1
|
Heidary M, Dashtbin S, Asadi A, Asadollahi P, Khatib A, Ebrahimi MA, Ghanbari Z, Darbandi A, Ghanavati R, Pakzad R. Prevalence of linezolid resistance in Streptococcus pneumoniae isolates: a systematic review and meta-analysis. Future Microbiol 2024; 19:449-459. [PMID: 38497912 DOI: 10.2217/fmb-2023-0170] [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: 07/30/2023] [Accepted: 11/13/2023] [Indexed: 03/19/2024] Open
Abstract
Aim: This study aimed to understand the current level of linezolid (LNZ) resistance in Streptococcus pneumoniae isolates reported over the past 10 years. Material & methods: An electronic search was conducted for the following keywords: ((Streptococcus pneumoniae [title/abstract]) OR (Pneumococcus [title/abstract]) OR (Pneumococci [title/abstract]) AND (linezolid [title/abstract]) OR (Zyvox [title/abstract])) OR (Zyvoxid [title/abstract])). Result: Out of all the studies, 80 had a cross-sectional design, while 11 followed a cohort approach. The prevalence of LNZ resistance among S. pneumoniae isolates ranged from 0% to 4.86%. Discussion: Urgent, high-powered, randomized, controlled trials with participants from endemic regions are needed to gain a comprehensive understanding of the impact on and significance of LNZ treatment to patients.
Collapse
Affiliation(s)
- Mohsen Heidary
- Cellular & Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Shirin Dashtbin
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Microbial Biotechnology Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Arezoo Asadi
- Endocrine Research Center, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Parisa Asadollahi
- Microbiology Department, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Khatib
- Department of Nursing, School of Medical Sciences, Yazd branch, Islamic Azad University, Yazd, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | | | - Zahra Ghanbari
- Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Atieh Darbandi
- Molecular Microbiology Research Center, Shahed University, Tehran, Iran
| | - Roya Ghanavati
- School of Medicine, Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| |
Collapse
|
2
|
Mamun GMS, Sarmin M, Shahid ASMSB, Nuzhat S, Shahrin L, Afroze F, Saha H, Shaima SN, Sultana MS, Ahmed T, Chisti MJ. Burden, predictors, and outcome of unconsciousness among under-five children hospitalized for community-acquired pneumonia: A retrospective study from a developing country. PLoS One 2023; 18:e0287054. [PMID: 37343025 DOI: 10.1371/journal.pone.0287054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/28/2023] [Indexed: 06/23/2023] Open
Abstract
Despite the reduction of death from pneumonia over recent years, pneumonia has still been the leading infectious cause of death in under-five children for the last several decades. Unconsciousness is a critical condition in any child resulting from any illness. Once it occurs during a pneumonia episode, the outcome is perceived to be fatal. However, data on children under five with pneumonia having unconsciousness are scarce. We've retrospectively analyzed the data of under-five children admitted at the in-patient ward of Dhaka Hospital of icddr,b during 1 January 2014 and 31 December 2017 with World Health Organization classified pneumonia or severe pneumonia. Children presented with or without unconsciousness were considered as cases and controls respectively. Among a total of 3,876 children fulfilling the inclusion criteria, 325 and 3,551 were the cases and the controls respectively. A multivariable logistic regression analysis revealed older children (8 months vs. 7.9 months) (adjusted odds ratio, aOR 1.02, 95% CI: 1.004-1.04, p = 0.015), hypoxemia (aOR 3.22, 95% CI: 2.39-4.34, p<0.001), severe sepsis (aOR 4.46, 95% CI: 3.28-6.06, p<0.001), convulsion (aOR 8.90, 95% CI: 6.72-11.79, p<0.001), and dehydration (aOR 2.08, 95% CI: 1.56-2.76, p<0.001) were found to be independently associated with the cases. The cases more often had a fatal outcome than the controls (23% vs. 3%, OR 9.56, 95% CI: 6.95-13.19, p<0.001). If the simple predicting factors of unconsciousness in children under five hospitalized for pneumonia with different severity can be initially identified and adequately treated with prompt response, pneumonia-related deaths can be reduced more effectively, especially in resource-limited settings.
Collapse
Affiliation(s)
- Gazi Md Salahuddin Mamun
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Monira Sarmin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Sharika Nuzhat
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Afroze
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Haimanti Saha
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shamsun Nahar Shaima
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mst Shahin Sultana
- National Institute of Population Research and Training (NIPORT), Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| |
Collapse
|
3
|
Tran-Quang K, Nguyen-Thi-Dieu T, Tran-Do H, Pham-Hung V, Nguyen-Vu T, Tran-Xuan B, Larsson M, Duong-Quy S. Antibiotic resistance of Streptococcus pneumoniae in Vietnamese children with severe pneumonia: a cross-sectional study. Front Public Health 2023; 11:1110903. [PMID: 37383272 PMCID: PMC10294427 DOI: 10.3389/fpubh.2023.1110903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/25/2023] [Indexed: 06/30/2023] Open
Abstract
Background Streptococcus pneumoniae is the most common bacterium that causes community-acquired pneumonia (CAP) in children. The rate of S. pneumoniae resistance to antibiotics is increasing, particularly in patients with severe CAP. Therefore, the level of antibiotic resistance of S. pneumoniae causing severe CAP in Vietnamese children requires regular monitoring. Methods This was a cross-sectional descriptive study. Nasopharyngeal aspiration specimens from children were cultured, isolated, and examined for S. pneumoniae. Bacterial strains were assessed for antimicrobial susceptibility, and the minimum inhibitory concentration (MIC) was determined. Results Eighty-nine strains of S. pneumoniae were isolated from 239 children with severe CAP. The majority of isolates were completely non-susceptible to penicillin (1.1% intermediate, 98.9% resistant) and highly resistant to erythromycin (96.6%) and clarithromycin (88.8%); the rate of resistance to ceftriaxone was 16.9%, with the proportion of intermediate resistance at 46.0%; 100% of strains were susceptible to vancomycin and linezolid. For most antibiotics, MIC50 and MIC90 were equal to the resistance threshold according to the Clinical and Laboratory Standards Institute 2021; penicillin had an eight-fold increase in MIC90 (64 mg/L) and ceftriaxone had a 1.5-fold increase in MIC90 (6 mg/L). Conclusion Streptococcus pneumoniae isolates described in this study were resistant to many antibiotics. Penicillin should not be the first-line antibiotic of choice, and ceftriaxone at an enhanced dose should be used instead.
