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Arntsberg L, Fernberg S, Berger AS, Hedin K, Moberg A. Management and documentation of pneumonia - a comparison of patients consulting primary care and emergency care. Scand J Prim Health Care 2024; 42:338-346. [PMID: 38459974 PMCID: PMC11003321 DOI: 10.1080/02813432.2024.2326469] [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: 06/03/2023] [Accepted: 02/27/2024] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVE To compare management and documentation of vital signs, symptoms and infection severity in pneumonia patients seeking primary care and emergency care without referral. DESIGN Medical record review of vital signs, examination findings and severity of pneumonia. SETTING Primary and emergency care. SUBJECTS Two hundred and forty patients diagnosed with pneumonia. MAIN OUTCOME MEASURES Vital signs, examination findings and severity of pneumonia. Assessments of pneumonia severity according to the reviewers, the traffic light score and CRB-65. RESULTS Respiratory rate, blood pressure, heart rate and oxygen saturation were less often documented in primary care (p < .001). Chest X-ray was performed in 5% of primary care patients vs. 88% of emergency care patients (p < .01). Primary care patients had longer symptom duration, higher oxygen saturation and lower respiratory rate. In total, the reviewers assessed 63% of all pneumonias as mild and 9% as severe. The traffic light scoring model identified 11 patients (9%) in primary care and 53 patients (44%) in emergency care at high risk of severe infection. CONCLUSIONS Vital signs were documented less often in primary care than in emergency care. Patients in primary care appear to have a less severe pneumonia, indicating attendance to the correct care level. The traffic light scoring model identified more patients at risk of severe infection than CRB-65, where the parameters were documented to a limited extent.
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Affiliation(s)
| | | | | | - Katarina Hedin
- Futurum, Jönköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - Anna Moberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Kärna Primary Health Care Centre, Linköping, Sweden
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Zhang X, Wang L, Li M, Dong S. Predictive value of miR-7110-5p and miR-223-3p as biomarkers for sepsis secondary to pneumonia. Technol Health Care 2024:THC231137. [PMID: 38759032 DOI: 10.3233/thc-231137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
BACKGROUND Investigating the secondary sepsis of pneumonia is of great significance for rapid diagnosis and early treatment of sepsis. OBJECTIVE This study aimed to investigate the predictive value of micro ribonucleic acids (miRNA) 7110-5p and miR-223-3p in sepsis secondary to pneumonia. A miRNA microarray was used to analyze the differences in miRNA expression between patients with pneumonia and those with sepsis secondary to pneumonia. METHODS The study included a total of 50 patients with pneumonia and 42 patients with sepsis secondary to pneumonia. Quantitative polymerase chain reaction analysis was conducted to measure the circulating miRNA expression levels in patients and assess their correlations with clinical characteristics and prognosis. In this study, nine miRNAs - hsa-miR-4689-5p, hsa-miR-4621-5p, hsa-miR-6740-5p, hsa-miR-7110-5p, hsa-miR-765, hsa-miR-940, hsa-miR-213-5p, hsa-miR-223-3p, and hsa-miR-122 - met the screening criteria of having a fold change ⩾ 2 or < 0.5; p< 0.01 indicated significant differences in the results. RESULTS The expression levels of miR-7110-5p and miR-223-3p differed between the two patient groups, being up-regulated in the plasma of patients with sepsis secondary to pneumonia. miR-7110-5p and miR-223-3p showed higher expression levels in both patients with pneumonia and sepsis compared to healthy controls. Moreover, the receiver operating characteristic curve revealed that the areas under the curve for predicting pneumonia using miR-7110-5p were 0.781 while those for predicting sepsis secondary to pneumonia were 0.862. For miR-223-3p, the corresponding values for predicting pneumonia and sepsis secondary to pneumonia were 0.879 and 0.924, respectively. However, there were no significant differences in the levels of miR-7110-5p and miR-223-3p between the plasma of survived and deceased patients with sepsis. CONCLUSIONS MiR-7110-5p and miR-223-3p have the potential to serve as biological indicators for predicting sepsis secondary to pneumonia.
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Affiliation(s)
- Xinliang Zhang
- Department of Emergency Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lin Wang
- Department of Trauma Emergency, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Mei Li
- Department of Emergency Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shimin Dong
- Department of Emergency Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Zhao H, Yan X, Guo Z, Li K, Wang Z, Wang J, Lv D, Zhu J, Chen Y. Comparison of outcomes and characteristics of patients admitted to the ICU with COVID-19 and other community-acquired pneumonia based on propensity score matching. BMC Infect Dis 2024; 24:419. [PMID: 38644489 PMCID: PMC11034039 DOI: 10.1186/s12879-024-09306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/09/2024] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE To compare the similarities and differences between patients with Coronavirus Disease 2019 (COVID-19) and those with other community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU), utilizing propensity score matching (PSM), regarding hospitalization expenses, treatment options, and prognostic outcomes, aiming to inform the diagnosis and treatment of COVID-19. METHODS Patients admitted to the ICU of the Third People's Hospital of Datong City, diagnosed with COVID-19 from December 2022 to February 2023, constituted the observation group, while those with other CAP admitted from January to November 2022 formed the control group. Basic information, clinical data at admission, and time from symptom onset to admission were matched using PSM. RESULTS A total of 70 patients were included in the COVID-19 group and 119 in the CAP group. The patients were matched by the propensity matching method, and 37 patients were included in each of the last two groups. After matching, COVID-19 had a higher failure rate than CAP, but the difference was not statistically significant (73% vs. 51%, p = 0.055). The utilization rate of antiviral drugs (40% vs. 11%, p = 0.003), γ-globulin (19% vs. 0%, p = 0.011) and prone position ventilation (PPV) (27% vs. 0%, p < 0.001) in patients with COVID-19 were higher than those in the CAP, and the differences were statistically significant. The total hospitalization cost of COVID-19 patients was lower than that of CAP patients, and the difference was statistically significant (27889.5 vs. 50175.9, p = 0.007). The hospital stay for COVID-19 patients was shorter than for CAP patients, but the difference was not statistically significant (10.9 vs. 16.6, p = 0.071). CONCLUSION Our findings suggest that limited medical resources influenced patient outcomes during the COVID-19 pandemic. Addressing substantial demands for ICU capacity and medications during this period could have potentially reduced the mortality rate among COVID-19 patients.
