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Bergbrant S, Sundell N, Andersson LM, Lindh M, Gustavsson L, Westin J. Syndromic testing for respiratory pathogens but not National Early Warning Score can be used to identify viral cause in hospitalised adults with lower respiratory tract infections. Infect Dis (Lond) 2024; 56:554-563. [PMID: 38564409 DOI: 10.1080/23744235.2024.2333973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Community-acquired lower respiratory tract infection (LRTI) is a common reason for hospitalisation. Antibiotics are frequently used while diagnostic microbiological methods are underutilised in the acute setting. OBJECTIVES We aimed to investigate the relative proportion of viral and bacterial infections in this patient group and explore methods for proper targeting of antimicrobial therapy. METHODS We collected nasopharyngeal samples prospectively from adults hospitalised with LRTIs during three consecutive winter seasons (2016-2019). Syndromic nasopharyngeal testing was performed using a multiplex PCR panel including 16 viruses and four bacteria. Medical records were reviewed for clinical data. RESULTS Out of 220 included patients, a viral pathogen was detected in 74 (34%), a bacterial pathogen in 63 (39%), both viral and bacterial pathogens in 49 (22%), while the aetiology remained unknown in 34 (15%) cases. The proportion of infections with an identified pathogen increased from 38% to 85% when syndromic testing was added to standard-of-care testing. Viral infections were associated with a low CRP level and absence of pulmonary infiltrates. A high National Early Warning Score did not predict bacterial infections. CONCLUSIONS Syndromic testing by a multiplex PCR panel identified a viral infection or viral/bacterial coinfection in a majority of hospitalised adult patients with community-acquired LRTIs.
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Affiliation(s)
- Susanna Bergbrant
- Department of Medicine Geriatrics and Emergency Medicine, Östra Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nicklas Sundell
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars-Magnus Andersson
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Gustavsson
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Westin
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
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2
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Petrie JG, Moore R, Lauring AS, Kaye KS. Incidence and outcomes of hospital-associated respiratory virus infections by viral species. Infect Control Hosp Epidemiol 2024; 45:618-629. [PMID: 38073596 PMCID: PMC11031349 DOI: 10.1017/ice.2023.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Although the incidence of hospital-associated respiratory virus infection (HARVI) is well recognized, the risk factors for infection and impact on patient outcomes are not well characterized. METHODS We identified a cohort of all inpatient admissions ≥24 hours duration at a single academic medical center from 2017 to 2020. HARVI were defined as respiratory virus detected in a test ordered after the 95th percentile of the virus-specific incubation period. Risk factors for HARVI were assessed using Cox proportional hazards models of the competing outcomes of HARVI and discharge. The associations between time-varying HARVI status and the rates of ICU admission, discharge, and in-hospital death were estimated using Cox-proportional hazards models in a competing risk framework. RESULTS HARVI incidences were 8.8 and 3.0 per 10,000 admission days for pediatric and adult patients, respectively. For adults, congestive heart failure, renal disease, and cancer increased HARVI risk independent of their associations with length of stay. HARVI risk was also elevated for patients admitted in September-June relative to July admissions. For pediatric patients, cardiovascular and respiratory conditions, cancer, medical device dependence, and admission in December increased HARVI risk. Lengths of stay were longer for adults with HARVI compared to those without, and hospital-associated influenza A was associated with increased risk of death. Rates of ICU admission were increased in the 5 days after HARVI identification for adult and pediatric patients. HARVI was not associated with length of stay or death among pediatric patients. CONCLUSIONS HARVI is associated chronic health conditions and increases morbidity and mortality.
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Affiliation(s)
- Joshua G. Petrie
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Riley Moore
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Adam S. Lauring
- Department of Microbiology and Immunology and Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Keith S. Kaye
- Division of Allergy, Immunology and Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
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3
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Levin S, Mayer D, Puius YA, Arora S, Gileles-Hillel A. Things We Do for No Reason™: Routine respiratory pathogen panels for emergency department and hospitalized patients. J Hosp Med 2024. [PMID: 38599820 DOI: 10.1002/jhm.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 03/20/2024] [Accepted: 03/31/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Samara Levin
- Division of General Internal Medicine, Section of Hospital Medicine, Weill Cornell Medicine, New York, New York, USA
| | - David Mayer
- Pediatric Division, Hadassah Medical Center, & Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Yoram A Puius
- Division of Infectious Diseases, Department of Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Shitij Arora
- Division of Hospital Medicine, Department of Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Alex Gileles-Hillel
- Pediatric Division, Hadassah Medical Center, & Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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4
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El Zakhem A, Mahmoud O, Bou Fakhreddine H, Mahfouz R, Bouakl I. Patterns and predictors of positive multiplex polymerase chain reaction respiratory panel among patients with acute respiratory infections in a single center in Lebanon. Mol Biol Rep 2024; 51:346. [PMID: 38401017 DOI: 10.1007/s11033-023-09133-6] [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: 07/26/2023] [Accepted: 12/08/2023] [Indexed: 02/26/2024]
Abstract
BACKGROUND Infectious agents associated with community-acquired acute respiratory infections (ARIs) remain understudied in Lebanon. We aim to assess the microbiological profiles of ARIs by employing polymerase chain reaction (PCR) and identifying predictors of positive PCR results among patients admitted for ARI. METHODS AND RESULTS We conducted a retrospective single-center study at the American University of Beirut Medical Center, including all respiratory PCR panels performed on pediatric (< 18) and adult (≥ 18) patients presenting with an ARI from January 2015 to March 2018, prior to the onset of the COVID-19 pandemic. We aimed to identify the epidemiological patterns of ARIs and the factors associated with positive PCRs in both adult and pediatric patients. Among 281 respiratory PCRs, 168 (59.7%) were positive for at least one pathogen, with 54.1% positive PCR for viruses, 7.8% for bacteria species, and 3.9% with virus-bacteria codetection. Almost 60% of the patients received antibiotics prior to PCR testing. PCR panels yielded more positive results in pediatric patients than in adults (P = 0.005). Bacterial detection was more common in adults compared to pediatrics (P < 0.001). The most common organism recovered in the entire population was Human Rhinovirus (RhV) (18.5%). Patients with pleural effusion on chest CT were less likely to have a positive PCR (95% Cl: 0.22-0.99). On multivariate analysis, pediatric age group (P < 0.001), stem cell transplant (P = 0.006), fever (P = 0.03) and UTRI symptoms (P = 0.004) were all predictive of a positive viral PCR. CONCLUSION Understanding the local epidemiology of ARI is crucial for proper antimicrobial stewardship. The identification of factors associated with positive respiratory PCR enhances our understanding of clinical characteristics and potential predictors of viral detection in our population.
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Affiliation(s)
- Aline El Zakhem
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, 110236, Lebanon
| | - Omar Mahmoud
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, 110236, Lebanon
| | - Hisham Bou Fakhreddine
- Division of Pulmonary and Critical Care, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Mahfouz
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad Bouakl
- Division of Pulmonary and Critical Care, American University of Beirut Medical Center, Beirut, Lebanon.
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5
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Wallick C, To TM, Korom S, Masters H, Wu N, Moawad D, Hanania NA. Impact of antiviral therapy on short- and long-term outcomes of patients with chronic obstructive pulmonary disease after influenza infection. Influenza Other Respir Viruses 2023; 17:e13231. [PMID: 38098649 PMCID: PMC10719080 DOI: 10.1111/irv.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
Background Respiratory complications often accompany influenza in patients with chronic obstructive pulmonary disease (COPD). In this retrospective study, we quantified the impact of antiviral therapy on exacerbations, healthcare resource utilization (HRU), and costs in patients with COPD across 5 influenza seasons. Methods Using claims data from US MarketScan® databases, we identified patients with COPD who had an influenza diagnosis during the 2012-2016 influenza seasons. Patients who received a neuraminidase inhibitor within 48 h of diagnosis (N = 4134) were identified and propensity score-matched 1:1 to a comparator cohort of untreated patients. We determined COPD- and pneumonia-related HRU and costs during month 1, each subsequent quarter, and months 2-13. Results Antiviral-treated patients had a significantly lower frequency of COPD-related outcomes than untreated patients during all periods (exacerbations: 10.4% vs 18.2% [month 1] and 17.7% vs 24.2% [months 2-13]; inpatient visit: 2.5% vs 7.9% [month 1] and 3.8% vs 6.7% [months 2-13]; P < 0.0001, all comparisons). Treated patients also had significantly lower outpatient and emergency department (ED) visits beyond month 1. Pneumonia-related inpatient, ED, and outpatient visits were significantly lower in antiviral-treated patients than in untreated patients over all periods (P < 0.0001, all comparisons). In all HRU categories, COPD- and pneumonia-related costs were significantly lower in treated patients over all periods (month-1 ED visit costs were higher). Conclusions Antiviral treatment in patients with COPD and influenza is associated with significantly lower HRU and costs in the postinfection month and for an entire year following infection compared with untreated patients.
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Affiliation(s)
| | - Tu My To
- Genentech, Inc.South San FranciscoCaliforniaUSA
| | | | | | - Ning Wu
- Genentech, Inc.South San FranciscoCaliforniaUSA
| | | | - Nicola A. Hanania
- Section of Pulmonary, Critical Care and Sleep MedicineBaylor College of MedicineHoustonTexasUSA
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6
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Serigstad S, Knoop ST, Markussen DL, Ulvestad E, Bjørneklett RO, Ebbesen MH, Kommedal Ø, Grewal HMS. Diagnostic utility of oropharyngeal swabs as an alternative to lower respiratory tract samples for PCR-based syndromic testing in patients with community-acquired pneumonia. J Clin Microbiol 2023; 61:e0050523. [PMID: 37585220 PMCID: PMC10512787 DOI: 10.1128/jcm.00505-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/06/2023] [Indexed: 08/17/2023] Open
Abstract
Syndromic PCR-based analysis of lower respiratory tract (LRT) samples in patients with community-acquired pneumonia (CAP) improves the bacterial yield and time-to-results compared to culture-based methods. However, obtaining adequate sputum samples can be challenging and is frequently not prioritized in the emergency department (ED). In this study, we assess the concordance of microbiological detections between oropharyngeal- (OP) and LRT samples from patients presenting to the ED with CAP using a syndromic PCR-based respiratory panel [Biofire FilmArray Pneumonia plus (FAP plus)]. Paired OP- and high-quality LRT samples were collected from 103 patients with confirmed CAP, who had been included in a randomized controlled trial (NCT04660084) or a subsequent observational study at Haukeland University Hospital, and analyzed using the FAP plus. The LRT samples were obtained mainly by sputum induction (88%). Using the LRT samples as a reference standard, the positive percent agreement (PPA), negative percent agreement (NPA), and overall percent agreement for the most common bacterial pathogens in CAP, Streptococcus pneumoniae and Haemophilus influenzae, were 85%, 99% and 95%, and 86%, 98% and 93%, respectively. For Moraxella catarrhalis, the PPA was lower (74%), while the NPA was 100%. For bacteria that are less likely causes of uncomplicated CAP (e.g., Staphylococcus aureus and Enterobacterales) the results were more divergent. In conclusion, the FAP plus detects the most common CAP pathogens S. pneumoniae and H. influenzae from OP samples with high PPAs and excellent NPAs when compared with LRT samples. For these pathogens, the PPAs for OP samples were higher than previous reports for nasopharyngeal samples. This suggests that analysis of OP samples with syndromic PCR panels could represent an alternative approach for rapid microbiological testing in the ED, especially in patients where LRT samples are difficult to obtain. Divergent results for bacteria that are less likely to cause uncomplicated CAP do, however, emphasize the need for clinical evaluation of positive test results.
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Affiliation(s)
- Sondre Serigstad
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Siri T. Knoop
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Dagfinn L. Markussen
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, Bergen, Norway
| | - Elling Ulvestad
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Rune O. Bjørneklett
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Marit H. Ebbesen
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Øyvind Kommedal
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Harleen M. S. Grewal
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
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7
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Albrecht U, Stefenelli U, Stange R. A combination of Tropaeolum majus herb and Armoracia rusticana root for the treatment of acute bronchitis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 116:154838. [PMID: 37167822 DOI: 10.1016/j.phymed.2023.154838] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Tropaeolum majus herb (nasturtium) and Armoracia rusticana root (horseradish) produce three different isothiocyanates as secondary metabolites, which exert antibacterial, anti-inflammatory, and immune-modulatory functions in humans. PURPOSE Combined in the medicinal product ANGOCIN® Anti-Infekt N, the two natural components demonstrated promising effects against acute bronchitis. STUDY DESIGN A randomized, two-armed, placebo-controlled, double-blind, phase IV study revealed the healing fostering effect of the two herbal plant components METHODS: This study included 384 patients, with 195 in the treatment and 189 in the placebo group. The 'bronchitis severity score' (BSS) was utilized as primary endpoint. This score sums the ratings for five significant bronchitis symptoms, which are established at the patient's visits to the clinic. RESULTS Compared to placebo intake, the group of patients treated with the phytomedicine showed statistically significant accelerated healing of bronchitis symptoms after three days of treatment, with reductions in coughing, mucous production, and chest pain. This beneficial effect persisted for the entire duration of treatment until day ten. CONCLUSION In conclusion, a combination of Tropaeolum majus herb and Armoracia rusticana root promotes an elevated improvement of bronchitis symptomatology.
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Affiliation(s)
| | | | - Rainer Stange
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin and Immanuel Hospital Berlin, Germany
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8
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Sivakumaran S, Alsallakh MA, Lyons RA, Quint JK, Davies GA. Estimating the contribution of respiratory pathogens to acute exacerbations of COPD using routine data. J Infect 2023; 86:233-238. [PMID: 36706962 DOI: 10.1016/j.jinf.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/28/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To characterise microbiology testing and results associated with emergency admissions for acute exacerbation of COPD (AECOPD), and determine the accuracy of ICD-10 codes in retrospectively identifying laboratory-confirmed respiratory pathogens in this setting. METHODS Using person-level data from the Secure Anonymised Information Linkage Databank in Wales, we extracted emergency admissions for COPD from 1/12/2016 to 30/11/2018 and undertook linkage of admissions data to microbiology data to identify laboratory-confirmed infection. We further used these data to assess the accuracy of pathogen-specific ICD-10 codes. RESULTS We analysed data from 15,950 people who had 25,715 emergency admissions for COPD over the two-year period. 99.5% of admissions could be linked to a laboratory test within 7 days of admission date. Sputum was collected in 5,013 (19.5%) of admissions, and respiratory virus testing in 1,219 (4.7%). Where respiratory virus testing was undertaken, 46.7% returned any positive result. Influenza was the virus most frequently detected, in 21.5% of admissions where testing was conducted. ICD-10 codes exhibited low sensitivity in detecting laboratory-confirmed respiratory pathogens. CONCLUSIONS In people admitted to hospital with AECOPD, increased testing for respiratory viruses could enable more effective antibiotic stewardship and isolation of cases. Linkage with microbiology data achieves more accurate and reliable case definitions.
