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Mata-Moreno G, Bernal-Silva S, García-Sepúlveda CA, González-Ortíz AM, Ochoa-Pérez UR, Medina-Serpa AU, Pérez-González LF, Noyola DE. Population-based Influenza and Respiratory Syncytial Virus Hospitalizations and In-hospital Mortality Rates Among Mexican Children Less Than Five Years of Age. Pediatr Infect Dis J 2024; 43:493-497. [PMID: 38359346 DOI: 10.1097/inf.0000000000004269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Population-based information regarding the impact of respiratory syncytial virus (RSV) and influenza on hospital admissions and mortality is scant for many countries. METHODS Prospective testing of RSV and influenza virus was undertaken in patients <5 years old admitted to hospital with acute respiratory infection (ARI) between July, 2014 and June, 2015, and mortality rates for children living in 3 municipalities in the state of San Luis Potosí were calculated. RESULTS During the 12-month study period, 790 children living in these municipalities were admitted with ARI. RSV was detected in 245 (31%) and influenza in 47 (5.9%). History of preterm birth was recorded for 112 children on admission. For children <5 years old, ARI-, RSV- and influenza-associated admission rates were 23.2, 7.2 and 1.4 (per 1000 population), respectively. The corresponding admission rates per 1000 infants <1 year old were 78, 25.2 and 4.4. Preterm infant admission rates were 2 times higher than those of term infants. Six children died; RSV was detected in 4 (66.6%) of the deceased, while no deaths were associated with influenza. ARI and RSV in-hospital mortality rates for children <5 years were 0.18 and 0.12 per 1000 population. ARI and RSV mortality rates in preterm infants were 7 and 14 times higher than in term infants, respectively. CONCLUSIONS RSV was associated with both high admission and in-hospital mortality rates in children <5 years old. Specific interventions, such as active or passive immunization, to prevent RSV infections are required to reduce ARI-associated infant mortality.
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Affiliation(s)
- Gabriel Mata-Moreno
- From the Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
- Centro de Investigación en Ciencias de la Salud y Biomedicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Sofía Bernal-Silva
- From the Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
- Centro de Investigación en Ciencias de la Salud y Biomedicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Christian A García-Sepúlveda
- Viral and Human Genomics Laboratory, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | | | - Uciel R Ochoa-Pérez
- From the Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | | | | | - Daniel E Noyola
- From the Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
- Centro de Investigación en Ciencias de la Salud y Biomedicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
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Trobajo-Sanmartín C, Navascués A, Fernández-Huerta M, Martínez-Baz I, Casado I, Ezpeleta C, Castilla J. Prevalence of Respiratory Viral Infections in Deceased Persons during the COVID-19 Pandemic Season 2021-2022: A Population-Based Observational Study. Viruses 2024; 16:533. [PMID: 38675876 PMCID: PMC11053769 DOI: 10.3390/v16040533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Although the omicron variant of SARS-CoV-2 circulated intensely during the 2021-2022 season, many patients with severe acute respiratory disease tested negative for COVID-19. The aim of this study was to assess the presence of different respiratory viruses in deceased persons. The proportion of deceased persons with respiratory viral infections in the 2021-2022 season in Navarre, Spain, was estimated considering all deaths caused by confirmed COVID-19 according to the epidemiological surveillance and the results of multiplex PCR tests for respiratory viruses performed in a sample of deceased persons with a cause of death other than COVID-19. Of 3578 deaths, 324 (9.1%) were initially reported as caused by pre-mortem confirmed COVID-19. A sample of 242 persons who died by causes other than COVID-19 were tested post-mortem; 64 (26.4%) of them were positive for any respiratory virus: 11.2% for SARS-CoV-2, 5.8% for rhinovirus, 3.7% for human coronavirus, 2.5% for metapneumovirus, 1.7% for respiratory syncytial virus, 1.7% for parainfluenza, 1.2% for influenza, and less than 1% each for adenovirus and bocavirus. Combining both approaches, we estimated that 34.4% of all deceased persons during the study period had a respiratory viral infection and 19.2% had SARS-CoV-2. Only 33.3% (9/27) of SARS-CoV-2 and 5.0% (2/40) of other viruses detected post-mortem had previously been confirmed pre-mortem. In a period with very intense circulation of SARS-CoV-2 during the pandemic, other respiratory viruses were also frequently present in deceased persons. Some SARS-CoV-2 infections and most other viral infections were not diagnosed pre-mortem. Several respiratory viruses may contribute to excess mortality in winter.
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Affiliation(s)
- Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain (I.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
| | - Ana Navascués
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Miguel Fernández-Huerta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain (I.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain (I.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
| | - Carmen Ezpeleta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain (I.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
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Bohrmann B, Massa MS, Ross S, Lewington S, Lacey B. Body Mass Index and Risk of Hospitalization or Death Due to Lower or Upper Respiratory Tract Infection. JAMA 2023; 329:1512-1514. [PMID: 37129662 PMCID: PMC10155062 DOI: 10.1001/jama.2023.2619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This study assesses the associations between body mass index and risk of hospitalization for or death due to COVID-19, lower respiratory tract infections, and upper respiratory tract infections.
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Affiliation(s)
- Bastian Bohrmann
- Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - M Sofia Massa
- Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Stephanie Ross
- Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Sarah Lewington
- Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Ben Lacey
- Nuffield Department of Population Health, University of Oxford, Oxford, England
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4
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Harris E. Early Respiratory Infections Tied to Premature Death Later in Life. JAMA 2023; 329:1053. [PMID: 36920427 DOI: 10.1001/jama.2023.3307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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O’Neal HR, Sheybani R, Caffery TS, Hamer D, Laperouse LM, Musso MW, O’Neal CS, Tse HTK, Shah AM, Thomas CB. Assessment of a cellular host response test to risk-stratify suspected COVID-19 patients in the Emergency Department setting. PLoS One 2022; 17:e0264220. [PMID: 35294441 PMCID: PMC8926179 DOI: 10.1371/journal.pone.0264220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/04/2022] [Indexed: 01/08/2023] Open
Abstract
Objective Assess the IntelliSep Index (ISI) for risk stratification of patients presenting to the Emergency Department (ED) with respiratory symptoms suspected of COVID-19 during the pandemic. Methods An observational single-center study of prospective cohort of patients presenting to the ED during the early COVID-19 pandemic with respiratory symptoms and a CBC drawn within 4.5 hours of initial vital signs. A sample of this blood was aliquoted for performance of the ISI, and patients were followed for clinical outcomes. The study required no patient-centered activity beyond standard of care and treating clinicians were unaware of study enrollment and ISI test results. Main findings 282 patients were included. The ISI ranges 0.1 to 10.0, with three interpretation bands indicating risk of adverse outcome: low (green), 0.1–4.9; intermediate (yellow), 5.0–6.2; and high (red), 6.3–10.0. Of 193 (68.4%) tested for SARS-CoV-2, 96 (49.7%) were positive. The ISI resulted in 182 (64.5%) green, 54 (18.1%) yellow, and 46 (15.6%) red band patients. Green band patients had a 1.1% (n = 2) 3-day mortality, while yellow and red band had 3.7% (n = 2, p > .05) and 10.9% (n = 5, p < .05) 3-day mortalities, respectively. Fewer green band patients required admission (96 [52.7%]) vs yellow (44 [81.5%]) and red (43 [93.5%]). Green band patients had more hospital free days (median 23 (Q1-Q3 20–25) than yellow (median 22 [Q1-Q3 0–23], p < 0.05) and red (median 21 [Q1-Q3 0–24], p < 0.01). SOFA increased with interpretation band: green (2, [Q1-Q3 0–4]) vs yellow (4, [Q1-Q3 2–5], p < 0.001) and red (5, [Q1-Q3 3–6]) p < 0.001). Conclusions The ISI rapidly risk-stratifies patients presenting to the ED during the early COVID-19 pandemic with signs or suspicion of respiratory infection.
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Affiliation(s)
- Hollis R. O’Neal
- Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
| | - Roya Sheybani
- Cytovale, Inc., San Francisco, California, United States of America
- * E-mail:
| | - Terrell S. Caffery
- Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
| | - Diana Hamer
- Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
| | - L. Mark Laperouse
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
| | - Mandi W. Musso
- Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
| | - Catherine S. O’Neal
- Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
| | - Henry T. K. Tse
- Cytovale, Inc., San Francisco, California, United States of America
| | - Ajay M. Shah
- Cytovale, Inc., San Francisco, California, United States of America
| | - Christopher B. Thomas
- Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States of America
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States of America
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Saravanos GL, Hsu P, Isaacs D, Macartney K, Wood NJ, Britton PN. Respiratory Syncytial Virus-attributable Deaths in a Major Pediatric Hospital in New South Wales, Australia, 1998-2018. Pediatr Infect Dis J 2022; 41:186-191. [PMID: 34845151 DOI: 10.1097/inf.0000000000003398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infection and an important contributor to child mortality. In this study, we estimated the frequency and described the clinical features of RSV-attributable deaths in Australian children. METHODS We conducted a retrospective observational study of RSV-associated deaths in hospitalized children <16 years of age over a 21-year period (1998-2018) in a pediatric tertiary/quaternary referral hospital in New South Wales (NSW), Australia. RSV-associated deaths were identified, reviewed, and classified according to RSV contribution to death. For 'RSV-attributable' deaths, we estimated frequency, case fatality ratio (CFR), and population death rate. We described demographic and clinical features of cases. RESULTS There were 20 RSV-attributable deaths. RSV was considered the primary cause of death for five cases and a contributory cause for 15 cases. The CFR among hospitalized cases was 0.2% (20/9779). The annual death rate was 0.6 per 10,000 hospitalized children. The population death rate was 1.2 (95% confidence interval 0.5-2.7) per million children <16 years of age in NSW. The median age at death was 28.7 months (interquartile range 8.8-75.0). All children had at least one medical comorbidity. Over half the deaths occurred in children ≥2 years of age (11, 55%). RSV healthcare-associated infection (RSV-HAI) was common (11, 55%). CONCLUSIONS RSV-attributable death is infrequent in this setting. Deaths occurred exclusively in children with medical comorbidity and a high proportion were RSV-HAI. Children with medical comorbidity, including those ≥2 years of age, should be prioritized for targeted prevention of RSV disease.
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Affiliation(s)
- Gemma L Saravanos
- From the Discipline of Child and Adolescent Health, University of Sydney
- National Centre for Immunisation Research and Surveillance
| | - Peter Hsu
- From the Discipline of Child and Adolescent Health, University of Sydney
- Department of Allergy and Immunology, The Children's Hospital at Westmead
| | - David Isaacs
- From the Discipline of Child and Adolescent Health, University of Sydney
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead
| | - Kristine Macartney
- From the Discipline of Child and Adolescent Health, University of Sydney
- National Centre for Immunisation Research and Surveillance
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead
| | - Nicholas J Wood
- From the Discipline of Child and Adolescent Health, University of Sydney
- National Centre for Immunisation Research and Surveillance
- Department of General Paediatric Medicine, The Children's Hospital at Westmead
| | - Philip N Britton
- From the Discipline of Child and Adolescent Health, University of Sydney
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead
- Sydney Medical School and Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
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Abstract
OBJECTIVE To assess the impact of the covid-19 pandemic on hospital admission rates and mortality outcomes for childhood respiratory infections, severe invasive infections, and vaccine preventable disease in England. DESIGN Population based observational study of 19 common childhood respiratory, severe invasive, and vaccine preventable infections, comparing hospital admission rates and mortality outcomes before and after the onset of the pandemic in England. SETTING Hospital admission data from every NHS hospital in England from 1 March 2017 to 30 June 2021 with record linkage to national mortality data. POPULATION Children aged 0-14 years admitted to an NHS hospital with a selected childhood infection from 1 March 2017 to 30 June 2021. MAIN OUTCOME MEASURES For each infection, numbers of hospital admissions every month from 1 March 2017 to 30 June 2021, percentage changes in the number of hospital admissions before and after 1 March 2020, and adjusted odds ratios to compare 60 day case fatality outcomes before and after 1 March 2020. RESULTS After 1 March 2020, substantial and sustained reductions in hospital admissions were found for all but one of the 19 infective conditions studied. Among the respiratory infections, the greatest percentage reductions were for influenza (mean annual number admitted between 1 March 2017 and 29 February 2020 was 5379 and number of children admitted from 1 March 2020 to 28 February 2021 was 304, 94% reduction, 95% confidence interval 89% to 97%), and bronchiolitis (from 51 655 to 9423, 82% reduction, 95% confidence interval 79% to 84%). Among the severe invasive infections, the greatest reduction was for meningitis (50% reduction, 47% to 52%). For the vaccine preventable infections, reductions ranged from 53% (32% to 68%) for mumps to 90% (80% to 95%) for measles. Reductions were seen across all demographic subgroups and in children with underlying comorbidities. Corresponding decreases were also found for the absolute numbers of 60 day case fatalities, although the proportion of children admitted for pneumonia who died within 60 days increased (age-sex adjusted odds ratio 1.71, 95% confidence interval 1.43 to 2.05). More recent data indicate that some respiratory infections increased to higher levels than usual after May 2021. CONCLUSIONS During the covid-19 pandemic, a range of behavioural changes (adoption of non-pharmacological interventions) and societal strategies (school closures, lockdowns, and restricted travel) were used to reduce transmission of SARS-CoV-2, which also reduced admissions for common and severe childhood infections. Continued monitoring of these infections is required as social restrictions evolve.
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Affiliation(s)
- Seilesh Kadambari
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Raphael Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Eva Morris
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael J Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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Jayaweera JAAS, Morel AJ, Abeykoon AMSB, Pitchai FNN, Kothalawela HS, Peiris JSM, Noordeen F. Viral burden and diversity in acute respiratory tract infections in hospitalized children in wet and dry zones of Sri Lanka. PLoS One 2021; 16:e0259443. [PMID: 34919553 PMCID: PMC8682885 DOI: 10.1371/journal.pone.0259443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/19/2021] [Indexed: 11/21/2022] Open
Abstract
The present study was done to identify the viral diversity, seasonality and burden associated with childhood acute respiratory tract infection (ARTI) in Sri Lanka. Nasopharyngeal aspirates (NPA) of hospitalized children (1 month-5 years) with ARTI were collected in 2 centers (wet and dry zones) from March 2013 to August 2014. Respiratory viral antigen detection by immunofluorescence assay (IFA) was used to identify the infecting viruses. IFA negative 100 NPA samples were tested for human metapeumovirus (hMPV), human bocavirus and corona viruses by polymerase chain reaction. Of the 443 and 418 NPAs, 37.2% and 39.4% were positive for any of the 8 different respiratory viruses tested from two centers studied. Viral co-infection was detected with respiratory syncytial virus (RSV) in both centers. Peak viral detection was noted in the wet zone from May-July 2013 and 2014 and in the dry zone from December-January 2014 suggesting a local seasonality for viral ARTI. RSV showed a clear seasonality with a direct correlation of monthly RSV infections with rainy days in the wet zone and an inverse correlation with temperature in both centers. The case fatality rate was 2.7% for RSV associated ARTI. The overall disability adjusted life years was 335.9 and for RSV associated ARTI it was 241.8. RSV was the commonly detected respiratory virus with an annual seasonality and distribution in rainy seasons in the dry and wet zones of Sri Lanka. Identifying the virus and seasonality will contribute to employ preventive measures and reduce the empirical use of antibiotics in resource limited settings.
