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Wang G, Sun J, Zhang Y, Wang N, Liu T, Ji W, Lv L, Yu X, Cheng X, Li M, Hu T, Shi Z. Aspirin reduces the mortality risk of patients with community-acquired pneumonia: a retrospective propensity-matched analysis of the MIMIC-IV database. Front Pharmacol 2024; 15:1402386. [PMID: 39346559 PMCID: PMC11427301 DOI: 10.3389/fphar.2024.1402386] [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: 03/17/2024] [Accepted: 09/02/2024] [Indexed: 10/01/2024] Open
Abstract
Background Community-acquired pneumonia (CAP) is a common infectious disease characterized by inflammation of the lung parenchyma in individuals who have not recently been hospitalized. It remains a significant cause of morbidity and mortality worldwide. Aspirin is a widely used drug, often administered to CAP patients. However, the benefits of aspirin remain controversial. Objective We sought to determine whether aspirin treatment has a protective effect on the outcomes of CAP patients. Methods We selected patients with CAP from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Propensity score matching (PSM) balanced baseline differences. A multivariate Cox regression model assessed the relationship between aspirin treatment and 28-day mortality. Results A total of 3,595 patients were included, with 2,261 receiving aspirin and 1,334 not. After PSM, 1,219 pairs were matched. The 28-day mortality rate for aspirin users was 20.46%, lower than non-users. Multivariate Cox regression indicated aspirin use was associated with decreased 28-day mortality (HR 0.75, 95% CI 0.63-0.88, p < 0.001). No significant differences were found between 325 mg/day and 81 mg/day aspirin treatments in terms of 28-day mortality, hospital mortality, 90-day mortality, gastrointestinal hemorrhage, and thrombocytopenia. However, intensive care unit (ICU) stay was longer for the 325 mg/day group compared to the 81 mg/day group (4.22 vs. 3.57 days, p = 0.031). Conclusion Aspirin is associated with reduced 28-day mortality in CAP patients. However, 325 mg/day aspirin does not provide extra benefits over 81 mg/day and may lead to longer ICU stays.
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Affiliation(s)
- Guangdong Wang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Jiaolin Sun
- Department of Respiratory and Critical Care Medicine, Shanxi Provincial People's Hospital, Xi'an, Shanxi, China
| | - Yaxin Zhang
- Department of Neurology, Fujian Medical University Affiliated Xiamen Hong 'ai Hospital, Xiamen Fujian, China
| | - Na Wang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Tingting Liu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Wenwen Ji
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Lin Lv
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Xiaohui Yu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Xue Cheng
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Mengchong Li
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Tinghua Hu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Zhihong Shi
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
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Ruiz LA, Serrano L, Pérez S, Castro S, Urrutia A, Uranga A, Artaraz A, Gómez A, España PP, Zalacain R. Impact of severe lymphopenia on the early prediction of clinical outcome in hospitalized patients with pneumococcal community-acquired pneumonia. Infection 2023; 51:1319-1327. [PMID: 36694093 PMCID: PMC9873546 DOI: 10.1007/s15010-023-01984-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the impact of an optimal and reproducible cutoff value set according to a predefined lymphopenia scale as an early predictor of in-hospital mortality and other outcomes in patients hospitalized with pneumococcal pneumonia and positive urinary antigen at admission to the emergency department. METHODS An observational cohort study was conducted based on analysis of a prospective registry of consecutive immunocompetent adults hospitalized for pneumococcal pneumonia in two tertiary hospitals. Generalized additive models were constructed to assess the smooth relationship between in-hospital mortality and lymphopenia. RESULTS We included 1173 patients. Lymphopenia on admission was documented in 686 (58.4%). No significant differences were observed between groups regarding the presence of comorbidities. Overall, 299 (25.5%) patients were admitted to intensive care and 90 (7.6%) required invasive mechanical ventilation. Fifty-nine (5%) patients died, among them 23 (38.9%) in the first 72 h after admission. A lymphocyte count < 500/μL, documented in 282 (24%) patients, was the predefined cutoff point that best predicted in-hospital mortality. After adjustment, these patients had higher rates of intensive care admission (OR 2.9; 95% CI 1.9-4.3), invasive mechanical ventilation (OR 2.2; 95% CI 1.2-3.9), septic shock (OR 1.8; 95% CI 1.1-2.9), treatment failure (OR 2.1; 95% CI 1.2-3.5), and in-hospital mortality (OR 2.2; 95% 1.1-4.9). Severe lymphopenia outperformed PSI score in predicting early and 30-day mortality in patients classified in the higher-risk classes. CONCLUSION Lymphocyte count < 500/μL could be used as a reproducible predictor of complicated clinical course in patients with an early diagnosis of pneumococcal pneumonia.
