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Pan S, Zhang Z, Pang W. The causal relationship between bacterial pneumonia and diabetes: a two-sample mendelian randomization study. Islets 2024; 16:2291885. [PMID: 38095344 PMCID: PMC10730180 DOI: 10.1080/19382014.2023.2291885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/03/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Previous observational studies have established the high prevalence of bacterial pneumonia in diabetic patients, which in turn leads to increased mortality. However, the presence of a causal connection between bacterial pneumonia and diabetes remains unobserved. METHODS We chose genome-wide significant (Ρ < 1 × 10-5 and Ρ < 1 × 10-6) and independent (r2 < 0.001) single-nucleotide polymorphisms (SNPs) as instrumental variables (IVs) to proceed a bidirectional two-sample MR study. The extracted SNPs explored the relationship between bacterial pneumonia and diabetes by Inverse variance weighted (IVW), MR-Egger, and weighted median methods. In addition, we conducted the Heterogeneity test, the Pleiotropy test, MR-presso and the Leave-one-out (LOO) sensitivity test to validate the reliability of results. RESULTS In an MR study with bacterial pneumonia as an exposure factor, four different types of diabetes as outcome. It was observed that bacterial pneumonia increases the incidence of GDM (OR = 1.150 (1.027-1.274, P = 0.011) and T1DM (OR = 1.277 (1.024-1.531), P = 0.016). In the reverse MR analysis, it was observed that GDM (OR = 1.112 (1.023-1.201, P = 0.009) is associated with an elevated risk of bacterial pneumonia. However, no significant association was observed bacterial pneumonia with T1DM and other types of diabetes (P > 0.05). CONCLUSION This study utilizing MR methodology yields robust evidence supporting a bidirectional causal association between bacterial pneumonia and GDM. Furthermore, our findings suggest a plausible causal link between bacterial pneumonia and T1DM.
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Affiliation(s)
- Songying Pan
- The School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin, Guangxi, China
| | - Zhongqi Zhang
- The School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin, Guangxi, China
| | - Weiyi Pang
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin, Guangxi, China
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Yamana H, Tsuchiya A, Horiguchi H, Fushimi K, Jo T, Yasunaga H. Microbiological findings in patients with community-acquired pneumonia: An analysis using the National Hospital Organization Clinical Data Archives. J Infect Chemother 2024; 30:567-570. [PMID: 38036029 DOI: 10.1016/j.jiac.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/16/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
Although large-scale administrative databases may be useful for studies of infectious diseases, conventional databases lack microbiological data. To illustrate the applicability of the National Hospital Organization Clinical Data Archives, a novel database of electronic medical records in Japan, we conducted a descriptive study of the microbiological findings in patients with community-acquired pneumonia using the database. We identified patients aged ≥18 years who were hospitalized for community-acquired bacterial pneumonia between April 2016 and March 2019. We evaluated the results of bacterial culture and antibacterial susceptibility of specimens obtained on the first day of hospitalization, in addition to patient characteristics, diagnosis codes, and intravenous antibiotics administered. The analysis identified 2200 eligible patients from 15 hospitals. Sulbactam-ampicillin was the most frequently used initial antibiotic (32 %), followed by ceftriaxone (22 %) and tazobactam-piperacillin (19 %). Overall, 56 %, 95 %, 56 %, and 73 % of patients with pathogen-specific diagnosis codes in the database for Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa, respectively, also tested positive for the corresponding pathogen in their sputum or blood cultures. Antibacterial susceptibilities were consistent with a previous report from Japan; 81 % of S. pneumoniae cases were resistant to azithromycin, and 48 % of H. influenzae cases were resistant to ampicillin. These microbiological characteristics warrant the future use of this database for detailed real-world research on infectious diseases.
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Affiliation(s)
- Hayato Yamana
- Data Science Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 3290498, Japan; Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, 2-5-21 Higashigaoka, Meguro, Tokyo 1528621, Japan.
| | - Asuka Tsuchiya
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 2591193, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 1130033, Japan
| | - Hiromasa Horiguchi
- Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, 2-5-21 Higashigaoka, Meguro, Tokyo 1528621, Japan
| | - Kiyohide Fushimi
- Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, 2-5-21 Higashigaoka, Meguro, Tokyo 1528621, Japan; Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo, Tokyo 1138519, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 1130033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 1130033, Japan
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Tilahun M, Belete MA, Gedefie A, Debash H, Alemayehu E, Gebretsadik D, Ebrahim H, Mohammed O. Etiology of bacterial pneumonia and multi-drug resistance pattern among pneumonia suspected patients in Ethiopia: a systematic review and meta-analysis. BMC Pulm Med 2024; 24:182. [PMID: 38627640 PMCID: PMC11022327 DOI: 10.1186/s12890-024-03000-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Bacterial pneumonia can affect all age groups, but people with weakened immune systems, young children, and the elderly are at a higher risk. Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa are the most common causative agents of pneumonia, and they have developed high MDR in recent decades in Ethiopia. This systematic review and meta-analysis aimed to determine the pooled prevalence of bacterial pneumonia and multidrug resistance in Ethiopia. METHODS The articles were searched extensively in the electronic databases and grey literature using entry terms or phrases. Studies meeting the eligibility criteria were extracted in MS Excel and exported for statistical analysis into STATA version 14 software. The pooled prevalence of bacterial pneumonia and multidrug resistance were calculated using a random-effects model. Heterogeneity was assessed by using the I2 value. Publication bias was assessed using a funnel plot and Egger's test. A sensitivity analysis was done to assess the impact of a single study on the pooled effect size. RESULT Of the 651 studies identified, 87 were eligible for qualitative analysis, of which 11 were included in the meta-analysis consisting of 1154 isolates. The individual studies reported prevalence of bacterial pneumonia ranging from 6.19 to 46.3%. In this systematic review and metanalysis, the pooled prevalence of bacterial pneumonia in Ethiopia was 37.17% (95% CI 25.72-46.62), with substantial heterogeneity (I2 = 98.4%, p < 0.001) across the studies. The pooled prevalence of multidrug resistance in bacteria isolated from patients with pneumonia in Ethiopia was 67.73% (95% CI: 57.05-78.40). The most commonly isolated bacteria was Klebsiella pneumoniae, with pooled prevalence of 21.97% (95% CI 16.11-27.83), followed by Streptococcus pneumoniae, with pooled prevalence of 17.02% (95% CI 9.19-24.86), respectively. CONCLUSION The pooled prevalence of bacterial isolates from bacterial pneumonia and their multidrug resistance were high among Ethiopian population. The initial empirical treatment of these patients remains challenging because of the strikingly high prevalence of antimicrobial resistance.
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Affiliation(s)
- Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Habtu Debash
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ermiyas Alemayehu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Daniel Gebretsadik
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Hussein Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ousman Mohammed
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Ishaq MS, Arabi EY. The prevalence of pneumothorax in human immunodeficiency virus patients. A single center study. Saudi Med J 2024; 45:442-445. [PMID: 38657977 DOI: 10.15537/smj.2024.45.4.20230807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/06/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To assess the prevalence, risk factors, and associated complications of pneumothorax that are present in patients with human immunodeficiency virus (HIV) at our institution and to provide an updated local study addressing the association between pneumothorax and HIV. METHODS This retrospective cohort study examined 161 patients who were admitted with a diagnosis of HIV from June 2017 to May 2022. They were divided into 2 groups depending on the presence of pneumothorax during their stay. Multiple variables were studied, including age, gender, tuberculosis infection, pneumocystis jiroveci pneumonia (PJP)infection, bacterial pneumonia, and pneumothorax type and treatment course. RESULTS There were 11 patients diagnosed with pneumothorax (prevalence rate: 6.8%). Bacterial lung infection was found in 9 (81.8%) of these patients, while fungal infection was found in 6 (54.5%) (p<0.001, 0.010). The MTB was found in 3 (27.3%) patients (p=0.728), while none were infected with PJP. Intercostal tube insertion was attempted in 9 (81.8%) patients, the mean duration of tube stay was 39.3±30.7 days, and the mortality rate was 72.7% (p=0.007). CONCLUSION Pneumothorax in patients with HIV is a manifestation of the progression of the disease and its poor outcome. It has a complicated treatment course and a high mortality rate.
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Affiliation(s)
- Mohammed S Ishaq
- From the Thoracic Surgery Department (Ishaq), King Saud Medical City, and from the General Surgery Department (Arabi), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Esraa Y Arabi
- From the Thoracic Surgery Department (Ishaq), King Saud Medical City, and from the General Surgery Department (Arabi), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
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Lyon E, Olarte L. Community-acquired bacterial pneumonia in children: an update on antibiotic duration and immunization strategies. Curr Opin Pediatr 2024; 36:144-149. [PMID: 38169463 DOI: 10.1097/mop.0000000000001325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW This review is structured to update clinicians on the epidemiology, antibiotic treatment, and prevention of pediatric bacterial pneumonia. The review provides information regarding the current research on antibiotic management for bacterial pneumonia and the newest immunization recommendations to prevent pneumococcal pneumonia and other respiratory infections. RECENT FINDINGS The recommended length of antibiotic therapy for bacterial pneumonia has been discrepant between low-income and high-income countries. Recently, randomized controlled trials conducted in high-income countries provided evidence to support a short antibiotic course (3-5 days) for uncomplicated bacterial pneumonia in otherwise healthy children. The negative impact of inaccurate penicillin allergy labels in children with pneumonia has emphasized the importance of prompt allergy de-labeling. Newer pneumococcal vaccines are recommended for children and are expected to have a significant impact on bacterial pneumonia rates. SUMMARY Pediatric bacterial pneumonia is an important contributor to childhood morbidity and mortality. A short antibiotic course seems to be sufficient for the outpatient management of uncomplicated bacterial pneumonia; however, more studies are required in the inpatient setting. Future studies will inform the impact of recently introduced pneumococcal and respiratory syncytial virus vaccines on the epidemiology of bacterial pneumonia.
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Affiliation(s)
- Edward Lyon
- Department of Pediatrics, Division of Infectious Diseases, Children's Mercy Kansas City
| | - Liset Olarte
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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Tzvi-Behr S, Frishberg Y, Megged O, Weinbrand-Goichberg J, Becher-Cohen R, Terespolsky H, Rinat C, Choshen S, Ben-Shalom E. Acute glomerulonephritis with concurrent suspected bacterial pneumonia - is it the tip of the iceberg? Pediatr Nephrol 2024; 39:1143-1147. [PMID: 37943374 DOI: 10.1007/s00467-023-06217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Post infectious glomerulonephritis is the most common glomerulopathy in children, occurring several weeks after nephritogenic streptococcal throat or skin infection. Reports of acute glomerulonephritis (AGN) occurring during active bacterial pneumonia in children are rare. The aim of this study was to evaluate the incidence of AGN concurrent with bacterial pneumonia in children. METHODS We reviewed records of all children admitted with a diagnosis of pneumonia to the pediatric department in a single tertiary medical center between January 2015 and April 2023. Patients with bacterial pneumonia and concurrent glomerulonephritis were included. RESULTS Eleven (0.98%) of 1,123 patients with bacterial pneumonia had concurrent AGN. All were males with a median age of 2.7 years (range 1-13). Mean time from bacterial pneumonia onset to acute glomerulonephritis symptoms was 2.7 ± 1.5 days. Five (45%) patients had evidence of pneumococcal infection. Hypertension was found in 10 (91%) patients. Mean trough eGFR was 43.5 ± 21.4 ml/min/1.73 m2 (range 11-73). Ten patients (91%) had low C3 levels. Median urinary protein-to-creatinine ratio was 2.5 mg/mg (IQR 2.15-14.75). All patients fully recovered. Microscopic hematuria was the last finding to normalize after a median of 29.5 days (IQR 17.25-38). CONCLUSION AGN during bacterial pneumonia may be more frequent than previously recognized. Kidney prognosis was excellent in all patients. Prospective studies are needed to evaluate the impact of this condition.
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Affiliation(s)
- Shimrit Tzvi-Behr
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel.
| | - Yaacov Frishberg
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Orli Megged
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | | | - Rachel Becher-Cohen
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Hadass Terespolsky
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Choni Rinat
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Sapir Choshen
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Efrat Ben-Shalom
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
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7
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Meyer Sauteur PM. Childhood community-acquired pneumonia. Eur J Pediatr 2024; 183:1129-1136. [PMID: 38112800 PMCID: PMC10950989 DOI: 10.1007/s00431-023-05366-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/21/2023]
Abstract
Community-acquired pneumonia (CAP) is a common disease in children, and its aetiological and clinical diagnosis are challenging for physicians in both private practice and hospitals. Over the past three decades, conjugate vaccines have successfully reduced the burden of the former main causes of CAP, Streptococcus pneumoniae and Haemophilus influenzae type b. Today, viruses are by far the most commonly detected pathogens in children with CAP. Conclusion: New insights into the aetiology and treatment of CAP in children in recent years have influenced management and are the focus of this review. In addition to reducing diagnostic uncertainty, there is an urgent need to reduce antibiotic overuse and antimicrobial resistance in children with CAP. What is Known: • Conjugate vaccines against Streptococcus pneumoniae and Haemophilus influenzae type b have shifted the epidemiology of childhood CAP to predominantly viral pathogens and Mycoplasma pneumoniae. • Clinical, laboratory, and radiological criteria cannot reliably distinguish between bacterial and viral aetiology in children with CAP. What is New: • Test results and epidemiological data must be carefully interpreted, as no single diagnostic method applied to non-pulmonary specimens has both high sensitivity and high specificity for determining pneumonia aetiology in childhood CAP. • This review provides a simple and pragmatic management algorithm for children with CAP to aid physicians in providing optimal and safe care and reducing antibiotic prescribing.
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Affiliation(s)
- Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
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Miyashita N, Nakamori Y, Ogata M, Fukuda N, Yamura A, Ishiura Y, Ito T. Is the JRS atypical pneumonia prediction score useful in detecting COVID-19 pneumonia under nursing or healthcare settings? Respir Investig 2024; 62:187-191. [PMID: 38185019 DOI: 10.1016/j.resinv.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND SARS-CoV-2 causes frequent outbreaks in elderly care facilities that meet the criteria for nursing and healthcare-associated pneumonia (NHCAP). We evaluated whether the Japanese Respiratory Society (JRS) atypical pneumonia prediction score could be adapted to the diagnosis of nursing and healthcare acquired COVID-19 (NHA-COVID-19) with pneumonia. METHODS We analyzed 516 pneumonia patients with NHA-COVID-19 and compared them with 1505 pneumonia patients with community-associated COVID-19 (CA-COVID-19). NHA-COVID-19 patients were divided into six groups; 80 cases had the ancestral strain, 76 cases had the Alfa variant, 30 cases had the Delta variant, 120 cases had the Omicron subvariant BA.1, 53 cases had the Omicron subvariant BA.2, and 157 cases had the Omicron subvariant BA.5. RESULTS The sensitivities of the diagnosis of atypical pneumonia in patients with NHA-COVID-19 based on four or more predictors were 22.8 % in the ancestral strain group, 32.0 % in the Alfa variant group, 34.5 % in the Delta variant group, 23.1 % in the BA.1 subvariant group, 32.7 % in the BA.2 subvariant group, and 30.4 % in the BA.5 subvariant group. The diagnostic sensitivity for the presumptive diagnosis of atypical pneumonia was significantly lower for NHA-COVID-19 than for CA-COVID-19 (28.2 % vs 64.1 %, p < 0.0001). CONCLUSIONS Our present study demonstrated that the JRS atypical pneumonia prediction score is not a useful tool in elderly patients even if there is a lot of atypical pneumonia in the NHCAP group. The caution is necessary that JRS atypical pneumonia prediction score was not fully applied to prediction for NHA-COVID-19 pneumonia.
