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Trombetta A. Role of childhood immunisation coverage in the increase of pyogenic infection in children after pandemic. Acta Paediatr 2024. [PMID: 39267601 DOI: 10.1111/apa.17426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 09/04/2024] [Indexed: 09/17/2024]
Affiliation(s)
- Andrea Trombetta
- Department of Paediatrics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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2
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Barchi L, Barbi E, Zamagni G, De Fanti A, Iughetti L, Trombetta A. Is there an increased number of community-acquired pneumonia requiring drainage placement in children after COVID-19 pandemic in Italy? Pediatr Pulmonol 2024. [PMID: 38961696 DOI: 10.1002/ppul.27150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/03/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024]
Affiliation(s)
- Luca Barchi
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Trieste, Italy
| | - Giulia Zamagni
- Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Trieste, Italy
| | - Alessandro De Fanti
- Pediatric Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
- Policlinico di Modena, Modena, Italy
| | - Andrea Trombetta
- Pediatric Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Reggio Emilia, Italy
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Jin Y, Yu X, Li J, Su M, Li X. Causal effects and immune cell mediators between prescription analgesic use and risk of infectious diseases: a Mendelian randomization study. Front Immunol 2023; 14:1319127. [PMID: 38193081 PMCID: PMC10772142 DOI: 10.3389/fimmu.2023.1319127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Clinical observations have found that prolonged use of analgesics increases the incidence of infection. However, the direct causal relationship between prescription analgesic use (PAU) and risk of infection (ROI) remains unclear. Methods This study used Mendelian randomization (MR) design to estimate the causal effect of PAU on ROI, as well as their mediating factors. Genetic data on prescription analgesics use and immune cells were obtained from published GWAS. Additionally, data on ROI were extracted from the FinnGen database. Two-sample MR analysis and multivariate MR (MVMR) analysis were performed using inverse variance weighting (IVW) to ascertain the causal association between PAU and ROI. Finally, 731 immune cell phenotypes were analyzed for their mediating role between analgesics and infection. Results Using two-sample MR, IVW modeling showed that genetically predicted opioid use was associated with increased risk of pulmonary infection (PI) (OR = 1.13, 95% CI: 1.05-1.21, p< 0.001) and upper respiratory infection (URI) (OR = 1.18, 95% CI: 1.08-1.30, p< 0.001); non-steroidal anti-inflammatory drugs (NSAIDs) were related to increased risk of skin and subcutaneous tissue infection (OR = 1.21, 95% CI: 1.05-1.39, p = 0.007), and antimigraine preparations were linked to a reduced risk of virus hepatitis (OR = 0.79, 95% CI: 0.69-0.91, p< 0.001). In MVMR, the association of opioids with URI and PI remained after accounting for cancer conditions. Even with a stricter threshold (p< 0.05/30), we found a significant causal association between opioids and respiratory infections (URI/PI). Finally, mediation analyses found that analgesics influence the ROI through different phenotypes of immune cells as mediators. Conclusion This MR study provides new genetic evidence for the causal relationship between PAU and ROI, and the mediating role of immune cells was demonstrated.
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Affiliation(s)
- Yi Jin
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Xinghao Yu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Jun Li
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Mingzhu Su
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Xiaomin Li
- The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Pharmacy, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
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Tuğcu GD, Özsezen B, Türkyılmaz İ, Pehlivan Zorlu B, Eryılmaz Polat S, Özkaya Parlakay A, Cinel G. Risk factors for complicated community-acquired pneumonia in children. Pediatr Int 2022; 64:e15386. [PMID: 36225107 DOI: 10.1111/ped.15386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/05/2022] [Accepted: 10/12/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) in children continues to be one of the prominent causes of pediatric morbidity and mortality worldwide. By determining the risk factors associated with the development of complicated CAP (CCAP), new approaches for early diagnosis and effective treatment can be identified. METHODS This retrospective cohort study enrolled patients with CAP and CCAP who visited the pediatric ward of the study hospital between January 1, 2017 and December 31, 2017. For patients with CCAP, data regarding medical procedures performed, surgical intervention, and hospitalization duration were collected. RESULTS A total of 111 patients, 93 (83.7%) with CAP and 18 (16.3%) with CCAP, aged between 3 months and 18 years were hospitalized because of severe pneumonia. The mean age of the patients was 3.6 ± 1.2 years and 60 (54%) of them were female. The mean age of patients with CCAP was higher than that of patients with CAP (4.2 ± 3.3 vs. 2.8 ± 2.1 years respectively); however, the difference was not significant (p = 0.012). Patients with CCAP exhibited a significantly higher C-reactive protein level than those with CAP (10.06 ± 7.55 vs. 4.43 ± 3.37 g/L respectively; p = 0.007). Hypoxia upon admission was noted more commonly in the CCAP group than in the CAP group (p < 0.001). CONCLUSION Findings related to hypoxia, respiratory distress, and pleural effusion on imaging are important distinguishing factors associated with the development of complications in patients hospitalized with CAP. Therefore, CCAP etiology, diagnosis, and treatment approaches should be established and protective measures adopted.
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Affiliation(s)
- Gökçen Dilşa Tuğcu
- Department of Pediatric Pulmonology, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
| | - Beste Özsezen
- Department of Pediatric Pulmonology, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
| | - İrem Türkyılmaz
- Department of Pediatrics, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
| | - Betül Pehlivan Zorlu
- Department of Pediatrics, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
| | - Sanem Eryılmaz Polat
- Department of Pediatric Pulmonology, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
| | - Aslınur Özkaya Parlakay
- Department of Pediatric Infectious Diseases, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
| | - Güzin Cinel
- Department of Pediatric Pulmonology, Children's Hospital, Ankara City Hospital, University of Health Science, Çankaya/Ankara, Turkey
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5
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Kuchar E, Karlikowska-Skwarnik M, Wawrzuta D. Anti-Inflammatory Therapy of Infections. ENCYCLOPEDIA OF INFECTION AND IMMUNITY 2022. [PMCID: PMC8496905 DOI: 10.1016/b978-0-12-818731-9.00181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Anti-inflammatory treatment of infections is challenging due to the heterogeneity of etiologic agents and complex immune interactions. Nevertheless, anti-inflammatory medications are commonly used in infections to reduce unpleasant symptoms and to modify host response. They may play a fundamental role in managing infection with over-inflammation by decreasing inflammatory organ damage, e.g., COVID-19. However, by its inherent inhibition of immune functions, they might also contribute to the development of serious bacterial infections. Moreover, reducing a patient's symptoms and signs may provide a false sense of security and delay diagnosing threatening infections.
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Gautam A, Wiseman G, Legg R, Lindsay D, Puvvadi R, Rathnamma BM, Stalewski H, Norton R, White AV. Management of Pediatric Thoracic Empyema in the North Queensland Region of Australia and Impact of a Local Evidence-based Treatment Guideline. Pediatr Infect Dis J 2022; 41:1-5. [PMID: 34889868 DOI: 10.1097/inf.0000000000003341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The North Queensland region of Australia has a high incidence of pediatric thoracic empyema (pTE). We describe the management of empyema at the Townsville University Hospital which is the regional referral center for these children. The impact of a newly developed institutional guideline is also discussed. METHODS This retrospective audit included children under the age of 16 years treated for empyema between 1 Jan 2007 and 31 December 2018. Demographic and management-related variables were correlated to outcomes. A local guideline was introduced at the beginning of 2017 and patient outcomes characteristics pre, and post introduction of this guideline are compared. RESULTS There were 153 children with pTE (123 before and 30 after the introduction of a local guideline). Nonsurgical management was associated with a higher treatment failure rate. Median length of stay (LOS) was 11.8 (IQR 9.3-16) days. Longer hospital LOS was associated with younger age (r2 -0.16, P = 0.04), Aboriginal and/or Torres Strait (ATSI) ancestry (13.8 vs. 10.5 days, P = 0.002) and concomitant respiratory viral infections (14.4 vs. 10.9 days, P = 0.003). The introduction of local guideline was associated with significant decrease in the use of empirical chest CT scans (54.4% before vs. 6.7% after, P < 0.001) and duration of intravenous antibiotics (14 days before vs. 10 days after, P = 0.02). There was no significant change in the hospital LOS (12.1 days pre and 11.7 post, P = 0.8). CONCLUSIONS Younger age, concomitant viral respiratory infections and ATSI ancestry were identified as potential risk factors for increase LOS. Hospital LOS following the adoption of an institutional guideline was unchanged. However, such a guideline may identify populations at risk for an unfavorable course and avoid unnecessary antibiotic treatment and radiation exposure.
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Affiliation(s)
- Anil Gautam
- From the Pediatric Intensive Care Unit, Townsville University Hospital, Douglas, Queensland, Australia
- James Cook University, Douglas, Queensland, Australia
| | - Gregory Wiseman
- From the Pediatric Intensive Care Unit, Townsville University Hospital, Douglas, Queensland, Australia
| | - Robert Legg
- Department of Pediatrics, Townsville University Hospital, Douglas, Queensland, Australia
- Great Ormond Street Institute of Child Health, University College London
| | - Daniel Lindsay
- Department of Public Health, James Cook University, Douglas, Queensland, Australia
| | - Ramaa Puvvadi
- Department of Pediatrics, Townsville University Hospital, Douglas, Queensland, Australia
| | | | - Harry Stalewski
- Pediatric Surgery, Townsville University Hospital, Douglas, Queensland, Australia
| | - Robert Norton
- Department of Microbiology, Townsville University Hospital, Douglas, Queensland, Australia
- University of Queensland, Brisbane, Australia
| | - Andrew Vernon White
- James Cook University, Douglas, Queensland, Australia
- Department of Pediatrics, Townsville University Hospital, Douglas, Queensland, Australia
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Masarweh K, Gur M, Toukan Y, Bar-Yoseph R, Kassis I, Gut G, Hakim F, Nir V, Bentur L. Factors associated with complicated pneumonia in children. Pediatr Pulmonol 2021; 56:2700-2706. [PMID: 33991059 DOI: 10.1002/ppul.25468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Community acquired pneumonia (CAP) is a leading cause of morbidity in children, despite advances in health care and anti-pneumococcal vaccine. Complicated pneumonia accounts for a significant burden with prolonged hospitalization. Finding risk factors for complicated pneumonia may help in tailoring management. We aimed to identify risk factors for developing complicated pneumonia and need for intervention. METHODS A retrospective single tertiary center study. Children admitted with a diagnosis of CAP and/or complicated pneumonia (parapneumonic effusion, empyema, necrotizing pneumonia, and lung abscess) on January 2001-March 2020 were included. Demographic, clinical, and laboratory parameters were collected using MDclone, a data acquisition tool. Risk factors for complicated pneumonia (on admission or during hospitalization) and risk for intervention were analyzed. RESULTS A total of 6778 children with pneumonia were included; 323 arrived at the Emergency Department with complicated pneumonia while 232 developed a complication during hospitalization. Risk factors for complicated pneumonia (on admission or during hospitalization) were Arab ethnicity, cardiac disease, increased age, and CRP and low O2 Sat (OR = 2.236 p < .001, OR = 4.376 p < .001, OR = 1.131 p < .001, OR = 1.065 p < .001 and OR = 0.959 p = .029, respectively). O2 Sat was lower, while fever and CRP were higher in patients with complicated pneumonia requiring intervention. CONCLUSIONS Identifying children at risk for complicated pneumonia may help in decision-making in the Emergency Department and during hospitalization. The increased risk of the Arab population for complicated pneumonia requires further understanding. Addressing the underlying socioeconomic and ethnic health inequities may help to decrease the disease burden in this population.
