201
|
Wang L, Feng Z, Shuai J, Liu J, Li G. Risk factors of 90-day rehospitalization following discharge of pediatric patients hospitalized with mycoplasma Pneumoniae pneumonia. BMC Infect Dis 2019; 19:966. [PMID: 31718584 PMCID: PMC6852903 DOI: 10.1186/s12879-019-4616-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Among pediatric patients hospitalized for Mycoplasma pneumoniae pneumonia (MPP), the risk factors for 90-day readmission after discharge is undefined. Methods We conducted a retrospective observational study of patients <14 years of age who were discharged with a diagnosis of MPP between January 2016 and February 2017. We collected clinical, laboratory and radiographic variables at the time of initial admission. We assessed pneumonia-related readmission within 90-day after discharge. Risk factors independently associated with rehospitalization were identified using multiple logistic regression models. Results Of the 424 MPP hospitalizations, 48 (11.3%) were readmitted within 90 days and were mainly diagnosed with pneumonia. Patients with younger age or coinfection with influenza A were more likely to be readmitted. In addition, compared with children without readmission, the readmission ones showed different clinical and laboratory characteristics at the index hospital admission. Multiple logistic regression analysis identified age (OR 0.815, 95%CI 0.706–0.940) and body temperature (OR 0.659, 95%CI 0.518–0.839) were significantly associated with lower risk of 90-day readmission. Coinfection with influenza was independently associated with a greater likelihood of 90-day readmission (OR 4.746, 95%CI 1.191–18.913). Conclusions Readmission after MPP are common and is related to patients’ age, body temperature and influenza A coinfection during initial hospital stay, indicating potential targets could be noticed to reduce the rehospitalization after pediatric MPP.
Collapse
Affiliation(s)
- Le Wang
- Institute of Pediatric Research, Children's Hospital of Hebei Province, 133 Jianhua South Street, Shijiazhuang, 050031, Hebei Province, China
| | - Zhishan Feng
- Hebei General Hospital, Shijiazhuang, 050000, China
| | - Jinfeng Shuai
- No.2 Department of Respiratory, Children's Hospital of Hebei Province, 133 Jianhua South Street, Shijiazhuang, 050031, Hebei Province, China
| | - Jianhua Liu
- No.2 Department of Respiratory, Children's Hospital of Hebei Province, 133 Jianhua South Street, Shijiazhuang, 050031, Hebei Province, China.
| | - Guixia Li
- Institute of Pediatric Research, Children's Hospital of Hebei Province, 133 Jianhua South Street, Shijiazhuang, 050031, Hebei Province, China.
| |
Collapse
|
202
|
Gaydos J, McNally A, Burnham EL. The impact of alcohol use disorders on pulmonary immune cell inflammatory responses to Streptococcus pneumoniae. Alcohol 2019; 80:119-130. [PMID: 30195043 DOI: 10.1016/j.alcohol.2018.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 12/11/2022]
Abstract
Community-acquired pneumonia due to Streptococcus pneumoniae occurs commonly in alcohol use disorders (AUDs). Pneumonia in the AUD patient is associated with poorer outcomes, and specific therapies to mitigate disease severity in these patients do not exist. Numerous investigations have attributed increased severity of pneumonia in AUDs to aberrant function of the alveolar macrophage (AM), a lung immune cell critical in host defense initiation. No studies have examined the response of human AMs to S. pneumoniae in AUDs. We hypothesized that the inflammatory mediators released by AMs after S. pneumoniae stimulation would differ quantitatively in individuals with AUDs compared to non-AUD participants. We further postulated that AM inflammatory mediators would be diminished after exposure to the antioxidant, N-acetylcysteine (NAC). For comparison, responses of peripheral blood mononuclear cells (PBMCs) to pneumococcal protein were also examined. Otherwise healthy participants with AUDs and smoking-matched controls underwent bronchoalveolar lavage and peripheral blood sampling to obtain AMs and PBMCs, respectively. Freshly collected cells were cultured with increasing doses of heat-killed S. pneumoniae protein, with and without exposure to N-acetylcysteine. Cell culture supernatants were collected, and inflammatory mediators were measured, including interferon (IFN)-γ, interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α. IFN-γ and IL-6 were significantly higher in unstimulated AM cell culture supernatants from subjects with AUDs. After stimulation with pneumococcal protein, a dose-response and time-dependent increase in pro-inflammatory cytokine production by both AMs and PBMCs was also observed; differences were not observed between AUD and non-AUD subjects. Addition of NAC to pneumococcal-stimulated AMs and PBMCs was generally associated with diminished cytokine production, with the exception of IL-1β that was elevated in AM culture supernatants from subjects with AUDs. Our observations suggest that AUDs contribute to basal alterations in AM pro-inflammatory cytokine elaboration, but did not support consistent differences in pneumococcal-stimulated AM or PBMC inflammatory mediator secretion that were referable to AUDs.
Collapse
|
203
|
Welte T, Kantecki M, Stone GG, Hammond J. Ceftaroline fosamil as a potential treatment option for Staphylococcus aureus community-acquired pneumonia in adults. Int J Antimicrob Agents 2019; 54:410-422. [PMID: 31404620 DOI: 10.1016/j.ijantimicag.2019.08.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/25/2019] [Accepted: 08/05/2019] [Indexed: 02/07/2023]
Abstract
Staphylococcus aureus (S. aureus), including methicillin-resistant S. aureus (MRSA), is an important aetiological cause of community-acquired pneumonia (CAP) and associated with significant morbidity and mortality. Empiric therapy for CAP frequently consists of β-lactam monotherapy or β-lactam/macrolide combination therapy. However, such agents are often ineffective against S. aureus and do not reflect the emergence and increasing prevalence of MRSA in the community setting. Ceftaroline fosamil is a fifth-generation parenteral cephalosporin with broad-spectrum activity against Gram-positive pathogens - such as S. aureus (including MRSA), Streptococcus pneumoniae and Streptococcus pyogenes - and typical Gram-negative pathogens, including Haemophilus influenzae and Moraxella catarrhalis. The approval of ceftaroline fosamil in the United States and Europe for the treatment of adults with moderate-to-severe CAP was based on two phase 3 trials (FOCUS 1 and 2), which demonstrated that ceftaroline fosamil was non-inferior to ceftriaxone, a standard empiric treatment for CAP, while exhibiting a comparable safety profile. Although head-to-head trials of ceftaroline fosamil versus comparators against MRSA CAP are lacking, the effectiveness of ceftaroline fosamil in subpopulations of patients not covered by phase 3 trials (e.g. those with MRSA CAP or severe renal impairment) has been demonstrated in the Clinical Assessment Program and Teflaro Utilization Registry (CAPTURE) study. As ineffective empiric therapy is associated with adverse outcomes, including mortality and increased costs, ceftaroline fosamil, with its extended spectrum of activity, is an attractive alternative to standard antibiotic CAP regimens.
Collapse
Affiliation(s)
- Tobias Welte
- University of Hannover, School of Medicine, Carl-Neuberg-Straße, 30625 Hannover, Germany.
| | | | | | | |
Collapse
|
204
|
Tanzella G, Motos A, Battaglini D, Meli A, Torres A. Optimal approaches to preventing severe community-acquired pneumonia. Expert Rev Respir Med 2019; 13:1005-1018. [PMID: 31414915 DOI: 10.1080/17476348.2019.1656531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Community-acquired pneumonia (CAP) has the highest rate of mortality of all infectious diseases, especially among the elderly. Severe CAP (sCAP) is defined as a CAP in which intensive care management is required and is associated with an unfavorable clinical course. Areas covered: This review aims to identify prevention strategies for reducing the incidence of CAP and optimized management of sCAP. We highlight the main prevention approaches for CAP, focusing on the latest vaccination plans and on the influence of health-risk behaviors. Lastly, we report the latest recommendations about the optimal approach for sCAP when CAP has already been diagnosed, including prompt admission to ICU, early empirical antibiotic therapy, and optimization of antibiotic use. Expert opinion: Despite improvements in the diagnosis and treatment of sCAP, more efforts are needed to combat preventable causes, including the implementation and improvement of vaccine coverage, anti-tobacco campaigns and correct oral hygiene. Moreover, future research should aim to assess the benefits of early antimicrobial therapy in primary care. Pharmacokinetic studies in the target population may help clinicians to adjust dosage regimens in critically ill patients with CAP and thus reduce rates of treatment failure.
Collapse
Affiliation(s)
- Giacomo Tanzella
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Department of Surgical Sciences and Integrated Diagnostics (DISC), San Martino Policlinico Hospital , Genoa , Italy
| | - Ana Motos
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias , Madrid , Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer , Barcelona , Spain.,Faculty of Medicine, University of Barcelona , Barcelona , Spain
| | - Denise Battaglini
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Department of Surgical Sciences and Integrated Diagnostics (DISC), San Martino Policlinico Hospital , Genoa , Italy
| | - Andrea Meli
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,University of Milan , Milan , Italy
| | - Antoni Torres
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias , Madrid , Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer , Barcelona , Spain.,Faculty of Medicine, University of Barcelona , Barcelona , Spain
| |
Collapse
|
205
|
Satokangas M, Lumme S, Arffman M, Keskimäki I. Trajectory modelling of ambulatory care sensitive conditions in Finland in 1996-2013: assessing the development of equity in primary health care through clustering of geographic areas - an observational retrospective study. BMC Health Serv Res 2019; 19:629. [PMID: 31484530 PMCID: PMC6727548 DOI: 10.1186/s12913-019-4449-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/20/2019] [Indexed: 02/02/2023] Open
Abstract
Background Due to stagnating resources and an increase in staff workload, the quality of Finnish primary health care (PHC) is claimed to have deteriorated slowly. With a decentralised PHC organisation and lack of national stewardship, it is likely that municipalities have adopted different coping strategies, predisposing them to geographic disparities. To assess whether these disparities emerge, we analysed health centre area trajectories in hospitalisations due to ambulatory care sensitive conditions (ACSCs). Methods ACSCs, a proxy for PHC quality, comprises conditions in which hospitalisation could be avoided by timely care. We obtained ACSCs of the total Finnish population aged ≥20 for the years 1996–2013 from the Finnish Hospital Discharge Register, and divided them into subgroups of acute, chronic and vaccine-preventable causes, and calculated annual age-standardised ACSC rates by gender in health centre areas. Using these rates, we conducted trajectory analyses for identifying health centre area clusters using group-based trajectory modelling. Further, we applied area-level factors to describe the distribution of health centre areas on these trajectories. Results Three trajectories – and thus separate clusters of health centre areas – emerged with different levels and trends of ACSC rates. During the study period, chronic ACSC rates decreased (40–63%) within each of the clusters, acute ACSC rates remained stable and vaccine-preventable ACSC rates increased (1–41%). While disparities in rate differences in chronic ACSC rates between trajectories narrowed, in the two other ACSC subgroups they increased. Disparities in standardised rate ratios increased in vaccine-preventable and acute ACSC rates between northern cluster and the two other clusters. Compared to the south-western cluster, 13–16% of health centre areas, in rural northern cluster, had 47–92% higher ACSC rates – but also the highest level of morbidity, most limitations on activities of daily living and highest PHC inpatient ward usage as well as the lowest education levels and private health and dental care usage. Conclusions We identified three differing trajectories of time trends for ACSC rates, suggesting that the quality of care, particularly in northern Finland health centre areas, may have lagged behind the general improvements. This calls for further investments to strengthen rural area PHC. Electronic supplementary material The online version of this article (10.1186/s12913-019-4449-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Markku Satokangas
- Social and Health Systems Research Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland. .,Department of General Practice and Primary Health Care, Network of Academic Health Centres, University of Helsinki, Helsinki, Finland. .,Health Stations, Department of Social Services and Health Care, City of Helsinki, Finland.
| | - Sonja Lumme
- Social and Health Systems Research Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Martti Arffman
- Social and Health Systems Research Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Ilmo Keskimäki
- Social and Health Systems Research Unit, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland
| |
Collapse
|
206
|
Nishizawa T, Niikura Y, Akasaka K, Watanabe M, Kurai D, Amano M, Ishii H, Matsushima H, Yamashita N, Takizawa H. Pilot study for risk assessment of aspiration pneumonia based on oral bacteria levels and serum biomarkers. BMC Infect Dis 2019; 19:761. [PMID: 31477059 PMCID: PMC6720072 DOI: 10.1186/s12879-019-4327-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/29/2019] [Indexed: 02/07/2023] Open
Abstract
Background Aspiration pneumonia is a serious problem among elderly patients; it is caused by many risk factors including dysphagia, poor oral hygiene, malnutrition, and sedative medications. The aim of this study was to define a convenient procedure to objectively evaluate the risk of aspiration pneumonia in the clinical setting. Methods This prospective study included an aspiration pneumonia (AP) group, a community-acquired pneumonia (CAP) group, and a control (Con) group (patients hospitalized for lung cancer chemotherapy). We used the Oral Health Assessment Tool (OHAT), which assesses oral hygiene, and evaluated performance status, body mass index, serum albumin levels, substance P values in plasma, and oral bacterial counts. Results The oral health as assessed by the OHAT of the aspiration pneumonia group was significantly impaired compared with that of the CAP group and the control (5.13 ± 0.18, 4.40 ± 0.26, 3.90 ± 0.22, respectively; p < 0.05). The oral bacterial count in the aspiration pneumonia group (7.20 ± 0.11) was significantly higher than that in the CAP group (6.89 ± 0.12), consistent with the OHAT scores. Oral bacterial count was significantly reduced by oral care. Conclusions OHAT and oral bacterial counts can be a tool to assess the requirement of taking oral care and other preventive procedures in patients at high risk of aspiration pneumonia.
