151
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Østergaard L, Mortensen RN, Kragholm K, Dalager-Pedersen M, Koch K, Køber L, Torp-Pedersen C, Fosbøl E. Work exposure and associated risk of hospitalisation with pneumonia and influenza: A nationwide study. Scand J Public Health 2020; 49:57-63. [PMID: 33124945 PMCID: PMC7859585 DOI: 10.1177/1403494820964974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Pneumonia and influenza are major health concerns and constitute a high
economic burden. However, few data are available on the associated risk of
pneumonia and influenza and work exposure on a large population scale. Aim: This study aimed to examine the associated risk of pneumonia and influenza by
type of work exposure. Methods: By cross-linking administrative Danish registries, we classified people in 10
different profession types. The main outcome was hospitalisation with
pneumonia or influenza. A multivariable Poisson regression analysis was used
to assess the associated incidence rate ratio (IRR) of being hospitalised
with pneumonia or influenza by type of profession. Results: A total of 1,327,606 people added risk time to the analyses. In a
multivariable model, work in day care, public transportation, sewers and
nursing home care was associated with an increased risk of hospitalisation
with pneumonia compared to work within public administration: IRR=1.20 (95%
confidence interval (CI) 1.12–1.28), IRR=1.21 (95% CI 1.09–1.34), IRR=1.61
(95% CI 1.19–2.19) and IRR=1.10 (95% CI 1.03–1.18), respectively. In a
multivariable analysis, people working within public transportation were
associated with an increased risk of hospitalisation with influenza compared
to people working within public administration: IRR=2.54 (95% CI
1.79–3.58). Conclusions: Working in day care, public transportation, sewers and nursing home
care increased the associated risk of hospitalisation with pneumonia,
and working within public transportation increased the associated risk
of being hospitalised with influenza compared to working within public
administration.
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Affiliation(s)
- Lauge Østergaard
- The Heart Centre, Rigshospitalet, Denmark.,Department of Clinical Epidemiology and Department of Cardiology, University of Aalborg, Denmark
| | | | - Kristian Kragholm
- Department of Clinical Epidemiology and Department of Cardiology, University of Aalborg, Denmark
| | | | - Kristoffer Koch
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | - Lars Køber
- The Heart Centre, Rigshospitalet, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Epidemiology and Department of Cardiology, University of Aalborg, Denmark
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152
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Cilloniz C, Dominedo C, Peroni HJ, Di Giannatale P, Garcia-Vidal C, Gabarrus A, Liapikou A, Ceccato A, Torres A. Difficult to treat microorganisms in patients aged over 80 years with community-acquired pneumonia: the prevalence of PES pathogens. Eur Respir J 2020; 56:13993003.00773-2020. [PMID: 32430413 DOI: 10.1183/13993003.00773-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/28/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Catia Cilloniz
- Dept of Pulmonology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Cristina Dominedo
- Dept of Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Héctor José Peroni
- Servicio de Clínica Medica, Sección de Neumonología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pierluigi Di Giannatale
- Dept of Anaesthesiology, Critical Care and Pain Management, "Gabriele d'Annunzio" University of Chieti-Pescara and "SS. Annunziata" Hospital of Chieti, Chieti, Italy
| | | | - Albert Gabarrus
- Dept of Pulmonology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
| | | | - Adrian Ceccato
- Dept of Pulmonology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Antoni Torres
- Dept of Pulmonology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
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153
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Sharma R, Sandrock CE, Meehan J, Theriault N. Community-Acquired Bacterial Pneumonia-Changing Epidemiology, Resistance Patterns, and Newer Antibiotics: Spotlight on Delafloxacin. Clin Drug Investig 2020; 40:947-960. [PMID: 32889706 PMCID: PMC7511281 DOI: 10.1007/s40261-020-00953-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality both in the USA and globally. As the burden of CAP continues to increase due to several factors, the advances in its diagnosis, prevention, and treatment have taken on even greater interest and importance. The majority of CAP patients are treated empirically, and selection of appropriate antibiotic treatment is increasingly difficult because the epidemiology of CAP is changing, in part due to antimicrobial resistance, and the causative CAP pathogens differ between countries and regions. There is also an increasing prevalence of chronic co-morbid diseases among CAP patients. Treatment of CAP has become challenging because of these factors along with the varying safety profiles and efficacy of well-established antibiotics, as well as limited new therapeutic options. Recently, however, new antibiotics have been approved, which will expand the treatment options for CAP, particularly in those patients with underlying complications. Recently approved delafloxacin, an anionic fluoroquinolone, has a unique structure and distinct chemical characteristics; it demonstrated non-inferiority to moxifloxacin in a phase III clinical trial, but was shown to be superior to moxifloxacin at early clinical response in CAP patients who also have chronic obstructive pulmonary disease (COPD) or asthma as a co-morbidity, and in CAP patients who may have severe illness. Delafloxacin could offer an additional therapy against resistant isolates and among these difficult-to-treat patients. This review summarizes the development, latest research, and safety profile of the new antibiotic delafloxacin, and its potential future role in the treatment of CAP.
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Affiliation(s)
- Roopali Sharma
- Department of Pharmacy Practice, Touro College of Pharmacy, 230 West 125th Street, New York, NY, 10027, USA.
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154
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Nehme J, Borghesan M, Mackedenski S, Bird TG, Demaria M. Cellular senescence as a potential mediator of COVID-19 severity in the elderly. Aging Cell 2020; 19:e13237. [PMID: 32955770 PMCID: PMC7576296 DOI: 10.1111/acel.13237] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 01/10/2023] Open
Abstract
SARS-CoV-2 is a novel betacoronavirus which infects the lower respiratory tract and can cause coronavirus disease 2019 (COVID-19), a complex respiratory distress syndrome. Epidemiological data show that COVID-19 has a rising mortality particularly in individuals with advanced age. Identifying a functional association between SARS-CoV-2 infection and the process of biological aging may provide a tractable avenue for therapy to prevent acute and long-term disease. Here, we discuss how cellular senescence-a state of stable growth arrest characterized by pro-inflammatory and pro-disease functions-can hypothetically be a contributor to COVID-19 pathogenesis, and a potential pharmaceutical target to alleviate disease severity. First, we define why older COVID-19 patients are more likely to accumulate high levels of cellular senescence. Second, we describe how senescent cells can contribute to an uncontrolled SARS-CoV-2-mediated cytokine storm and an excessive inflammatory reaction during the early phase of the disease. Third, we discuss the various mechanisms by which senescent cells promote tissue damage leading to lung failure and multi-tissue dysfunctions. Fourth, we argue that a high senescence burst might negatively impact on vaccine efficacy. Measuring the burst of cellular senescence could hypothetically serve as a predictor of COVID-19 severity, and targeting senescence-associated mechanisms prior and after SARS-CoV-2 infection might have the potential to limit a number of severe damages and to improve the efficacy of vaccinations.
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Affiliation(s)
- Jamil Nehme
- European Research Institute for the Biology of Ageing (ERIBA)University Medical Center Groningen (UMCG)University of Groningen (RUGGroningen NLThe Netherlands
- Doctoral School of Science and TechnologyLebanese UniversityBeirutLebanon
| | - Michela Borghesan
- European Research Institute for the Biology of Ageing (ERIBA)University Medical Center Groningen (UMCG)University of Groningen (RUGGroningen NLThe Netherlands
| | - Sebastian Mackedenski
- European Research Institute for the Biology of Ageing (ERIBA)University Medical Center Groningen (UMCG)University of Groningen (RUGGroningen NLThe Netherlands
| | - Thomas G. Bird
- Cancer Research UK Beatson InstituteGlasgowUK
- Institute of Cancer SciencesUniversity of GlasgowGlasgowUK
- MRC Centre for Inflammation ResearchThe Queen's Medical Research InstituteUniversity of EdinburghEdinburghUK
| | - Marco Demaria
- European Research Institute for the Biology of Ageing (ERIBA)University Medical Center Groningen (UMCG)University of Groningen (RUGGroningen NLThe Netherlands
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155
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Prasad R, Daly B, Manley G. Effect of daily manual toothbrushing with 0.2% chlorhexidine gel on pneumonia-associated pathogens in adults living with profound neuro-disability. Access Microbiol 2020; 1:e000066. [PMID: 32974500 PMCID: PMC7491933 DOI: 10.1099/acmi.0.000066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the effect of daily toothbrushing with 0.2 % chlorhexidine digluconate (CHX) on the colonization of dental plaque by pathogens associated with pneumonia amongst non-ventilated adults with a neuro-disability. Methodology Forty-nine patients living in long-term care were recruited. Daily toothbrushing with 0.2 % CHX gel was conducted for 48 weeks. Plaque accumulation was assessed and microbiological sampling was undertaken every 6 weeks. Results At any one time point at least 65 % (n=32) of subjects were found to harbour respiratory pathogens. Although there were significant changes in the proportion of individuals colonized over time with Gram-negative bacilli and Pseudomonas aeruginosa, the changes were not sustained. By week 48 there was no significant difference from the levels that had been recorded at baseline. Conclusions Bacteria known to be causal in pneumonia are present and colonize the dental plaque of non-ventilated adults with a neuro-disability. Daily toothbrushing with 0.2 % CHX gel did not produce a sustained reduction in intra-oral respiratory pathogen counts after 48 weeks.
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Affiliation(s)
- Ria Prasad
- Department of Special Care Dentistry, King's College Dental Hospital, Bessemer Road, Camberwell, London, SE5 9R9, UK
| | - Blanaid Daly
- Division of Public & Child Dental Health, Dublin Dental University Hospital, School of Dental Sciences, Trinity College Dublin, Lincoln Place 2, Dublin 2, Ireland
| | - Graham Manley
- Royal Hospital For Neuro-disability, West Hill Putney, London SW15 3SW, UK
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156
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Fekete M, Pako J, Nemeth AN, Tarantini S, Varga JT. Prevalence of influenza and pneumococcal vaccination in chronic obstructive pulmonary disease patients in association with the occurrence of acute exacerbations. J Thorac Dis 2020; 12:4233-4242. [PMID: 32944335 PMCID: PMC7475525 DOI: 10.21037/jtd-20-814] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Based on current evidence, vaccination is recommended against the influenza virus and pneumococcus to avoid serious acute exacerbations in patients with chronic obstructive pulmonary disease (COPD), but the rate of their vaccination coverage is still suboptimal. To determine the prevalence and effectiveness of influenza and pneumococcal vaccination in COPD patients, and to prove its hypothetical association with the decreasing number of acute exacerbations. Methods We conducted a retrospective, population-based cohort study. Influenza and pneumococcal vaccination history were collected from 250 patients selected by simple random sampling from all COPD patients in Budapest at the Department of Pulmonary Rehabilitation of the National Koranyi Institute of Pulmonology between 01 January 2019 and 01 June 2019. Inclusion criteria were the following: age 40 years and diagnosis of COPD. Odds ratios (ORs) were evaluated based on the occurrence of acute exacerbations during the preceding year. Results The average age was 66.62 (±8.34) years, 67.30 (±8.54) for males, and 66.09 (±8.16) for females. Man:woman ratio: 43.6%:56.4% in total. Overall prevalence of influenza vaccination was 23.6%, and the pneumococcal vaccination rate was 10.8% among COPD patients. Influenza and pneumococcal vaccination showed a significant protective effect and reduced the occurrence of exacerbations in the following year, influenza vaccination OR: 2.11 (95% CI: 0.88-5.02), pneumococcal vaccination OR: 1.06 (95% CI: 0.84-1.34), when taking both vaccination: OR: 2.37 (95% CI: 1.39-4.08). Conclusions We found association between influenza and pneumococcal vaccination and the reduced risk of hospitalization due to exacerbations in the ensuing year. The prevalence of vaccination is significantly below the optimal level.
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Affiliation(s)
- Monika Fekete
- Department of Public Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Judit Pako
- National Koranyi Institute for Pulmonology, Budapest, Hungary
| | - Anna N Nemeth
- Department of Public Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Stefano Tarantini
- Department of Biochemistry and Molecular Biology at University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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157
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Covino M, Piccioni A, Bonadia N, Onder G, Sabia L, Carbone L, Candelli M, Ojetti V, Murri R, Franceschi F. Early procalcitonin determination in the emergency department and clinical outcome of community-acquired pneumonia in old and oldest old patients. Eur J Intern Med 2020; 79:51-57. [PMID: 32409204 DOI: 10.1016/j.ejim.2020.04.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 03/11/2020] [Accepted: 04/27/2020] [Indexed: 02/05/2023]
Abstract
UNLABELLED We evaluated patients admitted through our ED for community-acquired pneumonia (CAP) to assess the relevance of an early procalcitonin (PCT) determination on patient's outcomes. METHODS We reviewed all patients admitted for CAP in a 10 years period (2008-2017). Patients were stratified according to age groups: (18-65 years; 65-84 years; and ≥85 years), CURB-65 score, need for ventilation, Sepsis-3 criteria at admission, enrollment period, blood culture in ED. In-hospital mortality rate and length of hospital stay (LOS) were compared between patients that had an early PCT determination in ED vs. patients admitted without. RESULTS Our study cohort consisted of 4056 CAP patients, age 76 [IQ range 64-84] years. We enrolled 1039 patients <65 years old, 2015 aged 65-84 years, and 1002 aged ≥85 years. Overall, the early PCT determination in ED was not associated to a reduced LOS (p=0.630), nor to a reduced mortality rate (p=0.134). However, in patients ≥ 85 years, the PCT determination in ED was associated with lower mortality in those with CURB-65 ≥ 2, and Charlson's score ≥ 2 (p=0.033 and p=0.002, respectively). CONCLUSIONS Although an early PCT assessment in ED was not associated with better outcomes in term of LOS and mortality in patients with CAP, our findings suggest that it might be associated with reduced mortality in patients ≥ 85 years with severe CAP or high comorbidity.