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Affiliation(s)
- Naoyuki Miyashita
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
| | - Yasushi Nakamori
- Department of Emergency Medicine, Kansai Medical University Medical Center, 10-15 Bunen-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Makoto Ogata
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Naoki Fukuda
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Akihisa Yamura
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Yoshihisa Ishiura
- First Department of Internal Medicine, Division of Respiratory Medicine, Oncology and Allergology, Kansai Medical University Medical Center, 10-15 Bunen-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
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Schleenvoigt BT, Ankert J, Barten-Neiner G, Voit F, Suttorp N, Boesecke C, Hoffmann C, Stolz D, Pletz MW, Rohde G, Witzenrath M, Panning M, Essig A, Rupp J, Degen O, Stephan C. Pathogen spectrum of community acquired pneumonia in people living with HIV (PLWH) in the German CAPNETZ-Cohort. Infection 2024; 52:129-137. [PMID: 37423969 PMCID: PMC10811115 DOI: 10.1007/s15010-023-02070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES The objective of this study was to identify the pathogen spectrum of community acquired pneumonia in people living with HIV (PLWH), and to compare it with a matched HIV negative group in order to reassess therapeutic strategies for PLWH. METHODS Seventy-three (n = 73) PLWH (median CD4 3-6 months before CAP: 515/µl; SD 309) with community acquired pneumonia (CAP) were matched with 218 HIV-negative CAP controls in a prospective study design. Pathogen identifications used blood culture, samples from the upper and lower respiratory tract (culture and multiplex PCR) and urinary pneumococcal and legionella antigen test. RESULTS Although the vaccination rate among PLWH with CAP was significantly higher (pneumococcal vaccination: 27.4 vs. 8.3%, p < 0.001; influenza vaccination: 34.2 vs. 17.4%, p = 0.009), pneumococci were found most frequently as pathogen among both PLWH (n = 19/21.3%) and controls (n = 34/17.2%; p = 0.410), followed by Haemophilus influenzae (PLWH, n = 12/13.5%, vs. controls, n = 25 / 12.6%; p = 0.850). Staphylococcus aureus was found equally in 20.2 and 19.2% in PLWH and controls, but infection or colonization could not be distinguished. Mortality during 6-month follow-up was significantly higher for PLWH (5/73, or 6.8%) versus controls (3/218, or 1.4%), however with lower case numbers than previously reported. Typical HIV-associated pathogens such as Pneumocystis jirovecii were found only exceptionally. CONCLUSIONS Our study underscores the persistent clinical burden of CAP for PLWH. From pathogen perspective, empirical antibiotic treatment for CAP in PLWH on antiretroviral therapy should cover pneumococci and Haemophilus influenzae and may be adopted from valid common recommendations.
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Affiliation(s)
- Benjamin T Schleenvoigt
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany.
| | - Juliane Ankert
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Grit Barten-Neiner
- CAPNETZ STIFTUNG, Hannover, Germany
- Institute of Virology, University Medical Center-University of Freiburg, Freiburg, Germany
| | - Florian Voit
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- German Center for Lung Research (DZL), Berlin, Germany
| | - Christoph Boesecke
- Department of Internal Medicine I, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Christian Hoffmann
- ICH Study Center Hamburg, Hamburg, Germany
- University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Daiana Stolz
- Department of Pneumology, University Medical Center Freiburg, Freiburg, Germany
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
| | - Gernot Rohde
- CAPNETZ STIFTUNG, Hannover, Germany
- Medical Department I, Department of Respiratory Medicine, Goethe University Hospital, Frankfurt/Main, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Martin Witzenrath
- CAPNETZ STIFTUNG, Hannover, Germany
- Department of Infectious Diseases, Respiratory and Critical Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Panning
- Institute of Virology, University Medical Center-University of Freiburg, Freiburg, Germany
| | - Andreas Essig
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Ulm, Germany
| | - Jan Rupp
- CAPNETZ STIFTUNG, Hannover, Germany
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Giessen, Germany
| | - Olaf Degen
- Outpatient Infectious Diseases Unit, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Christoph Stephan
- Medical Department II, Section Infectious Diseases, University Medical Center, Frankfurt am Main, Germany
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Gramegna A, Misuraca S, Lombardi A, Premuda C, Barone I, Ori M, Amati F, Retucci M, Nazzari E, Alicandro G, Ferrarese M, Codecasa L, Bandera A, Aliberti S, Daccò V, Blasi F. Treatable traits and challenges in the clinical management of non-tuberculous mycobacteria lung disease in people with cystic fibrosis. Respir Res 2023; 24:316. [PMID: 38104098 PMCID: PMC10725605 DOI: 10.1186/s12931-023-02612-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Over the last ten years an increasing prevalence and incidence of non-tuberculous mycobacteria (NTM) has been reported among patients with cystic fibrosis (CF) Viviani (J Cyst Fibros, 15(5):619-623, 2016). NTM pulmonary disease has been associated with negative clinical outcomes and often requires pharmacological treatment. Although specific guidelines help clinicians in the process of diagnosis and clinical management, the focus on the multidimensional assessment of concomitant problems is still scarce. MAIN BODY This review aims to identify the treatable traits of NTM pulmonary disease in people with CF and discuss the importance of a multidisciplinary approach in order to detect and manage all the clinical and behavioral aspects of the disease. The multidisciplinary complexity of NTM pulmonary disease in CF requires careful management of respiratory and extra-respiratory, including control of comorbidities, drug interactions and behavioral factors as adherence to therapies. CONCLUSIONS The treatable trait strategy can help to optimize clinical management through systematic assessment of all the aspects of the disease, providing a holistic treatment for such a multi-systemic and complex condition.
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Affiliation(s)
- Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Sofia Misuraca
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Andrea Lombardi
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Premuda
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Ivan Barone
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Margherita Ori
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Francesco Amati
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
- Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Mariangela Retucci
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
- Healthcare Professions Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Erica Nazzari
- Cystic Fibrosis Center, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Maurizio Ferrarese
- Regional TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
| | - Luigi Codecasa
- Regional TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
- Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Valeria Daccò
- Cystic Fibrosis Center, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
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Hansen K, Yamba Yamba L, Wasserstrom L, Rünow E, Göransson T, Nilsson A, Ahl J, Riesbeck K. Exploring the microbial landscape: uncovering the pathogens associated with community-acquired pneumonia in hospitalized patients. Front Public Health 2023; 11:1258981. [PMID: 38152664 PMCID: PMC10752608 DOI: 10.3389/fpubh.2023.1258981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/10/2023] [Indexed: 12/29/2023] Open
Abstract
Objectives This study aimed to investigate the etiology, clinical features, and outcomes of community-acquired pneumonia (CAP) in adults. Understanding the causative pathogens is essential for effective treatment and prevention. Design Between 2016-2018, 518 hospitalized adults with CAP and 241 controls without symptoms were prospectively enrolled. Urine samples were collected for pneumococcal urinary antigen tests and nasopharyngeal swabs for viral and bacterial analysis, combined with routine diagnostic care. Results Among the included CAP patients, Streptococcus pneumoniae was the most common pathogen, detected in 28% of patients, followed by Haemophilus influenzae in 16%. Viruses were identified in 28%, and concurrent viruses and bacteria were detected in 15%. There was no difference in mortality, length of stay, or symptoms at hospitalization when comparing patients with bacterial, viral, or mixed etiologies. Among the control subjects without respiratory symptoms, S. pneumoniae, H. influenzae, or Moraxella catarrhalis were detected in 5-7%, and viruses in 7%. Conclusion Streptococcus pneumoniae emerged as the predominant cause of CAP, followed closely by viruses and H. influenzae. Intriguingly, symptoms and outcome were similar regardless of etiology. These findings highlight the complexity of this respiratory infection and emphasize the importance of comprehensive diagnostic and treatment strategies.Clinical Trial Registration: ClinicalTrials.gov, identifier [NCT03606135].
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Affiliation(s)
- Karin Hansen
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine Lund University, Malmö, Sweden
- Infectious Diseases, Department of Translational Medicine, Faculty of Medicine Lund University, Malmö, Sweden
| | - Linda Yamba Yamba
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine Lund University, Malmö, Sweden
| | - Lisa Wasserstrom
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine Lund University, Malmö, Sweden
- Clinical Microbiology, Infection Control and Prevention, Laboratory Medicine, Lund, Sweden
| | - Elisabeth Rünow
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine Lund University, Malmö, Sweden
- Infectious Diseases, Department of Translational Medicine, Faculty of Medicine Lund University, Malmö, Sweden
| | - Tommy Göransson
- Clinical Microbiology, Infection Control and Prevention, Laboratory Medicine, Lund, Sweden
| | - Anna Nilsson
- Infectious Diseases, Department of Translational Medicine, Faculty of Medicine Lund University, Malmö, Sweden
| | - Jonas Ahl
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine Lund University, Malmö, Sweden
- Infectious Diseases, Department of Translational Medicine, Faculty of Medicine Lund University, Malmö, Sweden
| | - Kristian Riesbeck
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine Lund University, Malmö, Sweden
- Clinical Microbiology, Infection Control and Prevention, Laboratory Medicine, Lund, Sweden
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Ekiz Iscanli IG, Aydin M, Şaylan B. Clinical characteristics and risk factors associated with secondary bacterial pneumonia among COVID-19 patients in ICU. J Infect Dev Ctries 2023; 17:1387-1393. [PMID: 37956367 DOI: 10.3855/jidc.17066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/23/2022] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION COVID-19 and secondary infections developing during COVID-19 follow-up are one of the most important causes of morbidity and mortality in intensive care units (ICU). In this study, we aimed to determine the frequency, microbiology, risk factors, and outcomes of secondary bacterial pneumonia in hospitalized patients due to COVID-19. METHODOLOGY We studied all patients with bacterial pneumonia developed in patients with severe COVID-19 infection in the COVID-19 intensive care unit in a single-center hospital between March 16, 2020 and June 17, 2020. Patients hospitalized and followed up in the ICU for respiratory failure were examined in terms of secondary infection affecting morbidity and mortality. RESULTS Ninety-six (20%) of 471 patients had secondary bacterial pneumonia, respectively; of the leading pathogens were Acinetobacter baumannii (44.8%) and Klebsiella pneumoniae (39.6%), followed by Pseudomonas aeruginosa (4.2%), Escherichia coli (3.1%), methicillin-resistant Staphylococcus aureus (MRSA) (3.1%), Streptococcus pneumoniae (3.1%), and Methicillin-susceptible Staphylococcus aureus (MSSA) (1%). The mortality rate among infected (75% / 47.5%) was significantly higher than in uninfected patients. Associated with the development of secondary bacterial pneumonia in COVID-19 patients; corticosteroid therapy [odds ratio (OR) 6250, 95% confidence interval (CI) 1.383-28.571, p = 0.017), corticosteroid dose (OR 8.862 CI 2.299-70.258, p= 0.006), duration of mechanical ventilation (OR 1.199 CI) 1.088-1.322, p< 0.001). CONCLUSIONS Secondary bacterial pneumonia was found to be associated with the severity and survival of the disease in patients admitted to ICU due to COVID-19. Duration of mechanical ventilation and use of corticosteroids and high-dose corticosteroids are risk factors for secondary bacterial pneumonia.
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Affiliation(s)
- Insa Gül Ekiz Iscanli
- Department of Respiratory Intensive Care Unit, Health Sciences University Sureyyapasa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehtap Aydin
- Department of Infectious Disease and Clinical Microbiology, Health Sciences University Umraniye Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Bengü Şaylan
- Department of Pulmonology, Health Sciences University Sultan Abdulhamid Han Training and Research Hospital, University of Health Science, Istanbul, Turkey
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Choi MH, Kim D, Lee KH, Cho JH, Jeong SH. Changes in the prevalence of pathogens causing hospital-acquired bacterial pneumonia and the impact of their antimicrobial resistance patterns on clinical outcomes: A propensity-score-matched study. Int J Antimicrob Agents 2023; 62:106886. [PMID: 37343808 DOI: 10.1016/j.ijantimicag.2023.106886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND This study aimed to evaluate changes in the prevalence of pathogens causing hospital-acquired bacterial pneumonia (HABP) and their antimicrobial resistance patterns in recent years, and to identify risk factors for 28-day all-cause mortality (ACM) in patients with HABP. METHODS A propensity-score-matched study was performed by randomly allocating patients with ventilator-associated and non-ventilator-associated bacterial pneumonia admitted to two university hospitals between 2011 and 2021. RESULTS In total, 17,250 patients with HABP were enrolled. The annual incidence of Staphylococcus aureus HABP decreased during the study period, while that of Klebsiella pneumoniae HABP increased significantly each year. Over the same period, the resistance rate of S. aureus to methicillin decreased from 88.4% to 64.4%, while the non-susceptibility rate of K. pneumoniae to carbapenems increased from 0% to 38%. HABP caused by A. baumannii [adjusted odds ratio (aOR) 1.50, 95% confidence interval (CI) 1.25-1.79], K. pneumoniae (aOR 1.28, 95% CI 1.16-1.40) and Stenotrophomonas maltophilia (aOR 1.32, 95% CI 1.05-1.66) was a risk factor for 28-day ACM. Patients with HABP caused by methicillin-resistant S. aureus and carbapenem-non-susceptible A. baumannii or K. pneumoniae had a significantly lower probability of survival. HABP with preceding coronavirus disease 2019 (COVID-19) was associated with high 28-day ACM (aOR 5.40, 955 CI 3.03-9.64) and high incidence of bacteraemic pneumonia (aOR 40.55, 95% CI 5.26-312.79). CONCLUSIONS This study showed shifting trends in HABP-causing pathogens in terms of annual incidence and resistance rates to major therapeutic antimicrobial agents. HABP-causing bacterial pathogens, their antimicrobial resistance phenotypes, and preceding COVID-19 were significantly associated with progression of HABP to bloodstream infection and 28-day ACM in infected patients.
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Affiliation(s)
- Min Hyuk Choi
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, South Korea; Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Dokyun Kim
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, South Korea; Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung Hwa Lee
- Division of Infectious Diseases, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, South Korea; Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, South Korea
| | - Jae Hwa Cho
- Division of Infectious Diseases, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, South Korea; Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, South Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, South Korea; Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.