Collapse
Affiliation(s)
- Tomotaka Nishizawa
- Department of Respiratory Medicine, Japanese Red Cross Society Saitama Hospital, 1-5 Shintoshin Chuo-ku Saitama-shi, Saitama, 330-8553, Japan. .,Department of Pharmacotherapy, Research Institute of Pharmaceutical Sciences Musashino University, Tokyo, Japan. .,Department of Respiratory Medicine, Graduate School of Medicine, Kyorin University, Tokyo, Japan.
| | - Yuichi Niikura
- Department of Pharmacotherapy, Research Institute of Pharmaceutical Sciences Musashino University, Tokyo, Japan
| | - Keiichi Akasaka
- Department of Respiratory Medicine, Japanese Red Cross Society Saitama Hospital, 1-5 Shintoshin Chuo-ku Saitama-shi, Saitama, 330-8553, Japan
| | - Masato Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyorin University, Tokyo, Japan
| | - Daisuke Kurai
- Department of General Medicine, Kyorin University, Tokyo, Japan
| | - Masako Amano
- Department of Respiratory Medicine, Japanese Red Cross Society Saitama Hospital, 1-5 Shintoshin Chuo-ku Saitama-shi, Saitama, 330-8553, Japan
| | - Haruyuki Ishii
- Department of Respiratory Medicine, Graduate School of Medicine, Kyorin University, Tokyo, Japan
| | - Hidekazu Matsushima
- Department of Respiratory Medicine, Japanese Red Cross Society Saitama Hospital, 1-5 Shintoshin Chuo-ku Saitama-shi, Saitama, 330-8553, Japan
| | - Naomi Yamashita
- Department of Pharmacotherapy, Research Institute of Pharmaceutical Sciences Musashino University, Tokyo, Japan
| | - Hajime Takizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyorin University, Tokyo, Japan
| |
Collapse
|
207
|
Papola D, Ostuzzi G, Gastaldon C, Morgano GP, Dragioti E, Carvalho AF, Fusar-Poli P, Correll CU, Solmi M, Barbui C. Antipsychotic use and risk of life-threatening medical events: umbrella review of observational studies. Acta Psychiatr Scand 2019; 140:227-243. [PMID: 31264708 DOI: 10.1111/acps.13066] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To quantify the risk of hip fracture, thromboembolism, stroke, myocardial infarction, pneumonia and sudden cardiac death associated with exposure to antipsychotics. METHODS Systematic searches were conducted in Medline, Embase and PsycINFO from inception until 30/07/2018 for systematic reviews of observational studies. AMSTAR-2 was used for the quality assessment of systematic reviews, while the strength of associations was measured using GRADE and quantitative umbrella review criteria (URC). RESULTS Sixty-eight observational studies from six systematic reviews were included. The association between antipsychotic exposure and pneumonia was the strongest [URC = class I; GRADE = low quality; odds ratio (OR) = 1.84, 95% confidence interval (CI) = 1.62-2.09; participants = 28 726; age = 76.2 ± 12.3 years], followed by the association with hip fracture (URC = class II; GRADE = low quality; OR = 1.57, 95% CI = 1.42-1.74; participants = 5 288 118; age = 55.4 ± 12.5 years), and thromboembolism (URC = class II; GRADE = very low quality; OR = 1.55, 95% CI = 1.31-1.83; participants = 31 417 175; age = 55.5 ± 3.2 years). The association was weak for stroke (URC = class III; GRADE = very low quality; OR = 1.45, 95% CI = 1.24-1.70; participants = 65 700; age = 68.7 ± 13.8 years), sudden cardiac death (URC = class III; GRADE = very low quality; OR = 2.24, 95% CI = 1.45-3.46; participants = 77 488; age = 52.2 ± 6.2 years) and myocardial infarction (URC = class III; GRADE = very low quality; OR = 2.21, 95% CI = 1.41-3.46; participants = 399 868; age = 74.1 ± 9.3 years). CONCLUSION The most robust results were found for the risk of pneumonia, followed by the risk of hip fracture and thromboembolism. For stroke, sudden cardiac death and myocardial infarction, the strength of association was weak. The observational nature of the primary studies may represent a source of bias.
Collapse
Affiliation(s)
- D Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - G Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - C Gastaldon
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - G P Morgano
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - E Dragioti
- Pain and Rehabilitation centre and Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, University of Linköping, Linköping, SE, Sweden
| | - A F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - P Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - C U Correll
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, NY, USA.,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - M Solmi
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Neuroscience Centre, University of Padua, Padua, Italy.,Department of Neuroscience, University of Padua, Padua, Italy
| | - C Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| |
Collapse
|
208
|
Kaplan A, Arsenault P, Aw B, Brown V, Fox G, Grossman R, Jadavji T, Laferrière C, Levitz S, Loeb M, McIvor A, Mody CH, Poulin Y, Shapiro M, Tessier D, Théorêt F, Weiss K, Yaremko J, Zhanel G. Vaccine strategies for prevention of community-acquired pneumonia in Canada: Who would benefit most from pneumococcal immunization? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:625-633. [PMID: 31515311 PMCID: PMC6741809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe the burden of pneumococcal disease and associated risk factors in the Canadian adult population, delineate available pneumococcal vaccines and associated efficacy and effectiveness data, and review current pneumococcal vaccine recommendations and community-acquired pneumonia (CAP) prevention strategies in Canada. QUALITY OF EVIDENCE Pneumococcal vaccination guidelines from the Canadian National Advisory Committee on Immunization in 2013 and 2016 constitute level III evidence for CAP prevention in the Canadian adult population. MAIN MESSAGE It is recommended that immunosuppressed adults of all ages receive the 13-valent pneumococcal conjugate vaccine (PCV13) (grades A and B recommendations). In 2016, the National Advisory Committee on Immunization also recommended that all adults aged 65 years and older receive PCV13 (grade A recommendation) on an individual basis, followed by the 23-valent pneumococcal polysaccharide vaccine (grade B recommendation). This update is based on a large clinical study that demonstrated PCV13 efficacy against vaccine-type CAP in this population. CONCLUSION Physicians should focus on improving pneumococcal vaccination rates among adults, which remain low. Vaccination with PCV13 should also be considered for adults with chronic conditions, whose baseline risk is often higher than that for healthy individuals aged 65 years and older.
Collapse
Affiliation(s)
- Alan Kaplan
- Clinical Lecturer in the Department of Family and Community Medicine at the University of Toronto in Ontario.
| | - Pierre Arsenault
- Associate Professor in the Department of Family and Emergency Medicine at the University of Sherbrooke in Quebec
| | - Brian Aw
- Family physician at the Ultimate Health Medical Centre in Richmond Hill, Ont
| | - Vivien Brown
- Assistant Professor in the Department of Family and Community Medicine at the University of Toronto
| | - George Fox
- Professor in the Department of Medicine (Respirology) at Memorial University of Newfoundland in St John's
| | - Ron Grossman
- Professor in the Department of Medicine at the University of Toronto
| | - Taj Jadavji
- Professor in the Department of Microbiology, Immunology and Infectious Diseases in the Cumming School of Medicine at the University of Calgary in Alberta
| | - Craig Laferrière
- Regional Medical Research Specialist and Medical Advisor with Pfizer Canada Inc in Kirkland, Que, at the time of writing
| | - Suzanne Levitz
- Assistant Professor in the Department of Family Medicine at McGill University in Montreal, Que
| | - Mark Loeb
- Professor in the Department of Pathology and Molecular Medicine at McMaster University in Hamilton, Ont
| | - Andrew McIvor
- Professor in the Division of Respirology in the Department of Medicine at McMaster University
| | - Christopher H Mody
- Professor and Head of the Department of Microbiology, Immunology and Infectious Diseases in the Cumming School of Medicine at the University of Calgary
| | - Yannick Poulin
- Assistant Professor in the Department of Medicine at the University of Sherbrooke
| | - Marla Shapiro
- Professor in the Department of Family and Community Medicine at the University of Toronto
| | - Dominique Tessier
- Clinician at the Hôpital Saint-Luc du CHUM in the Groupe de médecine de famille du Quartier Latin and Medical Director of the Groupe Santé Voyage in Montreal
| | - Francois Théorêt
- Family physician on the Lower Outaouais Family Health Team in Hawkesbury, Ont
| | - Karl Weiss
- Chief of the Division of Infectious Diseases at the Jewish General Hospital of McGill University
| | - John Yaremko
- Assistant Professor in the Department of Pediatrics and the Department of Family Medicine at McGill University
| | - George Zhanel
- Professor in the Department of Medical Microbiology and Infectious Diseases at the University of Manitoba in Winnipeg
| |
Collapse
|
209
|
Kjerpeseth LJ, Selmer R, Ariansen I, Karlstad Ø, Ellekjær H, Skovlund E. Comparative effectiveness of warfarin, dabigatran, rivaroxaban and apixaban in non-valvular atrial fibrillation: A nationwide pharmacoepidemiological study. PLoS One 2019; 14:e0221500. [PMID: 31449560 PMCID: PMC6709911 DOI: 10.1371/journal.pone.0221500] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/09/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To compare effectiveness and safety of warfarin and the direct oral anticoagulants (DOAC) dabigatran, rivaroxaban and apixaban in non-valvular atrial fibrillation in routine care. METHODS From nationwide registries, we identified treatment-naïve patients initiating warfarin, dabigatran, rivaroxaban or apixaban for non-valvular atrial fibrillation from July 2013 to December 2015 in Norway. We assessed prescription duration using reverse waiting time distribution. Adjusting for confounding in a Cox proportional hazards model, we estimated one-year risks for ischemic stroke, transient ischemic attack (TIA) or systemic embolism, major or clinically relevant non-major bleeding; intracranial; gastrointestinal; and other bleeding. We censored at switch of treatment or 365 days of follow-up. RESULTS We included 30,820 treatment-naïve patients. Compared to warfarin, the adjusted hazard ratios (HR) for ischemic stroke, TIA or systemic embolism were 0.96 (95% CI 0.71-1.28) for dabigatran, 1.12 (95% CI 0.87-1.45) for rivaroxaban and 0.97 (95% CI 0.75-1.26) for apixaban. Corresponding hazard ratios for major or clinically relevant non-major bleeding were 0.73 (95% CI 0.62-0.86) for dabigatran, 0.97 (95% CI 0.84-1.12) for rivaroxaban and 0.71 (95% CI 0.62-0.82) for apixaban. Statistically significant differences of other safety outcomes compared to warfarin were fewer intracranial bleedings with dabigatran (HR 0.28, 95% CI 0.14-0.56), rivaroxaban (HR 0.40, 95% CI 0.23-0.69) and apixaban (HR 0.56, 95% CI 0.34-0.92); fewer gastrointestinal bleedings with apixaban (HR 0.70, 95% CI 0.52-0.93); and fewer other bleedings with dabigatran (HR 0.67, 95% CI 0.55-0.81) and apixaban (HR 0.70, 95% CI 0.59-0.83). CONCLUSION After 1 year follow-up in treatment-naïve patients initiating oral anticoagulation for non-valvular atrial fibrillation, all DOACs were similarly effective as warfarin in prevention of ischemic stroke, TIA or systemic embolism. Safety from bleedings was similar or better, including fewer intracranial bleedings with all direct oral anticoagulants, fewer gastrointestinal bleedings with apixaban and fewer other bleedings with dabigatran and apixaban.
Collapse
Affiliation(s)
- Lars J. Kjerpeseth
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- * E-mail:
| | - Randi Selmer
- Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Inger Ariansen
- Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Øystein Karlstad
- Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Stroke Unit, Department of Internal Medicine, St. Olav’s Hospital, Trondheim, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
210
|
Prasad R, Daly B, Manley G. The impact of 0.2% chlorhexidine gel on oral health and the incidence of pneumonia amongst adults with profound complex neurodisability. SPECIAL CARE IN DENTISTRY 2019; 39:524-532. [PMID: 31432537 DOI: 10.1111/scd.12414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022]
Abstract
AIMS Investigate the effect of toothbrushing with 0.2% chlorhexidine gel on oral health and pneumonia amongst patients with a neurodisability who are fed via percutaneous endoscopic gastrostomy. METHOD Forty-nine patients at the Royal Hospital for Neuro-disability were recruited to an observational study. Daily toothbrushing with 0.2% chlorhexidine gel was undertaken for 12 months by trained nursing staff. Plaque and gingival health were assessed every six weeks using the Simplified Debris Index and the Basic Periodontal Examination. The annual incidence and prevalence of episodes of pneumonia experienced by patients whilst using the chlorhexidine gel were compared to rates from the previous year. RESULTS Plaque levels and the proportion of patients with periodontal pocketing > 3.5 mm significantly reduced, P < .001, with chlorhexidine toothbrushing. Total number of pneumonia episodes (75-67), antibiotics administered (73-64), and radiographs taken (19 to 16) were lower in the year wherein chlorhexidine was employed, and hospitalisations dropped by 31% (16-11), but these reductions were not statistically significant. No adverse events were reported. CONCLUSION Daily toothbrushing with 0.2% chlorhexidine undertaken by a trained and supported nursing staff was effective in improving oral health but did not significantly affect annual rates of pneumonia amongst patients.