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Affiliation(s)
- Marcello Covino
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Francesco Vito 1, 00168, Roma, Italia.
| | - Andrea Piccioni
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Francesco Vito 1, 00168, Roma, Italia
| | - Nicola Bonadia
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Francesco Vito 1, 00168, Roma, Italia
| | - Graziano Onder
- Department of Gerontology, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
| | - Luca Sabia
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Francesco Vito 1, 00168, Roma, Italia
| | - Luigi Carbone
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Francesco Vito 1, 00168, Roma, Italia
| | - Marcello Candelli
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Francesco Vito 1, 00168, Roma, Italia
| | - Veronica Ojetti
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Francesco Vito 1, 00168, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
| | - Rita Murri
- Department of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
| | - Francesco Franceschi
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Francesco Vito 1, 00168, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
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158
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Shimizu T, Ishizuka M, Shiraki T, Sakuraoka Y, Mori S, Abe A, Iso Y, Takagi K, Aoki T, Kubota K. The clinical influence of the preoperative lymphocyte-to-monocyte ratio on the postoperative outcome of patients with early-stage gastrointestinal cancer. Ann Gastroenterol Surg 2020; 4:580-590. [PMID: 33005853 PMCID: PMC7511555 DOI: 10.1002/ags3.12369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 01/19/2023] Open
Abstract
AIM The lymphocyte-to-monocyte ratio (LMR) is useful for predicting the prognosis of patients with gastric cancer (GC) and those with colorectal cancer (CRC) undergoing surgery. The relationship between the LMR and postoperative outcome of patients with early-stage gastrointestinal cancers such as stage I GC and CRC remains unclear. METHODS We retrospectively evaluated 323 stage I GC and 152 stage I CRC patients undergoing surgery. Univariate and multivariate analyses using the Cox proportional hazards model were performed to identify the clinical characteristics associated with overall survival (OS), and the cut-off values of these variables were determined by receiver operating characteristic analysis. The Kaplan-Meier method and log-rank test were used for postoperative survival comparisons according to the LMR (GC: LMR < 4.2 vs ≥4.2; CRC: LMR < 3.0 vs ≥3.0). RESULTS Univariate and multivariate analyses revealed that OS was significantly associated with the LMR (<4.2/≥4.2) (HR, 2.489; 95% CI, 1.317-4.702; P = 0.005), as well as age (>75/≤75 years) (HR, 3.511; 95% CI, 1.881-6.551; P < 0.001) and albumin level (≤3.5/>3.5 g/dL) (HR, 3.040; 95% CI, 1.575-5.869; P = 0.001), in stage I GC patients. Survival analysis demonstrated a significantly poorer OS in stage I GC patients with a LMR < 4.2 compared with ≥4.2 (P < 0.001). In stage I CRC patients, despite a significant difference in OS according to the LMR (<3.0 vs ≥3.0) (P = 0.040), univariate analysis revealed no significant association between the LMR and OS. CONCLUSION LMR is a useful predictor of the postoperative outcome of stage I GC patients treated surgically.
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Affiliation(s)
- Takayuki Shimizu
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Mitsuru Ishizuka
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Takayuki Shiraki
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Yuhki Sakuraoka
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Shozo Mori
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Akihito Abe
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Yukihiro Iso
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Kazutoshi Takagi
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Taku Aoki
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Keiichi Kubota
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
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159
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Abstract
More than one-third of patients with chronic obstructive pulmonary disease (COPD) continue to smoke cigarettes despite knowing they have the disease. This behavior has a negative impact on prognosis and progression, as repeated injury enhances the pathobiological mechanisms responsible for the disease. A combination of counseling plus pharmacotherapy is the most effective cessation treatment of smokers with COPD, and varenicline seems to be the most effective pharmacologic intervention. Preventing exacerbations in patients with COPD is a major goal of treatment, and vaccination against influenza and pneumococcus is an effective preventive strategy to achieve this goal.
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Affiliation(s)
- Maria Montes de Oca
- Servicio de Neumonología, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Centro Médico de Caracas, Av. Los Erasos, Edf. Anexo B, Piso 4, Consultorio 4B, San Bernardino, Caracas, Venezuela.
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160
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Shimizu A, Maeda K, Wakabayashi H, Nishioka S, Nagano A, Kayashita J, Fujishima I, Momosaki R. Predictive Validity of Body Mass Index Cutoff Values Used in the Global Leadership Initiative on Malnutrition Criteria for Discriminating Severe and Moderate Malnutrition Based on In‐Patients With Pneumonia in Asians. JPEN J Parenter Enteral Nutr 2020; 45:941-950. [DOI: 10.1002/jpen.1959] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/30/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Akio Shimizu
- Department of Nutrition Hamamatsu City Rehabilitation Hospital Hamamatsu Shizuoka Japan
- Department of Palliative and Supportive Medicine Graduate School of Medicine Aichi Medical University Nagakute Aichi Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine Graduate School of Medicine Aichi Medical University Nagakute Aichi Japan
- Department of Geriatric Medicine National Center for Geriatrics and Gerontology Obu Aichi Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine Tokyo Women's Medical University Hospital Shinjuku‐ku Tokyo Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service Nagasaki Rehabilitation Hospital Nagasaki Nagasaki Japan
| | - Ayano Nagano
- Department of Nursing Care Nishinomiya Kyoritsu Neurosurgical Hospital Nishinomiya Hyogo Japan
| | - Jun Kayashita
- Department of Health Sciences Faculty of Human Culture and Science Prefectural University of Hiroshima Hiroshima Hiroshima Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine Hamamatsu City Rehabilitation Hospital Hamamatsu Shizuoka Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine Mie University Graduate School of Medicine Tsu Mie Japan
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161
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Marin-Corral J, Pascual-Guardia S, Amati F, Aliberti S, Masclans JR, Soni N, Rodriguez A, Sibila O, Sanz F, Sotgiu G, Anzueto A, Dimakou K, Petrino R, van de Garde E, Restrepo MI. Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia. Chest 2020; 159:58-72. [PMID: 32687909 DOI: 10.1016/j.chest.2020.06.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. RESEARCH QUESTION What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? STUDY DESIGN AND METHODS This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. RESULTS We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P = .021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P < .001) when compared with patients with severe CAP/AspRF+ and severe CAP/AspRF-, respectively. Most patients (>50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. INTERPRETATION Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.
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Affiliation(s)
- Judith Marin-Corral
- Critical Care Department, Hospital del Mar, Barcelona, Spain, and the Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Sergi Pascual-Guardia
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Respiratory Department, Hospital del Mar, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Francesco Amati
- Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, and University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Stefano Aliberti
- Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, and University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Joan R Masclans
- Critical Care Department, Hospital del Mar, Barcelona, Spain, and the Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Nilam Soni
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX
| | - Alejandro Rodriguez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain; Critical Care Medicine, Hospital Universitari Joan XXIII and Rovira & Virgili University, Tarragona, Spain
| | - Oriol Sibila
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain; Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and University of Barcelona, Barcelona, Spain
| | - Francisco Sanz
- Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Antonio Anzueto
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX
| | - Katerina Dimakou
- 5th Department of Pulmonary Medicine, Sotiria Chest Diseases Hospital, Athens, Greece
| | | | - Ewoudt van de Garde
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marcos I Restrepo
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX.
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162
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Ghilotti F, Bellocco R, Ye W, Adami HO, Trolle Lagerros Y. Obesity and risk of infections: results from men and women in the Swedish National March Cohort. Int J Epidemiol 2020; 48:1783-1794. [PMID: 31292615 DOI: 10.1093/ije/dyz129] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Previous studies have shown an association between body mass index (BMI) and infections, but the literature on type-specific community acquired infections is still limited. METHODS We included 39 163 Swedish adults who completed a questionnaire in September 1997 and were followed through record-linkages until December 2016. Information on BMI was self-reported and infections were identified from the Swedish National Patient Register using International Classification of Diseases (ICD), Tenth Revision (ICD-10) codes. We fitted multivariable Cox proportional hazards models for time-to-first-event analysis, and we used extensions of the standard Cox model when repeated events were included. RESULTS During a 19-year follow-up 32% of the subjects had at least one infection requiring health care contact, leading to a total of 27 675 events. We found an increased incidence of any infection in obese women [hazard ratio (HR) = 1.22; 95% confidence interval (CI) = 1.12; 1.33] and obese men (HR = 1.25; 95% CI = 1.09; 1.43) compared with normal weight subjects. For specific infections, higher incidences were observed for skin infections in both genders (HR = 1.76; 95% CI = 1.47; 2.12 for obese females and HR = 1.74; 95% CI = 1.33; 2.28 for obese males) and gastrointestinal tract infections (HR = 1.44; 95% CI = 1.19; 1.75), urinary tract infections (HR = 1.30; 95% CI = 1.08; 1.55) and sepsis (HR = 2.09; 95% CI = 1.46; 2.99) in obese females. When accounting for repeated events, estimates similar to the aforementioned ones were found. CONCLUSIONS Obesity was associated with an increased risk of infections in both genders. Results from multiple-failure survival analysis were consistent with those from classic Cox models.
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Affiliation(s)
- Francesca Ghilotti
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Rino Bellocco
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ylva Trolle Lagerros
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.,Obesity Center, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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163
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Vartan P, Asmar S, Bible L, Chehab M, Khurrum M, Castanon L, Ditillo M, Joseph B. Alcohol Use Disorder Is Bad for Broken Ribs: A Nationwide Analysis of 19,638 Patients With Rib Fractures. J Surg Res 2020; 255:556-564. [PMID: 32640407 DOI: 10.1016/j.jss.2020.05.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/30/2020] [Accepted: 05/05/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Alcohol use disorder (AUD) has deleterious effects on many organ systems. The aim of our study was to assess the impact of AUD on outcomes in patients with rib fractures. We hypothesized that AUD is associated with increased risk adverse outcomes. METHODS We performed a 2013-2014 retrospective analysis of all adult trauma patients diagnosed with rib fractures from the American College of Surgeons-Trauma Quality Improvement Program database. We excluded patients who were acutely intoxicated with alcohol. Patients were stratified into two groups: AUD + and AUD -. A 1:1 ratio propensity score matching for demographics, admission vitals, injury severity, smoking status, operative intervention, and number of rib fractures was performed. Outcome measures were in-hospital complications, mortality, hospital and intensive care unit length of stay, and ventilator days. RESULTS We matched 19,638 patients (AUD +:9,819, AUD -:9819). Mean age was 53 ± 22y, and median injury severity score was 15[10-20]. Matched groups were similar in age (P = 0.18), smoking status (P = 0.82), injury severity score (P = 0.28), chest Abbreviated Injury Scale (P = 0.24), and number of rib fractures (2[1-4] versus 2[1-4], P = 0.86). Alcoholic patients had higher rates of pneumonia (18.1% versus 9.2%, P < 0.01), unplanned intubation (18.5% versus 9.7, P < 0.001), sepsis (10.8% versus 6.3%, P < 0.001), acute respiratory distress syndrome (12.2% versus 7.4%, P < 0.001), and mortality (8.0 versus 5.7%, P < 0.001). Patients with AUD spent more days in the hospital and intensive care unit . There was no difference in ventilator days between the two groups. CONCLUSIONS Patients with AUD and rib fractures had higher rates of adverse events than patients without AUD. Early identification of patients with rib fractures with AUD may allow better resource allocation and help improve outcomes. LEVEL OF EVIDENCE Level III prognostic.
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Affiliation(s)
- Phillip Vartan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Samer Asmar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Letitia Bible
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Mohamad Chehab
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Muhammad Khurrum
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Lourdes Castanon
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Michael Ditillo
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
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Seo YB, Moon SJ, Jeon CH, Song JY, Sung YK, Jeong SJ, Kwon KT, Kim ES, Kim JH, Kim HA, Park DJ, Park SH, Park JK, Ahn JK, Oh JS, Yun JW, Lee JH, Lee HY, Choi MJ, Choi WS, Choi YH, Choi JH, Heo JY, Cheong HJ, Lee SS. The Practice Guideline for Vaccinating Korean Patients With Autoimmune Inflammatory Rheumatic Disease. JOURNAL OF RHEUMATIC DISEASES 2020. [DOI: 10.4078/jrd.2020.27.3.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Su-Jin Moon
- Division of Rheumatology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Chan Hong Jeon
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eu Suk Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Hoon Kim
- Department of Rheumatology, Korea University Guro Hospital, Seoul, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Dong-Jin Park
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Sung-Hoon Park
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jin Kyun Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joong Kyong Ahn
- Division of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Seon Oh
- Department of Information Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Won Yun
- Division of Infectious Disease Control, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Joo-Hyun Lee
- Division of Rheumatology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hee Young Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Joo Choi
- Division of Infectious Disease, Department of Internal Medicine, Catholic Kwandong University International St. Mary’s Hospital, Incheon, Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jung-Hyun Choi
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea, Eunpyeong St. Mary’s Hospital, Seoul, Korea
| | - Jung Yeon Heo
- Department of Infectious Diseases, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Korea
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165
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Qin S, Zhang W, Chen F, Luo F, Zhou Q, Ke P, Chen C. Antibodies against atypical pathogens and respiratory viruses detected by Pneumoslide IgM test in adults with community-acquired pneumonia in Guangzhou City. J Clin Lab Anal 2020; 34:e23419. [PMID: 32537759 PMCID: PMC7521227 DOI: 10.1002/jcla.23419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/21/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022] Open
Abstract
Background To detect the serum antibodies against respiratory viruses and atypical pathogens in adults with community‐acquired pneumonia (CAP) in Guangzhou City (Guangdong province, China). Methods A retrospective study was carried out with samples from 685 adults who were admitted with CAP and 108 non‐CAP control patients. Atypical pathogens and respiratory viruses in serum were detected using the Pneumoslide IgM test from Vircell, Spain. All patients were divided into 6 groups according to age: 18‐24, 25‐44, 45‐59, 60‐74, 75‐89, and >90. Results The total positive rate of CAP was 35.4%, which was highest in the 18‐24 age group (P < .05). The highest positive rate, 17.11%, was observed for Mycoplasma pneumoniae (MP). The mean age of MP‐infected patients was higher than that of the controls (P < .05). The positive rates for influenza B (INFB), Legionella pneumophila (LP1), Coxiella burnetii (COX), influenza A (INFA), parainfluenza virus (PIV), respiratory syncytial virus (RSV), Chlamydophila pneumoniae (CP), and adenovirus (ADV) were 5.56%, 3.07%, 2.63%, 2.34%, 1.90%, 1.61, 0.88%, and 0.29%, respectively. There were 4.37% of patients with CAP having multiple infections. The main symptoms observed in the 685 CAP patients were cough and sputum production, in 78.4% and 67.4%. Fever was followed by 54% of CAP patients. Dyspnea (39.1%), anorexia (36.8%), increased thirst (26.7%), chills (18.7), headache (14.6%), and nausea (13.1%) were also frequently observed in the CAP patients. Conclusions MP infection was the most common in adult CAP patients in Guangzhou City with the highest positive rate in the 18‐24 age groups.
