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Kim P, Rothberg MB, Nowacki AS, Yu PC, Gugliotti D, Deshpande A. Derivation and external validation of a prediction model for pneumococcal urinary antigen test positivity in patients with community-acquired pneumonia. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e166. [PMID: 38028917 PMCID: PMC10644161 DOI: 10.1017/ash.2023.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 12/01/2023]
Abstract
Objective Derive and externally validate a prediction model for pneumococcal urinary antigen test (pUAT) positivity. Methods Retrospective cohort study of adults admitted with community-acquired pneumonia (CAP) to 177 U.S. hospitals in the Premier Database (derivation and internal validation samples) or 12 Cleveland Clinic hospitals (external validation sample). We utilized multivariable logistic regression to predict pUAT positivity in the derivation dataset, followed by model performance evaluation in both validation datasets. Potential predictors included demographics, comorbidities, clinical findings, and markers of disease severity. Results Of 198,130 Premier patients admitted with CAP, 27,970 (14.1%) underwent pUAT; 1962 (7.0%) tested positive. The strongest predictors of pUAT positivity were history of pneumococcal infection in the previous year (OR 6.99, 95% CI 4.27-11.46), severe CAP on admission (OR 1.76, 95% CI 1.56-1.98), substance abuse (OR 1.57, 95% CI 1.27-1.93), smoking (OR 1.23, 95% CI 1.09-1.39), and hyponatremia (OR 1.35, 95% CI 1.17-1.55). Negative predictors included IV antibiotic use in past year (OR 0.65, 95% CI 0.52-0.82), congestive heart failure (OR 0.72, 95% CI 0.63-0.83), obesity (OR 0.71, 95% CI 0.60-0.85), and admission from skilled nursing facility (OR 0.60, 95% CI 0.45-0.78). Model c-statistics were 0.60 and 0.67 in the internal and external validation cohorts, respectively. Compared to guideline-recommended testing of severe CAP patients, our model would have detected 23% more cases with 5% fewer tests. Conclusion Readily available data can identify patients most likely to have a positive pUAT. Our model could be incorporated into automated clinical decision support to improve test efficiency and antimicrobial stewardship.
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Affiliation(s)
- Priscilla Kim
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Michael B. Rothberg
- Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amy S. Nowacki
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Pei-Chun Yu
- Vaccine and Infectious Disease and Public Health Sciences Divisions, Fred Hutch Cancer Research Center, Seattle, WA, USA
| | - David Gugliotti
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Abhishek Deshpande
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
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2
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Khaleel M, Samreen S, Sirangi S, Dinesh Eshwar M, R M P, Dhanekula K. Evaluation of a Rapid Urine Antigen Detection Assay as a Point-of-Care Test in the Diagnosis of Community-Acquired Pneumonia. Cureus 2023; 15:e44078. [PMID: 37750146 PMCID: PMC10518050 DOI: 10.7759/cureus.44078] [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] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
Introduction Community-acquired pneumonia (CAP) is among the most common public health problems encountered throughout the world. CAP is a frequent cause of lower respiratory tract infections among children and geriatric-age persons. The etiology of CAP is complex but generally involves infection with bacteria like Streptococcus pneumoniae (S. pneumoniae), which is the most common cause of CAP. The underdiagnosis of CAP due to the limitations of conventional culture methods could be responsible for severe morbidity and mortality, especially among susceptible populations. We evaluated the usefulness of a rapid immunochromatographic test (BinaxNOW™, Abbott, Chicago, IL) that detects S. pneumoniae through a rapid urine antigen test (RUAT) as a point-of-care (POC) diagnostic method in the early detection of CAP. Methods A prospective study was conducted in a university-affiliated teaching hospital between January 2019 and September 2019 (nine months). The study recruited 300 inpatients who revealed signs and symptoms associated with pneumonia. The study was approved by the institutional ethics committee, and all participants provided their voluntary informed consent. Laboratory evaluation included the collection of sputum samples, which were processed for Gram stain and routine culture. Five milliliters of blood were collected from all the subjects for carrying out a blood culture. A urine sample was collected from each participant for the detection of S. pneumoniae through the point-of-care urinary antigen test. Results Of the 300 patients diagnosed with CAP, the S. pneumoniae RUAT was positive in 110 out of 140 cases of pneumococcal pneumoniae (78.57%). The RUAT results were positive for 20 (66.6%) out of 30 bacteremic patients and for 90 (81.8%) out of 110 patients positive for sputum culture. The RUAT was positive in 10 out of 20 cases of pneumonia with an unknown microbial etiology. The overall sensitivity (78.57%), specificity (100%), positive predictive value (100%), negative predictive value (98.88%), and accuracy (90%) of the RUAT were similar to sputum culture results. Conclusion The RUAT has shown comparable efficacy with sputum culture and therefore can be used as a complementary approach to conventional methods in the early diagnosis of CAP caused by S. pneumoniae. Due to its ease of use and rapid results, it could be incorporated as a POC diagnostic test.