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Affiliation(s)
- Luis A Ruiz
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain.
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.
- Department of Medicine, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Bilbao, Bizkaia, Spain.
| | - Leyre Serrano
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Bilbao, Bizkaia, Spain
| | - Silvia Pérez
- Bioinformatic and Statistic Unit, BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Sonia Castro
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Medicine, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Bilbao, Bizkaia, Spain
| | - Amaia Urrutia
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Medicine, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Bilbao, Bizkaia, Spain
| | - Ane Uranga
- Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Amaia Artaraz
- Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Ainhoa Gómez
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Pedro P España
- Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Rafael Zalacain
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
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'Stolen Time'-Delivering Nursing at the Bottom of a Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing for Patients with Community-Acquired Pneumonia. Healthcare (Basel) 2021; 9:healthcare9111524. [PMID: 34828571 PMCID: PMC8620708 DOI: 10.3390/healthcare9111524] [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: 10/13/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/20/2022] Open
Abstract
The research has reported a high prevalence of low-quality and missed care for patients with community-acquired pneumonia (CAP). Optimised nursing treatment and care will benefit CAP patients. The aim of this study was to describe the barriers and facilitators influencing registered nurses’ (RNs’) adherence to evidence-based guideline (EBG) recommendations for nursing care (NC) for older patients admitted with CAP. Semi-structured focus group interviews (n = 2), field observations (n = 14), and individual follow-up interviews (n = 10) were conducted in three medical units and analysed by a qualitative content analysis. We found a main theme: ‘‘stolen time’—delivering nursing at the bottom of a hierarchy’, and three themes: (1) ‘under the dominance of stronger paradigms’, (2) ‘the loss of professional identity’, and (3) ‘the power of leadership’. These themes, each comprising two to three subthemes, illustrated that RNs’ adherence to EBG recommendations was strongly influenced by the individual RN’s professionalism and professional identity; contextual barriers, including the interdisciplinary team, organisational structure, culture, and evaluation of the NC; and the nurse manager’s leadership skills. This study identified central factors that may help RNs to understand the underlying dynamics in a healthcare setting hindering and facilitating the performance of NC and make them better equipped for changing practices.
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Almirall J, Boixeda R, de la Torre MC, Torres A. Aspiration pneumonia: A renewed perspective and practical approach. Respir Med 2021; 185:106485. [PMID: 34087609 DOI: 10.1016/j.rmed.2021.106485] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
Aspiration pneumonia (AP) is a sub-type of community-acquired pneumonia (CAP) still poorly recognized especially in the absence of an aspiration event. A further difficulty is the differentiation between AP and aspiration pneumonitis. From a clinical perspective, AP is becoming increasingly relevant as a potential cause of severe and life-threatening respiratory infection among frail and very old patients, particularly among those with CAP requiring inpatient care. Moreover, AP is frequently underdiagnosed and a clear-cut definition of this pathological entity is lacking. There are different factors that increase the risk for aspiration, but other common factors influencing oral colonization such as malnutrition, smoking, poor oral hygiene or dry mouth, are also important in the pathogenesis of AP and should be considered. While there is no doubt in the diagnosis of AP in cases of a recent witnessed aspiration of oropharyngeal or gastric content, we here proposed a definition of AP that also includes silent unobserved aspirations. For this reason, the presence of one or more risk factors of oropharyngeal aspiration is required together with one or more risk factors for oral bacterial colonization. This proposed definition based on expert opinion not only unifies the diagnostic criteria of AP, but also provides the possibility to devise easily applicable strategies to prevent oral colonization.