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14
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Shanks GD. Why Did Black Soldiers Historically Have More Pneumonia Than White Soldiers in the U.S. Army? Am J Trop Med Hyg 2023; 108:1105-1108. [PMID: 37127276 PMCID: PMC10540094 DOI: 10.4269/ajtmh.23-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/15/2023] [Indexed: 05/03/2023] Open
Abstract
Black U.S. Army soldiers had four times as much bacterial pneumonia as White U.S. Army soldiers during both the U.S. Civil War and World War I (WWI). Pneumonia case fatality rates were a third greater in Black soldiers during the U.S. Civil War, but were the same between the racial groups by WWI. During WWII, the use of antibiotics decreased bacterial pneumonia mortality rates 100-fold and apparently erased racial differences. Similar differences in bacterial pneumonia rates by racial group were observed in African colonial soldiers of the French and British Armies during WWI. Pneumonia rates in Indian, Filipino, and Puerto Rican soldiers suggested that genetic polymorphisms were not a decisive factor determining Black pneumonia mortality. Postmeasles pneumonias did not suggest an immune deficit in Black soldiers. Geographic focus of pneumonia in Black soldiers from the southern U.S. states and other tropical regions raises the possibility that increased bacterial pneumonia rates were related indirectly to malaria infections. Malaria remains a difficult-to-measure but potentially important mortality risk factor in pneumonia.
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Affiliation(s)
- G Dennis Shanks
- Australian Defence Force Malaria and Infectious Disease Institute, Enoggera, Australia
- School of Public Health, University of Queensland, Brisbane, Australia
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15
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Clemente I, Santini SJ, Vittorini P, Pallotta E, Sinatti G, Fontana A, Mammarella L, Rancitelli E, Balsano C. Fall of viral and bacterial pneumonia hospitalizations following COVID-19 pandemic mitigation strategies: a central Italian Region retrospective study. Intern Emerg Med 2023; 18:1181-1189. [PMID: 36750536 PMCID: PMC9904871 DOI: 10.1007/s11739-023-03213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Abstract
Community-Acquired Pneumonia (CAP) represents one of the first causes of hospitalization and death in the elderly all over the world and weighs heavily on public health system. Since the beginning of the COVID-19 (CoronaVirus Disease-19) pandemic, everybody's behavior was forced to change, as the result of a global lockdown strategy and the obligation of using personal protection equipment (PPE). We aimed to evaluate how the mitigation strategies adopted to fight SARS-CoV-2 (Severe Acute Respiratory Coronavirus Syndrome 2) infection have influenced hospitalizations due to CAP in two different Local Health Boards (LHBs) of central Italy. We considered two main periods of observation: before and after the national start of lockdown, in two Abruzzo's LHBs. We analyzed 19,558 hospital discharge records of bacterial and viral CAP. Excluding SARS-CoV2 infection, a significant decrease in CAP hospitalizations was observed. Through the analysis of Diagnosis Related Group (DRG) values, we highlighted a significant saving of founds for the Regional Health Service. The enactment of social distancing measures to contain COVID-19 spread, brought down admissions for bacterial and viral pneumonia. Our study emphasizes that costs for hospitalizations due to CAP could be drastically reduced by mask wearing and social distancing.
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Affiliation(s)
- Irma Clemente
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Silvano Junior Santini
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
- Francesco Balsano Foundation, Via Giovanni Battista Martini 6, 00198, Rome, Italy
| | - Pierpaolo Vittorini
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Enrico Pallotta
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Gaia Sinatti
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Antonella Fontana
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Leondino Mammarella
- U.O.S.D. Servizio Gestione Flussi Informativi e Statistica Sanitaria, L'Aquila, Italy
| | | | - Clara Balsano
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy.
- Francesco Balsano Foundation, Via Giovanni Battista Martini 6, 00198, Rome, Italy.
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Zilberberg MD, Nathanson BH, Puzniak LA, Zilberberg NWD, Shorr AF. Descriptive epidemiology of hospitalized patients with bacterial nosocomial pneumonia who experience 30-day readmission in the US, 2014-2019. PLoS One 2022; 17:e0276192. [PMID: 36490261 PMCID: PMC9733878 DOI: 10.1371/journal.pone.0276192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 09/30/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Nosocomial pneumonia (NP) remains associated with excess morbidity and mortality. The effect of NP on measures such as re-admission at 30 days remains unclear. Moreover, differing types of NP may have varying impacts on re-admissions. METHODS We conducted a multicenter retrospective cohort study within the Premier Research database, a source containing administrative, pharmacy, and microbiology data. We compared NP patients readmitted with pneumonia (RaP) as the principal diagnosis to those readmitted for other reasons (RaO) with respect to the type of NP (ventilator-associated bacterial pneumonia [VABP], ventilated hospital-acquired bacterial pneumonia [vHABP], and non-ventilated HABP [nvHABP]), and characteristics and outcomes of the index hospitalization. RESULTS Among 17,819 patients with NP, 14,123 (79.3%) survived to discharge, of whom 2,151 (15.2%) required an acute readmission within 30 days of index discharge. Of these, 106 (4.9%) were RaP, and the remainder were RaO. At index hospitalization, RaP patients were older (mean age [SD] 67.4 (13.9] vs. 63.0 [15.2] years), more likely medical (44.3% vs. 36.7%), and less chronically ill (median [IQR] Charlson scores (3 [2-5] vs. 4 [2-5]) than persons with RaO. Bacteremia (10.4% vs. 17.5%), need for vasopressors (15.1% vs. 20.0%), dialysis (9.4% vs. 16.5%), and/or sepsis (9.4% vs. 16.5%) or septic shock 14.2% vs. 17.1%) occurred less frequently in the RaP group. With respect to NP type, nvHABP was most common in RaP (47.2%) and VABP in RaO (38.1%). CONCLUSIONS One in seven survivors of a hospitalization complicated by NP requires an acute rehospitalization within 30 days. However, few of these readmissions had a principal diagnosis of pneumonia, irrespective of NP type. Of the 5% of NP subjects with RaP, the plurality initially suffered from nvHABP.
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Affiliation(s)
| | | | | | - Noah W. D. Zilberberg
- EviMed Research Group, LLC, Goshen, MA, United States of America
- Universty of Massachusetts, Amherst, MA, United States of America
| | - Andrew F. Shorr
- Washington Hospital Center, Washington, DC, United States of America
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Cotter JM, Hall M, Shah SS, Molloy MJ, Markham JL, Aronson PL, Stephens JR, Steiner MJ, McCoy E, Collins M, Tchou MJ. Variation in bacterial pneumonia diagnoses and outcomes among children hospitalized with lower respiratory tract infections. J Hosp Med 2022; 17:872-879. [PMID: 35946482 DOI: 10.1002/jhm.12940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Current diagnostics do not permit reliable differentiation of bacterial from viral causes of lower respiratory tract infection (LRTI), which may lead to over-treatment with antibiotics for possible bacterial community-acquired pneumonia (CAP). OBJECTIVES We sought to describe variation in the diagnosis and treatment of bacterial CAP among children hospitalized with LRTIs and determine the association between CAP diagnosis and outcomes. DESIGN, SETTING AND PARTICIPANTS This multicenter cross-sectional study included children hospitalized between 2017 and 2019 with LRTIs at 42 children's hospitals. MAIN OUTCOME AND METHODS We calculated the proportion of children with LRTIs who were diagnosed with and treated for bacterial CAP. After adjusting for confounders, hospitals were grouped into high, moderate, and low CAP diagnosis groups. Multivariable regression was used to examine the association between high and low CAP diagnosis groups and outcomes. RESULTS We identified 66,581 patients hospitalized with LRTIs and observed substantial variation across hospitals in the proportion diagnosed with and treated for bacterial CAP (median 27%, range 12%-42%). Compared with low CAP diagnosing hospitals, high diagnosing hospitals had higher rates of CAP-related revisits (0.6% [95% confidence interval: 0.5, 0.7] vs. 0.4% [0.4, 0.5], p = .04), chest radiographs (58% [53, 62] vs. 46% [41, 51], p = .02), and blood tests (43% [33, 53] vs. 26% [19, 35], p = .046). There were no significant differences in length of stay, all-cause revisits or readmissions, CAP-related readmissions, or costs. CONCLUSION There was wide variation across hospitals in the proportion of children with LRTIs who were treated for bacterial CAP. The lack of meaningful differences in clinical outcomes among hospitals suggests that some institutions may over-diagnose and overtreat bacterial CAP.
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Affiliation(s)
- Jillian M Cotter
- Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Samir S Shah
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Matthew J Molloy
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jessica L Markham
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Paul L Aronson
- Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - John R Stephens
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael J Steiner
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elisha McCoy
- Department of Pediatrics and Medicine, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Megan Collins
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Michael J Tchou
- Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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Alhoufie ST, Ibrahim NA, Alsharif NH, Alfarouk KO, Makhdoom HM, Aljabri KR, Saeed SH, Khoumaeys AA, Almutawif YA, Najim MA, Ali HM, Aljifri AA, Kheyami AM, Alhazmi AA. Seroprevalence of community-acquired atypical bacterial pneumonia among adult COVID-19 patients from a single center in Al Madinah Al Munawarah, Saudi Arabia: A retrospective cohort study. Saudi Med J 2022; 43:1000-1006. [PMID: 36104051 PMCID: PMC9987659 DOI: 10.15537/smj.2022.43.9.20220379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate the seroprevalence of the community-acquired bacterial that causes atypical pneumonia among confirmed severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) patients. METHODS In this cohort study, we retrospectively investigated the seroprevalence of Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila among randomly selected 189 confirmed COVID-19 patients at their time of hospital presentation via commercial immunoglobulin M (IgM) antibodies against these bacteria. We also carried out quantitative measurements of procalcitonin in patients' serum. RESULTS The seropositivity for L. pneumophila was 12.6%, with significant distribution among patientsolder than 50 years (χ2 test, p=0.009), while those of M. pneumoniae was 6.3% and C. pneumoniae was 2.1%, indicating an overall co-infection rate of 21% among COVID-19 patients. No significant difference (χ2 test, p=0.628) in the distribution of bacterial co-infections existed between male and female patients. Procalcitonin positivity was confirmed amongst 5% of co-infected patients. CONCLUSION Our study documented the seroprevalence of community-acquired bacteria co-infection among COVID-19 patients. In this study, procalcitonin was an inconclusive biomarker for non-severe bacterial co-infections among COVID-19 patients. Consideration and proper detection of community-acquired bacterial co-infection may minimize misdiagnosis during the current pandemic and positively reflect disease management and prognosis.
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Affiliation(s)
- Sari T Alhoufie
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Nadir A Ibrahim
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Naif H Alsharif
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Khalid O Alfarouk
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Hatim M Makhdoom
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Khaled R Aljabri
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Sayed H Saeed
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Adnan A Khoumaeys
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Yahya A Almutawif
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Mustafa A Najim
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Hamza M Ali
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Alanoud A Aljifri
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Ali M Kheyami
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
| | - Areej A Alhazmi
- From the Medical Laboratories Technology Department (Alhoufie, Ibrahim, Makhdoom, Almutawif, Najim, Ali, Alhazmi), College of Applied Medical Sciences, Taibah University; from the Department of Medical laboratory,(Alsharif, Saeed, Aljabri, khoumaeys) king Salman Medical City, Al Madinah General hospital, from Al-Madinah Health Cluster(Aljifri and Kheyami, Ministry of Health Madinah Al Munwarah, Kingdom of Saudi Arabia; and from the Institute of Endemic Diseases (Alfarouk), University of Khartoum, Khartoum, Sudan
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Burrows D, Slavic D, Miltenburg C, Ojkic D, Brooks AS, Caswell JL. Laboratory investigation of cases of fatal bacterial pneumonia in dairy cows. Can Vet J 2022; 63:845-850. [PMID: 35919462 PMCID: PMC9281884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Bacterial bronchopneumonia occurs in mature dairy cows but much of the information is extrapolated from knowledge of the disease in calves. The study was prompted by perceptions of an increasing occurrence and a paucity of information on fatal Mannheimia haemolytica pneumonia in dairy cows in Ontario. The study objectives were to describe the seasonality, main pathogens involved, and suggested predisposing factors for cases of fatal bacterial bronchopneumonia in mature dairy cows submitted for postmortem examination to a diagnostic laboratory, and to evaluate if the frequency of such submissions has increased over time. ANIMALS Mature dairy cows. PROCEDURE Retrospective study of cases submitted for postmortem examination to a diagnostic laboratory from 2007-2020 that were diagnosed as bacterial bronchopneumonia. RESULTS Most of the postmortem cases of bacterial bronchopneumonia in dairy cows were submitted from November to February (54% of cases). Mannheimia haemolytica was isolated from lung of 61/101 cases. Viruses were only identified in 8/55 cases tested. A minority (29/92) of bacterial isolates had in vitro resistance to antimicrobials used to treat pneumonia. Frequently suggested predisposing factors included recent introductions or movement of animals, recent or imminent calving, inclement weather, concurrent diseases, and poor ventilation in barns. CONCLUSION AND CLINICAL RELEVANCE This study describes seasonal and annual trends, major pathogens, antimicrobial resistance profiles, and suggested predisposing factors in Ontario dairy cows submitted to a diagnostic laboratory for postmortem investigation of pneumonia and provides insights for understanding why outbreaks occur.
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Affiliation(s)
- DeLenn Burrows
- Department of Pathobiology (Burrows, Caswell) and Animal Health Laboratory (Slavic, Ojkic, Brooks), University of Guelph, Guelph, Ontario, Canada; Ontario Ministry of Agriculture, Food and Rural Affairs, Guelph, Ontario, Canada (Miltenburg)
| | - Durda Slavic
- Department of Pathobiology (Burrows, Caswell) and Animal Health Laboratory (Slavic, Ojkic, Brooks), University of Guelph, Guelph, Ontario, Canada; Ontario Ministry of Agriculture, Food and Rural Affairs, Guelph, Ontario, Canada (Miltenburg)
| | - Cynthia Miltenburg
- Department of Pathobiology (Burrows, Caswell) and Animal Health Laboratory (Slavic, Ojkic, Brooks), University of Guelph, Guelph, Ontario, Canada; Ontario Ministry of Agriculture, Food and Rural Affairs, Guelph, Ontario, Canada (Miltenburg)
| | - Davor Ojkic
- Department of Pathobiology (Burrows, Caswell) and Animal Health Laboratory (Slavic, Ojkic, Brooks), University of Guelph, Guelph, Ontario, Canada; Ontario Ministry of Agriculture, Food and Rural Affairs, Guelph, Ontario, Canada (Miltenburg)
| | - Andrew S Brooks
- Department of Pathobiology (Burrows, Caswell) and Animal Health Laboratory (Slavic, Ojkic, Brooks), University of Guelph, Guelph, Ontario, Canada; Ontario Ministry of Agriculture, Food and Rural Affairs, Guelph, Ontario, Canada (Miltenburg)
| | - Jeff L Caswell
- Department of Pathobiology (Burrows, Caswell) and Animal Health Laboratory (Slavic, Ojkic, Brooks), University of Guelph, Guelph, Ontario, Canada; Ontario Ministry of Agriculture, Food and Rural Affairs, Guelph, Ontario, Canada (Miltenburg)
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20
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Boettiger DC, An VT, Lumbiganon P, Wittawatmongkol O, Truong KH, Do VC, Van Nguyen L, Ly PS, Kinikar A, Ounchanum P, Puthanakit T, Kurniati N, Kumarasamy N, Wati DK, Chokephaibulkit K, Jamal Mohamed TA, Sudjaritruk T, Yusoff NKN, Fong MS, Nallusamy RA, Kariminia A. Severe Recurrent Bacterial Pneumonia Among Children Living With HIV. Pediatr Infect Dis J 2022; 41:e208-e215. [PMID: 35185140 PMCID: PMC10140183 DOI: 10.1097/inf.0000000000003494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bacterial pneumonia imparts a major morbidity and mortality burden on children living with HIV, yet effective prevention and treatment options are underutilized. We explored clinical factors associated with severe recurrent bacterial pneumonia among children living with HIV. METHODS Children enrolled in the TREAT Asia Pediatric HIV Observational Database were included if they started antiretroviral therapy (ART) on or after January 1st, 2008. Factors associated with severe recurrent bacterial pneumonia were assessed using competing-risk regression. RESULTS A total of 3,944 children were included in the analysis; 136 cases of severe recurrent bacterial pneumonia were reported at a rate of 6.5 [95% confidence interval (CI): 5.5-7.7] events per 1,000 patient-years. Clinical factors associated with severe recurrent bacterial pneumonia were younger age [adjusted subdistribution hazard ratio (aHR): 4.4 for <5 years versus ≥10 years, 95% CI: 2.2-8.4, P < 0.001], lower weight-for-age z-score (aHR: 1.5 for <-3.0 versus >-2.0, 95% CI: 1.1-2.3, P = 0.024), pre-ART diagnosis of severe recurrent bacterial pneumonia (aHR: 4.0 versus no pre-ART diagnosis, 95% CI: 2.7-5.8, P < 0.001), past diagnosis of symptomatic lymphoid interstitial pneumonitis or chronic HIV-associated lung disease, including bronchiectasis (aHR: 4.8 versus no past diagnosis, 95% CI: 2.8-8.4, P < 0.001), low CD4% (aHR: 3.5 for <10% versus ≥25%, 95% CI: 1.9-6.4, P < 0.001) and detectable HIV viral load (aHR: 2.6 versus undetectable, 95% CI: 1.2-5.9, P = 0.018). CONCLUSIONS Children <10-years-old and those with low weight-for-age, a history of respiratory illness, low CD4% or poorly controlled HIV are likely to gain the greatest benefit from targeted prevention and treatment programs to reduce the burden of bacterial pneumonia in children living with HIV.