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Affiliation(s)
- Mohammed Khaleel
- Microbiology, Mahavir Institute of Medical Sciences, Vikarabad, IND
| | - Sara Samreen
- General Surgery, Deccan College of Medical Sciences, Hyderabad, IND
| | - Saritha Sirangi
- Microbiology, Mahavir Institute of Medical Sciences, Vikarabad, IND
| | | | - Padmaja R M
- Microbiology, Mahavir Institute of Medical Sciences, Vikarabad, IND
| | - Kalyani Dhanekula
- Internal Medicine, Mahavir Institute of Medical Sciences, Vikarabad, IND
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3
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Lansbury L, Lim B, McKeever TM, Lawrence H, Lim WS. Non-invasive pneumococcal pneumonia due to vaccine serotypes: A systematic review and meta-analysis. EClinicalMedicine 2022; 44:101271. [PMID: 35112072 PMCID: PMC8790487 DOI: 10.1016/j.eclinm.2022.101271] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Non-invasive pneumococcal pneumonia causes significant morbidity and mortality in older adults. Understanding pneumococcal sero-epidemiology in adults ≥50 years is necessary to inform vaccination policies and the updating of pneumococcal vaccines. METHODS We conducted a systematic review and random-effects meta-analysis to determine the proportion of community-acquired pneumonia (CAP) in people ≥50 years due to pneumococcus and the proportion caused by pneumococcal vaccine serotypes. We searched MEDLINE, EMBASE and PubMed from 1 January 1990 to 30 March 2021. Heterogeneity was explored by subgroup analysis according to a) patient group (stratified versus age) and depth of testing, b) detection/serotyping method, and c) continent. The protocol is registered with PROSPERO (CRD42020192002). FINDINGS Twenty-eight studies were included (34,216 patients). In the period 1-5 years after introduction of childhood PCV10/13 immunisation, 18% of CAP cases (95% CI 13-24%) were attributable to pneumococcus, with 49% (43-54%) of pneumococcal CAP due to PCV13 serotypes. The estimated proportion of pneumococcal CAP was highest in one study that used 24-valent serotype-specific urinary-antigen detection (ss-UAD)(30% [28-31%]), followed by studies based on diagnostic serology (28% [24-33%]), PCR (26% [15-37%]), ss-UAD14 (17% [13-22%]), and culture alone (14% [10-19%]). A higher estimate was observed in Europe (26% [21-30%] than North America (11% [9-12%](p<0·001). PCV13-serotype estimates were also influenced by serotyping methods. INTERPRETATION Non-invasive pneumococcal CAP and vaccine-type pneumococcal CAP remains a burden in older adults despite widespread introduction of pneumococcal infant immunisation. Studies heavily reliant on ss-UADs restricted to vaccine-type serotypes may overestimate the proportion of potentially vaccine-preventable pneumococcal pneumonia. Sero-epidemiological data from low-income countries are lacking.