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Affiliation(s)
- Kamal Masarweh
- Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yazeed Toukan
- Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Imad Kassis
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Infectious Diseases Unit and Department of Pediatrics B, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Guy Gut
- Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Fahed Hakim
- Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Vered Nir
- Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute and CF Center, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Wong AY, MacKenna B, Morton CE, Schultze A, Walker AJ, Bhaskaran K, Brown JP, Rentsch CT, Williamson E, Drysdale H, Croker R, Bacon S, Hulme W, Bates C, Curtis HJ, Mehrkar A, Evans D, Inglesby P, Cockburn J, McDonald HI, Tomlinson L, Mathur R, Wing K, Forbes H, Eggo RM, Parry J, Hester F, Harper S, Evans SJ, Smeeth L, Douglas IJ, Goldacre B. Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis based on two cohorts. Ann Rheum Dis 2021; 80:943-951. [PMID: 33478953 PMCID: PMC7823433 DOI: 10.1136/annrheumdis-2020-219517] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To assess the association between routinely prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and deaths from COVID-19 using OpenSAFELY, a secure analytical platform. METHODS We conducted two cohort studies from 1 March to 14 June 2020. Working on behalf of National Health Service England, we used routine clinical data in England linked to death data. In study 1, we identified people with an NSAID prescription in the last 3 years from the general population. In study 2, we identified people with rheumatoid arthritis/osteoarthritis. We defined exposure as current NSAID prescription within the 4 months before 1 March 2020. We used Cox regression to estimate HRs for COVID-19 related death in people currently prescribed NSAIDs, compared with those not currently prescribed NSAIDs, accounting for age, sex, comorbidities, other medications and geographical region. RESULTS In study 1, we included 536 423 current NSAID users and 1 927 284 non-users in the general population. We observed no evidence of difference in risk of COVID-19 related death associated with current use (HR 0.96, 95% CI 0.80 to 1.14) in the multivariable-adjusted model. In study 2, we included 1 708 781 people with rheumatoid arthritis/osteoarthritis, of whom 175 495 (10%) were current NSAID users. In the multivariable-adjusted model, we observed a lower risk of COVID-19 related death (HR 0.78, 95% CI 0.64 to 0.94) associated with current use of NSAID versus non-use. CONCLUSIONS We found no evidence of a harmful effect of routinely prescribed NSAIDs on COVID-19 related deaths. Risks of COVID-19 do not need to influence decisions about the routine therapeutic use of NSAIDs.
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Affiliation(s)
- Angel Ys Wong
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Brian MacKenna
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Caroline E Morton
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Anna Schultze
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Alex J Walker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jeremy P Brown
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Christopher T Rentsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Williamson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Henry Drysdale
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Richard Croker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Seb Bacon
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - William Hulme
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Helen J Curtis
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Amir Mehrkar
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - David Evans
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Peter Inglesby
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Helen I McDonald
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Laurie Tomlinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin Wing
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Harriet Forbes
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rosalind M Eggo
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Stephen Jw Evans
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ian J Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Goldacre
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
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Green C, Krafft H, Guyatt G, Martin D. Symptomatic fever management in children: A systematic review of national and international guidelines. PLoS One 2021; 16:e0245815. [PMID: 34138848 PMCID: PMC8211223 DOI: 10.1371/journal.pone.0245815] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/19/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Divergent attitudes towards fever have led to a high level of inconsistency in approaches to its management. In an attempt to overcome this, clinical practice guidelines (CPGs) for the symptomatic management of fever in children have been produced by several healthcare organizations. To date, a comprehensive assessment of the evidence level of the recommendations made in these CPGs has not been carried out. METHODS Searches were conducted on Pubmed, google scholar, pediatric society websites and guideline databases to locate CPGs from each country (with date coverage from January 1995 to September 2020). Rather than assessing overall guideline quality, the level of evidence for each recommendation was evaluated according to criteria of the Oxford Centre for Evidence-Based Medicine (OCEBM). A GRADE assessment was undertaken to assess the body of evidence related to a single question: the threshold for initiating antipyresis. Methods and results are reported according to the PRISMA statement. RESULTS 74 guidelines were retrieved. Recommendations for antipyretic threshold, type and dose; ambient temperature; dress/covering; activity; fluids; nutrition; proctoclysis; external applications; complementary/herbal recommendations; media; and age-related treatment differences all varied widely. OCEBM evidence levels for most recommendations were low (Level 3-4) or indeterminable. The GRADE assessment revealed a very low level of evidence for a threshold for antipyresis. CONCLUSION There is no recommendation on which all guidelines agree, and many are inconsistent with the evidence-this is true even for recent guidelines. The threshold question is of fundamental importance and has not yet been answered. Guidelines for the most frequent intervention (antipyresis) remain problematic.
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Affiliation(s)
- Cari Green
- Gerhard Kienle Chair, Health Department, University of Witten/Herdecke, Herdecke, Germany
| | - Hanno Krafft
- Gerhard Kienle Chair, Health Department, University of Witten/Herdecke, Herdecke, Germany
| | - Gordon Guyatt
- Departments of Health Research Methods, Evidence and Impact and Medicine at McMaster University, Hamilton, Canada
| | - David Martin
- Gerhard Kienle Chair, Health Department, University of Witten/Herdecke, Herdecke, Germany
- University Children’s Hospital, Tübingen University, Tübingen, Germany
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Quaglietta L, Martinelli M, Staiano A. Serious infectious events and ibuprofen administration in pediatrics: a narrative review in the era of COVID-19 pandemic. Ital J Pediatr 2021; 47:20. [PMID: 33514404 PMCID: PMC7844800 DOI: 10.1186/s13052-021-00974-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/21/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose of review Despite its recognized efficacy and tolerability profile, during the last decade a rise of adverse events following ibuprofen administration in children has been reported, including a possible role in worsening the clinical course of infections. Our aim was to critically evaluate the safety of ibuprofen during the course of pediatric infectious disease in order to promote its appropriate use in children. Recent findings Ibuprofen is associated with severe necrotizing soft tissue infections (NSTI) during chickenpox course. Pre-hospital use of ibuprofen seems to increase the risk of complicated pneumonia in children. Conflicting data have been published in septic children, while ibuprofen in the setting of Cystic Fibrosis (CF) exacerbations is safe and efficacious. No data is yet available for ibuprofen use during COVID-19 course. Summary Ibuprofen should not be recommended for chickenpox management. Due to possible higher risks of complicated pneumonia, we suggest caution on its use in children with respiratory symptoms. While it remains unclear whether ibuprofen may have harmful effects during systemic bacterial infection, its administration is recommended in CF course. Despite the lack of data, it is seems cautious to prefer the use of paracetamol during COVID-19 acute respiratory distress syndrome in children.
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Affiliation(s)
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
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11
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Florin TA, Tancredi DJ, Ambroggio L, Babl FE, Dalziel SR, Eckerle M, Mintegi S, Neuman M, Plint AC, Kuppermann N. Predicting severe pneumonia in the emergency department: a global study of the Pediatric Emergency Research Networks (PERN)-study protocol. BMJ Open 2020; 10:e041093. [PMID: 33268423 PMCID: PMC7713188 DOI: 10.1136/bmjopen-2020-041093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Pneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalisations in children. There are no evidence-based, validated tools to assist physicians in management and disposition decisions for children presenting to the ED with community-acquired pneumonia (CAP). The objective of this study is to develop a clinical prediction model to accurately stratify children with CAP who are at risk for low, moderate and severe disease across a global network of EDs. METHODS AND ANALYSIS This study is a prospective cohort study enrolling up to 4700 children with CAP at EDs at ~80 member sites of the Pediatric Emergency Research Networks (PERN; https://pern-global.com/). We will include children aged 3 months to <14 years with a clinical diagnosis of CAP. We will exclude children with hospital admissions within 7 days prior to the study visit, hospital-acquired pneumonias or chronic complex conditions. Clinical, laboratory and imaging data from the ED visit and hospitalisations within 7 days will be collected. A follow-up telephone or text survey will be completed 7-14 days after the visit. The primary outcome is a three-tier composite of disease severity. Ordinal logistic regression, assuming a partial proportional odds specification, and recursive partitioning will be used to develop the risk stratification models. ETHICS AND DISSEMINATION This study will result in a clinical prediction model to accurately identify risk of severe disease on presentation to the ED. Ethics approval was obtained for all sites included in the study. Cincinnati Children's Hospital Institutional Review Board (IRB) serves as the central IRB for most US sites. Informed consent will be obtained from all participants. Results will be disseminated through international conferences and peer-reviewed publications. This study overcomes limitations of prior pneumonia severity scores by allowing for broad generalisability of findings, which can be actively implemented after model development and validation.
