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Li Y, Zhou W, Wang H, Yang J, Li X. The risk factors and predictive modeling of mortality in patients with mental disorders combined with severe pneumonia. Front Psychiatry 2024; 14:1300740. [PMID: 38274425 PMCID: PMC10808291 DOI: 10.3389/fpsyt.2023.1300740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Background We explored clinical characteristics and risk factors for mortality in patients with mental disorders combined with severe pneumonia and developed predictive models. Methods We retrospectively analyzed the data of 161 patients with mental disorders combined with severe pneumonia in the intensive care unit (ICU) of a psychiatric hospital from May 2020 to February 2023, and divided them into two groups according to whether they died or not, and analyzed their basic characteristics, laboratory results and treatments, etc. We analyzed the risk factors of patients' deaths using logistics regression, established a prediction model, and drew a dynamic nomogram based on the results of the regression analysis. Based on the results of regression analysis, a prediction model was established and a dynamic nomogram was drawn. Results The non-survivor group and the survivor group of patients with mental disorders combined with severe pneumonia were statistically different in terms of age, type of primary mental illness, whether or not they were intubated, whether or not they had been bedridden for a long period in the past, and the Montreal Cognitive Assessment (MoCA) scale, procalcitonin (PCT), albumin (ALB), hemoglobin (Hb), etc. Logistics regression analysis revealed the following: MoCA scale (OR = 0.932, 95% CI:0.872-0.997), age (OR = 1.077, 95%CI:1.029-1.128), PCT (OR = 1.078, 95% CI:10.006-10.155), ALB (OR = 0.971, 95%CI:0.893-1.056), Hb (OR = 0.971, 95% CI: 0.942-0.986) were statistically significant. The ROC curve showed that the model predicted patient death with an area under the curve (AUC) of 0.827 with a sensitivity of 73.4% and a specificity of 80.4%. Conclusion Low MoCA score, age, PCT, and low Hb are independent risk factors for death in patients with mental disorders with severe pneumonia, and the prediction model constructed using these factors showed good predictive efficacy.
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Affiliation(s)
- Yaolin Li
- Department of Respiratory and Critical Care Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Weiguo Zhou
- Department of Critical Care Medicine, Chengdu Fourth People's Hospital, Chengdu, China
| | - Huiqin Wang
- The Affiliated Women's and Children's Hospital, School of Medicine, UESTC, Chengdu, China
| | - Jing Yang
- Department of Critical Care Medicine, Chengdu Fourth People's Hospital, Chengdu, China
| | - Xiayahu Li
- Department of Critical Care Medicine, Chengdu Second's People Hospital, Chengdu, China
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2
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Zhang G, Yao Y, Gao Y, Yu X, Fang J. Quantitative Value of Bacteria Associated with Leukocytes in Differential Diagnosis of Lower Respiratory Tract Infection in Children, in Comparison to Sputum Culture and Procalcitonin. Lab Med 2024; 55:56-61. [PMID: 37184444 DOI: 10.1093/labmed/lmad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND The mortality and morbidity rates in children with lower respiratory tract infection (LRTI) remain high. OBJECTIVE To describe the number of bacteria that is associated with leukocytes in differential diagnosis of bacterial, mycoplasma, and viral LRTI in children. METHODS Sputum smears were Gram stained for counting single-morphology bacteria associated with leukocytes. The differential diagnostic values of bacterial number were assessed in children with LRTI. RESULTS The area under the receiver operating characteristic (ROC) curve was 0.95 for bacterial number in the differential diagnosis of bacterial infection from mycoplasma and viral infections. The area under the ROC curve was 0.62 for procalcitonin and 0.94 for bacterial number in the differential diagnosis of bacterial infection from mycoplasma infection. CONCLUSION The number of bacteria associated with leukocytes in sputum was valuable and rapid in differential diagnosis of bacterial infection in children with suspected bacterial, mycoplasma, and viral LRTI.
