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Méndez R, González-Jiménez P, Mengot N, Menéndez R. Treatment Failure and Clinical Stability in Severe Community-Acquired Pneumonia. Semin Respir Crit Care Med 2024; 45:225-236. [PMID: 38224700 DOI: 10.1055/s-0043-1778139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Treatment failure and clinical stability are important outcomes in community-acquired pneumonia (CAP). It is essential to know the causes and risk factors for treatment failure and delay in reaching clinical stability in CAP. The study of both as well as the associated underlying mechanisms and host response are key to improving outcomes in pneumonia.
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Affiliation(s)
- Raúl Méndez
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Paula González-Jiménez
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Noé Mengot
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Rosario Menéndez
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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2
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Garnacho-Montero J, Roquilly A. Increasing evidence to use early corticosteroids in patients with severe community-acquired pneumonia even in the absence of shock. J Crit Care 2024; 80:154508. [PMID: 38157683 DOI: 10.1016/j.jcrc.2023.154508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Jose Garnacho-Montero
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - Antoine Roquilly
- Nantes Université, Inserm, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes F-44000, France; Nantes Université, CHU Nantes, Service d'Anesthesie Réanimation, Nantes F-44000, France
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3
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Cavallazzi R, Ramirez JA. Definition, Epidemiology, and Pathogenesis of Severe Community-Acquired Pneumonia. Semin Respir Crit Care Med 2024; 45:143-157. [PMID: 38330995 DOI: 10.1055/s-0044-1779016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
The clinical presentation of community-acquired pneumonia (CAP) can vary widely among patients. While many individuals with mild symptoms can be managed as outpatients with excellent outcomes, there is a distinct subgroup of patients who present with severe CAP. In these cases, the mortality rate can reach approximately 25% within 30 days and even up to 50% within a year. It is crucial to focus attention on these patients who are at higher risk. Among the various definitions of severe CAP found in the literature, one commonly used criterion is the requirement for admission to intensive care unit. Notable epidemiological characteristics of these patients include the impact of acute cardiovascular diseases on clinical outcomes and the enduring, independent effect of pneumonia on long-term outcomes. Factors such as pathogen virulence, the presence of comorbidities, and the host response are important contributors to the pathogenesis of severe CAP. In these patients, the host response may be dysregulated and compartmentalized. Gaining a better understanding of the epidemiology and pathogenesis of severe CAP will provide a foundation for the development of new therapies for this condition. This manuscript aims to review the definition, epidemiology, and pathogenesis of severe CAP, shedding light on important aspects that can aid in the improvement of patient care and outcomes.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, Kentucky
| | - Julio A Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
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4
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Çelik E, Kara SS, Çevik Ö. The Potential Use of Saliva as a Biofluid for Systemic Inflammatory Response Monitoring in Children with Pneumonia. Indian J Pediatr 2022; 89:477-483. [PMID: 34595601 DOI: 10.1007/s12098-021-03973-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the levels of C-reactive protein, procalcitonin, calprotectin, interleukin 1 beta (IL-1β), IL-6, and tumor necrosis factor-alpha (TNF-α) in both saliva and serum in children with community-acquired pneumonia and to compare the saliva response with the systemic response. METHODS Forty hospitalized children with community-acquired pneumonia aged between 1 mo and 15 y; and 40 healthy controls were included. Both serum and saliva samples were collected on admission and at the time of discharge. RESULTS Calculated differences between values for each serum and salivary parameter on admission and before discharge named delta (Δ) values were used for correlation analysis. Salivary Δ values of each parameter were moderately/strongly correlated with their corresponding serum Δ levels [IL-1β ÷ (r = 0.554, p < 0.001); IL-6 ÷ (r = 0.484, p = 0.002); PCT ÷ (r = 0.737, p < 0.001); TNF-α ÷ (r = 0.587, p < 0.001); CRP ÷ (r = 0.703, p < 0.001); and calprotectin ÷ (r = 0.774, p < 0.001)]. CONCLUSIONS This study will evaluate the reflection of systemic changes in saliva and the efficacy of saliva in pediatric patients with pneumonia. Results will highlight saliva potential use as a biofluid for systemic monitoring in this patient group.
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Affiliation(s)
- Elif Çelik
- Department of Pediatrics, Faculty of Medicine, Adnan Menderes University, Aydın, 09010, Turkey.
| | - Soner Sertan Kara
- Department of Pediatric Infectious Disease, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Özge Çevik
- Department of Biochemistry, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
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5
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Glerup R, Svensson M, Jakobsen LH, Fellstrøm B, Jensen JD, Christensen JH. Multiplex proteomics as risk predictor of infection in patients treated with hemodialysis-A prospective multicenter study. Hemodial Int 2021; 26:191-201. [PMID: 34964538 DOI: 10.1111/hdi.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/11/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Severe infection is a major problem in hemodialysis patients. Multiplex proteomics might reveal novel insights into disease mechanisms increasing the risk of infection and might also be used as a risk prediction tool. The aims of this study were (1) to evaluate associations between 92 proteins assessed by a proximity extension assay and the development of severe infection in patients on hemodialysis and (2) to develop a risk prediction model for severe infection using prespecified clinical variables and proteomics. METHODS Prospective, observational multicenter cohort study with 5-year follow-up. Patients receiving in-center hemodialysis in five facilities in Denmark were included. The primary composite endpoint was death caused by infection, bacteremia, and infections requiring hospitalization of at least 2 days or prolonging a hospital stay. FINDINGS Of 331 patients included 210 patients reached the primary endpoint during follow-up. In adjusted Cox regression analyses, 14 plasma proteins were associated with severe infection. Correcting for multiple testing revealed only cathepsin-L1 and interleukin-6 significantly associated with the primary outcome. Cathepsin-L1-hazard ratio: 1.64 (95% confidence interval [CI] 1.24-2.17) and interleukin-6-hazard ratio: 1.16 (95% CI 1.05-1.29). Apparent C-statistics of the risk prediction model using clinical variables was 0.605, addition of cathepsin-L1 and interleukin-6 to the model improved discrimination slightly: C = 0.625. DISCUSSION Proteomic profiling identified cathepsin-L1 and interleukin-6 as markers for infectious risk in hemodialysis patients. Further studies are needed to replicate the results and to examine possible causality. The developed risk prediction models need considerable improvement before implementation in clinical practice is meaningful.
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Affiliation(s)
- Rie Glerup
- Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark
| | - My Svensson
- Department of Renal Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lasse H Jakobsen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Bengt Fellstrøm
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jens D Jensen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jeppe H Christensen
- Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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6
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Ceccato A, Russo A, Barbeta E, Oscanoa P, Tiseo G, Gabarrus A, Di Giannatale P, Nogas S, Cilloniz C, Menichetti F, Ferrer M, Niederman M, Falcone M, Torres A. Real-world corticosteroid use in severe pneumonia: a propensity-score-matched study. Crit Care 2021; 25:432. [PMID: 34915895 PMCID: PMC8674860 DOI: 10.1186/s13054-021-03840-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/24/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide despite correct antibiotic use. Corticosteroids have long been evaluated as a treatment option, but heterogeneous effects on survival have precluded their widespread implementation. We aimed to evaluate whether corticosteroids might improve clinical outcomes in patients with severe CAP and high inflammatory responses. STUDY DESIGN AND METHODS We analyzed two prospective observational cohorts of patients with CAP in Barcelona and Rome who were admitted to intensive care with a high inflammatory response. Propensity score (PS) matching was used to obtain balance among the baseline variables in both groups, and we excluded patients with viral pneumonia or who received hydrocortisone. RESULTS Of the 610 patients admitted with severe CAP, 198 (32%) received corticosteroids and 387 had major criteria for severe CAP. All patients had a baseline serum C-reactive protein above 15 mg/dL. Patients who received corticosteroids were more commonly male, had more comorbidities (e.g., cancer or chronic obstructive pulmonary disease), and presented with significantly higher sequential organ failure assessment scores. Eighty-nine patients met major severity criteria (invasive mechanical ventilation and/or septic shock) and were matched per group. Twenty-eight-day mortality was lower among patients receiving corticosteroids (16 patients, 18%) than among those not receiving them (28 patients, 31%; p = 0.037). After PS matching, corticosteroid therapy reduced the 28-day mortality risk in patients who met major severity criteria (hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.29-0.98) (p = 0.043). In patients who did not meet major severity criteria, no benefits were observed with corticosteroid use (HR 0.88 (95%CI 0.32-2.36). CONCLUSIONS Corticosteroid treatment may be of benefit for patients with CAP who have septic shock and/or a high inflammatory response and requirement for invasive mechanical ventilation. Corticosteroids appear to have no impact on mortality when these features are not present.
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Affiliation(s)
- A Ceccato
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
| | - A Russo
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - E Barbeta
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - P Oscanoa
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - G Tiseo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Gabarrus
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - P Di Giannatale
- Department of Medical, Oral and Biotechnological Sciences, School of Medicine and Health Sciences, Section of Anesthesia Analgesia, Perioperative and Intensive Care, SS. Annunziata Hospital, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - S Nogas
- Dipartimento Scienze Chirurgiche E Diagnostiche Integrate (DISC), Università Degli Studi Di Genova, Genova, Italy
| | - C Cilloniz
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - F Menichetti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Ferrer
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - M Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - M Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Torres
- Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain.
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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7
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Abstract
Severe pneumonia is associated with high mortality (short and long term), as well as pulmonary and extrapulmonary complications. Appropriate diagnosis and early initiation of adequate antimicrobial treatment for severe pneumonia are crucial in improving survival among critically ill patients. Identifying the underlying causative pathogen is also critical for antimicrobial stewardship. However, establishing an etiological diagnosis is challenging in most patients, especially in those with chronic underlying disease; those who received previous antibiotic treatment; and those treated with mechanical ventilation. Furthermore, as antimicrobial therapy must be empiric, national and international guidelines recommend initial antimicrobial treatment according to the location's epidemiology; for patients admitted to the intensive care unit, specific recommendations on disease management are available. Adherence to pneumonia guidelines is associated with better outcomes in severe pneumonia. Yet, the continuing and necessary research on severe pneumonia is expansive, inviting different perspectives on host immunological responses, assessment of illness severity, microbial causes, risk factors for multidrug resistant pathogens, diagnostic tests, and therapeutic options.