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Affiliation(s)
- Jordi Almirall
- Intensive Care Unit, Hospital de Mataró, Universitat Autònoma de Barcelona, Consorci Sanitari Del Maresme, Mataró, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Ramon Boixeda
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Service of Internal Medicine, Hospital de Mataró, Consorci Sanitari Del Maresme, Mataró, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Mari C de la Torre
- Intensive Care Unit, Hospital de Mataró, Universitat Autònoma de Barcelona, Consorci Sanitari Del Maresme, Mataró, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Antoni Torres
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Universitat de Barcelona, Barcelona, Spain; Service of Pneumology, Institut Clínic Del Torax, Institut D'Investigació Biomédica Agustí Pi I Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain.
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Comparison of clinical characteristics of patients with pandemic SARS-CoV-2-related and community-acquired pneumonias in Hungary - a pilot historical case-control study. GeroScience 2020; 43:53-64. [PMID: 33174170 PMCID: PMC7655144 DOI: 10.1007/s11357-020-00294-x] [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: 07/06/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022] Open
Abstract
The distinction between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related and community-acquired pneumonias poses significant difficulties, as both frequently involve the elderly. This study aimed to predict the risk of SARS-CoV-2-related pneumonia based on clinical characteristics at hospital presentation. Case-control study of all patients admitted for pneumonia at Semmelweis University Emergency Department. Cases (n = 30) were patients diagnosed with SARS-CoV-2-related pneumonia (based on polymerase chain reaction test) between 26 March 2020 and 30 April 2020; controls (n = 82) were historical pneumonia cases between 1 January 2019 and 30 April 2019. Logistic models were built with SARS-CoV-2 infection as outcome using clinical characteristics at presentation. Patients with SARS-CoV-2-related pneumonia were younger (mean difference, 95% CI: 9.3, 3.2-15.5 years) and had a higher lymphocyte count, lower C-reactive protein, presented more frequently with bilateral infiltrate, less frequently with abdominal pain, diarrhoea, and nausea in age- and sex-adjusted models. A logistic model using age, sex, abdominal pain, C-reactive protein, and the presence of bilateral infiltrate as predictors had an excellent discrimination (AUC 0.88, 95% CI: 0.81-0.96) and calibration (p = 0.27-Hosmer-Lemeshow test). The clinical use of our screening prediction model could improve the discrimination of SARS-CoV-2 related from other community-acquired pneumonias and thus help patient triage based on commonly used diagnostic approaches. However, external validation in independent datasets is required before its clinical use.
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Community-Acquired Pneumonia. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) Guidelines. 2020 Update. Arch Bronconeumol 2020. [PMID: 32139236 DOI: 10.1016/j.arbres.2020.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The guidelines for community-acquired pneumonia, last published in 2010, have been updated to provide recommendations based on a critical summary of the latest literature to help health professionals make the best decisions in the care of immunocompetent adult patients. The methodology was based on 6 PICO questions (on etiological studies, assessment of severity and decision to hospitalize, antibiotic treatment and duration, and pneumococcal conjugate vaccination), agreed by consensus among a working group of pulmonologists and an expert in documentation science and methodology. A comprehensive review of the literature was performed for each PICO question, and these were evaluated in in-person meetings. The American Thoracic Society guidelines were published during the preparation of this paper, so the recommendations of this association were also evaluated. We concluded that the etiological source of the infection should be investigated in hospitalized patients who have suspected resistance or who fail to respond to treatment. Prognostic scales, such as PSI, CURB 65, and CRB65, are useful for assessing severity and the decision to hospitalize. Different antibiotic regimens are indicated, depending on the treatment setting - outpatient, hospital, or intensive care unit - and the resistance of PES microorganisms should be calculated. The minimum duration of antibiotic treatment should be 5 days, based on criteria of clinical stability. Finally, we reviewed the indication of the 13-valent conjugate vaccine in immunocompetent patients with risk factors and comorbidity.