Collapse
Affiliation(s)
- Khai Tran-Quang
- Department of Paediatrics, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | | | - Hung Tran-Do
- Department of Nursing and Medical Technology, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Van Pham-Hung
- International Research of Gene and Immunology Institute, Laboratory of Nam Khoa Biotek Company, Ho Chi Minh City, Vietnam
| | - Trung Nguyen-Vu
- Department of Microbiology, Hanoi Medical University, Hanoi, Vietnam
| | - Bach Tran-Xuan
- Department of Health Economics, Institute of Health Economics and Technology, Hanoi Medical University, Hanoi, Vietnam
| | - Mattias Larsson
- Global Public Health Department, Karolinska Institutet, Stockholm, Sweden
| | - Sy Duong-Quy
- Biomedical Research Center, Lam Dong Medical College, Dalat, Vietnam
- Division of Immuno-Allergology and Pulmonology, Penn State Medical College, Hershey Medical Center, Hershey, PA, United States
| |
Collapse
|
4
|
Wilkes C, Bava M, Graham HR, Duke T. What are the risk factors for death among children with pneumonia in low- and middle-income countries? A systematic review. J Glob Health 2023; 13:05003. [PMID: 36825608 PMCID: PMC9951126 DOI: 10.7189/jogh.13.05003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Background Knowledge of the risk factors for and causes of treatment failure and mortality in childhood pneumonia is important for prevention, diagnosis, and treatment at an individual and population level. This review aimed to identify the most important risk factors for mortality among children aged under ten years with pneumonia. Methods We systematically searched MEDLINE, EMBASE, and PubMed for observational and interventional studies reporting risk factors for mortality in children (aged two months to nine years) in low- and middle-income countries (LMICs). We screened articles according to specified inclusion and exclusion criteria, assessed risk of bias using the EPHPP framework, and extracted data on demographic, clinical, and laboratory risk factors for death. We synthesized data descriptively and using Forest plots and did not attempt meta-analysis due to the heterogeneity in study design, definitions, and populations. Findings We included 143 studies in this review. Hypoxaemia (low blood oxygen level), decreased conscious state, severe acute malnutrition, and the presence of an underlying chronic condition were the risk factors most strongly and consistently associated with increased mortality in children with pneumonia. Additional important clinical factors that were associated with mortality in the majority of studies included particular clinical signs (cyanosis, pallor, tachypnoea, chest indrawing, convulsions, diarrhoea), chronic comorbidities (anaemia, HIV infection, congenital heart disease, heart failure), as well as other non-severe forms of malnutrition. Important demographic factors associated with mortality in the majority of studies included age <12 months and inadequate immunisation. Important laboratory and investigation findings associated with mortality in the majority of studies included: confirmed Pneumocystis jirovecii pneumonia (PJP), consolidation on chest x-ray, pleural effusion on chest x-ray, and leukopenia. Several other demographic, clinical and laboratory findings were associated with mortality less consistently or in a small numbers of studies. Conclusions Risk assessment for children with pneumonia should include routine evaluation for hypoxaemia (pulse oximetry), decreased conscious state (e.g. AVPU), malnutrition (severe, moderate, and stunting), and the presence of an underlying chronic condition as these are strongly and consistently associated with increased mortality. Other potentially useful risk factors include the presence of pallor or anaemia, chest indrawing, young age (<12 months), inadequate immunisation, and leukopenia.
Collapse
Affiliation(s)
- Chris Wilkes
- Murdoch Children’s Research Institution, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Mohamed Bava
- Murdoch Children’s Research Institution, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Hamish R Graham
- Murdoch Children’s Research Institution, Royal Children’s Hospital, Parkville, Victoria, Australia,Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Trevor Duke
- Murdoch Children’s Research Institution, Royal Children’s Hospital, Parkville, Victoria, Australia,Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Parkville, Victoria, Australia
| | | |
Collapse
|
5
|
Anteneh ZA, Arega HE, Mihretie KM. Validation of risk prediction for outcomes of severe community-acquired pneumonia among under-five children in Amhara region, Northwest Ethiopia. PLoS One 2023; 18:e0281209. [PMID: 36791115 PMCID: PMC9931104 DOI: 10.1371/journal.pone.0281209] [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: 02/23/2022] [Accepted: 01/10/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Globally there are over 1,400 cases of pneumonia per 100,000 children every year, where children in South Asia and Sub-Saharan Africa are disproportionately affected. Some of the cases develop poor treatment outcome (treatment failure or antibiotic change or staying longer in the hospital or death), while others develop good outcome during interventions. Although clinical decision-making is a key aspect of the interventions, there are limited tools such as risk scores to assist the clinical judgment in low-income settings. This study aimed to validate a prediction model and develop risk scores for poor outcomes of severe community-acquired pneumonia (SCAP). METHODS A cohort study was conducted among 539 under-five children hospitalized with SCAP. Data analysis was done using R version 4.0.5 software. A multivariable analysis was done. We developed a simplified risk score to facilitate clinical utility. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plot. Bootstrapping was used to validate all accuracy measures. A decision curve analysis was used to evaluate the clinical and public health utility of our model. RESULTS The incidence of poor outcomes of pneumonia was 151(28%) (95%CI: 24.2%-31.8%). Vaccination status, fever, pallor, unable to breastfeed, impaired consciousness, CBC abnormal, entered ICU, and vomiting remained in the reduced model. The AUC of the original model was 0.927, 95% (CI (0.90, 0.96), whereas the risk score model produced prediction accuracy of an AUC of 0.89 (95%CI: 0.853-0.922. Our decision curve analysis for the model provides a higher net benefit across ranges of threshold probabilities. CONCLUSIONS Our model has excellent discrimination and calibration performance. Similarly, the risk score model has excellent discrimination and calibration ability with an insignificant loss of accuracy from the original. The models can have the potential to improve care and treatment outcomes in the clinical settings.
