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Cho NA, Strayer K, Dobson B, McDonald B. Pathogenesis and therapeutic opportunities of gut microbiome dysbiosis in critical illness. Gut Microbes 2024; 16:2351478. [PMID: 38780485 PMCID: PMC11123462 DOI: 10.1080/19490976.2024.2351478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
For many years, it has been hypothesized that pathological changes to the gut microbiome in critical illness is a driver of infections, organ dysfunction, and other adverse outcomes in the intensive care unit (ICU). The advent of contemporary microbiome methodologies and multi-omics tools have allowed researchers to test this hypothesis by dissecting host-microbe interactions in the gut to better define its contribution to critical illness pathogenesis. Observational studies of patients in ICUs have revealed that gut microbial communities are profoundly altered in critical illness, characterized by markedly reduced alpha diversity, loss of commensal taxa, and expansion of potential pathogens. These key features of ICU gut dysbiosis have been associated with adverse outcomes including life-threatening hospital-acquired (nosocomial) infections. Current research strives to define cellular and molecular mechanisms connecting gut dysbiosis with infections and other outcomes, and to identify opportunities for therapeutic modulation of host-microbe interactions. This review synthesizes evidence from studies of critically ill patients that have informed our understanding of intestinal dysbiosis in the ICU, mechanisms linking dysbiosis to infections and other adverse outcomes, as well as clinical trials of microbiota-modifying therapies. Additionally, we discuss novel avenues for precision microbial therapeutics to combat nosocomial infections and other life-threatening complications of critical illness.
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Affiliation(s)
- Nicole A Cho
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathryn Strayer
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Breenna Dobson
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Braedon McDonald
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Královcová M, Karvunidis T, Matějovič M. Critical care for multimorbid patients. VNITRNI LEKARSTVI 2023; 69:166-172. [PMID: 37468311 DOI: 10.36290/vnl.2023.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Multimorbidity - the simultaneous presence of several chronic diseases - is very common in the critically ill patients. Its prevalence is roughly 40-85 % and continues to increase further. Certain chronic diseases such as diabetes, obesity, chronic heart, pulmonary, liver or kidney disease and malignancy are associated with higher risk of developing serious acute complications and therefore the possible need for intensive care. This review summarizes and discusses selected specifics of critical care for multimorbid patients.
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IBRAHIM AO, SHABI OM, AREMU SK, OMOSANYA EO, KOLAWOLE FT, AJETUNMOBI AO. Community‐acquired pneumonia and its predictors of mortality in rural southwestern Nigeria: A‐five year retrospective observational study. Afr J Emerg Med 2022; 12:293-297. [PMID: 35782194 PMCID: PMC9240974 DOI: 10.1016/j.afjem.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/09/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022] Open
Abstract
Majority of people in sub-Sahara Africa reside in rural areas. Many hospitals in rural and sub-urban centres do not have adequate personnel and infrastructures. There are limited dataoncommunity-acquired pneumonia and its predictors of mortality and were largely restricted to urban and suburban centres. The results of the present study would guide the stakeholders on how to reduce community- acquired pneumonia mortality in rural centres.
Introduction The predictors of community-acquired pneumonia (CAP) mortality are important outcome measures in epidemiological studies and clinical trials. There is an observed paucity of data regarding the predictors of mortality of CAP in Nigeria. Few studies from the urban centres have been reported in the literature, with none from the rural centres. The objective of this study is to ascertain the clinical presentations, risk factors, and predictors of mortality among patients admitted for CAP in rural Southwestern Nigeria. Methods A retrospective observational study using a data form and a standardised questionnaire reviewed the 176 patients admitted to Southwestern Nigeria hospital between January 2015 and December 2019. The data were analysed using SPSS Version 22.0. The results were presented in descriptive and tabular formats. Results A total of 176 patients were studied. Their mean age was 53.3±16.8 years. There were more males, 112 (63.6%), than females. The most common clinical presentations were cough, fever and sputum expectoration. The case fatality rate was 9.1% and its predictors were older aged patients [Adjusted Odds Ration (AOR), 4.135: 95% Confidence Interval (CI) (1.389-12.315); p =0.005], hypoxia [AOR, 11.118: 95% CI (2.607-47.405); p<0.001], tobacco smoking [AOR, 3.632: 95% CI (1.459-9.039); p=0.008], chronic obstructive pulmonary disease (COPD) [AOR, 10.111: 95%CI (2.370-43.139); p <0.001], and human immunodeficiency virus (HIV) [AOR, 9.444: 95% CI (4.304-20.725), p<0.001]. Conclusion The case -fatality rate was 9.1%, and its predictors were older age patients, patients with hypoxia, tobacco smoking, COPD, and HIV. This study strengthens the argument on the higher prevalence of CAP and its mortality in rural Southwestern Nigeria. The findings may provide an impetus for prospective research on these outcomes.
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Affiliation(s)
- Azeez Oyemomi IBRAHIM
- Department of Family medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria
- Corresponding author.
| | - Olabode Muftau SHABI
- Department of Family Medicine, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Shuaib Kayode AREMU
- Department of Otorhinolaryngology, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
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Clinical and laboratory findings in elderly with Community-Acquired Pneumonia in Babol, northern Iran – 2017-2019. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2021. [DOI: 10.2478/cipms-2021-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Morbidity and mortality are higher in older adults with community-acquired pneumonia (CAP) than in other age groups. Also, CAP in older adults has various clinical manifestations with other. A higher mortality rate in the elderly with CAP may contribute to a delay in management. Consequently, the purpose of this study was to investigate the clinical and laboratory manifestations of CAP in the elderly. This cross-sectional study was conducted on 221 elderly patients with CAP who were admitted to Ayatollah Rouhani Hospital, in Babol, northern of Iran, in 2017-2019. Patient outcomes included 170 cases that recovered from CAP, and 51 cases that died of complications. Patients were evaluated in terms of their clinical and laboratory manifestations. The most common symptoms of pneumonia were cough (79.6%), sputum (73.8%), weakness (72.9%), fever (56%), dyspnea (46.2%). The most frequent underlying disease was ischemic heart disease (43.9%). In our study, clinical and laboratory characteristics in older patients with CAP were evaluated and compared with other studies confirming past findings, but there were differences in some cases, such as vital signs, gastrointestinal symptoms, and disturbance of the level of consciousness. Therefore, it recommends carefully taking the patients’ initial histories and accurately recording their clinical and laboratory symptoms.
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Navarro-Torné A, Montuori EA, Kossyvaki V, Méndez C. Burden of pneumococcal disease among adults in Southern Europe (Spain, Portugal, Italy, and Greece): a systematic review and meta-analysis. Hum Vaccin Immunother 2021; 17:3670-3686. [PMID: 34106040 PMCID: PMC8437551 DOI: 10.1080/21645515.2021.1923348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/07/2021] [Accepted: 04/23/2021] [Indexed: 12/18/2022] Open
Abstract
The aim was to summarize pneumococcal disease burden data among adults in Southern Europe and the potential impact of vaccines on epidemiology. Of 4779 identified studies, 272 were selected. Invasive pneumococcal disease (IPD) incidence was 15.08 (95% CI 11.01-20.65) in Spain versus 2.56 (95% CI 1.54-4.24) per 100,000 population in Italy. Pneumococcal pneumonia incidence was 19.59 (95% CI 10.74-35.74) in Spain versus 2.19 (95% CI 1.36-3.54) per 100,000 population in Italy. Analysis of IPD incidence in Spain comparing pre-and post- PCV7 and PCV13 periods unveiled a declining trend in vaccine-type IPD incidence (larger and statistically significant for the elderly), suggesting indirect effects of childhood vaccination programme. Data from Portugal, Greece and, to a lesser extent, Italy were sparse, thus improved surveillance is needed. Pneumococcal vaccination uptake, particularly among the elderly and adults with chronic and immunosuppressing conditions, should be improved, including shift to a higher-valency pneumococcal conjugate vaccine when available.
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Arnaíz de Las Revillas F, Sousa D, Ardunay C, García-Vidal C, Montejo M, Rodríguez-Álvarez R, Pasquau J, Bouza E, Oteo JA, Balseiro C, Méndez C, Lwoff N, Llinares P, Fariñas MC. Healthcare-associated pneumonia: a prospective study in Spain. REVISTA ESPANOLA DE QUIMIOTERAPIA 2020; 33:358-368. [PMID: 32693555 PMCID: PMC7528418 DOI: 10.37201/req/067.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The aim of the study was to describe the epidemiological characteristics and factors related to outcome in Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated pneumonia (HCAP). Patients and method A 3-year prospective observational epidemiological case study of HCAP was conducted in seven Spanish hospitals. Microbiological and patient characteristics and outcomes were collected and classified by causative pathogen into 4 categories: “S. pneumoniae”, “MRSA”, “Others” and “Unknown”. Patients were followed up 30 days after discharge. Results A total of 258 (84.6%) patients were enrolled (170 were men [65.9%]). Mean age was 72.4 years ± 15 years (95% CI [70.54-74.25]). The etiology of pneumonia was identified in 73 cases (28.3%):S. pneumoniae in 35 patients (13.6%), MRSA in 8 (3.1%), and other microorganisms in 30 patients (11.6%). Significant differences in rates of chronic obstructive pulmonary disease (p < 0.05), previous antibiotic treatment (p < 0.05), other chronic respiratory diseases, inhaled corticosteroids (p < 0.01), and lymphoma (p < 0.05) were observed among the four groups. Patients with MRSA pneumonia had received more previous antibiotic treatment (87.5%). Thirty-three (12.8%) patients died during hospitalisation; death in 27 (81.2%) was related to pneumonia. Conclusions The etiology of HCAP was identified in only one quarter of patients, with S. pneumoniae being the most prevalent microorganism. Patients with chronic respiratory diseases more frequently presented HCAP due to MRSA than to S. pneumoniae. Death at hospital discharge was related in most cases to pneumonia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - M C Fariñas
- María Carmen Fariñas. Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008 Santander, Cantabria, Spain.