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Affiliation(s)
- David C. Boettiger
- The Kirby Institute, UNSW Sydney, Australia
- Institute for Health and Aging, University of California, San Francisco, USA
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Vu Thien An
- Children Hospital 2, Ho Chi Minh City, Vietnam
| | - Pagakrong Lumbiganon
- Division of Infectious Disease, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Orasri Wittawatmongkol
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | - Penh Sun Ly
- National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
| | - Aarti Kinikar
- BJ Medical College and Sassoon General Hospitals, Maharashtra, India
| | | | - Thanyawee Puthanakit
- Department of Pediatrics and Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nia Kurniati
- Cipto Mangunkusumo – Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), VHS-Infectious Diseases Medical Centre, VHS, Chennai, India
| | | | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thahira A. Jamal Mohamed
- Department of Pediatrics, Women and Children Hospital Kuala Lumpur (WCHKL), Kuala Lumpur, Malaysia
| | - Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine, and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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21
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Affiliation(s)
- Peter J Gill
- Institute of Health Policy, Management and Evaluation (Gill, Mahant), University of Toronto; Department of Paediatrics (Gill, Mahant), The Hospital for Sick Children, Toronto, Ont.; Royal Devon and Exeter NHS Foundation Trust (Chanchlani); University of Exeter (Chanchlani), Exeter, UK
| | - Neil Chanchlani
- Institute of Health Policy, Management and Evaluation (Gill, Mahant), University of Toronto; Department of Paediatrics (Gill, Mahant), The Hospital for Sick Children, Toronto, Ont.; Royal Devon and Exeter NHS Foundation Trust (Chanchlani); University of Exeter (Chanchlani), Exeter, UK
| | - Sanjay Mahant
- Institute of Health Policy, Management and Evaluation (Gill, Mahant), University of Toronto; Department of Paediatrics (Gill, Mahant), The Hospital for Sick Children, Toronto, Ont.; Royal Devon and Exeter NHS Foundation Trust (Chanchlani); University of Exeter (Chanchlani), Exeter, UK
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22
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Lin SY, Lin CL, Chang SS, Hsu WH, Lin CC, Kao CH. Association between Hydroxychloroquine and bacterial pneumonia in rheumatic patients: A population-based propensity score matching cohort study. Int J Clin Pract 2021; 75:e14737. [PMID: 34388303 DOI: 10.1111/ijcp.14737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/12/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Whether hydroxychloroquine (HCQ) use could reduce lesser risk of bacterial infections is unknown. We aimed to conduct a retrospective cohort propensity-matching study to investigate the association between HCQ use and the incidence of bacterial pneumonia in rheumatic patients. METHODS The Longitudinal Health Insurance Database (LHID) from Taiwan National Health Insurance Research Database (NHIRD) of 23 million Taiwanese populations was used. We included patients who were newly diagnosed with rheumatic and immune disease (ICD-9-CM codes 696.0, 710, 714) within 2000-2012. HCQ users and non-users were then matched according to age, sex, urbanisation level, monthly income, comorbidities and medications in the ratio of 1:1 by the propensity score matching. Cox proportional hazard model was used to evaluate the risk of bacterial pneumonia in rheumatic patients who used HCQ and who did not use HCQ. RESULTS There were total 3285 patients with rheumatic and immune disease enrolled. The cumulative incidence curve of patients with the use of HCQ sulphate had no difference to that of patient without the use of HCQ sulphate in propensity score-matched cohort, (Log-rank test: P = .5). However, patients who used HCQ sulphate for more than 1400 average use days had a lesser risk of bacterial pneumonia (adjusted HR = 0.55, 95% CI = 0.35, 0.89) in the cohort matched, with regarding HCQ non-users as a reference. CONCLUSION Rheumatic patients taking HCQ had no overall significant differences of bacterial pneumonia incidences compared with rheumatic patients not taking HCQ. HCQ used more than >1400 days or lupus patients using HCQ was associated with lower risk of bacterial pneumonia.
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Affiliation(s)
- Shih-Yi Lin
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Sheng Chang
- Division of Cardiology, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
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Rathmann J, Jayne D, Segelmark M, Jönsson G, Mohammad AJ. Incidence and predictors of severe infections in ANCA-associated vasculitis: a population-based cohort study. Rheumatology (Oxford) 2021; 60:2745-2754. [PMID: 33253372 DOI: 10.1093/rheumatology/keaa699] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/19/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine the incidence rate, predictors and outcome of severe infections in a population-based cohort of ANCA-associated vasculitis (AAV). METHODS The study included 325 cases of AAV (152 female) diagnosed from 1997 through 2016 from a defined geographic area in Sweden. All severe infection events (requiring hospitalization and treatment with intravenous antimicrobials) were identified. The Birmingham vasculitis activity score (BVAS) was used to evaluate disease activity, and organ damage was assessed using the vasculitis damage index (VDI). Patients were followed from time of AAV diagnosis to death or December 2017. RESULTS A total of 129 (40%) patients suffered at least one severe infection. In 2307 person-years (PY) of follow-up, 210 severe infections were diagnosed. The incidence rate of severe infections was 9.1/100 PY and was highest during the first year following AAV diagnosis at 22.1/100 PY (P < 0.001). Pneumonia, sepsis and urinary tract infection were the most common infections. Opportunistic infections constituted only 6% of all severe infections. In Cox regression analysis age and BVAS at diagnosis were the only factors independently predicting severe infection [hazard ratio: 1.54 (P < 0.001) and 1.27 (P = 0.001), respectively]. Severe infection was associated with poorer prognosis with respect to median VDI score 12 months post-AAV diagnosis, renal survival and mortality. Severe infections were the cause of death in 32 patients (22% of all deaths). CONCLUSION . Severe infection is a common problem in AAV, with the most important prognostic factors being older age and high disease activity at diagnosis. Severe infections are associated with permanent organ damage and high mortality.
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Affiliation(s)
- Jens Rathmann
- Division of Rheumatology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Mårten Segelmark
- Division of Nephrology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Göran Jönsson
- Division of Infectious Diseases, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Aladdin J Mohammad
- Division of Rheumatology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
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Kan T, Komiya K, Yamasue M, Itai M, Tanaka A, Takeno Y, Takikawa S, Hiramatsu K, Kadota JI. Comparison of chest computed tomography features between pulmonary tuberculosis patients with culture-positive and culture-negative sputum for non-mycobacteria: A retrospective observational study. Medicine (Baltimore) 2021; 100:e26897. [PMID: 34397866 PMCID: PMC8341271 DOI: 10.1097/md.0000000000026897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/17/2021] [Indexed: 01/04/2023] Open
Abstract
Although complication with non-mycobacterial pneumonia among patients with pulmonary tuberculosis (TB) may lead to poor prognosis, discrimination between TB complicated with and without non-mycobacterial pneumonia using radiological imaging has not been fully elucidated. We aimed to clarify the differences in chest computed tomography (CT) features between pulmonary TB patients with culture-positive and culture-negative sputum for non-mycobacteria.We retrospectively included consecutive patients admitted to our hospital from January 2013 to December 2015 for bacteriologically-confirmed pulmonary TB, who were tested by sputum culture for non-mycobacteria, and who underwent chest CT within 2 weeks before or after admission. Chest CT features were compared between pulmonary TB patients who had positive non-mycobacterial cultures and in those who had not.Of 202 patients with pulmonary TB, 186 (92%) were tested by sputum culture for non-mycobacteria and underwent chest CT. Among these, non-mycobacteria were isolated in 118 patients (63%), while 68 patients (37%) had negative cultures. Patients with a positive culture for non-mycobacteria were significantly older and had lower levels of physical activity and albumin, higher levels of C-reactive protein, and a greater number of respiratory failures. By CT, emphysematous lesions, ground-glass opacities, airspace consolidation, air-bronchogram, interlobular septal thickening, bronchiectasis, pleural effusion, pleural thickening, and lymph node enlargement were more frequently in patients with a positive culture for non-mycobacteria. These chest CT features could be helpful for detecting complication with non-mycobacterial pneumonia in patients with pulmonary TB.
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Affiliation(s)
- Takamasa Kan
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, Japan
| | - Kosaku Komiya
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, Japan
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, Japan
| | - Mari Yamasue
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, Japan
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, Japan
| | - Mariko Itai
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, Japan
| | - Ai Tanaka
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, Japan
| | - Yukiko Takeno
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, Japan
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, Japan
| | - Shuichi Takikawa
- Department of Internal Medicine, National Hospital Organization Nishi-Beppu Hospital, 4548 Tsurumi, Beppu, Oita, Japan
| | - Kazufumi Hiramatsu
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, Japan
| | - Jun-ichi Kadota
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, Japan
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Canetti M, Carmi A, Paret G, Goldberg L, Adler A, Amit S, Rokney A, Ron M, Grisaru-Soen G. Invasive Group A Streptococcus Infection in Children in Central Israel in 2012-2019. Pediatr Infect Dis J 2021; 40:612-616. [PMID: 34097654 DOI: 10.1097/inf.0000000000003087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Group A Streptococcus can cause serious and sometimes life-threatening disease in children. The past few years have witnessed a rise in invasive group A Streptococcus infection (iGASi) for unclear reasons. This study attempted to describe the epidemiology, the clinical and demographic characteristics and the outcomes associated with iGASi in hospitalized children in central Israel. METHODS We retrospectively analyzed the medical records of children <18 years old discharged with a diagnosis of iGASi between January 2012 and December 2019. Clinical, laboratory and microbiologic data, and immunization status were retrieved. The patients were divided into severe and nonsevere groups based on their clinical presentation. The emm type was determined at the national reference center. RESULTS A total of 167 patients with 206 positive cultures for group A Streptococcus were identified. Hospitalizations for iGASi increased from 701 to 958 per 100,000 admissions between 2012-2015 and 2016-2019, respectively, representing an increase of 37%. The majority of the isolates were from the otolaryngologic system followed by blood, deep soft tissue and respiratory sites. Uncomplicated mastoiditis was the most common diagnosis, followed by bacteremia. Pneumonia was the main diagnosis in the severe group (39.4%). CONCLUSIONS The admissions because of iGASi in children <18 years old increased during the last 8 years. Surveillance systems and prospective studies should be conducted to expend our understanding of the epidemiology of iGASi in children, better assess the pathogenesis and specific risk factors and monitor changes in emm-type distribution.
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Affiliation(s)
- Michal Canetti
- From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Carmi
- Department of Pediatric Intensive Care, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
| | - Gideon Paret
- From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Intensive Care, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
| | - Lior Goldberg
- From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Intensive Care, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
| | - Amos Adler
- From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sharon Amit
- From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Rokney
- Government Central Laboratories, Ministry of Health, Jerusalem, Israel
| | - Merav Ron
- Government Central Laboratories, Ministry of Health, Jerusalem, Israel
| | - Galia Grisaru-Soen
- From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Infectious Disease Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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26
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Paglicci L, Borgo V, Lanzarone N, Fabbiani M, Cassol C, Cusi MG, Valassina M, Scolletta S, Bargagli E, Marchetti L, Paladini P, Luzzi L, Fossi A, Bennett D, Montagnani F. Incidence and risk factors for respiratory tract bacterial colonization and infection in lung transplant recipients. Eur J Clin Microbiol Infect Dis 2021; 40:1271-1282. [PMID: 33479881 PMCID: PMC8139905 DOI: 10.1007/s10096-021-04153-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/06/2021] [Indexed: 01/06/2023]
Abstract
To evaluate incidence of and risk factors for respiratory bacterial colonization and infections within 30 days from lung transplantation (LT). We retrospectively analyzed microbiological and clinical data from 94 patients transplanted for indications other than cystic fibrosis, focusing on the occurrence of bacterial respiratory colonization or infection during 1 month of follow-up after LT. Thirty-three percent of patients developed lower respiratory bacterial colonization. Bilateral LT and chronic heart diseases were independently associated to a higher risk of overall bacterial colonization. Peptic diseases conferred a higher risk of multi-drug resistant (MDR) colonization, while longer duration of aerosol prophylaxis was associated with a lower risk. Overall, 35% of lung recipients developed bacterial pneumonia. COPD (when compared to idiopathic pulmonary fibrosis, IPF) and higher BMI were associated to a lower risk of bacterial infection. A higher risk of MDR infection was observed in IPF and in patients with pre-transplant colonization and infections. The risk of post-LT respiratory infections could be stratified by considering several factors (indication for LT, type of LT, presence of certain comorbidities, and microbiologic assessment before LT). A wider use of early nebulized therapies could be useful to prevent MDR colonization, thus potentially lowering infectious risk.