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Affiliation(s)
- Hongli Zhao
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
| | - Xiulin Yan
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China.
| | - Ziru Guo
- Science and Education Section, Datong Third People's Hospital, Datong, Shanxi, China
| | - Kaiyu Li
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
| | - Zhaopeng Wang
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
| | - Jun Wang
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
| | - Dong Lv
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
| | - Jianling Zhu
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
| | - Ye Chen
- Department of Critical Care Medicine, Datong Third People's Hospital, Datong, Shanxi, China
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Kusulja M, Žarković M, Kudoić N, Mudrovčić M, Sovina Stražičić N, Gornik I, Krajinović V. Outpatient treatment of pneumonia in a setting with and without an infectious disease doctor. Croat Med J 2023; 64:45-51. [PMID: 36864818 PMCID: PMC10028564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
AIM To compare the outpatient treatment of community acquired pneumonia (CAP) by infectious disease doctors (IDDs) and doctors of other specialties (nIDDs). METHODS We retrospectively identified 600 outpatients with CAP: 300 treated by IDDs and 300 by nIDDs in two tertiary hospitals during 2019. The two groups were compared in terms of adherence to guidelines, antibiotic group prescription, frequency of combined treatment, and treatment duration. RESULTS IDDs prescribed significantly more first-line treatment (P<0.001) and alternative treatment (P=0.008). NIDDs prescribed more reasonable (P<0.001) and unnecessary (P=0.002) second-line treatment, and inadequate treatment (P=0.004). IDDs significantly more frequently prescribed amoxicillin (P<0.001) for typical and doxycycline (P=0.045) for atypical CAP, while nIDDs significantly more frequently prescribed amoxicillin-clavulanate (P<0.001) for typical and fluoroquinolones for both typical (P<0.001) and atypical (P<0.001) CAP. No significant differences were found in the frequency of combined treatment, which exceeded 50% in both groups, or in treatment duration. CONCLUSIONS Outpatient treatment of CAP in the absence of IDDs meant more broad-spectrum antibiotic prescription and more disregard for national guidelines. Our results highlight the need for antibiotic stewardship, especially in settings with no IDDs.
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Affiliation(s)
- Marija Kusulja
- Marija Kusulja, Dr Fran Mihaljević University Hospital for Infectious Diseases, Mirogojska 8, 10 000 Zagreb, Croatia,
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Kusulja M, Žarković M, Kudoić N, Mudrovčić M, Sovina Stražičić N, Gornik I, Krajinović V. Outpatient treatment of pneumonia in a setting with and without an infectious disease doctor. Croat Med J 2023. [PMID: 36864818 PMCID: PMC10028564 DOI: 10.3325/cmj.2023.64.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
AIM To compare the outpatient treatment of community acquired pneumonia (CAP) by infectious disease doctors (IDDs) and doctors of other specialties (nIDDs). METHODS We retrospectively identified 600 outpatients with CAP: 300 treated by IDDs and 300 by nIDDs in two tertiary hospitals during 2019. The two groups were compared in terms of adherence to guidelines, antibiotic group prescription, frequency of combined treatment, and treatment duration. RESULTS IDDs prescribed significantly more first-line treatment (P<0.001) and alternative treatment (P=0.008). NIDDs prescribed more reasonable (P<0.001) and unnecessary (P=0.002) second-line treatment, and inadequate treatment (P=0.004). IDDs significantly more frequently prescribed amoxicillin (P<0.001) for typical and doxycycline (P=0.045) for atypical CAP, while nIDDs significantly more frequently prescribed amoxicillin-clavulanate (P<0.001) for typical and fluoroquinolones for both typical (P<0.001) and atypical (P<0.001) CAP. No significant differences were found in the frequency of combined treatment, which exceeded 50% in both groups, or in treatment duration. CONCLUSIONS Outpatient treatment of CAP in the absence of IDDs meant more broad-spectrum antibiotic prescription and more disregard for national guidelines. Our results highlight the need for antibiotic stewardship, especially in settings with no IDDs.
