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Bondarchuk CP, Grobman B, Mansur A, Lu CY. National trends in pneumonia-related mortality in the United States, 1999-2019. Infect Dis (Lond) 2024:1-10. [PMID: 39115964 DOI: 10.1080/23744235.2024.2390180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/26/2024] [Accepted: 08/04/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Pneumonia is one of the most common causes of hospital admissions in the United States and remains a major cause of death. However, less is known regarding the mortality burden from pneumonia in the United States and how this burden has changed over time. METHODS Death rates from causes related to pneumonia were determined using the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) data from 1999-2019. Pneumonia deaths were calculated for the overall population as well as for sociodemographic subgroups. We also analysed changes in death rates over time. RESULTS Overall, 2.1% of total US deaths during the period between 1999 and 2019 were due to pneumonia (2.6% in 1999 and 1.5% in 2019). Mortality declined over time for both men and women, and across most age cohorts, as well as all racial, urbanisation, and regional categories. Rates of pneumonia deaths were higher among males as compared to females (age-adjusted mortality rate ratio (AAMRR) = 1.35; 95% CI: 1.34-1.35). Compared to White Americans, Black Americans had the highest pneumonia-related mortality rates of any racial group (AAMRR = 1.11; 95% CI: 1.10-1.11). CONCLUSIONS Rates of pneumonia-related death have decreased in the United States in recent decades. However, significant racial and gender disparities remain, indicating the need for more equitable care.
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Affiliation(s)
| | - Benjamin Grobman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Arian Mansur
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Christine Y Lu
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia
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Stattin K, Eriksson M, Frithiof R, Kawati R, Crockett D, Hultström M, Lipcsey M. Smoking is associated with higher risk of contracting bacterial infection and pneumonia, intensive care unit admission and death. PLoS One 2024; 19:e0302505. [PMID: 38722836 PMCID: PMC11081217 DOI: 10.1371/journal.pone.0302505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/05/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Smoking has been associated with a higher risk of contracting pneumonia, but contradictory results have shown that smoking may or may not decrease the risk of dying in pneumonia. The aim of this study is to investigate how smoking is associated with contracting any infection and pneumonia and death. METHOD AND FINDINGS Participants were drawn from the population-based Cohort of Swedish Men and the Swedish Mammography Cohort, which are representative of the Swedish population. Participants have answered detailed lifestyle questionnaires and have been followed in national registers, such as the Patient Register, Cause of Death register and Swedish Intensive Care Registry. The risks of contracting infection and pneumonia or dying in infection and pneumonia were assessed using Cox regression. Of 62,902 cohort participants, 25,297 contracted an infection of which 4,505 died; and 10,471 contracted pneumonia of which 2,851 died. Compared to never smokers, former smokers at baseline had hazard ratio (HR) 1.08 (95% confidence interval (CI) 1.05-1.12) of contracting and HR 1.19 (95% CI 1.11-1.28) of dying in infection and HR 1.17 (95% CI 1.12-1.23) of contracting and HR 1.16 (95% CI 1.06-1.27) of dying in pneumonia during follow-up. Compared to never smokers, current smokers at baseline had HR 1.17 (95% CI 1.13-1.21) of contracting infection and HR 1.64 (95% CI 1.52-1.77) dying in infection; HR 1.42 (95% CI 1.35-1.49) of contracting pneumonia and HR 1.70 (95% CI 1.55-1.87) of dying in pneumonia during follow-up. The risk of contracting and dying in infection and pneumonia increased in a dose-response manner with number of pack years smoked and decreased with years since smoking cessation. CONCLUSION Smoking is associated with contracting and dying in any infection and pneumonia and the risk increases with pack years smoked, highlighting the importance of both primary prevention and smoking cessation.
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Affiliation(s)
- Karl Stattin
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Mikael Eriksson
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Rafael Kawati
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Douglas Crockett
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Michael Hultström
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
- Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Idigo AJ, Wells JM, Brown ML, Wiener HW, Griffin RL, Cutter G, Shrestha S, Lee RA. Socio-demographic and comorbid risk factors for poor prognosis in patients hospitalized with community-acquired bacterial pneumonia in southeastern US. Heart Lung 2024; 65:31-39. [PMID: 38382142 DOI: 10.1016/j.hrtlng.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND How socio-demographic characteristics and comorbidities affect bacterial community-acquired pneumonia (CAP) prognosis during/after hospitalization is important in disease management. OBJECTIVES To identify predictors of medical intensive care unit (MICU) admission, length of hospital stay (LOS), in-hospital mortality, and bacterial CAP readmission in patients hospitalized with bacterial CAP. METHODS ICD-9/10 codes were used to query electronic medical records to identify a cohort of patients hospitalized for bacterial CAP at a tertiary hospital in Southeastern US between 01/01/2013-12/31/2019. Adjusted accelerated failure time and modified Poisson regression models were used to examine predictors of MICU admission, LOS, in-hospital mortality, and 1-year readmission. RESULTS There were 1956 adults hospitalized with bacterial CAP. Median (interquartile range) LOS was 11 days (6-23), and there were 26 % (513) MICU admission, 14 % (266) in-hospital mortality, and 6 % (117) 1-year readmission with recurrent CAP. MICU admission was associated with heart failure (RR 1.38; 95 % CI 1.17-1.62) and obesity (RR 1.26; 95 % CI 1.04-1.52). Longer LOS was associated with heart failure (adjusted time ratio[TR] 1.27;95 %CI 1.12-1.43), stroke (TR 1.90;95 %CI 1.54,2.35), type 2 diabetes (TR 1.20;95 %CI 1.07-1.36), obesity (TR 1.50;95 %CI 1.31-1.72), Black race (TR 1.17;95 %CI 1.04-1.31), and males (TR 1.24;95 %CI 1.10-1.39). In-hospital mortality was associated with stroke (RR 1.45;95 %CI 1.03-2.04) and age ≥65 years (RR 1.34;95 %CI 1.06-1.68). 1-year readmission was associated with COPD (RR 1.55;95 %CI 1.05-2.27) and underweight BMI (RR 1.74;95 %CI 1.04-2.90). CONCLUSIONS Comorbidities and socio-demographic characteristics have varying impacts on bacterial CAP in-hospital prognosis and readmission. More studies are warranted to confirm these findings to develop comprehensive care plans and inform public health interventions.
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Affiliation(s)
- Adeniyi J Idigo
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Alabama, United States.
| | - J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care Medicine, UAB, United States; UAB Lung Health Center, United States; Birmingham VA Medical Center, United States
| | | | - Howard W Wiener
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Alabama, United States
| | - Russell L Griffin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Alabama, United States
| | - Gary Cutter
- Department of Biostatistics, School of Public Health, UAB, United States
| | - Sadeep Shrestha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Alabama, United States
| | - Rachael A Lee
- Birmingham VA Medical Center, United States; Department of Medicine, Division of Infectious Diseases, UAB School of Medicine, Alabama, United States
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Ferreira JP, Zannad F, Packer M, Filippatos G, Pocock SJ, Vasques-Nóvoa F, Böhm M, Butler J, Anker S. Empagliflozin and risk of lower respiratory tract infection in heart failure with mildly reduced and preserved ejection fraction: An EMPEROR-Preserved analysis. Eur J Heart Fail 2024; 26:952-959. [PMID: 38439585 DOI: 10.1002/ejhf.3180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 03/06/2024] Open
Abstract
AIMS Lower respiratory tract infections (LRTI) are common worldwide. Patients with heart failure and mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) have a high risk of developing LRTI. Prior studies were able to show that sodium-glucose cotransporter 2 inhibitors may reduce the incidence of LRTI in patients with type 2 diabetes. The aim of this study was to evaluate patient characteristics and prognosis according to LRTI status and to assess the effect of empagliflozin on LRTI in 5988 patients with HFmrEF/HFpEF enrolled in the EMPEROR-Preserved trial randomized to either empagliflozin or placebo over a median follow-up of 26 months. METHODS AND RESULTS Time-updated models were used to study the mortality risk after a LRTI. Cox regression was used to study the effect of empagliflozin on incident LRTI. Throughout the follow-up, 699 of 5988 (11.7%) patients developed LRTI: these were older, were more frequently hospitalized within the previous year, had type 2 diabetes, chronic kidney disease, and had higher N-terminal pro-B-type natriuretic peptide levels than patients without incident LRTI. Patients who developed LRTI had a 2.7-fold higher risk of subsequent mortality compared to patients without LRTI. The incidence of LRTI was 5.2 (95% confidence interval [CI] 4.6-5.8) events per 100 person-years in the empagliflozin group and 6.2 (95% CI 5.6-6.9) events per 100 person-years in the placebo group (hazard ratio 0.83, 95% CI 0.71-0.96, p = 0.014). The total number of LRTI events was reduced in the empagliflozin group (incidence rate ratio 0.80, 95% CI 0.68-0.94, p = 0.008). No effect of empagliflozin was observed on COVID-19 incidence. CONCLUSION In EMPEROR-Preserved, LRTI was frequent and associated with a poor prognosis. Empagliflozin was associated with a reduced risk of LRTI compared to placebo.
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Affiliation(s)
- João Pedro Ferreira
- UnIC@RISE, Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, and INSERM U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Faiez Zannad
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, and INSERM U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Milton Packer
- Baylor Heart and Vascular Institute, Dallas, TX, USA
- Imperial College, London, UK
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Francisco Vasques-Nóvoa
- UnIC@RISE, Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA
- University of Mississippi, Jackson, MS, USA
| | - Stefan Anker
- Department of Cardiology, (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland
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Jang SA, Min Kim K, Jin Kang H, Heo SJ, Sik Kim C, Won Park S. Higher mortality and longer length of stay in hospitalized patients with newly diagnosed diabetes. Diabetes Res Clin Pract 2024; 210:111601. [PMID: 38432469 DOI: 10.1016/j.diabres.2024.111601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
AIMS We investigated the association between diabetes status at admission and in-hospital outcomes in all hospitalized patients, regardless of the reason for admission. METHODS All individuals aged 20 years or older who were admitted to Yongin Severance Hospital between March 2020 and February 2022 were included in study. Subjects were categorized into three groups: non-DM, known DM, and newly diagnosed DM, based on medical history, anti-diabetic medications use, and laboratory test. Hospitalization-related outcomes, including in-hospital mortality and length of hospital stay, were compared between groups. RESULTS 33,166 participants were enrolled. At hospitalization, 6,572 (19.8 %) subjects were classified as known DM, and another 2,634 (7.9 %) subjects were classified as newly diagnosed DM. In-hospital mortality was highest in newly diagnosed DM (HR 1.89, 95% CI 1.58-2.26, p < 0.001) followed by known DM (HR 1.41, 95% CI 1.18-1.69, p < 0.001) compared to non-DM. Length of hospital stay was significantly longer in newly diagnosed DM (median [IQR] 9.0 [5.0-18.0],days) than known DM (median [IQR] 5.0 [3.0-10.0],days)(p < 0.001) and non-DM (median [IQR] 4.0 [2.0-7.0],days). After adjusting for multiple covariates, newly diagnosed diabetes was independently associated with increased in-hospital mortality (p < 0.001). CONCLUSIONS Diabetes status at admission was closely linked to hospitalization-related outcomes. Notably, individuals with newly diagnosed diabetes demonstrated a higher risk of in-hospital mortality and a prolonged length of hospital stay.
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Affiliation(s)
- Seol A Jang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Kyoung Min Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Hye Jin Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Sik Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Seok Won Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
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Oh S, Jang W, Kim B. Is the fluoroquinolone combination necessary for empirical antibiotic regimen in severe community-acquired pneumonia? Postgrad Med 2024; 136:337-345. [PMID: 38658366 DOI: 10.1080/00325481.2024.2347830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/23/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES This study aimed to assess whether superior clinical outcomes can be attained through piperacillin/tazobactam (TZP)+fluoroquinolone (FQ) combination therapy for severe community-acquired pneumonia (CAP) compared to TZP monotherapy. METHODS This retrospective study was conducted at a tertiary care hospital in Korea. Adult inpatients diagnosed with pneumonia within 48 hours of hospitalization were included. Severe CAP was defined as a CURB-65 score of ≥ 3 or based on the 2007 guidelines of the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) definition. Only patients who received either TZP and FQ combination or TZP as initial empirical therapy were included. RESULTS The final analysis included 145 patients; 57.9% received combination therapy and 42.1% received monotherapy. In the combination therapy group, body mass index (20.67 ± 3.28 vs. 22.26 ± 4.80, p = 0.030) and asthma prevalence (0 vs. 8.3%, p = 0.022) were significantly higher; initial symptoms, clinical severity, and causative pathogens were not significantly different between groups. White blood cell counts (12,641.64 ± 6,544.66 vs. 12,491.67 ± 10,528.24, p = 0.008), and C-reactive protein levels (18.78 ± 11.47 vs. 26.58 ± 14.97, p < 0.001) were significantly higher in the combination therapy group. Clinical outcomes, including all-cause in-hospital mortality rate (26.2 vs. 33.3%, p = 0.358), were not significantly different between the groups. Multivariate analysis identified no significant association between FQ combination and all-cause in-hospital mortality. CONCLUSION In patients with severe CAP, there were no differences in the clinical outcomes, including mortality, between the TZP and FQ combination therapy and TZP monotherapy. FQ combination was not significantly associated with in-hospital mortality.