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Affiliation(s)
- Catia Cillóniz
- Department of pneumology, Hospital Clinic of Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Antoni Torres
- Department of pneumology, Hospital Clinic of Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Michael S Niederman
- Weill Cornell Medical College, Department of Pulmonary Critical Care Medicine, New York, NY, USA
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8
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Ewig S, Kolditz M, Pletz M, Altiner A, Albrich W, Drömann D, Flick H, Gatermann S, Krüger S, Nehls W, Panning M, Rademacher J, Rohde G, Rupp J, Schaaf B, Heppner HJ, Krause R, Ott S, Welte T, Witzenrath M. [Management of Adult Community-Acquired Pneumonia and Prevention - Update 2021 - Guideline of the German Respiratory Society (DGP), the Paul-Ehrlich-Society for Chemotherapy (PEG), the German Society for Infectious Diseases (DGI), the German Society of Medical Intensive Care and Emergency Medicine (DGIIN), the German Viological Society (DGV), the Competence Network CAPNETZ, the German College of General Practitioneers and Family Physicians (DEGAM), the German Society for Geriatric Medicine (DGG), the German Palliative Society (DGP), the Austrian Society of Pneumology Society (ÖGP), the Austrian Society for Infectious and Tropical Diseases (ÖGIT), the Swiss Respiratory Society (SGP) and the Swiss Society for Infectious Diseases Society (SSI)]. Pneumologie 2021; 75:665-729. [PMID: 34198346 DOI: 10.1055/a-1497-0693] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The present guideline provides a new and updated concept of the management of adult patients with community-acquired pneumonia. It replaces the previous guideline dating from 2016.The guideline was worked out and agreed on following the standards of methodology of a S3-guideline. This includes a systematic literature search and grading, a structured discussion of recommendations supported by the literature as well as the declaration and assessment of potential conflicts of interests.The guideline has a focus on specific clinical circumstances, an update on severity assessment, and includes recommendations for an individualized selection of antimicrobial treatment.The recommendations aim at the same time at a structured assessment of risk for adverse outcome as well as an early determination of treatment goals in order to reduce mortality in patients with curative treatment goal and to provide palliation for patients with treatment restrictions.
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Affiliation(s)
- S Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, EVK Herne und Augusta-Kranken-Anstalt Bochum
| | - M Kolditz
- Universitätsklinikum Carl-Gustav Carus, Klinik für Innere Medizin 1, Bereich Pneumologie, Dresden
| | - M Pletz
- Universitätsklinikum Jena, Institut für Infektionsmedizin und Krankenhaushygiene, Jena
| | - A Altiner
- Universitätsmedizin Rostock, Institut für Allgemeinmedizin, Rostock
| | - W Albrich
- Kantonsspital St. Gallen, Klinik für Infektiologie/Spitalhygiene
| | - D Drömann
- Universitätsklinikum Schleswig-Holstein, Medizinische Klinik III - Pulmologie, Lübeck
| | - H Flick
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Klinische Abteilung für Lungenkrankheiten, Graz
| | - S Gatermann
- Ruhr Universität Bochum, Abteilung für Medizinische Mikrobiologie, Bochum
| | - S Krüger
- Kaiserswerther Diakonie, Florence Nightingale Krankenhaus, Klinik für Pneumologie, Kardiologie und internistische Intensivmedizin, Düsseldorf
| | - W Nehls
- Helios Klinikum Erich von Behring, Klinik für Palliativmedizin und Geriatrie, Berlin
| | - M Panning
- Universitätsklinikum Freiburg, Department für Medizinische Mikrobiologie und Hygiene, Freiburg
| | - J Rademacher
- Medizinische Hochschule Hannover, Klinik für Pneumologie, Hannover
| | - G Rohde
- Universitätsklinikum Frankfurt, Medizinische Klinik I, Pneumologie und Allergologie, Frankfurt/Main
| | - J Rupp
- Universitätsklinikum Schleswig-Holstein, Klinik für Infektiologie und Mikrobiologie, Lübeck
| | - B Schaaf
- Klinikum Dortmund, Klinik für Pneumologie, Infektiologie und internistische Intensivmedizin, Dortmund
| | - H-J Heppner
- Lehrstuhl Geriatrie Universität Witten/Herdecke, Helios Klinikum Schwelm, Klinik für Geriatrie, Schwelm
| | - R Krause
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Klinische Abteilung für Infektiologie, Graz
| | - S Ott
- St. Claraspital Basel, Pneumologie, Basel, und Universitätsklinik für Pneumologie, Universitätsspital Bern (Inselspital) und Universität Bern
| | - T Welte
- Medizinische Hochschule Hannover, Klinik für Pneumologie, Hannover
| | - M Witzenrath
- Charité, Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Berlin
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Cilloniz C, Peroni HJ, Gabarrús A, García-Vidal C, Pericàs JM, Bermejo-Martin J, Torres A. Lymphopenia Is Associated With Poor Outcomes of Patients With Community-Acquired Pneumonia and Sepsis. Open Forum Infect Dis 2021; 8:ofab169. [PMID: 34189165 PMCID: PMC8231373 DOI: 10.1093/ofid/ofab169] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/30/2021] [Indexed: 12/29/2022] Open
Abstract
Background Lymphopenia is a marker of poor prognosis in patients with community-acquired pneumonia (CAP), yet its impact on outcomes in patients with CAP and sepsis remains unknown. We aim to investigate the impact of lymphopenia on outcomes, risk of intensive care unit (ICU) admission, and mortality in CAP patients with sepsis. Methods This was a retrospective, observational study of prospectively collected data from an 800-bed tertiary teaching hospital (2005–2019). Results Of the 2203 patients with CAP and sepsis, 1347 (61%) did not have lymphopenia, while 856 (39%) did. When compared with the nonlymphopenic group, patients with sepsis and lymphopenia more frequently required ICU admission (P = .001), had a longer hospital length of stay (P ˂ .001), and presented with a higher rate of in-hospital (P ˂ .001) and 30-day mortality (P = .001). Multivariable analysis showed that C-reactive protein ≥15 mg/dL, lymphopenia, pleural effusion, and acute respiratory distress syndrome within 24 hours of admission were risk factors for ICU admission; age ≥80 years was independently associated with decreased ICU admission. In addition, age ≥80 years, chronic renal disease, chronic neurologic disease, being a nursing home resident, lymphopenia, and pleural effusion were independently associated with increased 30-day mortality, whereas pneumococcal vaccination, diabetes mellitus, and fever were independently associated with reduced 30-day mortality. Conclusions Lymphopenia was independently associated with risk of ICU admission and higher in-hospital and 30-day mortality in patients with CAP and sepsis. Early identification of lymphopenia could help identify septic patients with CAP who require or will shortly require critical care.
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Affiliation(s)
- Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Centres in Respiratory Diseases (Ciberes) Barcelona, Spain
| | - Héctor José Peroni
- Respiratory Medicine Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Emergency Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Albert Gabarrús
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute-IDIBAPS, University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Centres in Respiratory Diseases (Ciberes) Barcelona, Spain
| | | | - Juan M Pericàs
- Infectious Disease Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Vall d'Hebron Institute for Research, Barcelona, Spain
| | - Jesús Bermejo-Martin
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, Salamanca, Spain.,Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
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10
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Zaicev AA, Sinopalnikov AI. "Difficult" pneumonia. TERAPEVT ARKH 2021; 93:300-310. [DOI: 10.26442/00403660.2021.03.200734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/22/2022]
Abstract
The article considers the issues of therapeutic management of patients with so-called difficult pneumonia, particularly, patients with diagnosed syndrome slowly resolving / nonresolving pneumonia, who do not respond to the treatment. The reasons and significant risk factors potentially affecting the effectiveness of therapy are analyzed, the therapeutic tactics of managing patients with no response to treatment are considered, the list of necessary diagnostic methods and directions of antibiotic therapy is updated. The article analyses the tactics of managing patients with pneumonia during a pandemic caused by SARS-CoV-2 coronavirus. It also provides directions of diagnostics with priority discussion of biological markers of the inflammatory response as well as antimicrobial therapy strategy.
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11
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Tanır Basaranoglu S, Ozsurekci Y, Aykac K, Iyigun I, Satirer O, Akin MS, Ceyhan M. Adhesion molecules as diagnostic and severity biomarkers in pediatric community-acquired pneumonia. CLINICAL RESPIRATORY JOURNAL 2021; 15:522-529. [PMID: 33484111 DOI: 10.1111/crj.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 09/09/2020] [Accepted: 01/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Discrimination of the cases with severe and mild pneumonia is crucial due to the requirement of hospitalization, additional management, and treatment protocols. We aimed to analyze the role of IL6 (Interleukin), IL8, IL10, VCAM-1 (soluble Vascular Cell Adhesion Molecule), and sSELE (soluble E-selectin) in the diagnosis and prognostic evaluation of community-acquired pneumonia (CAP). METHODS Pediatric patients with severe pneumonia (SP) were hospitalized and patients with mild disease (MP) were treated in the community. IL6, IL8, IL10, VCAM-1, and sSELE levels of the patients were investigated and compared with the age- and gender-matched healthy subjects. RESULTS A total of 113 patients fulfilling the criteria for a diagnosis of CAP were enrolled in the study, 62 (54.8%) of which had SP and 51 (45%) had MP. MP and SP groups were significantly different in terms of IL8, IL10, and sSELE levels. Patients with SP and MP had significantly different WBC, ESR, and CRP values, as well. CONCLUSIONS Besides classical acute phase parameters, inflammatory response parameters such as IL6 and VCAM-1 levels may be helpful in diagnosis of pneumonia. In terms of determination of disease severity in pediatric CAP, systemic inflammatory markers like IL8 and IL10 and adhesion molecules like sSELE seem useful in clinical settings.
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Affiliation(s)
| | - Yasemin Ozsurekci
- Pediatric Infectious Disease Department, Ihsan Dogramacı Children Hospital, Hacettepe University, Ankara, Turkey
| | - Kubra Aykac
- Ankara Training and Research Hospital, Ankara, Turkey
| | - Irem Iyigun
- Department of Pediatrics, Ihsan Dogramacı Children Hospital, Hacettepe University, Ankara, Turkey
| | - Ozlem Satirer
- Department of Pediatrics, Ihsan Dogramacı Children Hospital, Hacettepe University, Ankara, Turkey
| | - Mustafa Senol Akin
- Department of Pediatrics, Ihsan Dogramacı Children Hospital, Hacettepe University, Ankara, Turkey
| | - Mehmet Ceyhan
- Pediatric Infectious Disease Department, Ihsan Dogramacı Children Hospital, Hacettepe University, Ankara, Turkey
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Detection of Viruses by Multiplex Real-Time Polymerase Chain Reaction in Bronchoalveolar Lavage Fluid of Patients with Nonresponding Community-Acquired Pneumonia. Can Respir J 2020; 2020:8715756. [PMID: 33294084 PMCID: PMC7714605 DOI: 10.1155/2020/8715756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/02/2020] [Accepted: 11/13/2020] [Indexed: 11/18/2022] Open
Abstract
Background Nonresponding pneumonia is responsible for the most mortality of community-acquired pneumonia (CAP). However, thus far, it is not clear whether viral infection plays an important role in the etiology of nonresponding CAP and whether there is a significant difference in the clinical characteristics between viral and nonviral nonresponding CAP. Methods From 2016 to 2019, nonresponding CAP patients were retrospectively enrolled in our study. All patients received bronchoalveolar lavage (BAL) and virus detection in BAL fluid by multiplex real-time polymerase chain reaction (PCR), and clinical, laboratory, and radiographic data were collected. Results A total of 43 patients were included. The median age was 62 years, and 65.1% of patients were male. Overall, 20 patients (46.5%) were identified with viral infection. Of these viruses, influenza virus (n = 8) and adenovirus (n = 7) were more frequently detected, and others included herpes simplex virus, human enterovirus, cytomegalovirus, human coronavirus 229E, rhinovirus, and parainfluenza virus. Compared with nonviral nonresponding CAP, only ground-glass opacity combined with consolidation was a more common imaging manifestation in viral nonresponding CAP. However, no obvious differences were found in clinical and laboratory findings between the presence and the absence of viral infections. Conclusions Viral infections were particularly frequent in adults with nonresponding CAP. The ground-glass opacity combined with consolidation was a specific imaging manifestation for viral nonresponding CAP, while the clinical and laboratory data showed no obvious differences between viral and nonviral nonresponding CAP.