Collapse
Affiliation(s)
- Zelalem Alamrew Anteneh
- Department of Epidemiology, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | | | | |
Collapse
|
6
|
Kazi S, Hernstadt H, Abo YN, Graham H, Palmer M, Graham SM. The utility of chest x-ray and lung ultrasound in the management of infants and children presenting with severe pneumonia in low-and middle-income countries: A pragmatic scoping review. J Glob Health 2022; 12:10013. [PMID: 36560909 PMCID: PMC9789364 DOI: 10.7189/jogh.12.10013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Chest x-ray (CXR) is commonly used (when available) to support clinical management decisions for child pneumonia and provide a reference standard for diagnosis in research studies. However, its diagnostic and technical limitations for both purposes are well recognised. Recent evidence suggests that lung ultrasound (LUS) may have diagnostic utility in pneumonia. This systematic scoping review of research on the utility of CXR and LUS in the management of severe childhood pneumonia aims to inform pragmatic guidelines for low- and middle-income countries (LMICs) and identify gaps in knowledge. Methods We included peer-reviewed studies published between 2000 and 2020 in infants and children aged from one month to nine years, presenting with severe pneumonia. CXR studies were limited to those from LMICs, while LUS studies included any geographic region. LUS and CXR articles were mapped into the following themes: indications, role in diagnosis, role in management, impact on outcomes, and practical considerations for LMIC settings. Results 85 articles met all eligibility criteria, including 27 CXR studies and 58 LUS studies. CXR studies were primarily observational and examined associations between radiographic abnormalities and pneumonia aetiology or outcomes. The most consistent finding was an association between CXR consolidation and risk of mortality. Difficulty obtaining quality CXR images and inter-reader variability in interpretation were commonly reported challenges. Research evaluating indications for CXR, role in management, and impact on patient outcomes was very limited. LUS studies primarily focused on diagnostic accuracy. LUS had higher sensitivity for identification of consolidation than CXR. There are gaps in knowledge regarding diagnostic criteria, as well as the practical utility of LUS in the diagnosis and management of pneumonia. Most LUS studies were conducted in HIC settings with experienced operators; however, small feasibility studies indicate that good inter-operator reliability may be achieved by training of novice clinicians in LMIC settings. Conclusions The available evidence does not support the routine use of CXR or LUS as essential tools in the diagnosis and initial management of severe pneumonia. Further evaluation is required to determine the clinical utility and feasibility of both imaging modalities in low-resource settings.
Collapse
Affiliation(s)
- Saniya Kazi
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,Monash Health, Melbourne, Victoria, Australia
| | | | - Yara-Natalie Abo
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
| | - Hamish Graham
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
| | - Megan Palmer
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephen M Graham
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,Monash Health, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
| | | |
Collapse
|
7
|
Mvalo T, Smith AG, Eckerle M, Hosseinipour MC, Kondowe D, Vaidya D, Liu Y, Corbett K, Nansongole D, Mtimaukanena TA, Lufesi N, McCollum ED. Antibiotic treatment failure in children aged 1 to 59 months with World Health Organization-defined severe pneumonia in Malawi: A CPAP IMPACT trial secondary analysis. PLoS One 2022; 17:e0278938. [PMID: 36516197 PMCID: PMC9750006 DOI: 10.1371/journal.pone.0278938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pneumonia is a leading cause of mortality in children <5 years globally. Early identification of hospitalized children with pneumonia who may fail antibiotics could improve outcomes. We conducted a secondary analysis from the Malawi CPAP IMPACT trial evaluating risk factors for antibiotic failure among children hospitalized with pneumonia. METHODS Participants were 1-59 months old with World Health Organization-defined severe pneumonia and hypoxemia, severe malnutrition, and/or HIV exposure/infection. All participants received intravenous antibiotics per standard care. First-line antibiotics were benzylpenicillin and gentamicin for five days. Study staff assessed patients for first-line antibiotic failure daily between days 3-6. When identified, patients failing antibiotics were switched to second-line ceftriaxone. Analyses excluded children receiving ceftriaxone and/or deceased by hospital day two. We compared characteristics between patients with and without treatment failure and fit multivariable logistic regression models to evaluate associations between treatment failure and admission characteristics. RESULTS From June 2015-March 2018, 644 children were enrolled and 538 analyzed. Antibiotic failure was identified in 251 (46.7%) participants, and 19/251 (7.6%) died. Treatment failure occurred more frequently with severe malnutrition (50.2% (126/251) vs 28.2% (81/287), p<0.001) and amongst those dwelling ≥10km from a health facility (22.3% (56/251) vs 15.3% (44/287), p = 0.026). Severe malnutrition occurred more frequently among children living ≥10km from a health facility than those living <10km (49.0% (49/100) vs 35.7% (275/428), p = 0.014). Children with severe malnutrition (adjusted odds ratio (aOR) 2.2 (95% CI 1.52, 3.24), p<0.001) and pre-hospital antibiotics ((aOR 1.47, 95% CI 1.01, 2.14), p = 0.043) had an elevated aOR for antibiotic treatment failure. CONCLUSION Severe malnutrition and pre-hospital antibiotic use predicted antibiotic treatment failure in this high-risk severe pneumonia pediatric population in Malawi. Our findings suggest addressing complex sociomedical conditions like severe malnutrition and improving pneumonia etiology diagnostics will be key for better targeting interventions to improve childhood pneumonia outcomes.
