151
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Veve MP, Wagner JL. Lefamulin: Review of a Promising Novel Pleuromutilin Antibiotic. Pharmacotherapy 2018; 38:935-946. [PMID: 30019769 DOI: 10.1002/phar.2166] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The emergence and spread of antimicrobial resistance have led to a global public health emergency requiring development of new antimicrobial classes. Lefamulin (formally BC-3781) is a novel pleuromutilin antibiotic currently undergoing Food and Drug Administration review for community-acquired bacterial pneumonia (CABP) as intravenous (IV) and oral (PO) formulations. Although pleuromutilin antibiotics were first developed in the 1950s, lefamulin is the first to be used for systemic treatment of bacterial infections in humans. Lefamulin exhibits a unique mechanism of action through inhibition of protein synthesis by binding to the peptidyl transferase center of the 50S bacterial ribosome, thus preventing the binding of transfer RNA for peptide transfer. Lefamulin displays activity against gram-positive and atypical organisms associated with CABP (i.e., Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Legionella pneumophila, and Chlamydophila pneumoniae), with an expanded gram-positive spectrum including Staphylococcus aureus (i.e., methicillin-resistant, vancomycin-intermediate, and heterogeneous strains) and vancomycin-resistant Enterococcus faecium. Lefamulin was also shown to retain activity against multidrug-resistant Neisseria gonorrhoeae and Mycoplasma genitalium. Lefamulin exhibits time-dependent killing, and the pharmacodynamic target best associated with antibacterial activity is ƒAUC0-24 /MIC (minimum inhibitory concentration [MIC]). Preclinical and phase II trials indicate that lefamulin concentrates in lung tissue are well tolerated at an IV dose of 150 mg twice/day over 1 hour or a PO dose of 600 mg twice/day, and preliminary phase III data suggest similar efficacy when compared with moxifloxacin with or without linezolid in CABP. Documented resistance and cross-resistance with other gram-positive antibacterials remains low. Additional published in vitro, in vivo, and preclinical trial data suggest further exploration of lefamulin in various infectious disease states (e.g., acute bacterial skin and skin structure infections, and sexually transmitted infections). This review discusses the pertinent bacterial spectrum of activity, preclinical and ongoing clinical data, and potential roles in therapy for lefamulin.
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Affiliation(s)
- Michael P Veve
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Knoxville, Tennessee
| | - Jamie L Wagner
- Department of Pharmacy Practice, University of Mississippi, Jackson, Mississippi
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Li HY, Guo Q, Song WD, Zhou YP, Li M, Chen XK, Liu H, Peng HL, Yu HQ, Chen X, Liu N, Lü ZD, Liang LH, Zhao QZ, Jiang M. Priority for Treatment and Intensive Care of Patients With Non-Severe Community-Acquired Pneumonia. Am J Med Sci 2018; 356:329-334. [PMID: 30360800 DOI: 10.1016/j.amjms.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Infectious Disease Society of America/the American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is unclear whether the patients with non-severe CAP meeting the minor criteria most strongly associated to mortality should have the priority for treatment and intensive care. It is warranted to explore this intriguing hypothesis. METHODS A retrospective cohort study of 1230 patients with CAP was performed. This was tested against a prospective 2-center cohort of 1749 adults with CAP. RESULTS The patients with CAP fulfilling the predictive findings most strongly associated to mortality, i.e. PaO2/FiO2 ≤ 250 mm Hg, confusion, and uremia, showed higher mortality rates than those not fulfilling the predictive findings in subgroup analyses of the retrospective cohort. The more the number of predictive findings present, the higher the mortality rates. The prospective cohort confirmed a similar pattern. Interestingly, the patients with non-severe CAP meeting the predictive findings demonstrated unexpectedly higher mortality rates compared with the patients with severe CAP not meeting the predictive findings in the prospective cohort (P = 0.003), although there only existed death of an uptrend in the retrospective cohort. Two similar and intriguing paradigms about sequential organ failure assessment (SOFA) scores and pneumonia severity index (PSI) scores were confirmed in the 2 cohorts. CONCLUSIONS The patients with non-severe CAP fulfilling the predictive findings most strongly associated to mortality demonstrated higher SOFA and PSI scores and mortality rates, and might have the priority for treatment and intensive care.
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Affiliation(s)
- Hai-Yan Li
- Department of Primary Care, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Qi Guo
- Department of Respiratory Medicine, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, Guangdong, China.
| | - Wei-Dong Song
- Department of Respiratory Medicine, Shenzhen Hospital, Peking University, Shenzhen, Guangdong, China
| | - Yi-Ping Zhou
- Department of Respiratory Medicine, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Ming Li
- Department of Respiratory Medicine, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Xiao-Ke Chen
- Department of Respiratory Medicine, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Hui Liu
- Department of Respiratory Medicine, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Hong-Lin Peng
- Department of Respiratory Medicine, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Hai-Qiong Yu
- Department of Respiratory Medicine, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Xia Chen
- Department of Respiratory Medicine, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Nian Liu
- Department of Respiratory Medicine, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Zhong-Dong Lü
- Department of Respiratory Medicine, Shenzhen Hospital, Peking University, Shenzhen, Guangdong, China
| | - Li-Hua Liang
- Department of Radiology, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Qing-Zhou Zhao
- Department of Radiology, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Mei Jiang
- Guangzhou Institute of Respiratory Diseases (State Key Laboratory of Respiratory Diseases), First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
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153
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Luan Y, Sun Y, Duan S, Zhao P, Bao Z. Pathogenic bacterial profile and drug resistance analysis of community-acquired pneumonia in older outpatients with fever. J Int Med Res 2018; 46:4596-4604. [PMID: 30027805 PMCID: PMC6259400 DOI: 10.1177/0300060518786915] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives To study the pathogenic bacterial profile and drug resistance in older patients with community-acquired pneumonia (CAP) in outpatients with fever, and provide evidence to diagnose and treat CAP timely and accurately. Methods We studied older (>60 years) patients with CAP in Beijing Shijitan Hospital from 2016 to 2017. Pathogenic bacteria from sputum of patients were isolated and identified and their resistance to antibiotics was tested. Risk factors for multidrug-resistant CAP (MDR-CAP) and clinical outcomes were analyzed. Results A total of 5563 outpatients with fever were recruited and 391 had CAP. A total of 117 isolates of pathogenic bacteria were obtained from 176 CAP cases. The main pathogenic bacteria were Klebsiella pneumoniae (27.4%), Escherichia coli (17.9%), Staphylococcus aureus (12.0%), Pseudomonas aeruginosa (10.3%), and Streptococcus pneumoniae (9.4%). A drug sensitivity test (DST) showed that K. pneumoniae, E. coli, and P. aeruginosa had good sensitivity to imipenem, cefoperazone/sulbactam, piperacillin/tazobactam, and amikacin. Staphylococcus aureus and Streptococcus pneumoniae had strong sensitivity to vancomycin, linezolid, and levofloxacin. Previous multiple antibiotic treatment was an independent risk factor for MDR-CAP. Conclusions Gram-negative bacteria are the main pathogenic bacteria in older patients with CAP. Identification and DSTs of pathogens could enable accurate diagnosis and treatment of CAP.
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Affiliation(s)
- Ying Luan
- Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Yuling Sun
- Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Shuhong Duan
- Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Ping Zhao
- Department of Clinical Laboratory, Beijing Shijitan Hospital, Capital Medical University; Beijing Key Laboratory of Urinary Cellular Molecular Diagnostics, Haidian District, Beijing, China
| | - Zhongying Bao
- Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China
- Zhongying Bao, Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tie Yi Road, Yang Fang Dian, Haidian District, Beijing, 100038, China.
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Cillóniz C, Liapikou A, Martin-Loeches I, García-Vidal C, Gabarrús A, Ceccato A, Magdaleno D, Mensa J, Marco F, Torres A. Twenty-year trend in mortality among hospitalized patients with pneumococcal community-acquired pneumonia. PLoS One 2018; 13:e0200504. [PMID: 30020995 PMCID: PMC6051626 DOI: 10.1371/journal.pone.0200504] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is only limited information on mortality over extended periods in hospitalized patients with pneumococcal community-acquired pneumonia (CAP). We aimed to evaluate the 30-day mortality and whether is changed over a 20-year period among immunocompetent adults hospitalized with pneumococcal CAP. METHODS We conducted a retrospective observational study of data that were prospectively collected at the Hospital Clinic of Barcelona of all adult patients hospitalized with diagnosis of pneumococcal CAP over a 20-year period. To aid analysis, results were divided into four periods of 5 years each (1997-2001, 2002-2006, 2007-2011, 2012-2016). The primary outcome was 30-day mortality, but secondary outcomes included intensive care unit (ICU) admission, lengths of hospital and ICU-stays, ICU-mortality, and need of mechanical ventilation. RESULTS From a cohort of 6,403 patients with CAP, we analyzed the data for 1,120 (17%) adults with a diagnosis of pneumococcal CAP. Over time, we observed decreases in the rates of alcohol consumption, smoking, influenza vaccination, and older patients (age ≥65 years), but increases in admissions to ICU and the need for non-invasive mechanical ventilation. The overall 30-day mortality rate was 8% (95% confidence interval, 6%-9%; 84 of 1,120 patients) and did not change significantly between periods (p = 0.33). Although, we observed a decrease in ICU-mortality comparing the first period (26%) to the second one (10%), statistical differences disappeared with adjustment (p0.38). CONCLUSION Over time, 30-day mortality of hospitalized pneumococcal CAP did not change significantly. Nor did it change in the propensity-adjusted multivariable analysis. Since mortality in pneumococcal pneumonia has remained unaltered for many years despite the availability of antimicrobial agents with proven in vitro activity, other non-antibiotic strategies should be investigated.
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Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona—Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)—SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Adamantia Liapikou
- Respiratory Department, Sotiria Chest Diseases Hospital, Mesogion, Athens, Greece
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), St James's University Hospital, Department of Clinical Medicine, Trinity College, Dublin, Ireland
| | | | - Albert Gabarrús
- Department 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
| | - Adrian Ceccato
- Department 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
| | - Daniel Magdaleno
- Superior Medical School of the National Polytechnic Institute Mexico City, Mexico City, Mexico
| | - Josep Mensa
- Department of Infectious Disease, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Francesc Marco
- Department of Microbiology, Biomedical Diagnostic Center (CDB), ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Antoni Torres
- Department 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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155
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Restrepo MI, Sibila O, Anzueto A. Pneumonia in Patients with Chronic Obstructive Pulmonary Disease. Tuberc Respir Dis (Seoul) 2018; 81:187-197. [PMID: 29962118 PMCID: PMC6030662 DOI: 10.4046/trd.2018.0030] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 03/30/2018] [Accepted: 04/01/2018] [Indexed: 11/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a frequent comorbid condition associated with increased morbidity and mortality. Pneumonia is the most common infectious disease condition. The purpose of this review is to evaluate the impact of pneumonia in patients with COPD. We will evaluate the epidemiology and factors associated with pneumonia. We are discussing the clinical characteristics of COPD that may favor the development of infections conditions such as pneumonia. Over the last 10 years, there is an increased evidence that COPD patients treated with inhaled corticosteroids are at increased risk to develp pneumonia. We will review the avaialbe information as well as the possible mechanism for this events. We also discuss the impact of influenza and pneumococcal vaccination in the prevention of pneumonia in COPD patients.