Collapse
Affiliation(s)
- Ria Prasad
- Department of Special Care Dentistry, King's College Dental Hospital, London, UK
| | - Blanaid Daly
- Division of Public and Child Dental Health, Dublin Dental University Hospital, Dublin, Ireland
| | - Graham Manley
- Dental Department, The Royal Hospital for Neuro-disability, London, UK
| |
Collapse
|
211
|
|
212
|
Méndez-Brich M, Serra-Prat M, Palomera E, Vendrell E, Morón N, Boixeda R, Cabré M, Almirall J. Social Determinants of Community-acquired Pneumonia: Differences by Age Groups. Arch Bronconeumol 2019; 55:447-449. [DOI: 10.1016/j.arbres.2018.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
|
213
|
Abstract
PURPOSE OF REVIEW The first guidelines on community-acquired pneumonia (CAP) were published in 1993, but since then many of the challenges regarding the outpatient management of CAP persist. These include the difficulty in establishing the initial clinical diagnosis, its risk stratification, which will dictate the place of treatment, the empirical choice of antibiotics, the relative scarcity of novel antibiotics and the importance of knowing local microbiological susceptibility patterns. RECENT FINDINGS New molecular biology methods have changed the etiologic perspective of CAP, especially the contribution of virus. Lung ultrasound and biomarkers might aid diagnosis and severity stratification in the outpatient setting. Antibiotic resistance is a growing problem that reinforces the importance of novel antibiotics. And finally, prevention and the use of anti-pneumococcal vaccine are instrumental in reducing the burden of disease. SUMMARY Most of CAP cases are managed in the community; however, most research comes from hospitalized severe patients. New and awaited advances might contribute to aid diagnosis, cause and assessment of patients with CAP in the community. This knowledge might prove decisive in the execution of stewardship programmes that maintain current antibiotics, safeguard future ones and reinforce prevention.
Collapse
|
214
|
Baskaran V, Murray RL, Hunter A, Lim WS, McKeever TM. Effect of tobacco smoking on the risk of developing community acquired pneumonia: A systematic review and meta-analysis. PLoS One 2019; 14:e0220204. [PMID: 31318967 PMCID: PMC6638981 DOI: 10.1371/journal.pone.0220204] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/10/2019] [Indexed: 01/19/2023] Open
Abstract
AIM To summarise and quantify the effect of tobacco smoking on the risk of developing community acquired pneumonia (CAP) in adults. METHODS We systematically searched MEDLINE, Embase, CINAHL, PsychINFO and Web of Science, from inception to October 2017, to identify case-control and cohort studies and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. The review protocol was registered with the PROSPERO database (CRD42018093943). Study quality was assessed by the Newcastle-Ottawa Scale. Pooled odds ratios (ORs) or hazard ratios (HRs) were estimated using a random-effects model. RESULTS Of 647 studies identified, 27 studies were included (n = 460,592 participants) in the systematic review. Most of the included studies were of moderate quality with a median score of six (IQR 6-7). Meta-analysis showed that current smokers (pooled OR 2.17, 95% CI 1.70-2.76, n = 13 studies; pooled HR 1.52, 95% CI 1.13-2.04, n = 7 studies) and ex-smokers (pooled OR 1.49, 95% CI 1.26-1.75, n = 8 studies; pooled HR 1.18, 95% CI 0.91-1.52, n = 6 studies) were more likely to develop CAP compared to never smokers. Although the association between passive smoking and risk of CAP in adults of all ages was not statistically significant (pooled OR 1.13, 95% CI 0.94-1.36, n = 5 studies), passive smoking in adults aged ≥65 years was associated with a 64% increased risk of CAP (pooled OR 1.64; 95% CI 1.17-2.30, n = 2 studies). Dose-response analyses of data from five studies revealed a significant trend; current smokers who smoked higher amount of tobacco had a higher risk of CAP. CONCLUSION Tobacco smoke exposure is significantly associated with the development of CAP in current smokers and ex-smokers. Adults aged > 65 years who are passive smokers are also at higher risk of CAP. For current smokers, a significant dose-response relationship is evident.
Collapse
Affiliation(s)
- Vadsala Baskaran
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Rachael L. Murray
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Abby Hunter
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Tricia M. McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
215
|
Cillóniz C, Dominedò C, Ielpo A, Ferrer M, Gabarrús A, Battaglini D, Bermejo-Martin J, Meli A, García-Vidal C, Liapikou A, Singer M, Torres A. Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia. J Clin Med 2019; 8:jcm8070961. [PMID: 31269766 PMCID: PMC6678833 DOI: 10.3390/jcm8070961] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/20/2019] [Accepted: 07/01/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Little is known about risk and prognostic factors in very old patients developing sepsis secondary to community-acquired pneumonia (CAP). Methods: We conducted a retrospective observational study of data prospectively collected at the Hospital Clinic of Barcelona over a 13-year period. Consecutive patients hospitalized with CAP were included if they were very old (≥80 years) and divided into those with and without sepsis for comparison. Sepsis was diagnosed based on the Sepsis-3 criteria. The main clinical outcome was 30-day mortality. Results: Among the 4219 patients hospitalized with CAP during the study period, 1238 (29%) were very old. The prevalence of sepsis in this age group was 71%. Male sex, chronic renal disease, and diabetes mellitus were independent risk factors for sepsis, while antibiotic therapy before admission was independently associated with a lower risk of sepsis. Thirty-day and intensive care unit (ICU) mortality did not differ between patients with and without sepsis. In CAP-sepsis group, chronic renal disease and neurological disease were independent risk factors for 30-day mortality. Conclusion: In very old patients hospitalized with CAP, in-hospital and 1-year mortality rates were increased if they developed sepsis. Antibiotic therapy before hospital admission was associated with a lower risk of sepsis.
Collapse
Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain.
- August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain.
- Biomedical Research Networking Centres in Respiratory Diseases (Ciberes), 28029 Madrid, Spain.
| | - Cristina Dominedò
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonella Ielpo
- Departments of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, 43121 Parma, Italy
| | - Miquel Ferrer
- Department of Pneumology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
- Biomedical Research Networking Centres in Respiratory Diseases (Ciberes), 28029 Madrid, Spain
| | - Albert Gabarrús
- Department of Pneumology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
- Biomedical Research Networking Centres in Respiratory Diseases (Ciberes), 28029 Madrid, Spain
| | - Denise Battaglini
- Department of Surgical Sciences and Integrated Diagnostic, Policlinico San Martino, University of Genova, 16126 Genova, Italy
| | - Jesús Bermejo-Martin
- Group for Biomedical Research in Sepsis (Bio Sepsis), Hospital Clínico Universitario de Valladolid/IECSCYL, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain
| | - Andrea Meli
- Department of Anesthesia and Intensive Care, University of Milan, 20122 Milan, Italy
| | - Carolina García-Vidal
- Infectious Diseases Department, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
| | - Adamanthia Liapikou
- Respiratory Department, Sotiria Chest Diseases Hospital, Mesogion 152, 11527Athens, Greece
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, Cruciform Building, Gower St, London WC1E 6BT, UK
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain.
- August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain.
- Biomedical Research Networking Centres in Respiratory Diseases (Ciberes), 28029 Madrid, Spain.
| |
Collapse
|
216
|
Temesgen D, Bereded F, Derbie A, Biadglegne F. Bacteriology of community acquired pneumonia in adult patients at Felege Hiwot Referral Hospital, Northwest Ethiopia: a cross-sectional study. Antimicrob Resist Infect Control 2019; 8:101. [PMID: 31223478 PMCID: PMC6570935 DOI: 10.1186/s13756-019-0560-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/10/2019] [Indexed: 01/25/2023] Open
Abstract
Background Community acquired pneumonia (CAP) is reported as a common cause of lower respiratory tract infection worldwide. Bacterial pathogens and antimicrobial resistance (AMR) associated with this infection varied between geographical regions. Knowledge of the pathogens in a given area and their up-to-date AMR profile is essential for optimal management of patients. This study was aimed at assessing the type of bacterial isolates and their AMR among CAP adult patients at the Felege Hiwot Referral Hospital (FHRH), Northwest Ethiopia. Methods This cross-sectional study was conducted during 1 April to 30 July 2018. Demographic related data were collected from the study participants using a structured questionnaire. Sputum samples were collected and processed to identify pathogens using the conventional culture and biochemical tests as per the standard procedures. The Kirby Bauer disk diffusion method was implemented for the AMR testing. Descriptive and multivariable analysis was conducted using SPSS version 23. Results Among 414 presumptively diagnosed study participants for CAP, bacterial pathogens were identified from 167 (40.3%) participants. Among these, multidrug resistance (MDR) accounted for 127(76%) of the isolates. The predominant isolates were Streptococcus pneumoniae at 60(35.9%) and Klebsella pneumoniae at 30(18%). Overcrowded living conditions [AOR 1.579 (95%CI: 1.015–2.456)] and alcohol use [AOR 4.043 (95% CI, 2.537–6.443)] were found statistically associated with culture positive sputum. Conclusions The study showed high prevalence of mono- and multi-drug resistant isolates in the study area. Therefore, regular surveillance of the type of isolates and their AMR patterns should be considered. Interventions for reducing community acquired pneumonia should be integrated with lifestyle factors related to household and alcohol use.
Collapse
Affiliation(s)
| | - Fetlewok Bereded
- 2Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, P.O.BOX: 1383, Bahir Dar, Ethiopia
| | - Awoke Derbie
- 2Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, P.O.BOX: 1383, Bahir Dar, Ethiopia.,3Center for Innovative Drug development and Therapeutics Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Fantahun Biadglegne
- 2Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, P.O.BOX: 1383, Bahir Dar, Ethiopia
| |
Collapse
|
217
|
Hamina A, Taipale H, Karttunen N, Tanskanen A, Tiihonen J, Tolppanen AM, Hartikainen S. Hospital-Treated Pneumonia Associated with Opioid Use Among Community Dwellers with Alzheimer’s Disease. J Alzheimers Dis 2019; 69:807-816. [DOI: 10.3233/jad-181295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Aleksi Hamina
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Heidi Taipale
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Niina Karttunen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Center for Psychiatric Research, Stockholm City Council, Stockholm, Sweden
| | - Anna-Maija Tolppanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
218
|
Faraday J, Salis C, Barrett A. Equipping Nurses and Care Staff to Manage Mealtime Difficulties in People With Dementia: A Systematic Scoping Review of Training Needs and Interventions. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:717-742. [PMID: 31136244 DOI: 10.1044/2018_ajslp-18-0062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose Mealtime difficulties are prevalent in dementia, posing major challenges to people with dementia (PWD), carers, and clinical services. Speech-language pathologists have a recognized role in providing training to carers of PWD who have mealtime difficulties. The aims of this study are (a) to identify the training needs of nurses and care staff with regard to managing mealtime difficulties in PWD, (b) to describe existing training interventions on this topic, and (c) to investigate the extent to which these interventions are relevant to the needs of nurses and care staff. Method A systematic search was carried out to identify studies relevant to the aims of the review. Data were extracted and then synthesized using thematic analysis and a synthesis matrix. Study quality was appraised using a validated appraisal tool. Results Various themes were identified in relation to the training needs of nurses and other care staff who manage mealtime difficulties in PWD. These were as follows: person-centered care; dealing with uncertainty; strategies, skills, and knowledge; and creating the right environment. Existing training interventions were described and compared against the training needs. The review found some correspondence between interventions and staff needs, but also some gaps. Conclusions Training interventions on this topic should be more systematically developed and better reported to facilitate effective implementation. Evidence to date indicates that training should do more to help staff deal with uncertainty. Further research assessing the benefits of speech-language pathologists' involvement in the development of training interventions is recommended because of this profession's specialist skills and knowledge with regard to both dysphagia and communication.
