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Potpalle D, Gada S, Devaguru A, Behera N, Dinesh Eshwar M. Comparison of Short-Term Versus Long-Term Antibiotic Therapy Among Severe Cases of Pneumonia: A Prospective Observational Study Among Children. Cureus 2023; 15:e35298. [PMID: 36968915 PMCID: PMC10037924 DOI: 10.7759/cureus.35298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction Pneumonia continues to be the leading cause of morbidity and mortality in children younger than five years. The World Health Organization (WHO) recommends intravenous antibiotics for five days for severe pneumonia. However, the optimum duration of parenteral antibiotic therapy for pneumonia is not practicable and feasible in poor and resource-constrained settings like India. Given the current Indian scenario wherein childhood pneumonia is extremely prevalent, we attempted to undertake this study to compare the duration of antibiotic therapy in severe cases of community-acquired pneumonia (CAP). Methods A prospective observational study was carried out on 225 cases of severe and very severe CAP patients at a tertiary care center. The study group included children between two months to five years of age. The participants were subjected to antibiotic therapy (parenteral) plus supportive care. The selection of antibiotics was empirical and according to the WHO acute respiratory infection control program. Hematological parameters including blood hemoglobin, C-reactive protein, erythrocyte sedimentation rate (ESR), and total leukocyte count, and radiological evaluation were performed on all the participants. Cases were followed up for the duration of clinical response. Results Out of the 225 cases, 25 patients did not respond to antibiotics and were categorized as the treatment failure group. Of the remaining 200 cases, 104 (52%) showed clinical response within three days (3.0±0.016), and 96 showed a response in four to seven days (4.4±0.064). The mean duration of antibiotic therapy among short-course versus long-course treatment was statistically significant (p<0.0001). The majority of patients developed leukocytosis, neutrophilia, and elevated ESR. Conclusion Short-course parenteral antibiotics therapy was equally effective as long-course therapy in severe pneumonia. However, very severe pneumonia patients required a longer course of parenteral antibiotics therapy. Very severe pneumonia was significantly associated with high mortality and treatment failure.
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Palii D, Kovalchuk V, Moroz L. ADDITIONAL RISKS ARISING IN THE PROCESS OF PROVIDING MEDICAL AID TO PATIENTS WITH COVID-19. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1906-1912. [PMID: 37898924 DOI: 10.36740/wlek202309102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVE The aim: In order to assess the degree of transforming danger, for face masks, used in the providing respiratory support process to specialized department patients with varying degrees of the COVID-19 course severity, we conducted a series of bacteriological studies into an additional opportunistic bacteria reservoir. With the purpose of assessment of the face respiratory masks inner surface bacterial contamination intensity during their use to provide respiratory support to patients with COVID-19. PATIENTS AND METHODS Materials and methods: A bacteriological study of the inner surface of 60 disposable individual face respiratory masks was carried out at different times of providing respiratory support to patients with COVID-19. RESULTS Results: It is shown that during use, the inner surface of the respiratory mask is colonized by staphylococci and gram-negative opportunistic bacteria. With increasing time of the mask using, the density of colonization of its inner surface increases. CONCLUSION Conclusions: In the process of long-term non-invasive lung ventilation and oxygen therapy for patients with COVID-19, the inner surface of face respiratory masks is colonized with opportunistic bacteria, which creates the risk of contamination by the latter of the pathologically changed lung parenchyma and the addition of secondary bacterial infection.
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Affiliation(s)
- Dmytro Palii
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
| | | | - Larysa Moroz
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
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Harikrishna J, Mohan A, Pradeep V, Bhargav K, Chaudhury A, Devi BV, Sarma K. Aetiology, Clinical Presentation and Outcome in Patients with Community-Acquired Pneumonia Requiring Hospitalisation: A Prospective Study. THE INDIAN JOURNAL OF CHEST DISEASES AND ALLIED SCIENCES 2022; 62:117-125. [DOI: 10.5005/ijcdas-62-3-117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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Khanna P, Khanna S. Respiratory vaccination. Indian J Tuberc 2022; 69 Suppl 2:S213-S219. [PMID: 36400512 DOI: 10.1016/j.ijtb.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/23/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Vaccinations are among the most cost-effective preventive health strategies to reduce healthcare costs and prevent morbidities. Every year, many adults and elderly encounter hospitalization because of infectious respiratory diseases. Among these, viral and bacterial pneumonia, tuberculosis, diphtheria and pertussis infections are some of the diseases that can be prevented and managed with fewer complications, with adequate preventive immunization. This review tries to outline the vaccines available for the prevention of these respiratory ailments along with their schedule and dosages.
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Affiliation(s)
- Puneet Khanna
- Department of Respiratory Medicine & Pulmonology, HCMCT Manipal Hospitals, Dwarka, New Delhi, 110085, India.
| | - Shilpi Khanna
- Department of Microbiology and Infectious Diseases, Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi, 110026, India
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Burnet M, Metcalf DG, Milo S, Gamerith C, Heinzle A, Sigl E, Eitel K, Haalboom M, Bowler PG. A Host-Directed Approach to the Detection of Infection in Hard-to-Heal Wounds. Diagnostics (Basel) 2022; 12:diagnostics12102408. [PMID: 36292097 PMCID: PMC9601189 DOI: 10.3390/diagnostics12102408] [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: 08/11/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 01/08/2023] Open
Abstract
Wound infection is traditionally defined primarily by visual clinical signs, and secondarily by microbiological analysis of wound samples. However, these approaches have serious limitations in determining wound infection status, particularly in early phases or complex, chronic, hard-to-heal wounds. Early or predictive patient-derived biomarkers of wound infection would enable more timely and appropriate intervention. The observation that immune activation is one of the earliest responses to pathogen activity suggests that immune markers may indicate wound infection earlier and more reliably than by investigating potential pathogens themselves. One of the earliest immune responses is that of the innate immune cells (neutrophils) that are recruited to sites of infection by signals associated with cell damage. During acute infection, the neutrophils produce oxygen radicals and enzymes that either directly or indirectly destroy invading pathogens. These granular enzymes vary with cell type but include elastase, myeloperoxidase, lysozyme, and cathepsin G. Various clinical studies have demonstrated that collectively, these enzymes, are sensitive and reliable markers of both early-onset phases and established infections. The detection of innate immune cell enzymes in hard-to-heal wounds at point of care offers a new, simple, and effective approach to determining wound infection status and may offer significant advantages over uncertainties associated with clinical judgement, and the questionable value of wound microbiology. Additionally, by facilitating the detection of early wound infection, prompt, local wound hygiene interventions will likely enhance infection resolution and wound healing, reduce the requirement for systemic antibiotic therapy, and support antimicrobial stewardship initiatives in wound care.
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Affiliation(s)
- Michael Burnet
- Synovo GmbH, Paul Ehrlich Straße 15, 72076 Tuebingen, Germany
- Correspondence:
| | - Daniel G. Metcalf
- ConvaTec Ltd., First Avenue, Deeside Industrial Park, Deeside CH5 2NU, UK
| | - Scarlet Milo
- ConvaTec Ltd., First Avenue, Deeside Industrial Park, Deeside CH5 2NU, UK
| | - Clemens Gamerith
- Austrian Centre of Industrial Biotechnology, Krennagsse 37, A-8010 Graz, Austria
| | - Andrea Heinzle
- Qualizyme Diagnostics GmbH & Co. KG, Neue Stiftingtalstrasse 2, A-8010 Graz, Austria
| | - Eva Sigl
- Qualizyme Diagnostics GmbH & Co. KG, Neue Stiftingtalstrasse 2, A-8010 Graz, Austria
| | - Kornelia Eitel
- Synovo GmbH, Paul Ehrlich Straße 15, 72076 Tuebingen, Germany
| | - Marieke Haalboom
- Medical School Twente, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands
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Khilnani GC, Tiwari P, Zirpe KG, Chaudhry D, Govil D, Dixit S, Kulkarni AP, Todi SK, Hadda V, Jain N, Govindagoudar MB, Samavedam S, Jha SK, Tyagi N, Jaju MR, Sharma A. Guidelines for the Use of Procalcitonin for Rational Use of Antibiotics. Indian J Crit Care Med 2022; 26:S77-S94. [PMID: 36896360 PMCID: PMC9989870 DOI: 10.5005/jp-journals-10071-24326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
Abstract
How to cite this article: Khilnani GC, Tiwari P, Zirpe KG, Chaudhary D, Govil D, Dixit S, et al. Guidelines for the Use of Procalcitonin for Rational Use of Antibiotics. Indian J Crit Care Med 2022;26(S2):S77-S94.
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Affiliation(s)
- Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary Medicine, School of Excellence in Pulmonary Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | | | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta - The Medicty, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan Surgery Hospital, Pune, Maharashtra, India; Department of Critical Care Medicine, MJM Hospital, Pune, Maharashtra, India
| | - Atul Prabhakar Kulkarni
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Jain
- Department of Pulmonary Medicine, Critical Care and Sleep Disorders, Pushpawati Singhania Hospital & Research Institute, New Delhi, India
| | | | - Srinivas Samavedam
- Department of Critical Care Management, Virinchi Hospital, Hyderabad, Telangana, India
| | | | - Niraj Tyagi
- Department of Institute of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Madhusudan R Jaju
- Critical Care Medicine Sunshine Hospital, Gachibowli, Hyderabad, India
| | - Anita Sharma
- Department of Lab Medicine, Fortes Hospital, Mohali, Punjab, India
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Torumkuney D, Poojary A, Shenoy B, Nijhara P, Dalal K, Manenzhe R. Country data on AMR in India in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome. J Antimicrob Chemother 2022; 77:i10-i17. [PMID: 36065726 PMCID: PMC9445854 DOI: 10.1093/jac/dkac212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action. Objectives To review the current situation with respect to AMR in India and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize further rises in AMR and to improve patient outcomes. Methods National AMR initiatives, antibiotic use and prescribing in India, and availability of susceptibility data, in particular for the key community-acquired respiratory tract infection (CA-RTI) pathogens (Streptococcus pneumoniae and Haemophilus influenzae) were identified. National and international antibiotic prescribing guidelines for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) commonly used locally were also reviewed, plus local antibiotic availability. Insights from a local clinician and clinical microbiologist were sought to contextualize this information. Conclusions Many initiatives have been launched since AMR was recognized as a national priority and organizations such as the Indian Academy of Paediatrics and the Global Antibiotic Resistance Partnership have worked to build awareness. The Indian Ministry of Health and Family Welfare published a 5 year national action plan on AMR. However, the burden of infectious disease and consumption of antibiotics in India is high. There have been national surveillance studies generating local data along with international studies such as Survey of Antibiotic Resistance (SOAR) and Antimicrobial Testing Leadership and Surveillance (ATLAS). For common RTIs, clinicians use a range of international and national guidelines. However, a more standardized inclusive approach to developing local guidelines, using up-to-date local surveillance data from community-acquired infections, could make guidelines more locally relevant. This would encourage more appropriate antibiotic prescribing and improve adherence. This would, in turn, potentially limit AMR development and improve patient outcomes.
