151
|
Kabeya Y, Kato K, Tomita M, Katsuki T, Oikawa Y, Shimada A. Association between diabetes and increased prevalence of paranasal sinus disease: a cross-sectional study in Japanese adults. J Epidemiol 2015; 25:297-302. [PMID: 25728620 PMCID: PMC4375284 DOI: 10.2188/jea.je20140163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 11/19/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The association between diabetes and paranasal sinus disease has not been thoroughly investigated. METHODS We cross-sectionally investigated the association between diabetes and the presence of paranasal sinus disease, which was confirmed by a head MRI scan in 1350 adults who underwent a health screening program focusing on brain diseases and metabolic syndrome. Logistic regression, which was adjusted for age, sex, body mass index, waist-to-hip ratio, hypertension, smoking status, alcohol intake, and white blood cell count, was performed to calculate the odds ratio (OR) of having paranasal sinus disease among adults with diabetes in relation to those without. The dose-response relationship between hemoglobin A1c (HbA1c) levels and the presence of paranasal sinus disease was also investigated. RESULTS Of the 1350 participants (mean age, 61.6 ± 10.0 years; 71.6% men), 220 diabetes cases were identified. Paranasal sinus disease was diagnosed in 151 adults. The adjusted OR of having paranasal sinus disease was 1.74 (95% confidence interval [CI], 1.12-2.71) in those with diabetes. The odds of having paranasal sinus disease increased with HbA1c levels. Compared to those with HbA1c of ≤5.4%, those with HbA1c of 5.5%-6.4%, 6.5%-7.9%, and ≥8.0% were more likely to have paranasal sinus disease, with adjusted ORs of 1.32 (95% CI, 0.88-1.98), 1.63 (95% CI, 0.86-3.09) and 2.71 (95% CI, 1.12-6.61), respectively (P for trend = 0.019). CONCLUSIONS Diabetes may be significantly associated with higher prevalence of paranasal sinus disease in Japanese adults. We should keep this increased risk in mind when a diabetic patient is suspected of having paranasal sinus disease.
Collapse
Affiliation(s)
- Yusuke Kabeya
- Department of Internal Medicine, Tokyo Saiseikai Central Hospital
| | | | | | | | | | | |
Collapse
|
152
|
Chen CY, Lee MY, Lin KD, Hsu WH, Lee YJ, Hsiao PJ, Shin SJ. Diabetes mellitus increases severity of thrombocytopenia in dengue-infected patients. Int J Mol Sci 2015; 16:3820-30. [PMID: 25674854 PMCID: PMC4346928 DOI: 10.3390/ijms16023820] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/02/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diabetes mellitus is known to exacerbate bacterial infection, but its effect on the severity of viral infection has not been well studied. The severity of thrombocytopenia is an indicator of the severity of dengue virus infection. We investigated whether diabetes is associated with thrombocytopenia in dengue-infected patients. METHODS We studied clinical characteristics of 644 patients with dengue infection at a university hospital during the epidemic on 1 June 2002 to 31 December 2002 in Taiwan. Platelet counts and biochemical data were compared between patients with and without diabetes. Potential risk factors associated with thrombocytopenia were explored using regression analyses. RESULTS Dengue-infected patients with diabetes had lower platelet counts than patients without diabetes during the first three days (54.54±51.69 vs. 86.58±63.4 (p≤0.001), 43.98±44.09 vs. 64.52±45.06 (p=0.002), 43.86±35.75 vs. 62.72±51.2 (p=0.012)). Diabetes mellitus, death, dengue shock syndrome (DSS) and dengue hemorrhagic fever (DHF) and increased glutamic-pyruvate transaminase (GPT) levels were significantly associated with lower platelet counts during the first day of hospitalization for dengue fever with regression β of -13.981 (95% confidence interval (CI) -27.587, -0.374), -26.847 (95% CI -37.562, -16.132), and 0.054 (95% CI 0.015, 0.094) respectively. Older age, hypoalbuminemia, and hypertriglyceridemia were independently correlated with thrombocytopenia in dengue patients with or without diabetes with regression β of -2.947 (p=0.004), 2.801 (p=0.005), and -3.568 (p≤0.001), respectively. Diabetic patients with dengue had a higher rate of dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS) than non-diabetic patients. They also had lower blood albumin, were older, and higher triglyceride levels. Older age, hypoalbuminemia, and hypertriglyceridemia were independently correlated with thrombocytopenia in dengue patients. CONCLUSIONS Dengue patients with diabetes tended to have more severe thrombocytopenia and were more likely to have DHF/DSS. Older age, hypoalbuminemia, and hypertriglyceridemia were independently associated with more severe thrombocytopenia in dengue patients.
Collapse
Affiliation(s)
| | - Mei-Yueh Lee
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung 812, Taiwan.
| | - Kun-Der Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
| | - Wei-Hao Hsu
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung 812, Taiwan.
| | | | - Pi-Jung Hsiao
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
| | - Shyi-Jang Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
- Center for Lipid and Glycomedicine Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| |
Collapse
|
153
|
Takajo D, Iwaya K, Katsurada Y, Miyai K, Takasu A, Matsubara O, Sakamoto T, Tamai S, Tsuda H. Community-acquired lobar pneumonia caused by Pseudomonas aeruginosa infection in Japan: a case report with histological and immunohistochemical examination. Pathol Int 2015; 64:224-30. [PMID: 24888776 DOI: 10.1111/pin.12162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 03/25/2014] [Indexed: 11/29/2022]
Abstract
Pseudomonas aeruginosa is a common pathogen in nosocomial and/or healthcare-associated pneumonia, but is rare in community-acquired pneumonia. A 50-year-old previously healthy woman was taken to the emergency department because of rapidly progressing dyspnea. Chest radiograph showed consolidation of the entire right upper lobe, a finding suggestive of lobar pneumonia. The patient died of respiratory failure with bronchial bleeding, on the same day of admission. Autopsy revealed that the alveoli throughout the upper right lobe were filled with dense inflammatory cells mainly consisting of macrophages and neutrophils. Immunoreactive bacilli by using an anti-P. aeruginosa antibody were localized within macrophages accumulated in the alveoli as well in the vessel walls. Lobar pneumonia composed of dense neutrophils and bacteria-laden macrophages with total lung congestion and edema may be characteristic for community-acquired P. aeruginosa pneumonia in a healthy adult.
Collapse
Affiliation(s)
- Daiji Takajo
- Student, National Defense Medical College, Tokorozawa, Saitama, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
154
|
Molecular epidemiological characteristics of Klebsiella pneumoniae associated with bacteremia among patients with pneumonia. J Clin Microbiol 2015; 53:879-86. [PMID: 25568434 DOI: 10.1128/jcm.03067-14] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Some important virulence factors have been elucidated in Klebsiella pneumoniae infections. We investigated the relationship between virulence factors and multilocus sequence types (STs) and assessed the risk factors for bacteremia in patients with pneumonia due to K. pneumoniae. From April 2004 through April 2012, a total of 120 K. pneumoniae isolates from patients with pneumonia (23 with bacteremia and 97 without bacteremia) were collected from 10 medical institutions in Japan. Additionally, 10 strains of K. pneumoniae serotype K2 that were isolated >30 years ago were included in this study. These isolates were characterized using multilocus sequence typing (MLST), and the characteristics of their virulence factors, such as hypermucoviscosity phenotype and RmpA and aerobactin production between patients with and without bacteremia, were examined. MLST analysis was performed on the 120 isolates from patients with pneumonia, and some sequence type groups were defined as genetic lineages (GLs). GL65 was more prevalent among patients with bacteremia (21.7%) than in those without bacteremia (7.2%). The majority of the strains with serotype K2 were classified into GL14 or GL65, and rmpA and the gene for aerobactin were present in all GL65-K2 strains but absent in all GL14-K2 strains. In a multivariate analysis, the independent risk factors for bacteremia included GL65 (adjusted odds ratio [AOR], 9.46; 95% confidence interval [CI], 1.81 to 49.31), as well as neoplastic disease (AOR, 9.94; 95% CI, 2.61 to 37.92), immunosuppression (AOR, 17.85; 95% CI, 1.49 to 214.17), and hypoalbuminemia (AOR, 4.76; 95% CI, 1.29 to 17.61). GL65 was more prevalent among patients with bacteremia and was associated with the virulence factors of K. pneumoniae.
Collapse
|
155
|
Viasus D, Garcia-Vidal C, Simonetti AF, Dorca J, Llopis F, Mestre M, Morandeira-Rego F, Carratalà J. The effect of simvastatin on inflammatory cytokines in community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial. BMJ Open 2015; 5:e006251. [PMID: 25564143 PMCID: PMC4289727 DOI: 10.1136/bmjopen-2014-006251] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES It has been suggested that statins have an effect on the modulation of the cytokine cascade and on the outcome of patients with community-acquired pneumonia (CAP). The aim of this prospective, randomised, double-blind, placebo-controlled trial was to determine whether statin therapy given to hospitalised patients with CAP improves clinical outcomes and reduces the concentration of inflammatory cytokines. SETTING A tertiary teaching hospital in Barcelona, Spain. PARTICIPANTS Thirty-four patients were randomly assigned and included in an intention-to-treat analysis (19 to the simvastatin group and 15 to the placebo group). INTERVENTION Patients were randomly assigned to receive 20 mg of simvastatin or placebo administered in the first 24 h of hospital admission and once daily thereafter for 4 days. OUTCOME Primary end point was the time from hospital admission to clinical stability. The secondary end points were serum concentrations of inflammatory cytokines and partial pressure of arterial oxygen/fractional inspired oxygen (PaO2/FiO2) at 48 h after treatment administration. RESULTS The trial was stopped because enrolment was much slower than originally anticipated. The baseline characteristics of the patients and cytokine concentrations at the time of enrolment were similar in the two groups. No significant differences in the time from hospital admission to clinical stability were found between study groups (median 3 days, IQR 2-5 vs 3 days, IQR 2-5; p=0.47). No significant differences in PaO2/FiO2 (p=0.37), C reactive protein (p=0.23), tumour necrosis factor-α (p=0.58), interleukin 6 (IL-6; p=0.64), and IL-10 (p=0.61) levels at 48 h of hospitalisation were found between simvastatin and placebo groups. Similarly, transaminase and total creatine kinase levels were similar between study groups at 48 h of hospitalisation (p=0.19, 0.08 and 0.53, respectively). CONCLUSIONS Our results suggest that the use of simvastatin, 20 mg once daily for 4 days, since hospital admission did not reduce the time to clinical stability and the levels of inflammatory cytokines in hospitalised patients with CAP. TRIAL REGISTRATION NUMBER ISRCTN91327214.