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Affiliation(s)
- Marcos I Restrepo
- South Texas Veterans Health Care System, San Antonio, TX, USA
- Veterans Evidence Based Research Dissemination and Implementation Center (VERDICT) (MR), San Antonio, TX, USA
| | - Oriol Sibila
- Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Anzueto
- South Texas Veterans Health Care System, San Antonio, TX, USA
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
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156
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Brooks LRK, Mias GI. Streptococcus pneumoniae's Virulence and Host Immunity: Aging, Diagnostics, and Prevention. Front Immunol 2018; 9:1366. [PMID: 29988379 PMCID: PMC6023974 DOI: 10.3389/fimmu.2018.01366] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/01/2018] [Indexed: 12/14/2022] Open
Abstract
Streptococcus pneumoniae is an infectious pathogen responsible for millions of deaths worldwide. Diseases caused by this bacterium are classified as pneumococcal diseases. This pathogen colonizes the nasopharynx of its host asymptomatically, but overtime can migrate to sterile tissues and organs and cause infections. Pneumonia is currently the most common pneumococcal disease. Pneumococcal pneumonia is a global health concern and vastly affects children under the age of five as well as the elderly and individuals with pre-existing health conditions. S. pneumoniae has a large selection of virulence factors that promote adherence, invasion of host tissues, and allows it to escape host immune defenses. A clear understanding of S. pneumoniae's virulence factors, host immune responses, and examining the current techniques available for diagnosis, treatment, and disease prevention will allow for better regulation of the pathogen and its diseases. In terms of disease prevention, other considerations must include the effects of age on responses to vaccines and vaccine efficacy. Ongoing work aims to improve on current vaccination paradigms by including the use of serotype-independent vaccines, such as protein and whole cell vaccines. Extending our knowledge of the biology of, and associated host immune response to S. pneumoniae is paramount for our improvement of pneumococcal disease diagnosis, treatment, and improvement of patient outlook.
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Affiliation(s)
- Lavida R. K. Brooks
- Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, United States
- Institute for Quantitative Health Science & Engineering, Michigan State University, East Lansing, MI, United States
| | - George I. Mias
- Institute for Quantitative Health Science & Engineering, Michigan State University, East Lansing, MI, United States
- Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI, United States
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157
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Lukoff J, Olmos J. Minimizing Medical Radiation Exposure by Incorporating a New Radiation "Vital Sign" into the Electronic Medical Record: Quality of Care and Patient Safety. Perm J 2018; 21:17-007. [PMID: 29035181 DOI: 10.7812/tpp/17-007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
There is a clearly perceived and imminent need to decrease unnecessary and detrimental exposure to medical ionizing radiation. We propose a new radiation "vital sign" that incorporates cumulative radiation exposure to create a risk score on the basis of an individualized assessment of potential harm from additional exposure to medical radiation. We propose to then tie the risk score to real-time, evidence-based, clinical decision support for procedures that use ionizing radiation. Additionally, we offer recommendations that minimize unnecessary or low-yield uses. Preference is given to approaches and modalities that use less or no ionizing radiation and that are medically appropriate, acceptable to, and safer for patients.
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Affiliation(s)
- Jonathan Lukoff
- Retired Pediatrician and Informatician from the Southern California Permanente Medical Group and The Permanente Federation in CA.
| | - Jaime Olmos
- Retired Nuclear Engineer from the San Onofre Nuclear Generating Station in Pendleton, CA.
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158
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Arnold FW, Lopardo G, Wiemken TL, Kelley R, Peyrani P, Mattingly WA, Feldman C, Gnoni M, Maurici R, Ramirez JA. Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia. Respir Med 2018; 140:115-121. [PMID: 29957272 DOI: 10.1016/j.rmed.2018.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/23/2018] [Accepted: 05/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide. MATERIALS AND METHODS Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included in-hospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability. RESULTS Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the non-macrolide group (adjusted relative risk (aRR)0.81; 95% confidence interval (CI)0.50-1.33; P = 0.41). Unadjusted in-hospital all-cause mortality was 7.3% in the macrolide group, and 18.9% in the non-macrolide group (aRR 0.54, 95% CI 0.30-0.98; P = 0.043). Length of stay and time to clinical stability were not significantly different. CONCLUSIONS In-hospital mortality, but not 30-day mortality, was significantly better in the macrolide group. Our data support the use of a macrolide in hospitalized patients with CAP and bacteraemia.
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Affiliation(s)
- Forest W Arnold
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - Gustavo Lopardo
- Hospital Professor Bernardo Houssay, Buenos Aires, Argentina.
| | - Timothy L Wiemken
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - Robert Kelley
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - Paula Peyrani
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - William A Mattingly
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - Charles Feldman
- Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Martin Gnoni
- Good Samaritan Hospital, Cincinnati, OH, United States.
| | - Rosemeri Maurici
- University Hospital, Federal University of Santa Catarina, Santa Catarina, Brazil.
| | - Julio A Ramirez
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
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159
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Lee MS, Oh JY, Kang CI, Kim ES, Park S, Rhee CK, Jung JY, Jo KW, Heo EY, Park DA, Suh GY, Kiem S. Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia. Infect Chemother 2018; 50:160-198. [PMID: 29968985 PMCID: PMC6031596 DOI: 10.3947/ic.2018.50.2.160] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 01/07/2023] Open
Abstract
Community-acquired pneumonia is common and important infectious disease in adults. This work represents an update to 2009 treatment guideline for community-acquired pneumonia in Korea. The present clinical practice guideline provides revised recommendations on the appropriate diagnosis, treatment, and prevention of community-acquired pneumonia in adults aged 19 years or older, taking into account the current situation regarding community-acquired pneumonia in Korea. This guideline may help reduce the difference in the level of treatment between medical institutions and medical staff, and enable efficient treatment. It may also reduce antibiotic resistance by preventing antibiotic misuse against acute lower respiratory tract infection in Korea.
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Affiliation(s)
- Mi Suk Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jee Youn Oh
- Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol In Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Ye Jung
- Division of Pulmonology, The Institute of Chest Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Wook Jo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sungmin Kiem
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
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160
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Rabbanikha F, Moradi R, Monafi F, Kazemi-Bollboloy A. Strategic Thinking Among Directors of the Ministry of Health and Medical Education. CASPIAN JOURNAL OF HEALTH RESEARCH 2018. [DOI: 10.29252/cjhr.3.2.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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161
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Ning P, Zheng Y, Luo Q, Liu X, Kang Y, Zhang Y, Zhang R, Xu Y, Yang D, Xi W, Wang K, Chen Y, An S, Gao Z. Metabolic profiles in community-acquired pneumonia: developing assessment tools for disease severity. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:130. [PMID: 29759075 PMCID: PMC5952829 DOI: 10.1186/s13054-018-2049-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 04/23/2018] [Indexed: 01/11/2023]
Abstract
Background This study aimed to determine whether community-acquired pneumonia (CAP) had a metabolic profile and whether this profile can be used for disease severity assessment. Methods A total of 175 individuals including 119 CAP patients and 56 controls were enrolled and divided into two cohorts. Serum samples from a discovery cohort (n = 102, including 38 non-severe CAP, 30 severe CAP, and 34 age and sex-matched controls) were determined by untargeted ultra-high-performance liquid chromatography with tandem mass spectrometry (LC-MS/MS)-based metabolomics. Selected differential metabolites between CAP patients versus controls, and between the severe CAP group versus non-severe CAP group, were confirmed by targeted mass spectrometry assays in a validation cohort (n = 73, including 32 non-severe CAP, 19 severe CAP and 22 controls). Pearson’s correlation analysis was performed to assess relationships between the identified metabolites and clinical severity of CAP. The area under the curve (AUC), sensitivity and specificity of the metabolites for predicting the severity of CAP were also investigated. Results The metabolic signature was markedly different between CAP patients and controls. Fifteen metabolites were found to be significantly dysregulated in CAP patients, which were mainly mapped to the metabolic pathways of sphingolipid, arginine, pyruvate and inositol phosphate. The alternation trends of five metabolites among the three groups including sphinganine, p-Cresol sulfate, dehydroepiandrosterone sulfate (DHEA-S), lactate and l-arginine in the validation cohort were consistent with those in the discovery cohort. Significantly lower concentrations of sphinganine, p-Cresol sulfate and DHEA-S were observed in CAP patients than in controls (p < 0.05). Serum lactate and sphinganine levels were positively correlated with confusion, urea level, respiratory rate, blood pressure, and age > 65 years (CURB-65), pneumonia severity index (PSI) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, while DHEA-S inversely correlated with the three scoring systems. Combining lactate, sphinganine and DHEA-S as a metabolite panel for discriminating severe CAP from non-severe CAP exhibited a better AUC of 0.911 (95% confidence interval 0.825–0.998) than CURB-65, PSI and APACHE II scores. Conclusions This study demonstrates that serum metabolomics approaches based on the LC-MS/MS platform can be applied as a tool to reveal metabolic changes during CAP and establish a metabolite signature related to disease severity. Trial registration ClinicalTrials.gov, NCT03093220. Registered retrospectively on 28 March 2017. Electronic supplementary material The online version of this article (10.1186/s13054-018-2049-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pu Ning
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Yali Zheng
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Qiongzhen Luo
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Xiaohui Liu
- National Protein Science Technology Center, Tsinghua University, Beijing, China.,School of Life Sciences, Tsinghua University, Beijing, China
| | - Yu Kang
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - Yan Zhang
- National Engineering Research Center for Beijing Biochip Technology, Beijing, China
| | - Rongbao Zhang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Yu Xu
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Donghong Yang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Wen Xi
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Keqiang Wang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Yusheng Chen
- Department of Respiratory Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Shuchang An
- Department of Respiratory Medicine, First Hospital of Tsinghua University, Beijing, China
| | - Zhancheng Gao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China.
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Jahanihashemi H, Babaie M, Bijani S, Bazzazan M, Bijani B. Poverty as an independent risk factor for in-hospital mortality in community-acquired pneumonia: A study in a developing country population. Int J Clin Pract 2018; 72:e13085. [PMID: 29665161 DOI: 10.1111/ijcp.13085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/18/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is one of the most severe lower respiratory tract infections with a high in-hospital mortality. The aim of this study was to investigate the socioeconomic and medical risk factors affecting the prognosis of acute pneumonia. The results of this study can mention the value of socioeconomic backgrounds like poverty and illiteracy in clinical practice, even in a well-known biological phenomenon (eg acute pneumonia). METHODS In this cross-sectional study, all admitted patients to a tertiary teaching hospital with a diagnosis of community acquired pneumonia in a 12-month period were enrolled. Socioeconomic and demographic characteristics, underlying conditions, clinical manifestations and para-clinical test results at admission registered prospectively. A logistic regression model was conducted using in-hospital mortality as the dependent variable. RESULTS A total of 621 patients was included in this study. Among them, 47 patients (7.6%) died during the hospitalisation period. In multiple logistic regression analysis, pleural effusion, a higher CURB-65 score, hyponatremia, hyperglycaemia and poverty (being in the lower economic class) were identified as independent risk factors for in-hospital mortality in community-acquired pneumonia. CONCLUSION Numerous factors can influence the prognosis of CAP. In addition to the CURB-65 score and some other medical risk factors, socioeconomic backgrounds can also affect the early outcome in CAP. In this study, being in the lower economic class (as an indicator of poverty) is interpreted as an independent risk factor for a poor prognosis in CAP.