Collapse
Affiliation(s)
- Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- * E-mail:
| | - Andrew G. Smith
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital, Cincinnati, OH, United States of America
| | - Mina C. Hosseinipour
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Division of Infectious Disease, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Davie Kondowe
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Dhananjay Vaidya
- Department of Medicine, Epidemiology and the BEAD Core, Johns Hopkins University, Baltimore, MD, United States of America
| | - Yisi Liu
- Department of Pediatrics and the BEAD Core, Johns Hopkins University, Baltimore, MD, United States of America
| | - Kelly Corbett
- Department of Pediatrics, Section of Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
| | - Dan Nansongole
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | | | - Eric D. McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Global Program for Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| |
Collapse
|
8
|
Niu BY, Wang G, Li B, Zhen GS, Weng YB. Sequential treatment of severe pneumonia with respiratory failure and its influence on respiratory mechanical parameters and hemodynamics. World J Clin Cases 2022; 10:7314-7323. [PMID: 36157993 PMCID: PMC9353906 DOI: 10.12998/wjcc.v10.i21.7314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/17/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The pathophysiological characteristics of severe pneumonia complicated by respiratory failure comprise pulmonary parenchymal changes leading to ventilation imbalance, alveolar capillary injury, pulmonary edema, refractory hypoxemia, and reduced lung compliance. Prolonged hypoxia can cause acid-base balance disorder, peripheral circulatory failure, blood-pressure reduction, arrhythmia, and other adverse consequences.
AIM To investigate sequential mechanical ventilation’s effect on severe pneumonia complicated by respiratory failure.
METHODS We selected 108 patients with severe pneumonia complicated by respiratory failure who underwent mechanical ventilation between January 2018 and September 2020 at the Luhe Hospital’s Intensive Care Unit and divided them into sequential and regular groups according to a randomized trial, with each group comprising 54 patients. The sequential group received invasive and non-invasive sequential mechanical ventilation, whereas the regular group received invasive mechanical ventilation. Blood-gas parameters, hemodynamic parameters, respiratory mechanical parameters, inflammatory factors, and treatment outcomes were compared between the two groups before and after mechanical-ventilation treatment.
RESULTS The arterial oxygen partial pressure and stroke volume variation values of the sequential group at 24, 48, and 72 h of treatment were higher than those of the conventional group (P < 0.05). The carbon dioxide partial pressure value of the sequential group at 72 h of treatment and the Raw value of the treatment group at 24 and 48 h were lower than those of the conventional group (P < 0.05). The pH value of the sequential group at 24 and 72 h of treatment, the central venous pressure value of the treatment at 24 h, and the Cst value of the treatment at 24 and 48 h were higher than those of the conventional group (P < 0.05). The tidal volume in the sequential group at 24 h of treatment was higher than that in the conventional group (P < 0.05), the measured values of interleukin-6 and tumor necrosis factor-α in the sequential group at 72 h of treatment were lower than those in the conventional group (P < 0.05), and the total time of mechanical ventilation in the sequential group was shorter than that in the conventional group, with a statistically significant difference (P < 0.05).
CONCLUSION Treating severe pneumonia complicated by respiratory failure with sequential mechanical ventilation is more effective in improving respiratory system compliance, reducing inflammatory response, maintaining hemodynamic stability, and improving patient blood-gas levels; however, from this study’s perspective, it cannot reduce patient mortality.
