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López-Lacort M, Amini M, Emborg HD, Nielsen J, McDonald SA, Valentiner-Branth P, Díez-Domingo J, Orrico-Sánchez A. Incidence of Invasive and Noninvasive Pneumococcal Pneumonia Hospitalizations in People Aged ≥50 Years: Assessing Variability Across Denmark and Spain. J Infect Dis 2024; 230:e559-e567. [PMID: 38459772 PMCID: PMC11420809 DOI: 10.1093/infdis/jiae088] [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: 10/30/2023] [Accepted: 02/22/2024] [Indexed: 03/10/2024] Open
Abstract
Determining pneumococcal pneumonia (PP) burden in the elderly population is challenging due to limited data on invasive PP (IPP) and, in particular, noninvasive PP (NIPP) incidence. Using retrospective cohorts of adults aged ≥50 years in Denmark (2 782 303) and the Valencia region, Spain (2 283 344), we found higher IPP hospitalization rates in Denmark than Valencia (18.3 vs 9/100 000 person-years [PY], respectively). Conversely, NIPP hospitalization rates were higher in Valencia (48.2 vs 7.2/100 000 PY). IPP and NIPP rates increased with age and comorbidities in both regions, with variations by sex and case characteristics (eg, complications, mortality). The burden of PP in adults is substantial, yet its true magnitude remains elusive. Discrepancies in clinical practices impede international comparisons; for instance, Valencia employed a higher frequency of urinary antigen tests compared to Denmark. Additionally, coding practices and prehospital antibiotic utilization may further influence these variations. These findings could guide policymakers and enhance the understanding of international disparities in disease burden assessments.
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Affiliation(s)
- Mónica López-Lacort
- Vaccine Research Department of Fisabio-Public Health, Valencia, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Marzyeh Amini
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Jens Nielsen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Scott A McDonald
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Amsterdam, The Netherlands
| | - Palle Valentiner-Branth
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Javier Díez-Domingo
- Vaccine Research Department of Fisabio-Public Health, Valencia, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- Chair of Vaccines, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - Alejandro Orrico-Sánchez
- Vaccine Research Department of Fisabio-Public Health, Valencia, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- Chair of Vaccines, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
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Marshall DC, Goodson RJ, Xu Y, Komorowski M, Shalhoub J, Maruthappu M, Salciccioli JD. Trends in mortality from pneumonia in the Europe union: a temporal analysis of the European detailed mortality database between 2001 and 2014. Respir Res 2018; 19:81. [PMID: 29728122 PMCID: PMC5935998 DOI: 10.1186/s12931-018-0781-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 04/17/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Pneumonia is responsible for approximately 230,000 deaths in Europe, annually. Comprehensive and comparable reports on pneumonia mortality trends across the European Union (EU) are lacking. METHODS A temporal analysis of national mortality statistics to compare trends in pneumonia age-standardised death rates (ASDR) of EU countries between 2001 and 2014 was performed. International Classification of Diseases version 10 (ICD-10) codes were used to extract data from the World Health Organisation European Detailed Mortality Database and trends were analysed using Joinpoint regression. RESULTS Median pneumonia mortality across the EU for the last recorded observation was 19.8 / 100,000 and 6.9 / 100,000 for males and females, respectively. Mortality was higher in males across all EU countries, most notably in Estonia and Lithuania where the ratio of male to female ASDR was 4.0 and 3.7, respectively. Gender mortality differences were lowest in the UK and Demark with ASDR ratios of 1.1 and 1.5, respectively. Pneumonia mortality across all countries decreased by a median of 31.0% over the observation period. Countries that demonstrated an increase in pneumonia mortality were Poland (males + 33.1%, females + 10.2%), and Lithuania (males + 6.0%). CONCLUSIONS Mortality from pneumonia is improving in most EU countries, however substantial variation in trends remains between countries and between genders.