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Affiliation(s)
- Sheng Qin
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weizheng Zhang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fu Chen
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fudong Luo
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiang Zhou
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peifeng Ke
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Cha Chen
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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166
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Høgli JU, Garcia BH, Svendsen K, Skogen V, Småbrekke L. Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study. BMC Pulm Med 2020; 20:169. [PMID: 32539706 PMCID: PMC7294665 DOI: 10.1186/s12890-020-01188-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 05/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Norwegian guideline recommendations on first-line empirical antibiotic prescribing in hospitalised patients with community-acquired pneumonia (CAP) are penicillin G/V in monotherapy, or penicillin G in combination with gentamicin (or cefotaxime) in severely ill patients. The aim of this study was to explore how different empirical antibiotic treatments impact on length of hospital stay (LOS) and 30-day hospital readmission. A secondary aim was to describe median intravenous- and total treatment duration. METHODS We included CAP patients (≥18 years age) hospitalised in North Norway during 2010 and 2012 in a retrospective study. Patients with negative chest x-ray, malignancies or immunosuppression or frequent readmissions were excluded. We collected data on patient characteristics, empirical antibiotic prescribing, treatment duration and clinical outcomes from electronic patient records and the hospital administrative system. We used directed acyclic graphs for statistical model selection, and analysed data with mulitvariable logistic and linear regression. RESULTS We included 651 patients. Median age was 77 years [IQR; 64-84] and 46.5% were female. Median LOS was 4 days [IQR; 3-6], 30-day readmission rate was 14.4% and 30-day mortality rate was 6.9%. Penicillin G/V were empirically prescribed in monotherapy in 51.5% of patients, penicillin G and gentamicin in combination in 22.9% and other antibiotics in 25.6% of patients. Prescribing other antibiotics than penicillin G/V monotherapy was associated with increased risk of readmission [OR 1.9, 95% CI; 1.08-3.42]. Empirical antibiotic prescribing was not associated with LOS. Median intravenous- and total treatment duration was 3.0 [IQR; 2-5] and 11.0 [IQR; 9.8-13] days. CONCLUSIONS Our findings show that empirical prescribing with penicillin G/V in monotherapy in hospitalised non-severe CAP-patients, without complicating factors such as malignancy, immunosuppression and frequent readmission, is associated with lower risk of 30-day readmission compared to other antibiotic treatments. Median total treatment duration exceeds treatment recommendations.
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Affiliation(s)
- June Utnes Høgli
- Regional Centre for Infection Control, University Hospital of North Norway, N-9038, Tromsø, Norway.,Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, N-9037, Tromsø, Norway
| | - Beate Hennie Garcia
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, N-9037, Tromsø, Norway
| | - Kristian Svendsen
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, N-9037, Tromsø, Norway.,Hospital Pharmacy of North Norway Trust, N-9291, Tromsø, Norway
| | - Vegard Skogen
- Department of Infectious Diseases, Division of Internal Medicine, University Hospital of North Norway, N-9038, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, N-9037, Tromsø, Norway.,Infectious Diseases Unit, LaFe University Hospital, Valencia, Spain
| | - Lars Småbrekke
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, N-9037, Tromsø, Norway.
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167
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Cen Y, Chen X, Shen Y, Zhang XH, Lei Y, Xu C, Jiang WR, Xu HT, Chen Y, Zhu J, Zhang LL, Liu YH. Risk factors for disease progression in patients with mild to moderate coronavirus disease 2019-a multi-centre observational study. Clin Microbiol Infect 2020; 26:1242-1247. [PMID: 32526275 PMCID: PMC7280135 DOI: 10.1016/j.cmi.2020.05.041] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 01/08/2023]
Abstract
Objectives Since December 2019, the novel coronavirus disease 2019 (COVID-19) that emerged in Wuhan city has spread rapidly around the world. The risk for poor outcome dramatically increases once a patient progresses to the severe or critical stage. The present study aims to investigate the risk factors for disease progression in individuals with mild to moderate COVID-19. Methods We conducted a cohort study that included 1007 individuals with mild to moderate COVID-19 from three hospitals in Wuhan. Clinical characteristics and baseline laboratory findings were collected. Patients were followed up for 28 days for observation of disease progression. The end point was the progression to a more severe disease stage. Results During a follow up of 28 days, 720 patients (71.50%) had recovered or were symptomatically stable, 222 patients (22.05%) had progressed to severe disease, 22 patients (2.18%) had progressed to the critically ill stage and 43 patients (4.27%) had died. Multivariate Cox proportional hazards models identified that increased age (hazard ratio (HR) 2.56, 95% CI 1.97–3.33), male sex (HR 1.79, 95% CI 1.41–2.28), presence of hypertension (HR 1.44, 95% CI 1.11–1.88), diabetes (HR 1.82, 95% CI 1.35–2.44), chronic obstructive pulmonary disease (HR 2.01, 95% CI 1.38–2.93) and coronary artery disease (HR 1.83, 95% CI 1.26–2.66) were risk factors for disease progression. History of smoking was protective against disease progression (HR 0.56, 95% CI 0.34–0.91). Elevated procalcitonin (HR 1.72, 95% CI 1.02–2.90), urea nitrogen (HR 1.72, 95% CI 1.21–2.43), α-hydroxybutyrate dehydrogenase (HR 3.02, 95% CI 1.26–7.21) and D-dimer (HR 2.01, 95% CI 1.12–3.58) at baseline were also associated with risk for disease progression. Conclusions This study identified a panel of risk factors for disease progression in individuals with mild to moderate COVID-19.
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Affiliation(s)
- Y Cen
- Department of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China; Department of Infectious Disease, Huoshenshan Hospital, Wuhan, China
| | - X Chen
- Department of Anaesthesiology, Daping Hospital, Army Medical University, Chongqing, China; Department of Critical Care Medicine, Huoshenshan Hospital, Wuhan, China
| | - Y Shen
- Department of Respiratory Disease, Daping Hospital, Army Medical University, Chongqing, China
| | - X-H Zhang
- Department of Infectious Disease, Huoshenshan Hospital, Wuhan, China; Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Y Lei
- Department of Infectious Disease, Huoshenshan Hospital, Wuhan, China; Department of Anaesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - C Xu
- Department of Oncology, General Hospital of the Central Theatre Command of the People's Liberation Army, Wuhan, China
| | - W-R Jiang
- Department of Critical Care Medicine, Huoshenshan Hospital, Wuhan, China; Department of Respiratory Disease, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - H-T Xu
- Department of Critical Care Medicine, Huoshenshan Hospital, Wuhan, China; Department of Anaesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Y Chen
- Department of Infectious Disease, Huoshenshan Hospital, Wuhan, China; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Army Medical University, Chongqing, China
| | - J Zhu
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Army Medical University, Chongqing, China
| | - L-L Zhang
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Army Medical University, Chongqing, China.
| | - Y-H Liu
- Department of Critical Care Medicine, Huoshenshan Hospital, Wuhan, China; Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Army Medical University, Chongqing, China.
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168
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Pneumonia risk and its associated factors in Parkinson's disease: A National Database Study. J Neurol Sci 2020; 415:116949. [PMID: 32505011 DOI: 10.1016/j.jns.2020.116949] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite pneumonia being an emerging burden on Parkinson's disease patients, there is essentially nothing known on whether they are at an increased risk of pneumonia occurrence and their associated factors. OBJECTIVES To determine whether Parkinson's disease is associated with the risk of pneumonia and its associated factors. METHODS Using nationwide database that covers the whole population in South Korea from 2002 to 2017, we identified newly diagnosed Parkinson's disease patients in 2004-2006, and selected four age- and sex-matched controls for each patient from the general population. From these patients and controls, we identified pneumonia occurrence until the end of the study period, and plotted Kaplan-Meier curves and Cox proportional hazards model to determine its risk. RESULTS We identified 10,159 Parkinson's disease patients and matched 39,574 controls. These patients showed a higher incidence rate than controls (11.21 vs. 3.61 events/1000 person-years) throughout the study period, and were at an increased risk of pneumonia (hazard ratio = 2.26; 95% CI, 2.17-2.36) even after adjusting for confounders. Old age, male sex, region of residence, diabetes mellitus, congestive heart failure, tuberculosis, atrial fibrillation, chronic kidney disease, cerebrovascular disease, dementia, chronic obstructive pulmonary disease, seizure disorder and antidiabetic drug usage were all associated with a higher risk of pneumonia, while dyslipidemia and antihypertensive medication usage lowered the risk. CONCLUSIONS Parkinson's disease patients may be more likely to experience pneumonia compared to the general population throughout the disease course from diagnosis. Therefore, physicians should focus on the modifiable risk factors of pneumonia in such patients.
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169
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Cillóniz C, Dominedò C, Magdaleno D, Ferrer M, Gabarrús A, Torres A. Pure Viral Sepsis Secondary to Community-Acquired Pneumonia in Adults: Risk and Prognostic Factors. J Infect Dis 2020; 220:1166-1171. [PMID: 31115456 PMCID: PMC7107497 DOI: 10.1093/infdis/jiz257] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/20/2019] [Indexed: 12/13/2022] Open
Abstract
We investigated the risk and prognostic factors of pure viral sepsis in adult patients with community-acquired pneumonia (CAP), using the Sepsis-3 definition. Pure viral sepsis was found in 3% of all patients (138 of 4028) admitted to the emergency department with a diagnosis of CAP, 19% of those with CAP (138 of 722) admitted to the intensive care unit, and 61% of those (138 of 225) with a diagnosis of viral CAP. Our data indicate that males and patients aged ≥65 years are at increased risk of viral sepsis.
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Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Hospital Clinic of Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Spain.,Biomedical Research Networking Centers in Respiratory Diseases, Barcelona, Spain
| | - Cristina Dominedò
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Miquel Ferrer
- Department of Pneumology, Hospital Clinic of Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Spain.,Biomedical Research Networking Centers in Respiratory Diseases, Barcelona, Spain
| | - Albert Gabarrús
- Department of Pneumology, Hospital Clinic of Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Spain.,Biomedical Research Networking Centers in Respiratory Diseases, Barcelona, Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Spain.,Biomedical Research Networking Centers in Respiratory Diseases, Barcelona, Spain
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170
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Lee L, Iyer S, Jose RJ, Manuel A. COVID-19 follow-up planning: what will we be missing? ERJ Open Res 2020; 6:00198-2020. [PMID: 32494576 PMCID: PMC7248349 DOI: 10.1183/23120541.00198-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/29/2020] [Indexed: 01/17/2023] Open
Abstract
Admissions to UK hospitals with novel coronavirus disease (COVID-19) are exponentially increasing, yet the healthcare community has not put much thought into follow-up of these patients who, in many cases, will be discharged early from hospital to ensure ongoing bed availability. There is currently no UK publication or guideline suggesting a criterion for safe discharge or follow-up advice for those testing positive for COVID-19. Severe acute respiratory syndrome (SARS) and viral pneumonia share symptoms and certain radiological findings with COVID-19. In 2003, the World Health Organization (WHO) advised that those with confirmed SARS were to self-isolate for 7 days post-discharge, and to have a chest radiograph and full blood count at day 7 [1], while the British Thoracic Society guidelines for community-acquired pneumonia (CAP) only recommend a chest radiograph at 6 weeks if the patient is still symptomatic or has a risk factor for lung cancer [2]. This therefore raises the question, what should be the optimal follow-up duration and imaging modality for hospital survivors of COVID-19? If no follow-up is deemed necessary, what could we be missing? There is a real need for a discharge plan for COVID-19 survivors in the UK. Follow-up imaging could help assess the resolution of infection, exclude underlying malignancy and identify post-inflammatory fibrosis.https://bit.ly/2YJ8hyg
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Affiliation(s)
- Lydia Lee
- University of Liverpool, Liverpool, UK
| | - Sriram Iyer
- Respiratory and Sleep, Aintree University Hospital, Liverpool, UK
| | | | - Ari Manuel
- Respiratory and Sleep, Aintree University Hospital, Liverpool, UK
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Meta-analysis of proton pump inhibitors induced risk of community-acquired pneumonia. Int J Qual Health Care 2020; 32:292-299. [DOI: 10.1093/intqhc/mzaa041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2020] [Indexed: 01/23/2023] Open
Abstract
Abstract
Purpose
Proton pump inhibitors (PPIs), one of the most widely used medications, are commonly used to suppress several acid-related upper gastrointestinal disorders. Acid-suppressing medication use could be associated with increased risk of community-acquired pneumonia (CAP), although the results of clinical studies have been conflicting.
Data sources
A comprehensive search of MEDLINE, EMBASE and Cochrane library and Database of Systematic Reviews from the earliest available online year of indexing up to October 2018.
Study selection
We performed a systematic review and meta-analysis of observational studies to evaluate the risk of PPI use on CAP outcomes.
Data extraction
Included study location, design, population, the prevalence of CAP, comparison group and other confounders. We calculated pooled odds ratio (OR) using a random-effects meta-analysis.
Results of data synthesis
Of the 2577 studies screening, 11 papers were included in the systematic review and 7 studies with 65 590 CAP cases were included in the random-effects meta-analysis. In current PPI users, pooled OR for CAP was 1.86 (95% confidence interval (CI), 1.30–2.66), and in the case of recent users, OR for CAP was 1.66 (95% CI, 1.22–2.25). In the subgroup analysis of CAP, significance association is also observed in both high-dose and low-dose PPI therapy. When stratified by duration of exposure, 3–6 months PPIs users group was associated with increased risk of developing CAP (OR, 2.05; 95% CI, 1.22–3.45). There was a statistically significant association between the PPI users and the rate of hospitalization (OR, 2.59; 95% CI, 1.83–3.66).
