1
|
Zubair M. Clinical applications of artificial intelligence in identification and management of bacterial infection: Systematic review and meta-analysis. Saudi J Biol Sci 2024; 31:103934. [PMID: 38304541 PMCID: PMC10831261 DOI: 10.1016/j.sjbs.2024.103934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024] Open
Abstract
Pneumonia is declared a global emergency public health crisis in children less than five age and the geriatric population. Recent advancements in deep learning models could be utilized effectively for the timely and early diagnosis of pneumonia in immune-compromised patients to avoid complications. This systematic review and meta-analysis utilized PRISMA guidelines for the selection of ten articles included in this study. The literature search was done through electronic databases including PubMed, Scopus, and Google Scholar from 1st January 2016 till 1 July 2023. Overall studies included a total of 126,610 images and 1706 patients in this meta-analysis. At a 95% confidence interval, for pooled sensitivity was 0.90 (0.85-0.94) and I2 statistics 90.20 (88.56 - 91.92). The pooled specificity for deep learning models' diagnostic accuracy was 0.89 (0.86---0.92) and I2 statistics 92.72 (91.50 - 94.83). I2 statistics showed low heterogeneity across studies highlighting consistent and reliable estimates, and instilling confidence in these findings for researchers and healthcare practitioners. The study highlighted the recent deep learning models single or in combination with high accuracy, sensitivity, and specificity to ensure reliable use for bacterial pneumonia identification and differentiate from other viral, fungal pneumonia in children and adults through chest x-rays and radiographs.
Collapse
Affiliation(s)
- Mohammad Zubair
- Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk 71491, Kingdom of Saudi Arabia
| |
Collapse
|
2
|
Geng Y, Hao Y, Xu X, Huang R, He F, Ni J, Zhan J, Chen Y, Hu F, Wu C. Clinical features and viral etiology of acute respiratory infection in an outpatient fever clinic during COVID-19 pandemic in a tertiary hospital in Nanjing, China. J Clin Lab Anal 2022; 36:e24778. [PMID: 36447425 PMCID: PMC9756996 DOI: 10.1002/jcla.24778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/27/2022] [Accepted: 11/08/2022] [Indexed: 12/10/2023] Open
Abstract
BACKGROUND Clinical feature and viral etiology for acute respiratory infection (ARI) in the community was unknown during coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE In a retrospective study, we aimed to characterize the clinical feature and etiology for the ARI patients admitted to the outpatient fever clinic in Nanjing Drum Tower Hospital between November 2020 and March 2021. METHODS Fifteen common respiratory pathogens were tested using pharyngeal swabs by multiplex reverse transcriptase-polymerase chain reaction assays. RESULTS Of the 242 patients, 56 (23%) were tested positive for at least one viral agent. The predominant viruses included human rhinovirus (HRV) (5.4%), parainfluenza virus type III (PIV-III) (5.0%), and human coronavirus-NL63 (HCoV-NL63) (3.7%). Cough, sputum, nasal obstruction, and rhinorrhea were the most prevalent symptoms in patients with viral infection. Elderly and the patients with underlying diseases were susceptible to pneumonia accompanied with sputum and chest oppression. Three (5.4%) patients in virus infection group, whereas 31 (16.7%) in non-viral infection group (p = 0.033), were empirically prescribed with antiviral agents. Among 149 patients who received antibiotic therapy, 30 (20.1%) patients were later identified with viral infection. CONCLUSION Our study indicated the importance of accurate diagnosis of ARI, especially during the COVID-19 pandemic, which might facilitate appropriate clinical treatment.