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Affiliation(s)
- Seungtak Oh
- School of Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Wooyoung Jang
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Thizy G, Flahault A, Scemla A, Roux O, Jarraud S, Lebeaux D, Pouchot J, Gautier-Vargas G, Malvezzi P, Murris M, Vuotto F, Girerd S, Pansu N, Antonini T, Elkrief L, Barrou B, Besch C, Blot M, Boignard A, Brenier H, Coilly A, Gouezel C, Hannah K, Housssel-Debry P, Jouan J, Lecuyer H, Limelette A, Luyt CE, Melloni B, Pison C, Rafat C, Rebibou JM, Savier E, Schvartz B, Scatton O, Toure F, Varnous S, Vidal P, Savoye E, Ader F, Lortholary O, Lanternier F, Lafont E. Legionnaires Disease in Solid Organ Transplant Recipients: A Decade-Long Nationwide Study in France. Chest 2024; 165:507-520. [PMID: 37839586 DOI: 10.1016/j.chest.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Legionnaires disease (LD) is a rare, life-threatening opportunistic bacterial infection that poses a significant risk to patients with impaired cell-mediated immunity such as solid organ transplant recipients. However, the epidemiologic features, clinical presentation, and outcomes of LD in this population are poorly described. RESEARCH QUESTION What are the clinical manifestations, radiologic presentation, risk factors for severity, treatment, and outcome of LD in solid organ transplant recipients? STUDY DESIGN AND METHODS In this 10-year multicenter retrospective cohort study in France, where LD notification is mandatory, patients were identified by hospital discharge databases. Diagnosis of LD relied on positive culture findings from any respiratory sample, positive urinary antigen test (UAT) results, positive specific serologic findings, or a combination thereof. Severe LD was defined as admission to the ICU. RESULTS One hundred one patients from 51 transplantation centers were eligible; 64 patients (63.4%) were kidney transplant recipients. Median time between transplantation and LD was 5.6 years (interquartile range, 1.5-12 years). UAT results were positive in 92% of patients (89/97). Among 31 patients with positive culture findings in respiratory samples, Legionella pneumophila serogroup 1 was identified in 90%. Chest CT imaging showed alveolar consolidation in 98% of patients (54 of 57), ground-glass opacity in 63% of patients (36 of 57), macronodules in 21% of patients (12 of 57), and cavitation in 8.8% of patients (5 of 57). Fifty-seven patients (56%) were hospitalized in the ICU. In multivariate analysis, severe LD was associated with negative UAT findings at presentation (P = .047), lymphopenia (P = .014), respiratory symptoms (P = .010), and pleural effusion (P = .039). The 30-day and 12-month mortality rates were 8% (8 of 101) and 20% (19 of 97), respectively. In multivariate analysis, diabetes mellitus was the only factor associated with 12-month mortality (hazard ratio, 3.2; 95% OR, 1.19-8.64; P = .022). INTERPRETATION LD is a late and severe complication occurring in solid organ transplant recipients that may present as pulmonary nodules on which diabetes impacts its long-term prognosis.
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Affiliation(s)
- Guillaume Thizy
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Adrien Flahault
- Service de Néphrologie et Transplantation Rénale, CHRU Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Anne Scemla
- Service de Transplantation Rénale, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Olivier Roux
- Service d'Hépatologie, Hôpital Beaujon, Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
| | - Sophie Jarraud
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, France; Centre International de Recherche en Infectiologie, Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Université de Lyon, France
| | - David Lebeaux
- Unité Mobile d'Infectiologie, Service de Microbiologie, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Gabriela Gautier-Vargas
- Service de Néphrologie et Transplantation, Hôpital Civil, CHRU Hautepierre, Université de Strasbourg, Strasbourg, France
| | - Paolo Malvezzi
- Service de Néphrologie, Dialyse, Aphérèses et Transplantation, CHU Grenoble Alpes, Université de Grenoble, la Tronche, France
| | - Marlene Murris
- Service de Pneumologie-Consultation Mucoviscidose, Pôle Voies Respiratoires, CHU de Toulouse-Hôpital Larrey, Université de Toulouse, Toulouse, France
| | - Fanny Vuotto
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Lille, Université de Lille, Lille, France
| | - Sophie Girerd
- Service de Néphrologie et Transplantation Rénale, CHRU Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Nathalie Pansu
- Service de Maladies Infectieuses et Tropicales, CHU Gui de Chauliac, Université de Montpellier, Montpellier, France
| | - Teresa Antonini
- Service d'Hépatologie, Hôpital Universitaire Croix-Rousse, Lyon, France; Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Laure Elkrief
- Service d'Hépatologie, CHRU de Tours, Hôpital Trousseau, Université de Tours, Chambray-lès-Tours, France
| | - Benoit Barrou
- Département d'Urologie, Néphrologie et Transplantation, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Camille Besch
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, CHRU Hautepierre, Université de Strasbourg, Strasbourg, France
| | - Mathieu Blot
- Département de Maladies Infectieuses, Centre Hospitalo-Universitaire de Dijon-Bourgogne, Université de Bourgogne, France
| | - Aude Boignard
- Service de Cardiologie, CHU de Grenoble, CHU Grenoble Alpes, Université de Grenoble, Grenoble, France
| | - Henri Brenier
- Service de Néphrologie, Centre Hospitalier Universitaire Pontchaillou, Hôpital Universitaire de Pontchaillou, Université de Rennes, Rennes, France
| | - Audrey Coilly
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Université Paris-Saclay, Villejuif, France
| | - Corentin Gouezel
- Service d'Anesthésie et Réanimation de Chirurgie Cardiaque, Hôpital Bichat, Université Paris Cité, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Kaminski Hannah
- Service de Néphrologie, Transplantation Dialyse, Aphérèses, CHU de Bordeaux, Hôpital Pellegrin, Université de Bordeaux, Bordeaux, France
| | - Pauline Housssel-Debry
- Service d'Hépatologie et Transplantation Hépatique, Hôpital Universitaire de Pontchaillou, Université de Rennes, Rennes, France
| | - Jerome Jouan
- Service de Chirurgie Cardiaque, CHU Limoges, Centre Hospitalier et Universitaire de Limoges, Université de Limoges, Limoges, France
| | - Hervé Lecuyer
- Service de Microbiologie Clinique, Hôpital Necker Enfants-Malades, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne Limelette
- Laboratoire de Microbiologie, Hôpital Robert Debré, CHU de Reims, Université de Reims, Reims, France
| | - Charles Edouard Luyt
- Médecine Intensive Réanimation, Hôpital Pitié-Salpêtrière, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Boris Melloni
- Service de Pathologie Respiratoire, CHU Limoges, Centre Hospitalier et Universitaire de Limoges, Université de Limoges, Limoges, France
| | - Christophe Pison
- Service de Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Université de Grenoble, Grenoble, France
| | - Cédric Rafat
- Service de Soins Intensifs Néphrologique et Rein Aigu, Hôpital Tenon, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Michel Rebibou
- Service de Néphrologie, Transplantation Hémodialyse, CHU, Université de Dijon, Dijon, France
| | - Eric Savier
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Transplantation Hépatique, CHU Pitié-Salpêtriere, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Betoul Schvartz
- Service de Néphrologie, Hémodialyse, Transplantation Rénale, CHU de Reims, Université de Reims, Reims, France
| | - Olivier Scatton
- Service de Chirurgie Digestive Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Fatouma Toure
- Service Néphrologie, CHU Limoges, Centre Hospitalier et Universitaire de Limoges, Université de Limoges, Limoges, France
| | - Shaida Varnous
- Service de Chirurgie Cardiaque et Thoracique, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Pauline Vidal
- Laboratoire de Bactériologie-Hygiène, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Emilie Savoye
- Organ and Tissue Procurement and Transplantation Department, French Biomedicine Agency, Saint Denis La Plaine, France
| | - Florence Ader
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, France; Centre International de Recherche en Infectiologie, Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Université de Lyon, France; Service de Maladies Infectieuses et Tropicales, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Hôpital Universitaire Croix-Rousse, Lyon, France
| | - Olivier Lortholary
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Emmanuel Lafont
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
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8
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Feng Y, Wen S, Xue S, Hou M, Jin Y. Potential co-infection of influenza A, influenza B, respiratory syncytial virus, and Chlamydia pneumoniae: a case report with literature review. Front Med (Lausanne) 2024; 10:1325482. [PMID: 38259842 PMCID: PMC10800736 DOI: 10.3389/fmed.2023.1325482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
The occurrence of a co-infection involving four distinct respiratory pathogens could be underestimated. Here, we report the case of a 72-year-old woman who presented to a community hospital with a cough productive of sputum as her main clinical manifestation. Antibody detection of common respiratory pathogens revealed potential co-infection with influenza A, influenza B, respiratory syncytial virus, and Chlamydia pneumoniae. We treated her with 75 mg oseltamivir phosphate administered orally twice daily for 5 days, 0.5 g azithromycin administered orally for 5 days, and 0.3 g acetylcysteine aerosol inhaled twice daily for 3 days. The patient showed a favorable outcome on the eighth day after early diagnosis and treatment. Since co-infection with these four pathogens is rare, we performed an extensive PubMed search of similar cases and carried out a systematic review to analyze the epidemiology, clinical manifestations, transmission route, susceptible population, and outcomes of these four different pathogens. Our report highlights the importance for general practitioners to be vigilant about the possibility of mixed infections when a patient presents with respiratory symptoms. Although these symptoms may be mild, early diagnosis and timely treatment could improve outcomes. Additionally, further research is warranted to explore the potential influence of SARS-CoV-2 infection on the co-occurrence of multiple respiratory pathogens.
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Affiliation(s)
| | | | | | | | - Ying Jin
- Huangpu District Dapuqiao Community Health Center, Shanghai, China
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9
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Kim TW, Lee SU, Park B, Jeon K, Park S, Suh GY, Oh DK, Lee SY, Park MH, Lee H, Lim CM, Ko RE. Clinical effects of bacteremia in sepsis patients with community-acquired pneumonia. BMC Infect Dis 2023; 23:887. [PMID: 38114902 PMCID: PMC10729397 DOI: 10.1186/s12879-023-08887-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Data regarding the clinical effects of bacteremia on severe community-acquired pneumonia (CAP) are limited. Thus, we investigated clinical characteristics and outcomes of severe CAP patients with bacteremia compared with those of subjects without bacteremia. In addition, we evaluated clinical factors associated with bacteremia at the time of sepsis awareness. METHODS We enrolled sepsis patients diagnosed with CAP at emergency departments (EDs) from an ongoing nationwide multicenter observational registry, the Korean Sepsis Alliance, between September 2019 and December 2020. For evaluation of clinical factors associated with bacteremia, we divided eligible patients into bacteremia and non-bacteremia groups, and logistic regression analysis was performed using the clinical characteristics at the time of sepsis awareness. RESULT During the study period, 1,510 (47.9%) sepsis patients were caused by CAP, and bacteremia was identified in 212 (14.0%) patients. Septic shock occurred more frequently in the bacteremia group than in the non-bacteremia group (27.4% vs. 14.8%; p < 0.001). In multivariable analysis, hematologic malignancies and septic shock were associated with an increased risk of bacteremia. However, chronic lung disease was associated with a decreased risk of bacteremia. Hospital mortality was significantly higher in the bacteremia group than in the non-bacteremia group (27.3% vs. 40.6%, p < 0.001). The most prevalent pathogen in blood culture was Klebsiella pneumoniae followed by Escherichia coli in gram-negative pathogens. CONCLUSION The incidence of bacteremia in severe CAP was low at 14.0%, but the occurrence of bacteremia was associated with increased hospital mortality. In severe CAP, hematologic malignancies and septic shock were associated with an increased risk of bacteremia.
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Affiliation(s)
- Tae Wan Kim
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Se-Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Boram Park
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Kyeongman Jeon
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soo Yeon Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mi Hyeon Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Haein Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea.
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10
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Ukai T, Maruyama T, Tomioka S, Fukui T, Matsuda S, Fushimi K, Iso H. Predictors of hospital mortality and multidrug-resistant pathogens in hospitalized pneumonia patients residing in the community. Heliyon 2023; 9:e22303. [PMID: 38125533 PMCID: PMC10730438 DOI: 10.1016/j.heliyon.2023.e22303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Background and objective The 2019 ATS/ADSA guidelines for adult community-acquired pneumonia (CAP) eliminated healthcare-associated pneumonia (HCAP) and considered it to be a form of CAP. This concept, however, was based on studies with relatively small sample sizes. Methods We investigated the risk factors of 30-day mortality, and methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa infections in patients with pneumonia coming from the community using the Diagnosis Procedure Combination database, a nationwide discharge database of acute care hospitals. Furthermore, we compared these factors between CAP and HCAP. Results A total of 272,337 patients aged ≥20 years with pneumonia were grouped into 145,082 CAP patients and 127,255 HCAP patients. The 30-day mortality rate (8.9 % vs.3.3 %), MRSA infection (2.4 % vs. 1.4 %), and Pseudomonas aeruginosa infection (1.6 % vs. 1.0 %) were significantly higher in HCAP than in CAP patients. Multivariable logistic regression analysis showed that 12 of 13 identified predictors of mortality (i.e., high age, male, underweight, non-ambulatory status, bedsore, dehydration, respiratory failure, consciousness disturbance, hypotension, admitted in critical care, comorbidity of heart failure, and chronic obstructive pulmonary disease) were identical in CAP and HCAP patients. Similarly, five of six distinct risk factors for MRSA infection, and three of three for Pseudomonas aeruginosa infection were identical between the patients. Conclusion The risk factors for mortality and MRSA or Pseudomonas aeruginosa infection were almost identical in patients with CAP and HCAP. The assessment of individual risk factors for mortality and MRSA or Pseudomonas aeruginosa infection in CAP and abandoning categorization as HCAP can improve and simplify empiric therapy.
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Affiliation(s)
- Tomohiko Ukai
- Department of Epidemiology and Clinical Research, The Research Institute of Tuberculosis, 3-1-24, Matsuyama, Kiyose City, Tokyo, 204-8553, Japan
- Division of Public Health, Osaka Institute of Public Health, 1-3-69 Nakamichi, Higashinari-ku, Osaka, Osaka 537-0025, Japan
| | | | | | - Takumi Fukui
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu, 807-8555, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu, 807-8555, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyoku, Tokyo, 113-8510, Japan
| | - Hiroyasu Iso
- Institute for Global Health Policy Research, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan
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11
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Waterer GW, Metersky M. Corticosteroids and Severe Community-acquired Pneumonia: New Data, New Questions and a Swinging Pendulum. Arch Bronconeumol 2023; 59:793-794. [PMID: 37625907 DOI: 10.1016/j.arbres.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Grant W Waterer
- East Metropolitan Health Service, Royal Perth Hospital, Perth, Australia.
| | - Mark Metersky
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Connecticut, United States
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12
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Choi SH, Cesar A, Snow TAC, Saleem N, Arulkumaran N, Singer M. Respiratory fluoroquinolone monotherapy vs. β-lactam plus macrolide combination therapy for hospitalized adults with community-acquired pneumonia: A systematic review and meta-analysis of randomized controlled trials. Int J Antimicrob Agents 2023; 62:106905. [PMID: 37385561 DOI: 10.1016/j.ijantimicag.2023.106905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Guidelines recommend respiratory fluoroquinolone monotherapy or β-lactam plus macrolide combination therapy as first-line options for hospitalized adults with mild-to-moderate community-acquired pneumonia (CAP). Efficacy of these regimens has not been adequately evaluated. METHODS A systematic review of randomized controlled trials (RCTs) comparing respiratory fluoroquinolone monotherapy and β-lactam plus macrolide combination therapy in hospitalised adults with CAP was performed. A meta-analysis was performed using a random effects model. The primary outcome was clinical cure rate. Quality of evidence (QoE) was evaluated using GRADE methodology. RESULTS A total of 4140 participants in 18 RCTs were included. Levofloxacin (11 trials) or moxifloxacin (6 trials) were the predominant respiratory fluoroquinolones evaluated, and the β-lactam plus macrolide group used ceftriaxone plus a macrolide (10 trials), cefuroxime plus azithromycin (5 trials), and amoxicillin/clavulanate plus a macrolide (2 trials). Patients receiving respiratory fluoroquinolone monotherapy had a significantly higher clinical cure rate (86.5% vs. 81.5%; odds ratio [OR] 1.47; 95% confidence interval [95% CI: 1.17-1.83]; P = 0.0008; I2 = 0%; 17 RCTs; moderate QoE) and microbiological eradication rate (86.0% vs. 81.0%; OR 1.51 [95% CI: 1.00-2.26]; P = 0.05; I2 = 0%; 15 RCTs; moderate QoE) than patients receiving β-lactam plus macrolide combination therapy. All-cause mortality (7.2% vs. 7.7%; OR 0.88 [95% CI: 0.67-1.17]; I2 = 0%; low QoE) and adverse events (24.8% vs. 28.1%; OR 0.87 [95% CI: 0.69-1.09]; I2 = 0%; low QoE] were similar in the two groups. CONCLUSION Respiratory fluoroquinolone monotherapy demonstrated an advantage in clinical cure and microbiological eradication; however, it did not impact mortality.