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Affiliation(s)
- Shanya Sivakumaran
- Population Data Science, Swansea University Medical School, Swansea, UK.
| | | | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Gwyneth A Davies
- Population Data Science, Swansea University Medical School, Swansea, UK
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9
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Malm Tillgren S, Nieto-Fontarigo JJ, Cerps S, Ramu S, Menzel M, Mahmutovic Persson I, Meissner A, Akbarshahi H, Uller L. C57Bl/6N mice have an attenuated lung inflammatory response to dsRNA compared to C57Bl/6J and BALB/c mice. J Inflamm (Lond) 2023; 20:6. [PMID: 36810092 PMCID: PMC9942641 DOI: 10.1186/s12950-023-00331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/26/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Lower respiratory infections caused by ssRNA viruses are a major health burden globally. Translational mouse models are a valuable tool for medical research, including research on respiratory viral infections. In in vivo mouse models, synthetic dsRNA can be used as a surrogate for ssRNA virus replication. However, studies investigating how genetic background of mice impacts the murine lung inflammatory response to dsRNA is lacking. Hence, we have compared lung immunological responses of BALB/c, C57Bl/6N and C57Bl/6J mice to synthetic dsRNA. METHODS dsRNA was administered intranasally to BALB/c, C57Bl/6N and C57Bl/6J mice once/day for three consecutive days. Lactate dehydrogenase (LDH) activity, inflammatory cells, and total protein concentration were analyzed in bronchoalveolar lavage fluid (BALF). Pattern recognition receptors levels (TLR3, MDA5 and RIG-I) were measured in lung homogenates using RT-qPCR and western blot. Gene expression of IFN-β, TNF-α, IL-1β and CXCL1 was assessed in lung homogenates by RT-qPCR. ELISA was used to analyze protein concentrations of CXCL1 and IL-1β in BALF and lung homogenates. RESULTS BALB/c and C57Bl/6J mice showed infiltration of neutrophils to the lung, and an increase in total protein concentration and LDH activity in response to dsRNA administration. Only modest increases in these parameters were observed for C57Bl/6N mice. Similarly, dsRNA administration evoked an upregulation of MDA5 and RIG-I gene and protein expression in BALB/c and C57Bl/6J, but not C57Bl/6N, mice. Further, dsRNA provoked an increase in gene expression of TNF-α in BALB/c and C57Bl/6J mice, IL-1β only in C57Bl/6N mice and CXCL1 exclusively in BALB/c mice. BALF levels of CXCL1 and IL-1β were increased in BALB/c and C57Bl/6J mice in response to dsRNA, whereas the response of C57Bl/6N was blunt. Overall, inter-strain comparisons of the lung reactivity to dsRNA revealed that BALB/c, followed by C57Bl/6J, had the most pronounced respiratory inflammatory responses, while the responses of C57Bl/6N mice were attenuated. CONCLUSIONS We report clear differences of the lung innate inflammatory response to dsRNA between BALB/c, C57Bl/6J and C57Bl/6N mice. Of particular note, the highlighted differences in the inflammatory response of C57Bl/6J and C57Bl/6N substrains underscore the value of strain selection in mouse models of respiratory viral infections.
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Affiliation(s)
- Sofia Malm Tillgren
- grid.4514.40000 0001 0930 2361Department of Experimental Medical Science, Unit of Respiratory immunopharmacology, Lund University, Lund, Sweden
| | - Juan José Nieto-Fontarigo
- grid.4514.40000 0001 0930 2361Department of Experimental Medical Science, Unit of Respiratory immunopharmacology, Lund University, Lund, Sweden
| | - Samuel Cerps
- grid.4514.40000 0001 0930 2361Department of Experimental Medical Science, Unit of Respiratory immunopharmacology, Lund University, Lund, Sweden
| | - Sangeetha Ramu
- grid.4514.40000 0001 0930 2361Department of Experimental Medical Science, Unit of Respiratory immunopharmacology, Lund University, Lund, Sweden
| | - Mandy Menzel
- grid.4514.40000 0001 0930 2361Department of Experimental Medical Science, Unit of Respiratory immunopharmacology, Lund University, Lund, Sweden
| | - Irma Mahmutovic Persson
- grid.4514.40000 0001 0930 2361Department of Experimental Medical Science, Unit of Respiratory immunopharmacology, Lund University, Lund, Sweden
| | - Anja Meissner
- grid.4514.40000 0001 0930 2361Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden ,grid.7307.30000 0001 2108 9006Department of Physiology, Institute of Theoretical Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany ,grid.4514.40000 0001 0930 2361Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Hamid Akbarshahi
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Lena Uller
- Department of Experimental Medical Science, Unit of Respiratory immunopharmacology, Lund University, Lund, Sweden.
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10
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Maes M, Khokhar F, Wilkinson SAJ, Smith AD, Kovalenko G, Dougan G, Quick J, Loman NJ, Baker S, Curran MD, Skittrall JP, Houldcroft CJ. Multiplex MinION sequencing suggests enteric adenovirus F41 genetic diversity comparable to pre-COVID-19 era. Microb Genom 2023; 9:mgen000920. [PMID: 36748435 PMCID: PMC9973849 DOI: 10.1099/mgen.0.000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/01/2022] [Indexed: 01/09/2023] Open
Abstract
Human adenovirus F41 causes acute gastroenteritis in children, and has recently been associated with an apparent increase in paediatric hepatitis of unknown aetiology in the UK, with further cases reported in multiple countries. Relatively little is known about the genetic diversity of adenovirus F41 in UK children; and it is unclear what, if any, impact the COVID-19 pandemic has had on viral diversity in the UK. Methods that allow F41 to be sequenced from clinical samples without the need for viral culture are required to provide the genomic data to address these questions. Therefore, we evaluated an overlapping-amplicon method of sequencing adenovirus genomes from clinical samples using Oxford Nanopore technology. We applied this method to a small sample of adenovirus-species-F-positive extracts collected as part of standard care in the East of England region in January-May 2022. This method produced genomes with >75 % coverage in 13/22 samples and >50 % coverage in 19/22 samples. We identified two F41 lineages present in paediatric patients in the East of England in 2022. Where F41 genomes from paediatric hepatitis cases were available (n=2), these genomes fell within the diversity of F41 from the UK and continental Europe sequenced before and after the 2020-2021 phase of the COVID-19 pandemic. Our analyses suggest that overlapping amplicon sequencing is an appropriate method for generating F41 genomic data from high-virus-load clinical samples, and currently circulating F41 viral lineages were present in the UK and Europe before the COVID-19 pandemic.
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Affiliation(s)
- Mailis Maes
- Clinical Microbiology and Public Health Laboratory, UK Health Security Agency, Addenbrooke’s Hospital, Cambridge, UK
| | - Fahad Khokhar
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0AW, UK
| | - Sam A. J. Wilkinson
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, UK
| | - Andrew D. Smith
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, UK
| | - Ganna Kovalenko
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Gordon Dougan
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0AW, UK
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Joshua Quick
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, UK
| | - Nicholas J. Loman
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, UK
| | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0AW, UK
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Martin D. Curran
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jordan P. Skittrall
- Clinical Microbiology and Public Health Laboratory, UK Health Security Agency, Addenbrooke’s Hospital, Cambridge, UK
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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11
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Yan Y, Sun J, Ji K, Guo J, Han L, Li F, Sun Y. High incidence of the virus among respiratory pathogens in children with lower respiratory tract infection in northwestern China. J Med Virol 2023; 95:e28367. [PMID: 36458544 PMCID: PMC9877598 DOI: 10.1002/jmv.28367] [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: 07/28/2022] [Revised: 09/20/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
Lower respiratory tract infection (LRTI) is one of the major reasons for childhood mortality that threaten the health of the public. We aimed to investigate the epidemiological pathogens and their infection analysis among children with LRTI. Sputum specimens were collected for polymerase chain reaction detection and microbiological tests to identify the viral infection and bacterial infection. The serological specimens were separated from venous blood using for Mycoplasma pneumoniae and Chlamydia pneumoniae detection. The virus was confirmed in 86.2% of the children. Human rhinovirus (38.3%), respiratory syncytial virus (32.1%), and parainfluenza virus type 3 (27.2%) were the most frequently identified pathogens. Patients with viral and bacterial coinfection showed younger age (p = 0.032), a higher proportion of wheezing rales (p = 0.032), three depressions sign (p = 0.028), and tachypnea (p = 0.038), and more likely associated with severe pneumonia (p = 0.035). Additionally, older children were more susceptible to viral-atypical bacterial coinfection (p = 0.032). Vomiting (p = 0.011) and fever (p = 0.003) were more likely to occur in children with viral-atypical bacterial coinfection. Attention should be paid to the virus infection of LRTI, as viral-bacterial coinfection and viral-atypical bacterial co-infection may have a detrimental impact on the gravity of LTRI.
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Affiliation(s)
- Yan Yan
- Department of Biochemistry and Molecular Biology, School of Basic Medical ScienceNingxia Medical UniversityYinchuanChina
| | - Jinhan Sun
- Department of Clinical MedicineNingxia Medical UniversityYinchuanChina
| | - Kai Ji
- Department of Biochemistry and Molecular Biology, School of Basic Medical ScienceNingxia Medical UniversityYinchuanChina
| | - Jianhui Guo
- Department of Biochemistry and Molecular Biology, School of Basic Medical ScienceNingxia Medical UniversityYinchuanChina
| | - Lei Han
- Clinical Laboratory of Yinchuan Women and Children Healthcare HospitalYinchuanChina
| | - Fang Li
- Department of Respiratory and Critical Care, General Hospital of Ningxia Medical UniversityNingxia Medical UniversityYinchuanChina
| | - Yuning Sun
- Department of Biochemistry and Molecular Biology, School of Basic Medical ScienceNingxia Medical UniversityYinchuanChina
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12
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Mulpuru S, Andrew MK, Ye L, Hatchette T, LeBlanc J, El‐Sherif M, MacKinnon‐Cameron D, Aaron SD, Alvarez GG, Forster AJ, Ambrose A, McNeil SA. Impact of respiratory viral infections on mortality and critical illness among hospitalized patients with chronic obstructive pulmonary disease. Influenza Other Respir Viruses 2022; 16:1172-1182. [PMID: 36069141 PMCID: PMC9530520 DOI: 10.1111/irv.13050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Seasonal respiratory viral infections are associated with exacerbations and morbidity among patients with COPD. The real-world clinical outcomes associated with seasonal viral infections are less well established among hospitalized patients. RESEARCH QUESTION To estimate the association between seasonal respiratory viral infections, 30-day mortality, and intensive care unit (ICU) admission among hospitalized COPD patients. STUDY DESIGN AND METHODS We conducted an analysis of a national prospective multicenter cohort of COPD patients hospitalized with acute respiratory illness during winter seasons (2011-2015) in Canada. Nasopharyngeal swabs were performed on all patients at the onset of hospital admission for diagnosis of viral infection. Primary outcomes were 30-day mortality and ICU admissions. Secondary outcomes included invasive/non-invasive ventilation use. RESULTS Among 3931 hospitalized patients with COPD, 28.5% (1122/3931) were diagnosed with seasonal respiratory viral infection. Viral infection was associated with increased admission to ICU (OR 1.5, 95% CI 1.2-1.9) and need for mechanical ventilation (OR 1.9, 95% CI 1.4-2.5), but was not associated with mortality (OR 1.1, 95% CI 0.8-1.4). Patients with respiratory syncytial virus (RSV) were equally likely to require ICU admission (OR 1.09, 95% CI 0.67-1.78), and more likely to need non-invasive ventilation (OR 3.1; 95% CI 1.8-5.1) compared to patients with influenza. INTERPRETATION Our results suggest COPD patients requiring hospitalization for respiratory symptoms should routinely receive viral testing at admission, especially for RSV and influenza, to inform prognosis, clinical management, and infection control practices during winter seasons. Patients with COPD will be an important target population for newly developed RSV therapeutics. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov ID: NCT01517191.
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Affiliation(s)
- Sunita Mulpuru
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Melissa K. Andrew
- Department of Medicine (Geriatrics), Faculty of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
- Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia HealthHalifaxNova ScotiaCanada
| | - Lingyun Ye
- Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia HealthHalifaxNova ScotiaCanada
| | - Todd Hatchette
- Department of Medicine (Infectious Diseases), Faculty of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Pathology, Faculty of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
- Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia HealthHalifaxNova ScotiaCanada
| | - Jason LeBlanc
- Department of Pathology, Faculty of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
- Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia HealthHalifaxNova ScotiaCanada
| | - May El‐Sherif
- Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia HealthHalifaxNova ScotiaCanada
| | - Donna MacKinnon‐Cameron
- Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia HealthHalifaxNova ScotiaCanada
| | - Shawn D. Aaron
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Gonzalo G. Alvarez
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Alan J. Forster
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | - Ardith Ambrose
- Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia HealthHalifaxNova ScotiaCanada
| | - Shelly A. McNeil
- Department of Medicine (Infectious Diseases), Faculty of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
- Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia HealthHalifaxNova ScotiaCanada
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13
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Serigstad S, Markussen DL, Ritz C, Ebbesen MH, Knoop ST, Kommedal Ø, Heggelund L, Ulvestad E, Bjørneklett RO, Grewal HMS. The changing spectrum of microbial aetiology of respiratory tract infections in hospitalized patients before and during the COVID-19 pandemic. BMC Infect Dis 2022; 22:763. [PMID: 36180842 PMCID: PMC9523652 DOI: 10.1186/s12879-022-07732-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background The COVID-19 pandemic was met with strict containment measures. We hypothesized that societal infection control measures would impact the number of hospital admissions for respiratory tract infections, as well as, the spectrum of pathogens detected in patients with suspected community acquired pneumonia (CAP). Methods This study is based on aggregated surveillance data from electronic health records of patients admitted to the hospitals in Bergen Hospital Trust from January 2017 through June 2021, as well as, two prospective studies of patients with suspected CAP conducted prior to and during the COVID-19 pandemic (pre-COVID cohort versus COVID cohort, respectively). In the prospective cohorts, microbiological detections were ascertained by comprehensive PCR-testing in lower respiratory tract specimens. Mann–Whitney’s U test was used to analyse continuous variables. Fisher’s exact test was used for analysing categorical data. The number of admissions before and during the outbreak of SARS-CoV-2 was compared using two-sample t-tests on logarithmic transformed values. Results Admissions for respiratory tract infections declined after the outbreak of SARS-CoV-2 (p < 0.001). The pre-COVID and the COVID cohorts comprised 96 and 80 patients, respectively. The proportion of viruses detected in the COVID cohort was significantly lower compared with the pre-COVID cohort [21% vs 36%, difference of 14%, 95% CI 4% to 26%; p = 0.012], and the proportion of bacterial- and viral co-detections was less than half in the COVID cohort compared with the pre-COVID cohort (19% vs 45%, difference of 26%, 95% CI 13% to 41%; p < 0.001). The proportion of bacteria detected was similar (p = 0.162), however, a difference in the bacterial spectrum was observed in the two cohorts. Haemophilus influenzae was the most frequent bacterial detection in both cohorts, followed by Streptococcus pneumoniae in the pre-COVID and Staphylococcus aureus in the COVID cohort. Conclusion During the first year of the COVID-19 pandemic, the number of admissions with pneumonia and the microbiological detections in patients with suspected CAP, differed from the preceding year. This suggests that infection control measures related to COVID-19 restrictions have an overall and specific impact on respiratory tract infections, beyond reducing the spread of SARS-CoV-2. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07732-5.
