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Saatchi A, Haverkate MR, Reid JN, Shariff SZ, Povitz M, Patrick DM, Silverman M, Morris AM, McCormack J, Marra F. Quality of antibiotic prescribing for pediatric community-acquired Pneumonia in outpatient care. BMC Pediatr 2023; 23:542. [PMID: 37898747 PMCID: PMC10612244 DOI: 10.1186/s12887-023-04355-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/10/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Antibiotics remain the primary treatment for community acquired pneumonia (CAP), however rising rates of antimicrobial resistance may jeopardize their future efficacy. With higher rates of disease reported in the youngest populations, effective treatment courses for pediatric pneumonia are of paramount importance. This study is the first to examine the quality of pediatric antibiotic use by agent, dose and duration. METHODS A retrospective cohort study included all outpatient/primary care physician visits for pediatric CAP (aged < 19 years) between January 1 2014 to December 31 2018. Relevant practice guidelines were identified, and treatment recommendations extracted. Amoxicillin was the primary first-line agent for pediatric CAP. Categories of prescribing included: guideline adherent, effective but unnecessary (excess dose and/or duration), under treatment (insufficient dose and/or duration), and not recommended. Proportions of attributable-antibiotic use were examined by prescribing category, and then stratified by age and sex. RESULT(S) A total of 42,452 episodes of pediatric CAP were identified. Of those, 31,347 (76%) resulted in an antibiotic prescription. Amoxicillin accounted for 51% of all prescriptions. Overall, 27% of prescribing was fully guideline adherent, 19% effective but unnecessary, 10% under treatment, and 44% not recommended by agent. Excessive duration was the hallmark of effective but unnecessary prescribing (97%) Macrolides accounted for the majority on non-first line agent use, with only 32% of not recommended prescribing preceded by a previous course of antibiotics. CONCLUSION(S) This study is the first in Canada to examine prescribing quality for pediatric CAP by agent, dose and duration. Utilizing first-line agents, and shorter-course treatments are targets for stewardship.
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Affiliation(s)
- Ariana Saatchi
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Manon R Haverkate
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jennifer N Reid
- London Health Sciences Centre, ICES Western, Lawson Health Research Institute, London, ON, Canada
| | - Salimah Z Shariff
- London Health Sciences Centre, ICES Western, Lawson Health Research Institute, London, ON, Canada
| | - Marcus Povitz
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - David M Patrick
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael Silverman
- Faculty of Medicine, University of Western Ontario, London, ON, Canada
| | - Andrew M Morris
- Sinai Health System, University Health Network and University of Toronto, Toronto, ON, Canada
| | - James McCormack
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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Increased Risk of Hospitalization for Pneumonia in Italian Adults from 2010 to 2019: Scientific Evidence for a Call to Action. Vaccines (Basel) 2023; 11:vaccines11010187. [PMID: 36680031 PMCID: PMC9862073 DOI: 10.3390/vaccines11010187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Background: Understanding trends in pneumonia-associated hospitalizations can help to quantify the burden of disease and identify risk conditions and at-risk populations. This study evaluated characteristics of hospitalizations due to pneumonia that occurred in Italy in a 10-year period from 2010 to 2019. Methods: All hospitalizations with a principal or secondary diagnosis of pneumonia over the 10-year period were included, which were identified by hospital discharges for all-cause pneumonia and pneumococcal pneumonia in the anonymized hospital discharge database of the Italian Health Ministry. Results: A total of 2,481,213 patients were hospitalized for pneumonia between 2010 and 2019; patients aged 75−86 years accounted for 30.1% of hospitalizations. Most hospitalizations (88.1%) had an unspecified pneumonia discharge code. In-hospital death was recorded in 13.0% of cases. The cumulative cost for pneumonia hospitalizations of the 10-year period were EUR 11,303,461,591. Over the observation period, the incidence rate for hospitalized all-cause pneumonia in any ages increased from 100 per 100,000 in 2010 to over 160 cases per 100,000 per year in 2019 (p < 0.001). Overall, there was a significant increase in annual percent changes in hospitalization rates (+3.47 per year), in-hospital death (+4.6% per year), and costs (+3.95% per year) over the 10-year period. Conclusions: Our analysis suggests that hospitalizations for pneumonia are increasing over time in almost all age groups, especially in the elderly. Given the substantial burden of pneumonia in terms of mortality, healthcare resources, and economic costs, greater public health efforts should thus be made to promote vaccinations against influenza and pneumococcus, particularly in high-risk groups.
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O'Reilly R, Lu H, Kwong JC, McGeer A, To T, Sander B. The epidemiology and healthcare costs of community-acquired pneumonia in Ontario, Canada: a population-based cohort study. J Med Econ 2023; 26:293-302. [PMID: 36756847 DOI: 10.1080/13696998.2023.2176679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES The aim of the present study was to determine incidence-based short- and long-term healthcare costs attributable to community-acquired pneumonia (CAP) from the healthcare payer perspective in Ontario, Canada. METHODS We conducted a retrospective population-based matched cohort study of residents in Ontario, Canada using health administrative data. We identified subjects with an incident episode of CAP (exposed subjects) between 1 January 2012 and 31 December 2014. The index date of each episode was based on the first inpatient or outpatient claim for pneumonia. Exposed subjects were matched without replacement to unexposed subjects from the general population using hard and propensity score matching on age, sex, income quintile, rural residence, comorbidities, and healthcare costs prior to index date. Attributable costs represented the mean difference in costs between the exposed subjects and their matched pairs. RESULTS We identified 692,090 subjects with at least one episode of CAP between 1 January 2012 and 31 December 2014. Adults aged 65 years and older had the highest annual incidence rate of 50.1 episodes per 1,000 person-years, while adults aged 18-64 years and children (aged 0-17) had incidence rates of 12.9 and 24.7 episodes per 1,000 person-years, respectively. The majority of episodes involved care exclusively in the outpatient setting (92.6%), with most of these episodes involving a single physician visit. The mean attributable costs were $1,595 (95% CI: $1,572-$1,616) per outpatient CAP episode and $12,576 (95% CI: $12.392-$12,761) per inpatient CAP episode. Attributable costs were significantly higher for adult subjects and those with time spent in the intensive care unit. Alternative case definitions yielded different results, although demonstrated the same overall trends across groups. CONCLUSION CAP is associated with substantially increased acute and long-term healthcare costs compared to unexposed subjects. This study highlights the burden of CAP in both the inpatient and outpatient setting, and will serve to inform strategic healthcare planning for future interventions and healthcare programs.