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Affiliation(s)
- Marija Kusulja
- Marija Kusulja, Dr Fran Mihaljević University Hospital for Infectious Diseases, Mirogojska 8, 10 000 Zagreb, Croatia,
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Risk of Acute Respiratory Distress Syndrome in Community-Acquired Pneumonia Patients: Use of an Artificial Neural Network Model. Emerg Med Int 2023; 2023:2631779. [PMID: 36816327 PMCID: PMC9929212 DOI: 10.1155/2023/2631779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 02/10/2023] Open
Abstract
This study aimed to explore the independent risk factors for community-acquired pneumonia (CAP) complicated with acute respiratory distress syndrome (ARDS) and to predict and evaluate the risk of ARDS in CAP patients based on artificial neural network models (ANNs). We retrospectively analyzed eligible 989 CAP patients (632 men and 357 women) who met the criteria from the comprehensive intensive care unit (ICU) and the respiratory and critical care medicine department of Changzhou Second People's Hospital, Jiangsu Provincial People's Hospital, Nanjing Military Region General Hospital, and Wuxi Fifth People's Hospital between February 2018 and February 2021. The best predictors to model the ANNs were selected from 51 variables measured within 24 h after admission. By using this model, patients were divided into a training group (n = 701) and a testing group (n = 288 patients). Results showed that in 989 CAP patients, 22 important variables were identified as risk factors. The sensitivity, specificity, and accuracy of the ANNs model training group were 88.9%, 90.1%, and 89.7%, respectively. When ANNs were used in the test group, their sensitivity, specificity, and accuracy were 85.0%, 87.3%, and 86.5%, respectively; when ANNs were used to predict ARDS, the area under the receiver operating characteristic (ROC) curve was 0.943 (95% confidence interval (0.918-0.968)). The nine most important independent variables affecting the ANNs models were lactate dehydrogenase (100%), activated partial thromboplastin time (84.6%), procalcitonin (83.8%), age (77.9%), maximum respiratory rate (76.0%), neutrophil (75.9%), source of admission (68.9%), concentration of total serum kalium (61.3%), and concentration of total serum bilirubin (50.4%) (all important >50%). The ANNs model and the logistic regression models were significantly different in predicting and evaluating ARDS in CAP patients. Thus, the ANNs model has a good predictive value in predicting and evaluating ARDS in CAP patients, and its performance is better than that of the logistic regression model in predicting the incidence of ARDS patients.
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Aldhahri RK, Gabb SG, Shoaib OA, Almadani RM, Eljaaly K, Thabit AK. Doxycycline vs. macrolides in combination with a β-lactam antibiotic for the treatment of community-acquired pneumonia in inpatients. Eur J Med Res 2022; 27:279. [PMID: 36482485 PMCID: PMC9730591 DOI: 10.1186/s40001-022-00912-8] [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: 09/30/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hospitalized patients with non-severe community-acquired pneumonia (CAP) are treated with a β-lactam plus either a macrolide or doxycycline. Limited data exist on the effectiveness of the latter combination. Therefore, we aimed to compare the combination of doxycycline vs. macrolide when either is combined with a β-lactam from effectiveness and safety perspectives. METHODS This was a retrospective cohort study in CAP inpatients between December 2013 and November 2020. Patients were divided into BL-D (β-lactam plus doxycycline) and BL-M (β-lactam plus a macrolide [azithromycin or clarithromycin]) groups. The primary endpoint was time to clinical stability. Secondary endpoints included length of stay (LOS) and in-hospital mortality. RESULTS Of 197 patients included, 57 were in the BL-D arm and 140 were in the BL-M arm. Patients were similar at baseline, except for the presence of leukocytosis, risk factors for drug resistance, and duration of therapy (P < 0.05 for all comparisons). No difference in clinical cure rate was observed (94.7% vs. 91.4%; P = 0.43). Time to clinical stability and LOS were similar in both groups at 4 (P = 0.82) and 7 days (P = 0.62), respectively. While only three patients died, only one (from the BL-M group) was due to sepsis. Liver enzymes elevation was more prominent in the BL-M group (21.4% vs. 5.3%; P = 0.01). A subgroup analysis showed shorter time to clinical stability with clarithromycin but higher cure rates with azithromycin. CONCLUSIONS Data on doxycycline use with a β-lactam are scarce. Our study showed that such regimen was comparable in effectiveness to regimens involving macrolides with a better safety profile.
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Affiliation(s)
- Raghad K. Aldhahri
- grid.412125.10000 0001 0619 1117Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd, Jeddah, 22254-2265 Saudi Arabia
| | - Shahad G. Gabb
- grid.412125.10000 0001 0619 1117Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd, Jeddah, 22254-2265 Saudi Arabia
| | - Ohoud A. Shoaib
- grid.412125.10000 0001 0619 1117Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd, Jeddah, 22254-2265 Saudi Arabia
| | - Reem M. Almadani
- grid.412125.10000 0001 0619 1117Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd, Jeddah, 22254-2265 Saudi Arabia
| | - Khalid Eljaaly
- grid.412125.10000 0001 0619 1117Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd, Jeddah, 22254-2265 Saudi Arabia
| | - Abrar K. Thabit
- grid.412125.10000 0001 0619 1117Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd, Jeddah, 22254-2265 Saudi Arabia
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Gong L, He D, Huang D, Wu Z, Shi Y, Liang Z. Clinical profile analysis and nomogram for predicting in-hospital mortality among elderly severe community-acquired pneumonia patients with comorbid cardiovascular disease: a retrospective cohort study. BMC Pulm Med 2022; 22:312. [PMID: 35964040 PMCID: PMC9375910 DOI: 10.1186/s12890-022-02113-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Researchers have linked cardiovascular disease (CVD) with advancing age; however, how it drives disease progression in elderly severe community acquired pneumonia (SCAP) patients is still unclear. This study aims to identify leading risk predictors of in-hospital mortality in elderly SCAP patients with CVD, and construct a comprehensive nomogram for providing personalized prediction. Patients and methods The study retrospectively enrolled 2365 elderly patients identified SCAP. Among them, 413 patients were found to have CVD. The LASSO regression and multivariate logistic regression analysis were utilized to select potential predictors of in-hospital mortality in elderly SCAP patients with CVD. By incorporating these features, a nomogram was then developed and subjected to internal validations. Discrimination, calibration, and clinical use of the nomogram were assessed via C-index, calibration curve analysis, and decision plot. Results Compared with patients without CVD, elderly SCAP patients with CVD had a significant poor outcome. Further analysis of the CVD population identified 7 independent risk factors for in-hospital mortality in elderly SCAP patients, including age, the use of vasopressor, numbers of primary symptoms, body temperature, monocyte, CRP and NLR. The nomogram model incorporated these 7 predictors showed sufficient predictive accuracy, with the C-index of 0.800 (95% CI 0.758–0.842). High C-index value of 0.781 was obtained in the internal validation via bootstrapping validation. Moreover, the calibration curve indicative a good consistency of risk prediction, and the decision curve manifested that the nomogram had good overall net benefits. Conclusion An integrated nomogram was developed to facilitate the personalized prediction of in-hospital mortality in elderly SCAP patients with CVD.