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Affiliation(s)
- Sondre Serigstad
- Emergency Care Clinic, Haukeland University Hospital, 5021, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, 5021, Bergen, Norway. .,Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway.
| | | | - Christian Ritz
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway.,National Institute of Public Health, University of Southern Denmark, 1455, Copenhagen, Denmark
| | - Marit H Ebbesen
- Department of Microbiology, Haukeland University Hospital, 5021, Bergen, Norway
| | - Siri T Knoop
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, 5021, Bergen, Norway
| | - Øyvind Kommedal
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, 5021, Bergen, Norway
| | - Lars Heggelund
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway.,Department of Internal Medicine, Vestre Viken Hospital Trust, 3004, Drammen, Norway
| | - Elling Ulvestad
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, 5021, Bergen, Norway
| | - Rune O Bjørneklett
- Emergency Care Clinic, Haukeland University Hospital, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, 5021, Bergen, Norway
| | - Harleen M S Grewal
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, University of Bergen, 5021, Bergen, Norway. .,Department of Microbiology, Haukeland University Hospital, 5021, Bergen, Norway.
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14
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Cheng G, She B, Mao B, Jiang H. Efficacy and safety of Tanreqing oral liquid in treatment of acute bronchitis: study protocol for a randomized controlled trial. Trials 2022; 23:373. [PMID: 35526026 PMCID: PMC9077961 DOI: 10.1186/s13063-022-06318-5] [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: 04/21/2021] [Accepted: 04/19/2022] [Indexed: 02/08/2023] Open
Abstract
Background Approximately 5% of adults have an episode of acute bronchitis each year, accounting for more than 10 million medical visits yearly. The primary goal of treatment is reduction of symptoms. Currently, available medications are questionable in effectiveness and safety and are not recommended for routine use in clinical practice. Although Chinese herbal medicine has been widely used in the management of acute bronchitis in China, evidence-based data is lacking. This trial aims to evaluate the efficacy and safety of Tanreqing oral liquid in the treatment of acute bronchitis with phlegm-heat obstructing lungs syndrome. Methods/design This study is a prospective, multi-center, randomized, double-blinded, parallel-group, placebo-controlled trial. A total of 270 acute bronchitis adult patients with phlegm-heat obstructing lungs syndrome will be enrolled from outpatients and emergency departments at nine study centers across China. All included patients will be randomly allocated to receive Tanreqing oral liquid or placebo oral liquid, 20 mL three times daily for seven consecutive days. The primary outcome will be cough resolution rate. Secondary outcomes will include change of bronchitis symptoms scores from baseline to post-treatment, cough relief rate, time to cough resolution, time to cough relief, resolution rate of a single symptom, combination medicine use, change of traditional Chinese medicine syndrome score from baseline to post-treatment, and adverse events. Discussion This trial may provide an alternative treatment option for acute bronchitis patients, especially those in outpatients and emergency departments. It may also add evidence to Chinese herbal medicine for treating acute bronchitis. Trial registration Chinese Clinical Trial Registry ChiCTR2000040264. Registered on 26 November 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06318-5.
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Affiliation(s)
- Guilan Cheng
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Bin She
- Department of Integrated Traditional Chinese and Western Medicine, Division of Respiratory Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Bing Mao
- Department of Integrated Traditional Chinese and Western Medicine, Division of Respiratory Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Hongli Jiang
- Department of Integrated Traditional Chinese and Western Medicine, Division of Respiratory Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, People's Republic of China.
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15
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Serigstad S, Markussen D, Grewal HMS, Ebbesen M, Kommedal Ø, Heggelund L, van Werkhoven CH, Faurholt-Jepsen D, Clark TW, Ritz C, Ulvestad E, Bjørneklett R, Knoop ST. Rapid syndromic PCR testing in patients with respiratory tract infections reduces time to results and improves microbial yield. Sci Rep 2022; 12:326. [PMID: 35013351 PMCID: PMC8748978 DOI: 10.1038/s41598-021-03741-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022] Open
Abstract
Lack of rapid and comprehensive microbiological diagnosis in patients with community acquired pneumonia (CAP) hampers appropriate antimicrobial therapy. This study evaluates the real-world performance of the BioFire FilmArray Pneumonia panel plus (FAP plus) and explores the feasibility of evaluation in a randomised controlled trial. Patients presenting to hospital with suspected CAP were recruited in a prospective feasibility study. An induced sputum or an endotracheal aspirate was obtained from all participants. The FAP plus turnaround time (TAT) and microbiological yield were compared with standard diagnostic methods (SDs). 96/104 (92%) enrolled patients had a respiratory tract infection (RTI); 72 CAP and 24 other RTIs. Median TAT was shorter for the FAP plus, compared with in-house PCR (2.6 vs 24.1 h, p < 0.001) and sputum cultures (2.6 vs 57.5 h, p < 0.001). The total microbiological yield by the FAP plus was higher compared to SDs (91% (162/179) vs 55% (99/179), p < 0.0001). Haemophilus influenzae, Streptococcus pneumoniae and influenza A virus were the most frequent pathogens. In conclusion, molecular panel testing in adults with CAP was associated with a significant reduction in time to actionable results and increased microbiological yield. The impact on antibiotic use and patient outcome should be assessed in randomised controlled trials.
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Affiliation(s)
- S Serigstad
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine and Dentistry, University of Bergen, The New Lab. Building, NO-5021, Bergen, Norway
| | - D Markussen
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - H M S Grewal
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine and Dentistry, University of Bergen, The New Lab. Building, NO-5021, Bergen, Norway. .,Department of Microbiology, Haukeland University Hospital, Bergen, Norway.
| | - M Ebbesen
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Ø Kommedal
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine and Dentistry, University of Bergen, The New Lab. Building, NO-5021, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - L Heggelund
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine and Dentistry, University of Bergen, The New Lab. Building, NO-5021, Bergen, Norway.,Department of Internal Medicine, Vestre Viken Hospital Trust, Drammen, Norway
| | - C H van Werkhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D Faurholt-Jepsen
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine and Dentistry, University of Bergen, The New Lab. Building, NO-5021, Bergen, Norway.,Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - T W Clark
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - C Ritz
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine and Dentistry, University of Bergen, The New Lab. Building, NO-5021, Bergen, Norway.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - E Ulvestad
- Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine and Dentistry, University of Bergen, The New Lab. Building, NO-5021, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - R Bjørneklett
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - S T Knoop
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
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16
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Wæhre T, Tunheim G, Bodin JE, Laake I, Kvale D, Kran AMB, Brekke H, Løken R, Oftung F, Mjaaland S, Dyrhol-Riise AM. Clinical characteristics and outcomes in hospitalized adult influenza patients: an observational study from Norway 2014-2018. Infect Dis (Lond) 2022; 54:367-377. [PMID: 34983302 DOI: 10.1080/23744235.2021.2022196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Seasonal influenza causes substantial numbers of hospitalizations annually. We have characterized the clinical picture and treatment practice in hospitalized adult influenza patients and assessed whether clinical risk scores on admission or influenza type were associated with severe outcomes. METHODS Clinical characteristics and risk scores on admission (CRB65, CRB, SIRS and quick Sequential Organ Failure Assessment [qSOFA]), treatment and severe outcomes (defined as: stay in intensive care unit (ICU), receiving oxygen supplementation or staying ≥5 days in hospital), were recorded in patients hospitalized with influenza at Oslo University Hospital, Norway, between 2014 and 2018. RESULTS Among the 156 included patients, 52.6% had influenza A(H3N2), 32.6% influenza B and 12.8% influenza A(H1N1). Median age was 70 years and 59.6% of patients were ≥65 years. Nine (5.8%) of the patients were treated in ICU, 43.0% received oxygen and 47.4% stayed ≥5 days in hospital. Overall, 34.6% of the patients had a high CRB score on admission which was associated with stay in ICU and oxygen supplementation. Multivariate analyses identified age, and pneumonia (46.8%), but not influenza type, to be associated with severe outcomes. Antiviral treatment was given to 37.2% of the patients, while 77.6% received antibiotics. Only 25.5% of patients with influenza B received antiviral therapy. CONCLUSIONS The influenza patients were mostly elderly, and few patients were treated in ICU. A high CRB score was associated with severe outcomes with possible implications for patient monitoring. Less than 40% of the patients received antiviral therapy, whereas the majority were treated with antibiotics, indicating potential for optimising treatment strategies.
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Affiliation(s)
- Torgun Wæhre
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway
| | - Gro Tunheim
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Johanna Eva Bodin
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Laake
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Dag Kvale
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Hanne Brekke
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Løken
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Fredrik Oftung
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Mjaaland
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Margarita Dyrhol-Riise
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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17
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Fjelltveit EB, Cox RJ, Kittang BR, Blomberg B, Buanes EA, Langeland N, Mohn KGI. Lower antibiotic prescription rates in hospitalized COVID-19 patients than influenza patients, a prospective study. Infect Dis (Lond) 2021; 54:79-89. [PMID: 34525895 DOI: 10.1080/23744235.2021.1974539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND COVID-19 patients are extensively treated with antibiotics despite few bacterial complications. We aimed to study antibiotic use in hospitalized COVID-19 patients compared to influenza patients in two consecutive years. Furthermore, we investigated changes in antibiotic use from the first to second pandemic wave. METHODS This prospective study included both patients from two referral hospitals in Bergen, Norway, admitted with influenza (n = 215) during the 2018/2019 epidemic and with COVID-19 (n = 82) during spring/summer 2020, and national data on registered Norwegian COVID-19 hospital admissions from March 2020 to January 2021 (n = 2300). Patient characteristics were compared, and logistic regression analysis was used to identify risk factors for antibiotic use. RESULTS National and local COVID-19 patients received significantly less antibiotics (53% and 49%) than influenza patients (69%, p < .001). Early antibiotics contributed to >90% of antibiotic prescriptions in the two local hospitals, and >70% of prescriptions nationally. When adjusted for age, comorbidities, symptom duration, chest X-ray infiltrates and oxygen treatment, local COVID-19 patients still had significantly lower odds of antibiotic prescription than influenza patients (aOR 0.21, 95%CI 0.09-0.50). At the national level, we observed a significant reduction in antibiotic prescription rates in the second pandemic wave compared to the first (aOR 0.35, 95% CI 0.29-0.43). CONCLUSION Fewer COVID-19 patients received antibiotics compared to influenza patients admitted to the two local hospitals one year earlier. The antibiotic prescription rate was lower during the second pandemic wave, possibly due to increased clinical experience and published evidence refuting the efficacy of antibiotics in treating COVID-19 pneumonia.
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Affiliation(s)
- Elisabeth B Fjelltveit
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Rebecca Jane Cox
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Bård Reiakvam Kittang
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Bjørn Blomberg
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Eirik A Buanes
- Norwegian Intensive Care and Pandemic Registry (NIPaR), Haukeland University Hospital, Bergen, Norway.,Helse Bergen Health Trust, Haukeland University Hospital, Bergen, Norway
| | | | - Nina Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Kristin G-I Mohn
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
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18
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Vock I, Aguilar-Bultet L, Egli A, Tamma PD, Tschudin-Sutter S. Infections in Patients Colonized With Extended-spectrum Beta-Lactamase-Producing Enterobacterales: A Retrospective Cohort Study. Clin Infect Dis 2021; 72:1440-1443. [PMID: 32604410 DOI: 10.1093/cid/ciaa895] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Abstract
We investigated relative proportions of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) versus non-ESBL-PE (nESBL-PE) infections in ESBL-PE colonized patients. ESBL-PE are not causative for the majority of infections in hospitalized patients colonized with ESBL-PE. Site of infection and patient-level exposures may be useful predictors of nESBL-PE infections, potentially guiding empiric treatment recommendations.
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Affiliation(s)
- Isabelle Vock
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland
| | - Lisandra Aguilar-Bultet
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland
| | - Adrian Egli
- Division of Clinical Microbiology, University Hospital Basel, University Basel, Switzerland
| | - Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, Switzerland
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19
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Ra SW, Kim SY, Lim YY, Park SJ, Rhee CK, Kim DK, Park YB, Lee CY, Yoon HK, Park JW, Yoo KH. The safety and efficacy of CKD-497 in patients with acute upper respiratory tract infection and bronchitis symptoms: a multicenter, double-blind, double-dummy, randomized, controlled, phase II clinical trial. J Thorac Dis 2021; 13:1-9. [PMID: 33569179 PMCID: PMC7867795 DOI: 10.21037/jtd-20-1567] [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: 05/22/2020] [Accepted: 10/22/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Acute upper respiratory tract infection (AURI) together with acute bronchitis is the most common illness worldwide. Botanical medicines used as expectorants and antitussives have proven to be effective while also having excellent safety margins. We aimed at evaluating the efficacy and safety of a new botanical drug, CKD-497, in patients with AURI and acute bronchitis. METHODS In this phase 2 study, 225 patients were enrolled and randomly assigned to one of four treatment groups: placebo (n=55), Synatura® (n=49), CKD-497 200 mg (n=68), or CKD-497 300 mg (n=53). The study drugs were administered three times daily over the course of 7 days. Primary endpoint was the change in the bronchitis severity score (BSS) from baseline to day 7. Secondary endpoint was evaluated based on clinical response rates on days 4 and 7. A safety analysis was also performed. RESULTS Between baseline and day 7, the mean BSS scores decreased significantly in each group (P<0.001): -4.04±1.85, -4.31±1.47, -4.09±1.48, and -4.28±1.69. However, neither the CKD-497 nor Synatura® group showed any significant effect on the difference in BSS change (P=0.75). The rate of clinical response was higher in the CKD-497 300 mg group as compared to the placebo only on day 4 (36% vs. 18%; P<0.05) and those having more severe bronchitis (phlegm score ≥3) showed a significant reduction of total BSS in the Synatura® and CKD-497 groups (P=0.042). No significant adverse events were observed in either of the CKD-497 groups. CONCLUSIONS CKD-497 and even the positive control drug had no significant effect on BSS change in this phase 2 clinical trial. However, CKD-497 300 mg had a mild but significant clinical improvement in early bronchitis patients with more severe phlegm. Considering both efficacy and safety, a future study using 300 mg of CKD-497 with a shorter-term endpoint is warranted in patients with more severe bronchitis symptoms.
