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Wannasrichan W, Krobthong S, Morgan CJ, Armbruster EG, Gerovac M, Yingchutrakul Y, Wongtrakoongate P, Vogel J, Aonbangkhen C, Nonejuie P, Pogliano J, Chaikeeratisak V. A phage nucleus-associated protein from the jumbophage Churi inhibits bacterial growth through protein translation interference. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.15.599175. [PMID: 38915640 PMCID: PMC11195228 DOI: 10.1101/2024.06.15.599175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Antibacterial proteins inhibiting Pseudomonas aeruginosa have been identified in various phages and explored as antibiotic alternatives. Here, we isolated a phiKZ-like phage, Churi, which encodes 364 open reading frames. We examined 15 early-expressed phage proteins for their ability to inhibit bacterial growth, and found that gp335, closely related to phiKZ-gp14, exhibits antibacterial activity. Similar to phiKZ-gp14, recently shown to form a complex with the P. aeruginosa ribosome, we predict experimentally that gp335 interacts with ribosomal proteins, suggesting its involvement in protein translation. GFP-tagged gp335 clusters around the phage nucleus as early as 15 minutes post-infection and remains associated with it throughout the infection, suggesting its role in protein expression in the cell cytoplasm. CRISPR-Cas13-mediated deletion of gp355 reveals that the mutant phage has a prolonged latent period. Altogether, we demonstrate that gp335 is an antibacterial protein of nucleus-forming phages that associates with the ribosomes at the phage nucleus.
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Ellingson MK, Weinberger DM, van der Linden M, Perniciaro S. Potential Impact of Higher-Valency Pneumococcal Conjugate Vaccines Among Adults in Different Localities in Germany. J Infect Dis 2024; 229:1669-1673. [PMID: 38059558 PMCID: PMC11175678 DOI: 10.1093/infdis/jiad538] [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: 06/13/2023] [Revised: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 12/08/2023] Open
Abstract
Next-generation pneumococcal conjugate vaccines (PCVs) have been approved for use. The serotype distribution of pneumococcal isolates can vary between regions. To understand the potential impacts of new PCVs, we evaluated trends in invasive pneumococcal disease (IPD) among adults in Germany at a local level using Bayesian hierarchical logistic regression. There was little spatial variation in IPD cases caused by 13-valent PCV serotypes, which dropped from 60% of IPD cases in 2006 to 30% in 2018. More than half of IPD cases in 2018 were attributable to serotypes covered by new PCVs (15-valent and 20-valent PCVs), which suggests they could further reduce the burden of IPD.
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Affiliation(s)
- Mallory K Ellingson
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Mark van der Linden
- German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Stephanie Perniciaro
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
- German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany
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3
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Li H, Wang C, Guo C. Post-marketing safety of lorlatinib: a real-world study based on the FDA adverse event reporting system. Front Pharmacol 2024; 15:1385036. [PMID: 38903993 PMCID: PMC11188337 DOI: 10.3389/fphar.2024.1385036] [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: 02/26/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Background Lorlatinib displays marked systemic and intracranial efficacy against anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer (NSCLC). We aimed to establish the safety profile of lorlatinib based on the Food and Drug Administration Adverse Event Reporting System (FAERS). Methods Reports from the FAERS between 2019 and 2023 were collected to conduct the disproportionality analysis. Reporting odds ratio (ROR) was employed to detect the potential adverse events (AEs) related to lorlatinib. The clinical characteristics, age and gender differences, time to onset of AEs were also investigated. Results A total of 2,941 AE reports were found to be associated with lorlatinib among the 8,818,870 AE reports obtained from the FAERS database. 167 lorlatinib-related AE signals were identified. The frequently reported AEs including hypercholesterolemia, oedema, and cognitive disorder were in line with those observed in clinical trials and drug instruction. However, AEs such as interstitial lung disease and AV block indicated in the drug label require further evaluation. More attention should be paid to the new potential unexpected AEs including pulmonary arterial hypertension and radiation necrosis. Furthermore, we examined the specific high-risk AEs of different ages and genders. In addition, majority of AEs occurred within the first 2 months after lorlatinib initiation with a median onset time of 51 days. Conclusion Our study provides valuable insight into the post-marketing safety profile of lorlatinib, which can potentially benefit the rational and safe administration of lorlatinib in the clinic. Further prospective studies are needed to validate the associations between lorlatinib and the identified AEs.
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Affiliation(s)
- Huqun Li
- Department of Pharmacy, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chongshu Wang
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cuilian Guo
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wang Y, Li Y, Liu W, Li C, Duo X, Meng X, Feng Y. ROS-Responsive Poly(α-l-lysine)-Based Nanoparticles Loaded with Doxycycline Combat Oxidative Stress and Bacterial Infection. Macromol Biosci 2024; 24:e2300580. [PMID: 38385581 DOI: 10.1002/mabi.202300580] [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: 12/19/2023] [Revised: 02/05/2024] [Indexed: 02/23/2024]
Abstract
Bacterial pneumonia is one of the major threats in clinical practice, and the reactive oxygen species (ROS) generated at the infection site can exacerbate the damage. Currently, conventional antibiotic therapies have low utilization, and their excessive use can result in substantial toxicity. Nanocarrier systems provide an ideal approach for treating bacterial infection by facilitating more efficient utilization of antibiotics. In this study, the ROS-responsive amphiphilic nanoparticles (NPs) are developed and used to encapsulate the antibiotic doxycycline (DOXY) to achieve antibacterial and antioxidant functionalities. The NPs are prepared from poly(α-l-lysine) (α-PLL) and phenylboronic acid pinacol ester simultaneously conjugated carbonyldiimidazole (abbreviated as CDIPB). The phenylboronic acid ester groups on CDIPB could react with excessive ROS to suppress oxidative damage at the infection site. The ROS-responsive degradation of CDIPB also facilitates the rapid release of internal DOXY, effectively killing the accumulated bacteria. Additionally, in vitro cell experiments demonstrate the good biocompatibility of the NPs. These results suggest that the ROS-responsive amphiphilic nanoparticles can serve as a novel nanoplatform for the treatment of bacterial pneumonia.
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Affiliation(s)
- Yuanchao Wang
- School of Chemical Engineering and Technology, Tianjin University, Yaguan Road 135, Tianjin, 300350, P. R. China
| | - Ying Li
- School of Chemical Engineering and Technology, Tianjin University, Yaguan Road 135, Tianjin, 300350, P. R. China
| | - Wen Liu
- School of Chemical Engineering and Technology, Tianjin University, Yaguan Road 135, Tianjin, 300350, P. R. China
| | - Chen Li
- School of Chemistry and Chemical Engineering, Qinghai University for Nationalities, Bayizhonglu 3, Xining, Qinghai, 810007, P. R. China
| | - Xinghong Duo
- School of Chemistry and Chemical Engineering, Qinghai University for Nationalities, Bayizhonglu 3, Xining, Qinghai, 810007, P. R. China
| | - Xiangyan Meng
- Institute of Disaster and Emergency Medicine, Tianjin University, Weijin Road 92, Tianjin, 300072, P. R. China
| | - Yakai Feng
- School of Chemical Engineering and Technology, Tianjin University, Yaguan Road 135, Tianjin, 300350, P. R. China
- Frontiers Science Center for Synthetic Biology, Tianjin University, Weijin Road 92, Tianjin, 300072, P. R. China
- Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Weijin Road 92, Tianjin, 300072, P. R. China
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Bhalla M, Herring S, Lenhard A, Wheeler JR, Aswad F, Klumpp K, Rebo J, Wang Y, Wilhelmsen K, Fortney K, Bou Ghanem EN. The prostaglandin D2 antagonist asapiprant ameliorates clinical severity in young hosts infected with invasive Streptococcus pneumoniae. Infect Immun 2024; 92:e0052223. [PMID: 38629842 PMCID: PMC11075459 DOI: 10.1128/iai.00522-23] [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: 12/13/2023] [Accepted: 03/29/2024] [Indexed: 05/03/2024] Open
Abstract
Streptococcus pneumoniae (pneumococcus) remains a serious cause of pulmonary and systemic infections globally, and host-directed therapies are lacking. The aim of this study was to test the therapeutic efficacy of asapiprant, an inhibitor of prostaglandin D2 signaling, against pneumococcal infection. Treatment of young mice with asapiprant after pulmonary infection with invasive pneumococci significantly reduced systemic spread, disease severity, and host death. Protection was specific against bacterial dissemination from the lung to the blood but had no effect on pulmonary bacterial burden. Asapiprant-treated mice had enhanced antimicrobial activity in circulating neutrophils, elevated levels of reactive oxygen species (ROS) in lung macrophages/monocytes, and improved pulmonary barrier integrity indicated by significantly reduced diffusion of fluorescein isothiocyanate (FITC)-dextran from lungs into the circulation. These findings suggest that asapiprant protects the host against pneumococcal dissemination by enhancing the antimicrobial activity of immune cells and maintaining epithelial/endothelial barrier integrity in the lungs.
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Affiliation(s)
- Manmeet Bhalla
- Department of Microbiology and Immunology, School of Medicine, University at Buffalo, Buffalo, New York, USA
| | - Sydney Herring
- Department of Microbiology and Immunology, School of Medicine, University at Buffalo, Buffalo, New York, USA
| | - Alexsandra Lenhard
- Department of Microbiology and Immunology, School of Medicine, University at Buffalo, Buffalo, New York, USA
| | - Joshua R. Wheeler
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Fred Aswad
- BIOAGE Labs Inc., Richmond, California, USA
| | | | | | - Yan Wang
- BIOAGE Labs Inc., Richmond, California, USA
| | | | | | - Elsa N. Bou Ghanem
- Department of Microbiology and Immunology, School of Medicine, University at Buffalo, Buffalo, New York, USA
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Hunold KM, Rozycki E, Brummel N. Optimizing Diagnosis and Management of Community-acquired Pneumonia in the Emergency Department. Emerg Med Clin North Am 2024; 42:231-247. [PMID: 38641389 PMCID: PMC11212456 DOI: 10.1016/j.emc.2024.02.001] [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] [Indexed: 04/21/2024]
Abstract
Pneumonia is split into 3 diagnostic categories: community-acquired pneumonia (CAP), health care-associated pneumonia, and ventilator-associated pneumonia. This classification scheme is driven not only by the location of infection onset but also by the predominant associated causal microorganisms. Pneumonia is diagnosed in over 1.5 million US emergency department visits annually (1.2% of all visits), and most pneumonia diagnosed by emergency physicians is CAP.
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Affiliation(s)
- Katherine M Hunold
- Department of Emergency Medicine, The Ohio State University, 376 W 10th Avenue, 760 Prior Hall, Columbus, OH 43220, USA.
| | - Elizabeth Rozycki
- Emergency Medicine, Department of Pharmacy, The Ohio State University, 376 W 10th Avenue, 760 Prior Hall, Columbus, OH 43220, USA
| | - Nathan Brummel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, 376 W 10th Avenue, 760 Prior Hall, Columbus, OH 43220, USA
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Huseth-Zosel AL, Fuller H, Hicks A, Carson PJ. Reliance on sources of immunization information and vaccine uptake among older adults in a rural state: The mediating role of trust. Vaccine 2024; 42:3107-3114. [PMID: 38604912 DOI: 10.1016/j.vaccine.2024.04.030] [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: 09/15/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
Older adults are more vulnerable to the negative impacts of infectious diseases than younger individuals. However, regardless of the importance and effectiveness of vaccines to reduce morbidity and mortality, issues remain with vaccine hesitancy among this population. Older adults' sources of immunization information and their level of trust in those sources may play a role in their vaccination behaviors. This research aimed to better understand the role of information sources and related issues of trust as related to vaccine uptake among older adults. A community-based, cross-sectional survey was conducted with 901 older adults in North Dakota in May-July 2022. Measures included extent of reliance on specific sources of immunization information, levels of trust, and uptake for influenza, pneumonia, shingles, and COVID-19 vaccinations. Immunization information sources were grouped into medical experts, informal, and public outlets. Results indicated older adults were more likely to rely on medical experts than informal sources or public outlets for immunization information. Greater reliance on medical experts was associated with a greater likelihood of vaccine uptake for all vaccines, while reliance on public outlets was associated with a greater likelihood of vaccine uptake only for COVID primary series and boosters. Reliance on informal sources for immunization information was associated with a reduced likelihood of vaccine uptake for all vaccines except shingles. Nearly half of respondents were uncertain who to trust for vaccine information. Uncertainty who to trust for immunization information significantly mediated the associations between reliance on medical experts and uptake for most vaccines indicating that trust in medical experts fosters vaccine uptake. Increasing reliance on medical experts as sources of immunization information is vital to increasing vaccine uptake among older adults. Additionally, this population must be assisted in increasing their ability to successfully assess the trustworthiness of immunization information sources.