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Affiliation(s)
- Louise Lansbury
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
- Corresponding author at: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, NG5 1PB, United Kingdom.
| | - Benjamin Lim
- Faculty of Biology (School of Medicine), University of Cambridge, Cambridge, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
| | - Hannah Lawrence
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Wei Shen Lim
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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4
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Dirkx KKT, Mulder B, Post AS, Rutten MH, Swanink CMA, Wertheim HFL, Cremers AJH. The drop in reported invasive pneumococcal disease among adults during the first COVID-19 wave in the Netherlands explained. Int J Infect Dis 2021; 111:196-203. [PMID: 34455081 PMCID: PMC8444629 DOI: 10.1016/j.ijid.2021.08.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 01/28/2023] Open
Abstract
Objectives: Streptococcus pneumoniae is the leading bacterial pathogen causing respiratory infections. Since the COVID-19 pandemic emerged, less invasive pneumococcal disease (IPD) was identified by surveillance systems worldwide. Measures to prevent transmission of SARS-CoV-2 also reduce transmission of pneumococci, but this would gradually lead to lower disease rates. Design: Here, we explore additional factors contributing to the instant drop in pneumococcal disease cases captured in surveillance. Results: Our observations on referral practices and other impediments to diagnostic testing indicate that residual IPD has likely occurred but remained undetected by conventional hospital-based surveillance. Conclusions: Depending on the setting, we discuss alternative monitoring strategies that could improve understanding of pneumococcal disease dynamics.
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Affiliation(s)
- Kirsten K T Dirkx
- Department of Clinical Microbiology and Infectious Diseases, Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; Department of Clinical Microbiology, Radboud Centre for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| | - Bert Mulder
- Department of Clinical Microbiology and Infectious Diseases, Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Annelies S Post
- Department of Clinical Microbiology and Infectious Diseases, Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Martijn H Rutten
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Caroline M A Swanink
- Department of Clinical Microbiology and Immunology, Rijnstate, Arnhem, the Netherlands
| | - Heiman F L Wertheim
- Department of Clinical Microbiology, Radboud Centre for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| | - Amelieke J H Cremers
- Department of Clinical Microbiology, Radboud Centre for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
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Ito A, Ishida T, Tachibana H, Nakanishi Y, Yamazaki A, Washio Y. Time Trend of the Sensitivity of the Pneumococcal Urinary Antigen Test for Diagnosing Pneumococcal Community-Acquired Pneumonia: An Analysis of 15-Year, Prospective Cohort Data. Infect Dis Ther 2021; 10:2309-2322. [PMID: 34339026 PMCID: PMC8572932 DOI: 10.1007/s40121-021-00508-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Whether the sensitivity of the BinaxNOW Streptococcus pneumoniae urinary antigen test kit (BinaxNOW), adjusted by some variables including vital signs, laboratory examinations and pneumonia severity, has been decreasing is unknown. The aim of the present study was to investigate whether BinaxNOW sensitivity has decreased recently and to identify the predictors of the BinaxNOW result, including the time trend. Methods This prospective cohort study enrolled consecutive patients with pneumococcal community-acquired pneumonia who were hospitalised at Kurashiki Central Hospital from January 2001 to December 2015. Pneumococcal community-acquired pneumonia was defined as positive blood or pleural effusion or sputum culture results. To evaluate the effect of the time trend for the sensitivity of BinaxNOW, time series regression analysis was performed. In addition, predictors of the BinaxNOW result were examined by multivariable analysis using variables such as sex, vital signs, blood tests such as C-reactive protein, albumin, blood urea nitrogen, creatinine, white blood cell count, haematocrit and platelets, antibiotic pre-treatment, bacteraemia, and pneumonia severity, in addition to time trend and seasonality. Results A total of 446 patients were included. BinaxNOW sensitivity showed a significant, gradual decrease from 2001 (81.3%) to 2015 (48.7%). On multivariable analysis [odds ratio (95% confidence interval)], bacteraemia [2.516 (1.387–4.561), P = 0.002] was a predictor of a positive BinaxNOW result, whereas male sex [0.467 (0.296–0.736), P = 0.001], white blood cell count [0.959 (0.930–0.989), P = 0.008] and the time trend per year [0.900 (0.859–0.943), P < 0.001] were predictors of a negative BinaxNOW result. Conclusions The sensitivity of BinaxNOW decreased over a 15-year period. We should be careful when interpreting BinaxNOW results in daily clinical practice, and the development of a new kit with good sensitivity is anticipated. Trial registration number UMIN000004353.