Conclusion
We found possible evidence linking PPI use to an increased risk of CAP. More randomized controlled studies are warranted to clarify an understanding of the association between PPI use and risk of CAP because observational studies cannot clarify whether the observed epidemiologic association is a causal effect or a result of unmeasured/residual confounding.
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Cerda-Mancillas MC, Santiago-Germán D, Andrade-Bravo B, Pedraza-Olivares F, Valenzo-Hernández F, Leaños-Miranda A, Isordia-Salas I. D-dimer as A Biomarker of Severity and Adverse Outcomes in Patients with Community Acquired Pneumonia. Arch Med Res 2020; 51:429-435. [PMID: 32402575 DOI: 10.1016/j.arcmed.2020.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 03/13/2020] [Accepted: 04/21/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) stands as a main cause of hospitalization and mortality worldwide. Because of their limitation scoring systems such as CURB-65 and Pneumonia Severity Index (PSI) may underestimate the severity of the disease. Intravascular and intra-alveolar activation of coagulation factors may lead to fibrin deposition in alveoli and lung interstitium. The clinical utility of D-dimer measurement in patients with CAP is still unclear. The aim of this study was to evaluate the association of D-dimer levels with severity of CAP, need for invasive mechanical ventilation, vasopressor support, and 7 d in-hospital mortality. METHODS Prospective observational study from August 2016-November 2017 in a secondary care level hospital at Mexico City. CURB-65 and PSI scores were calculated on admission. D-dimer levels were measured by a fluorescence immunoassay. RESULTS A total of 61 adult patients with CAP were analyzed and categorized into low or high-risk groups using CURB 65 and PSI score. The average age was 71.6 ± 15 years, predominantly men (52%). Statistically significant higher D-dimer levels, vasopressor support, and mechanical ventilation were observed in high-risk groups. The AUC to predict 7 d in-hospital mortality was 0.93 (p <0.0001) for PSI, 0.853 (p = 0.01) for CURB 65, and 0.789 (p = 0.001) for D-dimer. A D-dimer cut-off point of 2400 mcg/L showed a sensitivity = 1 and a specificity = 0.614, as well as a positive predictive value = 0.154 and a negative predictive value = 1. CONCLUSION D-dimer plasma levels are associated with the severity of CAP. Patients with D-dimer below 2400 mcg/L have low probability of mortality at 7 d after admission to the emergency department.
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Affiliation(s)
- Megan Carolina Cerda-Mancillas
- Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Hospital General Regional, No 1. Dr. Carlos Mac Gregor Sánchez Navarro, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - David Santiago-Germán
- Departamento de Emergencia, Hospital General Regional, No 1. Dr. Carlos Mac Gregor Sánchez Navarro, Instituto Mexicano del Seguro Social, Ciudad de México, México; Departamento de Educación e Investigación en Salud, Unidad Médica de Alta Especialidad, Traumatología, Ortopedia y Rehabilitación, Dr. Victorio de Fuente Narvaez, Instituto Mexicano del Seguro Social, México, México
| | - Berenice Andrade-Bravo
- Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Hospital General Regional, No 1. Dr. Carlos Mac Gregor Sánchez Navarro, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Fredy Pedraza-Olivares
- Departamento de Emergencia, Hospital General Regional, No 1. Dr. Carlos Mac Gregor Sánchez Navarro, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Felipe Valenzo-Hernández
- Departamento de Emergencia, Hospital General Regional, No 1. Dr. Carlos Mac Gregor Sánchez Navarro, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Alfredo Leaños-Miranda
- Unidad de Investigación Médica en Medicina Reproductiva, Hospital Ginecología y Obstetricia 4, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Irma Isordia-Salas
- Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Hospital General Regional, No 1. Dr. Carlos Mac Gregor Sánchez Navarro, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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Hedima EW, Adeyemi MS, Ikunaiye NY. WITHDRAWN: Community pharmacists: On the frontline of health service against COVID-19 in LMICs. Res Social Adm Pharm 2020:S1551-7411(20)30381-8. [PMID: 32340893 PMCID: PMC7167226 DOI: 10.1016/j.sapharm.2020.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/15/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Erick Wesley Hedima
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Gombe State University, Nigeria.
| | | | - Nasiru Yakubu Ikunaiye
- Department of Pharmaceutical Services, University of Maiduguri Teaching Hospital, Maidugri, Nigeria
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174
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Hedima EW, Adeyemi MS, Ikunaiye NY. Community Pharmacists: On the frontline of health service against COVID-19 in LMICs. Res Social Adm Pharm 2020; 17:1964-1966. [PMID: 32317154 PMCID: PMC7162785 DOI: 10.1016/j.sapharm.2020.04.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/12/2020] [Indexed: 12/23/2022]
Abstract
The COVID-19 outbreak is a global public health crisis which has affected healthcare practice across professions. In the context of this pandemic, there is a need to highlight the roles and responsibilities of pharmacists. Community pharmacists are the most accessible healthcare professionals to the general public and have a lot to offer amid the COVID-19 response. This have led to significant changes in the health systems of many countries. This article seeks to highlight additional roles and activities relating to the public health response that can be undertaken by community pharmacists that could help to reduce pressure on general practice and other areas of the health service.
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Affiliation(s)
- Erick Wesley Hedima
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Gombe State University, Nigeria.
| | | | - Nasiru Yakubu Ikunaiye
- Department of Pharmaceutical Services, University of Maiduguri Teaching Hospital, Maidugri, Nigeria
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Corticosteroid Use and Incident Myocardial Infarction in Adults Hospitalized for Community-acquired Pneumonia. Ann Am Thorac Soc 2020; 16:91-98. [PMID: 30188173 DOI: 10.1513/annalsats.201806-419oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE Adults hospitalized for community-acquired pneumonia (CAP) have an increased risk of myocardial infarction. Corticosteroid treatment lowers CAP morbidity and mortality, but it is not known whether it influences in-hospital myocardial infarction. OBJECTIVES The aim of the present study was to investigate the potential interplay between corticosteroid treatment and in-hospital myocardial infarction in adults with CAP. METHODS We retrospectively analyzed adults with CAP referred to the University Hospital Policlinico Umberto I (Rome, Italy), consecutively recruited, and prospectively followed until discharge. The primary outcome was the occurrence of myocardial infarction during hospitalization. We used propensity score-adjusted Cox models to examine the association between corticosteroid use and myocardial infarction. RESULTS Seven hundred fifty-eight patients (493 males, 265 females; mean ± standard deviation age, 71.7 ± 14.4 yr) were included in the study. Of these, 241 (32%) were treated with systemic corticosteroids (methylprednisolone, betamethasone, or prednisone). During follow-up, 62 (8.2%) had a myocardial infarction during their hospitalization (incidence, 0.72 per 100 person-days; 95% confidence interval [CI], 0.55 to 0.92). Those treated with corticosteroids had a lower incidence of myocardial infarction (0.42 per 100 person-days) than those not treated with corticosteroids (0.89 per 100 person-days; absolute rate difference, -0.48 per 100 person-days; 95% CI, -0.85 to -0.10). In a propensity score-adjusted Cox model, corticosteroid use was associated with a lower incidence of myocardial infarction (hazard ratio, 0.46; 95% CI, 0.24 to 0.88; P = 0.02). CONCLUSIONS We found that in-hospital corticosteroid treatment was associated with a lower incidence of myocardial infarction in adults hospitalized with CAP.
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Ferreira-Coimbra J, Sarda C, Rello J. Burden of Community-Acquired Pneumonia and Unmet Clinical Needs. Adv Ther 2020; 37:1302-1318. [PMID: 32072494 PMCID: PMC7140754 DOI: 10.1007/s12325-020-01248-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Indexed: 12/26/2022]
Abstract
Community-acquired pneumonia (CAP) is the leading cause of death among infectious diseases and an important health problem, having considerable implications for healthcare systems worldwide. Despite important advances in prevention through vaccines, new rapid diagnostic tests and antibiotics, CAP management still has significant drawbacks. Mortality remains very high in severely ill patients presenting with respiratory failure or shock but is also high in the elderly. Even after a CAP episode, higher risk of death remains during a long period, a risk mainly driven by inflammation and patient-related co-morbidities. CAP microbiology has been altered by new molecular diagnostic tests that have turned viruses into the most identified pathogens, notwithstanding uncertainties about the specific role of each virus in CAP pathogenesis. Pneumococcal vaccines also impacted CAP etiology and thus had changed Streptococcus pneumoniae circulating serotypes. Pathogens from specific regions should also be kept in mind when treating CAP. New antibiotics for CAP treatment were not tested in severely ill patients and focused on multidrug-resistant pathogens that are unrelated to CAP, limiting their general use and indications for intensive care unit (ICU) patients. Similarly, CAP management could be personalized through the use of adjunctive therapies that showed outcome improvements in particular patient groups. Although pneumococcal vaccination was only convincingly shown to reduce invasive pneumococcal disease, with a less significant effect in pneumococcal CAP, it remains the best therapeutic intervention to prevent bacterial CAP. Further research in CAP is needed to reduce its population impact and improve individual outcomes.
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Affiliation(s)
- João Ferreira-Coimbra
- Internal Medicine Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Cristina Sarda
- Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jordi Rello
- Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institute of Research, Barcelona, Spain
- CIBERES-Centro de investigación en red de enfermedades respiratorias, Madrid, Spain
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Espinosa J, Alvarez PA, Castro V, Caceres MF, Soler-Riera MC, Bril F. Central Nervous System Depressants and Risk of Hospitalization due to Community-Acquired Pneumonia in very Old Patients. Curr Drug Saf 2020; 15:131-136. [PMID: 32189596 DOI: 10.2174/1574886315666200319110114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/18/2020] [Accepted: 02/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Central Nervous System (CNS) depressants like antipsychotics, opioids, benzodiazepines and zolpidem are frequently used by patients of a wide range of ages. Uncertainty remains about their effect in very old adults (>80 years old) and their potential for pharmacodynamic and pharmacokinetic drug-drug interactions in this population. OBJECTIVE To assess if the use of CNS depressants is associated with a higher risk of hospitalization due to community-acquired pneumonia (CAP) in very old patients. METHODS In this prospective study, 362 patients over 80 years of age who had been consequently admitted to the general ward of a teaching hospital were examined. Each patient was assessed, by our pharmacovigilance team within 24 hours of admission, to identify outpatient medication use and potential drug-drug interactions. RESULTS The overall use of CNS depressants as a group was not associated with a higher risk of admission due to CAP in very old patients (55% vs. 49%; OR=1.28 [0.76-2.16], p=0.34). However, the use of antipsychotics was associated with a higher rate of admissions due to CAP in this population (OR=1.98 [1.10-3.57], p=0.02). No association was seen between opioids (p=0.27), zolpidem (p=0.83), or benzodiazepines (p=0.15) and the rate of admissions due to CAP in these patients. Moreover, pharmacodynamic or pharmacokinetic interactions leading to CNS depression were equally found in patients admitted for CAP and those admitted for other reasons. CONCLUSION The use of antipsychotics in very old adults was associated with an increased risk of hospital admission due to CAP. This suggests that the use of these medications in this population should be done with caution. No association was observed with opioids, benzodiazepines and zolpidem with the latter outcome.
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Affiliation(s)
- Jeronimo Espinosa
- Department of Medicine, Centro de Educación Médica e Investigacion Clínica (CEMIC) "Norberto Quirno", Buenos Aires, Argentina
| | - Paulino A Alvarez
- Department of Medicine, Centro de Educación Médica e Investigacion Clínica (CEMIC) "Norberto Quirno", Buenos Aires, Argentina.,Department of Internal Medicine and Cardiovascular Medicine, University of Iowa Hospital and Clinics, Iowa City, IA 52242, United States
| | - Veronica Castro
- Department of Pharmacy, Centro de Educacion Medica e Investigacion Clinica (CEMIC) "Norberto Quirno", Buenos Aires, Argentina
| | - Maria F Caceres
- Department of Medicine, Centro de Educación Médica e Investigacion Clínica (CEMIC) "Norberto Quirno", Buenos Aires, Argentina
| | - Maria C Soler-Riera
- Department of Medicine, Centro de Educación Médica e Investigacion Clínica (CEMIC) "Norberto Quirno", Buenos Aires, Argentina
| | - Fernando Bril
- Department of Medicine, Centro de Educación Médica e Investigacion Clínica (CEMIC) "Norberto Quirno", Buenos Aires, Argentina.,Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL 32611, United States
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178
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Hoyer N, Thomsen LH, Wille MMW, Wilcke T, Dirksen A, Pedersen JH, Saghir Z, Ashraf H, Shaker SB. Increased respiratory morbidity in individuals with interstitial lung abnormalities. BMC Pulm Med 2020; 20:67. [PMID: 32188453 PMCID: PMC7081690 DOI: 10.1186/s12890-020-1107-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/03/2020] [Indexed: 01/26/2023] Open
Abstract
Background Interstitial lung abnormalities (ILA) are common in participants of lung cancer screening trials and broad population-based cohorts. They are associated with increased mortality, but less is known about disease specific morbidity and healthcare utilisation in individuals with ILA. Methods We included all participants from the screening arm of the Danish Lung Cancer Screening Trial with available baseline CT scan data (n = 1990) in this cohort study. The baseline scan was scored for the presence of ILA and patients were followed for up to 12 years. Data about all hospital admissions, primary healthcare visits and medicine prescriptions were collected from the Danish National Health Registries and used to determine the participants’ disease specific morbidity and healthcare utilisation using Cox proportional hazards models. Results The 332 (16.7%) participants with ILA were more likely to be diagnosed with one of several respiratory diseases, including interstitial lung disease (HR: 4.9, 95% CI: 1.8–13.3, p = 0.008), COPD (HR: 1.7, 95% CI: 1.2–2.3, p = 0.01), pneumonia (HR: 2.0, 95% CI: 1.4–2.7, p < 0.001), lung cancer (HR: 2.7, 95% CI: 1.8–4.0, p < 0.001) and respiratory failure (HR: 1.8, 95% CI: 1.1–3.0, p = 0.03) compared with participants without ILA. These findings were confirmed by increased hospital admission rates with these diagnoses and more frequent prescriptions for inhalation medicine and antibiotics in participants with ILA. Conclusions Individuals with ILA are more likely to receive a diagnosis and treatment for several respiratory diseases, including interstitial lung disease, COPD, pneumonia, lung cancer and respiratory failure during long-term follow-up.