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Affiliation(s)
- Guoqiang Zhang
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
| | - Yihui Yao
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
| | - Ying Gao
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
| | - Xiaolu Yu
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
| | - Jiabin Fang
- Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China
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Kanungo A, Rao S, Bellipady SS, Shetty S. Procalcitonin Guided Antibiotic Stewardship in Pediatric Sepsis and Lower Respiratory Tract Infections. Indian J Pediatr 2023:10.1007/s12098-023-04960-8. [PMID: 38105402 DOI: 10.1007/s12098-023-04960-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES To determine the impact of procalcitonin-guided antibiotic stewardship protocol (PCT-ASP) in children admitted with sepsis and lower respiratory tract infection on the duration of antibiotic therapy and clinical outcome. METHODS This was a single-center study involving children with infections treated with antibiotic therapy according to the PCT-ASP as the study group. The control group consisted of children with same age and diagnosis who were treated with antibiotics according to individual unit protocol before the implementation of PCT-ASP. The primary outcome was median duration of antibiotic therapy and hospital stay. RESULTS Among 127 patients, 66 were enrolled in the study and 61 in the control group respectively. The median (IQR) PCT values at admission, day 4 and day 6 of antibiotic therapy were 5.59 (61.3), 2.57 (47.35), and 0.35 (0.47) ng/ml respectively, and showed a decreasing trend. All the children in the control group received antibiotics at admission while 12% of children in the study group were not initiated on antibiotics. In the study group, 53% of the children received antibiotics only for three days in the absence of treatment failure. The duration of antibiotics (p = 0.001) and hospital stay (p = 0.03) were less in the study group when compared to the control group. CONCLUSIONS PCT-ASP reduces the duration of antibiotics and duration of hospital stay without increasing morbidity and mortality.
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Affiliation(s)
- Adyasha Kanungo
- Department of Pediatrics, NITTE (Deemed to be University), KS Hegde Medical Academy, Karnataka, India
| | - Swathi Rao
- Department of Pediatrics, NITTE (Deemed to be University), KS Hegde Medical Academy, Karnataka, India.
| | - Sumanth Shetty Bellipady
- Department of Pediatrics, NITTE (Deemed to be University), KS Hegde Medical Academy, Karnataka, India
| | - Sukanya Shetty
- Department of Biochemistry, NITTE (Deemed to be University), KS Hegde Medical Academy, Karnataka, India
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Hu L, Zhang S, Song W, Dong F, Xie Z, Chen X, Liu M, Cui B, Zhang Y, Zhang R, Wang Q. A sensitive mass spectrometry-based method to identify common respiratory pathogens in children. Microbiol Spectr 2023; 11:e0185823. [PMID: 37754782 PMCID: PMC10580997 DOI: 10.1128/spectrum.01858-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/11/2023] [Indexed: 09/28/2023] Open
Abstract
Public health threats posed by emerging respiratory infections are a significant concern, particularly in children and infants. Traditional culture-based detection methods are time-consuming and typically require 1-3 days. Herein, we developed and evaluated a 23-plex common respiratory pathogen mass spectrometry assay that enables the simultaneous detection of 18 common respiratory pathogens in children. This assay combines matrix-assisted laser desorption/ionization time of flight mass spectrometry with multiplex reverse transcription-PCR and targets 11 bacterial and 7 viral pathogens (including 10 subtypes), and two internal controls. The detection limit of the common respiratory pathogen mass spectrometry assay was as low as 1 copy/µL, with no cross-reactivity with other organisms. We assessed the clinical performance of the common respiratory pathogen mass spectrometry assay using respiratory samples from 450 children. The total 450 clinical specimens underwent analysis via matrix-assisted laser desorption/ionization time of flight mass spectrometry, and the outcomes were juxtaposed with those derived from real-time reverse-transcriptase PCR conducted concurrently. The concordance between these methods was 96.0%, and the multiple infection identification rate was 7.1%. This innovative approach enables the simultaneous analysis of numerous outcomes from a solitary examination across 192 specimens within a timeframe of approximately 7 hours, with a dramatically reduced sample use and cost. In summary, the common respiratory pathogen mass spectrometry assay is a sensitive, accurate, and cost-effective method for detecting common respiratory pathogens in children and has the potential to revolutionize the diagnosis of respiratory tract infections. IMPORTANCE This study aimed to present and evaluate a novel co-detection method that enables the simultaneous identification of 11 bacterial and 7 viral pathogens in about 7 hours using matrix-assisted laser desorption/ionization time of flight mass spectrometry. Our approach utilizes a combination of multiplex reverse transcription-PCR and matrix-assisted laser desorption/ionization time of flight mass spectrometry, which overcomes the limitations of conventional assays, which include a long assessment time, technical difficulty, and high costs. As a screening method for common respiratory pathogens in children, common respiratory pathogen mass spectrometry assay has the potential to revolutionize the diagnosis of respiratory tract infections by providing an accurate etiological diagnosis. The common respiratory pathogen mass spectrometry assay is expected to be a critical tool for the diagnosis of respiratory infections in children, offering a more efficient, cost-effective, and accurate approach for the detection of common respiratory pathogens.