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hiromasa Tachibana
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.,Department of Respiratory Medicine, National Hospital Organization Minami Kyoto Hospital, 11 Nakaashihara, Joyo, Kyoto, Japan
| | - Yosuke Nakanishi
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Akio Yamazaki
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.,Department of Respiratory Medicine, Shiga University of Medical Science, Tsukinowa Seta-Cho, Otsu, Shiga, Japan
| | - Yasuyoshi Washio
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.,Graduate School of Medical Sciences, Research Institute for Diseases of the Chest, Kyushu University, 3-1-1 Higashiku, Maidashi, Fukuoka, Japan
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6
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Bellew S, Grijalva CG, Williams DJ, Anderson EJ, Wunderink RG, Zhu Y, Waterer GW, Bramley AM, Jain S, Edwards KM, Self WH. Pneumococcal and Legionella Urinary Antigen Tests in Community-acquired Pneumonia: Prospective Evaluation of Indications for Testing. Clin Infect Dis 2019; 68:2026-2033. [PMID: 30265290 PMCID: PMC7182343 DOI: 10.1093/cid/ciy826] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/26/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adult, community-acquired pneumonia (CAP) guidelines from the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) include indications for urinary antigen tests (UATs) for Streptococcus pneumoniae (SP) and Legionella pneumophila (LP). These recommendations were based on expert opinions and have not been rigorously evaluated. METHODS We used data from a multicenter, prospective, surveillance study of adults hospitalized with CAP to evaluate the sensitivity and specificity of the IDSA/ATS UAT indications for identifying patients who test positive. SP and LP UATs were completed on all included patients. Separate analyses were completed for SP and LP, using 2-by-2 contingency tables, comparing the IDSA/ATS indications (UAT recommended vs not recommended) and UAT results (positive vs negative). Additionally, logistic regression was used to evaluate the association of each individual criterion in the IDSA/ATS indications with positive UAT results. RESULTS Among 1941 patients, UATs were positive for SP in 81 (4.2%) and for LP in 32 (1.6%). IDSA/ATS indications had 61% sensitivity (95% confidence interval [CI] 49-71%) and 39% specificity (95% CI 37-41%) for SP, and 63% sensitivity (95% CI 44-79%) and 35% specificity (95% CI 33-37%) for LP. No clinical characteristics were strongly associated with positive SP UATs, while features associated with positive LP UATs were hyponatremia, fever, diarrhea, and recent travel. CONCLUSIONS Recommended indications for SP and LP urinary antigen testing in the IDSA/ATS CAP guidelines have poor sensitivity and specificity for identifying patients with positive tests; future CAP guidelines should consider other strategies for determining which patients should undergo urinary antigen testing.
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Affiliation(s)
- Shawna Bellew
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | - Yuwei Zhu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Anna M Bramley
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Seema Jain
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, Tennessee
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7
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Viasus D, Calatayud L, McBrown MV, Ardanuy C, Carratalà J. Urinary antigen testing in community-acquired pneumonia in adults: an update. Expert Rev Anti Infect Ther 2019; 17:107-115. [PMID: 30618315 DOI: 10.1080/14787210.2019.1565994] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) continues to be a leading cause of hospitalization and mortality worldwide. Streptococcus pneumoniae and Legionella pneumophila remain the major etiological agents and are responsible for a significant proportion of CAP mortality. Among diagnostic tests for CAP, urine antigen detection of S. pneumoniae and L. pneumophila is widely accepted due to the simplicity of collection and the rapidity of the test results. Areas covered: This comprehensive review outlines the urinary antigen tests available, discusses their sensitivity and specificity, and assesses the usefulness of their results as the basis for targeted therapy. Expert commentary: There have been advances in urine antigen detection tests for patients with CAP. New methodologies show greater sensitivity, detect S. pneumoniae and L. pneumophila in a single test, and also detect pneumococcal serotypes. In addition, urine antigen detection tests have shown a high specificity, which means that a positive result practically indicates the causative pathogen of CAP. Therefore, a positive result can lead to a targeted therapy that is likely to improve patient outcomes and reduce the risk of resistance and adverse events. However, well-designed studies are needed to evaluate the usefulness of urine antigen detection tests with regard to clinical outcomes.