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Eekholm S, Ahlström G, Kristensson J, Lindhardt T. Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia: a descriptive cross-sectional study. BMC Infect Dis 2020; 20:73. [PMID: 31973742 PMCID: PMC6979078 DOI: 10.1186/s12879-019-4742-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 12/27/2019] [Indexed: 02/03/2023] Open
Abstract
Background Community acquired pneumonia (CAP) remains a significant cause of morbidity and in-hospital mortality, and readmission rates are rising for older persons (> 65 years). Optimized treatment and nursing care will benefit patients and the health economy. Hence, there is a need to describe gaps between current clinical practice and recommendations in evidence-based guidelines for diagnostic procedures, medical treatment and nursing interventions for older patients with CAP. Methods Structured observations, individual ad hoc interviews and audits of patient records were carried out in an emergency department and three medical units. Data were analysed by manifest content analysis and descriptive statistics. Results Thirty patients (median age 74 years) admitted with CAP and 86 physicians, nurses, physiotherapists were included. The median length of stay (LOS) was 6.5 days, in-hospital mortality was10 and 40.7% were readmitted within one month. The severity assessment tool (CURB-65) was used in 16.7% of the patients, correct antibiotic treatment prescribed for 13.3% and chest radiography (≤6 weeks post-discharge) prescribed for 22.2%. Fluid therapy, nutrition support and mobilisation plans were found to be developed sporadically, and interventions to be performed unsystematically and sparingly. Positive Expiratory Pressure therapy and oral care were the nursing interventions with lowest adherence, ranging from 18.2 to 55.6%. Conclusions Adherence to recommendations was low for several central treatment and nursing care interventions for patients with CAP with possible consequences for patients and the use of resources. Thus, there is an urgent need to identify and remove barriers to adherence to recommendations in the neglected areas in view of the potential to improve patient outcomes.
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Affiliation(s)
- Signe Eekholm
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden. .,Research Unit for Clinical Nursing, Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
| | - Jimmie Kristensson
- Department of Health Sciences, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
| | - Tove Lindhardt
- Research Unit for Clinical Nursing, Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Herlev Ringvej 75, 2730, Herlev, Denmark
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Purba AKR, Ascobat P, Muchtar A, Wulandari L, Dik JW, d'Arqom A, Postma MJ. Cost-Effectiveness Of Culture-Based Versus Empirical Antibiotic Treatment For Hospitalized Adults With Community-Acquired Pneumonia In Indonesia: A Real-World Patient-Database Study. Clinicoecon Outcomes Res 2019; 11:729-739. [PMID: 31819563 PMCID: PMC6890194 DOI: 10.2147/ceor.s224619] [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: 07/25/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study analyzes the cost-effectiveness of culture-based treatment (CBT) versus empirical treatment (ET) as a guide to antibiotic selection and use in hospitalized patients with community-acquired pneumonia (CAP). PATIENTS AND METHODS A model was developed from the individual patient data of adults with CAP hospitalized at an academic hospital in Indonesia between 2014 and 2017 (ICD-10 J.18x). The directed antibiotic was assessed based on microbiological culture results in terms of the impact on hospital costs and life expectancy (LE). We conducted subgroup analyses for implementing CBT and ET in adults under 60 years, elderly patients (≥ 60 years), moderate-severe CAP (PSI class III-V) cases, and ICU patients. The model was designed with a lifetime horizon and adjusted patients' ages to the average LE of the Indonesian population with a 3% discount each for cost and LE. We applied a sensitivity analyses on 1,000 simulation cohorts to examine the economic acceptability of CBT in practice. Willingness to pay (WTP) was defined as 1 or 3 times the Indonesian GDP per capita (US$ 3,570). RESULTS CBT would effectively increase the patients' LE and be cost-saving (dominant) as well. The ET group's hospitalization cost had the greatest influence on economic outcomes. Subgroup analyses showed that CBT's dominance remained for Indonesian patients aged under 60 years or older, patients with moderate-severe CAP, and patients in the ICU. Acceptability rates of CBT over ET were 74.9% for 1xWTP and 82.8% for 3xWTP in the base case. CONCLUSION Both sputum and blood cultures provide advantages for cost-saving and LE gains for hospitalized patients with CAP. CBT is cost-effective in patients all ages, PSI class III or above patients, and ICU patients.