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Affiliation(s)
- Andrea L Huseth-Zosel
- Department of Public Health, North Dakota State University, Fargo, ND, United States.
| | - Heather Fuller
- Department of Human Development and Family Science, North Dakota State University, Fargo, ND, United States
| | - Alexandria Hicks
- Department of Public Health, North Dakota State University, Fargo, ND, United States
| | - Paul J Carson
- Department of Public Health, North Dakota State University, Fargo, ND, United States
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Huseth-Zosel AL, Fuller H, Carson PJ. Vaccination Motivators and Deterrents Among Undervaccinated Older Adults in North Dakota. J Community Health 2024:10.1007/s10900-024-01351-8. [PMID: 38615100 DOI: 10.1007/s10900-024-01351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/15/2024]
Abstract
Despite increased risk of morbidity and mortality among older adults due to preventable infectious diseases such as influenza, shingles, pneumonia, and COVID-19, many forego receiving some, if not all, of these vaccinations. This study examines vaccination motivators and deterrents for undervaccinated older adults in North Dakota (ND). Adults aged 65+ in ND were mailed a survey (n = 901) with questions gauging vaccination behaviors and perceptions, with 132 of these indicating not receiving certain vaccinations. Further questions assessed reasons they have not been vaccinated against the following diseases: influenza, shingles, pneumonia, and COVID-19 (e.g., "Concerned about side effects", "Vaccines are dangerous", "I'm healthy and I do not need it") and what would make it more likely to get a vaccine (e.g., "More information", "Doctor recommendation", "Easy access to vaccines"). Reasons for remaining unvaccinated varied by vaccine. For influenza and pneumococcal vaccines, respondents were more likely to indicate they are healthy and do not need the vaccine. For shingles and COVID-19, respondents were more likely to indicate concerns about side effects. Factors reported to motivate increasing the likelihood of getting a vaccine were receiving a doctor recommendation, receiving more information, and having a vaccine provided at no cost. These results contribute to our understanding of vaccination behaviors among older adults and underscore specific issues around which to frame interventions tailored to increase vaccine uptake for this population.
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Affiliation(s)
- Andrea L Huseth-Zosel
- Department of Public Health, North Dakota State University, Dept. 2662, PO Box 6050, Fargo, ND, 58108-6050, USA.
| | - Heather Fuller
- Department of Human Development and Family Science, North Dakota State University, Fargo, ND, USA
| | - Paul J Carson
- Department of Public Health, North Dakota State University, Dept. 2662, PO Box 6050, Fargo, ND, 58108-6050, USA
- Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
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Elias C, Nunes MC, Saadatian-Elahi M. Epidemiology of community-acquired pneumonia caused by S treptococcus pneumoniae in older adults: a narrative review. Curr Opin Infect Dis 2024; 37:144-153. [PMID: 38323404 DOI: 10.1097/qco.0000000000001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE OF REVIEW This review covers updated perspectives on different aspects of pneumococcal community-acquired pneumonia (pCAP), including the epidemiology, clinical presentation, risk factors, antibiotic treatment, and existing preventive strategies in older adults. RECENT FINDINGS pCAP remains the most prevalent condition among lower respiratory tract infections in the older adults according to Global Burden of Diseases 2019. Older adults can display atypical symptoms such as confusion, general clinical deterioration, new onset of and exacerbation of underlying illness that might trigger clinical suspicion of pCAP. Older adults with pCAP often experience increased disease severity and a higher risk of pulmonary complications compared with younger individuals, owing to age-related changes in immunity and a higher prevalence of comorbidities. Vaccination stands fundamental for prevention, emphasizing the need for effective immunization strategies, specifically tailored for older adults. There is a pressing need to reinforce efforts aimed at boosting pneumococcal vaccination rates. SUMMARY Despite a high morbidity and mortality, the burden of pCAP, in particular hospital admission and occurrence of invasive infections, among the elderly population is not sufficiently documented. This review findings emphasize the substantial burden of pCAP in this vulnerable population, driven by factors such as advancing age and underlying comorbidities. The emergence of antibiotic-resistant pneumococcal strains further complicates treatment decisions and highlights the importance of tailored approaches for managing pCAP in older adults.
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Affiliation(s)
- Christelle Elias
- Service d'Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon
- Équipe Santé Publique, Epidémiologie et Eco-évolution des Maladies Infectieuses (PHE ID), Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon
| | - Marta C Nunes
- Équipe Santé Publique, Epidémiologie et Eco-évolution des Maladies Infectieuses (PHE ID), Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon
- Center of Excellence in Respiratory Pathogens (CERP), Hospices Civils de Lyon, Lyon, France
- South African Medical Research Council, Vaccines & Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mitra Saadatian-Elahi
- Service d'Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon
- Équipe Santé Publique, Epidémiologie et Eco-évolution des Maladies Infectieuses (PHE ID), Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon
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Smedemark SA, Laursen CB, Jarbøl DE, Rosenvinge FS, Andersen-Ranberg K. Extended use of point-of-care technology versus usual care for in-home assessment by acute community nurses in older adults with signs of potential acute respiratory disease: an open-label randomised controlled trial protocol. BMC Geriatr 2024; 24:161. [PMID: 38365595 PMCID: PMC10870485 DOI: 10.1186/s12877-024-04774-z] [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: 02/23/2023] [Accepted: 02/03/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Due to ageing-related physiological changes, diagnosing older adults is challenging. Delayed disease recognition may lead to adverse health outcomes and increased hospitalisation, necessitating the development of new initiatives for timely diagnosis and treatment of older adults. Point-of-care technology, such as focused lung ultrasound scan and bedside analysis of blood samples (leucocytes with differential count, electrolytes, and creatinine) conducted in the patients' home, may support clinical decision-making, and potentially reduce acute hospital admissions. We present the protocol for a randomized controlled trial, which aims at assessing the effect of focused lung ultrasound scan and bedside blood analysis during in-home assessments among older adults with signs of potential acute respiratory disease on hospital admissions. METHOD We will use a parallel open-label, individually randomised controlled trial design in an acute community healthcare setting. The trial will initiate on October 2022 and is expected to end one year later. The study population will include older adults (65 + year), with at least one of the following inclusion criteria: Cough, dyspnoea, fever, fall, or rapid functional decline. Expected study sample will comprise 632 participants. Participants in the control group will receive usual care, while the intervention group will undergo extended point-of-care technology (focused lung ultrasound scan and bedside venous blood analysis), in addition to usual care. The primary outcome is acute hospital admission within 30 days follow-up. Secondary outcomes include readmissions, mortality, length of hospital stay, hospital-free days, complications during hospital admission, treatment initiations or changes, functional level, re-referrals to the acute community healthcare service, and contacts to the primary care physician. A tertiary outcome is the diagnostic accuracy of Acute Community Nurses for conducting focused lung ultrasound compared with a specialist. Outcomes will be analysed as intention-to-treat. DISCUSSION To our knowledge, this is the first randomised controlled trial examining the effect of extended use of point-of-care technology conducted in an in-home setting. We expect that the results may contribute to the development of new interventions aiming to improve timely diagnostics, treatment decisions, and reduce acute hospital admissions. TRIAL REGISTRATION www. CLINICALTRIALS org NCT05546073 (Date of registration: September 19th, 2022).
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Affiliation(s)
- Siri Aas Smedemark
- Department of Geriatric Medicine, Geriatric Research Unit, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Christian B Laursen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense Respiratory Research Unit, Odense University Hospital, Odense, Denmark
| | - Dorte Ejg Jarbøl
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | | | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Geriatric Research Unit, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Sun H, Dong D, Zhao M, Jian J. Infection with multi‑drug resistant organisms in patients with limb fractures: Analysis of risk factors and pathogens. Biomed Rep 2024; 20:28. [PMID: 38259588 PMCID: PMC10801349 DOI: 10.3892/br.2023.1716] [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: 03/20/2023] [Accepted: 10/17/2023] [Indexed: 01/24/2024] Open
Abstract
Infection with multi-drug resistant organisms (MDROs) has emerged as a global problem in medical institutions. Overuse of antibiotics is the main cause of drug resistance. Notably, the incidence of infection with MDROs increases in patients with limb fractures who have undergone invasive surgery. The present study aimed to analyze the risk factors for postoperative MDROs infection in a cohort of patients with limb fractures. A retrospective study was performed on the data of patients with fractures between January 2020 and August 2022. Postoperative surgical site infection occurred in 114 patients in total, of which 47 were infected with MDROs. Univariate logistic regression analysis and multivariate binary logistic regression were used to confirm the associations between independent risk factors and MDRO infection. A total of 155 bacteria were collected from patients with MDROs infection and patients with non-MDROs infection, of which 66.5% were gram-positive bacteria and 33.5% were gram-negative. Staphylococcus aureus accounted for 26.5% of the 155 pathogens. MDROs, such as methicillin-resistant S. aureus and extended-spectrum β-lactamases-positive gram-negative bacillus, were detected after antibiotic treatment. Univariate analysis indicated that the number of antibiotics administered, being bedridden, repeat infection, operative time and repeated operation were different in the two groups. In addition, univariate logistic analysis indicated that being bedridden (OR, 3.98; P=0.001), administration of >2 antibiotics (OR, 2.42; P=0.026), an operative time of >3 h (OR, 3.37; P=0.003), repeated infection (OR, 3.08; P=0.009) and repetition of procedures (OR, 2.25; P=0.039) were individual risk factors for MDRO infection. Multivariate analysis showed that being bedridden (OR, 2.66; P=0.037), repeated infection (OR, 4.00; P=0.005) and an operative time of >3 h (OR, 2.28; P=0.023) were risk factors of MDRO infection. In conclusion, constrained antibiotic use, shortened operative time and increased activity duration can effectively prevent surgical-site infection with MDROs in patients with fractures.
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Affiliation(s)
- Honggang Sun
- Clinical Laboratory, Bayi Orthopedic Hospital, Chengdu, Sichuan 610052, P.R. China
| | - Dagao Dong
- Clinical Laboratory, Bayi Orthopedic Hospital, Chengdu, Sichuan 610052, P.R. China
| | - Min Zhao
- Clinical Laboratory, Bayi Orthopedic Hospital, Chengdu, Sichuan 610052, P.R. China
| | - Jie Jian
- Clinical Laboratory, Bayi Orthopedic Hospital, Chengdu, Sichuan 610052, P.R. China
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Darvishi M, Amiri MM, Heidari-Soureshjani S, Sherwin CMT, Mardani-Nafchi H. The Association between Statins Intake and Risk of Post Stroke Pneumonia: A Systematic Review and Meta-Analysis. Curr Rev Clin Exp Pharmacol 2024; 19:285-293. [PMID: 37817662 DOI: 10.2174/0127724328258172230926070748] [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: 05/07/2023] [Revised: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 10/12/2023]
Abstract
AIM This research aimed to examine the relationship between the intake of statins and the risk of post-stroke pneumonia in a systematic review and meta-analysis study. METHODS An extensive search of published articles on March 21st, 2023, was done in several databases, like Web of Science (ISI), PubMed, Cochrane Library, Embase, Scopus, and Google Scholar. The Newcastle Ottawa Scale (NOS) checklist was employed to evaluate the quality of observational studies. Statistical tests (Chi-square test and I2) and graphical techniques (Forest plot) were used to determine whether heterogeneity existed in the meta-analysis studies. Funnel plots and Begg and Egger's tests were used to assess the publication bias. RESULTS Seven studies (5 cohort and 2 case-control studies) were retrieved to examine the association between statins and post-stroke pneumonia. The sample size of the studies compiled in the meta- analysis was obtained to be 68,966 participants. Meta-analysis demonstrated that the overall odds of post-stroke pneumonia in the statin group was equal to 0.87 (95% CI: 0.67 - 1.13; p-value 0.458). Subgroup analysis indicated that the odds of post-stroke pneumonia in the statin group was equal to 0.93 (95% CI: 0.73-1.18; p-value = 0.558) in the cohort studies, and equal to 0.92 (95% CI: 0.37-2.26; p-value = 0.857) in the case-control studies. The examination of the association between the intake of statins and post-stroke pneumonia showed no evidence of publication bias (Begg's test, p-value = 0.368; Eggers test, p-value = 0.282). CONCLUSION In this study, no relationship has been observed between receiving statins and the risk of post-stroke pneumonia.
