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Shafiqa N, Aston S, Howard A, Turtle L, Abrams S, Young B, Sherratt F, Alvarez Nishio A, Wilshaw S, Jones AP, Wootton DG. HAP-FAST: a feasibility study incorporating qualitative, mechanistic and costing sub-studies alongside a randomised pilot trial comparing chest x-ray to low-dose CT scan and empirical antibiotics to antibiotics guided by the BIOFIRE® FILM ARRAY® pneumonia plus panel in adults with suspected non-ventilator-associated hospital-cquired pneumonia. BMJ Open 2024; 14:e088490. [PMID: 38964799 PMCID: PMC11227820 DOI: 10.1136/bmjopen-2024-088490] [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: 05/07/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Non-ventilator-associated hospital-acquired pneumonia (nv-HAP) is the most common healthcare-associated infection (HCAI), is associated with high mortality and morbidity and places a major burden on healthcare systems. Diagnosis currently relies on chest x-rays to confirm pneumonia and sputum cultures to determine the microbiological cause. This approach leads to over-diagnosis of pneumonia, rarely identifies a causative pathogen and perpetuates unnecessary and imprecise antibiotic use. The HAP-FAST study aims to evaluate the feasibility of a randomised trial to evaluate the clinical impact of low-dose, non-contrast-enhanced thoracic CT scans and rapid molecular sputum analysis using the BIOFIRE® FILMARRAY® pneumonia plus panel (FAPP) for patients suspected with nv-HAP. METHODS AND ANALYSIS The HAP-FAST feasibility study consists of a pilot randomised trial, a qualitative study, a costing analysis and exploratory analyses of clinical samples to investigate the immune-pathophysiology of HAP. Participants are identified and recruited from four acute hospitals in the Northwest of the UK. Using a Research Without Prior Consent model, the pilot trial will recruit 220 adult participants, with or without mental capacity, and with suspected HAP. HAP-FAST is a non-blinded, sequential, multiple assignment, randomised trial with two possible stages of randomisation: first, chest x-ray (CXR) or CT; second, if treated as nv-HAP, FAPP or standard microbiological processing alone (no FAPP). Pathogen-specific antibiotic guidance will be provided for FAPP results. Randomisation uses a web-based platform and followed up for 90 days. The feasibility of a future trial will be determined by assessing trial processes, outcome measures and patient and staff experiences. ETHICS AND DISSEMINATION This study has undergone combined review by the UK NHS Research Ethics Committee and Health Research Authority. Results will be disseminated via peer-reviewed journals, via the funders' website and through a range of media to engage the public. TRIAL REGISTRATION NUMBER NCT05483309.
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Affiliation(s)
- Natalia Shafiqa
- Department of Clinical Infection, Microbiology and Immunology (CIMI), University of Liverpool, Liverpool, UK
- Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Stephen Aston
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Department of Antimicrobial Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Alex Howard
- Department of Antimicrobial Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Lance Turtle
- Department of Clinical Infection, Microbiology and Immunology (CIMI), University of Liverpool, Liverpool, UK
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Simon Abrams
- Department of Clinical Infection, Microbiology and Immunology (CIMI), University of Liverpool, Liverpool, UK
| | - Bridget Young
- Institute of Population Health, Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Frances Sherratt
- Institute of Population Health, Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | | | - Stephanie Wilshaw
- Liverpool Clinical Trials Centre (LCTC), University of Liverpool, Liverpool, UK
| | - Ashley P Jones
- Liverpool Clinical Trials Centre (LCTC), University of Liverpool, Liverpool, UK
| | - Dan G Wootton
- Department of Clinical Infection, Microbiology and Immunology (CIMI), University of Liverpool, Liverpool, UK
- Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
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Sinishaw KM, Sebsbie G, Kebede MA. Predictors of recovery time from severe community-acquired pneumonia among paediatrics patients in selected hospitals in Addis Ababa, Ethiopia: an institution-based retrospective cohort study. BMJ Open 2024; 14:e078721. [PMID: 38514151 PMCID: PMC10961574 DOI: 10.1136/bmjopen-2023-078721] [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] [Received: 08/11/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE Severe community-acquired pneumonia (SCAP) is a significant cause of morbidity worldwide and a major cause of morbidity and mortality in developing countries. Ethiopia ranks 6th out of 15 countries with the highest mortality rate due to pneumonia in children under 5 years of age. The aim of this study was to determine the recovery time from SCAP and factors in paediatric patients in selected hospitals in Addis Ababa. DESIGN, PARTICIPANTS AND SETTING A retrospective cohort study was conducted among 407 randomly selected paediatric patients admitted with SCAP in Addis Ababa public hospitals from 1 January 2018 to 31 December 2020. PRIMARY AND SECONDARY OUTCOMES Recovery time and recovery rate from SCAP were estimated using Kaplan-Meier and simple frequency statistics, respectively, and the adjusted HR with a 95% CI was used to identify associated factors for recovery. RESULTS 91.5% (95% CI: 88.3% to 94.1%) of children recovered from SCAP with an overall recovery rate of 11.5 (95% CI: 10.37 to 12.76) per 100 person-day observation, and the median recovery time was 6 days. In the multivariable analysis, older age and the absence of comorbidities were protective factors for early recovery, while stunting and late utilisation of medical care were risk factors. CONCLUSION The median recovery time after SCAP was very long compared with the optimal recovery time of 3 days given in the British Thoracic Society guidelines. Older age and absence of comorbidities were found to shorten recovery time, whereas stunting and late initiation of treatment delayed recovery. Therefore, measures that increase the recovery rate and shorten the recovery time, such as primary prevention to eliminate malnutrition and increase the utilisation of medical care in the community, should be strengthened, and health workers should focus on the early detection and treatment of comorbid diseases.