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Affiliation(s)
- Hassan Jahanihashemi
- Department of Community Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mona Babaie
- Clinical Microbiology Research Centre, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Soroush Bijani
- Clinical Microbiology Research Centre, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Maryam Bazzazan
- Clinical Microbiology Research Centre, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Behzad Bijani
- Clinical Microbiology Research Centre, Qazvin University of Medical Sciences, Qazvin, Iran
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Pouzot-Nevoret C, Goy-Thollot I, Billet D, Barthélemy A, Blesch M, Pin A, Hopper K. Evaluation of a new chest physiotherapy technique in dogs with airway fluid accumulation hospitalized in an intensive care unit. J Vet Emerg Crit Care (San Antonio) 2018; 28:213-220. [PMID: 29645400 DOI: 10.1111/vec.12713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/26/2016] [Accepted: 11/02/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate the feasibility, benefits, and adverse effects of prolonged slow expiration (PSE) and assisted cough (AC) as chest physiotherapy (CP) techniques in dogs with airway fluid accumulation. DESIGN Prospective interventional study. SETTINGS University teaching hospital. ANIMALS Intervention group of 30 client-owned dogs and retrospective control group of 71 client-owned dogs. INTERVENTIONS PSE was performed on dogs with evidence of airway fluid accumulation, identified based on physical examination and thoracic radiographs. AC was performed if spontaneous cough or swallowing were not evident. The PSE treatment was performed every 6 hours until normalization of respiratory status or hospital discharge. Animals were monitored for respiratory distress, discomfort, and SpO2 during the procedure. A retrospective control group was identified by computer search. MEASUREMENTS AND MAIN RESULTS One hundred thirty-three sessions of CP were performed on 30 dogs. Discomfort frequency during physiotherapy was low (9%). The most commonly used position for CP was in lateral recumbency (95%) and this was well tolerated in most cases. There was no significant difference in the median SpO2 before and after CP sessions (P = 0.24). Sixty percent of sessions had a spontaneous cough or swallowing evident, 21% had successful AC performed, and no cough or swallowing occurred in the remaining (19%) sessions despite attempts of AC being made. The length of hospitalization was significantly longer in the intervention group (6 days vs 4) (P = 0.02). There was no difference in survival between the intervention (76.7%) and the control (57.7%) group (P = 0.055). CONCLUSIONS PSE associated with AC are easily adaptable, well-tolerated techniques in dogs. The benefit of CP in dogs with airway fluid accumulation remains to be determined and it is hoped that future randomized controlled prospective studies may help answer this line of inquiry.
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Affiliation(s)
- Céline Pouzot-Nevoret
- Intensive Care Unit (SIAMU).,APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis
| | - Isabelle Goy-Thollot
- Intensive Care Unit (SIAMU).,APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis
| | | | - Anthony Barthélemy
- Intensive Care Unit (SIAMU).,APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis.,VetAgro-Sup campus vétérinaire de Lyon, Université de Lyon, Marcy l'Etoile, France; IKARE, 18 rue du Prof. Joseph Nicolas, Lyon, France
| | | | | | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, University of California Davis, CA
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Satchidanand N, Servoss TJ, Singh R, Bosinski AM, Tirpak P, Horton LL, Naughton BJ. Development of a Risk Tool to Support Discussions of Care for Older Adults Admitted to the ICU With Pneumonia. Am J Hosp Palliat Care 2018; 35:1201-1206. [PMID: 29552894 DOI: 10.1177/1049909118764093] [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: 11/16/2022] Open
Abstract
BACKGROUND Early, data-driven discussion surrounding palliative care can improve care delivery and patient experience. OBJECTIVE To develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course. DESIGN Retrospective Electronic Health Record (EHR) review. SETTING Four urban and suburban hospitals in a Western New York hospital system. PARTICIPANTS A total of 1237 consecutive patients (>75 years) admitted to the ICU with pneumonia from July 2011 to December 2014. MEASUREMENTS Data abstracted included demographics, insurance type, comorbidities, and clinical factors. Thirty-day mortality was also determined. Logistic regression identified predictors of 30-day mortality. Area under the receiver operating curve (ROC) was calculated to quantify the degree to which the model accurately classified participants. Using the coordinates of the ROC, a predicted probability was identified to indicate high risk. RESULTS A total of 1237 patients were included with 30-day mortality data available for 100% of patients. The mortality rate equaled 14.3%. Age >85 years, having active cancer, Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), sepsis, and being on a vasopressor all predicted mortality. Using the derived index, with a predicted probability of mortality >0.146 as a cutoff, sensitivity equaled 70.6% and specificity equaled 65.6%. The area under the ROC was 0.735. CONCLUSION Our risk tool can help care teams make more informed decisions among care options by identifying a patient group for whom a careful review of goals of care is indicated both during and after hospitalization. External validation and further refinement of the index with a larger sample will improve prognostic value.
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Affiliation(s)
- Nikhil Satchidanand
- 1 Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Ranjit Singh
- 1 Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Angela M Bosinski
- 1 Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Luo Q, Ning P, Zheng Y, Shang Y, Zhou B, Gao Z. Serum suPAR and syndecan-4 levels predict severity of community-acquired pneumonia: a prospective, multi-centre study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:15. [PMID: 29368632 PMCID: PMC5784729 DOI: 10.1186/s13054-018-1943-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 01/04/2018] [Indexed: 12/22/2022]
Abstract
Background Community-acquired pneumonia (CAP) is a major cause of death worldwide and occurs with variable severity. There are few studies focused on the expression of soluble urokinase-type plasminogen activator receptor (suPAR) and syndecan-4 in patients with CAP. Methods A prospective, multi-centre study was conducted between January 2014 and December 2016. A total of 103 patients with severe CAP (SCAP), 149 patients with non-SCAP, and 30 healthy individuals were enrolled. Clinical data were recorded for all enrolled patients. Serum suPAR and syndecan-4 levels were determined by quantitative enzyme-linked immunosorbent assay. The t test and Mann–Whitney U test were used to compare between two groups; one-way analysis of variance and the Kruskal–Wallis test were used to compare multiple groups. Correlations were assessed using Pearson and Spearman tests. Area under the curve (AUCs), optimal threshold values, sensitivity, and specificity were calculated. Survival curves were constructed and compared by log-rank test. Regression analyses assessed the effect of multiple variables on 30-day survival. Results suPAR levels increased in all patients with CAP, especially in severe cases. Syndecan-4 levels decreased in patients with CAP, especially in non-survivors. suPAR and syndecan-4 levels were positively and negatively correlated with severity scores, respectively. suPAR exhibited high accuracy in predicting SCAP among patients with CAP with an AUC of 0.835 (p < 0.001). In contrast, syndecan-4 exhibited poor diagnostic value for predicting SCAP (AUC 0.550, p = 0.187). The AUC for predicting mortality in patients with SCAP was 0.772 and 0.744 for suPAR and syndecan-4, respectively; the respective prediction threshold values were 10.22 ng/mL and 6.68 ng/mL. Addition of both suPAR and syndecan-4 to the Pneumonia Severity Index significantly improved their prognostic accuracy, with an AUC of 0.885. Regression analysis showed that suPAR ≥10.22 ng/mL and syndecan-4 ≤ 6.68 ng/mL were reliable independent markers for prediction of 30-day survival. Conclusion suPAR exhibits high accuracy for both diagnosis and prognosis of SCAP. Syndecan-4 can reliably predict mortality in patients with SCAP. Addition of both suPAR and syndecan-4 to a clinical scoring method could improve prognostic accuracy. Trial registration ClinicalTrials.gov, NCT03093220. Registered on 28 March 2017 (retrospectively registered).
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Affiliation(s)
- Qiongzhen Luo
- Department of Respiratory & Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Pu Ning
- Department of Respiratory & Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yali Zheng
- Department of Respiratory & Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Ying Shang
- Department of Respiratory & Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Bing Zhou
- Department of Respiratory & Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Zhancheng Gao
- Department of Respiratory & Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China.
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166
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Khdour MR, Hallak HO, Aldeyab MA, Nasif MA, Khalili AM, Dallashi AA, Khofash MB, Scott MG. Impact of antimicrobial stewardship programme on hospitalized patients at the intensive care unit: a prospective audit and feedback study. Br J Clin Pharmacol 2018; 84:708-715. [PMID: 29236303 DOI: 10.1111/bcp.13486] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/26/2017] [Accepted: 11/29/2017] [Indexed: 12/13/2022] Open
Abstract
AIMS Inappropriate use of antibiotics is one of the most important factors contributing to the emergence of drug resistant pathogens. The purpose of this study was to measure the clinical impact of antimicrobial stewardship programme (ASP) interventions on hospitalized patients at the Intensive care unit at Palestinian Medical Complex. METHODS A prospective audit with intervention and feedback by ASP team within 48-72 h of antibiotic administration began in September 2015. Four months of pre-ASP data were compared with 4 months of post-ASP data. Data collected included clinical and demographic data; use of antimicrobials measured by defined daily doses, duration of therapy, length of stay, readmission and all-cause mortality. RESULTS Overall, 176 interventions were made the ASP team with an average acceptance rate of 78.4%. The most accepted interventions were dose optimization (87.0%) followed by de-escalation based on culture results with an acceptance rate of 84.4%. ASP interventions significantly reduces antimicrobial use by 24.3% (87.3 defined daily doses/100 beds vs. 66.1 defined daily doses/100 beds P < 0.001). The median (interquartile range) of length of stay was significantly reduced post ASP [11 (3-21) vs. 7 (4-19) days; P < 0.01]. Also, the median (interquartile range) of duration of therapy was significantly reduced post-ASP [8 (5-12) days vs. 5 (3-9); P = 0.01]. There was no significant difference in overall 30-day mortality or readmission between the pre-ASP and post-ASP groups (26.9% vs. 23.9%; P = 0.1) and (26.1% vs. 24.6%; P = 0.54) respectively. CONCLUSIONS Our prospective audit and feedback programme was associated with positive impact on antimicrobial use, duration of therapy and length of stay.