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Affiliation(s)
- Mohammad Darvishi
- Infectious Diseases and Tropical Medicine Research Centre (IDTMRC), Department of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohammadian Amiri
- Department of Emergency Medicine, School of Medicine, Babol University of Medical Sciences, Mazandaran, Iran
| | | | - Catherine M T Sherwin
- Pediatric Clinical Pharmacology and Toxicology, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, One Children's Plaza, Dayton, Ohio, USA
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13
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García Cenoz M, Martínez Baz I. [Morbi-mortality of lower respiratory tract infections and vaccination]. An Sist Sanit Navar 2023; 46:e1063. [PMID: 38146946 PMCID: PMC10807199 DOI: 10.23938/assn.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023]
Affiliation(s)
- Manuel García Cenoz
- Gobierno de Navarra. Departamento de Salud. Instituto de Salud Pública y Laboral de Navarra. Pamplona. España..
| | - Iván Martínez Baz
- Gobierno de Navarra. Departamento de Salud. Instituto de Salud Pública y Laboral de Navarra. Pamplona. España..
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Vicentini C, Russotto A, Bazzolo S, Rolfini E, Blengini V, Gamba D, Agodi A, Barchitta M, Bellio S, Fabbri E, Forni S, Ricchizzi E, Ripabelli G, Sticchi C, D’Ancona F“P, Zotti CM. Implementation of a centralized, web-based surveillance for healthcare associated infections among residents of long-term care facilities in Italy. PUBLIC HEALTH IN PRACTICE 2023; 6:100421. [PMID: 37661965 PMCID: PMC10472289 DOI: 10.1016/j.puhip.2023.100421] [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: 04/03/2023] [Revised: 07/24/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023] Open
Abstract
Objective The Italian National Action Plan to contrast AMR identified among its objectives the development and implementation of a national Healthcare-Associated Infection (HAI) surveillance system based on European Centre for Disease Prevention and Control (ECDC) indications, through point prevalence surveys (PPS) of HAIs and antibiotic use in acute-care hospitals and long-term care facilities (LTCFs). We aimed to assess feasibility and appropriateness of proposed tools for a national surveillance system of HAIs and antibiotic use in LTCFs. Study design Point prevalence survey. Methods A pilot PPS was conducted between May-June 2022, among 15 LTCFs of 7 Italian regions. Data were collected in a single day in each LTCF, at the LTCF, ward, and resident levels, using a web-based data collection tool developed ad hoc. Data collector teams of each facility were invited to complete a questionnaire investigating opinions on the proposed tools. Results Among 1025 included residents, the prevalence of residents with at least one HAI was 2.5% (95% CI 1.7%-3.7%) considering all HAIs and 2.2% (95% CI 1.3%-3%) without considering SARS-CoV-2 infections. The prevalence of antimicrobial use was 3% (95% CI 0.2%-4.3%). Overall, most respondents were satisfied with the web-based software, training and protocol, even though some difficulties were reported. Conclusions A national surveillance network was established, which will facilitate future surveillance efforts. Further studies are necessary to evaluate the impact of the pandemic on HAI transmission and antibiotic use in LTCFs.
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Affiliation(s)
- Costanza Vicentini
- Department of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - Antonino Russotto
- Department of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - Stefano Bazzolo
- Department of Environment, Land and Infrastructure Engineering (DIATI), Politecnico of Turin, Torino, Italy
| | - Edoardo Rolfini
- Department of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - Valentina Blengini
- Department of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - Dario Gamba
- Department of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | | | - Elisa Fabbri
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Bologna, Italy
| | - Silvia Forni
- Agenzia Regionale di Sanità della Regione Toscana, Firenze, Italy
| | - Enrico Ricchizzi
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Bologna, Italy
| | - Giancarlo Ripabelli
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | | | | | - Carla Maria Zotti
- Department of Public Health and Paediatrics, University of Turin, Torino, Italy
| | - working group “HALT pilota 2022”
- Department of Public Health and Paediatrics, University of Turin, Torino, Italy
- Department of Environment, Land and Infrastructure Engineering (DIATI), Politecnico of Turin, Torino, Italy
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
- Azienda Zero, Regione del Veneto, Padova, Italy
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Bologna, Italy
- Agenzia Regionale di Sanità della Regione Toscana, Firenze, Italy
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
- A.Li.Sa, Regione Liguria, Genova, Italy
- Istituto Superiore di Sanità (ISS), Rome, Italy
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15
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Wijit K, Sonthisombat P, Diewsurin J. A score to predict Pseudomonas aeruginosa infection in older patients with community-acquired pneumonia. BMC Infect Dis 2023; 23:700. [PMID: 37858082 PMCID: PMC10585923 DOI: 10.1186/s12879-023-08688-w] [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: 02/05/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND In Thailand, the incidence of community-acquired pseudomonal pneumonia among 60- to 65-year-olds ranges from 10.90% to 15.51%, with a mortality rate of up to 19.00%. Antipseudomonal agents should be selected as an empirical treatment for elderly patients at high risk for developing this infection. The purpose of this study was to identify risk factors and develop a risk predictor for Pseudomonas aeruginosa infection in older adults with community-acquired pneumonia (CAP). METHODS A retrospective data collection from an electronic database involved the elderly hospitalized patients with P. aeruginosa- and non-P. aeruginosa-causing CAP, admitted between January 1, 2016, and June 30, 2021. Risk factors for P. aeruginosa infection were analysed using logistic regression, and the instrument was developed by scoring each risk factor based on the beta coefficient and evaluating discrimination and calibration using the area under the receiver operating characteristic curve (AuROC) and observed versus predicted probability (E/O) ratio. RESULTS The inclusion criteria were met by 81 and 104 elderly patients diagnosed with CAP caused by P. aeruginosa and non-P. aeruginosa, respectively. Nasogastric (NG) tube feeding (odd ratios; OR = 40.68), bronchiectasis (B) (OR = 4.13), immunocompromised condition (I) (OR = 3.76), and other chronic respiratory illnesses (r) such as atelectasis, pulmonary fibrosis, and lung bleb (OR = 2.61) were the specific risk factors for infection with P. aeruginosa. The "60-B-r-I-NG" risk score was named after the 4 abbreviated risk variables and found to have good predicative capability (AuROC = 0.77) and accuracy comparable to or near true P. aeruginosa infection (E/O = 1). People who scored at least two should receive empirically antipseudomonal medication. CONCLUSIONS NG tube feeding before admission, bronchiectasis, immunocompromisation, atelectasis, pulmonary fibrosis and lung bleb were risk factors for pseudomonal CAP in the elderly. The 60-B-r-I-NG was developed for predicting P. aeruginosa infection with a high degree of accuracy, equal to or comparable to the existing P. aeruginosa infection. Antipseudomonal agents may be started in patients who are at least 60 years old and have a score of at least 2 in order to lower mortality and promote the appropriate use of these medications.
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Affiliation(s)
- Kingkarn Wijit
- The College of Pharmacotherapy of Thailand, Nonthaburi, Thailand
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Paveena Sonthisombat
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Jaruwan Diewsurin
- Department of Medicine, Buddhachinaraj Hospital, Phitsanulok, Thailand
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16
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Al-Dalfi MHK, Al Ibraheem SAH, Al-Rubaye AKQ. The severity of pneumonia and its association with socio-demographic factors among children under five years old in Wasit governorate hospitals, Iraq. J Public Health Afr 2023; 14:2674. [PMID: 37859708 PMCID: PMC10583494 DOI: 10.4081/jphia.2023.2674] [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: 04/29/2023] [Accepted: 05/29/2023] [Indexed: 10/21/2023] Open
Abstract
Background Pneumonia is the leading infectious cause of death among children under five globally. Objective The study aims to determine socio-demographic factors associated with the severity of pneumonia among children under five in Wasit Governorate. Methods A cross-sectional study and convenience sampling (non-probability) were conducted among 477 children admitted to Wasit governorate hospitals. This sample was distributed throughout five hospitals selected using convenience sampling techniques, including AL-Zahra Hospital, AL-Numaniyah General Hospital, AL-Karama Teaching Hospital, Martyr Fairouz General Hospital, and AL-Kut Gynecology Hospital. It was conducted from October 1st, 2022, to May 1st, 2023. Through questionnaires, data were collected and analyzed through descriptive and inferential statistics. Results The results showed that the participants' distribution according to pneumonia severity was such that the majority of children (81%) included in the study suffered from pneumonia. 14% of children suffered from very severe pneumonia, and 5% suffered from severe pneumonia. The children at risk of developing pneumonia were within the age group of 1-11 months (55.6%), were male (60.6%), and resided in urban areas (63.7%). Both the mother and the father had completed their primary education (50.9% and 47.4%, respectively), and 99.4% and 97.5% of the mothers were married and housewives. More than half of the fathers, 59.5%, were self-employed, and 25.6% suffered from house overcrowding. In addition, 65% had low socioeconomic status. There was a significant relationship between pneumonia severity and the father's occupation and socioeconomic status. Conclusions This study concludes that pneumonia was the most common diagnosis at admission. Among the risk factors studied, low socioeconomic status and the father's occupation were significant risk factors for pneumonia in children.
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Affiliation(s)
- Mortadha H. Kreeb Al-Dalfi
- Department of Community Health Techniques, College of Health and Medical Technology, Southern Technical University, Basrah
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17
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Kakehi E, Uehira R, Ohara N, Akamatsu Y, Osaka T, Sakurai S, Hirotani A, Nozaki T, Shoji K, Adachi S, Kotani K. Utility of the New Early Warning Score (NEWS) in combination with the neutrophil-lymphocyte ratio for the prediction of prognosis in older patients with pneumonia. Fam Med Community Health 2023; 11:e002239. [PMID: 37344123 DOI: 10.1136/fmch-2023-002239] [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: 06/23/2023] Open
Abstract
OBJECTIVE Predictors of prognosis are necessary for use in routine clinical practice for older patients with pneumonia, given the ageing of the population. Recently, the National Early Warning Score (NEWS), a comprehensive predictor of severity that consists solely of physiological indicators, has been proposed to predict the prognosis of pneumonia. The neutrophil/lymphocyte ratio (NLR) is a simple index of inflammation that may also be predictive of pneumonia. In the present study, we aimed to determine whether NEWS or a combination of NEWS and NLR predicts mortality in older patients with pneumonia. DESIGN A retrospective cohort study. SETTING A general hospital in Japan. PARTICIPANTS We collected data from patients aged ≥65 years with pneumonia who were admitted between 2018 and 2020 (n=282; age=85.3 (7.9)). Data regarding vital signs, demographics and the length of hospital stay, in addition to the NEWS and NLR, were extracted from the participants' electronic medical records. INTERVENTION The utility of the combination of NEWS and NLR was assessed using NEWS×NLR and NEWS+NLR. MAIN OUTCOME MEASURES Their predictive ability for 30-day mortality as the primary outcome was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS According to the NEWS classification, 80 (28.3%), 64 (22.7%) and 138 (48.9%) of the participants were at low, medium and high risk of mortality, respectively. The 30-day mortality for the entire cohort was 9.2% (n=26), and the mortality rate increased with the NEWS classification: low, 1.3%; medium, 7.8%; and high, 14.5%. The NLRs were 6.0 (4.2-9.8), 6.8 (4.8-10.4) and 14.6 (9.4-22.2), respectively (p<0.001). The areas under the ROC curves for 30-day mortality were 0.73 for the NEWS score, 0.84 for NEWS×NLR and 0.83 for NEWS+NLR, indicating that the combinations represent superior predictors of mortality to the NEWS alone. NEWS×NLR and NEWS+NLR tended to have better sensitivity, accuracy, positive predictive value and negative predictive value than NEWS alone (p=0.06). CONCLUSIONS A combination of the NEWS and NLR (NEWS×NLR or NEWS+NLR) may be superior to the NEWS alone for the prediction of 30-day mortality in older patients with pneumonia. However, further validation of these combinations for use in the prediction of prognosis is required.
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Affiliation(s)
- Eiichi Kakehi
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Ryo Uehira
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Nobuaki Ohara
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Yukinobu Akamatsu
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Taeko Osaka
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Shigehisa Sakurai
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Akane Hirotani
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Takafumi Nozaki
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Keisuke Shoji
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Seiji Adachi
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Japan
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Doumat G, Daher D, Itani M, Abdouni L, El Asmar K, Assaf G. The effect of polypharmacy on healthcare services utilization in older adults with comorbidities: a retrospective cohort study. BMC PRIMARY CARE 2023; 24:120. [PMID: 37237338 DOI: 10.1186/s12875-023-02070-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Older adults are more prone to increasing comorbidities and polypharmacy. Polypharmacy is associated with inappropriate prescribing and an increased risk of adverse effects. This study examined the effect of polypharmacy in older adults on healthcare services utilization (HSU). It also explored the impact of different drug classes of polypharmacy including psychotropic, antihypertensive, and antidiabetic polypharmacy on HSU. METHODS This is a retrospective cohort study. Community-dwelling older adults aged ≥ 65 years were selected from the primary care patient cohort database of the ambulatory clinics of the Department of Family Medicine at the American University of Beirut Medical Center. Concomitant use of 5 or more prescription medications was considered polypharmacy. Demographics, Charlson Comorbidity index (CCI), and HSU outcomes, including the rate of all-cause emergency department (ED) visits, rate of all-cause hospitalization, rate of ED visits for pneumonia, rate of hospitalization for pneumonia, and mortality were collected. Binomial logistic regression models were used to predict the rates of HSU outcomes. RESULTS A total of 496 patients were analyzed. Comorbidities were present in all patients, with 22.8% (113) of patients having mild to moderate comorbidity and 77.2% (383) of patients having severe comorbidity. Patients with polypharmacy were more likely to have severe comorbidity compared to patients with no polypharmacy (72.3% vs. 27.7%, p = 0.001). Patients with polypharmacy were more likely to visit the ED for all causes as compared to patients without polypharmacy (40.6% vs. 31.4%, p = 0.05), and had a significantly higher rate of all-cause hospitalization (adjusted odds ratio aOR 1.66, 95 CI = 1.08-2.56, p = 0.022). Patients with psychotropic polypharmacy were more likely to be hospitalized due to pneumonia (crude odds ratio cOR 2.37, 95 CI = 1.03-5.46, p = 0.043), and to visit ED for Pneumonia (cOR 2.31, 95 CI = 1.00-5.31, p = 0.049). The association lost significance after adjustment. CONCLUSIONS The increasing prevalence of polypharmacy amongst the geriatric population with comorbidity is associated with an increase in HSU outcomes. As such, frequent medication revisions in a holistic, multi-disciplinary approach are needed.