Collapse
Affiliation(s)
- Yu Geng
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western MedicineNanjing University of Chinese MedicineNanjingChina
| | - Yingying Hao
- Department of Intensive Care UnitsNanjing Drum Tower Hospital, Nanjing University Medical SchoolNanjingChina
| | - Xiaoming Xu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western MedicineNanjing University of Chinese MedicineNanjingChina
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western MedicineNanjing University of Chinese MedicineNanjingChina
| | - Fei He
- Department of Emergency MedicineNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Jun Ni
- Department of Laboratory MedicineNanjing Drum Tower Hospital Clinical College of Jiangsu University, Jiangsu UniversityNanjingChina
| | - Jie Zhan
- Department of Infectious DiseasesNanjing Drum Tower Hospital, Clinical College of Nanjing Medical UniversityNanjingJiangsuChina
| | - Yuxin Chen
- Department of Laboratory MedicineNanjing Drum Tower Hospital Clinical College of Jiangsu University, Jiangsu UniversityNanjingChina
| | - FengHua Hu
- Department of Laboratory MedicineNanjing Drum Tower Hospital Clinical College of Jiangsu University, Jiangsu UniversityNanjingChina
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western MedicineNanjing University of Chinese MedicineNanjingChina
| |
Collapse
|
3
|
Hyun H, Song JY, Yoon JG, Seong H, Noh JY, Cheong HJ, Kim WJ. Risk factor-based analysis of community-acquired pneumonia, healthcare-associated pneumonia and hospital-acquired pneumonia: Microbiological distribution, antibiotic resistance, and clinical outcomes. PLoS One 2022; 17:e0270261. [PMID: 35767562 PMCID: PMC9242491 DOI: 10.1371/journal.pone.0270261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Healthcare-associated pneumonia (HCAP) lies in the intersection of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). Although HCAP is excluded from the revised HAP guideline, reassessment for HCAP is needed considering its heterogeneous characteristics.
Methods
The microbiological distribution, antibiotic resistance, and clinical outcomes in CAP, HCAP, and HAP were studied retrospectively. The susceptibility to standard CAP regimens (β-lactams plus macrolide or fluoroquinolone monotherapy) and rates of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (P. aeruginosa) infections were evaluated in the CAP group and HCAP subgroups.
Results
In total, 933 cases were included (CAP, n = 557; HCAP, n = 264; HAP, n = 112). In the CAP and HCAP cases, Streptococcus pneumoniae (7.4% vs. 5.7%) and P. aeruginosa (9.2% vs. 18.6%) were the most common gram-positive and gram-negative pathogens. Staphylococcus aureus (methicillin-resistant, 2.7%; methicillin-susceptible, 2.4%) and carbapenem-resistant Acinetobacter baumannii (20.5%) were the most common Gram-positive and Gram-negative pathogens in the HAP group, respectively. Higher susceptibility to levofloxacin was observed in CAP and HCAP isolates than that to β-lactam agents. However, levofloxacin non-susceptibility was significantly higher in long-term care facility (LTCF)-onset HCAP compared to community-onset HCAP (43.6% vs. 22.7%, P = 0.014).
Conclusion
HCAP showed higher rates of P. aeruginosa and MRSA infections than CAP. Empirical antipseudomonal therapy should be considered in the treatment of HCAP. Prior isolation of P. aeruginosa was the most important risk factor for P. aeruginosa infection.
Collapse
Affiliation(s)
- Hakjun Hyun
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Jin Gu Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye Seong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
4
|
Kim JY, Yang KS, Chung Y, Lee KB, Suh JW, Kim SB, Sohn JW, Yoon YK. Epidemiologic Characteristics and Clinical Significance of Respiratory Viral Infections Among Adult Patients Admitted to the Intensive Care Unit. Front Med (Lausanne) 2022; 9:829624. [PMID: 35685411 PMCID: PMC9171106 DOI: 10.3389/fmed.2022.829624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background The diagnosis of respiratory viral infections (RVIs) in critically ill patients is important for determining treatment options and adhering to infection-control protocols. However, data on the incidence and occurrence patterns of RVIs are scarce. We investigated the epidemiology and clinical impact of RVIs in critically ill patients. Methods This retrospective observational study was conducted in a tertiary hospital in South Korea between November 2014 and September 2020. Adult patients (≥ 18 years of age) who tested positive for an RVI by multiplex polymerase chain reaction (mPCR) and were admitted to the intensive care unit (ICU) were included in the study. Clinical characteristics and outcomes were obtained by reviewing electronic medical records. Pearson's χ2 test and Fisher's exact test, Mann-Whitney U test was used to compare between groups of patients. Trend analysis and the χ2-based Q test was used to analyze test behavior of physicians performing mPCR test. Results Among 22,517 patients admitted to the ICU during the study period, 2,222 (9.9%) underwent mPCR testing for an RVI. The median timing of mPCR testing after ICU admission was 1 day (IQR, 0-2). A total of 335 (15.1%) non-duplicative RVI-positive cases were included in the analysis. The incidence rate of RVIs in ICU patients was 30.45 per 10,000 patient-days. The most frequently detected RVI was influenza A (27.8%), followed by rhinovirus (25.4%). Thirty-two (9.6%) RVI-positive patients were diagnosed with upper respiratory infections, 193 (64.1%) with community-acquired, and 108 (35.9%) with hospital-acquired pneumonia. All-cause mortality and mortality related to respiratory tract infection (RTI) were 30.7% and 22.1%, respectively. The initial presentation of septic shock, requirement for mechanical ventilation, and lymphocytopenia were significant predictors of RTI-related mortality. Of the RVI-positive patients, 151 (45.1%) had nonviral coinfections and presented with higher clinical severity and longer hospital stays than patients infected solely with viral pathogens. Conclusion The incidence of RVIs in ICU patients is common. ICU patients with RVIs had high mortality and frequently presented with coinfections with nonviral pathogens, which were associated with a higher clinical severity than sole RVI. Increased testing for RVIs will enhance infection-control efforts and improve patient care.