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Affiliation(s)
- Sang-Ho Choi
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom; Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Antoni Cesar
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Timothy Arthur Chandos Snow
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Naveed Saleem
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Nishkantha Arulkumaran
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
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13
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Liu S, Huang S, Li F, Sun Y, Fu J, Xiao F, Jia N, Huang X, Sun C, Zhou J, Wang Y, Qu D. Rapid detection of Pseudomonas aeruginosa by recombinase polymerase amplification combined with CRISPR-Cas12a biosensing system. Front Cell Infect Microbiol 2023; 13:1239269. [PMID: 37637458 PMCID: PMC10449609 DOI: 10.3389/fcimb.2023.1239269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Pseudomonas aeruginosa (P. aeruginosa) is an important bacterial pathogen involved in a wide range of infections and antimicrobial resistance. Rapid and reliable diagnostic methods are of vital important for early identification, treatment, and stop of P. aeruginosa infections. In this study, we developed a simple, rapid, sensitive, and specific detection platform for P. aeruginosa infection diagnosis. The method integrated recombinase polymerase amplification (RPA) technique with clustered regularly interspaced short palindromic repeat (CRISPR)-CRISPR-associated protein 12a (Cas12a) biosensing system and was termed P. aeruginosa-CRISPR-RPA assay. The P. aeruginosa-CRISPR-RPA assay was subject to optimization of reaction conditions and evaluation of sensitivity, specificity, and clinical feasibility with the serial dilutions of P. aeruginosa genomic DNA, the non-P. aeruginosa strains, and the clinical samples. As a result, the P. aeruginosa-CRISPR-RPA assay was able to complete P. aeruginosa detection within half an hour, including RPA reaction at 42°C for 20 min and CRISPR-Cas12a detection at 37°C for 10 min. The diagnostic method exhibited high sensitivity (60 fg per reaction, ~8 copies) and specificity (100%). The results of the clinical samples by P. aeruginosa-CRISPR-RPA assay were consistent to that of the initial result by microfluidic chip method. These data demonstrated that the newly developed P. aeruginosa-CRISPR-RPA assay was reliable for P. aeruginosa detection. In summary, the P. aeruginosa-CRISPR-RPA assay is a promising tool to early and rapid diagnose P. aeruginosa infection and stop its wide spread especially in the hospital settings.
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Affiliation(s)
- Shuang Liu
- Department of Critical Medicine, Children’s Hospital Affiliated Capital Institute of Pediatrics, Beijing, China
| | - Siyuan Huang
- Department of Critical Medicine, Children’s Hospital Affiliated Capital Institute of Pediatrics, Beijing, China
| | - Fang Li
- Department of Critical Medicine, Children’s Hospital Affiliated Capital Institute of Pediatrics, Beijing, China
| | - Yuanyuan Sun
- Department of Critical Medicine, Children’s Hospital Affiliated Capital Institute of Pediatrics, Beijing, China
| | - Jin Fu
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, China
| | - Fei Xiao
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, China
| | - Nan Jia
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, China
| | - Xiaolan Huang
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, China
| | - Chunrong Sun
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, China
| | - Juan Zhou
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, China
| | - Yi Wang
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, China
| | - Dong Qu
- Department of Critical Medicine, Children’s Hospital Affiliated Capital Institute of Pediatrics, Beijing, China
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14
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Floeystad HK, Holter JC, Husebye E, Siljan WW, Berild D, Holm AM, Heggelund L. Nausea Predicts Bacteremia in Immunocompetent Patients with Pneumococcal Community-Acquired Pneumonia: Secondary Data Analysis from a Prospective Cohort. J Clin Med 2023; 12:3924. [PMID: 37373619 DOI: 10.3390/jcm12123924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND In pneumococcal community-acquired pneumonia (CAP), bacteremia is associated with increased mortality, but initial clinical severity scores frequently fail to identify bacteremic patients at risk. We have previously shown that gastrointestinal symptoms are common among patients admitted to the hospital with pneumococcal bacteremia. The aim of this study was to examine gastrointestinal symptoms and inflammatory responses in bacteremic and non-bacteremic pneumococcal CAP in a prospective cohort of immunocompromised and immunocompetent patients hospitalized with CAP. METHODS Logistic regression analysis was used to estimate the predictive value of gastrointestinal symptoms for pneumococcal bacteremia in patients with CAP. The Mann-Whitney test was used to compare inflammatory responses in patients with bacteremic vs. non-bacteremic pneumococcal CAP. RESULTS Eighty-one patients with pneumococcal CAP were included, of whom 21 (26%) had bacteremia. Immunocompetent patients with pneumococcal CAP had an odds ratio of 16.5 (95% CI 3.0-90.9, p = 0.001) for bacteremia if nausea was present, whereas no such association was found in the immunocompromised patients (OR 0.22, 95% CI 0.02-2.05, p = 0.18). The serum levels of C-reactive protein, procalcitonin and interleukin 6 were significantly higher in the patients with bacteremic pneumococcal CAP compared to non-bacteremic pneumococcal CAP patients (p < 0.001, p = 0.005, and p = 0.019, respectively). CONCLUSIONS In immunocompetent patients hospitalized with pneumococcal CAP, nausea may be a predictor of bacteremia. Bacteremic pneumococcal CAP patients display an increased inflammatory response compared to non-bacteremic pneumococcal CAP patients.
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Affiliation(s)
- Hans Kristian Floeystad
- Department of Internal Medicine, Sorlandet Hospital, 4615 Kristiansand, Norway
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Jan Cato Holter
- Department of Microbiology, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Einar Husebye
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - William Ward Siljan
- Department of Pulmonary Medicine, Division of Medicine, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Dag Berild
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Infectious Disease, Oslo University Hospital, 0424 Oslo, Norway
| | - Are Martin Holm
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Respiratory Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Lars Heggelund
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, 3004 Drammen, Norway
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen, 7804 Bergen, Norway
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15
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Halabi JE, Hariri E, Pack QR, Guo N, Yu PC, Patel NG, Imrey PB, Rothberg MB. Differential Impact of Systolic and Diastolic Heart Failure on In-Hospital Treatment, Outcomes, and Cost of Patients Admitted for Pneumonia. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 9:100025. [PMID: 38835731 PMCID: PMC11149766 DOI: 10.1016/j.ajmo.2022.100025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 09/07/2022] [Accepted: 09/18/2022] [Indexed: 06/06/2024]
Abstract
Background Patients admitted with pneumonia and heart failure (HF) have increased mortality and cost compared to those without HF, but it is not known whether outcomes differ between systolic and diastolic HF. Management of concomitant pneumonia and HF is complicated because HF treatments can worsen complications of pneumonia. Methods This is a retrospective cohort study from the Premier Database among patients admitted with pneumonia between 2010-2015. Patients were categorized based on systolic, diastolic, and combined HF using ICD-9 codes. The primary outcome was in-hospital mortality. Secondary outcomes included use of HF medications, length of stay, cost, intensive care unit (ICU) admission, as well as use of invasive mechanical ventilation (IMV), vasopressors and inotropes. Multivariable logistic regression was used to describe associations of these outcomes with type of HF. Results Of 123,211 patients with pneumonia and HF, 41,196 (33.4%) had systolic HF, 69,982 (56.8%) diastolic HF, and 12,033 (9.8%) had combined HF. Compared to patients with diastolic HF, after multivariable adjustment systolic HF was associated with higher in-hospital mortality (OR 1.15; 95% CI:1.11-1.20), ICU admission, and use of IMV and vasoactive agents, but not with increased length of stay or cost. Among patients with systolic HF, 80% received a loop diuretic, 72% a beta blocker, 48% angiotensin converting enzyme inhibitor or angiotensin receptor blocker, and 12.5% a mineralocorticoid receptor antagonist. Conclusion Systolic HF is associated with added risk in pneumonia compared to diastolic HF. There may also be an opportunity to optimize medications in systolic HF prior to discharge.
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Affiliation(s)
- Jessica El Halabi
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Essa Hariri
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Quinn R. Pack
- Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA, United States
| | - Ning Guo
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Ave, Mail Code G10, Cleveland, OH 44195, United States
- Department of Quantitative Health Sciences, Cleveland Clinic, OH, United States
| | - Pei-Chun Yu
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Ave, Mail Code G10, Cleveland, OH 44195, United States
- Department of Quantitative Health Sciences, Cleveland Clinic, OH, United States
| | - Niti G. Patel
- Department of Medicine, Northwestern Medicine, Chicago, IL, United States
| | - Peter B. Imrey
- Department of Quantitative Health Sciences, Cleveland Clinic, OH, United States
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, United States
| | - Michael B. Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Ave, Mail Code G10, Cleveland, OH 44195, United States
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16
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Lupia T, Corcione S, Shbaklo N, Rizzello B, De Benedetto I, Concialdi E, Navazio AS, Penna M, Brusa MT, De Rosa FG. Legionella pneumophila Infections during a 7-Year Retrospective Analysis (2016-2022): Epidemiological, Clinical Features and Outcomes in Patients with Legionnaires' Disease. Microorganisms 2023; 11:microorganisms11020498. [PMID: 36838463 PMCID: PMC9965988 DOI: 10.3390/microorganisms11020498] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
Legionella pneumophila (LP) is one of the main causative agents of community-acquired pneumonia in Europe and its fifth bacterial cause in Italy (4.9%). We conducted a seven year retrospective analysis of LP infection serogroup 1 in Asti, Piedmont, between 2016 and 2022. Patients were included if they tested positive for the Legionella urinary antigen. Clinical, laboratory, and radiologic data were analyzed to describe the risk factors for mortality. Fifty patients with LD were collected, mainly male, with a median age of 69 years. The main comorbidities were cardiovascular diseases (50%), pulmonary diseases (26%), and neurological diseases (12%). The most common clinical presentations were fever, respiratory, gastrointestinal, and neurologic symptoms. Older age (p = 0.004), underlying cardiovascular diseases (p = 0.009), late diagnosis at admission (p = 0.035), and neurological symptoms at diagnosis (p = 0.046) were more common in the non-survivor group. Moreover, a septic-shock presentation or the need for non-invasive ventilation at admission were associated with a higher mortality. No considerable differences in the biochemical data were found between the two groups except for the median neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio, and PCT value. We did not find any differences in mortality related to the choice of antibiotic regimen. Differences in outcome were associated with the median duration of treatment (p =< 0.001) but not to the choice of antibiotic regimen (mainly levofloxacin or azithromycin). In conclusion, early individuation of the wide spectrum of clinical characteristics of LP infection such as respiratory, cardiac, and neurological manifestations of the patient's comorbidities, and significant biochemical data should help clinicians flag high risk patients and potentially improve their outcome.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- School of Medicine, Tufts University, Boston, MA 02111, USA
- Correspondence: ; Tel.: +39-0141-489974
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Barbara Rizzello
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Erika Concialdi
- Microbiology Unit, Cardinal Massaia Hospital, 14100 Asti, Italy
| | | | - Maurizio Penna
- Microbiology Unit, Cardinal Massaia Hospital, 14100 Asti, Italy
| | | | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
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17
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Pharaboz A, Kimmoun A, Gunst J, Duarte K, Merkling T, Gayat E, Mebazaa A, Glenn-Chousterman B. Association between type II diabetes mellitus and 90-day mortality in a large multicenter prospectively collected cohort. A FROG ICU post-hoc study. J Crit Care 2023; 73:154195. [PMID: 36368176 DOI: 10.1016/j.jcrc.2022.154195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/01/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Factors associated with adverse outcomes in ICU patients with type II (T2DM) are poorly defined. The main goal of this study is to determine the impact of pre-existing T2DM on 90-day mortality post ICU admission. MATERIAL Post-hoc analysis from the FROG-ICU cohort. All patients admitted to ICU who were ventilated and/or treated by a vasoactive agent for >24 h were included. Association between T2DM and 90-day mortality was analyzed in unmatched, and populations matched by propensity score (PS) method to balance confounders recorded before ICU admission. Analysis was performed in non-imputed and imputed datasets. RESULTS 2002 patients were included, and 16% had a history of T2DM. The latter were at inclusion more severely ill (SAPSII score 51(39-67) vs 48(35-61), p < 0.0001; Charlson score 2(1-3) vs 0(0-2), p < 0.0001). In the unmatched cohort, T2DM patients had a higher 90-day risk of death compared to no-DM patients (HR 1.35(1.1-1.65)). The 90-day risk of death was not significantly different T2DM and no T2DM patients after PS matching (HR: 0.81 (0.56-1.18). Results were similar with the analysis performed on imputed datasets (pooled HR: 0.95 (0.69-1.30)). CONCLUSIONS In the present study, T2DM was not associated with 90-day mortality post ICU admission.
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Affiliation(s)
- Alexandre Pharaboz
- Université de Paris, AP-HP, CHU Lariboisière, Department of Anesthesiology and Critical Care, FHU PROMICE, INSERM U942, F-CRIN-INI CRCT, Paris, France
| | - Antoine Kimmoun
- Université de Lorraine, CHRU de Nancy, Médecine Intensive et Réanimation Brabois, INSERM INSERM U942 and U1116, F-CRIN-INIC RCT, Vandœuvre-lès-Nancy, France
| | - Jan Gunst
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven Herestraat 49, B-3000 Leuven, Belgium
| | - Kevin Duarte
- Université de Lorraine, CHRU de Nancy, INSERM CIC-P 1433, INSERM, F-CRIN-INI CRCT, Vandœuvre-lès-Nancy, France
| | - Thomas Merkling
- Université de Lorraine, CHRU de Nancy, INSERM CIC-P 1433, INSERM, F-CRIN-INI CRCT, Vandœuvre-lès-Nancy, France
| | - Etienne Gayat
- Université de Paris, AP-HP, CHU Lariboisière, Department of Anesthesiology and Critical Care, FHU PROMICE, INSERM U942, F-CRIN-INI CRCT, Paris, France
| | - Alexandre Mebazaa
- Université de Paris, AP-HP, CHU Lariboisière, Department of Anesthesiology and Critical Care, FHU PROMICE, INSERM U942, F-CRIN-INI CRCT, Paris, France
| | - Benjamin Glenn-Chousterman
- Université de Paris, AP-HP, CHU Lariboisière, Department of Anesthesiology and Critical Care, FHU PROMICE, INSERM U942, F-CRIN-INI CRCT, Paris, France.