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Affiliation(s)
- Didem Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - Aruna Poojary
- Department of Pathology and Microbiology, Breach Candy Hospital Trust, Mumbai, Maharashtra, India
| | - Bhaskar Shenoy
- Department of Paediatrics, Manipal Hospitals, Bangalore, Karnataka, India
| | - Puja Nijhara
- GlaxoSmithKline, 252, Dr Annie Besant Road, Worli, 400030, Mumbai, India
| | - Krunal Dalal
- GlaxoSmithKline, 252, Dr Annie Besant Road, Worli, 400030, Mumbai, India
| | - Rendani Manenzhe
- GlaxoSmithKline, The Campus, Flushing Meadows, 57 Sloane Street, Bryanston, Gauteng, 2021, South Africa
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Li HY, Wang HS, Wang YL, Wang J, Huo XC, Zhao Q. Management of Ventilator-Associated Pneumonia: Quality Assessment of Clinical Practice Guidelines and Variations in Recommendations on Drug Therapy for Prevention and Treatment. Front Pharmacol 2022; 13:903378. [PMID: 35668946 PMCID: PMC9163435 DOI: 10.3389/fphar.2022.903378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/29/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose: To assess the quality of clinical practice guidelines (CPGs) related to drug therapy for prevention and control of ventilator-associated pneumonia (VAP) and compare the differences and similarities between recommendations. Methods: Electronic databases (including PubMed, Cochrane library, Embase, Web of Science), guideline development organizations, and professional societies were searched to identify CPGs for VAP from 20 January 2012 to 20 January 2022. The Appraisal of Guidelines Research & Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. The recommendations on drug therapy for prevention and treatment for each guideline were extracted, and then a descriptive synthesis was performed to analyze the scope/topic, and consistency of the recommendations. Results: Thirteen CPGs were included. The median score and interquartile range (IQR) in each domain are shown below: scope and purpose 72.22% (63.89%,83.33%); stakeholder involvement 44.44% (38.89%,52.78%); rigor of development 43.75% (31.25%,57.29%); clarity and presentation 94.44% (77.78%,94.44%); applicability 20.83 (8.34%,33.34%) and editorial independence 50% (33.33%,66.67%). We extracted 21 recommendations on drug therapy for prevention of VAP and 51 recommendations on drugs used for treatment. Some controversies remained among the included guidelines. Conclusion: There is considerable variability in the development processes and reporting of VAP guidelines. Despite many similarities, the recommendations still had some inconsistencies in the details. For the prevention and treatment of VAP, local microbial epidemiology and antibiotic sensitivity must be considered, and recommendations should be regularly revised as new evidence emerges.
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Affiliation(s)
- Hong-Yan Li
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Hai-Shan Wang
- Department of Intensive Care Unit, Yantai YEDA Hospital, Yantai, China
| | - Ying-Lin Wang
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Jing Wang
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Xue-Chen Huo
- Department of Hepatobiliary Surgery, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
- *Correspondence: Xue-Chen Huo, ; Quan Zhao,
| | - Quan Zhao
- Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
- *Correspondence: Xue-Chen Huo, ; Quan Zhao,
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Kalita D, Deka S, Sharma KR, Sarma RK, Hazarika NK. Seasonal predominance of atypical agents in adult community-acquired pneumonia in India's northeastern region: Is it the time to look again at empirical therapy guidelines? Trop Doct 2022; 52:304-306. [DOI: 10.1177/00494755221080587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Atypical agents such as Mycoplasma, Legionella, Chlamydia species, and Coxiella burnetii (Q-fever agent) are responsible for some adult community-acquired pneumonia (CAP). Insufficient studies on this topic can be blamed for the failure to include atypical pathogens in empirical management. We followed adult CAP cases for two years, and samples (respiratory and serum) were tested by culture, ELISA (IgM, IgG, and IgA), and PCR. A risk factor analysis was performed. Overall in 21.3% adult CAP patients, atypical agents found were Mycoplasma pneumoniae (51.5%), Legionella pneumophila (28.8%), and Chlamydophila pneumoniae (19.7%). However, amongst patients <60 years of age and in the summer season, the proportion of atypical agents increased significantly. There is thus a need to re-examine empirical antibiotic regimes.
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Affiliation(s)
- Deepjyoti Kalita
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Sangeeta Deka
- Fakharuddin Ali Ahmed Medical Collee, Barpeta, Assam, India
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Zhuo C, Huang Y, Liu W, Xu JF, Zhu WY, Stone GG, Yan JL, Mohamed N. Efficacy and Safety of Ceftaroline Fosamil in Hospitalized Patients with Community-Acquired Pneumonia in China: Subset Analysis of an International Phase 3 Randomized Controlled Trial. Infect Drug Resist 2022; 15:605-617. [PMID: 35237053 PMCID: PMC8882473 DOI: 10.2147/idr.s342558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion Trial Registration
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Affiliation(s)
- Chao Zhuo
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
- Correspondence: Chao Zhuo, Email
| | - Yijiang Huang
- Respiratory Clinical Medical Center, Hainan Cancer Hospital, Hainan, People’s Republic of China
| | - Wenyuan Liu
- Respiratory Department, Sichuan Provincial People’s Hospital, Chengdu, People’s Republic of China
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Wei Yun Zhu
- Medical Department, Pfizer Investment Co. Ltd., Beijing, People’s Republic of China
| | | | - Jean Li Yan
- Biopharmaceuticals Group, Pfizer Inc., Cambridge, MA, USA
| | - Naglaa Mohamed
- Biopharmaceuticals Group, Pfizer Inc., New York, NY, USA
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Ruzsics I, Matrai P, Hegyi P, Nemeth D, Tenk J, Csenkey A, Eross B, Varga G, Balasko M, Petervari E, Veres G, Sepp R, Rakonczay Z, Vincze A, Garami A, Rumbus Z. Noninvasive ventilation improves the outcome in patients with pneumonia-associated respiratory failure: systematic review and meta-analysis. J Infect Public Health 2022; 15:349-359. [DOI: 10.1016/j.jiph.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/29/2021] [Accepted: 02/09/2022] [Indexed: 11/29/2022] Open
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de Moura LV, Mattjie C, Dartora CM, Barros RC, Marques da Silva AM. Explainable Machine Learning for COVID-19 Pneumonia Classification With Texture-Based Features Extraction in Chest Radiography. Front Digit Health 2022; 3:662343. [PMID: 35112097 PMCID: PMC8801500 DOI: 10.3389/fdgth.2021.662343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 11/29/2021] [Indexed: 12/18/2022] Open
Abstract
Both reverse transcription-PCR (RT-PCR) and chest X-rays are used for the diagnosis of the coronavirus disease-2019 (COVID-19). However, COVID-19 pneumonia does not have a defined set of radiological findings. Our work aims to investigate radiomic features and classification models to differentiate chest X-ray images of COVID-19-based pneumonia and other types of lung patterns. The goal is to provide grounds for understanding the distinctive COVID-19 radiographic texture features using supervised ensemble machine learning methods based on trees through the interpretable Shapley Additive Explanations (SHAP) approach. We use 2,611 COVID-19 chest X-ray images and 2,611 non-COVID-19 chest X-rays. After segmenting the lung in three zones and laterally, a histogram normalization is applied, and radiomic features are extracted. SHAP recursive feature elimination with cross-validation is used to select features. Hyperparameter optimization of XGBoost and Random Forest ensemble tree models is applied using random search. The best classification model was XGBoost, with an accuracy of 0.82 and a sensitivity of 0.82. The explainable model showed the importance of the middle left and superior right lung zones in classifying COVID-19 pneumonia from other lung patterns.
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Affiliation(s)
- Luís Vinícius de Moura
- Medical Image Computing Laboratory, School of Technology, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Christian Mattjie
- Medical Image Computing Laboratory, School of Technology, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Caroline Machado Dartora
- Medical Image Computing Laboratory, School of Technology, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Rodrigo C. Barros
- Machine Learning Theory and Applications Lab, School of Technology, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Ana Maria Marques da Silva
- Medical Image Computing Laboratory, School of Technology, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
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Singhal T, Rodrigues C, Soman R, Wattal C, Swaminathan S, Nambi S, Talwar D, Singh RK, Todi S. Treatment of MRSA infections in India: Clinical insights from a Delphi analysis. Indian J Med Microbiol 2021; 40:35-45. [PMID: 34785281 DOI: 10.1016/j.ijmmb.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE International and Indian guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections are available, but the local guidelines are not MRSA-specific. This study aimed to provide clinical insights for the treatment of MRSA infections in India. METHODS We used a three-step modified Delphi method to obtain insights. Ten experts comprising infectious disease specialists, microbiologists, pulmonologists, and critical care experts agreed to participate in the analysis. In round 1, a total of 161 statements were circulated to the panel and the experts were asked to 'agree' or 'disagree' by responding 'yes' or 'no' to each statement and provide comments. The same process was used for 73 statements in round 2. Direct interaction with the experts was carried out in round 3 wherein 35 statements were discussed. At least 80% of the experts had to agree for a statement to reach concordance. RESULTS Eighty-eight statements in round 1, thirty-eight statements in round 2, and eight statements in round 3 reached concordance and were accepted without modification. The final document comprised 152 statements on the management of various syndromes associated with MRSA such as skin and soft tissue infections, bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system infections. CONCLUSIONS This analysis will assist clinicians in India to choose an appropriate course of action for MRSA infections.
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Affiliation(s)
- Tanu Singhal
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | | | - Chand Wattal
- Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Subramanian Swaminathan
- Infectious Diseases and Infection Control at Gleneagles Global Hospitals (Chennai, Bangalore, Hyderabad), India
| | | | - Deepak Talwar
- Metro Respiratory Center Pulmonology & Sleep Medicine, Metro Hospital, Noida, India
| | | | - Subhash Todi
- Critical Care Medicine, Department of Academics & Health Research, AMRI Hospitals, Kolkata, India.
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Radhakrishnan A, Behera B, Mishra B, Mohapatra PR, Kumar R, Singh AK. Clinico-microbiological description and evaluation of rapid lateral flow immunoassay and PCR for detection of Burkholderia pseudomallei from patients hospitalized with sepsis and pneumonia: A twenty-one months study from Odisha, India. Acta Trop 2021; 221:105994. [PMID: 34118206 DOI: 10.1016/j.actatropica.2021.105994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 05/18/2021] [Accepted: 05/31/2021] [Indexed: 12/26/2022]
Abstract
Establishing a diagnosis of melioidosis based on clinical grounds is difficult in hospitalized patients with sepsis or community acquired pneumonia (CAP). We aimed to ascertain the prevalence, clinico-epidemiological and laboratory profile of melioidosis in hospitalized patients with sepsis or CAP, and to evaluate the diagnostic utility of rapid lateral flow immunoassay (LFI) and PCR in comparison with culture. In all patients with sepsis or CAP, blood, sputum/throat swab, and urine sample were subjected to culture along with other samples based on clinical presentation. In addition, PCR assay targeting the type III secretion system 1 (TTS1) and LFI was performed. Thirty-three (33/196, 17%) out of the total 196 cases were diagnosed as melioidosis by culture. The prevalence of melioidosis in patients who had only sepsis without CAP, had both sepsis and CAP, had CAP without sepsis was 31% (26/84), 22 % (4/18) and 3%(3/94) respectively. All the LFI or PCR positive cases were culture positive from at least one or more samples (blood/sputum/urine/pus). The sensitivity, specificity, positive predictive value and negative predictive value of TTS1 PCR was 78% (18/23 melioidosis patients), 100% (34/34 non-melioidosis patients), 100% (18/18 melioidosis patients) and 87% (34/39 non-melioidosis patients). The sensitivity, specificity, positive predictive value and negative predictive value of Rapid LFI was 91% (21/23 melioidosis patients), 100% (22/22 non-melioidosis patients), 100% (21/21 melioidosis patients) and 91% (22/24 non-melioidosis patients). On sample wise stratification of LFI and TTS1 with respect to culture, plasma/serum samples showed the highest discordance by PCR (9/55, 16.3%) and LFI (11/35, 31.4%). The lowest discordance was noted in respiratory tract samples (2/32, 6.2%) by PCR and pus/body fluids samples (2/14, 14.2%) by LFI and these findings are in line with previous published literature. The clinical utility of PCR and LFI needs to be further validated in a large scale study for early diagnosis of septicaemic melioidosis.