Collapse
Affiliation(s)
- Diego Viasus
- Biotechnology and Clinical Research Groups, Department of Internal Medicine, Faculty of Medicine, Universidad del Norte, Barranquilla, Colombia
- Department of Infectious Diseases, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonella F Simonetti
- Department of Infectious Diseases, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Dorca
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Ferran Llopis
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Department of Emergency Medicine, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mariona Mestre
- Department of Immunology, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Morandeira-Rego
- Department of Immunology, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Emergency Medicine, Hospital Universitari de Bellvitge—IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
156
|
Torres A, Cillóniz C. Epidemiology, etiology, and risk factors of bacterial pneumonia. CLINICAL MANAGEMENT OF BACTERIAL PNEUMONIA 2015. [PMCID: PMC7124005 DOI: 10.1007/978-3-319-22062-8_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
|
157
|
Acute Pneumonia. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7151914 DOI: 10.1016/b978-1-4557-4801-3.00069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
158
|
Belon C, Gannoun-Zaki L, Lutfalla G, Kremer L, Blanc-Potard AB. Mycobacterium marinum MgtC plays a role in phagocytosis but is dispensable for intracellular multiplication. PLoS One 2014; 9:e116052. [PMID: 25545682 PMCID: PMC4278808 DOI: 10.1371/journal.pone.0116052] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/04/2014] [Indexed: 01/04/2023] Open
Abstract
MgtC is a virulence factor involved in intramacrophage growth that has been reported in several intracellular pathogens, including Mycobacterium tuberculosis and Salmonella enterica serovar Typhimurium. MgtC participates also in adaptation to Mg2+ deprivation. Herein, we have constructed a mgtC mutant in Mycobacterium marinum to further investigate the role of MgtC in mycobacteria. We show that the M. marinum mgtC gene (Mma mgtC) is strongly induced upon Mg2+ deprivation and is required for optimal growth in Mg2+-deprived medium. The behaviour of the Mma mgtC mutant has been investigated in the Danio rerio infection model using a transgenic reporter zebrafish line that specifically labels neutrophils. Although the mgtC mutant is not attenuated in the zebrafish embryo model based on survival curves, our results indicate that phagocytosis by neutrophils is enhanced with the mgtC mutant compared to the wild-type strain following subcutaneous injection. Increased phagocytosis of the mutant strain is also observed ex vivo with the murine J774 macrophage cell line. On the other hand, no difference was found between the mgtC mutant and the wild-type strain in bacterial adhesion to macrophages and in the internalization into epithelial cells. Unlike the role reported for MgtC in other intracellular pathogens, Mma MgtC does not contribute significantly to intramacrophage replication. Taken together, these results indicate an unanticipated function of Mma MgtC at early step of infection within phagocytic cells. Hence, our results indicate that although the MgtC function is conserved among pathogens regarding adaptation to Mg2+ deprivation, its role towards phagocytic cells can differ, possibly in relation with the specific pathogen's lifestyles.
Collapse
Affiliation(s)
- Claudine Belon
- Laboratoire de Dynamique des Interactions Membranaires Normales et Pathologiques, Universités Montpellier 2 et 1, Place Eugène Bataillon, 34095, Montpellier, Cedex 05, France
- Centre National de la Recherche Scientifique, UMR5235, Montpellier, France
| | - Laïla Gannoun-Zaki
- Laboratoire de Dynamique des Interactions Membranaires Normales et Pathologiques, Universités Montpellier 2 et 1, Place Eugène Bataillon, 34095, Montpellier, Cedex 05, France
- Centre National de la Recherche Scientifique, UMR5235, Montpellier, France
| | - Georges Lutfalla
- Laboratoire de Dynamique des Interactions Membranaires Normales et Pathologiques, Universités Montpellier 2 et 1, Place Eugène Bataillon, 34095, Montpellier, Cedex 05, France
- Centre National de la Recherche Scientifique, UMR5235, Montpellier, France
| | - Laurent Kremer
- Laboratoire de Dynamique des Interactions Membranaires Normales et Pathologiques, Universités Montpellier 2 et 1, Place Eugène Bataillon, 34095, Montpellier, Cedex 05, France
- Centre National de la Recherche Scientifique, UMR5235, Montpellier, France
- Institut national de la santé et de la recherche médicale, Montpellier, France
| | - Anne-Béatrice Blanc-Potard
- Laboratoire de Dynamique des Interactions Membranaires Normales et Pathologiques, Universités Montpellier 2 et 1, Place Eugène Bataillon, 34095, Montpellier, Cedex 05, France
- Centre National de la Recherche Scientifique, UMR5235, Montpellier, France
| |
Collapse
|
159
|
Estimated hospitalization rate for diseases attributable to Streptococcus pneumoniae in the Veneto region of north-east Italy. Prev Med Rep 2014; 2:27-31. [PMID: 27114894 PMCID: PMC4832486 DOI: 10.1016/j.pmedr.2014.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Streptococcus pneumoniae (SP) is a major cause of morbidity and mortality worldwide in all age groups. Serious diseases often caused by pneumococci include pneumonia, meningitis and bacteremia. Objective The aim of this work was to estimate the hospitalization rate for SP in the Veneto region by investigating pneumococcal-related discharges. Material and methods This was a retrospective study based on hospital discharge data collected from 2008 to 2012 in the Veneto Region (north-east Italy). All hospitalizations for diseases potentially associated with SP were identified by searching the hospital discharge records, then the proportions of hospital admissions for pneumonia, meningitis and septicemia attributable to the infection were calculated. Comorbidities were also graded according to the Charlson Comorbidity Index (CCI). Data were analyzed using the chi square test and Student's t-test for unpaired data, as appropriate. Significant trends over the years considered were examined in terms of average annual percent changes (AAPC). A p value < 0.05 was considered significant. Results We identified 62,946 hospital discharge records concerning diseases potentially associated with SP. Among them, the proportion of SP-related hospital admissions (SP-HA) was estimated to be 23,089 (37.2%). The estimated incidence of SP-HA was 94.0/100,000 population (102.8/100,000 in males and 85.6/100,000 in females; p < 0.01): 89.0 for pneumonia, 0.9 for meningitis, and 4.1 for septicemia. The incidence of SP-HA was higher in children and the elderly, and the overall fatality rate was 11.0%. The overall economic burden of SP-HA during the period considered was around €14.8 million a year, with an average cost of €3120 per hospitalization. Conclusion This study shows that hospitalization for SP-related disease has a considerable impact on the health services, especially as far as children and the elderly are concerned. Estimated hospitalization rate was higher in children and the elderly Overall fatality rate was 11.0%. Economic burden of SP-HA was around €14.8 million a year in Veneto Region.
Collapse
|
160
|
Bello S, Menéndez R, Antoni T, Reyes S, Zalacain R, Capelastegui A, Aspa J, Borderías L, Martin-Villasclaras JJ, Alfageme I, Rodríguez de Castro F, Rello J, Luis M, Ruiz-Manzano J. Tobacco smoking increases the risk for death from pneumococcal pneumonia. Chest 2014; 146:1029-1037. [PMID: 24811098 DOI: 10.1378/chest.13-2853] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Active smoking increases the risk of developing community-acquired pneumonia (CAP) and invasive pneumococcal disease, although its impact on mortality in pneumococcal CAP outcomes remains unclear. The aim of this study was to investigate the influence of current smoking status on pneumococcal CAP mortality. METHODS We performed a multicenter, prospective, observational cohort study in 4,288 hospitalized patients with CAP. The study group consisted of 892 patients with pneumococcal CAP: 204 current smokers (22.8%), 387 nonsmokers (43.4%), and 301 exsmokers (33.7%). RESULTS Mortality at 30 days was 3.9%: 4.9% in current smokers vs 4.3% in nonsmokers and 2.6% in exsmokers. Current smokers with CAP were younger (51 years vs 74 years), with more alcohol abuse and fewer cardiac, renal, and asthma diseases. Current smokers had lower CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) scores, although 40% had severe sepsis at diagnosis. Current smoking was an independent risk factor (OR, 5.0; 95% CI, 1.8-13.5; P = .001) for 30-day mortality of pneumococcal CAP after adjusting for age (OR, 1.06; P = .001), liver disease (OR, 4.5), sepsis (OR, 2.3), antibiotic adherence to guidelines, and first antibiotic dose given < 6 h. The independent risk effect of current smokers remained when compared only with nonsmokers (OR, 4.0; 95% CI, 1.3-12.6; P = .015) or to exsmokers (OR, 3.9; 95% CI, 1.09-4.95; P = .02). CONCLUSIONS Current smokers with pneumococcal CAP often develop severe sepsis and require hospitalization at a younger age, despite fewer comorbid conditions. Smoking increases the risk of 30-day mortality independently of tobacco-related comorbidity, age, and comorbid conditions. Current smokers should be actively targeted for preventive strategies.