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Affiliation(s)
- J. A. A. S. Jayaweera
- Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - A. J. Morel
- Teaching Hospital, Gampola, Gampola, Sri Lanka
| | - A. M. S. B. Abeykoon
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - F. N. N. Pitchai
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - H. S. Kothalawela
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - J. S. M. Peiris
- School of Public Health, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - F. Noordeen
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Levy MR, Thors V, Elínardottir SH, Moller AD, Haraldsson A. Decreasing death rates and causes of death in Icelandic children-A longitudinal analysis. PLoS One 2021; 16:e0257536. [PMID: 34591867 PMCID: PMC8483359 DOI: 10.1371/journal.pone.0257536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/06/2021] [Indexed: 12/05/2022] Open
Abstract
Background Global death rate in children has been declining during the last decades worldwide, especially in high income countries. This has been attributed to several factors, including improved prenatal and perinatal care, immunisations, infection management as well as progress in diagnosis and treatment of most diseases. However, there is certainly room for further progress. The aim of the current study was to describe the changes in death rates and causes of death in Iceland, a high-income country during almost half a century. Methods The Causes of Death Register at The Directorate of Health was used to identify all children under the age of 18 years in Iceland that died during the study period from January 1st, 1971 until December 31st, 2018. Using Icelandic national identification numbers, individuals could be identified for further information. Hospital records, laboratory results and post-mortem diagnosis could be accessed if cause of death was unclear. Findings Results showed a distinct decrease in death rates in children during the study period that was continuous over the whole period. This was established for almost all causes of death and in all age groups. This reduction was primarily attributed to a decrease in fatal accidents and fewer deaths due to infections, perinatal or congenital disease as well as malignancies, the reduction in death rates from other causes was less distinct. Childhood suicide rates remained constant. Interpretation Our results are encouraging for further prevention of childhood deaths. In addition, our results emphasise the need to improve measures to detect and treat mental and behavioural disorders leading to childhood suicide.
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Affiliation(s)
- Marina Ros Levy
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Valtyr Thors
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Children’s Hospital Iceland, Landspítali University Hospital Iceland, Reykjavík, Iceland
| | | | | | - Asgeir Haraldsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Children’s Hospital Iceland, Landspítali University Hospital Iceland, Reykjavík, Iceland
- * E-mail:
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Ayeni OA, Walaza S, Tempia S, Groome M, Kahn K, Madhi SA, Cohen AL, Moyes J, Venter M, Pretorius M, Treurnicht F, Hellferscee O, von Gottberg A, Wolter N, Cohen C. Mortality in children aged <5 years with severe acute respiratory illness in a high HIV-prevalence urban and rural areas of South Africa, 2009-2013. PLoS One 2021; 16:e0255941. [PMID: 34383824 PMCID: PMC8360538 DOI: 10.1371/journal.pone.0255941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/27/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Severe acute respiratory illness (SARI) is an important cause of mortality in young children, especially in children living with HIV infection. Disparities in SARI death in children aged <5 years exist in urban and rural areas. OBJECTIVE To compare the factors associated with in-hospital death among children aged <5 years hospitalized with SARI in an urban vs. a rural setting in South Africa from 2009-2013. METHODS Data were collected from hospitalized children with SARI in one urban and two rural sentinel surveillance hospitals. Nasopharyngeal aspirates were tested for ten respiratory viruses and blood for pneumococcal DNA using polymerase chain reaction. We used multivariable logistic regression to identify patient and clinical characteristics associated with in-hospital death. RESULTS From 2009 through 2013, 5,297 children aged <5 years with SARI-associated hospital admission were enrolled; 3,811 (72%) in the urban and 1,486 (28%) in the rural hospitals. In-hospital case-fatality proportion (CFP) was higher in the rural hospitals (6.9%) than the urban hospital (1.3%, p<0.001), and among HIV-infected than the HIV-uninfected children (9.6% vs. 1.6%, p<0.001). In the urban hospital, HIV infection (odds ratio (OR):11.4, 95% confidence interval (CI):5.4-24.1) and presence of any other underlying illness (OR: 3.0, 95% CI: 1.0-9.2) were the only factors independently associated with death. In the rural hospitals, HIV infection (OR: 4.1, 95% CI: 2.3-7.1) and age <1 year (OR: 3.7, 95% CI: 1.9-7.2) were independently associated with death, whereas duration of hospitalization ≥5 days (OR: 0.5, 95% CI: 0.3-0.8) and any respiratory virus detection (OR: 0.4, 95% CI: 0.3-0.8) were negatively associated with death. CONCLUSION We found that the case-fatality proportion was substantially higher among children admitted to rural hospitals and HIV infected children with SARI in South Africa. While efforts to prevent and treat HIV infections in children may reduce SARI deaths, further efforts to address health care inequality in rural populations are needed.
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Affiliation(s)
- Oluwatosin A. Ayeni
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
| | - Stefano Tempia
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Programme, Centers for Disease Control and Prevention-South Africa, Pretoria, South Africa
- Mass Genics, Duluth, Georgia, Unites States of America
| | - Michelle Groome
- Faculty of Health Sciences, Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
- INDEPTH Network, Accra, Ghana
| | - Shabir A. Madhi
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- Faculty of Health Sciences, Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam L. Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Programme, Centers for Disease Control and Prevention-South Africa, Pretoria, South Africa
| | - Jocelyn Moyes
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
| | - Marietjie Venter
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Marthi Pretorius
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Florette Treurnicht
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
| | - Orienka Hellferscee
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Division of Infectious Diseases, Hubert Department of Global Health, Rollins School of Public Health, School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Nicole Wolter
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
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11
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Njuguna HN, Zaki SR, Roberts DJ, Rogena EA, Walong E, Fligner CL, Keating MK, Gachii AK, Maleche-Obimbo E, Irimu G, Mathaiya J, Orata N, Lopokoiyit R, Michuki J, Emukule GO, Onyango CO, Gikunju S, Owuor C, Muturi PK, Bunei M, Gloria Carvalho M, Fields B, Mott JA, Widdowson MA, Chaves SS. Postmortem Study of Cause of Death Among Children Hospitalized With Respiratory Illness in Kenya. Pediatr Infect Dis J 2021; 40:715-722. [PMID: 33967229 PMCID: PMC8274582 DOI: 10.1097/inf.0000000000003159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In resource-limited settings, acute respiratory infections continue to be the leading cause of death in young children. We conducted postmortem investigations in children <5 years hospitalized with a clinical diagnosis of respiratory disease at Kenya's largest referral hospital. METHODS We collected respiratory and other tissues postmortem to examine pathologic processes using histology, molecular and immunohistochemistry assays. Nasopharyngeal, trachea, bronchi and lung specimens were tested using 21-target respiratory pathogen real-time reverse transcription polymerase chain reaction assays deployed on Taqman Array Cards. Expert panels reviewed all findings to determine causes of death and associated pathogens. RESULTS From 2014 to 2015, we investigated 64 pediatric deaths (median age 7 months). Pneumonia was determined as cause of death in 70% (42/52) of cases where death was associated with an infectious disease process. The main etiologies of pneumonia deaths were respiratory syncytial virus (RSV) (n = 7, 19%), Pneumocystis jirovecii (n = 7, 19%), influenza A (n = 5, 14%) and Streptococcus pneumoniae (n = 5, 14%)-10% of cases had multi-pathogen involvement. Among the other 10 deaths associated with a nonpneumonia infectious process, 4 did not have an etiology assigned, the others were associated with miliary tuberculosis (2), cerebral thrombosis due to HIV (1), Enterobacteriaceae (1), rotavirus (1), and 1 case of respiratory infection with severe hypokalemia associated with RSV. CONCLUSIONS In spite of well-established vaccination programs in Kenya, some deaths were still vaccine preventable. Accelerated development of RSV monoclonal antibodies and vaccines, introduction of seasonal influenza vaccination, and maintenance or improved uptake of existing vaccines can contribute to further reductions in childhood mortality.
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Affiliation(s)
- Henry N. Njuguna
- From the Influenza Program, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Sherif R. Zaki
- Centers for Disease Control and Prevention (CDC), Infectious Diseases Pathology Branch, Atlanta, Georgia
| | - Drucilla J. Roberts
- Obstetric and Perinatal Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily A. Rogena
- Department of Pathology, University of Nairobi, Nairobi, Kenya
| | - Edwin Walong
- Department of Pathology, University of Nairobi, Nairobi, Kenya
| | | | - M. Kelly Keating
- Centers for Disease Control and Prevention (CDC), Infectious Diseases Pathology Branch, Atlanta, Georgia
| | - Andrew K. Gachii
- Department of Pathology, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Grace Irimu
- Department of Pathology, University of Nairobi, Nairobi, Kenya
| | - John Mathaiya
- Department of Pathology, University of Nairobi, Nairobi, Kenya
| | - Noelle Orata
- Department of Pathology, University of Nairobi, Nairobi, Kenya
| | | | - Jackson Michuki
- Department of Pathology, University of Nairobi, Nairobi, Kenya
| | - Gideon O. Emukule
- From the Influenza Program, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Clayton O. Onyango
- From the Influenza Program, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Stella Gikunju
- Influenza Program, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Collins Owuor
- Influenza Program, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Peter K. Muturi
- Influenza Program, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Milka Bunei
- Influenza Program, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Maria Gloria Carvalho
- Centers for Disease Control and Prevention (CDC), Respiratory Diseases Branch, Atlanta, Georgia
| | - Barry Fields
- From the Influenza Program, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- Centers for Disease Control and Prevention (CDC), Division of Global Health Protection, Atlanta, Georgia
| | - Joshua A. Mott
- Centers for Disease Control and Prevention (CDC), Influenza Division, Atlanta, Georgia
| | - Marc-Alain Widdowson
- From the Influenza Program, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Sandra S. Chaves
- From the Influenza Program, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- Centers for Disease Control and Prevention (CDC), Influenza Division, Atlanta, Georgia
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12
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Illouz T, Biragyn A, Iulita MF, Flores-Aguilar L, Dierssen M, De Toma I, Antonarakis SE, Yu E, Herault Y, Potier MC, Botté A, Roper R, Sredni B, London J, Mobley W, Strydom A, Okun E. Immune Dysregulation and the Increased Risk of Complications and Mortality Following Respiratory Tract Infections in Adults With Down Syndrome. Front Immunol 2021; 12:621440. [PMID: 34248930 PMCID: PMC8267813 DOI: 10.3389/fimmu.2021.621440] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/02/2021] [Indexed: 12/12/2022] Open
Abstract
The risk of severe outcomes following respiratory tract infections is significantly increased in individuals over 60 years, especially in those with chronic medical conditions, i.e., hypertension, diabetes, cardiovascular disease, dementia, chronic respiratory disease, and cancer. Down Syndrome (DS), the most prevalent intellectual disability, is caused by trisomy-21 in ~1:750 live births worldwide. Over the past few decades, a substantial body of evidence has accumulated, pointing at the occurrence of alterations, impairments, and subsequently dysfunction of the various components of the immune system in individuals with DS. This associates with increased vulnerability to respiratory tract infections in this population, such as the influenza virus, respiratory syncytial virus, SARS-CoV-2 (COVID-19), and bacterial pneumonias. To emphasize this link, here we comprehensively review the immunobiology of DS and its contribution to higher susceptibility to severe illness and mortality from respiratory tract infections.
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Affiliation(s)
- Tomer Illouz
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
- The Paul Feder Laboratory on Alzheimer’s Disease Research, Bar-Ilan University, Ramat Gan, Israel
| | - Arya Biragyn
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, National Institute of Health, Baltimore, MD, United States
| | - Maria Florencia Iulita
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Lisi Flores-Aguilar
- Department of Anatomy and Cell Biology, McGill University, Montreal, QC, Canada
| | - Mara Dierssen
- Center for Genomic Regulation, The Barcelona Institute for Science and Technology, Barcelona, Spain
- University Pompeu Fabra, Barcelona, Spain
- Biomedical Research Networking Center for Rare Diseases (CIBERER), Barcelona, Spain
| | - Ilario De Toma
- Center for Genomic Regulation, The Barcelona Institute for Science and Technology, Barcelona, Spain
- University Pompeu Fabra, Barcelona, Spain
- Biomedical Research Networking Center for Rare Diseases (CIBERER), Barcelona, Spain
| | - Stylianos E. Antonarakis
- Department of Genetic Medicine and Development, University of Geneva, Geneva, Switzerland
- Medigenome, Swiss Institute of Genomic Medicine, Geneva, Switzerland
- iGE3 Institute of Genetics and Genomics of Geneva, Geneva, Switzerland
| | - Eugene Yu
- The Children’s Guild Foundation Down Syndrome Research Program, Genetics and Genomics Program and Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
- Genetics, Genomics and Bioinformatics Program, State University of New York at Buffalo, Buffalo, NY, United States
| | - Yann Herault
- Université de Strasbourg, CNRS, INSERM, Institut de Génétique Biologie Moléculaire et Cellulaire, IGBMC - UMR 7104 - Inserm U1258, Illkirch, France
| | - Marie-Claude Potier
- Paris Brain Institute (ICM), CNRS UMR7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Alexandra Botté
- Paris Brain Institute (ICM), CNRS UMR7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Randall Roper
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Benjamin Sredni
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | | | - William Mobley
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Eitan Okun
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
- The Paul Feder Laboratory on Alzheimer’s Disease Research, Bar-Ilan University, Ramat Gan, Israel
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
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13
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Saito T, Kuru S, Takahashi T, Suzuki M, Ogata K. [Changing medical care for amyotrophic lateral sclerosis patients and cause of death - review of muscular dystrophy wards (1999-2013)]. Rinsho Shinkeigaku 2021; 61:161-165. [PMID: 33627584 DOI: 10.5692/clinicalneurol.cn-001536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We analyzed the records of inpatients with amyotrophic lateral sclerosis (ALS) treated at 27 specialized institutions for muscular dystrophy in Japan from 1999 to 2013 registered in a database on October 1 of each year. The total number of ALS inpatients in 1999 was 29, then that showed rapid increases in 2006 and 2007, and reached 164 in 2013. Age regardless of year was predominantly greater than 50 years. In 1999, the respirator dependent rate was 68.9% and then increased to 92.7% in 2013, while the oral nutritional supply rate was 41.4% in 1999 and decreased to 10.4% in 2013. The number of deaths from 2000 to 2013 was 118. Cause of death was respiratory failure in 26 of 30 patients who maintained voluntary respiration at the time of death and in 5 of 6 with non-invasive ventilation. On the other hand, the main cause of death in patients with tracheostomy invasive ventilation was respiratory infection, which was noted in 26 of 82, while other causes varied. It is expected that the number of ALS patients admitted to specialized institutions with muscular dystrophy wards will continue to increase.