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18
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Cavallazzi R, Ramirez JA. How and when to manage respiratory infections out of hospital. Eur Respir Rev 2022; 31:31/166/220092. [PMID: 36261157 DOI: 10.1183/16000617.0092-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/19/2022] [Indexed: 12/13/2022] Open
Abstract
Lower respiratory infections include acute bronchitis, influenza, community-acquired pneumonia, acute exacerbation of COPD and acute exacerbation of bronchiectasis. They are a major cause of death worldwide and often affect the most vulnerable: children, elderly and the impoverished. In this paper, we review the clinical presentation, diagnosis, severity assessment and treatment of adult outpatients with lower respiratory infections. The paper is divided into sections on specific lower respiratory infections, but we also dedicate a section to COVID-19 given the importance of the ongoing pandemic. Lower respiratory infections are heterogeneous entities, carry different risks for adverse events, and require different management strategies. For instance, while patients with acute bronchitis are rarely admitted to hospital and generally do not require antimicrobials, approximately 40% of patients seen for community-acquired pneumonia require admission. Clinicians caring for patients with lower respiratory infections face several challenges, including an increasing population of patients with immunosuppression, potential need for diagnostic tests that may not be readily available, antibiotic resistance and social aspects that place these patients at higher risk. Management principles for patients with lower respiratory infections include knowledge of local surveillance data, strategic use of diagnostic tests according to surveillance data, and judicious use of antimicrobials.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, KY, USA
| | - Julio A Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA
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19
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Abate G, Wang G, Frisby J. Ceftaroline: Systematic Review of Clinical Uses and Emerging Drug Resistance. Ann Pharmacother 2022; 56:1339-1348. [PMID: 35300514 DOI: 10.1177/10600280221082326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the success rates of off-label uses of ceftaroline for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and evaluate emerging ceftaroline resistance. DATA SOURCES We queried PubMed/MEDLINE, with the search term "Ceftaroline." Articles were restricted to the English language and year of publication (January 1, 2009-January 31, 2022). STUDY SELECTION AND DATA EXTRACTION Clinical trials, observational studies, and case reports that reported efficacy, safety, pharmacokinetics, use in MRSA infections other than acute bacterial skin infection and community-acquired pneumonia, and ceftaroline resistance were selected. DATA SYNTHESIS The search pooled 103 publications and all abstracts were reviewed. Forty-six articles that reported efficacy, safety, pharmacokinetics, or off-label use in multiple patients and 7 articles on ceftaroline resistance are used in this review. Ceftaroline has been approved for treatment of acute skin/soft tissue infection and community-acquired pneumonia. Ceftaroline's efficacy in off-label infections ranged from 66.7% to 87.3% depending on the types of infection. There were 14 documented cases of ceftaroline resistance associated with PBP2a changes. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Case series and observational studies have documented success with ceftaroline alone or in combination with vancomycin or daptomycin for treatment of MRSA bone and joint, endovascular, diabetic foot infections, and bacteremia from other causes. CONCLUSION Despite the lack of randomized controlled trials, ceftaroline is used as salvage therapy for different MRSA infections. The data from case series and observational studies are promising but ceftaroline should be used judiciously as ceftaroline-resistant MRSA begin to emerge.
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Affiliation(s)
- Getahun Abate
- Division of Infectious Diseases, Saint Louis University, Saint Louis, MO, USA
| | - Grace Wang
- Division of Infectious Diseases, Saint Louis University, Saint Louis, MO, USA
| | - Jared Frisby
- Division of Infectious Diseases, Saint Louis University, Saint Louis, MO, USA
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20
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Abstract
There is a growing awareness of the importance of sex and gender in medicine and research. Women typically have stronger immune responses to self and foreign antigens than men, resulting in sex-based differences in autoimmunity and infectious diseases. In both animals and humans, males are generally more susceptible than females to bacterial infections. At the same time, gender differences in health-seeking behavior, quality of health care, and adherence to treatment recommendations have been reported. This review explores our current understanding of differences between males and females in bacterial diseases. We describe how genetic, immunological, hormonal, and anatomical factors interact to influence sex-based differences in pathophysiology, epidemiology, clinical presentation, disease severity, and prognosis, and how gender roles affect the behavior of patients and providers in the health care system.
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21
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Pletz MW, Jensen AV, Bahrs C, Davenport C, Rupp J, Witzenrath M, Barten-Neiner G, Kolditz M, Dettmer S, Chalmers JD, Stolz D, Suttorp N, Aliberti S, Kuebler WM, Rohde G. Unmet needs in pneumonia research: a comprehensive approach by the CAPNETZ study group. Respir Res 2022; 23:239. [PMID: 36088316 PMCID: PMC9463667 DOI: 10.1186/s12931-022-02117-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Despite improvements in medical science and public health, mortality of community-acquired pneumonia (CAP) has barely changed throughout the last 15 years. The current SARS-CoV-2 pandemic has once again highlighted the central importance of acute respiratory infections to human health. The “network of excellence on Community Acquired Pneumonia” (CAPNETZ) hosts the most comprehensive CAP database worldwide including more than 12,000 patients. CAPNETZ connects physicians, microbiologists, virologists, epidemiologists, and computer scientists throughout Europe. Our aim was to summarize the current situation in CAP research and identify the most pressing unmet needs in CAP research.
Methods
To identify areas of future CAP research, CAPNETZ followed a multiple-step procedure. First, research members of CAPNETZ were individually asked to identify unmet needs. Second, the top 100 experts in the field of CAP research were asked for their insights about the unmet needs in CAP (Delphi approach). Third, internal and external experts discussed unmet needs in CAP at a scientific retreat.
Results
Eleven topics for future CAP research were identified: detection of causative pathogens, next generation sequencing for antimicrobial treatment guidance, imaging diagnostics, biomarkers, risk stratification, antiviral and antibiotic treatment, adjunctive therapy, vaccines and prevention, systemic and local immune response, comorbidities, and long-term cardio-vascular complications.
Conclusion
Pneumonia is a complex disease where the interplay between pathogens, immune system and comorbidities not only impose an immediate risk of mortality but also affect the patients’ risk of developing comorbidities as well as mortality for up to a decade after pneumonia has resolved. Our review of unmet needs in CAP research has shown that there are still major shortcomings in our knowledge of CAP.
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22
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Corica B, Tartaglia F, D'Amico T, Romiti GF, Cangemi R. Sex and gender differences in community-acquired pneumonia. Intern Emerg Med 2022; 17:1575-1588. [PMID: 35852675 PMCID: PMC9294783 DOI: 10.1007/s11739-022-02999-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022]
Abstract
Awareness of the influence of sex ands gender on the natural history of several diseases is increasing. Community-acquired pneumonia (CAP) is the most common acute respiratory disease, and it is associated with both morbidity and mortality across all age groups. Although a role for sex- and gender-based differences in the development and associated complications of CAP has been postulated, there is currently high uncertainty on the actual contribution of these factors in the epidemiology and clinical course of CAP. More evidence has been produced on the topic during the last decades, and sex- and gender-based differences have also been extensively studied in COVID-19 patients since the beginning of the SARS-CoV-2 pandemic. This review aims to provide an extensive outlook of the role of sex and gender in the epidemiology, pathogenesis, treatment, and outcomes of patients with CAP, and on the future research scenarios, with also a specific focus on COVID-19.
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Affiliation(s)
- Bernadette Corica
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00162, Rome, Italy
| | - Francesco Tartaglia
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00162, Rome, Italy
| | - Tania D'Amico
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00162, Rome, Italy
| | - Giulio Francesco Romiti
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00162, Rome, Italy
| | - Roberto Cangemi
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00162, Rome, Italy.
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23
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Magawa S, Nii M, Maki S, Enomoto N, Takakura S, Kusaka N, Maegawa Y, Osato K, Tanaka H, Kondo E, Ikeda T. Comparative study of the usefulness of risk score assessment in the early stages of
COVID
‐19 affected pregnancies: Omicron variant versus previous variants. J Obstet Gynaecol Res 2022; 48:2721-2729. [PMID: 36319204 PMCID: PMC9538931 DOI: 10.1111/jog.15387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 01/08/2023]
Abstract
Aim To evaluate the utility of the risk score in assessing the current status and prognosis of COVID‐19 in pregnancy. Methods Seventy‐seven cases affected before the Omicron variant epidemic and 50 pregnant cases affected by the Omicron variant were included. The risk score consists of maternal background, current condition, and examination findings. We determined the risk score in the early stages of disease onset. Results There were no significant differences in the maternal or gestational ages between the groups. The risk score was significantly lower in the After‐Group patients (those affected during the Omicron epoch), while 14.3% of the Before‐Group patients (those affected during the pre‐Delta and Delta epochs), experienced a worsening of disease after the visit to the center, whereas none of the After‐Group patients did. The Before Group's frequency of risk score items was higher among the two groups for “fever for ≥48 h,” “mild pneumonia image,” and “blood tests,” whereas “disease onset 14 days after the second vaccination” was increased in After Group. The blood test parameters for platelet count, C‐reactive protein, and D‐dimer levels were not significantly different between the groups. Conclusions The risk score system appeared superior in detecting deteriorating cases. There were no cases of post‐illness deterioration in the After‐Group, suggesting that cases of the Omicron variant in pregnancy may have had a less severe course compared to that of previous variants. However, there was no significant difference between the groups in terms of a specific blood test evaluation, suggesting the need for a combined evaluation of cases affected during pregnancy.
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Affiliation(s)
- Shoichi Magawa
- Department of Obstetrics and Gynecology Mie University Faculty Medicine Mie Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology Mie University Faculty Medicine Mie Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology Mie University Faculty Medicine Mie Japan
| | - Naosuke Enomoto
- Department of Obstetrics and Gynecology Mie University Faculty Medicine Mie Japan
| | - Sho Takakura
- Department of Obstetrics and Gynecology Mie University Faculty Medicine Mie Japan
| | - Naoko Kusaka
- Department of Obstetrics and Gynecology Mie Central Medical Center Mie Japan
| | - Yuka Maegawa
- Department of Obstetrics and Gynecology Mie Central Medical Center Mie Japan
| | - Kazuhiro Osato
- Department of Obstetrics and Gynecology Mie Prefectural General Medical Center Mie Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology Mie University Faculty Medicine Mie Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology Mie University Faculty Medicine Mie Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology Mie University Faculty Medicine Mie Japan
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24
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Surgical Treatment for Empyema Thoracis: Prognostic Role of Preoperative Transthoracic Echocardiography and Serum Calcium. J Pers Med 2022; 12:jpm12061014. [PMID: 35743797 PMCID: PMC9225271 DOI: 10.3390/jpm12061014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/16/2022] [Accepted: 06/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Empyema is a major cause of mortality and hospitalization. Symptoms include difficulty breathing and chest pain. Calcium plays an essential role in the physiology of the cardiovascular system. However, there is little evidence on the role of echocardiography and the serum calcium levels of patients undergoing video-assisted thoracoscopic surgery (VATS) for empyema. This study aimed to investigate the risk factors for postoperative mortality in patients with empyema who required surgery. Methods: This single-institution retrospective study compared the outcomes of VATS for thoracic empyema (in terms of survival and mortality) in 122 patients enrolled between July 2015 and June 2019. Results: This study examined patients with thoracic empyema. The majority of the patients were males (100/122, 81.9%). The in-hospital/30-day mortality rate was 10.6% (13 patients). The calcium levels were 7.82 ± 1.17 mg/dL in the survival group and 6.88 ± 1.88 mg/dL in the mortality group (p = 0.032). In the mortality group, the utilization of echocardiography and serum calcium levels independently contributed to the risk prediction more than clinical variables. Patients in our cohort exhibited elevated pulmonary artery systolic pressure (PASP) and hypocalcemia, which were associated with increased postoperative mortality. Conclusion: Elevated PASP and calcium levels at the low end of the normal range demonstrated significant prognostic value in predicting mortality in patients with thoracic empyema who required surgical intervention. Recognizing this potential is critical in order to obtain better outcomes.
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25
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Hyams C, Begier E, Garcia Gonzalez M, Southern J, Campling J, Gray S, Oliver J, Gessner BD, Finn A. Incidence of acute lower respiratory tract disease hospitalisations, including pneumonia, among adults in Bristol, UK, 2019, estimated using both a prospective and retrospective methodology. BMJ Open 2022; 12:e057464. [PMID: 35705333 PMCID: PMC9204403 DOI: 10.1136/bmjopen-2021-057464] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 06/06/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine the disease burden of acute lower respiratory tract disease (aLRTD) and its subsets (pneumonia, lower respiratory tract infection (LRTI) and heart failure) in hospitalised adults in Bristol, UK. SETTING Single-centre, secondary care hospital, Bristol, UK. DESIGN We estimated aLRTD hospitalisations incidence in adults (≥18 years) in Bristol, UK, using two approaches. First, retrospective International Classification of Diseases 10th revision (ICD-10) code analysis (first five positions/hospitalisation) identified aLRTD events over a 12-month period (March 2018 to February 2019). Second, during a 21-day prospective review (19 August 2019 to 9 September 2019), aLRTD admissions were identified, categorised by diagnosis and subsequently annualised. Hospital catchment denominators were calculated using linked general practice and hospitalisation data, with each practice's denominator contribution calculated based on practice population and per cent of the practices' hospitalisations admitted to the study hospital. PARTICIPANTS Prospective review: 1322 adults screened; 410 identified with aLRTD. Retrospective review: 7727 adult admissions. PRIMARY AND SECONDARY OUTCOME MEASURES The incidence of aLRTD and its subsets in the adult population of Southmead Hospital, Bristol UK. RESULTS Based on ICD-10 code analysis, annual incidences per 100 000 population were: aLRTD, 1901; pneumonia, 591; LRTI, 739; heart failure, 402. aLRTD incidence was highest among those ≥65 years: 65-74 (3684 per 100 000 adults), 75-84 (6962 per 100 000 adults) and ≥85 (11 430 per 100 000 adults). During the prospective review, 410/1322 (31%) hospitalised adults had aLRTD signs/symptoms and annualised incidences closely replicated retrospective analysis results. CONCLUSIONS The aLRTD disease burden was high, increasing sharply with age. The aLRTD incidence is probably higher than estimated previously due to criteria specifying respiratory-specific symptoms or radiological change, usage of only the first diagnosis code and mismatch between case count sources and population denominators. This may have significant consequences for healthcare planning, including usage of current and future vaccinations against respiratory infection.