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Affiliation(s)
- Diego Viasus
- a Department of Medicine, Health Sciences Division , Universidad del Norte and Hospital Universidad del Norte , Barranquilla , Colombia
| | - Laura Calatayud
- b Department of Microbiology , Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), University of Barcelona , Barcelona , Spain.,c Research Network for Respiratory Diseases (CIBERES) , Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
| | - María V McBrown
- a Department of Medicine, Health Sciences Division , Universidad del Norte and Hospital Universidad del Norte , Barranquilla , Colombia
| | - Carmen Ardanuy
- b Department of Microbiology , Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), University of Barcelona , Barcelona , Spain.,c Research Network for Respiratory Diseases (CIBERES) , Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
| | - Jordi Carratalà
- d Department of Infectious Diseases , Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), University of Barcelona , Barcelona , Spain.,e Spanish Network for Research in Infectious Diseases (REIPI) , Instituto de Salud Carlos III (ISCIII) , Madrid , Spain
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8
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Heo JY, Song JY. Disease Burden and Etiologic Distribution of Community-Acquired Pneumonia in Adults: Evolving Epidemiology in the Era of Pneumococcal Conjugate Vaccines. Infect Chemother 2018; 50:287-300. [PMID: 30600652 PMCID: PMC6312904 DOI: 10.3947/ic.2018.50.4.287] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Indexed: 12/23/2022] Open
Abstract
Pneumonia is the leading cause of morbidity and mortality, particularly in old adults. The incidence and etiologic distribution of community-acquired pneumonia is variable both geographically and temporally, and epidemiology might evolve with the change of population characteristics and vaccine uptake rates. With the increasing prevalence of chronic medical conditions, a wide spectrum of healthcare-associated pneumonia could also affect the epidemiology of community-acquired pneumonia. Here, we provide an overview of the epidemiological changes associated with community-acquired pneumonia over the decades since pneumococcal conjugate vaccine introduction.
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Affiliation(s)
- Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Asian Pacific Influenza Institute, Korea University College of Medicine, Seoul, Korea.
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9
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Choi MJ, Kang SO, Oh JJ, Park SB, Kim MJ, Cheong HJ. Cost-effectiveness analysis of 13-valent pneumococcal conjugate vaccine versus 23-valent pneumococcal polysaccharide vaccine in an adult population in South Korea. Hum Vaccin Immunother 2018; 14:1914-1922. [PMID: 29953307 PMCID: PMC6149703 DOI: 10.1080/21645515.2018.1456602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/07/2018] [Accepted: 03/18/2018] [Indexed: 10/28/2022] Open
Abstract
In South Korea, the National Immunization Program offers a 23-valent pneumococcal polysaccharide vaccine (PPSV23) for the elderly; however, the 13-valent pneumococcal conjugate vaccine (PCV13) is not included, and vaccination is not offered to younger, at-risk populations. This study offers a comparative analysis of PCV13 and PPSV23 in Korea's adults, stratified by age and risk group. A Markov model with a lifetime horizon was developed from the healthcare perspective. Data sources included the Health Insurance Review & Assessment Service, Korea Centre for Disease Control & Prevention and Korean medical institutions. An expert panel tested data validity. The CAPiTA trial and Cochrane meta-analysis were used to obtain vaccine effectiveness data. Regardless of co-morbidity, when the sequential PCV13-PPSV23 strategy was compared to that using PPSV23-only, in elderly populations, the incremental cost-effectiveness ratio (ICER) was 3,300 USD per quality-adjusted life years (QALY). For the risk group aged ≥65 years, the ICER of the addition of PCV13 over the existing PPSV23-only strategy was 3,404 USD/QALY. However, on replacing PPSV23 with PCV13, for all elderly populations, an ICER of 1,421 USD/QALY resulted; for the risk group aged ≥65 years, the ICER was 1,736 USD/QALY. For the 18-64 year-old risk group, the sequential PCV13-PPSV23 strategy yielded an ICER of 3,629 USD/QALY over the PPSV23-only strategy, and 6,643 USD/QALY compared to no vaccination. Thus, the PCV13→PPSV23 combination strategy for elderly populations was found to be a cost-effective alternative to the current National Immunization Program regardless of co-morbidity. This finding was the same as that for younger, at-risk populations.