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Affiliation(s)
- Dominic C Marshall
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | - Ross J Goodson
- Department of Medicine, Imperial College London, London, UK
| | - Yiwang Xu
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Matthieu Komorowski
- Department of Medicine, Imperial College London, London, UK. .,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Hospitalized community-acquired pneumonia in the elderly: an Australian case-cohort study. Epidemiol Infect 2008; 137:194-202. [PMID: 18559126 DOI: 10.1017/s0950268808000812] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study describes the epidemiology of community-acquired pneumonia (CAP) in elderly Australians for the first time. Using a case-cohort design, cases with CAP were in-patients aged > or = 65 years with ICD-10-AM codes J10-J18 admitted over 2 years to two tertiary hospitals. The cohort sample was randomly selected from all hospital discharges, frequency-matched to cases by month. Logistic regression was used to estimate risk ratios for factors predicting CAP or associated mortality. A total of 4772 in-patients were studied. There were 1952 cases with CAP that represented 4% of all elderly admissions: mean length of stay was 9.0 days and 30-day mortality was 18%. Excluding chest radiograph, 520/1864 (28%) cases had no investigations performed. The strongest predictors of CAP were previous pneumonia, history of other respiratory disease, and aspiration. Intensive-care-unit admission, renal disease and increasing age were the strongest predictors of mortality, while influenza vaccination conferred protection. Hospitalization with CAP in the elderly is common, frequently fatal and a considerable burden to the Australian community. Investigation is ad hoc and management empirical. Influenza vaccination is associated with reduced mortality. Patient characteristics can predict risk of CAP and subsequent mortality.
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Community-Acquired Pneumonia—Back to Basics. ANTIBIOTIC POLICIES: FIGHTING RESISTANCE 2008. [PMCID: PMC7121559 DOI: 10.1007/978-0-387-70841-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Lower respiratory tract infections are among the most common infectious diseases worldwide and are caused by the inflammation and consolidation of lung tissue due to an infectious agent.1 The clinical criteria for the diagnosis include chest pain, cough, auscultatory findings such as rales or evidence of pulmonary consolidation, fever, or leukocytosis.
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Skull SA, Andrews RM, Byrnes GB, Kelly HA, Nolan TM, Brown GV, Campbell DA. Validity of self-reported influenza and pneumococcal vaccination status among a cohort of hospitalized elderly inpatients. Vaccine 2007; 25:4775-83. [PMID: 17499402 DOI: 10.1016/j.vaccine.2007.04.015] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2007] [Revised: 03/29/2007] [Accepted: 04/09/2007] [Indexed: 10/23/2022]
Abstract
Use of self-reported vaccination status is commonplace in assessing vaccination coverage for public health programs and individuals, yet limited validity data exist. We compared self-report with provider records for pneumococcal (23vPPV) and influenza vaccine for 4887 subjects aged>or=65 years from two Australian hospitals. Self-reported influenza vaccination status had high sensitivity (98%), positive predictive value (PPV) (88%) and negative predictive value (NPV) (91%), but low specificity (56%). Self-reported 23vPPV (previous 5 years) had a sensitivity of 84%, specificity 77%, PPV 85% and NPV 76%. Clinicians can be reasonably confident of self-reported influenza vaccine status, and for positive self-report for 23vPPV in this setting. For program evaluation, self-reported influenza vaccination coverage among inpatients overestimates true coverage by about 10% versus 1% for 23vPPV. Self-report remains imperfect and whole-of-life immunisation registers a preferable goal.
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Affiliation(s)
- Susan A Skull
- Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
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Skull SA, Andrews RM, Byrnes GB, Campbell DA, Nolan TM, Brown GV, Kelly HA. ICD-10 codes are a valid tool for identification of pneumonia in hospitalized patients aged > or = 65 years. Epidemiol Infect 2007; 136:232-40. [PMID: 17445319 PMCID: PMC2870806 DOI: 10.1017/s0950268807008564] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
This study examines the validity of using ICD-10 codes to identify hospitalized pneumonia cases. Using a case-cohort design, subjects were randomly selected from monthly cohorts of patients aged > or = 65 years discharged from April 2000 to March 2002 from two large tertiary Australian hospitals. Cases had ICD-10-AM codes J10-J18 (pneumonia); the cohort sample was randomly selected from all discharges, frequency matched to cases by month. Codes were validated against three comparators: medical record notation of pneumonia, chest radiograph (CXR) report and both. Notation of pneumonia was determined for 5098/5101 eligible patients, and CXR reports reviewed for 3349/3464 (97%) patients with a CXR. Coding performed best against notation of pneumonia: kappa 0.95, sensitivity 97.8% (95% CI 97.1-98.3), specificity 96.9% (95% CI 96.2-97.5), positive predictive value (PPV) 96.2% (95% CI 95.4-97.0) and negative predictive value (NPV) 98.2% (95% CI 97.6-98.6). When medical record notation of pneumonia is used as the standard, ICD-10 codes are a valid method for retrospective ascertainment of hospitalized pneumonia cases and appear superior to use of complexes of symptoms and signs, or radiology reports.