Collapse
Affiliation(s)
- Bing-Yin Niu
- Department of Critical Care Medicine, Beijing Luhe Hospital, Beijing 101100, China
| | - Guan Wang
- Department of Critical Care Medicine, Beijing Luhe Hospital, Beijing 101100, China
| | - Bin Li
- Department of Critical Care Medicine, Beijing Luhe Hospital, Beijing 101100, China
| | - Gen-Shen Zhen
- Department of Critical Care Medicine, Beijing Luhe Hospital, Beijing 101100, China
| | - Yi-Bing Weng
- Department of Critical Care Medicine, Beijing Luhe Hospital, Beijing 101100, China
| |
Collapse
|
9
|
Kapoor A, Awasthi S, Kumar Yadav K. Predicting Mortality and Use of RISC Scoring System in Hospitalized Under-Five Children Due to WHO Defined Severe Community Acquired Pneumonia. J Trop Pediatr 2022; 68:6612197. [PMID: 35727140 DOI: 10.1093/tropej/fmac050] [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] [Indexed: 11/14/2022]
Abstract
BACKGROUND Pneumonia acquired in the community is a leading cause of hospitalization and death in under-five children. Predicting mortality in children remains a challenge. There is a need of consolidated scoring system to predict mortality in under-five children in developing nations. METHODS This is a hospital-based prospective nested case-control study, conducted in a tertiary care teaching hospital of north India. Included were under-five hospitalized children due to WHO defined severe community acquired pneumonia (CAP). Those who did not survive were categorized as cases, while those who were discharged were categorized as controls. RESULTS The mortality rate among the recruited 180 hospitalized children with severe CAP was 9.4%. The mortality in under-five children was higher among infants, children who resided in rural areas and were unimmunized or partially immunized for the present age. Mortality was also statistically significantly higher among under-five children with weight for age and weight for length/height below -2Z score; SpO2 < 90% at room air at admission, cyanosis, convulsion, high C-reactive protein (CRP), blood culture positive sepsis and end point consolidation. These predictors were found to be independent risk factors for the mortality after analyzing in multivariate model while presence of wheeze and exclusive breast feeding for first six months of life were found to be protective. The receiver operating characteristic (ROC) curve for respiratory index of severity in children (RISC) score has area under curve (AUC) 0.91 while AUC of RISC score with King George's Medical University (KGMU) modification has 0.88 for prediction of mortality. At the cut-off level of 3, the sensitivity of the RISC score in predicting mortality was 94.1% while the specificity was 73.6%. However, the sensitivity of the RISC score with KGMU modification in predicting mortality at cut-off level of 3 was 88.4% with a specificity of 74.8%. CONCLUSION Various predictors for mortality under-five children are young age, malnutrition, cyanosis, high CRP, blood culture positive sepsis and end point consolidation. It is also possible to predict mortality using RISC score which comprises simple variables and can be easily used at centers of periphery. Similar accuracy had been also found through the use of an age independent modified score (RISC score with KGMU modification).Lay summaryPneumonia is a primary cause of hospitalization as well as death among the children under the age of five. A variety of severity or mortality predicting scores have been produced for adults, but such scores for children are scarce. Furthermore, their utility in developing nations has not been proven. This is a hospital-based prospective study. Included were children under five (2 to 59 months) hospitalized due to severe community acquired pneumonia (CAP) defined as per World Health Organization (WHO) and were not hospitalized in last 14 days elsewhere. Those who did not survive were classified as cases while those who were discharged were classified as controls. A total of 200 consecutively hospitalized children with severe CAP based on WHO were screened and 180 children were recruited. Among recruited children, the percentage of mortality was 9.4% while 90.6% were discharged. The mortality was higher among children younger than 12 months, those belonged to rural area and were unimmunized or partially immunized for the present age. Mortality was also higher among under-five children with severe malnutrition, anemia, SpO2 < 90% at room air at admission, cyanosis, convulsion, thrombocytopenia, high CRP, blood culture positive sepsis and end point consolidation. After assessing in a multivariate model, these predictors were determined to be independent risk factor for death, while wheezing and exclusive breast feeding throughout the first six months of life were found to be protective. The receiver operating characteristic (ROC) curve for respiratory index of severity in children (RISC) score has an area under curve (AUC) of 0.91 while AUC of RISC score with King George's Medical University (KGMU) modification was 0.88 for the prediction of death in under-five children hospitalized due to severe CAP.
Collapse
Affiliation(s)
- Ashutosh Kapoor
- Division of Neonatology, All India Institute of Medical Sciences, New Delhi, India
| | - Shally Awasthi
- Department of Pediatrics, King George's Medical University, Lucknow, India
| | - Krishna Kumar Yadav
- Department of Pediatrics, Dr. R.M.L. Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
10
|
Kulkarni D, Wang X, Sharland E, Stansfield D, Campbell H, Nair H. The global burden of hospitalisation due to pneumonia caused by Staphylococcus aureus in the under-5 years children: A systematic review and meta-analysis. EClinicalMedicine 2022; 44:101267. [PMID: 35072019 PMCID: PMC8763635 DOI: 10.1016/j.eclinm.2021.101267] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pneumonia is a leading cause of childhood morbidity and mortality. This study aimed to estimate the global hospitalisation due to Staphylococcus aureus pneumonia in under-5 children. METHODS We conducted a systematic review and meta-analysis of primary studies following the PRISMA-P guidelines. We searched Medline, Embase, Global Health, CINAHL, Global Index Medicus, Scopus, China National Knowledge Infrastructure, Wanfang, and CQvip. We included studies reporting data on Staphylococcus aureus pneumonia, confirmed by detection of the pathogen in sterile-site samples in under-5 hospitalised children, published in English or Chinese language and conducted between 1st January 1990 and 4th November 2021 and between 1st January 1990 and 30th September 2020, respectively. We excluded those testing upper respiratory tract samples and not reporting data on samples with other bacteria or absence of bacteria. We screened papers against pre-specified criteria, extracted data and assessed the bacteriological quality, and combined epidemiological and microbiological quality of studies using two self-designed checklists. Pooled proportions of hospitalisation episodes for Staphylococcus aureus pneumonia amongst all-cause pneumonia and the 95% confidence intervals were calculated using the random-effects model. The review protocol was registered on PROSPERO (CRD42021236606). FINDINGS Of 26,218 studies identified, thirty-five studies enroling 20,708 hospitalised pneumonia episodes were included. Out of the total hospitalised pneumonia cases in this population, the pooled proportion of Staphylococcal pneumonia cases was 3% (95% CI 2% to 4%; I2=96%). amongst 12 studies with higher microbiological quality, the pooled estimate was 6% (95% CI 2% to 10%; I2= 98%). Based on the recent global estimates of hospitalised pneumonia in this age group, the 3% and 6% estimates represent 738 thousand and 1.48 million hospitalisations in 2019, respectively. Based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), the overall quality of evidence was considered to be moderate. INTERPRETATION Our findings are probably an underestimate because of the unknown and the likely limited sensitivity of current testing methods for Staphylococcal pneumonia diagnosis and widespread reported use of antibiotics before recruitment (in 46% of cases). Staphylococcus aureus is an important cause of hospitalisation for pneumonia in young children globally. FUNDING Bill and Melinda Gates Foundation (OPP 1,172,551) through a prime award to John Hopkins University.