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Affiliation(s)
- Min-Joo Choi
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | | | | | | | - Min-Ja Kim
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee-Jin Cheong
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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10
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Abrard S, Cousin B, Reydel T, Ammi M, Beydon L. Pneumococcal urinary antigen test: A tool for pneumococcal aortitis diagnosis? IDCases 2018; 14:e00415. [PMID: 29998060 PMCID: PMC6037901 DOI: 10.1016/j.idcr.2018.e00415] [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: 03/26/2018] [Revised: 05/18/2018] [Accepted: 06/26/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Aortitis is rare. The etiological diagnosis is difficult but essential for treatment. Even with appropriate treatment mortality remains high. We present a case of pneumococcal aortitis followed by a brief review of the literature. Presentation of Case In this case, the aortic disease was characterized by multiple inflammatory aneurysms. Blood cultures were negative but urine was tested for the presence of pneumococcal urinary antigen postoperatively was positive. Treatment consisted of antibacterial therapy and both surgical and endovascular procedures. The patient was discharged and is well. Discussion Preoperative determination of etiology is crucial in implementing a specific treatment. Pneumococcus is a common bacterium in infectious aortitis. Identification of the causative microbe is necessary to guide antimicrobial therapy. Blood cultures are frequently sterile. The pneumococcal urinary antigen test may be more sensitive than blood cultures, as is the case in pneumococcal pneumonia. Conclusions The pneumococcal urinary antigen test may was a useful diagnostic tool in establishing the cause for aortitis in this case. Its potential value should be assessed in furthers studies.
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Affiliation(s)
- Stanislas Abrard
- Département d’Anesthésie Réanimation, Anesthesiology and Intensive Care Department, Centre Hospitalier Universitaire d’Angers, Angers University Hospital, 4 Rue Larrey, 49100 Angers, France
| | - Benoit Cousin
- Département d’Anesthésie Réanimation, Anesthesiology and Intensive Care Department, Centre Hospitalier Universitaire d’Angers, Angers University Hospital, 4 Rue Larrey, 49100 Angers, France
| | - Thomas Reydel
- Département d’Anesthésie Réanimation, Anesthesiology and Intensive Care Department, Centre Hospitalier Universitaire d’Angers, Angers University Hospital, 4 Rue Larrey, 49100 Angers, France
| | - Myriam Ammi
- Département de Chirurgie Vasculaire et Thoracique, Department of Vascular and Thoracic Surgery, Centre Hospitalier Universitaire d’Angers, Angers University Hospital, 4 Rue Larrey, 49100 Angers, France
| | - Laurent Beydon
- Département d’Anesthésie Réanimation, Anesthesiology and Intensive Care Department, Centre Hospitalier Universitaire d’Angers, Angers University Hospital, 4 Rue Larrey, 49100 Angers, France
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Lee MS, Oh JY, Kang CI, Kim ES, Park S, Rhee CK, Jung JY, Jo KW, Heo EY, Park DA, Suh GY, Kiem S. Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia. Infect Chemother 2018; 50:160-198. [PMID: 29968985 PMCID: PMC6031596 DOI: 10.3947/ic.2018.50.2.160] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 01/07/2023] Open
Abstract
Community-acquired pneumonia is common and important infectious disease in adults. This work represents an update to 2009 treatment guideline for community-acquired pneumonia in Korea. The present clinical practice guideline provides revised recommendations on the appropriate diagnosis, treatment, and prevention of community-acquired pneumonia in adults aged 19 years or older, taking into account the current situation regarding community-acquired pneumonia in Korea. This guideline may help reduce the difference in the level of treatment between medical institutions and medical staff, and enable efficient treatment. It may also reduce antibiotic resistance by preventing antibiotic misuse against acute lower respiratory tract infection in Korea.