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Affiliation(s)
- Seung Won Ra
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sun Young Kim
- Department of Botanical Drug, Chong Kun Dang (CKD) Pharm Research Institute, Yongin-si, Gyeonggi-do, Korea
| | - Yun Young Lim
- Department of Botanical Drug, Chong Kun Dang (CKD) Pharm Research Institute, Yongin-si, Gyeonggi-do, Korea
| | - Shin Jung Park
- Department of Botanical Drug, Chong Kun Dang (CKD) Pharm Research Institute, Yongin-si, Gyeonggi-do, 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
| | - Deog Kyeom Kim
- Department of Internal Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Chang Youl Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon, Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong-Woong Park
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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20
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Fjelltveit EB, Cox RJ, Østensjø J, Blomberg B, Ebbesen MH, Langeland N, Mohn KGI. Point-of-care influenza testing impacts clinical decision, patient flow and length of stay in hospitalized adults. J Infect Dis 2020; 226:97-108. [PMID: 33151320 PMCID: PMC9373161 DOI: 10.1093/infdis/jiaa690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/28/2020] [Indexed: 01/03/2023] Open
Abstract
Background Influenza is difficult to distinguish clinically from other acute respiratory infections. Rapid laboratory diagnosis can help initiate early effective antiviral treatment and isolation. Implementing a novel point-of-care test (POCT) for influenza in the emergency department (ED) could improve treatment and isolation strategies and reduce the length of stay (LOS). Methods In a prospective, controlled observational cohort study, we enrolled patients admitted due to acute respiratory illness to 2 public hospitals in Bergen, Norway, one using a rapid POCT for influenza (n = 400), the other (n = 167) using conventional rapid laboratory-based assay. Results Prevalence of influenza was similar in the 2 hospitals (154/400, 38% vs 38%, 63/167; P = .863). Most patients in both hospitals received antiviral (83% vs 81%; P = .703) and antibiotic treatment (72% vs 62%; P = .149). Isolation was more often initiated in ED in the hospital using POCT (91% vs 80%; P = .025). Diagnosis by POCT was associated with shorter hospital stay; old age, diabetes, cancer, and use of antibiotics, particularly broad-spectrum antibiotics, were associated with prolonged stay. Conclusions POCT implementation in ED resulted in improved targeted isolation and shorter LOS. Regardless of POCT use, most influenza patients received antivirals (>80%) and antibiotics (>69%).
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Affiliation(s)
- E B Fjelltveit
- The Influenza Centre, University of Bergen, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway.,Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - R J Cox
- The Influenza Centre, University of Bergen, Bergen, Norway.,Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - J Østensjø
- Haraldsplass Deaconess Hospital, Bergen, Norway
| | - B Blomberg
- Department of Clinical Science, University of Bergen, Bergen, Norway.,National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - M H Ebbesen
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - N Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway.,Department of Research and Development, Haukeland University Hospital, Bergen, Norway.,Haraldsplass Deaconess Hospital, Bergen, Norway
| | - K G-I Mohn
- The Influenza Centre, University of Bergen, Bergen, Norway.,Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
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21
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Brendish NJ, Poole S, Naidu VV, Mansbridge CT, Norton N, Borca F, Phan HT, Wheeler H, Harvey M, Presland L, Clark TW. Clinical characteristics, symptoms and outcomes of 1054 adults presenting to hospital with suspected COVID-19: A comparison of patients with and without SARS-CoV-2 infection. J Infect 2020; 81:937-943. [PMID: 32998038 PMCID: PMC7521430 DOI: 10.1016/j.jinf.2020.09.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 01/08/2023]
Abstract
We analysed data from 1054 hospitalised adults tested for SARS-CoV-2. COVID-19 patients less frequently were smokers or had COPD vs negative patients. Over a fifth of COVID-19 patients were healthcare workers vs <6% negative patients. About a third of COVID-19 patients reported anosmia vs <10% negative patients. COVID-19 patients had longer hospitalisation and invasive ventilation duration.
Objectives Most reports describing the characteristics of patients hospitalised with COVID-19 lack a comparator group. We compared clinical characteristics, symptoms, and outcomes of adults presenting to hospital during the pandemic first wave, who tested positive and negative for SARS-CoV-2. Methods Detailed patient data was obtained from a large, controlled, non-randomised trial of molecular point-of-care testing versus laboratory RT-PCR for SARS-CoV-2 in adults presenting to a large UK hospital with suspected COVID-19. Results 1054 patients were included: 352 (33.4%) tested positive and 702 (66.6%) negative. 13.4% (47/352) COVID-19-positive patients had COPD versus 18.7% (131/702) of COVID-19-negative patients (difference=5.3% [95%CI −9.7% to −0.5%], p = 0.0297). 5.7% (20/352) of COVID-19-positive patients were smokers versus 16.5% (116/702) of negative patients (difference=−10.8% [−14.4% to −7.0%], p = 0.0001). 70.5% (248/352) of COVID-19-positive patients were White-British versus 85.5% (600/702) of negative patients (difference=−15.0% [−20.5% to −9.7%], p<0.0001). 20.9% (39/187) of COVID-19-positive patients were healthcare workers versus 5.2% (15/287) of negative patients (p<0.0001). Anosmia was reported in 33.1% (47/142) versus 8.8% (19/216) of COVID-19-positive and negative patients respectively (p<0.0001). Non-SARS-CoV-2 respiratory viruses or atypical bacteria were detected in 2.5% (5/197) of COVID-19 patients versus 7.9% (24/302) of COVID-19-negative patients (p = 0.0109). Hospitalisation duration and 30-day-mortality were higher in COVID-19 patients and invasive ventilation was more frequent (11.1% vs 2.8%, p<0.0001), and longer (14.5 vs 4.7 days, p = 0.0015). Conclusions There were substantial differences between patients with and without COVID-19 in terms of ethnicity, healthcare worker-status, comorbidities, symptoms, and outcomes. These data can inform healthcare planning for the next phase of the pandemic.
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Affiliation(s)
- Nathan J Brendish
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Stephen Poole
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS, Foundation Trust, Southampton, UK
| | - Vasanth V Naidu
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Nicholas Norton
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Florina Borca
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS, Foundation Trust, Southampton, UK; Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hang Tt Phan
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS, Foundation Trust, Southampton, UK; Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen Wheeler
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS, Foundation Trust, Southampton, UK
| | - Matthew Harvey
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS, Foundation Trust, Southampton, UK
| | - Laura Presland
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS, Foundation Trust, Southampton, UK
| | - Tristan W Clark
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS, Foundation Trust, Southampton, UK; NIHR Post Doctoral Fellowship Programme, UK
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22
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O'Riordan F, Shiely F, Byrne S, O'Brien D, Palmer B, Dahly D, O'Connor TM, Curran D, Fleming A. An investigation of the effects of procalcitonin testing on antimicrobial prescribing in respiratory tract infections in an Irish university hospital setting: a feasibility study. J Antimicrob Chemother 2020; 74:3352-3361. [PMID: 31325313 DOI: 10.1093/jac/dkz313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/03/2019] [Accepted: 06/20/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Diagnostic uncertainty and a high prevalence of viral infections present unique challenges for antimicrobial prescribing for respiratory tract infections (RTIs). Procalcitonin (PCT) has been shown to support prescribing decisions and reduce antimicrobial use safely in patients with RTIs, but recent study results have been variable. METHODS We conducted a feasibility study of the introduction of PCT testing in patients admitted to hospital with a lower RTI to determine if PCT testing is an effective and worthwhile intervention to introduce to support the existing antimicrobial stewardship (AMS) programme and safely decrease antimicrobial prescribing in patients admitted with RTIs. RESULTS A total of 79 patients were randomized to the intervention PCT-guided treatment group and 40 patients to the standard care respiratory control group. The addition of PCT testing led to a significant decrease in duration of antimicrobial prescriptions (mean 6.8 versus 8.9 days, P = 0.012) and decreased length of hospital stay (median 7 versus 8 days, P = 0.009) between the PCT and respiratory control group. PCT did not demonstrate a significant reduction in antimicrobial consumption when measured as DDDs and days of therapy. CONCLUSIONS PCT testing had a positive effect on antimicrobial prescribing during this feasibility study. The successful implementation of PCT testing in a randomized controlled trial requires an ongoing comprehensive education programme, greater integration into the AMS programme and delivery of PCT results in a timely manner. This feasibility study has shown that a larger randomized controlled trial would be beneficial to further explore the positive aspects of these findings.
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Affiliation(s)
- F O'Riordan
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - F Shiely
- HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - S Byrne
- Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - D O'Brien
- Department of Microbiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - B Palmer
- HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - D Dahly
- HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | - T M O'Connor
- Department of Respiratory Medicine, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - D Curran
- Department of Respiratory Medicine, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - A Fleming
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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23
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Reacher M, Warne B, Reeve L, Verlander NQ, Jones NK, Ranellou K, Christou S, Wright C, Choudhry S, Zambon M, Sander C, Zhang H, Jalal H. Influenza-associated mortality in hospital care: a retrospective cohort study of risk factors and impact of oseltamivir in an English teaching hospital, 2016 to 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 31690364 PMCID: PMC6836682 DOI: 10.2807/1560-7917.es.2019.24.44.1900087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Evidence of an oseltamivir treatment effect on influenza A(H3N2) virus infections in hospitalised patients is incomplete. Aims This cohort study aimed to evaluate risk factors for death among PCR-confirmed hospitalised cases of seasonal influenza A(H3N2) of all ages and the impact of oseltamivir. Methods Participants included all 332 PCR-confirmed influenza A(H3N2) cases diagnosed between 30 August 2016 and 17 March 2017 in an English university teaching Hospital. Oseltamivir treatment effect on odds of inpatient death was assessed by backward stepwise multivariable logistic regression analysis. Results The odds of death were reduced by two thirds (odds ratio (OR): 0.32; 95% confidence interval (CI): 0.11–0.93), in inpatients treated with a standard course of oseltamivir 75 mg two times daily for 5 days – compared with those untreated with oseltamivir, after adjustment for age, sex, current excess alcohol intake, receipt of 2016/17 seasonal influenza vaccine, serum haemoglobin and hospital vs community attribution of acquisition of influenza. Conclusions Oseltamivir treatment given according to National Institutes of Clinical Excellence (NICE); United States Centres for Disease Control and Prevention (CDC); Infectious Diseases Society of America (IDSA) and World Health Organization (WHO) guidelines was shown to be effective in reducing the odds of mortality in inpatients with PCR-confirmed seasonal influenza A(H3N2) after adjustment in a busy routine English hospital setting. Our results highlight the importance of hospitals complying with relevant guidelines for prompt seasonal influenza PCR testing and ensuring standard oseltamivir treatment to all PCR-confirmed cases of seasonal influenza.
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Affiliation(s)
- Mark Reacher
- Public Health England and Cambridge Universities Hospitals NHS Foundation Trust Cambridge, Cambridge, United Kingdom.,Public Health England Field Service, Cambridge Institute of Public Health, Cambridge, United Kingdom
| | - Ben Warne
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Lucy Reeve
- Public Health England Field Service, Cambridge Institute of Public Health, Cambridge, United Kingdom
| | - Neville Q Verlander
- Statistics Unit, Statistics, Modelling and Economics Department, National Infection Service - Data and Analytical Sciences, Public Health England, London, United Kingdom
| | - Nicholas K Jones
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Kyriaki Ranellou
- Division of Virology, Department of Pathology, University of Cambridge, United Kingdom.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Silvana Christou
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Callum Wright
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Saher Choudhry
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Maria Zambon
- National Infection Service, Public Health England, London, United Kingdom
| | - Clare Sander
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Hongyi Zhang
- Public Health England and Cambridge Universities Hospitals NHS Foundation Trust Cambridge, Cambridge, United Kingdom
| | - Hamid Jalal
- Public Health England and Cambridge Universities Hospitals NHS Foundation Trust Cambridge, Cambridge, United Kingdom
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24
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Di Pasquale M, Aliberti S, Mantero M, Gramegna A, Blasi F. Pharmacotherapeutic management of bronchial infections in adults: non-cystic fibrosis bronchiectasis and chronic obstructive pulmonary disease. Expert Opin Pharmacother 2020; 21:1975-1990. [PMID: 32808825 DOI: 10.1080/14656566.2020.1793958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Effective management of both acute and chronic bronchial infections is mandatory due to their high frequency rate, the relevant morbidity and mortality and the significant burden to health care systems, especially with the aging of population. Bacteria are the main causative pathogens, followed by viruses, and less commonly by fungi. The clinical evaluation of new therapeutic associations is mandatory to cope with the increases in resistance, in association with better infection control and antimicrobial policies. AREAS COVERED The authors searched Medline for any article published in English language up until March 1, 2020 that concerns the treatment of acute exacerbations and chronic infections in chronic obstructive respiratory disease and bronchiectasis. EXPERT OPINION As acute exacerbations are a main common and detrimental event in patients with COPD and bronchiectasis, effective antimicrobial therapies and regimens should be optimized. The development of new molecules or combination regimens is vital to patients with severe and/or difficult-to-treat infections. Moreover, chronic infection control is mandatory in these patients to their improve quality of life, respiratory function and prognosis as well as for reducing health care costs.