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Affiliation(s)
- Abdul Khairul Rizki Purba
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga-Soetomo Hospital, Surabaya, Indonesia.,Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology And -Economics (PTE2), University of Groningen, Groningen, The Netherlands
| | - Purwantyastuti Ascobat
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Armen Muchtar
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Laksmi Wulandari
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga-Soetomo Hospital, Surabaya, Indonesia
| | - Jan-Willem Dik
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette d'Arqom
- Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga-Soetomo Hospital, Surabaya, Indonesia.,Faculty of Science, Faculty of Medicine Ramatibodhi Hospital, Faculty of Dentistry, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Maarten J Postma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga-Soetomo Hospital, Surabaya, Indonesia.,Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology And -Economics (PTE2), University of Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics and Finance, University of Groningen, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
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Méndez R, Menéndez R, Cillóniz C, Amara-Elori I, Amaro R, González P, Posadas T, Gimeno A, España PP, Almirall J, Torres A. Initial Inflammatory Profile in Community-acquired Pneumonia Depends on Time since Onset of Symptoms. Am J Respir Crit Care Med 2018; 198:370-378. [DOI: 10.1164/rccm.201709-1908oc] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Raúl Méndez
- Pneumology Department, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Ph.D. Program in Medicine and Translational Research, University of Barcelona, Barcelona, Spain
| | - Rosario Menéndez
- Pneumology Department, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Centro de Investigación Biomédica En Red-Enfermedades Respiratorias CB06/06/0028, Madrid, Spain
| | - Catia Cillóniz
- Centro de Investigación Biomédica En Red-Enfermedades Respiratorias CB06/06/0028, Madrid, Spain
- Pneumology Department, Hospital Clínic/Institut D’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Amara-Elori
- Pneumology Department, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Rosanel Amaro
- Centro de Investigación Biomédica En Red-Enfermedades Respiratorias CB06/06/0028, Madrid, Spain
- Pneumology Department, Hospital Clínic/Institut D’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Paula González
- Pneumology Department, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Tomás Posadas
- Pneumology Department, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Alexandra Gimeno
- Pneumology Department, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Pedro P. España
- Pneumology Department, Hospital de Galdakao-Usansolo, Galdakao, Spain; and
| | - Jordi Almirall
- Intensive Care Unit, Hospital de Mataró, Barcelona, Spain
| | - Antoni Torres
- Centro de Investigación Biomédica En Red-Enfermedades Respiratorias CB06/06/0028, Madrid, Spain
- Pneumology Department, Hospital Clínic/Institut D’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
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Ferrari R, Viale P, Muratori P, Giostra F, Agostinelli D, Lazzari R, Voza R, Cavazza M. Rebounds after discharge from the emergency department for community-acquired pneumonia: focus on the usefulness of severity scoring systems. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 88:519-528. [PMID: 29350672 PMCID: PMC6166183 DOI: 10.23750/abm.v88i4.6685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 11/23/2022]
Abstract
Background: Community-acquired pneumonia (CAP) is common cause of hospital admission and leading cause of morbidity and mortality. Severity scoring systems are used to predict risk profile, outcome and mortality, and to help decisions about management strategies. Aim of the work and Methods: To critically analyze pneumonia “rebound” cases, once discharged from the emergency department (ED) and afterwards admitted. We conducted an observational clinical study in the acute setting of a university teaching hospital, prospectively analyzing, in a 1 year period, demographic, medical, clinical and laboratory data, and the outcome. Results: 249 patients were discharged home with diagnosis of CAP; 80 cases (32.1%) resulted in the high-intermediate risk class according to CURB-65 or CRB-65. Twelve patients (4.8%) presented to the ED twice and were then admitted. At their first visit 5 were in the high-intermediate risk group; just 4 of them were in the non-low risk group at the time of their admission. The rebound cohort showed some peculiar abnormalities in laboratory parameters (coagulation and renal function) and severe chest X-rays characteristics. None died in 30 days. Conclusions: The power of CURB-65 to correctly predict mortality for CAP patients discharged home from the ED is not confirmed by our results; careful clinical judgement seems to be irreplaceable in the management process. Many patients with a high-intermediate risk according to CURB-65 can be safely treated as outpatients, according to adequate welfare conditions; we identified a subgroup of cases that should worth a special attention and, therefore, a brief observation period in the ED before the final decision to safely discharge or admit. (www.actabiomedica.it)
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Affiliation(s)
- Rodolfo Ferrari
- Policlinico Sant'Orsola - Malpighi. Azienda Ospedaliero - Universitaria di Bologna..