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Affiliation(s)
- Lixin Hu
- Capital Medical University, Beijing, China
- Department of Clinical Laboratory, Beijing Chao-Yang Hospita, Capital Medical University, Beijing, China
- Department of Clinical Laboratory, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Shenyan Zhang
- Beijing BGI-GBI Biotech Co., Ltd., Beijing, China
- BGI Genomics, Shenzhen, China
| | - Wenqi Song
- Department of Clinical Laboratory, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Fang Dong
- Department of Clinical Laboratory, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Zhengde Xie
- Department of Clinical Laboratory, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xiangpeng Chen
- Department of Clinical Laboratory, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Meng Liu
- Beijing BGI-GBI Biotech Co., Ltd., Beijing, China
| | - Baoxue Cui
- Beijing BGI-GBI Biotech Co., Ltd., Beijing, China
| | | | - Rui Zhang
- Department of Clinical Laboratory, Beijing Chao-Yang Hospita, Capital Medical University, Beijing, China
| | - Qingtao Wang
- Department of Clinical Laboratory, Beijing Chao-Yang Hospita, Capital Medical University, Beijing, China
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The Etiology of Community-Acquired Pneumonia Correlates with Serum Inflammatory Markers in Children. J Clin Med 2022; 11:jcm11195506. [PMID: 36233374 PMCID: PMC9571658 DOI: 10.3390/jcm11195506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 11/22/2022] Open
Abstract
Community-acquired pneumonia (CAP) severely affects pediatric hospitalizations. This study assessed the contribution of CAP to hospitalizations, its etiology in relationship with age, and the inflammatory markers. Between 2013 and 2018, 1064 CAP patients were hospitalized and diagnosed with bacterial/possibly bacterial pneumonia (BP), viral/possibly viral pneumonia (VP) and atypical pneumonia (AP). The etiology was confirmed using blood/pleural fluid culture/polymerase chain reaction (PCR), rapid antigen test/PCR in nasopharyngeal swabs, or serological studies. CAP accounted for 9.9% of hospitalizations and 14.8% of patient days. BP was diagnosed in 825 (77.5%), VP in 190 (17.9%), and AP in 49 (4.6%) cases; the confirmed etiology (n = 209; 20%) included mostly influenza (39%; n = 82), respiratory syncytial virus (RSV, 35%; n = 72), and Mycoplasma pneumoniae (19%; n = 39). VP frequency decreased with age (41% in < 3 mo to 9% in ≥ 60 mo), in contrast to AP (13% in ≥ 60 mo). Among the analyzed parameters, the best differentiating potential was shown by: C-reactive protein (CRP, AUCBP-VP = 0.675; 95% CI: 0.634−0.715), procalcitonin (AUCBP-AP = 0.73; 95% CI: 0.67−0.794), and CRP/procalcitonin (AUCAP-VP = 0.752; 95% CI: 0.67−0.83); a good positive predictive value (88.8%, 98.3%, and 91.6%, respectively) but a low negative predictive value (29.5%, 13.1%, and 40.7%, respectively) was observed. CAP influences hospital patient days more than the crude number of patients would suggest. On a clinical basis, BP is mainly recognized, although viral pneumonia is confirmed most often. RSV and influenza are responsible for a huge percentage of hospitalized cases, as well as M. pneumoniae in children aged ≥ 5 years. Serum inflammatory markers may help differentiate etiological factors.
