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Han X, Liu X, Chen L, Wang Y, Li H, Zhou F, Xing X, Zhang C, Suo L, Wang J, Yu G, Wang G, Yao X, Yu H, Wang L, Liu M, Xue C, Liu B, Zhu X, Li Y, Xiao Y, Cui X, Li L, Cao B. Disease burden and prognostic factors for clinical failure in elderly community acquired pneumonia patients. BMC Infect Dis 2020; 20:668. [PMID: 32919458 PMCID: PMC7486582 DOI: 10.1186/s12879-020-05362-3] [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: 04/04/2020] [Accepted: 08/19/2020] [Indexed: 02/08/2023] Open
Abstract
Background The study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP). Methods 3011 hospitalized elderly patients were enrolled from 13 national teaching hospitals between January 1, 2014 and December 31, 2014 initiated by the CAP-China network. Risk factors for CF were screened by multivariable logistic regression analysis. Results The incidence of CF in elderly CAP patients was 13.1%. CF patients were older, longer hospital stays and higher treatment costs than clinical success (CS) patients. The CF patients were more prone to present hyperglycemia, hyponatremia, hypoproteinemia, pleural effusion, respiratory failure and cardiovascular events. Inappropriate initial antimicrobial regimens in CF group were significantly higher than CS group. Undertreatment, CURB-65, PH < 7.3, PaO2/FiO2 < 200 mmHg, sodium < 130 mmol/L, healthcare-associated pneumonia, white blood cells > 10,000/mm3, pleural effusion and congestive heart failure were independent risk factors for CF in multivariable logistic regression analysis. Male and bronchiectasis were protective factors. Conclusions Discordant therapy was a cause of CF. Early accurate detection and management of prevention to potential causes is likely to improve clinical outcomes in elderly patients CAP. Trial registration A Retrospective Study on Hospitalized Patients With Community-acquired Pneumonia in China (CAP-China) (RSCAP-China), NCT02489578. Registered 16 March 2015, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005E5S&selectaction=Edit&uid=U0000GWC&ts=2&cx=1bnotb
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Affiliation(s)
- Xiudi Han
- Department of Respiratory Medicine, Qingdao Municipal Hospital Group, Jiaozhou Road, Qingdao City, 266011, Shandong Province, China.
| | - Xuedong Liu
- Department of Respiratory Medicine, Qingdao Municipal Hospital Group, Jiaozhou Road, Qingdao City, 266011, Shandong Province, China
| | - Liang Chen
- Department of Infectious Disease, Beijing Jishuitan Hospital, Xinjiekou East Street, Xi-cheng District, Beijing, 100044, China
| | - Yimin Wang
- National Clinical Research Center of Respiratory Diseases,Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-yang District, Beijing, 100020, China
| | - Hui Li
- National Clinical Research Center of Respiratory Diseases,Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-yang District, Beijing, 100020, China
| | - Fei Zhou
- National Clinical Research Center of Respiratory Diseases,Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-yang District, Beijing, 100020, China
| | - Xiqian Xing
- Department of Respiratory Medicine, Yan'an Hospital Affiliated to Kunming Medical University, Renmin East Road, Kunming City, 652199, Yunnan Province, China
| | - Chunxiao Zhang
- Department of Respiratory Medicine, Beijing Huimin Hospital, Youanmen Street, West District, Beijing, 100054, China
| | - Lijun Suo
- Department of Respiratory Medicine, Linzi District People's Hospital, Huangong Road, Zibo City, 255000, Shandong Province, China
| | - Jinxiang Wang
- Department of Respiratory Medicine, Beijing Luhe Hospital, Capital Medical University, Xinhua South Road, Tongzhou District, Beijing, 101149, China
| | - Guohua Yu
- Department of Pulmonary and Critical Care Medicine, Weifang No. 2 People's Hospital, Yuanxiao Street, Weifang City, 261599, Shandong Province, China
| | - Guangqiang Wang
- Department of Respiratory Medicine, Shandong University Affiliated Qilu Hospital (Qingdao), Hefei Road, Qingdao City, 266035, Shandong Province, China
| | - Xuexin Yao
- Department of Respiratory Medicine, The 2nd Hospital of Beijing Corps, Chinese Armed Police Forces, Yuetan North Street, Xi-cheng District, Beijing, 100044, China
| | - Hongxia Yu
- Department of Infectious Disease, Qingdao University Medical College Affiliated Yantaiyuhuangding Hospital, Yudong Road, Yantai City, 100191, Shandong Province, China
| | - Lei Wang
- Department of Respiratory Medicine, Rizhao Chinese Medical Hospital Affiliated to Shandong Chinese Medical University, Wanghai Road, Rizhao City, 276800, Shandong Province, China
| | - Meng Liu
- Department of Respiratory Medicine, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Meishuguan Street, East District, Beijing, 100010, China
| | - Chunxue Xue
- Department of Respiratory Medicine, Beijing Luhe Hospital, Capital Medical University, Xinhua South Road, Tongzhou District, Beijing, 101149, China