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Affiliation(s)
- Toshio Saito
- Division of Child Neurology, Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center
| | - Satoshi Kuru
- Department of Neurology, National Hospital Organization Suzuka National Hospital
| | - Toshiaki Takahashi
- Department of Neurology, National Hospital Organization Sendai-Nishitaga Hospital
| | - Mikiya Suzuki
- Department of Neurology, National Hospital Organization Higashisaitama National Hospital
| | - Katsuhisa Ogata
- Department of Neurology, National Hospital Organization Higashisaitama National Hospital
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14
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Minozzi S, Pifferi S, Brazzi L, Pecoraro V, Montrucchio G, D'Amico R. Topical antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving mechanical ventilation. Cochrane Database Syst Rev 2021; 1:CD000022. [PMID: 33481250 PMCID: PMC8094382 DOI: 10.1002/14651858.cd000022.pub4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients treated with mechanical ventilation in intensive care units (ICUs) have a high risk of developing respiratory tract infections (RTIs). Ventilator-associated pneumonia (VAP) has been estimated to affect 5% to 40% of patients treated with mechanical ventilation for at least 48 hours. The attributable mortality rate of VAP has been estimated at about 9%. Selective digestive decontamination (SDD), which consists of the topical application of non-absorbable antimicrobial agents to the oropharynx and gastroenteric tract during the whole period of mechanical ventilation, is often used to reduce the risk of VAP. A related treatment is selective oropharyngeal decontamination (SOD), in which topical antibiotics are applied to the oropharynx only. This is an update of a review first published in 1997 and updated in 2002, 2004, and 2009. OBJECTIVES To assess the effect of topical antibiotic regimens (SDD and SOD), given alone or in combination with systemic antibiotics, to prevent mortality and respiratory infections in patients receiving mechanical ventilation for at least 48 hours in ICUs. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register, PubMed, and Embase on 5 February 2020. We also searched the WHO ICTRP and ClinicalTrials.gov for ongoing and unpublished studies on 5 February 2020. All searches included non-English language literature. We handsearched references of topic-related systematic reviews and the included studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-RCTs assessing the efficacy and safety of topical prophylactic antibiotic regimens in adults receiving intensive care and mechanical ventilation. The included studies compared topical plus systemic antibiotics versus placebo or no treatment; topical antibiotics versus no treatment; and topical plus systemic antibiotics versus systemic antibiotics. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included a total of 41 trials involving 11,004 participants (five new studies were added in this update). The minimum duration of mechanical ventilation ranged from 2 (19 studies) to 6 days (one study). Thirteen studies reported the mean length of ICU stay, ranging from 11 to 33 days. The percentage of immunocompromised patients ranged from 0% (10 studies) to 22% (1 study). The reporting quality of the majority of included studies was very poor, so we judged more than 40% of the studies as at unclear risk of selection bias. We judged all studies to be at low risk of performance bias, though 47.6% were open-label, because hospitals usually have standardised infection control programmes, and possible subjective decisions on who should be tested for the presence or absence of RTIs are unlikely in an ICU setting. Regarding detection bias, we judged all included studies as at low risk for the outcome mortality. For the outcome RTIs, we judged all double-blind studies as at low risk of detection bias. We judged five open-label studies as at high risk of detection bias, as the diagnosis of RTI was not based on microbiological exams; we judged the remaining open-label studies as at low risk of detection bias, as a standardised set of diagnostic criteria, including results of microbiological exams, were used. Topical plus systemic antibiotic prophylaxis reduces overall mortality compared with placebo or no treatment (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.73 to 0.96; 18 studies; 5290 participants; high-certainty evidence). Based on an illustrative risk of 303 deaths in 1000 people this equates to 48 (95% CI 15 to 79) fewer deaths with topical plus systemic antibiotic prophylaxis. Topical plus systemic antibiotic prophylaxis probably reduces RTIs (RR 0.43, 95% CI 0.35 to 0.53; 17 studies; 2951 participants; moderate-certainty evidence). Based on an illustrative risk of 417 RTIs in 1000 people this equates to 238 (95% CI 196 to 271) fewer RTIs with topical plus systemic antibiotic prophylaxis. Topical antibiotic prophylaxis probably reduces overall mortality compared with no topical antibiotic prophylaxis (RR 0.96, 95% CI 0.87 to 1.05; 22 studies, 4213 participants; moderate-certainty evidence). Based on an illustrative risk of 290 deaths in 1000 people this equates to 19 (95% CI 37 fewer to 15 more) fewer deaths with topical antibiotic prophylaxis. Topical antibiotic prophylaxis may reduce RTIs (RR 0.57, 95% CI 0.44 to 0.74; 19 studies, 2698 participants; low-certainty evidence). Based on an illustrative risk of 318 RTIs in 1000 people this equates to 137 (95% CI 83 to 178) fewer RTIs with topical antibiotic prophylaxis. Sixteen studies reported adverse events and dropouts due to adverse events, which were poorly reported with sparse data. The certainty of the evidence ranged from low to very low. AUTHORS' CONCLUSIONS Treatments based on topical prophylaxis probably reduce respiratory infections, but not mortality, in adult patients receiving mechanical ventilation for at least 48 hours, whereas a combination of topical and systemic prophylactic antibiotics reduces both overall mortality and RTIs. However, we cannot rule out that the systemic component of the combined treatment provides a relevant contribution in the observed reduction of mortality. No conclusion can be drawn about adverse events as they were poorly reported with sparse data.
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Affiliation(s)
- Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Silvia Pifferi
- Department of Anesthesiology and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Anaesthesia, Intensive Care and Emergency, 'Città della salute e della Scienza' Hospital, Turin, Italy
| | - Valentina Pecoraro
- Department of Laboratory Medicine, Ospedale Civile Sant'Agostino Estense, Modena, Italy
| | - Giorgia Montrucchio
- Department of Anaesthesia, Intensive Care and Emergency, 'Città della salute e della Scienza' Hospital, Turin, Italy
| | - Roberto D'Amico
- Italian Cochrane Centre, University of Modena and Reggio Emilia, Modena, Italy
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia School of Medicine, Modena, Italy
- Unit of Methodological/Statistical Support to Clinical Research, Azienda-Ospedaliero Universitaria, Modena, Italy
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15
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von Philipsborn P, Biallas R, Burns J, Drees S, Geffert K, Movsisyan A, Pfadenhauer LM, Sell K, Strahwald B, Stratil JM, Rehfuess E. Adverse effects of non-steroidal anti-inflammatory drugs in patients with viral respiratory infections: rapid systematic review. BMJ Open 2020; 10:e040990. [PMID: 33444207 PMCID: PMC7678345 DOI: 10.1136/bmjopen-2020-040990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with viral respiratory infections on acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival. DESIGN Rapid systematic review. PARTICIPANTS Humans with viral respiratory infections, exposed to systemic NSAIDs. PRIMARY OUTCOMES Acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival. RESULTS We screened 10 999 titles and abstracts and 738 full texts, including 87 studies. No studies addressed COVID-19, Severe Acute Respiratory Syndrome or Middle East Respiratory Syndrome; none examined inpatient healthcare utilisation, quality of life or long-term survival. Effects of NSAIDs on mortality and cardiovascular events in adults with viral respiratory infections are unclear (three observational studies; very low certainty). Children with empyema and gastrointestinal bleeding may be more likely to have taken NSAIDs than children without these conditions (two observational studies; very low certainty). In patients aged 3 years and older with acute respiratory infections, ibuprofen is associated with a higher rate of reconsultations with general practitioners than paracetamol (one randomised controlled trial (RCT); low certainty). The difference in death from all causes and hospitalisation for renal failure and anaphylaxis between children with fever receiving ibuprofen versus paracetamol is likely to be less than 1 per 10 000 (1 RCT; moderate/high certainty). Twenty-eight studies in adults and 42 studies in children report adverse event counts. Most report that no severe adverse events occurred. Due to methodological limitations of adverse event counts, this evidence should be interpreted with caution. CONCLUSIONS It is unclear whether the use of NSAIDs increases the risk of severe adverse outcomes in patients with viral respiratory infections. This absence of evidence should not be interpreted as evidence for the absence of such risk. This is a rapid review with a number of limitations. PROSPERO REGISTRATION NUMBER CRD42020176056.
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Affiliation(s)
- Peter von Philipsborn
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Renke Biallas
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jacob Burns
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Simon Drees
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karin Geffert
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ani Movsisyan
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Lisa Maria Pfadenhauer
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Kerstin Sell
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Brigitte Strahwald
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jan M Stratil
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Eva Rehfuess
- Chair of Public Health and Health Services Research in its capacity as a WHO Collaborating Centre for Evidence-Based Public Health, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians University Munich Medical Faculty, Munchen, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Amoroso MG, Lucifora G, Degli Uberti B, Serra F, De Luca G, Borriello G, De Domenico A, Brandi S, Cuomo MC, Bove F, Riccardi MG, Galiero G, Fusco G. Fatal Interstitial Pneumonia Associated with Bovine Coronavirus in Cows from Southern Italy. Viruses 2020; 12:v12111331. [PMID: 33228210 PMCID: PMC7699522 DOI: 10.3390/v12111331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022] Open
Abstract
An outbreak of winter dysentery, complicated by severe respiratory syndrome, occurred in January 2020 in a high production dairy cow herd located in a hilly area of the Calabria region. Of the 52 animals belonging to the farm, 5 (9.6%) died with severe respiratory distress, death occurring 3–4 days after the appearance of the respiratory signs (caught and gasping breath). Microbiological analysis revealed absence of pathogenic bacteria whilst Real-time PCR identified the presence of RNA from Bovine Coronavirus (BCoV) in several organs: lungs, small intestine (jejunum), mediastinal lymph nodes, liver and placenta. BCoV was therefore hypothesized to play a role in the lethal pulmonary infection. Like the other CoVs, BCoV is able to cause different syndromes. Its role in calf diarrhea and in mild respiratory disease is well known: we report instead the involvement of this virus in a severe and fatal respiratory disorder, with symptoms and disease evolution resembling those of Severe Acute Respiratory Syndromes (SARS).
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Affiliation(s)
- Maria Grazia Amoroso
- Unit of Virology, Department of Animal Health, Experimental Zooprophylactic Institute of Southern Italy, Via Salute 2, 80055 Portici, Italy; (B.D.U.); (F.S.); (G.D.L.); (S.B.); (G.F.)
- Correspondence:
| | - Giuseppe Lucifora
- Section of Vibo Valentia, Experimental Zooprophylactic Institute of Southern Italy, Contrada Piano di Bruno, 89852 Mileto, Italy;
| | - Barbara Degli Uberti
- Unit of Virology, Department of Animal Health, Experimental Zooprophylactic Institute of Southern Italy, Via Salute 2, 80055 Portici, Italy; (B.D.U.); (F.S.); (G.D.L.); (S.B.); (G.F.)
| | - Francesco Serra
- Unit of Virology, Department of Animal Health, Experimental Zooprophylactic Institute of Southern Italy, Via Salute 2, 80055 Portici, Italy; (B.D.U.); (F.S.); (G.D.L.); (S.B.); (G.F.)
| | - Giovanna De Luca
- Unit of Virology, Department of Animal Health, Experimental Zooprophylactic Institute of Southern Italy, Via Salute 2, 80055 Portici, Italy; (B.D.U.); (F.S.); (G.D.L.); (S.B.); (G.F.)
| | - Giorgia Borriello
- Department of Animal Health, Experimental Zooprophylactic Institute of Southern Italy, Via Salute 2, 80055 Portici, Italy; (G.B.); (M.C.C.); (F.B.); (M.G.R.); (G.G.)
| | - Alessandro De Domenico
- Freelance Veterinary, Ordine dei Veterinari di Vibo Valentia, 89900 Vibo Valentia, Italy;
| | - Sergio Brandi
- Unit of Virology, Department of Animal Health, Experimental Zooprophylactic Institute of Southern Italy, Via Salute 2, 80055 Portici, Italy; (B.D.U.); (F.S.); (G.D.L.); (S.B.); (G.F.)
| | - Maria Concetta Cuomo
- Department of Animal Health, Experimental Zooprophylactic Institute of Southern Italy, Via Salute 2, 80055 Portici, Italy; (G.B.); (M.C.C.); (F.B.); (M.G.R.); (G.G.)
| | - Francesca Bove
- Department of Animal Health, Experimental Zooprophylactic Institute of Southern Italy, Via Salute 2, 80055 Portici, Italy; (G.B.); (M.C.C.); (F.B.); (M.G.R.); (G.G.)
| | - Marita Georgia Riccardi
- Department of Animal Health, Experimental Zooprophylactic Institute of Southern Italy, Via Salute 2, 80055 Portici, Italy; (G.B.); (M.C.C.); (F.B.); (M.G.R.); (G.G.)
| | - Giorgio Galiero
- Department of Animal Health, Experimental Zooprophylactic Institute of Southern Italy, Via Salute 2, 80055 Portici, Italy; (G.B.); (M.C.C.); (F.B.); (M.G.R.); (G.G.)
| | - Giovanna Fusco
- Unit of Virology, Department of Animal Health, Experimental Zooprophylactic Institute of Southern Italy, Via Salute 2, 80055 Portici, Italy; (B.D.U.); (F.S.); (G.D.L.); (S.B.); (G.F.)
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Thindwa D, Garcia Quesada M, Liu Y, Bennett J, Cohen C, Knoll MD, von Gottberg A, Hayford K, Flasche S. Use of seasonal influenza and pneumococcal polysaccharide vaccines in older adults to reduce COVID-19 mortality. Vaccine 2020; 38:5398-5401. [PMID: 32600911 PMCID: PMC7303659 DOI: 10.1016/j.vaccine.2020.06.047] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Deus Thindwa
- Centre for Mathematical Modelling of Infectious Disease, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Maria Garcia Quesada
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yang Liu
- Centre for Mathematical Modelling of Infectious Disease, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia Bennett
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Maria Deloria Knoll
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Kyla Hayford
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stefan Flasche
- Centre for Mathematical Modelling of Infectious Disease, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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18
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Heimes E, Baier M, Forstner C, Weis S, Bauer M, Fritzenwanger M, Scherag A, Pletz MW, Kesselmeier M, Hagel S. Effect of Antiviral Therapy on the Outcome of Mechanically Ventilated Patients With Herpes Simplex Virus Type 1 in BAL Fluid: A Retrospective Cohort Study. Chest 2020; 158:1867-1875. [PMID: 32629035 DOI: 10.1016/j.chest.2020.06.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Herpes simplex virus type 1 (HSV-1) is frequently detected in the BAL fluid of patients on mechanical ventilation. RESEARCH QUESTION The aim of the study was to investigate whether antiviral therapy is associated with improved overall survival within 30 days. STUDY DESIGN AND METHODS This was a retrospective cohort study in four ICUs between January 2011 and December 2017. All adult patients on mechanical ventilation with a respiratory tract infection with positive polymerase chain reaction testing for HSV-1 in the BAL were included. Patients already receiving antiviral agents on the day BAL was performed were excluded. We performed uni- and multivariable Cox and logistic regression modeling. RESULTS Overall, 306 patients were included in the analysis. Among them, 177 patients (57.8%) received antiviral therapy (90.9% acyclovir, 6.2% ganciclovir, 2.9% both). The overall 30-day mortality rate was 42.4% (n = 75) in the antiviral treatment group and 50.4% (n = 65) in the control group. The adjusted hazard ratio (HR) for the primary outcome was 0.62 (95% CI, 0.44-0.87; P = .005), indicating better overall survival within 30 days for the antiviral-treated group than for the untreated group. This benefit was also present in the subgroup of patients without immunosuppression (n = 246; adjusted HR, 0.53; 95% CI, 0.36-0.78; P = .001). Overall, the median lengths of hospital stay (31 vs 24 days, P = .002) and ICU stay (24 vs 17 days, P < .001), and the duration of mechanical ventilation (18 vs 11 days, P < .001), were longer for patients with therapy. No evidence for the treatment-related deterioration of renal function was observed. INTERPRETATION These data suggest that detection of HSV-1 in the BAL of patients on mechanical ventilation may be of clinical significance and that specific antiviral treatment may improve clinical outcomes. However, this needs to be proven in multicenter randomized controlled trials before implementation into the clinical routine.
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Affiliation(s)
- Elisabeth Heimes
- Institutes for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Michael Baier
- Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Christina Forstner
- Institutes for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Sebastian Weis
- Institutes for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Department of Anesthesiology and Intensive Care Therapy, Jena University Hospital, Jena, Germany; Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Michael Bauer
- Department of Anesthesiology and Intensive Care Therapy, Jena University Hospital, Jena, Germany
| | - Michael Fritzenwanger
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, Jena University Hospital, Jena, Germany
| | - André Scherag
- Research Group Clinical Epidemiology, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany; Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Mathias W Pletz
- Institutes for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Miriam Kesselmeier
- Research Group Clinical Epidemiology, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Stefan Hagel
- Institutes for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
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19
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Wee LE, Ko KKK, Ho WQ, Kwek GTC, Tan TT, Wijaya L. Community-acquired viral respiratory infections amongst hospitalized inpatients during a COVID-19 outbreak in Singapore: co-infection and clinical outcomes. J Clin Virol 2020; 128:104436. [PMID: 32447256 PMCID: PMC7235565 DOI: 10.1016/j.jcv.2020.104436] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/10/2020] [Indexed: 12/17/2022]
Abstract
AIMS During the ongoing COVID-19 outbreak, co-circulation of other common respiratory viruses can potentially result in co-infections; however, reported rates of co-infections for SARS-CoV-2 vary. We sought to evaluate the prevalence and etiology of all community acquired viral respiratory infections requiring hospitalization during an ongoing COVID-19 outbreak, with a focus on co-infection rates and clinical outcomes. METHODS Over a 10-week period, all admissions to our institution, the largest tertiary hospital in Singapore, were screened for respiratory symptoms, and COVID-19 as well as a panel of common respiratory viral pathogens were systematically tested for. Information was collated on clinical outcomes, including requirement for mechanical ventilation and in hospital mortality. RESULTS One-fifth (19.3%, 736/3807) of hospitalized inpatients with respiratory symptoms had a PCR-proven viral respiratory infection; of which 58.5% (431/736) tested positive for SARS-CoV-2 and 42.2% (311/736) tested positive for other common respiratory viruses. The rate of co-infection with SARS-CoV-2 was 1.4% (6/431); all patients with co-infection had mild disease and stayed in communal settings. The in-hospital mortality rate and proportion of COVID-19 patients requiring invasive ventilation was low, at around 1% of patients; these rates were lower than patients with other community-acquired respiratory viruses admitted over the same period (p < 0.01). CONCLUSION Even amidst an ongoing COVID-19 outbreak, common respiratory viruses still accounted for a substantial proportion of hospitalizations. Coinfections with SARS-CoV-2 were rare, with no observed increase in morbidity or mortality.