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Bewley MA, Budd RC, Ryan E, Cole J, Collini P, Marshall J, Kolsum U, Beech G, Emes RD, Tcherniaeva I, Berbers GAM, Walmsley SR, Donaldson G, Wedzicha JA, Kilty I, Rumsey W, Sanchez Y, Brightling CE, Donnelly LE, Barnes PJ, Singh D, Whyte MKB, Dockrell DH. Opsonic Phagocytosis in Chronic Obstructive Pulmonary Disease Is Enhanced by Nrf2 Agonists. Am J Respir Crit Care Med 2018; 198:739-750. [PMID: 29547002 PMCID: PMC6222469 DOI: 10.1164/rccm.201705-0903oc] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 03/14/2018] [Indexed: 01/01/2023] Open
Abstract
RATIONALE Previous studies have identified defects in bacterial phagocytosis by alveolar macrophages (AMs) in patients with chronic obstructive pulmonary disease (COPD), but the mechanisms and clinical consequences remain incompletely defined. OBJECTIVES To examine the effect of COPD on AM phagocytic responses and identify the mechanisms, clinical consequences, and potential for therapeutic manipulation of these defects. METHODS We isolated AMs and monocyte-derived macrophages (MDMs) from a cohort of patients with COPD and control subjects within the Medical Research Council COPDMAP consortium and measured phagocytosis of bacteria in relation to opsonic conditions and clinical features. MEASUREMENTS AND MAIN RESULTS COPD AMs and MDMs have impaired phagocytosis of Streptococcus pneumoniae. COPD AMs have a selective defect in uptake of opsonized bacteria, despite the presence of antipneumococcal antibodies in BAL, not observed in MDMs or healthy donor AMs. AM defects in phagocytosis in COPD are significantly associated with exacerbation frequency, isolation of pathogenic bacteria, and health-related quality-of-life scores. Bacterial binding and initial intracellular killing of opsonized bacteria in COPD AMs was not reduced. COPD AMs have reduced transcriptional responses to opsonized bacteria, such as cellular stress responses that include transcriptional modules involving antioxidant defenses and Nrf2 (nuclear factor erythroid 2-related factor 2)-regulated genes. Agonists of the cytoprotective transcription factor Nrf2 (sulforaphane and compound 7) reverse defects in phagocytosis of S. pneumoniae and nontypeable Haemophilus influenzae by COPD AMs. CONCLUSIONS Patients with COPD have clinically relevant defects in opsonic phagocytosis by AMs, associated with impaired transcriptional responses to cellular stress, which are reversed by therapeutic targeting with Nrf2 agonists.
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Affiliation(s)
- Martin A Bewley
- 1 Department of Infection, Immunity and Cardiovascular Disease and
- 2 The Florey Institute for Host-Pathogen Interactions, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Richard C Budd
- 1 Department of Infection, Immunity and Cardiovascular Disease and
- 2 The Florey Institute for Host-Pathogen Interactions, University of Sheffield Medical School, Sheffield, United Kingdom
- 3 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Eilise Ryan
- 4 Department of Respiratory Medicine
- 5 MRC Centre for Inflammation Research, and
| | - Joby Cole
- 1 Department of Infection, Immunity and Cardiovascular Disease and
- 2 The Florey Institute for Host-Pathogen Interactions, University of Sheffield Medical School, Sheffield, United Kingdom
- 3 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Paul Collini
- 1 Department of Infection, Immunity and Cardiovascular Disease and
- 2 The Florey Institute for Host-Pathogen Interactions, University of Sheffield Medical School, Sheffield, United Kingdom
- 3 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Jennifer Marshall
- 5 MRC Centre for Inflammation Research, and
- 6 Department of Infection Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Umme Kolsum
- 7 Medicines Evaluation Unit, University of Manchester, Manchester, United Kingdom
- 8 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Gussie Beech
- 7 Medicines Evaluation Unit, University of Manchester, Manchester, United Kingdom
- 8 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Richard D Emes
- 9 School of Veterinary Medicine and Science and
- 10 Advanced Data Analysis Centre, University of Nottingham, United Kingdom
| | - Irina Tcherniaeva
- 11 Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Utrecht, the Netherlands
| | - Guy A M Berbers
- 11 Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Utrecht, the Netherlands
| | - Sarah R Walmsley
- 4 Department of Respiratory Medicine
- 5 MRC Centre for Inflammation Research, and
| | - Gavin Donaldson
- 12 National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jadwiga A Wedzicha
- 12 National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Iain Kilty
- 13 Pfizer Inc., Cambridge, Massachusetts
| | - William Rumsey
- 14 Stress and Repair Discovery Performance Unit, Respiratory Therapy Area, GSK, King of Prussia, Pennsylvania; and
| | - Yolanda Sanchez
- 14 Stress and Repair Discovery Performance Unit, Respiratory Therapy Area, GSK, King of Prussia, Pennsylvania; and
| | | | - Louise E Donnelly
- 12 National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Peter J Barnes
- 12 National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Dave Singh
- 7 Medicines Evaluation Unit, University of Manchester, Manchester, United Kingdom
- 8 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Moira K B Whyte
- 4 Department of Respiratory Medicine
- 5 MRC Centre for Inflammation Research, and
| | - David H Dockrell
- 5 MRC Centre for Inflammation Research, and
- 6 Department of Infection Medicine, University of Edinburgh, Edinburgh, United Kingdom
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Bewley MA, Preston JA, Mohasin M, Marriott HM, Budd RC, Swales J, Collini P, Greaves DR, Craig RW, Brightling CE, Donnelly LE, Barnes PJ, Singh D, Shapiro SD, Whyte MKB, Dockrell DH. Impaired Mitochondrial Microbicidal Responses in Chronic Obstructive Pulmonary Disease Macrophages. Am J Respir Crit Care Med 2017; 196:845-855. [PMID: 28557543 DOI: 10.1164/rccm.201608-1714oc] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Chronic obstructive pulmonary disease (COPD) is characterized by impaired clearance of pulmonary bacteria. OBJECTIVES The effect of COPD on alveolar macrophage (AM) microbicidal responses was investigated. METHODS AMs were obtained from bronchoalveolar lavage from healthy donors or patients with COPD and challenged with opsonized serotype 14 Streptococcus pneumoniae. Cells were assessed for apoptosis, bactericidal activity, and mitochondrial reactive oxygen species (mROS) production. A transgenic mouse line in which the CD68 promoter ensures macrophage-specific expression of human induced myeloid leukemia cell differentiation protein Mcl-1 (CD68.hMcl-1) was used to model the molecular aspects of COPD. MEASUREMENTS AND MAIN RESULTS COPD AMs had elevated levels of Mcl-1, an antiapoptotic B-cell lymphoma 2 family member, with selective reduction of delayed intracellular bacterial killing. CD68.hMcl-1 AMs phenocopied the microbicidal defect because transgenic mice demonstrated impaired clearance of pulmonary bacteria and increased neutrophilic inflammation. Murine bone marrow-derived macrophages and human monocyte-derived macrophages generated mROS in response to pneumococci, which colocalized with bacteria and phagolysosomes to enhance bacterial killing. The Mcl-1 transgene increased oxygen consumption rates and mROS expression in mock-infected bone marrow-derived macrophages but reduced caspase-dependent mROS production after pneumococcal challenge. COPD AMs also increased basal mROS expression, but they failed to increase production after pneumococcal challenge, in keeping with reduced intracellular bacterial killing. The defect in COPD AM intracellular killing was associated with a reduced ratio of mROS/superoxide dismutase 2. CONCLUSIONS Up-regulation of Mcl-1 and chronic adaption to oxidative stress alter mitochondrial metabolism and microbicidal function, reducing the delayed phase of intracellular bacterial clearance in COPD.
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Affiliation(s)
- Martin A Bewley
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Julie A Preston
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Mohammed Mohasin
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Helen M Marriott
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Richard C Budd
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom.,3 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Julie Swales
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Paul Collini
- 1 The Florey Institute for Host-Pathogen Interactions and.,2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, United Kingdom.,3 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - David R Greaves
- 4 Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | - Ruth W Craig
- 5 Department of Pharmacology and Toxicology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | | | - Louise E Donnelly
- 7 Airway Disease National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Peter J Barnes
- 7 Airway Disease National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Dave Singh
- 8 Centre for Respiratory and Allergy, University of Manchester, Manchester, United Kingdom.,9 Medicines Evaluation Unit, Manchester, United Kingdom.,10 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Steven D Shapiro
- 11 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
| | - Moira K B Whyte
- 12 Department of Respiratory Medicine.,13 MRC Centre for Inflammation Research, and
| | - David H Dockrell
- 13 MRC Centre for Inflammation Research, and.,14 Department of Infection Medicine, University of Edinburgh, Edinburgh, United Kingdom
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Walters JAE, Tang JNQ, Poole P, Wood‐Baker R. Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017; 1:CD001390. [PMID: 28116747 PMCID: PMC6422320 DOI: 10.1002/14651858.cd001390.pub4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND People with chronic obstructive pulmonary disease (COPD) are at increased risk of pneumococcal disease, especially pneumonia, as well as acute exacerbations with associated morbidity and healthcare costs. OBJECTIVES To determine the efficacy of injectable pneumococcal vaccination for preventing pneumonia in persons with COPD. SEARCH METHODS We searched the Cochrane Airways COPD Trials Register and the databases CENTRAL, MEDLINE and Embase, using prespecified terms. Searches are current to November 2016. SELECTION CRITERIA We included randomised controlled trials (RCT) comparing injectable pneumococcal polysaccharide vaccine (PPV) or pneumococcal conjugated vaccine (PCV) versus a control or alternative vaccine type in people with COPD. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. For meta-analyses, we subgrouped studies by vaccine type. MAIN RESULTS For this update, we added five studies (606 participants), meaning that the review now includes a total of 12 RCTs involving 2171 participants with COPD. Average age of participants was 66 years, male participants accounted for 67% and mean forced expiratory volume in one second (FEV1) was 1.2 L (five studies), 54% predicted (four studies). We assessed risks of selection, attrition and reporting bias as low, and risks of performance and detection bias as moderate.Compared with control, the vaccine group had a lower likelihood of developing community-acquired pneumonia (CAP) (odds ratio (OR) 0.62, 95% confidence interval (CI) 0.43 to 0.89; six studies, n = 1372; GRADE: moderate), but findings did not differ specifically for pneumococcal pneumonia (Peto OR 0.26, 95% CI 0.05 to 1.31; three studies, n = 1158; GRADE: low). The number needed to treat for an additional beneficial outcome (NNTB) (preventing one episode of CAP) was 21 (95% CI 15 to 74). Mortality from cardiorespiratory causes did not differ between vaccine and control groups (OR 1.07, 95% CI 0.69 to 1.66; three studies, n = 888; GRADE: moderate), nor did all-cause mortality differ (OR 1.00, 95% CI 0.72 to 1.40; five studies, n = 1053; GRADE: moderate). The likelihood of hospital admission for any cause, or for cardiorespiratory causes, did not differ between vaccine and control groups. Vaccination significantly reduced the likelihood of a COPD exacerbation (OR 0.60, 95% CI 0.39 to 0.93; four studies, n = 446; GRADE: moderate). The NNTB to prevent a patient from experiencing an acute exacerbation was 8 (95% CI 5 to 58). Only one study (n = 181) compared the efficacy of different vaccine types - 23-valent PPV versus 7-valent PCV - and reported no differences for CAP, all-cause mortality, hospital admission or likelihood of a COPD exacerbation, but investigators described a greater likelihood of some mild adverse effects of vaccination with PPV-23. AUTHORS' CONCLUSIONS Injectable polyvalent pneumococcal vaccination provides significant protection against community-acquired pneumonia, although no evidence indicates that vaccination reduced the risk of confirmed pneumococcal pneumonia, which was a relatively rare event. Vaccination reduced the likelihood of a COPD exacerbation, and moderate-quality evidence suggests the benefits of pneumococcal vaccination in people with COPD. Evidence was insufficient for comparison of different pneumococcal vaccine types.
