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Baranov AA, Kozlov RS, Namazova-Baranova LS, Andreeva IV, Bakradze MD, Vishneva EA, Karaseva MS, Kuznetsova TA, Kulichenko TV, Lashkova YS, Lyutina EI, Manerov FK, Mayanskiy NA, Platonova MM, Polyakova AS, Selimzyanova LR, Tatochenko VK, Starovoytova EV, Stetsiouk OU, Fedoseenko MV, Chashchina IL, Kharkin AV. Modern approaches at the management of children with community-acquired pneumonia. PEDIATRIC PHARMACOLOGY 2023. [DOI: 10.15690/pf.v20i1.2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Experts of The Union of Pediatricians of Russia have developed current clinical guidelines for management of children with community-acquired pneumonia, which were approved by the Scientific and Practice Council of Ministry of Public Health of the Russian Federation in January 2022. Particular attention is paid to the etiological structure, modern classification, diagnostic tests and flagship approaches to antibacterial therapy of community-acquired pneumonia in children based on the principles of evidentiary medicine.
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Affiliation(s)
- Aleksander A. Baranov
- Sechenov First Moscow State Medical University;
Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | - Leyla S. Namazova-Baranova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
| | | | | | - Elena A. Vishneva
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
| | - Mariya S. Karaseva
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | | | - Yulia S. Lashkova
- Pirogov Russian National Research Medical University;
National Medical Research Center of Children’s Health
| | | | | | | | - Mariya M. Platonova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | - Lilia R. Selimzyanova
- Sechenov First Moscow State Medical University;
Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
| | | | | | | | - Marina V. Fedoseenko
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
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Jones BE, Ying J, Nevers MR, Alba PR, Patterson OV, Peterson KS, Rutter E, Christensen MA, Stern S, Jones MM, Gundlapalli A, Dean NC, Samore MC, Greene T. Trends in Illness Severity, Hospitalization, and Mortality for Community-Onset Pneumonia at 118 US Veterans Affairs Medical Centers. J Gen Intern Med 2022; 37:3839-3847. [PMID: 35266121 PMCID: PMC8906522 DOI: 10.1007/s11606-022-07413-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/13/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Deaths from pneumonia were decreasing globally prior to the COVID-19 pandemic, but it is unclear whether this was due to changes in patient populations, illness severity, diagnosis, hospitalization thresholds, or treatment. Using clinical data from the electronic health record among a national cohort of patients initially diagnosed with pneumonia, we examined temporal trends in severity of illness, hospitalization, and short- and long-term deaths. DESIGN Retrospective cohort PARTICIPANTS: All patients >18 years presenting to emergency departments (EDs) at 118 VA Medical Centers between 1/1/2006 and 12/31/2016 with an initial clinical diagnosis of pneumonia and confirmed by chest imaging report. EXPOSURES Year of encounter. MAIN MEASURES Hospitalization and 30-day and 90-day mortality. Illness severity was defined as the probability of each outcome predicted by machine learning predictive models using age, sex, comorbidities, vital signs, and laboratory data from encounters during years 2006-2007, and similar models trained on encounters from years 2015 to 2016. We estimated the changes in hospitalizations and 30-day and 90-day mortality between the first and the last 2 years of the study period accounted for by illness severity using time covariate decompositions with model estimates. RESULTS Among 196,899 encounters across the study period, hospitalization decreased from 71 to 63%, 30-day mortality 10 to 7%, 90-day mortality 16 to 12%, and 1-year mortality 29 to 24%. Comorbidity risk increased, but illness severity decreased. Decreases in illness severity accounted for 21-31% of the decrease in hospitalizations, and 45-47%, 32-24%, and 17-19% of the decrease in 30-day, 90-day, and 1-year mortality. Findings were similar among underrepresented patients and those with only hospital discharge diagnosis codes. CONCLUSIONS Outcomes for community-onset pneumonia have improved across the VA healthcare system after accounting for illness severity, despite an increase in cases and comorbidity burden.
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Affiliation(s)
- Barbara E Jones
- Division of Pulmonary & Critical Care, University of Utah, 50 North Medical Drive, Salt Lake City, UT, 84132, USA.