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Affiliation(s)
- Catherine Hyams
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Bristol Vaccine Centre, University of Bristol, Bristol, UK
| | - Elizabeth Begier
- Global Medical and Scientific Affairs, Pfizer Inc, New York City, New York, USA
| | - Maria Garcia Gonzalez
- Population Health Sciences, University of Bristol, Bristol, UK
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
| | - Jo Southern
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth, Surrey, UK
| | - James Campling
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth, Surrey, UK
| | - Sharon Gray
- Global Medical and Scientific Affairs, Pfizer Inc, New York City, New York, USA
| | - Jennifer Oliver
- Bristol Vaccine Centre, University of Bristol, Bristol, UK
- Schools of Cellular and Molecular Medicine and Population Health Sciences, University of Bristol, Bristol, UK
| | - Bradford D Gessner
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, Pennsylvania, USA
| | - Adam Finn
- Bristol Vaccine Centre, University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
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26
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Song Y, Wang X, Chen C, Wei T, Lang K, Yang D, Song Y. Weaker Response to XueBiJing Treatment in Severe Community-Acquired Pneumonia Patients With Higher Body Mass Index or Hyperglycemia: A Post Hoc Analysis of a Randomized Controlled Trial. Front Pharmacol 2022; 13:755536. [PMID: 35721170 PMCID: PMC9204492 DOI: 10.3389/fphar.2022.755536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Overweight and hyperglycemia might result in poor prognosis in patients with severe community-acquired pneumonia (SCAP). XueBiJing treatment could significantly improve the outcomes of patients with SCAP. We investigated the efficacy of XueBiJing injection in patients with SCAP stratified by body mass index (BMI) and fasting blood glucose (FBG). Methods: This is a post hoc analysis of XueBiJing trial, a large prospective, randomized, controlled study conducted in 33 hospitals in China. We compared data from non-overweight (BMI <24 kg/m2, n = 425) vs. overweight (BMI ≥24 kg/m2, n = 250) patients as well as non-hyperglycemia (FBG <7 mmol/L, n = 315) vs. hyperglycemia (FBG ≥7 mmol/L, n = 360) patients with XueBiJing, 100 ml, q12 h, or a visually indistinguishable placebo treatment for 5–7 days. Results: Among patients with BMI <24 kg/m2 (n = 425), 33 (15.3%), XueBiJing recipients and 52 (24.9%) placebo recipients (p = 0.0186) died within 28 days. Among patients with BMI ≥24 kg/m2 (n = 250), XueBiJing recipients still had lower mortality (XueBiJing 16.9% vs. placebo 24.2%; p = 0.2068) but without significantly statistical difference. For the FBG group, patients with FBG <7 mmol/L (n = 315), 18 (11.2%) XueBiJing recipients and 32 (20.8%) placebo recipients (p = 0.030) died within 28 days. Among patients with FBG ≥7 mmol/L (n = 360), XueBiJing recipients still had lower mortality (XueBiJing 20.2% vs. placebo 27.8%; p = 0.120) but without significantly statistical difference. The total duration of the ICU stay and the duration of mechanical ventilation were similar in both groups (p > 0.05). Conclusion: Overweight or hyperglycemia might weaken the efficacy of XueBiJing injection in the treatment of SCAP as indicated by the significant elevated risk of 28-day mortality. Additional studies are needed to validate our findings and to further understand the underlying mechanisms.
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27
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Hariri E, Patel NG, Bassil E, Matta M, Yu PC, Pack QR, Rothberg MB. Acute but not chronic heart failure is associated with higher mortality among patients hospitalized with pneumonia: An analysis of a nationwide database ☆. AMERICAN JOURNAL OF MEDICINE OPEN 2022; 7:100013. [PMID: 35734378 PMCID: PMC9211036 DOI: 10.1016/j.ajmo.2022.100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/25/2022] [Accepted: 04/01/2022] [Indexed: 11/15/2022]
Abstract
Background Among patients admitted for pneumonia, heart failure (HF) is associated with worse outcomes. It is unclear whether this association is due to acute HF exacerbations, complex medical management, or chronic co-morbid conditions. Methods This is a retrospective cohort study of patients admitted between July 2010 and June 2015 at 651 US hospitals with a principal diagnosis of either pneumonia or secondary diagnosis of pneumonia with a primary diagnosis of respiratory failure or sepsis. Comorbidities were identified by ICD-9 codes and medical management by daily charge codes. Patients were categorized according to the presence and acuity of admission diagnosis of HF. In-hospital mortality was the primary outcome. Secondary outcomes included length of stay, hospital cost, ICU admission, use of mechanical ventilation, vasopressors and inotropes. Logistic regression was used to study the association of outcomes with presence and acuity of HF. Results Of 783,702 patients who met inclusion criteria, 212,203 (27%) had a diagnosis of HF. Of these, 56,306 (26.5%) had acute while 48,188 (22.7%) had chronic HF on admission; 51% had a diagnosis of unspecified HF. In multivariable-adjusted models, having any HF was associated with increased mortality (OR 1.35 [1.33 - 1.38]) compared to those without HF; increased mortality was associated with acute HF (OR 1.19 [1.15 - 1.22]) but not chronic HF (OR 0.92 [0.89 - 0.96]). Conclusion The worse outcomes for pneumonia patients with HF appear due to acute HF exacerbations. Adjustment for HF without accounting for chronicity could lead to biased prognostic and billing estimates.
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Affiliation(s)
- Essa Hariri
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, United States
| | - Niti G. Patel
- Department of Medicine, Northwestern Medicine, Chicago, ILChicago
| | - Elias Bassil
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, United States
| | - Milad Matta
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, United States
| | - Pei-Chun Yu
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, United States
| | - Quinn R. Pack
- Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA, United States
| | - Michael B. Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, United States
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28
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Jahn K, Kohler TP, Swiatek LS, Wiebe S, Hammerschmidt S. Platelets, Bacterial Adhesins and the Pneumococcus. Cells 2022; 11:cells11071121. [PMID: 35406684 PMCID: PMC8997422 DOI: 10.3390/cells11071121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 01/25/2023] Open
Abstract
Systemic infections with pathogenic or facultative pathogenic bacteria are associated with activation and aggregation of platelets leading to thrombocytopenia and activation of the clotting system. Bacterial proteins leading to platelet activation and aggregation have been identified, and while platelet receptors are recognized, induced signal transduction cascades are still often unknown. In addition to proteinaceous adhesins, pathogenic bacteria such as Staphylococcus aureus and Streptococcus pneumoniae also produce toxins such as pneumolysin and alpha-hemolysin. They bind to cellular receptors or form pores, which can result in disturbance of physiological functions of platelets. Here, we discuss the bacteria-platelet interplay in the context of adhesin–receptor interactions and platelet-activating bacterial proteins, with a main emphasis on S. aureus and S. pneumoniae. More importantly, we summarize recent findings of how S. aureus toxins and the pore-forming toxin pneumolysin of S. pneumoniae interfere with platelet function. Finally, the relevance of platelet dysfunction due to killing by toxins and potential treatment interventions protecting platelets against cell death are summarized.
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Lynch JP, Zhanel GG. Pseudomonas aeruginosa Pneumonia: Evolution of Antimicrobial Resistance and Implications for Therapy. Semin Respir Crit Care Med 2022; 43:191-218. [PMID: 35062038 DOI: 10.1055/s-0041-1740109] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pseudomonas aeruginosa (PA), a non-lactose-fermenting gram-negative bacillus, is a common cause of nosocomial infections in critically ill or debilitated patients, particularly ventilator-associated pneumonia (VAP), and infections of urinary tract, intra-abdominal, wounds, skin/soft tissue, and bloodstream. PA rarely affects healthy individuals, but may cause serious infections in patients with chronic structural lung disease, comorbidities, advanced age, impaired immune defenses, or with medical devices (e.g., urinary or intravascular catheters, foreign bodies). Treatment of pseudomonal infections is difficult, as PA is intrinsically resistant to multiple antimicrobials, and may acquire new resistance determinants even while on antimicrobial therapy. Mortality associated with pseudomonal VAP or bacteremias is high (> 35%) and optimal therapy is controversial. Over the past three decades, antimicrobial resistance (AMR) among PA has escalated globally, via dissemination of several international multidrug resistant "epidemic" clones. We discuss the importance of PA as a cause of pneumonia including health care-associated pneumonia, hospital-acquired pneumonia, VAP, the emergence of AMR to this pathogen, and approaches to therapy (both empirical and definitive).
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
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Ryrsø CK, Dungu AM, Hegelund MH, Jensen AV, Sejdic A, Faurholt-Jepsen D, Krogh-Madsen R, Lindegaard B. Body composition, physical capacity, and immuno-metabolic profile in community-acquired pneumonia caused by COVID-19, influenza, and bacteria: a prospective cohort study. Int J Obes (Lond) 2022; 46:817-824. [PMID: 34987205 PMCID: PMC8729099 DOI: 10.1038/s41366-021-01057-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/01/2021] [Accepted: 12/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Different pathogens can cause community-acquired pneumonia (CAP); however, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) has re-emphasized the vital role of respiratory viruses as a cause of CAP. The aim was to explore differences in metabolic profile, body composition, physical capacity, and inflammation between patients hospitalized with CAP caused by different etiology. METHODS A prospective study of Danish patients hospitalized with CAP caused by SARS-CoV-2, influenza, or bacteria. Fat (FM) and fat-free mass (FFM) were assessed with bioelectrical impedance analysis. Physical activity and capacity were assessed using questionnaires and handgrip strength. Plasma (p)-glucose, p-lipids, hemoglobin A1c (HbA1c), p-adiponectin, and cytokines were measured. RESULTS Among 164 patients with CAP, etiology did not affect admission levels of glucose, HbA1c, adiponectin, or lipids. Overall, 15.2% had known diabetes, 6.1% had undiagnosed diabetes, 51.3% had pre-diabetes, 81% had hyperglycemia, and 60% had low HDL-cholesterol, with no difference between groups. Body mass index, FM, and FFM were similar between groups, with 73% of the patients being characterized with abdominal obesity, although waist circumference was lower in patients with COVID-19. Physical capacity was similar between groups. More than 80% had low handgrip strength and low physical activity levels. Compared to patients with influenza, patients with COVID-19 had increased levels of interferon (IFN)-γ (mean difference (MD) 4.14; 95% CI 1.36-12.58; p = 0.008), interleukin (IL)-4 (MD 1.82; 95% CI 1.12-2.97; p = 0.012), IL-5 (MD 2.22; 95% CI 1.09-4.52; p = 0.024), and IL-6 (MD 2.41; 95% CI 1.02-5.68; p = 0.044) and increased IFN-γ (MD 6.10; 95% CI 2.53-14.71; p < 0.001) and IL-10 (MD 2.68; 95% CI 1.53-4.69; p < 0.001) compared to patients with bacterial CAP, but no difference in IL-1β, tumor necrosis factor-α, IL-8, IL-18, IL-12p70, C-reactive protein, and adiponectin. CONCLUSION Despite higher inflammatory response in patients with COVID-19, metabolic profile, body composition, and physical capacity were similar to patients with influenza and bacterial CAP.
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Affiliation(s)
- Camilla Koch Ryrsø
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark.,Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Arnold Matovu Dungu
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maria Hein Hegelund
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Vestergaard Jensen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Adin Sejdic
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | - Birgitte Lindegaard
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark. .,Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Riccobono E, Bussini L, Giannella M, Viale P, Rossolini GM. Rapid diagnostic tests in the management of pneumonia. Expert Rev Mol Diagn 2021; 22:49-60. [PMID: 34894965 DOI: 10.1080/14737159.2022.2018302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Pneumonia is one of the main causes of mortality associated with infectious diseases worldwide. Several challenges have been identified in the management of patients with pneumonia, ranging from accurate and cost-effective microbiological investigations, prompt and adequate therapeutic management, and optimal treatment duration. AREAS COVERED In this review, an updated summary on the current management of pneumonia patients is provided and the epidemiological issues of infectious respiratory diseases, which in the current pandemic situation are of particular concern, are addressed. The clinical and microbiological approaches to pneumonia diagnosis are reviewed, including discussion about the new molecular assays pointing out both their strengths and limitations. Finally, the current recommendations about antibiotic treatment are examined and discussed depending on the epidemiological contexts, including those with high prevalence of multidrug-resistant bacteria. EXPERT OPINION We claim that rapid diagnostic tests, if well-positioned in the diagnostic workflow and reserved for the subset of patients who could most benefit from these technologies, may represent an interesting and feasible tool to optimize timing of targeted treatments especially in terms of early de-escalation or discontinuation of antibiotic therapy.
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Affiliation(s)
- Eleonora Riccobono
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Linda Bussini
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant' Orsola, Bologna, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant' Orsola, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant' Orsola, Bologna, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
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Im H, Ser J, Sim U, Cho H. Promising Expectations for Pneumococcal Vaccination during COVID-19. Vaccines (Basel) 2021; 9:1507. [PMID: 34960253 PMCID: PMC8708837 DOI: 10.3390/vaccines9121507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/07/2023] Open
Abstract
The emergence of new viral infections has increased over the decades. The novel virus is one such pathogen liable for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, popularly known as coronavirus disease 2019 (COVID-19). Most fatalities during the past century's influenza pandemics have cooperated with bacterial co/secondary infections. Unfortunately, many reports have claimed that bacterial co-infection is also predominant in COVID-19 patients (COVID-19 associated co/secondary infection prevalence is up to 45.0%). In the COVID-19 pandemic, Streptococcus pneumoniae is the most common coinfecting pathogen. Half of the COVID-19 mortality cases showed co-infection, and pneumonia-related COVID-19 mortality in patients >65 years was 23%. The weakening of immune function caused by COVID-19 remains a high-risk factor for pneumococcal disease. Pneumococcal disease and COVID-19 also have similar risk factors. For example, underlying medical conditions on COVID-19 and pneumococcal diseases increase the risk for severe illness at any age; COVID-19 is now considered a primary risk factor for pneumococcal pneumonia and invasive pneumococcal disease. Thus, pneumococcal vaccination during the COVID-19 pandemic has become more critical than ever. This review presents positive studies of pneumococcal vaccination in patients with COVID-19 and other medical conditions and the correlational effects of pneumococcal disease with COVID-19 to prevent morbidity and mortality from co/secondary infections and superinfections. It also reports the importance and role of pneumococcal vaccination during the current COVID-19 pandemic era to strengthen the global health system.