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Affiliation(s)
- Julia AE Walters
- La Trobe University55 Commercial RdAlfred Health Clinical SchoolMelbourneVictoriaAustralia3004
| | | | - Phillippa Poole
- University of AucklandDepartment of MedicinePrivate Bag 92019AucklandNew Zealand
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Williams NP, Coombs NA, Johnson MJ, Josephs LK, Rigge LA, Staples KJ, Thomas M, Wilkinson TM. Seasonality, risk factors and burden of community-acquired pneumonia in COPD patients: a population database study using linked health care records. Int J Chron Obstruct Pulmon Dis 2017; 12:313-322. [PMID: 28176888 PMCID: PMC5261550 DOI: 10.2147/copd.s121389] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Community-acquired pneumonia (CAP) is more common in patients with COPD than in the adult general population, with studies of hospitalized CAP patients consistently reporting COPD as a frequent comorbidity. However, despite an increasing recognition of its importance, large studies evaluating the incidence patterns over time, risk factors and burden of CAP in COPD are currently lacking. Methods A retrospective observational study using a large UK-based database of linked primary and secondary care records was conducted. Patients with a diagnosis of COPD aged ≥40 years were followed up for 5 years from January 1, 2010. CAP and exacerbation episodes were identified from hospital discharge data and primary care coding records, and rates were calculated per month, adjusting for mortality, and displayed over time. In addition, baseline factors predicting future risk of CAP and hospital admission with CAP were identified. Results A total of 14,513 COPD patients were identified: 13.4% (n=1,938) had ≥1 CAP episode, of whom 18.8% suffered from recurrent (≥2) CAP. Highest rates of both CAP and exacerbations were seen in winter. A greater proportion of frequent, compared to infrequent, exacerbators experienced recurrent CAP (5.1% versus 2.0%, respectively, P<0.001); 75.6% of CAP episodes were associated with hospital admission compared to 22.1% of exacerbations. Older age and increasing grade of airflow limitation were independently associated with increased odds of CAP and hospital admission with CAP. Other independent predictors of future CAP included lower body mass index, inhaled corticosteroid use, prior frequent exacerbations and comorbidities, including ischemic heart disease and diabetes. Conclusion CAP in COPD demonstrates clear seasonal patterns, with patient characteristics predictive of the odds of future CAP and hospital admission with CAP. Highlighting this burden of COPD-associated CAP during the winter period informs us of the likely triggers and the need for more effective preventive strategies.
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Affiliation(s)
- Nicholas P Williams
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital
| | - Ngaire A Coombs
- Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital
| | - Matthew J Johnson
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Lynn K Josephs
- Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital; NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Lucy A Rigge
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital; NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Karl J Staples
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital
| | - Mike Thomas
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital; Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital; NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Tom Ma Wilkinson
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital; NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
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11
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Cukic V, Hadzic A. The Most Common Detected Bacteria in Sputum of Patients with Community Acquired Pneumonia (CAP) Treated In Hospital. Med Arch 2016; 70:354-358. [PMID: 27994296 PMCID: PMC5136428 DOI: 10.5455/medarh.2016.70.354-358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 10/11/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction: Community acquired pneumonia (CAP) is the most common infective pulmonary disease. Objective: To show the most common detected bacteria in bacterial culture of sputum in patients with CAP hospitalized in Clinic for Pulmonary Diseases and TB “Podhrastovi” in four-year period: from 2012 to 2015. Material and methods: This is the retrospective analysis. Each patient gave sputum 3 days in a row when admitted to hospital. Sputum has been examined: bacterial culture with antibiotics sensitivity, Gram stain, Mycobacterium tuberculosis; in cases with high temperature blood cultures were done; when we were suspicious about bronchial carcinoma bronchoscopy with BAL (bronchoalveolar lavage) was done. We show analyzed patients according to age, sex, whether they had pneumonia or bronchopneumonia, bacteria isolated in sputum and in BAL. Results: 360 patients with CAP were treated in four-year period (247 males and 113 females). 167 or 43, 39 % had pneumonia (119 males and 48 females). Number of males was significantly bigger (χ2 = 30,186; p<0,001). 193 or 53, 61 % had bronchopneumonia (128 males and 65 females). Number of males was significantly bigger (χ2 = 20,556; p<0,001). Number of patients with negative bacterial culture of sputum (131–78, 44%) was significantly bigger than number of patients with positive culture (36–21, 56%) (χ2 = 50,042; p<0,001) in pneumonia. Number of patients with negative bacterial culture of sputum (154- 79, 79%) was significantly bigger than number of patients with positive culture (39- 20, 21%) (χ2 = 68,523; p<0,001) in bronchopneumonia. Streptococcus pneumoniae was significantly most common detected bacterium compared with the number of other isolated bacteria; in pneumonia (χ2 =33,222; p<0,001) and in bronchopneumonia (χ2 =51,231; p<0,001). Conclusion: It is very important to detect the bacterial cause of CAP to administrate the targeted antibiotic therapy.
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Affiliation(s)
- Vesna Cukic
- Clinic for Pulmonary Diseases and TB "Podhrastovi", Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Armin Hadzic
- Department for Pulmonary Diseases, Cantonal hospital Zenica, Zenica, Bosnia and Herzegovina
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12
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Sharafkhaneh A, Spiegelman AM, Main K, Tavakoli-Tabasi S, Lan C, Musher D. Mortality in Patients Admitted for Concurrent COPD Exacerbation and Pneumonia. COPD 2016; 14:23-29. [PMID: 27661473 DOI: 10.1080/15412555.2016.1220513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
It is unclear whether concurrent pneumonia and chronic obstructive pulmonary disease (COPD) have a higher mortality than either condition alone. Further, it is unknown how this interaction changes over time. We explored the effect of pneumonia and COPD on inpatient, 30-day and overall mortality. We used a Veterans Health Affairs database to compare patients who were hospitalized for a COPD exacerbation without pneumonia (AECOPD), patients hospitalized for pneumonia without COPD (PNA) and patients hospitalized for pneumonia who had a concurrent diagnosis of COPD (PCOPD). We studied records of 15,065 patients with the following primary discharge diagnoses: (a) AECOPD cohort (7,154 individuals); (b) PNA cohort (4,433 individuals); and (c) PCOPD (3,478 individuals), comparing inpatient, 30-day and overall mortality in the three study cohorts. We observed a stepwise increase in inpatient mortality for AECOPD, PNA and PCOPD (4.8%, 9.5% and 13.2%, respectively). These differences persisted at 30 days post-discharge (AECOPD = 6.7%, PNA = 12.4% and PCOPD = 14.6%; p < 0.0001), but not throughout the study period (median follow-up: 37 months). With time, the death rate rose disproportionally in patients who had been admitted for AECOPD (AECOPD = 64.5%; PNA = 57.4% and PCOPD 66.2%; p < 0.001). In multivariate analysis, PCOPD predicted the greatest inpatient mortality (p < 0.001). The data showed a progression in inpatient and 30-day mortality from AECOPD to PNA to PCOPD. Pneumonia and COPD differentially affected inpatient, 30-day and overall mortality with pneumonia affecting predominantly inpatient and 30-day mortality while COPD affecting the overall mortality.
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Affiliation(s)
- Amir Sharafkhaneh
- a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.,b Department of Medicine , Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine , Houston , TX , USA
| | | | - Kevin Main
- d Allied Health Sciences, Baylor College of Medicine , Houston , TX , USA
| | - Shahriar Tavakoli-Tabasi
- a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.,c Department of Medicine , Section of Infectious Diseases, Baylor College of Medicine , Houston , TX , USA
| | - Charlie Lan
- a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.,b Department of Medicine , Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine , Houston , TX , USA
| | - Daniel Musher
- a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.,c Department of Medicine , Section of Infectious Diseases, Baylor College of Medicine , Houston , TX , USA
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13
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Kurashima K, Takaku Y, Nakamoto K, Kanauchi T, Takayanagi N, Yanagisawa T, Sugita Y, Araki R. Risk Factors for Pneumonia and the Effect of the Pneumococcal Vaccine in Patients With Chronic Airflow Obstruction. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2016; 3:610-619. [PMID: 28848887 DOI: 10.15326/jcopdf.3.3.2015.0167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: To evaluate the risk factors for pneumonia and the efficacy of the pneumococcal polysaccharide vaccine (PPV) in patients with chronic airflow obstruction. Methods: We retrospectively studied the risk factors for pneumonia in 820 consecutive patients with chronic obstructive pulmonary disease (COPD) (n=509) and patients with asthma-COPD overlap syndrome (ACOS) (n=311). The effects of asthma, age, smoking history, chronic sputum, use of inhaled corticosteroids, percent predicted forced vital capacity (%FVC), percent predicted forced expiratory volume in 1 second (%FEV1), body mass index (BMI), computed tomography (CT)-diagnosed emphysema, and the pneumococcal vaccination on the frequency of pneumonia were assessed. Results: There was no difference in the frequency of pneumonia in patients with COPD and those with ACOS. In a univariate analysis, age (p= 0.031), %FVC (p< 0.001), %FEV1 (p < 0.001), BMI (p = 0.003), the presence of emphysema (p < 0.001) and a history of vaccination with the PPV (p = 0.034) were associated with the frequency of pneumonia. A multivariate analysis identified low BMI, the presence of emphysema and the absence of a pneumococcal vaccination as independent risk factors. The combination index of these factors, the BOVE index, which is calculated from low BMI (<22 kg/m2), low %FEV1 (<60%), vaccination history and emphysema was associated with the overall frequency of pneumonia. Conclusions:The index of multidimensional risk factors is useful to predict the frequency of pneumonia in patients with chronic airflow obstruction. The pneumococcal vaccination was associated with significantly lower incidence of pneumonia.