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Affiliation(s)
| | - Bijayini Behera
- Department of Microbiology, AIIMS, Bhubaneswar, Odisha, India.
| | | | | | - Rajesh Kumar
- Department of General Medicine, AIIMS, Bhubaneswar Odisha, India.
| | - Arvind Kumar Singh
- Department of Community and Family Medicine, AIIMS, Bhubaneswar, Odisha, India.
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Sun T, Wu B, Luo Z, Wang J, Deng S, Huang Q. Cell population data in identifying active tuberculosis and community-acquired pneumonia. Open Med (Wars) 2021; 16:1143-1149. [PMID: 34435139 PMCID: PMC8359903 DOI: 10.1515/med-2021-0322] [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: 10/06/2020] [Revised: 05/28/2021] [Accepted: 07/01/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Leukocyte morphological parameters known as CPD (cell population data) is detected by hematology analyzer UniCel DxH800 with VCS technology. This study aimed to investigate the diagnostic efficacy of morphological changes in CPD parameters in distinguishing active tuberculosis from community-acquired pneumonia. Methods From October 2018 to February 2019, 88 patients with active tuberculosis, 78 patients with community-acquired pneumonia, and 89 healthy controls were enrolled in this study. CPD was obtained using Unicel DxH800 analyzer for all whole blood samples, one-way ANOVA (non-parametric) and area analysis under ROC curve were performed. Results The neutrophil mean conductivity (NMC), monocyte mean volume (MMV), monocyte mean conductivity (MMC), lymphocyte percentage (LY%), and monocyte percentage (MO%) were significantly higher in the active tuberculosis group than in the community-acquired pneumonia group. The white blood cell (WBC) count and neutrophil percentage (NE%) were significantly lower in the active tuberculosis group than in the community-acquired pneumonia group. The analysis of the area under the ROC curve proved that WBC count, neutrophil percentage (NE%), lymphocyte percentage (LY%), and monocyte percentage (MO%) did not achieve a higher area under the curve (AUC: 0.63, 0.71, 0.62, and 0.7, respectively). However, the AUC of NMC, MMV, and MMC in the CPD parameters was 0.951, 0.877, 0.98, respectively, and the simultaneous measurement of the three parameters was 0.99. The sensitivity and specificity were 98.5% and 91.1%, respectively. Conclusion The combined diagnosis of NMC, MMV, and MMC could assist the clinical diagnosis of active tuberculosis and community-acquired pneumonia.
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Affiliation(s)
- Tingting Sun
- Department of Laboratory Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Bin Wu
- Department of Laboratory Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Zhonglan Luo
- Department of Laboratory Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Jing Wang
- Department of Laboratory Medicine, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Shaoli Deng
- Department of Laboratory Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Qing Huang
- Department of Laboratory Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
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Stalteri Mastrangelo R, Santesso N, Bognanni A, Darzi A, Karam S, Piggott T, Baldeh T, Schünemann F, Ventresca M, Morgano GP, Moja L, Loeb M, Schunemann H. Consideration of antimicrobial resistance and contextual factors in infectious disease guidelines: a systematic survey. BMJ Open 2021; 11:e046097. [PMID: 34330853 PMCID: PMC8327810 DOI: 10.1136/bmjopen-2020-046097] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/14/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Guidelines that include antimicrobial recommendations should explicitly consider contextual factors that influence antimicrobial resistance and their downstream effects on resistance selection. The objectives were to analyse (1) how, and to what extent, tuberculosis, gonorrhoea and respiratory tract infection guidelines are considering antimicrobial resistance; (2) are of acceptable quality and (3) if they can be easily contextualised to fit the needs of specific populations and health systems. METHODS We conducted a systematic review and searched Ovid MEDLINE and Embase from 1 January 2007 to 7 June 2019 for tuberculosis, gonorrhoea and respiratory tract infection guidelines published in English. We also searched guideline databases, key websites and reference lists. We identified guidelines and recommendations that considered contextual factors including antimicrobial resistance, values, resource use, equity, acceptability and feasibility. We assessed quality of the guidelines using the Appraisal of Guidelines for Research and Evaluation II tool focusing on the domains scope and purpose, rigour of development, and editorial independence. RESULTS We screened 10 365 records, of which 74 guidelines met inclusion criteria. Of these guidelines, 39% (n=29/74) met acceptable quality scores. Approximately two-thirds of recommendations considered antimicrobial resistance at the population and/or outcome level. Five of the 29 guidelines reported all factors required for recommendation contextualisation. Equity was the least considered across guidelines. DISCUSSION Relatively few guidelines for highly prevalent infectious diseases are considering resistance at a local level, and many do not consider contextual factors necessary for appropriate antimicrobial use. Improving the quality of guidelines targeting specific regional areas is required. PROSPERO REGISTRATION NUMBER CRD42020145235.
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Affiliation(s)
- Rosa Stalteri Mastrangelo
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Antonio Bognanni
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Darzi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Samer Karam
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Tejan Baldeh
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
| | - Finn Schünemann
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthew Ventresca
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lorenzo Moja
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Mark Loeb
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Holger Schunemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Cochrane Canada and MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada
- Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Abstract
Community-acquired pneumonia (CAP) is a common cause for admission to the hospital and contributes significantly to patient morbidity and healthcare cost. We present a review of the epidemiology, pathophysiology, risk factors, symptoms, diagnosis, presentations, risk-stratification, markers, and management of CAP in the United States (US). The overall incidence of CAP is 16 to 23 cases per 1000 persons per year, and the rate increases with age. Some of the risk factors for CAP include comorbidities such as, chronic obstructive pulmonary disease (COPD), asthma, and heart failure. CAP symptoms vary, and typically include productive cough, dyspnea, pleuritic pain, abnormal vital signs (e.g., fever, tachycardia), and abnormal lung examination findings. A diagnosis can be made by radiography, which has the additional benefit of helping to identify patterns associated with typical and atypical CAP. There are risk-stratification calculators that can be used routinely by physicians to triage patients, and to determine adequate management. The Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) developed the Pneumonia Severity Index (PSI) which incorporates 20 risk factors to place patients into 5 classes correlated with mortality risk. In addition, the British Thoracic Society (BTS) established the original severity score CURB (confusion, uremia, respiratory rate, low blood pressure) to identify patients with CAP who may be candidates for outpatient vs. inpatient treatment. Inflammatory markers, such as procalcitonin (PCT), can be used to guide management throughout hospital stay. Antibiotic coverage will vary depending on whether outpatient vs. inpatient management is required.
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18
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Sharma R, Sandrock CE, Meehan J, Theriault N. Community-Acquired Bacterial Pneumonia-Changing Epidemiology, Resistance Patterns, and Newer Antibiotics: Spotlight on Delafloxacin. Clin Drug Investig 2020; 40:947-960. [PMID: 32889706 PMCID: PMC7511281 DOI: 10.1007/s40261-020-00953-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality both in the USA and globally. As the burden of CAP continues to increase due to several factors, the advances in its diagnosis, prevention, and treatment have taken on even greater interest and importance. The majority of CAP patients are treated empirically, and selection of appropriate antibiotic treatment is increasingly difficult because the epidemiology of CAP is changing, in part due to antimicrobial resistance, and the causative CAP pathogens differ between countries and regions. There is also an increasing prevalence of chronic co-morbid diseases among CAP patients. Treatment of CAP has become challenging because of these factors along with the varying safety profiles and efficacy of well-established antibiotics, as well as limited new therapeutic options. Recently, however, new antibiotics have been approved, which will expand the treatment options for CAP, particularly in those patients with underlying complications. Recently approved delafloxacin, an anionic fluoroquinolone, has a unique structure and distinct chemical characteristics; it demonstrated non-inferiority to moxifloxacin in a phase III clinical trial, but was shown to be superior to moxifloxacin at early clinical response in CAP patients who also have chronic obstructive pulmonary disease (COPD) or asthma as a co-morbidity, and in CAP patients who may have severe illness. Delafloxacin could offer an additional therapy against resistant isolates and among these difficult-to-treat patients. This review summarizes the development, latest research, and safety profile of the new antibiotic delafloxacin, and its potential future role in the treatment of CAP.
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Affiliation(s)
- Roopali Sharma
- Department of Pharmacy Practice, Touro College of Pharmacy, 230 West 125th Street, New York, NY, 10027, USA.
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19
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Triana AJ, Molinares JL, Del Rio-Pertuz G, Meza JL, Ariza-Bolívar O, Robledo-Solano A, Acosta-Reyes J. Clinical practice guidelines for the management of community-acquired pneumonia: A critical appraisal using the AGREE II instrument. Int J Clin Pract 2020; 74:e13478. [PMID: 31927777 DOI: 10.1111/ijcp.13478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/28/2019] [Accepted: 01/08/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to appraise the methodological quality of published clinical practice guidelines (CPGs) of community-acquired pneumonia (CAP) using AGREE II instrument for further enhancing the CAP CPG development. METHODS We performed a systematic review of published CPGs on CAP from January 2007 to May 2019. All reviewers independently assessed each CPG using the AGREE II instrument. A standardised score was calculated for each of the six domains. RESULTS Our search strategy identified 4125 citations but just 18 met our inclusion criteria. Agreement among reviewers was very good: 0.98. The domains that scored better were: "scope and purpose" and "clarity and presentation". Those that scored worse were "editorial independence", and "applicability". According to the AGREE II evaluation for each Guideline, the NICE, IDSA, BTS, SWAB, Korea, Consensur II, Colombian and Peruvian CPGs were the only recommended with no further modifications. In addition, ERS and SEPAR CPGs were recommended with modifications, with lower scores regarding the editorial independence and applicability. CONCLUSION In conclusion, published CPGs for CAP management vary in quality with a need to improve the methodological and applicability rigour. This could be achieved following the standards for guidelines development and a better emphasis on how to apply CPGs recommendations in clinical practice.
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Affiliation(s)
- Abel J Triana
- Division of Health Sciences, Department of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Jorge L Molinares
- Division of Health Sciences, Department of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Gaspar Del Rio-Pertuz
- Division of Health Sciences, Department of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Jose L Meza
- Division of Health Sciences, Department of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Orlando Ariza-Bolívar
- Division of Health Sciences, Department of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Andrea Robledo-Solano
- Division of Health Sciences, Department of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Jorge Acosta-Reyes
- Division of Health Sciences, Department of Public Health, Universidad del Norte, Barranquilla, Colombia
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Gong Z, Li J, Luo H, Zhan D, Liu X, Gao C, Huang J, Qian Y, Song Y, Quan W, An S, Tian Y, Hu Z, Sun J, Yuan H, Jiang R. Low-temperature laminar flow ward for the treatment of multidrug resistance Acinetobacter baumannii pneumonia. Eur J Clin Microbiol Infect Dis 2020; 39:877-887. [PMID: 31898800 PMCID: PMC7223702 DOI: 10.1007/s10096-019-03790-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 12/04/2019] [Indexed: 01/17/2023]
Abstract
This study was designed to investigate the effect of low-temperature laminar flow ward (LTLFW) on the Acinetobacter baumannii pneumonia (MDR-ABP) in neurosurgical intensive care unit (NICU) patients. We evaluated whether patients in a LTLFW had significantly improved clinical outcomes as compared to those in nonconstant-temperature NICU (room temperature). The association of temperature with the prevalence of ABP and A. baumannii isolates (ABI) found in NICU patients was specifically investigated. In vitro microbiological experiments were conducted to measure the proliferation, antibiotic sensitivity, and genomic profiles of A. baumannii (AB) that grew in variable temperatures. MDR-ABP patients in LTLFW had significantly improved outcomes than those in the room temperature NICU. In addition, the numbers of ABI were positively associated with mean ambient outdoor temperatures (P = 0.002), with the incidence of ABP and average numbers of ABI among NICU patients being substantially lower in the winter as compared to other seasons. However, there were no significant seasonal variations in the other strains of the top five bacteria. Consistent with these clinical observations, AB growing at 20°C and 25°C had significantly reduced viability and antibiotic resistance compared to those growing at 35°C. The expression of genes related to AB survival ability, drug resistance, and virulence also differed between AB growing at 20°C and those at 35°C. LTLFW is effective in promoting the recovery of MDR-ABP patients because low temperatures reduced the density and virulence of AB and enhanced the efficacy of antibiotics, likely at the genetic level.