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Affiliation(s)
- Linjing Gong
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.,Laboratory of Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Dingxiu He
- Department of Emergency Medicine, The People's Hospital of Deyang, Deyang, Sichuan, China
| | - Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.,Laboratory of Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zhenru Wu
- Laboratory of Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Yujun Shi
- Laboratory of Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
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Liu H, Zhang Y, Chen G, Sun S, Wang J, Chen F, Liu C, Zhuang Q. Diagnostic Significance of Metagenomic Next-Generation Sequencing for Community-Acquired Pneumonia in Southern China. Front Med (Lausanne) 2022; 9:807174. [PMID: 35242783 PMCID: PMC8885724 DOI: 10.3389/fmed.2022.807174] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/10/2022] [Indexed: 12/15/2022] Open
Abstract
Background The morbidity and mortality of community-acquired pneumonia are relatively high, but many pneumonia pathogens cannot be identified accurately. As a new pathogen detection technology, metagenomic next-generation sequencing (mNGS) has been applied more and more clinically. We aimed to evaluate the diagnostic significance of mNGS for community-acquired pneumonia (CAP) in the south of China. Methods Our study selected CAP patients who visited the 3rd Xiangya Hospital from May 2019 to April 2021. Pathogens in bronchoalveolar lavage fluid (BALF) specimens were detected using mNGS and traditional microbiological culture. mNGS group: detected by both mNGS and BALF culture; control group: detected only by BALF or sputum culture. The diagnostic performance of pathogens and the antibiotic adjustments were compared within mNGS group. Results The incidence of acute respiratory distress syndrome (ARDS) was 28.3% in the mNGS group and 17.3% in the control group. Within the mNGS group, the positive rate of pathogens detected by mNGS was 64%, thus by BALF culture was only 28%. Pathogens detected by mNGS were consisted of bacteria (55%), fungi (18%), special pathogens (18%), and viruses (9%). The most detected pathogen by mNGS was Chlamydia psittaci. Among the pathogen-positive cases, 26% was not pathogen-covered by empirical antibiotics, so most of which were made an antibiotic adjustment. Conclusions mNGS can detect pathogens in a more timely and accurate manner and assist clinicians to adjust antibiotics in time. Therefore, we recommend mNGS as the complementary diagnosis of severe pneumonia or complicated infections.
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Affiliation(s)
- Hanying Liu
- Department of Respiratory Diseases, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Ying Zhang
- Transplantation Center, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Guiyang Chen
- Department of Cardiology, Hunan Aerospace Hospital, Changsha, China
| | - Shenghua Sun
- Department of Respiratory Diseases, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Jiangang Wang
- Department of Health Management, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | | | - Chun Liu
- Department of Respiratory Diseases, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Quan Zhuang
- Transplantation Center, The 3rd Xiangya Hospital, Central South University, Changsha, China.,Research Center of National Health Ministry on Transplantation Medicine, Changsha, China
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Trivedi M, Gupta A. A lightweight deep learning architecture for the automatic detection of pneumonia using chest X-ray images. MULTIMEDIA TOOLS AND APPLICATIONS 2022; 81:5515-5536. [PMID: 34975283 PMCID: PMC8711865 DOI: 10.1007/s11042-021-11807-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/26/2021] [Accepted: 12/14/2021] [Indexed: 05/07/2023]
Abstract
Pneumonia is a life-threatening respiratory lung disease. Children are more prone to be affected by the disease and accurate manual detection is not easy. Generally, chest radiographs are used for the manual detection of pneumonia and expert radiologists are required for the assessment of the X-ray images. An automatic system would be beneficial for the diagnosis of pneumonia based on chest radiographs as manual detection is time-consuming and tedious. Therefore, a method is proposed in this paper for the fast and automatic detection of pneumonia. A deep learning-based architecture 'MobileNet' is proposed for the automatic detection of pneumonia based on the chest X-ray images. A benchmark dataset of 5856 chest X-ray images was taken for the training, testing, and evaluation of the proposed deep learning network. The proposed model was trained within 3 Hrs. and achieved a training accuracy of 97.34%, a validation accuracy of 87.5%, and a testing accuracy of 94.23% for automatic detection of pneumonia. However, the combined accuracy was achieved as 97.09% with 0.96 specificity, 0.97 precision, 0.98 recall, and 0.97 F-Score. The proposed method was found faster and computationally lesser expensive as compared to other methods in the literature and achieved a promising accuracy.