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Sekmen M, Johnson J, Zhu Y, Sartori LF, Grijalva CG, Stassun J, Arnold DH, Ampofo K, Robison J, Gesteland PH, Pavia AT, Williams DJ. Association Between Procalcitonin and Antibiotics in Children With Community-Acquired Pneumonia. Hosp Pediatr 2022; 12:384-391. [PMID: 35362055 DOI: 10.1542/hpeds.2021-006510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine whether empirical antibiotic initiation and selection for children with pneumonia was associated with procalcitonin (PCT) levels when results were blinded to clinicians. METHODS We enrolled children <18 years with radiographically confirmed pneumonia at 2 children's hospitals from 2014 to 2019. Blood for PCT was collected at enrollment (blinded to clinicians). We modeled associations between PCT and (1) antibiotic initiation and (2) antibiotic selection (narrow versus broad-spectrum) using multivariable logistic regression models. To quantify potential stewardship opportunities, we calculated proportions of noncritically ill children receiving antibiotics who also had a low likelihood of bacterial etiology (PCT <0.25 ng/mL) and those receiving broad-spectrum therapy, regardless of PCT level. RESULTS We enrolled 488 children (median PCT, 0.37 ng/mL; interquartile range [IQR], 0.11-2.38); 85 (17%) received no antibiotics (median PCT, 0.32; IQR, 0.09-1.33). Among the 403 children receiving antibiotics, 95 (24%) received narrow-spectrum therapy (median PCT, 0.24; IQR, 0.08-2.52) and 308 (76%) received broad-spectrum (median PCT, 0.46; IQR, 0.12-2.83). In adjusted analyses, PCT values were not associated with antibiotic initiation (odds ratio [OR], 1.02, 95% confidence interval [CI], 0.97%-1.06%) or empirical antibiotic selection (OR 1.07; 95% CI, 0.97%-1.17%). Of those with noncritical illness, 246 (69%) were identified as potential targets for antibiotic stewardship interventions. CONCLUSION Neither antibiotic initiation nor empirical antibiotic selection were associated with PCT values. Whereas other factors may inform antibiotic treatment decisions, the observed discordance between objective likelihood of bacterial etiology and antibiotic use suggests important opportunities for stewardship.
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Affiliation(s)
| | | | - Yuwei Zhu
- bBiostatistics, Vanderbilt University School of Medicine, Nashville Tennessee
| | - Laura F Sartori
- aDepartments of Pediatrics
- eDepartment of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carlos G Grijalva
- cDepartment of Health Policy, Vanderbilt University Medical Center; Nashville, Tennessee
| | - Justine Stassun
- aDepartments of Pediatrics
- cDepartment of Health Policy, Vanderbilt University Medical Center; Nashville, Tennessee
| | - Donald H Arnold
- cDepartment of Health Policy, Vanderbilt University Medical Center; Nashville, Tennessee
| | - Krow Ampofo
- dDepartment of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jeff Robison
- dDepartment of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Per H Gesteland
- dDepartment of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Andrew T Pavia
- dDepartment of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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Abo YN, Freyne B, Kululanga D, Bryant PA. The Impact of Antimicrobial Stewardship in Children in Low- and Middle-income Countries: A Systematic Review. Pediatr Infect Dis J 2022; 41:S10-S17. [PMID: 35134035 PMCID: PMC8815847 DOI: 10.1097/inf.0000000000003317] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) is central to the World Health Organisation Global Action Plan against antimicrobial resistance (AMR). If antibiotics are used without restraint, morbidity and mortality from AMR will continue to increase. In resource-rich settings, AMS can safely reduce antibiotic consumption. However, for children