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Wang M, Zhu Q, Fu J, Liu L, Xiao M, Du Y. Differences of inflammatory and non-inflammatory indicators in Coronavirus disease-19 (COVID-19) with different severity. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2020; 85:104511. [PMID: 32858231 PMCID: PMC7448737 DOI: 10.1016/j.meegid.2020.104511] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022]
Abstract
Background A variety of inflammatory and non-inflammatory indicators were increased in severe and critical Coronavirus disease-19 (COVID-19) and some of them were used to evaluate the severity and predict prognosis of community-acquired pneumonia. The aim of this study was to investigate the association of these indicators in COVID-19 with different severity. Methods Clinical data of 46 patients with severe COVID-19 and 31 patients with critical COVID-19 were collected. The general characteristics and comorbidities of the patients were retrospectively analyzed. The initial and peak concentrations of serum troponin I (cTnI), D-dimer (D-D), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), initial and peak neutrophil counts and initial and trough lymphocyte counts were compared between two groups. The correlation between the variation of cTnI, D-D, CRP, IL-6, PCT, neutrophils, lymphocytes and the severity of the disease was analyzed. The efficacy of the initial concentrations of cTnI, D-D, CRP, IL-6, PCT, the initial neutrophil and lymphocyte counts in predicting critical COVID-19 were evaluated by receiver operating characteristic (ROC) curve. Results The initial and peak concentrations of cTnI, D-D, CRP, IL-6, PCT, initial and peak neutrophil counts in critical group were higher than those in severe group, the initial and trough counts of lymphocyte were lower than those in the severe group. Except for the initial level of PCT, the other differences were statistically significant (p < 0.05). The increase of cTnI, D-D, CRP, IL-6, PCT, neutrophils and the decrease of lymphocytes were related to the severity of the disease, OR values were 28.80, 2.20, 18.47, 10.80, 52.00, 9.60 and 21.08, respectively. Except for D-D, the other differences were statistically significant. The areas under ROC curves for predicting critical COVID-19 by initial concentrations of cTnI, D-D, CRP, IL-6, PCT, initial lymphocyte and neutrophil counts were 0.76, 0.78, 0.83, 0.95, 0.56, 0.68 and 0.62, respectively. Conclusions The severe and critical COVID-19 patients had significant differences in concentrations of serum cTnI, D-D, CRP, IL-6, PCT, neutrophil and lymphocyte counts. The increase of cTnI, CRP, IL-6, PCT, neutrophils and decrease of lymphocytes indicated severe condition. The initial IL-6 might be a good indicator of COVID-19 severity.
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Affiliation(s)
- Miao Wang
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Qiguo Zhu
- Department of Respiratory Medicine, Xiamen Children's Hospital, Xiamen, China
| | - Jianguo Fu
- Department of Hospital Infection Management, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Lilong Liu
- Intensive Care Unit, Fujian Medical University Xiamen Humanity Hospital, Xiamen, China
| | - Mingzhe Xiao
- The Medical Department, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, China,The State Key Lab of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, China
| | - Yu Du
- Department of Pharmacy, Zhongshan Hospital Xiamen University, Xiamen, China.
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14
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Procalcitonin as a predictor of early antibiotic treatment failure in patients with gram-negative bloodstream infections caused by urinary tract infections. Diagn Microbiol Infect Dis 2020; 99:115256. [PMID: 33220639 DOI: 10.1016/j.diagmicrobio.2020.115256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 11/21/2022]
Abstract
We retrospectively evaluated whether initial procalcitonin (PCT) levels can predict early antibiotic treatment failure (ATF) in patients with gram-negative bloodstream infections (GN-BSI) caused by urinary tract infections from January 2018 to November 2019. Early ATF was defined as the following: (1) hemodynamically unstable or febrile at Day 3; (2) the need for mechanical ventilation or continuous renal replacement therapy at Day 3; (3) patients who died within 3 days (date of blood culture: Day 0). The study included 189 patients; 42 showed early ATF. Independent risk factors for early ATF were initial admission to the intensive care unit (odds ratio: 7.735, 95% confidence interval: 2.567-23.311; P < 0.001) and PCT levels ≥30 ng/mL (odds ratio: 5.413, 95% confidence interval: 2.188-13.388; P < 0.001). Antibiotic factors were not associated with early ATF. Initial PCT levels may be helpful to predict early ATF in these patients.
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15
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Systemic Inflammatory Response and Outcomes in Community-Acquired Pneumonia Patients Categorized According to the Smoking Habit or Presence of Chronic Obstructive Pulmonary Disease. J Clin Med 2020; 9:jcm9092884. [PMID: 32906593 PMCID: PMC7564982 DOI: 10.3390/jcm9092884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 01/01/2023] Open
Abstract
The systemic inflammatory response (SIR) may help to predict clinical progression, treatment failure, and prognosis in community-acquired pneumonia (CAP). Exposure to tobacco smoke may affect the SIR; the role of smoking in CAP has not been consolidated. We evaluated the SIR and outcomes of hospitalized CAP patients stratified by smoking habits and the presence of COPD. This retrospective analysis was conducted at the Hospital Clinic of Barcelona. Baseline, clinical, microbiological, and laboratory variables were collected at admission, using C-reactive protein (CRP) levels as a marker of SIR. The study outcomes were pleural complications, hospital stay, non-invasive and invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission. We also considered the in-hospital and 30-day mortality. Data were grouped by smoking habit (non-, former-, and current-smokers) and the presence of COPD. Current smokers were younger, had fewer comorbidities, and fewer previous pneumonia episodes. CRP levels were higher in current smokers than in other groups. Current smokers had a higher risk of pleural complications independent of CRP levels, the presence of pleuritic pain, and a higher platelet count. Current smokers more often required IMV and ICU admission. Current smokers have a greater inflammatory response and are at increased risk of pleural complications.
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16
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Zeenny RM, Mansour H, Kabbara WK, Chamoun N, Audi M, Yared Y, Salameh P. Effects of statins on clinical outcomes in hospitalized patients with community-acquired pneumonia. J Int Med Res 2020; 48:300060520938586. [PMID: 32780619 PMCID: PMC7557788 DOI: 10.1177/0300060520938586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective We evaluated the effect of chronic use of statins based on C-reactive protein (CRP) levels and hospital length of stay (LOS) in patients admitted with community-acquired pneumonia (CAP). Methods We conducted a retrospective study over 12 months at a teaching hospital in Lebanon comparing patients with CAP taking chronic statins with patients not taking statins. Included patients with CAP were older than age 18 years and had two CRP level measures during hospitalization. CURB-65 criteria were used to assess the severity of pneumonia. A decrease in CRP levels on days 1 and 3, LOS, and normalization of fever were used to assess the response to antibiotics. Results Sixty-one patients were taking statins and 90 patients were not taking statins. Patients on statins had significantly more comorbid conditions; both groups had comparable CURB-65 scores. In both groups, no statistically significant difference was seen for the decrease in CRP level on days 1 and 3 and LOS. No difference in days to normalization of fever was detected in either group. Conclusion No association was found between the chronic use of statins and CRP levels, LOS, or days to fever normalization in patients with CAP.
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Affiliation(s)
- Rony M Zeenny
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Hanine Mansour
- Lebanese American University, School of Pharmacy, Byblos, Lebanon
| | - Wissam K Kabbara
- Lebanese American University, School of Pharmacy, Byblos, Lebanon
| | - Nibal Chamoun
- Lebanese American University, School of Pharmacy, Byblos, Lebanon
| | - Myriam Audi
- Lebanese American University, School of Pharmacy, Byblos, Lebanon.,Pharmacy Manager, Pharmacie Aoude, Jounieh, Lebanon
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17
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Hinojosa CA, Gonzalez-Juarbe N, Rahman MM, Fernandes G, Orihuela CJ, Restrepo MI. Omega-3 fatty acids in contrast to omega-6 protect against pneumococcal pneumonia. Microb Pathog 2020; 141:103979. [PMID: 31954822 PMCID: PMC7190430 DOI: 10.1016/j.micpath.2020.103979] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to assess if long-term supplementation of omega-3 fatty acids or a diet rich in omega-6 fatty acids ameliorates disease severity in a murine model of pneumococcal pneumonia. We hypothesize that long-term dietary supplementation of omega-3 fatty acids will reduce inflammation, disease severity and improve survival compared to omega-6 fatty acids. METHODS Mice receiving diets supplemented with Omega-3 or Omega-6 for two months were intranasally infected with Streptococcus pneumoniae. We analyzed survival, bacterial burden, histopathology and inflammatory biomarkers. RESULTS Our results showed that Omega-3 supplementation had increased survival (p = 0.005), less bacteremia (p = 0.0001) and lower bacterial burden in the lungs (p = 0.0002) when compared to the Omega-6 supplementation. Overall, Omega-3 reduced lung pathology, in particular peribronchial inflammation and cell death. Analyses of lung homogenates showed the Omega-3 cohort had decreased levels of the inflammatory cytokine interleukin-6 and an increase in anti-inflammatory cytokine interleukin-10. CONCLUSIONS Supplementation of mouse diets with Omega-3 fatty acids improved survival, bacterial invasion in the blood and lungs as well as decreased overall lung tissue inflammation and cell death when compared to the Omega-6 supplemented diets. Translation of these findings in humans may improve outcomes of patients at risk for pneumonia.
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Affiliation(s)
- Cecilia A Hinojosa
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | | | - Gabriel Fernandes
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Marcos I Restrepo
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
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18
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Ito A, Ito I, Inoue D, Marumo S, Ueda T, Nakagawa H, Taki M, Nakagawa A, Tatsumi S, Nishimura T, Shiota T, Ishida T. The utility of serial procalcitonin measurements in addition to pneumonia severity scores in hospitalised community-acquired pneumonia: A multicentre, prospective study. Int J Infect Dis 2020; 92:228-233. [DOI: 10.1016/j.ijid.2020.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/29/2022] Open
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19
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Méndez R, Aldás I, Menéndez R. Biomarkers in Community-Acquired Pneumonia (Cardiac and Non-Cardiac). J Clin Med 2020; 9:jcm9020549. [PMID: 32085380 PMCID: PMC7073979 DOI: 10.3390/jcm9020549] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 12/18/2022] Open
Abstract
Community-acquired pneumonia (CAP) remains the first cause of morbidity and mortality worldwide due to infection. Several aspects such as severity and host response are related to its clinical course and outcome. Beyond the acute implications that the infection provokes in the host, pneumonia also has long-term negative consequences. Among them, cardiovascular complications and mortality are the most outstanding. Therefore, an adequate recognition and stratification of the risk of complications and mortality is crucial. Many biomarkers have been studied for these reasons, considering that each biomarker mirrors a different aspect. Moreover, the clinical application of many of them is still being deliberated because of their limitations and the heterogeneity of the disease. In this review, we examine some of the most relevant biomarkers that we have classified as cardiac and non-cardiac. We discuss some classic biomarkers and others that are considered novel biomarkers, which are mainly involved in cardiovascular risk.