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Affiliation(s)
- S A Skull
- Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.
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Abstract
In this review, we aim to lead the readers through the historical highlights of pathophysiological concepts and treatment of pneumonia. Understanding the aetiology, the risk factors and the pathophysiology influenced our management approaches to pneumonia. Pneumonia is still associated with significant morbidity and mortality, presents in a variety of healthcare settings and imposes a considerable cost to healthcare services. Guidelines have been issued by international and national scientific societies in order to spread the scientific knowledge on this important disease and to improve its management.
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Affiliation(s)
- Francesco Blasi
- Istituto di Tisiologia e Malattie dell'Apparato Respiratorio, University of Milan, Ospedale Maggiore Fondazione IRCCS Policlinico, Mangiagalli e Regina Elena, Via F. Sforza 35, Milan 20122, Italy.
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Korsgaard J, Møller JK, Kilian M. Antibiotic treatment and the diagnosis of Streptococcus pneumoniae in lower respiratory tract infections in adults. Int J Infect Dis 2005; 9:274-9. [PMID: 16095941 DOI: 10.1016/j.ijid.2004.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2003] [Revised: 07/08/2004] [Accepted: 07/14/2004] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To analyze the possible influence of antibiotic treatment on the results of different diagnostic tests for the diagnosis of lower respiratory tract infections with Streptococcus pneumoniae. MATERIAL AND METHODS A prospective cohort of 159 unselected adult immunocompetent patients admitted to Silkeborg County Hospital in Denmark with community-acquired lower respiratory tract infections underwent microbiological investigations with fiber-optic bronchoscopy with bronchoalveolar lavage, blood and sputum culture and urine antigen test for type-specific polysaccharide capsular antigens of S. pneumoniae. RESULTS When stratified for antibiotic treatment prior to microbiological sampling, three different groups of patients with documented or probable infection with S. pneumoniae could be identified. The first group comprised 14 patients who were culture positive in one or more culture tests, where most (11/14) did not receive any antibiotic treatment within 24 hours of sampling. The second group consisted of nine patients with a positive urine antigen test where 8/9 and 9/9 received antibiotic treatment 24 and 48 hours, respectively, prior to urine sampling. Only a single patient was positive in both systems, making a total of 22 patients with documented pneumococcal infection. As a positive culture test was dependent on the absence of antibiotic treatment, whereas a positive urine antigen test depended on antibiotic treatment within 48 hours, the two tests were complementary in the diagnosis of infection with S. pneumoniae. The third group of patients with probable pneumococcal infection were identified as 26% and 20% of the remaining 137 patients with unknown or known non-pneumococcal etiology, respectively, who received recent antibiotic treatment within 2-4 weeks of diagnostic sampling. By comparison, 0% (p < 0.01) with documented pneumococcal infection received antibiotic treatment in weeks 2-4 prior to microbiological sampling. As such a further eight patients should be expected to have infection with S. pneumoniae but would test negative in both culture tests and the urine antigen test because of antibiotic treatment within weeks 2-4 prior to sampling. CONCLUSION The diagnosis of infection with S. pneumoniae is very dependent on whether or not recent (within 2-4 weeks) or immediate (within 48 hours) antibiotic treatment has been given prior to microbiological sampling of patients. The results suggest an optimized diagnostic strategy with, if possible, sampling for culture prior to antibiotic treatment, while sampling for pneumococcal antigens should wait 24-48 hours for antibiotic treatment.
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Affiliation(s)
- Jens Korsgaard
- Department of Chest Diseases, Aarhus University Hospital Aalborg, Denmark.