Collapse
Affiliation(s)
- Jeong Yeon Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Kyung Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Youseung Chung
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Ki-Byung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Jin Woong Suh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Sun Bean Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| |
Collapse
|
5
|
Stokes K, Castaldo R, Federici C, Pagliara S, Maccaro A, Cappuccio F, Fico G, Salvatore M, Franzese M, Pecchia L. The use of artificial intelligence systems in diagnosis of pneumonia via signs and symptoms: A systematic review. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
6
|
Luyt CE, Hékimian G, Bréchot N, Chastre J. Viral Ventilator-Associated Pneumonia/Hospital-Acquired Pneumonia. Semin Respir Crit Care Med 2022; 43:310-318. [PMID: 35100650 DOI: 10.1055/s-0041-1740981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Among the viruses possibly responsible for hospital-acquired and ventilator-associated pneumonia, herpes simplex virus (HSV) is probably the most often involved: HSV reactivation is frequent in intensive care unit patients, and lung parenchymal infection (HSV bronchopneumonitis) has been well described, either using cytological signs of parenchymal involvement in cells obtained during bronchoalveolar lavage or using HSV virus load in the lower respiratory tract. Although treating patients with HSV bronchopneumonitis may be recommended, based on expert opinion, prophylactic or preemptive treatment of HSV reactivation should be avoided. Ventilator-associated pneumonia due to cytomegalovirus (CMV) is less frequent than HSV bronchopneumonitis, and more difficult to diagnose. No data exists on the impact of antiviral treatment on CMV pneumonia. The involvement of respiratory viruses has been described in patients with healthcare-associated pneumonia and hospital-acquired pneumonia, but their role in ventilator-associated pneumonia is not clear.
Collapse
Affiliation(s)
- Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris.,INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris
| | - Guillaume Hékimian
- Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris.,INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris
| | - Nicolas Bréchot
- Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris.,INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris
| | - Jean Chastre
- Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris.,INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris
| |
Collapse
|
7
|
Stokes K, Castaldo R, Franzese M, Salvatore M, Fico G, Pokvic LG, Badnjevic A, Pecchia L. A machine learning model for supporting symptom-based referral and diagnosis of bronchitis and pneumonia in limited resource settings. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
8
|
Normothermia in Patients With Sepsis Who Present to Emergency Departments Is Associated With Low Compliance With Sepsis Bundles and Increased In-Hospital Mortality Rate. Crit Care Med 2021; 48:1462-1470. [PMID: 32931189 DOI: 10.1097/ccm.0000000000004493] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To investigate the impact of normothermia on compliance with sepsis bundles and in-hospital mortality in patients with sepsis who present to emergency departments. DESIGN Retrospective multicenter observational study. PATIENTS Nineteen university-affiliated hospitals of the Korean Sepsis Alliance participated in this study. Data were collected regarding patients who visited emergency departments for sepsis during the 1-month period. The patients were divided into three groups based on their body temperature at the time of triage in the emergency department (i.e., hypothermia [< 36°C] vs normothermia [36-38°C] vs hyperthermia [> 38°C]). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 64,021 patients who visited emergency departments, 689 with community-acquired sepsis were analyzed (182 hyperthermic, 420 normothermic, and 87 hypothermic patients). The rate of compliance with the total hour-1 bundle was lowest in the normothermia group (6.0% vs 9.3% in hyperthermia vs 13.8% in hypothermia group; p = 0.032), the rate for lactate measurement was lowest in the normothermia group (62.1% vs 73.1% vs 75.9%; p = 0.005), and the blood culture rate was significantly lower in the normothermia than in the hyperthermia group (p < 0.001). The in-hospital mortality rates in the hyperthermia, normothermia, and hypothermia groups were 8.5%, 20.6%, and 30.8%, respectively (p < 0.001), but there was no significant association between compliance with sepsis bundles and in-hospital mortality. However, in a multivariate analysis, compared with hyperthermia, normothermia was significantly associated with an increased in-hospital mortality (odds ratio, 2.472; 95% CI, 1.005-6.080). This association remained significant even after stratifying patients by median lactate level. CONCLUSIONS Normothermia at emergency department triage was significantly associated with an increased risk of in-hospital mortality and a lower rate of compliance with the sepsis bundle. Despite several limitations, our findings suggest a need for new strategies to improve sepsis outcomes in this group of patients.