in low- and middle-income countries (LMIC), the impact of different AMS interventions is unknown. AIM To determine the impact of different AMS interventions on antibiotic use and clinical and microbiologic outcomes in children in LMIC. METHODS MEDLINE, Embase and PubMed were searched for studies of AMS interventions in pediatric population in LMIC settings. Controlled trials, controlled before-and-after studies and interrupted time series studies were included. Outcomes assessed were antibiotic use, multidrug-resistant organism (MDRO) rates, clinical outcomes and cost. RESULTS Of 1462 studies, 34 met inclusion criteria including a total population of >5,000,000 in 17 countries. Twenty were in inpatients, 2 in ED, 10 in OPD and 2 in both. Seven studies were randomized controlled trials. All types of interventions reported a positive impact on antibiotic prescribing. AMS bundles with education, and clinical decision tools appeared more effective than guidelines alone. AMS interventions resulted in significantly decreased clinical infections (4/4 studies) and clinical failure (2/2) and reduced MDRO colonization rate (4/4). There was no concomitant increase in mortality (4/4 studies) or length of stay (2/2). CONCLUSION Multiple effective strategies exist to reduce antibiotic consumption in LMIC. However, marked heterogeneity limit conclusions regarding the most effective approach, particularly regarding clinical outcomes. Overall, AMS strategies are important tools in the reduction of MDRO-related morbidity in children in LMIC.
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Affiliation(s)
- Yara-Natalie Abo
- From the Infectious Diseases Unit, Royal Children’s Hospital, Melbourne, Victoria, Australia, Blantyre, Malawi
| | - Bridget Freyne
- Malawi-Liverpool Wellcome Trust Research Programme
- Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, Merseyside, UK
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Diana Kululanga
- Malawi-Liverpool Wellcome Trust Research Programme
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Penelope A. Bryant
- From the Infectious Diseases Unit, Royal Children’s Hospital, Melbourne, Victoria, Australia, Blantyre, Malawi
- Clinical Paediatrics, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Jullien S, Richard-Greenblatt M, Casellas A, Tshering K, Ribó JL, Sharma R, Tshering T, Pradhan D, Dema K, Ngai M, Muñoz-Almagro C, Kain KC, Bassat Q. Association of Clinical Signs, Host Biomarkers and Etiology With Radiological Pneumonia in Bhutanese Children. Glob Pediatr Health 2022; 9:2333794X221078698. [PMID: 35252478 PMCID: PMC8891828 DOI: 10.1177/2333794x221078698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/20/2022] [Indexed: 11/15/2022] Open
Abstract
Diagnosing pneumonia and identifying those requiring antibiotherapy remain challenging. Chest radiographs (CXR) are often used as the reference standard. We aimed to describe clinical characteristics, host-response biomarkers and etiology, and assess their relationship to CXR findings in children with pneumonia in Thimphu, Bhutan. Children between 2 and 59 months hospitalized with WHO-defined pneumonia were prospectively enrolled and classified into radiological endpoint and non-endpoint pneumonia. Blood and nasopharyngeal washing were collected for microbiological analyses and plasma levels of 11 host-response biomarkers were measured. Among 149 children with readable CXR, 39 (26.2%) presented with endpoint pneumonia. Identification of respiratory viruses was common, with no significant differences by radiological outcomes. No clinical sign was suggestive of radiological pneumonia, but children with radiological pneumonia presented higher erythrocyte sedimentation rate, C-reactive protein and procalcitonin. Markers of endothelial and immune activation had little accuracy for the reliable identification of radiological pneumonia.
