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Forster J, Piazza G, Goettler D, Kemmling D, Schoen C, Rose M, Streng A, Liese JG. Effect of Prehospital Antibiotic Therapy on Clinical Outcome and Pathogen Detection in Children With Parapneumonic Pleural Effusion/Pleural Empyema. Pediatr Infect Dis J 2021; 40:544-549. [PMID: 33395211 DOI: 10.1097/inf.0000000000003036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Parapneumonic pleural effusion and pleural empyema (PPE/PE) are complications of community-acquired pneumonia. The objective of this study was to analyze prehospital antibiotic therapy (PH-ABT) of children with PPE/PE and investigate its effects on clinical outcome and pathogen detection. METHODS Prospective nationwide active surveillance in Germany between October 2010 and June 2018. Children and adolescents <18 years of age with pneumonia-associated PE or PPE requiring drainage or with persistence of PPE/PE >7 days were included. RESULTS A total of 1724 children with PPE/PE were reported, of whom 556 children (32.3% of 1719 with available data) received PH-ABT. Children with PH-ABT had a shorter median hospital length of stay (15 vs. 18 days, P < 0.001), a longer time from onset of symptoms until hospital discharge (25 vs. 23 days, P = 0.002), a lower rate of intensive care unit admission (58.3% vs. 64.4%, P = 0.015) and fewer infectious complications (5.9% vs. 10.0%; P = 0.005). Bacterial pathogens in blood or pleural fluid culture were detected in 597 (34.5%) of 1513 children. Positive culture results were less frequent in children with than without PH-ABT (81/466 [17.4%] vs. 299/1005 [29.8%]; P < 0.001), whereas detection rates in pleural fluid samples by polymerase chain reaction were similar (91/181 [50.3%] vs. 220/398 [55.3%]; P = 0.263). CONCLUSIONS In children with PPE/PE, PH-ABT significantly reduced the overall rate of bacterial pathogen detection by culture, but not by polymerase chain reaction. PH-ABT was associated with a lower rate of infectious complications but did not affect the overall duration of disease. We therefore speculate that the duration of PPE/PE is mainly a consequence of an infection-induced inflammatory process, which can only partially be influenced by antibiotic treatment.
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Affiliation(s)
- Johannes Forster
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
| | - Giuseppina Piazza
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
- Klinikum Stuttgart, Olgahospital- Pediatric Pulmonology, Stuttgart, Germany
| | - David Goettler
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Daniel Kemmling
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Christoph Schoen
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
| | - Markus Rose
- Klinikum Stuttgart, Olgahospital- Pediatric Pulmonology, Stuttgart, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
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Tanzella G, Motos A, Battaglini D, Meli A, Torres A. Optimal approaches to preventing severe community-acquired pneumonia. Expert Rev Respir Med 2019; 13:1005-1018. [PMID: 31414915 DOI: 10.1080/17476348.2019.1656531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Community-acquired pneumonia (CAP) has the highest rate of mortality of all infectious diseases, especially among the elderly. Severe CAP (sCAP) is defined as a CAP in which intensive care management is required and is associated with an unfavorable clinical course. Areas covered: This review aims to identify prevention strategies for reducing the incidence of CAP and optimized management of sCAP. We highlight the main prevention approaches for CAP, focusing on the latest vaccination plans and on the influence of health-risk behaviors. Lastly, we report the latest recommendations about the optimal approach for sCAP when CAP has already been diagnosed, including prompt admission to ICU, early empirical antibiotic therapy, and optimization of antibiotic use. Expert opinion: Despite improvements in the diagnosis and treatment of sCAP, more efforts are needed to combat preventable causes, including the implementation and improvement of vaccine coverage, anti-tobacco campaigns and correct oral hygiene. Moreover, future research should aim to assess the benefits of early antimicrobial therapy in primary care. Pharmacokinetic studies in the target population may help clinicians to adjust dosage regimens in critically ill patients with CAP and thus reduce rates of treatment failure.
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Affiliation(s)
- Giacomo Tanzella
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Department of Surgical Sciences and Integrated Diagnostics (DISC), San Martino Policlinico Hospital , Genoa , Italy
| | - Ana Motos
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias , Madrid , Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer , Barcelona , Spain.,Faculty of Medicine, University of Barcelona , Barcelona , Spain
| | - Denise Battaglini
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Department of Surgical Sciences and Integrated Diagnostics (DISC), San Martino Policlinico Hospital , Genoa , Italy
| | - Andrea Meli
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,University of Milan , Milan , Italy
| | - Antoni Torres
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias , Madrid , Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer , Barcelona , Spain.,Faculty of Medicine, University of Barcelona , Barcelona , Spain
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Potjo M, Theron AJ, Cockeran R, Sipholi NN, Steel HC, Bale TV, Meyer PW, Anderson R, Tintinger GR. Interleukin-10 and interleukin-1 receptor antagonist distinguish between patients with sepsis and the systemic inflammatory response syndrome (SIRS). Cytokine 2019; 120:227-233. [DOI: 10.1016/j.cyto.2019.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 12/29/2022]
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Abstract
PURPOSE OF REVIEW The first guidelines on community-acquired pneumonia (CAP) were published in 1993, but since then many of the challenges regarding the outpatient management of CAP persist. These include the difficulty in establishing the initial clinical diagnosis, its risk stratification, which will dictate the place of treatment, the empirical choice of antibiotics, the relative scarcity of novel antibiotics and the importance of knowing local microbiological susceptibility patterns. RECENT FINDINGS New molecular biology methods have changed the etiologic perspective of CAP, especially the contribution of virus. Lung ultrasound and biomarkers might aid diagnosis and severity stratification in the outpatient setting. Antibiotic resistance is a growing problem that reinforces the importance of novel antibiotics. And finally, prevention and the use of anti-pneumococcal vaccine are instrumental in reducing the burden of disease. SUMMARY Most of CAP cases are managed in the community; however, most research comes from hospitalized severe patients. New and awaited advances might contribute to aid diagnosis, cause and assessment of patients with CAP in the community. This knowledge might prove decisive in the execution of stewardship programmes that maintain current antibiotics, safeguard future ones and reinforce prevention.