Collapse
Affiliation(s)
- James Faraday
- Department of Adult Speech and Language Therapy, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | - Christos Salis
- Department of Speech and Language Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Anne Barrett
- Department of Speech and Hearing Sciences, University College Cork, Ireland
| |
Collapse
|
219
|
Species, Risk Factors, and Antimicrobial Susceptibility Profiles of Bacterial Isolates from HIV-Infected Patients Suspected to Have Pneumonia in Mekelle Zone, Tigray, Northern Ethiopia. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8768439. [PMID: 31192259 PMCID: PMC6525850 DOI: 10.1155/2019/8768439] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/02/2019] [Accepted: 04/16/2019] [Indexed: 12/16/2022]
Abstract
Background Pneumonia is a condition, where bacterial infections are implicated as the most common causes of morbidity and mortality in humans. The actual burden of HIV-infected patients with pneumonia is not well documented in Mekelle region of Ethiopia. This study estimated the prevalence of bacterial pneumonia in HIV patients, antimicrobial susceptibility patterns of pathogens implicated in pneumonia, and associated risk factors in Mekelle zone, Tigray, Northern Ethiopia, during August-December 2016. Methods Sputum specimens were collected from 252 HIV seropositive individuals with suspected pneumonia. Data on sociodemographics and risk factors were also collected using a structured questionnaire. Blood, Chocolate, and Mac Conkey agar plates (Oxoid, Hampshire, UK) were used to grow the isolates. The isolated colonies were identified based on Gram stain, colony morphology, pigmentation, hemolysis, and biochemical tests. The antimicrobial susceptibility test was performed using the modified Kirby-Bauer disc diffusion method. The analysis was performed using SPSS version 22 and p-value < 0.05 with corresponding 95% confidence interval (CI) was considered statistically significant. Results Out of the 252 samples, 110 (43.7%) were positive for various bacterial species. The predominant bacterial species were Klebsiella pneumoniae (n=26, 23.6 %) followed by Streptococcus pneumoniae (n=17, 15.5 %), Escherichia coli (n=16, 14.5%), Klebsiella spp. (n=15, 13.6%), Staphylococcus aureus (n=9, 8.2%), Enterobacter spp. (n=7, 6.3%), Pseudomonas aeruginosa (4, n=3.6%), Proteus spp. (n=4, 3.6%), Citrobacter freundii (n=7, 6.3%), Streptococcus pyogenes (3, 2.7%), and Haemophilus influenzae (n=2, 1.8%). Young age (18-29), recent CD4+ count less than 350 cells/mL, alcohol consumption, and HIV WHO stage II showed significant association with the occurrence of bacterial pneumonia. Resistance to penicillin, co-trimoxazole, and tetracycline was observed in 81.8%, 39.8%, and 24.5% of the isolates, respectively. Conclusions The problem of pneumonia among HIV patients was significant in the study area. The high prevalence of drug-resistant bacteria isolated from the patient's samples possesses a health risk in immunocompromised HIV patients. There is a need to strengthen and expand culture and susceptibility procedures for the administration of appropriate therapy to improve patients management and care which may aid in decreasing the mortality.
Collapse
|
220
|
Laterre PF, Colin G, Dequin PF, Dugernier T, Boulain T, Azeredo da Silveira S, Lajaunias F, Perez A, François B. CAL02, a novel antitoxin liposomal agent, in severe pneumococcal pneumonia: a first-in-human, double-blind, placebo-controlled, randomised trial. THE LANCET. INFECTIOUS DISEASES 2019; 19:620-630. [PMID: 31056427 DOI: 10.1016/s1473-3099(18)30805-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Severe community-acquired pneumonia caused by Streptococcus pneumoniae is associated with high morbidity and mortality rates. CAL02, a novel antitoxin agent with an unprecedented mode of action, consists of liposomes that capture bacterial toxins known to dysregulate inflammation, cause organ damage, and impede immune defence. We aimed to assess the safety of CAL02 as an add-on therapy to antibiotics. METHODS This randomised, double-blind, multicentre, placebo-controlled trial was done in ten intensive care units (ICUs) in France and Belgium (but only six units enrolled patients), in patients with severe community-acquired pneumococcal pneumonia who required ICU admission and had been identified as being infected with S pneumoniae. We randomly assigned participants in two stages-the first stage randomly assigned six patients (1:1) to either low-dose CAL02 or placebo, and the second stage randomly assigned 18 patients (14:4) to either high-dose CAL02 or placebo, and stratified in four blocks (4:1, 4:1, 3:1, and 3:1), in addition to standard of care. Block randomisation was done with a computer-generated random number list. Participants, investigators, other site study personnel, the sponsor, and the sponsor's designees involved in study management and monitoring were masked to the randomisation list and treatment assignment. Patients were treated with low-dose (4 mg/kg) or high-dose (16 mg/kg) CAL02 or placebo (saline), in addition to standard antibiotic therapy. Two intravenous doses of study treatment were infused, with a 24 h interval, at a concentration of 10 mg/mL, stepwise, over a maximum of 2 h on days 1 and 2. The primary objective of the study was to assess the safety and tolerability of low-dose and high-dose CAL02 in patients with severe community-acquired pneumonia treated with standard antibiotic therapy, and the primary analysis was done on the safety population (all patients who received at least one dose of the study treatment). Efficacy was a secondary outcome. This trial is registered with ClinicalTrials.gov, number NCT02583373. FINDINGS Between March 21, 2016, and Jan 13, 2018, we screened 280 patients with community-acquired pneumonia. 19 patients were enrolled and randomly assigned, resulting in 13 patients in the CAL02 groups (three assigned to low-dose CAL02 and ten assigned to high-dose CAL02) and six in the placebo group. One patient randomly assigned to placebo was allocated to the wrong treatment group and received high-dose CAL02 instead of placebo. Thus, 14 patients received CAL02 (three received low-dose CAL02 and 11 received high-dose CAL02) and five patients received placebo, constituting the safety population. At baseline, the mean APACHE II score for the total study population was 21·5 (SD 4·9; 95% CI 19·3-23·7) and 11 (58%) of 19 patients had septic shock. Adverse events occurred in 12 (86%) of 14 patients in the CAL02 treatment groups combined and all five (100%) patients in the placebo group. Serious adverse events occurred in four (29%) of 14 patients in the CAL02 treatment groups combined and two (40%) of five patients in the placebo group. One non-serious adverse event (mild increase in triglycerides) in a patient in the high-dose CAL02 group was reported as related to study drug. However, analysis of the changes in triglyceride levels in the CAL02 groups compared with the placebo group revealed no correlation with administration of CAL02. No adverse events were linked to local tolerability events. All patients, apart from one who died in the low CAL02 group (death not related to the study drug) achieved clinical cure at the test of cure visit between days 15 and 22. The sequential organ failure assessment score decreased by mean 65·0% (95% CI 50·7-79·4) in the combined CAL02 groups compared with 29·2% (12·8-45·5) in the placebo group between baseline and day 8. INTERPRETATION The nature of adverse events was consistent with the profile of the study population and CAL02 showed a promising safety profile and tolerability. However, the difference between high-dose and low-dose CAL02 could not be assessed in this study. Efficacy was in line with the expected benefits of neutralising toxins. The results of this study support further clinical development of CAL02 and provide a solid basis for a larger clinical study. FUNDING Combioxin.
Collapse
Affiliation(s)
- Pierre-François Laterre
- Intensive Care Unit, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium.
| | - Gwenhael Colin
- Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France
| | | | | | - Thierry Boulain
- Service de Médecine Intensive Réanimation, Hôpital La Source, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | | | | | - Bruno François
- Medical-Surgical Intensive Care Unit, University Hospital Limoges Dupuytren Hospital, Limoges, France; Inserm CIC-1435, University Hospital Limoges Dupuytren Hospital, Limoges, France; Inserm UMR 1092, Faculté de Médecine, Université de Limoges, Limoges, France
| |
Collapse
|
221
|
|
222
|
Abstract
Pneumonia is among the leading causes of morbidity and mortality worldwide. Although Streptococcus pneumoniae is the most likely cause in most cases, the variety of potential pathogens can make choosing a management strategy a complex endeavor. The setting in which pneumonia is acquired heavily influences diagnostic and therapeutic choices. Because the causative organism is typically unknown early on, timely administration of empiric antibiotics is a cornerstone of pneumonia management. Disease severity and rates of antibiotic resistance should be carefully considered when choosing an empiric regimen. When complications arise, further work-up and consultation with a pulmonary specialist may be necessary.
Collapse
Affiliation(s)
- Charles W Lanks
- Division of Respiratory and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 402, Torrance, CA 90509, USA.
| | - Ali I Musani
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Hospital, 12631 East 17th Street, Office #8102, Aurora, CO 80045, USA
| | - David W Hsia
- Division of Respiratory and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 402, Torrance, CA 90509, USA
| |
Collapse
|
223
|
Garin N, Marti C, Carballo S, Darbellay Farhoumand P, Montet X, Roux X, Scheffler M, Serratrice C, Serratrice J, Claessens YE, Duval X, Loubet P, Stirnemann J, Prendki V. Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies. J Clin Med 2019; 8:E514. [PMID: 30991716 PMCID: PMC6518125 DOI: 10.3390/jcm8040514] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/05/2019] [Accepted: 04/12/2019] [Indexed: 11/16/2022] Open
Abstract
Diagnosing pneumonia in emergency departments is challenging because the accuracy of symptoms, signs and laboratory tests is limited. As a confirmation test, chest X-ray has significant limitations and is outperformed by CT-scan. However, obtaining a CT-scan in all cases of suspected pneumonia has significant drawbacks. We used a cohort of 200 consecutive elderly patients admitted to the hospital for suspected pneumonia to build a simple prediction score, which was used to determine indication for performing a CT-scan. The reference diagnosis was adjudicated by experts considering all available data, including evolution until discharge and CT scan in all patients. Results were externally validated in a second cohort of 319 patients. Pneumonia was confirmed in 133 patients (67%). Area under the receiver operator curve (AUROC) of physician evaluation was 0.55 (0.46-0.64). The score incorporated four variables independently predicting confirmed pneumonia: male gender, acute cough, C-reactive protein >70 mg/L, and urea <7 mmol/L. AUROC of the score was 0.68 (95% confidence interval (CI) 0.60-0.76). When a CT-scan was obtained for patients at low or intermediate predicted risk (108 patients, 54% of the cohort), AUROC was 0.71 (0.63-0.80) and 0.69 (0.64-0.74) in the derivation and validation cohort, respectively. A simple prediction score for pneumonia had moderate accuracy and could guide the performance of a CT-scan.
Collapse
Affiliation(s)
- Nicolas Garin
- Department of Internal Medicine, Riviera-Chablais Hospitals, 1870 Monthey, Switzerland.
- Department of Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland.
| | - Christophe Marti
- Department of Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland.
| | - Sebastian Carballo
- Department of Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland.
| | | | - Xavier Montet
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland.
- Department of Radiology, Geneva University Hospitals, 1205 Geneva, Switzerland.
| | - Xavier Roux
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals, 1205 Geneva, Switzerland.
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland.
| | - Max Scheffler
- Department of Radiology, Geneva University Hospitals, 1205 Geneva, Switzerland.
| | - Christine Serratrice
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals, 1205 Geneva, Switzerland.
| | - Jacques Serratrice
- Department of Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland.
| | - Yann-Erick Claessens
- Department of Emergency Medicine, Centre Hospitalier Princesse Grace, 98000 Monaco, Monaco.
| | - Xavier Duval
- Department of Infectious Disease, Bichat-Claude Bernard University Hospital, 75877 Paris, France.
- INSERM, IAME, UMR 1137, 75870 Paris, France.
| | - Paul Loubet
- Department of Infectious Disease, Bichat-Claude Bernard University Hospital, 75877 Paris, France.
- INSERM, IAME, UMR 1137, 75870 Paris, France.
| | - Jérôme Stirnemann
- Department of Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland.
| | - Virginie Prendki
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland.
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals, 1205 Geneva, Switzerland.
| |
Collapse
|
224
|
Ahnert P, Creutz P, Horn K, Schwarzenberger F, Kiehntopf M, Hossain H, Bauer M, Brunkhorst FM, Reinhart K, Völker U, Chakraborty T, Witzenrath M, Löffler M, Suttorp N, Scholz M. Sequential organ failure assessment score is an excellent operationalization of disease severity of adult patients with hospitalized community acquired pneumonia - results from the prospective observational PROGRESS study. Crit Care 2019; 23:110. [PMID: 30947753 PMCID: PMC6450002 DOI: 10.1186/s13054-019-2316-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/07/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND CAP (Community acquired pneumonia) is frequent, with a high mortality rate and a high burden on health care systems. Development of predictive biomarkers, new therapeutic concepts, and epidemiologic research require a valid, reproducible, and quantitative measure describing CAP severity. METHODS Using time series data of 1532 patients enrolled in the PROGRESS study, we compared putative measures of CAP severity for their utility as an operationalization. Comparison was based on ability to correctly identify patients with an objectively severe state of disease (death or need for intensive care with at least one of the following: substantial respiratory support, treatment with catecholamines, or dialysis). We considered IDSA/ATS minor criteria, CRB-65, CURB-65, Halm criteria, qSOFA, PSI, SCAP, SIRS-Score, SMART-COP, and SOFA. RESULTS SOFA significantly outperformed other scores in correctly identifying a severe state of disease at the day of enrollment (AUC = 0.948), mainly caused by higher discriminative power at higher score values. Runners-up were the sum of IDSA/ATS minor criteria (AUC = 0.916) and SCAP (AUC = 0.868). SOFA performed similarly well on subsequent study days (all AUC > 0.9) and across age groups. In univariate and multivariate analysis, age, sex, and pack-years significantly contributed to higher SOFA values whereas antibiosis before hospitalization predicted lower SOFA. CONCLUSIONS SOFA score can serve as an excellent operationalization of CAP severity and is proposed as endpoint for biomarker and therapeutic studies. TRIAL REGISTRATION clinicaltrials.gov NCT02782013 , May 25, 2016, retrospectively registered.