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Affiliation(s)
- Todd Adam Florin
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | | - Lilliam Ambroggio
- Department of Pediatrics, University of Colorado and Sections of Emergency Medicine and Hospital Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Franz E Babl
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Children's Emergency Department, Starship Children's Hospital, Newmarket, New Zealand
| | - Michelle Eckerle
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo, Spain
- University of the Basque Country, UPV/EHU, Bilbao, Spain
| | - Mark Neuman
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy C Plint
- Departments of Pediatrics and Emergency Medicine, University of Ottawa and Division of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, UC Davis School of Medicine and UC Davis Health, Sacramento, California, USA
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12
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Martins‐Filho PR, do Nascimento‐Júnior EM, Santos VS. No current evidence supporting risk of using Ibuprofen in patients with COVID-19. Int J Clin Pract 2020; 74:e13576. [PMID: 32506743 PMCID: PMC7300561 DOI: 10.1111/ijcp.13576] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
| | | | - Victor Santana Santos
- Centre for Epidemiology and Public HealthFederal University of AlagoasArapiracaBrazil
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13
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Tan E, Braithwaite I, McKinlay CJD, Dalziel SR. Comparison of Acetaminophen (Paracetamol) With Ibuprofen for Treatment of Fever or Pain in Children Younger Than 2 Years: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2022398. [PMID: 33125495 PMCID: PMC7599455 DOI: 10.1001/jamanetworkopen.2020.22398] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Acetaminophen (paracetamol) and ibuprofen are the most widely prescribed and available over-the-counter medications for management of fever and pain in children. Despite the common use of these medications, treatment recommendations for young children remain divergent. OBJECTIVE To compare acetaminophen with ibuprofen for the short-term treatment of fever or pain in children younger than 2 years. DATA SOURCES Systematic search of the databases MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials and the trial registers ClinicalTrials.gov and the Australian New Zealand Clinical Trials Registry from inception to March 2019, with no language limits. STUDY SELECTION Studies of any design that included children younger than 2 years and directly compared acetaminophen with ibuprofen, reporting antipyretic, analgesic, and/or safety outcomes were considered. There were no limits on length of follow-up. DATA EXTRACTION AND SYNTHESIS Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline, 2 authors independently extracted data and assessed quality. Data were pooled using a fixed-effects method if I2 was less than 50% and using a random-effects method if I2 was 50% or greater. MAIN OUTCOMES AND MEASURES The primary outcomes were fever or pain within 4 hours of treatment onset. Safety outcomes included serious adverse events, kidney impairment, gastrointestinal bleeding, hepatotoxicity, severe soft tissue infection, empyema, and asthma and/or wheeze. RESULTS Overall, 19 studies (11 randomized; 8 nonrandomized) of 241 138 participants from 7 countries and various health care settings (hospital-based and community-based) were included. Compared with acetaminophen, ibuprofen resulted in reduced temperature at less than 4 hours (4 studies with 435 participants; standardized mean difference [SMD], 0.38; 95% CI, 0.08-0.67; P = .01; I2 = 49%; moderate quality evidence) and at 4 to 24 hours (5 studies with 879 participants; SMD, 0.24; 95% CI, 0.03-0.45; P = .03; I2 = 57%; moderate-quality evidence) and less pain at 4 to 24 hours (2 studies with 535 participants; SMD, 0.20; 95% CI, 0.03-0.37; P = .02; I2 = 25%; moderate-quality evidence). Adverse events were uncommon. Acetaminophen and ibuprofen appeared to have similar serious adverse event profiles (7 studies with 27 932 participants; ibuprofen vs aceteminophen: odds ratio, 1.08; 95% CI, 0.87-1.33; P = .50, I2 = 0%; moderate-quality evidence). CONCLUSIONS AND RELEVANCE In this study, use of ibuprofen vs acetaminophen for the treatment of fever or pain in children younger than 2 years was associated with reduced temperature and less pain within the first 24 hours of treatment, with equivalent safety.
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Affiliation(s)
- Eunicia Tan
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Emergency Department, Middlemore Hospital, Auckland, New Zealand
| | | | - Christopher J. D. McKinlay
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- Kidz First Neonatal Care, Middlemore Hospital, Auckland, New Zealand
| | - Stuart R. Dalziel
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
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Vaja R, Chan JSK, Ferreira P, Harky A, Rogers LJ, Gashaw HH, Kirkby NS, Mitchell JA. The COVID-19 ibuprofen controversy: A systematic review of NSAIDs in adult acute lower respiratory tract infections. Br J Clin Pharmacol 2020; 87:776-784. [PMID: 32805057 DOI: 10.1111/bcp.14514] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS In light of the recent safety concerns relating to NSAID use in COVID-19, we sought to evaluate cardiovascular and respiratory complications in patients taking NSAIDs during acute lower respiratory tract infections. METHODS We carried out a systematic review of randomised controlled trials and observational studies. Studies of adult patients with short-term NSAID use during acute lower respiratory tract infections, including bacterial and viral infections, were included. Primary outcome was all-cause mortality. Secondary outcomes were cardiovascular, renal and respiratory complications. RESULTS In total, eight studies including two randomised controlled trials, three retrospective and three prospective observational studies enrolling 44 140 patients were included. Five of the studies were in patients with pneumonia, two in patients with influenza, and one in a patient with acute bronchitis. Meta-analysis was not possible due to significant heterogeneity. There was a trend towards a reduction in mortality and an increase in pleuro-pulmonary complications. However, all studies exhibited high risks of bias, primarily due to lack of adjustment for confounding variables. Cardiovascular outcomes were not reported by any of the included studies. CONCLUSION In this systematic review of NSAID use during acute lower respiratory tract infections in adults, we found that the existing evidence for mortality, pleuro-pulmonary complications and rates of mechanical ventilation or organ failure is of extremely poor quality, very low certainty and should be interpreted with caution. Mechanistic and clinical studies addressing the captioned subject are urgently needed, especially in relation to COVID-19.
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Affiliation(s)
- Ricky Vaja
- Imperial College London, National Heart & Lung Institute, London, UK.,Royal Brompton Hospital, London, UK
| | - Jeffrey Shi Kai Chan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.,Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Plinio Ferreira
- Imperial College London, National Heart & Lung Institute, London, UK
| | - Amer Harky
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Luke J Rogers
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Hime H Gashaw
- Imperial College London, National Heart & Lung Institute, London, UK
| | - Nicholas S Kirkby
- Imperial College London, National Heart & Lung Institute, London, UK
| | - Jane A Mitchell
- Imperial College London, National Heart & Lung Institute, London, UK
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Sodhi M, Khosrow-Khavar F, FitzGerald JM, Etminan M. Non-steroidal Anti-inflammatory Drugs and the Risk of Pneumonia Complications: A Systematic Review. Pharmacotherapy 2020; 40:970-977. [PMID: 32715498 DOI: 10.1002/phar.2451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There have been concerns regarding the safety of nonsteroidal antiinflammatory drugs (NSAIDs) in patients with respiratory infections. However, to date, the quality of the evidence has not been systematically assessed. The purpose of this systematic review was to evaluate the role of NSAIDs on pneumonia complications. OVID MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Google Scholar were searched. Studies that examined pneumonia complications in patients who had taken NSAIDs before onset of symptoms were identified. Quality assessment was conducted using the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) assessment tool, which was adapted to include biases that were pertinent to this question. The search strategy identified 1721 potential studies through the 5 primary databases and searching reference lists. Of these, 10 studies met the inclusion criteria, including 5 nested case-control studies, 2 population-based case-control studies, and 3 cohort studies. In total, 59,724 adults were included from 4 of the studies (range = 57-59,250) and 1217 children from 5 studies (range = 148-540). All studies demonstrated a positive association; in adults (odds ratio/risk ratio range = 1.8-8.1) and children (odds ratio/risk ratio range = 1.9-6.8). Studies were limited by moderate or serious risk of confounding bias, exposure misclassification, and protopathic biases and sparse data bias. The results of this review demonstrate that published studies on the effect of NSAIDs use and risk of pneumonia complications are subject to a number of biases. These results should not be extrapolated as evidence of harm for NSAIDs, including ibuprofen, in respiratory ailments but highlight the need for more methodologically robust studies to evaluate this potential relationship.
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Affiliation(s)
- Mohit Sodhi
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - John Mark FitzGerald
- Centre for Heart and Lung Health, UBC Institute for Heart and Lung Health, The Lung Centre Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Faisantieu N, Kowalski V, Soulié B. [Benefits and risks of ibuprofen in children with fever: Overview of the literature with a view to producing a written information tool for parents]. Therapie 2020; 75:553-567. [PMID: 32571587 DOI: 10.1016/j.therap.2020.04.005] [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: 09/04/2019] [Revised: 02/02/2020] [Accepted: 04/29/2020] [Indexed: 11/27/2022]
Abstract
Drug information, as it appears in package leaflet, lacks relevant encrypted data for the patient. The aim of our research was to propose a written model of drug information inspired from the concept of the "Drug Facts Box", about ibuprofen in children with fever. To this end, we carried out a systematic review of systematic literature reviews ("overview") to look for data on the benefits and risks of ibuprofen compared to placebo, paracetamol or a treatment alternating or combining paracetamol and ibuprofen in children with fever aged 0-18 years. 9 systematic reviews were included from the Pubmed/Medline, Embase and Cochrane databases. 1 clinical practice guideline and 2 documents published by the French Haute Autorité de santé (HAS) and the French Agence nationale de sécurité du médicament et des produits de santé (ANSM) were also included. Paracetamol and ibuprofen have a comparable efficacy and safety profile in children with fever. A low increased risk of adverse reactions to ibuprofen is to be feared in specifics clinical situations (chicken pox, pneumonia, angina). Treatments alternating or combining paracetamol and ibuprofen can further lower the temperature compared to paracetamol or ibuprofen alone, but there is no evidence of improved child comfort. The limited data available on the adverse effects of these treatment regimens suggests that they should not be routinely recommended. There is little evidence of the comfort of the febrile child even though it is the primary objective of antipyretic treatment.
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Affiliation(s)
| | | | - Benoît Soulié
- Cabinet de médecine générale, 8, rue des Cerisiers, 14210 Evrecy, France.
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17
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Non-steroidal anti-inflammatory drugs, pharmacology, and COVID-19 infection. Therapie 2020; 75:355-362. [PMID: 32418728 PMCID: PMC7204680 DOI: 10.1016/j.therap.2020.05.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/05/2020] [Indexed: 01/08/2023]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) have an optional prescription status that has resulted in frequent use, in particular for the symptomatic treatment of fever and non-rheumatic pain. In 2019, a multi-source analysis of complementary pharmacological data showed that using NSAIDs in these indications (potentially indicative of an underlying infection) increases the risk of a severe bacterial complication, in particular in the case of lung infections. First, the clinical observations of the French Pharmacovigilance Network showed that severe bacterial infections can occur even after a short NSAID treatment, and even if the NSAID is associated with an antibiotic. Second, pharmacoepidemiological studies, some of which minimized the protopathic bias, all converged and confirmed the risk. Third, experimental in vitro and in vivo animal studies suggest several biological mechanisms, which strengthens a causal link beyond the well-known risk of delaying the care of the infection (immunomodulatory effects, effects on S. pyogenes infections, and reduced antibiotics efficacy). Therefore, in case of infection, symptomatic treatment with NSAIDs for non-severe symptoms (fever, pain, or myalgia) is not to be recommended, given a range of clinical and scientific arguments supporting an increased risk of severe bacterial complication. Besides, the existence of a safer drug alternative, with paracetamol at recommended doses, makes this recommendation of precaution and common sense even more legitimate. In 2020, such recommendation is more topical than ever with the emergence of COVID-19, especially since it results in fever, headaches, muscular pain, and cough, and is further complicated with pneumopathy, and given experimental data suggesting a link between ibuprofen and the level of expression of angiotensin-converting enzyme 2.