- VA Salt Lake City Healthcare System, Salt Lake City, USA.
| | - Jian Ying
- Division of Epidemiology, University of Utah, Salt Lake City, USA
| | | | - Patrick R Alba
- VA Salt Lake City Healthcare System, Salt Lake City, USA
- Division of Epidemiology, VA Informatics and Computing Infrastructure, University of Utah, Salt Lake City, USA
| | - Olga V Patterson
- VA Salt Lake City Healthcare System, Salt Lake City, USA
- Division of Epidemiology, VA Informatics and Computing Infrastructure, University of Utah, Salt Lake City, USA
| | - Kelly S Peterson
- VA Salt Lake City Healthcare System, Salt Lake City, USA
- Division of Epidemiology, Veterans Health Administration Office of Analytics and Performance Integration, University of Utah, Salt Lake City, USA
| | - Elizabeth Rutter
- VA Salt Lake City Healthcare System, Salt Lake City, USA
- Division of Emergency Medicine, University of Utah, Salt Lake City, USA
| | - Matthew A Christensen
- Division of Allergy, Pulmonary, & Critical Care Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Sarah Stern
- Division of Pulmonary & Critical Care, University of Utah, 50 North Medical Drive, Salt Lake City, UT, 84132, USA
- VA Salt Lake City Healthcare System, Salt Lake City, USA
| | - Makoto M Jones
- VA Salt Lake City Healthcare System, Salt Lake City, USA
- Division of Epidemiology, University of Utah, Salt Lake City, USA
| | - Adi Gundlapalli
- VA Salt Lake City Healthcare System, Salt Lake City, USA
- Division of Epidemiology, University of Utah, Salt Lake City, USA
| | - Nathan C Dean
- Division of Pulmonary & Critical Care, University of Utah, 50 North Medical Drive, Salt Lake City, UT, 84132, USA
| | - Matthew C Samore
- VA Salt Lake City Healthcare System, Salt Lake City, USA
- Division of Epidemiology, University of Utah, Salt Lake City, USA
| | - Tome Greene
- Department of Population Health Sciences, University of Utah, Salt Lake City, USA
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Waterer GW, Self WH, Courtney DM, Grijalva CG, Balk RA, Girard TD, Fakhran SS, Trabue C, McNabb P, Anderson EJ, Williams DJ, Bramley AM, Jain S, Edwards KM, Wunderink RG. In-Hospital Deaths Among Adults With Community-Acquired Pneumonia. Chest 2018; 154:628-635. [PMID: 29859184 DOI: 10.1016/j.chest.2018.05.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/10/2018] [Accepted: 05/01/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Adults hospitalized with community-acquired pneumonia (CAP) are at high risk for short-term mortality. However, it is unclear whether improvements in in-hospital pneumonia care could substantially lower this risk. We extensively reviewed all in-hospital deaths in a large prospective CAP study to assess the cause of each death and assess the extent of potentially preventable mortality. METHODS We enrolled adults hospitalized with CAP at five tertiary-care hospitals in the United States. Five physician investigators reviewed the medical record and study database for each patient who died to identify the cause of death, the contribution of CAP to death, and any preventable factors potentially contributing to death. RESULTS Among 2,320 enrolled patients, 52 (2.2%) died during initial hospitalization. Among these 52 patients, 33 (63.4%) were ≥ 65 years old, and 32 (61.5%) had ≥ two chronic comorbidities. CAP was judged to be the direct cause of death in 27 patients (51.9%). Ten patients (19.2%) had do-not-resuscitate orders prior to admission. Four patients were identified in whom a lapse in quality of care potentially contributed to death; preexisting end-of-life limitations were present in two of these patients. Two patients seeking full medical care experienced a lapse in in-hospital quality of pneumonia care that potentially contributed to death. CONCLUSIONS In this study of adults with CAP at tertiary-care hospitals with a low mortality rate, most in-hospital deaths did not appear to be preventable with improvements in in-hospital pneumonia care. Preexisting end-of-life limitations in care, advanced age, and high comorbidity burden were common among those who died.