Collapse
Affiliation(s)
- Salvador Bello
- The Servicio de Neumología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Rosario Menéndez
- Servicio de Neumología, IIS Hospital Universitario la Fe, Valencia, Spain
| | - Torres Antoni
- Servei de Pneumologia, Institut Clinic del Torax, Universitat de Barcelona, Ciberes GRS, Barcelona, Spain
| | - Soledad Reyes
- Servicio de Neumología, IIS Hospital Universitario la Fe, Valencia, Spain
| | | | | | - Javier Aspa
- Servicio de Neumología, Hospital de la Princesa Spain, Madrid, Spain
| | - Luis Borderías
- Servicio de Neumología, Hospital San Jorge, Huesca, Spain
| | | | | | | | - Jordi Rello
- Critical Care, Hospital Vall d'Hebron, Institut de Recerca Vall d'Hebron-UAB, CIBERES, Barcelona, Spain
| | - Molinos Luis
- Servicio de Neumología, Hospital Central de Asturias, Oviedo, Spain
| | - Juan Ruiz-Manzano
- Servicio de Neumología, Hospital Germans Trias i Pujol, Badalona, Spain
| |
Collapse
|
161
|
Rogliani P, Calzetta L, Segreti A, Barrile A, Cazzola M. Diabetes mellitus among outpatients with COPD attending a university hospital. Acta Diabetol 2014; 51:933-40. [PMID: 24728837 DOI: 10.1007/s00592-014-0584-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/24/2014] [Indexed: 12/18/2022]
Abstract
Type 2 diabetes mellitus is a common comorbidity of COPD, but there are still many doubts about the relation among diabetes and COPD. We retrospectively collected data from patients afferent to our Respiratory Diseases outpatient clinic at the Tor Vergata University Hospital between 2010 and 2012. The study population was analyzed by clusters of age, gender, body mass index (BMI), smoking status, lung function, concomitant pharmacologic therapies and comorbidities. The values of the association between variables were expressed as odds ratio. Data were adjusted for gender, age and possible confounding variables by Mantel-Haenszel method. We identified 493 patients with COPD. Ninety-two (18.7 %) patients were affected by type 2 diabetes mellitus, with no significant gender differences. The prevalence distribution was similar among the different age clusters, but the association was stronger in patients younger than 65 years. The association was present only in obese subjects in whom it was significant only in patients with moderate-to-severe COPD, but not mild COPD. The presence of cardiovascular diseases was significantly associated with diabetes mellitus in patients with COPD. There was a slight association of inhaled corticosteroid (ICS) use with the presence of diabetes mellitus in COPD, but the combination of an ICS with a β2-agonist apparently reduced this association. The association with type 2 diabetes mellitus was greater in patients with COPD respect to general population, and correlated with the increase in BMI and the presence of other comorbidities, suggesting that both diseases may be targets of systemic inflammation.
Collapse
Affiliation(s)
- Paola Rogliani
- Department of System Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | | | | | | | | |
Collapse
|
162
|
Athlin S, Kaltoft M, Slotved HC, Herrmann B, Holmberg H, Konradsen HB, Strålin K. Association between serotype-specific antibody response and serotype characteristics in patients with pneumococcal pneumonia, with special reference to degree of encapsulation and invasive potential. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:1541-9. [PMID: 25230937 PMCID: PMC4248763 DOI: 10.1128/cvi.00259-14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/30/2014] [Indexed: 11/20/2022]
Abstract
We studied the immunoglobulin (Ig) response to causative serotype-specific capsular polysaccharides in adult pneumococcal pneumonia patients. The serotypes were grouped according to their degree of encapsulation and invasive potential. Seventy patients with pneumococcal pneumonia, 20 of whom were bacteremic, were prospectively studied. All pneumococcal isolates from the patients were serotyped, and the Ig titers to the homologous serotype were determined in acute- and convalescent-phase sera using a serotype-specific enzyme-linked immunosorbent assay. The Ig titers were lower in bacteremic cases than in nonbacteremic cases (P < 0.042). The Ig titer ratio (convalescent/acute titer) was ≥2 in 33 patients, 1 to 1.99 in 20 patients, and <1 in 17 patients. Patients ≥65 years old had a lower median Ig titer ratio than did younger patients (P < 0.031). The patients with serotypes with a thin capsule (1, 4, 7F, 9N, 9V, and 14) and medium/high invasive potential (1, 4, 7F, 9N, 9V, 14, and 18C) had higher Ig titer ratios than did patients with serotypes with a thick capsule (3, 6B, 11A, 18C, 19A, 19F, and 23F) and low invasive potential (3, 6B, 19A, 19F, and 23F) (P < 0.05 for both comparisons after adjustment for age). Ig titer ratios of <1 were predominantly noted in patients with serotypes with a thick capsule. In 8 patients with pneumococcal DNA detected in plasma, the three patients with the highest DNA load had the lowest Ig titer ratios. In conclusion, a high antibody response was associated with serotypes with a thin capsule and medium/high invasive potential, although a low antibody response was associated with serotypes with a thick capsule and a high pneumococcal plasma load.
Collapse
Affiliation(s)
- Simon Athlin
- Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden
| | | | | | - Björn Herrmann
- Section of Clinical Microbiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Holmberg
- Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden
| | | | - Kristoffer Strålin
- Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden Department of Medicine, Division of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| |
Collapse
|
163
|
Robinson SB, Ernst FR, Lipkin C, Huang X. Patient Outcomes on Day 4 of Intravenous Antibiotic Therapy in Non-Intensive Care Unit Hospitalized Adults With Community-Acquired Bacterial Pneumonia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014; 22:320-325. [PMID: 25411532 PMCID: PMC4232336 DOI: 10.1097/ipc.0000000000000143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Community-acquired bacterial pneumonia (CABP) is a leading cause of morbidity and mortality especially in hospitalized patients. In place of clinical end points traditionally used to evaluate antimicrobial efficacy for its treatment, Food and Drug Administration guidelines now require all registration trials to assess clinical response at day 4. The primary objective of this study was to assess health outcomes (length of stay [LOS] and hospital charges) between responders and nonresponders at this time point. METHODS The Premier database was used to identify adult patients from 4 participating hospitals with a principal diagnosis of CABP (International Classification of Diseases, Ninth Revision, Clinical Modification, codes 481, 482.0, 483.8, 484.3, 484.5, 485, 486, or 487.0) hospitalized between July 1, 2010, and June 30, 2011. Only non-intensive care unit patients with hospital stays exceeding 2 days and receiving intravenous antibiotic agents within 24 hours of admission were included. After institutional review board approvals, a retrospective chart review extracted data for patient demographics, clinical efficacy variables at day 4, LOS, and total hospital charges. Data analysis included multivariable gamma regression models to control for patient demographics and clinical differences between responders and nonresponders. RESULTS A total of 666 patients met study the criteria. Mean (SD) age was 70.7 (17.9) years, and 42.5% were males. Among these patients, 277 (41.6%) achieved clinical response by day 4 of initial antibiotic therapy. The unadjusted mean (SD) LOS was 6.3 (2.8) days for responders and 7.4 (5.6) days for nonresponders (P = 0.0009). Respective unadjusted total hospital charges were $22,827 (SD, $17,724) and $26,403 ($36,882) (P = 0.0031). Adjusted for demographics and clinical factors, nonresponders compared with responders had an increased LOS of 0.9 days (8.4 vs 7.5 days; P = 0.0008), resulting in associated charges of approximately $2500 ($34,139 vs $36,629; P = 0.0768). CONCLUSIONS In this real-world chart study, less than half of hospitalized patients with CABP achieved clinical response at day 4 of initial intravenous antibiotic therapy. The observed clinical response was associated with a significantly shorter hospital stay and trended toward lower total hospital charges. These findings corroborate the Food and Drug Administration guidance for assessing antimicrobial therapy at day 4 because responder is associated with improved health outcomes.
Collapse
Affiliation(s)
- Scott B. Robinson
- From the *Premier Research Services, Charlotte, NC; and †Forest Research Institute, Jersey City, NJ
| | - Frank R. Ernst
- From the *Premier Research Services, Charlotte, NC; and †Forest Research Institute, Jersey City, NJ
| | - Craig Lipkin
- From the *Premier Research Services, Charlotte, NC; and †Forest Research Institute, Jersey City, NJ
| | - Xingyue Huang
- From the *Premier Research Services, Charlotte, NC; and †Forest Research Institute, Jersey City, NJ
| |
Collapse
|
164
|
Tagami T, Matsui H, Horiguchi H, Fushimi K, Yasunaga H. Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients. Eur Respir J 2014; 45:463-72. [DOI: 10.1183/09031936.00081514] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The relationship between low-dose corticosteroid use and mortality in patients with severe community-acquired pneumonia (CAP) remains unclear.6925 patients with severe CAP who received mechanical ventilation with or without shock (defined as use of catecholamines) at 983 hospitals were identified using a Japanese nationwide administrative database. The main outcome measure was 28-day mortality.2524 patients with severe CAP who received catecholamines were divided into corticosteroid (n=631) and control (n=1893) groups. The 28-day mortality was significantly different between corticosteroid and control groups (unmatched: 24.6% versus 36.3%, p<0.001; propensity score-matched: 25.3% versus 32.6%, p=0.01; inverse probability-weighted: 27.5% versus 34.2%, p<0.001). 4401 patients with severe CAP who did not receive catecholamines were also divided into corticosteroid (n=1112) and control (n=3289) groups. The 28-day mortality was not significantly different between corticosteroid and control groups in propensity score-matched analyses (unmatched: 16.0% versus 19.4%, p=0.01; propensity score-matched: 17.7% versus 15.6%, p=0.22; inverse probability-weighted: 18.8% versus 18.2%, p=0.44).Low-dose corticosteroid use may be associated with reduced 28-day mortality in patients with septic shock complicating CAP.
Collapse
|
165
|
Pradelli J, Risso K, de Salvador FG, Cua E, Ruimy R, Roger PM. Community-acquired pneumonia: impact of empirical antibiotic therapy without respiratory fluoroquinolones nor third-generation cephalosporins. Eur J Clin Microbiol Infect Dis 2014; 34:511-8. [PMID: 25273975 DOI: 10.1007/s10096-014-2254-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 11/26/2022]
Abstract
Guidelines for inpatients with community-acquired pneumonia (CAP) propose to use respiratory fluoroquinolone (RFQ) and/or third-generation cephalosporins (Ceph-3). However, broad-spectrum antibiotic therapy is associated with the emergence of drug-resistant bacteria. We established a guideline in which RFQ and Ceph-3 were excluded as a first course. Our aim was to evaluate the impact of our therapeutic choices for CAP on the length of hospital stay (LOS) and patient outcome. This was a cohort study of patients with CAP from July 2005 to June 2014. We compared patients benefiting from our guideline established in 2008 to those receiving non-consensual antibiotics. Disease severity was evaluated through the Pneumonia Severity Index (PSI). The empirical treatment for PSI III to V was a combination therapy of amoxicillin-clavulanic acid (AMX-C) + roxithromycin (RX) or AMX + ofloxacin. Adherence to guidelines was defined by the prescription of one of these antibiotic agents. Requirement for intensive care or death defined unfavorable outcome. Among 1,370 patients, 847 were treated according to our guideline (61.8 %, group 1) and 523 without concordant therapy (38.2 %, group 2). The mean PSI was similar: 82 vs. 83, p > 0.5. The mean LOS was lower in group 1: 7.6 days vs. 9.1 days, p < 0.001. An unfavorable outcome was less frequent in group 1: 5.4 % vs. 9.9 %, p = 0.001. In logistic regression models, concordant therapy was associated with a favorable outcome: adjusted odds ratio (AOR) [95 % confidence interval (CI)] 1.85 [1.20-2.88], p = 0.005. CAP therapy without RFQ and Ceph-3 use was associated with a shorter LOS and fewer unfavorable outcomes.