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Affiliation(s)
- Ryan O'Reilly
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Hong Lu
- ICES, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine-Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Teresa To
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
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Pernica JM, Kam AJ, Eltorki M, Khan S, Goldfarb DM, Smaill F, Wong J, Ewusie J, Smieja M, Sung M, Mertz D, Thabane L, Loeb M. Novel care pathway to optimise antimicrobial prescribing for uncomplicated community-acquired pneumonia: study protocol for a prospective before-after cohort study in the emergency department of a tertiary care Canadian children's hospital. BMJ Open 2022; 12:e062360. [PMID: 36396301 PMCID: PMC9677018 DOI: 10.1136/bmjopen-2022-062360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Evidence-based recommendations for paediatric community-acquired pneumonia (CAP) diagnosis and management are needed. Uncomplicated CAP is often caused by respiratory viruses, especially in younger children; these episodes self-resolve without antibiotic treatment. Unfortunately, there are no clinical criteria that reliably discriminate between viral and bacterial disease, and so the majority of children diagnosed with CAP are given antibiotics-even though these will often not help and may cause harm. We have developed a novel care pathway that incorporates point-of-care biomarkers, radiographic patterns, microbiological testing and targeted follow-up. The primary study objective is to determine if the care pathway will be associated with less antimicrobial prescribing. METHODS AND ANALYSIS A prospective, before-after, study. Previously well children aged≥6 months presenting to a paediatric emergency department (ED) that have at least one respiratory symptom/sign, receive chest radiography, and are diagnosed with CAP by the ED physician will be eligible. Those with medical comorbidities, recently diagnosed pulmonary infection, or ongoing fever after≥4 days of antimicrobial therapy will be excluded. In the control (before) phase, eligible participants will be managed as per the standard of care. In the intervention (after) phase, eligible participants will be managed as per the novel care pathway. The primary outcome will be the proportion of participants in each phase who receive antimicrobial treatment for CAP. The secondary outcomes include: clinical cure; re-presentation to the ED; hospitalisation; time to resolution of symptoms; drug adverse events; caregiver satisfaction; child absenteeism from daycare/school; and caregiver absenteeism from work. ETHICS AND DISSEMINATION All study documentation has been approved by the Hamilton Integrated Research Ethics Board and informed consent will be obtained from all participants. Data from this study will be presented at major conferences and published in peer-reviewed publications to facilitate collaborations with networks of clinicians experienced in the dissemination of clinical guidelines. TRIAL REGISTRATION NUMBER NCT05114161.
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Affiliation(s)
- Jeffrey M Pernica
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - April J Kam
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Mohamed Eltorki
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Sarah Khan
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fiona Smaill
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jacqueline Wong
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Joycelyne Ewusie
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Marek Smieja
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Melani Sung
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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Wong EKC, Watt J, Zou H, Chandraraj A, Zhang AW, Brookes J, Verduyn A, Berall A, Norman R, Piggott KL, Izukawa T, Straus SE, Liu B. Characteristics, treatment and delirium incidence of older adults hospitalized with COVID-19: a multicentre retrospective cohort study. CMAJ Open 2022; 10:E692-E701. [PMID: 35882392 PMCID: PMC9334012 DOI: 10.9778/cmajo.20210176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected older adults disproportionately, and delirium is a concerning consequence; however, the relationship between delirium and corticosteroid use is uncertain. The objective of the present study was to describe patient characteristics, treatments and outcomes among older adults hospitalized with COVID-19, with a focus on dexamethasone use and delirium incidence. METHODS We completed this retrospective cohort study at 7 sites (including acute care, rehabilitation and long-term care settings) in Toronto, Ontario, Canada. We included adults aged 65 years or older, consecutively hospitalized with confirmed SARS-CoV-2 infection, between Mar. 11, 2020, and Apr. 30, 2021. We abstracted patient characteristics and outcomes from charts and analyzed them descriptively. We used a logistic regression model to determine the association between dexamethasone use and delirium incidence. RESULTS During the study period, 927 patients were admitted to the acute care hospitals with COVID-19. Patients' median age was 79.0 years (interquartile range [IQR] 72.0-87.0), and 417 (45.0%) were female. Most patients were frail (61.9%), based on a Clinical Frailty Scale score of 5 or greater. The prevalence of delirium was 53.6%, and the incidence was 33.1%. Use of restraints was documented in 20.4% of patients. In rehabilitation and long-term care settings (n = 115), patients' median age was 86.0 years (IQR 78.5-91.0), 72 (62.6%) were female and delirium occurred in 17 patients (14.8%). In patients admitted to acute care during wave 2 of the pandemic (Aug. 1, 2020, to Feb. 20, 2021), dexamethasone use had a nonsignificant association with delirium incidence (adjusted odds ratio 1.38, 95% confidence interval 0.77-2.50). Overall, in-hospital death occurred in 262 (28.4%) patients in acute care settings and 28 (24.3%) patients in rehabilitation or long-term care settings. INTERPRETATION In-hospital death, delirium and use of restraints were common in older adults admitted to hospital with COVID-19. Further research should be directed to improving the quality of care for this population with known vulnerabilities during continued waves of the COVID-19 pandemic.