Collapse
|
9
|
Fragkou PC, Moschopoulos CD, Karofylakis E, Kelesidis T, Tsiodras S. Update in Viral Infections in the Intensive Care Unit. Front Med (Lausanne) 2021; 8:575580. [PMID: 33708775 PMCID: PMC7940368 DOI: 10.3389/fmed.2021.575580] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/02/2021] [Indexed: 12/15/2022] Open
Abstract
The advent of highly sensitive molecular diagnostic techniques has improved our ability to detect viral pathogens leading to severe and often fatal infections that require admission to the Intensive Care Unit (ICU). Viral infections in the ICU have pleomorphic clinical presentations including pneumonia, acute respiratory distress syndrome, respiratory failure, central or peripheral nervous system manifestations, and viral-induced shock. Besides de novo infections, certain viruses fall into latency and can be reactivated in both immunosuppressed and immunocompetent critically ill patients. Depending on the viral strain, transmission occurs either directly through contact with infectious materials and large droplets, or indirectly through suspended air particles (airborne transmission of droplet nuclei). Many viruses can efficiently spread within hospital environment leading to in-hospital outbreaks, sometimes with high rates of mortality and morbidity, thus infection control measures are of paramount importance. Despite the advances in detecting viral pathogens, limited progress has been made in antiviral treatments, contributing to unexpectedly high rates of unfavorable outcomes. Herein, we review the most updated data on epidemiology, common clinical features, diagnosis, pathogenesis, treatment and prevention of severe community- and hospital-acquired viral infections in the ICU settings.
Collapse
Affiliation(s)
- Paraskevi C. Fragkou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Charalampos D. Moschopoulos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Emmanouil Karofylakis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Theodoros Kelesidis
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| |
Collapse
|
10
|
Fullana Barceló MI, Asensio Rodriguez J, Artigues Serra F, Ferre Beltran A, Salva D'agosto P, Almodovar Garcia M, Lopez Bilbao MDC, Sanchis Cortés P, Reina Prieto J, Riera Jaume M. Epidemiological and clinical characteristics of community-acquired and nosocomial influenza cases and risk factors associated with complications: A four season analysis of all adult patients admitted in a tertiary hospital. Influenza Other Respir Viruses 2020; 15:352-360. [PMID: 33125178 PMCID: PMC8051698 DOI: 10.1111/irv.12823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/08/2023] Open
Abstract
Background Information on the characteristics of patients with nosocomial influenza and associated complications is scarce. This study compared epidemiological and clinical characteristics of patients admitted with hospital‐acquired influenza (HAI) to those with community‐acquired influenza (CAI) and analyzed risk factors associated with complications. Methods This retrospective, observational study included all adult patients with confirmed influenza virus infection admitted to Son Espases University Hospital during the influenza season in Spain (October to May) from 2012‐2013 to 2015‐2016. Symptom onset before admission was included as CAI, and 2 days after admission or within 48 hours after previous discharge were considered as HAI. Results Overall, 666 patients with laboratory‐confirmed influenza were included; 590 (88.6%) and 76 (11.4%) had CAI and HAI, respectively. Baseline characteristics and vaccination rates were similar in both groups. Patients with HAI had significantly fewer symptoms, less radiological alterations, and earlier microbiological diagnosis than those with CAI. Eighty‐five (14.4%) and 20 (27.6%) CAI and HAI patients, respectively, experienced at least one complication, including septic shock, admission to the intensive care unit, mechanical ventilation or evolution to death (any one, P = .003). Univariate and multivariate binary logistic regression was performed to assess independent risk factors associated with the occurrence of complications: nosocomial infection, diabetes, oseltamivir treatment, having received no vaccination, microbiological delay, dyspnea, and the state of confusion were the most important significant factors. Conclusions Our study shows the need to implement microbiological diagnostic measures in the first 48 hours to reduce HAI frequency and associated complications.