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Affiliation(s)
| | - Girum Sebsbie
- School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda
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Mathioudakis AG, Fally M, Hansel J, Robey RC, Haseeb F, Williams T, Kouta A, Welte T, Wootton DG, Clarke M, Waterer G, Dark P, Williamson PR, Vestbo J, Felton TW. Clinical trials of pneumonia management assess heterogeneous outcomes and measurement instruments. J Clin Epidemiol 2023; 164:88-95. [PMID: 37898460 DOI: 10.1016/j.jclinepi.2023.10.011] [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] [Received: 05/30/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES To inform clinical practice guidelines, randomized controlled trials (RCTs) of the management of pneumonia need to address the outcomes that are most important to patients and health professionals using consistent instruments, to enable results to be compared, contrasted, and combined as appropriate. This systematic review describes the outcomes reported in clinical trials of pneumonia management and the instruments used to measure these outcomes. STUDY DESIGN AND SETTING Based on a prospective protocol, we searched MEDLINE/PubMed, Cochrane CENTRAL and clinical trial registries for ongoing or completed clinical trials evaluating pneumonia management in adults in any clinical setting. We grouped reported outcomes thematically and classified them following the COMET Initiative's taxonomy. We describe instruments used for assessing each outcome. RESULTS We found 280 eligible RCTs of which 115 (41.1%) enrolled critically ill patients and 165 (58.9%) predominantly noncritically ill patients. We identified 43 distinct outcomes and 108 measurement instruments, excluding nonvalidated scores and questionnaires. Almost all trials reported clinical/physiological outcomes (97.5%). Safety (63.2%), mortality (56.4%), resource use (48.6%) and life impact (11.8%) outcomes were less frequently addressed. The most frequently reported outcomes were treatment success (60.7%), mortality (56.4%) and adverse events (41.1%). There was significant variation in the selection of measurement instruments, with approximately two-thirds used in less than 10 of the 280 RCTs. None of the patient-reported outcomes were used in 10 or more RCTs. CONCLUSION This review reveals significant variation in outcomes and measurement instruments reported in clinical trials of pneumonia management. Outcomes that are important to patients and health professionals are often omitted. Our findings support the need for a rigorous core outcome set, such as that being developed by the European Respiratory Society.
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Affiliation(s)
- Alexander G Mathioudakis
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Markus Fally
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jan Hansel
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK; North West School of Intensive Care Medicine, Health Education England North West, Manchester, UK
| | - Rebecca C Robey
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Faiuna Haseeb
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Thomas Williams
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Ahmed Kouta
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Tobias Welte
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hanover, Germany
| | - Dan G Wootton
- Institute of Infection, Veterinary and Ecological Sciences, NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Mike Clarke
- Centre of Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Grant Waterer
- School of Medicine and Pharmacology, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Paul Dark
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Paula R Williamson
- Department of Health Data Science, MRC/NIHR Trials Methodology Research Partnership, University of Liverpool, Liverpool, UK
| | - Jørgen Vestbo
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Timothy W Felton
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Biru GD, Derebe MA, Workie DL. Joint modeling of longitudinal changes of pulse rate and body temperature with time to recovery of pneumonia patients under treatment: a prospective cohort study. BMC Infect Dis 2023; 23:682. [PMID: 37828463 PMCID: PMC10571452 DOI: 10.1186/s12879-023-08646-6] [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] [Received: 03/17/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Pneumonia is the leading infectious cause of mortality worldwide and one of the most common lower respiratory tract infections that is contributing significantly to the burden of antibiotic consumption. The study aims to identify the determinants of the progress of pulse rate, body temperature and time to recovery of pneumonia patients. METHOD A prospective cohort study design was used from Felege Hiwot referral hospital on 214 sampled pneumonia patients from March 01, 2022 up to May 31, 2022. The Kaplan-Meier survival estimate and Log-Rank test was used to compare the survival time. Joint model of bivariate longitudinal and time to event model was used to identify factors of longitudinal change of pulse rate and body temperature with time to recovery jointly. RESULT As the follow up time of pneumonia patient's increase by one hour the average longitudinal change of pulse rate and body temperature were decreased by 0.4236 bpm and 0.0119 [Formula: see text]. The average longitudinal change of pulse rate and body temperature of patients who lived in rural was 1.4602 bpm and 0.1550 [Formula: see text] times less as compared to urban residence. Patients who had dangerous signs are significantly increased the average longitudinal change of pulse rate and body temperature by 2.042 bpm and 0.6031 [Formula: see text] as compared to patients who had no dangerous signs. A patient from rural residence was 1.1336 times more likely to experience the event of recovery as compared to urban residence. The estimated values of the association parameter for pulse rate and body temperature were -0.4236 bpm and -0.0119 respectively, which means pulse rate and body temperature were negatively related with patients recovery time. CONCLUSION Pulse rate and body temperature significantly affect the time to the first recovery of pneumonia patients who are receiving treatment. Age, residence, danger sign, comorbidity, baseline symptom and visiting time were the joint determinant factors for the longitudinal change of pulse rate, body temperature and time to recovery of pneumonia patients. The joint model approach provides precise dynamic predictions, widespread information about the disease transitions, and better knowledge of disease etiology.
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Affiliation(s)
- Getu Dessie Biru
- Department of Statistics, Dembi Dolo University, Debretabor University, Ethiopia
| | - Muluwerk Ayele Derebe
- Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Demeke Lakew Workie
- Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
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Mponponsuo K, Pinto R, Fowler R, Rogers B, Daneman N. Fixed versus individualized treatment for five common bacterial infectious syndromes: a survey of the perspectives and practices of clinicians. JAC Antimicrob Resist 2023; 5:dlad087. [PMID: 37533760 PMCID: PMC10391701 DOI: 10.1093/jacamr/dlad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/26/2023] [Indexed: 08/04/2023] Open
Abstract
Background Traditionally, bacterial infections have been treated with fixed-duration antibiotic courses; however, some have advocated for individualized durations. It is not known which approach currently predominates. Methods We conducted a multinational clinical practice survey asking prescribers their approach to treating skin and soft tissue infection (SSTI), community-acquired pneumonia (CAP), pyelonephritis, cholangitis and bloodstream infection (BSI) of an unknown source. The primary outcome was self-reported treatment approach as being fully fixed duration, fixed minimum, fixed maximum, fixed minimum and maximum, or fully individualized durations. Secondary questions explored factors influencing duration of therapy. Multivariable logistic regression with generalized estimating equations was used to examine predictors of use of fully fixed durations. Results Among 221 respondents, 170 (76.9%) completed the full survey; infectious diseases physicians accounted for 60.6%. Use of a fully fixed duration was least common for SSTI (8.5%) and more common for CAP (28.3%), BSI (29.9%), cholangitis (35.7%) and pyelonephritis (36.3%). Fully individualized therapy, with no fixed minimum or maximum, was used by only a minority: CAP (4.9%), pyelonephritis (5.0%), cholangitis (9.9%), BSI (13.6%) and SSTI (19.5%). In multivariable analyses, a fully fixed duration approach was more common among Canadian respondents [adjusted OR (aOR) 1.76 (95% CI 1.12-2.76)] and for CAP (aOR 4.25, 95% CI 2.53-7.13), cholangitis (aOR 6.01, 95% CI 3.49-10.36), pyelonephritis (aOR 6.08, 95% CI 3.56-10.39) and BSI (aOR 4.49, 95% CI 2.50-8.09) compared with SSTI. Conclusions There is extensive practice heterogeneity in fixed versus individualized treatment; clinical trials would be helpful to compare these approaches.