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Affiliation(s)
- Megha Trivedi
- School of Electronics and Communication Engineering, Shri Mata Vaishno Devi University, Kakryal, Katra, Jammu and Kashmir 182 320 India
| | - Abhishek Gupta
- School of Computer Science & Engineering, Shri Mata Vaishno Devi University, Kakryal, Katra, Jammu and Kashmir 182 320 India
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Farajzadeh Sheikh A, Rahimi R, Meghdadi H, Alami A, Saki M. Multiplex polymerase chain reaction detection of Streptococcus pneumoniae and Haemophilus influenzae and their antibiotic resistance in patients with community-acquired pneumonia from southwest Iran. BMC Microbiol 2021; 21:343. [PMID: 34906085 PMCID: PMC8670030 DOI: 10.1186/s12866-021-02408-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the occurrence of Streptococcus pneumoniae and Haemophilus influenzae in sputum of patients with community-acquired pneumonia (CAP) using culture and multiplex polymerase chain reaction (M-PCR) methods and to survey the antibiotic resistance patterns of aforesaid isolates. RESULT In total, 23.9 % (n = 22/92) of sputum samples showed positive results in the culture method. S. pneumoniae and H. influenzae were isolated from 15 (16.3 %) and 7 (7.6%) samples, respectively. Using M-PCR, 44 (47.8 %) samples were positive for S. pneumoniae and H. influenzae. Of these, S. pneumoniae and H. influenzae were detected in 33 (35.8%) and 11 (11.9%) of the sputum samples, respectively. The sensitivity, specificity, and accuracy rates of PCR in detection of S. pneumoniae in comparison with culture method were 100, 76.6, and 83.6%, respectively. While, the sensitivity, specificity, and accuracy rates of PCR in detection of H. influenzae in comparison with culture method were 100, 95.3, and 95.8%, respectively. Out of 11 isolates of H. influenzae, two strains confirmed as H. influenzae type b (Hib) and 3 isolates were type f. However, 6 isolates were non-typable. The co-trimoxazole and amoxicillin/clavulanate were the less effective antibiotics against S. pneumonia and H. influenzae, respectively. Ceftriaxone with 13.3% resistance rates was the most effective antibiotic against S. pneumoniae, while, clarithromycin, ceftriaxone, and gentamicin with resistance rates of 28.6% for each one were the most effective chemicals against H. influenzae isolates. CONCLUSION In this study, the prevalence of S. pneumoniae was more than H. influenzae using culture and M-PCR methods. The M-PCR provided better efficiency in detecting the bacterial agents in CAP patients compared to culture method. This method can improve the early detection of pathogens contributed to CAP. The drug resistant S. pneumoniae and H. influenzae indicated the need to develop a codified monitoring program to prevent further spread of these strains.
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Affiliation(s)
- Ahmad Farajzadeh Sheikh
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Robab Rahimi
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. .,Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Hossein Meghdadi
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ameneh Alami
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Morteza Saki
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. .,Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. .,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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12
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Shakeel S, Muneswarao J, Abdul Aziz A, Yeong Le H, Abd. Halim FS, Rehman AU, Hussain R. Adherence to National Antimicrobial Guidelines in Hospitalized Geriatric Patients with Community-Acquired Pneumonia: A Prospective Observational study in a Malaysian Hospital. Antibiotics (Basel) 2021; 10:antibiotics10121490. [PMID: 34943702 PMCID: PMC8698928 DOI: 10.3390/antibiotics10121490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022] Open
Abstract
The evaluation of disease progression and onsite therapeutic care choices for community-acquired pneumonia (CAP) patients is vital for their well-being and the optimum utilization of healthcare resources. The current study was conducted to assess physicians’ adherence to clinical practice standards and antibiotic prescribing behavior for the treatment of CAP in older people. A prospective study that included 121 consecutive patients admitted for CAP was conducted at Kulim Hospital, Kedah, from March 2020 to August 2020. Medical records including demographic data, comorbidity, physical examination, laboratory or radiologic findings, and drugs used for the treatment of CAP were accessed from bed head tickets (BHT). The mean age for patients was 73.5 ± 6.2 years, 73 (60.3%) and 48 (39.6%) were males and females, respectively. Amoxicillin/clavulanate (19.8%) was the most prescribed antibiotic for non-severe pneumonia followed by ampicillin sodium/sulbactam sodium (6.6%), while in patients with severe CAP beta-lactam + beta lactamase inhibitors (BLIs) with a combination of macrolide were the most common antibiotics prescribed either in patients with (21.4%) or without co-morbidities (8.2%). The average length of stay in the hospital with severe pneumonia was 6–7 days for 23.9% of patients and < 5 days for 21.4% of patients. The duration of intravenous antibiotics in patients with severe pneumonia was 6–7 days for 32.2% of patients. The present findings revealed the adherence of antibiotic prescribing practices to the Malaysian National Antimicrobial Guideline 2019 for CAP therapy among geriatric patients and adherence to the CAP criteria for hospital admissions.