Collapse
Affiliation(s)
- J Pradelli
- Infectiologie, Hôpital de l'Archet 1, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, BP 3079, 06202, Nice, France
| | | | | | | | | | | |
Collapse
|
166
|
Fekih Hassen M, Ben Haj Khalifa A, Tilouche N, Ben Sik Ali H, Ayed S, Kheder M, Elatrous S. [Severe community-acquired pneumonia admitted at the intensive care unit: main clinical and bacteriological features and prognostic factors: a Tunisian experience]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:253-259. [PMID: 24874404 DOI: 10.1016/j.pneumo.2014.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 03/11/2014] [Accepted: 03/15/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Severe community-acquired pneumonia (SCAP) remains a major cause of death. The aim of this study was to describe the main clinical and bacteriological features and to determine predictive factors for death in patients with SCAP who were admitted in intensive care unit (ICU) in a Tunisian setting. METHOD It is a retrospective study conducted between March 2005 and December 2010 at the intensive care unit of the University Hospital of Mahdia (Tunisia). All patients hospitalized at the ICU with a SCAP diagnosis according to the American Thoracic Society criteria were included. RESULTS Two hundred and nine patients (mean age: 64±16 years, and mean SAPS II: 42±17) were included. Overall, 24% had a bacteriological diagnosis. Streptococcus pneumoniae was the most frequently detected. Use of mechanical ventilation was required in 57% of patients and 45% experimented septic shock upon admission. The mortality rate at ICU was 29% (n=60). In multivariate analysis, a septic shock at admission and the use of mechanical ventilation were both associated with death. CONCLUSION SCAP were associated with high mortality in the ICU.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents/therapeutic use
- Community-Acquired Infections/diagnosis
- Community-Acquired Infections/microbiology
- Community-Acquired Infections/mortality
- Community-Acquired Infections/therapy
- Drug Resistance, Bacterial
- Female
- Hospital Mortality
- Hospitals, University
- Humans
- Intensive Care Units
- Male
- Middle Aged
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/microbiology
- Pneumonia, Bacterial/mortality
- Pneumonia, Bacterial/therapy
- Pneumonia, Pneumococcal/diagnosis
- Pneumonia, Pneumococcal/microbiology
- Pneumonia, Pneumococcal/mortality
- Pneumonia, Pneumococcal/therapy
- Prognosis
- Respiration, Artificial
- Retrospective Studies
- Shock, Septic/diagnosis
- Shock, Septic/microbiology
- Shock, Septic/therapy
- Tunisia
Collapse
Affiliation(s)
- M Fekih Hassen
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
| | - A Ben Haj Khalifa
- Laboratoire de microbiologie, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie.
| | - N Tilouche
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
| | - H Ben Sik Ali
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
| | - S Ayed
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
| | - M Kheder
- Laboratoire de microbiologie, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie
| | - S Elatrous
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
| |
Collapse
|
167
|
Horikawa C, Kodama S, Fujihara K, Hirasawa R, Yachi Y, Suzuki A, Hanyu O, Shimano H, Sone H. High risk of failing eradication of Helicobacter pylori in patients with diabetes: a meta-analysis. Diabetes Res Clin Pract 2014; 106:81-7. [PMID: 25110103 DOI: 10.1016/j.diabres.2014.07.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/02/2014] [Accepted: 07/04/2014] [Indexed: 12/12/2022]
Abstract
AIMS Eradication of Helicobacter pylori (HP) is an effective approach to improve intestinal symptoms and prevent gastric cancer. However, there has been concern that the presence of diabetes reduces the effectiveness of antibiotics. We performed this meta-analysis to investigate the effect of diabetes on the risk of failing eradication in patients with diabetes. METHODS An electronic literature search was conducted using Biosis, MEDLINE, Embase, PASCAL, and SciSearch through November 30, 2012. Selected studies had to provide data on the number of individuals who received treatment for HP infection and on the failure of HP eradication in groups with and without diabetes. Two authors independently extracted relevant data. RESULTS Data were obtained from 8 eligible studies (693 total participants including 273 participants with diabetes). Overall, the pooled risk ratio (RR) of failing HP eradication for diabetic patients compared with non-diabetic participants was 2.19 [95%CI, 1.65-2.90] (P<0.001). Excluding the 2 studies that used a non-standard protocol for HP eradication, individuals with diabetes had a higher risk of failure of eradication compared to those without diabetes (RR=2.31 [95%CI, 1.72-3.11]). CONCLUSIONS Current meta-analysis confirmed the higher risk of HP eradication failure in individuals with diabetes compared with those without diabetes, suggesting the necessity of prolonging treatment or developing a new regimen for HP eradication in patients with diabetes.
Collapse
Affiliation(s)
- Chika Horikawa
- Department of Health and Nutrition, University of Niigata Prefecture, Faculty of Human Life Studies, Niigata, Japan; Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan; Department of Internal Medicine, University of Tsukuba, Institute of Clinical Medicine, Ibaraki, Japan
| | - Saroru Kodama
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan; Department of Health Management Center, Mito Kyodo General Hospital, Ibaraki, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan; Department of Internal Medicine, University of Tsukuba, Institute of Clinical Medicine, Ibaraki, Japan
| | - Reiko Hirasawa
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan
| | - Yoko Yachi
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan; Department of Faculty of Health and Nutrition, Yamanashi Gakuin University, Yamanashi, Japan
| | - Akiko Suzuki
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan
| | - Osamu Hanyu
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan
| | - Hitoshi Shimano
- Department of Internal Medicine, University of Tsukuba, Institute of Clinical Medicine, Ibaraki, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University, Faculty of Medicine, Niigata, Japan.
| |
Collapse
|
168
|
Gattarello S, Borgatta B, Solé-Violán J, Vallés J, Vidaur L, Zaragoza R, Torres A, Rello J. Decrease in mortality in severe community-acquired pneumococcal pneumonia: impact of improving antibiotic strategies (2000-2013). Chest 2014; 146:22-31. [PMID: 24371840 DOI: 10.1378/chest.13-1531] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE The objective of the present study was to compare antibiotic prescribing practices and survival in the ICU for patients with pneumococcal severe community-acquired pneumonia (SCAP) between 2000 and 2013. METHODS This was a matched case-control study of two prospectively recorded cohorts in Europe. Eighty patients from the Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos (CAPUCI) II study (case group) were matched with 80 patients from CAPUCI I (control group) based on the following: shock at admission, need of mechanical ventilation, COPD, immunosuppression, and age. RESULTS Demographic data were comparable in the two groups. Combined antibiotic therapy increased from 66.2% to 87.5% (P < .01), and the percentage of patients receiving the first dose of antibiotic within 3 h increased from 27.5% to 70.0% (P < .01). ICU mortality was significantly lower (OR, 0.82; 95% CI, 0.68-0.98) in cases, both in the whole population and in the subgroups of patients with shock (OR, 0.67; 95% CI, 0.50-0.89) or receiving mechanical ventilation (OR, 0.73; 95% CI, 0.55-0.96). In the multivariate analysis, ICU mortality increased in patients requiring mechanical ventilation (OR, 5.23; 95% CI, 1.60-17.17) and decreased in patients receiving early antibiotic treatment (OR, 0.36; 95% CI, 0.15-0.87) and combined therapy (OR, 0.19; 95% CI, 0.07-0.51). CONCLUSIONS In pneumococcal SCAP, early antibiotic prescription and use of combination therapy increased. Both were associated with improved survival.
Collapse
Affiliation(s)
- Simone Gattarello
- Critical Care Department, Vall d'Hebron Hospital, Universitat Autonoma de Barcelona and Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Barcelona.
| | - Bárbara Borgatta
- Critical Care Department, Vall d'Hebron Hospital, Universitat Autonoma de Barcelona and Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Barcelona
| | - Jordi Solé-Violán
- Intensive Care Unit, Dr Negrin University Hospital, Las Palmas de Gran Canaria, Sabadell; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Bunyola, Islas Baleares, Spain
| | - Jordi Vallés
- Critical Care Center, Sabadell Hospital, Consorci Hospitalari Universitari Parc Taulí, Sabadell; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Bunyola, Islas Baleares, Spain
| | - Loreto Vidaur
- Intensive Care Department, Donostia Hospital, Donostia; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Bunyola, Islas Baleares, Spain
| | - Rafael Zaragoza
- Intensive Care Department, Dr Peset University Hospital, Valencia
| | - Antoni Torres
- Respiratory Disease Department, Hospital Clínic i Provincial de Barcelona, University of Barcelona, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Bunyola, Islas Baleares, Spain
| | - Jordi Rello
- Critical Care Department, Vall d'Hebron Hospital, Universitat Autonoma de Barcelona and Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Bunyola, Islas Baleares, Spain
| | | |
Collapse
|
169
|
Asao K, Kaminski J, McEwen LN, Wu X, Lee JM, Herman WH. Assessing the burden of diabetes mellitus in emergency departments in the United States: the National Hospital Ambulatory Medical Care Survey (NHAMCS). J Diabetes Complications 2014; 28:639-45. [PMID: 24680472 PMCID: PMC4134427 DOI: 10.1016/j.jdiacomp.2014.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/10/2014] [Accepted: 02/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the performance of three alternative methods to identify diabetes in patients visiting Emergency Departments (EDs), and to describe the characteristics of patients with diabetes who are not identified when the alternative methods are used. RESEARCH DESIGN AND METHODS We used data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2009 and 2010. We assessed the sensitivity and specificity of using providers' diagnoses and diabetes medications (both excluding and including biguanides) to identify diabetes compared to using the checkbox for diabetes as the gold standard. We examined the characteristics of patients whose diabetes was missed using multivariate Poisson regression models. RESULTS The checkbox identified 5,567 ED visits by adult patients with diabetes. Compared to the checkbox, the sensitivity was 12.5% for providers' diagnoses alone, 20.5% for providers' diagnoses and diabetes medications excluding biguanides, and 21.5% for providers' diagnoses and diabetes medications including biguanides. The specificity of all three of the alternative methods was >99%. Older patients were more likely to have diabetes not identified. Patients with self-payment, those who had glucose measured or received IV fluids in the ED, and those with more diagnosis codes and medications, were more likely to have diabetes identified. CONCLUSIONS NHAMCS's providers' diagnosis codes and medication lists do not identify the majority of patients with diabetes visiting EDs. The newly introduced checkbox is helpful in measuring ED resource utilization by patients with diabetes.