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18
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Capuano A, Scavone C, Racagni G, Scaglione F. NSAIDs in patients with viral infections, including Covid-19: Victims or perpetrators? Pharmacol Res 2020; 157:104849. [PMID: 32360482 PMCID: PMC7189871 DOI: 10.1016/j.phrs.2020.104849] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/31/2022]
Abstract
Taking anti-inflammatory drugs, including non-steroidal (NSAIDs), during Covid-19 infection, how much is risky? The French Minister of Health, who has raised an alarm on a possible risk deriving from the use of ibuprofen for the control of fever and other symptoms during the disease, opened the debate a few days ago. In this paper we examine available evidence from preclinical and clinical studies that had analysed the role of COX in the inflammatory process and the effects of NSAIDs in patients with infections. Most of the published studies that suggested not protective effects of NSAIDs were mainly performed in vitro or on animals. Therefore, their meaning in humans is to be considered with great caution. Based also on data suggesting protective effects of NSAIDs, we concluded that currently there is no evidence suggesting a correlation between NSAIDs and a worsening of infections. Further studies will be certainly needed to better define the role of NSAIDs and particularly COX2 inhibitors in patients with infections. In the meantime, we must wait for results of the revision started by the PRAC on May 2019 on the association ibuprofen/ketoprofen and worsening of infections. Since nowadays no scientific evidence establishes a correlation between NSAIDS and worsening of COVID-19, patients should be advice against any NSAIDs self-medication when COVID-19 like symptoms are present.
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Affiliation(s)
- Annalisa Capuano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy; Regional Centre of Pharmacogilance, Campania Region, Naples, Italy.
| | - Cristina Scavone
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy; Regional Centre of Pharmacogilance, Campania Region, Naples, Italy
| | - Giorgio Racagni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy; Clinical Pharmacology Unit, ASST-GOM Niguarda Hospital, Milan, Italy
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19
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Skehin K, Thompson A, Moriarty P. Is use of ibuprofen safe in children with signs and symptoms of lower respiratory tract infection? Arch Dis Child 2020; 105:408-410. [PMID: 31699682 DOI: 10.1136/archdischild-2019-318217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 01/21/2023]
Affiliation(s)
- Kate Skehin
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Andrew Thompson
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Paul Moriarty
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
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20
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Vagedes J, Martin D, Müller V, Helmert E, Huber BM, Andrasik F, von Schoen-Angerer T. Restrictive antibiotic use in children hospitalized for pneumonia: A retrospective inpatient study. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Nicollas R, Moreddu E, Le Treut-Gay C, Mancini J, Akkari M, Mondain M, Scavarda D, Hosanna G, Fayoux P, Pondaven-Letourmy S, Lescanne E, Triglia JM. Ibuprofen as risk-factor for complications of acute anterior sinusitis in children. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:99-103. [PMID: 31627971 DOI: 10.1016/j.anorl.2019.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
IMPORTANCE Non-steroidal anti-inflammatory drugs (NSAIDs) are known to inhibit chemotaxis, oxidative burst and phagocytosis, bacterial killing in granulocytes as well as inhibiting neutrophil aggregation or degranulation, thereby interfering with the function of lymphocytes. On the other hand, ibuprofen is widely prescribed in pediatrics for its powerful analgesic and antipyretic effects. To our knowledge, no previous publication outlines the relationship between Ibuprofen therapy and an increased risk of intracranial and/or orbital complications of acute fronto-ethmoidal sinusitis in childhood. OBJECTIVE To look for a relationship between ibuprofen and occurrence of intra-cranial and/or orbital complications of acute fronto-ethmoidal sinusitis in pediatrics. SETTING AND METHODS The medical charts of patients younger than 18 years admitted into the E.N.T. departments of 4 academic care centers during 2 consecutive years for fronto ethmoidal sinusitis were reviewed retrospectively. The history of ibuprofen intake, the occurrence of complication (orbital or intracranial) as well as the usual demographic data were noted. A statistical analysis was performed in order to ascertain whether a relationship between taking NSAIDs and the onset of an intracranial and/or orbital complication exists. RESULTS Intake of ibuprofen appeared to be a risk-factor of intracranial complications or associated orbital and intracranial complications of acute fronto-ethmoidal sinusitis in children. Neither gender nor age nor initial pain intensity were statistically related to the onset of complications. CONCLUSION AND RELEVANCE This retrospective multicenter cohort study appears to suggest that ibuprofen increases the risk of orbital and/or intracranial complications of acute fronto-ethmoidal sinusitis in childhood. Therefore, we recommend not prescribing ibuprofen if one suspects an acute sinusitis in a child or adolescent.
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Affiliation(s)
- R Nicollas
- Aix-Marseille University, Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital, 264, rue St Pierre, 13385 Marseille cedex 5, France.
| | - E Moreddu
- Aix-Marseille University, Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital, 264, rue St Pierre, 13385 Marseille cedex 5, France
| | - C Le Treut-Gay
- Aix-Marseille University, Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital, 264, rue St Pierre, 13385 Marseille cedex 5, France
| | - J Mancini
- Aix-Marseille University Department of Biostatistics and Communication and Information Technologies, BiosTIC, La Timone Hospital, Inserm, IRD, UMR912 SESSTIMF, 264, rue Saint Pierre, 13385 Marseille cedex 5, France
| | - M Akkari
- Department of Otolaryngology Head and Neck Surgery, Gui de Chauliac Hospital, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - M Mondain
- Department of Otolaryngology Head and Neck Surgery, Gui de Chauliac Hospital, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - D Scavarda
- Aix-Marseille University, Department of Pediatric Neurosurgery, La Timone Children's Hospital, 264, rue St Pierre, 13385 Marseille cedex 5, France
| | - G Hosanna
- Department of Otolaryngology Head and Neck Surgery, avenue Eugène-Avinée, 59037 Lille, France
| | - P Fayoux
- Department of Otolaryngology Head and Neck Surgery, avenue Eugène-Avinée, 59037 Lille, France
| | - S Pondaven-Letourmy
- Department of Otolaryngology Head and Neck Surgery, Gatien Clocheville Children's Hospital, 49, boulevard Béranger, 37000 Tours, France
| | - E Lescanne
- Department of Otolaryngology Head and Neck Surgery, Gatien Clocheville Children's Hospital, 49, boulevard Béranger, 37000 Tours, France
| | - J-M Triglia
- Aix-Marseille University, Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital, 264, rue St Pierre, 13385 Marseille cedex 5, France
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Lai-Cheung-Kit I, Lemarchand B, Bouscaren N, Gaüzère BA. Consommation des anti-inflammatoires non stéroïdiens lors de la préparation au Grand Raid 2016 à La Réunion. Sci Sports 2019. [DOI: 10.1016/j.scispo.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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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:E786. [PMID: 31163625 PMCID: PMC6617416 DOI: 10.3390/jcm8060786] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [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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Predicting Complicated Parapneumonic Effusion in Community Acquired Pneumonia: Hospital Based Case-Control Study. Indian J Pediatr 2019; 86:140-147. [PMID: 30182278 DOI: 10.1007/s12098-018-2769-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To identify predictors of complicated parapneumonic effusion (CPE)/empyema in patients of community acquired pneumonia (CAP) by using clinical and simple laboratory variables like hemoglobin (Hb), serum C-reactive protein (CRP), serum albumin (SA) levels and total leukocyte counts (TLC). METHODS This prospective case-control study was conducted after institutional ethical approval. Subjects between ages of 2-59 mo with World Health Organization (WHO) defined CAP with written, informed parental consent were included. Cases had CAP with CPE/empyema diagnosed by pleurocentesis. Controls had severe CAP without significant pleural collection on chest X-ray (CXR). Patients with congenital and chronic diseases/infections and possible immune deficiency were excluded. Variables with univariate association with case-control status were considered as potential predictors. Final prediction model was developed by Forward Stepwise Logistic Regression (FSLR). Adjusted odd's ratios (Adj OR) were smoothened into nearest whole numbers to develop KGMU-CPE score. RESULTS From 2016 to 17, 30 cases (66.6% males, age 38.7 + 14.9 mo) and 118 controls (78% males, age 17.8 + 16.9 mo) were included. In FSLR, predictors of CPE/empyema were ibuprofen intake (adj OR 6.8; 95%CI: 1.07-43.6), infective focus elsewhere (adj OR 28.2; 95%CI: 1.4-563.1), hypoalbuminemia <3.1 g/dL (adj OR 6.9; 95%CI: 1.22-39.3), serum CRP >20 mg/dL (adj OR 59; 95%CI: 1.86-1874.7), Hb <10 g/dL (adj OR 21.1; 95%CI: 2.8-158.1) and TLC >10,000 (adj OR 37; 95%CI: 5.7-239.8) and these six variables formed KGMU-CPE Score with a minimum score of 0 and maximum of 25. KGMU-CPE score area under the ROC curve was 0.97 and cut- off 15.55 had sensitivity of 80% and specificity of 94% for predicting CPE/empyema. CONCLUSIONS Using simple clinical and laboratory parameters it is possible to predict CAP with CPE/empyema. Use of ibuprofen is to be avoided in CAP as it associated with CPE. KGMU-CPE score had good diagnostic accuracy and needs external validation.
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Abstract
Ibuprofen is the most widely used non-steroidal anti-inflammatory drug (NSAID) for the treatment of inflammation, mild-to-moderate pain and fever in children, and is the only NSAID approved for use in children aged ≥3 months. Its efficacy and safety profile have led to its increasing use in paediatric care, even without medical prescription. However, an increase of suspected adverse reactions to ibuprofen has been noted in concomitance with the raised, often medically unsupervised, consumption of the drug. The purpose of this work was a critical review of the paediatric literature over the last 15 years on side effects and adverse events associated with ibuprofen, in order to highlight circumstances associated with higher risks and to promote safe and appropriate use of this drug. The literature from 2000 to date demonstrates that gastrointestinal events are rare, but (when they occur) include both upper and lower digestive tract lesions. Dehydration plays an important role in triggering renal damage, so ibuprofen should not be given to patients with diarrhoea and vomiting, with or without fever. Likewise, ibuprofen should never be administered to patients who are sensitive to it or to other NSAIDs. It is contraindicated in neonates and in children with wheezing and persistent asthma and/or during varicella. Most of the analysed studies reported adverse events when ibuprofen was being used for fever symptoms or flu-like syndrome. Ibuprofen should not be used as an antipyretic, except in rare cases. Ibuprofen remains the drug of first choice in the treatment of inflammatory pain in children.