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Affiliation(s)
- Maher R Khdour
- Faculty of Pharmacy, Al-Quds University, Abu Deis, PO Box 20002, West Bank, Palestine
| | - Hussein O Hallak
- Faculty of Pharmacy, Al-Quds University, Abu Deis, PO Box 20002, West Bank, Palestine
| | - Mamoon A Aldeyab
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, County Londonderry, UK
| | - Mowaffaq A Nasif
- Head of Intensive Care Department at Palestinian Medical Complex, Baladiya St. 00972, Ramallah, West Bank, Palestine
| | - Aliaa M Khalili
- Internal Medicine Resident at Palestinian Medical Complex, Baladiya St. 00972, Ramallah, West Bank, Palestine
| | - Ahamad A Dallashi
- Internal Medicine Resident at Palestinian Medical Complex, Baladiya St. 00972, Ramallah, West Bank, Palestine
| | - Mohammad B Khofash
- Clinical Pharmacist at Palestinian Medical Complex, Baladiya St. 00972, Ramallah, Palestine
| | - Michael G Scott
- Pharmacy and Medicines Management Centre, Antrim Area Hospital, BT41 2RL, Northern Ireland
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Broad- versus Narrow-Spectrum Oral Antibiotic Transition and Outcomes in Health Care-associated Pneumonia. Ann Am Thorac Soc 2018; 14:200-205. [PMID: 27690519 DOI: 10.1513/annalsats.201606-486bc] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Guidelines recommend a switch from intravenous to oral antibiotics once patients who are hospitalized with pneumonia achieve clinical stability. However, little evidence guides the selection of an oral antibiotic for patients with health care-associated pneumonia, especially where no microbiological diagnosis is made. OBJECTIVES To compare outcomes between patients who were transitioned to broad- versus narrow-spectrum oral antibiotics after initially receiving broad-spectrum intravenous antibiotic coverage. METHODS We performed a secondary analysis of an existing database of adults with community-onset pneumonia admitted to seven Utah hospitals. We identified 220 inpatients with microbiology-negative health care-associated pneumonia from 2010 to 2012. After excluding inpatient deaths and treatment failures, 173 patients remained in which broad-spectrum intravenous antibiotics were transitioned to an oral regimen. We classified oral regimens as broad-spectrum (fluoroquinolone) versus narrow-spectrum (usually a β-lactam). We compared demographic and clinical characteristics between groups. Using a multivariable regression model, we adjusted outcomes by severity (electronically calculated CURB-65), comorbidity (Charlson Index), time to clinical stability, and length of intravenous therapy. MEASUREMENTS AND MAIN RESULTS Age, severity, comorbidity, length of intravenous therapy, and clinical response were similar between the two groups. Observed 30-day readmission (11.9 vs. 21.4%; P = 0.26) and 30-day all-cause mortality (2.3 vs. 5.3%; P = 0.68) were also similar between the narrow and broad oral antibiotic groups. In multivariable analysis, we found no statistically significant differences for adjusted odds of 30-day readmission (adjusted odds ratio, 0.56; 95% confidence interval, 0.06-5.2; P = 0.61) or 30-day all-cause mortality (adjusted odds ratio, 0.55; 95% confidence interval, 0.19-1.6; P = 0.26) between narrow and broad oral antibiotic groups. CONCLUSIONS On the basis of analysis of a limited number of patients observed retrospectively, our findings suggest that it may be safe to switch from broad-spectrum intravenous antibiotic coverage to a narrow-spectrum oral antibiotic once clinical stability is achieved for hospitalized patients with health care-associated pneumonia when no microbiological diagnosis is made. A larger retrospective study with propensity matching or regression-adjusted test of equivalence or ideally a prospective comparative effectiveness study will be necessary to confirm our observations.
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168
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Ferrari R, Viale P, Muratori P, Giostra F, Agostinelli D, Lazzari R, Voza R, Cavazza M. Rebounds after discharge from the emergency department for community-acquired pneumonia: focus on the usefulness of severity scoring systems. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 88:519-528. [PMID: 29350672 PMCID: PMC6166183 DOI: 10.23750/abm.v88i4.6685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 11/23/2022]
Abstract
Background: Community-acquired pneumonia (CAP) is common cause of hospital admission and leading cause of morbidity and mortality. Severity scoring systems are used to predict risk profile, outcome and mortality, and to help decisions about management strategies. Aim of the work and Methods: To critically analyze pneumonia “rebound” cases, once discharged from the emergency department (ED) and afterwards admitted. We conducted an observational clinical study in the acute setting of a university teaching hospital, prospectively analyzing, in a 1 year period, demographic, medical, clinical and laboratory data, and the outcome. Results: 249 patients were discharged home with diagnosis of CAP; 80 cases (32.1%) resulted in the high-intermediate risk class according to CURB-65 or CRB-65. Twelve patients (4.8%) presented to the ED twice and were then admitted. At their first visit 5 were in the high-intermediate risk group; just 4 of them were in the non-low risk group at the time of their admission. The rebound cohort showed some peculiar abnormalities in laboratory parameters (coagulation and renal function) and severe chest X-rays characteristics. None died in 30 days. Conclusions: The power of CURB-65 to correctly predict mortality for CAP patients discharged home from the ED is not confirmed by our results; careful clinical judgement seems to be irreplaceable in the management process. Many patients with a high-intermediate risk according to CURB-65 can be safely treated as outpatients, according to adequate welfare conditions; we identified a subgroup of cases that should worth a special attention and, therefore, a brief observation period in the ED before the final decision to safely discharge or admit. (www.actabiomedica.it)
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Affiliation(s)
- Rodolfo Ferrari
- Policlinico Sant'Orsola - Malpighi. Azienda Ospedaliero - Universitaria di Bologna..
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Wang LT, Cleveland RH, Binder W, Zwerdling RG, Stamoulis C, Ptak T, Sherman M, Haver K, Sagar P, Hibberd P. Similarity of chest X-ray and thermal imaging of focal pneumonia: a randomised proof of concept study at a large urban teaching hospital. BMJ Open 2018; 8:e017964. [PMID: 29306882 PMCID: PMC5780734 DOI: 10.1136/bmjopen-2017-017964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To assess the diagnostic accuracy of thermal imaging (TI) in the setting of focal consolidative pneumonia with chest X-ray (CXR) as the gold standard. SETTING A large, 973-bed teaching hospital in Boston, Massachusetts. PARTICIPANTS 47 patients enrolled, 15 in a training set, 32 in a test set. Age range 10 months to 82 years (median=50 years). MATERIALS AND METHODS Subjects received CXR with subsequent TI within 4 hours of each other. CXR and TI were assessed in blinded random order. Presence of focal opacity (pneumonia) on CXR, the outcome parameter, was recorded. For TI, presence of area(s) of increased heat (pneumonia) was recorded. Fisher's exact test was used to assess the significance of the correlations of positive findings in the same anatomical region. RESULTS With TI compared with the CXR (the outcome parameter), sensitivity was 80.0% (95% CIs 29.9% to 98.9%), specificity was 57.7% (95% CI 37.2% to 76.0%). Positive predictive value of TI was 26.7% (95% CI 8.9% to55.2%) and its negative predictive value was 93.8% (95% CI 67.7% to 99.7%). CONCLUSIONS This feasibility study confirms proof of concept that chest TI is consistent with CXR in suggesting similarly localised focal pneumonia with high sensitivity and negative predictive value. Further investigation of TI as a point-of-care imaging modality is warranted.
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Affiliation(s)
- Linda T Wang
- Department of Emergency Medicine and Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Robert H Cleveland
- Department of Radiology and Department of Medicine, Boston Childrens Hospital, Boston, MA, USA
| | - William Binder
- Department of Emergency Medicine, Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Robert G Zwerdling
- Department of Pediatrics, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | | | - Thomas Ptak
- Department of Radiology and Nuclear Medicine, University of Maryland Medical Center and The R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Mindy Sherman
- Department of Emergency Medicine and Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Kenan Haver
- Department of Medicine, Boston Childrens Hospital, Boston, MA, USA
| | - Pallavi Sagar
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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170
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Zhao C, Li Z, Zhang F, Zhang X, Ji P, Zeng J, Hu B, Hu Z, Liao K, Sun H, Zhang R, Cao B, Zhuo C, Jia W, Mei Y, Chu Y, Xu X, Yang Q, Jin Y, Fu Q, Xu X, Li H, Wang L, Ni Y, Liang H, Wang H. Serotype distribution and antibiotic resistance of Streptococcus pneumoniae isolates from 17 Chinese cities from 2011 to 2016. BMC Infect Dis 2017; 17:804. [PMID: 29284419 PMCID: PMC5747162 DOI: 10.1186/s12879-017-2880-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/04/2017] [Indexed: 01/08/2023] Open
Abstract
Background Streptococcus pneumoniae, the leading pathogen of bacterial infections in infants and the elderly, is responsible for pneumococcal diseases with severe morbidity and mortality. Emergence of drug-resistant strains presented new challenges for treatment and prevention. Vaccination has proven to be an effective means of preventing pneumococcal infection worldwide. Detailed epidemiological information of antibiotic susceptibilities and serotype distribution will be of great help to the management of pneumococcal infections. Methods A total of 881 S. pneumoniae isolates were collected from patients at 23 teaching hospitals in 17 different cities from 2011 to 2016. The main specimen types included sputum, blood, broncho-alveolar lavage fluid, pharyngeal swabs, and cerebrospinal fluid. Minimum inhibitory concentrations (MICs) were determined using the agar dilution method. Capsular serotypes were identified using latex agglutination and quellung reaction test. Molecular epidemiology was investigated using multilocus sequence typing. Results S. pneumoniae isolates were highly resistant to macrolides, tetracycline, and trimethoprim/sulfamethoxazole. The rate of resistance to penicillin was 51.6% (oral breakpoint). However, levofloxacin and moxifloxacin maintained excellent antimicrobial activity and all of the isolated strains were susceptible to vancomycin. Twenty-two serotypes were identified among the 881 isolates. Prevalent serotypes were 19F (25.7%), 19A (14.0%), 15 (6.8%), 6B (3.6%), 6A (3.0%), and 17 (2.8%). The overall vaccine coverage rates for 7- and 13-valent pneumococcal conjugate vaccines were 37.5% and 58.3%, respectively. Vaccine coverage rates in young children and economically underdeveloped regions were higher than those in older adults and developed regions. Vaccine-covered serotypes demonstrated higher resistance compared with uncovered serotypes. Molecular epidemiological typing demonstrated that S. pneumoniae showed significant clonal dissemination and that ST271 (120, 28.3%), ST320 (73, 17.2%) and ST81 (27, 6.6%) were the major STs. Conclusions High resistance to clinical routine antibiotics was observed for all 881 S. pneumoniae strains. Drug resistance varied among different serotypes and age groups. Prevalent serotypes among the isolates were 19F, 19A, 15, 6B, 6A, and 17. Community-acquired strains should also be included in future studies to gain a better understanding of the prevalence and resistance of S. pneumoniae in China. Electronic supplementary material The online version of this article (doi: 10.1186/s12879-017-2880-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chunjiang Zhao
- Department of Clinical Laboratory, Peking University Peoples Hospital, Beijing, 100044, China
| | - Zongbo Li
- Department of Clinical Laboratory, Peking University Peoples Hospital, Beijing, 100044, China
| | - Feifei Zhang
- Department of Clinical Laboratory, Peking University Peoples Hospital, Beijing, 100044, China
| | - Xiaobing Zhang
- Department of Clinical Laboratory, Southwest Hospital, Chongqing, China
| | - Ping Ji
- Department of Clinical Laboratory, The First Affiliated Hospital of Xinjiang Medial University, Ürümqi, China
| | - Ji Zeng
- Department of Clinical Laboratory, Huazhong University of Science and Technology Tongji Medical College Affiliated Pu Ai Hospital, Wuhan, China
| | - Bijie Hu
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhidong Hu
- Department of Clinical Laboratory, Tianjin Medical University General Hospital, Tianjin, China
| | - Kang Liao
- Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hongli Sun
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Beijing, China
| | - Rong Zhang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China
| | - Bin Cao
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, China
| | - Chao Zhuo
- Department of Clinical Laboratory, Guangzhou Institute of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
| | - Wei Jia
- Department of Clinical Laboratory, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yaning Mei
- Department of Clinical Laboratory, Jiangsu Provincial Peoples Hospital, Nanjing, China
| | - Yunzhuo Chu
- Department of Clinical Laboratory, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xuesong Xu
- Department of Clinical Laboratory, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qing Yang
- Department of Clinical Laboratory, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China
| | - Yan Jin
- Department of Clinical Laboratory, Shandong Provincial Hospital, Jinan, China
| | - Quan Fu
- Department of Clinical Laboratory, Affiliated Hospital of Inner Mongolia Medical College, Hohhot, China
| | - Xiuli Xu
- Department of Clinical Laboratory, Xijing Hospital, Xi'an, China
| | - Hongling Li
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Lijun Wang
- Department of Clinical Laboratory, Beijing Tsinghua Chang Gung Hospital, Beijing, China
| | - Yuxing Ni
- Department of Clinical Laboratory, Shanghai Jiaotong University Affiliated Ruijin Hospital, Shanghai, China
| | - Hongjie Liang
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hui Wang
- Department of Clinical Laboratory, Peking University Peoples Hospital, Beijing, 100044, China.