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Affiliation(s)
- George Doumat
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Darine Daher
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mira Itani
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Lina Abdouni
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Khalil El Asmar
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Georges Assaf
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
- Division of Academic Internal Medicine & Geriatrics, The University of Illinois at Chicago, Chicago, USA.
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Hus I, Szymczyk A, Mańko J, Drozd-Sokołowska J. COVID-19 in Adult Patients with Hematological Malignancies-Lessons Learned after Three Years of Pandemic. BIOLOGY 2023; 12:biology12040545. [PMID: 37106746 PMCID: PMC10136203 DOI: 10.3390/biology12040545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
The COVID-19 pandemic is undoubtedly the most difficult health challenge of the 21st century with more than 600 million laboratory-confirmed SARS-CoV-2 infections and over 6.5 million deaths worldwide. The coronavirus pandemic contributed to rapid development of mRNA vaccines, which, along with new antiviral drugs, have been the subject of extensive research for many decades. Nevertheless, elderly, multi-morbid and immunocompromised patients continue to face a more severe clinical course and a higher risk of death from COVID-19, even now that the risk of COVID-19 in the general population is significantly reduced due to the introduction of global vaccination strategies. In this paper, we present the mechanisms of increased susceptibility to infectious complications and the evolution of the clinical course of COVID-19 in patients with hematological malignancies, taking into account the mutation of the virus and the introduction of vaccines and new antiviral drugs. We also present current recommendations for prophylactic and therapeutic management in patients with hematological malignancies.
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Affiliation(s)
- Iwona Hus
- Department of Hematology, National Medical Institute of the Ministry of Interior and Administration, 137 Wołoska Str., 02-507 Warsaw, Poland
- Department of Clinical Transplantology, Medical University of Lublin, 7 Chodźki Str., 20-093 Lublin, Poland
| | - Agnieszka Szymczyk
- Department of Hematology, National Medical Institute of the Ministry of Interior and Administration, 137 Wołoska Str., 02-507 Warsaw, Poland
- Department of Clinical Transplantology, Medical University of Lublin, 7 Chodźki Str., 20-093 Lublin, Poland
| | - Joanna Mańko
- Department of Hematology, National Medical Institute of the Ministry of Interior and Administration, 137 Wołoska Str., 02-507 Warsaw, Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, 1a Banacha Str., 02-097 Warsaw, Poland
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20
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Al-Jabri M, Rosero C, Saade EA. Vaccine-Preventable Diseases in Older Adults. Infect Dis Clin North Am 2023; 37:103-121. [PMID: 36805008 DOI: 10.1016/j.idc.2022.11.005] [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: 02/17/2023]
Abstract
Older adults are at an increased risk of vaccine-preventable diseases partly because of physiologic changes in the immune and other body systems related to age and/or accumulating comorbidities that increase the vulnerability to infections and decrease the response to vaccines. Strategies to improve the response to vaccines include using a higher antigenic dose (such as in the high-dose inactivated influenza vaccines) as well as adding adjuvants (such as MF59 in the adjuvanted inactivated influenza vaccine).
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Affiliation(s)
- Maha Al-Jabri
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue - Mailstop Fol. 5083, Cleveland, OH 44106, USA; Case Western Reserve University, Cleveland, OH, USA
| | - Christian Rosero
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue - Mailstop Fol. 5083, Cleveland, OH 44106, USA; Case Western Reserve University, Cleveland, OH, USA
| | - Elie A Saade
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue - Mailstop Fol. 5083, Cleveland, OH 44106, USA.
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21
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Multidrug-resistant Gram-negative bacilli recovered from respiratory and blood specimens from adults: the ATLAS surveillance program in European hospitals, 2018-2020. Int J Antimicrob Agents 2023; 61:106724. [PMID: 36642231 DOI: 10.1016/j.ijantimicag.2023.106724] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 12/20/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
The population of people ≥65 years of age is increasing in Europe. Pneumonia is a prominent cause of infection in this age group. These patients may be at heightened risk of infection caused by multidrug-resistant (MDR) organisms owing to their frequent and prolonged contact with healthcare facilities as well as frequent exposure to antimicrobials and medical devices. However, ATLAS surveillance data did not demonstrate any difference in the incidence of MDR Gram-negative pathogens among patients ≥65 years of age and those aged <65 years. Higher rates of carbapenem-resistant Enterobacterales (CRE) and MDR Pseudomonas aeruginosa were observed in patients aged 18-64 years (10.7% and 32.3%, respectively) than in patients aged ≥65 years (5.0% and 25.4%, respectively). Significant therapeutic gaps were identified for CRE, carbapenem-resistant Acinetobacter baumannii (65.9% of isolates tested) and MDR P. aeruginosa, which continue to be prevalent in European hospitals. Among the antimicrobials evaluated, only colistin provided >75% in vitro coverage for these pathogens.
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22
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Vazquez S, Stadlan Z, Lapow JM, Feldstein E, Shah S, Das A, Naftchi AF, Spirollari E, Thaker A, Kazim SF, Dominguez JF, Patel N, Kurian C, Chong J, Mayer SA, Kaur G, Gandhi CD, Bowers CA, Al-Mufti F. Frailty and outcomes in lacunar stroke. J Stroke Cerebrovasc Dis 2023; 32:106942. [PMID: 36525849 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106942] [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: 09/20/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lacunar strokes (LS) are ischemic strokes of the small perforating arteries of deep gray and white matter of the brain. Frailty has been associated with greater mortality and attenuated response to treatment after stroke. However, the effect of frailty on patients with LS has not been previously described. OBJECTIVE To analyze the association between frailty and outcomes in LS. METHODS Patients with LS were selected from the National Inpatient Sample (NIS) 2016-2019 using the International Classification of Disease, 10th edition (ICD-10) diagnosis codes. The 11-point modified frailty scale (mFI-11) was used to group patients into severely frail and non-severely frail cohorts. Demographics, clinical characteristics, and complications were defined. Health care resource utilization (HRU) was evaluated by comparing total hospital charges and length of stay (LOS). Other outcomes studied were discharge disposition and inpatient death. RESULTS Of 48,980 patients with LS, 10,830 (22.1%) were severely frail. Severely frail patients were more likely to be older, have comorbidities, and pertain to lower socioeconomic status categories. Severely frail patients with LS had worse clinical stroke severity and increased rates of complications such as urinary tract infection (UTI) and pneumonia (PNA). Additionally, severe frailty was associated with unfavorable outcomes and increased HRU. CONCLUSION Severe frailty in LS patients is associated with higher rates of complications and increased HRU. Risk stratification based on frailty may allow for individualized treatments to help mitigate adverse outcomes in the setting of LS.
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Affiliation(s)
- Sima Vazquez
- School of Medicine, New York Medical College, Valhalla, NY, United States
| | - Zehavya Stadlan
- School of Medicine, New York Medical College, Valhalla, NY, United States
| | - Justin M Lapow
- School of Medicine, New York Medical College, Valhalla, NY, United States
| | - Eric Feldstein
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, United States
| | - Smit Shah
- Department of Neurology, University of South Carolina/PRISMA Health Richland, Columbia, SC, United States
| | - Ankita Das
- School of Medicine, New York Medical College, Valhalla, NY, United States
| | | | - Eris Spirollari
- School of Medicine, New York Medical College, Valhalla, NY, United States
| | - Akash Thaker
- School of Medicine, New York Medical College, Valhalla, NY, United States
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, United States
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, United States
| | - Neisha Patel
- Department of Neurology, Westchester Medical Center, Valhalla, NY, United States
| | - Christeena Kurian
- Department of Neurology, Westchester Medical Center, Valhalla, NY, United States
| | - Ji Chong
- Department of Neurology, Westchester Medical Center, Valhalla, NY, United States
| | - Stephan A Mayer
- Department of Neurology, Westchester Medical Center, Valhalla, NY, United States
| | - Gurmeen Kaur
- Department of Neurology, Westchester Medical Center, Valhalla, NY, United States
| | - Chirag D Gandhi
- School of Medicine, New York Medical College, Valhalla, NY, United States; Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, United States
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, United States
| | - Fawaz Al-Mufti
- School of Medicine, New York Medical College, Valhalla, NY, United States; Department of Neurology, Westchester Medical Center, Valhalla, NY, United States
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23
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TEKİN S, COSKUM N, ADIYEKE E, ŞEN E, TOPCUOGLU SARI O, AYGÜN MU, ŞABABLI ÇETİN A, YILMAZ-KARADAĞ F, BAKAN N. Effect of vaccine on prognosis and mortality in COVID-19. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1176884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION:The purpose of our study is to reveal the factors affecting the clinical course of the Covid-19 infection and mortality in the immunized and non-immunized 65-year-old and older patients.
METHOD AND MATERIAL: The study was conducted by screening the files of 1,642 65-year-old and older Covid-19 cases in total.1337 cases enrolled in the study were categorized into two groups as follows: the patients vaccinated with the 2nd dose of CoronaVac but infected with Covid-19 after the 14-day period during which immunization is supposed to develop (Group I) and the patients who have never been vaccinated, who have been vaccinated with a single dose, or who have been infected with Covid-19 before the 14-day period is completed in spite of being vaccinated with the 2nd dose (Group II).The groups were compared with each other with regard to mortality and the factors affecting mortality.
RESULTS: The length of ICU stay and the total length of hospital stay were significantly longer in Group II than Group I ( p
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Affiliation(s)
- Selda TEKİN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL SANCAKTEPE ŞEHİR PROF. DR. İLHAN VARANK SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ ANABİLİM DALI
| | - Nilufer COSKUM
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL SANCAKTEPE ŞEHİR PROF. DR. İLHAN VARANK SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ ANABİLİM DALI
| | - Esra ADIYEKE
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL SANCAKTEPE ŞEHİR PROF. DR. İLHAN VARANK SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ ANABİLİM DALI
| | - Erman ŞEN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL SANCAKTEPE ŞEHİR PROF. DR. İLHAN VARANK SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ ANABİLİM DALI
| | - Ozgun TOPCUOGLU SARI
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL SANCAKTEPE ŞEHİR PROF. DR. İLHAN VARANK SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ ANABİLİM DALI
| | - Mücahit Uğur AYGÜN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL SANCAKTEPE ŞEHİR PROF. DR. İLHAN VARANK SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ ANABİLİM DALI
| | - Ayşe ŞABABLI ÇETİN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL SANCAKTEPE ŞEHİR PROF. DR. İLHAN VARANK SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, ENFEKSİYON HASTALIKLARI ANABİLİM DALI
| | - Fatma YILMAZ-KARADAĞ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL SANCAKTEPE ŞEHİR PROF. DR. İLHAN VARANK SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, ENFEKSİYON HASTALIKLARI ANABİLİM DALI
| | - Nurten BAKAN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL SANCAKTEPE ŞEHİR PROF. DR. İLHAN VARANK SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ ANABİLİM DALI
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Sun X, Zhou J, Huang W, Wang B, Zhang Y, Duan L, Chen W. Association between IL-38 and inflammatory indicators in patients with bacterial pneumonia. Cytokine 2023; 161:156052. [PMID: 36375397 DOI: 10.1016/j.cyto.2022.156052] [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: 04/03/2022] [Revised: 08/23/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND IL-38, a recently discovered cytokine of IL-1 family, exerts immunoregulatory activities in multi-type inflammatory diseases. However, its expression level and underlying clinical importance for IL-38 in respiratory bacterial infections remain unknown. METHODS Thirty-five patients with bacterial pneumonia and twenty age- and gender- matched healthy individuals were enrolled in the study to determine serum IL-38 concentrations by ELISA. Then, the correlation between serum IL-38 levels and clinical features were analyzed and ROC curve was used to evaluate the potential diagnostic value for bacterial infections. In vitro, LPS-stimulated human respiratory epithelial cell model was employed to explore immunomodulatory mechanism of IL-38 in pulmonary infections. RESULTS Elevated serum levels of IL-38 were determined in patients with bacterial pneumonia when compared with healthy controls. In addition, serum IL-38 levels were negatively correlated with clinical inflammation parameters, including WBC count, CRP, PCT and proinflammatory IL-6 and IL-8. In vitro, we demonstrated that recombinant IL-38 was able to remarkably inhibit expression of proinflammatory IL-6, IL-8, IL-1β and TNF-α as well as adhesion molecule ICAM-1, which were partially mediated by attenuated activation of STAT3 and NF-κB signal cascades in BEAS-2B cells. Furthermore, we identified the diagnostic efficiency of IL-38 in discriminating patients with bacterial pneumonia from healthy individuals. CONCLUSIONS Our study indicates higher serum IL-38 levels in patients with bacterial pneumonia are involved in anti-inflammatory activities in respiratory infections revealing a critical role of IL-38 in attenuating excessive pulmonary inflammation against exogenous pathogens. More importantly, IL-38 exhibited a potential novel biomarker for bacterial pneumonia. Thus, our data may provide useful insights for both clinical and basic research for bacterial pneumonia diagnosis.