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Affiliation(s)
- Nils Hoyer
- Department of Respiratory Medicine, Herlev and Gentofte Hospital, Kildegårdsvej 28, 2900 Hellerup, Copenhagen, Denmark.
| | - Laura H Thomsen
- Department of Respiratory Medicine, Amager and Hvidovre Hospital, Copenhagen, Denmark
| | | | - Torgny Wilcke
- Department of Respiratory Medicine, Herlev and Gentofte Hospital, Kildegårdsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | - Asger Dirksen
- Department of Respiratory Medicine, Herlev and Gentofte Hospital, Kildegårdsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | - Jesper H Pedersen
- Department of Cardiothoracic Surgery RT, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Zaigham Saghir
- Department of Respiratory Medicine, Herlev and Gentofte Hospital, Kildegårdsvej 28, 2900 Hellerup, Copenhagen, Denmark
| | - Haseem Ashraf
- Department of Radiology, Akershus University Hospital, Loerenskog, Norway.,Division of Medicine and Laboratory Sciences, University of Oslo, Oslo, Norway
| | - Saher B Shaker
- Department of Respiratory Medicine, Herlev and Gentofte Hospital, Kildegårdsvej 28, 2900 Hellerup, Copenhagen, Denmark
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Critical Parameters for the Development of Novel Therapies for Severe and Resistant Infections-A Case Study on CAL02, a Non-Traditional Broad-Spectrum Anti-Virulence Drug. Antibiotics (Basel) 2020; 9:antibiotics9020094. [PMID: 32098274 PMCID: PMC7168140 DOI: 10.3390/antibiotics9020094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/16/2020] [Accepted: 02/16/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Poor outcomes in severe and resistant infections, together with the economic struggles of companies active in the field of anti-infective development, call for new solutions and front runners with novel approaches. Among “non-traditional” approaches, blocking virulence could be a game changer. Objectives: This review offers a perspective on parameters that have determined the development path of CAL02, a novel anti-virulence agent, with a view to steering clear of the obstacles and limitations that impede market sustainability for new anti-infective drugs. Conclusions and implications of key findings: This case study highlights four pillars that may support the development of other non-traditional drugs and, concurrently, provide a new model that could reshape the field. Therapeutic triggers, study designs, and economic parameters are discussed.
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Cillóniz C, Dominedò C, Pericàs JM, Rodriguez-Hurtado D, Torres A. Community-acquired pneumonia in critically ill very old patients: a growing problem. Eur Respir Rev 2020; 29:29/155/190126. [PMID: 32075858 PMCID: PMC9488936 DOI: 10.1183/16000617.0126-2019] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022] Open
Abstract
Very old (aged ≥80 years) adults constitute an increasing proportion of the global population. Currently, this subgroup of patients represents an important percentage of patients admitted to the intensive care unit. Community-acquired pneumonia (CAP) frequently affects very old adults. However, there are no specific recommendations for the management of critically ill very old CAP patients. Multiple morbidities, polypharmacy, immunosenescence and frailty contribute to an increased risk of pneumonia in this population. CAP in critically ill very old patients is associated with higher short- and long-term mortality; however, because of its uncommon presentation, diagnosis can be very difficult. Management of critically ill very old CAP patients should be guided by their baseline characteristics, clinical presentation and risk factors for multidrug-resistant pathogens. Hospitalisation in intermediate care may be a good option for critical ill very old CAP patients who do not require invasive procedures and for whom intensive care is questionable in terms of benefit. There is currently no international recommendation for the management of critically ill older patients over 80 years of age with CAP. We report and discuss recent literature in order to help physicians in the decision-making process of these patients.http://bit.ly/2ql0mIz
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Affiliation(s)
- Catia Cillóniz
- Dept of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Cristina Dominedò
- Dept of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Juan M Pericàs
- Clinical Direction of Infectious Diseases and Microbiology, Hospital Universitari Arnau de Vilanova-Hospital Universitari Santa Maria, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Diana Rodriguez-Hurtado
- Dept of Medicine, National Hospital "Arzobispo Loayza", Peruvian University "Cayetano Heredia", Lima, Perú
| | - Antoni Torres
- Dept of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
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181
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Estimating the Risk of Pneumonia in Patients With Schizophrenia Newly Receiving Clozapine: A Nationwide Cohort Study. J Clin Psychopharmacol 2020; 39:297-304. [PMID: 31188233 DOI: 10.1097/jcp.0000000000001052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE/BACKGROUND Patients with schizophrenia are vulnerable to pneumonia. Clozapine is associated with the greatest risk of pneumonia. We investigated the risk factors of pneumonia in patients with schizophrenia who use clozapine. METHODS/PROCEDURES We used a large cohort of patients with schizophrenia (N = 22,774) who newly use clozapine (baseline). We divided the data set into a training cohort (entry between 1998 and 2008, n = 18,496) and test cohort (entry between 2009 and 2012, n = 4278), where 483 and 168 patients developed pneumonia requiring hospitalization within 1 year after baseline, respectively. For prediction, we developed a static model using Cox proportional hazards regression and a dynamic model using Cox regression with time-dependent modeling. Areas under receiver operating curves (AUCs) for the predictive model were estimated in the training cohort and then in the test cohort for validation. FINDINGS/RESULTS Based on the baseline characteristics, the static model for predicting pneumonia in 3 periods (90, 180, and 365 days) was unsatisfactory (AUCs, 0.64, 0.64, and 0.65, respectively). The predictors were older age, male sex, history of nonpsychiatric hospitalization, dementia, asthma, and tuberculosis within 1 year before baseline. However, the results were improved (AUCs, 0.83, 0.79, and 0.77, respectively) after control for time-dependent variables, namely, duration of clozapine use and concomitant medications (ie, benzodiazepines, valproic acid, systemic corticosteroids). IMPLICATIONS/CONCLUSIONS Several risk factors for predicting subsequent pneumonia after initial use of clozapine were explored, including older age, male, history of nonpsychiatric hospitalization, dementia, asthma, tuberculosis, benzodiazepines, valproic acid, systemic corticosteroids, and the use duration of clozapine. Clinical staff can use the risk factors to administer evidence-based treatment.
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182
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Giraudo C, Evangelista L, Fraia AS, Lupi A, Quaia E, Cecchin D, Casali M. Molecular Imaging of Pulmonary Inflammation and Infection. Int J Mol Sci 2020; 21:ijms21030894. [PMID: 32019142 PMCID: PMC7037834 DOI: 10.3390/ijms21030894] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/14/2022] Open
Abstract
Infectious and inflammatory pulmonary diseases are a leading cause of morbidity and mortality worldwide. Although infrequently used in this setting, molecular imaging may significantly contribute to their diagnosis using techniques like single photon emission tomography (SPET), positron emission tomography (PET) with computed tomography (CT) or magnetic resonance imaging (MRI) with the support of specific or unspecific radiopharmaceutical agents. 18F-Fluorodeoxyglucose (18F-FDG), mostly applied in oncological imaging, can also detect cells actively involved in infectious and inflammatory conditions, even if with a low specificity. SPET with nonspecific (e.g., 67Gallium-citrate (67Ga citrate)) and specific tracers (e.g., white blood cells radiolabeled with 111Indium-oxine (111In) or 99mTechnetium (99mTc)) showed interesting results for many inflammatory lung diseases. However, 67Ga citrate is unfavorable by a radioprotection point of view while radiolabeled white blood cells scan implies complex laboratory settings and labeling procedures. Radiolabeled antibiotics (e.g., ciprofloxacin) have been recently tested, although they seem to be quite unspecific and cause antibiotic resistance. New radiolabeled agents like antimicrobic peptides, binding to bacterial cell membranes, seem very promising. Thus, the aim of this narrative review is to provide a comprehensive overview about techniques, including PET/MRI, and tracers that can guide the clinicians in the appropriate diagnostic pathway of infectious and inflammatory pulmonary diseases.
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Affiliation(s)
- Chiara Giraudo
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
- Correspondence: ; Tel.: +39-049-821-2357; Fax: +39-049-821-1878
| | - Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (L.E.); (D.C.)
| | - Anna Sara Fraia
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
| | - Amalia Lupi
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
| | - Emilio Quaia
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (L.E.); (D.C.)
- Padova Neuroscience Center (PNC), University of Padova, 35131 Padova, Italy
| | - Massimiliano Casali
- Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, 42121 Reggio Emilia, Italy;
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Croft DP, Zhang W, Lin S, Thurston SW, Hopke PK, van Wijngaarden E, Squizzato S, Masiol M, Utell MJ, Rich DQ. Associations between Source-Specific Particulate Matter and Respiratory Infections in New York State Adults. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:975-984. [PMID: 31755707 PMCID: PMC6978840 DOI: 10.1021/acs.est.9b04295] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 05/22/2023]
Abstract
The response of respiratory infections to source-specific particulate matter (PM) is an area of active research. Using source-specific PM2.5 concentrations at six urban sites in New York State, a case-crossover design, and conditional logistic regression, we examined the association between source-specific PM and the rate of hospitalizations and emergency department (ED) visits for influenza or culture-negative pneumonia from 2005 to 2016. There were at most N = 14 764 influenza hospitalizations, N = 57 522 influenza ED visits, N = 274 226 culture-negative pneumonia hospitalizations, and N = 113 997 culture-negative pneumonia ED visits included in our analyses. We separately estimated the rate of respiratory infection associated with increased concentrations of source-specific PM2.5, including secondary sulfate (SS), secondary nitrate (SN), biomass burning (BB), pyrolyzed organic carbon (OP), road dust (RD), residual oil (RO), diesel (DIE), and spark ignition vehicle emissions (GAS). Increased rates of ED visits for influenza were associated with interquartile range increases in concentrations of GAS (excess rate [ER] = 9.2%; 95% CI: 4.3%, 14.3%) and DIE (ER = 3.9%; 95% CI: 1.1%, 6.8%) for lag days 0-3. There were similar associations between BB, SS, OP, and RO, and ED visits or hospitalizations for influenza, but not culture-negative pneumonia hospitalizations or ED visits. Short-term increases in PM2.5 from traffic and other combustion sources appear to be a potential risk factor for increased rates of influenza hospitalizations and ED visits.
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Affiliation(s)
- Daniel P. Croft
- Department
of Medicine, Department of Biostatistics and Computational Biology, Department of Public
Health Sciences, and Department of Environmental Medicine, University
of Rochester Medical Center, Rochester, New York 14642, United States
- E-mail: . Phone: 585 275 4161. Fax: 585 271 1171
| | - Wangjian Zhang
- Department
of Environmental Health Sciences, University at Albany, The State University of New York, Rensselaer, New York 12203, United States
| | - Shao Lin
- Department
of Environmental Health Sciences, University at Albany, The State University of New York, Rensselaer, New York 12203, United States
| | - Sally W. Thurston
- Department
of Medicine, Department of Biostatistics and Computational Biology, Department of Public
Health Sciences, and Department of Environmental Medicine, University
of Rochester Medical Center, Rochester, New York 14642, United States
| | - Philip K. Hopke
- Department
of Medicine, Department of Biostatistics and Computational Biology, Department of Public
Health Sciences, and Department of Environmental Medicine, University
of Rochester Medical Center, Rochester, New York 14642, United States
- Center for
Air Resources Engineering and Science, Clarkson
University, Potsdam, New York 13699, United States
| | - Edwin van Wijngaarden
- Department
of Medicine, Department of Biostatistics and Computational Biology, Department of Public
Health Sciences, and Department of Environmental Medicine, University
of Rochester Medical Center, Rochester, New York 14642, United States
| | - Stefania Squizzato
- Department
of Medicine, Department of Biostatistics and Computational Biology, Department of Public
Health Sciences, and Department of Environmental Medicine, University
of Rochester Medical Center, Rochester, New York 14642, United States
| | - Mauro Masiol
- Department
of Medicine, Department of Biostatistics and Computational Biology, Department of Public
Health Sciences, and Department of Environmental Medicine, University
of Rochester Medical Center, Rochester, New York 14642, United States
| | - Mark J. Utell
- Department
of Medicine, Department of Biostatistics and Computational Biology, Department of Public
Health Sciences, and Department of Environmental Medicine, University
of Rochester Medical Center, Rochester, New York 14642, United States
| | - David Q. Rich
- Department
of Medicine, Department of Biostatistics and Computational Biology, Department of Public
Health Sciences, and Department of Environmental Medicine, University
of Rochester Medical Center, Rochester, New York 14642, United States
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184
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Factors associated with in-hospital mortality from community-acquired pneumonia in Portugal: 2000-2014. BMC Pulm Med 2020; 20:18. [PMID: 31964385 PMCID: PMC6974967 DOI: 10.1186/s12890-019-1045-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/30/2019] [Indexed: 11/22/2022] Open
Abstract
Background Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality worldwide, often leading to hospital admissions. In Portugal, the factors associated with in-hospital mortality due to CAP are not fully documented. The aim of this study was to characterize the trends of CAP hospitalization in all age groups and the factors associated with their mortality between 2000 and 2014. Methods We conducted a cross-sectional study using CAP hospitalization data in all age groups, in Portugal Mainland. Logistic regression was used to identify the factors associated with in-hospital mortality. Results Between 2001 and 2011, CAP hospitalization rate increased from 2.8 to 4.3 per 1000 population. Hospitalization rates were higher in the extreme ages ( ≤ 4 and ≥ 75 years). However, a decrease in the hospitalization rate and its mortality was observed, in the younger ages. A total of 548,699 hospitalization CAP episodes, between 2000 and 2014, were analyzed, with male (56.2%) and elderly ≥65 years (91.7%) predominance, resulting in 101,740 deaths (18.5%). Men had a significantly lower mean age (64.3 ± 26.4 years versus 67.9 ± 27.5 years; p < 0.001). During the studied 15 years, there was an increase of 45.2% in the number of annual hospitalizations, concomitant with the admission increase of individuals aged over 75 years. Since 2012 a decrease in hospitalizations and associated deaths were detected. The increase in age represented a progressive and significant rise in the probability of death, except for the age group 1–4 years. The age group ≥85 years old (Adjusted OR = 124.256; 95%CI: 97.838–157.807) and males (Adjusted OR = 1.261; 95%CI: 1.243–1.280) were significantly associated with death risk for CAP hospitalization. After 2010, this risk decreased (Adjusted OR = 0.961; 95%CI: 0.940–0.982). The main factors affecting mortality were age, sex, unemployment rate, number of performed procedures and admission quinquennia. Conclusions Despite a trend of decrease in CAP hospitalizations and associated death since 2012, the numbers of in-hospital mortality showed, in the 15 years under analysis, an overall increase over time, mainly associated with age, in particular very old people ( ≥ 75 years), males and a higher parish unemployment rate. Therefore, the implementation of CAP preventive measures should be reinforced in these vulnerable groups.