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Affiliation(s)
- Grant W Waterer
- University of Western Australia, Perth, WA, Australia; Northwestern University Feinberg School of Medicine, Chicago, IL.
| | | | - D Mark Courtney
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | - Christopher Trabue
- University of Tennessee Health Science Center/Saint Thomas Health, Nashville, TN
| | - Paul McNabb
- University of Tennessee Health Science Center/Saint Thomas Health, Nashville, TN
| | | | | | | | - Seema Jain
- Centers for Disease Control and Prevention, Atlanta, GA
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Hadfield J, Bennett L. Determining best outcomes from community-acquired pneumonia and how to achieve them. Respirology 2017; 23:138-147. [PMID: 29150897 DOI: 10.1111/resp.13218] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 10/12/2017] [Accepted: 10/19/2017] [Indexed: 12/12/2022]
Abstract
Community-acquired pneumonia (CAP) is a common acute medical illness with a standard, effective treatment that was introduced before the evidenced-based medicine era. Mortality rates have improved in recent decades but improvements have been minimal when compared to other conditions such as acute coronary syndromes. The standardized approach to treatment makes CAP a target for comparative performance and outcome measures. While easy to collect, simplistic outcomes such as mortality, readmission and length of stay are difficult to interpret as they can be affected by subjective choices and health care resources. Proposed clinical- and patient-reported outcomes are discussed below and include measures such as the time to clinical stability (TTCS) and patient satisfaction, which can be compared between health institutions. Strategies to improve these outcomes include use of a risk stratification tool, local antimicrobial guidelines with antibiotic stewardship and care bundles to include early administration of antibiotics and early mobilization.
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Affiliation(s)
- Jane Hadfield
- Department of Respiratory Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - Lesley Bennett
- Department of Respiratory Medicine, Royal Perth Hospital, Perth, WA, Australia
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Biteker FS, Başaran Ö, Doğan V, Çaylak SD, Yıldırım B, Sözen H. Prognostic value of transthoracic echocardiography and biomarkers of cardiac dysfunction in community-acquired pneumonia. Clin Microbiol Infect 2016; 22:1006.e1-1006.e6. [PMID: 27596535 DOI: 10.1016/j.cmi.2016.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 08/11/2016] [Accepted: 08/13/2016] [Indexed: 02/05/2023]
Abstract
The aim of this study was to determine the prognostic role of echocardiography and compare with admission N-terminal proB-type natriuretic peptide (NT-proBNP) levels in adult patients with community-acquired pneumonia (CAP). Consecutive adult patients hospitalized with CAP were prospectively enrolled and followed-up until hospital discharge or death. Echocardiography was performed within the first 48 hours. Complicated hospitalization (CH) was defined as intensive care unit admission, need for mechanical ventilation or in-hospital mortality. This study was registered with ClinicalTrials.gov, number NCT02441855. A total of 15 CH (13.5%) occurred among 111 patients with CAP. CAP patients with a CH compared with those without CH had significantly higher NT-proBNP values (1267.4±1146.1 vs. 305.6±545.7 pg/mL, p <0.001) and troponin I (23.8±24.3 vs. 10.3±6.3 ng/mL, p 0.02) but had lower left ventricle ejection fraction (52.7±8.7 vs. 60.5±6.7%, p <0.001) and tricuspid annular plane systolic excursion (TAPSE), which is a measure of right ventricular systolic function (17.1±4.4 vs. 21.8±4 mm; p 0.001). Patients with elevation of NT-proBNP and decreased TAPSE at presentation had a significantly higher probability of CH (60%) than patients with either elevated NT-proBNP or decreased TAPSE (40%). Patients with neither elevated NT-proBNP nor decreased TAPSE had a 0% probability of CH. This is the first study to demonstrate that decreased right ventricular systolic function is associated with increased rates of adverse events in patients with CAP.
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Affiliation(s)
- F S Biteker
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey.
| | - Ö Başaran
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology, Turkey
| | - V Doğan
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology, Turkey
| | - S Dirgen Çaylak
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey
| | - B Yıldırım
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Emergency Medicine, Muğla, Turkey
| | - H Sözen
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey
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