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Affiliation(s)
- Raúl Méndez
- Pneumology Department, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria (IIS) La Fe, 46026 Valencia, Spain; Pneumology Department, Hospital Universitario y Politécnico La Fe, Avda, Fernando Abril Martorell 106, 46026 Valencia, Spain;
| | - Irene Aldás
- University of Valencia, Medicine Faculty, 46026 Valencia, Spain;
- Pneumology Department, Hospital Germans Trias i Pujol, 08916 Badalona, Spain
| | - Rosario Menéndez
- Pneumology Department, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria (IIS) La Fe, 46026 Valencia, Spain; Pneumology Department, Hospital Universitario y Politécnico La Fe, Avda, Fernando Abril Martorell 106, 46026 Valencia, Spain;
- University of Valencia, Medicine Faculty, 46026 Valencia, Spain;
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Correspondence:
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20
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Torres A, Ceccato A, Ferrer M, Gabarrus A, Sibila O, Cilloniz C, Mendez R, Menendez R, Bermejo-Martin J, Niederman MS. Effect of Corticosteroids on C-Reactive Protein in Patients with Severe Community-Acquired Pneumonia and High Inflammatory Response: The Effect of Lymphopenia. J Clin Med 2019; 8:jcm8091461. [PMID: 31540339 PMCID: PMC6780068 DOI: 10.3390/jcm8091461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/30/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Lymphopenic patients with community-acquired pneumonia (CAP) have shown high mortality rates. Corticosteroids have immunomodulatory properties and regulate cytokine storm in CAP. However, it is not known whether their modulatory effect on cytokine secretion differs in lymphopenic and non-lymphopenic patients with CAP. Therefore, we aimed to test whether the presence of lymphopenia may modify the response to corticosteroids (mainly in C reactive protein (CRP)) in patients with severe CAP and high inflammatory status). Methods: A post hoc analysis of a randomized controlled trial (NCT00908713) which evaluated the effect of corticosteroids in patients with severe CAP and high inflammatory response (CRP > 15 mg/dL). Patients were clustered according to the presence of lymphopenia (lymphocyte count below 1000 cell/mm3). Results: At day 1, 35 patients (59%) in the placebo group presented with lymphopenia, compared to 44 patients (73%) in the corticosteroid group. The adjusted mean changes from day 1 showed an increase of 1.19 natural logarithm (ln) cell/mm3 in the corticosteroid group and an increase of 0.67 ln cell/mm3 in the placebo group (LS mean difference of the changes in ln (methylprednisolone minus placebo) 0.51, 95% CI (0.02 to 1.01), p = 0.043). A significant effect was also found for the interaction (p = 0.043) between corticosteroids and lymphopenia in CRP values at day 3, with lower values in patients without lymphopenia receiving corticosteroids after adjustments for potential confounders. Conclusion: In this exploratory post hoc analysis from ramdomized controlled trial (RCT) data, the response to corticosteroids, measured by CRP, may differ according to lymphocyte count. Further larger studies are needed to confirm this data.
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Affiliation(s)
- Antoni Torres
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
- Correspondence:
| | - Adrian Ceccato
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
| | - Miquel Ferrer
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
| | - Albert Gabarrus
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
| | - Oriol Sibila
- Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain;
| | - Catia Cilloniz
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
| | - Raúl Mendez
- Servicio de Neumología, IIS/Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, n° 106 Valencia, CIBERES, 46026 València, Spain;
- PhD program in Medicine and Traslational Research, University of Barcelona, Gran Via de les Corts Catalanes, 585, 08007 Barcelona, Spain
| | - Rosario Menendez
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
- Servicio de Neumología, IIS/Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, n° 106 Valencia, CIBERES, 46026 València, Spain;
| | - Jesus Bermejo-Martin
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
- Group For Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación BIomédica de Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Michael S. Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY 10065, USA;
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Pereira JM, Laszczyńska O, Azevedo A, Basílio C, Sousa-Dias C, Mergulhão P, Paiva JA. Early prediction of treatment failure in severe community-acquired pneumonia: The PRoFeSs score. J Crit Care 2019; 53:38-45. [PMID: 31177029 DOI: 10.1016/j.jcrc.2019.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 05/17/2019] [Accepted: 05/29/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify a single/panel of biomarkers and to provide a point score that, after 48 h of treatment, could early predict treatment failure at fifth day of Intensive Care Unit (ICU) stay in severe community-acquired pneumonia (SCAP) patients. MATERIALS AND METHODS Single-center, prospective cohort study of 107 ICU patients with SCAP. Primary outcome included death or absence of improvement in Sequential Organ Failure Assessment score by ≥2 points within 5 days of treatment. Biomarkers were evaluated within 12 h of first antibiotic dose (D1) and 48 h after the first assessment (D3). RESULTS A model based on Charlson's score and a panel of biomarkers (procalcitonin on D1 and D3, B-natriuretic peptide on D1, D-dimer and lactate on D3) had good discrimination for primary outcome in both derivation (AUC 0.82) and validation (AUC 0.76) samples and was well calibrated (X2 = 0.98; df = 1; p = .32). A point score system (PRoFeSs score) built on the estimates of regression coefficients presented good discrimination (AUC 0.81; 95% Confidence Interval 0.72-0.89) for primary outcome. CONCLUSIONS In SCAP, a combination of biomarkers measured at admission and 48 h later may early predict treatment failure. PRoFeSs score may recognize patients with poor short-term prognosis.
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Affiliation(s)
- José Manuel Pereira
- Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - Olga Laszczyńska
- EPIUnit - Institute of Public Health, University of Porto, Portugal
| | - Ana Azevedo
- EPIUnit - Institute of Public Health, University of Porto, Portugal; Hospital Epidemiology Centre, Centro Hospitalar São João EPE, Porto, Portugal; Department of Public Health and Forensic Sciences and Medical Education, University of Porto Medical School, Portugal.
| | - Carla Basílio
- Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal
| | - Conceição Sousa-Dias
- Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal
| | - Paulo Mergulhão
- Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - José Artur Paiva
- Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Relationship Between the Serum Level of C-Reactive Protein and Severity and Outcomes of Community-acquired Pneumonia. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019. [DOI: 10.5812/archcid.63893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lymphopenic community-acquired pneumonia is associated with a dysregulated immune response and increased severity and mortality. J Infect 2019; 78:423-431. [PMID: 30965065 DOI: 10.1016/j.jinf.2019.04.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/20/2019] [Accepted: 04/02/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Lymphopenic (<724 lymphocytes/µL) community-acquired pneumonia (L-CAP) is an immunophenotype with an increased risk of mortality. We aimed to characterize the l-CAP immunophenotype though lymphocyte subsets and the inflammatory response and its relationship with severity at presentation and outcome. METHODS Prospective study of 217 immunocompetent patients hospitalized for CAP. Lymphocyte subsets (CD4+, CD8+, CD19+, and natural killer [NK] cells) and inflammatory cytokines were analyzed on days 1 and 4, and immunoglobulin subclasses were analyzed on day 1 in a nested group. RESULTS 39% of patients showed l-CAP, with decreased levels of all lymphocyte subsets with a partial recovery of CD4+ and CD8+ cells by day 4. l-CAP patients exhibited higher initial severity and systemic levels of interleukin (IL)-8, IL-10, granulocyte colony-stimulating factor, and monocyte chemoattractant protein-1. Initial IgG2 levels were lower in patients with <724 lymphocytes/µL and positively correlated with ALC, CD4+, and CD19+ cell counts. Low CD4+ counts (<129 cells/µL) also independently predicted 30-day mortality after adjusting for age, gender, and the CURB-65 score. CONCLUSIONS l-CAP is characterized by CD4+ depletion, a higher inflammatory response, and low IgG2 levels that correlated with greater severity at presentation and worse prognosis. l-CAP is an immunophenotype useful for rapidly recognizing severity.
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Bobylev AA, Rachina SA, Avdeev SN, Kozlov RS, Mladov VV. C-reactive protein evaluation in communityacquired pneumonia with comorbid chronic heart failure as criterion of antibiotic prescription. KARDIOLOGIYA 2019; 59:40-46. [PMID: 30853012 DOI: 10.18087/cardio.2661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/18/2022]
Abstract
AIM To prove that diagnostic algorithm based on additional measurement of serum C-reactive protein (CRP) for administration of systemic antibacterial therapy (ABT) to patients with suspected community-acquired pneumonia (CAP) and concomitant chronic heart failure (CHF) does not influence outcomes of disease. MATERIALS AND METHODS This open, single-center, randomized, prospective, noninferiority study included 160 adult patients with documented functional class II-IV CHF who had been admitted with a preliminary diagnosis of non-severe CAP. Patients were randomized at 1:1 to two groups; group 1 - with additional measurement of CRP (n=80) and group 2 - with the use of routine diagnostic methods (n=80). In group 1, systemic ABT was administered only when serum CRP was >28.5 mg / l (threshold level of the biomarker calculated at the previous stage of the study); group 2 received a standard treatment. Noninferiority test result for both algorithms was evaluated by the number of patients with clinical success on days 12-14 (primary endpoint). Non-inferiority margin was δ=-13.5 %. In addition secondary endpoints (early clinical response on days 3-5; early in-hospital adverse events (development of complications; admission to intensive care unit (ICU); death), death, recurrent CAP or CHF worsening with readmission at 28 day; mortality at 90 and 180 days) were estimated. Standard statistical tools were used for all intergroup comparisons. RESULTS 76 patients of each group reached the primary endpoint. Systemic ABT was administered to 51 (67.1 %) patients in group 1 and 76 (100 %) patients in group 2 (p<0.05). Both groups were comparable (p>0.05) regarding all endpoints: clinical success, 70 (92.1 %) vs. 69 (90.8 %), Δ=1.3 % (one-sided 97.5 % CI: - 8.25 % for non-inferiority margin δ=-13.5 %); early clinical response, 66 (86.8 %) vs. 68 (89.5 %); admission to ICU, 1 (1.3 %) vs. 1 (1.3 %); development of complications, 20 (26.3 %) vs. 22 (28.9 %); readmission, 5 (6.6 %) vs. 6 (7.9 %); in-hospital mortality, 2 (2.6 %) vs. 1 (1.3 %), mortality at 28 day, 3 (3.9 %) vs. 2 (2.6 %), at 90 day, 5 (6.6 %) vs. 4 (5.3 %), at 180 day, 8 (10.5 %) vs. 9 (11.8 %) cases, respectively. CONCLUSION additional measurement of serum CRP in patients with CHF and suspected non-severe CAP was able to reduce rate of systemic ABT administration without outcomes and prognosis worsening.