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Affiliation(s)
- Zhitao Gong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | | | - Hongliang Luo
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Daqiang Zhan
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
- Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Xuanhui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Yu Qian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Yiming Song
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Wei Quan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Shuo An
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Zhidong Hu
- Department of clinical laboratories, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Jian Sun
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Hengjie Yuan
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.
- Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China.
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China.
- Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.
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21
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Carugati M, Aliberti S, Sotgiu G, Blasi F, Gori A, Menendez R, Encheva M, Gallego M, Leuschner P, Ruiz-Buitrago S, Battaglia S, Fantini R, Pascual-Guardia S, Marin-Corral J, Restrepo MI. Bacterial etiology of community-acquired pneumonia in immunocompetent hospitalized patients and appropriateness of empirical treatment recommendations: an international point-prevalence study. Eur J Clin Microbiol Infect Dis 2020; 39:1513-1525. [PMID: 32242314 PMCID: PMC7222990 DOI: 10.1007/s10096-020-03870-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/18/2020] [Indexed: 12/03/2022]
Abstract
An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for selecting appropriate antimicrobial treatments. Very few etiological studies assessed the appropriateness of empiric guideline recommendations at a multinational level. This study aims at the following: (i) describing the bacterial etiologic distribution of CAP and (ii) assessing the appropriateness of the empirical treatment recommendations by clinical practice guidelines (CPGs) for CAP in light of the bacterial pathogens diagnosed as causative agents of CAP. Secondary analysis of the GLIMP, a point-prevalence international study which enrolled adults hospitalized with CAP in 2015. The analysis was limited to immunocompetent patients tested for bacterial CAP agents within 24 h of admission. The CAP CPGs evaluated included the following: the 2007 and 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA), the European Respiratory Society (ERS), and selected country-specific CPGs. Among 2564 patients enrolled, 35.3% had an identifiable pathogen. Streptococcus pneumoniae (8.2%) was the most frequently identified pathogen, followed by Pseudomonas aeruginosa (4.1%) and Klebsiella pneumoniae (3.4%). CPGs appropriately recommend covering more than 90% of all the potential pathogens causing CAP, with the exception of patients enrolled from Germany, Pakistan, and Croatia. The 2019 ATS/IDSA CPGs appropriately recommend covering 93.6% of the cases compared with 90.3% of the ERS CPGs (p < 0.01). S. pneumoniae remains the most common pathogen in patients hospitalized with CAP. Multinational CPG recommendations for patients with CAP seem to appropriately cover the most common pathogens and should be strongly encouraged for the management of CAP patients.
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Affiliation(s)
- Manuela Carugati
- Internal Medicine Department, Division of Infectious Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Milan, Italy. .,Division of Infectious Diseases and International Health, Duke University, Durham, USA.
| | - S Aliberti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - F Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - A Gori
- Internal Medicine Department, Division of Infectious Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Centre for Multidisciplinary Research in Health Science, Milan, Italy
| | - R Menendez
- Pneumology Service, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - M Encheva
- Clinic of Pulmonary Diseases, Military Medical Academy, Sofia, Bulgaria
| | - M Gallego
- Department of Respiratory Medicine, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, CIBER de Enfermedades Respiratorias, CIBERES, Bunyola, Spain
| | - P Leuschner
- Serviço de Medicina, Centro Hospitalar Universitario do Porto, Porto, Portugal
| | - S Ruiz-Buitrago
- Emergency Medicine Department, University Hospital Hairmyres, Glasgow, Scotland
| | - S Battaglia
- Pneumologia PROMISE, University of Palermo, Palermo, Italy
| | - R Fantini
- Respiratory Diseases Clinic, Policlinico di Modena, Modena, Italy
| | - S Pascual-Guardia
- Respiratory Department, Hospital del Mar - IMIM, DCEXS-UPF, CIBERES, BRN, Barcelona, Spain
| | - J Marin-Corral
- Critical Care Department, Hospital del Mar - IMIM, Barcelona, Spain
| | - M I Restrepo
- South Texas Veterans Health Care System and University of Texas Health San Antonio, San Antonio, USA
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Role of systemic antibiotic prophylaxis in acute burns: A retrospective analysis from a tertiary care center. Burns 2020; 46:1060-1065. [PMID: 32081382 DOI: 10.1016/j.burns.2019.12.004] [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: 10/04/2019] [Revised: 11/28/2019] [Accepted: 12/06/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Burns are a worldwide problem with majority of them occurring in low and middle-income countries. The hurdles in treatment of burns in the resource restricted setting are unique and challenging. The role of intravenous antibiotics in reducing mortality and morbidity related to infection and sepsis has not been studied extensively in the Indian sub-continent. MATERIALS AND METHODS This was a retrospective study conducted at a tertiary burn care center in India over a period of six months with follow up of one month from the day of burn injury. RESULTS Data from a total of 157 patients were collected and analysed. In Prophylaxis group (n = 77), sepsis was detected in 33 patients and 38 patients expired. In No Prophylaxis group (n = 80), sepsis was detected in 37 patients and 40 patients expired. In Inhalational burns subgroup, patients belonging to Prophylaxis group (n = 30) had 20 patients diagnosed with pneumonia while 22 patients did not survive till 30th post burn day. Patients in No Prophylaxis group who had inhalational burns were 38 in number. Pneumonia was diagnosed in 29 of them while 27 did not survive till 30th post burn day. In Pneumonia subgroup, patients belonging to Prophylaxis group had lower mortality rate as compared to No Prophylaxis group. CONCLUSION Our study does not support the routine usage of antibiotic prophylaxis in patients with burn injuries, but their administration can be considered in certain specific subgroups like patients with inhalational burns and patients developing pneumonia. Pneumonia is an independent risk factor for mortality when no antibiotic prophylaxis is used in burn patients.
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Iqbal N, Irfan M, Siddique F, Arshad V, Zubairi ABS. Factors predicting in-hospital mortality among patients admitted with community acquired pneumonia at a tertiary care hospital Karachi, Pakistan. CLINICAL RESPIRATORY JOURNAL 2020; 14:328-334. [PMID: 31863551 DOI: 10.1111/crj.13137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/13/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Community Acquired Pneumonia (CAP) is associated with significant morbidity and mortality globally, but unfortunately there is limited data available from South East Asia. OBJECTIVE To determine the risk factors associated with in-hospital mortality in patients with CAP in a tertiary care hospital of Pakistan. METHODS A retrospective study was conducted on adult patients admitted with a diagnosis of CAP from January 2011 till December 2016. Their clinical records were reviewed and a multivariable analysis was done to determine the factors associated with in-hospital mortality. RESULTS A total of 1100 files were reviewed, of which 509 were included in the analysis. The mean age was 63.6 ± 16.5 years and 302 (52.16%) were males. The most Common isolated pathogen was Staphylococcus aureus (23%). Overall mortality was 10.8%. On univariate analysis factors associated with mortality were old age patients (P = 0.02); history of pneumonia in last 12 months (P = 0.008); CURB 65 score ≥ 3 (P < 0.001) and high dependency units as initial site of care (P < 0.001). On multivariable analysis CURB65 ≥ 3 score; high dependency unit as initial site of care; bedridden status; presence of bilateral infiltrates on chest X-ray and hemoglobin of 10.4 g/dL or less at the time of admission were key determinants of in-hospital mortality. CONCLUSION We found CURB65 ≥ 3 score; high dependency unit as initial site of care; bedridden status; bilateral infiltrates on chest X-ray and low hemoglobin (10.4 g/dL or less) at the time of admission as independent risk factors of in-hospital mortality. Staphylococcus aureus was the most common organism isolated in patients.
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Affiliation(s)
- Nousheen Iqbal
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.,Department of Medicine, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Muhammad Irfan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Faraz Siddique
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Ali Bin Sarwar Zubairi
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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24
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Mohan A, Bhargav KM. Predicting outcomes in patients with community-acquired pneumonia using weighted track & trigger early warning systems: Lessons learnt & insights for future use. Indian J Med Res 2020; 152:332-334. [PMID: 33380697 PMCID: PMC8061590 DOI: 10.4103/ijmr.ijmr_261_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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25
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Tujula B, Hämäläinen S, Kokki H, Pulkki K, Kokki M. Review of clinical practice guidelines on the use of procalcitonin in infections. Infect Dis (Lond) 2019; 52:227-234. [DOI: 10.1080/23744235.2019.1704860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Benita Tujula
- Department of Anaesthesia and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sari Hämäläinen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Hannu Kokki
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Kari Pulkki
- Laboratory Division, Turku University Hospital, Turku, Finland
- Department of Clinical Chemistry, Faculty of Medicine, University of Turku, Turku, Finland
| | - Merja Kokki
- Department of Anaesthesia and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
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Vyas L, Kulshreshtha D, Maurya P, Singh A, Qavi A, Thacker A. A 2 DS 2 Score to Predict the Risk of Stroke-Associated Pneumonia in Acute Stroke: An Indian Perspective. J Neurosci Rural Pract 2019; 10:465-471. [PMID: 31595119 PMCID: PMC6779542 DOI: 10.1055/s-0039-1697893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Stroke-associated pneumonia (SAP) is an important cause of poststroke morbidity and mortality. Several clinical risk scores predict the risk of SAP. In this study, we used the A 2 DS 2 score (age, atrial fibrillation, dysphagia, sex, and stroke severity) to assess the risk of SAP in patients admitted with acute stroke. Methods A high (5-10) and a low (0-4) A 2 DS 2 score was assigned to patients with acute stroke admitted to the neurology ward. Univariate binary logistic regression analysis was performed to find the strength of association of SAP and A 2 DS 2 score. Results There were 250 patients with acute stroke of which 46 developed SAP. Forty-four patients developed SAP in high score as against 2 in low-score group (odds ratio [OR] = 0.03, 95% confidence interval [CI] = 0.01-0.15, p = 0.0001). A 2 DS 2 score >5 had sensitivity of 82.6% and specificity of 65.1% to predict SAP. The mean A 2 DS 2 score in patients with pneumonia was 7.02 ± 1.40 compared to 4.75 ± 1.92 in patients without pneumonia ( p = 0.0001). Conclusions A 2 DS 2 score has a high sensitivity of 82% in predicting the risk of SAP and is a useful tool to monitor patients after acute stroke. A 2 DS 2 score can help in timely detection and prevention of SAP and reduction in caregiver's burden.