Collapse
Affiliation(s)
- Keiko Asao
- The University of Michigan, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, Ann Arbor, MI.
| | - James Kaminski
- The University of Michigan, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, Ann Arbor, MI
| | - Laura N McEwen
- The University of Michigan, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, Ann Arbor, MI
| | - Xiejian Wu
- The University of Michigan, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, Ann Arbor, MI; Eastern Michigan University, College of Health & Human Services, The Program of Health Administration, Ypsilanti, MI
| | - Joyce M Lee
- The University of Michigan, Division of Pediatric Endocrinology, Child Health Evaluation and Research Unit, Ann Arbor, MI
| | - William H Herman
- The University of Michigan, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, Ann Arbor, MI; The University of Michigan, Department of Epidemiology, Ann Arbor, MI
| |
Collapse
|
170
|
Cho WH, Yeo HJ, Yoon SH, Lee SE, Jeon DS, Kim YS, Lee SJ, Jo EJ, Mok JH, Kim MH, Kim KU, Lee K, Park HK, Lee MK. Lysophosphatidylcholine as a prognostic marker in community-acquired pneumonia requiring hospitalization: a pilot study. Eur J Clin Microbiol Infect Dis 2014; 34:309-15. [DOI: 10.1007/s10096-014-2234-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
|
171
|
Capelastegui A, Zalacain R, Bilbao A, Egurrola M, Iturriaga LAR, Quintana JM, Gomez A, Esteban C, España PP. Pneumococcal pneumonia: differences according to blood culture results. BMC Pulm Med 2014; 14:128. [PMID: 25096919 PMCID: PMC4127038 DOI: 10.1186/1471-2466-14-128] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/24/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bacteremia by Streptococcus pneumoniae has been traditionally associated with poor outcomes in patients with pneumonia; however, data on its impact on outcomes are limited and are sometimes contradictory. METHODS We performed a prospective study in two hospitals in northern Spain in which cases diagnosed with pneumococcal pneumonia were selected from a cohort of hospitalized patients with pneumonia between January 2001 and July 2009. We compared patients with pneumococcal bacteremic pneumonia with those with pneumococcal non-bacteremic pneumonia. RESULTS We compared 492 patients with negative blood culture and 399 with positive culture results. Host related factors were very similar in both groups. Severity of illness on admission measured by CURB-65 score was similar in both groups. Adjusted analysis showed a greater likelihood of septic shock during in-hospital course among patients with pneumococcal bacteremia (OR, 2.1; 95% CI, 1.2-3.5; P=0.006). Likewise, patients with positive blood culture had greater in-hospital mortality (OR 2.1; 95% CI, 1.1- -3.9; P=0.02), 15-day mortality (OR 3.6; 95% CI, 1.7-7.4; P=0.0006), and 30-day mortality (OR, 2.7; 95% CI, 1.5-5; P=0.002). CONCLUSIONS Although host related factors and severity on admission were very similar in the two groups, bacteremic patients had worse in-hospital course and outcomes. Bacteraemia in pneumococcal pneumonia is of prognostic significance.
Collapse
Affiliation(s)
- Alberto Capelastegui
- Service of Pneumology, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia E-48960, Spain
| | - Rafael Zalacain
- From the Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Amaia Bilbao
- From the Research Unit, Hospital Universitario Basurto - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Bizkaia, Spain
| | - Mikel Egurrola
- Service of Pneumology, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia E-48960, Spain
| | | | - Jose M Quintana
- From the Research Unit - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Ainhoa Gomez
- From the Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Cristobal Esteban
- Service of Pneumology, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia E-48960, Spain
| | - Pedro P España
- Service of Pneumology, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia E-48960, Spain
| |
Collapse
|
172
|
Bertsias A, Tsiligianni IG, Duijker G, Siafakas N, Lionis C. Studying the burden of community-acquired pneumonia in adults aged ≥50 years in primary health care: an observational study in rural Crete, Greece. NPJ Prim Care Respir Med 2014; 24:14017. [PMID: 24965889 PMCID: PMC4373318 DOI: 10.1038/npjpcrm.2014.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/14/2014] [Accepted: 04/29/2014] [Indexed: 12/03/2022] Open
Abstract
Background: Community-acquired pneumonia (CAP) is a potentially life-threatening condition that often requires hospitalisation particularly in the elderly population or in patients with comorbidities. Aims: The aims of this study were to estimate the CAP frequency and severity in a well-defined primary healthcare setting in rural Crete, to record patient characteristics, their immunisation status and to estimate hospitalisation frequency and determinants. Methods: An observational study was designed and implemented in a rural setting within the prefecture of Heraklion in the island of Crete, Greece. Eligible patients were those aged 50 years or above, presenting with CAP based on signs and symptoms and positive X-ray findings. Results: A total of 124 CAP cases were recorded, 40 of which (32.3%) were hospitalised. Τhe age-standardised CAP incidence was estimated to be 236.7 cases per 100,000 persons aged ⩾50 years. Forty-three patients (35.2%) were vaccinated against pneumococcus. The most frequent chronic illnesses were heart disease (64.5%), chronic obstructive pulmonary disease (32.5%), and type 2 diabetes (21%). Hospitalisation determinants included advanced age (⩾74 years, Odds ratio (OR) 7.13; P value=0.001; 95% confidence interval (CI), 2.23–22.79), obesity (OR 3.36, P=0.037; 95% CI, 1.08–10.52), ⩾40 pack-years of smoking (OR 3.82, P value=0.040; 95% CI, 1.07–18.42), presence of multimorbidity (OR 5.77, P value=0.003; 95% CI, 1.81–18.42) and pneumococcal vaccination (OR 0.29, P value=0.041; 95% CI, 0.09–0.95). Conclusions: This study highlighted patient characteristics and aspects of CAP epidemiology in the context of a rural primary care setting in southern Europe where limited data have been published until now.
Collapse
Affiliation(s)
- Antonios Bertsias
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Ioanna G Tsiligianni
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - George Duijker
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Nikolaos Siafakas
- Department of Thoracic Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | | |
Collapse
|
173
|
|
174
|
Adamuz J, Viasus D, Jiménez-Martínez E, Isla P, Garcia-Vidal C, Dorca J, Carratalà J. Incidence, timing and risk factors associated with 1-year mortality after hospitalization for community-acquired pneumonia. J Infect 2014; 68:534-41. [DOI: 10.1016/j.jinf.2014.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/27/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
|
175
|
Adewuyi A, Fasusi OH, Oderinde RA. Antibacterial activities of acetonides prepared from the seed oils of Calophyllum inophyllum and Pterocarpus osun. J Acute Med 2014. [DOI: 10.1016/j.jacme.2014.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
176
|
Goulenok T. Vaccination anti-pneumococcique chez l’adulte : comment améliorer la couverture vaccinale ? ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.antinf.2014.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
177
|
Lin SC, Tsai YJ, Huang CT, Kuo YW, Ruan SY, Chuang YC, Yu CJ. Prognostic value of plasma N-terminal pro B-type natriuretic peptide levels in pneumonia patients requiring intensive care unit admission. Respirology 2014; 18:933-41. [PMID: 23600467 DOI: 10.1111/resp.12096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/13/2013] [Accepted: 01/20/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Correct and early risk stratification for critically ill pneumonia patients remains an unmet medical need. This study aimed to test whether N-terminal pro B-type natriuretic peptide (NT-proBNP) can serve as a prognostic marker in this setting. METHODS This prospective study enrolled 216 pneumonia patients admitted to intensive care unit. Plasma NT-proBNP samples were obtained upon admission and primary outcome was all-cause mortality at 30 days. Meanwhile, Acute Physiology and Chronic Health Evaluation (APACHE) II and Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) 2007 minor criteria were assessed. RESULTS Overall 30-day mortality was 30%. NT-proBNP levels were significantly higher in nonsurvivors than survivors (11 938 ± 13 121 vs 5658 ± 9240 pg/mL, P = 0.001). Area under receiver operating characteristic curves of NT-proBNP, APACHE II and IDSA/ATS 2007 minor criteria were not significantly different regarding prediction of mortality (0.715, 0.754 vs 0.654, P = 0.085). Adding NT-proBNP to APACHE II significantly increased the area under receiver operating characteristic curve from 0.754 to 0.794 (P = 0.048). Receiver operating characteristic analysis revealed optimal NT-proBNP and APACHE II cut-offs of 2177.5 pg/mL and 25.5, respectively. In multivariate analysis, both NT-proBNP and APACHE II values above cut-offs had a significantly higher probability of death than those below cut-offs. A categorical approach combining NT-proBNP and APACHE II cut-offs provides additional risk stratification over a single marker approach. CONCLUSIONS For pneumonia patients admitted to intensive care unit, NT-proBNP strongly and independently predicts mortality, and its prognostic accuracy is comparable with APACHE II and IDSA/ATS 2007 minor criteria.