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Ceccato A, Ferrer M, Barbeta E, Torres A. Adjunctive Therapies for Community-Acquired Pneumonia. Clin Chest Med 2018; 39:753-764. [DOI: 10.1016/j.ccm.2018.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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26
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Ceccato A, Cilloniz C, Martin-Loeches I, Ranzani OT, Gabarrus A, Bueno L, Garcia-Vidal C, Ferrer M, Niederman MS, Torres A. Effect of Combined β-Lactam/Macrolide Therapy on Mortality According to the Microbial Etiology and Inflammatory Status of Patients With Community-Acquired Pneumonia. Chest 2018; 155:795-804. [PMID: 30471269 DOI: 10.1016/j.chest.2018.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/05/2018] [Accepted: 11/05/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Antibiotic combinations that include macrolides have shown lower mortality rates than β-lactams in monotherapy or combined with fluoroquinolones in patients with community-acquired pneumonia (CAP). However, this effect has not been studied according to the levels of C-reactive protein in CAP with identified microbial cause. In patients with CAP and known microbial cause we aimed to evaluate 30-day mortality of a β-lactam plus macrolide (BL + M) compared with a fluoroquinolone alone or with a β-lactam (FQ ± BL). METHODS We analyzed a prospective observational cohort of patients with CAP admitted to the Hospital Clinic of Barcelona between 1996 and 2016. We included only patients with known microbial cause. RESULTS Of 1,715 patients (29%) with known etiology, a total of 932 patients (54%) received BL + M. Despite lower crude mortality in the BL + M group in the overall population (BL + M, 5% vs FQ ± BL, 8%; P = .015), after adjustment by a propensity score and baseline characteristics, the combination of BL + M had a protective effect on mortality only in patients with high inflammatory response (C-reactive protein, > 15 mg/dL) and pneumococcal CAP (adjusted OR, 0.28; 95% CI, 0.09-0.93). No benefits on mortality were observed for the population without high inflammatory response and pneumococcal CAP or with other etiologies. CONCLUSIONS The combination of a β-lactam with a macrolide was associated with decreased mortality in patients with pneumococcal CAP and in patients with high systemic inflammatory response. When both factors occurred together, BL + M was protective for mortality in the multivariate analysis.
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Affiliation(s)
- Adrian Ceccato
- Department of Pneumology, the Hospital Clinic of Barcelona, the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), the University of Barcelona (UB), SGR 911-CIBER de Enfermedades Respiratorias (CIBERES), and ICREA Academia, Barcelona, Spain
| | - Catia Cilloniz
- Department of Pneumology, the Hospital Clinic of Barcelona, the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), the University of Barcelona (UB), SGR 911-CIBER de Enfermedades Respiratorias (CIBERES), and ICREA Academia, Barcelona, Spain
| | | | - Otavio T Ranzani
- Department of Pneumology, the Hospital Clinic of Barcelona, the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), the University of Barcelona (UB), SGR 911-CIBER de Enfermedades Respiratorias (CIBERES), and ICREA Academia, Barcelona, Spain; Respiratory Intensive Care Unit, Pulmonary Division, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Albert Gabarrus
- Department of Pneumology, the Hospital Clinic of Barcelona, the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), the University of Barcelona (UB), SGR 911-CIBER de Enfermedades Respiratorias (CIBERES), and ICREA Academia, Barcelona, Spain
| | - Leticia Bueno
- Department of Pneumology, the Hospital Clinic of Barcelona, the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), the University of Barcelona (UB), SGR 911-CIBER de Enfermedades Respiratorias (CIBERES), and ICREA Academia, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Service, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Miquel Ferrer
- Department of Pneumology, the Hospital Clinic of Barcelona, the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), the University of Barcelona (UB), SGR 911-CIBER de Enfermedades Respiratorias (CIBERES), and ICREA Academia, Barcelona, Spain
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Antoni Torres
- Department of Pneumology, the Hospital Clinic of Barcelona, the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), the University of Barcelona (UB), SGR 911-CIBER de Enfermedades Respiratorias (CIBERES), and ICREA Academia, Barcelona, Spain.
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El-Sokkary RH, Ramadan RA, El-Shabrawy M, El-Korashi LA, Elhawary A, Embarak S, Tash RME, Elantouny NG. Community acquired pneumonia among adult patients at an Egyptian university hospital: bacterial etiology, susceptibility profile and evaluation of the response to initial empiric antibiotic therapy. Infect Drug Resist 2018; 11:2141-2150. [PMID: 30464557 PMCID: PMC6223388 DOI: 10.2147/idr.s182777] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Effective empirical antibiotic therapy for community acquired pneumonia (CAP), based on frequently updated data about the pattern of bacterial distribution and their antimicrobial susceptibilities, is mandatory. Aim To identify the bacterial etiology of CAP in adults and their antibiotic susceptibility patterns and to evaluate the response to initial empirical antibiotic therapy in an Egyptian university hospital. Settings and design A cross-sectional hospital-based study. Patients and methods CAP cases were selected by systemic random sampling from those admitted to the chest department. All were evaluated at admission and 4 days after starting empiric therapy. Typical bacteria were isolated, identified and tested for their antibiotic susceptibility. An indirect IF assay was used to diagnose atypical bacteria. Clinical response to initial empiric antibiotic therapy was clinically, laboratory and radiologically evaluated. Results Two hundred and seventy CAP patients were included. Bacteria represented 50.4% of them. Klebsiella pneumoniae was the most prevalent bacterium (10.37%) followed by Streptococcus pneumoniae and P. aeruginosa (7.78% each). Overall, 76.2% of isolates showed a multidrug resistant phenotype: 82.61% (19/23) S. pneumoniae, 89.66 % (26/29) K. pneumoniae, 65.22% (15/23) Pseudomonas aeruginosa, 87.50% (7/8) Escherichia coli and 81.25 % (13/16) Staphylococcus aureus. Broad spectrum β-lactams, especially carbapenems, and moxifloxacin showed in vitro efficacy on most of the tested isolates. Forty-three cases (15.9%) were nonresponders, 37 (86%) of them showed bacterial etiology. The highest rate of nonresponsiveness (30.43%) was observed in cases receiving antipseudomonal/antipneumococcal β-lactam plus a fluoroquinolone for suspected P. aeruginosa infection. Conclusion Multidrug resistance in bacteria causing CAP and high frequency of isolation of hospital pathogens are prominent features of this study. Azithromycin containing regimens were associated with the lowest rates of nonresponsiveness. Development and implementation of an antibiotic stewardship program are highly recommended for CAP management.
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Affiliation(s)
- Rehab H El-Sokkary
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt,
| | - Raghdaa A Ramadan
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt,
| | | | - Lobna A El-Korashi
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt,
| | - Abeer Elhawary
- Chest Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh Embarak
- Chest Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rehab M Elsaid Tash
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt,
| | - Neveen G Elantouny
- Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Garnacho-Montero J, Barrero-García I, Gómez-Prieto MDG, Martín-Loeches I. Severe community-acquired pneumonia: current management and future therapeutic alternatives. Expert Rev Anti Infect Ther 2018; 16:667-677. [DOI: 10.1080/14787210.2018.1512403] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jose Garnacho-Montero
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Irene Barrero-García
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ignacio Martín-Loeches
- Department of Anaesthesia and Critical Care, St James University Hospital, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Ireland
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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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Transporters MRP1 and MRP2 Regulate Opposing Inflammatory Signals To Control Transepithelial Neutrophil Migration during Streptococcus pneumoniae Lung Infection. mSphere 2018; 3:3/4/e00303-18. [PMID: 29976647 PMCID: PMC6034076 DOI: 10.1128/msphere.00303-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Streptococcus pneumoniae is a Gram-positive bacterium that normally inhabits the human nasopharynx asymptomatically. However, it is also a major cause of pneumonia, bacteremia, and meningitis. The transition from pneumonia to bacteremia is critical, as patients that develop septicemia have ~20% mortality rates. Previous studies have shown that while neutrophils, a major bacterium-induced leukocyte, aid in S. pneumoniae elimination, they also contribute to pathology and may mediate the lung-to-blood passage of the bacteria. Herein, we show that epithelium-derived MRP1 and MRP2 efflux immunomodulatory agents that assist in controlling passage of neutrophils during infection and that limiting neutrophil infiltration produced less bacteremia and better survival during murine infection. The importance of our work is twofold: ours is the first to identify an MRP1/MRP2 axis of neutrophil control in the lung. The second is to provide possible therapeutic targets to reduce excess inflammation, thus reducing the chances of developing bacteremia during pneumococcal pneumonia. Streptococcus pneumoniae remains a source of morbidity and mortality in both developed and underdeveloped nations of the world. Disease can manifest as pneumonia, bacteremia, and meningitis, depending on the localization of infection. Interestingly, there is a correlation in experimental murine infections between the development of bacteremia and influx of neutrophils into the pulmonary lumen. Reduction of this neutrophil influx has been shown to improve survivability during infection. In this study, we use in vitro biotinylation and neutrophil transmigration and in vivo murine infection to identify a system in which two epithelium-localized ATP-binding cassette transporters, MRP1 and MRP2, have inverse activities dictating neutrophil transmigration into the lumen of infected mouse lungs. MRP1 effluxes an anti-inflammatory molecule that maintains homeostasis in uninfected contexts, thus reducing neutrophil infiltration. During inflammatory events, however, MRP1 decreases and MRP2 both increases and effluxes the proinflammatory eicosanoid hepoxilin A3. If we then decrease MRP2 activity during experimental murine infection with S. pneumoniae, we reduce both neutrophil infiltration and bacteremia, showing that MRP2 coordinates this activity in the lung. We conclude that MRP1 assists in depression of polymorphonuclear cell (PMN) migration by effluxing a molecule that inhibits the proinflammatory effects of MRP2 activity. IMPORTANCEStreptococcus pneumoniae is a Gram-positive bacterium that normally inhabits the human nasopharynx asymptomatically. However, it is also a major cause of pneumonia, bacteremia, and meningitis. The transition from pneumonia to bacteremia is critical, as patients that develop septicemia have ~20% mortality rates. Previous studies have shown that while neutrophils, a major bacterium-induced leukocyte, aid in S. pneumoniae elimination, they also contribute to pathology and may mediate the lung-to-blood passage of the bacteria. Herein, we show that epithelium-derived MRP1 and MRP2 efflux immunomodulatory agents that assist in controlling passage of neutrophils during infection and that limiting neutrophil infiltration produced less bacteremia and better survival during murine infection. The importance of our work is twofold: ours is the first to identify an MRP1/MRP2 axis of neutrophil control in the lung. The second is to provide possible therapeutic targets to reduce excess inflammation, thus reducing the chances of developing bacteremia during pneumococcal pneumonia.
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Lee MS, Oh JY, Kang CI, Kim ES, Park S, Rhee CK, Jung JY, Jo KW, Heo EY, Park DA, Suh GY, Kiem S. Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia. Infect Chemother 2018; 50:160-198. [PMID: 29968985 PMCID: PMC6031596 DOI: 10.3947/ic.2018.50.2.160] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 01/07/2023] Open
Abstract
Community-acquired pneumonia is common and important infectious disease in adults. This work represents an update to 2009 treatment guideline for community-acquired pneumonia in Korea. The present clinical practice guideline provides revised recommendations on the appropriate diagnosis, treatment, and prevention of community-acquired pneumonia in adults aged 19 years or older, taking into account the current situation regarding community-acquired pneumonia in Korea. This guideline may help reduce the difference in the level of treatment between medical institutions and medical staff, and enable efficient treatment. It may also reduce antibiotic resistance by preventing antibiotic misuse against acute lower respiratory tract infection in Korea.