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Affiliation(s)
- Limesh Vyas
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Dinkar Kulshreshtha
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pradeep Maurya
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajai Singh
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abdul Qavi
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anup Thacker
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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27
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Wan K, Liang H, Yan G, Zou B, Huang C, Jiang M. A quality assessment of evidence-based guidelines for the prevention and management of ventilator-associated pneumonia: a systematic review. J Thorac Dis 2019; 11:2795-2807. [PMID: 31463108 DOI: 10.21037/jtd.2019.06.56] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Numerous evidence-based guidelines (EBGs) pertaining to ventilator-associated pneumonia (VAP) have been published by domestic and international organizations, but their qualities have not been reported. Methods A systematic search of the literature was performed up to July 2018 for relevant guidelines. Guidelines were eligible for inclusion if they incorporated recommendation statements for prevention and/or management in adults or children with VAP and were developed on a systematic evidence-based method. Four reviewers evaluated each guideline using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, which comprises 23 items organized into six domains in addition to two overall items. Results Thirteen EBGs were identified for review. An overall high degree of agreement among reviewers was reached [intra-class correlation coefficient (ICC), 0.885; 95% CI, 0.862-0.905] during their review. The scores (mean, range) for the six AGREE domains were: scope and purpose (61%, 51-74%), stakeholder involvement (36%, 18-68%), rigor of development (41%, 22-59%), clarity and presentation (56%, 47-71%), applicability (38%, 21-59%) and editorial independence (50%, 0-77%). Only two EBGs (15.4%) were rated "recommended" for clinical practice. Approximately 86% of recommendations were based on moderate or low levels of evidence (levels B-D were 46.2%, 19.0%, and 21.2%, respectively). The recommendations for prevention and management of VAP were similar among the different EBGs. Conclusions The overall quality of the identified EBGs pertaining to VAP was classified as moderate. The management of VAP varied by guideline. More high-quality evidence is needed to improve guideline recommendations.
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Affiliation(s)
- Kairui Wan
- Nanshan School, Guangzhou Medical University, Guangzhou 511436, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Hengrui Liang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Guolin Yan
- Nanshan School, Guangzhou Medical University, Guangzhou 511436, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Bangyu Zou
- Nanshan School, Guangzhou Medical University, Guangzhou 511436, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Chuxin Huang
- Nanshan School, Guangzhou Medical University, Guangzhou 511436, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Mei Jiang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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Wen Z, Zhang X, Liu Y, Li Y, Li X, Wei L. Humidified versus nonhumidified low-flow oxygen therapy in children with Pierre-Robin syndrome: Study protocol for a randomised controlled trial. J Clin Nurs 2019; 28:3522-3528. [PMID: 31162860 DOI: 10.1111/jocn.14943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/08/2019] [Accepted: 05/26/2019] [Indexed: 12/27/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the necessity of oxygen humidification for low-flow oxygen therapy in children with Pierre-Robin syndrome. BACKGROUND Whether to carry out humidification or not in the low-flow oxygen delivery remains unclear, and currently, there is no published study on this issue in the population of children. Therefore, it is necessary to conduct more studies to elucidate this issue. DESIGN A randomised controlled trial. METHODS We attempt to report this randomised controlled trial to comply with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT). 188 children with Pierre-Robin syndrome will be expected to inclusion. The participants will be randomly divided into the humidified group (n = 94) and nonhumidified group (n = 94) at a ratio of 1:1. For humidified group, the oxygen will be routinely humidified with disposable bottle containing sterile water, whereas for nonhumidified group, the oxygen will not be humidified. Average arterial oxygen partial pressure (PaO2 ) and carbon dioxide partial pressure (PaCO2 ), incidence of ventilator-associated pneumonia (VAP), nasal cavity dryness, nasal mucosal bleeding and bacterial contamination of the humidified bottle, the cost of nasal oxygen therapy and duration of ICU stay are collected and analysed. RESULTS The study is planned to start in May 2019, and the results will be expected in July 2020. CONCLUSIONS This study is expected to provide a credible evidence on the necessity of routine oxygen humidification in low-flow oxygen delivery. RELEVANCE TO CLINICAL PRACTICE Understanding the role of oxygen humidification and no humidification for low-flow oxygen therapy in the population of children is beneficial to the nursing care of healthcare providers in clinical setting.
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Affiliation(s)
- Zunjia Wen
- Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xin Zhang
- Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yingfei Liu
- Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Li
- Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoyan Li
- Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Li Wei
- Children's Hospital of Nanjing Medical University, Nanjing, China
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29
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Koli PG, Kshirsagar NA, Shetty YC, Mehta D, Mittal Y, Parmar U. A systematic review of standard treatment guidelines in India. Indian J Med Res 2019; 149:715-729. [PMID: 31496524 PMCID: PMC6755779 DOI: 10.4103/ijmr.ijmr_902_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background & objectives Standard treatment guidelines (STGs) are the cornerstone to therapeutics. Multiple agencies in India develop STGs. This systematic review was conducted to find out STGs available in India, evaluate if these were as per World Health Organization (WHO) recommendations for STGs and compare these with National Institute for Health and Care Excellence (NICE) guidelines. Information on legal authority and responsibility for formulating STGs was also sought. Methods PRISMA guidelines were followed. Publications from PubMed and Google Scholar were searched for STGs using terms 'Standard Treatment Guidelines AND India'. Data from STGs were compiled in excel as per the WHO and authors' criteria for STGs and compared with NICE guidelines. Results PubMed and Google Scholar search provided 56 publications (out of 1695 search results) mentioning 27 STGs. Google search and replies from authors led us 36 STGs, totalling to 63 STGs. No STG mentioned any specific period of revision, eight STGs were not evidence-based, 55 had some Indian references, 48 STGs were for single disease and the remaining multi-disease, three STGs did not include diagnostic criteria, 16 STGs did not give prescribing information of recommended treatment and 16 STGs provide no referral criteria for patients. Fifty five STGs did not mention level of health care. While NICE is a single legal authority in England and guidelines are as per WHO recommendations for STGs, in India although Acts and rules do not vest authority, National Health Systems Resource Center is generally designated responsible for STGs. Interpretation & conclusions In India, although there are multiple STGs developed by various authorities and professionals for the same conditions, these fulfil WHO recommendations only partially. Authority with statutory duty collaborating with professional organizations, a standard methodology for adopting international guidelines, Indian data for evidence base, attention to local needs will help in developing better STGs and their acceptance.
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Affiliation(s)
- Paresh Girdharlal Koli
- Department of Pharmacology & Therapeutics, Seth Gordhandas Sunderdas Medical College & King Edward Memorial Hospital, Mumbai, India
| | - Nilima A. Kshirsagar
- National Chair of Clinical Pharmacology, Indian Council of Medical Research, New Delhi, India
| | - Yashashri C. Shetty
- Department of Pharmacology & Therapeutics, Seth Gordhandas Sunderdas Medical College & King Edward Memorial Hospital, Mumbai, India
| | | | | | - Urwashi Parmar
- Department of Pharmacology & Therapeutics, Seth Gordhandas Sunderdas Medical College & King Edward Memorial Hospital, Mumbai, India
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30
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Chou CC, Shen CF, Chen SJ, Chen HM, Wang YC, Chang WS, Chang YT, Chen WY, Huang CY, Kuo CC, Li MC, Lin JF, Lin SP, Ting SW, Weng TC, Wu PS, Wu UI, Lin PC, Lee SSJ, Chen YS, Liu YC, Chuang YC, Yu CJ, Huang LM, Lin MC. Recommendations and guidelines for the treatment of pneumonia in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 52:172-199. [PMID: 30612923 DOI: 10.1016/j.jmii.2018.11.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 01/19/2023]
Abstract
Pneumonia is a leading cause of death worldwide, ranking third both globally and in Taiwan. This guideline was prepared by the 2017 Guidelines Recommendations for Evidence-based Antimicrobial agents use in Taiwan (GREAT) working group, formed under the auspices of the Infectious Diseases Society of Taiwan (IDST). A consensus meeting was held jointly by the IDST, Taiwan Society of Pulmonary and Critical Care Medicine (TSPCCM), the Medical Foundation in Memory of Dr. Deh-Lin Cheng, the Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education and CY Lee's Research Foundation for Pediatric Infectious Diseases and Vaccines. The final guideline was endorsed by the IDST and TSPCCM. The major differences between this guideline and the 2007 version include the following: the use of GRADE methodology for the evaluation of available evidence whenever applicable, the specific inclusion of healthcare-associated pneumonia as a category due to the unique medical system in Taiwan and inclusion of recommendations for treatment of pediatric pneumonia. This guideline includes the epidemiology and recommendations of antimicrobial treatment of community-acquired pneumonia, hospital-acquired pneumonia, ventilator-associated pneumonia, healthcare-associated pneumonia in adults and pediatric pneumonia.
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Affiliation(s)
- Chih-Chen Chou
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ching-Fen Shen
- Division of Infectious Diseases, Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Su-Jung Chen
- Division of Infectious Diseases, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hsien-Meng Chen
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Shuo Chang
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Ting Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Yu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ching-Ying Huang
- Department of Pediatrics, MacKay Children's Hospital and MacKay Memorial Hospital, Taipei, Taiwan
| | - Ching-Chia Kuo
- Division of Infectious Diseases and Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ming-Chi Li
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Fu Lin
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Ping Lin
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Wen Ting
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Tzu-Chieh Weng
- Division of Holistic Care Unit, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ping-Sheng Wu
- Division of Infectious Diseases, Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Un-In Wu
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Chin Lin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Susan Shin-Jung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
| | - Yao-Shen Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Yung-Ching Liu
- Division of Infectious Diseases, Taipei Medical University Shuang Ho Hospital, Taipei, Taiwan
| | - Yin-Ching Chuang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chong-Jen Yu
- National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Ming Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
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Nayar S, Hasan A, Waghray P, Ramananthan S, Ahdal J, Jain R. Management of community-acquired bacterial pneumonia in adults: Limitations of current antibiotics and future therapies. Lung India 2019; 36:525-533. [PMID: 31670301 PMCID: PMC6852216 DOI: 10.4103/lungindia.lungindia_38_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Community-acquired bacterial pneumonia (CABP) is one of the leading causes of morbidity and mortality in India and worldwide. Evidence indicates that Gram-positive, Gram-negative, and atypical bacteria are encountered with near-equal frequency. Despite guideline recommendations and antibiotic options for the management of CABP, burden of morbidity and mortality is high, which is attributable to a variety of factors. Failure of empirical therapy, probably because of insufficient microbial coverage, increasing bacterial resistance, and adverse effects of existing treatments, underlies the unsuccessful treatment of CABP, especially in India. Multiple novel therapies that have entered clinical development phases have potential to address some of these issues. This article discusses the current treatment guidelines in CABP, management limitations, and emerging potential treatment options in the management of CABP.
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Affiliation(s)
- Sandeep Nayar
- Department of Respiratory Medicine, Centre for Chest and Respiratory Disease, BLK Super Speciality Hospital, New Delhi, India
| | - Ashfaq Hasan
- Department of Respiratory Medicine, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| | - Pradyut Waghray
- Department of Respiratory Medicine, Kunal Institute of Pulmonology, Hyderabad, Telangana, India
| | - Srinivasan Ramananthan
- Department of Critical Care Medicine, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Jaishid Ahdal
- Department of Medical Affairs, Wockhardt Ltd., BKC, Mumbai, Maharashtra, India
| | - Rishi Jain
- Department of Medical Affairs, Wockhardt Ltd., BKC, Mumbai, Maharashtra, India
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Khilnani, GC, Zirpe, K, Hadda, V, Mehta, Y, Madan, K, Kulkarni, A, Mohan, A, Dixit, S, Guleria, R, Bhattacharya, P. Guidelines for Antibiotic Prescription in Intensive Care Unit. Indian J Crit Care Med 2019; 23:S1-S63. [PMID: 31516211 PMCID: PMC6734471 DOI: 10.5005/jp-journals-10071-23101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
How to cite this article: Khilnani GC, Zirpe K, Hadda V, Mehta Y, Madan K, Kulkarni A, Mohan A, Dixit S, Guleria R, Bhattacharya P. Guidelines for Antibiotic Prescription in Intensive Care Unit. Indian Journal of Critical Care Medicine 2019;23 (Suppl 1):1-63.