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Affiliation(s)
- Xiaoyu Sun
- Department of Laboratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yu Zhong District, Chongqing, PR China
| | - Jie Zhou
- Department of Clinical Laboratory, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Wenjuan Huang
- Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing 400010, PR China
| | - Bo Wang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yu Zhong District, Chongqing, PR China
| | - Yi Zhang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yu Zhong District, Chongqing, PR China
| | - Liang Duan
- Department of Laboratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yu Zhong District, Chongqing, PR China.
| | - Weixian Chen
- Department of Laboratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yu Zhong District, Chongqing, PR China.
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How Are Older Adults Different Than Other Adults for Infections? INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tang J, Ouyang Q, Li Y, Zhang P, Jin W, Qu S, Yang F, He Z, Qin M. Nanomaterials for Delivering Antibiotics in the Therapy of Pneumonia. Int J Mol Sci 2022; 23:ijms232415738. [PMID: 36555379 PMCID: PMC9779065 DOI: 10.3390/ijms232415738] [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: 09/21/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022] Open
Abstract
Bacterial pneumonia is one of the leading causes of death worldwide and exerts a significant burden on health-care resources. Antibiotics have long been used as first-line drugs for the treatment of bacterial pneumonia. However, antibiotic therapy and traditional antibiotic delivery are associated with important challenges, including drug resistance, low bioavailability, and adverse side effects; the existence of physiological barriers further hampers treatment. Fortunately, these limitations may be overcome by the application of nanotechnology, which can facilitate drug delivery while improving drug stability and bioavailability. This review summarizes the challenges facing the treatment of bacterial pneumonia and also highlights the types of nanoparticles that can be used for antibiotic delivery. This review places a special focus on the state-of-the-art in nanomaterial-based approaches to the delivery of antibiotics for the treatment of pneumonia.
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Affiliation(s)
- Jie Tang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming 650118, China
| | - Qiuhong Ouyang
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Yanyan Li
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming 650118, China
| | - Peisen Zhang
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Weihua Jin
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming 650118, China
| | - Shuang Qu
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Fengmei Yang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming 650118, China
| | - Zhanlong He
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming 650118, China
- Correspondence: (Z.H.); (M.Q.)
| | - Meng Qin
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
- Correspondence: (Z.H.); (M.Q.)
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Yamanaka M, Yamaguchi K, Muramatsu M, Miura H, Ochi M. Using the Oral Assessment Guide to Predict the Onset of Pneumonia in Residents of Long-Term Care and Welfare Facilities: A One-Year Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13731. [PMID: 36360610 PMCID: PMC9654310 DOI: 10.3390/ijerph192113731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Appropriate oral health care, depending on oral assessments, reduces the onset of pneumonia. However, the relationship between risk evaluation using an oral assessment tool and pneumonia in residents of long-term care facilities has not been fully elucidated. In the present study, we aim to examine the relationship between the total scores of the Oral Assessment Guide (OAG) and the incidence of pneumonia after a one-year baseline study of residents in long-term care facilities. The settings for sampling include nine long-term care facilities in Hokkaido. At baseline, there were 267 study subjects. A total of 72 individuals dropped out and 11 individuals met the exclusion criteria. Therefore, the subject sample included 184 individuals. Among the subjects included in our analyses, eight individuals developed pneumonia (six males and two females). A multiple logistic regression analysis was performed with the risk factors for developing pneumonia. Evaluations were performed based on the odds ratio (OR) and 95% confidence interval (CI). We observed that the OR for pneumonia onset was 2.29 (CI: 1.27-4.14) after being adjusted for pneumonia risk factors. Therefore, it was suggested that the total scores of the OAG could be used to screen for the risk of pneumonia onset in residents of long-term care and welfare facilities.
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Affiliation(s)
- Masahiro Yamanaka
- Division of Fixed Prosthodontics and Oral Implantology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-gun 061-0293, Japan
| | - Kanetaka Yamaguchi
- Division of Fixed Prosthodontics and Oral Implantology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-gun 061-0293, Japan
| | - Masumi Muramatsu
- School of Nursing, Sapporo City University, Sapporo 060-0011, Japan
| | - Hiroko Miura
- Division of Disease Control and Epidemiology, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-gun 061-0293, Japan
| | - Morio Ochi
- Division of Fixed Prosthodontics and Oral Implantology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-gun 061-0293, Japan
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Lv C, Li M, Shi W, Pan T, Muhith A, Peng W, Xu J, Deng J. Exploration of prognostic factors for prediction of mortality in elderly CAP population using a nomogram model. Front Med (Lausanne) 2022; 9:976148. [PMID: 36300178 PMCID: PMC9588947 DOI: 10.3389/fmed.2022.976148] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background The incidence and mortality rate of community-acquired pneumonia (CAP) in elderly patients were higher than the younger population. The assessment tools including CURB-65 and qSOFA have been applied in early detection of high-risk patients with CAP. However, several disadvantages exist to limit the efficiency of these tools for accurate assessment in elderly CAP. Therefore, we aimed to explore a more comprehensive tool to predict mortality in elderly CAP population by establishing a nomogram model. Methods We retrospectively analyzed elderly patients with CAP in Minhang Hospital, Fudan University. The least absolute shrinkage and selection operator (LASSO) logistic regression combined with multivariate analyses were used to select independent predictive factors and established nomogram models via R software. Calibration plots, decision curve analysis (DCA) and receiver operating characteristic curve (ROC) were generated to assess predictive performance. Results LASSO and multiple logistic regression analyses showed the age, pulse, NLR, albumin, BUN, and D-dimer were independent risk predictors. A nomogram model (NB-DAPA model) was established for predicting mortality of CAP in elderly patients. In both training and validation set, the area under the curve (AUC) of the NB-DAPA model showed superiority than CURB-65 and qSOFA. Meanwhile, DCA revealed that the predictive model had significant net benefits for most threshold probabilities. Conclusion Our established NB-DAPA nomogram model is a simple and accurate tool for predicting in-hospital mortality of CAP, adapted for patients aged 65 years and above. The predictive performance of the NB-DAPA model was better than PSI, CURB-65 and qSOFA.
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Affiliation(s)
- Chunxin Lv
- Department of Oncology, Punan Hospital of Pudong New District, Shanghai, China
| | - Mengyuan Li
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Wen Shi
- Department of Dermatology, Punan Hospital of Pudong New District, Shanghai, China
| | - Teng Pan
- Key Laboratory of Cancer Prevention and Therapy, The Third Department of Breast Cancer, Tianjin’s Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Abdul Muhith
- Department of Oncology, Royal Marsden Hospital, London, United Kingdom
| | - Weixiong Peng
- Hunan Zixing Artificial Intelligence Technology Group Co., Ltd., Changsha, China
| | - Jiayi Xu
- Department of Geriatric, Minhang Hospital, Fudan University, Shanghai, China,*Correspondence: Jiayi Xu,
| | - Jinhai Deng
- Richard Dimbleby Department of Cancer Research, Comprehensive Cancer Centre, King’s College London, London, United Kingdom,Jinhai Deng,
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Hernandez A, Zhou J, Bohannon JK, McBride MA, Gibson-Corley KN, Patil NK, Owen AM, Burelbach KR, Sherwood ER. INTRAPULMONARY TREATMENT WITH A NOVEL TLR4 AGONIST CONFERS PROTECTION AGAINST KLEBSIELLA PNEUMONIA. Shock 2022; 58:295-303. [PMID: 36018281 PMCID: PMC9647733 DOI: 10.1097/shk.0000000000001977] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Objectives: Nosocomial pneumonia is a common complication in critically ill patients. The goal of this study was to examine the efficacy of the Toll-like receptor 4 agonist 3-deacyl phosphorylated hexacyl disaccharide (3D PHAD), in a clinically relevant murine model of pneumonia, and assess the cellular mechanisms that mediate the protective response. Design: Mice received intrapulmonary 3D PHAD (20 μg) or vehicle for 2 consecutive days before challenge with intrapulmonary Klebsiella pneumoniae (2.3 × 10 3 colony-forming units). Mice were followed for 14-day survival, pulmonary K. pneumoniae burden, lung leukocyte profile, leukocyte phagocytic capacity, and cytokine production. Pneumonia severity and leukocyte recruitment were further assessed by histological evaluation. Setting: Research laboratory. Subjects: Wild-type, male C57BL/6 J mice. Interventions: Intrapulmonary treatment with 20 μg 3D PHAD for 2 consecutive days. Measurements and main results: Intrapulmonary treatment with 3D PHAD decreased lung K. pneumoniae colony-forming units and pneumonia severity with an associated improvement in survival compared with mice treated with vehicle. The numbers of neutrophils, monocytes, and macrophages in the lungs of 3D PHAD-treated mice were higher than those in vehicle-treated mice before infection but were not significantly different from vehicle-treated mice at 48 h after K. pneumoniae challenge. Lung innate leukocytes from 3D PHAD-treated mice had increased phagocytic capacity. Treatment with 3D PHAD alone increased cytokines in the lungs but decreased cytokines in plasma during K. pneumoniae pneumonia as compared with control. Conclusions: Intrapulmonary treatment with 3D PHAD augments innate immunity in the lung and facilitates resistance to K. pneumoniae pneumonia.
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Affiliation(s)
- Antonio Hernandez
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jing Zhou
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julia K. Bohannon
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret A. McBride
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine N. Gibson-Corley
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Naeem K. Patil
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Allison M. Owen
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine R. Burelbach
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward R. Sherwood
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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Hyams C, Challen R, Begier E, Southern J, King J, Morley A, Szasz-Benczur Z, Gonzalez MG, Kinney J, Campling J, Gray S, Oliver J, Hubler R, Valluri S, Vyse A, McLaughlin JM, Ellsbury G, Maskell NA, Gessner BD, Danon L, Finn A. Incidence of community acquired lower respiratory tract disease in Bristol, UK during the COVID-19 pandemic: A prospective cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2022; 21:100473. [PMID: 35965672 PMCID: PMC9359590 DOI: 10.1016/j.lanepe.2022.100473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background The emergence of COVID-19 and public health measures implemented to reduce SARS-CoV-2 infections have both affected acute lower respiratory tract disease (aLRTD) epidemiology and incidence trends. The severity of COVID-19 and non-SARS-CoV-2 aLRTD during this period have not been compared in detail. Methods We conducted a prospective cohort study of adults age ≥18 years admitted to either of two acute care hospitals in Bristol, UK, from August 2020 to November 2021. Patients were included if they presented with signs or symptoms of aLRTD (e.g., cough, pleurisy), or a clinical or radiological aLRTD diagnosis. Findings 12,557 adult aLRTD hospitalisations occurred: 10,087 were associated with infection (pneumonia or non-pneumonic lower respiratory tract infection [NP-LRTI]), 2161 with no infective cause, with 306 providing a minimal surveillance dataset. Confirmed SARS-CoV-2 infection accounted for 32% (3178/10,087) of respiratory infections. Annual incidences of overall, COVID-19, and non- SARS-CoV-2 pneumonia were 714.1, 264.2, and 449.9, and NP-LRTI were 346.2, 43.8, and 302.4 per 100,000 adults, respectively. Weekly incidence trends in COVID-19 aLRTD showed large surges (median 6.5 [IQR 0.7-10.2] admissions per 100,000 adults per week), while other infective aLRTD events were more stable (median 14.3 [IQR 12.8-16.4] admissions per 100,000 adults per week) as were non-infective aLRTD events (median 4.4 [IQR 3.5-5.5] admissions per 100,000 adults per week). Interpretation While COVID-19 disease was a large component of total aLRTD during this pandemic period, non- SARS-CoV-2 infection still caused the majority of respiratory infection hospitalisations. COVID-19 disease showed significant temporal fluctuations in frequency, which were less apparent in non-SARS-CoV-2 infection. Despite public health interventions to reduce respiratory infection, disease incidence remains high. Funding AvonCAP is an investigator-led project funded under a collaborative agreement by Pfizer.