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Affiliation(s)
- Liang En Wee
- Singhealth Infectious Diseases Residency, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - Kwan Ki Karrie Ko
- Department of Microbiology, Singapore General Hospital, Singapore; Department of Molecular Pathology, Singapore General Hospital, Singapore
| | - Wan Qi Ho
- Division of Medicine, Singapore General Hospital, Singapore
| | | | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Limin Wijaya
- Department of Infectious Diseases, Singapore General Hospital, Singapore
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20
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Bravo LE, Collazos P, Grillo Ardila EK, García LS, Millan E, Mera P, Holguín J. Mortality from respiratory infections and chronic non-communicable diseases before the COVID-19 pandemic in Cali, Colombia. Colomb Med (Cali) 2020; 51:e4270. [PMID: 33012885 PMCID: PMC7518731 DOI: 10.25100/cm.v51i2.4270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/25/2020] [Accepted: 05/04/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The COVID-19 disease pandemic is a health emergency. Older people and those with chronic noncommunicable diseases are more likely to develop serious illnesses, require ventilatory support, and die from complications. OBJECTIVE To establish deaths from respiratory infections and some chronic non-communicable diseases that occurred in Cali, before the SARS-CoV-2 disease pandemic. METHODS During the 2003-2019 period, 207,261 deaths were registered according to the general mortality database of the Municipal Secretary of Health of Cali. Deaths were coded with the International Classification of Diseases and causes of death were grouped according to WHO guidelines. Rates were standardized by age and are expressed per 100,000 people-year. RESULTS A direct relationship was observed between aging and mortality from respiratory infections and chronic non-communicable diseases. Age-specific mortality rates were highest in those older than 80 years for all diseases evaluated. Seasonal variation was evident in respiratory diseases in the elderly. COMMENTS Estimates of mortality rates from respiratory infections and chronic non-communicable diseases in Cali provide the baseline that will serve as a comparison to estimate the excess mortality caused by the COVID-19 pandemic. Health authorities and decision makers should be guided by reliable estimates of mortality and of the proportion of infected people who die from SARS-CoV-2 virus infection.
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Affiliation(s)
- Luis Eduardo Bravo
- Registro Poblacional de Cáncer de Cali. Cali, Colombia
- Universidad del Valle, Facultad de Salud, Departamento de Patología, Cali, Colombia
| | | | - Elvia Karina Grillo Ardila
- Registro Poblacional de Cáncer de Cali. Cali, Colombia
- Universidad del Valle, Facultad de Salud, Doctorado en Salud. Cali, Colombia
| | | | | | - Patricia Mera
- Secretaria de Salud Pública Municipal de Cali, Cali, Colombia
| | - Jorge Holguín
- Secretaria de Salud Pública Municipal de Cali, Cali, Colombia
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21
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Doran SJ, Henry RJ, Shirey KA, Barrett JP, Ritzel RM, Lai W, Blanco JC, Faden AI, Vogel SN, Loane DJ. Early or Late Bacterial Lung Infection Increases Mortality After Traumatic Brain Injury in Male Mice and Chronically Impairs Monocyte Innate Immune Function. Crit Care Med 2020; 48:e418-e428. [PMID: 32149839 PMCID: PMC7541908 DOI: 10.1097/ccm.0000000000004273] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Respiratory infections in the postacute phase of traumatic brain injury impede optimal recovery and contribute substantially to overall morbidity and mortality. This study investigated bidirectional innate immune responses between the injured brain and lung, using a controlled cortical impact model followed by secondary Streptococcus pneumoniae infection in mice. DESIGN Experimental study. SETTING Research laboratory. SUBJECTS Adult male C57BL/6J mice. INTERVENTIONS C57BL/6J mice were subjected to sham surgery or moderate-level controlled cortical impact and infected intranasally with S. pneumoniae (1,500 colony-forming units) or vehicle (phosphate-buffered saline) at 3 or 60 days post-injury. MAIN RESULTS At 3 days post-injury, S. pneumoniae-infected traumatic brain injury mice (TBI + Sp) had a 25% mortality rate, in contrast to no mortality in S. pneumoniae-infected sham (Sham + Sp) animals. TBI + Sp mice infected 60 days post-injury had a 60% mortality compared with 5% mortality in Sham + Sp mice. In both studies, TBI + Sp mice had poorer motor function recovery compared with TBI + PBS mice. There was increased expression of pro-inflammatory markers in cortex of TBI + Sp compared with TBI + PBS mice after both early and late infection, indicating enhanced post-traumatic neuroinflammation. In addition, monocytes from lungs of TBI + Sp mice were immunosuppressed acutely after traumatic brain injury and could not produce interleukin-1β, tumor necrosis factor-α, or reactive oxygen species. In contrast, after delayed infection monocytes from TBI + Sp mice had higher levels of interleukin-1β, tumor necrosis factor-α, and reactive oxygen species when compared with Sham + Sp mice. Increased bacterial burden and pathology was also found in lungs of TBI + Sp mice. CONCLUSIONS Traumatic brain injury causes monocyte functional impairments that may affect the host's susceptibility to respiratory infections. Chronically injured mice had greater mortality following S. pneumoniae infection, which suggests that respiratory infections even late after traumatic brain injury may pose a more serious threat than is currently appreciated.
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Affiliation(s)
- Sarah J Doran
- Department of Anesthesiology and Shock, Trauma and Anesthesiology Research (STAR) Center, University of Maryland School of Medicine, Baltimore, MD
| | - Rebecca J Henry
- Department of Anesthesiology and Shock, Trauma and Anesthesiology Research (STAR) Center, University of Maryland School of Medicine, Baltimore, MD
| | - Kari Ann Shirey
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD
| | - James P Barrett
- Department of Anesthesiology and Shock, Trauma and Anesthesiology Research (STAR) Center, University of Maryland School of Medicine, Baltimore, MD
| | - Rodney M Ritzel
- Department of Anesthesiology and Shock, Trauma and Anesthesiology Research (STAR) Center, University of Maryland School of Medicine, Baltimore, MD
| | - Wendy Lai
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Alan I Faden
- Department of Anesthesiology and Shock, Trauma and Anesthesiology Research (STAR) Center, University of Maryland School of Medicine, Baltimore, MD
| | - Stefanie N Vogel
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD
| | - David J Loane
- Department of Anesthesiology and Shock, Trauma and Anesthesiology Research (STAR) Center, University of Maryland School of Medicine, Baltimore, MD
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
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22
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Verfürden ML, Fitzpatrick T, Holder L, Zylbersztejn A, Rosella L, Gilbert R, Guttmann A, Hardelid P. Deprivation and mortality related to pediatric respiratory tract infection: a cohort study in 3 high-income jurisdictions. CMAJ Open 2020; 8:E273-E281. [PMID: 32345706 PMCID: PMC7207030 DOI: 10.9778/cmajo.20190074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Deaths from respiratory tract infections (RTIs) in children are preventable through timely access to public health and medical interventions. We aimed to assess whether socioeconomic disparities in mortality related to pediatric RTI persisted after accounting for health status at birth. METHODS We compared the prevalence of and risk factors for RTI-related death in singletons aged 28 days to 4 years across Ontario (Canada), Scotland and England (jurisdictions with universal health care) using linked administrative data for 2003-2013. We estimated rates of RTI-related mortality for children living in deprived areas and those born to teenage girls; we estimated both crude rates and those adjusted for health status at birth. RESULTS A total of 1 299 240 (Ontario), 547 556 (Scotland) and 3 910 401 (England) children were included in the study. Across all jurisdictions, children born in the most deprived areas experienced the highest rates of RTI-related mortality. After adjustment for high-risk chronic conditions and prematurity, we observed differences in mortality according to area-level deprivation in Ontario and England but not in Scotland. In Ontario, teenage motherhood was also an independent risk factor for RTI-related mortality. INTERPRETATION Socioeconomic disparities played a substantial role in child mortality related to RTI in all 3 jurisdictions. Context-specific investigations around the mechanisms of this increased risk and development of programs to address socioeconomic disparities are needed.
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Affiliation(s)
- Maximiliane L Verfürden
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont.
| | - Tiffany Fitzpatrick
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
| | - Laura Holder
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
| | - Ania Zylbersztejn
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
| | - Laura Rosella
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
| | - Ruth Gilbert
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
| | - Astrid Guttmann
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
| | - Pia Hardelid
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
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23
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Kozak R, Prost K, Yip L, Williams V, Leis JA, Mubareka S. Severity of coronavirus respiratory tract infections in adults admitted to acute care in Toronto, Ontario. J Clin Virol 2020; 126:104338. [PMID: 32278299 PMCID: PMC7142695 DOI: 10.1016/j.jcv.2020.104338] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/19/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022]
Abstract
Coronaviruses represent a significant burden in acute care settings. Female gender and smoking were associated with poor prognosis. All cause mortality in our cohort was similar to what is observed for influenza virus.
Background The World Health Organization has highlighted the need for improved surveillance and understanding of the health burden imposed by non-influenza RNA respiratory viruses. Human coronaviruses (CoVs) are a major cause of respiratory and gastrointestinal tract infections with associated morbidity and mortality. Objectives The objective of our study was to characterize the epidemiology of CoVs in our tertiary care centre, and identify clinical correlates of disease severity. Study design A cross-sectional study was performed of 226 patients admitted with confirmed CoV respiratory tract infection between 2010 and 2016. Variables consistent with a severe disease burden were evaluated including symptoms, length of stay, intensive care unit (ICU) admission and mortality. Results CoVs represented 11.3% of all positive respiratory virus samples and OC43 was the most commonly identified CoV. The majority of infections were community-associated while 21.6% were considered nosocomial. The average length of stay was 11.8 days with 17.3% of patients requiring ICU admission and an all-cause mortality of 7%. In a multivariate model, female gender and smoking were associated with increased likelihood of admission to ICU or death. Conclusion This study highlights the significant burden of CoVs and justifies the need for surveillance in the acute care setting.
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Affiliation(s)
- Robert Kozak
- Department of Laboratory Medicine and Molecular Diagnostics, Division of Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Karren Prost
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Lily Yip
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Victoria Williams
- Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jerome A Leis
- Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre and Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Samira Mubareka
- Department of Laboratory Medicine and Molecular Diagnostics, Division of Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre and Department of Medicine, University of Toronto, Toronto, ON, Canada.
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24
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Tabak YP, Sung A, Ye G, Vankeepuram L, Gupta V, McCann E. Attributable burden in patients with carbapenem-nonsusceptible gram-negative respiratory infections. PLoS One 2020; 15:e0229393. [PMID: 32084236 PMCID: PMC7034906 DOI: 10.1371/journal.pone.0229393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 02/05/2020] [Indexed: 11/24/2022] Open
Abstract
Objective We aimed to describe the clinical and economic burden attributable to carbapenem-nonsusceptible (C-NS) respiratory infections. Methods This retrospective matched cohort study assessed clinical and economic outcomes of adult patients (aged ≥18 years) who were admitted to one of 78 acute care hospitals in the United States with nonduplicate C-NS and carbapenem-susceptible (C-S) isolates from a respiratory source. A subset analysis of patients with principal diagnosis codes denoting bacterial pneumonia or other diagnoses was also conducted. Isolates were classified as community- or hospital-onset based on collection time. A generalized linear mixed model method was used to estimate the attributable burden for mortality, 30-day readmission, length of stay (LOS), cost, and net gain/loss (payment minus cost) using propensity score-matched C-NS versus C-S cohorts. Results For C-NS cases, mortality (25.7%), LOS (29.4 days), and costs ($81,574) were highest in the other principal diagnosis, hospital-onset subgroup; readmissions (19.4%) and net loss (-$9522) were greatest in the bacterial pneumonia, hospital-onset subgroup. Mortality and readmissions were not significantly higher for C-NS cases in any propensity score-matched subgroup. Significant C-NS–attributable burden was found for both other principal diagnosis subgroups for LOS (hospital-onset: 3.7 days, P = 0.006; community-onset: 1.5 days, P<0.001) and cost (hospital-onset: $12,777, P<0.01; community-onset: $2681, P<0.001). Conclusions Increased LOS and cost burden were observed in propensity score-matched patients with C-NS compared with C-S respiratory infections; the C-NS–attributable burden was significant only for patients with other principal diagnoses.
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Affiliation(s)
- Ying P. Tabak
- Digital Health, Medical Affairs, Becton, Dickinson and Company, Franklin Lakes, New Jersey, United States of America
| | - Anita Sung
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - Gang Ye
- Digital Health, Medical Affairs, Becton, Dickinson and Company, Franklin Lakes, New Jersey, United States of America
| | - Latha Vankeepuram
- Digital Health, Medical Affairs, Becton, Dickinson and Company, Franklin Lakes, New Jersey, United States of America
| | - Vikas Gupta
- Digital Health, Medical Affairs, Becton, Dickinson and Company, Franklin Lakes, New Jersey, United States of America
| | - Eilish McCann
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey, United States of America
- * E-mail:
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Wu PQ, Zeng SQ, Yin GQ, Huang JJ, Xie ZW, Lu G, Jiang WH. Clinical manifestations and risk factors of adenovirus respiratory infection in hospitalized children in Guangzhou, China during the 2011-2014 period. Medicine (Baltimore) 2020; 99:e18584. [PMID: 31977849 PMCID: PMC7004600 DOI: 10.1097/md.0000000000018584] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/11/2019] [Accepted: 12/03/2019] [Indexed: 11/25/2022] Open
Abstract
To evaluate epidemiology and risk factors of severe adenovirus respiratory infection in hospitalized children in Guangzhou, China.A retrospective review study was conducted, and 542 children hospitalized for adenovirus respiratory infection, were included from January 2011 to December 2014. Patients were younger than 14 years. Disease severity was classified into severe and mild. Laboratory tests and clinical characteristics were analyzed for risk factors of adenovirus respiratory infection by multivariable logistic regression.Among these 542 children, 92.1% were aged < 6 years. Clinical diagnoses were upper respiratory infections in 11.6%, bronchiolitis in 16%, and mild pneumonia in 62.0% of children. Severe pneumonia rate was 10.3% (56/542) with a mortality rate of 0.9% (5/542). The cohort comprised 542 patients; 486 patients with mild adenovirus respiratory infection and 56 patients with severe adenovirus respiratory infection. Multivariable logistic regression was used to confirm associations between variables and adenovirus respiratory infection, after age and gender adjustment. Hospital stay, still significantly associated with adenovirus respiratory infection. Patients with longer hospital stay (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.13-1.28, P < .001), lower LYMPH (OR = 0.73 95% CI: 0.55-0.99, P = .039), and increased LDH (OR = 1.002, 95% CI: 1.001-1.003, P = .001) had a higher risk of severe adenovirus respiratory infection.Adenovirus is a major pathogen in hospitalized children with respiratory infection. High serum LDH level and low lymphocyte count could be used as predictors of adenovirus respiratory infection severity in children.