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Affiliation(s)
- Eric Kai-Chung Wong
- Li Ka Shing Knowledge Institute (Wong, Watt, Chandraraj, Straus), and Division of Geriatric Medicine (Wong, Watt, Straus), Department of Medicine, St. Michael's Hospital, Unity Health Toronto; Division of Geriatric Medicine (Wong, Watt, Norman, Piggott, Izukawa, Straus, Liu), Department of Medicine, University of Toronto; Division of Geriatric Medicine (Zou, Norman), Department of Medicine, Sinai Health and University Health Network; Division of Geriatric Medicine (Zhang, Piggott), Department of Medicine, Sunnybrook Health Sciences Centre; Kunin-Lunenfeld Centre for Applied Research & Evaluation (Brookes, Berall, Izukawa), Rotman Research Institute, Baycrest Health Sciences Centre; Providence Healthcare and Houses of Providence (Verduyn), Unity Health Toronto; Division of Geriatric Medicine (Izukawa), Department of Medicine, Baycrest Health Sciences Centre, Toronto, Ont
| | - Jennifer Watt
- Li Ka Shing Knowledge Institute (Wong, Watt, Chandraraj, Straus), and Division of Geriatric Medicine (Wong, Watt, Straus), Department of Medicine, St. Michael's Hospital, Unity Health Toronto; Division of Geriatric Medicine (Wong, Watt, Norman, Piggott, Izukawa, Straus, Liu), Department of Medicine, University of Toronto; Division of Geriatric Medicine (Zou, Norman), Department of Medicine, Sinai Health and University Health Network; Division of Geriatric Medicine (Zhang, Piggott), Department of Medicine, Sunnybrook Health Sciences Centre; Kunin-Lunenfeld Centre for Applied Research & Evaluation (Brookes, Berall, Izukawa), Rotman Research Institute, Baycrest Health Sciences Centre; Providence Healthcare and Houses of Providence (Verduyn), Unity Health Toronto; Division of Geriatric Medicine (Izukawa), Department of Medicine, Baycrest Health Sciences Centre, Toronto, Ont
| | - Hanyan Zou
- Li Ka Shing Knowledge Institute (Wong, Watt, Chandraraj, Straus), and Division of Geriatric Medicine (Wong, Watt, Straus), Department of Medicine, St. Michael's Hospital, Unity Health Toronto; Division of Geriatric Medicine (Wong, Watt, Norman, Piggott, Izukawa, Straus, Liu), Department of Medicine, University of Toronto; Division of Geriatric Medicine (Zou, Norman), Department of Medicine, Sinai Health and University Health Network; Division of Geriatric Medicine (Zhang, Piggott), Department of Medicine, Sunnybrook Health Sciences Centre; Kunin-Lunenfeld Centre for Applied Research & Evaluation (Brookes, Berall, Izukawa), Rotman Research Institute, Baycrest Health Sciences Centre; Providence Healthcare and Houses of Providence (Verduyn), Unity Health Toronto; Division of Geriatric Medicine (Izukawa), Department of Medicine, Baycrest Health Sciences Centre, Toronto, Ont
| | - Arthana Chandraraj
- Li Ka Shing Knowledge Institute (Wong, Watt, Chandraraj, Straus), and Division of Geriatric Medicine (Wong, Watt, Straus), Department of Medicine, St. Michael's Hospital, Unity Health Toronto; Division of Geriatric Medicine (Wong, Watt, Norman, Piggott, Izukawa, Straus, Liu), Department of Medicine, University of Toronto; Division of Geriatric Medicine (Zou, Norman), Department of Medicine, Sinai Health and University Health Network; Division of Geriatric Medicine (Zhang, Piggott), Department of Medicine, Sunnybrook Health Sciences Centre; Kunin-Lunenfeld Centre for Applied Research & Evaluation (Brookes, Berall, Izukawa), Rotman Research Institute, Baycrest Health Sciences Centre; Providence Healthcare and Houses of Providence (Verduyn), Unity Health Toronto; Division of Geriatric Medicine (Izukawa), Department of Medicine, Baycrest Health Sciences Centre, Toronto, Ont
| | - Alissa Wenyue Zhang
- Li Ka Shing Knowledge Institute (Wong, Watt, Chandraraj, Straus), and Division of Geriatric Medicine (Wong, Watt, Straus), Department of Medicine, St. Michael's Hospital, Unity Health Toronto; Division of Geriatric Medicine (Wong, Watt, Norman, Piggott, Izukawa, Straus, Liu), Department of Medicine, University of Toronto; Division of Geriatric Medicine (Zou, Norman), Department of Medicine, Sinai Health and University Health Network; Division of Geriatric Medicine (Zhang, Piggott), Department of Medicine, Sunnybrook Health Sciences Centre; Kunin-Lunenfeld Centre for Applied Research & Evaluation (Brookes, Berall, Izukawa), Rotman Research Institute, Baycrest Health Sciences Centre; Providence Healthcare and Houses of Providence (Verduyn), Unity Health Toronto; Division of Geriatric Medicine (Izukawa), Department of Medicine, Baycrest Health Sciences Centre, Toronto, Ont
| | - Jahnel Brookes
- Li Ka Shing Knowledge Institute (Wong, Watt, Chandraraj, Straus), and Division of Geriatric Medicine (Wong, Watt, Straus), Department of Medicine, St. Michael's Hospital, Unity Health Toronto; Division of Geriatric Medicine (Wong, Watt, Norman, Piggott, Izukawa, Straus, Liu), Department of Medicine, University of Toronto; Division of Geriatric Medicine (Zou, Norman), Department of Medicine, Sinai Health and University Health Network; Division of Geriatric Medicine (Zhang, Piggott), Department of Medicine, Sunnybrook Health Sciences Centre; Kunin-Lunenfeld Centre for Applied Research & Evaluation (Brookes, Berall, Izukawa), Rotman Research Institute, Baycrest Health Sciences Centre; Providence Healthcare and Houses of Providence (Verduyn), Unity Health Toronto; Division of Geriatric Medicine (Izukawa), Department of Medicine, Baycrest Health Sciences Centre, Toronto, Ont
| | - Ashley Verduyn