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Affiliation(s)
- Mi Suk Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jee Youn Oh
- Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol In Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Ye Jung
- Division of Pulmonology, The Institute of Chest Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Wook Jo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sungmin Kiem
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
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Morley D, Torres A, Cillóniz C, Martin-Loeches I. Predictors of treatment failure and clinical stability in patients with community acquired pneumonia. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:443. [PMID: 29264360 DOI: 10.21037/atm.2017.06.54] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Community acquired pneumonia (CAP) is the leading infectious cause of mortality worldwide with approximately 10% of patients hospitalized requiring intensive care unit (ICU) admission. The ability to predict clinical stability (CS) and treatment failure (TF) enables the clinician to alter antibiotics appropriately, facilitate a timely ICU admission, or arrange a suitable discharge. The detection of CS and TF can be difficult and changes in clinical signs may be subtle or delayed. Thus clinical scores and biomarkers are routinely used to identify severity and monitor clinical progression. The evidence, however, is vast and the definitive role of these systems is at times difficult to elucidate. The aim of this review is to analyse the current literature and to provide a rational and clinically focused view of the predictive utility of various systems used to identify CS and TF in CAP.
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Affiliation(s)
- Deirdre Morley
- Multidisciplinary Intensive Care Research Organization (MICRO), St James's University Hospital, Dublin, Ireland
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic Barcelona, Universidad Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Catia Cillóniz
- Department of Pneumology, Hospital Clinic Barcelona, Universidad Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), St James's University Hospital, Dublin, Ireland.,Department of Clinical Medicine, Trinity Centre for Health Sciences, Dublin, Ireland
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When antibiotic treatment fails. Intensive Care Med 2017; 44:73-75. [PMID: 29032500 DOI: 10.1007/s00134-017-4962-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023]
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Cao B, Huang Y, She DY, Cheng QJ, Fan H, Tian XL, Xu JF, Zhang J, Chen Y, Shen N, Wang H, Jiang M, Zhang XY, Shi Y, He B, He LX, Liu YN, Qu JM. Diagnosis and treatment of community-acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association. CLINICAL RESPIRATORY JOURNAL 2017; 12:1320-1360. [PMID: 28756639 PMCID: PMC7162259 DOI: 10.1111/crj.12674] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/25/2017] [Indexed: 02/05/2023]
Abstract
Community‐acquired pneumonia (CAP) in adults is an infectious disease with high morbidity in China and the rest of the world. With the changing pattern in the etiological profile of CAP and advances in medical techniques in diagnosis and treatment over time, Chinese Thoracic Society of Chinese Medical Association updated its CAP guideline in 2016 to address the standard management of CAP in Chinese adults. Extensive and comprehensive literature search was made to collect the data and evidence for experts to review and evaluate the level of evidence. Corresponding recommendations are provided appropriately based on the level of evidence. This updated guideline covers comprehensive topics on CAP, including aetiology, antimicrobial resistance profile, diagnosis, empirical and targeted treatments, adjunctive and supportive therapies, as well as prophylaxis. The recommendations may help clinicians manage CAP patients more effectively and efficiently. CAP in pediatric patients and immunocompromised adults is beyond the scope of this guideline. This guideline is only applicable for the immunocompetent CAP patients aged 18 years and older. The recommendations on selection of antimicrobial agents and the dosing regimens are not mandatory. The clinicians are recommended to prescribe and adjust antimicrobial therapies primarily based on their local etiological profile and results of susceptibility testing, with reference to this guideline.
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Affiliation(s)
- Bin Cao
- National Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship Hospital, Capital Medical University, Beijing 100029, China
| | - Yi Huang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China
| | - Dan-Yang She
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Qi-Jian Cheng
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
| | - Hong Fan
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan 610041, China
| | - Xin-Lun Tian
- Department of Pulmonary Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jing Zhang
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yu Chen
- Department of Respiratory and Critical Care Medicine, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - Ning Shen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Hui Wang
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Mei Jiang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xiang-Yan Zhang
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital, Guizhou 550002, China
| | - Yi Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing 210002, China
| | - Bei He
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Li-Xian He
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - You-Ning Liu
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Jie-Ming Qu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
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Ceccato A, Cilloniz C, Ranzani OT, Menendez R, Agusti C, Gabarrus A, Ferrer M, Sibila O, Niederman MS, Torres A. Treatment with macrolides and glucocorticosteroids in severe community-acquired pneumonia: A post-hoc exploratory analysis of a randomized controlled trial. PLoS One 2017; 12:e0178022. [PMID: 28617807 PMCID: PMC5472276 DOI: 10.1371/journal.pone.0178022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/05/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Systemic corticosteroids have anti-inflammatory effects, whereas macrolides also have immunomodulatory activity in addition to their primary antimicrobial actions. We aimed to evaluate the potential interaction effect between corticosteroids and macrolides on the systemic inflammatory response in patients with severe community-acquired pneumonia to determine if combining these two immunomodulating agents was harmful, or possibly beneficial. METHODS We performed a post-hoc exploratory analysis of a randomized clinical trial conducted in three tertiary hospitals in Spain. This trial included patients with severe community-acquired pneumonia with high inflammatory response (C-reactive protein [CRP] >15 mg/dL) who were randomized to receive methylprednisolone 0.5 mg/kg/tpd or placebo. The choice of antibiotic treatment was at the physician's discretion. One hundred and six patients were classified into four groups according to antimicrobial therapy combination (β-lactam plus macrolide or β-lactam plus fluoroquinolone) and corticosteroid arm (placebo or corticosteroids). The primary outcome was treatment failure (composite outcome of early treatment failure, or of late treatment failure, or of both early and late treatment failure). RESULTS The methylprednisolone with β-lactam plus macrolide group had more elderly patients, with comorbidities, and higher pneumonia severity index (PSI) risk class V, but a lower proportion of intensive care unit admission, compared to the other groups. We found non differences in treatment failure between groups (overall p = 0.374); however, a significant difference in late treatment failure was observed (4 patients in the placebo with β-lactam plus macrolide group (31%) vs. 9 patients in the placebo with β-lactam plus fluoroquinolone group (24%) vs. 0 patients in the methylprednisolone with β-lactam plus macrolide group (0%) vs. 2 patients [5%] in the methylprednisolone with β-lactam plus fluoroquinolone group overall p = 0.009). We found a significant difference for In-hospital mortality in the per protocol population (overall p = 0.01). We did not find significant differences in treatment failure, early or late; or In-hospital mortality after adjusting for severity (PSI), year and centre of enrolment. CONCLUSIONS In this exploratory analysis, we observed that the glucocorticosteroids and macrolides combination had no statistically significant association with main clinical outcomes compared with other combinations in patients with severe community acquired pneumonia and a high inflammatory response after taking account potential confounders. TRIAL REGISTRATION Clinicaltrials.gov NCT00908713.
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Affiliation(s)
- Adrian Ceccato
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona—Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)—SGR 911—Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028) Villarroel, Barcelona, Spain
- Seccion Neumologia, Hospital Nacional Prof. Alejandro Posadas, Illia y Marconi s/n Palomar, Argentina
| | - Catia Cilloniz
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona—Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)—SGR 911—Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028) Villarroel, Barcelona, Spain
| | - Otavio T. Ranzani
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona—Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)—SGR 911—Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028) Villarroel, Barcelona, Spain
- Respiratory Intensive Care Unit, Pulmonary Division, Heart Institute, Hospital das Clínicas, University of São Paulo, Av. Dr. Arnaldo, 455-Cerqueira César—CEP: São Paulo, Brazil
| | - Rosario Menendez
- Servicio de Neumología, IIS/Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, Valencia, CIBERES, Spain
| | - Carles Agusti
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona—Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)—SGR 911—Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028) Villarroel, Barcelona, Spain
| | - Albert Gabarrus
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona—Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)—SGR 911—Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028) Villarroel, Barcelona, Spain
| | - Miquel Ferrer
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona—Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)—SGR 911—Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028) Villarroel, Barcelona, Spain
| | - Oriol Sibila
- Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, Barcelona, Spain
| | - Michael S. Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York Presbyterian/Weill Cornell Medical Center, NY, New York, NY, United States of America
| | - Antoni Torres
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona—Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)—SGR 911—Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028) Villarroel, Barcelona, Spain
- * E-mail:
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Yang T, Wan C, Wang H, Qin J, Chen L, Shen Y, Wen F. The prognostic and risk-stratified value of neutrophil–lymphocyte count ratio in Chinese patients with community-acquired pneumonia. EUR J INFLAMM 2017. [DOI: 10.1177/1721727x17702150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Community-acquired pneumonia is a common disease associated with high mortality. This retrospective study examined whether the neutrophil–lymphocyte count ratio (NLR), already widely used as an index of inflammation, can be used to predict in-hospital mortality of adults with community-acquired pneumonia. Clinical characteristics, CURB-65 and pneumonia severity index score of pneumonia severity, NLR, serum levels of C-reactive protein and procalcitonin, and in-hospital mortality were analyzed for 318 consecutive adults with community-acquired pneumonia admitted to West China Hospital between July 2012 and December 2013. The ability of NLR and other parameters to predict in-hospital mortality was assessed using receiver operating characteristic (ROC) curves. Results showed that NLR increased with increasing CURB-65 ( P < 0.05) and pneumonia severity index ( P < 0.05), and NLR correlated positively with serum levels of C-reactive protein (r = 0.239, P < 0.05) and procalcitonin (r = 0.211, P < 0.05). The median value of NLR was significantly higher among patients who died in hospital (11.96) than among those who were alive at the end of hospitalization (4.19, P < 0.05). Based on a cut-off NLR of 7.12, this index predicted in-hospital mortality with a sensitivity of 82.61% and specificity of 72.20% (area under ROC curve, 0.799). Predictive power was greater for the combination of NLR and serum levels of C-reactive protein and procalcitonin. These results suggest that NLR may be useful for predicting prognosis in Chinese adults with community-acquired pneumonia, and it may work better in combination with traditional markers.
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Affiliation(s)
- Ting Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Chun Wan
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Hao Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Jiangyue Qin
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Fuqiang Wen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
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Nobre V, Borges I. Prognostic value of procalcitonin in hospitalized patients with lower respiratory tract infections. Rev Bras Ter Intensiva 2017; 28:179-89. [PMID: 27305038 PMCID: PMC4943056 DOI: 10.5935/0103-507x.20160019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/14/2016] [Indexed: 01/04/2023] Open
Abstract
Lower respiratory tract infections are common and potentially lethal conditions
and are a major cause of inadequate antibiotic prescriptions. Characterization
of disease severity and prognostic prediction in affected patients can aid
disease management and can increase accuracy in determining the need for and
place of hospitalization. The inclusion of biomarkers, particularly
procalcitonin, in the decision taken process is a promising strategy. This study
aims to present a narrative review of the potential applications and limitations
of procalcitonin as a prognostic marker in hospitalized patients with lower
respiratory tract infections. The studies on this topic are heterogeneous with
respect to procalcitonin measurement techniques, cutoff values, clinical
settings, and disease severity. The results show that procalcitonin delivers
moderate performance for prognostic prediction in patients with lower
respiratory tract infections; its predictive performance was not higher than
that of classical methods, and knowledge of procalcitonin levels is most useful
when interpreted together with other clinical and laboratory results. Overall,
repeated measurement of the procalcitonin levels during the first days of
treatment provides more prognostic information than a single measurement;
however, information on the cost-effectiveness of this procedure in intensive
care patients is lacking. The results of studies that evaluated the prognostic
value of initial procalcitonin levels in patients with community-acquired
pneumonia are more consistent and have greater potential for practical
application; in this case, low procalcitonin levels identify those patients with
a low risk of adverse outcomes.