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Affiliation(s)
- Mi Suk Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jee Youn Oh
- Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol In Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Ye Jung
- Division of Pulmonology, The Institute of Chest Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Wook Jo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sungmin Kiem
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
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12
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Heo JY, Seo YB, Choi WS, Lee J, Yoon JG, Lee SN, Choi MJ, Noh JY, Ahn JY, Jeong HW, Cheong HJ, Kim WJ, Lee HY, Song JY. Incidence and case fatality rates of community-acquired pneumonia and pneumococcal diseases among Korean adults: Catchment population-based analysis. PLoS One 2018; 13:e0194598. [PMID: 29596444 PMCID: PMC5875769 DOI: 10.1371/journal.pone.0194598] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 02/20/2018] [Indexed: 11/21/2022] Open
Abstract
Background Pneumonia is a leading infectious cause of morbidity and mortality among adults. Pneumococcal pneumonia (PP) is the most common vaccine-preventable bacterial etiology of pneumonia. In this study, we estimated the incidence of community-acquired pneumonia (CAP) and pneumococcal diseases among Korean adults. Methods Clinical and microbiological databases from three hospitals were retrospectively reviewed to determine the incidence and case fatality rates of CAP and pneumococcal diseases in Korean adults aged ≥19 years from 2011 to 2014. Incidence and case fatality rates of CAP, PP and invasive pneumococcal diseases (IPD) were evaluated based on the catchment population. Catchment population was calculated using national health insurance data, estimating the proportion of patients with pneumonia that were medically attended at each hospital. Results Among 5,783 patients with medically attended CAP, 833 (14.4%) had PP. For IPD, a total of 91 culture-confirmed cases were identified. The overall incidence of CAP was 307.7 cases per 100,000 persons per year with an in-hospital mortality rate of 6.2%. The estimated annual incidence of pneumococcal pneumonia was 42.2–49.4 cases per 100,000 persons per year, increasing with age to >280 per 100,000 persons per year in older patients over 70 years. The annual incidence of IPD had a range of 4.1–6.5 cases per 100,000 persons per year. The overall case fatality rate for invasive pneumococcal diseases was 30.8% with the highest rate of 66.7% in patients over 80 years. Conclusion Over the study period, incidences of CAP, PP and IPD were consistently high, particularly in older people. These results provide baseline data to establish healthcare strategies and estimate their impact among Korean adults.
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Affiliation(s)
- Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Jin Gu Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Saem Na Lee
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Joo Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Asian Pacific Influenza Institute (APII), Korea University Guro Hospital, Seoul, Korea
| | - Jin-Young Ahn
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hye Won Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- Division of Infectious Diseases, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Asian Pacific Influenza Institute (APII), Korea University Guro Hospital, Seoul, Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Asian Pacific Influenza Institute (APII), Korea University Guro Hospital, Seoul, Korea
| | - Hee Young Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- * E-mail: (HYL); (JYS)
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- Asian Pacific Influenza Institute (APII), Korea University Guro Hospital, Seoul, Korea
- * E-mail: (HYL); (JYS)
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13
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Dinh A, Duran C, Davido B, Lagrange A, Sivadon-Tardy V, Bouchand F, Beauchet A, Gaillard JL, Beaune S, Salomon J, Grenet J. Cost effectiveness of pneumococcal urinary antigen in Emergency Department: a pragmatic real-life study. Intern Emerg Med 2018; 13:69-73. [PMID: 27988829 DOI: 10.1007/s11739-016-1586-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/30/2016] [Indexed: 01/23/2023]
Abstract
Community-acquired pneumonia (CAP) is frequent and can be life-threatening. Streptococcus pneumoniae is the main bacteria involved, and is susceptible to penicillin A. Rapid microbiological diagnosis could then help reduce the antimicrobial spectrum. The pneumococcal urinary antigen (PUA) test is fast and easy to perform, but its impact on antimicrobial prescription and cost-effectiveness in emergency departments (ED) is not well known. We performed a pragmatic real life retrospective study in an adult ED to assess its usefulness: proportion of positive results, impact on antimicrobial prescriptions and cost-effectiveness. Over 3 years (from January 1st 2012 to December 31st 2014), 979 PUA tests were reutilized in our ED among 1224 patients who consulted for CAP; 51 (5.2%) were positive. Among them, 10 led to a modification of the antimicrobial treatment, but only 7 (14.3%) were in accordance with the results. The total cost of a PUA test is 27€. As only 7 PUA tests led to appropriate antimicrobial modification, we deemed that 972 had no impact, and the potential cost savings, if the test had not been used, would have been 26,244 € (972 × 27) during 3 years, that is 8748 € per year. Thus, it seems that the PUA test should not be generally used in the ED considering its low rate of positivity and the difficulties for physicians to adapt antibiotic treatment accordingly. This attitude change in utilization would lead to substantial cost savings.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France.