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Affiliation(s)
- Catherine Hyams
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, UK
- Academic Respiratory Unit, University of Bristol, UK
| | | | - Elizabeth Begier
- Global Medical Development Scientific and Clinical Affairs, Pfizer Vaccines, Ireland
| | - Jo Southern
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth KT20 7NS, UK
| | - Jade King
- Clinical Research and Imaging Centre, UHBW NHS Trust, Bristol, UK
| | - Anna Morley
- Academic Respiratory Unit, University of Bristol, UK
| | | | | | - Jane Kinney
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, UK
| | - James Campling
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth KT20 7NS, UK
| | - Sharon Gray
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | - Robin Hubler
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Srinivas Valluri
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Andrew Vyse
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth KT20 7NS, UK
| | - John M. McLaughlin
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | | | - Bradford D. Gessner
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Leon Danon
- Engineering Mathematics, University of Bristol, UK
| | - Adam Finn
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, UK
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31
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Hyams C, Challen R, Begier E, Southern J, King J, Morley A, Szasz-Benczur Z, Gonzalez MG, Kinney J, Campling J, Gray S, Oliver J, Hubler R, Valluri S, Vyse A, McLaughlin JM, Ellsbury G, Maskell NA, Gessner BD, Danon L, Finn A. Incidence of community acquired lower respiratory tract disease in Bristol, UK during the COVID-19 pandemic: A prospective cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2022; 21:100473. [PMID: 35965672 DOI: 10.2139/ssrn.4087373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The emergence of COVID-19 and public health measures implemented to reduce SARS-CoV-2 infections have both affected acute lower respiratory tract disease (aLRTD) epidemiology and incidence trends. The severity of COVID-19 and non-SARS-CoV-2 aLRTD during this period have not been compared in detail. METHODS We conducted a prospective cohort study of adults age ≥18 years admitted to either of two acute care hospitals in Bristol, UK, from August 2020 to November 2021. Patients were included if they presented with signs or symptoms of aLRTD (e.g., cough, pleurisy), or a clinical or radiological aLRTD diagnosis. FINDINGS 12,557 adult aLRTD hospitalisations occurred: 10,087 were associated with infection (pneumonia or non-pneumonic lower respiratory tract infection [NP-LRTI]), 2161 with no infective cause, with 306 providing a minimal surveillance dataset. Confirmed SARS-CoV-2 infection accounted for 32% (3178/10,087) of respiratory infections. Annual incidences of overall, COVID-19, and non- SARS-CoV-2 pneumonia were 714.1, 264.2, and 449.9, and NP-LRTI were 346.2, 43.8, and 302.4 per 100,000 adults, respectively. Weekly incidence trends in COVID-19 aLRTD showed large surges (median 6.5 [IQR 0.7-10.2] admissions per 100,000 adults per week), while other infective aLRTD events were more stable (median 14.3 [IQR 12.8-16.4] admissions per 100,000 adults per week) as were non-infective aLRTD events (median 4.4 [IQR 3.5-5.5] admissions per 100,000 adults per week). INTERPRETATION While COVID-19 disease was a large component of total aLRTD during this pandemic period, non- SARS-CoV-2 infection still caused the majority of respiratory infection hospitalisations. COVID-19 disease showed significant temporal fluctuations in frequency, which were less apparent in non-SARS-CoV-2 infection. Despite public health interventions to reduce respiratory infection, disease incidence remains high. FUNDING AvonCAP is an investigator-led project funded under a collaborative agreement by Pfizer.
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Affiliation(s)
- Catherine Hyams
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, UK
- Academic Respiratory Unit, University of Bristol, UK
| | | | - Elizabeth Begier
- Global Medical Development Scientific and Clinical Affairs, Pfizer Vaccines, Ireland
| | - Jo Southern
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth KT20 7NS, UK
| | - Jade King
- Clinical Research and Imaging Centre, UHBW NHS Trust, Bristol, UK
| | - Anna Morley
- Academic Respiratory Unit, University of Bristol, UK
| | | | | | - Jane Kinney
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, UK
| | - James Campling
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth KT20 7NS, UK
| | - Sharon Gray
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | - Robin Hubler
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Srinivas Valluri
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Andrew Vyse
- Vaccines Medical Affairs, Pfizer Ltd, Tadworth KT20 7NS, UK
| | - John M McLaughlin
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | | | - Bradford D Gessner
- Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Leon Danon
- Engineering Mathematics, University of Bristol, UK
| | - Adam Finn
- Bristol Vaccine Centre, Population Health Sciences, University of Bristol, UK
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Kelley WJ, Wragg KM, Chen J, Murthy T, Xu Q, Boyne MT, Podojil JR, Elhofy A, Goldstein DR. Nanoparticles reduce monocytes within the lungs to improve outcomes after influenza virus infection in aged mice. JCI Insight 2022; 7:156320. [PMID: 35737459 PMCID: PMC9462478 DOI: 10.1172/jci.insight.156320] [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: 11/02/2021] [Accepted: 06/21/2022] [Indexed: 01/26/2023] Open
Abstract
Older people exhibit dysregulated innate immunity to respiratory viral infections, including influenza and SARS-CoV-2, and show an increase in morbidity and mortality. Nanoparticles are a potential practical therapeutic that could reduce exaggerated innate immune responses within the lungs during viral infection. However, such therapeutics have not been examined for effectiveness during respiratory viral infection, particular in aged hosts. Here, we employed a lethal model of influenza viral infection in vulnerable aged mice to examine the ability of biodegradable, cargo-free nanoparticles, designated ONP-302, to resolve innate immune dysfunction and improve outcomes during infection. We administered ONP-302 via i.v. injection to aged mice at day 3 after infection, when the hyperinflammatory innate immune response was already established. During infection, we found that ONP-302 treatment reduced the numbers of inflammatory monocytes within the lungs and increased their number in both the liver and spleen, without impacting viral clearance. Importantly, cargo-free nanoparticles reduced lung damage, reduced histological lung inflammation, and improved gas exchange and, ultimately, the clinical outcomes in influenza-infected aged mice. In conclusion, ONP-302 improves outcomes in influenza-infected aged mice. Thus, our study provides information concerning a practical therapeutic, which, if translated clinically, could improve disease outcomes for vulnerable older patients suffering from respiratory viral infections.
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Affiliation(s)
| | | | - Judy Chen
- Department of Internal Medicine and,Graduate Program in Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Tushar Murthy
- Research and Development, COUR Pharmaceuticals Development Company Inc., Northbrook, Illinois, USA
| | - Qichen Xu
- Research and Development, COUR Pharmaceuticals Development Company Inc., Northbrook, Illinois, USA
| | - Michael T. Boyne
- Research and Development, COUR Pharmaceuticals Development Company Inc., Northbrook, Illinois, USA
| | - Joseph R. Podojil
- Research and Development, COUR Pharmaceuticals Development Company Inc., Northbrook, Illinois, USA
| | - Adam Elhofy
- Research and Development, COUR Pharmaceuticals Development Company Inc., Northbrook, Illinois, USA
| | - Daniel R. Goldstein
- Department of Internal Medicine and,Graduate Program in Immunology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Microbiology and Immunology, University of Michigan, Michigan, USA
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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] [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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T. Nguyen K, T. Pham S, P.M. Vo T, X. Duong C, A. Perwitasari D, H.K. Truong N, T.H. Quach D, N.P. Nguyen T, T.T. Duong V, M. Nguyen P, H. Nguyen T, Taxis K, Nguyen T. Pneumonia: Drug-Related Problems and Hospital Readmissions. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.100127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Pneumonia is one of the most common infectious diseases and the fourth leading cause of death globally. According to US statistics in 2019, pneumonia is the most common cause of sepsis and septic shock. In the US, inpatient pneumonia hospitalizations account for the top 10 highest medical costs, totaling $9.5 billion for 960,000 hospital stays. The emergence of antibiotic resistance in the treatment of infectious diseases, including the treatment of pneumonia, is a globally alarming problem. Antibiotic resistance increases the risk of death and re-hospitalization, prolongs hospital stays, and increases treatment costs, and is one of the greatest threats in modern medicine. Drug-related problems (DRPs) in pneumonia - such as suboptimal antibiotic indications, prolonged treatment duration, and drug interactions - increase the rate of antibiotic resistance and adverse effects, thereby leading to an increased burden in treatment. In a context in which novel and effective antibiotics are scarce, mitigating DRPs in order to reduce antibiotic resistance is currently a prime concern. A variety of interventions proven useful in reducing DRPs are antibiotic stewardship programs, the use of biomarkers, computerized physician order entries and clinical decision support systems, and community-acquired pneumonia scores.
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Assefa M. Multi-drug resistant gram-negative bacterial pneumonia: etiology, risk factors, and drug resistance patterns. Pneumonia (Nathan) 2022; 14:4. [PMID: 35509063 PMCID: PMC9069761 DOI: 10.1186/s41479-022-00096-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/11/2022] [Indexed: 12/27/2022] Open
Abstract
Bacterial pneumonia is one of the most serious public health issues owing to its medical and economic costs, which result in increased morbidity and mortality in people of all ages around the world. Furthermore, antimicrobial resistance has risen over time, and the advent of multi-drug resistance in GNB complicates therapy and has a detrimental impact on patient outcomes. The current review aimed to summarize bacterial pneumonia with an emphasis on gram-negative etiology, pathogenesis, risk factors, resistance mechanisms, treatment updates, and vaccine concerns to tackle the problem before it causes a serious consequence. In conclusion, the global prevalence of GNB in CAP was reported 49.7% to 83.1%, whereas in VAP patients ranged between 76.13% to 95.3%. The most commonly reported MDR-GNB causes of pneumonia were A. baumannii, K. pneumoniae, and P. aeruginosa, with A. baumannii isolated particularly in VAP patients and the elderly. In most studies, ampicillin, tetracyclines, amoxicillin-clavulanic acid, cephalosporins, and carbapenems were shown to be highly resistant. Prior MDR-GNB infection, older age, previous use of broad-spectrum antibiotics, high frequency of local antibiotic resistance, prolonged hospital stays, ICU admission, mechanical ventilation, and immunosuppression are associated with the MDR-GNB colonization. S. maltophilia was reported as a severe cause of HAP/VAP in patients with mechanically ventilated and having hematologic malignancy due to its ability of biofilm formation, site adhesion in respiratory devices, and its intrinsic and acquired drug resistance mechanisms. Effective combination therapies targeting PDR strains and drug-resistant genes, antibiofilm agents, gene-based vaccinations, and pathogen-specific lymphocytes should be developed in the future.
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Affiliation(s)
- Muluneh Assefa
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
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36
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Affiliation(s)
| | - Terry Fulmer
- The John A. Hartford Foundation, New York, New York
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37
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Pérez-Cobas AE, Baquero F, de Pablo R, Soriano MC, Coque TM. Altered Ecology of the Respiratory Tract Microbiome and Nosocomial Pneumonia. Front Microbiol 2022; 12:709421. [PMID: 35222291 PMCID: PMC8866767 DOI: 10.3389/fmicb.2021.709421] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022] Open
Abstract
Nosocomial pneumonia is one of the most frequent infections in critical patients. It is primarily associated with mechanical ventilation leading to severe illness, high mortality, and prolonged hospitalization. The risk of mortality has increased over time due to the rise in multidrug-resistant (MDR) bacterial infections, which represent a global public health threat. Respiratory tract microbiome (RTM) research is growing, and recent studies suggest that a healthy RTM positively stimulates the immune system and, like the gut microbiome, can protect against pathogen infection through colonization resistance (CR). Physiological conditions of critical patients and interventions as antibiotics administration and mechanical ventilation dramatically alter the RTM, leading to dysbiosis. The dysbiosis of the RTM of ICU patients favors the colonization by opportunistic and resistant pathogens that can be part of the microbiota or acquired from the hospital environments (biotic or built ones). Despite recent evidence demonstrating the significance of RTM in nosocomial infections, most of the host-RTM interactions remain unknown. In this context, we present our perspective regarding research in RTM altered ecology in the clinical environment, particularly as a risk for acquisition of nosocomial pneumonia. We also reflect on the gaps in the field and suggest future research directions. Moreover, expected microbiome-based interventions together with the tools to study the RTM highlighting the "omics" approaches are discussed.