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Oosterheert JJ, van Loon AM, Schuurman R, Hoepelman AIM, Hak E, Thijsen S, Nossent G, Schneider MME, Hustinx WMN, Bonten MJM. Impact of rapid detection of viral and atypical bacterial pathogens by real-time polymerase chain reaction for patients with lower respiratory tract infection. Clin Infect Dis 2005; 41:1438-44. [PMID: 16231254 PMCID: PMC7107964 DOI: 10.1086/497134] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2005] [Accepted: 06/30/2005] [Indexed: 01/28/2023] Open
Abstract
Background. Rapid diagnostic tests with a high sensitivity for lower respiratory tract infection (LRTI) could lead to improved patient care and reduce unnecessary antibiotic use and associated costs. Diagnostic yields, feasibility, and costs of real-time polymerase chain reaction (PCR) of nasopharyngeal and oropharyngeal swab specimens in the routine diagnostic work-up for LRTI were determined. Methods. In a randomized controlled trial, nasopharyngeal and oropharyngeal swab specimens from patients admitted for antibiotic treatment of LRTI were evaluated by means of real-time PCR for respiratory viruses and atypical pathogens, as well as by conventional diagnostic procedures. Real-time PCR results for patients in the intervention group were reported to the treating physician; results for patients in the control group were not made available. Results. A total of 107 patients (mean age [± standard deviation], 63.6 ± 16.3 years) were included, of whom 55 were allocated to the intervention group. The pathogens detected most frequently were influenza virus (14 patients), Streptococcus pneumoniae (8), coronavirus (6), Staphylococcus aureus (5), and rhinoviruses (5). Real-time PCR increased the diagnostic yield from 23 cases (21% of patients) to 47 cases (43% of patients), compared with conventional diagnostic tests. The detection of viral pathogens by PCR was associated with the winter season, less infiltrates on chest radiographs, lower C-reactive protein levels, and shorter duration of symptoms. Use of real-time PCR results resulted in partial or total cessation of antibiotic treatment for 6 patients (11%; 95% confidence interval, 2–19), but overall antibiotic use was comparable in the intervention group and the control group (median duration of treatment, 10.0 vs. 9.0 days; P = not significant). Use of real-time PCR increased treatment and diagnostic costs with €318.17 per patient. Conclusions. Implementation of real-time PCR for the etiological diagnosis of LRTI increased the diagnostic yield considerably, but it did not reduce antibiotic use or costs.
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Affiliation(s)
- Jan Jelrik Oosterheert
- Division of Medicine, Department of Internal Medicine and Infectious Diseases, Utrecht, The Netherlands
| | - Anton M. van Loon
- Department of Virology, Utrecht, The Netherlands
- Eijkman Winkler Institute for Infectious Diseases, Microbiology, and Inflammation, Utrecht, The Netherlands
| | - Rob Schuurman
- Department of Virology, Utrecht, The Netherlands
- Eijkman Winkler Institute for Infectious Diseases, Microbiology, and Inflammation, Utrecht, The Netherlands
| | - Andy I. M. Hoepelman
- Division of Medicine, Department of Internal Medicine and Infectious Diseases, Utrecht, The Netherlands
- Eijkman Winkler Institute for Infectious Diseases, Microbiology, and Inflammation, Utrecht, The Netherlands
| | - Eelko Hak
- Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Steven Thijsen
- Departments of Medical Microbiology, Utrecht, The Netherlands
| | - George Nossent
- Department of Respiratory Medicine, University Medical Center, Utrecht, The Netherlands
| | - Margriet M. E. Schneider
- Division of Medicine, Department of Internal Medicine and Infectious Diseases, Utrecht, The Netherlands
| | | | - Marc J. M. Bonten
- Division of Medicine, Department of Internal Medicine and Infectious Diseases, Utrecht, The Netherlands
- Eijkman Winkler Institute for Infectious Diseases, Microbiology, and Inflammation, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
- Reprints or correspondence: Prof. M. J. M. Bonten, Dept. of Internal Medicine and Infectious Diseases, University Medical Center, Rm. F02 126, P.O. Box 85500, 3508 GA Utrecht, The Netherlands ()
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Álvarez-Rocha L, Alós J, Blanquer J, Álvarez-Lerma F, Garau J, Guerrero A, Torres A, Cobo J, Jordá R, Menéndez R, Olaechea P, Rodríguez de castro F. [Guidelines for the management of community pneumonia in adult who needs hospitalization]. Med Intensiva 2005; 29:21-62. [PMID: 38620135 PMCID: PMC7131443 DOI: 10.1016/s0210-5691(05)74199-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2004] [Indexed: 11/01/2022]
Abstract
Community acquired pneumonia is still an important health problem. In Spain the year incidence is 162 cases per 100,000 inhabitants with 53,000 hospital admission costing 115 millions of euros per year. In the last years there have been significant advances in the knowledge of: aetiology, diagnostic tools, treatment alternatives and antibiotic resistance. The Spanish Societies of Intensive and Critical Care (SEMICYUC), Infectious Diseases and Clinical Microbiology (SEIMC) and Pulmonology and Thoracic Surgery (SEPAR) have produced these evidence-based Guidelines for the management of community acquired pneumonia in Adults. The main objective is to help physicians to make decisions about this disease. The different points that have been developed are: aetiology, diagnosis, treatment and prevention.