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Affiliation(s)
- GC Khilnani,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Zirpe,
- Neuro-Trauma Unit, Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Vijay Hadda,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Yatin Mehta,
- Indian Society of Critical Care Medicine, Medanta Institute of Critical Care and Anesthesiology, Gurugram, Haryana, India
| | - Karan Madan,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kulkarni,
- Department of Anaesthesiology, Division of Critical Care Medicine, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anant Mohan,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Subhal Dixit,
- Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Randeep Guleria,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Bhattacharya,
- Department of Anaesthesiology, Critical Care and Emergency Services, Bhopal, Madhya Pradesh, India
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Mammen J, Choudhuri J, Paul J, Sudarsan TI, Josephine T, Mahasampath G, Jeyaseelan V, Nair SC, Peter JV. Cytomorphometric Neutrophil and Monocyte Markers May Strengthen the Diagnosis of Sepsis. J Intensive Care Med 2018; 33:656-662. [PMID: 30411670 DOI: 10.1177/0885066616682940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND: The diagnosis of sepsis is challenging in the absence of a gold standard test. Recent studies have explored the role of neutrophil and monocyte volume, conductivity, and scatter (VCS), derived from automated hematology analyzers, in diagnosing sepsis. We assessed the diagnostic accuracy of VCS parameters in critically ill patients with sepsis. METHODOLOGY: In this prospective study, VCS parameters, procalcitonin, and C-reactive protein (CRP) were assessed in patients with proven sepsis (cases) and 2 control groups (intensive care unit [ICU] patients without sepsis and healthy blood donors). The diagnostic property of each test was explored by calculating sensitivity, specificity, negative and positive predictive values, and area under the curve (AUC). RESULTS: The study included 65 patients with sepsis, 58 nonseptic ICU controls, and 98 blood donors. Procalcitonin and CRP were not significantly different ( P > .06) between patients with sepsis and nonseptic patients. Mean (95% confidence interval [CI]) neutrophil volume (MNV) was significantly higher ( P < .001) in patients with sepsis (165.5; 95%CI 161.6-169.4) than in nonseptic (157.3; 95%CI 154.6-160.1) patients and donors (148.9; 95%CI 147.9-150). A similar pattern was seen with mean monocyte volume (MMoV). Neutrophil and monocyte conductivity and scatter parameters were variably associated. The AUC was highest for MMoV (0.74) and lowest for CRP (0.62). Among all parameters, MNV and MMoV had the highest specificity of 85% and 80%, respectively. CONCLUSION: In critically ill patients with suspected sepsis, VCS parameters may help strengthen the diagnostic probability of sepsis. Future studies may explore the role of serial monitoring of VCS to track response to antimicrobial therapy.
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Affiliation(s)
- Joy Mammen
- 1 Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jui Choudhuri
- 1 Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Joshua Paul
- 1 Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - T Josephine
- 1 Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gowri Mahasampath
- 3 Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vishali Jeyaseelan
- 3 Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sukesh C Nair
- 1 Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - John Victor Peter
- 2 Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
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Mane A, Gujar P, Gaikwad S, Bembalkar S, Gaikwad S, Dhamgaye T, Risbud A. Aetiological spectrum of severe community-acquired pneumonia in HIV-positive patients from Pune, India. Indian J Med Res 2018; 147:202-206. [PMID: 29806610 PMCID: PMC5991133 DOI: 10.4103/ijmr.ijmr_1590_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Arati Mane
- Department of Microbiology, ICMR- National AIDS Research Institute, Pune 411 001, Maharashtra, India
| | - Pankaj Gujar
- Department of Tuberculosis & Chest Diseases, Sassoon General Hospitals, Pune 411 001, Maharashtra, India
| | - Shraddha Gaikwad
- Department of Microbiology, ICMR- National AIDS Research Institute, Pune 411 001, Maharashtra, India
| | - Shilpa Bembalkar
- Department of Microbiology, ICMR- National AIDS Research Institute, Pune 411 001, Maharashtra, India
| | - Sanjay Gaikwad
- Department of Tuberculosis & Chest Diseases, Sassoon General Hospitals, Pune 411 001, Maharashtra, India
| | - Tilak Dhamgaye
- Department of Tuberculosis & Chest Diseases, Sassoon General Hospitals, Pune 411 001, Maharashtra, India
| | - Arun Risbud
- Department of Microbiology, ICMR- National AIDS Research Institute, Pune 411 001, Maharashtra, India
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Abstract
Pneumonia is a common cause of respiratory infection, accounting for more than 800,000 hospitalizations in the United States annually. Presenting symptoms of pneumonia are typically cough, pleuritic chest pain, fever, fatigue, and loss of appetite. Children and the elderly have different presenting features of pneumonia, which include headache, nausea, abdominal pain, and absence of one or more of the prototypical symptoms. Knowledge of local bacterial pathogens and their antibiotic susceptibility and resistance profiles is the key for effective pharmacologic selection and treatment of pneumonia.
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Affiliation(s)
- Samuel N Grief
- Clinical Family Medicine, Department of Family Medicine, University of Illinois at Chicago, 1919 West Taylor Street, Suite 143, Chicago, IL 60612, USA.
| | - Julie K Loza
- Department of Family Medicine, University of Illinois at Chicago, 1919 West Taylor Street, Chicago, IL 60612, USA
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Tabla: A Proof-of-Concept Auscultatory Percussion Device for Low-Cost Pneumonia Detection. SENSORS 2018; 18:s18082689. [PMID: 30115828 PMCID: PMC6111795 DOI: 10.3390/s18082689] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 11/17/2022]
Abstract
Pneumonia causes the deaths of over a million people worldwide each year, with most occurring in countries with limited access to expensive but effective diagnostic methods, e.g., chest X-rays. Physical examination, the other major established method of diagnosis, suffers from several drawbacks, most notably low accuracy and high interobserver error. We sought to address this diagnostic gap by developing a proof-of-concept non-invasive device to identify the accumulation of fluid in the lungs (consolidation) characteristic of pneumonia. This device, named Tabla after the percussive instrument of the same name, utilizes the technique of auscultatory percussion; a percussive input sound is sent through the chest and recorded with a digital stethoscope for analysis. Tabla analyzes differences in sound transmission through the chest at audible frequencies as a marker for lung consolidation. This paper presents preliminary data from five pneumonia patients and eight healthy subjects. We demonstrate 92.3% accuracy in distinguishing between healthy subjects and patients with pneumonia after data analysis with a K-nearest neighbors algorithm. This prototype device is low cost and simple to implement and may offer a rapid and inexpensive method for pneumonia diagnosis appropriate for general use and in areas with limited medical infrastructure.
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Solanki BB, Juergens C, Chopada MB, Supe P, Sundaraiyer V, Le Dren-Narayanin N, Cutler MW, Gruber WC, Scott DA, Schmoele-Thoma B. Safety and immunogenicity of a 13-valent pneumococcal conjugate vaccine in adults 50 to 65 years of age in India: An open-label trial. Hum Vaccin Immunother 2018; 13:2065-2071. [PMID: 28881165 DOI: 10.1080/21645515.2017.1331796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Streptococcus pneumoniae infection is a major global public health concern in older adults, especially as life expectancy continues to increase in most countries, including India. Recently, a 13-valent pneumococcal conjugate vaccine (PCV13) with the ability to enhance immunity (immunologic memory) on natural exposure or revaccination has been shown to protect against community-acquired pneumonia and invasive pneumococcal disease in adults 65 years of age and older. An unconjugated 23-valent pneumococcal polysaccharide vaccine has been available for decades; however, data on protection against pneumonia are inconsistent. For the first time, a multicenter study has been conducted in India to assess the safety and immunogenicity of a single dose of PCV13 in adults aged 50 to 65 years. In this study, PCV13 elicited robust immune responses against all 13 pneumococcal serotypes as reflected by the magnitude of geometric mean fold rises (range, 6.6-102.7) in functional antibody levels from before to 1 month after vaccination. No serious adverse events occurred. These clinical trial findings support the safety and immunogenicity of PCV13 when administered to adults in India and indicate that a single dose of PCV13 has the potential to protect against vaccine-type pneumococcal disease in adults aged 50 to 65 years. ClinicalTrials.gov identifier: NCT02034877.
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Affiliation(s)
| | | | | | - Pravin Supe
- d Supe Heart and Diabetes Hospital and Research Centre , Maharashtra , India
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Mahassadi AK, Nguieguia JLK, Kissi HY, Awuah AAA, Bangoura AD, Doffou SA, Attia AK. Systemic inflammatory response syndrome and model for end-stage liver disease score accurately predict the in-hospital mortality of black African patients with decompensated cirrhosis at initial hospitalization: a retrospective cohort study. Clin Exp Gastroenterol 2018; 11:143-152. [PMID: 29670387 PMCID: PMC5898600 DOI: 10.2147/ceg.s140655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Systemic inflammatory response syndrome (SIRS) and model for end-stage liver disease (MELD) predict short-term mortality in patients with cirrhosis. Prediction of mortality at initial hospitalization is unknown in black African patients with decompensated cirrhosis. Aim This study aimed to look at the role of MELD score and SIRS as the predictors of morbidity and mortality at initial hospitalization. Patients and methods In this retrospective cohort study, we enrolled 159 patients with cirrhosis (median age: 49 years, 70.4% males). The role of Child–Pugh–Turcotte (CPT) score, MELD score, and SIRS on mortality was determined by the Kaplan–Meier method, and the prognosis factors were assessed with Cox regression model. Results At initial hospitalization, 74.2%, 20.1%, and 37.7% of the patients with cirrhosis showed the presence of ascites, hepatorenal syndrome, and esophageal varices, respectively. During the in-hospital follow-up, 40 (25.2%) patients died. The overall incidence of mortality was found to be 3.1 [95% confidence interval (CI): 2.2–4.1] per 100 person-days. Survival probabilities were found to be high in case of patients who were SIRS negative (log-rank test= 4.51, p=0.03) and in case of patients with MELD score ≤16 (log-rank test=7.26, p=0.01) compared to the patients who were SIRS positive and those with MELD score >16. Only SIRS (hazard ratio (HR)=3.02, [95% CI: 1.4–7.4], p=0.01) and MELD score >16 (HR=2.2, [95% CI: 1.1–4.3], p=0.02) were independent predictors of mortality in multivariate analysis except CPT, which was not relevant in our study. Patients with MELD score >16 experienced hepatorenal syndrome (p=0.002) and encephalopathy (p=0.001) more frequently than that of patients with MELD score ≤16. SIRS was not useful in predicting complications. Conclusion MELD score and SIRS can be used as tools for the prediction of mortality in black African patients with decompensated cirrhosis.