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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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Pneumococcal Vaccination and Pneumonia Associated With Pleural Effusion in a Pediatric Population. Pediatr Infect Dis J 2018; 37:e87-e92. [PMID: 28938258 DOI: 10.1097/inf.0000000000001798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to assess the effect of the nonsystematic pneumococcal conjugate vaccine (PCV) on incidence of pneumonia associated with parapneumonic pleural effusion (PPE) in vaccinated and unvaccinated children. METHODS Cases were patients <15 years of age who had been diagnosed with pneumonia associated with PPE in a tertiary hospital in Navarra (Spain) between 1995 and 2014. The population <15 years of age and covered by the public health service was used as reference. The vaccination status of the cases and population was obtained from computerized medical records. Logistic regression analyses included vaccination status, age group and time periods: prevaccine (1995-2001) and vaccination with PCV7 (2002-2010) and PCV13 (2011-2014). RESULTS A total of 321 cases of PPE were included. The risk of PPE increased between the prevaccine and PCV7 period (adjusted odds ratio [OR], 3.34; 95% confidence interval [CI]: 2.37-4.71), while vaccination with PCV7 was found to be an independent risk factor (OR, 1.44; 95% CI: 1.09-1.89) in the same analysis. In the PCV13 period, the risk of PPE returned to the prevaccination incidence level among children vaccinated with PCV13 (OR, 1.07; 95% CI: 0.56-2.04), while unvaccinated children (OR, 1.69; 95% CI: 0.96-2.98) and overall those vaccinated with PCV7 (OR, 3.64; 95% CI: 2.15-6.17) maintained an increased risk of PPE. CONCLUSION The nonsystematic introduction of PCV7 was followed by an increased incidence of PPE. The subsequent introduction of PCV13 was associated with a return to the incidence level in the prevaccine period, mainly in children vaccinated with PCV13.
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Wojsyk-Banaszak I, Krenke K, Jończyk-Potoczna K, Ksepko K, Wielebska A, Mikoś M, Bręborowicz A. Long-term sequelae after lung abscess in children - Two tertiary centers' experience. J Infect Chemother 2018; 24:376-382. [PMID: 29454633 DOI: 10.1016/j.jiac.2017.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/06/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
AIM The aim of the study was to describe the epidemiology and clinical characteristic of children hospitalized with pneumonia complicated by lung abscess, as well as to evaluate the long-term sequelae of the disease. METHODS A retrospective review of medical records of all patients treated for pulmonary abscess in two tertiary centers was undertaken. Pulmonary function tests and lung ultrasound were performed at a follow-up. RESULTS During the study period, 5151 children with pneumonia were admitted, and 49 (0.95%) cases were complicated with lung abscess. In 38 (77.5%) patients, lung abscess was treated solely with antibiotics, and in nine cases (16.3%) surgically. In 21 (51.21%) children complete radiological regression was documented. The mean time for radiological abnormalities regression was 84.14 ± 51.57 days, regardless of the treatment mode. Fifteen patients were followed up at 61.6 ± 28.3 months after discharge. Lung ultrasound revealed minor residual abnormalities: pleural thickening, subpleural consolidations and line B artefacts in 11 (73.3%) children. Pulmonary function tests results were abnormal in eight (53.3%) patients, the most frequent abnormality being hyperinflation. We did not find a restrictive disorder in any of the children. There were no deaths in our study. CONCLUSIONS Lung abscess is a rare but severe complication of pneumonia in children. Most children recover uneventfully with no significant long-term pulmonary sequelae.
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Affiliation(s)
- I Wojsyk-Banaszak
- Department of Pulmonology, Pediatric Allergy and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - K Krenke
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland.
| | - K Jończyk-Potoczna
- Department of Pediatric Radiology, Poznań University of Medical Sciences, Poznań, Poland
| | - K Ksepko
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - A Wielebska
- Department of Pulmonology, Pediatric Allergy and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - M Mikoś
- Department of Pulmonology, Pediatric Allergy and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - A Bręborowicz
- Department of Pulmonology, Pediatric Allergy and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
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Masters IB, Isles AF, Grimwood K. Necrotizing pneumonia: an emerging problem in children? Pneumonia (Nathan) 2017; 9:11. [PMID: 28770121 PMCID: PMC5525269 DOI: 10.1186/s41479-017-0035-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In children, necrotizing pneumonia (NP) is an uncommon, severe complication of pneumonia. It is characterized by destruction of the underlying lung parenchyma resulting in multiple small, thin-walled cavities and is often accompanied by empyema and bronchopleural fistulae. REVIEW NP in children was first reported in children in 1994, and since then there has been a gradual increase in cases, which is partially explained by greater physician awareness and use of contrast computed tomography (CT) scans, and by temporal changes in circulating respiratory pathogens and antibiotic prescribing. The most common pathogens detected in children with NP are pneumococci and Staphylococcus aureus. The underlying disease mechanisms are poorly understood, but likely relate to multiple host susceptibility and bacterial virulence factors, with viral-bacterial interactions also possibly having a role. Most cases are in previously healthy young children who, despite adequate antibiotic therapy for bacterial pneumonia, remain febrile and unwell. Many also have evidence of pleural effusion, empyema, or pyopneumothorax, which has undergone drainage or surgical intervention without clinical improvement. The diagnosis is generally made by chest imaging, with CT scans being the most sensitive, showing loss of normal pulmonary architecture, decreased parenchymal enhancement and multiple thin-walled cavities. Blood culture and culture and molecular testing of pleural fluid provide a microbiologic diagnosis in as many as 50% of cases. Prolonged antibiotics, draining pleural fluid and gas that causes mass effects, and maintaining ventilation, circulation, nutrition, fluid, and electrolyte balance are critical components of therapy. Despite its serious nature, death is uncommon, with good clinical, radiographic and functional recovery achieved in the 5-6 months following diagnosis. Increased knowledge of NP's pathogenesis will assist more rapid diagnosis and improve treatment and, ultimately, prevention. CONCLUSION It is important to consider that our understanding of NP is limited to individual case reports or small case series, and treatment data from randomized-controlled trials are lacking. Furthermore, case series are retrospective and usually confined to single centers. Consequently, these studies may not be representative of patients in other locations, especially when allowing for temporal changes in pathogen behaviour and differences in immunization schedules and antibiotic prescribing practices.
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Affiliation(s)
- I. Brent Masters
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Alan F. Isles
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Gold Coast campus, Griffith University, Building G40, Southport Gold Coast, QLD Australia
- Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Southport Gold Coast, QLD Australia
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Empyema in Children: Update of Aetiology, Diagnosis and Management Approaches. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0161-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Basille D, Plouvier N, Trouve C, Duhaut P, Andrejak C, Jounieaux V. Non-steroidal Anti-inflammatory Drugs may Worsen the Course of Community-Acquired Pneumonia: A Cohort Study. Lung 2016; 195:201-208. [PMID: 28005149 DOI: 10.1007/s00408-016-9973-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 12/16/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed or used as self-medication in cases of community-acquired pneumonia (CAP). Nevertheless, the consequences of such medication on the risk of pleuroparenchymal complications are not well known. The aim was to investigate whether exposure to NSAIDs prior to hospital admission among patients suffering from CAP is associated with the development of pleural complications or a lung abscess. METHODS All consecutive non-immunocompromised patients with CAP and admitted to a university hospital were prospectively included (2-year period). The risk of pleuropulmonary complications was analyzed according to previous exposure to NSAIDs. RESULTS Of the 221 included patients, 40 (18.1%) had developed a pleuropulmonary complication. NSAIDs intake prior to admission was reported for 24 patients (10.9%) who were younger (50.6 ± 18.5 vs. 66.5 ± 16.4 years; p = 0.001), had less comorbidities (60 vs. 25.1%; p = 0.001), had a longer duration between the first symptoms of CAP and the start of an antibiotic therapy (6.1 ± 7.6 vs. 2.8 ± 3.8 days; p = 0.001), and who had a higher incidence of pleuropulmonary complications (33.3 vs. 16.2%; p = 0.048). In multivariate analyses, two factors were independently associated with the development of pleuroparenchymal complications: NSAIDs intake [Odds Ratio (OR) = 2.57 [1.02-6.64]; p = 0.049] and alcohol abuse (OR = 2.68 [1.27-5.69]; p = 0.01). CONCLUSIONS Our findings suggest that NSAIDs, often taken by young and healthy patients, may worsen the course of CAP with delayed therapy and a higher rate of pleuropulmonary complications.
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Affiliation(s)
- Damien Basille
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, 80054, France. .,Recif Unit, University Hospital Amiens, Amiens, France.
| | - Nathalie Plouvier
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, 80054, France
| | - Charlotte Trouve
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, 80054, France
| | - Pierre Duhaut
- Recif Unit, University Hospital Amiens, Amiens, France.,Internal Medicine, University Hospital Amiens, Amiens, France
| | - Claire Andrejak
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, 80054, France.,Recif Unit, University Hospital Amiens, Amiens, France
| | - Vincent Jounieaux
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, 80054, France
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32
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Martin DD. Fever: Views in Anthroposophic Medicine and Their Scientific Validity. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:3642659. [PMID: 27999605 PMCID: PMC5143743 DOI: 10.1155/2016/3642659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/18/2016] [Indexed: 02/06/2023]
Abstract
Objective. To conduct a scoping review to characterize how fever is viewed in anthroposophic medicine (AM) and discuss the scientific validity of these views. Methods. Systematic searches were run in Medline, Embase, CAMbase, and Google Scholar. Material from anthroposophic medical textbooks and articles was also used. Data was extracted and interpreted. Results. Most of the anthroposophic literature on this subject is in the German language. Anthroposophic physicians hold a beneficial view on fever, rarely suppress fever with antipyretics, and often use complementary means of alleviating discomfort. In AM, fever is considered to have the following potential benefits: promoting more complete recovery; preventing infection recurrences and atopic diseases; providing a unique opportunity for caregivers to provide loving care; facilitating individual development and resilience; protecting against cancer and boosting the anticancer effects of mistletoe products. These views are discussed with regard to the available scientific data. Conclusion. AM postulates that fever can be of short-term and long-term benefit in several ways; many of these opinions have become evidence-based (though still often not practiced) while others still need empirical studies to be validated, refuted, or modified.
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Affiliation(s)
- David D. Martin
- University Children's Hospital, Tübingen, Germany
- Filderklinik, Filderstadt, Germany
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33
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Dinh A, Jean M, Bouchand F, Davido B, Descatha A, Duran C, Gras G, Perronne C, Mulleman D, Salomon J, Bernard L. Impact of Anti-Inflammatory Drugs on Pyogenic Vertebral Osteomyelitis: A Prospective Cohort Study. Int J Rheumatol 2016; 2016:9345467. [PMID: 27833642 PMCID: PMC5090101 DOI: 10.1155/2016/9345467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022] Open
Abstract
Objective. Pyogenic vertebral osteomyelitis (PVO) are frequently misdiagnosed and patients often receive anti-inflammatory drugs for their back pain. We studied the impact of these medications. Methods. We performed a prospective study enrolling patients with PVO and categorized them depending on their drugs intake. Then, we compared diagnosis delay, clinical presentation at hospitalization, incidence of complications, and cure rate. Results. In total, 79 patients were included. Multivariate analysis found no correlation between anti-inflammatory drug intake and diagnosis delay, clinical presentation, complications, or outcome. Conclusion. Anti-inflammatory drugs intake does not affect diagnostic delay, severity at diagnosis, or complications of PVO.