Collapse
Affiliation(s)
| | | | | | - Adrian Ferre Beltran
- Internal Medicine Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Pilar Salva D'agosto
- Internal Medicine Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | - Pilar Sanchis Cortés
- Department of Chemistry, University of Balearic Islands, Palma de Mallorca, Spain
| | - Jorge Reina Prieto
- Virology Unit, Clinical Microbiology Service, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Melchor Riera Jaume
- Infectious Diseases Section, Internal Medicine Department, Infectious Diseases and HIV Group, Hospital Universitario Son Espases, IDISBA, Palma de Mallorca, Spain
| |
Collapse
|
11
|
Rachow T, Lamik T, Kalkreuth J, Kurze S, Wagner K, Stier P, Hammersen FJ, Rüthrich MM, Winkelmann N, Klink A, Hilgendorf I, Hermann B, Lang S, Hochhaus A, von Lilienfeld-Toal M. Detection of community-acquired respiratory viruses in allogeneic stem-cell transplant recipients and controls-A prospective cohort study. Transpl Infect Dis 2020; 22:e13415. [PMID: 32779843 PMCID: PMC7404629 DOI: 10.1111/tid.13415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/28/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023]
Abstract
Background Community‐acquired respiratory viruses (CARV) cause upper and lower respiratory tract infections (URTI/LRTI) and may be life‐threatening for recipients of an allogeneic stem cell transplantation (allo‐SCT). Methods In a prospective study encompassing 4 winter‐seasons, we collected throat gargles (TG) at random time points from allo‐SCT recipients (patients) and controls and followed them up for at least 3 weeks including repetitive sampling and documentation of symptoms. A Multiplex‐PCR system to identify 20 CARV and Mycoplasma pneumoniae was used to detect CARV. Results One hundred ninety‐four patients with 426 TG and 273 controls with 549 TG were included. There were more patients with a positive test result (25% vs 11% in the controls), and the patients had a higher number of positive TG (70 = 16%) compared to controls (32 = 6%) (P < .001). Altogether, 115 viruses were detected. Multiple viruses in one TG (11/48, 34%) and prolonged shedding were only observed in patients (13/48, 27%). Patients had more RSV (18/83, 26%) and adenovirus (15/83, 21%) than controls (both viruses 2/32, 6%). Independent risk factors for the detection of CARV included age >40 years (OR 3.38, 95% CI 1.8‐6.4, P < .001) and presence of URTI‐symptoms (OR 3.22, 95% CI 1.9‐5.5, P < .001). No controls developed a LRTI or died whereas 4/48 (8%) patients developed a LRTI (coronavirus in 2, RSV in 1 and influenza A H1N1 in 1 patient). One patient died of CARV (influenza A H1N1). Conclusion Allo‐SCT‐recipients have more CARV‐infections, exhibit a different epidemiology, have more cases of co‐infection or prolonged shedding and have a higher rate of LRTI and mortality.