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Affiliation(s)
- Marta Di Pasquale
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan, Italy
| | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan, Italy
| | - Marco Mantero
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan, Italy
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25
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Meier GC, Watkins J, McEwan P, Pockett RD. Resource use and direct medical costs of acute respiratory illness in the UK based on linked primary and secondary care records from 2001 to 2009. PLoS One 2020; 15:e0236472. [PMID: 32760071 PMCID: PMC7410242 DOI: 10.1371/journal.pone.0236472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background Previous studies have shown that influenza is associated with a substantial healthcare burden in the United Kingdom (UK), but more studies are needed to evaluate the resource use and direct medical costs of influenza in primary care and secondary care. Methods A retrospective observational database study in the UK to describe the primary care and directly-associated secondary care resource use, and direct medical costs of acute respiratory illness (ARI), according to age, and risk status (NCT Number: 01521416). Patients with influenza, ARI or influenza-related respiratory infections during 9 consecutive pre-pandemic influenza peak seasons were identified by READ codes in the linked Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) dataset. The study period was from 21st January 2001 to 31st March 2009. Results A total of 156,193 patients had ≥1 general practitioner (GP) episode of ARI, and a total of 82,204 patients received ≥1 GP prescription, at a mean of 2.5 (standard deviation [SD]: 3.0) prescriptions per patient. The total cost of GP consultations and prescriptions equated to £462,827 per year per 100,000 patients. The yearly cost of prescribed medication for ARI was £319,732, at an estimated cost of £11,596,350 per year extrapolated to the UK, with 40% attributable to antibiotics. The mean cost of hospital admissions equated to a yearly cost of £981,808 per 100,000 patients. The total mean direct medical cost of ARI over 9 influenza seasons was £21,343,445 (SD: £10,441,364), at £136.65 (SD: £66.85) per case. Conclusions Extrapolating to the UK population, for pre-pandemic influenza seasons from 2001 to 2009, the direct medical cost of ARI equated to £86 million each year. More studies are needed to assess the costs of influenza disease to help guide public health decision-making for seasonal influenza in the UK.
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Affiliation(s)
| | - John Watkins
- Public Health Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Phil McEwan
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales, United Kingdom
| | - Rhys D. Pockett
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales, United Kingdom
- * E-mail:
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26
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Kim WY, Park MJ, Rhee CK, Lee SY, Kim DJ, Kim DG, Choi CM, Kim DK, Kim YH, Yoon HJ, Kim JY. HL301 versus Umckamin in the treatment of acute bronchitis: a phase III, randomized, controlled, double-blind, multicenter study. Curr Med Res Opin 2020; 36:503-508. [PMID: 31855086 DOI: 10.1080/03007995.2019.1706044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: HL301 is a combination product of seven medicinal plants that has been proven effective in acute bronchitis by two phase II studies. In the present study, its efficacy and safety compared with those of Umckamin in the treatment of acute bronchitis were evaluated in phase III, randomized, controlled, double-blind, multicenter trial design.Methods: A total of 246 acute bronchitis patients were randomized to receive either HL301 (600 mg/day) or Umckamin (333 mg/day) for seven days. The primary outcome was the difference in their baseline (visit 2) and end of treatment (visit 3) bronchitis severity score (BSS). Other efficacy variables included the change in each BSS component (cough, sputum, dyspnea, chest pain, and crackle), response rate, improvement rate, and satisfaction rate with treatment.Results: A full analysis set and per protocol set analysis of both groups revealed that the difference of BSS between visit 2 and visit 3 in the HL301 and Umckamin group was not significantly different (4.58 ± 1.79 versus 4.29 ± 1.88, p = .37 and 4.60 ± 1.81 versus 4.33 ± 1.88, p = .42, respectively). The change in five BSS components (cough, sputum, dyspnea, chest pain, and crackle) of the HL301 and Umckamin groups did not differ after treatment. HL301 or Umckamin treated participants showed an equal level of response, improvement, and satisfaction rates with treatment. Both the HL301 group and Umckamin group showed the same safety profile.Conclusions: HL301 (600 mg/day) was as effective and safe as Umckamin (333 mg/day) in treating acute bronchitis.
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Affiliation(s)
- Won-Young Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Myung Jae Park
- Department of Pulmonology and Critical Care Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Chin Kook Rhee
- Department of Internal Medicine, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Yeub Lee
- Department of Internal Medicine, College of Medicine, Korea University Hospital, Seoul, Republic of Korea
| | - Do Jin Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Dong Gyu Kim
- Department of Internal Medicine, Hallym University Kangnam Hospital, Seoul, Republic of Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Deog Kyeom Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Yee Hyung Kim
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Jae Yeol Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
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27
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Piñana J, Montoro J, Aznar C, Lorenzo I, Gómez MD, Guerreiro M, Carretero C, González-Barberá EM, Balaguer-Roselló A, Sanz R, Salavert M, Navarro D, Sanz MA, Sanz G, Sanz J. The clinical benefit of instituting a prospective clinical community-acquired respiratory virus surveillance program in allogeneic hematopoietic stem cell transplantation. J Infect 2020; 80:333-341. [PMID: 31972212 PMCID: PMC7112613 DOI: 10.1016/j.jinf.2019.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/11/2019] [Accepted: 12/05/2019] [Indexed: 02/06/2023]
Abstract
Rapid detection methods used as first diagnostic test for CARVs may delayed the start of antiviral therapy in a significant number of influenza and RSV cases. Syndromic multiplex RT-PCR-based prospective clinical CARV survey in allo-HCT recipients translates into a lower mortality rate as compared to standard clinical practice based on RSV and influenza virus rapid detection test. We found that donor/recipient HLA mismatch, CARV LRTD and high-risk ISI were also associated with higher mortality.
Background There is a lack of studies comparing clinical outcomes among retrospective versus prospective cohorts of allogeneic stem cell transplant (allo-HCT) recipients with community acquired respiratory virus (CARV) infections. Methods We compare outcomes in two consecutive cohorts of allo-HCT recipients with CARV infections. The retrospective cohort included 63 allo-HCT recipients with 108 CARV infections from January 2013 to April 2016 who were screened and managed following standard clinical practice based on influenza and respiratory syncytial virus rapid antigen detection methods. The prospective cohort was comprised of 144 consecutive recipients with 297 CARV episodes included in a prospective interventional clinical surveillance program (ProClinCarvSur-P) based on syndromic multiplex PCR as first-line test from May 2016 to December 2018 at a single transplant center. Results CARV infections in the retrospective cohort showed more severe clinical features at the time of diagnosis compared to the prospective cohort (fever 83% vs. 57%, hospital admission 69% vs. 28% and lower respiratory tract 58% vs. 31%, respectively, p ≤ 0.002 for all comparisons). Antiviral therapy was more commonly prescribed in the prospective cohort (69 vs. 43 treated CARV episodes), particularly at the upper respiratory tract disease stage (34 vs. 12 treated CARV episodes). Three-month all-cause mortality was significantly higher in the retrospective cohort (n = 23, 37% vs. n = 10, 7%, p < 0.0001). Multivariate logistic regression analysis showed that recipients included in ProClinCarvSur-P had lower mortality rate [odds ratio 0.31, 95% confidence interval 0.12–0.7, p = 0.01]. Conclusion This study report on outcome differences when reporting retrospective vs. prospective CARV infections after allo-HCT. Recipients included in a ProClinCarvSur-P had lower mortality.
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Affiliation(s)
- JoséLuis Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain.
| | - Juan Montoro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carla Aznar
- Outpatient hematology/Oncology nursing unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María Dolores Gómez
- Microbiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carlos Carretero
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | - Rosa Sanz
- Outpatient hematology/Oncology nursing unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - David Navarro
- Microbiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Miguel A Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Guillermo Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
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Yoon SW, Park MJ, Rhee CK, Park JH, Lee SY, Kim DJ, Kim DG, Kim JY. HL301 in the treatment of acute bronchitis: a phase 2b, randomized, double-blind, placebocontrolled, multicenter study. Korean J Intern Med 2020; 35:133-141. [PMID: 30962409 PMCID: PMC6960049 DOI: 10.3904/kjim.2018.181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/24/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS There is insufficient quality data to recommend the use of herbs for the treatment of acute bronchitis. Small number of randomized trials of plant extracts for this purpose were determined to be low quality and there are concerns for the safety. HL301 is a combined product of seven medicinal plants. In the present study, we tried to evaluate the efficacy and safety of HL301 for the treatment of acute bronchitis with a randomized, double-blind, placebo-controlled, multicenter trial design. METHODS A total of 166 patients with acute bronchitis were randomized to receive placebo or HL301 (600 mg/day) for 7 days. The primary endpoint was change in bronchitis severity score (BSS) from baseline visit (visit 2) to the end of treatment (visit 3). Other efficacy variables were the change of each component of the BSS (cough, sputum, dyspnea, chest pain, and crackle) with treatment, response rate, improvement rate, satisfaction rate and number of rescue medications taken. RESULTS Changes in the BSS from visit 2 to visit 3 were higher in the HL301 group than in the placebo group both in the full analysis set (4.57 ± 1.82 vs. 3.15 ± 3.08, p < 0.01) and in the per protocol set (4.62 ± 1.81 vs. 3.30 ± 3.03, p < 0.01). Four BSS components (cough, sputum, dyspnea, and chest pain) improved more with HL301 treatment than with placebo treatment. Participants treated with HL301 showed higher response, improvement, and satisfaction rates and less use of rescue medication than the placebo group. CONCLUSION HL301 (600 mg/day) was effective and safe for symptomatic treatment of acute bronchitis.
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Affiliation(s)
- Sang Won Yoon
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myung Jae Park
- Department of Pulmonology and Critical Care Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chin Kook Rhee
- Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Sang Yeub Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Do Jin Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Dong Gyu Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jae Yeol Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Correspondence to Jae Yeol Kim, M.D. Department of Internal Medicine, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea Tel: +82-2-6299-1396 Fax: +82-2-825-7571 E-mail:
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Jiwa N, Ibe U, Beri R, Feinn R. The Discontinuation of Antibiotics in Patients with Chronic Obstructive Pulmonary Disease Exacerbation and a Positive Respiratory Viral Assay: A Single-center Retrospective Analysis. Cureus 2019; 11:e6491. [PMID: 32025413 PMCID: PMC6984173 DOI: 10.7759/cureus.6491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background The use of antibiotics in chronic obstructive pulmonary disorder (COPD) exacerbations attributed to viral infections is observed in this study. The aim of this analysis is to describe the rate of discontinuation of antibiotics in patients who have an acute exacerbation of COPD (AECOPD) caused by viral infections, in turn encouraging the use of the respiratory viral panel in an effort to improve antibiotic stewardship at our facility. Methods A retrospective chart review was performed. A total of 92 patients were analyzed who had a positive respiratory viral polymerase chain reaction (PCR) (RVP) admitted for COPD exacerbations, of which 20 patients had a bacterial co-infection by a sputum analysis. Patients with a positive infiltrate on chest X-ray (CXR) were excluded. The rate of discontinuation of antibiotics, excluding azithromycin and doxycycline, in patients with a positive RVP with and without a bacterial co-infection were analyzed. Results Of these 92 patients, we found that a bacterial co-infection was detected by sputum culture in 20 patients. The average number of days until discontinuation for patients with no bacterial coinfection was 1.67 days while for those with a bacterial co-infection was 3.20 days. The difference in the number of days was statistically significant (p<0.001). Conclusion In conclusion, patients with an identified viral etiology of COPD exacerbations had antibiotics discontinued significantly sooner than those patients with bacterial coinfections.
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Affiliation(s)
- Nasheena Jiwa
- Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, USA
| | | | - Rohit Beri
- Pulmonary and Critical Care Medicine, St. Mary's Hospital, Waterbury, USA
| | - Richard Feinn
- Statistics, Frank H. Netter MD School of Medicine, North Haven, USA
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Beard K, Brendish N, Malachira A, Mills S, Chan C, Poole S, Clark T. Pragmatic multicentre randomised controlled trial evaluating the impact of a routine molecular point-of-care 'test-and-treat' strategy for influenza in adults hospitalised with acute respiratory illness (FluPOC): trial protocol. BMJ Open 2019; 9:e031674. [PMID: 31852699 PMCID: PMC6937093 DOI: 10.1136/bmjopen-2019-031674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Influenza infections often remain undiagnosed in patients admitted to hospital due to lack of routine testing. When tested for, the diagnosis and treatment of influenza are often delayed due to the slow turnaround times of centralised laboratory PCR testing. Newer molecular systems, have comparable accuracy to laboratory PCR testing, and can generate a result in under 1 hour, making them potentially deployable as point-of-care tests (POCTs). High-quality evidence for the impact of routine POCT for influenza on clinical outcomes is, however, currently lacking. This large pragmatic multicentre randomised controlled trial aims to address this evidence gap. METHODS AND ANALYSIS The FluPOC trial is a pragmatic, multicentre, randomised controlled trial evaluating adults admitted to a large teaching hospital and a district general hospital with an acute respiratory illness, during influenza season and defined by Public Health England. Up to 840 patients will be recruited over up to three influenza seasons, and randomised (1:1) to receive either POCT using the FilmArray respiratory panel, or routine clinical care. Clinical and infection control teams will be informed of the results in real time and where influenza is detected clinical teams will be encouraged to offer neuraminidase inhibitor (NAI) treatment in accordance with national guidelines. Those allocated to standard clinical care will have a swab taken for later analysis to allow assessment of missed diagnoses. The outcomes assessment will be by retrospective case note analysis. The outcome measures include the proportion of influenza-positive patients detected and appropriately treated with NAIs, isolation facility use, antibiotic use, length of hospital stay, complications and mortality. ETHICS AND DISSEMINATION Prior to commencing the study, approval was obtained from the South Central Hampshire A Ethics Committee (reference 17/SC/0368, granted 7 September 2017). Results generated from this protocol will be published in peer-reviewed scientific journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN17197293.
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Affiliation(s)
- Kate Beard
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nathan Brendish
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ahalya Malachira
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Samuel Mills
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Cathleen Chan
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stephen Poole
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tristan Clark
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Post-pandemic influenza A/H1N1pdm09 is associated with more severe outcomes than A/H3N2 and other respiratory viruses in adult hospitalisations. Epidemiol Infect 2019; 147:e310. [PMID: 31775940 PMCID: PMC7003621 DOI: 10.1017/s095026881900195x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This study compares the frequency and severity of influenza A/H1N1pdm09 (A/H1), influenza A/H3N2 (A/H3) and other respiratory virus infections in hospitalised patients. Data from 17 332 adult hospitalised patients admitted to Sir Charles Gairdner Hospital, Perth, Western Australia, with a respiratory illness between 2012 and 2015 were linked with data containing reverse transcription polymerase chain reaction results for respiratory viruses including A/H1, A/H3, influenza B, human metapneumovirus, respiratory syncytial virus and parainfluenza. Of these, 1753 (10.1%) had test results. Multivariable regression analyses were conducted to compare the viruses for clinical outcomes including ICU admission, ventilation, pneumonia, length of stay and death. Patients with A/H1 were more likely to experience severe outcomes such as ICU admission (OR 2.5, 95% CI 1.2–5.5, P = 0.016), pneumonia (OR 3.0, 95% CI 1.6–5.7, P < 0.001) and lower risk of discharge from hospital (indicating longer lengths of hospitalisation; HR 0.64 95% CI 0.47–0.88, P = 0.005), than patients with A/H3. Patients with a non-influenza respiratory virus were less likely to experience severe clinical outcomes than patients with A/H1, however, had similar likelihood when compared to patients with A/H3. Patients hospitalised with A/H1 had higher odds of severe outcomes than patients with A/H3 or other respiratory viruses. Knowledge of circulating influenza strains is important for healthcare preparedness.