| | - Clara Duran
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Benjamin Davido
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Aurore Lagrange
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Valérie Sivadon-Tardy
- Microbiology Laboratory, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Frédérique Bouchand
- Pharmacy Department, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, Garches, France
| | - Alain Beauchet
- IT Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Jean-Louis Gaillard
- Microbiology Laboratory, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Sébastien Beaune
- Emergency Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
| | - Jérôme Salomon
- Infectious Disease Unit, University Hospital Raymond Poincaré, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Julie Grenet
- Emergency Department, University Hospital Ambroise Paré, AP-HP, Versailles Saint-Quentin University, Boulogne-Billancourt, France
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14
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Choi MJ, Song JY, Noh JY, Yoon JG, Lee SN, Heo JY, Yoon JW, Jo YM, Cheong HJ, Kim WJ. Disease burden of hospitalized community-acquired pneumonia in South Korea: Analysis based on age and underlying medical conditions. Medicine (Baltimore) 2017; 96:e8429. [PMID: 29095281 PMCID: PMC5682800 DOI: 10.1097/md.0000000000008429] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Pneumonia is a leading cause of hospitalization and mortality worldwide. Despite recognition of the importance of community-acquired pneumonia (CAP) in adults, limited epidemiologic information is available in South Korea. This study aimed to evaluate the disease burden of hospitalized CAP in adults aged ≥19 years and its epidemiologic trend using Health Insurance and Review Assessment (HIRA) data.This is a retrospective study using the HIRA database from year 2009 to 2013. We estimated the incidence rate and direct medical cost of hospitalized CAP in adults aged ≥19 years in South Korea. These were further analyzed with respect to age and underlying medical conditions.During 2009 to 2013, 1216,916 hospitalizations were recorded. On average, the annual age-adjusted incidence rate of hospitalized CAP was 626 per 100,000 persons, with the rate increasing with age. When stratified by age- and risk groups, elderly people ≥75 years showed the highest incidence rate of hospitalized CAP over 5-year study periods. With respect to the risk groups based on underlying medical conditions, incidence rate ratios were 2.04 to 5.86 for the high-risk group versus the low-risk group and 1.28 to 5.49 for the moderate-risk group versus the low-risk group. Overall, mean direct medical cost for hospitalized CAP was 1851 USD per capita during the 5-year period: 1263 USD in the low-risk group, 2353 USD in the moderate-risk group, and 2841 USD in the high-risk group.This study shows that the incidence and medical cost of hospitalized CAP were consistently high over the 5-year study period. In particular, elderly people and adults with underlying medical conditions were at increased risk for hospitalized CAP.
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Affiliation(s)
- Min Joo Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine
- Asian Pacific Influenza Institute, Seoul
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine
- Asian Pacific Influenza Institute, Seoul
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine
- Asian Pacific Influenza Institute, Seoul
| | - Jin Gu Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine
| | - Saem Na Lee
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine
| | - Jung Yeon Heo
- Division of Infectious Diseases, Department of Internal Medicine, Chungbuk National University College of Medicine
- Division of Infectious Diseases, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jae Won Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine
| | - Yu Mi Jo
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine
- Asian Pacific Influenza Institute, Seoul
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine
- Asian Pacific Influenza Institute, Seoul
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15
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Abstract
Bacterial pneumonias exact unacceptable morbidity on patients with cancer. Although the risk is often most pronounced among patients with treatment-induced cytopenias, the numerous contributors to life-threatening pneumonias in cancer populations range from derangements of lung architecture and swallow function to complex immune defects associated with cytotoxic therapies and graft-versus-host disease. These structural and immunologic abnormalities often make the diagnosis of pneumonia challenging in patients with cancer and impact the composition and duration of therapy. This article addresses host factors that contribute to pneumonia susceptibility, summarizes diagnostic recommendations, and reviews current guidelines for management of bacterial pneumonia in patients with cancer.
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Affiliation(s)
- Justin L Wong
- Division of Internal Medicine, Department of Pulmonary, Critical Care and Sleep Medicine, The University of Texas Health Sciences Center, 6431 Fannin Street, MSB 1.434, Houston, TX 77030, USA
| | - Scott E Evans
- Division of Internal Medicine, Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1100, Houston, TX 77030, USA.
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