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Affiliation(s)
- L Paglicci
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, Siena University Hospital, Siena, Italy
| | - V Borgo
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, Siena University Hospital, Siena, Italy
| | - N Lanzarone
- Department of Medical and Surgical Sciences & Neurosciences, Respiratory Diseases and Lung Transplantation Unit, Siena University Hospital, Siena, Italy
| | - M Fabbiani
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, Siena University Hospital, Siena, Italy
| | - C Cassol
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, Siena University Hospital, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - M G Cusi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Innovation, Experimentation and Clinical Research, Microbiology and Virology Unit, Siena University Hospital, Siena, Italy
| | - M Valassina
- Department of Innovation, Experimentation and Clinical Research, Microbiology and Virology Unit, Siena University Hospital, Siena, Italy
| | - S Scolletta
- Department of Emergency and Urgency, Medicine, Surgery and Neurosciences, Unit of Intensive Care Medicine, Siena University Hospital, Siena, Italy
| | - E Bargagli
- Department of Medical and Surgical Sciences & Neurosciences, Respiratory Diseases and Lung Transplantation Unit, Siena University Hospital, Siena, Italy
| | - L Marchetti
- Cardio-Thoracic-Vascular Department, Anesthesia and Cardio-Thoracic-Vascular Intensive Care Unit, Siena University Hospital, Siena, Italy
| | - P Paladini
- Cardio-Thoracic-Vascular Department, Thoracic Surgery Unit, Siena University Hospital, Siena, Italy
| | - L Luzzi
- Cardio-Thoracic-Vascular Department, Thoracic Surgery Unit, Siena University Hospital, Siena, Italy
| | - A Fossi
- Department of Medical and Surgical Sciences & Neurosciences, Respiratory Diseases and Lung Transplantation Unit, Siena University Hospital, Siena, Italy
| | - D Bennett
- Department of Medical and Surgical Sciences & Neurosciences, Respiratory Diseases and Lung Transplantation Unit, Siena University Hospital, Siena, Italy
| | - F Montagnani
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, Siena University Hospital, Siena, Italy.
- Department of Medical Biotechnologies, University of Siena, Siena, Italy.
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d’Humières C, Patrier J, Lortat-Jacob B, Tran-dinh A, Chemali L, Maataoui N, Rondinaud E, Ruppé E, Burdet C, Ruckly S, Montravers P, Timsit JF, Armand-Lefevre L. Two original observations concerning bacterial infections in COVID-19 patients hospitalized in intensive care units during the first wave of the epidemic in France. PLoS One 2021; 16:e0250728. [PMID: 33914786 PMCID: PMC8084132 DOI: 10.1371/journal.pone.0250728] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/12/2021] [Indexed: 12/28/2022] Open
Abstract
Among 197 COVID-19 patients hospitalized in ICU, 88 (44.7%) experienced at least one bacterial infection, with pneumonia (39.1%) and bloodstream infections (15,7%) being the most frequent. Unusual findings include frequent suspicion of bacterial translocations originating from the digestive tract as well as bacterial persistence in the lungs despite adequate therapy.
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Affiliation(s)
- Camille d’Humières
- Université de Paris, INSERM, IAME, Paris, France
- AP-HP, Hôpital Bichat, Bacteriology, Paris, France
| | - Juliette Patrier
- AP-HP, Hôpital Bichat, Medical and Infectious Diseases ICU (MI2), Paris, France
| | - Brice Lortat-Jacob
- Department of Anesthesiology and Surgical Critical Care, AP-HP, Hôpital Bichat, Paris, France
| | - Alexy Tran-dinh
- Department of Anesthesiology and Surgical Critical Care, AP-HP, Hôpital Bichat, Paris, France
- Université de Paris, INSERM U 1148, Paris, France
| | | | - Naouale Maataoui
- Université de Paris, INSERM, IAME, Paris, France
- AP-HP, Hôpital Bichat, Bacteriology, Paris, France
| | - Emilie Rondinaud
- Université de Paris, INSERM, IAME, Paris, France
- AP-HP, Hôpital Bichat, Bacteriology, Paris, France
| | - Etienne Ruppé
- Université de Paris, INSERM, IAME, Paris, France
- AP-HP, Hôpital Bichat, Bacteriology, Paris, France
| | - Charles Burdet
- Université de Paris, INSERM, IAME, Paris, France
- Département d’Epidémiologie, Biostatistique et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, France
| | - Stéphane Ruckly
- AP-HP, Hôpital Bichat, Medical and Infectious Diseases ICU (MI2), Paris, France
| | - Philippe Montravers
- Department of Anesthesiology and Surgical Critical Care, AP-HP, Hôpital Bichat, Paris, France
- INSERM 1152 –ANR-10-LABX-17, Paris, France
| | - Jean-François Timsit
- Université de Paris, INSERM, IAME, Paris, France
- AP-HP, Hôpital Bichat, Medical and Infectious Diseases ICU (MI2), Paris, France
| | - Laurence Armand-Lefevre
- Université de Paris, INSERM, IAME, Paris, France
- AP-HP, Hôpital Bichat, Bacteriology, Paris, France
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28
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Guo JG, Kong Q, Liu C, Kang TS, Qin C. Evaluating the Health Risks of Pneumonia from Airborne Bacterial Communities Using 16S rDNA Sequences of Pneumonia-related Pathogens. Biomed Environ Sci 2021; 34:265-271. [PMID: 33894805 DOI: 10.3967/bes2021.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/19/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Airborne microbial communities include a significant number of uncultured and poorly characterized bacteria. No effective method currently exists to evaluate the health risks of such complex bacterial populations, particularly for pneumonia. METHODS We developed a method to evaluate risks from airborne microorganisms, guided by the principle that closer evolutionary relationships reflect similar biological characteristics, and thus used 16S rDNA sequences of 10 common pneumonia-related bacterial pathogens. We calculated a risk of breath-related ( Rbr) index of airborne bacterial communities and verified effectiveness with artificial flora and a clinical project. RESULTS We suggested applying Rbr80 to evaluate the health risks of airborne bacterial communities that comprise 80% of dominant operational taxonomic units (OTUs). The feasibility of Rbr80 was confirmed by artificial flora and by pneumonia data from a hospital. A high Rbr80 value indicated a high risk of pneumonia from airborne bacterial communities. CONCLUSION Rbr80 is an effective index to evaluate the pneumonia-associated risk from airborne bacteria. Values of Rbr80 greater than 15.40 are considered high risk.
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Affiliation(s)
- Jian Guo Guo
- NHC Key Laboratory of Human Disease Comparative Medicine, Institute of Laboratory Animal Sciences, CAMS & PUMC, Beijing 100021, China;Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese Medicine, Beijing 100021, China
| | - Qi Kong
- NHC Key Laboratory of Human Disease Comparative Medicine, Institute of Laboratory Animal Sciences, CAMS & PUMC, Beijing 100021, China;Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese Medicine, Beijing 100021, China
| | - Ce Liu
- Department of Infectious Disease, Beijing Chuiyangliu Hospital affiliated to Tsinghua University, Beijing 100022, China
| | - Tai Sheng Kang
- NHC Key Laboratory of Human Disease Comparative Medicine, Institute of Laboratory Animal Sciences, CAMS & PUMC, Beijing 100021, China;Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese Medicine, Beijing 100021, China
| | - Chuan Qin
- NHC Key Laboratory of Human Disease Comparative Medicine, Institute of Laboratory Animal Sciences, CAMS & PUMC, Beijing 100021, China;Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese Medicine, Beijing 100021, China
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Ayede AI, Ashubu OO, Fowobaje KR, Aboubaker S, Nisar YB, Qazi SA, Bahl R, Falade AG. Management of possible serious bacterial infection in young infants where referral is not possible in the context of existing health system structure in Ibadan, South-west Nigeria. PLoS One 2021; 16:e0248720. [PMID: 33784321 PMCID: PMC8009401 DOI: 10.1371/journal.pone.0248720] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/03/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Neonatal infections contribute substantially to infant mortality in Nigeria and globally. Management requires hospitalization, which is not accessible to many in low resource settings. World Health Organization developed a guideline to manage possible serious bacterial infection (PSBI) in young infants up to two months of age when a referral is not feasible. We evaluated the feasibility of implementing this guideline to achieve high coverage of treatment. Methods This implementation research was conducted in out-patient settings of eight primary health care centres (PHC) in Lagelu Local Government Area (LGA) of Ibadan, Oyo State, Nigeria. We conducted policy dialogue with the Federal and State officials to adopt the WHO guideline within the existing programme setting and held orientation and sensitization meetings with communities. We established a Technical Support Unit (TSU), built the capacity of health care providers, supervised and mentored them, monitored the quality of services and collected data for management and outcomes of sick young infants with PSBI signs. The Primary Health Care Directorate of the state ministry and the local government led the implementation and provided technical support. The enablers and barriers to implementation were documented. Results From 1 April 2016 to 31 July 2017 we identified 5278 live births and of these, 1214 had a sign of PSBI. Assuming 30% of births were missed due to temporary migration to maternal homes for delivery care and approximately 45% cases came from outside the catchment area due to free availability of medicines, the treatment coverage was 97.3% (668 cases/6861 expected births) with an expected 10% PSBI prevalence within the first 2 months of life. Of 1214 infants with PSBI, 392 (32%) infants 7–59 days had only fast breathing (pneumonia), 338 (27.8%) infants 0–6 days had only fast breathing (severe pneumonia), 462 (38%) presented with signs of clinical severe infection (CSI) and 22 (1.8%) with signs of critical illness. All but two, 7–59 days old infants with pneumonia were treated with oral amoxicillin without a referral; 80% (312/390) adhered to full treatment; 97.7% (381/390) were cured, and no deaths were reported. Referral to the hospital was not accepted by 87.7% (721/822) families of infants presenting with signs of PSBI needing hospitalization (critical illness 5/22; clinical severe infection; 399/462 and severe pneumonia 317/338). They were treated on an outpatient basis with two days of injectable gentamicin and seven days of oral amoxicillin. Among these 81% (584/721) completed treatment; 97% (700/721) were cured, and three deaths were reported (two with critical illness and one with clinical severe infection). We identified health system gaps including lack of staff motivation and work strikes, medicines stockouts, sub-optimal home visits that affected implementation. Conclusions When a referral is not feasible, outpatient treatment for young infants with signs of PSBI is possible within existing programme structures in Nigeria with high coverage and low case fatality. To scale up this intervention successfully, government commitment is needed to strengthen the health system, motivate and train health workers, provide necessary commodities, establish technical support for implementation and strengthen linkages with communities. Registration Trial is registered on Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001373369.
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MESH Headings
- Ambulatory Care/methods
- Amoxicillin/therapeutic use
- Anti-Bacterial Agents/therapeutic use
- Delivery of Health Care/methods
- Feasibility Studies
- Follow-Up Studies
- Gentamicins/therapeutic use
- Guideline Adherence
- Health Personnel
- House Calls
- Humans
- Infant
- Infant Mortality
- Infant, Newborn
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/microbiology
- Infant, Newborn, Diseases/mortality
- Nigeria/epidemiology
- Pneumonia, Bacterial/drug therapy
- Pneumonia, Bacterial/epidemiology
- Pneumonia, Bacterial/microbiology
- Pneumonia, Bacterial/mortality
- Practice Guidelines as Topic
- Referral and Consultation
- Registries
- Treatment Outcome
- World Health Organization
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Affiliation(s)
- Adejumoke Idowu Ayede
- Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
- Centre for African Newborn Health and Nutrition, University College Hospital, Ibadan, Nigeria
- * E-mail:
| | - Oluwakemi Oluwafunmi Ashubu
- Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
- Centre for African Newborn Health and Nutrition, University College Hospital, Ibadan, Nigeria
| | - Kayode Raphael Fowobaje
- Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
- Centre for African Newborn Health and Nutrition, University College Hospital, Ibadan, Nigeria
| | | | - Yasir Bin Nisar
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | | | - Rajiv Bahl
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Adegoke Gbadegesin Falade
- Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
- Centre for African Newborn Health and Nutrition, University College Hospital, Ibadan, Nigeria
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30
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Rahman AE, Hossain AT, Zaman SB, Salim N, K C A, Day LT, Ameen S, Ruysen H, Kija E, Peven K, Tahsina T, Ahmed A, Rahman QSU, Khan J, Kong S, Campbell H, Hailegebriel TD, Ram PK, Qazi SA, El Arifeen S, Lawn JE. Antibiotic use for inpatient newborn care with suspected infection: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:229. [PMID: 33765948 PMCID: PMC7995687 DOI: 10.1186/s12884-020-03424-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND An estimated 30 million neonates require inpatient care annually, many with life-threatening infections. Appropriate antibiotic management is crucial, yet there is no routine measurement of coverage. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aimed to validate maternal and newborn indicators to inform measurement of coverage and quality of care. This paper reports validation of reported antibiotic coverage by exit survey of mothers for hospitalized newborns with clinically-defined infections, including sepsis, meningitis, and pneumonia. METHODS EN-BIRTH study was conducted in five hospitals in Bangladesh, Nepal, and Tanzania (July 2017-July 2018). Neonates were included based on case definitions to focus on term/near-term, clinically-defined infection syndromes (sepsis, meningitis, and pneumonia), excluding major congenital abnormalities. Clinical management was abstracted from hospital inpatient case notes (verification) which was considered as the gold standard against which to validate accuracy of women's report. Exit surveys were conducted using questions similar to The Demographic and Health Surveys (DHS) approach for coverage of childhood pneumonia treatment. We compared survey-report to case note verified, pooled across the five sites using random effects meta-analysis. RESULTS A total of 1015 inpatient neonates admitted in the five hospitals met inclusion criteria with clinically-defined infection syndromes. According to case note verification, 96.7% received an injectable antibiotic, although only 14.5% of them received the recommended course of at least 7 days. Among women surveyed (n = 910), 98.8% (95% CI: 97.8-99.5%) correctly reported their baby was admitted to a neonatal ward. Only 47.1% (30.1-64.5%) reported their baby's diagnosis in terms of sepsis, meningitis, or pneumonia. Around three-quarters of women reported their baby received an injection whilst in hospital, but 12.3% reported the correct antibiotic name. Only 10.6% of the babies had a blood culture and less than 1% had a lumbar puncture. CONCLUSIONS Women's report during exit survey consistently underestimated the denominator (reporting the baby had an infection), and even more so the numerator (reporting known injectable antibiotics). Admission to the neonatal ward was accurately reported and may have potential as a contact point indicator for use in household surveys, similar to institutional births. Strengthening capacity and use of laboratory diagnostics including blood culture are essential to promote appropriate use of antibiotics. To track quality of neonatal infection management, we recommend using inpatient records to measure specifics, requiring more research on standardised inpatient records.