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Vos LM, Bruning AHL, Reitsma JB, Schuurman R, Riezebos-Brilman A, Hoepelman AIM, Oosterheert JJ. Rapid Molecular Tests for Influenza, Respiratory Syncytial Virus, and Other Respiratory Viruses: A Systematic Review of Diagnostic Accuracy and Clinical Impact Studies. Clin Infect Dis 2019; 69:1243-1253. [PMID: 30689772 PMCID: PMC7108200 DOI: 10.1093/cid/ciz056] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/16/2019] [Indexed: 01/03/2023] Open
Abstract
We systematically reviewed available evidence from Embase, Medline, and the Cochrane Library on diagnostic accuracy and clinical impact of commercially available rapid (results <3 hours) molecular diagnostics for respiratory viruses as compared to conventional molecular tests. Quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies criteria for diagnostic test accuracy (DTA) studies, and the Cochrane Risk of Bias Assessment and Risk of Bias in Nonrandomized Studies of Interventions criteria for randomized and observational impact studies, respectively. Sixty-three DTA reports (56 studies) were meta-analyzed with a pooled sensitivity of 90.9% (95% confidence interval [CI], 88.7%-93.1%) and specificity of 96.1% (95% CI, 94.2%-97.9%) for the detection of either influenza virus (n = 29), respiratory syncytial virus (RSV) (n = 1), influenza virus and RSV (n = 19), or a viral panel including influenza virus and RSV (n = 14). The 15 included impact studies (5 randomized) were very heterogeneous and results were therefore inconclusive. However, we suggest that implementation of rapid diagnostics in hospital care settings should be considered.
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Affiliation(s)
- Laura M Vos
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Andrea H L Bruning
- Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
| | | | - Rob Schuurman
- Department of Microbiology and Virology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Annelies Riezebos-Brilman
- Department of Microbiology and Virology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Andy I M Hoepelman
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Jan Jelrik Oosterheert
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht University, The Netherlands
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Garvey MI, Wilkinson MAC, Bradley CW, Biggs M, Reddy-Kolanu V, Osman H, Carmalt S, Holden E. Impact of a PCR point of care test for influenza A/B on an acute medical unit in a large UK teaching hospital: results of an observational, pre and post intervention study. Antimicrob Resist Infect Control 2019; 8:120. [PMID: 31346461 PMCID: PMC6636012 DOI: 10.1186/s13756-019-0575-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/09/2019] [Indexed: 01/13/2023] Open
Abstract
Background Influenza viruses is a leading cause of acute respiratory infection, placing a significant burden on healthcare. To reduce hospital transmission, patients clinically suspected of having influenza are isolated and offered empirical antiviral treatment. Here we report the use of a point of care test (POCT) for influenza viruses in an acute medical unit (AMU) at Queen Elizabeth Hospital Birmingham for patients presenting with influenza-like illness. Methods A PCR POCT was installed on AMU in Dec 17 – Mar 18 (period 2) and used to test any patient with influenza-like illness. We conducted an evaluation against influenza virus’s data collected between Dec 16–Mar 17 (period 1) where no POCT was used. Four outcomes were measured: length of stay, oseltamivir utilisation, time to isolation and in-hospital cases of influenza viruses. Results There were 51 confirmed influenza virus cases in period 1 vs 666 in period 2. During period 2, the length of stay of patients presenting with influenza-like illness (2.4 vs 7.9 days) and time to isolation from receipt of a positive result (0.09 vs 1.26 days) was significantly shorter. The time to initial receipt of antivirals for patients with influenza virus was significantly quicker in period 2 (0.59 vs 1.1 days) and the total number of influenza virus cases identified after 72 h of admission was significantly lower (9% vs 51%). Discussion Following introduction of the POCT, there was an increase in appropriately targeted oseltamivir prescribing, shorter time to isolation, proportionally less post-72-h influenza virus cases and a reduction in length of stay of patients presenting with influenza-like illness. Conclusions Routine use of POCTs for viruses should be introduced into diagnostic pathways for acute respiratory illness, especially at the front door of hospitals.
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Affiliation(s)
- Mark I Garvey
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK.,2Institute of Microbiology and Infection, The University of Birmingham, Edgbaston, Birmingham, UK
| | - Martyn A C Wilkinson
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
| | - Craig W Bradley
- 3Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Royal Hospital, Gloucester, GL1 3NN UK
| | - Martin Biggs
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
| | - Vinay Reddy-Kolanu
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
| | - Husam Osman
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
| | - Sarah Carmalt
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
| | - Elisabeth Holden
- 1University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2WB UK
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Tickoo M, Ruthazer R, Bardia A, Doron S, Andujar-Vazquez GM, Gardiner BJ, Snydman DR, Kurz SG. The effect of respiratory viral assay panel on antibiotic prescription patterns at discharge in adults admitted with mild to moderate acute exacerbation of COPD: a retrospective before- after study. BMC Pulm Med 2019; 19:118. [PMID: 31262278 PMCID: PMC6604457 DOI: 10.1186/s12890-019-0872-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Despite well-defined criteria for use of antibiotics in patients presenting with mild to moderate Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), their overuse is widespread. We hypothesized that following implementation of a molecular multiplex respiratory viral panel (RVP), AECOPD patients with viral infections would be more easily identified, limiting antibiotic use in this population. The primary objective of our study was to investigate if availability of the RVP decreased antibiotic prescription at discharge among patients with AECOPD. Methods This is a single center, retrospective, before (pre-RVP) - after (post-RVP) study of patients admitted to a tertiary medical center from January 2013 to March 2016. The primary outcome was antibiotic prescription at discharge. Groups were compared using univariable and multivariable logistic-regression. Results A total of 232 patient-episodes were identified, 133 following RVP introduction. Mean age was 68.1 (pre-RVP) and 68.3 (post-RVP) years respectively (p = 0.88). Patients in pre-RVP group were similar to the post-RVP group with respect to gender (p = 0.54), proportion of patients with BMI < 21(p = 0.23), positive smoking status (p = 0.19) and diagnoses of obstructive sleep apnea (OSA, p = 0.16). We found a significant reduction in antibiotic prescription rate at discharge in patients admitted with AECOPD after introduction of the respiratory viral assay (pre-RVP 77.8% vs. post-RVP 63.2%, p = 0.01). In adjusted analyses, patients in the pre-RVP group [OR 2.11 (CI: 1.13–3.96), p = 0.019] with positive gram stain in sputum [OR 4.02 (CI: 1.61–10.06), p = 0.003] had the highest odds of antibiotic prescription at discharge. Conclusions In patients presenting with mild to moderate Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), utilization of a comprehensive respiratory viral panel can significantly decrease the rate of antibiotic prescription at discharge.
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Affiliation(s)
- Mayanka Tickoo
- Department of Internal Medicine, Division of Pulmonary, Sleep and Critical Care, Yale School of Medicine, New Haven, CT, USA.
| | - Robin Ruthazer
- Biostatistics, Epidemiology, Research, and Design Center, Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA, USA
| | - Amit Bardia
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Shira Doron
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Gabriela M Andujar-Vazquez
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Bradley J Gardiner
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - David R Snydman
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Sebastian G Kurz
- Pulmonary and Critical Care Division, Mount Sinai National Jewish Respiratory Institute, New York, NY, USA
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Brendish NJ, Mills S, Ewings S, Clark TW. Impact of point-of-care testing for respiratory viruses on antibiotic use in adults with exacerbation of airways disease. J Infect 2019; 79:357-362. [PMID: 31233809 PMCID: PMC7112619 DOI: 10.1016/j.jinf.2019.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/20/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The ResPOC study demonstrated that syndromic molecular point-of-care testing (POCT) for respiratory viruses was associated with early discontinuation of unnecessary antibiotics compared to routine clinical care. Subgroup analysis suggests these changes occur predominantly in patients with exacerbation of airways disease. Use of molecular POCT for respiratory viruses is becoming widespread but there is a lack of evidence to inform the choice between multiplex syndromic panels versus POCT for influenza only. MATERIALS/METHODS We evaluated patients from the ResPOC study with exacerbation of asthma or COPD who were treated with antibiotics. The duration of antibiotics and proportion with early discontinuation were compared between patients testing positive and negative for viruses by POCT, and controls. Patients testing positive for viruses by POCT were compared according to virus types. RESULTS 118 patient with exacerbation of airways disease received antibiotics in the POCT group and 111 in the control group. In the POCT group 49/118 (42%) patients tested positive for viruses. Of those testing positive for viruses 17/49 (35%) had early discontinuation of antibiotics versus 9/69 (13%) testing negative and 7/111 (6%) of controls, p<0.0001. Of those positive for viruses by POCT 10/49 (20%) were positive for influenza, 21/49 (43%) for rhinovirus and 18/49 (37%) for other viruses. The proportion with early discontinuation of antibiotics was not different between the virus types (p = 0.34). CONCLUSIONS This data suggests that syndromic molecular POCT for respiratory viruses should be favoured over POCT for influenza alone in adults with exacerbation of airways disease.
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Affiliation(s)
- Nathan J Brendish
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, LF101, South Academic block, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Samuel Mills
- Department of Infection, University Hospital Southampton NHS Foundation Trust, LF101, South Academic block, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Sean Ewings
- Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Tristan W Clark
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, LF101, South Academic block, Southampton General Hospital, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Post-Doctoral Fellowship Programme, UK.
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Braman SS, Poor A. The Spectrum of Non-asthmatic Airway Diseases Contributing to Cough in the Adult. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019; 7:106-115. [PMID: 32226660 PMCID: PMC7100269 DOI: 10.1007/s40136-019-00238-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Cough becomes a pathologic reflex when the airways are inflamed and overwhelmed with excessive mucus. The goal of this review is to discuss acute and chronic cough syndromes caused by non-asthmatic airway diseases. RECENT FINDINGS Acute cough syndrome is short-lived and self-limited. Acute bronchitis and diffuse acute infectious bronchiolitis (DAIB) are examples. The former is usually caused by a viral illness; the latter by Mycoplasma pneumoniae, influenza, and Haemophilus influenzae. Causes of chronic cough in the adult include chronic bronchitis, non-infectious bronchiolitis, and non-cystic fibrosis bronchiectasis. SUMMARY Supportive measures are recommended for acute bronchitis and antibiotic use is discouraged. Antibiotics may be needed for DAIB. Smoking cessation and bronchodilators can control cough in chronic bronchitis. Therapeutic approaches for non-infectious bronchiolitis depend on the varied etiology. The hallmark of bronchiectasis is a chronic infection of the airways, and antibiotics, mucus clearance measures, and bronchodilators are all supportive.
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Affiliation(s)
- Sidney S. Braman
- Icahn School of Medicine at Mount Sinai, 1 Gustav L. Levy Pl., Box 1232, New York, NY 10029 USA
- Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Armeen Poor
- Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
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Abstract
Viral respiratory tract infections are common in both children and adults. Mouse models of viral infection enable the characterization of host immune factors that protect against or promote virus infection; thus, mouse models are essential for interrogation of potential therapeutic targets. Moreover, they serve as critical models for the development of novel vaccine strategies. In this chapter, we describe methods for establishing mouse models of respiratory syncytial virus (RSV) and H1N1 influenza A virus infection. Protocols are provided for viral culture and expansion, plaque-forming assays for viral quantification, and infection of mice. Alternate modifications to the models are also described, and their potential impact is discussed.
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Brendish NJ, Malachira AK, Beard KR, Armstrong L, Lillie PJ, Clark TW. Hospitalised adults with pneumonia are frequently misclassified as another diagnosis. Respir Med 2019; 150:81-84. [PMID: 30961956 DOI: 10.1016/j.rmed.2019.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/09/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
Using data from a large randomised controlled trial of adults hospitalised with acute respiratory illness, we examined the reliability of pneumonia diagnosis on discharge documentation. 50 (28.2%) of 177 patients with a pneumonia diagnosis had no radiological evidence of pneumonia. 67 (34.9%) of 192 patients with clinico-radiological evidence of pneumonia did not have a diagnosis of pneumonia listed; 'COPD exacerbation' or 'lower respiratory tract infection' was often listed instead. These patients more frequently had a respiratory comorbidity and lower oxygen saturations, CRP and temperature at presentation. Pneumonia diagnoses misclassification on discharge documentation may have clinical, financial, and research data implications.
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Affiliation(s)
- Nathan J Brendish
- Academic Unit of Clinical and Experimental Sciences, University of Southampton, Southampton, UK; NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Ahalya K Malachira
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kate R Beard
- Academic Unit of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Lawrence Armstrong
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Patrick J Lillie
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Infectious Diseases Department, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Tristan W Clark
- Academic Unit of Clinical and Experimental Sciences, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Post-Doctoral Fellowship Programme, UK
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Abstract
PURPOSE OF REVIEW Non-influenza respiratory virus infections are a frequent cause of severe acute respiratory infections, especially in infants, the elderly, and the immunocompromised. We review here the current treatment options for non-influenza respiratory viruses and promising candidate antiviral agents currently in development. RECENT FINDINGS Small molecule antiviral agents active against respiratory syncytial virus (RSV), such as ALS-8176 and GS-5806, show considerable promise in challenge studies and are undergoing late-phase clinical trials in hospitalised adults and children. Monoclonal antibodies (mAbs) active against non-influenza respiratory viruses are broadly at a preclinical stage. Broad-spectrum antivirals, such as favipiravir and nitrazoxanide, have potential utility in treating illness caused by non-influenza respiratory viruses but further definitive clinical trials are needed. SUMMARY Severe non-influenza respiratory virus infection is common and current treatment is largely supportive. Ribavirin is used in immunocompromised patients but its use is limited by toxicity and the evidence for its efficacy is weak. Effective antiviral treatment for RSV may shortly become available, pending the results of ongoing clinical trials. For other non-influenza viruses, effective treatments may become available in the medium term. Early detection of respiratory viruses with rapid molecular test platforms will be crucial in differentiating virus types and directing the prompt initiation of novel treatments when available.