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Affiliation(s)
- Aurélien Dinh
- Infectious Diseases Unit, University Hospital R. Poincaré, APHP, Versailles Saint Quentin University, Garches, France
| | - Maxime Jean
- Infectious Diseases Unit, University Hospital R. Poincaré, APHP, Versailles Saint Quentin University, Garches, France
| | - Frédérique Bouchand
- Pharmacy Department, University Hospital R. Poincaré, APHP, Versailles Saint Quentin University, Garches, France
| | - Benjamin Davido
- Infectious Diseases Unit, University Hospital R. Poincaré, APHP, Versailles Saint Quentin University, Garches, France
| | - Alexis Descatha
- Infectious Diseases Unit, University Hospital R. Poincaré, APHP, Versailles Saint Quentin University, Garches, France
| | - Clara Duran
- Infectious Diseases Unit, University Hospital R. Poincaré, APHP, Versailles Saint Quentin University, Garches, France
| | - Guillaume Gras
- Infectious Diseases Unit, University Hospital of Bretonneau, Denis Diderot University, Tours, France
| | - Christian Perronne
- Infectious Diseases Unit, University Hospital R. Poincaré, APHP, Versailles Saint Quentin University, Garches, France
| | - Denis Mulleman
- Rheumatology Department, University Hospital of Bretonneau, Denis Diderot University, Tours, France
| | - Jérôme Salomon
- Infectious Diseases Unit, University Hospital R. Poincaré, APHP, Versailles Saint Quentin University, Garches, France
| | - Louis Bernard
- Infectious Diseases Unit, University Hospital of Bretonneau, Denis Diderot University, Tours, France
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Nonsteroidal Anti-Inflammatory Drug without Antibiotics for Acute Viral Infection Increases the Empyema Risk in Children: A Matched Case-Control Study. J Pediatr 2016; 175:47-53.e3. [PMID: 27339249 PMCID: PMC7094675 DOI: 10.1016/j.jpeds.2016.05.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/12/2016] [Accepted: 05/09/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To investigate the risk factors of empyema after acute viral infection and to clarify the hypothesized association(s) between empyema and some viruses and/or the use of nonsteroidal anti-inflammatory drugs (NSAIDs). STUDY DESIGN A case-control study was conducted in 15 centers. Cases and controls were enrolled for a source population of children 3-15 years of age with acute viral infections between 2006 and 2009. RESULTS Among 215 empyemas, 83 cases (children with empyema and acute viral infection within the 15 preceding days) were included, and 83 controls (children with acute viral infection) were matched to cases. Considering the intake of any drug within 72 hours after acute viral infection onset and at least 6 consecutive days of antibiotic use and at least 1 day of NSAIDs exposure, the multivariable analysis retained an increased risk of empyema associated with NSAIDs exposure (aOR 2.79, 95% CI 1.4-5.58, P = .004), and a decreased risk associated with antibiotic use (aOR 0.32, 95% CI 0.11-0.97, P = .04). The risk of empyema associated with NSAIDs exposure was greater for children not prescribed an antibiotic and antibiotic intake diminished that risk for children given NSAIDs. CONCLUSIONS NSAIDs use during acute viral infection is associated with an increased risk of empyema in children, and antibiotics are associated with a decreased risk. The presence of antibiotic-NSAIDs interaction with this risk is suggested. These findings suggest that NSAIDs should not be recommended as a first-line antipyretic treatment during acute viral infections in children.
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35
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Krenke K, Krawiec M, Kraj G, Peradzynska J, Krauze A, Kulus M. Risk factors for local complications in children with community-acquired pneumonia. CLINICAL RESPIRATORY JOURNAL 2016; 12:253-261. [PMID: 27401931 DOI: 10.1111/crj.12524] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 06/29/2016] [Accepted: 07/02/2016] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to evaluate the factors that could predict the development of local complications (parapneumonic effusion/pleural empyema, necrotizing pneumonia, and lung abscess) in children with community-acquired pneumonia (CAP). METHODS Demographic, clinical, and laboratory data were prospectively collected and compared in children with noncomplicated and complicated CAP. RESULTS Two-hundred and three patients aged from 2 months to 17 years were enrolled. There were 141 and 62 children with noncomplicated and complicated CAP, respectively. Significantly longer duration of fever and a higher level of acute phase reactants were demonstrated in complicated when noncomplicated to complicated CAP. Asymmetric chest pain as well as prehospital treatment with ibuprofen and acetaminophen were significantly more common in patients with complicated CAP (P < .001, P = .02 and P = .003, respectively). Preadmission cumulative dose of ibuprofen exceeding 78.3 mg/kg (median dose for the entire group) was associated with 2.5-fold higher odds ratio (OR) for CAP complications [OR 2.54 CI (1.31-4.94); P = .008)]. In contrast, pneumococcal vaccination was associated with lower odds ratio [OR.03 CI (.23-.89); P = .03] for local complications. CONCLUSIONS Some clinical and laboratory data including chest pain, longer duration of fever, higher acute phase reactants, and especially preadmission treatment with ibuprofen or acetaminophen were associated with local complications of CAP. The results of this study highlight the association between the dose of ibuprofen and local CAP complications.
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Affiliation(s)
- Katarzyna Krenke
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marta Krawiec
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Grażyna Kraj
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Peradzynska
- Department of Epidemiology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Krauze
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marek Kulus
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
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Choi MS, Chun JH, Lee KS, Rha YH, Choi SH. Clinical characteristics of lung abscess in children: 15-year experience at two university hospitals. KOREAN JOURNAL OF PEDIATRICS 2016; 58:478-83. [PMID: 26770223 PMCID: PMC4705328 DOI: 10.3345/kjp.2015.58.12.478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/03/2014] [Accepted: 12/12/2014] [Indexed: 12/01/2022]
Abstract
Purpose Information on the clinical features of lung abscess, which is uncommon in children, at hospitalizationis helpful to anticipate the disease course and management. There is no report concerning lung abscess in Korean children. We aimed to identify the clinical characteristics of pediatric lung abscess and compare the difference between primary and secondary abscess groups. Methods The medical records of 11 lung abscess patients (7 males and 4 females) from March 1998 to August 2011 at two university hospitals were retrospectively reviewed. The clinical characteristics, symptoms, underlying disease, laboratory and radiologic findings, microbiological results, and treatments were examined. Results Six patients had underlying structural-related problems (e.g., skeletal anomalies). No immunologic or hematologic problem was recorded. The mean ages of the primary and secondary groups were 2.4 and 5.3 years, respectively, but the difference was not statistically significant. The mean length of hospital stay was similar in both groups (22.8 days vs. 21.4 days). Immunologic studies were performed in 3 patients; the results were within the normal range. Most patients had prominent leukocytosis. Seven and 4 patients had right and left lung abscess, respectively. Staphylococcus aureus, Streptococcus pneumoniae, and antimycoplasma antibodies were detected in both groups. Two patients with primary lung abscess were administered antibiotics in the absence of other procedures, while 8 underwent interventional procedures, including 5 with secondary abscess. Conclusion The most common symptoms were fever and cough. All patients in the primary group were younger than 3 years. Structural problems were dominant. Most patients required interventional procedures and antibiotics.
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Affiliation(s)
- Mi Suk Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.; Department of Pediatrics, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ji Hye Chun
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kyung Suk Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Yeong Ho Rha
- Department of Pediatrics, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Dirou S, Voiriot G. [Anti-inflammatory drugs and community-acquired pneumonia]. Rev Mal Respir 2015; 32:841-4. [PMID: 26372616 DOI: 10.1016/j.rmr.2015.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/03/2015] [Indexed: 11/28/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in ambulatory medicine for their analgesic and antipyretic properties and are often used as self-medication. Their use in community-acquired pneumonia is associated with an increased risk of loco-regional complications, especially pleural empyema. Appropriate therapeutic care and hospital admissions are often delayed because of initial improvement of symptoms with NSAIDs. Despite worrying observational data, a causal link remains to be established. Currently, there is no recommendation cautioning against the use of NSAIDs in the management of community-acquired pneumonia.
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Affiliation(s)
- S Dirou
- Service de pneumologie, l'institut du thorax, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard J.-Monod, 44093 Nantes cedex 1, France.
| | - G Voiriot
- Service de réanimation médicale et infectieuse, hôpital Bichat-Claude-Bernard, Assistance publique-hôpitaux de Paris, 75018 Paris, France
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Abstract
OBJECTIVES To determine predictors for surgical intervention of thoracic empyema in children, and its associated morbidity. METHODS We conducted a retrospective review of medical records of children with empyema thoracis admitted in the Maternity and Children Hospital, Al Madinah Al Munawwarah, Saudi Arabia between January 2007 and January 2012. The data extracted included: socio-demographic data, clinical data, method of treatment, and follow up data. According to the introduced therapeutic methods, a total of 62 patients were divided into 2 groups; patients treated with chest tube (CT) insertion (51 cases), and 11 cases that required thoracotomy (TH); groups were compared to determine predictors for thoracotomy. RESULTS Of 62 patients, 37 were females and 25 were males. In terms of age, side of lesion, presence of cough, or dyspnea, both groups were homogenous. Both groups had significant differences for duration of complaint (TH and CT) (13.5±6.5 days versus 10±3.6, p=0.005), presence of fever (90.2% versus 36.4%, p less than 0.001), history of recurrent chest infections (90.9% versus 37.3%, p=0.001), and radiological findings. However, it was not evident that any of these variables influenced treatment decision except absence of fever, which was significantly less in patients treated with thoracotomy. CONCLUSION No specific indicator was found to increase expectancy for surgical intervention as a treatment choice, except the absence of fever, which may reflect the delayed referral and prolonged use of antibiotics and cannot be interpreted truly without caution as an indicator for surgical intervention.
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Affiliation(s)
- Hamdi H Almaramhy
- Surgery Department, Faculty of Medicine, Taibah University, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia. E-mail.
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Lima EJ, Mello MJ, Albuquerque MF, Lopes MI, Serra GH, Abreu-Lima MA, Correia JB. Clinical and epidemiological characteristics of severe community-acquired pneumonia in children after introduction of the 10-valent pneumococcal vaccine. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2015; 6:131-138. [PMID: 29388602 PMCID: PMC5683263 DOI: 10.2147/phmt.s88132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Pneumonia is an important cause of morbimortality in Brazil, despite the extensive vaccination coverage and the socioeconomic improvement in the past years. Objective To describe the epidemiological and clinical characteristics of severe community-acquired pneumonia in children after the introduction of the 10-valent pneumococcal conjugate vaccine (PCV10). Methods A prospective study included children <5 years old hospitalized for pneumonia between October 2010 and September 2013 in a tertiary hospital. Newborns and children with comorbidities were excluded. Pneumonia classification followed the clinical and radiological criteria established by World Health Organization (WHO). Clinical history, nutritional status, immunizations, diagnosis, disease course, and prognosis were analyzed. Results Among 452 children, almost 70% were <2 years, with no sex differences, and 10% had weight-for-age z score below than -2.0. Family income was up to one minimum wage in half the households, and 40% of mothers had completed high school. The suitability of both influenza and PCV10 vaccine schedules was ∼50%. The first medical care happened later than 72 hours after the onset of symptoms in 42% of cases. Pneumonia was classified as severe or very severe in 83.9% of patients and for 23% as complicated. Global mortality was 1.5%. Hypoxia, diagnosed in 51.5% of children, looked like a better prognosis predictor than the WHO classification. Conclusion New strategies for health care are necessary, such as the incorporation of peripheral saturometry as the "fifth signal", investment in vaccine coverage, and the adequacy of hospital infrastructure for assistance of severely affected patients.