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Affiliation(s)
- L. Álvarez-Rocha
- Grupo de Trabajo de Enfermedades Infecciosas. Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (GTEI de la SEMICYUC)
| | - J.I. Alós
- Grupo de Estudio de la Infección en Atención Primaria. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIAP de la SEIMC)
| | - J. Blanquer
- Área de Tuberculosis e Infección Respiratoria. Sociedad Española de Neumología y Cirugía Torácica (Area TIR de la SEPAR)
| | - F. Álvarez-Lerma
- Grupo de Estudio de la Infección en el Paciente Crítico. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIPC de la SEIMC)
| | - J. Garau
- Grupo de Estudio de la Infección en Atención Primaria. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIAP de la SEIMC)
| | - A. Guerrero
- Grupo de Estudio de la Infección en Atención Primaria. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIAP de la SEIMC)
| | - A. Torres
- Área de Tuberculosis e Infección Respiratoria. Sociedad Española de Neumología y Cirugía Torácica (Area TIR de la SEPAR)
| | - J. Cobo
- Grupo de Estudio de la Infección en Atención Primaria. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIAP de la SEIMC)
| | - R. Jordá
- Grupo de Trabajo de Enfermedades Infecciosas. Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (GTEI de la SEMICYUC)
| | - R. Menéndez
- Área de Tuberculosis e Infección Respiratoria. Sociedad Española de Neumología y Cirugía Torácica (Area TIR de la SEPAR)
| | - P. Olaechea
- Grupo de Trabajo de Enfermedades Infecciosas. Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (GTEI de la SEMICYUC)
| | - F. Rodríguez de castro
- Área de Tuberculosis e Infección Respiratoria. Sociedad Española de Neumología y Cirugía Torácica (Area TIR de la SEPAR)
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Pelton SI, Hammerschlag MR. Overcoming current obstacles in the management of bacterial community-acquired pneumonia in ambulatory children. Clin Pediatr (Phila) 2005; 44:1-17. [PMID: 15678226 DOI: 10.1177/000992280504400101] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Silva RMD, Teixeira PJZ, Moreira JDS. O escarro induzido no diagnóstico das doenças pulmonares em pacientes positivos ao vírus da imunodeficiência humana. J Bras Pneumol 2004. [DOI: 10.1590/s1806-37132004000500009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O escarro induzido é utilizado para monitorar a inflamação de vias aéreas, porém seu papel como ferramenta diagnóstica de doenças pulmonares em pacientes imunocomprometidos ainda necessita de melhor definição. OBJETIVOS: Determinar o rendimento do escarro induzido no diagnóstico das doenças pulmonares em pacientes positivos ao virus da imunodeficiência humana (HIV). MÉTODO: No período de janeiro de 2001 a setembro de 2002, foram avaliados todos os pacientes com idade superior a 14 anos, infectados com o HIV, admitidos em Hospital de Referência. Foram incluídos aqueles indivíduos que apresentavam manifestações clínicas do aparelho respiratório há pelo menos 7 dias, associadas, ou não, a alterações radiológicas, bem como indivíduos assintomáticos do ponto de vista respiratório, com alterações no radiograma de tórax. Os pacientes foram submetidos à avaliação clínica, radiológica e laboratorial e realizaram a indução de escarro, seguida pela broncofibroscopia, lavado broncoalveolar e biópsia pulmonar transbrônquica. As amostras foram processadas para bacterioscopia pelo método de Gram e Ziehl-Neelsen, cultura quantitativa para bactérias, exame micológico direto, cultura para micobactérias e fungos, pesquisa de citomegalovírus e Pneumocystis jiroveci, bem como celularidade total e diferencial. RESULTADOS: 54 pacientes foram incluídos no estudo. A pesquisa de agente etiológico resultou negativa em 7 pacientes, sendo que nos casos restantes foram isolados 60 agentes. Dentre os agentes isolados, 46,7% foram P. jiroveci; 33,5% bactérias piogênicas e 16,7% Mycobacterium tuberculosis. O escarro induzido apresentou sensibilidade de 57,5%, especificidade de 42,9%, valor preditivo positivo de 87,1%, valor preditivo negativo de 13% e acurácia de 55,6%. CONCLUSÕES: Nesta população, a análise do escarro induzido é um procedimento simples, seguro e com bom rendimento diagnóstico.