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Affiliation(s)
- Kazuyoshi Kurashima
- Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan
| | - Yotaro Takaku
- Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan
| | - Keitaro Nakamoto
- Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan
| | - Tetsu Kanauchi
- Radiology, Saitama Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan
| | - Noboru Takayanagi
- Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan
| | - Tsutomu Yanagisawa
- Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan
| | - Yutaka Sugita
- Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya City, Saitama, Japan
| | - Ryuichiro Araki
- Community Health Science Center, Saitama Medical University, Moroyama-machi, Saitama, Japan
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14
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Walterspacher S, Fuhrmann C, Germann M, Ratka-Krüger P, Windisch W. Dental care before lung transplantation: are we being too rigorous? CLINICAL RESPIRATORY JOURNAL 2016; 7:220-5. [PMID: 22788979 DOI: 10.1111/j.1752-699x.2012.00308.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Poor dental status is known to cause infections in severely sick and in elderly patients. In patients awaiting lung transplantation, rigorous dental treatment is a common prerequisite, although evidence-based data are lacking with regard to extent, necessity and effect on post-transplantation infectious status. MATERIALS AND METHODS In the present retrospective study, dental status [dental history (missing teeth, caries, tooth restorations and extractions, prevalence of periodontitis) and dental treatment prior transplantation] was assessed in 85 lung transplant candidates at the University Hospital of Freiburg, Germany and evaluated for infectious foci in the first 3 years following transplantation. RESULTS Forty-nine patients got transplanted in the observed timespan. Total tooth count differed significantly between chronic obstructive pulmonary disease (16 ± 9), pulmonary fibrosis (22 ± 7) or cystic fibrosis (30 ± 3) patients prior transplantation (P > 0.001). Periodontitis prevalence yielded no difference and was mainly not treated prior transplantation. No dental-related infectious focus could be diagnosed post-transplantation. However, 15% of post-transplantation infections were of unknown focus, and infection rate was increased in year 2 post-transplantation in patients without periodontitis. CONCLUSION No clearly defined dental foci were registered following transplantation. This raises the question of whether current dental treatment in these highly compromised patients is too rigorous with regard to tooth extractions. However, no focus could be detected in 15% of the registered infections. Therefore, controversially, post-transplantation dental care could also be insufficient with regard to undertreated periodontitis.
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Affiliation(s)
- Stephan Walterspacher
- Department of Respiratory Medicine, University Hospital Freiburg, Freiburg, Germany.
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15
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Bryant K, Frenck R, Gurtman A, Rubino J, Treanor J, Thompson A, Jones T, Sundaraiyer V, Baxter L, Gruber W, Emini E, Scott D, Schmoele-Thoma B. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in adults 18–49 years of age, naive to 23-valent pneumococcal polysaccharide vaccine. Vaccine 2015; 33:5854-5860. [DOI: 10.1016/j.vaccine.2015.08.080] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/25/2015] [Accepted: 08/28/2015] [Indexed: 11/25/2022]
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16
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Yamauchi Y, Yasunaga H, Matsui H, Hasegawa W, Jo T, Takami K, Fushimi K, Nagase T. Comparison of clinical characteristics and outcomes between aspiration pneumonia and community-acquired pneumonia in patients with chronic obstructive pulmonary disease. BMC Pulm Med 2015; 15:69. [PMID: 26152178 PMCID: PMC4495636 DOI: 10.1186/s12890-015-0064-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 06/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) patients often have dysphagia through age and several co-morbidities, leading to aspiration pneumonia (AsP). COPD patients also have increased risk of developing community-acquired pneumonia (CAP). Using a national inpatient database in Japan, we aimed to compare clinical characteristics and outcomes between AsP and CAP in COPD patients and to verify the factors that affect in-hospital morality. Methods We retrospectively collected data on COPD patients (age ≥40 years) who were admitted for AsP or CAP in 1,165 hospitals across Japan between July 2010 and May 2013. We performed multivariable logistic regression analyses to examine the association of various factors with all-cause in-hospital mortality for AsP and CAP. Results Of 87,330 eligible patients, AsP patients were more likely to be older, male and have poorer general condition and more severe pneumonia than those with CAP. In-hospital mortality in the AsP group was 22.7 % and 12.2 % in the CAP group. After adjustment for patient background, AsP patients had significantly higher mortality than CAP patients (adjusted odds ratio, 1.19; 95 % confidence interval, 1.08–1.32). Subgroup analyses showed higher mortality to be associated with male gender, underweight, dyspnea, physical disability, pneumonia severity, and several co-morbidities. Further, older age and worse level of consciousness were associated with higher mortality in the CAP group, whereas those were not associated in the AsP group. Conclusions Clinical characteristics differed significantly between AsP and CAP in COPD patients. AsP patients had significantly higher mortality than those with CAP. Electronic supplementary material The online version of this article (doi:10.1186/s12890-015-0064-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yasuhiro Yamauchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Division for Health Service Promotion, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Wakae Hasegawa
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Taisuke Jo
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Division for Health Service Promotion, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Kazutaka Takami
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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17
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Stolberg VR, McCubbrey AL, Freeman CM, Brown JP, Crudgington SW, Taitano SH, Saxton BL, Mancuso P, Curtis JL. Glucocorticoid-Augmented Efferocytosis Inhibits Pulmonary Pneumococcal Clearance in Mice by Reducing Alveolar Macrophage Bactericidal Function. THE JOURNAL OF IMMUNOLOGY 2015; 195:174-84. [PMID: 25987742 DOI: 10.4049/jimmunol.1402217] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 04/22/2015] [Indexed: 12/31/2022]
Abstract
Inhaled corticosteroids (ICS) increase community-acquired pneumonia (CAP) incidence in patients with chronic obstructive pulmonary disease (COPD) by unknown mechanisms. Apoptosis is increased in the lungs of COPD patients. Uptake of apoptotic cells (ACs) ("efferocytosis") by alveolar macrophages (AMøs) reduces their ability to combat microbes, including Streptococcus pneumoniae, the most common cause of CAP in COPD patients. Having shown that ICS significantly increase AMø efferocytosis, we hypothesized that this process, termed glucocorticoid-augmented efferocytosis, might explain the association of CAP with ICS therapy in COPD. To test this hypothesis, we studied the effects of fluticasone, AC, or both on AMøs of C57BL/6 mice in vitro and in an established model of pneumococcal pneumonia. Fluticasone plus AC significantly reduced TLR4-stimulated AMø IL-12 production, relative to either treatment alone, and decreased TNF-α, CCL3, CCL5, and keratinocyte-derived chemoattractant/CXCL1, relative to AC. Mice treated with fluticasone plus AC before infection with viable pneumococci developed significantly more lung CFUs at 48 h. However, none of the pretreatments altered inflammatory cell recruitment to the lungs at 48 h postinfection, and fluticasone plus AC less markedly reduced in vitro mediator production to heat-killed pneumococci. Fluticasone plus AC significantly reduced in vitro AMø killing of pneumococci, relative to other conditions, in part by delaying phagolysosome acidification without affecting production of reactive oxygen or nitrogen species. These results support glucocorticoid-augmented efferocytosis as a potential explanation for the epidemiological association of ICS therapy of COPD patients with increased risk for CAP, and establish murine experimental models to dissect underlying molecular mechanisms.
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Affiliation(s)
| | | | - Christine M Freeman
- Research Service, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109
| | - Jeanette P Brown
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109
| | - Sean W Crudgington
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109
| | - Sophina H Taitano
- Graduate Program in Immunology, University of Michigan, Ann Arbor, MI 48109
| | | | - Peter Mancuso
- Graduate Program in Immunology, University of Michigan, Ann Arbor, MI 48109; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109; and
| | - Jeffrey L Curtis
- Graduate Program in Immunology, University of Michigan, Ann Arbor, MI 48109; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109; Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105
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18
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Acute Pneumonia. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7151914 DOI: 10.1016/b978-1-4557-4801-3.00069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Community-Acquired Pneumonia in Patients with Chronic Obstructive Pulmonary Disease. Curr Infect Dis Rep 2014; 17:444. [DOI: 10.1007/s11908-014-0444-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Abstract
This article represents a review of the current literature on the role of infection in the pathogenesis of chronic obstructive pulmonary disease (COPD), in stable disease, exacerbations, and pneumonia. It outlines the complex interactions between respiratory pathogens and host immune defenses that underlie the clinical manifestations of infection in COPD.
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Affiliation(s)
- Kamen Rangelov
- Pulmonary and Critical Care Medicine, University at Buffalo, SUNY, 3435 Main Street, Buffalo, NY 14214, USA
| | - Sanjay Sethi
- Pulmonary, Critical Care, and Sleep Medicine, VA Western New York Healthcare System, University at Buffalo, The State University of New York, 3495 Bailey Avenue, Buffalo, NY 14215, USA.
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21
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Wenisch C, Weiss G, Lechner A, Meilinger M, Rittler K, Muzatko N, Pomogyi B, Kutilek M, Bellmann-Weiler R, Fürst UM, Andorfer A, Wenisch JM. Epidemiology of patients hospitalised for pneumonia in 2011: a prospective multicentre cohort study. Wien Klin Wochenschr 2013; 125:621-8. [DOI: 10.1007/s00508-013-0419-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 07/28/2013] [Indexed: 11/29/2022]
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22
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Vadiraj S, Nayak R, Choudhary GK, Kudyar N, Spoorthi BR. Periodontal pathogens and respiratory diseases- evaluating their potential association: a clinical and microbiological study. J Contemp Dent Pract 2013; 14:610-615. [PMID: 24309337 DOI: 10.5005/jp-journals-10024-1373] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate whether any potential association exists between respiratory diseases such as chronic obstructive pulmonary disease (COPD) and periodontal health status clinically and or microbiologically. MATERIALS AND METHODS Fifty patients of COPD (test group) and 50 Patients without COPD (control group) were recruited for the study with more than 20 years of age with at least six natural teeth. All the patients were nonsmokers. Periodontal health was assessed by measuring clinical attachment loss (CAL) and gingival bleeding by using William's graduated periodontal probe. Microbiological evaluation was done by collecting sputum samples of the subjects with respiratory diseases to find out any periodontal pathogen in the lung fluid. RESULT AND CONCLUSION The results showed that the subjects with COPD had significantly more bleeding sites (i.e. >20%) and had more of the clinical mean attachment loss (2.84 ± 0.66) than those without COPD. On the basis of the observed results of the study, we can hypothesize that the risk for COPD appeared to be significantly elevated when attachment loss was found to be severe. CLINICAL SIGNIFICANCE It is conceivable that oral interventions that improve oral health status may prove to lower the severity of lung infection in susceptible populations.