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Affiliation(s)
- Eduardo Jf Lima
- Instituto de Medicina Integral Prof. Fernando Figueira - IMIP Recife.,Faculdade, Pernambucana de Saúde - FPS Recife
| | - Maria Jg Mello
- Instituto de Medicina Integral Prof. Fernando Figueira - IMIP Recife.,Faculdade, Pernambucana de Saúde - FPS Recife
| | | | - Maria Il Lopes
- Hospital das Clínicas, Universidade Federal de Pernambuco - UFPE, Recife, Pernambuco, Brazil
| | | | | | - Jailson B Correia
- Instituto de Medicina Integral Prof. Fernando Figueira - IMIP Recife
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Elemraid MA, Thomas MF, Blain AP, Rushton SP, Spencer DA, Gennery AR, Clark JE. Risk factors for the development of pleural empyema in children. Pediatr Pulmonol 2015; 50:721-6. [PMID: 24692118 DOI: 10.1002/ppul.23041] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 02/28/2014] [Indexed: 11/11/2022]
Abstract
Pediatric pleural empyema has increased substantially over the past 20 years and reasons for this rise remain not fully explained. We investigated potential risk factors for the development of empyema in children by examining a cohort of patients with community-acquired pneumonia. Demographic, clinical, and socioeconomic characteristics, use of Ibuprofen prior to presentation and selected potential epidemiological risk factors were analyzed. Data were collected from a prospective etiological study of radiologically confirmed pneumonia in hospitalized children aged ≤16 years. One hundred sixty children were enrolled; 56% were male and 69% aged <5 years. Empyema complication developed in 40 (25%) children. Children with empyema were more frequently prescribed Ibuprofen prior to admission to hospital than those without (82% vs. 46.2%; OR 1.94, 97.5% credible interval 0.80-3.18). Bacterial infection was strongly associated with the development of empyema (OR 3.34, 97.5% credible interval 1.70-5.14). In contrast age, sex, maternal age, parental smoking, level of socioeconomic status, nursery attendance, asthma, household characteristics (bedrooms and number of occupants) were not significantly different between groups. In conclusion, children with pneumonia who developed empyema had more often received Ibuprofen prior to hospitalization and confirmed bacterial infection. We suggest a population-based study involving both primary and secondary care settings would help to investigate the role of Ibuprofen use in modulating the course of disease in children with pneumonia.
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Affiliation(s)
- Mohamed A Elemraid
- Department of Paediatric Infectious Disease and Immunology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Matthew F Thomas
- Biological, Clinical and Environmental Systems Modelling Group, School of Biology, Newcastle University, Newcastle upon Tyne, United Kingdom.,Department of Respiratory Paediatrics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Alasdair P Blain
- Biological, Clinical and Environmental Systems Modelling Group, School of Biology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stephen P Rushton
- Biological, Clinical and Environmental Systems Modelling Group, School of Biology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David A Spencer
- Department of Respiratory Paediatrics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Andrew R Gennery
- Department of Paediatric Infectious Disease and Immunology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Julia E Clark
- Department of Paediatric Infectious Disease, Royal Children's Hospital, Brisbane, Australia
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Huang CY, Chang L, Liu CC, Huang YC, Chang LY, Huang YC, Chiu NC, Lin HC, Ho YH, Chi H, Huang LM. Risk factors of progressive community-acquired pneumonia in hospitalized children: A prospective study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 48:36-42. [DOI: 10.1016/j.jmii.2013.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 04/22/2013] [Accepted: 06/24/2013] [Indexed: 12/25/2022]
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Cardoso MRA, Nascimento-Carvalho CMC, Ferrero F, Berezin EN, Ruvinsky R, Sant'Anna CC, Brandileone MCDC, March MDFBP, Maggi R, Feris-Iglesias J, Benguigui Y, Camargos PAM. Empyema and bacteremic pneumococcal pneumonia in children under five years of age. ACTA ACUST UNITED AC 2014; 40:69-72. [PMID: 24626272 PMCID: PMC4075916 DOI: 10.1590/s1806-37132014000100010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/28/2013] [Indexed: 11/22/2022]
Abstract
We compared bacteremic pneumococcal pneumonia (BPP) and pneumococcal empyema (PE), in terms of clinical, radiological, and laboratory findings, in under-fives. A cross-sectional nested cohort study, involving under-fives (102 with PE and 128 with BPP), was conducted at 12 centers in Argentina, Brazil, and the Dominican Republic. Among those with PE, mean age was higher; disease duration was longer; and tachypnea, dyspnea, and high leukocyte counts were more common. Among those with BPP, fever and lethargy were more common. It seems that children with PE can be distinguished from those with BPP on the basis of clinical and laboratory findings. Because both conditions are associated with high rates of morbidity and mortality, prompt diagnosis is crucial.
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Affiliation(s)
- Maria Regina Alves Cardoso
- University of São Paulo School of Public Health, Department of Epidemiology, São Paulo, Brazil, Associate Professor. Department of Epidemiology, University of São Paulo School of Public Health, São Paulo, Brazil
| | - Cristiana Maria Costa Nascimento-Carvalho
- Federal University of São Paulo Paulista, School of Medicine, São Paulo, Brazil, Associate Professor II. Federal University of São Paulo Paulista School of Medicine, São Paulo, Brazil
| | - Fernando Ferrero
- Pedro de Elizalde Children's Hospital, Buenos Aires, Argentina, Researcher. Pedro de Elizalde Children's Hospital, Buenos Aires, Argentina
| | - Eitan Naaman Berezin
- Santa Casa School of Medical Sciences in São Paulo, Department of Pediatrics, São Paulo, Brazil, Associate Professor. Department of Pediatrics, Santa Casa School of Medical Sciences in São Paulo, São Paulo, Brazil
| | - Raul Ruvinsky
- Durand Municipal Hospital, Department of Maternal and Child Health, Buenos Aires, Argentina, Head. Department of Maternal and Child Health, Durand Municipal Hospital, Buenos Aires, Argentina
| | - Clemax Couto Sant'Anna
- Federal University of Rio de Janeiro, School of Medicine, Department of Pediatrics, Rio de Janeiro, Brazil, Associate Professor. Department of Pediatrics, Federal University of Rio de Janeiro School of Medicine, Rio de Janeiro, Brazil
| | | | | | - Ruben Maggi
- Institute of Integrative Medicine, Recife, Brazil, Coordinator. Pediatric Clinic, Professor Fernando Figueira Institute of Integrative Medicine, Recife, Brazil
| | - Jesus Feris-Iglesias
- Dr. Robert Reid Cabral Children's Hospital, Department of Infectious Diseases, Santo Domingo, Dominican Republic, Head. Department of Infectious Diseases, Dr. Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
| | - Yehuda Benguigui
- World Health Organization, WashingtonDC, USA, Senior Neonatal and Child Health Advisor. Pan American Health Organization, World Health Organization, Washington, DC, USA
| | - Paulo Augusto Moreira Camargos
- Federal University of Minas Gerais, Belo Horizonte, Brazil, Full Professor of Pediatrics. Federal University of Minas Gerais, Belo Horizonte, Brazil
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Abstract
Necrotising pneumonia remains an uncommon complication of pneumonia in children but its incidence is increasing. Pneumococcal infection is the predominant cause in children but Methicillin resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL) staphylococcal infection are also important causes of severe necrotising pneumonia. Clinical features of necrotic pneumonia are similar to those of an uncomplicated pneumonia except that the patient is clinically much more unwell and has usually failed to respond adequately to what would normally be considered as appropriate antibiotics. Pleural involvement is frequent. Initial management is similar to that for non-complicated pneumonia with careful attention to fluid balance and adequate analgesia required. Some patients will need intensive care support, particularly those with PVL-positive staphylococcal infection. Broad-spectrum antibiotics should be given intravenously, with the exact choice of agent informed by local resistance patterns. Pleural drainage is often required. Despite the severity of the illness, outcomes remain excellent with the majority of children making a full recovery.
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Deceuninck G, Quach C, Panagopoulos M, Thibeault R, Côté-Boileau T, Tapiéro B, Coïc L, De Wals P, Ovetchkine P. Pediatric Pleural Empyema in the Province of Quebec: Analysis of a 10-Fold Increase Between 1990 and 2007. J Pediatric Infect Dis Soc 2014; 3:119-26. [PMID: 26625364 DOI: 10.1093/jpids/pit075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 08/19/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although the frequency of pneumonia has decreased over time, an increase in pleural empyema has been observed in different settings worldwide. This study assessed the epidemiology of community-acquired pediatric pleural empyema in the province of Quebec through validation of cases found in a hospitalization discharge database. METHODS We used the national administrative database of hospitalization to identify children (6 months-14 years) hospitalized for pleural empyema or pleural effusion with drainage from January 1990 until December 2007 and reviewed their medical charts. Patients with pleural effusion secondary to chest trauma, thoracic surgery, malignancies, cardiac failure, or metabolic disorders were excluded. RESULTS Predictive positive value (PPV) of empyema code in any position among discharge diagnostics in the administrative database was 86.5% (95% confidence interval: 81.9%-90.3%). After chart revision, 292 met the inclusion criteria. Age-adjusted incidence of pleural empyema in the pediatric population increased from 0.23 in 1990 to 4.01/100,000 person-years in 2007. A bacterial pathogen was identified in 46.5%; Streptococcus pneumoniae (Sp) (42%) and S pyogenes (30%) were most frequent. There was no obvious change in the PPV and proportions of children with chronic disease or asthma and in identified pathogens over time, but an increase in pre-admission respiratory symptoms duration (from 3.8 days to 5.7) and nonsteroidal anti-inflammatory drug use (from 0% to 19%) was observed. CONCLUSIONS From 1990 to 2007, we observed a 10-fold increase in the incidence of pediatric hospitalizations associated with pleural empyema. This increase preceded the introduction of a pneumococcal conjugated vaccine program in Quebec. Sp remained the major pathogen identified.