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185
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Iqbal N, Irfan M, Siddique F, Arshad V, Zubairi ABS. Factors predicting in-hospital mortality among patients admitted with community acquired pneumonia at a tertiary care hospital Karachi, Pakistan. CLINICAL RESPIRATORY JOURNAL 2020; 14:328-334. [PMID: 31863551 DOI: 10.1111/crj.13137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/13/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Community Acquired Pneumonia (CAP) is associated with significant morbidity and mortality globally, but unfortunately there is limited data available from South East Asia. OBJECTIVE To determine the risk factors associated with in-hospital mortality in patients with CAP in a tertiary care hospital of Pakistan. METHODS A retrospective study was conducted on adult patients admitted with a diagnosis of CAP from January 2011 till December 2016. Their clinical records were reviewed and a multivariable analysis was done to determine the factors associated with in-hospital mortality. RESULTS A total of 1100 files were reviewed, of which 509 were included in the analysis. The mean age was 63.6 ± 16.5 years and 302 (52.16%) were males. The most Common isolated pathogen was Staphylococcus aureus (23%). Overall mortality was 10.8%. On univariate analysis factors associated with mortality were old age patients (P = 0.02); history of pneumonia in last 12 months (P = 0.008); CURB 65 score ≥ 3 (P < 0.001) and high dependency units as initial site of care (P < 0.001). On multivariable analysis CURB65 ≥ 3 score; high dependency unit as initial site of care; bedridden status; presence of bilateral infiltrates on chest X-ray and hemoglobin of 10.4 g/dL or less at the time of admission were key determinants of in-hospital mortality. CONCLUSION We found CURB65 ≥ 3 score; high dependency unit as initial site of care; bedridden status; bilateral infiltrates on chest X-ray and low hemoglobin (10.4 g/dL or less) at the time of admission as independent risk factors of in-hospital mortality. Staphylococcus aureus was the most common organism isolated in patients.
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Affiliation(s)
- Nousheen Iqbal
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.,Department of Medicine, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Muhammad Irfan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Faraz Siddique
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Ali Bin Sarwar Zubairi
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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186
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Poole S, Clark TW. Rapid syndromic molecular testing in pneumonia: The current landscape and future potential. J Infect 2020; 80:1-7. [PMID: 31809764 PMCID: PMC7132381 DOI: 10.1016/j.jinf.2019.11.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/27/2019] [Accepted: 11/29/2019] [Indexed: 12/18/2022]
Abstract
Community acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and ventilator associated pneumonia (VAP) are all associated with significant mortality and cause huge expense to health care services around the world. Early, appropriate antimicrobial therapy is crucial for effective treatment. Syndromic diagnostic testing using novel, rapid multiplexed molecular platforms represents a new opportunity for rapidly targeted antimicrobial therapy to improve patient outcomes and facilitate antibiotic stewardship. In this article we review the currently available testing platforms and discuss the potential benefits and pitfalls of rapid testing in pneumonia.
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Affiliation(s)
- Stephen Poole
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust Southampton, United Kingdom.
| | - Tristan W Clark
- School of Clinical and Experimental Sciences, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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187
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Gee S, Gaughran F, MacCabe J, Shergill S, Whiskey E, Taylor D. Management of clozapine treatment during the COVID-19 pandemic. Ther Adv Psychopharmacol 2020; 10:2045125320928167. [PMID: 32542111 PMCID: PMC7256815 DOI: 10.1177/2045125320928167] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 01/08/2023] Open
Abstract
Clozapine is the only available treatment for refractory schizophrenia but its use involves frequent physical contact with healthcare workers for the purpose of mandatory blood monitoring. During the COVID-19 pandemic, patients taking clozapine will be self-isolating to reduce the risk of infection, not least because these patients are at high risk of serious illness and fatality because of high rates of diabetes, obesity and pulmonary disease and an increased risk of pneumonia. Problems may also arise because both clozapine-induced myocarditis and neutropenic sepsis share signs and symptoms with COVID-19 (fever, chest pain, dyspnoea, etc.). We recommend decreasing the frequency of physical contacts by extending the blood monitoring interval to 12 weeks in those patients taking clozapine for more than 1 year. To distinguish COVID-19 from clozapine-related physical adverse effects, we suggest an urgent antigen test alongside a full blood count. In those taking clozapine who develop COVID-19, we suggest continuing with clozapine whenever possible (even during ventilation), reducing the dose if necessary in line with blood assay results. Blood monitoring should continue but clozapine should only cease if there is a significant fall in neutrophils (COVID-19 is linked to lymphopenia but not neutropenia). To protect against the likelihood and severity of respiratory infection, we recommend the use of vitamin D in all clozapine patients. Initiation of clozapine is likely to remain problematic while the risk of infection remains, given the degree of physical contact required to assure safety.
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Affiliation(s)
- Siobhan Gee
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Fiona Gaughran
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - James MacCabe
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Sukhi Shergill
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Eromona Whiskey
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - David Taylor
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London SE5 8AZ, UK
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188
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Seo YB, Moon SJ, Jeon CH, Song JY, Sung YK, Jeong SJ, Kwon KT, Kim ES, Kim JH, Kim HA, Park DJ, Park SH, Park JK, Ahn JK, Oh JS, Yun JW, Lee JH, Lee HY, Choi MJ, Choi WS, Choi YH, Choi JH, Heo JY, Cheong HJ, Lee SS. The Practice Guideline for Vaccinating Korean Patients with Autoimmune Inflammatory Rheumatic Disease. Infect Chemother 2020; 52:252-280. [PMID: 32618150 PMCID: PMC7335656 DOI: 10.3947/ic.2020.52.2.252] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 01/03/2023] Open
Abstract
To develop a clinical practice guideline for vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), the Korean College of Rheumatology and the Korean Society of Infectious Diseases developed a clinical practice guideline according to the clinical practice guideline development manual. Since vaccination is unlikely to cause AIIRD or worsen disease activities, required vaccinations are recommended. Once patients are diagnosed with AIIRD, treatment strategies should be established and, at the same time, monitor their vaccination history. It is recommended to administer vaccines when the disease enters the stabilized stage. Administering live attenuated vaccines in patients with AIIRD who are taking immunosuppressants should be avoided. Vaccination should be considered in patients with AIIRD, prior to initiating immunosuppressants. It is recommended to administer influenza, Streptococcus pneumoniae, hepatitis A, hepatitis B, herpes zoster, measles-mumps-rubella virus, human papillomavirus, and tetanus-diphtheria-pertussis vaccines in patients with AIIRD; such patients who planned to travel are generally recommended to be vaccinated at the recommended vaccine level of healthy adults. Those who live in a household with patients with AIIRD and their caregivers should also be vaccinated at levels that are generally recommended for healthy adults.
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Affiliation(s)
- Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Su Jin Moon
- Division of Rheumatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Chan Hong Jeon
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Guro Hospital, Seoul, Korea
| | - Yoon Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Eu Suk Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hoon Kim
- Department of Rheumatology, Korea University Guro Hospital, Seoul, Korea
| | - Hyoun Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Dong Jin Park
- Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Sung Hoon Park
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin Kyun Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joong Kyong Ahn
- Division of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Seon Oh
- Department of Information Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Won Yun
- Division of Infectious Disease Control, Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Joo Hyun Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inje University Ilsan Paik Hospital, Ilsan, Korea
| | - Hee Young Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Joo Choi
- Division of Infectious Disease, Department of Internal Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Ansan Hospital, Ansan, Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Jung Hyun Choi
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Korea
| | - Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Guro Hospital, Seoul, Korea.
| | - Shin Seok Lee
- Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Korea.
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189
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Butler M, Bano F, Calcia M, McMullen I, Sin Fai Lam CC, Smith LJ, Taylor D, Gee S. Clozapine prescribing in COVID-19 positive medical inpatients: a case series. Ther Adv Psychopharmacol 2020; 10:2045125320959560. [PMID: 32974002 PMCID: PMC7493264 DOI: 10.1177/2045125320959560] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/21/2020] [Indexed: 01/15/2023] Open
Abstract
There is both uncertainty regarding the safety of clozapine in COVID-19 patients owing to limited published data and a lack of consensus on continuing clozapine in patients with severe respiratory infections. COVID-19 is known to induce an acute immune response which can affect haematological parameters associated with clozapine monitoring, and systemic infection may reduce clozapine clearance. Clozapine, which has been associated with worse outcomes in some pneumonias, may in theory worsen outcomes in COVID-19. Despite these concerns, there are some data to indicate it is safe to continue clozapine in COVID-19 infection. In this retrospective case series, we describe our experiences of clozapine prescribing and disease progression of eight SARS-CoV-2 positive patients on medical wards in a major London teaching hospital. In four cases clozapine was stopped during the hospital admission. A COVID-19 pneumonia developed in four patients: three of these required intensive care unit admission for an average of 34 days. At the time of writing, three patients had died (two directly from COVID-19 pneumonia), two remained in general hospital wards, two were recovering in the community and one had been transferred to an inpatient psychiatric hospital. Follow-up length varied but in each case was not more than 104 days. Delirium was the most common adverse neuropsychiatric event, and in one case a relapse of psychosis occurred after cessation of clozapine. This retrospective case series illustrates the safe use of clozapine during COVID-19 infection. Our experiences suggest that consideration should be made to continuing clozapine even in those most unwell with COVID-19. We also identify areas which require larger scale hypothesis-testing research.
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Affiliation(s)
- Matthew Butler
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, SE5 8AF, UK and South London and Maudsley NHS Foundation Trust, London, UK
| | - Felicity Bano
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Marilia Calcia
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | | | | | | | - David Taylor
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Siobhan Gee
- South London and Maudsley NHS Foundation Trust, London, UK
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190
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Violi F, Calvieri C, Cangemi R. Effect of corticosteroids on myocardial injury among patients hospitalized for community-acquired pneumonia: rationale and study design. The colosseum trial. Intern Emerg Med 2020; 15:79-86. [PMID: 31152308 PMCID: PMC7223724 DOI: 10.1007/s11739-019-02117-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/24/2019] [Indexed: 02/08/2023]
Abstract
Community-acquired pneumonia (CAP) is often complicated by elevation of cardiac troponin, a marker of myocardial injury that can be isolated or associated with myocardial infarction (MI). A retrospective study showed that corticosteroid treatment lowers the incidence of MI during the hospital stay. No data exist so far on the effect of corticosteroids on myocardial injury in CAP patients. The primary objective of the study is to evaluate if methylprednisolone is able to reduce myocardial injury, as assessed by serum high-sensitivity cardiac T Troponin (hs-cTnT), in a cohort of patients hospitalized for CAP. Secondary aims are to evaluate the potential effect of methylprednisolone on cardiovascular events during hospitalization, at 30 days from hospital admission and during 2 years' follow-up. The trial will also examine whether the potential protective effects of methylprednisolone might be due to platelet activation down-regulation. Double-blind randomized placebo-controlled trial. One hundred twenty-two eligible patients will be randomized to a week treatment with iv methylprednisolone (20 mg b.i.d) or placebo from hospital admission. Serum hs-cTnT will be measured at admission and every day until up 3 days from admission. ECG will be monitored every day until discharge. After discharge, all patients will be followed-up 2 years. This is the first clinical trial aimed at examining whether methylprednisolone treatment may reduce myocardial injury. The results of this trial may constitute the basis for conducting a larger multicenter trial aimed to evaluate the effect of corticosteroid on cardiovascular events in this setting.
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Affiliation(s)
- Francesco Violi
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Camilla Calvieri
- Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, La Sapienza University, Rome, Italy
| | - Roberto Cangemi
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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191
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Hasegawa S, Sada R, Yaegashi M, Morimoto K, Mori T. 1g versus 2 g daily intravenous ceftriaxone in the treatment of community onset pneumonia - a propensity score analysis of data from a Japanese multicenter registry. BMC Infect Dis 2019; 19:1079. [PMID: 31878894 PMCID: PMC6933656 DOI: 10.1186/s12879-019-4552-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community-onset pneumonia (COP) is a combined concept of community acquired pneumonia and the previous classification of healthcare-associated pneumonia. Although ceftriaxone (CRO) is one of the treatment choices for COP, it is unclear whether 1 or 2 g CRO daily has better efficacy. We compared the effectiveness of 1 g with 2 g of CRO for COP treatment. We hypothesized that 1 g CRO would show non-inferiority over 2 g CRO. METHODS This study was an analysis of prospectively registered data of the patients with COP from four Japanese hospitals (the Adult Pneumonia Study Group-Japan: APSG-J). We included subjects who were initially treated solely with 1 or 2 g of CRO. The propensity score was estimated from the 33 pre-treatment variables, including age, sex, weight, pre-existing comorbidities, prescribed drugs, risk factors for aspiration pneumonia, vital signs, laboratory data, and a finding from chest xrays. The primary endpoint was the cure rate, for which a non-inferiority analysis was performed with a margin of 0.05. In addition, we performed three sensitivity analyses; using data limited to the group in which CRO solely was used until the completion of treatment, using data limited to inpatient cases, and performing a generalized linear mixed-effect logistic regression analysis to assess the primary outcome after adjusting for random hospital effects. RESULTS Of the 3817 adult subjects with pneumonia who were registered in the APSG-J study, 290 and 216 were initially treated solely with 1 or 2 g of CRO, respectively. Propensity score matching was used to extract 175 subjects in each group. The cure rate was 94.6 and 93.1% in the 1 and 2 g CRO groups, respectively (risk difference 1.5%; 95% confidence interval - 3.1 to 6.0; p = 0.009 for non-inferiority). The results of the sensitivity analyses were consistent with the primary result. CONCLUSIONS The propensity score-matched analysis of multicenter cohort data from Japan revealed that the cure rate for COP patients treated with 1 g daily CRO was non-inferior to that of patients treated with 2 g daily CRO.