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Affiliation(s)
| | - Ruxandra Pinto
- Sunnybrook Research Institute, Toronto, Canada
- Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Robert Fowler
- Sunnybrook Research Institute, Toronto, Canada
- Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ben Rogers
- Division of Infectious Diseases, Monash Health, Clayton, VIC, Australia
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Azmeraw S, Wube Y, Lakew D. Joint modeling of longitudinal measures of pneumonia and time to convalescence among pneumonia patients: a comparison of separate and joint models. Pneumonia (Nathan) 2022; 14:10. [PMID: 36566222 DOI: 10.1186/s41479-022-00101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 11/24/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Globally, pneumonia is the leading cause of children under age five morbidity and mortality with 98% of deaths in developing countries. OBJECTIVE This study aimed to identify the determinants of longitudinal measures of pneumonia and time to convalescence or recovery of under five admitted pneumonia patients at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia. METHODS A prospective cohort study was conducted among a randomly selected sample of 101 pneumonia patients using simple random sampling who were on follow up from December 2019 to February 2020. A Linear mixed effect model were used for the longitudinal outcomes and joint model for modeling both longitudinal and time to event outcomes jointly respectively. RESULTS The significant values of shared parameters in the survival sub model shows that the use of joint modeling of multivariate longitudinal outcomes with the time to event outcome is the best model compared to separate models. The estimated values of the association parameters: - 0.297(p-value = 0.0021), - 0.121) (p-value = < 0.001) and 0.5452 (p-value = 0.006) indicates association of respiratory rate, pulse rate and oxygen saturation respectively with time to recovery. The significant values show that there is an evidence to say that there is a negative relationship between longitudinal measures of respiratory rate and pulse rate with time to recovery and there is positive relationship between longitudinal measures of oxygen saturation with time to recovery. Variables age, birth order, dangerous signs, severity and visit time were significant factors on the longitudinal measure of pulse rate. The significant factors related to longitudinal measures of oxygen saturation were birth order, severity and visit. From this we can conclude that birth order, severity and visit were significant variables that simultaneously affect the longitudinal measures of respiratory rate, pulse rate and oxygen saturation of patients at 5% level of significance. CONCLUSION Results of multivariate joint analysis shows that severity was significant variable that jointly affects the three longitudinal measures and time to recovery of pneumonia patients and we can conclude that patients with severe pneumonia have high values of respiratory rate and pulse rate as well as less amount of oxygen saturation and they need longer time to recover from the disease.
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Affiliation(s)
- Sindu Azmeraw
- Department of Statistics, Faculty of Natural and Computational Science, Woldia University, Woldia, Ethiopia
| | - Yenefenta Wube
- Department of Statistics, Faculty of Natural and Computational Science, Woldia University, Woldia, Ethiopia.
| | - Demeke Lakew
- Department of Statistics, Faculty of Natural and Computational Science, Bahir Dar University, Bahir Dar, Ethiopia
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van der Feltz-Cornelis CM, Sweetman J, Allsopp G, Attree E, Crooks MG, Cuthbertson DJ, Forshaw D, Gabbay M, Green A, Heightman M, Hillman T, Hishmeh L, Khunti K, Lip GYH, Lorgelly P, Montgomery H, Strain WD, Wall E, Watkins C, Williams N, Wootton DG, Banerjee A. STIMULATE-ICP-Delphi (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways Delphi): Study protocol. PLoS One 2022; 17:e0277936. [PMID: 36449461 PMCID: PMC9710789 DOI: 10.1371/journal.pone.0277936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/17/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION As mortality rates from COVID-19 disease fall, the high prevalence of long-term sequelae (Long COVID) is becoming increasingly widespread, challenging healthcare systems globally. Traditional pathways of care for Long Term Conditions (LTCs) have tended to be managed by disease-specific specialties, an approach that has been ineffective in delivering care for patients with multi-morbidity. The multi-system nature of Long COVID and its impact on physical and psychological health demands a more effective model of holistic, integrated care. The evolution of integrated care systems (ICSs) in the UK presents an important opportunity to explore areas of mutual benefit to LTC, multi-morbidity and Long COVID care. There may be benefits in comparing and contrasting ICPs for Long COVID with ICPs for other LTCs. METHODS AND ANALYSIS This study aims to evaluate health services requirements for ICPs for Long COVID and their applicability to other LTCs including multi-morbidity and the overlap with medically not yet explained symptoms (MNYES). The study will follow a Delphi design and involve an expert panel of stakeholders including people with lived experience, as well as clinicians with expertise in Long COVID and other LTCs. Study processes will include expert panel and moderator panel meetings, surveys, and interviews. The Delphi process is part of the overall STIMULATE-ICP programme, aimed at improving integrated care for people with Long COVID. ETHICS AND DISSEMINATION Ethical approval for this Delphi study has been obtained (Research Governance Board of the University of York) as have approvals for the other STIMULATE-ICP studies. Study outcomes are likely to inform policy for ICPs across LTCs. Results will be disseminated through scientific publication, conference presentation and communications with patients and stakeholders involved in care of other LTCs and Long COVID. REGISTRATION Researchregistry: https://www.researchregistry.com/browse-the-registry#home/registrationdetails/6246bfeeeaaed6001f08dadc/.