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Affiliation(s)
- Ana Elena Pérez-Cobas
- Department of Microbiology, Ramón y Cajal Institute for Health Research (IRYCIS), Ramón y Cajal University Hospital, Madrid, Spain
| | - Fernando Baquero
- Department of Microbiology, Ramón y Cajal Institute for Health Research (IRYCIS), Ramón y Cajal University Hospital, Madrid, Spain.,CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Raúl de Pablo
- Intensive Care Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - María Cruz Soriano
- Intensive Care Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Teresa M Coque
- Department of Microbiology, Ramón y Cajal Institute for Health Research (IRYCIS), Ramón y Cajal University Hospital, Madrid, Spain.,CIBER in Infectious Diseases (CIBERINFEC), Madrid, Spain
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Gaget V, Inacio MC, Tivey DR, Jorissen RN, Babidge W, Visvanathan R, Maddern GJ. Trends in utilisation of plain X-rays by older Australians (2010-2019). BMC Geriatr 2022; 22:100. [PMID: 35120445 PMCID: PMC8817507 DOI: 10.1186/s12877-022-02786-1] [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] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/19/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Older Australians are major health service users and early diagnosis is key in the management of their health. Radiological services are an important component of diagnosis and disease management planning in older Australians, but their national utilisation of diagnostic services has never been investigated in Australia. PURPOSE This study aims to evaluate the utilisation of major plain X-rays by Australians ≥ 65 years old. METHODS A population-based epidemiological evaluation and yearly cross-sectional analyses of X-ray examinations per 1,000 Australians aged ≥ 65 years old between 2009 and 2019 were conducted using publicly available Medicare Benefits Schedule and Australian Bureau of Statistics data sources. Age and sex specific incidence rate (IR) of plain X-rays per 1,000 Australians, adjusted incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using a negative binomial regression model. RESULTS During the study period, the Australian population over 65 years old increased by 39% while the crude plain X-ray utilisation by this population increased by 63%. Most X-rays were conducted on extremities or the chest. Men used chest radiography more than women, and particularly for lungs, where the incidence increased the most in those ≥ 85 years old. There was an increase in X-rays of extremities and the hip joint between 2009-10 and 2013-14 in people ≥ 85 years old. CONCLUSION The utilisation of plain X-rays of the chest, the gastro-intestinal tract and extremities was high and has increased among older Australians between 2009-10 and 2018-19. Plain X-rays remain a commonly used diagnostic tool for conditions affecting the older population.
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Affiliation(s)
- Virginie Gaget
- Surgical Specialities, University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA, 5011, Australia.
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, Australia.,UniSA Allied Health and Human Movement, University of South Australia, Adelaide, Australia
| | - David R Tivey
- Royal Australasian College of Surgeons, Adelaide, SA, 5001, Australia
| | - Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, Australia
| | - Wendy Babidge
- Surgical Specialities, University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA, 5011, Australia.,Royal Australasian College of Surgeons, Adelaide, SA, 5001, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research With Aged Care Centre (GTRAC), Faculty of Health and Medical Sciences, University of Adelaide, Woodville, SA, 5011, Australia.,Aged & Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville, SA, 5011, Australia
| | - Guy J Maddern
- Surgical Specialities, University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA, 5011, Australia
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39
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Lapa SA, Miftakhov RA, Klochikhina ES, Ammur YI, Blagodatskikh SA, Shershov VE, Zasedatelev AS, Chudinov AV. Development of Multiplex RT-PCR with Immobilized Primers for Identification of Infectious Human Pneumonia Pathogens. Mol Biol 2021; 55:828-838. [PMID: 34955557 PMCID: PMC8682033 DOI: 10.1134/s0026893321040063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/23/2022]
Abstract
A prototype of a system for the detection of infectious human pneumonia pathogens based on multiplex solid-phase reverse transcription PCR (RT-PCR) was developed. Primers were designed to identify the DNA of six bacterial pneumonia pathogen strains, and the RNA of two viral pathogens of pneumonia: influenza A and SARS-CoV-2. The signal accumulation of elongated immobilized primers occurs due to the incorporation of fluorescently labeled nucleotides in the chain. The signal is detected after all the components of the mixture are removed, which significantly reduces the background signal and increases the sensitivity of the analysis. The use of a specialized detector makes it possible to read the signals of elongated primers directly through the transparent cover film of the reaction chamber. This solution is designed to prevent cross-contamination and is suitable for simultaneous testing of a large number of test samples. The proposed platform is able to detect the presence of several pathogens of pneumonia in a sample and has an open architecture that allows expansion of the range of pathogenic bacteria and viruses that can be detected.
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Affiliation(s)
- S A Lapa
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - R A Miftakhov
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - E S Klochikhina
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Yu I Ammur
- Mechnikov Institute of Vaccines and Serums, 105064 Moscow, Russia
| | - S A Blagodatskikh
- Scientific Center of Applied Microbiology and Biotechnology, 142279 Obolensk, Russia
| | - V E Shershov
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - A S Zasedatelev
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - A V Chudinov
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
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Prevalence and Clinical Significance of Occult Pulmonary Infection in Elderly Patients with Type 2 Diabetes Mellitus. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3187388. [PMID: 34901268 PMCID: PMC8660195 DOI: 10.1155/2021/3187388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022]
Abstract
The occult pulmonary infection is the most common complications in elderly patients with type 2 diabetes mellitus (T2DM). Since its etiological characteristics has not been clarified, infection control remains a serious problem for public health. To investigate the prevalence and clinical significance of occult pulmonary infection in elderly T2DM patients, in this study, 573 elderly patients cochallenged with T2DM and community-acquired pulmonary infection from January 2018 to December 2020 were selected in the hospitals and divided into occult pneumonia group (OP, n = 249) and nonoccult pneumonia group (NOP, n = 324) according to the nature of infection. Clinical medical records were analyzed retrospectively to summarize the infection characteristics of elderly diabetics with occult pneumonia. The prevalence of the cases (278/324, 85.8%) in NOP group was not higher than that in OP group (206/249, 82.7%; P > 0.05). Also, there was not significant difference in the distribution of isolated pathogens among the positive patients. The length of hospitalization and mortality of OP patients were significantly higher than those NOP patients. Multivariate logistic regression showed that advanced age, comorbidities, hypothyroidism, senile dementia, and prolonged bed rest were independent risk factors for occult pneumonia in elderly diabetic patients. Therefore, the results demonstrated that the pulmonary infection in elderly patients with diabetes mellitus is often occult. Gram-negative bacteria are the predominant pathogens and cause poor prognosis. Advanced age, comorbidities (senile dementia, hypothyroidism), and prolonged bed rest are the independent risk factors for occult pneumonia.
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Kuo YL, Chou WT, Chu CH. Urban-rural differences in factors affecting mortality and causes of death among older adults. Geriatr Nurs 2021; 43:151-158. [PMID: 34896672 DOI: 10.1016/j.gerinurse.2021.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Abstract
This study examined the differences in factors affecting mortality between urban and rural areas in Taiwan. A retrospective study design was adopted by using the older adult health examination data during 2013-2019 from Hualien, Taiwan. The overall mortality risk in rural areas was significantly higher than urban areas. However, there was no significant difference in the mortality risk between the urban and rural older adults with unhealthy behaviors. Betel nut chewing was a significant risk factor of mortality among the rural older adults, while alcohol consumption was a protective factor; smoking, hepatitis C, and mental illness were significant risk factors among the urban older adults. The rural older adults had a higher rate of death from heart disease and lower rate of death from sepsis than the urban older adults. This study highlights the importance of individualized health promotion strategies for urban and rural areas for reducing mortality from disease.
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Affiliation(s)
- Yu-Lun Kuo
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan, 880, Sec. 2, Chien-Kuo Rd. Hualien, 970, Taiwan (R.O.C.)
| | - Wei-Ting Chou
- Hualien County Health Bureau, Hualien, Taiwan, No.200, Xinxing Rd., Hualien City, Hualien County 970, Taiwan (R.O.C.)
| | - Chia-Hsiang Chu
- Hualien County Health Bureau, Hualien, Taiwan, No.200, Xinxing Rd., Hualien City, Hualien County 970, Taiwan (R.O.C.).
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42
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Choi YR, Chang SO. Nurses' conceptualizations of managing emergencies in nursing homes. Nurs Health Sci 2021; 24:113-122. [PMID: 34741563 DOI: 10.1111/nhs.12900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022]
Abstract
Emergencies can negatively affect the morbidity and mortality of nursing home residents. As nurses employed at nursing homes play a key role in such situations, their conceptualizations of emergency management should be considered to improve care. Accordingly, this study aimed to identify nurses' conceptualizations of managing emergencies in nursing homes. A qualitative research design was conducted using interviews with 20 nurses working in five different nursing homes in the Republic of Korea between September 2019 and August 2020. The data were analyzed using phenomenography. This study identified two main perspectives used by nurses in nursing homes to manage emergencies, depending on the resident's condition: emergency care and daily preventive care. Nurses' conceptualizations of care provided in emergencies were organized under the frames of assessment and intervention, whereas routine care carried out during daily life activities fell under the frame of prevention. This study's findings, which elucidate nurses' complex practical and experiential knowledge, provide insights for the development of emergency management training.
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Affiliation(s)
- Young-Rim Choi
- College of Nursing, Korea University, Seoul, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
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Lv C, Chen Y, Shi W, Pan T, Deng J, Xu J. Comparison of Different Scoring Systems for Prediction of Mortality and ICU Admission in Elderly CAP Population. Clin Interv Aging 2021; 16:1917-1929. [PMID: 34737556 PMCID: PMC8560064 DOI: 10.2147/cia.s335315] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/21/2021] [Indexed: 01/22/2023] Open
Abstract
Background The incidence and mortality rate of community-acquired pneumonia (CAP) in elderly patients were higher than the younger population. Different scoring systems, including The quick Sequential Organ Function Assessment (qSOFA), Combination of Confusion, Urea, Respiratory Rate, Blood Pressure, and Age ≥65 (CURB-65), Modified Early Warning Score (MEWS) and National Early Warning Score (NEWS), were used widely for predicting mortality and ICU admission of patients with community-acquired pneumonia (CAP). This study aimed to identify the most suitable score system for better hospitalization. Methods We retrospectively analyzed elderly patients with CAP in Minhang Hospital, Fudan University from 1 January 2018 to 1 January 2020. We recorded information of the patients including age, gender, underlying disease, consciousness state, vital signs, physiological and laboratory variables and further calculated the qSOFA, CURB-65, MEWS, and NEWS scores. Receiver operating characteristic (ROC) curves were used to predict the mortality risk and ICU admission. Kaplan–Meier survival curves were used in survival rate. Results In total, 1044 patients were selected for analysis and divided into two groups, namely survivor groups (902 cases) and non-survivor groups (142 cases). Depending on ICU admission enrolled patients were classified into ICU admission (n = 102) and non-ICU admission (n = 942) groups. Mortality expressed as AUC values were 0.844 (p < 0.001), 0.868 (p < 0.001), 0.927 (p < 0.001) and 0.892 (p < 0.001) for qSOFA, CURB 65, MEWS and NEWS, respectively. There were clear differences in MEWS vs CURB-65 (p < 0.0001), MEWS vs NEWS (p < 0.001), MEWS vs qSOFA (p < 0.0001). For ICU-admission, the AUC values of qSOFA, CURB-65, MEWS and NEWS scores were 0.866 (p < 0.001), 0.854 (p < 0.001), 0.922 (p < 0.001), 0.976 (p < 0.001), respectively. There were significant differences in NEWS vs CURB-65 (p < 0.0001), NEWS vs MEWS (p < 0.001), NEWS vs qSOFA (p < 0.0001). Conclusion We explored the outcome prediction values of CURB65, qSOFA, MEWS and NEWS for patients aged 65-years and older with community-acquired pneumonia. We found that MEWS showed superiority over the other severity scores in predicting hospital mortality, and NEWS showed superiority over the other scores in predicting ICU admission.
