(s)
- Jason Richter
- From the Army-Baylor University, Fort Sam Houston, San Antonio, Texas
| | - Olena Mazurenko
- Department of Health Policy and Management, Indiana University, Richard M. Fairbanks School of Public Health, Indianapolis, Indiana
| | - Abby Swanson Kazley
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina
| | - Eric W Ford
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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