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Affiliation(s)
- Christina M. van der Feltz-Cornelis
- Dept of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, (HYMS), University of York, York, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- * E-mail:
| | | | - Gail Allsopp
- Royal College of General Practitioners, London, United Kingdom
- National Institute of Health and Care Excellence, London, United Kingdom
| | | | - Michael G. Crooks
- Hull York Medical School, University of Hull, Hull, United Kingdom
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Daniel J. Cuthbertson
- Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Denise Forshaw
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom
| | - Mark Gabbay
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
- NIHR ARC NWC, Liverpool, United Kingdom
| | - Angela Green
- Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Melissa Heightman
- Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Toby Hillman
- Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- UCL Respiratory, University College London, London, United Kingdom
| | | | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Paula Lorgelly
- School of Population Health and Department of Economics, University of Auckland, Auckland, New Zealand
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Hugh Montgomery
- Department of Medicine, University College London, London, United Kingdom
| | - W. David Strain
- Diabetes and Vascular Medicine Research Centre, Institute of Biomedical and Clinical Science and College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Emma Wall
- Francis Crick Institute, London, United Kingdom
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre and NIHR UCLH Clinical Research Facility, London, United Kingdom
| | - Caroline Watkins
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom
- Faculty of Health and Care, University of Central Lancashire, Preston, United Kingdom
| | - Nefyn Williams
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Dan G. Wootton
- Institute of Infection Veterinary and Ecological Sciences and NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
- Department of Cardiology, University College London Hospitals NHS Trust, London, United Kingdom
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Lemma Tirore L, Abose Nadamo S, Tamrat Derilo H, Erkalo D, Sedore T, Tadesse T, Ermias D, Yaekob T. Time to Recovery from Covid-19 and Its Predictors Among Patients Admitted to Treatment Centers of Southern Nations Nationalities and Peoples Region (SNNPR), ETHIOPIA: Multi-Center Retrospective Cohort Study. Infect Drug Resist 2022; 15:3047-3062. [PMID: 35747331 PMCID: PMC9209334 DOI: 10.2147/idr.s365986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/10/2022] [Indexed: 01/08/2023] Open
Abstract
Background The world is currently facing a pandemic of Coronavirus Disease 2019 (Covid-19). It has caused significant morbidity and mortality. So far little is known about recovery time (prolonged hospital stay) from Covid-19 and its determinants in Ethiopia as well as in the study area. Therefore, the aim of this study was to determine time to recovery from Covid-19, and identify predictors of time to recovery among patients admitted to treatment centers of Southern Nations Nationalities and Peoples Region (SNNPR). Methods and Materials A facility-based retrospective cohort study was conducted among Covid-19 patients admitted to care centers of SNNPR from May 30, 2020 to October 15, 2021. A sample of 845 patients was included in the study. Summarization of the data was done using mean (standard deviation) and median (inter quartile range). Kaplan–Meier Survival Curve was used to estimate recovery time from Covid-19 and the independent effects of covariates on recovery time was analyzed using multivariable Cox-proportional hazard model. Results The incidence density of recovery was 8.24 per 100 person-days (95% CI: 7.67, 8.85). The overall median recovery time was 10 days (IQR: 8–16 days). Critical stage of Covid-19 (aHR = 0.19, 95% CI: 0.12, 0.29), severe stage of Covid-19 (aHR = 0.40, 95% CI: 0.29, 0.56), mechanical ventilation (aHR = 0.20, 95% CI: 0.073, 0.56) and treatment center (aHR = 0.68, 95% CI: 0.51, 0.90) were significant predictors of recovery rate among Covid-19 patients. Conclusion The median time to recovery from Covid-19 was relatively short. The incidence density of recovery was 8.24 per 100 person-days. The hazard of recovery was lower for patients at higher levels of Covid-19 severity and for patients in need of mechanical ventilation. Early identification of severity levels of the patients is required at the time of admission. Special attention, critical follow–up and management is warranted for patients at higher levels of Covid-19 severity.
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Affiliation(s)
| | | | | | - Desta Erkalo
- Department of Public Health, Wachemo University, Hossana, Ethiopia
| | - Tagesse Sedore
- Department of Public Health, Wachemo University, Hossana, Ethiopia
| | - Tegegn Tadesse
- Department of Public Health, Wachemo University, Hossana, Ethiopia
| | - Dejene Ermias
- Department of Public Health, Wachemo University, Hossana, Ethiopia
| | - Temesgen Yaekob
- Department of Statistics, Wachemo University, Hossana, Ethiopia
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Hao M, Guo J, Lu J, Chang T, Yin Z. Correlation between Platelet miRNA Expression and Coagulation Function in Children with Severe Pneumonia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2826115. [PMID: 35783531 PMCID: PMC9242775 DOI: 10.1155/2022/2826115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/30/2022] [Accepted: 05/31/2022] [Indexed: 12/04/2022]
Abstract
Objective To investigate the relationship between expression levels of platelet miRNAs and severe pneumonia (SP) in children. Methods A randomized controlled trial was conducted in 129 children with SP hospitalized from May 2018 to May 2020. All children joined the study group and were divided into the mild infection group, moderate infection group, and severe infection group according to the diagnostic criteria, 43 cases in each group. Besides, 129 healthy children were selected as the control group. The expression levels of platelet miR-223 and miR-192 were detected by real-time quantitative polymerase chain reaction (qPCR). The prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (FIB) were detected by the Sysmex CA-1500 System (Sysmex Corporation, Japan). The Pearson analysis was conducted to evaluate the correlation between coagulation function and the levels of miR-223 and miR-192. Results Compared with the control group, miR-223 in the study group was significantly higher and miR-192 was significantly lower (P < 0.05). Compared with the mild infection group, miR-223 was significantly higher and miR-192 was significantly lower in the moderate infection group and severe infection group (P < 0.05). Compared with the control group, PT and APTT were significantly lower and FIB was significantly higher in the study group (P < 0.05). Pearson correlation analysis revealed that miR-223 was positively correlated with PT and APTT (P < 0.05) and negatively correlated with FIB (P < 0.05); miR-192 was negatively correlated with PT and APTT (P < 0.05) and positively correlated with FIB (P < 0.05). Conclusion miR-223 and miR-192 can reflect coagulation function in children with SP, which can provide a certain reference basis for clinical guidance and treatment and prognosis.
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Affiliation(s)
- Mingming Hao
- Department of Pediatrics, Hengshui People's Hospital, Hengshui, Hebei, China
| | - Jing Guo
- Department of Pediatrics, Hengshui People's Hospital, Hengshui, Hebei, China
| | - Jinying Lu
- Department of Pediatrics, Hengshui People's Hospital, Hengshui, Hebei, China
| | - Taotao Chang
- Department of Pediatrics, Hengshui People's Hospital, Hengshui, Hebei, China
| | - Zhanru Yin
- Department of Pediatrics, Hengshui People's Hospital, Hengshui, Hebei, China
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10
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Khalaf M, Alboraie M, Abdel-Gawad M, Abdelmalek M, Abu-Elfatth A, Abdelhamed W, Zaghloul M, ElDeeb R, Abdeltwab D, Abdelghani M, El-Raey F, Aboalam H, Badry A, Tharwat M, Afify S, Elwazzan D, Abdelmohsen AS, Fathy H, Wagih Shaltout S, Hetta HF, Bazeed SE. Prevalence and Predictors of Persistent Symptoms After Clearance of SARS-CoV-2 Infection: A Multicenter Study from Egypt. Infect Drug Resist 2022; 15:2575-2587. [PMID: 35619736 PMCID: PMC9128749 DOI: 10.2147/idr.s355064] [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: 12/21/2021] [Accepted: 05/12/2022] [Indexed: 02/05/2023] Open
Abstract
Background and Aim Little is known about the persistence of symptoms after clearance of SARS-CoV-2 infection. Our study aimed to assess persistent symptoms in COVID-19 patients after clearance of SARS-CoV-2 infection. Methodology A multi-center survey was conducted on first wave COVID-19 patients with confirmed SARS-CoV-2 infection. Sociodemographic and clinical characteristics, including presenting symptoms and persistent symptoms after viral clearance and possible factors contributing to persistence of such symptoms, were collected using an online multicomponent questionnaire. Descriptive and inferential statistical analysis was performed to detect the most persisting symptoms and factors contributing to their persistence. Results Overall, 538 patients were enrolled. Mean age was 41.17 (±SD 14.84), 54.1% were males, and 18.6% were smokers. Hypertension and diabetes were the most reported co-morbidities. Mild symptoms were reported in 61.3% of patients, 51.3% were admitted to hospital and 6.5% were admitted to the intensive care unit. Our study identified 49 types of persisting symptoms. Fatigue (59.1%), sense of fever (46.5%), anorexia (24.3%) and diarrhea (24.3%) were the most commonly reported persisting symptoms followed by loss of taste and smell (22.3%), headache (21.4%), cough (20.8) and dyspnea (21%). The use of hydroxychloroquine, azithromycin and multivitamins were significantly associated with persistence of symptoms (OR = 8.03, 8.89 and 10.12, respectively). Conclusion Our study revealed that in COVID-19 recovered patients, many patients reported persistence of at least one symptom, particularly fatigue and sense of fever. Follow-up of patients after discharge from hospital is recommended until complete resolution of symptoms.