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Affiliation(s)
- Hyobin Im
- Marketing Department, Pfizer Pharmaceuticals Korea, Pfizer Tower 110, Seoul 04631, Korea;
| | - Jinhui Ser
- Department of School of Materials Science & Engineering, Chonnam National University, Yongbong-ro 77, Gwangju 61186, Korea;
| | - Uk Sim
- Department of School of Materials Science & Engineering, Chonnam National University, Yongbong-ro 77, Gwangju 61186, Korea;
- Research Institute, NEEL Science, Incorporation, Yongbong-ro 77, Gwangju 61186, Korea
| | - Hoonsung Cho
- Department of School of Materials Science & Engineering, Chonnam National University, Yongbong-ro 77, Gwangju 61186, Korea;
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Facile synthesis and biological evaluation of chrysin derivatives. JOURNAL OF CHEMICAL RESEARCH 2021. [DOI: 10.1177/17475198211057467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this paper, novel synthetic methods, including microwave O-alkylation, were used to produce several chrysin derivatives. These compounds were purified, characterised and tested on different cell lines and bacterial strains. From this family, 7-(2,4-dinitrophenoxy)-5-hydroxy-3-phenyl-4H-chromen-4-one (C3) was shown to be extremely active on bacterial strains methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella pneumoniae as well as having anticancer activity on a range of cancer cell lines with IC50 values less than 30 µM. Chrysin has been known for their anticancer and antimicrobial properties, and this study not only corroborates this but also shows that it is possible to synthesise new improved derivatives with therapeutic possibilities.
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Serrano Fernández L, Ruiz Iturriaga LA, España Yandiola PP, Méndez Ocaña R, Pérez Fernández S, Tabernero Huget E, Uranga Echeverria A, Gonzalez Jimenez P, García Hontoria P, Torres Martí A, Menendez Villanueva R, Zalacain Jorge R. Bacteraemic pneumococcal pneumonia and SARS-CoV-2 pneumonia: differences and similarities. Int J Infect Dis 2021; 115:39-47. [PMID: 34800689 PMCID: PMC8598257 DOI: 10.1016/j.ijid.2021.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To analyse differences in clinical presentation and outcome between bacteraemic pneumococcal community-acquired pneumonia (B-PCAP) and sSvere Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pneumonia. METHODS This observational multi-centre study was conducted on patients hospitalized with B-PCAP between 2000 and 2020 and SARS-CoV-2 pneumonia in 2020. Thirty-day survival, predictors of mortality, and intensive care unit (ICU) admission were compared. RESULTS In total, 663 patients with B-PCAP and 1561 patients with SARS-CoV-2 pneumonia were included in this study. Patients with B-PCAP had more severe disease, a higher ICU admission rate and more complications. Patients with SARS-CoV-2 pneumonia had higher in-hospital mortality (10.8% vs 6.8%; P=0.004). Among patients admitted to the ICU, the need for invasive mechanical ventilation (69.7% vs 36.2%; P<0.001) and mortality were higher in patients with SARS-CoV-2 pneumonia. In patients with B-PCAP, the predictive model found associations between mortality and systemic complications (hyponatraemia, septic shock and neurological complications), lower respiratory reserve and tachypnoea; chest pain and purulent sputum were protective factors in these patients. In patients with SARS-CoV-2 pneumonia, mortality was associated with previous liver and cardiac disease, advanced age, altered mental status, tachypnoea, hypoxaemia, bilateral involvement, pleural effusion, septic shock, neutrophilia and high blood urea nitrogen; in contrast, ≥7 days of symptoms was a protective factor in these patients. In-hospital mortality occurred earlier in patients with B-PCAP. CONCLUSIONS Although B-PCAP was associated with more severe disease and a higher ICU admission rate, the mortality rate was higher for SARS-CoV-2 pneumonia and deaths occurred later. New prognostic scales and more effective treatments are needed for patients with SARS-CoV-2 pneumonia.
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Affiliation(s)
- Leyre Serrano Fernández
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain.
| | - Luis Alberto Ruiz Iturriaga
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain.
| | | | - Raúl Méndez Ocaña
- Pneumology Service, Hospital Universitari i politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - Silvia Pérez Fernández
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo. Bizkaia, Spain.
| | - Eva Tabernero Huget
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.
| | - Ane Uranga Echeverria
- Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
| | - Paula Gonzalez Jimenez
- Pneumology Service, Hospital Universitari i politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | | | - Antoni Torres Martí
- Pneumology Service, Hospital Clinic/Institut D´Investigacions Biomediques August Pi I Sunyer, University of Barcelona, Barcelona, Spain.
| | - Rosario Menendez Villanueva
- Pneumology Service, Hospital Universitari i politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
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Lopez-de-Andres A, Jimenez-Garcia R, Hernandez-Barrera V, de Miguel-Diez J, de Miguel-Yanes JM, Carabantes-Alarcon D, Zamorano-Leon JJ, Sanz-Rojo S, Lopez-Herranz M. Sex-Related Disparities in the Incidence and Outcomes of Community-Acquired Pneumonia among Type 2 Diabetes Patients: A Propensity Score-Matching Analysis Using the Spanish National Hospital Discharge Database for the Period 2016-2019. J Clin Med 2021; 10:3975. [PMID: 34501421 PMCID: PMC8432254 DOI: 10.3390/jcm10173975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 12/19/2022] Open
Abstract
(1) Background: To analyze incidence, clinical characteristics, procedures, and in-hospital outcomes among patients hospitalized with community-acquired pneumonia (CAP) according to the presence of T2DM in Spain (2016-2019) and to assess the role of gender among those with T2DM. (2) Methods: Using the Spanish National Hospital Discharge Database, we estimated hospitalized CAP incidence. Propensity score matching was used to compare population subgroups. (3) Results: CAP was coded in 520,723 patients, of whom 140,410 (26.96%) had T2DM. The hospitalized CAP incidence was higher in patients with T2DM (both sexes) (IRR 4.25; 95% CI 4.23-4.28). The hospitalized CAP incidence was higher in men with T2DM than in women with T2DM (IRR 1.46; 95% CI 1.45-1.47). The hospitalized CAP incidence among T2DM patients increased over time; however, the in-hospital mortality (IHM) decreased between 2016 and 2019. IHM was higher among non-T2DM men and women than matched T2DM men and women (14.23% and 14.22% vs. 12.13% and 12.91%; all p < 0.001, respectively), After adjusting for confounders, men with T2DM had a 6% higher mortality risk than women (OR 1.06; 95% CI 1.02-1.1). (4) Conclusions: T2DM is associated with a higher hospitalized CAP incidence and is increasing overtime. Patients hospitalized with CAP and T2DM have lower IHM. Male sex is a significant risk factor for mortality after CAP among T2DM patients.
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Affiliation(s)
- Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.L.-d.-A.); (D.C.-A.); (J.J.Z.-L.); (S.S.-R.)
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.L.-d.-A.); (D.C.-A.); (J.J.Z.-L.); (S.S.-R.)
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain;
| | - Javier de Miguel-Diez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Jose M. de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.L.-d.-A.); (D.C.-A.); (J.J.Z.-L.); (S.S.-R.)
| | - Jose J. Zamorano-Leon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.L.-d.-A.); (D.C.-A.); (J.J.Z.-L.); (S.S.-R.)
| | - Sara Sanz-Rojo
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.L.-d.-A.); (D.C.-A.); (J.J.Z.-L.); (S.S.-R.)
| | - Marta Lopez-Herranz
- Nursing Department, Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, 28040 Madrid, Spain;
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Benadji A, Duval X, Danis K, Hoen B, Page B, Béraud G, Vernet-Garnier V, Strady C, Brieu N, Maulin L, Roy C, Ploy MC, Gaillat J, Varon E, Tubiana S. Relationship between serotypes, disease characteristics and 30-day mortality in adults with invasive pneumococcal disease. Infection 2021; 50:223-233. [PMID: 34468953 DOI: 10.1007/s15010-021-01688-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Invasive pneumococcal disease (IPD) is responsible for substantial mortality and morbidity worldwide. We aimed to identify host and bacterial factors associated with 30-day mortality in 18-year-old patients hospitalized with IPD in France from 2013 to 2015. METHODS This study analyzed data collected from consecutives IPD cases included in two parallel multi-center cohort studies: COMBAT study (280 patients with pneumococcal community-acquired bacterial meningitis) and SIIP study (491 patients with non-meningitis IPD). Factors associated with 30-day mortality were identified using logistic regression. RESULTS Among the 771 enrolled patients (median age 66 years, IQR [52.0-79.7]), 592/767 (77.2%) had at least one chronic disease. Patients with meningitis were younger (60.2 vs 70.9 years; p < 0.001) and had fewer chronic diseases than those with non-meningitis IPD (73.3% vs 79.4%; p = 0.05). Non-vaccine serotypes were more frequent in meningitis patients than in those with other IPD (36.1% vs 23.1%; p < 0.001). The overall 30-day mortality was 16.7% and patients with concurrent meningitis and extra-cerebral IPD had the highest 30-day mortality rate (26.5%). On multivariate analyses, older age, history of malignant solid tumor, meningeal IPD and serotypes previously identified with high mortality potential were independently associated with 30-day mortality. Of the serotypes with high mortality potential, 80% were included in licensed (PCV13 or PPV23) vaccines. CONCLUSION We observed an effect of both host factors and pneumococcal serotypes on 30-day mortality in IPD. This highlights the need for a focused strategy to vaccinate at-risk patients. CLINICAL TRIAL ClinicalTrial. Gov identification number: NCT01730690.
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Affiliation(s)
- Amine Benadji
- AP-HP, Centre d'Investigation Clinique, Inserm CIC 1425, Hôpital Bichat Claude Bernard, 46, Rue Henri Huchard, 75018, Paris, France
| | - Xavier Duval
- AP-HP, Centre d'Investigation Clinique, Inserm CIC 1425, Hôpital Bichat Claude Bernard, 46, Rue Henri Huchard, 75018, Paris, France. .,IAME, INSERM, Université de Paris, 75018, Paris, France.
| | - Kostas Danis
- Santé Publique France, The French National Public Health Agency, Saint Maurice, France
| | - Bruno Hoen
- Service de Maladies Infectieuses et Tropicales, University Hospital Nancy, Hôpitaux de Brabois, 54511, Vandoeuvre-lès-Nancy, France
| | - Bernard Page
- AP-HP, Intensive Care Unit, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Guillaume Béraud
- Médecine Interne et Maladies Infectieuses, CHU de Poitiers, 86021, Poitiers, France
| | | | - Christophe Strady
- Cabinet d'Infectiologie, Clinique Courlancy, Groupe Courlancy-Reims, Reims, France
| | | | - Laurence Maulin
- Infectiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Carine Roy
- AP-HP, Unité de Recherche Clinique, Paris Nord, Hôpital Bichat, Paris, France
| | - Marie-Cécile Ploy
- Regional Observatories for Pneumococci (Observatoires Régionaux du Pneumocoque), University Hospital Centre Limoges, Limoges, France.,INSERM, CHU Limoges, RESINFIT, University of Limoges, U1092, F-87000, Limoges, France
| | | | - Emmanuelle Varon
- National Centre for Pneumococci, Centre Hospitalier Intercommunal Créteil, Créteil, France
| | - Sarah Tubiana
- AP-HP, Centre d'Investigation Clinique, Inserm CIC 1425, Hôpital Bichat Claude Bernard, 46, Rue Henri Huchard, 75018, Paris, France.,IAME, INSERM, Université de Paris, 75018, Paris, France
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Tabernero E, Ruiz LA, España PP, Méndez R, Serrano L, Santos B, Uranga A, González P, Garcia P, Torres A, Menendez R, Zalacain R. COVID-19 in young and middle-aged adults: predictors of poor outcome and clinical differences. Infection 2021; 50:179-189. [PMID: 34463951 PMCID: PMC8406039 DOI: 10.1007/s15010-021-01684-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/10/2021] [Indexed: 12/27/2022]
Abstract
Introduction Young and middle-aged adults are the largest group of patients infected with SARS-CoV-2 and some of them develop severe disease. Objective To investigate clinical manifestations in adults aged 18–65 years hospitalized for COVID-19 and identify predictors of poor outcome. Secondary objectives: to explore differences compared to the disease in elderly patients and the suitability of the commonly used community-acquired pneumonia prognostic scales in younger populations. Methods Multicenter prospective registry of consecutive patients hospitalized for COVID-19 pneumonia aged 18–65 years between March and May 2020. We considered a composite outcome of “poor outcome” including intensive care unit admission and/or use of noninvasive ventilation, continuous positive airway pressure or high flow nasal cannula oxygen and/or death. Results We identified 513 patients < 65 years of age, from a cohort of 993 patients. 102 had poor outcomes (19.8%) and 3.9% died. 78% and 55% of patients with poor outcomes were classified as low risk based on CURB and PSI scores, respectively. A multivariate Cox regression model identified six independent factors associated with poor outcome: heart disease, absence of chest pain or anosmia, low oxygen saturation, high LDH and lymphocyte count < 800/mL. Conclusions COVID-19 in younger patients carries significant morbidity and differs in some respects from this disease in the elderly. Baseline heart disease is a relevant risk factor, while anosmia and pleuritic pain are associated to better prognosis. Hypoxemia, LDH and lymphocyte count are predictors of poor outcome. We consider that CURB and PSI scores are not suitable criteria for deciding admission in this population.