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Affiliation(s)
| | - Caroline Quach
- Division of Infectious Diseases, Department of Pediatrics and Medical Microbiology, The Montreal Children's Hospital and McGill University, and
| | - Markos Panagopoulos
- Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada
| | - Roseline Thibeault
- Division of Infectious Diseases, Department of Pediatrics, CHU Quebec and Laval University, Quebec City, Quebec, Canada
| | | | - Bruce Tapiéro
- Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada
| | - Léna Coïc
- Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada
| | - Philippe De Wals
- Department of Social and Preventive Medicine, Laval University, Quebec City, Quebec, Canada
| | - Philippe Ovetchkine
- Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada
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Cantais A, Mory O, Pillet S, Verhoeven PO, Bonneau J, Patural H, Pozzetto B. Epidemiology and microbiological investigations of community-acquired pneumonia in children admitted at the emergency department of a university hospital. J Clin Virol 2014; 60:402-7. [PMID: 24915939 PMCID: PMC7106426 DOI: 10.1016/j.jcv.2014.05.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 05/02/2014] [Accepted: 05/12/2014] [Indexed: 01/15/2023]
Abstract
Systematic antimicrobials are recommended in community-acquired pneumonia of child. A large panel of bacteria and viruses was detected in 85 children exhibiting CAP. More than 60% of children with CAP exhibited an exclusive viral infection. A co-infection with at least 2 viruses was observed in >40% of the children. Data suggest that the use of antimicrobials in child's CAP should be revisited.
Background The management of children with community-acquired pneumonia (CAP) is largely influenced by the development of new molecular diagnostic tests that allow the simultaneous detection of a wide range of pathogens. Objectives Evaluation of a diagnostic approach including multiplex PCR assays for revisiting the epidemiology and etiology of CAP in children at hospital. Study design Children of all ages consulting at the Emergency Department of the University hospital of Saint-Etienne, France, during the 2012–2013 winter period were included. In addition to bacterial cultures, the following pathogens were detected using biplex commercially-available rt-PCR tests: adenovirus, respiratory syncytial virus, human metapneumovirus, bocavirus, rhinovirus/enterovirus, coronavirus, influenza viruses A and B, parainfluenza viruses, Mycoplasma pneumoniae and Chlamydophila pneumonia. Results From 85 patients with CAP, at least one pathogen was identified in 81 cases (95.3%), including 4 bacterial exclusive infections (4.7%), 53 viral exclusive infections (62.4%) and 24 mixed infections (28.2%). Coinfection by at least two viruses was observed in 37 cases (43.5%). Mean age was higher in the case of documented bacterial infection (P < 0.05). In the subgroup of viral exclusive infection, the mean age of severe cases was 2.0 years vs 3.8 years in mild and moderate cases (P < 0.05). Conclusions These findings highlight the huge proportion of CAP of viral origin, the high number of co-infection by multiple viruses and the low number of bacterial CAP, notably in children under 5 years, and address the need to re-evaluate the indications of empiric antimicrobial treatment in this age group.
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Affiliation(s)
- Aymeric Cantais
- Department of Pediatric Emergency, University-Hospital of Saint-Etienne, CHU de Saint-Etienne, 42055 Saint-Etienne Cedex 02, France
| | - Olivier Mory
- Department of Pediatric Emergency, University-Hospital of Saint-Etienne, CHU de Saint-Etienne, 42055 Saint-Etienne Cedex 02, France
| | - Sylvie Pillet
- Groupe Immunité des Muqueuses et Agents Pathogènes, EA3064, Faculty of Medicine of Saint-Etienne, University of Lyon, 42023 Saint-Etienne Cedex 02, France
| | - Paul O Verhoeven
- Groupe Immunité des Muqueuses et Agents Pathogènes, EA3064, Faculty of Medicine of Saint-Etienne, University of Lyon, 42023 Saint-Etienne Cedex 02, France
| | - Julie Bonneau
- Groupe Immunité des Muqueuses et Agents Pathogènes, EA3064, Faculty of Medicine of Saint-Etienne, University of Lyon, 42023 Saint-Etienne Cedex 02, France
| | - Hugues Patural
- Pediatric Intensive Care Unit, University-Hospital of Saint-Etienne, CHU de Saint Etienne, 42055 Saint-Etienne Cedex 02, France
| | - Bruno Pozzetto
- Groupe Immunité des Muqueuses et Agents Pathogènes, EA3064, Faculty of Medicine of Saint-Etienne, University of Lyon, 42023 Saint-Etienne Cedex 02, France.
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Yu D, Buchvald F, Brandt B, Nielsen KG. Seventeen-year study shows rise in parapneumonic effusion and empyema with higher treatment failure after chest tube drainage. Acta Paediatr 2014; 103:93-9. [PMID: 24117621 DOI: 10.1111/apa.12426] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 08/20/2013] [Accepted: 09/19/2013] [Indexed: 12/19/2022]
Abstract
AIM To evaluate epidemiology, pre-admission characteristics and management of paediatric parapneumonic effusions (PPEs) and empyema in a tertiary paediatric pulmonary centre between 1993 and 2010. METHODS Retrospective chart review study using paediatric and thoracic database searches, with particular emphasis on pre-admission characteristics, disease stage (simple or complex effusion or empyema), general management and surgical procedures. RESULTS One hundred children were eligible, exhibiting a significant increase in incidence from 0.5 to 2.6 per 100 000 across the study period. Baseline characteristics were similar across disease stages. Streptococcus pneumoniae was the most common pathogen. Surgical intervention beyond chest tube drainage (CTD) was required in 50%; this rate showed a particular increase in children aged 0-5 years (OR, 3.1), but was otherwise not influenced by baseline characteristics, disease stage or use of intrapleural fibrinolytics. Length of hospitalisation did not differ across disease stages or primary interventional procedures. CONCLUSION This study confirmed an increasing incidence of PPEs and empyema in a Scandinavian tertiary paediatric pulmonary centre. Young children exhibited higher treatment failure after CTD. Length of hospitalisation was similar across disease stages and was comparable to previous reports according to primary interventional procedure.
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Affiliation(s)
- Danny Yu
- Paediatric Pulmonary Service; Department of Paediatrics and Adolescent Medicine; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Frederik Buchvald
- Paediatric Pulmonary Service; Department of Paediatrics and Adolescent Medicine; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Bodil Brandt
- Department of Thoracic Surgery; The Heart and Lung Surgical Clinic; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Kim G Nielsen
- Paediatric Pulmonary Service; Department of Paediatrics and Adolescent Medicine; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
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Suppressing childhood fever with antipyretics: inducing a false sense of security. J Pediatr 2013; 163:1796. [PMID: 24112866 DOI: 10.1016/j.jpeds.2013.08.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 08/29/2013] [Indexed: 11/22/2022]
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Crocker JC, Evans MR, Powell CVE, Hood K, Butler CC. Why some children hospitalized for pneumonia do not consult with a general practitioner before the day of hospitalization. Eur J Gen Pract 2013; 19:213-20. [PMID: 23815375 DOI: 10.3109/13814788.2013.795538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early consultation in primary care may provide an opportunity for early intervention in children developing pneumonia, but little is known about why some children do not consult a general practitioner (GP) before hospitalization. OBJECTIVES To identify differences between children who consulted a GP and children who did not consult a GP before the day of hospital presentation with pneumonia or empyema. METHODS Carers of children aged six months to 16 years presenting to hospital with pneumonia or empyema completed a questionnaire, with a subset participating in an interview to identify physical, organizational and psychological barriers to consultation. Responses from those who had consulted a GP before the day of hospital presentation were compared with those who had not on a range of medical, social and environmental variables. RESULTS Fifty seven (38%) of 151 participants had not consulted a GP before the day of hospital presentation. On multivariate analysis, illness duration ≥ 3 days (odds ratio [OR] 4.36, 95% confidence interval [CI]: 1.67-11.39), prior antibiotic use (OR: 10.35, 95% CI: 2.16-49.55) and home ownership (OR: 3.17, 95% CI: 1.07-9.37) were significantly associated with early GP consultation (P < 0.05). Interviews with 28 carers whose children had not seen a GP before the day of presentation revealed that most had not considered it and/or did not think their child's initial symptoms were serious or unusual; 11 (39.3%) had considered consulting a GP but reported barriers to access. CONCLUSION Lack of early GP consultation was strongly associated with rapid evolution of pneumonia.
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Affiliation(s)
- Joanna C Crocker
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University , Cardiff , UK
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Du JM, Sang G, Jiang CM, He XJ, Han Y. Relationship between plasma copeptin levels and complications of community-acquired pneumonia in preschool children. Peptides 2013; 45:61-5. [PMID: 23659862 DOI: 10.1016/j.peptides.2013.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 04/24/2013] [Accepted: 04/27/2013] [Indexed: 01/08/2023]
Abstract
High plasma copeptin level has been associated with clinical outcomes after acute illness. The present study was undertaken to investigate the plasma copeptin concentrations in preschool children with community-acquired pneumonia (CAP) and to analyze the correlations of copeptin with CAP-related complications and pleural effusion. Plasma copeptin concentrations of 100 healthy children and 165 preschool children with CAP were measured. 35 children (21.2%) presented with complicated CAP and 28 children (17.0%) presented with pleural effusion. The admission copeptin levels were significantly increased in all patients (49.7 ± 21.4 pmol/L), children with complicated CAP (73.0 ± 16.9 pmol/L), those with uncomplicated CAP (43.4 ± 17.8 pmol/L), those with pleural effusion (70.9 ± 17.4 pmol/L) and those without pleural effusion (45.3 ± 19.5 pmol/L) compared with healthy control individuals (9.0 ± 2.7 pmol/L, all P<0.001). Multivariate logistic regression analysis showed that plasma copeptin levels were independently related to CAP-related complications (odds ratio 1.214, 95% confidence interval 1.104-1.872, P<0.001) and pleural effusion (odds ratio 1.226, 95% confidence interval 1.109-1.917, P<0.001). A receiver operating characteristic curve analysis showed plasma copeptin level better predicted CAP-related complications (area under curve 0.876, 95% confidence interval 0.815-0.922) and pleural effusion (area under curve 0.831, 95% confidence interval 0.765-0.885). Thus, plasma copeptin level may represent a novel biomarker for predicting CAP-related complications in preschool children.
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Affiliation(s)
- Jian-Min Du
- Department of Paediatrics, The First People's Hospital of Hangzhou, Nanjing Medical University, 261 Huansha Road, Hangzhou 310006, China
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Abstract
BACKGROUND Estimates of the disease burden from childhood pneumonia are available for most developed countries, but they are based mainly on models. Measured country-specific pneumonia burden data are limited to a few nations and differ in case definitions and case ascertainment methods. This review describes pneumonia disease burden in developed countries. METHODS We reviewed studies describing childhood pneumonia incidence in North America, Europe, Australia, New Zealand and Japan. Available estimates suggest that each year in developed countries there are up to 2.6 million cases of pneumonia, including 1.5 million hospitalized cases and around 3000 pneumonia deaths (compared with approximately 640 annual deaths from meningitis) in children <5 years of age. RESULTS Data to inform policy decisions would be improved by information on burden and etiology of severe pneumonia, population-based incidence of ambulatory visits and hospitalizations and prevalence of complications and sequelae.
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