Collapse
Affiliation(s)
- Peter Ahnert
- University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Härtelstr. 16-18, 04107 Leipzig, Germany
| | - Petra Creutz
- Department of Infectious Disease and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchowklinikum, Augustenburgerplatz 1, 13353 Berlin, Germany
| | - Katrin Horn
- University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Härtelstr. 16-18, 04107 Leipzig, Germany
| | - Fabian Schwarzenberger
- Faculty of Informatics / Mathematics, HTW Dresden University of Applied Sciences, Friedrich-List-Platz 1, 01069 Dresden, Germany
| | - Michael Kiehntopf
- Jena University Hospital, Integrated Biobank Jena (IBBJ) and Institute of Clinical Chemistry and Laboratory Diagnostics, Am Klinikum 1, 07740 Jena, Germany
| | - Hamid Hossain
- Technische Hochschule Mittelhessen, University of Applied Sciences, Life Science Engineering, Wiesenstr. 14, 35390 Gießen, Germany
| | - Michael Bauer
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Frank Martin Brunkhorst
- Center for Clinical Studies and Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Konrad Reinhart
- Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Uwe Völker
- Department Functional Genomics, Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, Felix-Hausdorff-Str. 8, 17475 Greifswald, Germany
| | - Trinad Chakraborty
- University Hospital Giessen, Institute for Medical Microbiology, Schubertstr. 81, 35392 Gießen, Germany
| | - Martin Witzenrath
- Department of Infectious Disease and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Markus Löffler
- Department of Infectious Disease and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Norbert Suttorp
- Department of Infectious Disease and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Markus Scholz
- University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Härtelstr. 16-18, 04107 Leipzig, Germany
| |
Collapse
|
225
|
Rivero-Calle I, Cebey-López M, Pardo-Seco J, Yuste J, Redondo E, Vargas DA, Mascarós E, Díaz-Maroto JL, Linares-Rufo M, Jimeno I, Gil A, Molina J, Ocaña D, Martinón-Torres F. Lifestyle and comorbid conditions as risk factors for community-acquired pneumonia in outpatient adults (NEUMO-ES-RISK project). BMJ Open Respir Res 2019; 6:e000359. [PMID: 31178994 PMCID: PMC6530500 DOI: 10.1136/bmjresp-2018-000359] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/30/2018] [Accepted: 12/26/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction Information about community-acquired pneumonia (CAP) risk in primary care is limited. We assess different lifestyle and comorbid conditions as risk factors (RF) for CAP in adults in primary care. Methods A retrospective-observational-controlled study was designed. Adult CAP cases diagnosed at primary care in Spain between 2009 and 2013 were retrieved using the National Surveillance System of Primary Care Data (BiFAP). Age-matched and sex-matched controls were selected by incidence density sampling (ratio 2:1). Associations are presented as percentages and OR. Binomial regression models were constructed to avoid bias effects. Results 51 139 patients and 102 372 controls were compared. Mean age (SD) was 61.4 (19.9) years. RF more significantly linked to CAP were: HIV (OR [95% CI]: 5.21 [4.35 to 6.27]), chronic obstructive pulmonary disease (COPD) (2.97 [2.84 to 3.12]), asthma (2.16 [2.07,2.26]), smoking (1.96 [1.91 to 2.02]) and poor dental hygiene (1.45 [1.41 to 1.49]). Average prevalence of any RF was 82.2% in cases and 69.2% in controls (2.05 [2.00 to 2.10]). CAP rate increased with the accumulation of RF and age: risk associated with 1RF was 1.42 (1.37 to 1.47) in 18–60-year-old individuals vs 1.57 (1.49 to 1.66) in >60 years of age, with 2RF 1.88 (1.80 to 1.97) vs 2.35 (2.23, 2.48) and with ≥ 3 RF 3.11 (2.95, 3.30) vs 4.34 (4.13 to 4.57). Discussion Prevalence of RF in adult CAP in primary care is high. Main RFs associated are HIV, COPD, asthma, smoking and poor dental hygiene. Our risk stacking results could help clinicians identify patients at higher risk of pneumonia.
Collapse
Affiliation(s)
- Irene Rivero-Calle
- Translational Pediatrics and Infectious Diseases Section, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Miriam Cebey-López
- Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jacobo Pardo-Seco
- Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Yuste
- Pneumococcal Unit of the Laboratory of Reference and Research in Bacterial Diseases Preventable by Vaccines, National Center of Microbiology and CIBER of Respiratory Diseases (CIBERES). Carlos III Health Institute, Madrid, Spain
| | - Esther Redondo
- Preventive and Public Health Activities Group SEMERGEN, International Heath Center, Madrid, Spain
| | - Diego A Vargas
- Versatile Hospitalization Unit, Hospital de Alta Resolución El Toyo, Agencia Pública Sanitaria, Hospital de Poniente, Almería, Spain
| | - Enrique Mascarós
- Health Department, Hospital Dr Peset, Primary Care Center Fuente de San Luís, Valencia, Spain
| | - Jose Luis Díaz-Maroto
- Primary Care Health Center Guadalajara, Infectious Diseases Group SEMERGEN, Guadalajara, Spain
| | - Manuel Linares-Rufo
- Specialist in Primary Care and Clinical Microbiology, Infectious Diseases Group SEMERGEN, Fundación io, Madrid, Spain
| | - Isabel Jimeno
- Primary Care Health Center Isla de Oza, Vaccine Responsible of SEMG, Madrid, Spain
| | - Angel Gil
- Preventive and Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Jesus Molina
- Primary Care, Health Care Center Francia, Fuenlabrada, Madrid, Spain
| | - Daniel Ocaña
- Primary Care, Health Care Center Algeciras, Algeciras, Spain
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases Section, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
226
|
Inducible lung epithelial resistance requires multisource reactive oxygen species generation to protect against bacterial infections. PLoS One 2019; 14:e0208216. [PMID: 30794556 PMCID: PMC6386317 DOI: 10.1371/journal.pone.0208216] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/01/2019] [Indexed: 12/22/2022] Open
Abstract
Pneumonia remains a global health threat, in part due to expanding categories of susceptible individuals and increasing prevalence of antibiotic resistant pathogens. However, therapeutic stimulation of the lungs’ mucosal defenses by inhaled exposure to a synergistic combination of Toll-like receptor (TLR) agonists known as Pam2-ODN promotes mouse survival of pneumonia caused by a wide array of pathogens. This inducible resistance to pneumonia relies on intact lung epithelial TLR signaling, and inducible protection against viral pathogens has recently been shown to require increased production of epithelial reactive oxygen species (ROS) from multiple epithelial ROS generators. To determine whether similar mechanisms contribute to inducible antibacterial responses, the current work investigates the role of ROS in therapeutically-stimulated protection against Pseudomonas aerugnosa challenges. Inhaled Pam2-ODN treatment one day before infection prevented hemorrhagic lung cytotoxicity and mouse death in a manner that correlated with reduction in bacterial burden. The bacterial killing effect of Pam2-ODN was recapitulated in isolated mouse and human lung epithelial cells, and the protection correlated with inducible epithelial generation of ROS. Scavenging or targeted blockade of ROS production from either dual oxidase or mitochondrial sources resulted in near complete loss of Pam2-ODN-induced bacterial killing, whereas deficiency of induced antimicrobial peptides had little effect. These findings support a central role for multisource epithelial ROS in inducible resistance against a bacterial pathogen and provide mechanistic insights into means to protect vulnerable patients against lethal infections.
Collapse
|
227
|
Kim AM, Kang S, Park JH, Yoon TH, Kim Y. A spatial analysis of geographic variation and factors associated with hospitalization for bacterial pneumonia in Korea. BMC Pulm Med 2019; 19:45. [PMID: 30786908 PMCID: PMC6383222 DOI: 10.1186/s12890-019-0798-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of pneumonia in Korea started to increase in the 1990's after a period of decrease and stabilization, and the mortality and hospitalization rates for pneumonia in Korea are alarmingly high. This study was performed to examine geographic variation and factors associated with hospitalization for bacterial pneumonia in Korea. METHODS Data were acquired from the inpatient claims of the 2015 period of the National Health Insurance Service. The age- and sex-standardized hospitalization rates for bacterial pneumonia were calculated for three age groups. Geographic variation was measured with the coefficient of variation, the ratio of the 90th to the 10th percentile of the distribution of rates, and the systematic component of variation. Considering the results of Moran's I statistic which suggested spatial autocorrelation, we estimated spatial regression models using spatial error models. RESULTS The hospitalization rate for bacterial pneumonia was 79.1 per 10,000 population, and the rate was the highest in the age group 0-14 at 325.3, and it was 161.5 among the elderly. The geographic variation statistics showed high variation with the coefficient variation at 0.6. The deprivation score showed positive associations, and the number of primary care physicians had a negative association with the hospitalization rates across all age groups but the age group 0-14. The number of beds in hospitals with less than 300 beds had a positive association with the hospitalization rates for bacterial pneumonia, and the impact was the strongest in the age group 0-14. CONCLUSIONS The present study shows that pneumonia can be a major public health issue even in a developed country. Socioeconomic conditions can still be a concern for pneumonia in developed countries, and the role of primary care physicians in preventing hospitalization for bacterial pneumonia needs to be recognized. Most of all, the strong impact of hospital beds on the hospitalization rates for pneumonia, especially for the children, should be addressed. High disease burden of pneumonia in Korea can partly be attributable to oversupply of hospital beds. These factors should be taken into consideration in establishing policy measures for the rise in pneumonia.
Collapse
Affiliation(s)
- Agnus M. Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Sungchan Kang
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jong Heon Park
- National Health Insurance Service, Wonju, Republic of Korea
| | - Tae Ho Yoon
- Department of Preventive and Occupational Medicine, School of Medicine, Pusan National University, Pusan, Republic of Korea
| | - Yoon Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| |
Collapse
|
228
|
Suissa S. Inhaled corticosteroids preventing pneumonia mortality: paradox or selection bias? Eur Respir J 2019; 53:53/2/1802112. [PMID: 30765484 DOI: 10.1183/13993003.02112-2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/30/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Samy Suissa
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, and the Depts of Epidemiology and Biostatistics and of Medicine, McGill University, Montreal, QC, Canada
| |
Collapse
|
229
|
Gale CR, Deary IJ, Batty GD. Cognitive ability and risk of death from lower respiratory tract infection: findings from UK Biobank. Sci Rep 2019; 9:1342. [PMID: 30718728 PMCID: PMC6362031 DOI: 10.1038/s41598-018-38126-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/18/2018] [Indexed: 01/10/2023] Open
Abstract
Dementia increases the risk of lower respiratory tract infection, but it is unclear whether risk varies across the normal range of cognitive ability. People with higher cognitive ability tend to behave in a healthier fashion as regards risk factors for lower respiratory tract infection and there is evidence that they have a lower risk of dying from respiratory disease as a whole. We therefore investigated the relationship between cognitive ability and mortality from lower respiratory tract infection. Participants were 434,413 people from UK Biobank (54% female). Cognitive ability was measured using tests of reaction time and reasoning. Data on deaths from lower respiratory infection were obtained from death certificates. Over a mean follow-up period of 6.99 years, 1,282 people died of lower respiratory infection. Mortality from lower respiratory tract infection fell as cognitive ability increased. For a standard deviation faster reaction time, the age- and sex-adjusted hazard ratio (95% confidence interval) was 0.80 (0.76, 0.83) and the multivariable-adjusted hazard ratio was 0.87 (0.83, 0.91). There were similar though weaker associations when cognitive ability was assessed using a reasoning test. These findings suggest that variation across the normal range of cognitive ability increase risk of dying from lower respiratory tract infection.
Collapse
Affiliation(s)
- Catharine R Gale
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. .,Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK. .,Department of Psychology, University of Edinburgh, Edinburgh, UK.
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - G David Batty
- Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK.,Department of Epidemiology and Public Health, University College, London, UK
| |
Collapse
|
230
|
Impact of Postoperative Pneumonia Developing After Discharge on Long-Term Follow-up for Resected Lung Cancer. World J Surg 2019; 42:3979-3987. [PMID: 29946786 DOI: 10.1007/s00268-018-4727-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postoperative nosocomial pneumonia is a common immediate complication following lung resection. However, the incidence and mortality of pneumonia developing after discharge (PDAD) for lung-resected patients during long-term observation remain unclear. The aim of this study was to investigate the clinical features of PDAD in patients with resected lung cancer. METHODS We conducted a retrospective cohort study of 357 consecutive patients with lung cancer who had undergone lung resection at a single institution, between April 2007 and December 2016. The clinical characteristics, pathological features, and overall survival were analyzed. Propensity score matched analysis was used for the evaluation of overall survival between PDAD and non-PDAD groups with adjusted relevant confounding factors. RESULTS PDAD was observed in 66 patients (18.5%). The cumulative incidence of PDAD was 14.9% at 3 years and 21.6% at 5 years. Mortality of PDAD was 30.3%. Multivariate analysis demonstrated that the risk factors for PDAD were age (OR 1.07; P = 0.005), oral steroid use (OR 5.62; P = 0.046), and lower-lobe resection (OR 1.87; P = 0.034). After propensity score matching, 52 patients with PDAD and 52 patients without it were compared. The incidence of PDAD resulted in a worse 5-year overall survival (56.1 vs. 69.3%; P = 0.024). The Cox proportional hazards model indicated that PDAD was associated with poor overall survival (HR 1.99, P = 0.027). CONCLUSIONS Our findings revealed a high incidence and mortality of PDAD among patients who had undergone lung resection with long-term follow-up. Therefore, PDAD could be associated with poorer overall survival.