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Cillóniz C, Dominedò C, Ielpo A, Ferrer M, Gabarrús A, Battaglini D, Bermejo-Martin J, Meli A, García-Vidal C, Liapikou A, Singer M, Torres A. Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia. J Clin Med 2019; 8:jcm8070961. [PMID: 31269766 PMCID: PMC6678833 DOI: 10.3390/jcm8070961] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/20/2019] [Accepted: 07/01/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Little is known about risk and prognostic factors in very old patients developing sepsis secondary to community-acquired pneumonia (CAP). Methods: We conducted a retrospective observational study of data prospectively collected at the Hospital Clinic of Barcelona over a 13-year period. Consecutive patients hospitalized with CAP were included if they were very old (≥80 years) and divided into those with and without sepsis for comparison. Sepsis was diagnosed based on the Sepsis-3 criteria. The main clinical outcome was 30-day mortality. Results: Among the 4219 patients hospitalized with CAP during the study period, 1238 (29%) were very old. The prevalence of sepsis in this age group was 71%. Male sex, chronic renal disease, and diabetes mellitus were independent risk factors for sepsis, while antibiotic therapy before admission was independently associated with a lower risk of sepsis. Thirty-day and intensive care unit (ICU) mortality did not differ between patients with and without sepsis. In CAP-sepsis group, chronic renal disease and neurological disease were independent risk factors for 30-day mortality. Conclusion: In very old patients hospitalized with CAP, in-hospital and 1-year mortality rates were increased if they developed sepsis. Antibiotic therapy before hospital admission was associated with a lower risk of sepsis.
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Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain.
- August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain.
- Biomedical Research Networking Centres in Respiratory Diseases (Ciberes), 28029 Madrid, Spain.
| | - Cristina Dominedò
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonella Ielpo
- Departments of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, 43121 Parma, Italy
| | - Miquel Ferrer
- Department of Pneumology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
- Biomedical Research Networking Centres in Respiratory Diseases (Ciberes), 28029 Madrid, Spain
| | - Albert Gabarrús
- Department of Pneumology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
- Biomedical Research Networking Centres in Respiratory Diseases (Ciberes), 28029 Madrid, Spain
| | - Denise Battaglini
- Department of Surgical Sciences and Integrated Diagnostic, Policlinico San Martino, University of Genova, 16126 Genova, Italy
| | - Jesús Bermejo-Martin
- Group for Biomedical Research in Sepsis (Bio Sepsis), Hospital Clínico Universitario de Valladolid/IECSCYL, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain
| | - Andrea Meli
- Department of Anesthesia and Intensive Care, University of Milan, 20122 Milan, Italy
| | - Carolina García-Vidal
- Infectious Diseases Department, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
| | - Adamanthia Liapikou
- Respiratory Department, Sotiria Chest Diseases Hospital, Mesogion 152, 11527Athens, Greece
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, Cruciform Building, Gower St, London WC1E 6BT, UK
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain.
- August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain.
- Biomedical Research Networking Centres in Respiratory Diseases (Ciberes), 28029 Madrid, Spain.
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Chakrabarti B, Wootton D, Lane S, Kanwar E, Somers J, Proctor J, Prospero N, Woodhead M. The association between pre-hospital antibiotic therapy and subsequent in-hospital mortality in adults presenting with community-acquired pneumonia: an observational study. Pneumonia (Nathan) 2018; 10:2. [PMID: 29593979 PMCID: PMC5866909 DOI: 10.1186/s41479-018-0047-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/12/2018] [Indexed: 01/09/2023] Open
Abstract
Background The majority of patients with community acquired-pneumonia (CAP) are treated in primary care and the mortality in this group is very low. However, a small but significant proportion of patients who begin treatment in the community subsequently require admission due to symptomatic deterioration. This study compared patients who received community antibiotics prior to admission to those who had not, and looked for associations with clinical outcomes. Methods This study analysed the Advancing Quality (AQ) Pneumonia database of patients admitted with CAP to 9 acute hospitals in the northwest of England over a 12-month period. Results There were 6348 subjects (mean age 72 [SD 16] years; gender ratio 1:1) admitted with CAP, of whom 17% had been pre-treated with antibiotics. The in-hospital mortality was 18.6% for the pre-treatment group compared to 13.2% in the "antibiotic naïve" group (p < 0.001). On multivariate analysis, age, male gender and antibiotic pre-treatment were predictors of in-hospital mortality along with a history of cerebrovascular accident, congestive cardiac failure, dementia, renal disease and cancer. After adjustment for CURB-65 score, age, co-morbidities and pre-treatment with antibiotics remained as independent risk factors for in-hospital mortality (OR 1.43, 95% CI 1.19-1.71). Conclusion CAP patients admitted to hospital were more likely to die during admission if they had received antibiotics for the same illness pre-admission. Future studies should endeavor to determine the mechanisms underlying this association, such as microbiological factors and the role of comorbidities. Patients hospitalized with CAP despite prior antibiotic treatment in the community require close monitoring.
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Affiliation(s)
| | - Dan Wootton
- 2Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,3Department of Respiratory Research, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Steven Lane
- 4Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | - Joseph Somers
- 1Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Jacyln Proctor
- 6Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | | | - Mark Woodhead
- 7Department of Respiratory Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,8Manchester Academic Health Science Centre and Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
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