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Affiliation(s)
- Sophie Jullien
- ISGlobal, Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Melissa Richard-Greenblatt
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | - Aina Casellas
- ISGlobal, Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | | | - Jose Luis Ribó
- Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Ragunath Sharma
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Tashi Tshering
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Dinesh Pradhan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Kumbu Dema
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Michelle Ngai
- University Health Network-Toronto General Hospital, Toronto, ON, Canada
| | - Carmen Muñoz-Almagro
- Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Universitat Internacional of Catalunya, Barcelona, Spain
| | - Kevin C. Kain
- University Health Network-Toronto General Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Quique Bassat
- ISGlobal, Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
- Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- ICREA, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
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Florin TA. Differentiating Bacterial From Viral Etiologies in Pediatric Community-Acquired Pneumonia: The Quest for the Holy Grail Continues. J Pediatric Infect Dis Soc 2021; 10:1047-1050. [PMID: 34363084 DOI: 10.1093/jpids/piab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Todd A Florin
- Department of Pediatrics, Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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10
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Florin TA, Williams DJ. PRO: Procalcitonin has clinical utility in children with community-acquired pneumonia. JAC Antimicrob Resist 2021; 3:dlab158. [DOI: 10.1093/jacamr/dlab158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abstract
Procalcitonin (PCT) is a useful, albeit imperfect, diagnostic aid that can help clinicians make more informed decisions around antibiotic use in children with lower respiratory tract infections (LRTI), including community-acquired pneumonia (CAP). Recent data suggest that a very low PCT concentration has a high negative predictive value to identify a population of children at low risk of typical bacterial infections. Although the preponderance of data on the clinical utility of PCT in LRTI come from adult studies, the potential for benefit is likely greatest in paediatric CAP and other LRTIs where viral aetiologies predominate, yet antibiotics are frequently prescribed.
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Affiliation(s)
- Todd A Florin
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and Division of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Derek J Williams
- Department of Pediatrics, Vanderbilt University School of Medicine and Division of Hospital Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
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Xie X, Song Z, Wang L, Qi M. Expression and significance of T lymphocyte subsets, RANTES and inflammatory factors levels in serum of patients with abdominal aortic aneurysm. Am J Transl Res 2021; 13:11987-11992. [PMID: 34786132 PMCID: PMC8581902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the expression levels and significance of T lymphocyte subsets, RANTES (regulated on activation, normal T cell expressed and secreted), and inflammatory factors in serum of patients with abdominal aortic aneurysm (AAA). METHODS 32 patients each with large (large AAA) and small (small AAA) groups were selected, and 32 normal subjects were selected as control group. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), RANTES and CD4+ T cells, CD8+ T cells and CD4+/CD8+ expressions in peripheral blood were compared among the three groups. RESULTS Compared with control group, CRP, TNF-α, IL-6, RANTES and CD8+ T cells levels were higher in large and small AAA groups, while CD4+ T cells and CD4+/CD8+ levels were lower (P<0.05). Compared with small AAA group, CRP, TNF-α, IL-6, RANTES and CD8+ T cells levels in large AAA group were higher, while CD4+ T cells and CD4+/CD8+ levels were lower (P<0.05). The abdominal aorta diameter was positively correlated with CRP, TNF-α, IL-6, RANTES and CD8+ T cells levels, while negatively correlated with CD4+ T cells and CD4+/CD8+ levels (P<0.001). Receiver operating characteristic curve results showed that the areas under the curve of CRP, TNF-α, IL-6 and RANTES in the diagnosis of AAA were all more than 0.800 (P<0.001). CONCLUSION The serum of patients with AAA was in a state of inflammatory activation, and the expression of T lymphocytes was abnormal. The levels of T lymphocyte subsets, RANTES and inflammatory factors were closely related to abdominal aorta diameter. CRP, TNF-α, IL-6 and RANTES levels could be used as auxiliary indicators for the diagnosis of AAA.