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Affiliation(s)
- Vandack Nobre
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Infectologia e Medicina Tropical, Belo Horizonte MG , Brazil, Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil., Universidade Federal de Minas Gerais.,Universidade Federal de Minas Gerais, Hospital das Clínicas, Unidade de Cuidados Intensivos do Adulto, Belo Horizonte MG , Brazil, Unidade de Cuidados Intensivos do Adulto, Hospital das Clínicas, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil., Universidade Federal de Minas Gerais
| | - Isabela Borges
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Infectologia e Medicina Tropical, Belo Horizonte MG , Brazil, Programa de Pós-Graduação em Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil., Universidade Federal de Minas Gerais
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Trabattoni D, Clerici M, Centanni S, Mantero M, Garziano M, Blasi F. Immunomodulatory effects of pidotimod in adults with community-acquired pneumonia undergoing standard antibiotic therapy. Pulm Pharmacol Ther 2017; 44:24-29. [PMID: 28302543 DOI: 10.1016/j.pupt.2017.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/07/2017] [Accepted: 03/12/2017] [Indexed: 01/31/2023]
Abstract
The morbidity and mortality of community-acquired pneumonia (CAP) are still elevated and two aspects seem to contribute to a worse outcome: an uncontrolled inflammatory reaction and an inadequate immune response. Adjuvants, including corticosteroids and intravenous immunoglobulins, have been proposed to counterbalance these effects but their efficacy is only partial. We examined the immunomodulatory activity of Pidotimod (PDT), a synthetic dipeptide molecule in adult patients hospitalized for CAP. Sixteen patients with a diagnosis of CAP and a PSI score III or IV and/or a CURB-65 0-2 were randomized to receive either levofloxacin 500 mg b.i.d. alone or levofloxacin plus PDT (800mg, 2 daily doses). Blood samples were drawn at baseline (T0), before initiation of therapy, as well as 3 (T3), and 5 (T5) days after initiation of therapy. Immunologic and clinical parameters were analyzed at each time point. Supplementation of antibiotic therapy with PDT resulted in an upregulation of antimicrobial and of immunomodulatory proteins as well as in an increased percentage of Toll like receptor (TLR)2- and TLR4, and of CD80- and CD86-expressing immune cells. Notably, Pidotimod supplementation was also associated with a robust reduction of TNFα-producing immune cells. No significant differences were observed in clinical parameters. These results confirm that supplementation of antibiotic therapy with Pidotimod in patients with CAP results in a potentially beneficial modulation of innate immunity.
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Affiliation(s)
- D Trabattoni
- Cattedra di Immunologia - Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università degli Studi Milano, Italy
| | - M Clerici
- Fondazione Don C. Gnocchi, IRCCS, Milano, and Department of Pathophysiology and Transplantation, Università degli Studi Milano, Italy.
| | - S Centanni
- U.O. di Pneumologia Ospedale Santi Paolo e Carlo, Milano - Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - M Mantero
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Cardio-thoracic Unit and Cystic Fibrosis Adult Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Italy
| | - M Garziano
- Cattedra di Immunologia - Dipartimento di Scienze Biomediche e Cliniche L. Sacco, Università degli Studi Milano, Italy
| | - F Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Cardio-thoracic Unit and Cystic Fibrosis Adult Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Italy
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Khan F, Owens MB, Restrepo M, Povoa P, Martin-Loeches I. Tools for outcome prediction in patients with community acquired pneumonia. Expert Rev Clin Pharmacol 2016; 10:201-211. [PMID: 27911103 DOI: 10.1080/17512433.2017.1268051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is one of the most common causes of mortality world-wide. The mortality rate of patients with CAP is influenced by the severity of the disease, treatment failure and the requirement for hospitalization and/or intensive care unit (ICU) management, all of which may be predicted by biomarkers and clinical scoring systems. Areas covered: We review the recent literature examining the efficacy of established and newly-developed clinical scores, biological and inflammatory markers such as C-Reactive protein (CRP), procalcitonin (PCT) and Interleukin-6 (IL-6), whether used alone or in conjunction with clinical severity scores to assess the severity of CAP, predict treatment failure, guide acute in-hospital or ICU admission and predict mortality. Expert commentary: The early prediction of treatment failure using clinical scores and biomarkers plays a developing role in improving survival of patients with CAP by identifying high-risk patients requiring hospitalization or ICU admission; and may enable more efficient allocation of resources. However, it is likely that combinations of scoring systems and biomarkers will be of greater use than individual markers. Further larger studies are needed to corroborate the additive value of these markers to clinical prediction scores to provide a safer and more effective assessment tool for clinicians.
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Affiliation(s)
- Faheem Khan
- a Intensive Care Medicine , St James's University Hospital , Dublin , Ireland
| | - Mark B Owens
- a Intensive Care Medicine , St James's University Hospital , Dublin , Ireland
| | - Marcos Restrepo
- b Department of Respiratory Medicine , South Texas Veterans Health Care System and the University of Texas Health Science Center at San Antonio , San Antonio , TX , USA
| | - Pedro Povoa
- c Department of Intensive Care Medicine , Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental , Lisbon , Portugal.,d Nova Medical School, CEDOC, New University of Lisbon , Lisbon , Portugal
| | - Ignacio Martin-Loeches
- a Intensive Care Medicine , St James's University Hospital , Dublin , Ireland.,e Department of Clinical Medicine , Trinity College, Welcome Trust-HRB Clinical Research Facility, St James Hospital , Dublin , Ireland
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Sibila O, Rodrigo-Troyano A, Torres A. Nonantibiotic Adjunctive Therapies for Community-Acquired Pneumonia (Corticosteroids and Beyond): Where Are We with Them? Semin Respir Crit Care Med 2016; 37:913-922. [PMID: 27960215 PMCID: PMC7171709 DOI: 10.1055/s-0036-1593538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Community-acquired pneumonia (CAP) is a leading cause of hospitalization, morbidity, and mortality. Despite advances in antibiotic treatments, mortality among patients with CAP is still high. For this reason, interest has been focused on nonantibiotic therapeutic measures directed to the host response rather than the microorganism. The development of an efficacious adjunctive treatment has important implications for reducing mortality in CAP. Some clinical studies performed in the last decade have shown a clinically beneficial effect of corticosteroids, possibly by diminishing local and systemic inflammatory host response. Recent meta-analyses showed faster resolution of symptoms, shorter time to clinically stability, reduction of mechanical ventilation needed, and reduction of mortality in the most severe population, although some methodological limitations must be taken into account. In addition, some studies using statins also suggested improved outcomes due to its anti-inflammatory effect in CAP, although this requires further research. Other adjunctive therapies such as immunoglobulins and stem cells are being explored, but are not yet in the stage of clinical trials. In summary, the use of corticosteroids and other adjuvant treatments are promising in CAP, but more studies are needed to determine their impact on mortality.
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Affiliation(s)
- Oriol Sibila
- Respiratory Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona (UAB), Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ana Rodrigo-Troyano
- Respiratory Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona (UAB), Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Antoni Torres
- Pulmonolgy Department, Respiratory Institute (ICR), Hospital Clinic of Barcelona, Spain
- Centro de Investigación Biomedica En Red - Enfermedades Respiratorias, Barcelona, Spain
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Andersen SB, Baunbæk Egelund G, Jensen AV, Petersen PT, Rohde G, Ravn P. Failure of CRP decline within three days of hospitalization is associated with poor prognosis of Community-acquired Pneumonia. Infect Dis (Lond) 2016; 49:251-260. [DOI: 10.1080/23744235.2016.1253860] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Stine Bang Andersen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital – Hillerød, Hillerød, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Gertrud Baunbæk Egelund
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital – Hillerød, Hillerød, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Vestergaard Jensen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital – Hillerød, Hillerød, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Pelle Trier Petersen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital – Hillerød, Hillerød, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Gernot Rohde
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CAPNETZ-Stiftung, Hannover Medical School, Hannover, Germany
| | - Pernille Ravn
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital – Hillerød, Hillerød, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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Gündüz C, Taşbakan MS, Sayıner A, Çilli A, Kılınç O, Şakar Coşkun A. Factors affecting treatment success in community-acquired pneumonia. Turk J Med Sci 2016; 46:1469-1474. [PMID: 27966314 DOI: 10.3906/sag-1502-87] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 01/20/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Treatment failure in hospitalized patients with community-acquired pneumonia is a major cause of mortality. The aim of this study was to evaluate the factors affecting treatment success in community-acquired pneumonia. MATERIALS AND METHODS A total of 537 patients (mean age: 66.1 ± 15.8 years, 365 males) registered to the Turkish Thoracic Society Pneumonia Database were analyzed. Of these, clinical improvement or cure, defined as treatment success, was achieved in 477, whereas 60 patients had treatment failure and/or died. RESULTS Lower numbers of neutrophils (5989.9 ± 6237.3 vs. 8495.6 ± 7279.5/mm3), higher blood urea levels (66.1 ± 42.1 vs. 51.2 ± 38.2 mg/dL), higher Pneumonia Severity Index (PSI) scores (123.3 ± 42.6 vs. 96.3 ± 32.9), higher CURB-65 scores (2.7 ± 1.2 vs. 2.2 ± 0.9), lower PaO2/FiO2 ratios (216.3 ± 86.8 vs. 269.9 ± 65.6), and the presence of multilobar (33.3% vs. 16.4%) and bilateral (41.7% vs. 18.9%) radiologic infiltrates were related to treatment failure. The PSI score and PaO2/FiO2 ratio were independent parameters affecting treatment results in multivariate linear regression analysis (P < 0.001). CONCLUSION The risk of treatment failure is high in patients with severe pneumonia and with respiratory failure. Effective treatment and close monitoring are required for these cases.
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Affiliation(s)
- Canan Gündüz
- Department of Chest Diseases, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | | | - Abdullah Sayıner
- Department of Chest Diseases, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Aykut Çilli
- Department of Chest Diseases, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Oğuz Kılınç
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ayşın Şakar Coşkun
- Department of Chest Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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Taşbakan MS, Gündüz C, Sayıner A, Çilli A, Çelenk Karaboğa B, Şakar Çoşkun A, Durmaz Yaman F, Kılınç O, Kılıç Soylar Ö. Serum procalcitonin and C-reactive protein kinetics as indicators of treatmentoutcome in hospitalized patients with community-acquired pneumonia. Turk J Med Sci 2016; 46:1422-1427. [PMID: 27966308 DOI: 10.3906/sag-1507-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 01/02/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM There has been growing interest in the use of serum procalcitonin (PCT) and C-reactive protein (CRP) in patients with community-acquired pneumonia (CAP). The aim of this study was to investigate whether an assessment of fever, leukocyte count, and serum CRP and PCT levels on admission and during follow-up (day 3) provides any information about the clinical outcome in hospitalized patients with CAP. MATERIALS AND METHODS Patients with a diagnosis of CAP who were admitted to and followed at four university hospitals were evaluated retrospectively using the Turkish Thoracic Society Pneumonia Database. RESULTS A total of 103 hospitalized CAP patients (57 males, mean age: 61.5 ± 16.7 years) were enrolled in the study. Treatment failure (TF) was observed in 20 patients (19.4%). Pneumonia Severity Index scores, serum CRP levels, and PCT levels on admission were significantly higher in the TF group. There were significant decreases in CRP and PCT levels between admission day and day 3 in the treatment success group. CONCLUSION In patients with CAP, the body temperature and leukocyte count on admission do not predict outcome. Monitoring levels of CRP and PCT may be useful as a predictor of treatment outcome.