Collapse
Affiliation(s)
- Shih-Chang Lin
- Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | |
Collapse
|
178
|
Tate JA, Snitz BE, Alvarez KA, Nahin RL, Weissfeld LA, Lopez O, Angus DC, Shah F, Ives DG, Fitzpatrick AL, Williamson JD, Arnold AM, DeKosky ST, Yende S. Infection hospitalization increases risk of dementia in the elderly. Crit Care Med 2014; 42:1037-46. [PMID: 24368344 PMCID: PMC4071960 DOI: 10.1097/ccm.0000000000000123] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Severe infections, often requiring ICU admission, have been associated with persistent cognitive dysfunction. Less severe infections are more common and whether they are associated with an increased risk of dementia is unclear. We determined the association of pneumonia hospitalization with risk of dementia in well-functioning older adults. DESIGN Secondary analysis of a randomized multicenter trial to determine the effect of Gingko biloba on incident dementia. SETTING Five academic medical centers in the United States. SUBJECTS Healthy community volunteers (n = 3,069) with a median follow-up of 6.1 years. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS We identified pneumonia hospitalizations using International Classification of Diseases, 9th Edition-Coding Manual codes and validated them in a subset. Less than 3% of pneumonia cases necessitated ICU admission, mechanical ventilation, or vasopressor support. Dementia was adjudicated based on neuropsychological evaluation, neurological examination, and MRI. Two hundred twenty-one participants (7.2%) incurred at least one hospitalization with pneumonia (mean time to pneumonia = 3.5 yr). Of these, dementia was developed in 38 (17%) after pneumonia, with half of these cases occurring 2 years after the pneumonia hospitalization. Hospitalization with pneumonia was associated with increased risk of time to dementia diagnosis (unadjusted hazard ratio = 2.3; CI, 1.6-3.2; p < 0.0001). The association remained significant when adjusted for age, sex, race, study site, education, and baseline mini-mental status examination (hazard ratio = 1.9; CI, 1.4-2.8; p < 0.0001). Results were unchanged when additionally adjusted for smoking, hypertension, diabetes, heart disease, and preinfection functional status. Results were similar using propensity analysis where participants with pneumonia were matched to those without pneumonia based on age, probability of developing pneumonia, and similar trajectories of cognitive and physical function prior to pneumonia (adjusted prevalence rates, 91.7 vs 65 cases per 1,000 person-years; adjusted prevalence rate ratio = 1.6; CI, 1.06-2.7; p = 0.03). Sensitivity analyses showed that the higher risk also occurred among those hospitalized with other infections. CONCLUSION Hospitalization with pneumonia is associated with increased risk of dementia.
Collapse
Affiliation(s)
- Judith A Tate
- 1Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA. 2Department of Neurology, University of Pittsburgh, Pittsburgh, PA. 3Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. 4National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health, Bethesda, MD. 5The Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh, Pittsburgh, PA. 6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. 7Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. 8Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. 9Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA. 10Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC. 11Department of Biostatistics, University of Washington, Seattle, WA. 12School of Medicine, University of Virginia, Charlottesville, VA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
179
|
Liu HH. Use of the respiratory fluoroquinolones for the outpatient management of community-acquired pneumonia. Curr Ther Res Clin Exp 2014; 65:225-38. [PMID: 24764589 DOI: 10.1016/s0011-393x(04)80047-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2004] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Approximately 4 million cases of community-acquired pneumonia (CAP) occur in the United States each year, with the majority treated on an outpatient basis. The first fluoroquinolones (eg, ciprofloxacin) were used with caution for respiratory tract infections due to limited in vitro activity against common gram-positive pathogens. With the availability of levofloxacin, followed by gatifloxacin and moxifloxacin hydrochloride, which exhibited increased activity against gram-positive organisms, the fluoroquinolones have become a practical choice for the treatment of CAP. OBJECTIVE The aim of this review was to compare the respiratory fluoroquinolones in the outpatient management of CAP. METHODS We conducted a search for English-language articles (key terms: fluoroquinolone, levofloxacin, gatifloxacin, moxifloxacin, and pneumonia; years: 1996-2004). Data from published literature were reviewed regarding clinical and microbiologic efficacy and tolerability; pharmacokinetic and pharmacodynamic properties; and drug costs of levofloxacin, gatifloxacin, and moxifloxacin. RESULTS The 3 fluoroquinolones reviewed showed comparable clinical and microbiologic efficacy for the treatment of CAP. In general, the fluoroquinolones were well tolerated, although some differences have been reported, including higher rates of gastrointestinal and other adverse events for gatifloxacin and moxifloxacin. Gatifloxacin and moxifloxacin exhibited greater in vitro potency than levofloxacin against Streptococcus pneumoniae. However, levofloxacin achieved a higher serum drug concentration than the other agents, allowing similar attainment of pharmacokinetic and pharmacodynamic targets required for effective treatment. CONCLUSIONS The respiratory fluoroquinolones provided appropriate first line treatment in select patients with CAP on the basis of their microbiologic and clinical efficacy and their safety profiles.
Collapse
Affiliation(s)
- Hans H Liu
- Jefferson Medical College, Philadelphia, Pennsylvania, and Bryn Mawr Medical Specialists Association, Bryn Mawr, Pennsylvania, USA
| |
Collapse
|
180
|
Arancibia F, Cortes CP, Valdés M, Cerda J, Hernández A, Soto L, Torres A. Importance of Legionella pneumophila in the etiology of severe community-acquired pneumonia in Santiago, Chile. Chest 2014; 145:290-296. [PMID: 23764871 DOI: 10.1378/chest.13-0162] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In US and European literature, Legionella pneumophila is reported as an important etiologic agent of severe community-acquired pneumonia (CAP), but in Chile this information is lacking. The aim of this study was to determine the incidence and identify predictors of severe CAP caused by L pneumophila in Santiago, Chile. METHODS A multicenter, prospective clinical study lasting 18 months was conducted; it included all adult patients with severe CAP admitted to the ICUs of four hospitals in Santiago. We excluded patients who were immunocompromised, had been hospitalized in the previous 4 weeks, or presented with another disease during their hospitalization. All data for the diagnosis of severe CAP were registered, and urinary antigens for L pneumophila serogroup 1 were determined. RESULTS A total of 104 patients with severe CAP were included (mean ± SD age, 58.3 ± 19.3 years; men, 64.4%; APACHE (Acute Physiology and Chronic Health Evaluation) II score, 16.7 ± 6.3; Sepsis-related Organ Failure Assessment score, 6.1 ± 3.2; Pitt Bacteremia Score, 3.4 ± 2.5; Pao2/Fio2, 170.8 ± 87.1). An etiologic agent was identified in 62 patients (59.6%), with the most frequent being Streptococcus pneumoniae (27 patients [26%]) and L pneumophila (nine patients [8.6%]). Logistic regression analysis showed that a plasma sodium level of ≤ 130 mEq/L was an independent predictor for L pneumophila severe CAP (OR, 11.3; 95% CI, 2.5-50.5; P = .002). Global mortality was 26% and 33% for L pneumophila. The Pitt bacteremia score and pneumonia score index were the best predictors of mortality. CONCLUSIONS We found that in Santiago, L pneumophila was second to S pneumoniae as the etiologic agent of severe CAP. Severe hyponatremia at admission appears to be an indicator for L pneumophila etiology in severe CAP.
Collapse
Affiliation(s)
- Francisco Arancibia
- Instituto Nacional del Tórax, Santiago, Chile; Clínica Santa María, Santiago, Chile.
| | - Claudia P Cortes
- Instituto Nacional del Tórax, Santiago, Chile; School of Medicine, University of Chile, Santiago, Chile
| | - Marcelo Valdés
- Instituto Nacional del Tórax, Santiago, Chile; Clínica Santa María, Santiago, Chile
| | - Javier Cerda
- Hospital Militar de Santiago, Santiago, Chile; Hospital San Borja-Arriarán, Santiago, Chile
| | | | - Luis Soto
- Instituto Nacional del Tórax, Santiago, Chile
| | - Antoni Torres
- Servei de Pneumologia, Institut del Tórax, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028)-Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
181
|
Lee J, Hwang SS, Kim K, Jo YH, Lee JH, Kim J, Rhee JE, Park C, Chung H, Jung JY. Bacteremia prediction model using a common clinical test in patients with community-acquired pneumonia. Am J Emerg Med 2014; 32:700-4. [PMID: 24856736 DOI: 10.1016/j.ajem.2014.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/09/2014] [Accepted: 04/09/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to construct a bacteremia prediction model using commonly available clinical variables in hospitalized patients with community-acquired pneumonia (CAP). BASIC PROCEDURES A prospective database including patients who were diagnosed with CAP in the emergency department was analyzed. Independent risk factors were investigated by using multivariable analysis in 60% of the cohort. We assigned a weighted value to predictive factor and made a prediction rule. This model was validated both internally and externally with the remaining 40% of the cohort and a cohort from an independent hospital. The low-risk group for bacteremia was defined as patients who have a risk of bacteremia less than 3%. MAIN FINDINGS A total of 2422 patients were included in this study. The overall rate of bacteremia was 5.7% in the cohort. The significant factors for predicting bacteremia were the following 7 variables: systolic blood pressure less than 90 mm Hg, heart rate greater than 125 beats per minute, body temperature less than 35 °C or greater than 40 °C, white blood cell less than 4000 or 12,000 cells per microliter, platelets less than 130,000 cells per microliter, albumin less than 3.3 g/dL, and C-reactive protein greater than 17 mg/dL. After using our prediction rule for the validation cohorts, 78.7% and 74.8% of the internal and external validation cohorts were classified as low-risk bacteremia groups. The areas under the receiver operating characteristic curves were 0.75 and 0.79 for the internal and external validation cohorts. PRINCIPAL CONCLUSIONS This model could provide guidelines for whether to perform blood cultures for hospitalized CAP patients with the goal of reducing the number of blood cultures.
Collapse
Affiliation(s)
- Jungyoup Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital
| | - Seung Sik Hwang
- Department of Social and Preventive Medicine, Inha University College of Medicine, Incheon South Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital.