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Chasqueira MJ, Paixão P, Rodrigues ML, Piedade C, Caires I, Palmeiro T, Botelho MA, Santos M, Curran M, Guiomar R, Pechirra P, Costa I, Papoila A, Alves M, Neuparth N. Respiratory infections in elderly people: Viral role in a resident population of elderly care centers in Lisbon, winter 2013-2014. Int J Infect Dis 2018; 69:1-7. [PMID: 29391246 PMCID: PMC7110569 DOI: 10.1016/j.ijid.2018.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The aim of this study was to analyze the etiology and clinical consequences of viral respiratory infections in 18 elderly care centers (ECC) in Lisbon, which housed a total of 1022 residents. METHODS Nasopharyngeal swabs were collected whenever an elderly had symptoms of acute respiratory infections (ARI). PCR and RT-PCR were performed for influenza A/B, human parainfluenza virus 1-4, adenovirus, human metapneumovirus (HMPV), respiratory syncytial virus (RSV), rhinovirus, enterovirus, human coronavirus and human Bocavirus (HBoV). Array cards for atypical bacteria were also used in severe cases. RESULTS In total, 188 episodes of ARI were reported, being rhinovirus the most frequently detected (n=53), followed by influenza A(H3) (n=19) and HBoV (n=14). Severe infections were reported in 19 patients, 11 of which were fatal, Legionela pneumophila, rhinovirus, HMPV and RSV associated with these fatalities. Nine influenza strains were analyzed, all antigenically dissimilar from vaccine strain 2013/14. "Age", "HMPV" and "Respiratory disease" showed an association with severe infection. CONCLUSIONS In this study an etiologic agent could be found in 60% of the acute respiratory episodes. These data provides information about the circulating viruses in ECC and highlights the importance of searching both viruses and atypical bacteria in severe ARI.
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Affiliation(s)
- Maria-Jesus Chasqueira
- NOVA Medical School-Faculdade de Ciências Médicas, Campo Mártires da Pátria, 130, 1169-056 Lisboa, Portugal.
| | - Paulo Paixão
- Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School-Faculdade de Ciências Médicas, CEDOC I, Rua do Instituto Bacteriológico, n.°s 5, 5-A e 5-B, 1150-190 Lisboa, Portugal.
| | - Maria-Lúcia Rodrigues
- NOVA Medical School-Faculdade de Ciências Médicas, Campo Mártires da Pátria, 130, 1169-056 Lisboa, Portugal.
| | - Cátia Piedade
- NOVA Medical School-Faculdade de Ciências Médicas, Campo Mártires da Pátria, 130, 1169-056 Lisboa, Portugal.
| | - Iolanda Caires
- Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School-Faculdade de Ciências Médicas, CEDOC I, Rua do Instituto Bacteriológico, n.°s 5, 5-A e 5-B, 1150-190 Lisboa, Portugal.
| | - Teresa Palmeiro
- Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School-Faculdade de Ciências Médicas, CEDOC I, Rua do Instituto Bacteriológico, n.°s 5, 5-A e 5-B, 1150-190 Lisboa, Portugal.
| | - Maria-Amalia Botelho
- Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School-Faculdade de Ciências Médicas, CEDOC I, Rua do Instituto Bacteriológico, n.°s 5, 5-A e 5-B, 1150-190 Lisboa, Portugal.
| | - Madalena Santos
- Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, Rua da Beneficência n.° 8, 1069-166 Lisboa, Portugal.
| | - Martin Curran
- Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, UK.
| | - Raquel Guiomar
- Laboratório Nacional de Referência para o Vírus da Gripe, Instituto Nacional de Saúde Ricardo Jorge, Av. Padre Cruz, 1600 Lisboa, Portugal.
| | - Pedro Pechirra
- Laboratório Nacional de Referência para o Vírus da Gripe, Instituto Nacional de Saúde Ricardo Jorge, Av. Padre Cruz, 1600 Lisboa, Portugal.
| | - Inês Costa
- Laboratório Nacional de Referência para o Vírus da Gripe, Instituto Nacional de Saúde Ricardo Jorge, Av. Padre Cruz, 1600 Lisboa, Portugal.
| | - Ana Papoila
- Epidemiology and Statistics, Research Unit, Centro Hospitalar de Lisboa Central, EPE, Rua José António Serrano, 1150-199 Lisboa, Portugal; CEAUL, Departamento de Bioestatística e Informática, NOVA Medical School-Faculdade de Ciências Médicas, CEDOC I, Rua do Instituto Bacteriológico, n.°s 5, 5-A e 5-B, 1150-190 Lisboa, Portugal.
| | - Marta Alves
- Epidemiology and Statistics, Research Unit, Centro Hospitalar de Lisboa Central, EPE, Rua José António Serrano, 1150-199 Lisboa, Portugal.
| | - Nuno Neuparth
- Centro de Estudos de Doenças Crónicas, CEDOC, NOVA Medical School-Faculdade de Ciências Médicas, CEDOC I, Rua do Instituto Bacteriológico, n.°s 5, 5-A e 5-B, 1150-190 Lisboa, Portugal.
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Alimi Y, Lim WS, Lansbury L, Leonardi-Bee J, Nguyen-Van-Tam JS. Systematic review of respiratory viral pathogens identified in adults with community-acquired pneumonia in Europe. J Clin Virol 2017; 95:26-35. [PMID: 28837859 PMCID: PMC7185624 DOI: 10.1016/j.jcv.2017.07.019] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/07/2017] [Accepted: 07/31/2017] [Indexed: 12/30/2022]
Abstract
Community-acquired pneumonia (CAP) is an important respiratory disease and the fifth leading cause of mortality in Europe. The development of molecular diagnostic tests has highlighted the contributions of respiratory viruses to the aetiology of CAP, suggesting the incidence of viral pneumonia may have been previously underestimated. We performed a systematic review and meta-analysis to describe the overall identification of respiratory viruses in adult patients with CAP in Europe, following PRISMA guidelines (PROSPERO; CRD42016037233). We searched EMBASE, MEDLINE, CINAHL, WHOLIS, COCHRANE library and grey literature sources for relevant studies, and screened these against protocol eligibility criteria. Two researchers performed data extraction and risk of bias assessments, independently, using a piloted form. Results were synthesised narratively, and random effects meta-analyses performed to calculate pooled estimates of effect; heterogeneity was quantified using I2. Twenty-eight studies met inclusion criteria of which 21 were included in the primary meta-analysis. The pooled proportion of patients with identified respiratory viruses was 22.0% (95% CI: 18.0%-27.0%), rising to 29.0% (25.0%-34.0%) in studies where polymerase chain reaction (PCR) diagnostics were performed. Influenza virus was the most frequently detected virus in 9% (7%-12%) of adults with CAP. Respiratory viruses make a substantial contribution to the aetiology of CAP in adult patients in Europe; one or more respiratory viruses are detected in about one quarter of all cases.
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Affiliation(s)
- Y Alimi
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - W S Lim
- University Hospitals NHS Trust, Nottingham, UK
| | - L Lansbury
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - J Leonardi-Bee
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - J S Nguyen-Van-Tam
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK.
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Casalino E, Antoniol S, Fidouh N, Choquet C, Lucet JC, Duval X, Visseaux B, Pereira L. Influenza virus infections among patients attending emergency department according to main reason to presenting to ED: A 3-year prospective observational study during seasonal epidemic periods. PLoS One 2017; 12:e0182191. [PMID: 28813449 PMCID: PMC5558947 DOI: 10.1371/journal.pone.0182191] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/13/2017] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The role of influenza virus in patients presenting at ED during seasonal-epidemic periods has not previously been specified. Our objective was to determine its frequency according to clinical presentation. METHODS This is a prospective observational study conducted during three-consecutive seasonal Influenza epidemics (2013-2015), including patients presenting i) community-acquired pneumonia (CAP); ii) severe acute symptoms (SAS): respiratory failure (RF), hemodynamic failure (HF), cardiac failure (CF), and miscellaneous symptoms (M); iii) symptoms suggesting influenza (PSSI). Patients were tested for influenza using specific PCR on naso-pharyngeal swabs. RESULTS Of 1,239 patients, virological samples were taken from 784 (63.3%), 213 (27.2%) of whom were positive for the influenza virus: CAP 52/177 (29.4%), SAS 115/447 (25.7%) and PSSI 46/160 (28.8%) (p = 0.6). In the SAS group positivity rates were: RF 76/263 (28.9%), HF 5/29 (17.2%), CF 15/68 (22.1%), and M 19/87 (21.8%) (p = 0.3). Among the major diagnostic categories, the influenza virus positivity rates were: asthma 60/231 (26%), acute exacerbation of chronic obstructive pulmonary disease 18/86 (20.9%), HIV 5/21 (23.8%) and cardiac failure 33/131 (25.2%). The positivity of the samples has not been associated (p>0.1) nor the presence of signs of severity or admission rate in medical ward nor intensive care unit. CONCLUSIONS Our results indicate that during seasonal influenza epidemics, Influenza virus-positivity rate is similar in patients attending ED for influenza-compatible clinical features, patients with acute symptoms including pneumonia, respiratory, hemodynamic and cardiac distress, and patients presenting for acute decompensation of chronic respiratory and cardiac diseases.
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Affiliation(s)
- Enrique Casalino
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Emergency Department, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, EA 7334 Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), Paris, France
- Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France
- * E-mail:
| | - Stephanie Antoniol
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Emergency Department, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, EA 7334 Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), Paris, France
- Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France
| | - Nadhira Fidouh
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Virology Department, Paris, France
| | - Christophe Choquet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Emergency Department, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, EA 7334 Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), Paris, France
- Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France
| | - Jean-Christophe Lucet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Infection Control Unit, Paris, France
| | - Xavier Duval
- Inserm CIC-1425, AP-HP, Hôpital Universitaire Bichat, Paris, France
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Benoit Visseaux
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Virology Department, Paris, France
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Laurent Pereira
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Universitaire Paris Nord Val de Seine, Emergency Department, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, EA 7334 Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), Paris, France
- Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France
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Akers IE, Weber R, Sax H, Böni J, Trkola A, Kuster SP. Influence of time to diagnosis of severe influenza on antibiotic use, length of stay, isolation precautions, and mortality: a retrospective study. Influenza Other Respir Viruses 2017; 11:337-344. [PMID: 28380272 PMCID: PMC5485868 DOI: 10.1111/irv.12454] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 11/30/2022] Open
Abstract
Background Timely diagnosis of influenza infection in patients might help reduce antibiotic use during influenza seasons and, consequently, antibiotic selection pressure. In this retrospective cohort study, we aimed to evaluate whether time to influenza diagnosis in patients with severe influenza is associated with the duration of antibiotic therapy. Methods We retrospectively included all hospitalized patients >16 years who tested positive for influenza A or B by polymerase chain reaction during influenza seasons 2013/2014 or 2014/2015 at the University Hospital Zurich. The primary aim was to assess the association between timing of laboratory‐confirmed influenza diagnosis and duration of antibiotic therapy. Secondary outcomes were length of hospital stay, duration of isolation precautions, and mortality. Early diagnosis was defined as laboratory confirmation on the day of or the day after hospital admission or symptom onset. Results A total of 126 patients were included (median age 57 years). Timing of influenza diagnosis was not associated with the duration of antibiotic treatment, the duration of isolation precautions, or mortality. Early influenza was associated with reduced length of hospital stay (median 7 vs 9 days [P=.014]) in patients with community‐acquired influenza. Conclusions Although the duration of antibiotic therapy and mortality were found unaffected by early influenza diagnosis, our data indicate that it is linked with a reduction in the length of hospitalization in patients with community‐acquired influenza. This highlights a need to also fully understand the effect of time to diagnosis of bacterial pathogens on antibiotic prescribing patterns in order to exploit the potential of early influenza diagnosis in patient care.
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Affiliation(s)
- Isabel E Akers
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hugo Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Alexandra Trkola
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
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Brendish NJ, Malachira AK, Armstrong L, Houghton R, Aitken S, Nyimbili E, Ewings S, Lillie PJ, Clark TW. Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomised controlled trial. THE LANCET RESPIRATORY MEDICINE 2017; 5:401-411. [PMID: 28392237 PMCID: PMC7164815 DOI: 10.1016/s2213-2600(17)30120-0] [Citation(s) in RCA: 211] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Respiratory virus infection is a common cause of hospitalisation in adults. Rapid point-of-care testing (POCT) for respiratory viruses might improve clinical care by reducing unnecessary antibiotic use, shortening length of hospital stay, improving influenza detection and treatment, and rationalising isolation facility use; however, insufficient evidence exists to support its use over standard clinical care. We aimed to assess the effect of routine POCT on a broad range of clinical outcomes including antibiotic use. METHODS In this pragmatic, parallel-group, open-label, randomised controlled trial, we enrolled adults (aged ≥18 years) within 24 h of presenting to the emergency department or acute medical unit of a large UK hospital with acute respiratory illness or fever higher than 37·5°C (≤7 days duration), or both, over two winter seasons. Patients were randomly assigned (1:1), via an internet-based allocation sequence with random permuted blocks, to have a molecular POC test for respiratory viruses or routine clinical care. The primary outcome was the proportion of patients who received antibiotics while hospitalised (up to 30 days). Secondary outcomes included duration of antibiotics, proportion of patients receiving single doses or brief courses of antibiotics, length of stay, antiviral use, isolation facility use, and safety. Analysis was by modified intention to treat, excluding patients who declined intervention or were withdrawn for protocol violations. This study is registered with ISRCTN, number 90211642, and has been completed. FINDINGS Between Jan 15, 2015, and April 30, 2015, and between Oct 1, 2015, and April 30, 2016, we enrolled 720 patients (362 assigned to POCT and 358 to routine care). Six patients withdrew or had protocol violations. 301 (84%) of 360 patients in the POCT group received antibiotics compared with 294 (83%) of 354 controls (difference 0·6%, 95% CI -4·9 to 6·0; p=0·84). Mean duration of antibiotics did not differ between groups (7·2 days [SD 5·1] in the POCT group vs 7·7 days [4·9] in the control group; difference -0·4, 95% CI -1·2 to 0·4; p=0·32). 50 (17%) of 301 patients treated with antibiotics in the POCT group received single doses or brief courses of antibiotics (<48 h) compared with 26 (9%) of 294 patients in the control group (difference 7·8%, 95% CI 2·5 to 13·1; p=0·0047; number needed to test=13). Mean length of stay was shorter in the POCT group (5·7 days [SD 6·3]) than in the control group (6·8 days [7·7]; difference -1·1, 95% CI -2·2 to -0·3; p=0·0443). Appropriate antiviral treatment of influenza-positive patients was more common in the POCT group (52 [91%] of 57 patients) than in the control group (24 [65%] of 37 patients; difference 26·4%, 95% CI 9·6 to 43·2; p=0·0026; number needed to test=4). We found no differences in adverse outcomes between the groups (77 [21%] of 360 patients in the POCT group vs 88 [25%] of 354 patients in the control group; -3·5%, -9·7 to 2·7; p=0·29). INTERPRETATION Routine use of molecular POCT for respiratory viruses did not reduce the proportion of patients treated with antibiotics. However, the primary outcome measure failed to capture differences in antibiotic use because many patients were started on antibiotics before the results of POCT could be made available. Although POCT was not associated with a reduction in the duration of antibiotics overall, more patients in the POCT group received single doses or brief courses of antibiotics than did patients in the control group. POCT was also associated with a reduced length of stay and improved influenza detection and antiviral use, and appeared to be safe. FUNDING University of Southampton.