- Li Ka Shing Knowledge Institute (Wong, Watt, Chandraraj, Straus), and Division of Geriatric Medicine (Wong, Watt, Straus), Department of Medicine, St. Michael's Hospital, Unity Health Toronto; Division of Geriatric Medicine (Wong, Watt, Norman, Piggott, Izukawa, Straus, Liu), Department of Medicine, University of Toronto; Division of Geriatric Medicine (Zou, Norman), Department of Medicine, Sinai Health and University Health Network; Division of Geriatric Medicine (Zhang, Piggott), Department of Medicine, Sunnybrook Health Sciences Centre; Kunin-Lunenfeld Centre for Applied Research & Evaluation (Brookes, Berall, Izukawa), Rotman Research Institute, Baycrest Health Sciences Centre; Providence Healthcare and Houses of Providence (Verduyn), Unity Health Toronto; Division of Geriatric Medicine (Izukawa), Department of Medicine, Baycrest Health Sciences Centre, Toronto, Ont
| | - Anna Berall
- Li Ka Shing Knowledge Institute (Wong, Watt, Chandraraj, Straus), and Division of Geriatric Medicine (Wong, Watt, Straus), Department of Medicine, St. Michael's Hospital, Unity Health Toronto; Division of Geriatric Medicine (Wong, Watt, Norman, Piggott, Izukawa, Straus, Liu), Department of Medicine, University of Toronto; Division of Geriatric Medicine (Zou, Norman), Department of Medicine, Sinai Health and University Health Network; Division of Geriatric Medicine (Zhang, Piggott), Department of Medicine, Sunnybrook Health Sciences Centre; Kunin-Lunenfeld Centre for Applied Research & Evaluation (Brookes, Berall, Izukawa), Rotman Research Institute, Baycrest Health Sciences Centre; Providence Healthcare and Houses of Providence (Verduyn), Unity Health Toronto; Division of Geriatric Medicine (Izukawa), Department of Medicine, Baycrest Health Sciences Centre, Toronto, Ont
| | - Richard Norman
- Li Ka Shing Knowledge Institute (Wong, Watt, Chandraraj, Straus), and Division of Geriatric Medicine (Wong, Watt, Straus), Department of Medicine, St. Michael's Hospital, Unity Health Toronto; Division of Geriatric Medicine (Wong, Watt, Norman, Piggott, Izukawa, Straus, Liu), Department of Medicine, University of Toronto; Division of Geriatric Medicine (Zou, Norman), Department of Medicine, Sinai Health and University Health Network; Division of Geriatric Medicine (Zhang, Piggott), Department of Medicine, Sunnybrook Health Sciences Centre; Kunin-Lunenfeld Centre for Applied Research & Evaluation (Brookes, Berall, Izukawa), Rotman Research Institute, Baycrest Health Sciences Centre; Providence Healthcare and Houses of Providence (Verduyn), Unity Health Toronto; Division of Geriatric Medicine (Izukawa), Department of Medicine, Baycrest Health Sciences Centre, Toronto, Ont
| | - Katrina Lynn Piggott
- Li Ka Shing Knowledge Institute (Wong, Watt, Chandraraj, Straus), and Division of Geriatric Medicine (Wong, Watt, Straus), Department of Medicine, St. Michael's Hospital, Unity Health Toronto; Division of Geriatric Medicine (Wong, Watt, Norman, Piggott, Izukawa, Straus, Liu), Department of Medicine, University of Toronto; Division of Geriatric Medicine (Zou, Norman), Department of Medicine, Sinai Health and University Health Network; Division of Geriatric Medicine (Zhang, Piggott), Department of Medicine, Sunnybrook Health Sciences Centre; Kunin-Lunenfeld Centre for Applied Research & Evaluation (Brookes, Berall, Izukawa), Rotman Research Institute, Baycrest Health Sciences Centre; Providence Healthcare and Houses of Providence (Verduyn), Unity Health Toronto; Division of Geriatric Medicine (Izukawa), Department of Medicine, Baycrest Health Sciences Centre, Toronto, Ont
| | - Terumi Izukawa
- Li Ka Shing Knowledge Institute (Wong, Watt, Chandraraj, Straus), and Division of Geriatric Medicine (Wong, Watt, Straus), Department of Medicine, St. Michael's Hospital, Unity Health Toronto; Division of Geriatric Medicine (Wong, Watt, Norman, Piggott, Izukawa, Straus, Liu), Department of Medicine, University of Toronto; Division of Geriatric Medicine (Zou, Norman), Department of Medicine, Sinai Health and University Health Network; Division of Geriatric Medicine (Zhang, Piggott), Department of Medicine, Sunnybrook Health Sciences Centre; Kunin-Lunenfeld Centre for Applied Research & Evaluation (Brookes, Berall, Izukawa), Rotman Research Institute, Baycrest Health Sciences Centre; Providence Healthcare and Houses of Providence (Verduyn), Unity Health Toronto; Division of Geriatric Medicine (Izukawa), Department of Medicine, Baycrest Health Sciences Centre, Toronto, Ont
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute (Wong, Watt, Chandraraj, Straus), and Division of Geriatric Medicine (Wong, Watt, Straus), Department of Medicine, St. Michael's Hospital, Unity Health Toronto; Division of Geriatric Medicine (Wong, Watt, Norman, Piggott, Izukawa, Straus, Liu), Department of Medicine, University of Toronto; Division of Geriatric Medicine (Zou, Norman), Department of Medicine, Sinai Health and University Health Network; Division of Geriatric Medicine (Zhang, Piggott), Department of Medicine, Sunnybrook Health Sciences Centre; Kunin-Lunenfeld Centre for Applied Research & Evaluation (Brookes, Berall, Izukawa), Rotman Research Institute, Baycrest Health Sciences Centre; Providence Healthcare and Houses of Providence (Verduyn), Unity Health Toronto; Division of Geriatric Medicine (Izukawa), Department of Medicine, Baycrest Health Sciences Centre, Toronto, Ont
| | - Barbara Liu
- Li Ka Shing Knowledge Institute (Wong, Watt, Chandraraj, Straus), and Division of Geriatric Medicine (Wong, Watt, Straus), Department of Medicine, St. Michael's Hospital, Unity Health Toronto; Division of Geriatric Medicine (Wong, Watt, Norman, Piggott, Izukawa, Straus, Liu), Department of Medicine, University of Toronto; Division of Geriatric Medicine (Zou, Norman), Department of Medicine, Sinai Health and University Health Network; Division of Geriatric Medicine (Zhang, Piggott), Department of Medicine, Sunnybrook Health Sciences Centre; Kunin-Lunenfeld Centre for Applied Research & Evaluation (Brookes, Berall, Izukawa), Rotman Research Institute, Baycrest Health Sciences Centre; Providence Healthcare and Houses of Providence (Verduyn), Unity Health Toronto; Division of Geriatric Medicine (Izukawa), Department of Medicine, Baycrest Health Sciences Centre, Toronto, Ont.