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Affiliation(s)
- Sadia Shakeel
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Dow College of Pharmacy, Dow University of Health Sciences, Karachi 74200, Pakistan;
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia;
| | - Jaya Muneswarao
- Pharmacy Department, Hospital Pulau Pinang, Ministry of Health Malaysia, Penang 10990, Malaysia;
| | - Azrina Abdul Aziz
- Pharmacy Department, Hospital Kulim, Ministry of Health Malaysia, Kedah 09090, Malaysia; (A.A.A.); (H.Y.L.); (F.S.A.H.)
| | - Heng Yeong Le
- Pharmacy Department, Hospital Kulim, Ministry of Health Malaysia, Kedah 09090, Malaysia; (A.A.A.); (H.Y.L.); (F.S.A.H.)
| | - Fatin Syazwanni Abd. Halim
- Pharmacy Department, Hospital Kulim, Ministry of Health Malaysia, Kedah 09090, Malaysia; (A.A.A.); (H.Y.L.); (F.S.A.H.)
| | - Anees Ur Rehman
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia;
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Rabia Hussain
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia;
- Correspondence:
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13
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Schons MJ, Caliebe A, Spinner CD, Classen AY, Pilgram L, Ruethrich MM, Rupp J, Nunes de Miranda S, Römmele C, Vehreschild J, Jensen BE, Vehreschild M, Degenhardt C, Borgmann S, Hower M, Hanses F, Haselberger M, Friedrichs AK. All-cause mortality and disease progression in SARS-CoV-2-infected patients with or without antibiotic therapy: an analysis of the LEOSS cohort. Infection 2021; 50:423-436. [PMID: 34625912 PMCID: PMC8500268 DOI: 10.1007/s15010-021-01699-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022]
Abstract
Purpose Reported antibiotic use in coronavirus disease 2019 (COVID-19) is far higher than the actual rate of reported bacterial co- and superinfection. A better understanding of antibiotic therapy in COVID-19 is necessary. Methods 6457 SARS-CoV-2-infected cases, documented from March 18, 2020, until February 16, 2021, in the LEOSS cohort were analyzed. As primary endpoint, the correlation between any antibiotic treatment and all-cause mortality/progression to the next more advanced phase of disease was calculated for adult patients in the complicated phase of disease and procalcitonin (PCT) ≤ 0.5 ng/ml. The analysis took the confounders gender, age, and comorbidities into account. Results Three thousand, six hundred twenty-seven cases matched all inclusion criteria for analyses. For the primary endpoint, antibiotic treatment was not correlated with lower all-cause mortality or progression to the next more advanced (critical) phase (n = 996) (both p > 0.05). For the secondary endpoints, patients in the uncomplicated phase (n = 1195), regardless of PCT level, had no lower all-cause mortality and did not progress less to the next more advanced (complicated) phase when treated with antibiotics (p > 0.05). Patients in the complicated phase with PCT > 0.5 ng/ml and antibiotic treatment (n = 286) had a significantly increased all-cause mortality (p = 0.029) but no significantly different probability of progression to the critical phase (p > 0.05). Conclusion In this cohort, antibiotics in SARS-CoV-2-infected patients were not associated with positive effects on all-cause mortality or disease progression. Additional studies are needed. Advice of local antibiotic stewardship- (ABS-) teams and local educational campaigns should be sought to improve rational antibiotic use in COVID-19 patients.
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Affiliation(s)
- Maximilian J Schons
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Amke Caliebe
- Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.,Kiel University, Kiel, Germany
| | - Christoph D Spinner
- School of Medicine, Department of Internal Medicine II, Technical University of Munich, University Hospital Rechts Der Isar, Munich, Germany
| | - Annika Y Classen
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Lisa Pilgram
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Maria M Ruethrich
- Institute for Infection Medicine and Hospital Hygiene, University Hospital Jena, Jena, Germany
| | - Jan Rupp
- University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | - Christoph Römmele
- Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany
| | - Janne Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Bjoern-Erik Jensen
- Clinic for Gastroenterology, Hepatology and Infectiology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Maria Vehreschild
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | | | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
| | - Martin Hower
- Department of Pneumology, Infectious Diseases and Intensive Care, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Frank Hanses
- Interdisciplinary Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | | | - Anette K Friedrichs
- Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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14
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Shen L, Wang L, Liu C, Shi S, Takahashi T, Wang T. Community-acquired pneumonia: Trends in and research on drug resistance and advances in new antibiotics. Biosci Trends 2021; 15:266-275. [PMID: 34483225 DOI: 10.5582/bst.2021.01342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Community-acquired pneumonia (CAP) refers to infectious inflammation of the lung parenchyma developing outside of a hospital. CAP has quite a high mortality and morbidity rate worldwide, and especially among elderly patients. The increasing burden of CAP is due to antibiotic resistance, the growth of the elderly population, and underlying comorbidities. Streptococcus pneumoniae remains the most common bacterial pathogen causing CAP, but multi-drug resistance bacteria and potential pathogens have increased the difficulty and challenges of managing CAP. Although preventive measures, diagnostic techniques, and treatment strategies are constantly advancing and improving, the susceptibility of multi-drug resistant pathogens, such as including Methicillin-Resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae, and Pseudomonas aeruginosa, has not improved significantly in recent decades, thus highlighting the importance and necessity of developing new antibiotics for the treatment of CAP. New antimicrobials have been approved over the past few years that will expand treatment options for CAP, and especially for patients with potential comorbidities. This situation also offers the chance to reduce the abuse of antibiotics, their toxicities, and their adverse reactions and to provide effective personalized antibiotic treatment.