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Shamsipour M, Hassanvand MS, Gohari K, Yunesian M, Fotouhi A, Naddafi K, Sheidaei A, Faridi S, Akhlaghi AA, Rabiei K, Mehdipour P, Mahdavi M, Amini H, Farzadfar F. National and sub-national exposure to ambient fine particulate matter (PM 2.5) and its attributable burden of disease in Iran from 1990 to 2016. Environ Pollut 2019; 255:113173. [PMID: 31521993 DOI: 10.1016/j.envpol.2019.113173] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 05/28/2023]
Abstract
Ambient particulate matter is a public health concern. We aimed (1) to estimate national and provincial long-term exposure of Iranians to ambient particulate matter (PM) < 2.5 μm (PM2.5) from 1990 to 2016, and (2) to estimate the national and provincial burden of disease attributable to PM2.5 in Iran. We used all available ground measurements of PM < 10 μm (PM10) (used to estimate PM2.5) from 91 monitoring stations. We estimated the annual mean exposure to PM2.5 for all Iranian population from 1990 to 2016 through a multi-stage modeling process. By applying comparative risk assessment methodology and using life table for years of life lost (YLL), we estimated the mortality and YLL attributable to PM2.5 for five outcomes. The predicted provincial annual mean PM2.5 concentrations range was between 21.7 μg/m3 (UI: 19.03-24.9) and 35.4 μg/m3 (UI: 31.4-39.4) from 1990 to 2016. We estimated in 2016, about 41,000 deaths (95% uncertainty interval [UI] 35634, 47014) and about 3,000,000 YLL (95% UI: 2632101, 3389342) attributable to the long-term exposure to PM2.5 in Iran. Ischemic heart disease was the leading cause of mortality by 31,363 deaths (95% UI: 27520, 35258), followed by stroke (7012 (5999, 8062) deaths), lower respiratory infection (1210 (912, 1519) deaths), chronic obstructive pulmonary disease (1019 (715, 1328) deaths), and lung cancer (668 (489, 848) deaths). In 2016, about 43% of all PM2.5 related mortality in Iran was, respectively, in the following provinces: Tehran (12.6%), Isfahan (9.3%), Khorasan Razavi (8.0%), Fars (6.5%), and Khozestan (6.4%). In summary, we found that the majority of Iranians were exposed to the levels of ambient particulate matter exceeding the WHO guidelines from 1990 to 2016. Further, we found that there was an increasing trend of total mortality attributed to PM2.5 in Iran from 1990 to 2016 where the slope was higher in western provinces.
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Affiliation(s)
- Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Kimiya Gohari
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Naddafi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Faridi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Asghar Akhlaghi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Katayoun Rabiei
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parinaz Mehdipour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mokhtar Mahdavi
- Saveh University of Medical Sciences, Saveh, Iran; Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Heresh Amini
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Hill JA, Vande Vusse LK, Xie H, Chung EL, Yeung CC, Seo S, Stevens-Ayers T, Fisher CE, Huang ML, Stewart FM, Jerome KR, Zerr DM, Corey L, Leisenring WM, Boeckh M. Human Herpesvirus 6B and Lower Respiratory Tract Disease After Hematopoietic Cell Transplantation. J Clin Oncol 2019; 37:2670-2681. [PMID: 31449472 PMCID: PMC7351330 DOI: 10.1200/jco.19.00908] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Human herpesvirus 6B (HHV-6B) DNA is frequently detected in bronchoalveolar lavage fluid (BALF) from immunocompromised subjects with lower respiratory tract disease (LRTD). Whether HHV-6B is a pulmonary pathogen is unclear. METHODS We tested BALF for HHV-6B DNA using polymerase chain reaction in allogeneic hematopoietic cell transplantation (HCT) recipients who underwent a BAL for evaluation of LRTD from 1992 to 2015. We used multivariable proportional hazards models to evaluate the association of HHV-6B+ BALF with overall mortality, death from respiratory failure, and the effect of anti-HHV-6B antivirals on these outcomes. We used branched-chain RNA in situ hybridization to detect HHV-6 messenger RNA (U41 and U57 transcripts) in lung tissue. RESULTS We detected HHV-6B+ BALF from 147 of 553 (27%) individuals. Subjects with HHV-6B+ BALF, with or without copathogens, had significantly increased risk of overall mortality (adjusted hazard ratio [aHR], 2.18; 95% CI, 1.41-3.39) and death from respiratory failure (aHR, 2.50; 95% CI, 1.56-4.01) compared with subjects with HHV-6B- BALF. Subjects with HHV-6B+ BALF who received antivirals within 3 days pre-BAL had an approximately 1 log10 lower median HHV-6B BALF viral load, as well as a lower risk of overall mortality (aHR, 0.42; 95% CI, 0.16-1.10), compared with subjects with HHV-6B+ BALF not receiving antivirals. We detected intraparenchymal HHV-6 gene expression by RNA in situ hybridization in lung tissue in all three tested subjects with HHV-6B+ BALF and sufficient tissue RNA preservation. CONCLUSION These data provide evidence that HHV-6B detection in BALF is associated with higher mortality in allogeneic hematopoietic cell transplantation recipients with LRTD. Definitive evidence of causation will require a randomized prevention or treatment trial.
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Affiliation(s)
- Joshua A. Hill
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lisa K. Vande Vusse
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Hu Xie
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Cecilia C.S. Yeung
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sachiko Seo
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Cynthia E. Fisher
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - F. Marc Stewart
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Keith R. Jerome
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Danielle M. Zerr
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lawrence Corey
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Michael Boeckh
- University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
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Abstract
Scedosporium genus as a significant emerging opportunist causes a broad spectrum of disease in not only immunosuppressed but also immunocompetent patients. The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its very high levels of antifungal resistance, surgery has been recommended as an important part in the treatment of pulmonary Scedosporium spp infection, even in immunocompetent cases. However, whether lung surgery could help to reduce the risk of death in immunocompetent patients is not clear.We retrospectively retrieved the records of pulmonary infections with Scedosporium species in immunocompetent patients through a comprehensive literature search. The association of surgery on all-cause mortality was explored using binary logistic regression (BLR). Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the capability of the model.The comprehensive searching strategy yielded 33 case reports and 3 case series in total, with 40 individual patients being included. The overall mortality was 12.50%. The fatality rate was 9.09% (2/22) in cases with surgery and 16.67% (3/18) in cases without surgery (odds ratio, 0.50; 95% confidence interval, 0.07-3.38; P = .48). Consistently, BLR analysis identified no statistical association between surgery and reduced mortality (odds ratio, 1.19; 95% confidence interval, 0.09-15.64; P = .89), after adjusting for age, gender, and antifungal chemotherapy. The area under the ROC curve was 0.88.For immunocompetent patients with pulmonary Scedosporium spp infection, surgical therapy may not be associated with reduced mortality. Surgical excision could be considered but is not imperative in this group of patients.
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Gaspard P, Mosnier A, Simon L, Ali-Brandmeyer O, Rabaud C, Larocca S, Heck B, Aho-Glélé S, Pothier P, Ambert-Balay K. Gastroenteritis and respiratory infection outbreaks in French nursing homes from 2007 to 2018: Morbidity and all-cause lethality according to the individual characteristics of residents. PLoS One 2019; 14:e0222321. [PMID: 31550261 PMCID: PMC6759171 DOI: 10.1371/journal.pone.0222321] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 08/27/2019] [Indexed: 01/09/2023] Open
Abstract
Background Gastroenteritis (GE) and respiratory tract infection (RTI) outbreaks are a significant issue in nursing homes. This study aimed to describe GE and RTI outbreaks with infection and all-cause lethality rates according to the individual characteristics of nursing home residents. Methods Clinical and virological surveillance were conducted (2007 to 2018). Virus stratifications for the analysis were: outbreaks with positive norovirus or influenza identifications (respectively NoV+ or Flu+), episodes with no NoV or influenza identification or testing (respectively NoV- or Flu-). Associations between individual variables (sex, age, length of stay (LOS), autonomy status) and infection and lethality rates were tested with univariate and Mantel-Haenszel (MH) methods. Results 61 GE outbreaks and 76 RTI oubreaks (total 137 outbreaks) were recorded involving respectively 4309 and 5862 residents. In univariate analysis, higher infection rates and age were associated in NoV+, NoV-, and Flu+ contexts, and lower infection rates were associated with longer stays (NoV+ and NoV-). In MH stratified analysis (virus, sex (female/male)) adjusted for LOS (<4 or ≥4 years), the odds of being infected remained significant among older residents (≥86 years): NoV+/male (Odds ratio (ORMH): 1.64, 95% confidence interval (CI): 1.16–2.30) and Flu+/female and male (respectively ORMH: 1.50, CI: 1.27–1.79 and 1.73, CI: 1.28–2.33). In univariate analysis, lower autonomy status (NoV+, Flu+ and Flu-) and increased age (Flu+) were associated with higher lethality. In MH adjusted analysis, significant ORage adjusted for autonomy was: Flu+/ ≥86 years compared with <86 years, 1.97 (1.19–3.25) and ORautonomy adjusted for age for the more autonomous group (compared with the less autonomous group) was: Flu+, 0.41 (0.24–0.69); Flu-, 0.42 (0.20, 0.90). Conclusion The residents of nursing homes are increasingly elderly and dependent. The specific infection and lethality risks according to these two factors indicate that surveillance and infection control measures are essential and of high priority.
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Affiliation(s)
- Philippe Gaspard
- Hospital Hygiene Service, Rouffach Hospital Center, Rouffach, France
- UMR 6249 Chrono-Environnement, University of Franche-Comté, Besançon, France
- * E-mail:
| | | | - Loic Simon
- Coordination Centre for Nosocomial Infection Control, Eastern Regions, Nancy University Hospital, Nancy, France
| | - Olivia Ali-Brandmeyer
- Coordination Centre for Nosocomial Infection Control, Eastern Regions, Nancy University Hospital, Nancy, France
| | - Christian Rabaud
- Coordination Centre for Nosocomial Infection Control, Eastern Regions, Nancy University Hospital, Nancy, France
| | - Sabrina Larocca
- Hospital Hygiene Service, Rouffach Hospital Center, Rouffach, France
| | - Béatrice Heck
- Hospital Hygiene Service, Rouffach Hospital Center, Rouffach, France
| | - Serge Aho-Glélé
- Department of Epidemiology and Infection Control, Dijon University Hospital, Dijon, France
| | - Pierre Pothier
- University Burgundy Franche-Comté, AgroSup Dijon, PAM UMR A 02.102, Dijon, France
- National Reference Center for Gastroenteritis Viruses, Laboratory of Biology and Pathology, University Hospital, Dijon, France
| | - Katia Ambert-Balay
- University Burgundy Franche-Comté, AgroSup Dijon, PAM UMR A 02.102, Dijon, France
- National Reference Center for Gastroenteritis Viruses, Laboratory of Biology and Pathology, University Hospital, Dijon, France
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Lu JD, Cao F, Ding YX, Wu YD, Guo YL, Li F. Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis. World J Gastroenterol 2019; 25:5162-5173. [PMID: 31558864 PMCID: PMC6747290 DOI: 10.3748/wjg.v25.i34.5162] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a common acute abdominal disease worldwide, and its incidence rate has increased annually. Approximately 20% of AP patients develop into necrotizing pancreatitis (NP), and 40% to 70% of NP patients have infectious complications, which usually indicate a worse prognosis. Infection is an important sign of complications in NP patients.
AIM To investigate the difference in infection time, infection site, and infectious strain in NP patients with infectious complications.
METHODS The clinical data of AP patients visiting the Department of General Surgery of Xuanwu Hospital of Capital Medical University from January 1, 2014 to December 31, 2018 were collected retrospectively. Enhanced computerized tomography or magnetic resonance imaging findings in patients with NP were included in the study. Statistical analysis of infectious bacteria, infection site, and infection time in NP patients with infectious complications was performed, because knowledge about pathogens and their antibiotic susceptibility patterns is essential for selecting an appropriate antibiotic. In addition, the factors that might influence the prognosis of patients were analyzed.
RESULTS In this study, 539 strains of pathogenic bacteria were isolated from 162 patients with NP infection, including 212 strains from pancreatic infections and 327 strains from extrapancreatic infections. Gram-negative bacteria were the main infectious species, the most common of which were Escherichia coli and Pseudomonas aeruginosa. The extrapancreatic infection time (9.1 ± 8.8 d) was earlier than the pancreatic infection time (13.9 ± 12.3 d). Among NP patients with early extrapancreatic infection (< 14 d), bacteremia (25.12%) and respiratory tract infection (21.26%) were predominant. Among NP patients with late extrapancreatic infection (> 14 d), bacteremia (15.94%), respiratory tract infection (7.74%), and urinary tract infection (7.71%) were predominant. Drug sensitivity analysis showed that P. aeruginosa was sensitive to enzymatic penicillins, third- and fourth-generation cephalosporins, and carbapenems. Acinetobacter baumannii and Klebsiella pneumoniae were sensitive only to tigecycline; Staphylococcus epidermidis and Enterococcus faecium were highly sensitive to linezolid, tigecycline, and vancomycin.
CONCLUSION In this study, we identified the timing, the common species, and site of infection in patients with NP.
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Affiliation(s)
- Jiong-Di Lu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yi-Xuan Ding
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yu-Duo Wu
- Department of Cardiac Surgery, Beijing Anzhen Hospital Affiliated to Capital University of Medical Sciences, Beijing 100029, China
| | - Yu-Lin Guo
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Harvey PR, Thomas T, Chandan JS, Bhala N, Nirantharakumar K, Trudgill NJ. Outcomes following feeding gastrostomy (FG) insertion in patients with learning disability: a retrospective cohort study using the health improvement network (THIN) database. BMJ Open 2019; 9:e026714. [PMID: 31221879 PMCID: PMC6588980 DOI: 10.1136/bmjopen-2018-026714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To measure the rates of lower respiratory tract infection (LRTI) and mortality following feeding gastrostomy (FG) placement in patients with learning disability (LD). Following this to compare these rates between those having LRTI prior to FG placement and those with no recent LRTI. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS The study population included patients with LD undergoing FG placement in the 'The Health Improvement Network' database. Patients with LRTI in the year prior (LYP) to their FG placement were compared with patients without a history of LRTI in the year prior (non-LYP) to FG placement. FG placement and LD were identified using Read codes previously developed by an expert panel. MAIN OUTCOME MEASURES Incidence rate ratio (IRR) of developing LRTI and mortality following FG, comparing patients with LRTI in the year prior to FG placement to patients without a history of LRTI. RESULTS 214 patients with LD had a FG inserted including 743.4 person years follow-up. 53.7% were males and the median age was 27.6 (IQR 19.6 to 38.6) years. 27.1% were in the LYP patients. 18.7% had a LRTI in the year following FG, with an estimated incidence rate of 254 per 1000-person years. Over the study period the incidence rate of LRTI in LYP patients was 369 per 1000-person years, in non-LYP patients this was 91 per 1000-person years (adjusted IRR 4.21 (95% CI 2.68 to 6.63) p<0.001). 27.1% of patients died during study follow-up. Incidence rate of death was 80 and 45 per 1000-person year for LYP and non-LYP patients, respectively (adjusted IRR 1.80 (1.00 to 3.23) p=0.05). CONCLUSION In LD patients, no clinically meaningful reduction in LRTI incidence was observed following FG placement. Mortality and LRTI were higher in patients with at least one LRTI in the year preceding FG placement, compared with those without a preceding LRTI.