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Abstract
RATIONALE Legionella pneumophila is an uncommon cause of community-acquired pneumonia in the south central region of the United States, and regular testing may not be cost effective in areas of low incidence. OBJECTIVES To evaluate the incidence of Legionella in central Texas and to determine the cost effectiveness of Legionella urinary antigen testing. METHODS We performed a single-center retrospective cohort study of patients admitted with pneumonia between January 2001 and December 2013. Patients were identified by Binax Legionella urinary antigen and International Classification of Disease, Ninth Revision codes. Demographic characteristics and clinical history of the confirmed Legionella pneumonia cases were obtained by chart review. Descriptive statistics were used to describe patient characteristics. MEASUREMENTS AND MAIN RESULTS Over 12 years, 5,807 patients with 11,377 admissions for pneumonia were tested for Legionella urinary antigen. A positive Legionella urinary antigen was found in 17 patients. Cumulative incidence during the study period was 0.23%. Among the Legionella-positive patients, intensive care unit admission and median length of stay were 58.8% and 8.5 days, respectively. Most patients (64.7%) met American Thoracic Society criteria for severe pneumonia. All patients empirically received either a macrolide or fluoroquinolone covering Legionella. There were two in-hospital and three total 90-day deaths in those with a positive urinary antigen. The estimated cost of screening this population with Legionella urinary antigen was $214,438 over 13 years. CONCLUSIONS This study reveals the low incidence of Legionella pneumonia in central Texas. Use of guideline-concordant antibiotic treatment provides coverage for Legionella. We speculate that testing in a low-prevalence area would not influence outcomes or be cost effective.
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172
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Asai N, Watanabe H, Shiota A, Kato H, Sakanashi D, Hagihara M, Koizumi Y, Yamagishi Y, Suematsu H, Mikamo H. Could qSOFA and SOFA score be correctly estimating the severity of healthcare-associated pneumonia? J Infect Chemother 2017; 24:228-231. [PMID: 29258809 DOI: 10.1016/j.jiac.2017.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/05/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
The Japanese Respiratory Society newly updated the prognostic guidelines for pneumonia in 2017. Quick Sequential Organ Failure Assessment (qSOFA) and Sequential Organ Failure Assessment (SOFA) score are used to evaluate the severity of pneumonia and to select the therapy for pneumonia. This is a retrospective study at Aichi Medical University hospital from January to December of 2016 to investigate the accuracy and usefulness of qSOFA and SOFA score in evaluating the severity and prognosis of healthcare-associated pneumonia (HCAP). A total of 81 HCAP patients were enrolled in this study. Both the 30-day and in-hospital mortality were 7.5% (6/81). qSOFA≧2 was in 33/78 patients (42%) and <2 in 45/78 patients (58%), showing a 30-day mortality of 9.1% (3/33) and 6.7% (3/45) (p = 0.45), respectively. Comparing with qSOFA≧2 and < 2 group, HCAP patients with qSOFA≧2 had much higher A-DROP (31. v.s. 2.2, p < 0.001), CURB-65 (2.7 v.s. 1.9, p < 0.001), PSI (133 v.s. 114, p = 0.014), I-ROAD (2.7 v.s. 1.9, p < 0.001) and SOFA scores (3.8 v.s. 2.8, p < 0.001). With respect to the diagnostic value of predictive values for 30-day mortality among HCAP patients, the area under the receiver-operating characteristic curve for SOFA score was 0.930 with a statistical significance (p < 0.001). The SOFA score cutoff value was 4 and had a sensitivity of 20%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 68%. In conclusion, SOFA core could be one of the most useful tools in evaluating the severity of HCAP.
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Affiliation(s)
- Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroki Watanabe
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Arufumi Shiota
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hideo Kato
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Daisuke Sakanashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Mao Hagihara
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroyuki Suematsu
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
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173
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Okumura J, Shindo Y, Takahashi K, Sano M, Sugino Y, Yagi T, Taniguchi H, Saka H, Matsui S, Hasegawa Y. Mortality in patients with community-onset pneumonia at low risk of drug-resistant pathogens: Impact of β-lactam plus macrolide combination therapy. Respirology 2017; 23:526-534. [PMID: 29239493 DOI: 10.1111/resp.13232] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 09/01/2017] [Accepted: 11/07/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Drug-resistant pathogen (DRP) risk stratification is important for choosing a treatment strategy for community-onset pneumonia. Evidence for benefits of non-antipseudomonal β-lactam plus macrolide combination therapy (BLM) on mortality is limited in patients at low DRP risk. Risk factors for mortality remain to be clarified. METHODS Post hoc analysis using a prospective multicentre study cohort of community-onset pneumonia was performed to assess 30-day differences in mortality between non-antipseudomonal β-lactam monotherapy (BL) and BLM groups. Logistic regression analysis was performed to assess the therapeutic effect and risk factors for mortality in patients at low DRP risk. RESULTS In total, 594 patients with community-onset pneumonia at low DRP risk (369 BL and 225 BLM) were analysed. The 30-day mortality in BL and BLM was 13.8% and 1.8%, respectively (P < 0.001). Multivariate analysis showed that BLM reduced the 30-day mortality (adjusted odds ratio: 0.28, 95% CI: 0.09-0.87) compared with BL. Independent prognostic factors for 30-day mortality included arterial partial pressure of carbon dioxide (PaCO2 ) > 50 mm Hg, white blood cell count < 4000/mm3 , non-ambulatory status, albumin < 3.0 g/dL, haematocrit < 30%, age ≥ 80 years, respiratory rate > 25/min and body temperature < 36°C. CONCLUSION In patients with community-onset pneumonia at low DRP risk, BLM treatment reduced 30-day mortality compared with BL. Independent risk factors for mortality are potential confounding factors when assessing antibiotic effects in randomized clinical trials.
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Affiliation(s)
- Junya Okumura
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichiro Shindo
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Sano
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuteru Sugino
- Department of Respiratory Medicine, Toyota Memorial Hospital, Toyota, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan
| | - Hiroyuki Taniguchi
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Hideo Saka
- Department of Respiratory Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Shigeyuki Matsui
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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174
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Bao A, Che KF, Bozinovski S, Ji J, Gregory JA, Kumlien Georén S, Adner M, Cardell LO, Lindén A. Recombinant human IL-26 facilitates the innate immune response to endotoxin in the bronchoalveolar space of mice in vivo. PLoS One 2017; 12:e0188909. [PMID: 29206862 PMCID: PMC5716532 DOI: 10.1371/journal.pone.0188909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/15/2017] [Indexed: 12/13/2022] Open
Abstract
Interleukin (IL)-26 is released in response to bacterial endotoxin (LPS) in the bronchoalveolar space of humans in vivo and it may potentiate neutrophil chemotaxis by enhanced IL-26 receptor stimulation. However, the effects of extracellular IL-26 protein on the innate immune response in the lungs in vivo remain unknown. Here, we characterized these effects of IL-26 on a wide range of aspects of the innate immune response to LPS in different compartments of the lungs in vivo over time. We administrated recombinant human (rh) IL-26 protein in the bronchoalveolar space using intranasal instillation in a mouse in vivo model, with and without prior instillation of LPS. We verified gene expression of the IL-26 receptor complex in mouse lungs and observed that, after instillation of LPS, rhIL-26 increases the phosphorylation of STAT3, a signaling molecule of the IL-26 receptor complex. We also observed that rhIL-26 exerted additional stimulatory and inhibitory actions that are compartment- and time-dependent, resulting in alterations of cytokines, proteinases, tissue inflammation and the accumulation of innate effector cells. Without the prior instillation of LPS, rhIL-26 exerted time-dependent effects on total gelatinase activity but few other effects. Most important, after instillation of LPS, rhIL-26 cleared inflammatory cells from local tissue and increased the accumulation of innate effector cells in the bronchoalveolar space. Tentatively, rhIL-26 may facilitate the innate immune response towards the bronchoalveolar space in vivo and represents a potential target for therapy in lung disorders involving the innate immune response.
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Affiliation(s)
- Aihua Bao
- Unit for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - Karlhans Fru Che
- Unit for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Steven Bozinovski
- RMIT University, School of Health and Biomedical Sciences, Bundoora, Victoria, Australia
| | - Jie Ji
- Unit for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joshua A Gregory
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Unit for Experimental Asthma and Allergy Research, Institute of Environmental Medicine, Stockholm, Sweden
| | - Susanna Kumlien Georén
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Division of ENT Diseases, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Adner
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Unit for Experimental Asthma and Allergy Research, Institute of Environmental Medicine, Stockholm, Sweden
| | - Lars-Olaf Cardell
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Division of ENT Diseases, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Anders Lindén
- Unit for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Lung Allergy Clinic, Karolinska University Hospital, Stockholm, Sweden
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175
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Kristensen M, Iversen AKS, Gerds TA, Østervig R, Linnet JD, Barfod C, Lange KHW, Sölétormos G, Forberg JL, Eugen-Olsen J, Rasmussen LS, Schou M, Køber L, Iversen K. Routine blood tests are associated with short term mortality and can improve emergency department triage: a cohort study of >12,000 patients. Scand J Trauma Resusc Emerg Med 2017; 25:115. [PMID: 29179764 PMCID: PMC5704435 DOI: 10.1186/s13049-017-0458-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prioritization of acutely ill patients in the Emergency Department remains a challenge. We aimed to evaluate whether routine blood tests can predict mortality in unselected patients in an emergency department and to compare risk prediction with a formalized triage algorithm. METHODS A prospective observational cohort study of 12,661 consecutive admissions to the Emergency Department of Nordsjælland University Hospital during two separate periods in 2010 (primary cohort, n = 6279) and 2013 (validation cohort, n = 6383). Patients were triaged in five categories by a formalized triage algorithm. All patients with a full routine biochemical screening (albumin, creatinine, c-reactive protein, haemoglobin, lactate dehydrogenase, leukocyte count, potassium, and sodium) taken at triage were included. Information about vital status was collected from the Danish Central Office of Civil registration. Multiple logistic regressions were used to predict 30-day mortality. Validation was performed by applying the regression models on the 2013 validation cohort. RESULTS Thirty-day mortality was 5.3%. The routine blood tests had a significantly stronger discriminative value on 30-day mortality compared to the formalized triage (AUC 88.1 [85.7;90.5] vs. 63.4 [59.1;67.5], p < 0.01). Risk stratification by routine blood tests was able to identify a larger number of low risk patients (n = 2100, 30-day mortality 0.1% [95% CI 0.0;0.3%]) compared to formalized triage (n = 1591, 2.8% [95% CI 2.0;3.6%]), p < 0.01. CONCLUSIONS Routine blood tests were strongly associated with 30-day mortality in acutely ill patients and discriminatory ability was significantly higher than with a formalized triage algorithm. Thus routine blood tests allowed an improved risk stratification of patients presenting in an emergency department.