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Affiliation(s)
- Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Nahya Salim
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
| | - Ashish K C
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
| | - Kimberly Peven
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Jasmin Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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Costenaro P, Cantarutti A, Barbieri E, Scamarcia A, Oletto A, Sacerdoti P, Lundin R, Cantarutti L, Giaquinto C, Donà D. Antibiotic Prescriptions for Children With Community-acquired Pneumonia: Findings From Italy. Pediatr Infect Dis J 2021; 40:130-136. [PMID: 33055500 DOI: 10.1097/inf.0000000000002934] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND OBJECTIVE Community-acquired pneumonia (CAP) is one of the most common reasons of prescribing antibiotics for children, often with overuse of broad-spectrum antibiotics. The aim of this study is to describe the antibiotic prescriptions for Italian children with CAP, at the primary care level. STUDY DESIGN Retrospective cohort study conducted among children 3 months-14 years of age with CAP, enrolled in Pedianet (http://www.pedianet.it) from January 1, 2009 to December 31, 2018. Antibiotic treatment was defined as narrow-spectrum (NS-ABT) if amoxicillin and broad-spectrum (BS-ABT) if amoxicillin/clavulanic acid, cephalosporins or any combination. Crude and adjusted logistic regressions for the odds of receiving NS-ABT were conducted (all episodes of CAP and per patient). A P value <0.05 was considered statistically significant. RESULTS Among 9691 CAP, 7260 episodes from 6409 children followed by 147 pediatricians were analyzed. The 16.7% of CAP [1216/7260, 95% confidence interval (CI): 15.9%-17.6%] received an NS-ABT while 53.3% (3863/7260, 95% CI: 52%-54.4%) received BS-ABTs and 30% (2181/7260, 95% CI: 28.9%-31.1%) macrolides. Within 10 years, a slight but increasing trend of NS-ABT prescription was observed (P < 0.001). Factors independently associated with reduced odds of receiving an NS-ABT compared with BS-ABT including macrolides were being older than 5 years [odds ratio (OR) 0.45, 95% CI: 0.39-0.52], living in Central/Southern Italy (OR 0.13, 95% CI: 0.10-0.16) and being exposed to ABT 3 months before (OR 0.61, 95% CI: 0.53-0.70). These findings were confirmed comparing NS-ABT versus BS-ABT excluding macrolides (n = 5079) and when the analysis was limited to index CAP. CONCLUSION Our findings report a very limited prescription of narrow-spectrum antibiotics for Italian children with CAP.
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Affiliation(s)
- Paola Costenaro
- From the Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua
| | - Anna Cantarutti
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca
- Department of Statistics and Quantitative Methods, Unit of Biostatistics Epidemiology and Public Health, University of Milano-Bicocca, Milan
| | - Elisa Barbieri
- From the Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca
- Department of Statistics and Quantitative Methods, Unit of Biostatistics Epidemiology and Public Health, University of Milano-Bicocca, Milan
- Pedianet Project
- Paediatric Network for Treatment of AIDS or Penta Foundation, Padua, Italy
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Andrea Oletto
- Paediatric Network for Treatment of AIDS or Penta Foundation, Padua, Italy
| | - Paolo Sacerdoti
- Paediatric Network for Treatment of AIDS or Penta Foundation, Padua, Italy
| | - Rebecca Lundin
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Carlo Giaquinto
- From the Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua
- Pedianet Project
- Paediatric Network for Treatment of AIDS or Penta Foundation, Padua, Italy
| | - Daniele Donà
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca
- Paediatric Network for Treatment of AIDS or Penta Foundation, Padua, Italy
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Antibacterial drugs for community-acquired pneumonia. Med Lett Drugs Ther 2021; 63:10-4. [PMID: 33512346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Moretti M, Van Laethem J, Minini A, Pierard D, Malbrain MLNG. Ventilator-associated bacterial pneumonia in coronavirus 2019 disease, a retrospective monocentric cohort study. J Infect Chemother 2021; 27:826-833. [PMID: 33583739 PMCID: PMC7826005 DOI: 10.1016/j.jiac.2021.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 01/08/2023]
Abstract
Introduction Severe coronavirus 2019 disease (CoViD-19) may lead to respiratory failure and mechanical ventilation. Therefore, ventilator associated pneumonia (VAP) may complicate the course of the disease. The aim of the current article was to investigate possible predictive factors for bacterial VAP on a retrospective manner, in a cohort of mechanically ventilated CoViD-19 patients. Additionally, determinant factors of lethality were analyzed. Methods Medical records of patients hospitalized in the intensive care units (ICU) at the university hospital UZ Brussel during the epidemic were reviewed. VAP was defined following the National Healthcare Safety Network 2017 criteria. Univariate and multivariate logistic regressions analyses were performed. Results Among the 39 patients included in the study, 54% were diagnosed with bacterial VAP. Case fatality rate was 44%, but 59% of the deceased patients had a do-not-resuscitate status. Multivariate logistic regression for prediction of VAP showed significant differences in duration of ICU hospitalization and in minimal lung compliance. Additional analyses were performed on CoViD-19 patients who were affected by bacterial respiratory superinfection. The responsible pathogens correspond to the commonly found bacteria in VAP. However, 71% of the isolated germs were multi-drug resistant and bacteraemia was reported in 38%. Multivariate analyses for prediction of lethality found significant difference in SOFA score. Conclusions Mechanically ventilated CoViD-19 patients might frequently develop VAP. Longer ICU hospitalization was associated with pulmonary superinfection in the current cohort. Moreover, decreased minimal lung compliance was correlated to VAP and higher SOFA score at VAP diagnosis was associated with lethality.
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Affiliation(s)
- Marco Moretti
- Department of Internal Medicine and Infectious Diseases, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
| | - Johan Van Laethem
- Department of Internal Medicine and Infectious Diseases, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Andrea Minini
- Faculty of Medicine and Pharmacy, University of Insubria, Como, Italy; Department of Intensive Care, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Denis Pierard
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Manu L N G Malbrain
- Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Schildkraut JA, Gallagher J, Morimoto K, Lange C, Haworth C, Floto RA, Hoefsloot W, Griffith DE, Wagner D, Ingen JV. Epidemiology of nontuberculous mycobacterial pulmonary disease in Europe and Japan by Delphi estimation. Respir Med 2020; 173:106164. [PMID: 32992265 DOI: 10.1016/j.rmed.2020.106164] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/06/2020] [Accepted: 09/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nontuberculous mycobacterial pulmonary disease (NTM-PD) is an emerging opportunistic infection, but basic epidemiological data are lacking in most regions. We have investigated epidemiology and diagnostic and treatment practices in five EU countries (United Kingdom, Spain, Italy, France, Germany; EU5) and Japan. STUDY DESIGN and methods: Annual prevalence in each country was established using a 2-round Delphi method in combination with a regional prevalence-estimation model that incorporated data obtained from a blinded physician screening survey (3154 physicians) and a real-world NTM-PD treating-physician/patient-chart observational study (619 physicians - 1429 patient charts). RESULTS The annual prevalence of NTM-PD was estimated at 6.2/100,000 in the EU5 and 24.9/100,000 in Japan. Overall prevalence between the EU5 was comparable, while differences in regional prevalence were found to be pronounced in France and The United Kingdom. Regional differences were also found in Japan, with the majority of cases in Chubu and Kanto regions. CONCLUSION This new methodology for obtaining often missing regional-level epidemiological data reveals dramatic variations in NTM-PD annual prevalence and helps pinpoint areas that may merit special preventative and treatment focus.
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Affiliation(s)
- Jodie A Schildkraut
- Radboud Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | | | - Kozo Morimoto
- Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.
| | - Charles Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, UK.
| | - R Andres Floto
- Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, UK.
| | - Wouter Hoefsloot
- Radboud Center for Infectious Diseases, Department of Respiratory Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - David E Griffith
- Department of Pulmonology, University of Texas Health Science Center at Tyler, Tyler, TX, USA.
| | - Dirk Wagner
- University Medical Center, Freiburg, Germany.
| | - Jakko van Ingen
- Radboud Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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Abstract
Complicated community-acquired pneumonia in a previously well child is a severe illness characterised by combinations of local complications (eg, parapneumonic effusion, empyema, necrotising pneumonia, and lung abscess) and systemic complications (eg, bacteraemia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death). Complicated community-acquired pneumonia should be suspected in any child with pneumonia not responding to appropriate antibiotic treatment within 48-72 h. Common causative organisms are Streptococcus pneumoniae and Staphylococcus aureus. Patients have initial imaging with chest radiography and ultrasound, which can also be used to assess the lung parenchyma, to identify pleural fluid; CT scanning is not usually indicated. Complicated pneumonia is treated with a prolonged course of intravenous antibiotics, and then oral antibiotics. The initial choice of antibiotic is guided by local microbiological knowledge and by subsequent positive cultures and molecular testing, including on pleural fluid if a drainage procedure is done. Information from pleural space imaging and drainage should guide the decision on whether to administer intrapleural fibrinolytics. Most patients are treated by drainage and more extensive surgery is rarely needed; in any event, in low-income and middle-income countries, resources for extensive surgeries are scarce. The clinical course of complicated community-acquired pneumonia can be prolonged, especially when patients have necrotising pneumonia, but complete recovery is the usual outcome.
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Affiliation(s)
| | - Eitan Kerem
- Department of Pediatrics, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Andrew A Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial School of Medicine, Imperial College London, London, UK.
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Ericson JE, McGuire J, Michaels MG, Schwarz A, Frenck R, Deville JG, Agarwal S, Bressler AM, Gao J, Spears T, Benjamin DK, Smith PB, Bradley JS. Hospital-acquired Pneumonia and Ventilator-associated Pneumonia in Children: A Prospective Natural History and Case-Control Study. Pediatr Infect Dis J 2020; 39:658-664. [PMID: 32150005 PMCID: PMC8293907 DOI: 10.1097/inf.0000000000002642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Clinical trials for antibiotics designed to treat hospital-acquired and ventilator-associated bacterial pneumonias (HABP/VABP) are hampered by making these diagnoses in a way that is acceptable to the United States Food and Drug Administration and consistent with standards of care. We examined laboratory and clinical features that might improve pediatric HABP/VABP trial efficiency by identifying risk factors predisposing children to HABP/VABP and describing the epidemiology of pediatric HABP/VABP. METHODS We prospectively reviewed the electronic medical records of patients <18 years of age admitted to intensive and intermediate care units (ICUs) if they received qualifying respiratory support or were started on antibiotics for a lower respiratory tract infection or undifferentiated sepsis. Subjects were followed until HABP/VABP was diagnosed or they were discharged from the ICU. Clinical, laboratory and imaging data were abstracted using structured chart review. We calculated HABP/VABP incidence and used a stepwise backward selection multivariable model to identify risk factors associated with development of HABP/VABP. RESULTS A total of 862 neonates, infants and children were evaluated for development of HABP/VABP; 10% (82/800) of those receiving respiratory support and 12% (103/862) overall developed HABP/VABP. Increasing age, shorter height/length, longer ICU length of stay, aspiration risk, blood product transfusion in the prior 7 days and frequent suctioning were associated with increased odds of HABP/VABP. The use of noninvasive ventilation and gastric acid suppression were both associated with decreased odds of HABP/VABP. CONCLUSIONS Food and Drug Administration-defined HABP/VABP occurred in 10%-12% of pediatric patients admitted to ICUs. Risk factors vary by age group.
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Affiliation(s)
| | | | | | - Adam Schwarz
- Children’s Hospital of Orange County, Orange, CA, USA
| | - Robert Frenck
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | - Jamie Gao
- Duke Clinical Research Institute, Durham, NC, USA
| | - Tracy Spears
- Duke Clinical Research Institute, Durham, NC, USA
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Durham, NC, USA
- Duke University Medical Center, Durham, NC USA
| | - P. Brian Smith
- Duke Clinical Research Institute, Durham, NC, USA
- Duke University Medical Center, Durham, NC USA
| | - John S. Bradley
- University of California, San Diego School of Medicine and Rady Children’s Hospital San Diego, San Diego, CA USA
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Kuo TJ, Hsu CL, Liao PH, Huang SJ, Hung YM, Yin CH. Nomogram for pneumonia prediction among children and young people with cerebral palsy: A population-based cohort study. PLoS One 2020; 15:e0235069. [PMID: 32628682 PMCID: PMC7337291 DOI: 10.1371/journal.pone.0235069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pneumonia is the leading cause of death among children and young people (CYP) with severe cerebral palsy (CP). Only a few studies used nomogram for assessing risk factors and the probability of pneumonia. Therefore, we aimed to identify risk factors and devise a nomogram for identifying the probability of severe pneumonia in CYP with severe CP. METHODS This retrospective nationwide population-based cohort study examined CYP with newly diagnosed severe CP before 18 years old between January 1st, 1997 and December 31st, 2013 and followed them up through December 31st, 2013. The primary endpoint was defined as the occurrence of severe pneumonia with ≥ 5 days of hospitalization. Logistic regression analysis was used for determining demographic factors and comorbidities associated with severe pneumonia. These factors were assigned integer points to create a scoring system to identify children at high risk for severe pneumonia. RESULTS Among 6,356 CYP with newly diagnosed severe CP, 2,135 (33.59%) had severe pneumonia. Multivariable logistic regression analysis revealed that seven independent predictive factors, namely age <3 years, male sex, and comorbidities of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications. A nomogram was devised by employing these seven significant predictive factors. The prediction model presented favorable discrimination performance. CONCLUSIONS The nomogram revealed that age, male sex, history of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications were potential risk factors for severe pneumonia among CYP with severe CP.
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Affiliation(s)
- Tsu Jen Kuo
- Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
| | - Chiao-Lin Hsu
- Center of Health Management, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Taiwan
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Hsun Liao
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Ju Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- Yuhing Junior College of Health Care and Management, Kaohsiung, Taiwan
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- * E-mail: (YMH); (CHY)
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- * E-mail: (YMH); (CHY)
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Al-Hajaya TS, Al-Zereini WA, Al-Younes HM. Chlamydia pneumoniae infection in patients hospitalised for community-acquired pneumonia in Southern Jordan. Indian J Med Microbiol 2020; 38:338-343. [PMID: 33154244 DOI: 10.4103/ijmm.ijmm_20_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose Chlamydia pneumoniae is associated with human respiratory diseases. Few reports examined the involvement of this bacterium in community-acquired pneumonia (CAP) in Jordan. This study investigates for the first time the role of C. pneumoniae in the establishment of CAP among nationals residing the southern part of Jordan. Materials and Methods Nasopharyngeal and sera samples were collected from 70 hospitalised CAP patients and 63 healthy controls from Al-Karak Governorate and examined using the microimmunofluorescence and polymerase chain reaction techniques. The overall prevalence of C. pneumoniae infection was estimated by detecting the chlamydial immunoglobulin G (IgG) antibodies at a titre of 1:16. Rate of acute infection was estimated by detecting chlamydial DNA in nasopharyngeal samples and IgG and IgM at titres of 1:512 and 1:16, respectively. Results A higher overall seroprevalence of C. pneumoniae IgG was detected in CAP patients than controls (44.3% vs. 30.2%). The rate of acute infection in the entire CAP patients, based on IgG titre of 1:512, was 7.14% compared to 1.58% in the controls. Approximately, three-fold increase in the rate of acute infection was observed in CAP cases, seropositive at IgG titre of 1:16, compared to seropositive controls (16.1% vs. 5.3%). Interestingly, chlamydial IgM antibodies were detectable in 27.1% compared to only 3.2% of the controls. The presence of chlamydial nucleic acids was confirmed in 40% of CAP patients and in 7.9% of controls. Conclusions The present findings clearly suggest a role of C. pneumoniae in the aetiology of CAP in Southern Jordan. However, coinfections with other respiratory pathogens should not be excluded.