Collapse
|
11
|
Onyango DO, Akelo V, van der Sande MAB, Ridzon R, Were JA, Agaya JA, Oele EA, Wandiga S, Igunza AK, Young PW, Blau DM, Joseph RH, Yuen CM, Zielinski-Gutierrez E, Tippett-Barr BA. Causes of death in HIV-infected and HIV-uninfected children aged under-five years in western Kenya. AIDS 2022; 36:59-68. [PMID: 34586084 DOI: 10.1097/qad.0000000000003086] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Describe the causes of death among infants and children less than 5 years stratified by HIV status. DESIGN Cross-sectional analysis of causes of death ascertained through minimally invasive tissue sampling (MITS) in the Kenya Child Health and Mortality Prevention Surveillance site. METHODS We included decedents aged 28 days to less than 5 years, whose death was reported within 36 h, underwent MITS, and had HIV test results and causes of death determined. MITS specimens were tested using Taqman Array Cards, culture, cytology, histopathology and immunohistochemistry and HIV PCR. A panel evaluated epidemiologic, clinical, verbal autopsy and laboratory data to assign causes of death using ICD-10 guidelines. Causes of death and etiological agents were stratified by HIV status. RESULTS Of 176 included decedents, 14% (n = 25) were HIV-infected, median viral load was 112 205 copies/ml [interquartile range (IQR) = 9349-2 670 143). HIV-disease (96%; n = 24) and malnutrition (23%; n = 34) were the leading underlying causes of death in HIV-infected and HIV-uninfected decedents, respectively. Malnutrition was more frequent in the causal chain of HIV-infected (56%; n = 14) than HIV-uninfected decedents (31%; n = 49) (P value = 0.03). Viral pneumonia was twice as common in HIV-infected (50%; n = 9) than HIV-uninfected decedents (22%; n = 7) (P value = 0.04). CONCLUSION Nearly all HIV-infected decedents' underlying cause of death was HIV disease, which was associated with malnutrition. Our findings underscore the need for strengthening early identification and management of HIV-infected children. Prevention, early diagnosis and treatment of malnutrition could be instrumental in improving the survival of HIV-infected and HIV-uninfected children.
Collapse
Affiliation(s)
- Dickens O Onyango
- Kisumu County Department of Health, Kisumu, Kenya
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Victor Akelo
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | - Marianne A B van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Renee Ridzon
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | - Joyce A Were
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Janet A Agaya
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Steve Wandiga
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Peter W Young
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | - Dianna M Blau
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachael H Joseph
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | | | | | - Beth A Tippett-Barr
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| |
Collapse
|
12
|
Sentinel surveillance for bacterial pneumonia and meningitis in children under the age of 5 in a tertiary pediatric hospital in Colombia - 2016. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2021; 41:62-75. [PMID: 34669279 PMCID: PMC8614369 DOI: 10.7705/biomedica.5658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Indexed: 02/04/2023]
Abstract
Introduction: Bacterial pneumonia and meningitis are vaccine-preventable diseases. Sentinel surveillance provides relevant information about their behavior. Objective: To present the data from sentinel surveillance carried out at the Fundación HOMI, Fundación Hospital Pediátrico La Misericordia in 2016. Materials and methods: We conducted a descriptive study from January 1 to December 31, 2016, on the daily surveillance of patients under 5 years of age diagnosed with pneumonia or bacterial meningitis according to PAHO's definitions. We identified the microorganisms using the automated VITEKTM 2 system. Bacterial isolates were sent to the Microbiology Group at the Colombian Instituto Nacional de Salud for confirmation, serotyping, phenotypic, and genotypic characterization. Antimicrobial susceptibility profiles were established. Results: From 1,343 suspected cases of bacterial pneumonia, 654 (48.7%) were probable, 84% had complete Hib vaccination schedules, and 87% had complete pneumococcal vaccination schedules for age. Blood culture was taken in 619 (94.6%) and 41 (6.6%) were positive while S. pneumoniae was isolated in 17 (41%) of them. The most frequent serotype was 19A in five cases (29.4%), and four 19A serotypes were associated with the reference isolate ST320. The incidence rate of probable bacterial pneumonia was 7.3 cases/100 hospitalized patients, and lethality was 2.1%. As for bacterial meningitis, 22 suspected cases were reported, 12 (54%) were probable, four (33%) were confirmed: two by Escherichia coli and two by group C N. meningitidis. The incidence of probable bacterial meningitis was 0.14 cases/100 hospitalized patients. Conclusion: Streptococcus pneumoniae serotypes 19A and 3 were the most frequent cause of pneumonia. Spn19A is related to the multi-resistant clone ST320. Strengthening and continuing this strategy will allow understanding the impact of vaccination.