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Affiliation(s)
- Marwa Khalaf
- Assiut Liver Center, Ministry of Health, Assiut, 71515, Egypt
- Correspondence: Marwa Khalaf, Assiut liver center, Ministry of health, Assiut, 71515, Egypt, Email
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Muhammad Abdel-Gawad
- Hepatology, Gastroenterology and Infectious Diseases Department, Al-Azhar University, Assiut, Egypt
| | - Mohamed Abdelmalek
- Tropical Medicine and Gastroenterology Department, Assiut University, Assiut, Egypt
| | - Ahmed Abu-Elfatth
- Tropical Medicine and Gastroenterology Department, Assiut University, Assiut, Egypt
| | - Walaa Abdelhamed
- Tropical Medicine and Gastroenterology Department, Sohag University Hospital, Sohag, Egypt
| | - Mariam Zaghloul
- Hepatology, Gastroenterology and Infectious Diseases Department, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt
| | - Rabab ElDeeb
- Tropical Medicine Department, Alexandria University, Alexandria, Egypt
| | - Doaa Abdeltwab
- Tropical Medicine and Gastroenterology Department, Assiut University, Assiut, Egypt
| | - Mohamed Abdelghani
- Tropical Medicine and Gastroenterology Department, Assiut University, Assiut, Egypt
| | - Fathiya El-Raey
- Hepatogastroenterology and Infectious Diseases Department, Al-Azhar University, Damietta, Egypt
| | - Hani Aboalam
- Assiut Liver Center, Ministry of Health, Assiut, 71515, Egypt
| | - Azza Badry
- Epidemiologist, Infectious Disease Control Department Preventive Medicine Assiut Health Affairs Directorate, Assiut, Egypt
| | - Mina Tharwat
- Tropical Medicine and Gastroenterology Department, Aswan University, Aswan, Egypt
| | - Shima Afify
- Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Doaa Elwazzan
- Tropical Medicine Department, Alexandria University, Alexandria, Egypt
| | | | - Hayam Fathy
- Internal Medicine, Hepatogastroenterology Unit, Assiut University, Assiut, Egypt
| | | | - Helal F Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
- Helal F Hetta, Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt, Email
| | - Shamardan E Bazeed
- Tropical Medicine and Gastroenterology Department, South Valley University, Qena, Egypt
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11
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Fernández-de-Las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Florencio LL, Cuadrado ML, Plaza-Manzano G, Navarro-Santana M. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis. Eur J Intern Med 2021; 92:55-70. [PMID: 34167876 PMCID: PMC8206636 DOI: 10.1016/j.ejim.2021.06.009] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/21/2021] [Accepted: 06/05/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Single studies support the presence of several post-COVID-19 symptoms; however, no meta-analysis differentiating hospitalized and non-hospitalized patients has been published to date. This meta-analysis analyses the prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized patients recovered from COVID-19 . METHODS MEDLINE, CINAHL, PubMed, EMBASE, and Web of Science databases, as well as medRxiv and bioRxiv preprint servers were searched up to March 15, 2021. Peer-reviewed studies or preprints reporting data on post-COVID-19 symptoms collected by personal, telephonic or electronic interview were included. Methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. We used a random-effects models for meta-analytical pooled prevalence of each post-COVID-19 symptom, and I² statistics for heterogeneity. Data synthesis was categorized at 30, 60, and ≥90 days after . RESULTS From 15,577 studies identified, 29 peer-reviewed studies and 4 preprints met inclusion criteria. The sample included 15,244 hospitalized and 9011 non-hospitalized patients. The methodological quality of most studies was fair. The results showed that 63.2, 71.9 and 45.9% of the sample exhibited ≥one post-COVID-19 symptom at 30, 60, or ≥90days after onset/hospitalization. Fatigue and dyspnea were the most prevalent symptoms with a pooled prevalence ranging from 35 to 60% depending on the follow-up. Other post-COVID-19 symptoms included cough (20-25%), anosmia (10-20%), ageusia (15-20%) or joint pain (15-20%). Time trend analysis revealed a decreased prevalence 30days after with an increase after 60days . CONCLUSION This meta-analysis shows that post-COVID-19 symptoms are present in more than 60% of patients infected by SARS-CoV‑2. Fatigue and dyspnea were the most prevalent post-COVID-19 symptoms, particularly 60 and ≥90 days after.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Avenida de Atenas s/n, Madrid, Alcorcón 28922 Spain.