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Affiliation(s)
| | - Wael Ali Al-Zereini
- Department of Biological Sciences, Faculty of Science, Mutah University, Al-Karak, Jordan
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39
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Hamilton JL, Evans SG, Bakshi M. Management of Fever in Infants and Young Children. Am Fam Physician 2020; 101:721-729. [PMID: 32538597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite dramatic reductions in the rates of bacteremia and meningitis since the 1980s, febrile illness in children younger than 36 months continues to be a concern with potentially serious consequences. Factors that suggest serious infection include age younger than one month, poor arousability, petechial rash, delayed capillary refill, increased respiratory effort, and overall physician assessment. Urinary tract infections are the most common serious bacterial infection in children younger than three years, so evaluation for such infections should be performed in those with unexplained fever. Abnormal white blood cell counts have poor sensitivity for invasive bacterial infections; procalcitonin and C-reactive protein levels, when available, are more informative. Chest radiography is rarely recommended for children older than 28 days in the absence of localizing signs. Lumbar puncture is not recommended for children older than three months without localizing signs; it may also be considered for those from one to three months of age with abnormal laboratory test results. Protocols such as Step-by-Step, Laboratory Score, or the Rochester algorithms may be helpful in identifying low-risk patients. Rapid influenza testing and tests for coronavirus disease 2019 (COVID-19) may be of value when those diseases are circulating. When empiric treatment is appropriate, suggested antibiotics include ceftriaxone or cefotaxime for infants one to three months of age and ampicillin with gentamicin or with cefotaxime for neonates. For children three months to three years of age, azithromycin or amoxicillin is recommended if pneumonia is suspected; for urinary infections, suggested antibiotics are cefixime, amoxicillin/clavulanate, or trimethoprim/sulfamethoxazole. Choice of antibiotics should reflect local patterns of microbial resistance.
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MESH Headings
- Algorithms
- Amoxicillin-Potassium Clavulanate Combination
- Anti-Bacterial Agents/therapeutic use
- Betacoronavirus
- Blood Culture
- C-Reactive Protein/metabolism
- COVID-19
- COVID-19 Testing
- Child, Preschool
- Clinical Decision-Making
- Clinical Laboratory Techniques
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Culture Techniques
- Fever/etiology
- Humans
- Infant
- Infant, Newborn
- Influenza, Human/complications
- Influenza, Human/diagnosis
- Influenza, Human/drug therapy
- Influenza, Human/epidemiology
- Leukocyte Count
- Pandemics
- Pneumonia, Bacterial/complications
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/drug therapy
- Pneumonia, Bacterial/epidemiology
- Pneumonia, Viral
- Procalcitonin/metabolism
- Radiography, Thoracic
- SARS-CoV-2
- Spinal Puncture
- Trimethoprim, Sulfamethoxazole Drug Combination
- Urinalysis
- Urinary Tract Infections/complications
- Urinary Tract Infections/diagnosis
- Urinary Tract Infections/drug therapy
- Urinary Tract Infections/epidemiology
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Affiliation(s)
| | - Susanna G Evans
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Munish Bakshi
- Drexel University College of Medicine, Philadelphia, PA, USA
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40
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Wang H, Lu Z, Bao Y, Yang Y, de Groot R, Dai W, de Jonge MI, Zheng Y. Clinical diagnostic application of metagenomic next-generation sequencing in children with severe nonresponding pneumonia. PLoS One 2020; 15:e0232610. [PMID: 32497137 PMCID: PMC7272011 DOI: 10.1371/journal.pone.0232610] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/18/2020] [Indexed: 12/12/2022] Open
Abstract
Pneumonia is one of the most important causes of morbidity and mortality in children. Identification and characterization of pathogens that cause infections are crucial for accurate treatment and accelerated recovery. However, in most cases, the causative agent cannot be identified, which is partly due to the limited spectrum of pathogens covered by current diagnostics based on nucleic acid amplification. Therefore, in this study, we explored the application of metagenomic next-generation sequencing (mNGS) for the diagnosis of children with severe pneumonia. From April to July 2017, 32 hospitalized children with severe nonresponding pneumonia in Shenzhen Children's Hospital were included in this study. Blood tests were conducted immediately after hospitalization to assess cell counts and inflammatory markers, oropharyngeal swabs were collected to identify common pathogens by qPCR and culture. After bronchoscopy, bronchoalveolar lavage fluid (BALF) samples were collected for further pathogen identification using standardized diagnostic tests and mNGS. Blood tests were normal in 3 of the 32 children. In 9 oropharyngeal swabs, bacterial pathogens were detected, in 5 of these Mycoplasma pneumoniae was detected. Adenovirus was detected in 5 BALF samples, using the Direct Immunofluorescence Assay (DFA). In 15 cases, no common pathogens were found in BALF samples, using the current standard diagnostic tests, while in all 32 BALFs, pathogens were identified using mNGS, including adenovirus, Mycoplasma pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, cytomegalovirus and bocavirus. This study shows that, with mNGS, the sensitivity of detection of the causative pathogens in children with severe nonresponding pneumonia is significantly improved. In addition, mNGS gives more strain specific information, helps to identify new pathogens and could potentially help to trace and control outbreaks. In this study, we have shown that it is possible to have the results within 24 hours, making the application of mNGS feasible for clinical diagnostics.
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MESH Headings
- Blood Cell Count
- Bronchoalveolar Lavage Fluid/microbiology
- Bronchoalveolar Lavage Fluid/virology
- Child
- Child, Preschool
- China/epidemiology
- Coinfection/microbiology
- Coinfection/virology
- DNA, Bacterial/analysis
- DNA, Viral/analysis
- Female
- Fluorescent Antibody Technique, Direct
- Humans
- Infant
- Inpatients
- Male
- Metagenome
- Metagenomics/methods
- Oropharynx/microbiology
- Oropharynx/virology
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/epidemiology
- Pneumonia, Bacterial/microbiology
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/virology
- Proof of Concept Study
- RNA, Viral/analysis
- Sensitivity and Specificity
- Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
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Affiliation(s)
- Heping Wang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, China
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands
| | - Zhiwei Lu
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, China
| | - Yaomin Bao
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, China
| | - Yonghong Yang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, China
| | - Ronald de Groot
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands
| | - Wenkui Dai
- Department of Computer Science, City University of Hong Kong, Hong Kong, China
| | - Marien I. de Jonge
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands
- * E-mail: (YZ); (MJ)
| | - Yuejie Zheng
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, China
- * E-mail: (YZ); (MJ)
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41
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Jullien S, Pradhan D, Tshering T, Sharma R, Dema K, Garcia-Garcia S, Ribó JL, Muñoz-Almagro C, Bassat Q. Pneumonia in children admitted to the national referral hospital in Bhutan: A prospective cohort study. Int J Infect Dis 2020; 95:74-83. [PMID: 32283281 PMCID: PMC7195124 DOI: 10.1016/j.ijid.2020.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The study aim was to describe the etiological profile and clinical characteristics of pneumonia among children hospitalized in Thimphu, Bhutan. METHODS This prospective study enrolled children aged 2-59 months admitted to the Jigme Dorji Wangchuck National Referral Hospital with World Health Organization (WHO)-defined clinical pneumonia. Demographic and clinico-radiological data were collected through questionnaires, physical examination, and chest radiography. Blood samples and nasopharyngeal washing were collected for microbiological analysis including culture and molecular methods. RESULTS From July 2017 to June 2018, 189 children were enrolled, of which 53.4% were infants. Pneumonia-related admissions were less frequent over the winter. Chest radiographies were obtained in 149 children; endpoints included pneumonia in 39 cases (26.2%), other infiltrates in 31 (20.8%), and were normal in 79 children (53.0%). Non-contaminated bacterial growth was detected in 8/152 (5.3%) blood cultures, with only two cases of Streptococcus pneumoniae. Viral detection in upper respiratory secretions was common, with at least one virus detected in 103/115 (89.6%). The three most-commonly isolated viruses were respiratory syncytial virus (52/115; 45.2%), rhinovirus (42/115; 36.5%), and human parainfluenza virus (19/115; 16.5%). A third of patients with viral infections showed mixed infections. Case fatality rate was 3.2% (6/189). CONCLUSION Respiratory viral infections predominated among this cohort of WHO-defined clinical pneumonia cases, whereas bacterial aetiologies were uncommon, highlighting the epidemiologic transition that Bhutan seems to have reached.
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MESH Headings
- Bacteria/isolation & purification
- Bhutan/epidemiology
- Child, Preschool
- Cohort Studies
- Coinfection/epidemiology
- Demography
- Female
- Hospitalization
- Humans
- Infant
- Male
- Pneumonia/epidemiology
- Pneumonia/mortality
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/diagnostic imaging
- Pneumonia, Bacterial/epidemiology
- Pneumonia, Bacterial/microbiology
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/diagnostic imaging
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/virology
- Prospective Studies
- Respiratory Syncytial Virus, Human/isolation & purification
- Respirovirus/isolation & purification
- Rhinovirus/isolation & purification
- Streptococcus pneumoniae/isolation & purification
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Affiliation(s)
- Sophie Jullien
- ISGlobal, Hospital Clínic - Universitat de Barcelona, carrer Rosselló, 132, 08036 Barcelona, Spain; Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Gongphel Lam, Thimphu, Bhutan.
| | - Dinesh Pradhan
- Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB), PO box 446, Old Medical Block, JDWNRH, Menkhang Lam, Thimphu, Bhutan.
| | - Tashi Tshering
- Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB), PO box 446, Old Medical Block, JDWNRH, Menkhang Lam, Thimphu, Bhutan.
| | - Ragunath Sharma
- Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Gongphel Lam, Thimphu, Bhutan.
| | - Kumbu Dema
- Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Gongphel Lam, Thimphu, Bhutan.
| | - Selene Garcia-Garcia
- Hospital Sant Joan de Déu (University of Barcelona), Pg. Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain.
| | - Jose Luis Ribó
- Hospital Universitari General de Catalunya, carrer Pedro i Pons 1, 08195 Sant Cugat del Vallés, Barcelona, Spain.
| | - Carmen Muñoz-Almagro
- Hospital Sant Joan de Déu (University of Barcelona), Pg. Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain; Department of Medicine, Universitat Internacional de Catalunya, Carrer de Josep Trueta, 08195 Sant Cugat del Vallés, Barcelona, Spain.
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, carrer Rosselló, 132, 08036 Barcelona, Spain; Hospital Sant Joan de Déu (University of Barcelona), Pg. Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Cambeve, Vila de Manhiça, CP 1929, Maputo, Mozambique; Catalan Institution for Research and Advanced Studies (ICREA), Pg. Lluís Companys 23, 08010 Barcelona, Spain.
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Abstract
Community-acquired pneumonia (CAP) is the leading cause of death among infectious diseases and an important health problem, having considerable implications for healthcare systems worldwide. Despite important advances in prevention through vaccines, new rapid diagnostic tests and antibiotics, CAP management still has significant drawbacks. Mortality remains very high in severely ill patients presenting with respiratory failure or shock but is also high in the elderly. Even after a CAP episode, higher risk of death remains during a long period, a risk mainly driven by inflammation and patient-related co-morbidities. CAP microbiology has been altered by new molecular diagnostic tests that have turned viruses into the most identified pathogens, notwithstanding uncertainties about the specific role of each virus in CAP pathogenesis. Pneumococcal vaccines also impacted CAP etiology and thus had changed Streptococcus pneumoniae circulating serotypes. Pathogens from specific regions should also be kept in mind when treating CAP. New antibiotics for CAP treatment were not tested in severely ill patients and focused on multidrug-resistant pathogens that are unrelated to CAP, limiting their general use and indications for intensive care unit (ICU) patients. Similarly, CAP management could be personalized through the use of adjunctive therapies that showed outcome improvements in particular patient groups. Although pneumococcal vaccination was only convincingly shown to reduce invasive pneumococcal disease, with a less significant effect in pneumococcal CAP, it remains the best therapeutic intervention to prevent bacterial CAP. Further research in CAP is needed to reduce its population impact and improve individual outcomes.
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Affiliation(s)
- João Ferreira-Coimbra
- Internal Medicine Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Cristina Sarda
- Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jordi Rello
- Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institute of Research, Barcelona, Spain
- CIBERES-Centro de investigación en red de enfermedades respiratorias, Madrid, Spain
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Ratnatunga CN, Lutzky VP, Kupz A, Doolan DL, Reid DW, Field M, Bell SC, Thomson RM, Miles JJ. The Rise of Non-Tuberculosis Mycobacterial Lung Disease. Front Immunol 2020; 11:303. [PMID: 32194556 PMCID: PMC7062685 DOI: 10.3389/fimmu.2020.00303] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/06/2020] [Indexed: 12/21/2022] Open
Abstract
The incidence and number of deaths from non-tuberculous mycobacterial (NTM) disease have been steadily increasing globally. These lesser known “cousins” of Mycobacterium tuberculosis (TB) were once thought to be harmless environmental saprophytics and only dangerous to individuals with defective lung structure or the immunosuppressed. However, NTM are now commonly infecting seemingly immune competent children and adults at increasing rates through pulmonary infection. This is of concern as the pathology of NTM is difficult to treat. Indeed, NTM have become extremely antibiotic resistant, and now have been found to be internationally dispersed through person-to-person contact. The reasons behind this NTM increase are only beginning to be elucidated. Solutions to the problem are needed given NTM disease is more common in the tropics. Importantly, 40% of the world's population live in the tropics and due to climate change, the Tropics are expanding which will increase NTM infection regions. This review catalogs the global and economic disease burden, at risk populations, treatment options, host-bacterial interaction, immune dynamics, recent developments and research priorities for NTM disease.
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Affiliation(s)
- Champa N. Ratnatunga
- The Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
- Centre for Molecular Therapeutics, James Cook University, Cairns, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- *Correspondence: Champa N. Ratnatunga
| | - Viviana P. Lutzky
- Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Andreas Kupz
- The Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
- Centre for Molecular Therapeutics, James Cook University, Cairns, QLD, Australia
| | - Denise L. Doolan
- The Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
- Centre for Molecular Therapeutics, James Cook University, Cairns, QLD, Australia
| | - David W. Reid
- Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Matthew Field
- The Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
- Centre for Tropical Bioinformatics and Molecular Biology, James Cook University, Cairns, QLD, Australia
| | - Scott C. Bell
- Immunology Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Rachel M. Thomson
- Immunology Department, Gallipoli Medical Research Institute, Brisbane, QLD, Australia
| | - John J. Miles
- The Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
- Centre for Molecular Therapeutics, James Cook University, Cairns, QLD, Australia
- Centre for Tropical Bioinformatics and Molecular Biology, James Cook University, Cairns, QLD, Australia
- John J. Miles
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Nathan AM, Teh CSJ, Jabar KA, Teoh BT, Tangaperumal A, Westerhout C, Zaki R, Eg KP, Thavagnanam S, de Bruyne JA. Bacterial pneumonia and its associated factors in children from a developing country: A prospective cohort study. PLoS One 2020; 15:e0228056. [PMID: 32059033 PMCID: PMC7021284 DOI: 10.1371/journal.pone.0228056] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Pneumonia in children is a common disease yet determining its aetiology remains elusive. Objectives To determine the a) aetiology, b) factors associated with bacterial pneumonia and c) association between co-infections (bacteria + virus) and severity of disease, in children admitted with severe pneumonia. Methods A prospective cohort study involving children aged 1-month to 5-years admitted with very severe pneumonia, as per the WHO definition, over 2 years. Induced sputum and blood obtained within 24 hrs of admission were examined via PCR, immunofluorescence and culture to detect 17 bacteria/viruses. A designated radiologist read the chest radiographs. Results Three hundred patients with a mean (SD) age of 14 (±15) months old were recruited. Significant pathogens were detected in 62% of patients (n = 186). Viruses alone were detected in 23.7% (n = 71) with rhinovirus (31%), human metapneumovirus (HMP) [22.5%] and respiratory syncytial virus (RSV) [16.9%] being the commonest. Bacteria alone was detected in 25% (n = 75) with Haemophilus influenzae (29.3%), Staphylococcus aureus (24%) and Streptococcus pneumoniae (22.7%) being the commonest. Co-infections were seen in 13.3% (n = 40) of patients. Male gender (AdjOR 1.84 [95% CI 1.10, 3.05]) and presence of crepitations (AdjOR 2.27 [95% CI 1.12, 4.60]) were associated with bacterial infection. C-reactive protein (CRP) [p = 0.007]) was significantly higher in patients with co-infections but duration of hospitalization (p = 0.77) and requirement for supplemental respiratory support (p = 0.26) were not associated with co-infection. Conclusions Bacteria remain an important cause of very severe pneumonia in developing countries with one in four children admitted isolating bacteria alone. Male gender and presence of crepitations were significantly associated with bacterial aetiology. Co-infection was associated with a higher CRP but no other parameters of severe clinical illness.