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Affiliation(s)
- S Vadiraj
- Reader, Department of Periodontics, PDU Dental College and Hospital, Solapur, Maharashtra, India, e-mail:
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23
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Sibila O, Mortensen EM, Anzueto A, Laserna E, Restrepo MI. Prior cardiovascular disease increases long-term mortality in COPD patients with pneumonia. Eur Respir J 2013; 43:36-42. [PMID: 23598950 DOI: 10.1183/09031936.00117312] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is controversy regarding the impact of chronic obstructive pulmonary disease (COPD) in clinical outcomes in elderly patients with pneumonia. Comorbidities such as cardiovascular disease have been reported to play an important role in patients with acute exacerbations of COPD. However, limited data are available regarding the impact of cardiovascular disease in elderly COPD patients who require hospitalisation for pneumonia. We examined a cohort of subjects with pneumonia and pre-existing COPD. Prior cardiovascular disease was defined as history of myocardial infarction, congestive heart failure, cardiac arrhythmia, unstable angina or stroke. Outcomes examined included 30-day, 90-day, 6-month and 1-year mortality. We included 17,140 elderly COPD patients who were hospitalised for pneumonia. Prior cardiovascular disease was present in 10 240 (59.7%) patients. Prior cardiovascular disease was independently associated with 90-day mortality (21.3% versus 19.4%; hazard ratio (HR) 1.29, 95% CI 1.02-1.17), 6-month mortality (29.0% versus 26.1%; HR 1.28, 95% CI 1.07-1.50) and 12-month mortality (39.2% versus 34.5%; HR 1.33, 95% CI 1.15-1.54) when compared to no prior cardiovascular disease. The temporal differential effect between groups increases from 1.0% at 30 days to 4.7% at 1 year. Prior cardiovascular disease is associated with increased long-term mortality in elderly COPD patients with pneumonia. Differences in mortality rates increased over time.
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Gupta D, Agarwal R, Aggarwal AN, Singh N, Mishra N, Khilnani GC, Samaria JK, Gaur SN, Jindal SK. Guidelines for diagnosis and management of community- and hospital-acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations. Lung India 2012; 29:S27-62. [PMID: 23019384 PMCID: PMC3458782 DOI: 10.4103/0970-2113.99248] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Dheeraj Gupta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - G. C. Khilnani
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - J. K. Samaria
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - S. N. Gaur
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - S. K. Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - for the Pneumonia Guidelines Working Group
- Pneumonia Guidelines Working Group Collaborators (43) A. K. Janmeja, Chandigarh; Abhishek Goyal, Chandigarh; Aditya Jindal, Chandigarh; Ajay Handa, Bangalore; Aloke G. Ghoshal, Kolkata; Ashish Bhalla, Chandigarh; Bharat Gopal, Delhi; D. Behera, Delhi; D. Dadhwal, Chandigarh; D. J. Christopher, Vellore; Deepak Talwar, Noida; Dhruva Chaudhry, Rohtak; Dipesh Maskey, Chandigarh; George D’Souza, Bangalore; Honey Sawhney, Chandigarh; Inderpal Singh, Chandigarh; Jai Kishan, Chandigarh; K. B. Gupta, Rohtak; Mandeep Garg, Chandigarh; Navneet Sharma, Chandigarh; Nirmal K. Jain, Jaipur; Nusrat Shafiq, Chandigarh; P. Sarat, Chandigarh; Pranab Baruwa, Guwahati; R. S. Bedi, Patiala; Rajendra Prasad, Etawa; Randeep Guleria, Delhi; S. K. Chhabra, Delhi; S. K. Sharma, Delhi; Sabir Mohammed, Bikaner; Sahajal Dhooria, Chandigarh; Samir Malhotra, Chandigarh; Sanjay Jain, Chandigarh; Subhash Varma, Chandigarh; Sunil Sharma, Shimla; Surender Kashyap, Karnal; Surya Kant, Lucknow; U. P. S. Sidhu, Ludhiana; V. Nagarjun Mataru, Chandigarh; Vikas Gautam, Chandigarh; Vikram K. Jain, Jaipur; Vishal Chopra, Patiala; Vishwanath Gella, Chandigarh
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Vila-Corcoles A, Ochoa-Gondar O. Pneumococcal vaccination among adults with chronic respiratory diseases: a historical overview. Expert Rev Vaccines 2012; 11:221-36. [PMID: 22309670 DOI: 10.1586/erv.11.176] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Streptococcus pneumoniae, the most common cause of community-acquired pneumonia, remains a major cause of morbidity and mortality worldwide. The presence of chronic respiratory illness is a major risk factor for pneumonia, and smoking (the most common cause of chronic obstructive pulmonary disease) is also an important risk factor for pneumonia and invasive pneumococcal disease. There are currently three established approaches to antipneumococcal vaccination: capsular polysaccharide pneumococcal vaccines (recommended for adults and some children at risk), protein-polysaccharide conjugate pneumococcal vaccines (classically recommended for infants and young children and currently under evaluation for adults aged 50 years or older for the prevention of invasive disease) and experimental protein-based pneumococcal vaccines (under investigation in animal models). Although patients with chronic respiratory diseases are commonly described as an at-risk population for pneumococcal infections, studies on pneumococcal vaccination efficacy in such patients are very limited and vaccination effectiveness remains controversial. This paper reviews available data on the efficacy and effectiveness of polysaccharide pneumococcal vaccination among adults with chronic respiratory diseases.
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Affiliation(s)
- Angel Vila-Corcoles
- Primary Care Service of Tarragona, EPIVAC Study Group, Institut Catala de la Salut, Prat de la Riba 39, 43001, Tarragona, Spain.
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Müllerova H, Chigbo C, Hagan GW, Woodhead MA, Miravitlles M, Davis KJ, Wedzicha JA. The natural history of community-acquired pneumonia in COPD patients: a population database analysis. Respir Med 2012; 106:1124-33. [PMID: 22621820 DOI: 10.1016/j.rmed.2012.04.008] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 04/06/2012] [Accepted: 04/23/2012] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients with Chronic Obstructive Pulmonary Disease (COPD) are at higher risk of developing Community-Acquired Pneumonia (CAP) than patients in the general population. However, no studies have been performed in general practice assessing longitudinal incidence rates for CAP in COPD patients or risk factors for pneumonia onset. METHODS A cohort of COPD patients aged ≥ 45 years, was identified in the General Research Practice Database (GPRD) between 1996 and 2005, and annual and 10-year incidence rates of CAP evaluated. A nested case-control analysis was performed, comparing descriptors in COPD patients with and without CAP using conditional logistic regression generating odds ratios (OR) and 95% confidence intervals (CI). RESULTS The COPD cohort consisted of 40,414 adults. During the observation period, 3149 patients (8%) experienced CAP, producing an incidence rate of 22.4 (95% CI 21.7-23.2) per 1000 person years. 92% of patients with pneumonia diagnosis had suffered only one episode. Multivariate modelling of pneumonia descriptors in COPD indicate that age over 65 years was significantly associated with increased risk of CAP. Other independent risk factors associated with CAP were co-morbidities including congestive heart failure (OR 1.4, 95% CI 1.2-1.6), and dementia (OR 2.6, 95%CI 1.9-3.). Prior severe COPD exacerbations requiring hospitalization (OR 2.7, 95% CI 2.3-3.2) and severe COPD requiring home oxygen or nebulised therapy (OR 1.4, 95% CI 1.1-1.6) were also significantly associated with risk of CAP. CONCLUSION COPD patients presenting in general practice with specific co-morbidities, severe COPD, and age >65 years are at increased risk of CAP.
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Affiliation(s)
- Hana Müllerova
- Worldwide Epidemiology, GlaxoSmithKline Research and Development, Building 9, Iron Bridge Road, Stockley Park West, Uxbridge, Middlesex UB11 1BT, UK.
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Vila-Corcoles A, Ochoa-Gondar O, Rodriguez-Blanco T, Gutierrez-Perez A, Vila-Rovira A. Clinical effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia in patients with chronic pulmonary diseases: a matched case-control study. Hum Vaccin Immunother 2012; 8:639-44. [PMID: 22634442 DOI: 10.4161/hv.19466] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The effectiveness of the 23-valent polysaccharide pneumococcal vaccine (PPV-23) is controversial, especially among people with high-risk conditions. This study assessed the clinical effectiveness of vaccination against pneumonia among patients with chronic pulmonary diseases. METHODS We conducted a population-based case-control study including 96 non-immunocompromised patients with clinical diagnosis of chronic pulmonary disease (chronic bronchitis, emphysema and/or asthma), aged 50 y or older, with radiographically confirmed pneumococcal pneumonia (19 bacteremic and 77 nonbacteremic cases) and 192 outpatient control subjects with similar chronic pulmonary diseases (matched by primary care center, age, sex and main comorbidity). Adjusted odds ratios (ORs) for vaccination were calculated using conditional logistic regression, controlling for by underlying conditions. RESULTS Pneumococcal vaccination did not alter significantly the risk of overall pneumococcal pneumonia [adjusted OR: 0.71; 95% confidence interval (CI): 0.37-1.39]. Point estimates of vaccine effectiveness was the maximum against bacteremic pneumococcal pneumonia due to vaccine-serotypes, although neither reached statistical significance (adjusted OR: 0.51; 95% CI: 0.03-8.19). Vaccination pointed to a smaller benefit against nonbacteremic pneumococcal pneumonia (adjusted OR: 0.66; 95% CI: 0.33-1.34). Pneumococcal vaccination was associated with a non-statistically significant reduction in the risk of all pneumococcal pneumonia among persons 75 y or older (adjusted OR: 0.45; 95% CI: 0.16-1.27), but no apparent protective effect emerged among people 50-74 y (adjusted OR: 1.48; 95% CI: 0.62-3.56). CONCLUSIONS The effectiveness of the PPV-23 in preventing pneumonia among patients with chronic pulmonary disease is uncertain. Our results point to PPV-23 having little or null effect against pneumococcal pneumonia in such patients, but definitive conclusions cannot be established based on our data.