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Affiliation(s)
- Michael Kristensen
- Department of Emergency Medicine, Sjællands Universitetshospital Køge, Køge, Denmark.,Department of Cardiology, Endocrinology and Nephrology, Nordsjællands Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Kristine Servais Iversen
- Department of Cardiology, Endocrinology and Nephrology, Nordsjællands Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Rebecca Østervig
- Department of Cardiology, Endocrinology and Nephrology, Nordsjællands Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jakob Danker Linnet
- Department of Anaesthesia, Sjællands Universitetshospital Køge, Køge, Denmark
| | - Charlotte Barfod
- Department of Anaesthesia, Centre of Head and Orthopaedics Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jakob Lundager Forberg
- Department of Prehospital and In-Hospital Emergency Medicine - Helsingborg Hospital, Helsingborg, Sweden
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lars Simon Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Endocrinology and Nephrology, Nordsjællands Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Endocrinology and Nephrology, Nordsjællands Hospital, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
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176
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Athlin S, Lidman C, Lundqvist A, Naucler P, Nilsson AC, Spindler C, Strålin K, Hedlund J. Management of community-acquired pneumonia in immunocompetent adults: updated Swedish guidelines 2017. Infect Dis (Lond) 2017; 50:247-272. [PMID: 29119848 DOI: 10.1080/23744235.2017.1399316] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Based on expert group work, Swedish recommendations for the management of community-acquired pneumonia in adults are here updated. The management of sepsis-induced hypotension is addressed in detail, including monitoring and parenteral therapy. The importance of respiratory support in cases of acute respiratory failure is emphasized. Treatment with high-flow oxygen and non-invasive ventilation is recommended. The use of statins or steroids in general therapy is not found to be fully supported by evidence. In the management of pleural infection, new data show favourable effects of tissue plasminogen activator and deoxyribonuclease installation. Detailed recommendations for the vaccination of risk groups are afforded.
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Affiliation(s)
- Simon Athlin
- a Department of Infectious Diseases , Örebro University Hospital , Örebro , Sweden.,b Faculty of Medicin and Health , Örebro University , Örebro , Sweden
| | - Christer Lidman
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Anders Lundqvist
- e Department of Infectious Diseases , Södra Älvsborgs Hospital , Borås , Sweden
| | - Pontus Naucler
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Anna C Nilsson
- f Infectious Disease Research Unit, Department of Translational Medicine , Lund University , Malmö , Sweden
| | - Carl Spindler
- d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Kristoffer Strålin
- b Faculty of Medicin and Health , Örebro University , Örebro , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,g Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Jonas Hedlund
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
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177
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Jiang M, Karasawa T, Steyger PS. Aminoglycoside-Induced Cochleotoxicity: A Review. Front Cell Neurosci 2017; 11:308. [PMID: 29062271 PMCID: PMC5640705 DOI: 10.3389/fncel.2017.00308] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/15/2017] [Indexed: 12/20/2022] Open
Abstract
Aminoglycoside antibiotics are used as prophylaxis, or urgent treatment, for many life-threatening bacterial infections, including tuberculosis, sepsis, respiratory infections in cystic fibrosis, complex urinary tract infections and endocarditis. Although aminoglycosides are clinically-essential antibiotics, the mechanisms underlying their selective toxicity to the kidney and inner ear continue to be unraveled despite more than 70 years of investigation. The following mechanisms each contribute to aminoglycoside-induced toxicity after systemic administration: (1) drug trafficking across endothelial and epithelial barrier layers; (2) sensory cell uptake of these drugs; and (3) disruption of intracellular physiological pathways. Specific factors can increase the risk of drug-induced toxicity, including sustained exposure to higher levels of ambient sound, and selected therapeutic agents such as loop diuretics and glycopeptides. Serious bacterial infections (requiring life-saving aminoglycoside treatment) induce systemic inflammatory responses that also potentiate the degree of ototoxicity and permanent hearing loss. We discuss prospective clinical strategies to protect auditory and vestibular function from aminoglycoside ototoxicity, including reduced cochlear or sensory cell uptake of aminoglycosides, and otoprotection by ameliorating intracellular cytotoxicity.
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Affiliation(s)
- Meiyan Jiang
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Takatoshi Karasawa
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States
| | - Peter S Steyger
- Oregon Hearing Research Center, Oregon Health & Science University, Portland, OR, United States.,National Center for Rehabilitative Auditory Research, Portland VA Medical Center (VHA), Portland, OR, United States
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178
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Liu F, Wen Z, Wei J, Xue H, Chen Y, Gao W, Melnick D, Gonzalez J, Hackett J, Li X, Deng S, Cao Z. Epidemiology, microbiology and treatment implications in adult patients hospitalized with pneumonia in different regions of China: a retrospective study. J Thorac Dis 2017; 9:3875-3887. [PMID: 29268397 DOI: 10.21037/jtd.2017.09.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Data describing epidemiology, clinical outcomes and treatment patterns, of hospitalised patients with pneumonia in China are limited. We aimed to describe such information among adult pneumonia patients in southern and northern China. Methods We retrospectively reviewed electronic medical records of pneumonia patients aged ≥18 years, hospitalized between 2008 and 2013 at Guangdong Provincial Hospital of Chinese Medicine (n=3,636), southern China, and between 2010 and 2014 at Peking University People's Hospital, Beijing (n=1,689), northern China, in order to collect data on patient demographics, microbiology, clinical outcomes and treatment and resistance patterns. Results The mean (SD) age of patients was 60.0 (21.4) and 64.4 (18.4) years in Guangdong and Beijing, respectively. Mean length of hospital stay was 12.1 and 20.8 days, and overall mortality was 2.9% and 8.0%, respectively. Gram-negative bacilli were most frequently isolated, predominantly Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. Infection with these bacteria was associated with unfavourable clinical outcomes, and the antibiotic resistance among these bacteria increased between 2008-2010 and 2011-2013 in both regions of China. The treatment and choice of antibiotics slightly varied between the two regions based on the susceptible pathogens identified among their populations. Conclusions Of the pathogens identified, Staphylococcus aureus infection (particularly the methicillin-resistant S. aureus) was associated with poor clinical outcomes; however antibiotic resistance among S. aureus generally decreased during the study data collection periods. Also, disease severity was greater in Beijing as compared with Guangdong, and this may be associated with higher microbiological diagnosis rate and higher frequency of initial antibiotic modification among Beijing populations.
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Affiliation(s)
- Fan Liu
- People's Hospital, Peking University, Beijing 100044, China
| | - Zehuai Wen
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Jia Wei
- AstraZeneca R & D Information, AstraZeneca China, Shanghai 201203, China
| | - Huiling Xue
- AstraZeneca R & D Information, AstraZeneca China, Shanghai 201203, China
| | - Yunqin Chen
- AstraZeneca R & D Information, AstraZeneca China, Shanghai 201203, China
| | - Weiguo Gao
- AstraZeneca R & D Information, AstraZeneca China, Shanghai 201203, China
| | | | | | | | - Xiaoyan Li
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Shizhou Deng
- People's Hospital, Peking University, Beijing 100044, China
| | - Zhaolong Cao
- People's Hospital, Peking University, Beijing 100044, China
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179
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Lopez-Mendoza D. Mortality prediction in community-acquired pneumonia: Simplifying reliable tools may be worth it. Respirology 2017; 22:1247-1248. [DOI: 10.1111/resp.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 05/22/2017] [Indexed: 11/30/2022]
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180
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Predictive value of procalcitonin for diagnosis of infections in patients with chronic kidney disease: a comparison with traditional inflammatory markers C-reactive protein, white blood cell count, and neutrophil percentage. Int Urol Nephrol 2017; 49:2205-2216. [DOI: 10.1007/s11255-017-1710-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/22/2017] [Indexed: 01/21/2023]
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181
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Marti C, John G, Genné D, Prendki V, Rutschmann OT, Stirnemann J, Garin N. Time to antibiotics administration and outcome in community-acquired pneumonia: Secondary analysis of a randomized controlled trial. Eur J Intern Med 2017. [PMID: 28648477 DOI: 10.1016/j.ejim.2017.06.012] [Citation(s) in RCA: 9] [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] [Indexed: 10/19/2022]
Abstract
BACKGROUND The association between early antibiotic administration and outcomes remains controversial in patients hospitalized for community-acquired pneumonia. METHODS We performed a secondary analysis of a randomized controlled trial comparing two antibiotic treatment strategies for patients hospitalized for moderately severe CAP. The univariate and multivariate associations between time to antibiotic administration (TTA) and time to clinical stability were assessed using a Cox proportional hazard model. Secondary outcomes were death, intensive care unit admission and hospital readmission up to 90days. RESULTS 371 patients (mean age 76years, CURB-65 score≥2 in 52%) were included. Mean TTA was 4.35h (SD 3.48), with 58.5% of patients receiving the first antibiotic dose within 4h. In multivariate analysis, number of symptoms and signs (HR 0.876, 95% CI 0.784-0.979, p=0.020), age (HR 0.986, 95% CI 0.975-0.996, p=0.007), initial heart rate (HR 0.992, 95% CI 0.986-0.999, p=0.023), and platelets count (HR 0.998, 95% CI 0.996-0.999, p=0.004) were associated with a reduced probability of reaching clinical stability. The association between TTA and time to clinical stability was not significant (HR 1.009, 95% CI 0.977-1.042, p=0.574). We found no association between TTA and the risk of intensive care unit admission, death or readmission up to 90days after the initial admission. CONCLUSION In patients hospitalized for moderately severe CAP, a shorter time to antibiotic administration was not associated with a favorable outcome. These findings support the current recommendations that do not assign a specific time frame for antibiotics administration.
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Affiliation(s)
- Christophe Marti
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Switzerland.
| | - Gregor John
- Department of Internal Medicine, Hôpital Neuchâtelois and Geneva University Hospitals, Switzerland.
| | - Daniel Genné
- Division of Internal Medicine, Centre Hospitalier de Bienne, Bienne, Switzerland.
| | - Virginie Prendki
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Switzerland.
| | - Olivier T Rutschmann
- Department of Community, Primary Care and Emergency Medicine, Division of Emergency Medicine, Geneva University Hospitals, Switzerland.
| | - Jérôme Stirnemann
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Switzerland.
| | - Nicolas Garin
- Department of General Internal Medicine, Riviera Chablais Hospitals and Geneva University Hospitals, Switzerland.