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Affiliation(s)
- Luyan Shen
- Laboratory of Pathobiology, Ministry of Education, Department of Pathophysiology, College of Basic Medical Sciences, Jilin University, Changchun, Jilin, China
| | - Lixiang Wang
- Department of Health Policy and Management, International University of Health and Welfare, Tokyo, Japan
| | - Cong Liu
- Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Shaomin Shi
- Department of Respiratory Medicine, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Tai Takahashi
- Department of Health Policy and Management, International University of Health and Welfare, Tokyo, Japan
| | - Tiejun Wang
- Department of Radiation Oncology, The Second Affiliated Hospital, Jilin University, Changchun, Jilin, China
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15
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Eraikhuemen N, Julien D, Kelly A, Lindsay T, Lazaridis D. Treatment of Community-Acquired Pneumonia: A Focus on Lefamulin. Infect Dis Ther 2021; 10:149-163. [PMID: 33528794 PMCID: PMC7851634 DOI: 10.1007/s40121-020-00378-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/26/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The goal of this article is to review the clinical pharmacology, pharmacokinetics, efficacy, and safety of lemafulin. DATA SOURCES We performed a systematic literature review using the search terms of lefamulin and BC-3781 in the PubMed and EMBASE databases. We also cross-referenced the pertinent articles and searched ClinicalTrials.gov to identify ongoing and nonpublished studies. STUDY SELECTION AND DATA EXTRACTION Published data from 2005 to 2019 evaluating the clinical pharmacology, efficacy, and safety studies of lefamulin were analyzed. DATA SYNTHESIS In phase 3 clinical trials, two multicenter, randomized double-blinded studies-Lefamulin Evaluation Against Pneumonia 1 and 2 (LEAP 1 and 2)-compared the efficacy and safety of lemafulin with moxifloxacin in patients diagnosed with community-acquired bacterial pneumonia (CABP). Lemafulin given in doses of 600 mg orally or 150 mg intravenously were reported to have comparable efficacy to those of moxifloxacin with or without linezolid in patients with CABP. After the trial, the lefamulin group had an early clinical response (ECR) of 87.3% and the moxifloxacin group had an ECR of 90.2%. The difference of - 2.9% in the ECR was non-significant (CI - 8.5, 2.8). RELEVANCE TO PATIENTS AND CLINICAL PRACTICE Lemafulin exhibits a unique binding property; therefore, it possess a potentially lower predisposition for the development of bacterial resistance and cross-resistance to other antimicrobial classes. Lefamulin is active against gram-positive including methicillin-resistant strains and atypical organisms which are often implicated in CABP. Lefamulin may be a safe alternative for adult patients with CABP who may not be candidates for respiratory fluoroquinolones. Lefamulin demonstrates both bactericidal and bacteriostatic activity against gram-positive, fastidious gram-negatives, atypical pathogens, and some gram-negative anaerobes. It is bactericidal in vitro against Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae (including macrolide-resistant strains) at concentrations of 0.06, 0.5, and 0.008 µg/ml respectively, and bacteriostatic against Staphylococcus aureus and Streptococcus pyogenes. The agent also demonstrates both time- and concentration-dependent killing against the pathogens S. pneumoniae and S. aureus. In vitro susceptibility testing demonstrated an MIC50/90 of 0.06/0.12 µg/ml against S. pneumoniae and S. aureus. The SENTRY Antimicrobial Surveillance Program found that at a concentration ≤ 1 µg/ml, lefamulin inhibited 100% S. pneumoniae isolates, 99.8% of S. aureus isolates, and 99.6% of methicillin-resistant S. aureus isolates. It was not affected by resistance to various antibiotic classes such as beta-lactams, fluoroquinolones, or macrolides.
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Affiliation(s)
- Nathaniel Eraikhuemen
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Davie, FL, USA.
| | - Daniel Julien
- Memorial Regional Hospital South, Hollywood, FL, USA
| | - Alandra Kelly
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Davie, FL, USA
| | - Taylor Lindsay
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Davie, FL, USA
| | - Dovena Lazaridis
- Department of Pharmacy, Memorial Regional Hospital, Hollywood, FL, USA
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16
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Postnikova LB, Klimkin PF, Boldina MV, Gudim AL, Kubysheva NI. [Fatal severe community-acquired pneumonia: risk factors, clinical characteristics and medical errors of hospital patients]. TERAPEVT ARKH 2020; 92:42-49. [PMID: 32598792 DOI: 10.26442/00403660.2020.03.000538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 01/28/2023]
Abstract
Community-acquired pneumonia (CAP) is the most common disease and potentially life-threatening infection in the worldwide. In the Nizhny Novgorod region, no analysis of the causes of mortality and medical errors of severe CAP patients. AIM To analyze the patients structure who died severe CAP in hospitals of the Nizhny Novgorod region, to identify the leading risk factors, to assess the clinical characteristics of fatal severe CAP and medical errors according to medical records of patients from 20152016. MATERIALS AND METHODS This was a retrospective study of medical records of 139 patients with fatal severe CAP from medical organizations of the Nizhny Novgorod region. The 72 patients died in 2015. The mortality rate from pneumonia was 67 cases in 2016. RESULTS The key predictors of the fatal severe CAP in patients of the Nizhny Novgorod region identified: socio-demographic status (men of working age, unemployed, smoking, alcohol and drug dependence), late treatment and hospitalization, tachypnea, hypotension, tachycardia, confusion, leukocytosis or leukopenia, thrombocytopenia, anemia, hyperglycemia, bilateral lung damage, pleural effusion, acute respiratory failure. The leading medical errors in fatal CAP were incorrect assessment of the severity of the patients condition, untimely CAP, non-monitoring of SpO2 on the first day of hospitalization, late transfer of patients to the intensive care unit, there was no influenza therapy, inadequate starting antibacterial therapy. CONCLUSION The main ways to avoid or minimize medical errors and reduce the mortality of patients with TVP is strict adherence to clinical recommendations, active preventive measures, diagnosis and treatment of chronic diseases.