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Affiliation(s)
- Angel Vila-Corcoles
- Primary Care Service of Tarragona-Valls, Institut Catalá de la Salut, Tarragona, Spain
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Abstract
OBJECTIVE To review the current knowledge of common comorbidities in the intensive care unit, including diabetes mellitus, chronic obstructive pulmonary disease, cancer, end-stage renal disease, end-stage liver disease, HIV infection, and obesity, with specific attention to epidemiology, contribution to diseases and outcomes, and the impact on treatments in these patients. DATA SOURCE Review of the relevant medical literature for specific common comorbidities in the critically ill. RESULTS Critically ill patients are admitted to the intensive care unit for various reasons, and often the admission diagnosis is accompanied by a chronic comorbidity. Chronic comorbid conditions commonly seen in critically ill patients may influence the decision to provide intensive care unit care, decisions regarding types and intensity of intensive care unit treatment options, and outcomes. The presence of comorbid conditions may predispose patients to specific complications or forms of organ dysfunction. The impact of specific comorbidities varies among critically ill medical, surgical, and other populations, and outcomes associated with certain comorbidities have changed over time. Specifically, outcomes for patients with cancer and HIV have improved, likely related to advances in therapy. Overall, the negative impact of chronic comorbidity on survival in critical illness may be primarily influenced by the degree of organ dysfunction or the cumulative severity of multiple comorbidities. CONCLUSION Chronic comorbid conditions are common in critically ill patients. Both the acute illness and the chronic conditions influence prognosis and optimal care delivery for these patients, particularly for adverse outcomes and complications influenced by comorbidities. Further work is needed to fully determine the individual and combined impact of chronic comorbidities on intensive care unit outcomes.
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Cillóniz C, Ewig S, Ferrer M, Polverino E, Gabarrús A, Puig de la Bellacasa J, Mensa J, Torres A. Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis. Crit Care 2011; 15:R209. [PMID: 21914220 PMCID: PMC3334753 DOI: 10.1186/cc10444] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 06/28/2011] [Accepted: 09/14/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The frequency and clinical significance of polymicrobial aetiology in community-acquired pneumonia (CAP) patients admitted to the ICU have been poorly studied. The aim of the present study was to describe the prevalence, clinical characteristics and outcomes of severe CAP of polymicrobial aetiology in patients admitted to the ICU. METHODS The prospective observational study included 362 consecutive adult patients with CAP admitted to the ICU within 24 hours of presentation; 196 (54%) patients had an established aetiology. RESULTS Polymicrobial infection was present in 39 (11%) cases (20% of those with defined aetiology): 33 cases with two pathogens, and six cases with three pathogens. The most frequently identified pathogens in polymicrobial infections were Streptococcus pneumoniae (n = 28, 72%), respiratory viruses (n = 15, 39%) and Pseudomonas aeruginosa (n = 8, 21%). Chronic respiratory disease and acute respiratory distress syndrome criteria were independent predictors of polymicrobial aetiology. Inappropriate initial antimicrobial treatment was more frequent in the polymicrobial aetiology group compared with the monomicrobial aetiology group (39% vs. 10%, P < 0.001), and was an independent predictor of hospital mortality (adjusted odds ratio = 10.79, 95% confidence interval = 3.97 to 29.30; P < 0.001). The trend for higher hospital mortality of the polymicrobial aetiology group compared with the monomicrobial aetiology group (n = 8, 21% versus n = 17, 11%), however, was not significantly different (P = 0.10). CONCLUSIONS Polymicrobial pneumonia occurs frequently in patients admitted to the ICU. This is a risk factor for inappropriate initial antimicrobial treatment, which in turn independently predicts hospital mortality.
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Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona-SGR 911-Ciber de Enfermedades Respiratorias, Villarroel 170, Barcelona 08036, Spain
| | - Santiago Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, EVK Herne und Augusta-Kranken-Anstalt Bochum, Bergstraße 26, 44791 Bochum, Germany
| | - Miquel Ferrer
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona-SGR 911-Ciber de Enfermedades Respiratorias, Villarroel 170, Barcelona 08036, Spain
| | - Eva Polverino
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona-SGR 911-Ciber de Enfermedades Respiratorias, Villarroel 170, Barcelona 08036, Spain
| | - Albert Gabarrús
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona-SGR 911-Ciber de Enfermedades Respiratorias, Villarroel 170, Barcelona 08036, Spain
| | | | - Josep Mensa
- Department of Infectious Disease, Hospital Clinic of Barcelona, Villarroel 170, Barcelona 08036, Spain
| | - Antoni Torres
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona-SGR 911-Ciber de Enfermedades Respiratorias, Villarroel 170, Barcelona 08036, Spain
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Chalmers JD, Taylor JK, Singanayagam A, Fleming GB, Akram AR, Mandal P, Choudhury G, Hill AT. Epidemiology, Antibiotic Therapy, and Clinical Outcomes in Health Care-Associated Pneumonia: A UK Cohort Study. Clin Infect Dis 2011; 53:107-13. [DOI: 10.1093/cid/cir274] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fernández-Serrano S, Dorca J, Garcia-Vidal C, Fernández-Sabé N, Carratalà J, Fernández-Agüera A, Corominas M, Padrones S, Gudiol F, Manresa F. Effect of corticosteroids on the clinical course of community-acquired pneumonia: a randomized controlled trial. Crit Care 2011; 15:R96. [PMID: 21406101 PMCID: PMC3219361 DOI: 10.1186/cc10103] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/04/2010] [Accepted: 03/15/2011] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The benefit of corticosteroids as adjunctive treatment in patients with severe community-acquired pneumonia (CAP) requiring hospital admission remains unclear. This study aimed to evaluate the impact of corticosteroid treatment on outcomes in patients with CAP. METHODS This was a prospective, double-blind and randomized study. All patients received treatment with ceftriaxone plus levofloxacin and methyl-prednisolone (MPDN) administered randomly and blindly as an initial bolus, followed by a tapering regimen, or placebo. RESULTS Of the 56 patients included in the study, 28 (50%) were treated with concomitant corticosteroids. Patients included in the MPDN group show a more favourable evolution of the pO2/FiO2 ratio and faster decrease of fever, as well as greater radiological improvement at seven days. The time to resolution of morbidity was also significantly shorter in this group. Six patients met the criteria for mechanical ventilation (MV): five in the placebo group (22.7%) and one in the MPDN group (4.3%). The duration of MV was 13 days (interquartile range 7 to 26 days) for the placebo group and three days for the only case in the MPDN group. The differences did not reach statistical significance. Interleukin (IL)-6 and C-reactive protein (CRP) showed a significantly quicker decrease after 24 h of treatment among patients treated with MPDN. No differences in mortality were found among groups. CONCLUSIONS MPDN treatment, in combination with antibiotics, improves respiratory failure and accelerates the timing of clinical resolution of severe CAP needing hospital admission. TRIAL REGISTRATION International Standard Randomized Controlled Trials Register, ISRCTN22426306.
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Affiliation(s)
- Silvia Fernández-Serrano
- Respiratory Medicine Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
| | - Jordi Dorca
- Respiratory Medicine Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
- CIBER de Enfermedades Respiratorias ISCIII, Madrid, Spain (Spanish Network for the Research in Respiratory Diseases), Recinto Hospitalario Joan March, Carretera Sóller Km 12; 07110 Bunyola, Mallorca, Spain
| | - Carolina Garcia-Vidal
- Infectious Disease Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
- REIPI (Spanish Network for the Research in Infectious Diseases), Fundación Reina Mercedes, Edificio de los laboratorios 6a pl; Av. Manuel Siurot s/n; 41013 Sevilla, Spain
| | - Núria Fernández-Sabé
- Infectious Disease Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
| | - Jordi Carratalà
- Infectious Disease Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
- REIPI (Spanish Network for the Research in Infectious Diseases), Fundación Reina Mercedes, Edificio de los laboratorios 6a pl; Av. Manuel Siurot s/n; 41013 Sevilla, Spain
| | - Ana Fernández-Agüera
- Respiratory Medicine Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
- Infectious Disease Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
| | - Mercè Corominas
- Immunology Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
| | - Susana Padrones
- Respiratory Medicine Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
| | - Francesc Gudiol
- Infectious Disease Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
- REIPI (Spanish Network for the Research in Infectious Diseases), Fundación Reina Mercedes, Edificio de los laboratorios 6a pl; Av. Manuel Siurot s/n; 41013 Sevilla, Spain
| | - Frederic Manresa
- Respiratory Medicine Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Barcelona, Spain
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Myint PK, Lowe D, Stone RA, Buckingham RJ, Roberts CM. UK National COPD Resources and Outcomes Project 2008: Patients with Chronic Obstructive Pulmonary Disease Exacerbations Who Present with Radiological Pneumonia Have Worse Outcome Compared to Those with Non-Pneumonic Chronic Obstructive Pulmonary Disease Exacerbations. Respiration 2011; 82:320-7. [DOI: 10.1159/000327203] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 02/17/2011] [Indexed: 11/19/2022] Open
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Porter SR, Czaplicki G, Mainil J, Horii Y, Misawa N, Saegerman C. Q fever in Japan: an update review. Vet Microbiol 2010; 149:298-306. [PMID: 21146331 DOI: 10.1016/j.vetmic.2010.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 11/02/2010] [Accepted: 11/09/2010] [Indexed: 10/18/2022]
Abstract
As neglected zoonosis for many years, Q fever is now ubiquitous in Japan. Similarly to elsewhere in the world, domestic animals are considered to be important reservoirs of the causal agent, Coxiella burnetii, a resistant intracellular bacterium. Infected animals shed bacteria in milk, feces, urine, vaginal mucous and birth products. Inhalation of bacteria present in the environment is the main route of animal and human infection. Shedding of C. burnetii in milk by domestic ruminants has a very limited impact as raw milk is seldom ingested by the Japanese population. The clinical expression of Q fever in Japan is similar to its clinical expression elsewhere. However clinical cases in children are more frequently reported in this country. Moreover, C. burnetii is specified as one of the causative organisms of atypical pneumonia in the Japanese Respiratory Society Guideline for the management of community-acquired pneumonia. In Japan, C. burnetii isolates are associated with acute illness and are mainly of moderate to low virulence. Cats are considered a significant source of C. burnetii responsible for human outbreaks in association with the presence of infected parturient cats. Since its recognition as a reportable disease in 1999, 7-46 clinical cases of Q fever have been reported by year. The epidemiology of Q fever in Japan remains to be elucidated and the exact modes of transmission are still unproven. Important further research is necessary to improve knowledge of the disease itself, the endogenous hosts and reservoirs, and the epidemiological cycle of coxiellosis in Japan.