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182
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Ultrasound: Can it replace CT in the evaluation of pneumonia in pediatric age group? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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183
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Kocsis B, Szabo D. New treatment options for lower respiratory tract infections. Expert Opin Pharmacother 2017; 18:1345-1355. [DOI: 10.1080/14656566.2017.1363179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bela Kocsis
- Institute of Medical Microbiology, Semmelweis University , Budapest, Hungary
| | - Dora Szabo
- Institute of Medical Microbiology, Semmelweis University , Budapest, Hungary
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184
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He C, Wang B, Li D, Xu H, Shen Y. Performance of procalcitonin in diagnosing parapneumonic pleural effusions: A clinical study and meta-analysis. Medicine (Baltimore) 2017; 96:e7829. [PMID: 28816982 PMCID: PMC5571719 DOI: 10.1097/md.0000000000007829] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Parapneumonic pleural effusion (PPE) is a common complication of pneumonia. The accurate diagnosis of PPE remains a challenge. Recent studies suggest that procalcitonin (PCT) emerges as a potential biomarker for PPE. Our study aimed to determine the diagnostic value of PCT for PPE by a clinical study and summarize the overall diagnostic performance of PCT through a meta-analysis. METHODS Demographic and clinical data of the patients with PPE and controls were collected in our clinical study. The diagnostic performances of serum PCT (s-PCT) were analyzed via receiver operating characteristic (ROC) curve analysis, using area under the curve (AUC) as a measure of accuracy. Literature databases were systematically searched for the studies examining the accuracy of PCT for diagnosing PPE. Data on sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR) were pooled. Summary ROC curves and AUC were used to evaluate overall test performance. RESULTS In our clinical study, 47 patients with PPE and 101 controls were included. The s-PCT levels were significantly increased in the setting of PPE (5.44 ± 9.82 ng/mL) compared with malignant PE (0.15 ± 0.19 ng/mL), tuberculous PE (0.18 ± 0.16 ng/mL), and transudates (0.09 ± 0.03 ng/mL) (P < .001). Using a cutoff value of 0.195 ng/mL, the sensitivity and specificity of s-PCT in diagnosing PPE were 0.83 and 0.80, respectively, and AUC was 0.89. In addition, 11 studies were included in our meta-analysis. Summary performance estimates for s-PCT in diagnosing PPE were as follows: sensitivity, 0.78 (95% CI: 0.71-0.84); specificity, 0.74 (95% CI: 0.69-0.78); PLR, 3.46 (95% CI: 2.09-5.74); NLR, 0.27 (95% CI: 0.14-0.54); DOR, 12.37 (95% CI: 4.34-41.17); and AUC, 0.84. The corresponding estimates for p-PCT were as follows: sensitivity, 0.62 (95% CI: 0.57-0.67); specificity, 0.71 (95% CI: 0.68-0.75); PLR 2.31 (95% CI: 1.81-2.95); NLR, 0.47 (95% CI: 0.35-0.63); DOR, 5.48 (95% CI: 3.07-9.77); and AUC, 0.80. CONCLUSION Both s-PCT and p-PCT might have modest performance in diagnosing PPE. However, more studies on a large scale should be performed to confirm our findings.
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Affiliation(s)
- Chao He
- Department of Laboratory Medicine
| | | | - Danni Li
- Department of Laboratory Medicine
| | - Huan Xu
- Department of Laboratory Medicine
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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185
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Hill JD, Anderegg SV, Couldry RJ. Development of a Pharmacy Technician-Driven Program to Improve Vaccination Rates at an Academic Medical Center. Hosp Pharm 2017; 52:617-622. [PMID: 29276298 DOI: 10.1177/0018578717722788] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Influenza and pneumococcal disease contribute substantially to the burden of preventable disease in the United States. Despite quality measures tied to immunization rates, health systems have struggled to achieve these targets in the inpatient setting. Pharmacy departments have had success through implementation of pharmacist standing order programs (SOP); however, these initiatives are labor-intensive and have not resulted in 100% immunization rates. Objective: The objective of this study was to evaluate a pilot utilizing pharmacy technician interventions, in combination with a nursing SOP, to improve vaccination rates of hospitalized patients for influenza and pneumococcal disease. Methods: A process was developed for pharmacy technicians to identify patients who were not previously screened or immunized during the weekend days on the Cardiovascular Progressive Care unit at the University of Kansas Health-System. Targeted pharmacy technician interventions consisted of phone call reminders and face-to-face discussions with nursing staff. The primary study outcome was the change in immunization compliance rates between the control and intervention groups. Results: Influenza vaccine rates showed a statistically significant increase from 72.2% (52 of 72) of patients during the control group to 92.9% (65 of 70, P = .001) of patients during the intervention group. A pneumococcal vaccination rate of 81.3% (61 of 75) was observed in the control group, compared with 84.3% (59 of 70) of patients in the intervention group (P = .638). Conclusion: An improvement in inpatient influenza immunization rates can be achieved through targeted follow-up performed by pharmacy technicians, in combination with a nursing-driven SOP.
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Affiliation(s)
- John D Hill
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Rick J Couldry
- The University of Kansas Health-System, Kansas City, KS, USA
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186
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Asai N, Suematsu H, Hagihara M, Nishiyama N, Kato H, Sakanashi D, Koizumi Y, Yamagishi Y, Mikamo H. The etiology and bacteriology of healthcare-associated empyema are quite different from those of community-acquired empyema. J Infect Chemother 2017; 23:661-667. [PMID: 28751154 DOI: 10.1016/j.jiac.2017.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/22/2017] [Accepted: 04/21/2017] [Indexed: 11/29/2022]
Abstract
OBJECTS Changes in patients' background and life environment could contribute to increase healthcare-associated (HCA) empyema. There are no guidelines and statements for HCA empyema. METHODS We retrospectively reviewed all patients with empyema who were admitted to the Aichi Medical University Hospital, Japan between 2008 and 2015. We evaluated patients' characteristics, microbial profiles, treatment and outcomes, and analyzed prognostic factors for 90-day mortality. RESULTS A total of 48 patients were enrolled in this study. They were categorized into community-acquired (CA) empyema (16 patients) and healthcare-associated (HCA) empyema (32 patients). HCA empyema patients had higher Charlson comorbidity index (CCI) scores, and poorer performance status (PS) than CA empyema patients. Potentially-drug resistant (PDR) pathogens were seen more frequently in HCA empyema than in CA empyema. Compared with survival and death groups, the death group showed higher CCI scores and poorer PSs than the survival group. The death group had more malignancy than the survival group. PDR pathogens were detected more frequently in the death group than in the survival group. Multivariate analysis showed that emergence of PDR pathogens and malignancies were independent poor prognostic factors for 90-days mortality among empyema. CONCLUSION The etiology and bacteriology of HCA empyema are quite different from those of CA empyema. Especially, the mortality of HCA empyema was higher than the one of CA empyema. Emergence of PDR pathogens in the pleural fluid detected by culture, pulmonary disease and malignancies were independent poor prognostic factors among CA and HCA empyema by multivariate logistic regression analysis.
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Affiliation(s)
- Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
| | - Hiroyuki Suematsu
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
| | - Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
| | - Naoya Nishiyama
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
| | - Hideo Kato
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
| | - Daisuke Sakanashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
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187
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Can Chest Computed Tomography Be Replaced by Lung Ultrasonography With or Without Plain Chest Radiography in Pediatric Pneumonia? J Thorac Imaging 2017; 31:247-52. [PMID: 27075744 DOI: 10.1097/rti.0000000000000209] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE The purpose of this study was to answer the following question: can chest computed tomography (CT) requested by pediatricians be replaced by lung ultrasonography (US) with or without chest radiography in pediatric pneumonia? MATERIALS AND METHODS A total of 98 children with suspected pneumonia who were referred by pediatricians for CT examinations were prospectively studied. Levels of agreement between CT findings and plain radiography, lung US, and chest radiography plus lung US results were investigated. RESULTS CT defined pneumonia in 84 patients, among which 26 cases were complicated. κ values between radiography and CT findings were 0.82 in complicated cases, 0.67 in uncomplicated cases, and 0.72 overall. The corresponding values between US and CT findings were 1, 0.52, and 0.62, respectively, and between radiography plus US and CT findings were 1, 0.86, and 0.88, respectively. CONCLUSIONS CT can be replaced by US when complex effusions are present in children with pneumonia. In case of an ambiguous diagnosis of pediatric pneumonia with or without complex effusions, a combination of chest radiography and US is a reliable surrogate for chest CT.
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188
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Nickler M, Ottiger M, Steuer C, Kutz A, Christ-Crain M, Zimmerli W, Thomann R, Hoess C, Henzen C, Bernasconi L, Huber A, Mueller B, Schuetz P. Time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:72. [PMID: 28335807 PMCID: PMC5364618 DOI: 10.1186/s13054-017-1656-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/28/2017] [Indexed: 01/21/2023]
Abstract
Background The hypothalamic-pituitary-adrenal stress axis plays a crucial role in community-acquired pneumonia (CAP), with high cortisol being associated with disease severity and corticosteroid treatment resulting in earlier time to recovery. Our aim in the present study was to compare different glucocorticoid hormones, including cortisol, 11-deoxycortisol, cortisone, and corticosterone, regarding their association with short- and long-term adverse outcomes in a well-defined CAP cohort. Methods We prospectively followed 285 patients with CAP from a previous Swiss multicenter trial for a median of 6.1 years and measured different admission glucocorticoid serum levels by liquid chromatography coupled with tandem mass spectrometry. We used adjusted Cox regression models to investigate associations between admission hormone levels and all-cause mortality at different time points. Results Mortality was 5.3% after 30 days and increased to 47.3% after 6 years. High admission cortisol was associated with adverse outcome after 30 days (adjusted OR 3.85, 95% CI 1.10–13.49, p = 0.035). In the long term (i.e.,), however, high admission cortisol was associated with better survival (adjusted HR after 3 years 0.53, 95% CI 0.32–0.89, p = 0.017; adjusted HR after 6 years 0.57, 95% CI 0.36–0.90, p = 0.015). Compared with 11-deoxycortisol, cortisone, and corticosterone, cortisol showed the highest association with mortality. Conclusions Among different glucocorticoid hormones, cortisol showed the highest association with mortality in CAP. Whereas a more pronounced glucocorticoid stress response on hospital admission was associated with higher short-term adverse outcome, long-term outcome was favorable in these patients. These data should support the correct interpretation of glucocorticoid blood data. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1656-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manuela Nickler
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Manuel Ottiger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian Steuer
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Werner Zimmerli
- Basel University Medical Clinic Liestal, Liestal, Switzerland
| | - Robert Thomann
- Department of Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Claus Hoess
- Department of Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Christoph Henzen
- Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Luca Bernasconi
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland. .,Medical Faculty, University of Basel, Basel, Switzerland.
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Kudo K, Manabe T, Izumi S, Takasaki J, Fujikura Y, Kawana A, Yamamoto K. Markers of Disease Severity in Patients with Spanish Influenza in the Japanese Armed Forces, 1919-1920. Emerg Infect Dis 2017; 23:662-664. [PMID: 28322699 PMCID: PMC5367422 DOI: 10.3201/eid2304.152097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We examined preserved medical charts of 470 Spanish influenza patients (8 with fatal cases) hospitalized at former army hospitals in Japan during 1919–1920. The following factors were associated with longer periods of hospitalization: adventitious discontinuous lung sounds, maximum respiration rate, continuation of high fever after hospital admission, and diphasic fever.