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Nasreen S, Wang J, Sadarangani M, Kwong JC, Quach C, Crowcroft NS, Wilson SE, McGeer A, Morris SK, Kellner JD, Sander B, Kus JV, Hoang L, Marra F, Fadel SA. Estimating population-based incidence of community-acquired pneumonia and acute otitis media in children and adults in Ontario and British Columbia using health administrative data, 2005-2018: a Canadian Immunisation Research Network (CIRN) study. BMJ Open Respir Res 2022; 9:9/1/e001218. [PMID: 35764362 PMCID: PMC9240885 DOI: 10.1136/bmjresp-2022-001218] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background There is a paucity of data on the burden of the full spectrum of community-acquired pneumonia (CAP) and acute otitis media (AOM) from outpatient and inpatient settings across the age spectrum. Methods We conducted a population-based retrospective study in Ontario and British Columbia (BC), Canada, to estimate the incidence rate of CAP and AOM in children and adults over a 14-year period using health administrative databases. CAP and AOM cases were identified from outpatient physician consultation and hospitalisation data in both provinces, and from emergency department visit data in Ontario. Results During 2005–2018, Ontario had 3 607 124 CAP, 172 290 bacterial CAP, 7814 pneumococcal pneumonia, and 8 026 971 AOM cases. The incidence rate of CAP declined from 3077/100 000 in 2005 to 2604/100 000 in 2010 before increasing to 2843/100 000 in 2018; bacterial CAP incidence rate also declined from 178/100 000 in 2005 to 112/100 000 in 2010 before increasing to 149/100 000 in 2018. The incidence rate of AOM decreased from 4192/100 000 in 2005 to 3178/100 000 in 2018. BC had 970 455 CAP, 317 913 bacterial CAP, 35 287 pneumococcal pneumonia and 2 022 871 AOM cases. The incidence rate of CAP in BC decreased from 2214/100 000 in 2005 to 1964/100 000 in 2010 before increasing to 2176/100 000 in 2018; bacterial CAP incidence rate increased from 442/100 000 in 2005 to 981/100 000 in 2018. The incidence rate of AOM decreased from 3684/100 000 in 2005 to 2398/100 000 in 2018. The incidence rate of bacterial CAP increased with age in older adults (≥65 years) with the highest burden in the oldest cohort aged ≥85 years both before and after 13-valent pneumococcal conjugate vaccine (PCV13) programme in both provinces. Hospitalised pneumococcal pneumonia decreased slightly but non-hospitalised pneumococcal pneumonia increased in BC during PCV13 period. No consistent direct benefit of PCV13 on CAP was observed in the paediatric population. Conclusions There is a substantial burden of CAP and AOM in Ontario and BC. Indirect benefits from childhood PCV vaccination and polysaccharide vaccination of older adults have not substantially decreased the burden of pneumococcal pneumonia in older adults.
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Affiliation(s)
- Sharifa Nasreen
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jun Wang
- Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Manish Sadarangani
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada,Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey C Kwong
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada,University Health Network, Toronto, Ontario, Canada
| | - Caroline Quach
- Departments of Microbiology, Infectious Diseases & Immunology and Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Natasha S Crowcroft
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E Wilson
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Allison McGeer
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Sinai Health System, Toronto, Ontario, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - James D Kellner
- Department of Paediatrics, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Beate Sander
- Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Julianne V Kus
- Public Health Ontario, Toronto, Ontario, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Linda Hoang
- BC Centre for Disease Control, Vancouver, British Columbia, Canada,Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaza A Fadel
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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7
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Kim B, Myung R, Lee MJ, Kim J, Pai H. Trend of Antibiotic Usage for Hospitalized Community-acquired Pneumonia Cases in Korea Based on the 2010-2015 National Health Insurance Data. J Korean Med Sci 2020; 35:e390. [PMID: 33289366 PMCID: PMC7721565 DOI: 10.3346/jkms.2020.35.e390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/14/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This study is to describe the changes in prescribing practices of antibiotics to treat community-acquired pneumonia (CAP) in Korea during 2010-2015. METHODS The claim database of the Health Insurance Review and Assessment Service in Korea was used to select adult patients (≥ 18 years of age) admitted between 2010 and 2015, with the International Classification of Diseases, Tenth Revision codes relevant to all-cause pneumonia for the first or second priority discharge diagnosis. The episodes with hospital-acquired or healthcare-associated pneumonia were excluded. Consumption of each antibiotic was converted to defined daily dose (DDD) per episode. The amount of antibiotic consumption was compared between patients with CAP aged < 65 years and those aged ≥ 65 years. RESULTS The average amount of antibiotic consumption per episode was 15.5 DDD, which remained stable throughout the study period (P = 0.635). Patients aged ≥ 65 years received more antibiotics than those aged < 65 years (15.7 vs. 15.3 DDD). Third-generation cephalosporin (4.9 DDD/episode, 31.4%) was the most commonly prescribed, followed by macrolide (2.7 DDD/episode, 17.1%) and beta-lactam/beta-lactamase inhibitor (BL/BLI) (2.1 DDD/episode, 13.6%). The consumption amount of fourth-generation cephalosporin (4th CEP) (P = 0.001), BL/BLI (P = 0.003) and carbapenem (P = 0.002) increased each year during the study period. The consumption of 4th CEP and carbapenem was doubled during 2010-2015. CONCLUSION The prescription of broad-spectrum antibiotics such as 4th CEP and carbapenem to treat CAP increased in Korea during 2010-2015.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Rangmi Myung
- Department of Economics, College of Political Science & Economics, Korea University, Seoul, Korea
| | - Myoung Jae Lee
- Department of Economics, College of Political Science & Economics, Korea University, Seoul, Korea.
| | - Jieun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
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8
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Feldman C, Anderson R. Recent advances in the epidemiology and prevention of Streptococcus pneumoniae infections. F1000Res 2020; 9. [PMID: 32411353 PMCID: PMC7212261 DOI: 10.12688/f1000research.22341.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 12/13/2022] Open
Abstract
The introduction of pneumococcal conjugate vaccines (PCVs) 7 and 13 into national childhood immunization programs in the US in 2000 and 2010, respectively, proved to be remarkably successful in reducing infant mortality due to invasive pneumococcal disease (IPD), resulting in widespread uptake of these vaccines. Secondary herd protection of non-vaccinated adults against IPD has proven to be an additional public health benefit of childhood immunization with PCVs, particularly in the case of the vulnerable elderly who are at increased risk due to immunosenescence and underlying comorbidity. Despite these advances in pneumococcal immunization, the global burden of pneumococcal disease, albeit of unequal geographic distribution, remains high. Reasons for this include restricted access of children living in many developing countries to PCVs, the emergence of infection due to non-vaccine serotypes of the pneumococcus, and non-encapsulated strains of the pathogen. Emerging concerns affecting the elderly include the realization that herd protection conferred by the current generation of PCVs (PCV7, PCV10, and PCV13) has reached a ceiling in many countries at a time of global population aging, compounded by uncertainty surrounding those immunization strategies that induce optimum immunogenicity and protection against IPD in the elderly. All of the aforementioned issues, together with a consideration of pipeline and pending strategies to improve access to, and serotype coverage of, PCVs, are the focus areas of this review.