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital
| | - Joong Eui Rhee
- Department of Emergency Medicine, Seoul National University Bundang Hospital
| | - Chanjong Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital
| | - Heajin Chung
- Department of Emergency Medicine, Seoul National University Bundang Hospital
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University College of Medicine
| |
Collapse
|
182
|
Ryan D, Connolly R, Fennell J, Fitzpatrick G. Aetiology of community-acquired pneumonia in the ICU setting and its effect on mortality, length of mechanical ventilation and length of ICU stay: a 1-year retrospective review. Crit Care 2014. [PMCID: PMC4273900 DOI: 10.1186/cc14067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
183
|
Neumonía con evolución inusual y sin relación clínico-radiológica. Semergen 2014; 40:159-62. [DOI: 10.1016/j.semerg.2013.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/13/2013] [Accepted: 09/04/2013] [Indexed: 11/23/2022]
|
184
|
Masclee GMC, Sturkenboom MCJM, Kuipers EJ. A Benefit–Risk Assessment of the Use of Proton Pump Inhibitors in the Elderly. Drugs Aging 2014; 31:263-82. [DOI: 10.1007/s40266-014-0166-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
185
|
Widmer D, Drozdov D, Rüegger K, Litke A, Arici B, Regez K, Guglielmetti M, Schild U, Conca A, Schäfer P, Kouegbe RB, Reutlinger B, Blum C, Schuetz P, Irani S, Huber A, Bürgi U, Müller B, Albrich WC. Effectiveness of Proadrenomedullin Enhanced CURB65 Score Algorithm in Patients with Community-Acquired Pneumonia in "Real Life", an Observational Quality Control Survey. J Clin Med 2014; 3:267-79. [PMID: 26237261 PMCID: PMC4449665 DOI: 10.3390/jcm3010267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/13/2014] [Accepted: 02/18/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND An intervention trial found a trend for shorter length of stay (LOS) in patients with community-acquired pneumonia (CAP) when the CURB65 score was combined with the prognostic biomarker proadrenomedullin (ProADM) (CURB65-A). However, the efficacy and safety of CURB65-A in real life situations remains unclear. METHODS From September, 2011, until April, 2012, we performed a post-study prospective observational quality control survey at the cantonal Hospital of Aarau, Switzerland of consecutive adults with CAP. The primary endpoint was length of stay (LOS) during the index hospitalization and within 30 days. We compared the results with two well-defined historic cohorts of CAP patients hospitalized in the same hospital with the use of multivariate regression, namely 83 patients in the observation study without ProADM (OPTIMA I) and the 169 patients in the intervention study (OPTIMA II RCT). RESULTS A total of 89 patients with confirmed CAP were included. As compared to patients with CURB65 only observed in the OPTIMA I study, adjusted regression analysis showed a significant shorter initial LOS (7.5 vs. 10.4 days; -2.32; 95% CI, -4.51 to -0.13; p = 0.04) when CURB65-A was used in clinical routine. No significant differences were found for LOS within 30 days. There were no significant differences in safety outcomes in regard to mortality and ICU admission between the cohorts. CONCLUSION This post-study survey provides evidence that the use of ProADM in combination with CURB65 (CURB65-A) in "real life" situations reduces initial LOS compared to the CURB65 score alone without apparent negative effects on patient safety.
Collapse
Affiliation(s)
- Daniel Widmer
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Daniel Drozdov
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Kristina Rüegger
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Alexander Litke
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Birsen Arici
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Katharina Regez
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Merih Guglielmetti
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Ursula Schild
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Antoinette Conca
- Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Petra Schäfer
- Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Rita Bossart Kouegbe
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Barbara Reutlinger
- Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Claudine Blum
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Philipp Schuetz
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Sarosh Irani
- Division of Pulmonary Medicine, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Ulrich Bürgi
- Department of Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Beat Müller
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
| | - Werner C Albrich
- Division of Infectious Diseases and Hospital Hygiene, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, St. Gallen CH-9007, Switzerland.
| |
Collapse
|
186
|
Yin Q, Liu B, Chen Y, Zhao Y, Li C. Soluble Thrombomodulin to Evaluate the Severity and Outcome of Community-Acquired Pneumonia. Inflammation 2014; 37:1271-9. [DOI: 10.1007/s10753-014-9854-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
187
|
Drijkoningen JJC, Rohde GGU. Pneumococcal infection in adults: burden of disease. Clin Microbiol Infect 2014; 20 Suppl 5:45-51. [PMID: 24313448 DOI: 10.1111/1469-0691.12461] [Citation(s) in RCA: 229] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To overview the present global burden of pneumococcal disease is important because new preventive measures such as the pneumococcal conjugate vaccine 13 are currently being evaluated. Pneumococcal disease is roughly divided into non-invasive and invasive disease. The burden of non-invasive pneumococcal disease in adults is mainly determined by community-acquired pneumonia. Pneumococcal pneumonia has high incidence rates and carries a high mortality risk, especially in the elderly. Within the cluster of invasive pneumococcal diseases, pneumonia also represents the most common infectious source. Incidence and mortality rates of both non-invasive and invasive disease have changed as a result of pneumococcal vaccination in children. However, especially elderly patients with comorbidities remain vulnerable to morbidity and mortality caused by pneumococcal disease. The current review summarizes the current knowledge on the epidemiology including outcome of the main clinical forms of pneumococcal disease, with a special focus on elderly patients. Furthermore, the economic burden and future vaccine strategies are briefly discussed.
Collapse
Affiliation(s)
- J J C Drijkoningen
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | |
Collapse
|
188
|
Fernandez JF, Sibila O, Restrepo MI. Predicting ICU admission in community-acquired pneumonia: clinical scores and biomarkers. Expert Rev Clin Pharmacol 2014; 5:445-58. [DOI: 10.1586/ecp.12.28] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
189
|
Aliberti S, Kaye KS. The changing microbiologic epidemiology of community-acquired pneumonia. Postgrad Med 2014; 125:31-42. [PMID: 24200759 DOI: 10.3810/pgm.2013.11.2710] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Community-acquired pneumonia (CAP) is a common infectious disease in the United States and the incidence continues to grow as the aging population increases. Overall, in-hospital patient mortality rates have been reported to be as high as 18%. Management of patients with CAP has been challenged by the evolution of resistant pathogens (particularly Streptococcus pneumoniae and Staphylococcus aureus) that have reduced susceptibility to recommended standard antimicrobial agents. Streptococcus pneumoniae continues to be the most frequently identified pathogen in CAP and recently, S. aureus has been found to be the second most often identified pathogen. Data from the SENTRY Antimicrobial Surveillance Program has shown declining susceptibility of pneumococci to penicillin, amoxicillin/clavulanate, and ceftriaxone from 1998 through 2011. In the Assessing Worldwide Resistance Evaluation (AWARE) surveillance program, > 50% of all S. aureus isolates from patient bloodstream infections, skin and skin structure infections, and pneumonia were methicillin-resistant. Stratifying risk factors to identify patients at risk for community-acquired multidrug-resistant pathogens should be considered when selecting therapy. Differences in microbiology and outcomes have been noted in patients presenting from the community with recent exposure to the health care system (eg, nursing home residents, patients with a recent hospital admission). These patients are at an increased risk of an infection caused by a multidrug-resistant pathogen. Understanding a patient's risk for drug-resistant pathogens will allow the physician to choose an appropriate empiric treatment regimen to optimize clinical outcomes.
Collapse
Affiliation(s)
- Stefano Aliberti
- Department of Health Science, University of Milan Bicocca, AO San Gerardo, Milan, Italy.
| | | |
Collapse
|
190
|
Abstract
The respiratory tract is a common site of infection in cancer patients and is associated with substantial moribidity and mortality in this population. Cancer, chemotherapy, and radiation can all cause noninfectious pulmonary infiltrates and respiratory symptoms that can masquerade as a respiratory tract infection. Cancer patients are at a particular risk for infection by a wide variety of different viruses, fungi, and bacteria that can be difficult to treat. Although noninvasive diagnostics have significantly improved recently, patients with severe pneumonia and those not responding to usual therapy should be candidates for aggressive diagnostic testing and tissue sampling. Initial therapy should be carefully chosen and individually tailored to account for the individual patient's underlying risk factors for multi-drug-resistant pathogens, viral pathogens, or fungi. Once diagnostic testing returns, therapy should be altered to appropriately narrow the spectrum of coverage.
Collapse
Affiliation(s)
- Valentina Stosor
- Div. Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
| | - Teresa R. Zembower
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
| |
Collapse
|
191
|
Almirall J, Blanquer J, Bello S. Community-acquired pneumonia among smokers. Arch Bronconeumol 2013; 50:250-4. [PMID: 24387877 DOI: 10.1016/j.arbres.2013.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/08/2013] [Accepted: 11/19/2013] [Indexed: 01/07/2023]
Abstract
Recent studies have left absolutely no doubt that tobacco increases susceptibility to bacterial lung infection, even in passive smokers. This relationship also shows a dose-response effect, since the risk reduces spectacularly 10 years after giving up smoking, returning to the level of non-smokers. Streptococcus pneumoniae is the causative microorganism responsible for community-acquired pneumonia (CAP) most frequently associated with smoking, particularly in invasive pneumococcal disease and septic shock. It is not clear how it acts on the progress of pneumonia, but there is evidence to suggest that the prognosis for pneumococcal pneumonia is worse. In CAP caused by Legionella pneumophila, it has also been observed that smoking is the most important risk factor, with the risk rising 121% for each pack of cigarettes smoked a day. Tobacco use may also favor diseases that are also known risk factors for CAP, such as periodontal disease and upper respiratory viral infections. By way of prevention, while giving up smoking should always be proposed, the use of the pneumococcal vaccine is also recommended, regardless of the presence of other comorbidities.
Collapse
Affiliation(s)
- Jordi Almirall
- Servicio de Cuidados Intensivos, Hospital de Mataró, Universitat Autónoma de Barcelona, CIBERES, Barcelona, España.
| | - José Blanquer
- Cuidados Intensivos Respiratorios, Hospital Clínico Universitario, INCLIVA, Valencia, España
| | - Salvador Bello
- Servicio de Neumología, Hospital Universitario Miguel Servet, CIBERES, Zaragoza, España
| |
Collapse
|
192
|
Song JY, Eun BW, Nahm MH. Diagnosis of pneumococcal pneumonia: current pitfalls and the way forward. Infect Chemother 2013; 45:351-66. [PMID: 24475349 PMCID: PMC3902818 DOI: 10.3947/ic.2013.45.4.351] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Indexed: 02/02/2023] Open
Abstract
Streptococcus pneumoniae is the most common cause of community-acquired pneumonia. However, it can also asymptomatically colonize the upper respiratory tract. Because of the need to distinguish between S. pneumoniae that is simply colonizing the upper respiratory tract and S. pneumoniae that is causing pneumonia, accurate diagnosis of pneumococcal pneumonia is a challenging issue that still needs to be solved. Sputum Gram stains and culture are the first diagnostic step for identifying pneumococcal pneumonia and provide information on antibiotic susceptibility. However, these conventional methods are relatively slow and insensitive and show limited specificity. In the past decade, new diagnostic tools have been developed, particularly antigen (teichoic acid and capsular polysaccharides) and nucleic acid (ply, lytA, and Spn9802) detection assays. Use of the pneumococcal antigen detection methods along with biomarkers (C-reactive protein and procalcitonin) may enhance the specificity of diagnosis for pneumococcal pneumonia. This article provides an overview of current methods of diagnosing pneumococcal pneumonia and discusses new and future test methods that may provide the way forward for improving its diagnosis.