Collapse
|
231
|
Viasus D, Calatayud L, McBrown MV, Ardanuy C, Carratalà J. Urinary antigen testing in community-acquired pneumonia in adults: an update. Expert Rev Anti Infect Ther 2019; 17:107-115. [PMID: 30618315 DOI: 10.1080/14787210.2019.1565994] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) continues to be a leading cause of hospitalization and mortality worldwide. Streptococcus pneumoniae and Legionella pneumophila remain the major etiological agents and are responsible for a significant proportion of CAP mortality. Among diagnostic tests for CAP, urine antigen detection of S. pneumoniae and L. pneumophila is widely accepted due to the simplicity of collection and the rapidity of the test results. Areas covered: This comprehensive review outlines the urinary antigen tests available, discusses their sensitivity and specificity, and assesses the usefulness of their results as the basis for targeted therapy. Expert commentary: There have been advances in urine antigen detection tests for patients with CAP. New methodologies show greater sensitivity, detect S. pneumoniae and L. pneumophila in a single test, and also detect pneumococcal serotypes. In addition, urine antigen detection tests have shown a high specificity, which means that a positive result practically indicates the causative pathogen of CAP. Therefore, a positive result can lead to a targeted therapy that is likely to improve patient outcomes and reduce the risk of resistance and adverse events. However, well-designed studies are needed to evaluate the usefulness of urine antigen detection tests with regard to clinical outcomes.
Collapse
Affiliation(s)
- Diego Viasus
- a Department of Medicine, Health Sciences Division , Universidad del Norte and Hospital Universidad del Norte , Barranquilla , Colombia
| | - Laura Calatayud
- b Department of Microbiology , Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), University of Barcelona , Barcelona , Spain.,c Research Network for Respiratory Diseases (CIBERES) , Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
| | - María V McBrown
- a Department of Medicine, Health Sciences Division , Universidad del Norte and Hospital Universidad del Norte , Barranquilla , Colombia
| | - Carmen Ardanuy
- b Department of Microbiology , Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), University of Barcelona , Barcelona , Spain.,c Research Network for Respiratory Diseases (CIBERES) , Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
| | - Jordi Carratalà
- d Department of Infectious Diseases , Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), University of Barcelona , Barcelona , Spain.,e Spanish Network for Research in Infectious Diseases (REIPI) , Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
| |
Collapse
|
232
|
Dirmesropian S, Liu B, Wood JG, MacIntyre CR, McIntyre P, Karki S, Jayasinghe S, Newall AT. Pneumonia hospitalisation and case-fatality rates in older Australians with and without risk factors for pneumococcal disease: implications for vaccine policy. Epidemiol Infect 2019; 147:e118. [PMID: 30869015 PMCID: PMC6518507 DOI: 10.1017/s0950268818003473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 11/16/2018] [Accepted: 11/30/2018] [Indexed: 12/04/2022] Open
Abstract
Community-acquired pneumonia (CAP) results in substantial numbers of hospitalisations and deaths in older adults. There are known lifestyle and medical risk factors for pneumococcal disease but the magnitude of the additional risk is not well quantified in Australia. We used a large population-based prospective cohort study of older adults in the state of New South Wales (45 and Up Study) linked to cause-specific hospitalisations, disease notifications and death registrations from 2006 to 2015. We estimated the age-specific incidence of CAP hospitalisation (ICD-10 J12-18), invasive pneumococcal disease (IPD) notification and presumptive non-invasive pneumococcal CAP hospitalisation (J13 + J18.1, excluding IPD), comparing those with at least one risk factor to those with no risk factors. The hospitalised case-fatality rate (CFR) included deaths in a 30-day window after hospitalisation. Among 266 951 participants followed for 1 850 000 person-years there were 8747 first hospitalisations for CAP, 157 IPD notifications and 305 non-invasive pneumococcal CAP hospitalisations. In persons 65-84 years, 54.7% had at least one identified risk factor, increasing to 57.0% in those ⩾85 years. The incidence of CAP hospitalisation in those ⩾65 years with at least one risk factor was twofold higher than in those without risk factors, 1091/100 000 (95% confidence interval (CI) 1060-1122) compared with 522/100 000 (95% CI 501-545) and IPD in equivalent groups was almost threefold higher (18.40/100 000 (95% CI 14.61-22.87) vs. 6.82/100 000 (95% CI 4.56-9.79)). The CFR increased with age but there were limited difference by risk status, except in those aged 45 to 64 years. Adults ⩾65 years with at least one risk factor have much higher rates of CAP and IPD suggesting that additional risk factor-based vaccination strategies may be cost-effective.
Collapse
Affiliation(s)
- S. Dirmesropian
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - B. Liu
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - J. G. Wood
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - C. R. MacIntyre
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - P. McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Kids Research Institute, Children's Hospital at Westmead, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Sydney, Australia
| | - S. Karki
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - S. Jayasinghe
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Kids Research Institute, Children's Hospital at Westmead, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Sydney, Australia
| | - A. T. Newall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
233
|
Chen J, Wang J, Jiang H, Li MC, He SY, Li XP, Shen D. Lower long-term mortality in obese patients with community-acquired pneumonia: possible role of CRP. Clinics (Sao Paulo) 2019; 74:e608. [PMID: 31291389 PMCID: PMC6607938 DOI: 10.6061/clinics/2019/e608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 12/04/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The present study aimed to investigate the relationship between obesity and mortality in patients with community-acquired pneumonia (CAP) in China. METHODS In total, 909 patients with CAP were recruited for this study from January 2010 to June 2015. All patients were selected and divided into 4 groups according to their body mass index (BMI) values. All patients' clinical information was recorded. The associations among mortality; BMI; the 30-day, 6-month and 1-year survival rates for different BMI classes; the etiology of pneumonia in each BMI group; and the risk factors for 1-year mortality in CAP patients were analyzed. RESULT With the exception of the level of C-reactive protein (CRP), no other clinical indexes showed significant differences among the different BMI groups. No significant differences were observed among all groups in terms of the 30-d and 6-month mortality rates (p>0.05). There was a significantly lower risk of 1-year mortality in the obese group than in the nonobese group, (p<0.05). Logistic regression analysis showed that there were seven independent risk factors for 1-year mortality in CAP patients, namely, age, cardiovascular disease, cerebrovascular disease, obesity, APACHE II score, level of CRP and CAP severity. CONCLUSION Compared with nonobese patients with CAP, obese CAP patients may have a lower mortality rate, especially with regard to 1-year mortality, and CRP may be associated with the lower mortality rate in obese individuals than in nonobese individuals.
Collapse
Affiliation(s)
- Jin Chen
- Department of Critical Care Medicine, Xiehe Hospital of Dongxihu District, Wuhan People's Hospital of Dongxihu District, Wuhan, 430000, China
- *Corresponding author. E-mail:
| | - Jia Wang
- Department of Critical Care Medicine, Xiehe Hospital of Dongxihu District, Wuhan People's Hospital of Dongxihu District, Wuhan, 430000, China
- *Corresponding author. E-mail:
| | - Hui Jiang
- Department of Respiratory, Wanbei Coal-Electricity Group General Hospital, Suzhou 234011, Anhui Province, China
- *Corresponding author. E-mail:
| | - Mao-Chun Li
- Department of Pharmacy, The Central Hospital of Wuhan affiliated to Tongji Medical College, Huazhong University of Science and Technology, 430024, Wuhan, China
| | - Si-Yuan He
- Department of Nephrology, Tongji Hospital affiliated to Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Peng Li
- Department of Neurosurgery, Tongji Hospital affiliated to Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dantong Shen
- Department of Neurologic Rehabilitation, Neurologic Specialized Hospital, General Hospital of Southern Theater Command, Guangzhou, 510010, China
- *Corresponding author. E-mail:
| |
Collapse
|
234
|
Peyrani P, Mandell L, Torres A, Tillotson GS. The burden of community-acquired bacterial pneumonia in the era of antibiotic resistance. Expert Rev Respir Med 2018; 13:139-152. [PMID: 30596308 DOI: 10.1080/17476348.2019.1562339] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is a significant global health problem and leading cause of death and hospitalization in both the US and abroad. Increasing macrolide resistance among Streptococcus pneumoniae and other pathogens results in a greater disease burden, along with changing demographics and a higher preponderance of comorbid conditions. Areas covered: This review summarizes current data on the clinical and economic burden of CAP, with particular focus on community-acquired bacterial pneumonia (CABP). Incidence, morbidity and mortality, and healthcare costs for the US and other regions of the world are among the topics covered. Major factors that are believed to be contributing to the increased impact of CABP, including antimicrobial resistance, the aging population, and the incidence of comorbidities are discussed, as well as unmet needs in current CABP management. Expert commentary: The clinical and economic burden of CABP is staggering, far-reaching, and expected to increase in the future as new antibiotic resistance mechanisms emerge and the world's population ages. Important measures must be initiated to stabilize and potentially decrease this burden. Urgent needs in CABP management include the development of new antimicrobials, adjuvant therapies, and rapid diagnostics.
Collapse
Affiliation(s)
- Paula Peyrani
- a Vaccine Clinical Research and Development , Pfizer Inc , Collegeville , PA , USA
| | - Lionel Mandell
- b Division of Infectious Diseases , McMaster University , Hamilton , Ontario , Canada
| | - Antoni Torres
- c Hospital Clinic, IDIBAPS, Ciberes , University of Barcelona , Barcelona , Spain
| | | |
Collapse
|
235
|
Feldman C, Shaddock E. Epidemiology of lower respiratory tract infections in adults. Expert Rev Respir Med 2018; 13:63-77. [DOI: 10.1080/17476348.2019.1555040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Erica Shaddock
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
236
|
Abstract
Pneumonia is a type of acute lower respiratory infection that is common and severe. The outcome of lower respiratory infection is determined by the degrees to which immunity is protective and inflammation is damaging. Intercellular and interorgan signaling networks coordinate these actions to fight infection and protect the tissue. Cells residing in the lung initiate and steer these responses, with additional immunity effectors recruited from the bloodstream. Responses of extrapulmonary tissues, including the liver, bone marrow, and others, are essential to resistance and resilience. Responses in the lung and extrapulmonary organs can also be counterproductive and drive acute and chronic comorbidities after respiratory infection. This review discusses cell-specific and organ-specific roles in the integrated physiological response to acute lung infection, and the mechanisms by which intercellular and interorgan signaling contribute to host defense and healthy respiratory physiology or to acute lung injury, chronic pulmonary disease, and adverse extrapulmonary sequelae. Pneumonia should no longer be perceived as simply an acute infection of the lung. Pneumonia susceptibility reflects ongoing and poorly understood chronic conditions, and pneumonia results in diverse and often persistent deleterious consequences for multiple physiological systems.
Collapse
Affiliation(s)
- Lee J Quinton
- Pulmonary Center, Boston University School of Medicine , Boston, Massachusetts
| | - Allan J Walkey
- Pulmonary Center, Boston University School of Medicine , Boston, Massachusetts
| | - Joseph P Mizgerd
- Pulmonary Center, Boston University School of Medicine , Boston, Massachusetts
| |
Collapse
|
237
|
Yoon YK, Kim MJ, Yang KS, Ham SY. The role of serum procalcitonin in the differential diagnosis of pneumonia from pulmonary edema among the patients with pulmonary infiltrates on chest radiography. Medicine (Baltimore) 2018; 97:e13348. [PMID: 30461655 PMCID: PMC6393097 DOI: 10.1097/md.0000000000013348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study is to evaluate the usefulness of serum procalcitonin (PCT) as a diagnostic biomarker for distinguishing pneumonia from pulmonary edema in patients presenting with pulmonary infiltrates on chest radiography.A comparative study was performed retrospectively in a university-affiliated hospital, from May, 2013 to April, 2015. Adult patients (≥18 years) who showed pulmonary infiltrates on chest radiography and had blood tests with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), PCT, and N-terminal pro-b-type natriuretic peptide (NT-proBNP) on admission were included in the study. Clinical parameters collected on admission were compared between the case group (n = 143) with pneumonia and the control group (n = 88) with pulmonary edema alone.During the study period, a total of 1217 patients were identified. Of them, a total of 231 patients were included in analyses based on exclusion criteria. In the multivariate logistic regression analysis, PCT ≥0.25 ng/mL, ESR ≥35 mm/h, CRP ≥18 mg/L, NT-proBNP ≤200 pg/mL, underlying neurologic diseases, fever, sputum, absence of cardiomegaly, and a low Charlson comorbidity index were independently associated with pneumonia. For this model, the sensitivity, specificity, positive predictive value, and negative predictive value in distinguishing between the 2 groups were 90.2%, 79.6%, 87.8%, and 83.3%, respectively, with an area under the curve of 0.93.This study suggests that the practical use of PCT in conjunction with clinical data can be valuable in the differential diagnosis of pulmonary infiltrates and guidance for clinicians to prevent antibiotic misuse.