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Affiliation(s)
- Shinya Hasegawa
- Department of Infectious Disease, Tokyo Metro Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524 Japan
- Department of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602 Japan
| | - Ryuichi Sada
- Department of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602 Japan
- Department of General Internal Medicine, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552 Japan
| | - Makito Yaegashi
- Department of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602 Japan
| | - Konosuke Morimoto
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, 1-14 Bunkyo-cho, Nagasaki, Nagasaki 852-8521 Japan
| | - Takahiro Mori
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575 Japan
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575 Japan
- Department of General Internal Medicine, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba, 283-8686 Japan
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192
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Ecarnot F, Crepaldi G, Juvin P, Grabenstein J, Del Giudice G, Tan L, O'Dwyer S, Esposito S, Bosch X, Gavazzi G, Papastergiou J, Gaillat J, Johnson R, Fonzo M, Rossanese A, Suitner C, Barratt J, di Pasquale A, Maggi S, Michel JP. Pharmacy-based interventions to increase vaccine uptake: report of a multidisciplinary stakeholders meeting. BMC Public Health 2019; 19:1698. [PMID: 31852470 PMCID: PMC6921486 DOI: 10.1186/s12889-019-8044-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 12/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the existence of efficacious vaccines, the burden of vaccine-preventable diseases remains high and the potential health benefits of paediatric, adolescent and adult vaccination are not being achieved due to suboptimal vaccine coverage rates. Based on emerging evidence that pharmacy-based vaccine interventions are feasible and effective, the European Interdisciplinary Council for Ageing (EICA) brought together stakeholders from the medical and pharmacy professions, the pharmaceutical industry, patient/ageing organisations and health authorities to consider the potential for pharmacy-based interventions to increase vaccine uptake. We report here the proceedings of this 3-day meeting held in March 2018 in San Servolo island, Venice, Italy, focussing firstly on examples from countries that have introduced pharmacy-based vaccination programmes, and secondly, listing the barriers and solutions proposed by the discussion groups. CONCLUSIONS A range of barriers to vaccine uptake have been identified, affecting all target groups, and in various countries and healthcare settings. Ease of accessibility is a potentially modifiable determinant in vaccine uptake, and thus, improving the diversity of settings where vaccines can be provided to adults, for example by enabling community pharmacists to vaccinate, may increase the number of available opportunities for vaccination.
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Affiliation(s)
- Fiona Ecarnot
- EA3920, University of Franche-Comté, Besancon, France. .,Department of Cardiology, University Hospital Jean Minjoz, Boulevard Fleming, 25000, Besancon, France.
| | | | - Philippe Juvin
- Global Product Quality Management, Sanofi Pasteur, Lyon, France
| | - John Grabenstein
- Executive Director, Global Vaccines Medical Affairs, Merck Research Laboratories, North Wales, PA 19454, USA
| | - Giuseppe Del Giudice
- Translational Science Leader, R&D Center Italy, GSK Vaccines Srl, 53100, Siena, Italy
| | - Litjen Tan
- Chief Strategy Officer, Immunization Action Coalition, United States; Co-Chair, National Adult and Influenza Immunization Summit, Saint Paul, MN, USA
| | - Susan O'Dwyer
- Boots Retail (Ireland) Limited, Nangor Road, Clondalkin, Dublin, 12, Ireland
| | - Susanna Esposito
- Pediatric Clinic, Department of Biomedical and Surgical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Xavier Bosch
- Catalan Institute of Oncology, Cancer Epidemiology Research Program, L'Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Gaetan Gavazzi
- University of Grenoble-Alpes, GREPI, FRE 3405 CNRS and University Clinic of Geriatric Medicine, University hospital of Grenoble, Grenoble, France
| | - John Papastergiou
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - Robert Johnson
- Hon. Senior Research Fellow, Faculty of Health Sciences: Emeritus Consultant in Pain Medicine, University of Bristol, Bristol, UK
| | - Marco Fonzo
- DCTV - Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padua, Padua, Italy
| | - Andrea Rossanese
- Centre for Tropical Diseases, "Sacro Cuore - Don Calabria" Hospital, Negrar, Verona, Italy
| | - Caterina Suitner
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | - Jane Barratt
- International Federation on Ageing, Toronto, Ontario, Canada
| | | | - Stefania Maggi
- CNR, Institute of Neuroscience - Aging Branch, Padua, Italy
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Purba AKR, Ascobat P, Muchtar A, Wulandari L, Dik JW, d'Arqom A, Postma MJ. Cost-Effectiveness Of Culture-Based Versus Empirical Antibiotic Treatment For Hospitalized Adults With Community-Acquired Pneumonia In Indonesia: A Real-World Patient-Database Study. Clinicoecon Outcomes Res 2019; 11:729-739. [PMID: 31819563 PMCID: PMC6890194 DOI: 10.2147/ceor.s224619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study analyzes the cost-effectiveness of culture-based treatment (CBT) versus empirical treatment (ET) as a guide to antibiotic selection and use in hospitalized patients with community-acquired pneumonia (CAP). PATIENTS AND METHODS A model was developed from the individual patient data of adults with CAP hospitalized at an academic hospital in Indonesia between 2014 and 2017 (ICD-10 J.18x). The directed antibiotic was assessed based on microbiological culture results in terms of the impact on hospital costs and life expectancy (LE). We conducted subgroup analyses for implementing CBT and ET in adults under 60 years, elderly patients (≥ 60 years), moderate-severe CAP (PSI class III-V) cases, and ICU patients. The model was designed with a lifetime horizon and adjusted patients' ages to the average LE of the Indonesian population with a 3% discount each for cost and LE. We applied a sensitivity analyses on 1,000 simulation cohorts to examine the economic acceptability of CBT in practice. Willingness to pay (WTP) was defined as 1 or 3 times the Indonesian GDP per capita (US$ 3,570). RESULTS CBT would effectively increase the patients' LE and be cost-saving (dominant) as well. The ET group's hospitalization cost had the greatest influence on economic outcomes. Subgroup analyses showed that CBT's dominance remained for Indonesian patients aged under 60 years or older, patients with moderate-severe CAP, and patients in the ICU. Acceptability rates of CBT over ET were 74.9% for 1xWTP and 82.8% for 3xWTP in the base case. CONCLUSION Both sputum and blood cultures provide advantages for cost-saving and LE gains for hospitalized patients with CAP. CBT is cost-effective in patients all ages, PSI class III or above patients, and ICU patients.
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Affiliation(s)
- Abdul Khairul Rizki Purba
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga-Soetomo Hospital, Surabaya, Indonesia.,Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology And -Economics (PTE2), University of Groningen, Groningen, The Netherlands
| | - Purwantyastuti Ascobat
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Armen Muchtar
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Laksmi Wulandari
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga-Soetomo Hospital, Surabaya, Indonesia
| | - Jan-Willem Dik
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette d'Arqom
- Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga-Soetomo Hospital, Surabaya, Indonesia.,Faculty of Science, Faculty of Medicine Ramatibodhi Hospital, Faculty of Dentistry, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Maarten J Postma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga-Soetomo Hospital, Surabaya, Indonesia.,Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology And -Economics (PTE2), University of Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics and Finance, University of Groningen, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
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194
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Arias Fernández L, Pardo Seco J, Cebey-López M, Gil Prieto R, Rivero-Calle I, Martinon-Torres F, Gil de Miguel Á, Martinón-Torres F, Vargas D, Mascarós E, Redondo E, Díaz-Maroto JL, Linares-Rufo M, Gil A, Molina J, Ocaña D, Rivero-Calle I. Differences between diabetic and non-diabetic patients with community-acquired pneumonia in primary care in Spain. BMC Infect Dis 2019; 19:973. [PMID: 31730464 PMCID: PMC6858692 DOI: 10.1186/s12879-019-4534-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 10/09/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Diabetes is one of the underlying risk factors for developing community-acquired pneumonia (CAP). The high prevalence of diabetes among population and the rising incidence of this illness, converts it as an important disease to better control and manage, to prevent its secondary consequences as CAP. The objective of this research is to describe the characteristics of the patients with diabetes and the differences with the no diabetes who have had an episode of CAP in the context of the primary care field. METHODS A retrospective, observational study in adult patients (> 18 years-old) who suffer from CAP and attended at primary care in Spain between 2009 and 2013 was developed using the Computerized Database for Pharmacoepidemiological Studies in Primary Care (BIFAP). We carried out a descriptive analysis of the first episodes of CAP, in patients with or without diabetes as comorbidity. Other morbidity (CVA, Anaemia, Arthritis, Asthma, Heart disease, Dementia, Depression, Dysphagia, Multiple sclerosis, Epilepsy, COPD, Liver disease, Arthrosis, Parkinson's disease, Kidney disease, HIV) and life-style factors were also included in the study. RESULTS A total of 51,185 patients were included in the study as they suffer from the first episode of CAP. Of these, 8012 had diabetes as comorbidity. There were differences between sex and age in patients with diabetes. Patients without diabetes were younger, and had less comorbidities including those related to lifestyles such as smoking, alcoholism, social and dental problems than patients with diabetes. CONCLUSIONS Patients who developed an episode of CAP with diabetes have more risk factors which could be reduced with an appropriate intervention, including vaccination to prevent successive CAP episodes and hospitalization. The burden of associated factors in these patients can produce an accumulation of risk. Health care professional should know this for treating and control these patients in order to avoid complications. Diabetes and those other risk factors associated could be reduced with an appropriate intervention, including vaccination to prevent the first and successive CAP episodes and the subsequent hospitalization in severe cases.
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Affiliation(s)
- Loreto Arias Fernández
- Epidemiology of Infectious Diseases, Rey Juan Carlos University, Avda. Atenas s/n, CP, 28922 Alcorcón, Madrid Spain
| | - Jacobo Pardo Seco
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Miriam Cebey-López
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ruth Gil Prieto
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Irene Rivero-Calle
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Federico Martinon-Torres
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ángel Gil de Miguel
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - on behalf of NEUMOEXPERTOS group
- Epidemiology of Infectious Diseases, Rey Juan Carlos University, Avda. Atenas s/n, CP, 28922 Alcorcón, Madrid Spain
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - F. Martinón-Torres
- Epidemiology of Infectious Diseases, Rey Juan Carlos University, Avda. Atenas s/n, CP, 28922 Alcorcón, Madrid Spain
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - D. Vargas
- Epidemiology of Infectious Diseases, Rey Juan Carlos University, Avda. Atenas s/n, CP, 28922 Alcorcón, Madrid Spain
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - E. Mascarós
- Epidemiology of Infectious Diseases, Rey Juan Carlos University, Avda. Atenas s/n, CP, 28922 Alcorcón, Madrid Spain
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - E. Redondo
- Epidemiology of Infectious Diseases, Rey Juan Carlos University, Avda. Atenas s/n, CP, 28922 Alcorcón, Madrid Spain
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - J. L. Díaz-Maroto
- Epidemiology of Infectious Diseases, Rey Juan Carlos University, Avda. Atenas s/n, CP, 28922 Alcorcón, Madrid Spain
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - M. Linares-Rufo
- Epidemiology of Infectious Diseases, Rey Juan Carlos University, Avda. Atenas s/n, CP, 28922 Alcorcón, Madrid Spain
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - A. Gil
- Epidemiology of Infectious Diseases, Rey Juan Carlos University, Avda. Atenas s/n, CP, 28922 Alcorcón, Madrid Spain
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - J. Molina
- Epidemiology of Infectious Diseases, Rey Juan Carlos University, Avda. Atenas s/n, CP, 28922 Alcorcón, Madrid Spain
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - D. Ocaña
- Epidemiology of Infectious Diseases, Rey Juan Carlos University, Avda. Atenas s/n, CP, 28922 Alcorcón, Madrid Spain
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - I. Rivero-Calle
- Epidemiology of Infectious Diseases, Rey Juan Carlos University, Avda. Atenas s/n, CP, 28922 Alcorcón, Madrid Spain
- Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Spa Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
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Wang L, Feng Z, Shuai J, Liu J, Li G. Risk factors of 90-day rehospitalization following discharge of pediatric patients hospitalized with mycoplasma Pneumoniae pneumonia. BMC Infect Dis 2019; 19:966. [PMID: 31718584 PMCID: PMC6852903 DOI: 10.1186/s12879-019-4616-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Among pediatric patients hospitalized for Mycoplasma pneumoniae pneumonia (MPP), the risk factors for 90-day readmission after discharge is undefined. Methods We conducted a retrospective observational study of patients <14 years of age who were discharged with a diagnosis of MPP between January 2016 and February 2017. We collected clinical, laboratory and radiographic variables at the time of initial admission. We assessed pneumonia-related readmission within 90-day after discharge. Risk factors independently associated with rehospitalization were identified using multiple logistic regression models. Results Of the 424 MPP hospitalizations, 48 (11.3%) were readmitted within 90 days and were mainly diagnosed with pneumonia. Patients with younger age or coinfection with influenza A were more likely to be readmitted. In addition, compared with children without readmission, the readmission ones showed different clinical and laboratory characteristics at the index hospital admission. Multiple logistic regression analysis identified age (OR 0.815, 95%CI 0.706–0.940) and body temperature (OR 0.659, 95%CI 0.518–0.839) were significantly associated with lower risk of 90-day readmission. Coinfection with influenza was independently associated with a greater likelihood of 90-day readmission (OR 4.746, 95%CI 1.191–18.913). Conclusions Readmission after MPP are common and is related to patients’ age, body temperature and influenza A coinfection during initial hospital stay, indicating potential targets could be noticed to reduce the rehospitalization after pediatric MPP.