Collapse
Affiliation(s)
- Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Byung Wook Eun
- Department of Pediatrics, Eulji General Hospital, Seoul, Korea
| | - Moon H Nahm
- Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. ; Department of Microbiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
193
|
Dartois N, Castaing N, Gandjini H, Cooper A. Tigecycline Versus Levofloxacin for the Treatment of Community-Acquired Pneumonia: European Experience. J Chemother 2013; 20 Suppl 1:28-35. [DOI: 10.1179/joc.2008.20.supplement-1.28] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
194
|
Birkhamshaw E, Waitt CJ, Innes M, Waitt PI. Severity assessment of lower respiratory tract infection in Malawi: derivation of a novel index (SWAT-Bp) which outperforms CRB-65. PLoS One 2013; 8:e82178. [PMID: 24324763 PMCID: PMC3855704 DOI: 10.1371/journal.pone.0082178] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/22/2013] [Indexed: 01/20/2023] Open
Abstract
Objective To assess the validity of CRB-65 (Confusion, Respiratory rate >30 breaths/min, BP<90/60 mmHg, age >65 years) as a pneumonia severity index in a Malawian hospital population, and determine whether an alternative score has greater accuracy in this setting. Design Forty three variables were prospectively recorded during the first 48 hours of admission in all patients admitted to Queen Elizabeth Central Hospital, Malawi, for management of lower respiratory tract infection over a two month period (N = 240). Calculation of sensitivity and specificity for CRB-65 in predicting mortality was followed by multivariate modeling to create a score with superior performance in this population. Results Median age 37, HIV prevalence 79.9%, overall mortality 18.3%. CRB-65 predicted mortality poorly, indicated by the area under the ROC curve of 0.649. Independent predictors of death were: Male sex, “S” (AOR 2.6); Wasting, “W” (AOR 6.6); non-ambulatory, “A” (AOR 2.5); Temp >38°C or <35°C, “T” (AOR 3.2); BP<100/60, “Bp” (AOR 3.7). Combining these factors to form a severity index (SWAT-Bp) predicted mortality with high sensitivity and specificity (AUC: 0.867). Mortality for scores 0–5 was 0%, 3.3%, 7.4%, 29.2%, 61.5% and 87.5% respectively. A score ≥3 was 84% sensitive and 77% specific for mortality prediction, with a negative predictive value of 95.8%. Conclusion CRB-65 performs poorly in this population. The SWAT-Bp score can accurately stratify patients; ≤2 indicates non-severe infection (mortality 4.4%) and ≥3 severe illness (mortality 45%).
Collapse
Affiliation(s)
- Edmund Birkhamshaw
- Birmingham College of Medicine, Birmingham University, Birmingham, United Kingdom
- * E-mail: (EB); (CW)
| | - Catriona J. Waitt
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
- * E-mail: (EB); (CW)
| | - Michael Innes
- Department of Primary Care, Birmingham University, Birmingham, United Kingdom
| | - Peter I. Waitt
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| |
Collapse
|
195
|
Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease. Ann Am Thorac Soc 2013; 10:81-9. [PMID: 23607835 DOI: 10.1513/annalsats.201208-043oc] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE There is a need to identify clinically meaningful predictors of mortality following hospitalized COPD exacerbation. OBJECTIVES The aim of this study was to systematically review the literature to identify clinically important factors that predict mortality after hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD). METHODS Eligible studies considered adults admitted to hospital with COPD exacerbation. Two authors independently abstracted data. Odds ratios were then calculated by comparing the prevalence of each predictor in survivors versus nonsurvivors. For continuous variables, mean differences were pooled by the inverse of their variance, using a random effects model. MEASUREMENTS AND MAIN RESULTS There were 37 studies included (189,772 study subjects) with risk of death ranging from 3.6% for studies considering short-term mortality, 31.0% for long-term mortality (up to 2 yr after hospitalization), and 29.0% for studies that considered solely intensive care unit (ICU)-admitted study subjects. Twelve prognostic factors (age, male sex, low body mass index, cardiac failure, chronic renal failure, confusion, long-term oxygen therapy, lower limb edema, Global Initiative for Chronic Lung Disease criteria stage 4, cor pulmonale, acidemia, and elevated plasma troponin level) were significantly associated with increased short-term mortality. Nine prognostic factors (age, low body mass index, cardiac failure, diabetes mellitus, ischemic heart disease, malignancy, FEV1, long-term oxygen therapy, and PaO2 on admission) were significantly associated with long-term mortality. Three factors (age, low Glasgow Coma Scale score, and pH) were significantly associated with increased risk of mortality in ICU-admitted study subjects. CONCLUSION Different factors correlate with mortality from COPD exacerbation in the short term, long term, and after ICU admission. These parameters may be useful to develop tools for prediction of outcome in clinical practice.
Collapse
|
196
|
Yang SC, Liao KM, Chen CW, Lin WC. Positive blood culture is not associated with increased mortality in patients with sepsis-induced acute respiratory distress syndrome. Respirology 2013; 18:1210-6. [DOI: 10.1111/resp.12121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 12/19/2012] [Accepted: 04/03/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Szu-Chun Yang
- Department of Internal Medicine; National Cheng Kung University Hospital Dou-Liou Branch; Yunlin Taiwan
| | - Kuang-Ming Liao
- Department of Internal Medicine; Chi Mei Hospital Chia-Li Branch; Tainan Taiwan
| | - Chang-Wen Chen
- Medical Intensive Care Unit; Department of Internal Medicine; National Cheng Kung University Medical College and Hospital; Tainan Taiwan
| | - Wei-Chieh Lin
- Medical Intensive Care Unit; Department of Internal Medicine; National Cheng Kung University Medical College and Hospital; Tainan Taiwan
| |
Collapse
|
197
|
|
198
|
Abstract
PURPOSE OF REVIEW Community-acquired pneumonia (CAP) is a major public health problem all over the world. The increasing number of antibiotic-resistant bacteria is a matter of concern for physicians when choosing antibiotic treatment in patients with CAP. This review focuses on the current recommendations of antibiotic treatment, recent information concerning antibiotic resistance of pathogens, and the advances in antibiotic therapy in the field of CAP. RECENT FINDINGS A significant increase in the frequency of resistance to the antibiotics commonly used against causative pathogens of CAP, such as β-lactams or macrolides, has been reported in recent years. At present, the prevalence of fluoroquinolone resistance in Streptococcus pneumoniae remains low. Community-acquired methicillin-resistant Staphylococcus aureus and influenza A(H1N1)pdm09 have been reported as causes of severe CAP. Several newly-developed antibiotics, including cepholosporins, ketolides and quinolones, present marked activity in vitro against the main causative pathogens of CAP. Many randomized controlled trials have demonstrated equivalent efficacy of the newer antibiotics compared with conventional antimicrobial therapy in mild-to-moderate CAP. SUMMARY An increase of resistance to the antibiotics used in CAP has been documented over the years. Several new antibiotics have been developed for treating CAP, with promising results. However, data regarding their efficacy and safety in patients with severe CAP are lacking.
Collapse
|
199
|
Retrospective analysis of nursing and healthcare-associated pneumonia: analysis of adverse prognostic factors and validity of the selection criteria. Respir Investig 2013; 52:114-20. [PMID: 24636267 DOI: 10.1016/j.resinv.2013.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 08/26/2013] [Accepted: 08/30/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nursing and healthcare-associated pneumonia (NHCAP) is a relatively new condition that was recently defined by the Japanese Respiratory Society. Previous reports and guidelines have not thoroughly investigated the adverse prognostic factors and validity of the selection criteria for NHCAP. The purpose of this research was to clarify the adverse prognostic factors of NHCAP and investigate the validity of the selection criteria with respect to patient deaths. METHODS We retrospectively analyzed 418 patients with pneumonia who were admitted to our hospital between January 2009 and December 2011. RESULTS We analyzed 215 (51.4%) cases of community-acquired pneumonia (CAP) and 203 (48.6%) cases of NHCAP. NHCAP patients were generally older and had poorer performance status (PS), more complications, and higher levels of mortality than CAP patients. In both groups, the most common causative pathogen was Streptococcus pneumoniae. A multivariate analysis of NHCAP revealed that age ≥ 80 years, oxygen saturation (SpO2) ≤ 90%, and methicillin-resistant Staphylococcus aureus (MRSA) infection to be independent factors associated with mortality. Of the NHCAP selection criteria, a PS ≥ 3 and a hospitalization history within the past 90 days were adverse prognostic factors in the broad community-acquired pneumonia category (CAP+NHCAP), according to a multivariate analysis. Univariate analysis revealed that admission to an extended care facility or nursing home was associated with death. CONCLUSIONS Our results demonstrated that age ≥ 80 years, SpO2 ≤ 90%, and MRSA infection were adverse prognostic factors for NHCAP patients. Furthermore, we confirmed the validity of the NHCAP selection criteria.
Collapse
|
200
|
Wenisch C, Weiss G, Lechner A, Meilinger M, Rittler K, Muzatko N, Pomogyi B, Kutilek M, Bellmann-Weiler R, Fürst UM, Andorfer A, Wenisch JM. Epidemiology of patients hospitalised for pneumonia in 2011: a prospective multicentre cohort study. Wien Klin Wochenschr 2013; 125:621-8. [DOI: 10.1007/s00508-013-0419-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 07/28/2013] [Indexed: 11/29/2022]
|