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Xu H, Gasparini A, Ishigami J, Mzayen K, Su G, Barany P, Ärnlöv J, Lindholm B, Elinder CG, Matsushita K, Carrero JJ. eGFR and the Risk of Community-Acquired Infections. Clin J Am Soc Nephrol 2017; 12:1399-1408. [PMID: 28818849 PMCID: PMC5586562 DOI: 10.2215/cjn.00250117] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 05/26/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Community-acquired infections are common, contributing to adverse outcomes and increased health care costs. We hypothesized that, with lower eGFR, the incidence of community-acquired infections increases, whereas the pattern of site-specific infections varies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among 1,139,470 health care users (mean age =52±18 years old, 53% women) from the Stockholm CREAtinine Measurements Project, we quantified the associations of eGFR with the risk of infections, overall and major types, over 12 months. RESULTS A total of 106,807 counts of infections were recorded throughout 1,128,313 person-years. The incidence rate of all infections increased with lower eGFR from 74/1000 person-years for individuals with eGFR=90-104 ml/min per 1.73 m2 to 419/1000 person-years for individuals with eGFR<30 ml/min per 1.73 m2. Compared with eGFR of 90-104 ml/min per 1.73 m2, the adjusted incidence rate ratios of community-acquired infections were 1.08 (95% confidence interval, 1.01 to 1.14) for eGFR of 30-59 ml/min per 1.73 m2 and 1.53 (95% confidence interval, 1.39 to 1.69) for eGFR<30 ml/min per 1.73 m2. The relative proportions of lower respiratory tract infection, urinary tract infection, and sepsis became increasingly higher along with lower eGFR strata (e.g., low respiratory tract infection accounting for 25% versus 15% of community-acquired infections in eGFR<30 versus 90-104 ml/min per 1.73 m2, respectively). Differences in incidence associated with eGFR were in general consistent for most infection types, except for nervous system and upper respiratory tract infections, for which no association was observed. CONCLUSIONS This region-representative health care study finds an excess community-acquired infections incidence in individuals with mild to severe CKD. Lower respiratory tract infection, urinary tract infection, and sepsis are major infections in CKD.
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Affiliation(s)
- Hong Xu
- Departments of Medical Epidemiology and Biostatistics and
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Alessandro Gasparini
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Guobin Su
- Public Health Sciences and
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China
| | - Peter Barany
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ärnlöv
- School of Health and Social Studies, Dalarna University, Falun, Sweden; and
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Carl Gustaf Elinder
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Juan Jesús Carrero
- Departments of Medical Epidemiology and Biostatistics and
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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12
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Batais MA, Khan AR, Bin Abdulhak AA. The Use of Statins and Risk of Community-Acquired Pneumonia. Curr Infect Dis Rep 2017. [PMID: 28639080 DOI: 10.1007/s11908-017-0581-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF THE REVIEW Community-acquired pneumonia (CAP) is still associated with a large burden and causes significant morbidity and mortality. Besides universal vaccination and antibiotic treatment, statins as adjunctive therapy may also have a beneficial role in the prevention and treatment of CAP. Our goal from this review is to discuss the epidemiology of CAP, and role of statins as adjunctive therapy in the development of CAP. RECENT FINDINGS Statins are lipid-lowering medications characterized by their ability to control hypercholesterolemia in addition to other pleiotropic effects that could explain their role in the pathogenesis of CAP. While most observational studies have shown that statins reduce risk of pneumonia in the general population, patients with diabetes, and recently in patients with myocardial infarction, no randomized controlled trial (RCT) to date has been conducted to assess the efficacy of statins to prevent development of CAP. Given the paucity of robust randomized evidence to assess statin use and the development of CAP, and considering conflicting results of the observational studies, we are not in favor of initiation of statins for either the prevention or treatment of CAP.