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Avenida de Atenas s/n, Madrid, Alcorcón 28922 Spain
| | | | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Avenida de Atenas s/n, Madrid, Alcorcón 28922 Spain
| | - María L Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Marcos Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
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12
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Tirore LL, Abame DE, Sedoro T, Ermias D, Arega A, Tadesse T, Nadamo SA. Time to Recovery from Severe Pneumonia and Its Predictors Among Children 2-59 Months of Age Admitted to Pediatric Ward of Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Hossana, Ethiopia: Retrospective Cohort Study. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:347-357. [PMID: 34321951 PMCID: PMC8312316 DOI: 10.2147/phmt.s321184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022]
Abstract
Background Severe pneumonia is still the greatest infectious cause of morbidity and mortality in children under the age of five around the world. Each night spent in the hospital raises the chance of bad drug responses, infections, and ulcers by 0.5%, 1.6%, and 0.5%, respectively. In Southern Ethiopia, as well as the research area, little is known regarding death and recovery time from severe pneumonia and their determinants. Objective To determine time to recovery from severe pneumonia and its predictors among children 2–59 months of age admitted to pediatric ward of Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital. Methods A facility-based retrospective cohort study was conducted among children 2–59 months of age. Three years’ medical records, from January 2017 to December 2020, were reviewed. A total of 280 children with severe pneumonia were included. In the case of survival time, median was calculated. Kaplan Meier survival curve was used to estimate recovery time from severe pneumonia, and the independent effects of covariates on recovery time were analyzed using multivariable Cox-proportional hazard model. Results The median time to recovery was 4 days (interquartile range = 3, 5). The incidence rate of recovery was 24.16 per 100 person-days. Underweight (adjusted hazard ratio = 0.56, 95% CI = 0.38–0.80), age group 12–35 months (adjusted hazard ratio= 2.0, 95% CI=1.30–3.30), treatment with ampicillin and gentamicin (adjusted hazard ratio= 0.35, 95% CI: 0.13–0.80), and antibiotic change (adjusted hazard ratio= 0.34, 95% CI = 0.21–0.53) were statistically significant predictors of time to recovery from severe pneumonia. Conclusion The median length of stay in the hospital was short (4 days [interquartile range =3, 5]). Time to recover from severe pneumonia was significantly influenced by being underweight, age, antibiotics administered first, and antibiotic change. Measures such as providing nutritious meals to children and ensuring that underweight children are properly managed should be bolstered.
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Affiliation(s)
- Lire Lemma Tirore
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Desta Erkalo Abame
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Tagesse Sedoro
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Dejene Ermias
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Abinet Arega
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Tegegn Tadesse
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Selamu Abose Nadamo
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
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13
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File TM, Alexander E, Goldberg L, Das AF, Sandrock C, Paukner S, Moran GJ. Lefamulin efficacy and safety in a pooled phase 3 clinical trial population with community-acquired bacterial pneumonia and common clinical comorbidities. BMC Pulm Med 2021; 21:154. [PMID: 33964925 PMCID: PMC8105923 DOI: 10.1186/s12890-021-01472-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/17/2021] [Indexed: 01/22/2023] Open
Abstract
Background Lefamulin, a first-in-class pleuromutilin antibiotic approved for intravenous and oral use in adults with community-acquired bacterial pneumonia (CABP), was noninferior to moxifloxacin in the Lefamulin Evaluation Against Pneumonia (LEAP) 1 intravenous-to-oral switch study and the LEAP 2 oral-only study. Using pooled LEAP 1/2 data, we examined lefamulin efficacy/safety overall and within subgroups of patients presenting with comorbidities typical in CABP management. Methods In LEAP 1, adults with CABP were randomized to receive intravenous lefamulin (150 mg every 12 h) for 5‒7 days or moxifloxacin (400 mg every 24 h) for 7 days, with optional intravenous-to-oral switch if predefined improvement criteria were met. In LEAP 2, adults with CABP were randomized to receive oral lefamulin (600 mg every 12 h) for 5 days or moxifloxacin (400 mg every 24 h) for 7 days. Both studies assessed early clinical response (ECR) at 96 ± 24 h after first study drug dose and investigator assessment of clinical response (IACR) at test-of-cure (5‒10 days after last dose). Pooled analyses of the overall population used a 10% noninferiority margin. Results Lefamulin (n = 646) was noninferior to moxifloxacin (n = 643) for ECR (89.3% vs 90.5%, respectively; difference − 1.1%; 95% CI − 4.4 to 2.2); IACR success rates at test-of-cure were similarly high (≥ 85.0%). High efficacy with both lefamulin and moxifloxacin was also demonstrated across all well-represented patient subgroups, including those with advanced age, diabetes mellitus, a history of cardiovascular diseases (e.g., hypertension, congestive heart failure, or arrhythmia) or chronic lung diseases (e.g., asthma or chronic obstructive pulmonary disease), elevated liver enzymes, or mild-to-moderate renal dysfunction. No new safety signals were identified. Conclusions Lefamulin may provide a valuable intravenous/oral monotherapy alternative to fluoroquinolones or macrolides for empiric treatment of patients with CABP, including cases of patients at risk for poor outcomes due to age or various comorbidities. Trial registration ClinicalTrials.gov LEAP 1 (NCT02559310; Registration Date: 24/09/2015) and LEAP 2 (NCT02813694; Registration Date: 27/06/2016). Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01472-z.
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Affiliation(s)
| | - Elizabeth Alexander
- Nabriva Therapeutics US, Inc., Fort Washington, PA, USA. .,Vir Biotechnology, Inc., 499 Illinois Street, Suite 500, San Francisco, CA, 94158, USA.
| | - Lisa Goldberg
- Nabriva Therapeutics US, Inc., Fort Washington, PA, USA
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14
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Mallia P, Meghji J, Wong B, Kumar K, Pilkington V, Chhabra S, Russell B, Chen J, Srikanthan K, Park M, Owles H, Liew F, Alcada J, Martin L, Coleman M, Elkin S, Ross C, Agrawal S, Gardiner T, Bell A, White A, Hampson D, Vithlani G, Manalan K, Bramer S, Martin Segura A, Kucheria A, Ratnakumar P, Sheeka A, Anandan L, Copley S, Russell G, Bloom CI, Kon OM. Symptomatic, biochemical and radiographic recovery in patients with COVID-19. BMJ Open Respir Res 2021; 8:8/1/e000908. [PMID: 33827856 PMCID: PMC8029037 DOI: 10.1136/bmjresp-2021-000908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 11/12/2022] Open
Abstract
Background The symptoms, radiography, biochemistry and healthcare utilisation of patients with COVID-19 following discharge from hospital have not been well described. Methods Retrospective analysis of 401 adult patients attending a clinic following an index hospital admission or emergency department attendance with COVID-19. Regression models were used to assess the association between characteristics and persistent abnormal chest radiographs or breathlessness. Results 75.1% of patients were symptomatic at a median of 53 days post discharge and 72 days after symptom onset and chest radiographs were abnormal in 47.4%. Symptoms and radiographic abnormalities were similar in PCR-positive and PCR-negative patients. Severity of COVID-19 was significantly associated with persistent radiographic abnormalities and breathlessness. 18.5% of patients had unscheduled healthcare visits in the 30 days post discharge. Conclusions Patients with COVID-19 experience persistent symptoms and abnormal blood biomarkers with a gradual resolution of radiological abnormalities over time. These findings can inform patients and clinicians about expected recovery times and plan services for follow-up of patients with COVID-19.