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Affiliation(s)
- Chunxin Lv
- Oncology Department, Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Yue Chen
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, London, EC1M 6BE, UK
| | - Wen Shi
- Department of Dermatology, Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Teng Pan
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Jinhai Deng
- Key Laboratory of Medical Immunology, Department of Immunology, Peking University Center for Human Disease Genomics, Ministry of Health, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People's Republic of China
| | - Jiayi Xu
- Geriatric Department, Fudan University, Minhang Hospital, Shanghai, 201100, People's Republic of China
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Antibiotic Prevalence Study and Factors Influencing Prescription of WHO Watch Category Antibiotic Ceftriaxone in a Tertiary Care Private Not for Profit Hospital in Uganda. Antibiotics (Basel) 2021; 10:antibiotics10101167. [PMID: 34680748 PMCID: PMC8532977 DOI: 10.3390/antibiotics10101167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/28/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Excessive use of ceftriaxone contributes to the emergence and spread of antimicrobial resistance (AMR). In low and middle-income countries, antibiotics are overused but data on consumption are scarcely available. We aimed to determine the prevalence and factors influencing ceftriaxone prescription in a tertiary care private not-for-profit hospital in Uganda. Methods: A cross-sectional study was carried out from October 2019 through May 2020 at Mengo Hospital in Uganda. Patients admitted to the medical ward and who had been prescribed antibiotics were enrolled. Sociodemographic and clinical data were recorded in a structured questionnaire. Bivariate and adjusted logistic regression analyses were performed to determine factors associated with ceftriaxone prescription. Results: Study participants were mostly female (54.7%). The mean age was 56.2 years (SD: 21.42). The majority (187, 73.3%) presented with fever. Out of the 255 participants included in this study, 129 (50.6%) participants were prescribed ceftriaxone. Sixty-five (25.5%) and forty-one (16.0%) participants had a prescription of levofloxacin and metronidazole, respectively. Seven participants (2.7%) had a prescription of meropenem. Out of 129 ceftriaxone prescriptions, 31 (24.0%) were in combination with other antibiotics. Overall, broad-spectrum antibiotic prescriptions accounted for 216 (84.7%) of all prescriptions. Ceftriaxone was commonly prescribed for pneumonia (40/129, 31%) and sepsis (38/129, 29.5%). Dysuria [OR = 0.233, 95% CI (0.07–0.77), p = 0.017] and prophylactic indication [OR = 7.171, 95% CI (1.36–37.83), p = 0.020] were significantly associated with ceftriaxone prescription. Conclusions: Overall, we observed a high prevalence of prescriptions of ceftriaxone at the medical ward of Mengo Hospital. We recommend an antibiotic stewardship program (ASP) to monitor antibiotic prescription and sensitivity patterns in a bid to curb AMR.
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Fernández L, Cima-Cabal MD, Duarte AC, Rodríguez A, García-Suárez MDM, García P. Gram-Positive Pneumonia: Possibilities Offered by Phage Therapy. Antibiotics (Basel) 2021; 10:antibiotics10081000. [PMID: 34439050 PMCID: PMC8388979 DOI: 10.3390/antibiotics10081000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 12/24/2022] Open
Abstract
Pneumonia is an acute pulmonary infection whose high hospitalization and mortality rates can, on occasion, bring healthcare systems to the brink of collapse. Both viral and bacterial pneumonia are uncovering many gaps in our understanding of host–pathogen interactions, and are testing the effectiveness of the currently available antimicrobial strategies. In the case of bacterial pneumonia, the main challenge is antibiotic resistance, which is only expected to increase during the current pandemic due to the widespread use of antibiotics to prevent secondary infections in COVID-19 patients. As a result, alternative therapeutics will be necessary to keep this disease under control. This review evaluates the advantages of phage therapy to treat lung bacterial infections, in particular those caused by the Gram-positive bacteria Streptococcus pneumoniae and Staphylococcus aureus, while also highlighting the regulatory impediments that hamper its clinical use and the difficulties associated with phage research.
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Affiliation(s)
- Lucía Fernández
- Instituto de Productos Lácteos de Asturias (IPLA-CSIC), Paseo Río Linares s/n, 33300 Villaviciosa, Asturias, Spain; (L.F.); (A.C.D.); (A.R.)
- DairySafe Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
| | - María Dolores Cima-Cabal
- Escuela Superior de Ingeniería y Tecnología (ESIT), Universidad Internacional de la Rioja (UNIR), Av. de la Paz, 137, 26006 Logroño, La Rioja, Spain;
| | - Ana Catarina Duarte
- Instituto de Productos Lácteos de Asturias (IPLA-CSIC), Paseo Río Linares s/n, 33300 Villaviciosa, Asturias, Spain; (L.F.); (A.C.D.); (A.R.)
- DairySafe Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
| | - Ana Rodríguez
- Instituto de Productos Lácteos de Asturias (IPLA-CSIC), Paseo Río Linares s/n, 33300 Villaviciosa, Asturias, Spain; (L.F.); (A.C.D.); (A.R.)
- DairySafe Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
| | - María del Mar García-Suárez
- Escuela Superior de Ingeniería y Tecnología (ESIT), Universidad Internacional de la Rioja (UNIR), Av. de la Paz, 137, 26006 Logroño, La Rioja, Spain;
- Correspondence: (M.d.M.G.-S.); (P.G.)
| | - Pilar García
- Instituto de Productos Lácteos de Asturias (IPLA-CSIC), Paseo Río Linares s/n, 33300 Villaviciosa, Asturias, Spain; (L.F.); (A.C.D.); (A.R.)
- DairySafe Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Asturias, Spain
- Correspondence: (M.d.M.G.-S.); (P.G.)
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Nasution A, Khairunnisa K, Sulaiman SAS. Impacts of Pharmacy Intervention on Appropriateness of Antibiotics Use in Pneumonia Patients. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: This study analyzed the impact of pharmacy intervention on appropriateness of antibiotics use in the treatment of inpatients with pneumonia admitted to Universitas Sumatera Utara (USU) Hospital, Medan, Indonesia.
METHODS: This cohort study analyzed appropriateness of antibiotic use in the treatment of in-patients with pneumonia without interventions or baseline group (n = 33) admitted to USU Hospital year 2018 and 3-month period admission with pharmacy intervention (n = 42) year 2019. Characteristics of the patients and antibiotics provided to both groups were descriptively analyzed. The appropriateness of antibiotics use in both groups was analyzed based on their medical conditions, culture and sensitivity tests, and trustable literatures, and then categorized applying Gyssens method regarding dose, intervals, routes, length of provision, effectivity, and costs. The significant difference in inappropriate use of antibiotics between groups with and without interventions was analyzed applying unpaired t-test (p < 0.05 was considered statistically significant).
RESULTS: Most of the pneumonia patients in both groups were male. Mean age of the patients (years) in group: without intervention, 60.20 ± 15.48; with intervention, 60.48 ± 14.76. The three most widely provided antibiotics were ceftriaxone, meropenem, and ciprofloxacin. Incidence of inappropriate use of antibiotics per patient in group: without intervention, 0.66; with intervention, 0.33. The inappropriate use of antibiotics reduced significantly in group with intervention, p = 0.049.
CONCLUSIONS: Pharmacy intervention is crucial to reduce the inappropriate use of antibiotics in the treatment of pneumonia.
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Walkowski W, Bassett J, Bhalla M, Pfeifer BA, Ghanem ENB. Intranasal Vaccine Delivery Technology for Respiratory Tract Disease Application with a Special Emphasis on Pneumococcal Disease. Vaccines (Basel) 2021; 9:vaccines9060589. [PMID: 34199398 PMCID: PMC8230341 DOI: 10.3390/vaccines9060589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/17/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022] Open
Abstract
This mini-review will cover recent trends in intranasal (IN) vaccine delivery as it relates to applications for respiratory tract diseases. The logic and rationale for IN vaccine delivery will be compared to methods and applications accompanying this particular administration route. In addition, we will focus extended discussion on the potential role of IN vaccination in the context of respiratory tract diseases, with a special emphasis on pneumococcal disease. Here, elements of this disease, including its prevalence and impact upon the elderly population, will be viewed from the standpoint of improving health outcomes through vaccine design and delivery technology and how IN administration can play a role in such efforts.
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Affiliation(s)
- William Walkowski
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA; (W.W.); (J.B.); (B.A.P.)
| | - Justin Bassett
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA; (W.W.); (J.B.); (B.A.P.)
| | - Manmeet Bhalla
- Department of Microbiology and Immunology, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA;
| | - Blaine A. Pfeifer
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA; (W.W.); (J.B.); (B.A.P.)
| | - Elsa N. Bou Ghanem
- Department of Microbiology and Immunology, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA;
- Correspondence:
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Moerings BGJ, de Graaff P, Furber M, Witkamp RF, Debets R, Mes JJ, van Bergenhenegouwen J, Govers C. Continuous Exposure to Non-Soluble β-Glucans Induces Trained Immunity in M-CSF-Differentiated Macrophages. Front Immunol 2021; 12:672796. [PMID: 34149707 PMCID: PMC8208035 DOI: 10.3389/fimmu.2021.672796] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
Beta-glucans enable functional reprogramming of innate immune cells, a process defined as "trained immunity", which results in enhanced host responsiveness against primary (training) and/or secondary infections (resilience). Trained immunity holds great promise for promoting immune responses in groups that are at risk (e.g. elderly and patients). In this study, we modified an existing in vitro model for trained immunity by actively inducing monocyte-to-macrophage differentiation using M-CSF and applying continuous exposure. This model reflects mucosal exposure to β-glucans and was used to study the training effects of a variety of soluble or non-soluble β-glucans derived from different sources including oat, mushrooms and yeast. In addition, trained immunity effects were related to pattern recognition receptor usage, to which end, we analyzed β-glucan-mediated Dectin-1 activation. We demonstrated that β-glucans, with different sources and solubilities, induced training and/or resilience effects. Notably, trained immunity significantly correlated with Dectin-1 receptor activation, yet Dectin-1 receptor activation did not perform as a sole predictor for β-glucan-mediated trained immunity. The model, as validated in this study, adds on to the existing in vitro model by specifically investigating macrophage responses and can be applied to select non-digestible dietary polysaccharides and other components for their potential to induce trained immunity.
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Affiliation(s)
- Bart G J Moerings
- Wageningen Food and Biobased Research, Wageningen University & Research, Wageningen, Netherlands.,Nutritional Biology Group, Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Priscilla de Graaff
- Wageningen Food and Biobased Research, Wageningen University & Research, Wageningen, Netherlands.,Laboratory of Tumor Immunology, Department of Medical Oncology, Erasmus Medical Center (MC)-Cancer Institute, Rotterdam, Netherlands
| | | | - Renger F Witkamp
- Nutritional Biology Group, Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Reno Debets
- Laboratory of Tumor Immunology, Department of Medical Oncology, Erasmus Medical Center (MC)-Cancer Institute, Rotterdam, Netherlands
| | - Jurriaan J Mes
- Wageningen Food and Biobased Research, Wageningen University & Research, Wageningen, Netherlands
| | | | - Coen Govers
- Wageningen Food and Biobased Research, Wageningen University & Research, Wageningen, Netherlands.,Cell Biology and Immunology Group, Department of Animal Sciences, Wageningen University & Research, Wageningen, Netherlands
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Theophanous R, Huang W, Ragsdale L. Cardiopulmonary Emergencies in Older Adults. Emerg Med Clin North Am 2021; 39:323-338. [PMID: 33863462 DOI: 10.1016/j.emc.2021.01.010] [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: 01/08/2023]
Abstract
Older adults are susceptible to serious illnesses, including atrial fibrillation, congestive heart failure, pneumonia, and pulmonary embolism. Atrial fibrillation is the most common arrhythmia in this age group and can cause complications such as thromboembolic events and stroke. Congestive heart failure is the most common cause of hospital admission and readmission in the older adult population. Older adults are at higher risk for pulmonary embolism because of age-related changes and comorbidities. Pneumonia is also prevalent and is one of the leading causes of death.
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Affiliation(s)
- Rebecca Theophanous
- Department of Surgery, Division of Emergency Medicine, Duke University Hospital, 2301 Erwin Road, Durham, NC 27710, USA. https://twitter.com/rbectheo
| | - Wennie Huang
- Department of Surgery, Division of Emergency Medicine, Duke University Hospital, 2301 Erwin Road, Durham, NC 27710, USA. https://twitter.com/pharmd_aware
| | - Luna Ragsdale
- Department of Surgery, Division of Emergency Medicine, Duke University Hospital, 2301 Erwin Road, Durham, NC 27710, USA; Emergency Department, Durham VA Health Care System, Durham, NC 27710, USA.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to address the relevant issues surrounding older adults with community-acquired pneumonia (CAP) today. RECENT FINDINGS Approximately 1 million people >65 years have CAP in the US per year, which is more than previously reported (or realized). Older adults are vulnerable to the increasing prevalence of viral CAP, as the SARS-CoV-2 pandemic emphasizes, but pneumococcus is still the most common pathogen to cause CAP. Racial disparities continue to need to be addressed in order to improve early and late outcomes of older adults with CAP. SUMMARY The epidemiology of CAP, specifically for older adults is changing. More recent pathogen incidence studies have included culture, as well as newer microbiological methods to determine etiology. Current disparities among disadvantaged populations, including African-Americans, result in more comorbidities which predisposes to more severe CAP. However, outcomes in the hospital between races tend to be similar, and outcomes between age groups tends to be worse for older compared to younger adults. Finally, the cost of CAP is significant compared to diabetes mellitus, myocardial infarction and stroke.
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