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Affiliation(s)
- Mohammed A Batais
- College of Medicine, King Saud University, Riyadh, 29391, Saudi Arabia.
| | - Abdur Rahman Khan
- Department of Medicine, Division of Cardiovascular Diseases, University of Louisville, Louisville, KY, USA
| | - Aref A Bin Abdulhak
- Department of Medicine, Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Int. Med. E315 GH, Iowa City, IA, 52242, USA
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13
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Peter A, Thompson KC, Routledge EJ. Barriers to effectiveLegionellacontrol in a changing world: a practitioner’s view. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/21622515.2017.1335352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Aji Peter
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | | | - Edwin John Routledge
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
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14
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Boyles TH, Brink A, Calligaro GL, Cohen C, Dheda K, Maartens G, Richards GA, van Zyl Smit R, Smith C, Wasserman S, Whitelaw AC, Feldman C. South African guideline for the management of community-acquired pneumonia in adults. J Thorac Dis 2017; 9:1469-1502. [PMID: 28740661 DOI: 10.21037/jtd.2017.05.31] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Tom H Boyles
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Adrian Brink
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa
| | - Greg L Calligaro
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Guy A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard van Zyl Smit
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | | | - Sean Wasserman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Andrew C Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Charles Feldman
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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15
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Anderson R, Feldman C. Pneumolysin as a potential therapeutic target in severe pneumococcal disease. J Infect 2017; 74:527-544. [PMID: 28322888 DOI: 10.1016/j.jinf.2017.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/09/2017] [Accepted: 03/11/2017] [Indexed: 12/13/2022]
Abstract
Acute pulmonary and cardiac injury remain significant causes of morbidity and mortality in those afflicted with severe pneumococcal disease, with the risk for early mortality often persisting several years beyond clinical recovery. Although remaining to be firmly established in the clinical setting, a considerable body of evidence, mostly derived from murine models of experimental infection, has implicated the pneumococcal, cholesterol-binding, pore-forming toxin, pneumolysin (Ply), in the pathogenesis of lung and myocardial dysfunction. Topics covered in this review include the burden of pneumococcal disease, risk factors, virulence determinants of the pneumococcus, complications of severe disease, antibiotic and adjuvant therapies, as well as the structure of Ply and the role of the toxin in disease pathogenesis. Given the increasing recognition of the clinical potential of Ply-neutralisation strategies, the remaining sections of the review are focused on updates of the types, benefits and limitations of currently available therapies which may attenuate, directly and/or indirectly, the injurious actions of Ply. These include recently described experimental therapies such as various phytochemicals and lipids, and a second group of more conventional agents the members of which remain the subject of ongoing clinical evaluation. This latter group, which is covered more extensively, encompasses macrolides, statins, corticosteroids, and platelet-targeted therapies, particularly aspirin.
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Affiliation(s)
- Ronald Anderson
- Department of Immunology and Institute of Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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16
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Abstract
Pneumococcal infections continue to cause significant morbidity and mortality in patients throughout the world. This microorganism remains the most common bacterial cause of community-acquired pneumonia and is associated with a considerable burden of disease and health-care costs in both developed and developing countries. Emerging antibiotic resistance has been a concern because of its potential negative impact on the outcome of patients who receive standard antibiotic therapy. However, there have been substantial changes in the epidemiology of this pathogen in recent years, not least of which has been due to the use of pneumococcal conjugate vaccines in children, with subsequent herd protection in unvaccinated adults and children. Furthermore, much recent research has led to a better understanding of the virulence factors of this pathogen and their role in the pathogenesis of severe pneumococcal disease, including the cardiac complications, as well as the potential role of adjunctive therapy in the management of severely ill cases. This review will describe recent advances in our understanding of the epidemiology, virulence factors, and management of pneumococcal community-acquired pneumonia.
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Affiliation(s)
- Charles Feldman
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand Medical School, Johannesburg, South Africa
| | - Ronald Anderson
- Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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