Collapse
Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine
| | - Kyung Sook Yang
- Department of Biostatistics, Korea University College of Medicine
| | - Soo-Youn Ham
- Department of Radiology, Kangbuk Samsung Medical Center; Seoul, Republic of Korea
| |
Collapse
|
238
|
Dzahini O, Singh N, Taylor D, Haddad PM. Antipsychotic drug use and pneumonia: Systematic review and meta-analysis. J Psychopharmacol 2018; 32:1167-1181. [PMID: 30334664 DOI: 10.1177/0269881118795333] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the association of antipsychotic exposure to the incidence and mortality of pneumonia. METHODS The design of this study involved meta-analysis of observational studies identified from electronic databases. RESULTS In total, 19 studies were included in the systematic review and 14 in the meta-analysis. Risk of pneumonia was increased by first-generation antipsychotics (risk ratio 1.69, 95% confidence interval 1.34-2.15; five studies), second-generation antipsychotics (risk ratio 1.93, 95% confidence interval 1.55-2.41; six studies) and all antipsychotics (risk ratio 1.83, 95% confidence interval 1.60-2.10; seven studies) compared with no antipsychotic use. Pneumonia risk did not differ in seven studies comparing first-generation antipsychotics with second-generation antipsychotics (risk ratio 1.07, 95% confidence interval 0.85-1.35). Case fatality rate was not different in pneumonia cases associated with antipsychotic exposure versus cases without exposure (risk ratio 1.50; 95% confidence interval 0.76-2.96; two studies). All antipsychotics with data from ⩾2 studies allowing meta-analysis, were associated with a significantly increased pneumonia risk (i.e. haloperidol, olanzapine, clozapine, risperidone, quetiapine, zotepine). CONCLUSION Exposure to both first-generation antipsychotics and second-generation antipsychotics is associated with an increased pneumonia risk. Clinicians need to be vigilant for the occurrence of pneumonia in patients commencing antipsychotics, especially those with other risk factors for pneumonia including older age, chronic respiratory disease, cerebrovascular disease, dysphagia and smoking.
Collapse
Affiliation(s)
- O Dzahini
- 1 Institute of Pharmaceutical Science, King's College London, London, UK.,2 South London and Maudsley NHS Foundation Trust, London, UK
| | - N Singh
- 3 Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - D Taylor
- 1 Institute of Pharmaceutical Science, King's College London, London, UK.,2 South London and Maudsley NHS Foundation Trust, London, UK
| | - P M Haddad
- 3 Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar.,4 University of Manchester, Manchester, UK
| |
Collapse
|
239
|
Stolbrink M, Bonnett LJ, Blakey JD. Amoxicillin is associated with a lower risk of further antibiotic prescriptions for lower respiratory tract infections in primary care - A database analysis spanning over 30 years. Eur Clin Respir J 2018; 5:1529535. [PMID: 30370019 PMCID: PMC6201792 DOI: 10.1080/20018525.2018.1529535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022] Open
Abstract
Antibiotic prescriptions for lower respiratory tract infections occur commonly in primary care but there is uncertainty about the most effective initial treatment strategy. Both increasing antimicrobial resistance and awareness of preventable harm from medicines make resolving this uncertainty a priority. Pragmatic, real-life epidemiological investigations are needed to inform future interventional studies. In this cross-sectional database study we analysed antibiotic prescriptions for non-pneumonic, lower respiratory tract infections (LRTI) in primary care as captured in the Optimum Care Database from 1984 to 2017. The primary outcome was a second antibiotic prescription for a LRTI code within 14 days of index prescription, the secondary outcome further antibiotic prescription for any indication. Only individuals without chronic respiratory diseases were included. We conducted univariable analysis to identify factors associated with repeat prescriptions and generate hypotheses for forthcoming projects. We analysed 367,188 index prescriptions for LRTI. Amoxicillin was the commonest used index drug (65.1%). In 6% a second antibiotic course coded for a further LRTI was prescribed (11.2% without this coding restriction). Further antibiotic prescriptions for LRTI were significantly associated with older age, previous smoking, seven day index courses and not using amoxicillin initially. The largest effect size was seen when amoxicillin was not used as index drug (odds ratio (OR) 1.15, p < 0.001). This would support current prescribing practice for amoxicillin as index drug in those without respiratory disease. Prospective studies are needed to explore the observed differences.
Collapse
Affiliation(s)
- Marie Stolbrink
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Laura J. Bonnett
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - John D. Blakey
- Health Services Research, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
- Royal Liverpool University Hospital, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK
| |
Collapse
|
240
|
Efficacy and safety of nintedanib in advanced idiopathic pulmonary fibrosis. Respir Res 2018; 19:203. [PMID: 30340638 PMCID: PMC6194688 DOI: 10.1186/s12931-018-0907-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/07/2018] [Indexed: 11/25/2022] Open
Abstract
Background Phase 3 trials have shown that nintedanib reduces the decline in forced vital capacity (FVC) in patients with mild-to-moderate idiopathic pulmonary fibrosis (IPF) with acceptable safety profiles; however, its effects on advanced IPF are unclear. We investigated the efficacy and safety of nintedanib in patients with advanced IPF. Methods Prospective data were obtained from 108 IPF patients administered at least one dose of nintedanib. Of these patients, 47.2% had advanced IPF (FVC < 50% predicted, or diffusing capacity < 30% predicted). Results The median treatment duration was 42.2 weeks. Nintedanib significantly reduced the decline rate in both FVC (− 0.55% [before] vs. -0.32% [after] predicted/month, p = 0.020) and total lung capacity (TLC) (− 0.35% vs. -0.06% predicted/month, p < 0.001) in all patients. A significant improvement in FVC decline rate after treatment was also observed in the advanced group (− 0.77% vs. -0.22% predicted/month, p = 0.003), but not in the non-advanced group (− 0.41% vs. -0.33% predicted/month, p = 0.564). Adverse events occurred in 97.2% of the cohort, including diarrhoea (50.0%) and anorexia (45.4%). Following adjustment for treatment duration, no inter-group difference in odds ratio was observed for the occurrence of adverse events. However, the advanced group showed a higher frequency of treatment interruption (68.0% vs. 40.0%), mainly as a result of disease progression (47.1% vs. 36.4%). Conclusions The efficacy and safety profiles of nintedanib in the advanced group were comparable to those in the non-advanced group except for a higher frequency of discontinuation, which may be due to the advanced status itself. Electronic supplementary material The online version of this article (10.1186/s12931-018-0907-8) contains supplementary material, which is available to authorized users.
Collapse
|
241
|
Fernandez-Sierra MA, Rueda-Domingo MT, Rodriguez-del-Aguila MM, Perez-Lozano MJ, Force L, Fernandez-Villa T, Astray J, Egurrola M, Castilla J, Sanz F, Toledo D, Dominguez A. Adaptation of antibiotic treatment to clinical practice guidelines in patients aged ⩾65 years hospitalised due to community-acquired pneumonia. Epidemiol Infect 2018; 146:1870-1877. [PMID: 30070190 PMCID: PMC9506693 DOI: 10.1017/s0950268818002121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/21/2018] [Accepted: 07/09/2018] [Indexed: 11/06/2022] Open
Abstract
Early, conforming antibiotic treatment in elderly patients hospitalised for community-acquired pneumonia (CAP) is a key factor in the prognosis and mortality. The objective was to examine whether empirical antibiotic treatment was conforming according to the Spanish Society of Pulmonology and Thoracic Surgery guidelines in these patients. Multicentre study in patients aged ⩾65 years hospitalised due to CAP in the 2013-14 and 2014-15 influenza seasons. We collected socio-demographic information, comorbidities, influenza/pneumococcal vaccination history and antibiotics administered using a questionnaire and medical records. Bivariate analyses and multilevel logistic regression were made. In total, 1857 hospitalised patients were included, 82 of whom required intensive care unit (ICU) admission. Treatment was conforming in 51.4% (95% confidence interval (CI) 49.1-53.8%) of patients without ICU admission and was associated with absence of renal failure without haemodialysis (odds ratio (OR) 1.49, 95% CI 1.15-1.95) and no cognitive dysfunction (OR 1.71, 95% CI 1.25-2.35), when the effect of the autonomous community was controlled for. In patients with ICU admission, treatment was conforming in 45.1% (95% CI 34.1-56.1%) of patients and was associated with the hospital visits in the last year (<3 vs. ⩾3, OR 2.70, 95% CI 1.03-7.12) and there was some evidence that this was associated with season. Although the reference guidelines are national, wide variability between autonomous communities was found. In patients hospitalised due to CAP, health services should guarantee the administration of antibiotics in a consensual manner that is conforming according to clinical practice guidelines.
Collapse
Affiliation(s)
- M. A. Fernandez-Sierra
- UGC Prevención Promoción y Vigilancia Salud. Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M. T. Rueda-Domingo
- UGC Prevención Promoción y Vigilancia Salud. Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M. M. Rodriguez-del-Aguila
- UGC Prevención Promoción y Vigilancia Salud. Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M. J. Perez-Lozano
- UGC Prevención, Promoción y Vigilancia Salud. Hospital de Valme, Sevilla, Spain
| | - L. Force
- Hospital de Mataró, Barcelona, Spain
| | - T. Fernandez-Villa
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS). Instituto de Biomedicina (IBIOMED). Universidad de León, León, Spain
| | - J. Astray
- Consejería de Sanidad de Madrid, Madrid, Spain
| | - M. Egurrola
- Hospital de Galdakao, Usansolo, Vizcaya, Spain
| | - J. Castilla
- Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - F. Sanz
- Consorci Hospital General Universitari de Valencia, Valencia, Spain
| | - D. Toledo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - A. Dominguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | |
Collapse
|
242
|
Ukawa S, Zhao W, Yatsuya H, Yamagishi K, Tanabe N, Iso H, Tamakoshi A. Associations of Daily Walking Time With Pneumonia Mortality Among Elderly Individuals With or Without a Medical History of Myocardial Infarction or Stroke: Findings From the Japan Collaborative Cohort Study. J Epidemiol 2018; 29:233-237. [PMID: 30249944 PMCID: PMC6522391 DOI: 10.2188/jea.je20170341] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The association between daily walking and pneumonia mortality, stratified by the presence of disease conditions, such as myocardial infarction (MI) or stroke, was investigated. Methods The study participants were 22,280 Japanese individuals (9,067 men and 13,213 women) aged 65–79 years. Inverse propensity weighted competing risk model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for pneumonia mortality. Results After a median of 11.9 years of follow-up, 1,203 participants died of pneumonia. Participants who did not have a history of MI or stroke and who walked for 1 hour/day or more were less likely to die from pneumonia (HR 0.90; 95% CI, 0.82–0.98) than those walked for 0.5 hours/day. A similar inverse association of pneumonia and walking (0.5 hours/day) was observed among participants with a history of MI (HR 0.66; 95% CI, 0.48–0.90). Among the participants with a history of stroke, those who walked for 0.6–0.9 hours/day were less likely to die because of pneumonia (HR 0.65; 95% CI, 0.43–0.98). Conclusions Regular walking for ≥1 hour/day may reduce the risk of pneumonia mortality in elderly individuals with or without cardiovascular disease history.
Collapse
Affiliation(s)
- Shigekazu Ukawa
- Department of Public Health, Faculty of Medicine and Graduate School of Medicine, Hokkaido University.,Research Unit of Advanced Interdisciplinary Care Science, Graduate School of Human Life Science, Osaka City University
| | - Wenjing Zhao
- Department of Public Health, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Hiroshi Yatsuya
- Department of Public Health, Fujita Health University School of Medicine
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba
| | - Naohito Tanabe
- Department of Health and Nutrition, Faculty of Human Life Studies, University of Niigata Prefecture
| | - Hiroyasu Iso
- Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka University
| | - Akiko Tamakoshi
- Department of Public Health, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| |
Collapse
|
243
|
Liapikou A, Cilloniz C, Torres A. Drugs that increase the risk of community-acquired pneumonia: a narrative review. Expert Opin Drug Saf 2018; 17:991-1003. [PMID: 30196729 DOI: 10.1080/14740338.2018.1519545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP), a major cause of morbidity and mortality, is the leading infectious cause of death in the developed world. Population-based studies and systematic reviews have identified a large number of risk factors for the development of pneumonia in adults. In addition to age, lifestyle habits, and comorbidities, some forms of pharmacotherapy may also increase the risk for CAP. AREAS COVERED MEDLINE, CENTRAL, and Web of Science were used in 2017 to search for case-control, cohort studies, as well as randomized controlled trials and meta-analysis that involved outpatient proton pump inhibitors (PPIs), inhaled corticosteroids (ICSs), antipsychotics, oral antidiabetics, and CAP diagnosis in patients aged >18 years. EXPERT OPINION Our review confirmed that the use of ICSs, PPIs or antipsychotic drugs was independently associated with an increased risk for CAP. We also identified a positive association between specific oral antidiabetics and the development of pneumonia.