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Affiliation(s)
- Philip R Harvey
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK
| | - Tom Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Neeraj Bhala
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK
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Hey J, Thompson-Leduc P, Kirson NY, Zimmer L, Wilkins D, Rice B, Iankova I, Krause A, Schonfeld SA, DeBrase CR, Bozzette S, Schuetz P. Procalcitonin guidance in patients with lower respiratory tract infections: a systematic review and meta-analysis. Clin Chem Lab Med 2019; 56:1200-1209. [PMID: 29715176 DOI: 10.1515/cclm-2018-0126] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/16/2018] [Indexed: 12/19/2022]
Abstract
Although effective for bacterial lower respiratory tract infections (LRTIs), antibiotic treatment is often incorrectly prescribed for non-bacterial LRTIs. Procalcitonin has emerged as a promising biomarker to diagnose bacterial infections and guide antibiotic treatment decisions. As part of a regulatory submission to the U.S. Food and Drug Administration, this systematic review and meta-analysis summarizes the effects of procalcitonin-guided antibiotic stewardship on antibiotic use and clinical outcomes in adult LRTI patients. PubMed and the Cochrane Database of Systematic Reviews were searched for English-language randomized controlled trials published between January 2004 and May 2016. Random and fixed effects meta-analyses were performed to study efficacy (initiation of antibiotics, antibiotic use) and safety (mortality, length of hospital stay). Eleven trials were retained, comprising 4090 patients. Procalcitonin-guided patients had lower odds of antibiotic initiation (odds ratio: 0.26; 95% confidence interval [CI]: 0.13-0.52) and shorter mean antibiotic use (weighted mean difference: -2.15 days; 95% CI: -3.30 to -0.99) compared to patients treated with standard care. Procalcitonin use had no adverse impact on mortality (relative risk: 0.94; 95% CI: 0.69-1.28) and length of hospital stay (weighted mean difference: -0.15 days; 95% CI: -0.60 to 0.30). Procalcitonin guidance reduces antibiotic initiation and use among adults with LRTIs with no apparent adverse impact on length of hospital stay or mortality.
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Affiliation(s)
| | | | - Noam Y Kirson
- Vice President, Analysis Group Inc., 111 Huntington Avenue, Fourteenth Floor, Boston, MA 02199-7668, USA
| | | | | | | | | | | | | | | | | | - Philipp Schuetz
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Navascués A, Casado I, Pérez-García A, Aguinaga A, Martínez-Baz I, Floristán Y, Ezpeleta C, Castilla J. Detection of Respiratory Viruses in Deceased Persons, Spain, 2017. Emerg Infect Dis 2019; 24:1331-1334. [PMID: 29912695 PMCID: PMC6038767 DOI: 10.3201/eid2407.180162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
During the 2016–17 influenza season in Spain, we tested specimens from 57 elderly deceased persons for respiratory viruses. Influenza viruses were detected in 18% of the specimens and any respiratory virus in 47%. Only 7% of participants had received a diagnosis of infection with the detected virus before death.
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Abstract
Pneumonia severity index (PSI) is an important scoring system that can assess the severity of community acquired pneumonia and determine admission status. However, there is a lack of research on whether this scoring system can be applied to viral community acquired pneumonia. The purpose of this study was to evaluate the usefulness of PSI in viral community acquired pneumonia. This retrospective cohort study included 1,434 adult patients (aged ≥18 years) who were admitted to the emergency department of a university hospital during 2013–2015 because of community-acquired pneumonia. Viral infections were diagnosed by multiplex PCR. Patients diagnosed with non-viral community-acquired pneumonia were included in the control group (N = 1,173). The main outcome was 30-day all-cause mortality. multivariate Cox regression analyses were performed to calculate the risk of death. Respiratory viruses were detected in 261 (18.2%) patients with community-acquired pneumonia. Two types of respiratory viruses were detected in 7 cases. Of the 254 cases detected with only one virus, 62 were influenza A, 18 were influenza B, 65 were rhinovirus, 35 were respiratory syncytial virus, 25 were metapneumovirus, 20 were parainfluenza, 17 were coronavirus, 7 were bocavirus, and 5 were adenovirus. Mortality was not significantly different between patients with respiratory virus and those without respiratory virus; the 30-day all-cause mortality rates were 20.3% and 22.4%, respectively (P = 0.45). Mortality rate increased with an increasing PSI score with or without respiratory viral infection. Pulmonary severity index was significantly associated with mortality adjusted for respiratory virus detection (hazard ratio = 1.024, 95% confidence interval = 1.020–1.028). Pneumonia severity index score is an important factor for assessing the prognosis of patients with community-acquired pneumonia, regardless of respiratory virus detection.
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Affiliation(s)
- Mi-Ae Kim
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Jae Seok Park
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Choong Won Lee
- Department of Occupational & Environmental Medicine, Sungso Hospital, Andong, Republic of Korea
| | - Won-Il Choi
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
- * E-mail:
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Torii R, Noguchi S, Shimabukuro I, Inokuchi Y, Tabaru A, Yoshii C, Yatera K. Pulmonary Mycobacterium abscessus Infection with Reactive AA Amyloidosis: A Case Report and Brief Review of the Literature. Intern Med 2019; 58:557-561. [PMID: 30333399 PMCID: PMC6421137 DOI: 10.2169/internalmedicine.1263-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We herein report a case involving a 64-year-old Japanese woman with a pulmonary Mycobacterium abscessus infection complicated by reactive AA amyloidosis, which, to our knowledge, has not been reported to date. The patient underwent gastrointestinal endoscopy for diarrhea during the treatment of pulmonary M. abscessus infection and was diagnosed with AA amyloidosis according to the histopathological findings from the endoscopic specimen. She died four months later. The prognosis of AA amyloidosis associated with pulmonary M. abscessus infection may be very poor, and physicians should pay attention to this rare condition when difficult-to-treat diarrhea occurs in patients with pulmonary M. abscessus infection.
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Affiliation(s)
- Ryo Torii
- Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan
| | - Shingo Noguchi
- Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Ikuko Shimabukuro
- Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan
| | - Yuri Inokuchi
- Department of Gastroenterology and Hepatology, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan
| | - Akinari Tabaru
- Department of Gastroenterology and Hepatology, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan
| | - Chiharu Yoshii
- Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
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Verfürden ML, Gilbert R, Sebire N, Hardelid P. Avoidable mortality from respiratory tract infection and sudden unexplained death in children with chronic conditions: a data linkage study. Arch Dis Child 2018; 103:1125-1131. [PMID: 30007945 PMCID: PMC6287561 DOI: 10.1136/archdischild-2017-314098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/22/2018] [Accepted: 06/09/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine the risk of death from two potentially avoidable causes with different aetiologies: respiratory tract infection (RTI) and sudden unexplained death (SUD) in children with and without chronic conditions. DESIGN Whole-country, birth cohort study using linked administrative health databases from Scotland. SETTING AND PARTICIPANTS Children aged 2 months to less than 5 years in Scotland between 2000 and 2014. MAIN OUTCOME MEASURES Relative risk of death (expressed as the HR) related to RTIs or SUD, in children with and without chronic conditions. We separately analysed deaths at ages 2-11 months and at 1-4 years and adjusted for birth characteristics, socioeconomic status and vaccination uptake using Cox regression. RESULTS The cohort comprised 761 172 children. Chronic conditions were recorded in 9.6% (n=72 901) of live births, 82.4% (n=173) of RTI-related deaths and 17.4% (n=49) of SUDs. Chronic conditions were very strongly associated with RTI mortality (2-11 months: HR 68.48, 95% CI (40.57 to 115.60), 1-4 years: HR 38.32, 95% CI (23.26 to 63.14)) and strongly associated with SUD (2-11 months: HR 2.42, 95% CI (1.67 to 3.63), 1-4 years: HR 2.53, 95% CI (1.36 to 4.71)). CONCLUSIONS The very strong association with chronic conditions suggests that RTI-related mortality may sometimes be a consequence of a terminal decline and not possible to defer or prevent in all cases. Recording whether death was expected on death certificates could indicate which RTI-related deaths might be avoidable through healthcare and public health measures.
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Affiliation(s)
- Maximiliane L Verfürden
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ruth Gilbert
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Neil Sebire
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Pia Hardelid
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
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Troeger C, Blacker B, Khalil IA, Rao PC, Cao J, Zimsen SRM, Albertson SB, Deshpande A, Farag T, Abebe Z, Adetifa IMO, Adhikari TB, Akibu M, Al Lami FH, Al-Eyadhy A, Alvis-Guzman N, Amare AT, Amoako YA, Antonio CAT, Aremu O, Asfaw ET, Asgedom SW, Atey TM, Attia EF, Avokpaho EFGA, Ayele HT, Ayuk TB, Balakrishnan K, Barac A, Bassat Q, Behzadifar M, Behzadifar M, Bhaumik S, Bhutta ZA, Bijani A, Brauer M, Brown A, Camargos PAM, Castañeda-Orjuela CA, Colombara D, Conti S, Dadi AF, Dandona L, Dandona R, Do HP, Dubljanin E, Edessa D, Elkout H, Endries AY, Fijabi DO, Foreman KJ, Forouzanfar MH, Fullman N, Garcia-Basteiro AL, Gessner BD, Gething PW, Gupta R, Gupta T, Hailu GB, Hassen HY, Hedayati MT, Heidari M, Hibstu DT, Horita N, Ilesanmi OS, Jakovljevic MB, Jamal AA, Kahsay A, Kasaeian A, Kassa DH, Khader YS, Khan EA, Khan MN, Khang YH, Kim YJ, Kissoon N, Knibbs LD, Kochhar S, Koul PA, Kumar GA, Lodha R, Magdy Abd El Razek H, Malta DC, Mathew JL, Mengistu DT, Mezgebe HB, Mohammad KA, Mohammed MA, Momeniha F, Murthy S, Nguyen CT, Nielsen KR, Ningrum DNA, Nirayo YL, Oren E, Ortiz JR, PA M, Postma MJ, Qorbani M, Quansah R, Rai RK, Rana SM, Ranabhat CL, Ray SE, Rezai MS, Ruhago GM, Safiri S, Salomon JA, Sartorius B, Savic M, Sawhney M, She J, Sheikh A, Shiferaw MS, Shigematsu M, Singh JA, Somayaji R, Stanaway JD, Sufiyan MB, Taffere GR, Temsah MH, Thompson MJ, Tobe-Gai R, Topor-Madry R, Tran BX, Tran TT, Tuem KB, Ukwaja KN, Vollset SE, Walson JL, Weldegebreal F, Werdecker A, West TE, Yonemoto N, Zaki MES, Zhou L, Zodpey S, Vos T, Naghavi M, Lim SS, Mokdad AH, Murray CJL, Hay SI, Reiner RC. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 2018; 18:1191-1210. [PMID: 30243584 PMCID: PMC6202443 DOI: 10.1016/s1473-3099(18)30310-4] [Citation(s) in RCA: 912] [Impact Index Per Article: 152.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/02/2018] [Accepted: 05/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Lower respiratory infections are a leading cause of morbidity and mortality around the world. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, provides an up-to-date analysis of the burden of lower respiratory infections in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 26 years and shows how the burden of lower respiratory infection has changed in people of all ages. METHODS We used three separate modelling strategies for lower respiratory infections in GBD 2016: a Bayesian hierarchical ensemble modelling platform (Cause of Death Ensemble model), which uses vital registration, verbal autopsy data, and surveillance system data to predict mortality due to lower respiratory infections; a compartmental meta-regression tool (DisMod-MR), which uses scientific literature, population representative surveys, and health-care data to predict incidence, prevalence, and mortality; and modelling of counterfactual estimates of the population attributable fraction of lower respiratory infection episodes due to Streptococcus pneumoniae, Haemophilus influenzae type b, influenza, and respiratory syncytial virus. We calculated each modelled estimate for each age, sex, year, and location. We modelled the exposure level in a population for a given risk factor using DisMod-MR and a spatio-temporal Gaussian process regression, and assessed the effectiveness of targeted interventions for each risk factor in children younger than 5 years. We also did a decomposition analysis of the change in LRI deaths from 2000-16 using the risk factors associated with LRI in GBD 2016. FINDINGS In 2016, lower respiratory infections caused 652 572 deaths (95% uncertainty interval [UI] 586 475-720 612) in children younger than 5 years (under-5s), 1 080 958 deaths (943 749-1 170 638) in adults older than 70 years, and 2 377 697 deaths (2 145 584-2 512 809) in people of all ages, worldwide. Streptococcus pneumoniae was the leading cause of lower respiratory infection morbidity and mortality globally, contributing to more deaths than all other aetiologies combined in 2016 (1 189 937 deaths, 95% UI 690 445-1 770 660). Childhood wasting remains the leading risk factor for lower respiratory infection mortality among children younger than 5 years, responsible for 61·4% of lower respiratory infection deaths in 2016 (95% UI 45·7-69·6). Interventions to improve wasting, household air pollution, ambient particulate matter pollution, and expanded antibiotic use could avert one under-5 death due to lower respiratory infection for every 4000 children treated in the countries with the highest lower respiratory infection burden. INTERPRETATION Our findings show substantial progress in the reduction of lower respiratory infection burden, but this progress has not been equal across locations, has been driven by decreases in several primary risk factors, and might require more effort among elderly adults. By highlighting regions and populations with the highest burden, and the risk factors that could have the greatest effect, funders, policy makers, and programme implementers can more effectively reduce lower respiratory infections among the world's most susceptible populations. FUNDING Bill & Melinda Gates Foundation.
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Balcan B, Ozcelik U, Ugurlu AO, Aydin M, Nalcaci S, Yarbug Karakayali F. Increased Mortality Among Renal Transplant Patients With Invasive Pulmonary Aspergillus Infection. Prog Transplant 2018; 28:349-353. [PMID: 30235978 DOI: 10.1177/1526924818800044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Renal transplantation is the most effective and preferred definite treatment option in patients with end-stage renal disease. Due to long-term immunesuppressive treatment, renal transplant recipients become vulnerable to opportunistic infections, especially to fungal infections. METHOD This was a single-center, retrospective observational study of 438 patients who underwent renal transplantation between 2010 and 2016. RESULTS Thirty-eight renal transplant recipients who had lower respiratory tract infection with median age of 41.5 years were evaluated for invasive pulmonary aspergillus (IPA). Of these, 52.6% were female and 84.2% had living donors. Eleven of 38 lower respiratory patients were found to have IPA infection, 5 with proven infection. Compared to patients who did not have fungal pulmonary infection, patients with invasive aspergillus were older and had high fever, galactomannan levels, and leukocyte counts. Mortality was also higher in those patients. Having fever at the baseline and IPA infection was significantly associated with mortality in univariate analysis and remained related in multivariate model after adjustment for age, gender, and fever. CONCLUSION Invasive pulmonary aspergillus infection is highly associated with increased mortality rates in renal transplant patients. Fungal pulmonary infections in immune-suppressed patients should be diagnosed and treated immediately in order to avoid the life-threatening complications and may greatly improve prognosis.
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Affiliation(s)
- Baran Balcan
- 1 Department of Pulmonary Medicine, Baskent University, Istanbul, Turkey
- 2 Department of Pulmonary Medicine, Marmara University, Istanbul, Turkey
| | - Umit Ozcelik
- 3 Department of General Surgery, Baskent University, Istanbul, Turkey
| | | | - Mehtap Aydin
- 4 Department of Infectious Diseases, Baskent University, Istanbul, Turkey
| | - Serdar Nalcaci
- 5 Department of Nephrology, Baskent University, Istanbul, Turkey
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Chen Y, Zang L, Du W, Xu D, Shen G, Zhang Q, Zou Q, Chen J, Zhao M, Yao D. Ambient air pollution of particles and gas pollutants, and the predicted health risks from long-term exposure to PM 2.5 in Zhejiang province, China. Environ Sci Pollut Res Int 2018; 25:23833-23844. [PMID: 29876857 DOI: 10.1007/s11356-018-2420-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/25/2018] [Indexed: 06/08/2023]
Abstract
In recent years, ambient air has been severely contaminated by particulate matters (PMs) and some gas pollutants (nitrogen dioxide (NO2) and sulfur dioxide (SO2)) in China, and many studies have demonstrated that exposure to these pollutants can induce great adverse impacts on human health. The concentrations of the pollutants were much higher in winter than those in summer, and the average concentrations in this studied area were lower than those in northern China. In the comparison between high-resolution emission inventory and spatial distribution of PM2.5, significant positive linear correlation was found. Though the pollutants had similar trends, NO2 and SO2 delayed with 1 h to PM2.5. Besides, PM2.5 had a lag time of 1 h to temperature and relative humidity. Significant linear correlation was found among pollutants and meteorological conditions, suggesting the impact of meteorological conditions on ambient air pollution other than emission. For the 24-h trend, lowest concentrations of PM2.5, NO2, and SO2 were found around 15:00-18:00. In 2015, the population attributable fractions (PAFs) for ischemic heart disease (IHD), cerebrovascular disease (stroke), chronic obstructive pulmonary disease (COPD), lung cancer (LC), and acute lower respiratory infection (ALRI) due to the exposure to PM2.5 in Zhejiang province were 25.82, 38.94, 17.73, 22.32, and 31.14%, respectively. The population-weighted mortality due to PM2.5 exposure in Zhejiang province was lower than the average level of the whole country-China.