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Affiliation(s)
| | - Canan Gündüz
- Department of Chest Diseases, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Abdullah Sayıner
- Department of Chest Diseases, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Aykut Çilli
- Department of Chest Diseases, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Burcu Çelenk Karaboğa
- Department of Chest Diseases, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ayşin Şakar Çoşkun
- Department of Chest Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Feride Durmaz Yaman
- Department of Chest Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Oğuz Kılınç
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Öznur Kılıç Soylar
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Prina E, Ceccato A, Torres A. New aspects in the management of pneumonia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:267. [PMID: 27716262 PMCID: PMC5045574 DOI: 10.1186/s13054-016-1442-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite improvements in the management of community-acquired pneumonia (CAP), morbidity and mortality are still high, especially in patients with more severe disease. Early and appropriate antibiotics remain the cornerstone in the treatment of CAP. However, two aspects seem to contribute to a worse outcome: an uncontrolled inflammatory reaction and an inadequate immune response. Adjuvant treatments, such as corticosteroids and intravenous immunoglobulins, have been proposed to counterbalance these effects. The use of corticosteroids in patients with severe CAP and a strong inflammatory reaction can reduce the time to clinical stability, the risk of treatment failure, and the risk of progression to acute respiratory distress syndrome. The administration of intravenous immunoglobulins seems to reinforce the immune response to the infection in particular in patients with inadequate levels of antibodies and when an enriched IgM preparation has been used; however, more studies are needed to determinate their impact on outcome and to define the population that will receive more benefit.
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Affiliation(s)
- Elena Prina
- Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Adrian Ceccato
- Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Seccion Neumologia, Hospital Nacional Alejandro Posadas, Palomar, Argentina
| | - Antoni Torres
- Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain. .,Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Barcelona, Spain. .,UVIR, Servei de Pneumologia, Hospital Clínic, Villarroel 170., 08036, Barcelona, Spain.
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Prognostic value of Pneumonia Severity Index, CURB-65, CRB-65, and procalcitonin in community-acquired pneumonia in Singapore. PROCEEDINGS OF SINGAPORE HEALTHCARE 2016. [DOI: 10.1177/2010105815623292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the performance of three severity scoring tools and procalcitonin (PCT) in severity stratification and mortality prediction among patients with community-acquired pneumonia (CAP) in Singapore. Methods: The method used was a retrospective observational study of all the consecutive patients with CAP admitted through the emergency department of Singapore General Hospital between 2012–2013. Results: Among 1902 study subjects, the overall 30-day mortality was 15.7%. The mortality rates for Pneumonia Severity Index (PSI) class I–III were 0, 0, and 3.7%, which were comparable to the original published data. CURB-65 and CRB-65 had higher mortality rates in all severity levels. In three levels of risk stratification, the low risk group of PSI (class I–III) included 42.6% of the patients with mortality rate of 1.9%, whereas the low risk group defined by CURB-65 (score 0–1) and CRB-65 (score 0) included 52.0% and 24.4% of the patients with higher mortality rates (7.3% and 4.5% respectively). PSI was the most sensitive in mortality prediction with area under receiver operating characteristic (ROC) curve of 0.82, higher than CURB-65 (0.71), CRB-65 (0.67), and PCT (0.63) ( p<0.001). The initial level of PCT was higher in non-survivors and intensive care unit (ICU)-admitted patients compared to survivors (0.91 vs 0.36 ng/ml, p<0.001) and non-ICU patients (3.70 vs 0.38 ng/ml, p<0.001). Incorporating PCT did not improve the discriminatory power of the scoring tools for mortality prediction. Conclusions: PSI was a reliable tool for severity stratification and morality prediction among the patients with CAP in Singapore.
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Havers F, Bramley AM, Finelli L, Reed C, Self WH, Trabue C, Fakhran S, Balk R, Courtney DM, Girard TD, Anderson EJ, Grijalva CG, Edwards KM, Wunderink RG, Jain S. Statin Use and Hospital Length of Stay Among Adults Hospitalized With Community-acquired Pneumonia. Clin Infect Dis 2016; 62:1471-1478. [PMID: 27169476 DOI: 10.1093/cid/ciw174] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prior retrospective studies suggest that statins may benefit patients with community-acquired pneumonia (CAP) due to antiinflammatory and immunomodulatory effects. However, prospective studies of the impact of statins on CAP outcomes are needed. We determined whether statin use was associated with improved outcomes in adults hospitalized with CAP. METHODS Adults aged ≥18 years hospitalized with CAP were prospectively enrolled at 3 hospitals in Chicago, Illinois, and 2 hospitals in Nashville, Tennessee, from January 2010-June 2012. Adults receiving statins before and throughout hospitalization (statin users) were compared with those who did not receive statins (nonusers). Proportional subdistribution hazards models were used to examine the association between statin use and hospital length of stay (LOS). In-hospital mortality was a secondary outcome. We also compared groups matched on propensity score. RESULTS Of 2016 adults enrolled, 483 (24%) were statin users; 1533 (76%) were nonusers. Statin users were significantly older, had more comorbidities, had more years of education, and were more likely to have health insurance than nonusers. Multivariable regression demonstrated that statin users and nonusers had similar LOS (adjusted hazard ratio [HR], 0.99; 95% confidence interval [CI], .88-1.12), as did those in the propensity-matched groups (HR, 1.03; 95% CI, .88-1.21). No significant associations were found between statin use and LOS or in-hospital mortality, even when stratified by pneumonia severity. CONCLUSIONS In a large prospective study of adults hospitalized with CAP, we found no evidence to suggest that statin use before and during hospitalization improved LOS or in-hospital mortality.
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Affiliation(s)
- Fiona Havers
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna M Bramley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyn Finelli
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carrie Reed
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Christopher Trabue
- University of Tennessee Health Sciences Center, Saint Thomas Health, Nashville
| | | | | | - D Mark Courtney
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Timothy D Girard
- Vanderbilt University School of Medicine.,Department of Veterans Affairs Medical Center, Nashville, Tennessee
| | | | | | | | | | - Seema Jain
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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Agnello L, Bellia C, Di Gangi M, Lo Sasso B, Calvaruso L, Bivona G, Scazzone C, Dones P, Ciaccio M. Utility of serum procalcitonin and C-reactive protein in severity assessment of community-acquired pneumonia in children. Clin Biochem 2015; 49:47-50. [PMID: 26386341 DOI: 10.1016/j.clinbiochem.2015.09.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Although the importance of serum Procalcitonin (PCT) levels at diagnosis is well established in adult Community-Acquired Pneumonia (CAP), its use remains controversial in pediatric CAP. The aim of our study is to investigate the role of PCT and C-Reactive Protein (CRP) in the assessment of pediatric CAP severity defined by the extent of consolidation on chest X-rays and the presence of pleural effusion. In this particular setting, no clinical severity score is available at present and chest X-ray, although important for diagnosis confirmation, is not recommended as routine test. DESIGN AND METHODS The study involved 119 children admitted to the Department of Pediatric Infectious Disease for radiographically documented CAP aged 1 year to 14 years, without chronic diseases. Baseline PCT, CRP and routine laboratory tests were performed on admission. RESULTS The median PCT (μg/L) and CRP (mg/L) were 0.11 (0.05–0.58) and 21.3 (4.2–48.1), respectively. PCT showed a good correlation with CRP, neutrophils and WBC (r = 0.538, P < 0.001; r = 0.377, P < 0.001; r = 0.285, P0.002, respectively). CRP, but not PCT, was associated with lobar consolidation (P = 0.007) and pleural effusion (P = 0.002). Logistic regression analysis revealed that only CRP was a predictor of lobar consolidation (OR: 1.078; 95% CI: 1.017–1.143; P = 0.011) and pleural effusion (OR: 1.076; 95% CI: 1.005–1.153; P = 0.036). CONCLUSION Our findings revealed that PCT is correlated to the main inflammatory markers in children with CAP. CRP, unlike PCT, is able to predict the extent of chest X-ray infiltration and ultimately the severity of the disease confirming its usefulness in the management of pneumonia
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Affiliation(s)
- Luisa Agnello
- Sezione Biochimica Clinica e Medicina Molecolare, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli studi di Palermo, Italy
| | - Chiara Bellia
- Sezione Biochimica Clinica e Medicina Molecolare, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli studi di Palermo, Italy
| | - Maria Di Gangi
- UOC Malattie Infettive Pediatriche, Ospedale dei Bambini G. Di Cristina, ARNAS, Palermo, Italy
| | - Bruna Lo Sasso
- Sezione Biochimica Clinica e Medicina Molecolare, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli studi di Palermo, Italy
| | - Luca Calvaruso
- Sezione Biochimica Clinica e Medicina Molecolare, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli studi di Palermo, Italy
| | - Giulia Bivona
- Sezione Biochimica Clinica e Medicina Molecolare, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli studi di Palermo, Italy
| | - Concetta Scazzone
- Sezione Biochimica Clinica e Medicina Molecolare, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli studi di Palermo, Italy
| | - Piera Dones
- UOC Malattie Infettive Pediatriche, Ospedale dei Bambini G. Di Cristina, ARNAS, Palermo, Italy
| | - Marcello Ciaccio
- Sezione Biochimica Clinica e Medicina Molecolare, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli studi di Palermo, Italy; UOC Medicina di Laboratorio-CoreLab, AOUP Policlinico P. Giaccone, Palermo, Italy.
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Hosny M, Rashad R, Atef D, Abed N. Predictive value of thyroid hormone assessment in septic patients in comparison with C-reactive protein. EGYPTIAN JOURNAL OF CRITICAL CARE MEDICINE 2015. [DOI: 10.1016/j.ejccm.2015.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW We are entering into a new era of healthcare wherein patient outcomes are increasingly being publicly reported, not just by institution, but by individual clinicians. This review focuses on the issue of quality of care of patients with community-acquired pneumonia (CAP), in particular the choice of outcome, quality of data needed and recommendations of the current bundle of care suggested by the available literature as delivering the best chance of favourable outcomes for patients. RECENT FINDINGS There is increasing evidence that pneumonia outcomes have improved over the past decade, particularly mortality. However, we have been oversimplistic in setting quality targets and that a bundle of care is required to deliver best outcomes, such as has been shown with the surviving sepsis campaign. Equally, the quality of data available to compare outcomes needs to be significantly improved on what is currently available. SUMMARY To achieve best outcomes for their patients, physicians must be actively comparing their outcomes against other institutions and not rely on historical data. A bundle of care that includes rapid administration of antibiotics, use of combination antibiotic therapy including a macrolide and early mobilization is a good starting point.
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