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Affiliation(s)
- Patrick Mallia
- Imperial College Healthcare NHS Trust, London, UK .,National Heart and Lung Institute, Imperial College, London, UK
| | - Jamilah Meghji
- Imperial College Healthcare NHS Trust, London, UK.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Brandon Wong
- Imperial College Healthcare NHS Trust, London, UK
| | - Kartik Kumar
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Ben Russell
- Imperial College Healthcare NHS Trust, London, UK
| | - Jian Chen
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Mirae Park
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Joana Alcada
- Imperial College Healthcare NHS Trust, London, UK
| | - Laura Martin
- Imperial College Healthcare NHS Trust, London, UK
| | - Meg Coleman
- Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Elkin
- Imperial College Healthcare NHS Trust, London, UK
| | - Clare Ross
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Aaron Bell
- Imperial College Healthcare NHS Trust, London, UK
| | - Alice White
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | - Solange Bramer
- Imperial College School of Medicine, Imperial College, London, UK
| | | | | | | | | | | | - Susan Copley
- Radiology Department, Imperial College Healthcare NHS Trust, London, UK
| | | | - Chloe I Bloom
- National Heart and Lung Institute, Imperial College, London, UK
| | - Onn Min Kon
- Imperial College Healthcare NHS Trust, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
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15
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Abstract
Pneumonia is a common acute respiratory infection that affects the alveoli and distal airways; it is a major health problem and associated with high morbidity and short-term and long-term mortality in all age groups worldwide. Pneumonia is broadly divided into community-acquired pneumonia or hospital-acquired pneumonia. A large variety of microorganisms can cause pneumonia, including bacteria, respiratory viruses and fungi, and there are great geographical variations in their prevalence. Pneumonia occurs more commonly in susceptible individuals, including children of <5 years of age and older adults with prior chronic conditions. Development of the disease largely depends on the host immune response, with pathogen characteristics having a less prominent role. Individuals with pneumonia often present with respiratory and systemic symptoms, and diagnosis is based on both clinical presentation and radiological findings. It is crucial to identify the causative pathogens, as delayed and inadequate antimicrobial therapy can lead to poor outcomes. New antibiotic and non-antibiotic therapies, in addition to rapid and accurate diagnostic tests that can detect pathogens and antibiotic resistance will improve the management of pneumonia.
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16
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Galal I, Hussein AARM, Amin MT, Saad MM, Zayan HEE, Abdelsayed MZ, Moustafa MM, Ezzat AR, Helmy RED, Abd_Elaal HK, Al Massry NA, Soliman MA, Ismail AM, Kholief KMS, Fathy E, Hashem MK. Determinants of persistent post-COVID-19 symptoms: value of a novel COVID-19 symptom score. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [PMCID: PMC7863043 DOI: 10.1186/s43168-020-00049-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Being a newly emerging disease, little is known about its long-lasting post-COVID-19 consequences. The aim of this work is to assess the frequency, patterns, and determinants of persistent post-COVID-19 symptoms and to evaluate the value of a proposed novel COVID-19 symptom score. Patients with confirmed COVID-19 in a hospital-based registry were included in a cross-sectional study (the hospitals including Assiut University Hospital, Assiut Chest Hospital, Aswan University Hospital, and Aswan Specialized Hospital). The patient demographics, comorbid disorders, the mean duration since the onset of the symptoms, history of hospital or ICU admittance, and the treatment taken during the acute state, as well as symptom score before and after convalescence, were recorded. Results The most frequent constitutional and neurological symptoms were myalgia (60.0%), arthralgia (57.2%), restriction of daily activities (57.0%), and sleeping troubles (50.9%), followed by anorexia (42.6%), chest pain (32.6%), gastritis (32.3%), cough (29.3%), and dyspnea (29.1%). The mean total score of acute stage symptoms was 31.0 ± 16.3 while post-COVID 19 symptom score was 13.1 ± 12.6 (P < 0.001). The main determinants of the persistent post-COVID-19 symptoms were the need for oxygen therapy (P < 0.001), pre-existing hypertension (P = 0.039), chronic pulmonary disorders (P = 0.012), and any chronic comorbidity (P = 0.004). There was a correlation between the symptom score during the acute attack and post-COVID-19 stage (P < 0.001, r = 0.67). The acute phase score had 83.5% sensitivity and 73.3% specificity for the cutoff point > 18 to predict occurrence of post-COVID-19 symptoms. Conclusions COVID-19 can present with a diverse spectrum of long-term post-COVID-19 symptoms. Increased acute phase symptom severity and COVID-19 symptom score > 18 together with the presence of any comorbid diseases increase the risk for persistent post-COVID-19 manifestations and severity.
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17
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Abstract
Among the most common causes of U.S. adult hospitalizations, pneumonia accounted for nearly 50,000 deaths in the United States in 2017. This article provides nurses with a thorough update on pneumonia risk factors, signs and symptoms, and diagnostic criteria, as well as inpatient treatment recommendations and recommendations for discharge and prevention, including the nurse's role in patient and family teaching. The article also details key similarities and differences between the new 2019 guideline jointly developed by the American Thoracic Society and the Infectious Diseases Society of America on diagnosis and treatment of adults with community-acquired pneumonia and their earlier 2007 guideline. One crucial difference is the growing recognition that the etiology of pneumonia is changing, necessitating the abandonment of prior categorizations of pneumonia type when determining antibiotic coverage in favor of reliance on local epidemiology and validated risk factors for antimicrobial resistance.
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18
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Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, Walshaw C, Kemp S, Corrado J, Singh R, Collins T, O'Connor RJ, Sivan M. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol 2020; 93:1013-1022. [PMID: 32729939 DOI: 10.1002/jmv.26368] [Citation(s) in RCA: 742] [Impact Index Per Article: 185.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is currently very limited information on the nature and prevalence of post-COVID-19 symptoms after hospital discharge. METHODS A purposive sample of 100 survivors discharged from a large University hospital were assessed 4 to 8 weeks after discharge by a multidisciplinary team of rehabilitation professionals using a specialist telephone screening tool designed to capture symptoms and impact on daily life. EQ-5D-5L telephone version was also completed. RESULTS Participants were between 29 and 71 days (mean 48 days) postdischarge from hospital. Thirty-two participants required treatment in intensive care unit (ICU group) and 68 were managed in hospital wards without needing ICU care (ward group). New illness-related fatigue was the most common reported symptom by 72% participants in ICU group and 60.3% in ward group. The next most common symptoms were breathlessness (65.6% in ICU group and 42.6% in ward group) and psychological distress (46.9% in ICU group and 23.5% in ward group). There was a clinically significant drop in EQ5D in 68.8% in ICU group and in 45.6% in ward group. CONCLUSIONS This is the first study from the United Kingdom reporting on postdischarge symptoms. We recommend planning rehabilitation services to manage these symptoms appropriately and maximize the functional return of COVID-19 survivors.