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Affiliation(s)
- Sarah Rebecca Porter
- Research Unit in Epidemiology and Risk Analysis applied to Veterinary Sciences (UREAR), Department of Infectious and Parasitic Diseases, Faculty of Veterinary Medicine, University of Liege, Boulevard de Colonster 20, B42, 4000 Liege, Belgium
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Walters JA, Smith S, Poole P, Granger RH, Wood-Baker R. Injectable vaccines for preventing pneumococcal infection in patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2010:CD001390. [PMID: 21069668 DOI: 10.1002/14651858.cd001390.pub3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND As chronic obstructive pulmonary disease (COPD) progresses, exacerbations can occur with increasing frequency. One goal of therapy is to prevent these exacerbations, thereby reducing morbidity and associated healthcare costs. Pneumococcal vaccinations are one strategy for reducing the risk of infective exacerbations. OBJECTIVES To determine the safety and efficacy of pneumococcal vaccination in COPD. The primary outcomes assessed were episodes of pneumonia and acute exacerbations. Secondary outcomes of interest included hospital admissions, adverse events related to treatment, disability, change in lung function, mortality, and cost effectiveness. SEARCH STRATEGY We searched the Cochrane Airways Group COPD trials register and the databases CENTRAL, MEDLINE and EMBASE using pre-specified terms. The latest searches were performed in March 2010. SELECTION CRITERIA Randomised controlled trials assessing the effects of injectable pneumococcal vaccine in people with COPD were included. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and three review authors independently assessed trial quality. MAIN RESULTS Seven studies were identified that met the inclusion criteria for this review and were included in the 2010 review update. Two older trials used a 14-valent vaccine and five more recent trials used a 23-valent injectable vaccine.In six studies involving 1372 people, the reduction in likelihood of developing pneumonia with pneumococcal vaccination compared to control did not achieve statistical significance, the odds ratio (OR) was 0.72 (95% confidence interval (CI) 0.51 to 1.01), with moderate heterogeneity present between studies. The reduction in likelihood of acute exacerbations of COPD from two studies involving 216 people was not statistically significant (Peto OR 0.58; 95% CI 0.30 to 1.13).Of the secondary outcomes for which data were available there was no statistically significant effect for reduction in hospital admissions (two studies) or emergency department visits (one study). There was no significant reduction in pooled results from three studies involving 888 people for odds of all-cause mortality for periods up to 48 months post-vaccination (OR 0.94; 95% CI 0.67 to 1.33), or for death from cardiorespiratory causes (OR 1.07; 95% CI 0.69 to 1.66). AUTHORS' CONCLUSIONS The limited evidence from randomised controlled trials (RCTs) included in this review suggests that, while it is possible that injectable polyvalent pneumococcal vaccines may provide some protection against morbidity in persons with COPD, no significant effect on any of the outcomes was shown. Further large RCTs in this population would be needed to confirm effectiveness of the vaccine suggested by results from longitudinal studies.
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Affiliation(s)
- Julia Ae Walters
- Menzies Research Institute, University of Tasmania, MS1, 17 Liverpool Street, PO Box 23, Hobart, Tasmania, Australia, 7001
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Menéndez R, Torres A, Aspa J, Capelastegui A, Prat C, Rodríguez de Castro F. Community-Acquired Pneumonia. New Guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1579-2129(11)60008-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Strålin K, Olcén P, Törnqvist E, Holmberg H. Definite, probable, and possible bacterial aetiologies of community-acquired pneumonia at different CRB-65 scores. ACTA ACUST UNITED AC 2010; 42:426-34. [PMID: 20141490 DOI: 10.3109/00365540903552353] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
According to the recommendations of the Swedish Community-Acquired Pneumonia (CAP) guidelines, the selection of empirical antibiotic therapy should be based on the CRB-65 rule. The guidelines recommend empirical therapy directed predominantly against Streptococcus pneumoniae for patients with low CRB-65 scores and broad-spectrum therapy for patients with high CRB-65 scores. In order to study the utility of the recommendations, we analyzed the data from an aetiological study previously performed on 235 hospitalized adult CAP patients at our medical centre. A definite, probable, or possible bacterial aetiology was noted in 194 cases (83%), including 112 cases (48%) with S. pneumoniae aetiology. The following frequencies of definite-probable aetiologies were noted in the patients with CRB-65 score 0-1 (n=155) and CRB-65 score 2-4 (n=80): S. pneumoniae 30% and 35%, Haemophilus influenzae 6.5% and 14% (p=0.063), Mycoplasma pneumoniae 15% and 5.0% (p=0.019), Chlamydophila species 2.6% and 1.2%, Legionella pneumophila 1.9% and 0%, and Staphylococcus aureus 1.3% and 1.2%, respectively. The high frequency of S. pneumoniae in the study supports the recommendations to predominantly cover this bacterium in the empirical therapy of patients with low CRB-65 scores. In the case of treatment failure in these patients, the study indicates that coverage against M. pneumoniae and H. influenzae should be considered.
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Affiliation(s)
- Kristoffer Strålin
- Department of Infectious Diseases, Orebro University Hospital, Orebro, Sweden.
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Menéndez R, Torres A, Aspa J, Capelastegui A, Prat C, Rodríguez de Castro F. [Community acquired pneumonia. New guidelines of the Spanish Society of Chest Diseases and Thoracic Surgery (SEPAR)]. Arch Bronconeumol 2010; 46:543-58. [PMID: 20832928 DOI: 10.1016/j.arbres.2010.06.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 06/18/2010] [Indexed: 10/19/2022]
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Singanayagam A, Chalmers JD, Hill AT. Inhaled corticosteroids and risk of pneumonia: evidence for and against the proposed association. QJM 2010; 103:379-85. [PMID: 20231237 DOI: 10.1093/qjmed/hcq023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Inhaled corticosteroids (ICS) are commonly used in the treatment of chronic obstructive pulmonary disease. Recent large prospective trials have reported an increased incidence of pneumonia in patients treated with ICS. Despite this, the link between ICS and pneumonia remains controversial. In this review, pro and con arguments for the association between ICS and increased pneumonia risk are discussed, drawing on evidence from experimental and clinical research.
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Affiliation(s)
- A Singanayagam
- Department of Respiratory medicine, Royal Infirmary of Edinburg, 51 Little France crescent, Edinburgh EHI64SA, UK.
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Utility of pneumococcal urinary antigen detection in diagnosing exacerbations in COPD patients. Respir Med 2010; 104:397-403. [DOI: 10.1016/j.rmed.2009.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Revised: 10/05/2009] [Accepted: 10/19/2009] [Indexed: 11/21/2022]
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Jeong SW, Lee JH, Choi KJ, Hwangbo Y, Kim YY, Lee YJ, Yoon WK, Kim M, Cha SI, Park JY, Jung TH, Kim CH. Comparisons of Clinical Characteristics and Outcomes in COPD Patients Hospitalized with Community-acquired Pneumonia and Acute Exacerbation. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.69.1.31] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Seung Wook Jeong
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Hee Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Keum Ju Choi
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yup Hwangbo
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yi Young Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yun Ji Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Won Kyung Yoon
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Min Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sung Ick Cha
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Yong Park
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae Hoon Jung
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Chang Ho Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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42
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Daubin C, Parienti JJ, Fradin S, Vabret A, Ramakers M, Terzi N, Freymuth F, Charbonneau P, du Cheyron D. Procalcitonin levels and bacterial aetiology among COPD patients admitted to the ICU with severe pneumonia: a prospective cohort study. BMC Infect Dis 2009; 9:157. [PMID: 19772586 PMCID: PMC2754485 DOI: 10.1186/1471-2334-9-157] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 09/21/2009] [Indexed: 02/06/2023] Open
Abstract
Background Serum procalcitonin (PCT) is considered useful in predicting the likeliness of developing bacterial infections in emergency setting. In this study, we describe PCT levels overtime and their relationship with bacterial infection in chronic obstructive pulmonary disease (COPD) critically ill patients with pneumonia. Methods We conducted a prospective cohort study in an ICU of a University Hospital. All consecutive COPD patients admitted for pneumonia between September 2005 and September 2006 were included. Respiratory samples were tested for the presence of bacteria and viruses. Procalcitonin was sequentially assessed and patients classified according to the probability of the presence of a bacterial infection. Results Thirty four patients were included. The PCT levels were assessed in 32/34 patients, median values were: 0.493 μg/L [IQR, 0.131 to 1.471] at the time of admission, 0.724 μg/L [IQR, 0.167 to 2.646] at six hours, and 0.557 μg/L [IQR, 0.123 to 3.4] at 24 hours. The highest PCT (PCTmax) levels were less than 0.1 μg/L in 3/32 (9%) patients and greater than 0.25 μg/L in 22/32 (69%) patients, suggesting low and high probability of bacterial infection, respectively. Fifteen bacteria and five viruses were detected in 15/34 (44%) patients. Bacteria were not detected in patients with PCTmax levels < 0.1 μg/L. In contrast, bacteria were detected in 4/7 (57%) patients estimated unlikely to have a bacterial infection by PCT levels (PCTmax > 0.1 and < 0.25 μg/L). Conclusion Based on these results we suggest that a PCT level cut off > 0.1 μg/L may be more appropriate than 0.25 μg/L (previously proposed for non severe lower respiratory tract infection) to predict the probability of a bacterial infection in severe COPD patients with pneumonia. Further studies testing procalcitonin-based antibiotic strategies are needed in COPD patients with severe pneumonia.
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Affiliation(s)
- Cédric Daubin
- The Department of Medical Intensive Care, Caen University Hospital, 14033 Caen Cedex, France.
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Garcia-Vidal C, Carratalà J, Fernández-Sabé N, Dorca J, Verdaguer R, Manresa F, Gudiol F. Aetiology of, and risk factors for, recurrent community-acquired pneumonia. Clin Microbiol Infect 2009; 15:1033-8. [PMID: 19673961 DOI: 10.1111/j.1469-0691.2009.02918.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recurrent community-acquired pneumonia (CAP) requiring hospitalization is a matter of particular concern. However, current information on its prevalence, aetiology and risk factors is lacking. To address these issues, we performed an observational analysis of a prospective cohort of hospitalized adults with CAP. Recurrence was defined as two or more episodes of CAP 1 month apart within 3 years. Patients with severe immunosuppression or local predisposing factors were excluded. Of the 1556 patients, 146 (9.4%) had recurrent CAP. The most frequent causative organism was Streptococcus pneumoniae, both in patients with recurrent CAP and in those without recurrence. Haemophilus influenzae, other Gram-negative bacilli and aspiration pneumonia were more frequent among patients with recurrent CAP, whereas Legionella pneumophila was rarely identified in this group. Independent factors associated with recurrent CAP were greater age, lack of pneumococcal vaccination, chronic obstructive pulmonary disease (COPD) and corticosteroid therapy. In a sub-analysis of 389 episodes of pneumococcal pneumonia, the only independent risk factor for recurrence was lack of pneumococcal vaccination. Recurrence of CAP is not a rare clinical problem and it occurs mainly in the elderly, patients with COPD, and those receiving corticosteroids. Our study provides support for recommending pneumococcal vaccination for adults at risk of pneumonia, including those with a first episode of CAP.