Collapse
Affiliation(s)
- Tobias Rachow
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Toni Lamik
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Jana Kalkreuth
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Stephanie Kurze
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Kathleen Wagner
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany.,Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie, Hans-Knöll-Institut, Jena, Germany
| | - Pia Stier
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany.,Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie, Hans-Knöll-Institut, Jena, Germany
| | - Friedrich J Hammersen
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Maria Madeleine Rüthrich
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Nils Winkelmann
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Anne Klink
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Inken Hilgendorf
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Beate Hermann
- Dianovis GmbH, Greiz, Germany.,Institut für Medizinische Mikrobiologie, Universitätsklinikum Jena, Jena, Germany
| | - Susanne Lang
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Marie von Lilienfeld-Toal
- Klinik für Innere Medizin II-Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany.,Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie, Hans-Knöll-Institut, Jena, Germany
| |
Collapse
|
12
|
Beyond personal protective equipment: adjunctive methods for control of healthcare-associated respiratory viral infections. Curr Opin Infect Dis 2020; 33:312-318. [PMID: 32657968 DOI: 10.1097/qco.0000000000000655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Prevention of nosocomial transmission of respiratory viruses is a priority in all healthcare settings and often achieved with the use of personal protective equipment. Several adjunctive infection prevention methods are in common use but their effectiveness in reducing healthcare-associated respiratory viral infections is unclear. In this review, recent advances regarding the effectiveness of several adjunctive infection prevention methods to reduce healthcare-associated respiratory viral infections are discussed. RECENT FINDINGS Training and education on hand hygiene guidelines, mandatory influenza vaccination for healthcare personnel, access to paid sick leave to reduce ill presenteeism, cohorting of patients with the same infection or clinical syndrome, neuraminidase inhibitor chemoprophylaxis during influenza outbreaks, and enhanced visitor restrictions in pediatric hospitals all have shown some degree of effectiveness in observational or quasi-experimental studies. SUMMARY Most of the studies evaluating the effect of adjunctive infection prevention methods on healthcare-associated respiratory viral infections are observational or quasi-experimental and are often combined with other interventions. Therefore, it is difficult to determine the precise effectiveness or efficacy of these interventions and more controlled trials are needed. Multimodal infection prevention policies are likely to be most effective in reducing healthcare-associated respiratory viral infections.
Collapse
|
13
|
Bajpai V, Gupta E, Mitra LG, Kumar H, Maiwall R, Soni KD, Gupta A. Spectrum of respiratory viral infections in liver disease patients with cirrhosis admitted in critical care unit. J Lab Physicians 2020; 11:356-360. [PMID: 31929704 PMCID: PMC6943874 DOI: 10.4103/jlp.jlp_6_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND: Clinical significance of respiratory viruses (RVs) as an etiology of pneumonia in liver disease patients with cirrhosis is usually underestimated. Therefore, the aim of this study was to evaluate the spectrum of RVs in cirrhotic patients with pneumonia admitted in critical care units (CCUs) and its impact on the clinical outcome of cirrhotic patients. MATERIAL AND METHOD: A prospective study was conducted in a tertiary care CCU, and consecutive cirrhotic patients with pneumonia were included. Bronchoalveolar lavage or throat swab/nasal swab was collected in viral transport medium for analysis of RVs by multiplex real-time polymerase chain reaction. A total of 135 cirrhotic patients were included, viral and bacterial etiology of pneumonia was identified, and analysis was done with the clinical outcome. RESULTS: Overall, RVs were detected in 30 (22.2%) cirrhotic patients and viral–bacterial coinfection in 16 (11.8%) cirrhotic patients. The most common virus detected was rhinovirus in 9 (30%) patients. Mortality in cirrhotic patients with RV infection was significantly higher in comparison to cirrhotic patients with no RV infection (25 [83.3%] and 11 [12.3%], respectively, P < 0.001). CONCLUSION: Respiratory viruses in cirrhotic patients with pneumonia are associated with poor clinical outcome.
Collapse
Affiliation(s)
- Vijeta Bajpai
- Departments of Clinical Virology, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Gupta
- Departments of Clinical Virology, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Lalita Gauri Mitra
- Critical Care and Anaesthesia, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Hemant Kumar
- Pulmonary Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Rakhi Maiwall
- Hepatology, Institute of Liver and Biliary Sciences, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Trauma and Critical Intensive Care Unit, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Department of Surgery, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
14
|
Esquinas AM, Vargas N. Pneumonia. VENTILATORY SUPPORT AND OXYGEN THERAPY IN ELDER, PALLIATIVE AND END-OF-LIFE CARE PATIENTS 2020. [PMCID: PMC7121799 DOI: 10.1007/978-3-030-26664-6_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pneumonia is a common cause of hospital admission and community-acquired pneumonia (CAP) is a growing health problem in developed country and worldwide. Elderly patients suffer from more severe disease, require intensive care unit (ICU) admission, and exhibit higher mortality compared with their younger counterparts. The immunological changes that occur with age called “immunosenescence” (decreased efficiency of the adaptive and innate immune systems) are known to be responsible for the increased susceptibility of elderly persons to infectious diseases and for their limited response to vaccines [1].