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Affiliation(s)
- Alassan Kouamé Mahassadi
- Medicine and Hepatogastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | | | - Henriette Ya Kissi
- Medicine and Hepatogastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | | | - Aboubacar Demba Bangoura
- Medicine and Hepatogastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Stanislas Adjeka Doffou
- Medicine and Hepatogastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Alain Koffi Attia
- Medicine and Hepatogastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d'Ivoire
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Sehgal IS, Agarwal R, Dhooria S, Prasad KT, Aggarwal AN, Behera D. Acute respiratory failure due to diffuse parenchymal lung diseases in a respiratory intensive care unit of North India. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2018; 35:363-370. [PMID: 32476924 PMCID: PMC7170122 DOI: 10.36141/svdld.v35i4.7066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/05/2018] [Indexed: 11/02/2022]
Abstract
Background: Acute respiratory failure (ARF) due to diffuse parenchymal lung diseases (DPLDs) is associated with high mortality. Whether ARF due to acute interstitial pneumonia (AIP), idiopathic pulmonary fibrosis (IPF) and non-IPF DPLDs behaves differently remains unclear. Methods: A retrospective analysis of consecutive DPLD subjects with ARF admitted to respiratory intensive care unit (RICU). The baseline clinical, demographic characteristics, cause of ARF and mortality were compared between the groups. Results: 145 (5.8% of RICU admission) subjects (mean [SD] age, 51.6 [14.7] years, 406% males) with DPLD-related ARF (17 AIP; 32 IPF; 96 non-IPF DPLD) were admitted. Common causes of ARF were acute exacerbation of the underlying DPLD (n=59, 40.4%) followed by infections (n=48, 37.5%). There was no difference in the peak, plateau and driving pressures across groups. The mortality rate was 45.5% (66/145) and was highest in AIP (82%) followed by IPF (59%) and non-IPF DPLD (34%). On multivariate logistic regression analysis, baseline APACHE II score, PaO2:FiO2 ratio, delta SOFA, and the use of invasive mechanical ventilation were independent predictors of mortality. The type of underlying DPLD however, did not affect survival. Conclusions: DPLD-related ARF is an uncommon cause of admission even in a RICU, and is associated with a high mortality. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 363-370).
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Affiliation(s)
- Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Liu F, Wen Z, Wei J, Xue H, Chen Y, Gao W, Melnick D, Gonzalez J, Hackett J, Li X, Deng S, Cao Z. Epidemiology, microbiology and treatment implications in adult patients hospitalized with pneumonia in different regions of China: a retrospective study. J Thorac Dis 2017; 9:3875-3887. [PMID: 29268397 DOI: 10.21037/jtd.2017.09.18] [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] [Indexed: 11/06/2022]
Abstract
Background Data describing epidemiology, clinical outcomes and treatment patterns, of hospitalised patients with pneumonia in China are limited. We aimed to describe such information among adult pneumonia patients in southern and northern China. Methods We retrospectively reviewed electronic medical records of pneumonia patients aged ≥18 years, hospitalized between 2008 and 2013 at Guangdong Provincial Hospital of Chinese Medicine (n=3,636), southern China, and between 2010 and 2014 at Peking University People's Hospital, Beijing (n=1,689), northern China, in order to collect data on patient demographics, microbiology, clinical outcomes and treatment and resistance patterns. Results The mean (SD) age of patients was 60.0 (21.4) and 64.4 (18.4) years in Guangdong and Beijing, respectively. Mean length of hospital stay was 12.1 and 20.8 days, and overall mortality was 2.9% and 8.0%, respectively. Gram-negative bacilli were most frequently isolated, predominantly Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. Infection with these bacteria was associated with unfavourable clinical outcomes, and the antibiotic resistance among these bacteria increased between 2008-2010 and 2011-2013 in both regions of China. The treatment and choice of antibiotics slightly varied between the two regions based on the susceptible pathogens identified among their populations. Conclusions Of the pathogens identified, Staphylococcus aureus infection (particularly the methicillin-resistant S. aureus) was associated with poor clinical outcomes; however antibiotic resistance among S. aureus generally decreased during the study data collection periods. Also, disease severity was greater in Beijing as compared with Guangdong, and this may be associated with higher microbiological diagnosis rate and higher frequency of initial antibiotic modification among Beijing populations.
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Affiliation(s)
- Fan Liu
- People's Hospital, Peking University, Beijing 100044, China
| | - Zehuai Wen
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Jia Wei
- AstraZeneca R & D Information, AstraZeneca China, Shanghai 201203, China
| | - Huiling Xue
- AstraZeneca R & D Information, AstraZeneca China, Shanghai 201203, China
| | - Yunqin Chen
- AstraZeneca R & D Information, AstraZeneca China, Shanghai 201203, China
| | - Weiguo Gao
- AstraZeneca R & D Information, AstraZeneca China, Shanghai 201203, China
| | | | | | | | - Xiaoyan Li
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Shizhou Deng
- People's Hospital, Peking University, Beijing 100044, China
| | - Zhaolong Cao
- People's Hospital, Peking University, Beijing 100044, China
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Mane A, Gujar P, Gaikwad S, Dhamgaye T, Risbud A. Detection of Cytomegalovirus in Bronchoalveolar Lavage Fluid from HIV-Positive Individuals with Community Acquired Pneumonia. J Clin Diagn Res 2017; 11:DC41-DC43. [PMID: 28892896 DOI: 10.7860/jcdr/2017/28148.10302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/07/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cytomegalovirus (CMV) pneumonia is one of the frequent viral pneumonia reported in persons with HIV infection. Knowledge of pulmonary CMV infection is important for deciding appropriate diagnostic strategies. However, there is scanty literature addressing the role of CMV aetiology among HIV positive individuals presenting with Community Acquired Pneumonia (CAP) using Bronchoalveolar Lavage (BAL) samples from India. AIM To detect CMV in BAL fluid from HIV-positive individuals presenting with CAP. MATERIALS AND METHODS This cross-sectional study was conducted using 107 archival BAL samples collected from consecutive HIV-positive patients presenting with CAP as per the Indian Chest Society and National College of Chest Physicians guidelines at the Department of Chest and Tuberculosis, Sassoon General Hospitals, Pune, India. The samples were tested for CMV by Polymerase Chain Reaction (PCR) targeting the IRL11 region at the National AIDS Research Institute, Pune. RESULTS Of the 107 BAL samples tested, 8 (7.4 %) were positive for CMV, while CMV was the sole pathogen in 5 (4.7%) cases. Co-infection with other pathogens was seen in 3 patients and Mycobacterium tuberculosis, Pneumocystis jiroveci and Streptococcus pneumoniae were the co-pathogens. Five patients had fatal clinical outcome of which three had CMV as the sole pathogen. CONCLUSION Ours is the first study to detect Cytomegalovirus (CMV) in bronchoalveolar lavage samples from HIV-positive individuals presenting with community acquired pneumonia from India and indicates the need for further multicentre studies to understand pulmonary CMV infection, which will eventually help in designing appropriate diagnostic strategies and therapeutic interventions.
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Affiliation(s)
- Arati Mane
- Scientist D, Department of Microbiology, National AIDS Research Institute, Pune, Maharashtra, India
| | - Pankaj Gujar
- Postgraduate Resident, Department of Chest and Tuberculosis, Sassoon General Hospitals, Pune, Maharashtra, India
| | - Shraddha Gaikwad
- Technical Assistant, Department of Microbiology, National AIDS Research Institute, Pune, Maharashtra, India
| | - Tilak Dhamgaye
- Professor and Head, Department of Chest and Tuberculosis, Sassoon General Hospitals, Pune, Maharashtra, India
| | - Arun Risbud
- Scientist G, Department of Microbiology, National AIDS Research Institute, Pune, Maharashtra, India
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Brown LA, Mitchell AM, Mitchell TJ. Streptococcus pneumoniae and lytic antibiotic therapy: are we adding insult to injury during invasive pneumococcal disease and sepsis? J Med Microbiol 2017; 66:1253-1256. [PMID: 28792379 DOI: 10.1099/jmm.0.000545] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Streptococcus pneumoniae (S. pneumoniae), otherwise known as 'the pneumococcus', is a fascinating microbe that continues to pose a significant problem to public health. Currently there are no specific National Institute for Clinical Excellence (NICE) or British Thoracic Society (BTS) clinical guidelines referring to the treatment of invasive pneumococcal infection. NICE clinical guidelines suggest the use of lytic β-lactam antibiotic regimens for the management of community-acquired pneumonia and bacterial meningitis; infections for which S. pneumoniae is a likely causative organism. Lytic antibiotics have been shown to increase the release of pneumolysin (the highly inflammatory and damaging toxin of the pneumococcus), thus theoretically increasing host damage, which may lead to a decline of clinical outcomes in vulnerable patients. In light of this information, should the use of non-lytic antibiotics, such as quinolones, rifamycins and macrolides, be considered for the treatment of invasive pneumococcal disease?
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Affiliation(s)
| | - Andrea M Mitchell
- Pneumococcal Research Group, Institute of Microbiology and Infection, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK
| | - Tim J Mitchell
- Pneumococcal Research Group, Institute of Microbiology and Infection, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK
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Mave V, Chandanwale A, Kagal A, Khadse S, Kadam D, Bharadwaj R, Dohe V, Robinson ML, Kinikar A, Joshi S, Raichur P, McIntire K, Kanade S, Sachs J, Valvi C, Balasubramanian U, Kulkarni V, Milstone AM, Marbaniang I, Zenilman J, Gupta A. High Burden of Antimicrobial Resistance and Mortality Among Adults and Children With Community-Onset Bacterial Infections in India. J Infect Dis 2017; 215:1312-1320. [PMID: 28329303 PMCID: PMC5853545 DOI: 10.1093/infdis/jix114] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/01/2017] [Indexed: 01/27/2023] Open
Abstract
Background In India, antimicrobial consumption is high, yet systematically collected data on the epidemiology, risk factors, and outcomes of antimicrobial-resistant infections are limited. Methods A prospective study of adults and children hospitalized for acute febrile illness was conducted between August 2013 and December 2015. In-hospital outcomes were recorded, and logistic regression was performed to identify independent predictors of community-onset antimicrobial-resistant infections. Results Among 1524 patients hospitalized with acute febrile illness, 133 isolates were found among 115 patients with community-onset infections; 66 isolates (50.0%) were multidrug resistant and, of 33 isolates tested for carbapenem susceptibility, 12 (36%) were resistant. Multidrug-resistant infections were associated with recent antecedent antibiotic use (adjusted odds ratio [aOR], 4.17; 95% confidence interval [CI], 1.19-19.7) and were independently associated with mortality (aOR, 6.06; 95% CI, 1.2-55.7). Conclusion We found a high burden of community-onset antimicrobial-resistant infection among patients with acute febrile illness in India. Multidrug-resistant infection was associated with prior antibiotic use and an increased risk of mortality.