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Affiliation(s)
- C Garcia-Vidal
- Infectious Disease, Institut d'Investigació Biomèdica de Bellvitge-Hospital Universitari de Bellvitge (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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44
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Molinos L, Clemente MG, Miranda B, Alvarez C, del Busto B, Cocina BR, Alvarez F, Gorostidi J, Orejas C. Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease. J Infect 2009; 58:417-24. [PMID: 19329187 DOI: 10.1016/j.jinf.2009.03.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 03/02/2009] [Accepted: 03/05/2009] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to analyse the possible differences, especially those regarding mortality, between patients hospitalized for community-acquired pneumonia (CAP) with and without chronic obstructive pulmonary disease (COPD), and the risk factors related to mortality in the COPD group. METHODS 710 patients with CAP were included in a prospective multicenter observational study. 244 of the patients had COPD confirmed by spirometry. RESULTS COPD was associated with mortality in patients with CAP (OR=2.62 CI: 1.08-6.39). Patients with COPD and CAP had a significantly higher 30-day mortality rate as compared to patients without COPD. Multivariate analysis showed that PaO(2)< or =60 mmHg (OR=7.95; 95% CI: 3.40-27.5), PaCO(2)> or =45 mmHg (OR=4.6; CI: 2.3-15.1); respiratory rate > or =30/min (OR=12.25; CI: 3.45-35.57), pleural effusion (OR=8.6; 95% CI: 2.01-24.7), septic shock (OR=12.6; 95% CI: 3.4-45.66) and renal failure (OR=13.4; 95% CI: 3.2-37.8) were significantly related to mortality. Purulent sputum and fever were considered as protective factors. CONCLUSIONS COPD was an independent risk factor for mortality in patients with CAP. Hypoxemia and hypercapnia are associated with mortality in patients with CAP with and without COPD. Chronic obstructive pulmonary disease and PaCO(2) value could be useful prognostic factors and should be incorporated in risk stratification in patients with CAP.
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Affiliation(s)
- L Molinos
- Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Spain.
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45
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Jorge RZ, Bonilla AG. Comorbilidad infecciosa en la EPOC. Arch Bronconeumol 2009; 45 Suppl 4:59-64. [DOI: 10.1016/s0300-2896(09)72867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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46
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File TM, Monte SV, Schentag JJ, Paladino JA, Klugman KP, Lavin B, Yu VL, Singer ME, Adelman MH. A disease model descriptive of progression between chronic obstructive pulmonary disease exacerbations and community-acquired pneumonia: roles for underlying lung disease and the pharmacokinetics/pharmacodynamics of the antibiotic. Int J Antimicrob Agents 2009; 33:58-64. [DOI: 10.1016/j.ijantimicag.2008.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 07/16/2008] [Accepted: 07/17/2008] [Indexed: 11/16/2022]
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Ko FW, Ip M, Chan PK, Ng SS, Chau S, Hui DS. A one-year prospective study of infectious etiology in patients hospitalized with acute exacerbations of COPD and concomitant pneumonia. Respir Med 2008; 102:1109-16. [PMID: 18573648 PMCID: PMC7127638 DOI: 10.1016/j.rmed.2008.03.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 03/18/2008] [Accepted: 03/18/2008] [Indexed: 12/04/2022]
Abstract
AIM This study assessed the infectious etiology of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with concomitant pneumonia. METHODS Patients admitted to medical wards in an acute hospital were recruited prospectively from May 1, 2004 to April 30, 2005. Sputum culture, blood culture, paired serology, and nasopharyngeal aspirates (NPA) viral culture and polymerase chain reaction (PCR) studies were performed. Spirometry was assessed in stable phase at 2-3 months post-hospital discharge. RESULTS Seventy eight subjects were admitted for AECOPD with concomitant pneumonia. The mean (SD) age was 77.1 (7.5) years, with FEV(1) of 41.5 (20.8)% predicted normal. Overall, an infectious etiology could be established in 48.7% of the subjects. Among the 71 subjects with sputum collected, 40.8% had positive bacterial culture. The commonest bacteria identified were Streptococcus pneumoniae (8[11.3%]), Pseudomonas aeruginosa (7[9.9%]) and Haemophilus influenzae (7[9.9%]). Among the 66 subjects with NPA collected, 9.0 and 12.2% had positive viral culture and PCR results, respectively. The commonest viruses identified by NPA PCR were influenza A (4[6.1%] subjects) and rhinovirus (2[3.0%]). Paired serology was positive in 4.4%. Patients on high dose inhaled corticosteroid (ICS) (>1000 mcg beclomethasone-equivalent/day) had a higher rate of positive sputum bacterial culture than those on low-medium dose of ICS (50.0% vs 18.2%, p=0.02). CONCLUSION An infectious etiology could be established in about half of patients hospitalized with AECOPD and concomitant pneumonia. The majority of identifiable causes were bacterial. Patients on high dose ICS might have impaired airway defense as reflected by the higher rate of positive sputum culture.
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MESH Headings
- Acute Disease
- Aged
- Aged, 80 and over
- Female
- Forced Expiratory Volume
- Hospitalization
- Humans
- Length of Stay/statistics & numerical data
- Male
- Nasopharynx/virology
- Pneumonia, Bacterial/complications
- Pneumonia, Bacterial/microbiology
- Pneumonia, Bacterial/physiopathology
- Pneumonia, Viral/complications
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/virology
- Positive-Pressure Respiration/statistics & numerical data
- Prognosis
- Prospective Studies
- Pulmonary Disease, Chronic Obstructive/microbiology
- Pulmonary Disease, Chronic Obstructive/physiopathology
- Pulmonary Disease, Chronic Obstructive/therapy
- Sputum/microbiology
- Vital Capacity
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Affiliation(s)
- Fanny W.S. Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Paul K.S. Chan
- Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - Susanna S.S. Ng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - S.S. Chau
- Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
| | - David S.C. Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
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Restrepo MI, Mortensen EM, Velez JA, Frei C, Anzueto A. A Comparative Study of Community-Acquired Pneumonia Patients Admitted to the Ward and the ICU. Chest 2008; 133:610-7. [DOI: 10.1378/chest.07-1456] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Effectiveness of pneumococcal vaccination in older adults with chronic respiratory diseases: results of the EVAN-65 study. Vaccine 2008; 26:1955-62. [PMID: 18343541 DOI: 10.1016/j.vaccine.2008.02.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 01/26/2008] [Accepted: 02/07/2008] [Indexed: 11/21/2022]
Abstract
A prospective cohort study evaluating the clinical effectiveness of the 23-valent pneumococcal polysaccharide vaccine was conducted among 1298 Spanish older adults with chronic respiratory diseases (bronchitis, emphysema or asthma) who were followed between 2002 and 2005. Main outcomes were all-cause community-acquired pneumonia (CAP) and 30 days mortality from CAP. The association between vaccination and the risk of each outcome was evaluated by multivariable Cox proportional-hazard models adjusted for age and comorbidity pneumococcal vaccination did not alter significantly the risk of overall CAP (hazard ratio [HR]: 0.77; 95% confidence interval [CI]: 0.56-1.07) and 30 days mortality from CAP (HR: 0.87; 95% CI: 0.33-2.28). However, a borderline significant reduction of 30% in the risk of all-cause hospitalisation for CAP was observed among vaccinated subjects (HR: 0.70; 95% CI: 0.48-1.00; p=0.052). The effectiveness of the vaccine on the combined endpoint of pneumococcal and unknown organism infections reached 34% (HR: 0.66; 95% CI: 0.43-1.01; p=0.059). Although our findings suggest moderate benefits from the vaccination, the evidence of clinical effectiveness appears limited.
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Marriott HM, Jackson LE, Wilkinson TS, Simpson AJ, Mitchell TJ, Buttle DJ, Cross SS, Ince PG, Hellewell PG, Whyte MKB, Dockrell DH. Reactive oxygen species regulate neutrophil recruitment and survival in pneumococcal pneumonia. Am J Respir Crit Care Med 2008; 177:887-95. [PMID: 18202350 DOI: 10.1164/rccm.200707-990oc] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RATIONALE The role of NADPH oxidase activation in pneumonia is complex because reactive oxygen species contribute to both microbial killing and regulation of the acute pulmonary infiltrate. The relative importance of each role remains poorly defined in community-acquired pneumonia. OBJECTIVES We evaluated the contribution of NADPH oxidase-derived reactive oxygen species to the pathogenesis of pneumococcal pneumonia, addressing both the contribution to microbial killing and regulation of the inflammatory response. METHODS Mice deficient in the gp91(phox) component of the phagocyte NADPH oxidase were studied after pneumococcal challenge. MEASUREMENTS AND MAIN RESULTS gp91(phox)(-/-) mice demonstrated no defect in microbial clearance as compared with wild-type C57BL/6 mice. A significant increase in bacterial clearance from the lungs of gp91(phox)(-/-) mice was associated with increased numbers of neutrophils in the lung, lower rates of neutrophil apoptosis, and enhanced activation. Marked alterations in pulmonary cytokine/chemokine expression were also noted in the lungs of gp91(phox)(-/-) mice, characterized by elevated levels of tumor necrosis factor-alpha, KC, macrophage inflammatory protein-2, monocyte chemotactic protein-1, and IL-6. The greater numbers of neutrophils in gp91(phox)(-/-) mice were not associated with increased lung injury. Levels of neutrophil elastase in bronchoalveolar lavage were not decreased in gp91(phox)(-/-) mice. CONCLUSIONS During pneumococcal pneumonia, NADPH oxidase-derived reactive oxygen species are redundant for host defense but limit neutrophil recruitment and survival. Decreased NADPH oxidase-dependent reactive oxygen species production is well tolerated and improves disease outcome during pneumococcal pneumonia by removing neutrophils from the tight constraints of reactive oxygen species-mediated regulation.
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Affiliation(s)
- Helen M Marriott
- Section of Infection and Inflammation, School of Medicine and Biomedical Sciences, University of Sheffield, LU107, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
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