Collapse
|
13
|
Kasundriya SK, Dhaneria M, Mathur A, Pathak A. Incidence and Risk Factors for Severe Pneumonia in Children Hospitalized with Pneumonia in Ujjain, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134637. [PMID: 32605136 PMCID: PMC7369688 DOI: 10.3390/ijerph17134637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 11/05/2022]
Abstract
Childhood pneumonia is a major public health problem. The aim of this prospective hospital-based study is to determine the incidence and risk factors for community-acquired severe pneumonia in children in Ujjain, India. The study includes 270 children, 161 (60%) boys and 109 (40%) girls, aged between 2 months and 5 years with World Health Organization defined and radiologically confirmed severe pneumonia. Considering the 270 children, 64% (95% confidence interval (CI) 57.9–69.4) have severe pneumonia. The following are identified as risk factors for severe pneumonia from the generalized logistic regression model: Born premature (adjusted odds ratio (AOR) 7.50; 95% CI 2.22–25.31; p = 0.001); history of measles (AOR 6.35; 95% CI 1.73–23.30; p = 0.005); incomplete vaccination (AOR 2.66; 95% CI 1.09–6.48; p = 0.031); acyanotic congenital heart disease (AOR 9.21; 95% CI 2.29–36.99; p = 0.002); home treatment tried (AOR 3.84; 95% CI 1.42–10.39; p = 0.008); living in a kuchha house (AOR 3.89; 95% CI 1.51–10.01; p = 0.027); overcrowding (AOR 4.50; 95% CI 1.75–11.51; p = 0.002);poor ventilation in living area (AOR 16.37; 95% CI 4.67–57.38; p < 0.001); and practicing open defecation (AOR 16.92; 95% CI 4.95–57.85; p < 0.001). Awareness of these risk factors can reduce mortality due to severe pneumonia.
Collapse
Affiliation(s)
- Sunil Kumar Kasundriya
- Department of Pediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain 456006, Madhya Pradesh, India; (S.K.K.); (M.D.); (A.M.)
- All India Institute of Medical Science, Raipur 492001, Chhattisgarh, India
| | - Mamta Dhaneria
- Department of Pediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain 456006, Madhya Pradesh, India; (S.K.K.); (M.D.); (A.M.)
| | - Aditya Mathur
- Department of Pediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain 456006, Madhya Pradesh, India; (S.K.K.); (M.D.); (A.M.)
| | - Ashish Pathak
- Department of Pediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain 456006, Madhya Pradesh, India; (S.K.K.); (M.D.); (A.M.)
- Department of Women and Children’s Health, International Maternal and Child Health Unit, Uppsala University, SE-751 85 Uppsala, Sweden
- Global Health—Health Systems and Policy: Medicines, Focusing Antibiotics, Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Correspondence: ; Tel.: +91-93-0223-9899
| |
Collapse
|
14
|
Jullien S, Pradhan D, Tshering T, Sharma R, Dema K, Garcia-Garcia S, Ribó JL, Muñoz-Almagro C, Bassat Q. Pneumonia in children admitted to the national referral hospital in Bhutan: A prospective cohort study. Int J Infect Dis 2020; 95:74-83. [PMID: 32283281 PMCID: PMC7195124 DOI: 10.1016/j.ijid.2020.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The study aim was to describe the etiological profile and clinical characteristics of pneumonia among children hospitalized in Thimphu, Bhutan. METHODS This prospective study enrolled children aged 2-59 months admitted to the Jigme Dorji Wangchuck National Referral Hospital with World Health Organization (WHO)-defined clinical pneumonia. Demographic and clinico-radiological data were collected through questionnaires, physical examination, and chest radiography. Blood samples and nasopharyngeal washing were collected for microbiological analysis including culture and molecular methods. RESULTS From July 2017 to June 2018, 189 children were enrolled, of which 53.4% were infants. Pneumonia-related admissions were less frequent over the winter. Chest radiographies were obtained in 149 children; endpoints included pneumonia in 39 cases (26.2%), other infiltrates in 31 (20.8%), and were normal in 79 children (53.0%). Non-contaminated bacterial growth was detected in 8/152 (5.3%) blood cultures, with only two cases of Streptococcus pneumoniae. Viral detection in upper respiratory secretions was common, with at least one virus detected in 103/115 (89.6%). The three most-commonly isolated viruses were respiratory syncytial virus (52/115; 45.2%), rhinovirus (42/115; 36.5%), and human parainfluenza virus (19/115; 16.5%). A third of patients with viral infections showed mixed infections. Case fatality rate was 3.2% (6/189). CONCLUSION Respiratory viral infections predominated among this cohort of WHO-defined clinical pneumonia cases, whereas bacterial aetiologies were uncommon, highlighting the epidemiologic transition that Bhutan seems to have reached.
Collapse
MESH Headings
- Bacteria/isolation & purification
- Bhutan/epidemiology
- Child, Preschool
- Cohort Studies
- Coinfection/epidemiology
- Demography
- Female
- Hospitalization
- Humans
- Infant
- Male
- Pneumonia/epidemiology
- Pneumonia/mortality
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/diagnostic imaging
- Pneumonia, Bacterial/epidemiology
- Pneumonia, Bacterial/microbiology
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/diagnostic imaging
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/virology
- Prospective Studies
- Respiratory Syncytial Virus, Human/isolation & purification
- Respirovirus/isolation & purification
- Rhinovirus/isolation & purification
- Streptococcus pneumoniae/isolation & purification
Collapse
Affiliation(s)
- Sophie Jullien
- ISGlobal, Hospital Clínic - Universitat de Barcelona, carrer Rosselló, 132, 08036 Barcelona, Spain; Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Gongphel Lam, Thimphu, Bhutan.
| | - Dinesh Pradhan
- Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB), PO box 446, Old Medical Block, JDWNRH, Menkhang Lam, Thimphu, Bhutan.