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Affiliation(s)
- Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Ronald Anderson
- Institute of Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences, University of Pretoria, 5 Bophelo Road, Gezina, 0186, South Africa
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9
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Wilson MR, Wasserman MD, Breton MC, Peloquin F, Earnshaw SR, McDade C, Sings HL, Farkouh RA. Health and Economic Impact of Routine Pediatric Pneumococcal Immunization Programs in Canada: A Retrospective Analysis. Infect Dis Ther 2020; 9:341-353. [PMID: 32270372 PMCID: PMC7237628 DOI: 10.1007/s40121-020-00294-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Indexed: 12/26/2022] Open
Abstract
Objective A model was developed to estimate the historical impact (including total societal health and economic benefit) of pneumococcal conjugate vaccine (PCV) programs in the overall Canadian population between 2005 and 2015, inclusively. Methods Historical incidence of invasive pneumococcal disease (IPD), pneumonia, and acute otitis media (AOM) were obtained from epidemiologic databases supplemented with published and unpublished data. Two scenarios were considered: (1) the observed historical incidence from 2005 to 2015 in the setting of PCV use; (2) a hypothetical scenario in which we estimated the number of disease cases assuming no PCV use. Disease cases averted as a result of PCV programs were calculated by subtracting the number of observed historical cases from the number of estimated cases expected in the absence of PCV use. Results PCV programs were estimated to have saved 6631 lives and averted 14,990 IPD cases, 735,700 pneumonia episodes, and 3,697,993 AOM episodes. Positive clinical outcomes resulted in total cost savings of CAD $1.76 billion over 11 years. Vaccination costs were offset by the direct medical cost savings from fewer cases of IPD, pneumonia, and AOM. Conclusions Canadian PCV programs have provided significant health benefits and resulted in a substantial value for money. Net savings achieved over the reviewed period would have provided funding for $1.76 billion in other health care costs or public health initiatives. These findings highlight the importance of considering the total value of a vaccination program, rather than vaccine acquisition costs only, when assessing the value of immunization programs. Electronic supplementary material The online version of this article (10.1007/s40121-020-00294-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Cheryl McDade
- RTI Health Solutions, Research Triangle Park, NC, USA
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10
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LeBlanc J, ElSherif M, Ye L, MacKinnon-Cameron D, Ambrose A, Hatchette TF, Lang AL, Gillis HD, Martin I, Demczuk WH, LaFerriere C, Andrew MK, Boivin G, Bowie W, Green K, Johnstone J, Loeb M, McCarthy A, McGeer A, Semret M, Trottier S, Valiquette L, Webster D, McNeil SA. Age-stratified burden of pneumococcal community acquired pneumonia in hospitalised Canadian adults from 2010 to 2015. BMJ Open Respir Res 2020; 7:e000550. [PMID: 32188585 PMCID: PMC7078693 DOI: 10.1136/bmjresp-2019-000550] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In Canada, 13-valent pneumococcal conjugate vaccine (PCV13) is recommended in childhood, in individuals at high risk of invasive pneumococcal disease (IPD) and in healthy adults aged ≥65 years for protection against vaccine-type IPD and pneumococcal community-acquired pneumonia (pCAP). Since vaccine recommendations in Canada include both age-based and risk-based guidance, this study aimed to describe the burden of vaccine-preventable pCAP in hospitalised adults by age. METHODS Surveillance for community-acquired pneumonia (CAP) in hospitalised adults was performed prospectively from 2010 to 2015. CAP was radiologically confirmed, and pCAP was identified using blood and sputum culture and urine antigen testing. Patient demographics and outcomes were stratified by age (16-49, 50-64, ≥65 and ≥50 years). RESULTS Of 6666/8802 CAP cases tested, 830 (12.5%) had pCAP, and 418 (6.3%) were attributed to a PCV13 serotype. Of PCV13 pCAP, 41% and 74% were in adults aged ≥65 and ≥50 years, respectively. Compared with non-pCAP controls, pCAP cases aged ≥50 years were more likely to be admitted to intensive care units (ICUs) and to require mechanical ventilation. Older adults with pCAP were less likely to be admitted to ICU or required mechanical ventilation, given their higher mortality and goals of care. Of pCAP deaths, 67% and 90% were in the ≥65 and ≥50 age cohorts, respectively. CONCLUSIONS Adults hospitalised with pCAP in the age cohort of 50-64 years contribute significantly to the burden of illness, suggesting that an age-based recommendation for adults aged ≥50 years should be considered in order to optimise the impact of pneumococcal vaccination programmes in Canada.
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Affiliation(s)
- Jason LeBlanc
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - May ElSherif
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amanda Ls Lang
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hayley D Gillis
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Irene Martin
- Streptocococcus & STI Unit, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | - Walter H Demczuk
- Streptocococcus & STI Unit, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | | | - Melissa K Andrew
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guy Boivin
- Department of Microbiology-Immunology and Infectious Diseases, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | - William Bowie
- Department of Medicine, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Green
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jennie Johnstone
- Department of Medicine, Public Health Ontario and University of Toronto, Toronto, Ontario, Canada
| | - Mark Loeb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anne McCarthy
- Division of Infectious Diseases, Ottawa Hospital General Campus and University of Ottawa, Hamilton, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Makeda Semret
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sylvie Trottier
- Department of Microbiology-Immunology and Infectious Diseases, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | - Louis Valiquette
- Department of Microbiology and Infectiology, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Duncan Webster
- Department of Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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11
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Kaplan A, Arsenault P, Aw B, Brown V, Fox G, Grossman R, Jadavji T, Laferrière C, Levitz S, Loeb M, McIvor A, Mody CH, Poulin Y, Shapiro M, Tessier D, Théorêt F, Weiss K, Yaremko J, Zhanel G. Vaccine strategies for prevention of community-acquired pneumonia in Canada: Who would benefit most from pneumococcal immunization? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:625-633. [PMID: 31515311 PMCID: PMC6741809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe the burden of pneumococcal disease and associated risk factors in the Canadian adult population, delineate available pneumococcal vaccines and associated efficacy and effectiveness data, and review current pneumococcal vaccine recommendations and community-acquired pneumonia (CAP) prevention strategies in Canada. QUALITY OF EVIDENCE Pneumococcal vaccination guidelines from the Canadian National Advisory Committee on Immunization in 2013 and 2016 constitute level III evidence for CAP prevention in the Canadian adult population. MAIN MESSAGE It is recommended that immunosuppressed adults of all ages receive the 13-valent pneumococcal conjugate vaccine (PCV13) (grades A and B recommendations). In 2016, the National Advisory Committee on Immunization also recommended that all adults aged 65 years and older receive PCV13 (grade A recommendation) on an individual basis, followed by the 23-valent pneumococcal polysaccharide vaccine (grade B recommendation). This update is based on a large clinical study that demonstrated PCV13 efficacy against vaccine-type CAP in this population. CONCLUSION Physicians should focus on improving pneumococcal vaccination rates among adults, which remain low. Vaccination with PCV13 should also be considered for adults with chronic conditions, whose baseline risk is often higher than that for healthy individuals aged 65 years and older.
