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Ruiz-Gaviria R, Marroquin-Rivera A, Pardi MD, Ross RW. Adherence to use of blood cultures according to current national guidelines and their impact in patients with community acquired pneumonia: A retrospective cohort. J Infect Chemother 2023; 29:646-653. [PMID: 36898501 DOI: 10.1016/j.jiac.2023.03.001] [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: 11/14/2022] [Revised: 02/25/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Community acquired pneumonia (CAP) is the most frequent cause of mortality secondary to infectious etiologies. Recommendations about the use of blood cultures in the diagnosis and treatment of CAP has been a contentious topic of debate and ever-changing recommendations. METHODS A cohort study was conducted in a community teaching hospital. All the patients that were admitted with a diagnosis of CAP, between January and December of 2019 were included. Sociodemographic and clinical characteristics were obtained. Blood cultures results were obtained, and it was evaluated if they were done in compliance with current recommendations by the Infectious Disease Society of America (IDSA). RESULTS 721 patients were included in the study. Median age was 68 years and 50% of the patients were male (n = 293). Patients presented from home (84%) and the most common comorbidities were hypertension and diabetes (68% and 31%). 96 patients had positive blood culture and 34% (n = 247) of all the blood cultures were adequately ordered. 80 patients died or went to hospice and the median length of hospital stay in our cohort was 7 days. The multivariate model showed that mortality was associated with positive blood cultures (OR = 3.1 95%CI 1.63-5.87) and appropriateness of blood cultures (OR = 2.96 95% CI 1.2-5.7). CONCLUSION Adequate use of blood cultures in patients with CAP might have some association with the outcomes of this disease. However, a prospective study evaluating the utility of this test following current IDSA recommendations is needed to understand their impact in mortality and morbidity.
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Affiliation(s)
- Rafael Ruiz-Gaviria
- Department of Medicine, Ascension Saint Agnes Hospital, Baltimore, MD, USA; Department of Medicine, Infectious Disease Section, Medstar Washington Hospital Center, Washington, DC, USA.
| | | | - Maria D Pardi
- Department of Medicine, Ascension Saint Agnes Hospital, Baltimore, MD, USA
| | - Robert W Ross
- Department of Medicine, Ascension Saint Agnes Hospital, Baltimore, MD, USA
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Epelboin L, Mahamat A, Bonifay T, Demar M, Abboud P, Walter G, Drogoul AS, Berlioz-Arthaud A, Nacher M, Raoult D, Djossou F, Eldin C. Q Fever as a Cause of Community-Acquired Pneumonia in French Guiana. Am J Trop Med Hyg 2022; 107:407-415. [PMID: 35977720 PMCID: PMC9393466 DOI: 10.4269/ajtmh.21-0711] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
In French Guiana, community-acquired pneumonia (CAP) represents over 90% of Coxiella burnetii acute infections. Between 2004 and 2007, we reported that C. burnetii was responsible for 24.4% of the 131 CAP hospitalized in Cayenne. The main objective of the present study was to determine whether the prevalence of Q fever pneumonia remained at such high levels. The secondary objectives were to identify new clinical characteristics and risk factors for C. burnetii pneumonia. A retrospective case-control study was conducted on patients admitted in Cayenne Hospital, between 2009 and 2012. All patients with CAP were included. The diagnosis of acute Q fever relied on titers of phase II IgG ≥ 200 and/or IgM ≥ 50 or seroconversion between two serum samples. Patients with Q fever were compared with patients with non-C. burnetii CAP in bivariate and multivariate analyses. During the 5-year study, 275 patients with CAP were included. The etiology of CAP was identified in 54% of the patients. C. burnetii represented 38.5% (106/275; 95% CI: 31.2-45.9%). In multivariate analysis, living in Cayenne area, being aged 30-60 years, C-reactive protein (CRP) > 185 mg/L, and leukocyte count < 10 G/L were independently associated with Q fever. The prevalence of Q fever among CAP increased to 38.5%. This is the highest prevalence ever reported in the world. This high prevalence justifies the systematic use of doxycycline in addition to antipneumococcal antibiotic regimens.