Collapse
Affiliation(s)
- Adamantia Liapikou
- a 6th Respiratory Department , Sotiria Chest Diseases Hospital , Athens , Greece
| | - Catia Cilloniz
- b 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
| | - Antoni Torres
- b 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
| |
Collapse
|
244
|
Cillóniz C, Ielpo A, Torres A. Treating HIV-Positive/Non-AIDS Patients for Community-Acquired Pneumonia with ART. Curr Infect Dis Rep 2018; 20:46. [PMID: 30203191 DOI: 10.1007/s11908-018-0652-7] [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: 01/17/2023]
Abstract
PURPOSE OF REVIEW This article reviews the most recent publications on community-acquired pneumonia (CAP) in the HIV-infected population on antiretroviral therapy (ART), focusing on epidemiology, prognostic factors, etiology, and antimicrobial therapy. The data discussed here were mainly obtained from a non-systematic review using Medline and references from relevant articles. RECENT FINDINGS CAP remains a major cause of morbidity and mortality among HIV-infected patients and incurs high health costs despite the introduction of ART. HIV-infected patients are generally known to be more susceptible to bacterial pneumonia. Streptococcus pneumoniae is the most frequently reported pathogen in HIV-infected patients on ART, who present a higher rate of bacteremia than non-HIV-infected patients. Several studies have also examined microbial etiology and prognostic factors of CAP in HIV-infected patients on ART. Despite the high rate of bacterial pneumonia in these patients, mortality rates are not higher than in patients without HIV infection.
Collapse
Affiliation(s)
- Catia Cillóniz
- Department of Pulmonary Medicine, 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), C/ Villarroel 170, 08036, Barcelona, Spain.
| | - Antonella Ielpo
- Department of Medicine and Surgery, Respiratory Disease, and Lung Function Unit, University of Parma, Parma, Italy
| | - Antoni Torres
- Department of Pulmonary Medicine, 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), C/ Villarroel 170, 08036, Barcelona, Spain.
| |
Collapse
|
245
|
Regev-Yochay G, Chowers M, Chazan B, Gonzalez E, Gray S, Zhang Z, Pride M. Distribution of 13-Valent pneumococcal conjugate vaccine serotype streptococcus pneumoniae in adults 50 Years and Older presenting with community-acquired pneumonia in Israel. Hum Vaccin Immunother 2018; 14:2527-2532. [PMID: 30188760 PMCID: PMC6284513 DOI: 10.1080/21645515.2018.1475811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Community acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide, and is a leading cause of hospitalization in previously healthy individuals without predisposing risk factors or comorbidities. In this study we determined PCV13 serotype distribution in adults aged ≥50 years with radiographically confirmed CAP in Israel. METHODS Subjects aged ≥50 years were enrolled from one of three hospitals (Emek Medical Center, Meir Medical Center and Sheba Medical Center) from March 2014 to July 2015. Information was collected on subject demographics, comorbidities, risk factors, and pneumococcal vaccine immunization status. Subjects presented with suspected CAP supported by radiographic evidence, and provided a urine sample and informed consent. Subjects without radiographic confirmation of CAP or who received PPSV23 within 30 days of study enrollment were excluded from the final analysis. Serotype distribution was performed using the urinary antigen detection (UAD) assay and/or microbiological culture. RESULTS Overall, 498 subjects with radiographically confirmed CAP were enrolled in the study. Eighty subjects (16.1%) were positive for any S. pneumoniae serotype by ≥1 assay, and 38 (7.6%) were positive for PCV13 serotypes via the UAD. The overall 30-day mortality rate was 1.2%, though S. pneumoniae was not isolated from any case leading to death. CONCLUSION Despite six years of high pneumococcal immunization coverage in children in Israel, we have shown that 7.6% of CAP cases among adults in Israel remain related to PCV13 serotypes; and that the burden of PCV13 may be as high as 47% of observed pneumococcal CAP.
Collapse
Affiliation(s)
- Gili Regev-Yochay
- a Sheba Medical Center, Ramat Gan, affiliated to the Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
| | - Michal Chowers
- b Meir Medical Center, Kfar Saba, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Bibiana Chazan
- c Ha'Emek Medical Center, Afula, Rappaport Faculty of Medicine , Technion , Haifa
| | | | | | | | | |
Collapse
|
246
|
López‐Alcalde J, Rodriguez‐Barrientos R, Redondo‐Sánchez J, Muñoz‐Gutiérrez J, Molero García JM, Rodríguez‐Fernández C, Heras‐Mosteiro J, Marin‐Cañada J, Casanova‐Colominas J, Azcoaga‐Lorenzo A, Hernandez Santiago V, Gómez‐García M. Short-course versus long-course therapy of the same antibiotic for community-acquired pneumonia in adolescent and adult outpatients. Cochrane Database Syst Rev 2018; 9:CD009070. [PMID: 30188565 PMCID: PMC6513237 DOI: 10.1002/14651858.cd009070.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a lung infection that can be acquired during day-to-day activities in the community (not while receiving care in a hospital). Community-acquired pneumonia poses a significant public health burden in terms of mortality, morbidity, and costs. Shorter antibiotic courses for CAP may limit treatment costs and adverse effects, but the optimal duration of antibiotic treatment is uncertain. OBJECTIVES To evaluate the efficacy and safety of short-course versus longer-course treatment with the same antibiotic at the same daily dosage for CAP in non-hospitalised adolescents and adults (outpatients). We planned to investigate non-inferiority of short-course versus longer-term course treatment for efficacy outcomes, and superiority of short-course treatment for safety outcomes. SEARCH METHODS We searched CENTRAL, which contains the Cochrane Acute Respiratory Infections Group Specialised Register, MEDLINE, Embase, five other databases, and three trials registers on 28 September 2017 together with conference proceedings, reference checking, and contact with experts and pharmaceutical companies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing short- and long-courses of the same antibiotic for CAP in adolescent and adult outpatients. DATA COLLECTION AND ANALYSIS We planned to use standard Cochrane methods. MAIN RESULTS Our searches identified 5260 records. We did not identify any RCTs that compared short- and longer-courses of the same antibiotic for the treatment of adolescents and adult outpatients with CAP.We excluded two RCTs that compared short courses (five compared to seven days) of the same antibiotic at the same daily dose because they evaluated antibiotics (gemifloxacin and telithromycin) not commonly used in practice for the treatment of CAP. In particular, gemifloxacin is no longer approved for the treatment of mild-to-moderate CAP due to its questionable risk-benefit balance, and reported adverse effects. Moreover, the safety profile of telithromycin is also cause for concern.We found one ongoing study that we will assess for inclusion in future updates of the review. AUTHORS' CONCLUSIONS We found no eligible RCTs that studied a short-course of antibiotic compared to a longer-course (with the same antibiotic at the same daily dosage) for CAP in adolescent and adult outpatients. The effects of antibiotic therapy duration for CAP in adolescent and adult outpatients remains unclear.
Collapse
Affiliation(s)
- Jesús López‐Alcalde
- Universidad Francisco de Vitoria (UFV) MadridFaculty of MedicineCtra. Pozuelo‐Majadahonda km. 1,800MadridSpain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS)Clinical Biostatistics UnitCtra. Colmenar, km. 9.100MadridSpain28034
| | - Ricardo Rodriguez‐Barrientos
- Gerencia Asistencial de Atención Primaria, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)Unidad de apoyo a la InvestigaciónJátiva Nº23 2ºcMadridSpain28007
| | - Jesús Redondo‐Sánchez
- Gerencia Asistencial Atención PrimariaCentro de Salud Ramon y CajalJabonería 67MadridSpain28921
| | - Javier Muñoz‐Gutiérrez
- Gerencia Asistencial Atención PrimariaCentro de Salud Buenos AiresPio FelipeMadridSpain28038
| | - José María Molero García
- Gerencia Asistencial Atención PrimariaCentro de Salud San AndrésAlberto Palacios, nº 22MadridMadridSpain28021
| | | | - Julio Heras‐Mosteiro
- Rey Juan Carlos UniversityDepartment of Preventive Medicine and Public Health & Immunology and MicrobiologyAvda. Atenas s/nAlcorcónMadridSpain28922
| | - Jaime Marin‐Cañada
- Gerencia Asistencial Atencion Primaria de MadridCentro de Salud Villarejo de SalvanesCalle Hospital 7Villarejo de SalvanesMadridSpain28590
| | - Jose Casanova‐Colominas
- Gerencia Asistencial de Atención PrimariaCentro de Salud Ciudad de los PeriodistasValencia de don Juan 1028034 MadridMadridSpain28034
| | - Amaya Azcoaga‐Lorenzo
- Gerencia Asistencial Atención PrimariaCentro de Salud Los PintoresC/Prolongación Cordoba s/nParlaMadridSpain29981
| | - Virginia Hernandez Santiago
- University of St AndrewsDivision of Population and Behavioural Sciences, School of MedicineNorth HaughDundeeUKKY16 9TF
| | - Manuel Gómez‐García
- Gerencia Asistencial Atención PrimariaCentro de Salud MirasierraC/ Mirador de la Reina nº 117MadridSpain28035
| | | |
Collapse
|
247
|
Ishigami J, Matsushita K. Clinical epidemiology of infectious disease among patients with chronic kidney disease. Clin Exp Nephrol 2018; 23:437-447. [PMID: 30178234 PMCID: PMC6435626 DOI: 10.1007/s10157-018-1641-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/24/2018] [Indexed: 12/20/2022]
Abstract
Infectious disease is recognized as an important complication among patients with end-stage renal disease, contributing to excess morbidity and health care costs. However, recent epidemiological studies have revealed that even mild to moderate stages of chronic kidney disease (CKD) substantially increase risk of infection. Regarding underlying mechanisms, evidence suggests various aspects of altered immune response in patients with CKD including impaired function of T cells, B cells and neutrophil. Multiple conditions surrounding CKD, such as older age, diabetes, and cardiovascular disease are important contributors in the increased susceptibility to infection in this population. In addition, several mechanisms impairing immune function have been hypothesized including accumulated uremic toxins, increased oxidative stress, endothelial dysfunction, low-grade inflammation, and mineral and bone disorders. In terms of prevention strategies, influenza and pneumococcal vaccines are most feasible and important. Nevertheless, the extent of vaccine utilization in CKD has not been well documented. In addition, antibody response to vaccination may be reduced in CKD patients, and thus a vaccine delivery strategy (e.g., dose and frequency) may need to be optimized among patients with CKD. Through this review, we demonstrate that infection is a major but underrecognized complication of CKD. As CKD is recognized as a serious public health issue, dedicated research is needed to better characterize the burden of infectious disease associated with CKD, understand the pathophysiology of infection in patients with CKD, and develop effective strategies to prevent infection and its sequela in this high risk population.
Collapse
Affiliation(s)
- Junichi Ishigami
- Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD, 21287, USA.
| | - Kunihiro Matsushita
- Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD, 21287, USA
| |
Collapse
|
248
|
Corrêa RDA, Costa AN, Lundgren F, Michelin L, Figueiredo MR, Holanda M, Gomes M, Teixeira PJZ, Martins R, Silva R, Athanazio RA, da Silva RM, Pereira MC. 2018 recommendations for the management of community acquired pneumonia. J Bras Pneumol 2018; 44:405-423. [PMID: 30517341 PMCID: PMC6467584 DOI: 10.1590/s1806-37562018000000130] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 09/11/2018] [Indexed: 12/17/2022] Open
Abstract
Community-acquired pneumonia (CAP) is the leading cause of death worldwide. Despite the vast diversity of respiratory microbiota, Streptococcus pneumoniae remains the most prevalent pathogen among etiologic agents. Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent decades, CAP ranks third as a cause of death in Brazil. Since the latest Guidelines on CAP from the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) were published (2009), there have been major advances in the application of imaging tests, in etiologic investigation, in risk stratification at admission and prognostic score stratification, in the use of biomarkers, and in the recommendations for antibiotic therapy (and its duration) and prevention through vaccination. To review these topics, the SBPT Committee on Respiratory Infections summoned 13 members with recognized experience in CAP in Brazil who identified issues relevant to clinical practice that require updates given the publication of new epidemiological and scientific evidence. Twelve topics concerning diagnostic, prognostic, therapeutic, and preventive issues were developed. The topics were divided among the authors, who conducted a nonsystematic review of the literature, but giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. All authors had the opportunity to review and comment on all questions, producing a single final document that was approved by consensus.
Collapse
Affiliation(s)
- Ricardo de Amorim Corrêa
- . Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Andre Nathan Costa
- . Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP) Brasil
| | | | - Lessandra Michelin
- . Faculdade de Medicina, Universidade de Caxias do Sul, Caxias do Sul (RS) Brasil
| | | | - Marcelo Holanda
- . Faculdade de Medicina, Universidade Federal do Ceará - UFC - Fortaleza (CE) Brasil
| | - Mauro Gomes
- . Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo (SP) Brasil
| | | | - Ricardo Martins
- . Faculdade de Medicina, Universidade de Brasília - UnB - Brasília (DF) Brasil
| | - Rodney Silva
- . Faculdade de Medicina, Universidade Federal do Paraná - UFPR - Curitiba (PR) Brasil
| | | | | | - Mônica Corso Pereira
- . Faculdade de Medicina, Universidade Estadual de Campinas - Unicamp - Campinas (SP) Brasil
| |
Collapse
|
249
|
|
250
|
Gea-Izquierdo E. Tendencias de mortalidad por afección del sistema respiratorio y neumonía en España: Serie 1992-2001. JOURNAL OF THE SELVA ANDINA RESEARCH SOCIETY 2018. [DOI: 10.36610/j.jsars.2018.090200068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|