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Affiliation(s)
- Le Wang
- Institute of Pediatric Research, Children's Hospital of Hebei Province, 133 Jianhua South Street, Shijiazhuang, 050031, Hebei Province, China
| | - Zhishan Feng
- Hebei General Hospital, Shijiazhuang, 050000, China
| | - Jinfeng Shuai
- No.2 Department of Respiratory, Children's Hospital of Hebei Province, 133 Jianhua South Street, Shijiazhuang, 050031, Hebei Province, China
| | - Jianhua Liu
- No.2 Department of Respiratory, Children's Hospital of Hebei Province, 133 Jianhua South Street, Shijiazhuang, 050031, Hebei Province, China.
| | - Guixia Li
- Institute of Pediatric Research, Children's Hospital of Hebei Province, 133 Jianhua South Street, Shijiazhuang, 050031, Hebei Province, China.
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196
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Gaydos J, McNally A, Burnham EL. The impact of alcohol use disorders on pulmonary immune cell inflammatory responses to Streptococcus pneumoniae. Alcohol 2019; 80:119-130. [PMID: 30195043 DOI: 10.1016/j.alcohol.2018.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 12/11/2022]
Abstract
Community-acquired pneumonia due to Streptococcus pneumoniae occurs commonly in alcohol use disorders (AUDs). Pneumonia in the AUD patient is associated with poorer outcomes, and specific therapies to mitigate disease severity in these patients do not exist. Numerous investigations have attributed increased severity of pneumonia in AUDs to aberrant function of the alveolar macrophage (AM), a lung immune cell critical in host defense initiation. No studies have examined the response of human AMs to S. pneumoniae in AUDs. We hypothesized that the inflammatory mediators released by AMs after S. pneumoniae stimulation would differ quantitatively in individuals with AUDs compared to non-AUD participants. We further postulated that AM inflammatory mediators would be diminished after exposure to the antioxidant, N-acetylcysteine (NAC). For comparison, responses of peripheral blood mononuclear cells (PBMCs) to pneumococcal protein were also examined. Otherwise healthy participants with AUDs and smoking-matched controls underwent bronchoalveolar lavage and peripheral blood sampling to obtain AMs and PBMCs, respectively. Freshly collected cells were cultured with increasing doses of heat-killed S. pneumoniae protein, with and without exposure to N-acetylcysteine. Cell culture supernatants were collected, and inflammatory mediators were measured, including interferon (IFN)-γ, interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α. IFN-γ and IL-6 were significantly higher in unstimulated AM cell culture supernatants from subjects with AUDs. After stimulation with pneumococcal protein, a dose-response and time-dependent increase in pro-inflammatory cytokine production by both AMs and PBMCs was also observed; differences were not observed between AUD and non-AUD subjects. Addition of NAC to pneumococcal-stimulated AMs and PBMCs was generally associated with diminished cytokine production, with the exception of IL-1β that was elevated in AM culture supernatants from subjects with AUDs. Our observations suggest that AUDs contribute to basal alterations in AM pro-inflammatory cytokine elaboration, but did not support consistent differences in pneumococcal-stimulated AM or PBMC inflammatory mediator secretion that were referable to AUDs.
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Welte T, Kantecki M, Stone GG, Hammond J. Ceftaroline fosamil as a potential treatment option for Staphylococcus aureus community-acquired pneumonia in adults. Int J Antimicrob Agents 2019; 54:410-422. [PMID: 31404620 DOI: 10.1016/j.ijantimicag.2019.08.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/25/2019] [Accepted: 08/05/2019] [Indexed: 02/07/2023]
Abstract
Staphylococcus aureus (S. aureus), including methicillin-resistant S. aureus (MRSA), is an important aetiological cause of community-acquired pneumonia (CAP) and associated with significant morbidity and mortality. Empiric therapy for CAP frequently consists of β-lactam monotherapy or β-lactam/macrolide combination therapy. However, such agents are often ineffective against S. aureus and do not reflect the emergence and increasing prevalence of MRSA in the community setting. Ceftaroline fosamil is a fifth-generation parenteral cephalosporin with broad-spectrum activity against Gram-positive pathogens - such as S. aureus (including MRSA), Streptococcus pneumoniae and Streptococcus pyogenes - and typical Gram-negative pathogens, including Haemophilus influenzae and Moraxella catarrhalis. The approval of ceftaroline fosamil in the United States and Europe for the treatment of adults with moderate-to-severe CAP was based on two phase 3 trials (FOCUS 1 and 2), which demonstrated that ceftaroline fosamil was non-inferior to ceftriaxone, a standard empiric treatment for CAP, while exhibiting a comparable safety profile. Although head-to-head trials of ceftaroline fosamil versus comparators against MRSA CAP are lacking, the effectiveness of ceftaroline fosamil in subpopulations of patients not covered by phase 3 trials (e.g. those with MRSA CAP or severe renal impairment) has been demonstrated in the Clinical Assessment Program and Teflaro Utilization Registry (CAPTURE) study. As ineffective empiric therapy is associated with adverse outcomes, including mortality and increased costs, ceftaroline fosamil, with its extended spectrum of activity, is an attractive alternative to standard antibiotic CAP regimens.
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Affiliation(s)
- Tobias Welte
- University of Hannover, School of Medicine, Carl-Neuberg-Straße, 30625 Hannover, Germany.
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198
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Tanzella G, Motos A, Battaglini D, Meli A, Torres A. Optimal approaches to preventing severe community-acquired pneumonia. Expert Rev Respir Med 2019; 13:1005-1018. [PMID: 31414915 DOI: 10.1080/17476348.2019.1656531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Community-acquired pneumonia (CAP) has the highest rate of mortality of all infectious diseases, especially among the elderly. Severe CAP (sCAP) is defined as a CAP in which intensive care management is required and is associated with an unfavorable clinical course. Areas covered: This review aims to identify prevention strategies for reducing the incidence of CAP and optimized management of sCAP. We highlight the main prevention approaches for CAP, focusing on the latest vaccination plans and on the influence of health-risk behaviors. Lastly, we report the latest recommendations about the optimal approach for sCAP when CAP has already been diagnosed, including prompt admission to ICU, early empirical antibiotic therapy, and optimization of antibiotic use. Expert opinion: Despite improvements in the diagnosis and treatment of sCAP, more efforts are needed to combat preventable causes, including the implementation and improvement of vaccine coverage, anti-tobacco campaigns and correct oral hygiene. Moreover, future research should aim to assess the benefits of early antimicrobial therapy in primary care. Pharmacokinetic studies in the target population may help clinicians to adjust dosage regimens in critically ill patients with CAP and thus reduce rates of treatment failure.
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Affiliation(s)
- Giacomo Tanzella
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Department of Surgical Sciences and Integrated Diagnostics (DISC), San Martino Policlinico Hospital , Genoa , Italy
| | - Ana Motos
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias , Madrid , Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer , Barcelona , Spain.,Faculty of Medicine, University of Barcelona , Barcelona , Spain
| | - Denise Battaglini
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Department of Surgical Sciences and Integrated Diagnostics (DISC), San Martino Policlinico Hospital , Genoa , Italy
| | - Andrea Meli
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,University of Milan , Milan , Italy
| | - Antoni Torres
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias , Madrid , Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer , Barcelona , Spain.,Faculty of Medicine, University of Barcelona , Barcelona , Spain
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Satokangas M, Lumme S, Arffman M, Keskimäki I. Trajectory modelling of ambulatory care sensitive conditions in Finland in 1996-2013: assessing the development of equity in primary health care through clustering of geographic areas - an observational retrospective study. BMC Health Serv Res 2019; 19:629. [PMID: 31484530 PMCID: PMC6727548 DOI: 10.1186/s12913-019-4449-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/20/2019] [Indexed: 02/02/2023] Open
Abstract
Background Due to stagnating resources and an increase in staff workload, the quality of Finnish primary health care (PHC) is claimed to have deteriorated slowly. With a decentralised PHC organisation and lack of national stewardship, it is likely that municipalities have adopted different coping strategies, predisposing them to geographic disparities. To assess whether these disparities emerge, we analysed health centre area trajectories in hospitalisations due to ambulatory care sensitive conditions (ACSCs). Methods ACSCs, a proxy for PHC quality, comprises conditions in which hospitalisation could be avoided by timely care. We obtained ACSCs of the total Finnish population aged ≥20 for the years 1996–2013 from the Finnish Hospital Discharge Register, and divided them into subgroups of acute, chronic and vaccine-preventable causes, and calculated annual age-standardised ACSC rates by gender in health centre areas. Using these rates, we conducted trajectory analyses for identifying health centre area clusters using group-based trajectory modelling. Further, we applied area-level factors to describe the distribution of health centre areas on these trajectories. Results Three trajectories – and thus separate clusters of health centre areas – emerged with different levels and trends of ACSC rates. During the study period, chronic ACSC rates decreased (40–63%) within each of the clusters, acute ACSC rates remained stable and vaccine-preventable ACSC rates increased (1–41%). While disparities in rate differences in chronic ACSC rates between trajectories narrowed, in the two other ACSC subgroups they increased. Disparities in standardised rate ratios increased in vaccine-preventable and acute ACSC rates between northern cluster and the two other clusters. Compared to the south-western cluster, 13–16% of health centre areas, in rural northern cluster, had 47–92% higher ACSC rates – but also the highest level of morbidity, most limitations on activities of daily living and highest PHC inpatient ward usage as well as the lowest education levels and private health and dental care usage. Conclusions We identified three differing trajectories of time trends for ACSC rates, suggesting that the quality of care, particularly in northern Finland health centre areas, may have lagged behind the general improvements. This calls for further investments to strengthen rural area PHC. Electronic supplementary material The online version of this article (10.1186/s12913-019-4449-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Markku Satokangas
- Social and Health Systems Research Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland. .,Department of General Practice and Primary Health Care, Network of Academic Health Centres, University of Helsinki, Helsinki, Finland. .,Health Stations, Department of Social Services and Health Care, City of Helsinki, Finland.
| | - Sonja Lumme
- Social and Health Systems Research Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Martti Arffman
- Social and Health Systems Research Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Ilmo Keskimäki
- Social and Health Systems Research Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland
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Nishizawa T, Niikura Y, Akasaka K, Watanabe M, Kurai D, Amano M, Ishii H, Matsushima H, Yamashita N, Takizawa H. Pilot study for risk assessment of aspiration pneumonia based on oral bacteria levels and serum biomarkers. BMC Infect Dis 2019; 19:761. [PMID: 31477059 PMCID: PMC6720072 DOI: 10.1186/s12879-019-4327-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/29/2019] [Indexed: 02/07/2023] Open
Abstract
Background Aspiration pneumonia is a serious problem among elderly patients; it is caused by many risk factors including dysphagia, poor oral hygiene, malnutrition, and sedative medications. The aim of this study was to define a convenient procedure to objectively evaluate the risk of aspiration pneumonia in the clinical setting. Methods This prospective study included an aspiration pneumonia (AP) group, a community-acquired pneumonia (CAP) group, and a control (Con) group (patients hospitalized for lung cancer chemotherapy). We used the Oral Health Assessment Tool (OHAT), which assesses oral hygiene, and evaluated performance status, body mass index, serum albumin levels, substance P values in plasma, and oral bacterial counts. Results The oral health as assessed by the OHAT of the aspiration pneumonia group was significantly impaired compared with that of the CAP group and the control (5.13 ± 0.18, 4.40 ± 0.26, 3.90 ± 0.22, respectively; p < 0.05). The oral bacterial count in the aspiration pneumonia group (7.20 ± 0.11) was significantly higher than that in the CAP group (6.89 ± 0.12), consistent with the OHAT scores. Oral bacterial count was significantly reduced by oral care. Conclusions OHAT and oral bacterial counts can be a tool to assess the requirement of taking oral care and other preventive procedures in patients at high risk of aspiration pneumonia.
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Affiliation(s)
- Tomotaka Nishizawa
- Department of Respiratory Medicine, Japanese Red Cross Society Saitama Hospital, 1-5 Shintoshin Chuo-ku Saitama-shi, Saitama, 330-8553, Japan. .,Department of Pharmacotherapy, Research Institute of Pharmaceutical Sciences Musashino University, Tokyo, Japan. .,Department of Respiratory Medicine, Graduate School of Medicine, Kyorin University, Tokyo, Japan.
| | - Yuichi Niikura
- Department of Pharmacotherapy, Research Institute of Pharmaceutical Sciences Musashino University, Tokyo, Japan
| | - Keiichi Akasaka
- Department of Respiratory Medicine, Japanese Red Cross Society Saitama Hospital, 1-5 Shintoshin Chuo-ku Saitama-shi, Saitama, 330-8553, Japan
| | - Masato Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyorin University, Tokyo, Japan
| | - Daisuke Kurai
- Department of General Medicine, Kyorin University, Tokyo, Japan
| | - Masako Amano
- Department of Respiratory Medicine, Japanese Red Cross Society Saitama Hospital, 1-5 Shintoshin Chuo-ku Saitama-shi, Saitama, 330-8553, Japan
| | - Haruyuki Ishii
- Department of Respiratory Medicine, Graduate School of Medicine, Kyorin University, Tokyo, Japan
| | - Hidekazu Matsushima
- Department of Respiratory Medicine, Japanese Red Cross Society Saitama Hospital, 1-5 Shintoshin Chuo-ku Saitama-shi, Saitama, 330-8553, Japan
| | - Naomi Yamashita
- Department of Pharmacotherapy, Research Institute of Pharmaceutical Sciences Musashino University, Tokyo, Japan
| | - Hajime Takizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyorin University, Tokyo, Japan
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