| | - Tashi Tshering
- Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB), PO box 446, Old Medical Block, JDWNRH, Menkhang Lam, Thimphu, Bhutan.
| | - Ragunath Sharma
- Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Gongphel Lam, Thimphu, Bhutan.
| | - Kumbu Dema
- Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Gongphel Lam, Thimphu, Bhutan.
| | - Selene Garcia-Garcia
- Hospital Sant Joan de Déu (University of Barcelona), Pg. Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain.
| | - Jose Luis Ribó
- Hospital Universitari General de Catalunya, carrer Pedro i Pons 1, 08195 Sant Cugat del Vallés, Barcelona, Spain.
| | - Carmen Muñoz-Almagro
- Hospital Sant Joan de Déu (University of Barcelona), Pg. Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain; Department of Medicine, Universitat Internacional de Catalunya, Carrer de Josep Trueta, 08195 Sant Cugat del Vallés, Barcelona, Spain.
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, carrer Rosselló, 132, 08036 Barcelona, Spain; Hospital Sant Joan de Déu (University of Barcelona), Pg. Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Cambeve, Vila de Manhiça, CP 1929, Maputo, Mozambique; Catalan Institution for Research and Advanced Studies (ICREA), Pg. Lluís Companys 23, 08010 Barcelona, Spain.
| |
Collapse
|
15
|
Kotb MA, Elmahdy HN, Seif El Dein HM, Mostafa FZ, Refaey MA, Rjoob KWY, Draz IH, Basanti CWS. The Machine Learned Stethoscope Provides Accurate Operator Independent Diagnosis of Chest Disease. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:13-22. [PMID: 32158281 PMCID: PMC6986244 DOI: 10.2147/mder.s221029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 12/03/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Contemporary stethoscope has limitations in diagnosis of chest conditions, necessitating further imaging modalities. Methods We created 2 diagnostic computer aided non-invasive machine-learning models to recognize chest sounds. Model A was interpreter independent based on hidden markov model and mel frequency cepstral coefficient (MFCC). Model B was based on MFCC, hidden markov model, and chest sound wave image interpreter dependent analysis (phonopulmonography (PPG)). Results We studied 464 records of actual chest sounds belonging to 116 children diagnosed by clinicians and confirmed by other imaging diagnostic modalities. Model A had 96.7% overall correct classification rate (CCR), 100% sensitivity and 100% specificity in discrimination between normal and abnormal sounds. CCR was 100% for normal vesicular sounds, crepitations 89.1%, wheezes 97.6%, and bronchial breathing 100%. Model B's CCR was 100% for normal vesicular sounds, crepitations 97.3%, wheezes 97.6%, and bronchial breathing 100%. The overall CCR was 98.7%, sensitivity and specificity were 100%. Conclusion Both models demonstrated very high precision in the diagnosis of chest conditions and in differentiating normal from abnormal chest sounds irrespective of operator expertise. Incorporation of computer-aided models in stethoscopes promises prompt, precise, accurate, cost-effective, non-invasive, operator independent, objective diagnosis of chest conditions and reduces number of unnecessary imaging studies.
Collapse
Affiliation(s)
- Magd Ahmed Kotb
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hesham Nabih Elmahdy
- Information Technology Department, Vice-Dean of Faculty of Computers and Information, Cairo University, Giza, Egypt
| | | | | | - Mohammed Ahmed Refaey
- Information Technology Department, Vice-Dean of Faculty of Computers and Information, Cairo University, Giza, Egypt
| | - Khaled Waleed Younis Rjoob
- Information Technology Department, Vice-Dean of Faculty of Computers and Information, Cairo University, Giza, Egypt
| | - Iman H Draz
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | |
Collapse
|
16
|
Arbo A, Lovera D, Martínez-Cuellar C. Mortality Predictive Scores for Community-Acquired Pneumonia in Children. Curr Infect Dis Rep 2019; 21:10. [PMID: 30834468 DOI: 10.1007/s11908-019-0666-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The use of severity score for the staging of pneumonias has emerged as a necessity for the physician caring for this disease. Although there are several established prognostic scoring systems for community-acquired pneumonia in adults, the availability for children are scarce. RECENT FINDINGS Recently, scoring system for risk stratification of children with pneumonia were developed in low- and middle-income countries. They use clinical variables that represent known risk factors for severe outcomes of respiratory illness in children, such as hypoxemia, chest indrawing, refusal to feed, malnutrition, age, and stage of HIV disease among others factors. Although they showed good discriminating power and are very useful in low-resource settings, the characteristics of the patients, the local epidemiology of concurrent diseases, the social conditions, and the facilities of the hospitals make them not applicable to developed countries. A new prognostic scale for estimating mortality based on the modified PIRO scale used in adults with pneumonia can be useful for developed countries. Although several scoring systems for the estimation of mortality in childhood CAP were developed in the last years, most of them come from developing countries and the results are not applicable to patients with pneumonia in developed countries. Prospective studies applying scores adapted to the reality of the developed countries are needed.
Collapse
Affiliation(s)
- Antonio Arbo
- Department of Pediatric, Instituto de Medicina Tropical, Avda. Venezuela y Florida, Asunción, Paraguay. .,Institute of Tropical Medicine, Asunción, Paraguay. .,National University of Asuncion, San Lorenzo, Paraguay.
| | - Dolores Lovera
- Institute of Tropical Medicine, Asunción, Paraguay.,National University of Asuncion, San Lorenzo, Paraguay
| | - Celia Martínez-Cuellar
- Institute of Tropical Medicine, Asunción, Paraguay.,National University of Asuncion, San Lorenzo, Paraguay
| |
Collapse
|