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Oosterheert JJ, Bonten MJM, Buskens E, Schneider MME, Hoepelman IM. Algorithm to determine cost savings of targeting antimicrobial therapy based on results of rapid diagnostic testing. J Clin Microbiol 2004; 41:4708-13. [PMID: 14532208 PMCID: PMC254365 DOI: 10.1128/jcm.41.10.4708-4713.2003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A rapid diagnosis of pneumococcal pneumonia may allow the earlier use of narrow-spectrum antimicrobial therapy. It is unknown, however, whether rapid diagnostic testing of patients hospitalized with community-acquired pneumonia (CAP) admitted to hospital lowers costs. Therefore, an algorithm to calculate the costs associated with the diagnosis and treatment of CAP was formulated. Subsequently, the algorithm was applied to clinical data for 122 consecutively admitted patients with CAP whose sputum samples were Gram stained and whose urine was tested for Streptococcus pneumoniae antigen. The costs of initial antimicrobial therapy, personnel, and materials were measured. Compared to the most expensive empirical regimen, rapid diagnostic testing would result in cost savings per patient (PP) of 3.51 Euros for Gram staining and 8.11 Euros for urinary pneumococcal antigen testing (1 Euro is equal to 1.13 US dollars, from 2000 to 2002). Compared to the cheapest regimen, Gram staining would increase the cost by 2.25 Euros PP, and urinary antigen testing would increase the cost by 24.26 Euros PP. In our setting, the use of rapid diagnostic testing would not lower costs. Cost savings depend, however, on the differences in the prices of the different antibiotics chosen and the proportion of evaluable and positive samples.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Algorithms
- Anti-Bacterial Agents/economics
- Anti-Bacterial Agents/therapeutic use
- Antigens, Bacterial/urine
- Community-Acquired Infections/diagnosis
- Community-Acquired Infections/drug therapy
- Community-Acquired Infections/economics
- Community-Acquired Infections/microbiology
- Cost Savings
- Gentian Violet
- Humans
- Middle Aged
- Phenazines
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/drug therapy
- Pneumonia, Bacterial/economics
- Pneumonia, Bacterial/microbiology
- Pneumonia, Pneumococcal/diagnosis
- Pneumonia, Pneumococcal/drug therapy
- Pneumonia, Pneumococcal/economics
- Pneumonia, Pneumococcal/microbiology
- Sensitivity and Specificity
- Sputum/microbiology
- Streptococcus pneumoniae/immunology
- Streptococcus pneumoniae/isolation & purification
- Time Factors
- Urine/microbiology
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Affiliation(s)
- J J Oosterheert
- Department of Emergency Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands.
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14
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Carroll KC. Laboratory diagnosis of lower respiratory tract infections: controversy and conundrums. J Clin Microbiol 2002; 40:3115-20. [PMID: 12202540 PMCID: PMC130746 DOI: 10.1128/jcm.40.9.3115-3120.2002] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Karen C Carroll
- University of Utah School of Medicine and Diagnostic Infectious Diseases Laboratories, ARUP Laboratories, Inc., Salt Lake City, Utah, USA.
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