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Affiliation(s)
- Yuanchen Chen
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Research Center of Environmental Science, Zhejiang University of Technology, Hangzhou, 310032, China
| | - Lu Zang
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Research Center of Environmental Science, Zhejiang University of Technology, Hangzhou, 310032, China
| | - Wei Du
- Ministry of Education Laboratory of Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, 100871, China
| | - Da Xu
- Zhejiang Province Environmental Monitoring Center, Hangzhou, 310012, China
| | - Guofeng Shen
- Ministry of Education Laboratory of Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, 100871, China
| | - Quan Zhang
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Research Center of Environmental Science, Zhejiang University of Technology, Hangzhou, 310032, China
| | - Qiaoli Zou
- Zhejiang Province Environmental Monitoring Center, Hangzhou, 310012, China
| | - Jinyuan Chen
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Research Center of Environmental Science, Zhejiang University of Technology, Hangzhou, 310032, China
| | - Meirong Zhao
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Province, College of Environment, Research Center of Environmental Science, Zhejiang University of Technology, Hangzhou, 310032, China
| | - Defei Yao
- Zhejiang Province Environmental Monitoring Center, Hangzhou, 310012, China.
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Zou B, Yeo YH, Jeong D, Sheen E, Park H, Nguyen P, Hsu YC, Garcia G, Nguyen MH. Higher mortality and hospital charges in patients with cirrhosis and acute respiratory illness: a population-based study. Sci Rep 2018; 8:9969. [PMID: 29967363 PMCID: PMC6028654 DOI: 10.1038/s41598-018-28317-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/19/2018] [Indexed: 01/13/2023] Open
Abstract
Both cirrhosis and acute respiratory illness (ARI) carry substantial disease and financial burden. To compare hospitalized patients with cirrhosis with ARI to cirrhotic patients without ARI, a retrospective cohort study was conducted using the California Office of Statewide Health Planning and Development database. To balance the groups, propensity score matching (PSM) was used. We identified a total of 46,192 cirrhotic patients during the three study periods (14,049, 15,699, and 16,444 patients, respectively). Among patients hospitalized with cirrhosis, the ARI prevalence was higher in older age groups (p < 0.001), the Asian population (p = 0.002), non-Hispanic population (p = 0.001), and among Medicare patients (p < 0.001). Compared to controls, patients with ARI had 53.8% higher adjusted hospital charge ($122,555 vs. $79,685 per patient per admission, p < 0.001) and 35.0% higher adjusted in-hospital mortality (p < 0.001). Older patients, patients with alcoholic liver disease or liver cancer were at particularly higher risk (adjusted hazard ratio = 2.94 (95% CI: 2.26-3.83), 1.22 (95% CI: 1.02-1.45), and 2.17 (95% CI: 1.76-2.68) respectively, p = 0.028 to <0.001). Mortality rates and hospital charges in hospitalized cirrhotic patients with ARI were higher than in cirrhotic controls without ARI. Preventive efforts such as influenza and pneumococcal vaccination, especially in older patients and those with liver cancer, or alcoholic liver disease, would be of value.
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Affiliation(s)
- Biyao Zou
- Stanford University Medical Center, Division of Gastroenterology and Hepatology, Palo Alto, CA, 94304, USA
| | - Yee Hui Yeo
- Stanford University Medical Center, Division of Gastroenterology and Hepatology, Palo Alto, CA, 94304, USA
| | - Donghak Jeong
- Stanford University Medical Center, Division of Gastroenterology and Hepatology, Palo Alto, CA, 94304, USA
| | - Edward Sheen
- Stanford University Medical Center, Division of Gastroenterology and Hepatology, Palo Alto, CA, 94304, USA
| | - Haesuk Park
- University of Florida College of Pharmacy, Pharmaceutical Outcomes & Policy, Gainesville, FL, 32608, USA
| | - Pauline Nguyen
- Stanford University Medical Center, Division of Gastroenterology and Hepatology, Palo Alto, CA, 94304, USA
| | - Yao-Chun Hsu
- Fu-Jen Catholic University Hospital, Division of Gastroenterology, New Taipei, Taiwan
| | - Gabriel Garcia
- Stanford University Medical Center, Division of Gastroenterology and Hepatology, Palo Alto, CA, 94304, USA
| | - Mindie H Nguyen
- Stanford University Medical Center, Division of Gastroenterology and Hepatology, Palo Alto, CA, 94304, USA.
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Chicaiza-Ayala W, Henríquez-Trujillo AR, Ortiz-Prado E, Douce RW, Coral-Almeida M. The burden of acute respiratory infections in Ecuador 2011-2015. PLoS One 2018; 13:e0196650. [PMID: 29715314 PMCID: PMC5929540 DOI: 10.1371/journal.pone.0196650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/17/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Burden of disease studies intend to improve public health decision-making and to measure social and economic impact in population. The objective of this study was to describe the burden of acute respiratory infections (ARI) in Ecuador between 2011 and 2015. METHODS Five-year period morbidity and mortality data available from national agencies of statistics was analyzed to estimate the burden of disease attributable to acute respiratory infections. Cases and deaths registered were grouped according to their ICD-10 code into three diagnostic groups: Acute upper respiratory infections (J00-J06), Influenza and pneumonia (J09-J18), and Bronchitis and other acute lower respiratory infections (J20-J22, J85, J86). Disability-adjusted life years stratified by diagnostic and age group were calculated using the "DALY" package for R. The productivity loss in monetary terms was estimated using the human capital method. RESULTS Over the 5-year period studied there were a total of 14.84 million cases of acute respiratory infections, with 17 757 deaths reported (0.12%). The yearly burden of disease ranged between 98 944 to 118 651 disability-adjusted life years, with an estimated average loss of productivity of US$152.16 million (±19.6) per year. Approximately 99% of the burden can be attributed to years life lost due to premature mortality in population under 5 years old and over 60 years-old. CONCLUSIONS The burden of acute respiratory infections remained steady during the analyzed period. Evidence-based prevention and control policies to tackle acute respiratory infections in Ecuador should focus on the population at extreme ages of life.
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Affiliation(s)
- Wilson Chicaiza-Ayala
- OneHealth Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
| | | | - Esteban Ortiz-Prado
- OneHealth Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
- Department of Medicine and Center for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York, United States of America
| | - Richard W. Douce
- Department of Internal Medicine, Lakeland Health Care, St. Joseph, Michigan, United States of America
| | - Marco Coral-Almeida
- OneHealth Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
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el Bcheraoui C, Mokdad AH, Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, Morozoff C, Shirude S, Naghavi M, Murray CJL. Trends and Patterns of Differences in Infectious Disease Mortality Among US Counties, 1980-2014. JAMA 2018; 319:1248-1260. [PMID: 29584843 PMCID: PMC5885870 DOI: 10.1001/jama.2018.2089] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Infectious diseases are mostly preventable but still pose a public health threat in the United States, where estimates of infectious diseases mortality are not available at the county level. OBJECTIVE To estimate age-standardized mortality rates and trends by county from 1980 to 2014 from lower respiratory infections, diarrheal diseases, HIV/AIDS, meningitis, hepatitis, and tuberculosis. DESIGN AND SETTING This study used deidentified death records from the National Center for Health Statistics (NCHS) and population counts from the US Census Bureau, NCHS, and the Human Mortality Database. Validated small-area estimation models were applied to these data to estimate county-level infectious disease mortality rates. EXPOSURES County of residence. MAIN OUTCOMES AND MEASURES Age-standardized mortality rates of lower respiratory infections, diarrheal diseases, HIV/AIDS, meningitis, hepatitis, and tuberculosis by county, year, and sex. RESULTS Between 1980 and 2014, there were 4 081 546 deaths due to infectious diseases recorded in the United States. In 2014, a total of 113 650 (95% uncertainty interval [UI], 108 764-117 942) deaths or a rate of 34.10 (95% UI, 32.63-35.38) deaths per 100 000 persons were due to infectious diseases in the United States compared to a total of 72 220 (95% UI, 69 887-74 712) deaths or a rate of 41.95 (95% UI, 40.52-43.42) deaths per 100 000 persons in 1980, an overall decrease of 18.73% (95% UI, 14.95%-23.33%). Lower respiratory infections were the leading cause of infectious diseases mortality in 2014 accounting for 26.87 (95% UI, 25.79-28.05) deaths per 100 000 persons (78.80% of total infectious diseases deaths). There were substantial differences among counties in death rates from all infectious diseases. Lower respiratory infection had the largest absolute mortality inequality among counties (difference between the 10th and 90th percentile of the distribution, 24.5 deaths per 100 000 persons). However, HIV/AIDS had the highest relative mortality inequality between counties (10.0 as the ratio of mortality rate in the 90th and 10th percentile of the distribution). Mortality from meningitis and tuberculosis decreased over the study period in all US counties. However, diarrheal diseases were the only cause of infectious diseases mortality to increase from 2000 to 2014, reaching a rate of 2.41 (95% UI, 0.86-2.67) deaths per 100 000 persons, with many counties of high mortality extending from Missouri to the northeastern region of the United States. CONCLUSIONS AND RELEVANCE Between 1980 and 2014, there were declines in mortality from most categories of infectious diseases, with large differences among US counties. However, over this time there was an increase in mortality for diarrheal diseases.
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Affiliation(s)
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | - Rebecca W Stubbs
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Chloe Morozoff
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Shreya Shirude
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
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Abstract
CLINICAL QUESTION Is the use of procalcitonin for guiding antibiotic decisions in patients with acute upper and lower respiratory tract infections associated with improved clinical outcomes compared with usual care? BOTTOM LINE Among patients with varying types and severity of acute respiratory infection, using procalcitonin to guide decisions about antibiotics is associated with lower rates of antibiotic exposure, antibiotic-related adverse effects, and mortality.
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Affiliation(s)
- Philipp Schuetz
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Yannick Wirz
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Barnes SR, Wansaula Z, Herrick K, Oren E, Ernst K, Olsen SJ, Casal MG. Mortality estimates among adult patients with severe acute respiratory infections from two sentinel hospitals in southern Arizona, United States, 2010-2014. BMC Infect Dis 2018; 18:78. [PMID: 29433471 PMCID: PMC5809880 DOI: 10.1186/s12879-018-2984-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/31/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND From October 2010 through February 2016, Arizona conducted surveillance for severe acute respiratory infections (SARI) among adults hospitalized in the Arizona-Mexico border region. There are few accurate mortality estimates in SARI patients, particularly in adults ≥ 65 years old. The purpose of this study was to generate mortality estimates among SARI patients that include deaths occurring shortly after hospital discharge and identify risk factors for mortality. METHODS Patients admitted to two sentinel hospitals between 2010 and 2014 who met the SARI case definition were enrolled. Demographic data were used to link SARI patients to Arizona death certificates. Mortality within 30 days after the date of admission was calculated and risk factors were identified using logistic regression models. RESULTS Among 258 SARI patients, 47% were females, 51% were white, non-Hispanic and 39% were Hispanic. The median age was 63 years (range, 19 to 97 years) and 80% had one or more pre-existing health condition; 9% died in hospital. Mortality increased to 12% (30/258, 30% increase) when electronic vital records and a 30-day post-hospitalization time frame were used. Being age ≥ 65 years (OR = 4.0; 95% CI: 1.6-9.9) and having an intensive care unit admission (OR = 7.4; 95% CI: 3.0-17.9) were independently associated with mortality. CONCLUSION The use of electronic vital records increased SARI-associated mortality estimates by 30%. These findings may help guide prevention and treatment measures, particularly in high-risk persons in this highly fluid border population.
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Affiliation(s)
- Steve R. Barnes
- Arizona Department of Health Services, Border Infectious Disease Surveillance Program, 400 West Congress, Suite 116, Tucson, AZ 85701 USA
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724 USA
| | - Zimy Wansaula
- Arizona Department of Health Services, Border Infectious Disease Surveillance Program, 400 West Congress, Suite 116, Tucson, AZ 85701 USA
| | - Kristen Herrick
- Arizona Department of Health Services, Office of Infectious Disease Services, 150 N 18th Ave Phoenix, Phoenix, AZ 85007 USA
| | - Eyal Oren
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724 USA
| | - Kacey Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724 USA
| | - Sonja J. Olsen
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027 USA
| | - Mariana G. Casal
- Arizona Department of Health Services, Border Infectious Disease Surveillance Program, 400 West Congress, Suite 116, Tucson, AZ 85701 USA
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Abstract
Health officials lack field-implementable tools for forecasting the effects that
a large-scale release of Bacillus anthracis spores would have
on public health and hospitals. We created a modeling tool (combining
inhalational anthrax caseload projections based on initial case reports, effects
of variable postexposure prophylaxis campaigns, and healthcare facility surge
capacity requirements) to project hospitalizations and casualties from a newly
detected inhalation anthrax event, and we examined the consequences of
intervention choices. With only 3 days of case counts, the model can predict
final attack sizes for simulated Sverdlovsk-like events (1979 USSR) with
sufficient accuracy for decision making and confirms the value of early
postexposure prophylaxis initiation. According to a baseline scenario, hospital
treatment volume peaks 15 days after exposure, deaths peak earlier (day 5), and
recovery peaks later (day 23). This tool gives public health, hospital, and
emergency planners scenario-specific information for developing quantitative
response plans for this threat.
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Vardakas KZ, Mavroudis AD, Georgiou M, Falagas ME. Intravenous plus inhaled versus intravenous colistin monotherapy for lower respiratory tract infections: A systematic review and meta-analysis. J Infect 2018; 76:321-327. [PMID: 29428226 DOI: 10.1016/j.jinf.2018.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/03/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate whether intravenous plus inhaled combination (IV/INHCC) compared to intravenous monotherapy (IVCM) was associated with patient outcomes and identify factors influencing study outcomes. METHODS PubMed and Scopus were searched till November 2016. Studies were included if they evaluated adult patients with lower respiratory tract infections due to MDR/XDR Gram-negative bacteria and reported comparative mortality data (adjusted and unadjusted) for patients receiving IV/INHCC versus IVCM. Random effects meta-analyses were performed. RESULTS Thirteen studies (11 retrospective, 2 prospective) were included. The overall quality of data was low to very low and characterized by the lack of adjusted data. The majority of the studies were designed to evaluate the outcome of the meta-analysis. Both IV and inhaled colistin were administered at variable doses. There was no difference in mortality between IV/INHCC and IVCM when all studies were combined (13 studies, 1115 patients, risk ratio 0.94, 95% confidence interval 0.81-1.08). Only the analysis that included studies with low-dose IV colistin showed significant difference in favor of IV/INHCC versus IVCM (0.65, 0.45-0.94). CONCLUSIONS Overall, low quality data suggest that IV/INHCC did not lower mortality in patients with MDR Gram negative infections unless low IV colistin dose was administered.