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Affiliation(s)
- Eva Tabernero
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain. .,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
| | - Luis A Ruiz
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain.,Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain
| | - Pedro P España
- Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Raúl Méndez
- Pneumology Service, Hospital Universitari I Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Leyre Serrano
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain.,Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain
| | - Borja Santos
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Ane Uranga
- Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Paula González
- Pneumology Service, Hospital Universitari I Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Patricia Garcia
- Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Antoni Torres
- Pneumology Service, Hospital Clinic/Institut D´Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Rosario Menendez
- Pneumology Service, Hospital Universitari I Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Rafael Zalacain
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain
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Ryrsø CK, Faurholt-Jepsen D, Ritz C, Pedersen BK, Hegelund MH, Dungu AM, Sejdic A, Lindegaard B, Krogh-Madsen R. The impact of physical training on length of hospital stay and physical function in patients hospitalized with community-acquired pneumonia: protocol for a randomized controlled trial. Trials 2021; 22:571. [PMID: 34454594 PMCID: PMC8397876 DOI: 10.1186/s13063-021-05503-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 08/02/2021] [Indexed: 01/10/2023] Open
Abstract
Background Community-acquired pneumonia (CAP) is a leading cause of hospitalization worldwide. Bed rest with low levels of physical activity is common during periods of hospitalization and leads to functional decline as well as increased risk of complications. The aim of this study is to assess the effect of supervised physical training during hospitalization with CAP compared with standard usual care for CAP on length of hospital stay, risk of readmission, mortality risk, physical capacity, muscle and fat mass, muscle strength, metabolic function, systemic inflammation, health-related quality of life, and physical activity level. Methods This study is a randomized controlled trial with three parallel experimental arms. Based on a sample size calculation, a total of 210 patients admitted with CAP at Nordsjællands Hospital, Hillerød, Denmark, will be recruited. Patients will be randomly allocated (1:1:1) to either (1) standard usual care, (2) standard usual care combined with in-bed cycling, or (3) standard usual care combined with exercises from a booklet. The primary outcome is differences in length of hospital stay between groups, with secondary outcomes being differences between groups in time to (1) 90-day readmission and (2) 180-day mortality. Further secondary outcomes are differences in changes from baseline between groups in (3) lean mass, (4) fat mass, (5) fat-free mass, (6) physical capacity, (7) health-related quality of life, (8) systemic inflammation, and (9) physical activity level after discharge. Data on length of hospital stay, readmission, and mortality will be collected from patient files, while total lean, fat, and fat-free mass will be quantitated by dual-energy x-ray absorptiometry and bioelectrical impedance analysis. Physical function will be assessed using grip strength, 30-s chair stand tests, and Barthel Index-100. Health-related quality of life will be assessed with the EQ-5D-5L questionnaire. Systemic inflammation will be assessed in blood samples, while accelerometers are used for measuring physical activity. Discussion If a simple physical training program appears to diminish the impact of critical illness and hospitalization on clinical outcome, mobility, and health-related quality of life, it may lead to novel therapeutic approaches in the treatment of patients hospitalized with CAP. Trial registration ClinicalTrials.gov NCT04094636. Registered on 1 April 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05503-2.
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Affiliation(s)
- Camilla Koch Ryrsø
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark.,Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Bente Klarlund Pedersen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Maria Hein Hegelund
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Arnold Matovu Dungu
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Adin Sejdic
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Birgitte Lindegaard
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark. .,Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
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Quah J, Liew CJY, Zou L, Koh XH, Alsuwaigh R, Narayan V, Lu TY, Ngoh C, Wang Z, Koh JZ, Ang C, Fu Z, Goh HL. Chest radiograph-based artificial intelligence predictive model for mortality in community-acquired pneumonia. BMJ Open Respir Res 2021; 8:8/1/e001045. [PMID: 34376402 PMCID: PMC8354266 DOI: 10.1136/bmjresp-2021-001045] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background Chest radiograph (CXR) is a basic diagnostic test in community-acquired pneumonia (CAP) with prognostic value. We developed a CXR-based artificial intelligence (AI) model (CAP AI predictive Engine: CAPE) and prospectively evaluated its discrimination for 30-day mortality. Methods Deep-learning model using convolutional neural network (CNN) was trained with a retrospective cohort of 2235 CXRs from 1966 unique adult patients admitted for CAP from 1 January 2019 to 31 December 2019. A single-centre prospective cohort between 11 May 2020 and 15 June 2020 was analysed for model performance. CAPE mortality risk score based on CNN analysis of the first CXR performed for CAP was used to determine the area under the receiver operating characteristic curve (AUC) for 30-day mortality. Results 315 inpatient episodes for CAP occurred, with 30-day mortality of 19.4% (n=61/315). Non-survivors were older than survivors (mean (SD)age, 80.4 (10.3) vs 69.2 (18.7)); more likely to have dementia (n=27/61 vs n=58/254) and malignancies (n=16/61 vs n=18/254); demonstrate higher serum C reactive protein (mean (SD), 109 mg/L (98.6) vs 59.3 mg/L (69.7)) and serum procalcitonin (mean (SD), 11.3 (27.8) μg/L vs 1.4 (5.9) μg/L). The AUC for CAPE mortality risk score for 30-day mortality was 0.79 (95% CI 0.73 to 0.85, p<0.001); Pneumonia Severity Index (PSI) 0.80 (95% CI 0.74 to 0.86, p<0.001); Confusion of new onset, blood Urea nitrogen, Respiratory rate, Blood pressure, 65 (CURB-65) score 0.76 (95% CI 0.70 to 0.81, p<0.001), respectively. CAPE combined with CURB-65 model has an AUC of 0.83 (95% CI 0.77 to 0.88, p<0.001). The best performing model was CAPE incorporated with PSI, with an AUC of 0.84 (95% CI 0.79 to 0.89, p<0.001). Conclusion CXR-based CAPE mortality risk score was comparable to traditional pneumonia severity scores and improved its discrimination when combined.
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Affiliation(s)
- Jessica Quah
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | | | - Lin Zou
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Xuan Han Koh
- Health Services Research, Changi General Hospital, Singapore
| | - Rayan Alsuwaigh
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | | | - Tian Yi Lu
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Clarence Ngoh
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Zhiyu Wang
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Juan Zhen Koh
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Christine Ang
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Zhiyan Fu
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Han Leong Goh
- Integrated Health Information Systems Pte Ltd, Singapore
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Salam AP, Rojek A, Cai E, Raberahona M, Horby P. Deaths Associated with Pneumonic Plague, 1946-2017. Emerg Infect Dis 2021; 26:2432-2434. [PMID: 32946734 PMCID: PMC7510718 DOI: 10.3201/eid2610.191270] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Chang KY, Wu PC, Lee CH, Lee YC, Chen HC, Huang WC, Wu MF. Clinical Features and Antimicrobial Susceptibility of Pseudomonas aeruginosa and Acinetobacter baumannii Complex Isolates in Intensive Care Patients with Chronic Obstructive Pulmonary Disease and Community-Acquired Pneumonia in Taiwan. Int J Chron Obstruct Pulmon Dis 2021; 16:1801-1811. [PMID: 34168441 PMCID: PMC8216665 DOI: 10.2147/copd.s311714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Little is known about the features and implications of Pseudomonas aeruginosa (PA) and Acinetobacter baumannii complex (ABC) isolates discovered in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring invasive mechanical ventilation and admission to an intensive care unit. Thus, our study aimed to investigate the clinical characteristics and antimicrobial susceptibilities of PA and ABC isolates cultured from endotracheal aspirates (EAs) in such population. Patients and Methods In this retrospective, cross-sectional study, clinical data from medical records were reviewed and collected for analysis. Results Of the 262 participants, 17.2% (45/262), 11.5% (30/262), and 27.1% (71/262) had PA, ABC, and any of the two isolates discovered from EA cultures, respectively. Patients with PA isolates were associated with poorer lung function (the Global Initiative for Chronic Obstructive Lung Disease (GOLD) III+IV versus GOLD I+II, odds ratio (OR)=2.39, p= 0.022) and a lower body mass index (per increase of 1 kg/m2, OR= 0.93, p= 0.106) while the former was an independent predictor. Moreover, both subjects with ABC isolates and those with any of these two microorganisms were independently associated with a lower serum albumin level (per increase of 1 g/dL, OR= 0.44, p=0.009 and OR= 0.59, p=0.023, respectively). Participants with PA isolates were more likely to have failed weaning (62.2% versus 44.7%, p= 0.048) and death (28.9% versus 12.4%, p= 0.010) than those without PA isolates. The majority of the PA and ABC isolates were susceptible and resistant to all the tested antimicrobials, respectively, except that tigecycline had a reliable activity against ABC. Conclusion Our findings provide important information to help intensivists make better treatment decisions in critically ill patients with COPD and CAP.
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Affiliation(s)
- Ko-Yun Chang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Pi-Chu Wu
- Nursing Department, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Ching-Hsiao Lee
- Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, 350, Taiwan
| | - Yu-Che Lee
- Department of Medicine, University at Buffalo-Catholic Health, Buffalo, NY, USA
| | - Hui-Chen Chen
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Wei-Chang Huang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 407, Taiwan
- Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, 350, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, 402, Taiwan
- Master Program for Health Administration, Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, 407, Taiwan
| | - Ming-Feng Wu
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, 407, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, 406, Taiwan
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Kukhon FR, Festic E. Adjuvant Inhaled Corticosteroids in Community-Acquired Pneumonia: A Review Article. Med Sci (Basel) 2021; 9:34. [PMID: 34071031 PMCID: PMC8162532 DOI: 10.3390/medsci9020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/15/2022] Open
Abstract
Community-acquired pneumonia is still a major cause of morbidity and mortality worldwide. Since the inflammatory response induced by the immune system is often a major contributor to the lung injury, it becomes reasonable to assess the potential benefit of anti-inflammatory agents in treating community-acquired pneumonia. The role of corticosteroids as adjunct anti-inflammatory agents in treating community-acquired pneumonia is still controversial. Several studies have assessed the benefit of their use in patients with community-acquired pneumonia. In most of those studies, the route of corticosteroids administration was systemic. The aim of this article is to provide a concise review of the role of corticosteroids in treating community-acquired pneumonia when administered via inhalational route, with the potential benefit of avoiding systemic side effects of corticosteroids while exerting the same anti-inflammatory effects on the lungs. Conclusion: the use of inhaled corticosteroids may be of benefit in certain patient subsets with community-acquired pneumonia. Further randomized controlled trials are needed for better determination of such patient subsets.
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Affiliation(s)
| | - Emir Festic
- Division of Pulmonary and Sleep Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA;
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43
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Averin A, Shaff M, Weycker D, Lonshteyn A, Sato R, Pelton SI. Mortality and readmission in the year following hospitalization for pneumonia among US adults. Respir Med 2021; 185:106476. [PMID: 34087608 DOI: 10.1016/j.rmed.2021.106476] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Increasing evidence suggests the impact of pneumonia persists beyond hospital discharge and the acute phase of respiratory symptoms. We characterized short-term and long-term risks of mortality and hospital readmission across the adult age span and spectrum of comorbidities. METHODS Retrospective cohort design and Optum's de-identified Integrated Claims-Clinical dataset (2012-2018) were employed. Study population comprised adults who had ≥1 pneumonia hospitalization; each hospitalization ≥365 days apart was considered. Cumulative risks of all-cause mortality (from pneumonia hospitalization through 360-day post-discharge period) and all-cause hospital readmission (during 360-day post-discharge period) were summarized on an overall basis as well as by age and comorbidity profile (i.e., healthy, at-risk, high-risk). RESULTS Study population totaled 37,006 patients who contributed 38,809 pneumonia hospitalizations; mean age was 71 years, 51% were female, and 88% had at-risk (33%) or high-risk (55%) conditions. Mortality was 3.5% in hospital, 8.2% from admission to 30 days post-discharge, and 17.7% from admission to 360 days post-discharge. Hospital readmission was 12.5% during the 30-day post-discharge period, and 42.3% during the 360-day post-discharge period. Mortality risk increased with age and severity of comorbidity profile; readmission risk was highest for persons aged 65-74 years and persons with high-risk conditions. CONCLUSIONS All-cause mortality up to 1 year following pneumonia hospitalization was substantial, and was associated with increasing age and worsening comorbidity profile. Both readmission and mortality were greater at all ages in at-risk and high-risk subgroups (vs. healthy counterparts). Strategies that prevent pneumonia and/or associated pathophysiologic changes, especially among individuals with comorbidities, have the potential to reduce morbidity and mortality.
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Affiliation(s)
- Ahuva Averin
- Policy Analysis Inc. (PAI), Chestnut Hill, MA, USA.
| | - Melody Shaff
- Policy Analysis Inc. (PAI), Chestnut Hill, MA, USA
| | | | | | | | - Stephen I Pelton
- Boston University Schools of Medicine and Public Health, Boston, MA, USA; Boston Medical Center, Boston, MA, USA
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Sözen M, Karatoprak AP, Demirhan Y, Nasırlıer GÇ, Selek A, Gezer E, Çetinarslan B, Cantürk Z, Tarkun İ, Köksalan D, Azak E. Awareness of influenza and pneumococcal vaccines in diabetic patients. J Diabetes Metab Disord 2021; 20:757-763. [PMID: 33996650 PMCID: PMC8104465 DOI: 10.1007/s40200-021-00812-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/27/2021] [Indexed: 01/03/2023]
Abstract
Purpose In our study, it was aimed to evaluate the awareness of diabetic patients about vaccination status and vaccines. Methods This cross-sectional study was conducted between January 2019 and February 2019. A survey questioning the level of knowledge about and vaccination status for influenza and pneumonia vaccines was applied by face-to-face interviews with patients with diabetes mellitus who admitted to the diabetes outpatient clinic. All results were evaluated with SPSS-20.0. Results A total of 202 patients [66 male (32.7%) and 136 female (67.3%) patients; with a mean age of 57.7 ± 11.3 years and mean duration of diabetes 10.7 ± 7.9 years] were recruited in the study. Majority of the patients (92.6%) were type 2 DM patients. 59.4% of the patients had never been vaccinated. The rate of those who had pneumonia vaccine was very low, only 14.7%. The vast majority of the patients had knowledge about vaccines and their most common source of information was nurses. 53% of patients believed that diabetic patients should be vaccinated regularly. 16.8% of the patients were reluctant to have the recommended vaccine. The factor with greatest impact on this was that they did not consider the vaccine necessary. 52.5% of the patients recommended to be vaccinated had the recommended vaccine. 26.4% of the patients who were not enthusiastic about the recommended vaccine had pneumococcal vaccine after being informed about the vaccine. Conclusion It was observed that the information given about vaccines positively affected the vaccination rate. The main barrier to vaccination was the lack of information about the need for influenza vaccination. Designing strategies and training programs for healthcare professionals and patients should be the main goal to improve vaccination coverage and vaccination rates.
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Affiliation(s)
- Mehmet Sözen
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | | | - Yeliz Demirhan
- Diabetes Outpatient Clinic, Kocaeli University Research and Application Hospital, Kocaeli, Turkey
| | - Gülten Çevik Nasırlıer
- Department of History of Medicine and Ethics, Kocaeli University Institute of Health Sciences, Kocaeli, Turkey
| | - Alev Selek
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Emre Gezer
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Berrin Çetinarslan
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Zeynep Cantürk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - İlhan Tarkun
- Department of Endocrinology and Metabolism, Anadolu Medical Center, Kocaeli, Turkey
| | - Damla Köksalan
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Emel Azak
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Chaudhry B, Alekseyev K, Didenko L, Malek A, Ryklin G. Post COVID-19 MSSA pneumonia. SAGE Open Med Case Rep 2021; 9:2050313X211005996. [PMID: 33889412 PMCID: PMC8040613 DOI: 10.1177/2050313x211005996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/04/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) was first identified at the end of 2019 as a cluster of pneumonia cases in Wuhan, China. By February 2020, this virus quickly spread, becoming a global pandemic. The spectrum of symptomatic infection severity can range from mild, severe, and critical disease. Many correlated comorbidities were established, including smoking, socioeconomic background, gender (male prevalence), hypertension, obesity, cardiovascular disease, chronic lung disease, diabetes mellitus, cancer, and chronic kidney disease. In an extensive literature search, post-COVID-19 necrotizing Staphylococcus aureus pneumonia with pneumothorax has not been recorded. We present a case about a 62-year-old male who presented with symptoms of COVID-19 with many underlying comorbidities, including hypertension and hyperlipidemia. He was on ventilatory support during his first week in the hospital and then received supplemental oxygenation as he recovered from his COVID-19 pneumonia. Nearly a month and a half after his initial presentation, he quickly decompensated and was started on supplemental oxygen and the necessary treatments. It was then, with the aid of lab work and imaging, that we determined that he had developed necrotizing Staphylococcus aureus pneumonia with pneumothorax. He was adequately treated, and once he was stable, he was discharged home and was told to continue his therapy.