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17
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Chan CH, Yang SF, Yeh HW, Yeh YT, Wang YH, Teng YH, Yeh CB. Risk of pneumonia in patients with burn injury: a population-based cohort study. Clin Epidemiol 2018; 10:1083-1091. [PMID: 30214313 PMCID: PMC6121749 DOI: 10.2147/clep.s172980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Burns are the main cause of accidental injury, and pneumonia is a common respiratory disease in humans. Aim The purpose of this study was to investigate the relationship between burn injury and pneumonia. Patients and methods A nationwide population-based cohort study was conducted using data from the National Health Insurance Research Database in Taiwan. We identified and enrolled 2,893 subjects with burn injury, who were individually matched to 2,893 subjects in the comparison group by using the propensity score. Furthermore, we used a self-controlled case-series design to estimate the temporal association between burn injury and pneumonia. Results Exposure to burn injury revealed a higher risk of pneumonia than that to non-burn injury within 1 year. The Cox proportional hazards model revealed that, compared with the non-burn injury, burn injury yielded a 2.39-fold (95% CI=1.44-3.96) increase in risk of pneumonia. The exposure period of burn injury within 30 days showed 2.76-fold increase in risk of pneumonia (95% CI=1.44-3.96) compared with that in the baseline period. Conclusion Burn injury was associated with a significant increased risk of pneumonia, especially occurring within 30 days.
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Affiliation(s)
- Chi-Ho Chan
- Department of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Shun-Fa Yang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Han-Wei Yeh
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Ying-Tung Yeh
- Graduate School of Dentistry, Chung Shan Medical University, Taichung, Taiwan, Republic of China.,School of Dentistry, Chung Shan Medical University, Taichung, Taiwan, Republic of China.,Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Ying-Hock Teng
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China, .,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China,
| | - Chao-Bin Yeh
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China, .,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China,
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18
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Anderson R, Nel JG, Feldman C. Multifaceted Role of Pneumolysin in the Pathogenesis of Myocardial Injury in Community-Acquired Pneumonia. Int J Mol Sci 2018; 19:E1147. [PMID: 29641429 PMCID: PMC5979279 DOI: 10.3390/ijms19041147] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/14/2018] [Accepted: 03/21/2018] [Indexed: 12/14/2022] Open
Abstract
Pneumolysin (PLY), a member of the family of Gram-positive bacterial, cholesterol-dependent, β-barrel pore-forming cytolysins, is the major protein virulence factor of the dangerous respiratory pathogen, Streptococcus pneumoniae (pneumococcus). PLY plays a major role in the pathogenesis of community-acquired pneumonia (CAP), promoting colonization and invasion of the upper and lower respiratory tracts respectively, as well as extra-pulmonary dissemination of the pneumococcus. Notwithstanding its role in causing acute lung injury in severe CAP, PLY has also been implicated in the development of potentially fatal acute and delayed-onset cardiovascular events, which are now recognized as being fairly common complications of this condition. This review is focused firstly on updating mechanisms involved in the immunopathogenesis of PLY-mediated myocardial damage, specifically the direct cardiotoxic and immunosuppressive activities, as well as the indirect pro-inflammatory/pro-thrombotic activities of the toxin. Secondly, on PLY-targeted therapeutic strategies including, among others, macrolide antibiotics, natural product antagonists, cholesterol-containing liposomes, and fully humanized monoclonal antibodies, as well as on vaccine-based preventive strategies. These sections are preceded by overviews of CAP in general, the role of the pneumococcus as the causative pathogen, the occurrence and types of CAP-associated cardiac complication, and the structure and biological activities of PLY.
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Affiliation(s)
- Ronald Anderson
- Department of Immunology and Institute for Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa.
| | - Jan G Nel
- Department of Haematology, Faculty of Health Sciences, University of Pretoria and Tshwane Academic Division of the National Health Laboratory Service, Pretoria 0001, South Africa.
| | - Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 0002, South Africa.
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19
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Hecker M, Sommer N, Tello K, Hecker A, Seeger W, Mayer K. [Community-acquired pneumonia]. Med Klin Intensivmed Notfmed 2018; 113:313-324. [PMID: 29637219 DOI: 10.1007/s00063-018-0426-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
Community-acquired pneumonia (CAP) is a frequent and potentially fatal disorder. Due to the notably high mortality within the first days, the immediate initiation of rational diagnostic pathways and treatment is of tremendous prognostic impact. In this review article, the current German guideline on the diagnosis and therapy of CAP is presented. Special focus is put on structured patient management based on the individual risk for early identification of critically ill patients. In particular, risk assessment directly influences rational diagnostics and adequate therapy. New recommendations concerning preventive strategies are also discussed in this article.
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Affiliation(s)
- M Hecker
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Klinikstraße 33, 35392, Gießen, Deutschland.
| | - N Sommer
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - K Tello
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - A Hecker
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - W Seeger
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - K Mayer
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
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Evangelatos N, Gerlach T. Adequate Risk Stratification. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:145. [PMID: 29563010 PMCID: PMC5876547 DOI: 10.3238/arztebl.2018.0145a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | - Thomas Gerlach
- **Medizinische Klinik 6, Zentrale Notaufnahme, Klinikum Nürnberg
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Kolditz M. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:145. [PMID: 29563011 PMCID: PMC5876548 DOI: 10.3238/arztebl.2018.0145b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Martin Kolditz
- *Abteilung für Pneumologie Medizinische Klinik und Poliklinik I Universitätsklinikum Carl Gustav Carus Dresden
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