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190
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Çiftci F, Çiledağ A, Erol S, Kaya A. Non-invasive ventilation for acute hypercapnic respiratory failure in older patients. Wien Klin Wochenschr 2017; 129:680-686. [DOI: 10.1007/s00508-017-1182-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/12/2017] [Indexed: 10/20/2022]
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191
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Wang KC, Liu PH, Yu KH, Weng YM, Ng CJ, Chiu TF, Chen SY. Is initial C-reactive protein level associated with corticosteroid use in lupus erythematosus patients during a bacterial infection episode? Immunol Lett 2017; 185:84-89. [PMID: 28286229 DOI: 10.1016/j.imlet.2017.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/08/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE C-reactive protein (CRP), a marker for inflammation, indicates bacterial infection in systemic lupus erythematosus (SLE) when markedly elevated. Our study investigated the association of regular corticosteroid or immunosuppressant use with initial CRP level in febrile SLE patients with bacterial infection. METHODS This retrospective cohort study included adult SLE patients (18 years of age or older) who presented with fever at the emergency department from January 2008 to December 2012. Data were retrieved from our institutional database. RESULTS CRP levels in the total 193 patient database were significantly increased in the bacterial infection group compared to the no infection and non-bacterial infection groups. Seventy-eight (86.7%) of the 90 patients in the bacterial infection group took regular corticosteroids (mean equivalent dose of prednisolone 0.33±0.26mg/kg/day) and 55 (61.1%) used immunosuppressants. Mean CRP level in the bacterial infection group was 97.8mg/L. CRP level was lower in patients using corticosteroids, but the difference between users and nonusers of corticosteroids was not statistically significant (p=0.367). The difference in CRP level between immunosuppressant and non-immunosuppressant users was also not significant (p=0.599). The Spearman test found no correlation between corticosteroid dosage and CRP level (p=0.911). CONCLUSION Initial CRP level was not significantly associated with regular corticosteroid or immunosuppressant use in SLEs patients during a bacterial infection episode, and CRP level was not dose-dependently related to daily corticosteroid use. An elevated CRP level might be an appropriate marker for bacterial infection at the emergency department for febrile SLE patients.
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Affiliation(s)
- Kuo-Cheng Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan
| | - Peng-Huei Liu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linko, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan
| | - Te-Fa Chiu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan.
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Garg M, Prabhakar N, Kiruthika P, Agarwal R, Aggarwal A, Gulati A, Khandelwal N. Imaging of Pneumonia: An Overview. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0209-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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193
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Uwaezuoke SN, Ayuk AC. Prognostic scores and biomarkers for pediatric community-acquired pneumonia: how far have we come? PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2017; 8:9-18. [PMID: 29388605 PMCID: PMC5774590 DOI: 10.2147/phmt.s126001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article aimed to review the current prognostic and diagnostic tools used for community-acquired pneumonia (CAP) and highlight those potentially applicable in children with CAP. Several scoring systems have been developed to predict CAP mortality risk and serve as guides for admission into the intensive care unit. Over the years, clinicians have adopted these tools for improving site-of-care decisions because of high mortality rates in the extremes of age. The major scoring systems designed for geriatric patients include the Pneumonia Severity Index and the confusion, uremia, respiratory rate, blood pressure, age >65 years (CURB-65) rule, as well as better predictors of intensive care unit admission, such as the systolic blood pressure, multilobar chest radiography involvement, albumin level, respiratory rate, tachycardia, confusion, oxygenation and arterial pH (SMART-COP) score, the Infectious Diseases Society of America/American Thoracic Society guidelines, the criteria developed by España et al as well as the systolic blood pressure, oxygenation, age and respiratory rate (SOAR) criteria. Only the modified predisposition, insult, response and organ dysfunction (PIRO) score has so far been applied to children with CAP. Because none of the tools is without its limitations, there has been a paradigm shift to incorporate biomarkers because they are reliable diagnostic tools and good predictors of disease severity and outcome, irrespective of age group. Despite the initial preponderance of reports on their utility in geriatric CAP, much progress has now been made in demonstrating their usefulness in pediatric CAP.
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Affiliation(s)
| | - Adaeze C Ayuk
- Pediatric Pulmonology Firm, Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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194
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Rubinstein E, Lagacé-Wiens P. Quinolones. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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195
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Rogan M. Respiratory Infections, Acute. INTERNATIONAL ENCYCLOPEDIA OF PUBLIC HEALTH 2017. [PMCID: PMC7150086 DOI: 10.1016/b978-0-12-803678-5.00383-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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196
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Pulmonary Infections: Pneumonia. MRI OF THE LUNG 2017. [PMCID: PMC7176241 DOI: 10.1007/174_2017_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The different appearances of pneumonia such as ill-defined nodules, ground-glass opacities, and consolidations can be easily detected and differentiated with MRI. Since very small nodules and calcifications are extremely challenging due to rather thick slices and loss of signal, MRI is highly recommended as a follow-up tool, to avoid repetitive investigations using ionizing radiation. With the sensitivity of T2-weighted sequences and the potential of contrast-enhanced T1-weighted sequences, important differential diagnostic considerations can be provided. Additionally, developing complications, such as pericardial or pleural effusions, empyema or lung abscess, are easily recognized. Current and future studies are to demonstrate that MRI is well suited as a monitoring and follow-up tool during and after therapy and compares favorably with CT or other imaging methods regarding sensitivity and specificity.
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197
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Ito A, Ishida T, Tokumasu H, Washio Y, Yamazaki A, Ito Y, Tachibana H. Impact of procalcitonin-guided therapy for hospitalized community-acquired pneumonia on reducing antibiotic consumption and costs in Japan. J Infect Chemother 2016; 23:142-147. [PMID: 28024740 DOI: 10.1016/j.jiac.2016.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/09/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE This study aimed to investigate the usefulness of procalcitonin-guided therapy in hospitalized community-acquired pneumonia patients to reduce antibiotic duration and costs without worsening prognosis. METHODS 352 hospitalized community-acquired pneumonia patients in an observational cohort study in which procalcitonin was measured three times serially, on admission (Day 1) and 2-3 days (Day 3) and 6-8 days (Day 7) after admission, between October 2010 and February 2016 were reviewed retrospectively. Antibiotics could be stopped if Day 7 procalcitonin was <0.25 ng mL-1 or ≤10% of the higher value of procalcitonin on Day 1 or 3. Antibiotic duration and costs and recurrence and mortality rates were evaluated in mild to moderate or severe pneumonia by theoretical procalcitonin guidance for community-acquired pneumonia treatment. RESULTS Using theoretical procalcitonin guidance, antibiotic duration could be reduced from 12.6 to 8.6 days (P < 0.001), while costs could be reduced from 45,833 to 38,952 yen (P = 0.005). Among the patients in whom theoretical procalcitonin guidance could be adopted, recurrence rates (5.6% vs. 8.1%, P = 0.15) and mortality rates (0% vs. 5.1%, P = 0.07) did not worsen between the group having the same antibiotic durations as with theoretical procalcitonin guidance in actual practice (N = 71) and the group having durations more than 2 days longer in actual practice than in theoretical procalcitonin guidance (N = 198). There was no significant difference in pneumonia severity using A-DROP, CURB-65, and PSI between two groups. CONCLUSIONS Procalcitonin-guided therapy may be useful in hospitalized community-acquired pneumonia patients to reduce antibiotic duration and costs without worsening the prognosis.
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan.
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Hironobu Tokumasu
- Department of Clinical Research Institute, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Yasuyoshi Washio
- Department of Respiratory Medicine, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Akio Yamazaki
- Department of Respiratory Medicine, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Yuhei Ito
- Department of Respiratory Medicine, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Hiromasa Tachibana
- Department of Respiratory Medicine, National Hospital Organization Minami Kyoto Hospital, Kyoto, Japan
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Abstract
Community-acquired pneumonia (CAP) is a world wide cause of morbidity and mortality. The etiology of CAP is different between countries and changes over time. With the increasing incidence, atypical pathogens are attracting more and more attention all over the world. In many countries, atypical pathogens are one of the main pathogens of CAP, and even could be the most prevalent etiology in China. Atypical pathogen infections can cause multi-system complications, which leads to a worse prognosis. Although still controversial, empirical antibiotic coverage of atypical pathogens in CAP may improve outcomes, shorten length of hospitalization, reduce mortality and lower total hospitalization costs. The macrolide resistance rate of atypical pathogens, especially Mycoplasma Pneumoniae (M. Pneumoniae) is high, so fluoroquinolones or tetracyclines should be considered as alternative therapy.
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Affiliation(s)
- Yun Yu
- Department of Emergency, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine
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199
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Chou SC, Ko HW, Lin YC. CRP/IL-6/IL-10 Single-Nucleotide Polymorphisms Correlate with the Susceptibility and Severity of Community-Acquired Pneumonia. Genet Test Mol Biomarkers 2016; 20:732-740. [DOI: 10.1089/gtmb.2016.0156] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Shou-Chu Chou
- Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - How-Wen Ko
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ying-Chin Lin
- Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Popovic M, Blum CA, Nigro N, Mueller B, Schuetz P, Christ-Crain M. Benefit of adjunct corticosteroids for community-acquired pneumonia in diabetic patients. Diabetologia 2016; 59:2552-2560. [PMID: 27614658 DOI: 10.1007/s00125-016-4091-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
Abstract
AIMS/HYPOTHESIS We have recently shown that adjunct prednisone shortens the time taken to reach clinical stability (time to clinical stability, TTCS) in patients with community-acquired pneumonia (CAP). Considering the hyperglycaemic effects of prednisone, there are concerns about the efficacy and safety of this therapy for diabetic patients with CAP. Our objective was to evaluate whether diabetes and/or hyperglycaemia on admission to hospital has an influence on the effect of corticosteroids on outcome in a well-defined cohort of patients with CAP. METHODS This is a preplanned subanalysis of a prospective randomised, double-blind placebo-controlled multicentre trial. Patients aged 18 years or older with CAP were eligible and were recruited from seven tertiary care hospitals in Switzerland within 24 h of presentation. Patients were randomised (1:1 ratio) to receive either 50 mg of prednisone daily for 7 days or placebo. Allocation was concealed with a prespecified computer-generated randomisation list. Patients, treating physicians, investigators and data assessors were masked to treatment allocation. The primary endpoint was TTCS; secondary endpoints were length of stay, mortality, duration of antibiotic treatment, CAP complications and new insulin requirement at day 30. Furthermore, we analysed whether these endpoints were influenced by a glycaemic dysregulation during the study time. RESULTS Of 802 patients randomised (n = 402 in the prednisone, n = 400 in the placebo group), 726 patients were treated per protocol and included in this analysis (n = 362 in the prednisone, n = 364 in the placebo group). Nineteen per cent of 726 patients had diabetes mellitus (n = 66 in the prednisone group, n = 72 in the placebo group). Adjunct prednisone shortened TTCS in diabetic and non-diabetic patients (HR 1.65 [95% CI 1.16, 2.35], p = 0.007; 1.30 [95% CI 1.10, 1.53], p = 0.002) with no evidence for effect modification by diabetes in interaction analysis (p = 0.44). No difference was found in other clinically relevant endpoints. Although adjunct prednisone was associated with glycaemic dysregulation, this did not translate into worse clinical outcomes in either group, and there was no difference in secondary endpoints. CONCLUSIONS/INTERPRETATION The benefit of adjunct prednisone in CAP patients is also valid for those with diabetes or hyperglycaemia on admission. Hyperglycaemia in diabetic patients or due to adjunct prednisone did not have a negative effect on outcome. TRIAL REGISTRATION ClinicalTrials.gov NCT00973154 FUNDING : This study was supported by a grant from the Swiss National Foundation and by the Nora van Meeuwen Häfliger Stiftung and the Gottfried Julia Bangerter-Rhyner Stiftung.
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Affiliation(s)
- Milica Popovic
- Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Claudine A Blum
- Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Medical University Clinic, Departments of Internal and Emergency Medicine and Department of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Aarau, Switzerland
| | - Nicole Nigro
- Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Beat Mueller
- Medical University Clinic, Departments of Internal and Emergency Medicine and Department of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Medical University Clinic, Departments of Internal and Emergency Medicine and Department of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
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