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Affiliation(s)
- Xu Xie
- Department of Vascular Surgery, The First Affiliated Hospital of Dalian Medical University Dalian, Liaoning Province, China
| | - Ze Song
- Department of Vascular Surgery, The First Affiliated Hospital of Dalian Medical University Dalian, Liaoning Province, China
| | - Lei Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Dalian Medical University Dalian, Liaoning Province, China
| | - Ming Qi
- Department of Vascular Surgery, The First Affiliated Hospital of Dalian Medical University Dalian, Liaoning Province, China
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Zhou W, Tan J. The expression and the clinical significance of eosinophils, PCT and CRP in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with pulmonary infection. Am J Transl Res 2021; 13:3451-3458. [PMID: 34017521 PMCID: PMC8129213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the expression and clinical significance of eosinophil (EOS), procalcitonin (PCT) and C-reactive protein (CRP) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pulmonary infection. METHODS All of the 167 AECOPD patients treated in our hospital were included as the research subjects for this retrospective study. The patients were divided into an infected group (n=41) and a non-infected group (n=126) according to the presence or absence of pulmonary infection. Etiological analysis and antimicrobial susceptibility test were performed on patients in the infection group, and the levels of serum PCT, CRP and EOS were compared between the two groups. According to the forced expiratory volume in one second (FEV1), the pulmonary function of the infection group was divided into 1-3 grades, and the levels of CRP, PCT and EOS in different grades were compared. The correlation between the levels of CRP, PCT, EOS and the ratio of FEV1/FVC (forced vital capacity) in infection group was analyzed. The ROC curve was used to analyze the clinical value of CRP, PCT and EOS levels in the diagnosis of AECOPD complicated with lung infection. RESULTS A total of 59 strains of pathogenic bacteria were isolated from 41 patients, including 41 strains of Gram-negative bacteria (69.49%), 16 strains of Gram-positive bacteria (27.12%) and 2 strains of fungi (3.39%). Among the Gram-negative bacteria, Klebsiella Pneumoniae and Pseudomonas Aeruginosa were highly resistant to Cefuroxime, Levofloxacin and Ampicillin. And among the Gram-positive bacteria, Staphylococcus Aureus and Streptococcus Pneumoniae were highly resistant to Penicillin, Gentamicin and Erythromycin. The levels of CRP, PCT and EOS in infected group were significantly higher than those in non-infected group (P<0.05); with the increase of pulmonary function grade, the levels of CRP, PCT and EOS were significant increased (P<0.05); and the levels of CRP, PCT and EOS were negatively correlated with the FEV1/FVC ratio (P<0.05). ROC curve results show that the levels of CRP, PCT and EOS have high clinical value in the diagnosis in patients of AECOPD complicated with pulmonary infection (all AUC>0.7). CONCLUSION Gram-negative bacteria are the main bacteria in AECOPD complicated with pulmonary infection, and drugs should be used rationally according to the results of antimicrobial susceptibility test. The levels of CRP, PCT and EOS increased significantly and were closely related to pulmonary function, and thus have obvious clinical value in the diagnosis of AECOPD complicated with pulmonary infection.
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Affiliation(s)
- Wen Zhou
- Department of Emergency, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine Wenzhou, Zhejiang Province, China
| | - Jie Tan
- Department of Emergency, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine Wenzhou, Zhejiang Province, China
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Donà D, Barbieri E, Daverio M, Lundin R, Giaquinto C, Zaoutis T, Sharland M. Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review. Antimicrob Resist Infect Control 2020; 9:3. [PMID: 31911831 PMCID: PMC6942341 DOI: 10.1186/s13756-019-0659-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.
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Affiliation(s)
- D. Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
- Fondazione Penta ONLUS, Padua, Italy
| | - E. Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
| | - M. Daverio
- Pediatric intensive care unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - R. Lundin
- Fondazione Penta ONLUS, Padua, Italy
| | - C. Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
- Fondazione Penta ONLUS, Padua, Italy
| | - T. Zaoutis
- Fondazione Penta ONLUS, Padua, Italy
- Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - M. Sharland
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
- Fondazione Penta ONLUS, Padua, Italy
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Sahulee R, McKinstry J, Chakravarti SB. The Use of the Biomarker Procalcitonin in Pediatric Cardiovascular Disorders. CURRENT PEDIATRICS REPORTS 2019. [DOI: 10.1007/s40124-019-00193-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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