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Affiliation(s)
- Anna Marie Nathan
- Department of Paediatrics, University Malaya Paediatric, Kuala Lumpur, Malaysia
- Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, University Malaya, Kuala Lumpur, Malaysia
| | - Kartini Abdul Jabar
- Department of Medical Microbiology, University Malaya, Kuala Lumpur, Malaysia
| | - Boon Teong Teoh
- Department of Tropical Infectious Diseases Research and Education Centre (TIDREC), University of Malaya, Kuala Lumpur, Malaysia
| | - Anithaa Tangaperumal
- Department of Biomedical Imaging, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Caroline Westerhout
- Department of Biomedical Imaging, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Rafdzah Zaki
- Centre for Epidemiology and Evidence-Based Practice, Department of Social & Preventive Medicine, Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Kah Peng Eg
- Department of Paediatrics, University Malaya Paediatric, Kuala Lumpur, Malaysia
- Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
| | - Surendran Thavagnanam
- Department of Paediatrics, University Malaya Paediatric, Kuala Lumpur, Malaysia
- Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
| | - Jessie Anne de Bruyne
- Department of Paediatrics, University Malaya Paediatric, Kuala Lumpur, Malaysia
- Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
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La Combe B, Clermont O, Messika J, Eveillard M, Kouatchet A, Lasocki S, Corvec S, Lakhal K, Billard-Pomares T, Fernandes R, Armand-Lefevre L, Bourdon S, Reignier J, Fihman V, de Prost N, Bador J, Goret J, Wallet F, Denamur E, Ricard JD. Pneumonia-Specific Escherichia coli with Distinct Phylogenetic and Virulence Profiles, France, 2012-2014. Emerg Infect Dis 2019; 25:710-718. [PMID: 30882313 PMCID: PMC6433033 DOI: 10.3201/eid2504.180944] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In a prospective, nationwide study in France of Escherichia coli responsible for pneumonia in patients receiving mechanical ventilation, we determined E. coli antimicrobial susceptibility, phylotype, O-type, and virulence factor gene content. We compared 260 isolates with those of 2 published collections containing commensal and bacteremia isolates. The preponderant phylogenetic group was B2 (59.6%), and the predominant sequence type complex (STc) was STc73. STc127 and STc141 were overrepresented and STc95 underrepresented in pneumonia isolates compared with bacteremia isolates. Pneumonia isolates carried higher proportions of virulence genes sfa/foc, papGIII, hlyC, cnf1, and iroN compared with bacteremia isolates. Virulence factor gene content and antimicrobial drug resistance were higher in pneumonia than in commensal isolates. Genomic and phylogenetic characteristics of E. coli pneumonia isolates from critically ill patients indicate that they belong to the extraintestinal pathogenic E. coli pathovar but have distinguishable lung-specific traits.
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Abstract
We report a case of community-acquired pneumonia in a patient in China. We verified Legionella pneumophila infection through next-generation sequencing of blood, sputum, and pleural effusion samples. Our results show the usefulness of next-generation sequencing and of testing different samples early in the course of illness to identify this bacterium.
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47
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Jump RLP, Wilson BM, Baechle D, Briggs JM, Banks RE, Song S, Zappernick T, Perez F. Risk Factors and Mortality Rates Associated With Invasive Group B Streptococcus Infections Among Patients in the US Veterans Health Administration. JAMA Netw Open 2019; 2:e1918324. [PMID: 31880800 PMCID: PMC6991221 DOI: 10.1001/jamanetworkopen.2019.18324] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE The incidence of invasive infections caused by group B Streptococcus (GBS) continues to increase in the United States. Although diabetes is a key risk factor for invasive GBS, the influence of long-term glycemic control is not well characterized; other risk factors and mortality rates associated with specific types of invasive GBS infections are unknown. OBJECTIVE To investigate risk factors and mortality rates associated with specific invasive GBS infectious syndromes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used US Veterans Health Administration data to assess active users of the Veterans Affairs health care system between January 1, 2008, and December 31, 2017. Data analysis was conducted from April 2018 to August 2019. EXPOSURES Invasive GBS infections. MAIN OUTCOMES AND MEASURES The specific types of infectious syndromes and comorbid conditions among patients with an invasive GBS infection were evaluated. RESULTS Between 2008 and 2017, 5175 patients in the Veterans Affairs health care system experienced 5497 invasive GBS infections (5027 [97.1%] men, 3737 [72.2%] white, and 4545 [87.8%] non-Latino); all-cause 30-day mortality was 8.7% (451 of 5175). The most frequently observed infections were osteomyelitis (1171 [21.3%]), bacteremia without focus (1009 [18.4%]), skin or soft-tissue infections (919 [16.7%]), and pneumonia or empyema (694 [12.6%]). All-cause 30-day mortality following the index infection for each patient was highest among patients with peritonitis (38 of 138 [27.5%]) and pneumonia or empyema (116 of 664 [17.5%]) and lowest among those with osteomyelitis (15 of 1075 [1.4%]) or joint infection (17 of 501 [3.4%]). The most common comorbid conditions among patients with invasive GBS infections were diabetes (3364 [65.0%]), obesity (2669 [51.6%]), and chronic heart conditions (1633 [31.6%]). From 2008 to 2017, the incidence of invasive GBS infections increased from 9.23 to 11.67 cases per 100 000 person-years (P = .049). Stratification by body mass index showed the highest incidence of infections among patients at the extremes of body mass index (body mass index <18.5, 25.1 cases per 100 000 person-years; body mass index ≥40, 31.0 cases per 100 000 person-years). The incidence among patients with diabetes and poor long-term glycemic control (ie, hemoglobin A1c ≥9.5%) was 4-fold greater than among patients with diabetes and good glycemic control (ie, hemoglobin A1c <7.5%) (78.3 cases vs 19.0 cases per 100 000 person-years; unadjusted incident rate ratio, 4.1; 95% CI, 3.7-4.4; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, comorbid conditions and 30-day mortality varied among types of invasive GBS infections. Obesity and poor long-term glycemic control were associated with invasive GBS infections. Efforts to reverse the trend of an increased incidence of invasive GBS infections should continue to support reducing obesity and focus on improving glycemic control.
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Affiliation(s)
- Robin L. P. Jump
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
- Specialty Care Center of Innovation, VA Northeast Ohio Healthcare System, Cleveland
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Brigid M. Wilson
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Daniel Baechle
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Janet M. Briggs
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
| | - Richard E. Banks
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
| | - Sunah Song
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Taissa Zappernick
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
| | - Federico Perez
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Kerai S, Nisar I, Muhammad I, Qaisar S, Feroz K, Raza A, Khalid F, Baloch B, Jehan F. A Community-Based Survey on Health-Care Utilization for Pneumonia in Children in Peri-Urban Slums of Karachi, Pakistan. Am J Trop Med Hyg 2019; 101:1034-1041. [PMID: 31482784 PMCID: PMC6838581 DOI: 10.4269/ajtmh.18-0656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
Pneumonia, as defined by WHO, is a syndromic diagnosis characterized by presence of cough or difficult breathing. Presentation to health-care provider depends on timely identification of signs and symptoms by caretakers. We explored patterns of health-care utilization among caretakers of a randomly selected sample of 1,152 children aged 2-59 months, residing in low-income settlements of Karachi, Pakistan. Information on household demographics, occurrence of pneumonia-specific symptoms, care seeking, air quality, and knowledge regarding preventive measures for pneumonia was collected. Predictors of care seeking were estimated using weighted logistic regression. Prevalence of pneumonia with cough and rapid or difficulty in breathing was found to be 40.8% and 37.1% in infants (2-11 months) and children (12-59 months), respectively. Ninety-five percentage of caretakers sought care, 68.5% privately. Odds ratios (ORs) for independent predictors of care-seeking were as follows: younger age of child (infants compared with children), 3.60 (95% CI = 2.65-4.87); caretaker with primary education compared with none, 3.40 (2.46-4.70); vaccine awareness, 1.65 (1.45-1.87); and breastfeeding awareness, 1.32 (1.13-1.53). Presence of symptoms such as fever OR, 1.51 (1.30-1.76); tachypnea, 1.57 (1.35-1.83); chest indrawing, 2.56 (2.05-3.18); persistent vomiting, 1.69 (1.37-2.09); and recurrent illness, 2.57 (2.23-2.97) were also predictive. There is high health-care utilization for pneumonia with the skewed presentation toward private services. Strategies should be focused on making pneumonia care standardized, efficient and affordable, especially in the private sector.
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Affiliation(s)
- Salima Kerai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ilyas Muhammad
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sana Qaisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Khalid Feroz
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Azhar Raza
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Faizan Khalid
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Benazir Baloch
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Marcus JE, Piper LC, Ainsworth CR, Sams VG, Batchinsky A, Okulicz JF, Barsoumian AE. Infections in patients with burn injuries receiving extracorporeal membrane oxygenation. Burns 2019; 45:1880-1887. [PMID: 31601427 DOI: 10.1016/j.burns.2019.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Extracorporeal Membrane Oxygenation (ECMO) has only recently been described in patients with burn injuries. We report the incidence and type of infections in critically ill burn and non-burn patients receiving ECMO. METHODS A retrospective chart review was performed on all patients at Brooke Army Medical Center who received ECMO between September 2012 and May 2018. RESULTS 78 patients underwent ECMO. Approximately half were men with a median age of 34 years with a median time on ECMO of 237 h (IQR 121-391). Compared to patients without burns (n = 58), patients with burns (n = 20) had no difference in time on ECMO, but had more overall infections (86 vs. 31 per 1000 days, p = 0.0002), respiratory infections (40 vs. 15 per 1000 days, p = 0.01), skin and soft tissue infections (21 vs. 5 per 1000 days, p = 0.02) and fungal infections (35% vs 10%, p = 0.02). Twenty percent of bacterial burn infections were due to drug resistant organisms. CONCLUSION This is the first study to describe the incidence of infection in burn injury patients who are undergoing ECMO. We observed an increase in infections in burn patients on ECMO compared to non-burn patients. ECMO remains a viable option for critically ill patients with burn injuries.
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Affiliation(s)
- Joseph E Marcus
- Department of Internal Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Ft. Sam Houston, San Antonio, TX 78234, United States.
| | - Lydia C Piper
- Department of Surgery, Brooke Army Medical Center, 3551 Roger Brook Drive, JBSA Ft. Sam Houston, San Antonio, TX 78234, United States
| | - Craig R Ainsworth
- U.S. Army Institute of Surgical Research, JBSA Ft. Sam Houston, San Antonio, TX, United States
| | - Valerie G Sams
- Department of Surgery, Brooke Army Medical Center, 3551 Roger Brook Drive, JBSA Ft. Sam Houston, San Antonio, TX 78234, United States
| | - Andriy Batchinsky
- U.S. Army Institute of Surgical Research, JBSA Ft. Sam Houston, San Antonio, TX, United States
| | - Jason F Okulicz
- Infectious Disease Service, MCHE-MDI, 3551 Roger Brooke Drive, JBSA Ft. Sam Houston, San Antonio, TX 78234, United States
| | - Alice E Barsoumian
- Infectious Disease Service, MCHE-MDI, 3551 Roger Brooke Drive, JBSA Ft. Sam Houston, San Antonio, TX 78234, United States
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50
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Hill K, Stewart KM, Rajeev S, Conan A, Dennis MM. PATHOLOGY OF LEATHERBACK SEA TURTLE ( DERMOCHELYS CORIACEA) EMBRYOS AND HATCHLINGS FROM NESTS IN ST. KITTS, WEST INDIES (2015-16). J Wildl Dis 2019; 55:782-793. [PMID: 31166849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sustained hatchling production is a priority for leatherback sea turtle (Dermochelys coriacea) conservation. Yet the species is challenged by notoriously low hatch success, much lower than other species of sea turtles, and the result of a high rate of embryo mortality for which the causes are not understood. The aim of our study was to describe the pathology of embryos and dead-in-nest hatchlings, to help understand the basis for low hatch success in St. Kitts, West Indies. We surveyed two leatherback nesting beaches, Keys and North Friars, in 2015-16. Pathology was present in 38% (32 of 84) of individuals, including renal mineralization (24%, 20 of 83), bacterial pneumonia (12%, 10 of 82), and skeletal muscle necrosis (7%, 6 of 84). Renal mineralization was seen in all stages of development that we examined and was associated with cardiac mineralization in two cases. Bacterial pneumonia affected dead-in-nest hatchlings and late-stage embryos and involved 40% (6 of 15) of nests evaluated, all laid by different mothers. Hematopoiesis was consistently observed in the liver, lung, kidneys, and heart. Gonad was histologically classified as female in 100% (68 of 68) of individuals examined. Rathke's gland was identified in the axillary musculature of 51 individuals, which has not previously been described in leatherbacks. Bacterial pneumonia and renal mineralization were presumed to be significant causes of death in leatherback embryos and hatchlings in St. Kitts. Overrepresentation of females in our study suggested high incubation temperatures in the nests.
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Affiliation(s)
- Kristine Hill
- Center for Conservation Medicine and Ecosystem Health, Ross University School of Veterinary Medicine, Camps, St. Kitts, West Indies
- St. Kitts Sea Turtle Monitoring Network, PO Box 2298, Basseterre, St. Kitts, West Indies
| | - Kimberly M Stewart
- Center for Conservation Medicine and Ecosystem Health, Ross University School of Veterinary Medicine, Camps, St. Kitts, West Indies
- St. Kitts Sea Turtle Monitoring Network, PO Box 2298, Basseterre, St. Kitts, West Indies
| | - Sreekumari Rajeev
- Center for Conservation Medicine and Ecosystem Health, Ross University School of Veterinary Medicine, Camps, St. Kitts, West Indies
| | - Anne Conan
- Center for Conservation Medicine and Ecosystem Health, Ross University School of Veterinary Medicine, Camps, St. Kitts, West Indies
| | - Michelle M Dennis
- Center for Conservation Medicine and Ecosystem Health, Ross University School of Veterinary Medicine, Camps, St. Kitts, West Indies
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