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Affiliation(s)
- Alan Kaplan
- Clinical Lecturer in the Department of Family and Community Medicine at the University of Toronto in Ontario.
| | - Pierre Arsenault
- Associate Professor in the Department of Family and Emergency Medicine at the University of Sherbrooke in Quebec
| | - Brian Aw
- Family physician at the Ultimate Health Medical Centre in Richmond Hill, Ont
| | - Vivien Brown
- Assistant Professor in the Department of Family and Community Medicine at the University of Toronto
| | - George Fox
- Professor in the Department of Medicine (Respirology) at Memorial University of Newfoundland in St John's
| | - Ron Grossman
- Professor in the Department of Medicine at the University of Toronto
| | - Taj Jadavji
- Professor in the Department of Microbiology, Immunology and Infectious Diseases in the Cumming School of Medicine at the University of Calgary in Alberta
| | - Craig Laferrière
- Regional Medical Research Specialist and Medical Advisor with Pfizer Canada Inc in Kirkland, Que, at the time of writing
| | - Suzanne Levitz
- Assistant Professor in the Department of Family Medicine at McGill University in Montreal, Que
| | - Mark Loeb
- Professor in the Department of Pathology and Molecular Medicine at McMaster University in Hamilton, Ont
| | - Andrew McIvor
- Professor in the Division of Respirology in the Department of Medicine at McMaster University
| | - Christopher H Mody
- Professor and Head of the Department of Microbiology, Immunology and Infectious Diseases in the Cumming School of Medicine at the University of Calgary
| | - Yannick Poulin
- Assistant Professor in the Department of Medicine at the University of Sherbrooke
| | - Marla Shapiro
- Professor in the Department of Family and Community Medicine at the University of Toronto
| | - Dominique Tessier
- Clinician at the Hôpital Saint-Luc du CHUM in the Groupe de médecine de famille du Quartier Latin and Medical Director of the Groupe Santé Voyage in Montreal
| | - Francois Théorêt
- Family physician on the Lower Outaouais Family Health Team in Hawkesbury, Ont
| | - Karl Weiss
- Chief of the Division of Infectious Diseases at the Jewish General Hospital of McGill University
| | - John Yaremko
- Assistant Professor in the Department of Pediatrics and the Department of Family Medicine at McGill University
| | - George Zhanel
- Professor in the Department of Medical Microbiology and Infectious Diseases at the University of Manitoba in Winnipeg
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12
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Zhou J, Zhang M, Lu L, Guo X, Gao L, Yan W, Pang H, Wang Y, Xing B. Validity of discharge ICD-10 codes in detecting the etiologies of endogenous Cushing's syndrome. Endocr Connect 2019; 8:1186-1194. [PMID: 31340196 PMCID: PMC6709541 DOI: 10.1530/ec-19-0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/24/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the validity of discharge ICD-10 codes in detecting the etiology of endogenous Cushing's syndrome (CS) in hospitalized patients. METHODS We evaluated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CS etiology-related ICD-10 codes or code combinations by comparing hospital discharge administrative data (DAD) with established diagnoses from medical records. RESULTS Coding for patients with adrenocortical adenoma (ACA) and those with bilateral macronodular adrenal hyperplasia (BMAH) demonstrated disappointingly low sensitivity at 78.8% (95% CI: 70.1-85.6%) and 83.9% (95% CI: 65.5-93.9%), respectively. BMAH had the lowest PPV of 74.3% (95% CI: 56.4-86.9%). In confirmed ACA patients, the sensitivity for ACA code combinations was higher in patients initially admitted to the Department of Endocrinology before surgery than that in patients directly admitted to the Department of Urology (90.0 vs 73.1%, P = 0.033). The same phenomenon was observed in the PPV for the BMAH code (100.0 vs 60.9%, P = 0.012). Misinterpreted or confusing situations caused by coders (68.1%) and by the omission or denormalized documentation of symptomatic diagnosis by clinicians (26.1%) accounted for the main source of coding errors. CONCLUSIONS Hospital DAD is an effective data source for evaluating the etiology of CS but not ACA and BMAH. Improving surgeons' documentation, especially in the delineation of symptomatic and locative diagnoses in discharge abstracts; department- or disease-specific training for coders and more multidisciplinary collaboration are ways to enhance the applicability of administrative data for CS etiologies.
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Affiliation(s)
- Jingya Zhou
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Collaborating Center for the WHO Family of International Classifications in China, Beijing, China
| | - Meng Zhang
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Collaborating Center for the WHO Family of International Classifications in China, Beijing, China
| | - Lin Lu
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of National Health Commission of People’s Republic of China, Beijing, China
| | - Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lu Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Weigang Yan
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyu Pang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, International Epidemiology Network, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Wang
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Collaborating Center for the WHO Family of International Classifications in China, Beijing, China
- Correspondence should be addressed to Y Wang or B Xing: or
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Correspondence should be addressed to Y Wang or B Xing: or
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13
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Feldman C, Shaddock E. Epidemiology of lower respiratory tract infections in adults. Expert Rev Respir Med 2018; 13:63-77. [DOI: 10.1080/17476348.2019.1555040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Erica Shaddock
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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14
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Kuchenbecker U, Chase D, Reichert A, Schiffner-Rohe J, Atwood M. Estimating the cost-effectiveness of a sequential pneumococcal vaccination program for adults in Germany. PLoS One 2018; 13:e0197905. [PMID: 29795647 PMCID: PMC5967715 DOI: 10.1371/journal.pone.0197905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/10/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction In Germany, a 23-valent polysaccharide pneumococcal vaccine (PPSV23) is recommended for elderly (60+) and patients 16+ with chronic diseases not associated with immune suppression. For all other patients at risk, sequential immunization with a 13-valent pneumococcal conjugate vaccine (PCV13) first, followed by PPSV23 is recommended. Repeated vaccination with PPSV23 is recommended every 6 years after individual assessment by the physician. This was adopted into the vaccination directive with binding reimbursement and funding. However, additional voluntary services allow statutory health insurances to differentiate from each other. Aim of this study is to estimate the cost-effectiveness of voluntary service scenarios compared to the strategy in place to support informed decision making. Methods A microsimulation framework with Markov-type process of a population susceptible to pneumococcal disease over a lifetime horizon was developed to compare effectiveness and cost-effectiveness of different vaccination strategies. We simulated 1,000 iterations for seven scenarios. Assumptions were derived from published literature and probabilistic sensitivity analysis was run to show the robustness of the model. Results Our study indicates that all voluntary service strategies could prevent further clinical cases compared to the existing policy. Depending on the scenario, 48–142 invasive pneumococcal disease (IPD), 24,000–45,000 hospitalized all-cause nonbacteremic pneumonia (NBP), 15,000–45,000 outpatient NBP cases, and 4,000–8,000 deaths could be avoided on average. This refers to potential savings of €115 Mio. - €187 Mio. for medical and non-medical costs. Additional costs per patient for the payer are €2.48 to €7.13 and for the society €2.20 to €6.85. The ICER per LYG ranged from €3,662 to €23,061 (payer) and €3,258 to €29,617 (societal). All but one scenario was cost-effective in ≥60% of the generated 1,000 simulations. Conclusion Compared to the vaccination strategy in place, the different hypothetical scenarios can be considered cost-effective and suitable as additional voluntary services.