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Affiliation(s)
- Nathan J Brendish
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ahalya K Malachira
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lawrence Armstrong
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rebecca Houghton
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sandra Aitken
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Esther Nyimbili
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sean Ewings
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Patrick J Lillie
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tristan W Clark
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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Brendish NJ, Malachira AK, Clark TW. Molecular point-of-care testing for respiratory viruses versus routine clinical care in adults with acute respiratory illness presenting to secondary care: a pragmatic randomised controlled trial protocol (ResPOC). BMC Infect Dis 2017; 17:128. [PMID: 28166743 PMCID: PMC5294894 DOI: 10.1186/s12879-017-2219-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/24/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Respiratory viruses are associated with a huge socio-economic burden and are responsible for a large proportion of acute respiratory illness in hospitalised adults. Laboratory PCR is accurate but takes at least 24 h to generate a result to clinicians and antigen-based point-of-care tests (POCT) lack sensitivity. Rapid molecular platforms, such as the FilmArray Respiratory Panel, have equivalent diagnostic accuracy to laboratory PCR and can generate a result in 1 h making them deployable as POCT. Molecular point-of-care testing for respiratory viruses in hospital has the potential to improve the detection rate of respiratory viruses, improve the use of influenza antivirals and reduce unnecessary antibiotic use, but high quality randomised trials with clinically relevant endpoints are needed. METHODS The ResPOC study is a pragmatic randomised controlled trial of molecular point-of-care testing for respiratory viruses in adults with acute respiratory illness presenting to a large teaching hospital in the United Kingdom. Eligible participants are adults presenting with acute respiratory illness to the emergency department or the acute medicine unit. Participants are allocated 1:1 by internet-based randomisation service to either the intervention of a nose and throat swab analysed immediately on the FilmArray Respiratory Panel as a POCT or receive routine clinical care. The primary outcome is the proportion of patients treated with antibiotics. Secondary outcomes include turnaround time, virus detection, neuraminidase inhibitor use, length of hospital stay and side room use. Analysis of the primary outcome will be by intention-to-treat and all enrolled participants will be included in safety analysis. DISCUSSION Multiple novel molecular POCT platforms for infections including respiratory viruses have been developed and licensed in the last few years and many more are in development but the evidence base for clinical benefit above standard practice is minimal. This randomised controlled trial aims to close this evidence gap by generating high quality evidence for the clinical impact of molecular POCT for respiratory viruses in secondary care and to act as an exemplar for future studies of molecular POCT for infections. This study has the potential to change practice and improve patient care for patients presenting to hospital with acute respiratory illness. TRIAL REGISTRATION This study was registered with ISRCTN, number ISRCTN90211642 , on 14th January 2015.
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Affiliation(s)
- Nathan J. Brendish
- NIHR Southampton Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ahalya K. Malachira
- NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tristan W. Clark
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Clark TW, Ewings S, Medina MJ, Batham S, Curran MD, Parmar S, Nicholson KG. Viral load is strongly associated with length of stay in adults hospitalised with viral acute respiratory illness. J Infect 2016; 73:598-606. [PMID: 27615557 PMCID: PMC7112535 DOI: 10.1016/j.jinf.2016.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 12/13/2022]
Abstract
Background Respiratory viruses are detectable in a large proportion of adults hospitalised with acute respiratory illness. For influenza and other viruses there is evidence that viral load and persistence are associated with certain clinical outcomes but it is not known if there is an association between viral load and hospital length of stay. Methods 306 adults hospitalised with viral acute respiratory illness were studied. Associations between viral load and length of stay were examined. Multiple linear regression analysis was performed to control for age, comorbidity, influenza vaccine status, duration of illness prior to hospitalisation, bacterial co-infection, clinical group and virus subtype. Results High viral load was associated with a longer duration of hospitalisation for all patients (p < 0.0001). This remained significant across all virus types and clinical groups and when adjusted for age, comorbidity, duration of illness prior to hospitalisation, bacterial co-infection and other factors. Conclusions High viral loads are associated with prolonged hospital length of stay in adults with viral acute respiratory illness. This further supports existing evidence demonstrating that viral acute respiratory illness is a viral load driven process and suggests that viral load could be used in clinical practise to predict prolonged hospitalisation and prioritise antivirals. International Standard Randomised Controlled Trial Number (ISRCTN): 21521552 It is not known if viral load is associated with length of stay in viral acute respiratory illness. We examined 306 adult patients hospitalised with confirmed viral acute respiratory illness. High viral load was associated with longer length of stay for all virus subtypes and all clinical groups. This could be used in clinical practise to identify high risk patients and prioritise antivirals.
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Affiliation(s)
- Tristan W Clark
- Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK; NIHR Respiratory Biomedical Research Unit, Southampton UK; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.
| | - Sean Ewings
- Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Marie-Jo Medina
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Sally Batham
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Martin D Curran
- Public Health England, Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK
| | - Surendra Parmar
- Public Health England, Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK
| | - Karl G Nicholson
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
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47
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NICKBAKHSH S, THORBURN F, VON WISSMANN B, McMENAMIN J, GUNSON RN, MURCIA PR. Extensive multiplex PCR diagnostics reveal new insights into the epidemiology of viral respiratory infections. Epidemiol Infect 2016; 144:2064-76. [PMID: 26931455 PMCID: PMC7113017 DOI: 10.1017/s0950268816000339] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/20/2015] [Accepted: 02/03/2016] [Indexed: 12/14/2022] Open
Abstract
Viral respiratory infections continue to pose a major global healthcare burden. At the community level, the co-circulation of respiratory viruses is common and yet studies generally focus on single aetiologies. We conducted the first comprehensive epidemiological analysis to encompass all major respiratory viruses in a single population. Using extensive multiplex PCR diagnostic data generated by the largest NHS board in Scotland, we analysed 44230 patient episodes of respiratory illness that were simultaneously tested for 11 virus groups between 2005 and 2013, spanning the 2009 influenza A pandemic. We measured viral infection prevalence, described co-infections, and identified factors independently associated with viral infection using multivariable logistic regression. Our study provides baseline measures and reveals new insights that will direct future research into the epidemiological consequences of virus co-circulation. In particular, our study shows that (i) human coronavirus infections are more common during influenza seasons and in co-infections than previously recognized, (ii) factors associated with co-infection differ from those associated with viral infection overall, (iii) virus prevalence has increased over time especially in infants aged <1 year, and (iv) viral infection risk is greater in the post-2009 pandemic era, likely reflecting a widespread change in the viral population that warrants further investigation.
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Affiliation(s)
- S. NICKBAKHSH
- MRC-University of Glasgow Centre for Virus Research, Institute of Infection, Inflammation and Immunity, Glasgow, UK
| | - F. THORBURN
- MRC-University of Glasgow Centre for Virus Research, Institute of Infection, Inflammation and Immunity, Glasgow, UK
| | - B. VON WISSMANN
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - J. McMENAMIN
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - R. N. GUNSON
- West of Scotland Specialist Virology Centre, NHS Greater Glasgow and Clyde, GlasgowUK
| | - P. R. MURCIA
- MRC-University of Glasgow Centre for Virus Research, Institute of Infection, Inflammation and Immunity, Glasgow, UK
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48
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Finianos M, Issa R, Curran MD, Afif C, Rajab M, Irani J, Hakimeh N, Naous A, Hajj MJ, Hajj P, El Jisr T, El Chaar M. Etiology, seasonality, and clinical characterization of viral respiratory infections among hospitalized children in Beirut, Lebanon. J Med Virol 2016; 88:1874-81. [PMID: 27061822 PMCID: PMC7167081 DOI: 10.1002/jmv.24544] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 11/23/2022]
Abstract
Acute respiratory tract viral infections occur worldwide and are one of the major global burdens of diseases in children. The aim of this study was to determine the viral etiology of respiratory infections in hospitalized children, to understand the viral seasonality in a major Lebanese hospital, and to correlate disease severity and the presence of virus. Over a 1‐year period, nasal and throat swabs were collected from 236 pediatric patients, aged 16‐year old or less and hospitalized for acute respiratory illness. Samples collected were tested for the presence of 17 respiratory viruses using multiplex real‐time RT‐PCR. Pathogens were identified in 165 children (70%) and were frequently observed during fall and winter seasons. Co‐infection was found in 37% of positive samples. The most frequently detected pathogens were human Rhinovirus (hRV, 23%), Respiratory Syncytial Virus (RSV, 19%), human Bocavirus (hBov, 15%), human Metapneumovirus (hMPV, 10%), and human Adenovirus (hAdV, 10%). A total of 48% of children were diagnosed with bronchiolitis and 25% with pneumonia. While bronchiolitis was often caused by RSV single virus infection and hAdV/hBoV coinfection, pneumonia was significantly associated with hBoV and HP1V1 infections. No significant correlation was observed between a single viral etiology infection and a specific clinical symptom. This study provides relevant facts on the circulatory pattern of respiratory viruses in Lebanon and the importance of using PCR as a useful tool for virus detection. Early diagnosis at the initial time of hospitalization may reduce the spread of the viruses in pediatric units. J. Med. Virol. 88:1874–1881, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mayda Finianos
- Faculty of Health Sciences, University of Balamand, Beirut, Lebanon
| | - Randi Issa
- Faculty of Health Sciences, University of Balamand, Beirut, Lebanon
| | - Martin D Curran
- Public Health England Clinical Microbiology Laboratory, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Claude Afif
- Faculty of Medicine, University of Balamand, Saint Georges University Medical Centre, Beirut, Lebanon
| | - Maryam Rajab
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Jihad Irani
- Faculty of Medicine, University of Balamand, Saint Georges University Medical Centre, Beirut, Lebanon
| | - Noha Hakimeh
- Faculty of Medicine, University of Balamand, Saint Georges University Medical Centre, Beirut, Lebanon
| | - Amal Naous
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Marie-Joelle Hajj
- Faculty of Medicine, University of Balamand, Saint Georges University Medical Centre, Beirut, Lebanon
| | - Pierre Hajj
- Faculty of Medicine, University of Balamand, Saint Georges University Medical Centre, Beirut, Lebanon
| | - Tamima El Jisr
- Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Mira El Chaar
- Faculty of Health Sciences, University of Balamand, Beirut, Lebanon
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49
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Altered Innate Immune Responses in Neutrophils from Patients with Well- and Suboptimally Controlled Asthma. Mediators Inflamm 2015; 2015:219374. [PMID: 26663987 PMCID: PMC4667029 DOI: 10.1155/2015/219374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/22/2015] [Accepted: 10/26/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Respiratory infections are a major cause of asthma exacerbations where neutrophilic inflammation dominates and is associated with steroid refractory asthma. Structural airway cells in asthma differ from nonasthmatics; however it is unknown if neutrophils differ. We investigated neutrophil immune responses in patients who have good (AGood) and suboptimal (ASubopt) asthma symptom control. METHODS Peripheral blood neutrophils from AGood (ACQ < 0.75, n = 11), ASubopt (ACQ > 0.75, n = 7), and healthy controls (HC) (n = 9) were stimulated with bacterial (LPS (1 μg/mL), fMLF (100 nM)), and viral (imiquimod (3 μg/mL), R848 (1.5 μg/mL), and poly I:C (10 μg/mL)) surrogates or live rhinovirus (RV) 16 (MOI1). Cell-free supernatant was collected after 1 h for neutrophil elastase (NE) and matrix metalloproteinase- (MMP-) 9 measurements or after 24 h for CXCL8 release. Results. Constitutive NE was enhanced in AGood neutrophils compared to HC. fMLF stimulated neutrophils from ASubopt but not AGood produced 50% of HC levels. fMLF induced MMP-9 was impaired in ASubopt and AGood compared to HC. fMLF stimulated CXCL8 but not MMP-9 was positively correlated with FEV1 and FEV1/FVC. ASubopt and AGood responded similarly to other stimuli. CONCLUSIONS Circulating neutrophils are different in asthma; however, this is likely to be related to airflow limitation rather than asthma control.
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50
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Remolina YA, Ulloa MM, Vargas H, Díaz L, Gómez SL, Saavedra A, Sánchez E, Cortés JA. Viral Infection in Adults with Severe Acute Respiratory Infection in Colombia. PLoS One 2015; 10:e0143152. [PMID: 26576054 PMCID: PMC4648489 DOI: 10.1371/journal.pone.0143152] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/30/2015] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To identify the viral aetiology in adult patients with severe acute respiratory infection (SARI) admitted to sentinel surveillance institutions in Bogotá in 2012. DESIGN A cross-sectional study was conducted in which microarray molecular techniques for viral identification were used on nasopharyngeal samples of adult patients submitted to the surveillance system, and further descriptions of clinical features and relevant clinical outcomes, such as mortality, need for critical care, use of mechanical ventilation and hospital stay, were obtained. SETTING Respiratory infections requiring hospital admission in surveillance centres in Bogotá, Colombia. PARTICIPANTS Ninety-one adult patients with acute respiratory infection (55% were female). MEASUREMENTS Viral identification, intensive care unit admission, hospital stay, and mortality. RESULTS Viral identification was achieved for 63 patients (69.2%). Comorbidity was frequently identified and mainly involved chronic pulmonary disease or pregnancy. Influenza, Bocavirus and Adenovirus were identified in 30.8%, 28.6% and 18.7% of the cases, respectively. Admission to the intensive care unit occurred in 42.9% of the cases, while mechanical ventilation was required for 36.3%. The average hospital stay was 9.9 days, and mortality was 15.4%. Antibiotics were empirically used in 90.1% of patients. CONCLUSIONS The prevalence of viral aetiology of SARI in this study was high, with adverse clinical outcomes, intensive care requirements and high mortality.
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Affiliation(s)
- Yuly Andrea Remolina
- Department of Internal Medicine, Faculty of Medicine, National University of Colombia, Bogotá, Colombia
| | - María Mercedes Ulloa
- Department of Internal Medicine, Faculty of Medicine, National University of Colombia, Bogotá, Colombia
| | - Hernán Vargas
- Public Health Laboratory, District Health Department, Bogota, Colombia
| | - Liliana Díaz
- Public Health Laboratory, District Health Department, Bogota, Colombia
| | | | - Alfredo Saavedra
- Department of Internal Medicine, Faculty of Medicine, National University of Colombia, Bogotá, Colombia
| | - Edgar Sánchez
- Department of Internal Medicine, Faculty of Medicine, National University of Colombia, Bogotá, Colombia
| | - Jorge Alberto Cortés
- Department of Internal Medicine, Faculty of Medicine, National University of Colombia, Bogotá, Colombia
- Infectious Disease Research Group, Faculty of Medicine, National University of Colombia, Bogotá, Colombia
- * E-mail:
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