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Affiliation(s)
- Vidya Mave
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Ajay Chandanwale
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Anju Kagal
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Sandhya Khadse
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Dileep Kadam
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Renu Bharadwaj
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Vaishali Dohe
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Matthew L Robinson
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Aarti Kinikar
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Samir Joshi
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Priyanka Raichur
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Katie McIntire
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Savita Kanade
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Jonathan Sachs
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Chhaya Valvi
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Usha Balasubramanian
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Vandana Kulkarni
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Aaron M Milstone
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ivan Marbaniang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | | | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee Jeejeebhoy Government Medical College, Pune, India
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Singh S, Singh N. Current trends of management of respiratory diseases by pulmonologists: Results of National Conference of Pulmonary Disease - 2015 survey. Lung India 2017; 34:13-18. [PMID: 28144054 PMCID: PMC5234191 DOI: 10.4103/0970-2113.197093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Context: Respiratory diseases are a common problem in our country and these are associated with significant morbidity and mortality. Aims: The aim of the paper was to analyze the pattern of diagnostic tests used and treatment prescribed for common respiratory diseases. Settings and Design: A total of 1028 pulmonologists, either member of Indian Chest Society or delegate attending the National Conference of Pulmonary Diseases (NAPCON) 2015, participated in the online survey. Subjects and Methods: The survey included questions pertinent to common respiratory diseases such as pulmonary tuberculosis (PTB), bronchial asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and pneumonia. Results: Investigation used for severity assessment and diagnosis of PTB, was sputum for acid-fast bacilli (83.5%), for IPF was high-resolution computed tomography chest (85.6%), for severe pneumonia was arterial blood gas analysis (69.3%), for asthma was spirometery and peak flow (96.8%) and for COPDs was spirometry (87.2%). The most popular choice of treatment for PTB was directly observed treatment short course (55.7%), for bronchial asthma, it was long-acting beta agonist with inhaled corticosteroids (LABA + ICSs) (41.1%), for COPD, it was LABA, ICS, and long-acting muscarinic antagonist (LABA + ICS + long-acting muscarinic antagonist) (32.4%) and for IPF, it was pirfenidone and N acetyl cysteine (38.3%). About 67.5% of doctors preferred hospitalization for patients with severe pneumonia. About 84.5% pulmonologists ordered diagnostic tests and 55.5% prescribed treatment as per current guidelines. Conclusions: The majority of doctors (70.1%) in our survey followed recommended guidelines for respiratory disease diagnosis and treatment. However, there is a need for upgradation of treatment strategies currently used by doctors.
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Affiliation(s)
- Sheetu Singh
- Department of Chest and Tuberculosis, SMS Medical College, Jaipur, Rajasthan, India
| | - Nishtha Singh
- Consultant, Department of Pulmonary Medicine, Asthma Bhawan, Jaipur, Rajasthan, India
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Choi ST, Song JS. Serum Procalcitonin as a Useful Serologic Marker for Differential Diagnosis between Acute Gouty Attack and Bacterial Infection. Yonsei Med J 2016; 57:1139-44. [PMID: 27401644 PMCID: PMC4960379 DOI: 10.3349/ymj.2016.57.5.1139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/07/2016] [Accepted: 01/28/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Patients with gout are similar to those with bacterial infection in terms of the nature of inflammation. Herein we compared the differences in procalcitonin (PCT) levels between these two inflammatory conditions and evaluated the ability of serum PCT to function as a clinical marker for differential diagnosis between acute gouty attack and bacterial infection. MATERIALS AND METHODS Serum samples were obtained from 67 patients with acute gouty arthritis and 90 age-matched patients with bacterial infection. Serum PCT levels were measured with an enzyme-linked fluorescent assay. RESULTS Serum PCT levels in patients with acute gouty arthritis were significantly lower than those in patients with bacterial infection (0.096±0.105 ng/mL vs. 4.94±13.763 ng/mL, p=0.001). However, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels showed no significant differences between the two groups. To assess the ability of PCT to discriminate between acute gouty arthritis and bacterial infection, the areas under the curves (AUCs) of serum PCT, uric acid, and CRP were 0.857 [95% confidence interval (CI), 0.798-0.917, p<0.001], 0.808 (95% CI, 0.738-0.878, p<0.001), and 0.638 (95% CI, 0.544-0.731, p=0.005), respectively. There were no significant differences in ESR and white blood cell counts between these two conditions. With a cut-off value of 0.095 ng/mL, the sums of sensitivity and specificity of PCT were the highest (81.0% and 80.6%, respectively). CONCLUSION Serum PCT levels were significantly lower in patients with acute gouty attack than in patients with bacterial infection. Thus, serum PCT can be used as a useful serologic marker to differentiate between acute gouty arthritis and bacterial infections.
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Affiliation(s)
- Sang Tae Choi
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
| | - Jung Soo Song
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Mbwele B, Slot A, De Mast Q, Kweka P, Msuya M, Hulscher M. The Use of Guidelines for Lower Respiratory Tract Infections in Tanzania: A Lesson from Kilimanjaro Clinicians. Ann Med Health Sci Res 2016; 6:100-8. [PMID: 27213093 PMCID: PMC4866362 DOI: 10.4103/2141-9248.181845] [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] [Indexed: 11/17/2022] Open
Abstract
Background: Evaluations of the guidelines for the management of Lower Respiratory Tract Infections (LRTI) Sub-Saharan Africa, particularly in Tanzania is scant. Aim: The aim of the study was to assess the usefulness of the current Tanzanian treatment guideline for the management lower respiratory tract infection. Subjects and Methods: A descriptive cross sectional study in 11 hospitals of different levels in the Kilimanjaro region Data were collected from May 2012 to July 2012 by semi-structured interview for clinicians using 2 dummy cases for practical assessment. Data were analyzed by STATA v11 (StataCorp, TX, USA). Qualitative narratives from the interviews were translated, transcribed then coded by colors into meaningful themes. Results: A variety of principles for diagnosing and managing LRTI were demonstrated by 53 clinicians of Kilimanjaro. For the awareness, 67.9% (36/53) clinicians knew their responsibility to use Standard Treatment Guideline for managing LRTI. The content derived from Standard Treatment Guideline could be cited by 11.3% of clinicians (6/53) however they all showed concern of gaps in the guideline. Previous training in the management of patients with LRTI was reported by 25.9% (14/53), majority were pulmonary TB related. Correct microorganisms causing different forms of LRTI were mentioned by 11.3% (6/53). Exact cause of Atypical pneumonia and Q fever as an example was stated by 13.0% (7/53) from whom the need of developing the guideline for LRTI was explicitly elaborated. Conclusion: The current guidelines have not been used effectively for the management of LRTI in Tanzania. There is a need to review its content for the current practical use.
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Affiliation(s)
- B Mbwele
- Kilimanjaro Christian Medical Center, Kilimanjaro Clinical Research Institute, Zanzibar, Tanzania; Programme Manager - Reproductive Maternal Newborn Child Health, Nutrition and WASH, Save the Children, Zanzibar, Tanzania
| | - A Slot
- Nijmegen Institute for International Health (NIIH, UMC Nijmegen), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Q De Mast
- Nijmegen Institute for International Health (NIIH, UMC Nijmegen), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - P Kweka
- Vijiji International, Kilimani Tower, Mawenzi Road, Moshi, Tanzania
| | - M Msuya
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - M Hulscher
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Kotwani A, Kumar S, Swain PK, Suri JC, Gaur SN. Antimicrobial drug prescribing patterns for community-acquired pneumonia in hospitalized patients: A retrospective pilot study from New Delhi, India. Indian J Pharmacol 2016; 47:375-82. [PMID: 26288468 PMCID: PMC4527057 DOI: 10.4103/0253-7613.161258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 05/25/2015] [Accepted: 06/25/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine patterns and frequency of antimicrobial drug use among hospitalized patients with community-acquired pneumonia (CAP). METHODOLOGY A retrospective 5 years (April 2007-March 2012) detailed medical record review of patients diagnosed with CAP and discharged to home from Non-Intensive Care Unit respiratory medicine wards of two public hospitals in Delhi. RESULTS A total of 261 medical records were analyzed. Over the 5 years, 82.0% (2007-08), 78.6% (2008-09), 59.5% (2009-10), 64.7% (2010-11), and 67.8% (2011-12) patients were prescribed two antimicrobials. In the last two study years, the proportion of patients receiving three antimicrobials increased (from 2.0% to 26.5% and 28.8%), while the proportion receiving monotherapy decreased (from 16.0% to 8.8% and 3.4%). In accordance with guidelines, beta-lactams and macrolides were the two most frequently prescribed antimicrobials (34.1%). However, newer generation beta-lactams were prescribed. A total of 37 patients were prescribed beta-lactam-tazobactam combination preparations. Overall, beta-lactams constituted more than 40% of prescriptions while macrolides were the second most prescribed class. Cephalosporin prescriptions significantly increased (P < 0.01) and penicillin prescriptions significantly decreased over study periods. The prescription of fluoroquinolones also decreased (21.5-6.0%, P < 0.01) and aminoglycoside prescription ranged from 9.7% to 16.4%, over 5 years. Reasons for prescribing three antimicrobials, use of aminoglycosides, or higher-end/reserve antibiotics were not mentioned in the medical records. There were no hospital-specific guidelines for doctors to follow in the treatment of CAP. CONCLUSIONS These findings suggest the need for implementing antimicrobial treatment guidelines. Adequate documentation and monitoring of antibiotic use for feedback are also lacking. An antimicrobial stewardship program may offer the most comprehensive solution for appropriate use of antimicrobials.
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Affiliation(s)
- Anita Kotwani
- Department of Pharmacology, V. P. Chest Institute, University of Delhi, New Delhi, India
| | - Santosh Kumar
- Department of Pharmacology, V. P. Chest Institute, University of Delhi, New Delhi, India
| | | | - J C Suri
- Department of Respiratory Medicine, Safdarjung Hospital, New Delhi, India
| | - S N Gaur
- Department of Respiratory Medicine, V. P. Chest Institute, University of Delhi, New Delhi, India
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Vicco MH, Ferini F, Rodeles L, Scholtus P, Long AK, Musacchio HM. In-hospital mortality risk factors in community acquired pneumonia: evaluation of immunocompetent adult patients without comorbidities. Rev Assoc Med Bras (1992) 2016; 61:144-9. [PMID: 26107364 DOI: 10.1590/1806-9282.61.02.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/03/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE several scores were developed in order to improve the determination of community acquired pneumonia (CAP) severity and its management, mainly CURB-65 and SACP score. However, none of them were evaluated for risk assessment of in-hospital mortality, particularly in individuals who were non-immunosuppressed and/or without any comorbidity. In this regard, the present study was carried out. METHODS we performed a cross-sectional study in 272 immunocompetent patients without comorbidities and with a diagnosis of CAP. Performance of CURB- 65 and SCAP scores in predicting in-hospital mortality was evaluated. Also, variables related to death were assessed. Furthermore, in order to design a model of in-hospital mortality prediction, sampled individuals were randomly divided in two groups. The association of the variables with mortality was weighed and, by multiple binary regression, a model was constructed in one of the subgroups. Then, it was validated in the other subgroup. RESULTS both scores yielded a fair strength of agreement, and CURB-65 showed a better performance in predicting in-hospital mortality. In our casuistry, age, white blood cell counts, serum urea and diastolic blood pressure were related to death. The model constructed with these variables showed a good performance in predicting in-hospital mortality; moreover, only one patient with fatal outcome was not correctly classified in the group where the model was constructed and in the group where it was validated. CONCLUSION our findings suggest that a simple model that uses only 4 variables, which are easily accessible and interpretable, can identify seriously ill patients with CAP.
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Affiliation(s)
- Miguel Hernan Vicco
- Internal Medicine Service, Hospital José Bernardo Iturraspe, Santa Fe, Argentina
| | - Franco Ferini
- Internal Medicine Service, Hospital José Bernardo Iturraspe, Santa Fe, Argentina
| | - Luz Rodeles
- Internal Medicine Service, Hospital José Bernardo Iturraspe, Santa Fe, Argentina
| | - Patricia Scholtus
- Internal Medicine Service, Hospital José Bernardo Iturraspe, Santa Fe, Argentina
| | - Ana Karina Long
- Internal Medicine Service, Hospital José Bernardo Iturraspe, Santa Fe, Argentina
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Narasimhan RL, Agarwal R, Sehgal IS. FAIM3:PLAC8 Ratio Compared with Existing Biomarkers for Diagnosis of Severe Community-acquired Pneumonia: Comparing Apples to Oranges? Am J Respir Crit Care Med 2016; 193:101-2. [PMID: 26720791 DOI: 10.1164/rccm.201508-1630le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Ritesh Agarwal
- 1 Postgraduate Institute of Medical Education and Research Chandigarh, India
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