Collapse
Affiliation(s)
- Antonio M. Esquinas
- Intensive Care Unit, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Nicola Vargas
- Geriatric and Intensive Geriatric Care, Azienda Ospedaliera S.Giuseppe Moscati, Avellino, Italy
| |
Collapse
|
15
|
Ewig S, Kolditz M, Pletz MW, Chalmers J. Healthcare-associated pneumonia: is there any reason to continue to utilize this label in 2019? Clin Microbiol Infect 2019; 25:1173-1179. [PMID: 30825674 DOI: 10.1016/j.cmi.2019.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is an ongoing controversy on the role of the healthcare-associated pneumonia (HCAP) label in the treatment of patients with pneumonia. OBJECTIVE To provide an update of the literature on patients meeting criteria for HCAP between 2014 and 2018. SOURCES The review is based on a systematic literature search using PubMed-Central full-text archive of biomedical and life sciences literature at the U.S. National Institutes of Health's National Library of Medicine (NIH/NLM). CONTENT Studies compared clinical characteristics of patients with HCAP and community-acquired pneumonia (CAP). HCAP patients were older and had a higher comorbidity. Mortality rates in HCAP varied from 5% to 33%, but seemed lower than those cited in the initial reports. Criteria behind the HCAP classification differed considerably within populations. Microbial patterns differed in that there was a higher incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, and, to a lesser extent, enterobacteriaceae. Definitions and rates of multidrug-resistant (MDR) pneumonia also varied considerably. Broad-spectrum guideline-concordant treatment did not reduce mortality in four observational studies. The HCAP criteria performed poorly as a predictive tool to identify MDR pneumonia or pathogens not covered by treatment for CAP. A new score (Drug Resistance in Pneumonia, DRIP) outperformed HCAP in the prediction of MDR pathogens. Comorbidity and functional status, but not different microbial patterns, seem to account for increased mortality. IMPLICATIONS HCAP should no longer be used to identify patients at risk of MDR pathogens. The use of validated predictive scores along with implementation of de-escalation strategies and careful individual assessment of comorbidity and functional status seem superior strategies for clinical management.
Collapse
Affiliation(s)
- S Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Herne und Bochum, Germany.
| | - M Kolditz
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - M W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - J Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| |
Collapse
|
16
|
Heo JY, Song JY. Disease Burden and Etiologic Distribution of Community-Acquired Pneumonia in Adults: Evolving Epidemiology in the Era of Pneumococcal Conjugate Vaccines. Infect Chemother 2018; 50:287-300. [PMID: 30600652 PMCID: PMC6312904 DOI: 10.3947/ic.2018.50.4.287] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Indexed: 12/23/2022] Open
Abstract
Pneumonia is the leading cause of morbidity and mortality, particularly in old adults. The incidence and etiologic distribution of community-acquired pneumonia is variable both geographically and temporally, and epidemiology might evolve with the change of population characteristics and vaccine uptake rates. With the increasing prevalence of chronic medical conditions, a wide spectrum of healthcare-associated pneumonia could also affect the epidemiology of community-acquired pneumonia. Here, we provide an overview of the epidemiological changes associated with community-acquired pneumonia over the decades since pneumococcal conjugate vaccine introduction.
Collapse
Affiliation(s)
- Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Asian Pacific Influenza Institute, Korea University College of Medicine, Seoul, Korea.
| |
Collapse
|
17
|
Korczyński P, Górska K, Konopka D, Al-Haj D, Filipiak KJ, Krenke R. Significance of congestive heart failure as a cause of pleural effusion: Pilot data from a large multidisciplinary teaching hospital. Cardiol J 2018; 27:254-261. [PMID: 30406935 DOI: 10.5603/cj.a2018.0137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/06/2018] [Accepted: 10/28/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Epidemiological data on the causes of pleural effusion (PE) are scarce. Data on the local prevalence of various causes of PE may play a crucial role in the management strategy of patients with PE. The aim of the study was to investigate the causes of PE and to assess 30-day mortality rate in unselected adult patients treated in a large, multidisciplinary hospital. METHODS Retrospective analysis of medical records, including chest radiographs, of 2835 consecutive patients admitted to the hospital was performed. Radiograhic signs of PE were found in 195 of 1936 patients in whom chest radigraphs were available. These patients formed the study group. RESULTS The leading causes of PE were as follows: congestive heart failure (CHF; 37.4%), pneumonia (19.5%), malignancy (15.4%), liver cirrhosis (4.2%) and pulmonary embolism. The cause of PE in 6.7% patients was not established. There was a significant predominance of small volume PE as compared to a moderate or large volume PEs (153, 28 and 14 patients, respectively). Almost 80% of patients with CHF presented with small volume PE, while almost 50% of patients with malignant PE demonstrated moderate or large volume PE. Thirty-day mortality rate ranged from 0% for tuberculous pleurisy to 40% for malignant PE (MPE). CONCLUSIONS Pleural effusion was found in 10.1% of patients treated in a large multidisciplinary hospital. CHF was the leading cause of PE. Although 30-day mortality in patients with CHF was rela-tively high, it was lower than that in parapneumonic PE and MPE.