| | - Bo Liu
- Department of Respiratory Medicine, Linzi District People's Hospital, Huangong Road, Zibo City, 255000, Shandong Province, China
| | - Xiaoli Zhu
- Department of Occupational Medicine and Toxicology, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Road, Chao-yang District, Beijing, 100020, China
| | - Yanli Li
- National Clinical Research Center of Respiratory Diseases,Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-yang District, Beijing, 100020, China
| | - Ying Xiao
- National Clinical Research Center of Respiratory Diseases,Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-yang District, Beijing, 100020, China
| | - Xiaojing Cui
- National Clinical Research Center of Respiratory Diseases,Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-yang District, Beijing, 100020, China
| | - Lijuan Li
- National Clinical Research Center of Respiratory Diseases,Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-yang District, Beijing, 100020, China
| | - Bin Cao
- National Clinical Research Center of Respiratory Diseases,Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Yinghuayuan East Street, Chao-yang District, Beijing, 100020, China
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Demirdogen Cetinoglu E, Uzaslan E, Sayıner A, Cilli A, Kılınc O, Sakar Coskun A, Hazar A, Kokturk N, Filiz A, Polatli M. Pneumococcal and influenza vaccination status of hospitalized adults with community acquired pneumonia and the effects of vaccination on clinical presentation. Hum Vaccin Immunother 2017; 13:2072-2077. [PMID: 28708954 PMCID: PMC5612214 DOI: 10.1080/21645515.2017.1339851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/15/2017] [Accepted: 06/05/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous reports have shown that vaccination rates of adult at-risk populations are low in Turkey. There are differing reports with regards to the effectiveness of the influenza and the pneumococcal polysaccharide vaccine (PPSV23) on the clinical outcomes of community acquired pneumonia (CAP). The purpose of this study was to analyze the influenza (FV) and pneumococcal vaccination (PV) status, the factors that influence the receipt of influenza/pneumococcal vaccine and the effects of prior vaccination on the clinical outcomes in adults hospitalized with CAP. PATIENTS AND METHODS Patients hospitalized with CAP between March 2009 and October 2013 and registered at the web-based Turkish Thoracic Society Pneumonia Database (TURCAP) were included in this multicentric, observational study. Of a total of 787 cases, data were analyzed for 466 patients for whom self-reported information on PV and FV was available. RESULTS In this adult population with CAP, the vaccination rate with both the pneumococcal and influenza vaccines was found to be 6%. Prior FV was found to be the sole variable that was associated with the receipt of PV [OR 17.8, 95% CI (25-75:8.56-37.01), p < 0.001]. Conversely, being vaccinated with PPSV23 was the only predictor of receipt of FV [OR 18.1, 95% CI (25 - 75:8.75 - 37.83), p < 0.001]. Compared to the unvaccinated cases, the chest radiograms of the vaccinated patients revealed less consolidation. The latter also reported fatigue, muscle pain and gastrointestinal symptoms less frequently. Although there was a trend for lower 30-day mortality and for lower rates of intensive care unit (ICU) admission, these did not reach statistical significance. A pneumonia severity index (PSI) score ≥ 90, CURB-65 score ≥3 and multilobar involvement, but not the vaccination status, were identified as independent determinants of ICU admission. CONCLUSIONS This study showed that, among patients hospitalized with CAP, the FV and/or PV rates are low. Prior vaccination does not appear to significantly affect the clinical outcomes.
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Affiliation(s)
| | - Esra Uzaslan
- Uludağ University Faculty of Medicine, Department of Pulmonary Diseases, Bursa, Turkey
| | - Abdullah Sayıner
- Ege University Faculty of Medicine, Department of Pulmonary Diseases, İzmir, Turkey
| | - Aykut Cilli
- Akdeniz University Faculty of Medicine, Department of Pulmonary Diseases, Antalya, Turkey
| | - Oguz Kılınc
- Dokuz Eylul University Faculty of Medicine, Department of Pulmonary Diseases, İzmir, Turkey
| | - Aysın Sakar Coskun
- Celal Bayar University Faculty of Medicine, Department of Pulmonary Diseases, Manisa, Turkey
| | - Armağan Hazar
- Sureyyapasa Pulmonary Diseases and Thoracic Surgery Training and Research Hospital, Department of Pulmonary Diseases, İstanbul, Turkey
| | - Nurdan Kokturk
- Gazi University Faculty of Medicine, Department of Pulmonary Diseases, Ankara, Turkey
| | - Ayten Filiz
- Gaziantep University Faculty of Medicine, Department of Pulmonary Diseases, Gaziantep, Turkey
| | - Mehmet Polatli
- Adnan Menderes University Faculty of Medicine, Department of Pulmonary Diseases, Aydin, Turkey
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