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15
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Anderson R, Nel JG, Feldman C. Multifaceted Role of Pneumolysin in the Pathogenesis of Myocardial Injury in Community-Acquired Pneumonia. Int J Mol Sci 2018; 19:E1147. [PMID: 29641429 PMCID: PMC5979279 DOI: 10.3390/ijms19041147] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/14/2018] [Accepted: 03/21/2018] [Indexed: 12/14/2022] Open
Abstract
Pneumolysin (PLY), a member of the family of Gram-positive bacterial, cholesterol-dependent, β-barrel pore-forming cytolysins, is the major protein virulence factor of the dangerous respiratory pathogen, Streptococcus pneumoniae (pneumococcus). PLY plays a major role in the pathogenesis of community-acquired pneumonia (CAP), promoting colonization and invasion of the upper and lower respiratory tracts respectively, as well as extra-pulmonary dissemination of the pneumococcus. Notwithstanding its role in causing acute lung injury in severe CAP, PLY has also been implicated in the development of potentially fatal acute and delayed-onset cardiovascular events, which are now recognized as being fairly common complications of this condition. This review is focused firstly on updating mechanisms involved in the immunopathogenesis of PLY-mediated myocardial damage, specifically the direct cardiotoxic and immunosuppressive activities, as well as the indirect pro-inflammatory/pro-thrombotic activities of the toxin. Secondly, on PLY-targeted therapeutic strategies including, among others, macrolide antibiotics, natural product antagonists, cholesterol-containing liposomes, and fully humanized monoclonal antibodies, as well as on vaccine-based preventive strategies. These sections are preceded by overviews of CAP in general, the role of the pneumococcus as the causative pathogen, the occurrence and types of CAP-associated cardiac complication, and the structure and biological activities of PLY.
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Affiliation(s)
- Ronald Anderson
- Department of Immunology and Institute for Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa.
| | - Jan G Nel
- Department of Haematology, Faculty of Health Sciences, University of Pretoria and Tshwane Academic Division of the National Health Laboratory Service, Pretoria 0001, South Africa.
| | - Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 0002, South Africa.
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Gillis HD, Demczuk WHB, Griffith A, Martin I, Warhuus M, Lang ALS, ElSherif M, McNeil SA, LeBlanc JJ. PCR-based discrimination of emerging Streptococcus pneumoniae serotypes 22F and 33F. J Microbiol Methods 2017; 144:99-106. [PMID: 29162393 DOI: 10.1016/j.mimet.2017.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/17/2017] [Accepted: 11/17/2017] [Indexed: 11/30/2022]
Abstract
Serotyping of Streptococcus pneumoniae is important to monitor disease epidemiology and assess the impact of pneumococcal vaccines. Traditionally, the Quellung reaction used serotype-specific antibodies to classify S. pneumoniae based on differences in capsular antigens. More recently, PCR-based serotype deduction relying on serotype-specific capsule biosynthesis genes has been broadly applied for pneumococcal surveillance. However, PCR-based serotyping lacks discrimination for certain S. pneumoniae serotypes, including the differentiation of serotype 22F from 22A, and serotype 33F from 33A and 37. Serotypes 22F and 33F are emerging serotypes that are absent in the currently licensed 13-valent pneumococcal conjugate vaccine, but present in the new candidate 15-valent formulation. This study validated novel PCR reactions to detect and discriminate S. pneumoniae serotypes 22F and 33F. In order to differentiate S. pneumoniae serotypes 22F or 33F from genetically similar serotypes, two novel PCR reactions were designed and validated. The specificity of all PCR targets was evaluated using all 92 different S. pneumoniae serotypes, as well as 32 other streptococci. Reproducibility was evaluated using geographically and genetically diverse strains of S. pneumoniae serotypes 22F and 22A, or serotypes 33F, 33A, and 37 that were previously characterized by reputable reference laboratories. Overall, S. pneumoniae serotypes 22F and 33F could be accurately and reproducibly be detected and discriminated using PCR alone. Such a molecular serotyping approach provides a valuable diagnostic tool that is feasible in any molecular laboratory, to enable pneumococcal serotype surveillance and subsequent assessment of the impact of the new 15-valent candidate pneumococcal vaccine.
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Affiliation(s)
- Hayley D Gillis
- Canadian Center for Vaccinology (CCfV), Dalhousie University, Halifax, Nova Scotia (NS), Canada; Nova Scotia Health Authority (NSHA), Halifax, Nova Scotia (NS), Canada
| | | | - Averil Griffith
- National Microbiology Laboratory (NML), Winnipeg, MB, Canada
| | - Irene Martin
- National Microbiology Laboratory (NML), Winnipeg, MB, Canada
| | - Michelle Warhuus
- Canadian Center for Vaccinology (CCfV), Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Amanda L S Lang
- Canadian Center for Vaccinology (CCfV), Dalhousie University, Halifax, Nova Scotia (NS), Canada; Nova Scotia Health Authority (NSHA), Halifax, Nova Scotia (NS), Canada
| | - May ElSherif
- Canadian Center for Vaccinology (CCfV), Dalhousie University, Halifax, Nova Scotia (NS), Canada; Nova Scotia Health Authority (NSHA), Halifax, Nova Scotia (NS), Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology (CCfV), Dalhousie University, Halifax, Nova Scotia (NS), Canada; Nova Scotia Health Authority (NSHA), Halifax, Nova Scotia (NS), Canada
| | - Jason J LeBlanc
- Canadian Center for Vaccinology (CCfV), Dalhousie University, Halifax, Nova Scotia (NS), Canada; Nova Scotia Health Authority (NSHA), Halifax, Nova Scotia (NS), Canada.
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