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Affiliation(s)
- Bilal Chaudhry
- Post-Acute Medical Rehabilitation Hospital of Dover, Dover, DE, USA
| | | | - Lidiya Didenko
- Christiana Care Health System, Newark, DE, USA
- Lidiya Didenko, Post-Acute Medical Rehabilitation Hospital of Dover, 1240 McKee Road, Dover, DE 19904, USA.
| | | | - Gennadiy Ryklin
- Post-Acute Medical Rehabilitation Hospital of Dover, Dover, DE, USA
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Dwyer R, Kalin M. Significance of the physician's and the patient's sex in hospitalized patients with community-acquired pneumonia. Infect Dis (Lond) 2021; 53:538-545. [PMID: 33750259 DOI: 10.1080/23744235.2021.1900906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Numerous studies have revealed that the sex of the patient or of the attending physician have impact on patient care, treatment, morbidity and mortality. Community-acquired pneumonia (CAP) is a common cause of hospitalization, antibiotic treatment and intensive care unit (ICU) admission. The purpose of this study was to examine if the patient's or the attending physicians' sex may influence the management of hospitalized patients with CAP. METHODS Our study included 826 consecutive inpatients with CAP (404 females, and 422 male patients, 429 patients initially treated by a female physician and 397 patients initially treated by a male physician). We examined if the patient's, or the initial attending physician's sex, affected treatment and outcome in patients with CAP. RESULTS Patients mean age was 69 years, 30-day mortality 9%. By use of the pneumonia severity index, male patients were found to be more severely ill at admission (p = .0008). Fewer female physicians' patients were admitted from the emergency department (ED) to the ICU when compared to male physicians' patients, 5% versus 10% (p = .006), and female physicians' patients received their first intravenous (IV) antibiotic dose later than male physicians' patients in the ED (p = .003). CONCLUSION Our study indicates that the sex of the attending physician may affect the chosen level of care and antibiotic treatment, and that admitted male patients with CAP were more seriously ill than admitted female patients with CAP.
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Affiliation(s)
- Richard Dwyer
- Department of Infectious Diseases/Venhälsan, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Mats Kalin
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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López-de-Andrés A, Albaladejo-Vicente R, de Miguel-Diez J, Hernández-Barrera V, Ji Z, Zamorano-León JJ, Lopez-Herranz M, Carabantes Alarcon D, Jimenez-Garcia R. Gender differences in incidence and in-hospital outcomes of community-acquired, ventilator-associated and nonventilator hospital-acquired pneumonia in Spain. Int J Clin Pract 2021; 75:e13762. [PMID: 33068052 DOI: 10.1111/ijcp.13762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/04/2020] [Indexed: 12/20/2022] Open
Abstract
AIMS We aim to compare the incidence and in-hospital outcomes of community-acquired pneumonia (CAP), ventilator-associated pneumonia (VAP) and nonventilator hospital-acquired pneumonia (NV-HAP) according to gender. METHODS This was a retrospective observational epidemiological study using the Spanish National Hospital Discharge Database for the years 2016 and 2017. RESULTS Of 277 785 hospital admissions, CAP was identified in 257 455 (41.04% females), VAP was identified in 3261 (30.42% females) and NV-HAP was identified in 17 069 (36.58% females). The incidence of all types of pneumonia was higher amongst males (CAP: incidence rate ratio [IRR] 1.05, 95% CI 1.03-1.06; VAP: IRR 1.36, 95% CI 1.26-1.46; and NV-HAP: IRR 1.16, 95% CI 1.14-1.18). The crude in-hospital mortality (IHM) rate for CAP was 11.44% in females and 11.80% in males (P = .005); for VAP IHM, the rate was approximately 35% in patients of both genders and for NV-HAP IHM, the rate was 23.97% for females and 26.40% for males (P < .001). After multivariable adjustment, in patients of both genders, older age and comorbidities were factors associated with IHM in the three types of pneumonia analysed. Female gender was a risk factor for IHM after VAP (OR 1.24; 95% CI 1.06-1.44), and no gender differences were found for CAP or NV-HAP. CONCLUSIONS Our findings show a difference between females and males, with females presenting a lower incidence of all types of pneumonia. However, female gender was a risk factor for IHM after VAP.
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Affiliation(s)
- Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Spain
| | - Romana Albaladejo-Vicente
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier de Miguel-Diez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Spain
| | - Zichen Ji
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - José J Zamorano-León
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Marta Lopez-Herranz
- Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Spain
| | - David Carabantes Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Brunetti VC, Ayele HT, Yu OHY, Ernst P, Filion KB. Type 2 diabetes mellitus and risk of community-acquired pneumonia: a systematic review and meta-analysis of observational studies. CMAJ Open 2021; 9:E62-E70. [PMID: 33495386 PMCID: PMC7843079 DOI: 10.9778/cmajo.20200013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND People with type 2 diabetes are at greater risk for infections than those without type 2 diabetes. Our objective was to examine the association between type 2 diabetes and the risk of community-acquired pneumonia (CAP). METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, CINAHL, ProQuest theses and dissertations, Global Health, the Global Index Medicus of the World Health Organization, and Google Scholar. We included observational studies published in English or French between Jan. 1, 1946 (start of MEDLINE) and July 18, 2020. Two independent reviewers extracted data and assessed quality using the ROBINS-I tool. DerSimonian-Laird random-effects models were used to pool estimates of the association between type 2 diabetes and CAP. RESULTS Our systematic review included 15 articles, reporting on 13 cohort studies and 4 case-control studies (14 538 968 patients). All studies reported an increased risk of pneumonia among patients with type 2 diabetes, and all were at serious risk of bias. When estimates were pooled across studies, the pooled relative risk was 1.64 (95% confidence interval [CI] 1.55-1.73); although there was a substantial amount of relative heterogeneity (I 2 94.2), the amount of absolute heterogeneity was more modest (T2 0.008). The relative risk was 1.70 (95% CI 1.63-1.77, I 2 85.2%, T2 0.002) among cohort studies (n = 13), and the odds ratio was 1.54 (95% CI 1.14-2.09, I 2 92.7%, T2 0.07) among case-control studies (n = 4). INTERPRETATION Type 2 diabetes may be associated with an increased risk of CAP; however, the available evidence is from studies at serious risk of bias, and additional, high-quality studies are needed to confirm these findings. PROSPERO REGISTRATION CRD42018116409.
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Affiliation(s)
- Vanessa C Brunetti
- Department of Epidemiology, Biostatistics and Occupational Health (Brunetti, Ayele, Filion), McGill University; Centre for Clinical Epidemiology (Brunetti, Ayele, Yu, Ernst, Filion), Lady Davis Institute for Medical Research, and Divisions of Endocrinology (Yu) and Pulmonary Medicine (Ernst), Jewish General Hospital, McGill University; Department of Medicine (Ernst, Filion), McGill University, Montréal, Que
| | - Henok Tadesse Ayele
- Department of Epidemiology, Biostatistics and Occupational Health (Brunetti, Ayele, Filion), McGill University; Centre for Clinical Epidemiology (Brunetti, Ayele, Yu, Ernst, Filion), Lady Davis Institute for Medical Research, and Divisions of Endocrinology (Yu) and Pulmonary Medicine (Ernst), Jewish General Hospital, McGill University; Department of Medicine (Ernst, Filion), McGill University, Montréal, Que
| | - Oriana Hoi Yun Yu
- Department of Epidemiology, Biostatistics and Occupational Health (Brunetti, Ayele, Filion), McGill University; Centre for Clinical Epidemiology (Brunetti, Ayele, Yu, Ernst, Filion), Lady Davis Institute for Medical Research, and Divisions of Endocrinology (Yu) and Pulmonary Medicine (Ernst), Jewish General Hospital, McGill University; Department of Medicine (Ernst, Filion), McGill University, Montréal, Que
| | - Pierre Ernst
- Department of Epidemiology, Biostatistics and Occupational Health (Brunetti, Ayele, Filion), McGill University; Centre for Clinical Epidemiology (Brunetti, Ayele, Yu, Ernst, Filion), Lady Davis Institute for Medical Research, and Divisions of Endocrinology (Yu) and Pulmonary Medicine (Ernst), Jewish General Hospital, McGill University; Department of Medicine (Ernst, Filion), McGill University, Montréal, Que
| | - Kristian B Filion
- Department of Epidemiology, Biostatistics and Occupational Health (Brunetti, Ayele, Filion), McGill University; Centre for Clinical Epidemiology (Brunetti, Ayele, Yu, Ernst, Filion), Lady Davis Institute for Medical Research, and Divisions of Endocrinology (Yu) and Pulmonary Medicine (Ernst), Jewish General Hospital, McGill University; Department of Medicine (Ernst, Filion), McGill University, Montréal, Que.
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49
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Akinosoglou K, Kapsokosta G, Mouktaroudi M, Rovina N, Kaldis V, Stefos A, Kontogiorgi M, Giamarellos-Bourboulis E, Gogos C. Diabetes on sepsis outcomes in non-ICU patients: A cohort study and review of the literature. J Diabetes Complications 2021; 35:107765. [PMID: 33187869 DOI: 10.1016/j.jdiacomp.2020.107765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/17/2020] [Accepted: 09/14/2020] [Indexed: 01/12/2023]
Abstract
AIMS We sought to determine whether primary outcomes differ between non-ICU septic patients with and without type 2 diabetes (T2D). METHODS This study utilized the Hellenic Sepsis Study Group Registry, collecting nationwide data for sepsis patients since 2006, and classified patients upon presence or absence of T2D. Patients were perfectly matched for a) Sepsis 3 definition criteria (including septic shock) b) gender, c) age, d) APACHE II score and e) Charlson's comorbidity index (CCI). Independent sample t-test and chi-square t-test was used to compare prognostic indices and primary outcomes. RESULTS Of 4320 initially included non-ICU sepsis patients, 812 were finally analysed, following match on criteria. Baseline characteristics were age 76 [±10.3] years, 46% male, APACHE II 15.5 [±6], CCI 5.1 [±1.8], 24% infection, 63.8% sepsis and 12.2% septic shock. No significant difference was noted between two groups in qSOFA, SOFA, or suPAR1 levels (p = 0.7, 0.1 & 0.3) respectively. Primary sepsis syndrome resolved in 70.9% of cases (p = 0.9), while mortality was 24% in 28-days time. Cause of death was similar between patients with and without T2D (sepsis 17.8% vs 15.8%, heart event 3.7% vs 3.2%, CNS event 0.5% vs 0.5%, malignancy 0.7% vs 2% respectively, p = 0.6). CONCLUSIONS DM does not appear to negatively affect outcomes in septic patients not requiring ICU.
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Affiliation(s)
- Karolina Akinosoglou
- Dept of Internal Medicine and Infectious Diseases, University Hospital of Patras, Greece.
| | | | - Maria Mouktaroudi
- 4th Dept of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Nikoletta Rovina
- 1st Dept of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, Greece
| | | | - Aggelos Stefos
- Dept of Internal Medicine, Larissa University General Hospital, University of Thessaly, Greece
| | - Marina Kontogiorgi
- 2nd Dept of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | | | - Charalambos Gogos
- Dept of Internal Medicine and Infectious Diseases, University Hospital of Patras, Greece
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50
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Zulkifli KK, Mohamed Shah FZ, Ismail AI, Abdul Rahman TH, Ghani RA. Prevalence and associated factors of dysglycemia among patients with chronic obstructive pulmonary disease. Chron Respir Dis 2021; 18:14799731211056348. [PMID: 34797178 PMCID: PMC8609099 DOI: 10.1177/14799731211056348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Dysglycemia is known to be a common comorbidity of chronic obstructive pulmonary disease (COPD). However, undiagnosed dysglycemia and the associated factors remain under-reported. This study aimed to determine the prevalence and the associated factors of dysglycemia among COPD patients. METHODS This was a cross-sectional, single-center study involving adults with established COPD (n = 186) divided into those with or without hospital admissions for acute exacerbation. Oral glucose tolerance test (OGTT) was performed in patients with no known history of dysglycemia. RESULTS There were 16 patients who had overt diabetes, and 32 had prediabetes following the OGTT. Forty percent had histories of hospital admissions for COPD exacerbations. Both groups demonstrated similar 2-h post prandial glucose, glycated hemoglobin (HbA1c) and fasting blood glucose. The incidences of newly diagnosed dysglycemia were higher in both groups (40.8% vs 34.6%, p = 0.57). Cumulative days of admission (≥6 days/year) and weight (≥65 kg) were identified as predictors for dysglycemia within the study population. DISCUSSION This study demonstrated a high number of overt and newly diagnosed dysglycemia among COPD patients who had no previous history of abnormal glucose. Recent acute exacerbations of COPD could have a negative impact on glycemia, although the results did not attain statistical significance. However, there is a need for adequate screening for dysglycemia, particularly among those with frequent acute exacerbations of their condition.
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Affiliation(s)
- Khairil K Zulkifli
- Dept of Internal Medicine, Faculty
of Medicine, Universiti Teknologi MARA
(UiTM), Sg Buloh, Malaysia
| | - Fatimah Z Mohamed Shah
- Dept of Internal Medicine, Faculty
of Medicine, Universiti Teknologi MARA
(UiTM), Sg Buloh, Malaysia
| | - Ahmad I Ismail
- Dept of Internal Medicine, Faculty
of Medicine, Universiti Teknologi MARA
(UiTM), Sg Buloh, Malaysia
- Cardiac Vascular Lung Research
Institute (CAVALRI), Sg Buloh, Malaysia
| | | | - Rohana A Ghani
- Dept of Internal Medicine, Faculty
of Medicine, Universiti Teknologi MARA
(UiTM), Sg Buloh, Malaysia
- Institute of Pathology, Laboratory
and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA
(UiTM), Petaling Jaya, Malaysia
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