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Affiliation(s)
- Loïc Epelboin
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, Guyane française
| | - Aba Mahamat
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- Corsica Centre for Healthcare-Associated Infections Control and Prevention, Hôpital Eugénie, Ajaccio, France
| | - Timothée Bonifay
- Département Universitaire de Médecine Générale, Université des Antilles, Pointe-à-Pitre, Guadeloupe
| | - Magalie Demar
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, Guyane française
- Laboratoire Hospitalo-Universitaire de Parasitologie et Mycologie, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, Guyane française
| | - Philippe Abboud
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, Guyane française
| | - Gaëlle Walter
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | | | | | - Mathieu Nacher
- Centre d’Investigation Clinique, CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | | | - Félix Djossou
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, Guyane française
| | - Carole Eldin
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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Echaniz-Aviles G, Garza-González E, Román-Mancha AL, Morfín-Otero R, Rodríguez-Noriega E, Ayala-Gaytán JJ, Guajardo-Lara CE, Soto-Nogueron A, Carnalla-Barajas MN, Camacho-Ortiz A. Clinical and microbiological characteristics of community-acquired pneumonia associated with Streptococcus pneumoniae in adult patients in Mexico. Rev Argent Microbiol 2019; 51:234-240. [PMID: 30635204 DOI: 10.1016/j.ram.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/29/2018] [Accepted: 10/09/2018] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to assess the risk factors and clinical and microbiological characteristics of community-acquired pneumonia (CAP) in adult patients in Mexico. Streptococcus pneumoniae classified as the causative agent of CAP in adult patients and patients with invasive S. pneumoniae isolates presented to three tertiary teaching hospitals during the 15-year study period were selected. Serotyping and susceptibility testing were performed for all included isolates. Clinical and demographic data were recorded. A total of 96 patients infected with S. pneumoniae (71 with CAP, 25 with invasive disease) were included. The CAP group involved more males (74.6%) than the invasive disease group (p=0.03). Head trauma was more common in the CAP group (21.1%) than in the invasive disease group (4.0%; p=0.03). The most prevalent serotype was 19A, followed by serotypes 3 and 23F. After the introduction of the heptavalent conjugated pneumococcal vaccine (PCV7), the prevalence of included serotypes declined significantly; no such change was found after the introduction of the PCV13 vaccine, including in the prevalence of serotype 19A. Susceptibility to all antimicrobials tested except vancomycin declined over the study period. In conclusion, head trauma was the most common comorbidity in the CAP group. The most prevalent serotype was 19A. Decreased susceptibility to most antimicrobials tested was observed.
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Affiliation(s)
| | - Elvira Garza-González
- Servicio de Gastroenterología y Departamento de Patología Clínica, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Alma Lucía Román-Mancha
- Coordinación de Epidemiología Hospitalaria, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Rayo Morfín-Otero
- Departamento de Infectología, Hospital Civil Fray Antonio Alcalde, e Instituto de Patología Infecciosa, Guadalajara, Jalisco, Mexico
| | - Eduardo Rodríguez-Noriega
- Departamento de Infectología, Hospital Civil Fray Antonio Alcalde, e Instituto de Patología Infecciosa, Guadalajara, Jalisco, Mexico
| | | | | | | | | | - Adrián Camacho-Ortiz
- Coordinación de Epidemiología Hospitalaria, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
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Teresa Aguado M, Barratt J, Beard JR, Blomberg BB, Chen WH, Hickling J, Hyde TB, Jit M, Jones R, Poland GA, Friede M, Ortiz JR. Report on WHO meeting on immunization in older adults: Geneva, Switzerland, 22-23 March 2017. Vaccine 2018; 36:921-931. [PMID: 29336923 PMCID: PMC5865389 DOI: 10.1016/j.vaccine.2017.12.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 12/30/2022]
Abstract
Many industrialized countries have implemented routine immunization policies for older adults, but similar strategies have not been widely implemented in low- and middle-income countries (LMICs). In March 2017, the World Health Organization (WHO) convened a meeting to identify policies and activities to promote access to vaccination of older adults, specifically in LMICs. Participants included academic and industry researchers, funders, civil society organizations, implementers of global health interventions, and stakeholders from developing countries with adult immunization needs. These experts reviewed vaccine performance in older adults, the anticipated impact of adult vaccination programs, and the challenges and opportunities of building or strengthening an adult and older adult immunization platforms. Key conclusions of the meeting were that there is a need for discussion of new opportunities for vaccination of all adults as well as for vaccination of older adults, as reflected in the recent shift by WHO to a life-course approach to immunization; that immunization in adults should be viewed in the context of a much broader model based on an individual's abilities rather than chronological age; and that immunization beyond infancy is a global priority that can be successfully integrated with other interventions to promote healthy ageing. As WHO is looking ahead to a global Decade of Healthy Ageing starting in 2020, it will seek to define a roadmap for interdisciplinary collaborations to integrate immunization with improving access to preventive and other healthcare interventions for adults worldwide.
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Affiliation(s)
| | - Jane Barratt
- International Federation on Ageing, Toronto, Canada.
| | - John R Beard
- Ageing and Life Course, World Health Organization, Geneva, Switzerland.
| | - Bonnie B Blomberg
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Wilbur H Chen
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA.
| | | | - Terri B Hyde
- Vaccine Introduction Team, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom; Modelling and Economics Unit, Public Health England, London, United Kingdom.
| | | | - Gregory A Poland
- Mayo Vaccine Research Group, Mayo Clinic and Foundation, Rochester, MN, USA.
| | - Martin Friede
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland.
| | - Justin R Ortiz
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland.
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