Collapse
Affiliation(s)
- Piotr Korczyński
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Poland
| | - Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Poland.
| | - Damian Konopka
- Students' Research Group "Alveolus", Medical University of Warsaw, Poland
| | - Dżamila Al-Haj
- Students' Research Group "Alveolus", Medical University of Warsaw, Poland
| | | | - Rafał Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Poland
| |
Collapse
|
18
|
Crane MJ, Xu Y, Henry WL, Gillis SP, Albina JE, Jamieson AM. Pulmonary influenza A virus infection leads to suppression of the innate immune response to dermal injury. PLoS Pathog 2018; 14:e1007212. [PMID: 30138446 PMCID: PMC6107272 DOI: 10.1371/journal.ppat.1007212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/12/2018] [Indexed: 12/31/2022] Open
Abstract
The innate immune system is responsible for many important functions in the body including responding to infection, clearing cancerous cells, healing wounds, and removing foreign substances. Although many of these functions happen simultaneously in life, most laboratory studies of the innate immune response focus on one activity. How the innate immune system responds to concurrent insults in different parts of the body is not well understood. This study explores the impact of a lung infection on the cutaneous wound healing process. We used two complimentary models of injury: the excisional tail wound and subcutaneous implantation of polyvinyl alcohol (PVA) sponges. These models allow for assessment of the rate of closure and measurement of cellular and cytokine responses during acute wound healing, respectively. When mice with these healing wounds were infected with influenza A virus (IAV) in the lung there was a delay in wound healing. The viral lung infection suppressed the innate immune response in a healing wound, including cellular infiltrate, chemokines, growth factors, and cytokines. However, there was not a global immune suppression as there was an increase in inflammation systemically in mice with both infection and healing wounds compared to mice with only wounds or IAV infection. In addition, the lung immune response was largely unaffected indicating that responding to a lung infection is prioritized over a healing wound. This study introduces the concept of immune triage, in that when faced with multiple insults the immune system prioritizes responses. This paradigm likely applies to many situations that involve the innate immune system, and understanding how the innate immune system handles multiple insults is essential to understanding how it can efficiently clear pathogens while responding to other inflammatory events. In a natural setting, the innate immune system is frequently faced with multiple insults, against which it must mount overlapping inflammatory responses. We are interested in how the innate immune system deals with multiple, simultaneously occurring inflammatory insults, and if the response to one will take priority. For example, the innate immune system is essential in mediating both the early control of pathogen replication in infected tissue and in the early stages of wound healing. Pulmonary infections occur frequently in injured patient populations; therefore, we set out to determine the impact of a respiratory infection on a healing wound. To examine this, mice with healing dermal wounds were infected with influenza A virus (IAV), a common cause of viral pneumonia. We found that the innate immune response to the lung infection took priority at the expense of the healing wound, in that the initial control of viral replication in the lung was not impacted, while the wound healing response was suppressed. Very little work has been done examining how the immune response can respond to overlapping inflammatory insults. Our work shows that not all immune responses are created equal, and that the cells of the innate immune system are preferentially routed towards fighting a lung infection rather than the healing dermal wound. This apparent prioritization of the innate immune response opens up a new direction of study. It is relevant to many fields where competing insults may alter the disease state.
Collapse
Affiliation(s)
- Meredith J. Crane
- Division of Biology and Medicine, Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island, United States of America
| | - Yun Xu
- Division of Biology and Medicine, Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island, United States of America
| | - William L. Henry
- Division of Biology and Medicine, Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island, United States of America
| | - Sean P. Gillis
- Division of Biology and Medicine, Department of Molecular Biology, Cell Biology, and Biochemistry, Brown University, Providence, Rhode Island, United States of America
| | - Jorge E. Albina
- Department of Surgery, Rhode Island Hospital and the Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, United States of America
| | - Amanda M. Jamieson
- Division of Biology and Medicine, Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island, United States of America
- * E-mail:
| |
Collapse
|