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Affiliation(s)
- Konstantinos Z Vardakas
- Alfa Institute of Biomedical Sciences, Athens, Greece; Department of Medicine, Henry Dunant Hospital Center, Athens, Greece
| | | | | | - Matthew E Falagas
- Alfa Institute of Biomedical Sciences, Athens, Greece; Department of Medicine, Henry Dunant Hospital Center, Athens, Greece; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
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48
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Henning LN, Carpenter S, Stark GV, Serbina NV. Development of Protective Immunity in New Zealand White Rabbits Challenged with Bacillus anthracis Spores and Treated with Antibiotics and Obiltoxaximab, a Monoclonal Antibody against Protective Antigen. Antimicrob Agents Chemother 2018; 62:e01590-17. [PMID: 29133571 PMCID: PMC5786786 DOI: 10.1128/aac.01590-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/03/2017] [Indexed: 02/08/2023] Open
Abstract
The recommended management of inhalational anthrax, a high-priority bioterrorist threat, includes antibiotics and antitoxins. Obiltoxaximab, a chimeric monoclonal antibody against anthrax protective antigen (PA), is licensed under the U.S. Food and Drug Administration's (FDA's) Animal Rule for the treatment of inhalational anthrax. Because of spore latency, disease reemergence after treatment cessation is a concern, and there is a need to understand the development of endogenous protective immune responses following antitoxin-containing anthrax treatment regimens. Here, acquired protective immunity was examined in New Zealand White (NZW) rabbits challenged with a targeted lethal dose of Bacillus anthracis spores and treated with antibiotics, obiltoxaximab, or a combination of both. Survivors of the primary challenge were rechallenged 9 months later and monitored for survival. Survival rates after primary and rechallenge for controls and animals treated with obiltoxaximab, levofloxacin, or a combination of both were 0, 65, 100, and 95%, and 0, 100, 95, and 89%, respectively. All surviving immune animals had circulating antibodies to PA and serum toxin-neutralizing titers prior to rechallenge. Following rechallenge, systemic bacteremia and toxemia were not detected in most animals, and the levels of circulating anti-PA IgG titers increased starting at 5 days postrechallenge. We conclude that treatment with obiltoxaximab, alone or combined with antibiotics, significantly improves the survival of rabbits that received a lethal inhalation B. anthracis spore challenge dose and does not interfere with the development of immunity. Survivors of primary challenge are protected against reexposure, have rare incidents of systemic bacteremia and toxemia, and have evidence of an anamnestic response.
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49
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Kanai Y, Kawagishi T, Okamoto M, Sakai Y, Matsuura Y, Kobayashi T. Lethal murine infection model for human respiratory disease-associated Pteropine orthoreovirus. Virology 2018; 514:57-65. [PMID: 29128757 PMCID: PMC7173163 DOI: 10.1016/j.virol.2017.10.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 12/24/2022]
Abstract
Pteropine orthoreovirus (PRV) is an emerging bat-borne human pathogen causing severe respiratory illness. To date, however, the evaluation of PRV virulence has largely depended on the limited numbers of clinical cases owing to the lack of animal models. To develop an in vivo model of PRV infection, an inbred C3H mouse strain was infected intranasally with pathogenic PRV strain Miyazaki-Bali/2007. C3H mice suffered severe lung infection with significant body weight reduction and died within 7 days after intranasal infection. Infectious viruses were isolated mainly from the lungs and trachea. Histopathological examination revealed interstitial pneumonia with monocytes infiltration. Following repeated intranasal infection, mice developed antibodies to particular structural and non-structural proteins of PRV. The results of these immunological assays will help to develop laboratory protocols for sero-epidemiological studies. Our small rodent model of lethal respiratory infection will further allow investigation of the molecular mechanisms underlying the high pathogenicity of PRV. A lethal PRV strain Miyazaki-Bali/2007 murine infection model was established. Susceptibility of different mouse strains to PRV infection was investigated. Antibody responses to PRV proteins in C3H mice post intranasal infection were studied.
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Affiliation(s)
- Yuta Kanai
- Department of Virology, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Takahiro Kawagishi
- Department of Virology, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Minoru Okamoto
- Department of Veterinary Pathology, Rakuno Gakuen University, Hokkaido, Japan
| | - Yusuke Sakai
- Laboratory of Veterinary Pathology, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Yoshiharu Matsuura
- Department of Molecular Virology, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Takeshi Kobayashi
- Department of Virology, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan.
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50
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Schuetz P, Wirz Y, Sager R, Christ‐Crain M, Stolz D, Tamm M, Bouadma L, Luyt CE, Wolff M, Chastre J, Tubach F, Kristoffersen KB, Burkhardt O, Welte T, Schroeder S, Nobre V, Wei L, Bucher HCC, Bhatnagar N, Annane D, Reinhart K, Branche A, Damas P, Nijsten M, de Lange DW, Deliberato RO, Lima SSS, Maravić‐Stojković V, Verduri A, Cao B, Shehabi Y, Beishuizen A, Jensen JS, Corti C, Van Oers JA, Falsey AR, de Jong E, Oliveira CF, Beghe B, Briel M, Mueller B. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev 2017; 10:CD007498. [PMID: 29025194 PMCID: PMC6485408 DOI: 10.1002/14651858.cd007498.pub3] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Acute respiratory infections (ARIs) comprise of a large and heterogeneous group of infections including bacterial, viral, and other aetiologies. In recent years, procalcitonin (PCT), a blood marker for bacterial infections, has emerged as a promising tool to improve decisions about antibiotic therapy (PCT-guided antibiotic therapy). Several randomised controlled trials (RCTs) have demonstrated the feasibility of using procalcitonin for starting and stopping antibiotics in different patient populations with ARIs and different settings ranging from primary care settings to emergency departments, hospital wards, and intensive care units. However, the effect of using procalcitonin on clinical outcomes is unclear. This is an update of a Cochrane review and individual participant data meta-analysis first published in 2012 designed to look at the safety of PCT-guided antibiotic stewardship. OBJECTIVES The aim of this systematic review based on individual participant data was to assess the safety and efficacy of using procalcitonin for starting or stopping antibiotics over a large range of patients with varying severity of ARIs and from different clinical settings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE, and Embase, in February 2017, to identify suitable trials. We also searched ClinicalTrials.gov to identify ongoing trials in April 2017. SELECTION CRITERIA We included RCTs of adult participants with ARIs who received an antibiotic treatment either based on a procalcitonin algorithm (PCT-guided antibiotic stewardship algorithm) or usual care. We excluded trials if they focused exclusively on children or used procalcitonin for a purpose other than to guide initiation and duration of antibiotic treatment. DATA COLLECTION AND ANALYSIS Two teams of review authors independently evaluated the methodology and extracted data from primary studies. The primary endpoints were all-cause mortality and treatment failure at 30 days, for which definitions were harmonised among trials. Secondary endpoints were antibiotic use, antibiotic-related side effects, and length of hospital stay. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable hierarchical logistic regression adjusted for age, gender, and clinical diagnosis using a fixed-effect model. The different trials were added as random-effects into the model. We conducted sensitivity analyses stratified by clinical setting and type of ARI. We also performed an aggregate data meta-analysis. MAIN RESULTS From 32 eligible RCTs including 18 new trials for this 2017 update, we obtained individual participant data from 26 trials including 6708 participants, which we included in the main individual participant data meta-analysis. We did not obtain individual participant data for four trials, and two trials did not include people with confirmed ARIs. According to GRADE, the quality of the evidence was high for the outcomes mortality and antibiotic exposure, and quality was moderate for the outcomes treatment failure and antibiotic-related side effects.Primary endpoints: there were 286 deaths in 3336 procalcitonin-guided participants (8.6%) compared to 336 in 3372 controls (10.0%), resulting in a significantly lower mortality associated with procalcitonin-guided therapy (adjusted OR 0.83, 95% CI 0.70 to 0.99, P = 0.037). We could not estimate mortality in primary care trials because only one death was reported in a control group participant. Treatment failure was not significantly lower in procalcitonin-guided participants (23.0% versus 24.9% in the control group, adjusted OR 0.90, 95% CI 0.80 to 1.01, P = 0.068). Results were similar among subgroups by clinical setting and type of respiratory infection, with no evidence for effect modification (P for interaction > 0.05). Secondary endpoints: procalcitonin guidance was associated with a 2.4-day reduction in antibiotic exposure (5.7 versus 8.1 days, 95% CI -2.71 to -2.15, P < 0.001) and lower risk of antibiotic-related side effects (16.3% versus 22.1%, adjusted OR 0.68, 95% CI 0.57 to 0.82, P < 0.001). Length of hospital stay and intensive care unit stay were similar in both groups. A sensitivity aggregate-data analysis based on all 32 eligible trials showed similar results. AUTHORS' CONCLUSIONS This updated meta-analysis of individual participant data from 12 countries shows that the use of procalcitonin to guide initiation and duration of antibiotic treatment results in lower risks of mortality, lower antibiotic consumption, and lower risk for antibiotic-related side effects. Results were similar for different clinical settings and types of ARIs, thus supporting the use of procalcitonin in the context of antibiotic stewardship in people with ARIs. Future high-quality research is needed to confirm the results in immunosuppressed patients and patients with non-respiratory infections.
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Affiliation(s)
- Philipp Schuetz
- Kantonsspital AarauMedical University DepartmentAarauSwitzerland
- Kantonsspital AarauDepartment of Endocrinology/Metabolism/Clinical Nutrition, Department of Internal MedicineAarauSwitzerland
- University of BaselMedical FacultyBaselSwitzerland
| | - Yannick Wirz
- Kantonsspital AarauMedical University DepartmentAarauSwitzerland
| | - Ramon Sager
- Kantonsspital AarauMedical University DepartmentAarauSwitzerland
| | - Mirjam Christ‐Crain
- University Hospital Basel, University of BaselClinic for Endocrinology, Diabetes and Metabolism, Department of Clinical ResearchPetersgraben 4BaselSwitzerlandCH‐4031
| | - Daiana Stolz
- University Hospital BaselClinic of Pneumology and Pulmonary Cell ResearchPetersgraben 4BaselSwitzerlandCH‐4031
| | - Michael Tamm
- University Hospital BaselClinic of Pneumology and Pulmonary Cell ResearchPetersgraben 4BaselSwitzerlandCH‐4031
| | - Lila Bouadma
- Hôpital Bichat‐Claude Bernard, Université Paris 7‐Denis‐DiderotService de Réanimation MédicaleParisFrance
| | - Charles E Luyt
- Groupe Hospitalier Pitié‐Salpêtrière, Assistance Publique–Hôpitaux de Paris, Université Paris 6‐Pierre‐et‐Marie‐CurieService de Réanimation MédicaleParisFrance
| | - Michel Wolff
- Université Paris 7‐Denis‐DiderotService de Réanimation MédicaleHôpital Bichat‐Claude‐BernardAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Jean Chastre
- Université Paris 6‐Pierre‐et‐Marie‐CurieService de Réanimation MédicaleHôpital Pitié?Salpêtrière (AP‐HP)ParisFrance
| | - Florence Tubach
- Santé Publique et Information Médicale, AP‐HP, Groupe Hospitalier Pitié‐Salpêtrière Charles‐Foix, INSERM CIC‐P 1421, Sorbonne Universités, UPMC Univ Paris 06Département BiostatistiqueParisFrance
| | - Kristina B Kristoffersen
- Aarhus University HospitalDepartment of Infectious DiseasesSkejbyBrendstrupgaardvej 100Aarhus NDenmark8200
| | - Olaf Burkhardt
- Medizinische Hochschule HannoverDepartment of Pulmonary MedicineCarl‐Neuberg‐Str. 1HannoverNiedersachsenGermany30625
| | - Tobias Welte
- Medizinische Hochschule HannoverDepartment of Pulmonary MedicineCarl‐Neuberg‐Str. 1HannoverNiedersachsenGermany30625
- German Center for Lung Reearch (DZL)Aulweg 130GießenGermany35392
| | - Stefan Schroeder
- Krankenhaus DuerenDepartment of Anesthesiology and Intensive Care MedicineDuerenGermany
| | - Vandack Nobre
- Universidade Federal de Minas GeraisDepartment of Internal Medicine, School of MedicineMinas GeraisBelo HorizonteBrazil
| | - Long Wei
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital (East campus)Department of Internal and Geriatric MedicineShanghaiChina
| | - Heiner C C Bucher
- University Hospital Basel and University of BaselBasel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical ResearchPetersgraben 4BaselSwitzerlandCH‐4031
- University Hospital BaselMedical FacultyBaselSwitzerland
| | - Neera Bhatnagar
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHamiltonONCanadaL8N 3Z5
| | - Djillali Annane
- Center for Neuromuscular Diseases; Raymond Poincaré Hospital (AP‐HP)Department of Critical Care, Hyperbaric Medicine and Home Respiratory UnitFaculty of Health Sciences Simone Veil, University of Versailles SQY‐ University of Paris Saclay104 Boulevard Raymond PoincaréGarchesFrance92380
| | - Konrad Reinhart
- Jena University HospitalDepartment of Anesthesiology and Intensive Care MedicineErlanger Allee 101JenaGermany07747
| | - Angela Branche
- University of Rochester School of MedicineDepartment of Medicine, Division of Infectious DiseasesRochesterNYUSA
| | - Pierre Damas
- University Hospital of Liege, Domaine universitaire de LiègeDepartment of General Intensive CareLiegeBelgium
| | - Maarten Nijsten
- University of GroningenUniversity Medical CentreGroningenNetherlands
| | - Dylan W de Lange
- University Medical Center UtrechtDepartment of Intensive CareHeidelberglaan 100UtrechtNetherlands3584 CX
| | | | - Stella SS Lima
- Universidade Federal de Minas GeraisGraduate Program in Infectious Diseases and Tropical Medicine, Department of Internal Medicine, School of MedicineBelo HorizonteBrazil
| | | | - Alessia Verduri
- University of Modena and Reggio EmiliaDepartment of Medical and Surgical Sciences, Policlinico di ModenaModenaItaly
| | - Bin Cao
- China‐Japan Friendship Hospital, National Clinical Research Center of Respiratory Diseases, Capital Medical UniversityCenter for Respiratory Diseases, Department of Pulmonary and Critical Care MedicineBeijingChina
| | - Yahya Shehabi
- Monash HealthCritical Care and Peri‐operative MedicineMelbourneVictoriaAustralia
- Monash UniversitySchool of Clinical Sciences, Faculty of Medicine Nursing and Health SciencesMelbourneVictoriaAustralia
| | | | - Jens‐Ulrik S Jensen
- Copenhagen University Hospital, Bispebjerg og FrederiksbergDepartment of Respiratory MedicineBispebjerg BakkeCopenhagen NVCapitol RegionDenmarkDK 2400
- Rigshospitalet, University of CopenhagenCHIP, Department of Infectious Diseases and Rheumatology, FinsencentretBlegdamsvej 9, DK‐2100CopenhagenDenmarkDK‐2100
| | - Caspar Corti
- Copenhagen University Hospital, Bispebjerg og FrederiksbergDepartment of Respiratory MedicineBispebjerg BakkeCopenhagen NVCapitol RegionDenmarkDK 2400
| | - Jos A Van Oers
- Elisabeth Tweesteden ZiekenhuisIntensive Care UnitTilburgNetherlands5022 GC
| | - Ann R Falsey
- University of Rochester School of MedicineDepartment of Medicine, Division of Infectious DiseasesRochesterNYUSA
| | - Evelien de Jong
- VU University Medical CenterDepartment of Intensive CareAmsterdamNetherlands1081HV
| | - Carolina F Oliveira
- Federal University of Minas GeraisDepartment of Internal Medicine, School of MedcineBelo HorizonteBrazil31130‐100
| | - Bianca Beghe
- AOU Policlinico di ModenaDepartment of Medical and Surgical SciencesModernaItaly41124
| | - Matthias Briel
- University of BaselMedical FacultyBaselSwitzerland
- University Hospital Basel and University of BaselBasel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical ResearchPetersgraben 4BaselSwitzerlandCH‐4031
| | - Beat Mueller
- Kantonsspital AarauMedical University DepartmentAarauSwitzerland
- Kantonsspital AarauDepartment of Endocrinology/Metabolism/Clinical Nutrition, Department of Internal MedicineAarauSwitzerland
- University of BaselMedical FacultyBaselSwitzerland
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