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Affiliation(s)
- Stephen J Halpin
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK.,National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Claire McIvor
- Department of Physiotherapy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Gemma Whyatt
- National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anastasia Adams
- National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Olivia Harvey
- National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lyndsay McLean
- Department of Occupational Therapy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Christopher Walshaw
- Department of Occupational Therapy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Steven Kemp
- School of Psychology, Leeds Beckett University, Leeds, UK
| | - Joanna Corrado
- National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rajinder Singh
- National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Rory J O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK.,National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Manoj Sivan
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK.,National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Community Healthcare NHS Trust, Leeds, UK
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Lloyd MA, Tang CY, Callander EJ, Janus ED, Karahalios A, Skinner EH, Lowe S, Karunajeewa HA. Patient-reported outcome measurement in community-acquired pneumonia: feasibility of routine application in an elderly hospitalized population. Pilot Feasibility Stud 2019; 5:97. [PMID: 31372236 PMCID: PMC6661077 DOI: 10.1186/s40814-019-0481-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/19/2019] [Indexed: 01/25/2023] Open
Abstract
Background Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, but few studies have evaluated the feasibility of routine patient-reported outcome measures (PROMs) in this illness. This study investigates the feasibility and limitations of three credible PROM instruments in a representative hospitalized cohort to identify potential barriers to routine application. Methods A sample of multimorbid hospitalized subjects meeting a standardized CAP definition was recruited. Demographic and clinical data of those able and unable to participate in PROM assessment were compared. The EQ-5D-5L, CAP-Sym 18 Questionnaire, and Late-Life Function and Disability Instrument (LLFDI) were administered (via face-to-face interview) at admission and discharge and (via phone interview or mail) at 30 and 90 days post-discharge. Feasibility measures included the proportion of individuals able to participate in assessment, attrition rates, data completeness, and instrument completion times. Scores at admission and 30 days post-discharge were examined for association with age. Results Of 82 subjects screened, 44 (54%) participated. Cognitive impairment (n = 12, 15%) commonly precluded participation. Seventeen (39%) participants were lost to follow-up by 90 days. Missing data at item level was negligible for all instruments, regardless of the mode of completion. Completion of the three instruments collectively in a face-to-face interview took a median of 17 min (IQ range 13-21) per participant. The burden of reported symptoms at admission was higher for younger participants aged 18-74 years (mean (standard deviation)) CAP-Sym 18 score at admission 34.2 (18.6) vs. 19.0 (11.3) for those aged ≥ 75 years. Conclusions Routine application of PROMs can provide valuable information relating to multiple aspects of clinical recovery for individuals hospitalized with CAP. However, heterogeneous demographic characteristics and complex underlying health status introduce challenges to feasibility and interpretability of these instruments in this population. Trial registration ClinicalTrials.gov, NCT02835040.
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Affiliation(s)
- Melanie A Lloyd
- 1Department of Physiotherapy, Western Health, St Albans, Victoria 3021 Australia.,2Melbourne Medical School - Western Precinct, The University of Melbourne, St Albans, Victoria 3021 Australia
| | - Clarice Y Tang
- 1Department of Physiotherapy, Western Health, St Albans, Victoria 3021 Australia.,3Department of Physiotherapy, La Trobe University, Bundoora, Victoria 3000 Australia.,4Department of Physiotherapy, Western Sydney University, Penrith, New South Wales 2751 Australia
| | - Emily J Callander
- 5School of Medicine, Griffith University, Southport, Queensland 4215 Australia
| | - Edward D Janus
- 2Melbourne Medical School - Western Precinct, The University of Melbourne, St Albans, Victoria 3021 Australia.,6General Internal Medicine Unit, Western Health, Sunshine Hospital, St Albans, Victoria 3021 Australia
| | - Amalia Karahalios
- 7Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010 Australia
| | - Elizabeth H Skinner
- 1Department of Physiotherapy, Western Health, St Albans, Victoria 3021 Australia.,8Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria 3010 Australia.,9Department of Physiotherapy, School of Primary Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199 Australia
| | - Stephanie Lowe
- 1Department of Physiotherapy, Western Health, St Albans, Victoria 3021 Australia
| | - Harin A Karunajeewa
- 2Melbourne Medical School - Western Precinct, The University of Melbourne, St Albans, Victoria 3021 Australia.,6General Internal Medicine Unit, Western Health, Sunshine Hospital, St Albans, Victoria 3021 Australia.,10The Walter and Eliza Hall Institute of Medical Research, Parkville, 3052 Victoria Australia
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Pick HJ, Bolton CE, Lim WS, McKeever TM. Patient-reported outcome measures in the recovery of adults hospitalised with community-acquired pneumonia: a systematic review. Eur Respir J 2019; 53:13993003.02165-2018. [PMID: 30635298 DOI: 10.1183/13993003.02165-2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/19/2018] [Indexed: 11/05/2022]
Abstract
Symptomatic and functional recovery are important patient-reported outcome measures (PROMs) in community-acquired pneumonia (CAP) that are increasingly used as trial end-points. This systematic review summarises the literature on PROMs in CAP.Comprehensive searches in accordance with the PRISMA statement were conducted to March 2017. Eligible studies included adults discharged from hospital following confirmed CAP and reporting PROMs.15 studies (n=5644 patients) were included; most were of moderate quality. Studies used a wide range of PROMs and assessment tools. At 4-6 weeks post-discharge, the commonest symptom reported was fatigue (45.0-72.6% of patients, three studies), followed by cough (35.3-69.7%) and dyspnoea (34.2-67.1%); corresponding values from studies restricted by age <65 years (two studies) were lower: fatigue 12.1-25.7%, cough 19.9-31.9% and dyspnoea 16.8-27.5%. Functional impairment 4 weeks post-discharge was reported in 18-51% of patients (two studies), while median time to return to normal activities was between 15 and 28 days (three studies).Substantial morbidity is reported by patients up to 6 weeks post-discharge. There is weak methodological consistency across existing studies. A core set of PROMs for use in future studies is suggested.
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Affiliation(s)
- Harry J Pick
- Dept of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Charlotte E Bolton
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Nottingham, UK
| | - Wei Shen Lim
- Dept of Respiratory Medicine, Nottingham University Hospital NHS Trust, Nottingham, UK.,NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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Waterer G. Recovery from community acquired pneumonia: the view from the top of the iceberg. Eur Respir J 2017; 49:49/6/1700571. [DOI: 10.1183/13993003.00571-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 11/05/2022]
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