Duration of Stay of Patients with Community-Acquired Pneumonia in Influenza Season

OBJECTIVES

There is a seasonal variation in the incidence of some infectious diseases. We analyzed the impact of influenza season (IS) on duration of stay (DOS) and some other characteristics of patients with community-acquired pneumonia (CAP).

MATERIALS AND METHODS

In our retrospective cohort study, we analyzed data of 369 patients with CAP.

RESULTS

The mean patient age was 65.5±16.69 years, and 267 (72.4%) patients were male. There was no difference between patients with CAP admitted to hospital and intensive care unit during IS and non-influenza season (NIS) with respect to age, mortality, and DOS. There was no difference in leukocyte and neutrophil counts, C-reactive protein level, and erythrocyte sedimentation rate in different seasons. Although most comorbid disease rates were similar, only cancer, especially lung cancer, was more prevalent in NIS. Bilateral CAP confirmed using thorax computed tomography was more frequent in IS.

CONCLUSION

Although more patients with bilateral pneumonias were hospitalized in IS, DOS was not different between IS and NIS.

Metabolic activity of primary tumour on PET/CT has a relationship with survival in stages I-III small-cell lung carcinoma

INTRODUCTION

There is limited evidence about the prognostic value of FDG-PET/CT metrics in small cell lung cancer (SCLC) patients staged with TNM staging system.

OBJECTIVES

The aim of this study is to examine the prognostic value of pretreatment FDG-SUVmax in patients with SCLC staged with 8th TNM staging system.

METHODS

A total of 344 (292 male) SCLC patients with pretreatment FDG- PET/CT were included. One hundred fifty-three of cases were stages I-III, 191 were stage IV. SUVmax values were obtained for primary tumour, lymph nodes and metastases. Univariate and multivariate analysis were performed to determine the effect of pretreatment SUVmax, with cut-off value of median, on progression-free and overall survival (PFS and OS).

RESULTS

Median OS and PFS for patients with stages I-III were 16.50 and 11.00 months, respectively. Median OS and PFS for patients with stage IV were 10.00 and 7.00 months, respectively. SUVmax of the primary tumour (PT), lymph nodes or metastasis were not associated with OS and PFS on univariate analysis. On multivariate analysis, SUVmax -PT with cut-off value of 11.60 was found to be an independent prognostic factor for OS in patients with stages I-III (HR;1.88, 95% CI:1.15-3.08, P = .012). But the SUVmax -PT (HR; 1.60, 95% CI: 0.99-2.60; P = .057) for PFS was found to be a prognostic factor with marginal significance. SUVmax were not significantly associated with OS and PFS in patients with stage IV disease.

CONCLUSION

Pretreatment SUVmax -PT (median cut-off 11.6) may have a prognostic value of OS and PFS in patients with TNM staged I-III SCLC.

Is Polymerase Chain Reaction Positivity More Common in Patients with COVID-19 Pneumonia with Fever?

Introduction

There is conflicting data about the rate of fever at admission and during hospitalization in COVID-19 pneumonia. We analyzed the rate of fever in our patients to find the diagnostic value of fever and to predict PCR status in COVID-19.

Methods

It was a retrospective cross-sectional study conducted in the Health Sciences University Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, which was a tertiary chest diseases pandemic hospital in İzmir. We included 389 patients hospitalized for COVID-19 and analyzed them according to PCR status and presence of fever. Fever was defined as temperature over 38°C.

Results

Thirty-eight percentage of our patients complained of fever before admission. However, when they were admitted, only 13.6% of them had objective high fever. 26.5% had high fever during hospital stay. PCR-positive patients had less comorbidity. More of PCR-positive patients had fever in the course of hospitalization and their length of hospital stay was longer and mortality was higher. Although we expected to find a high sensitivity, the sensitivity of high fever in our settings was low. Sensitivity, specificity, positive, and negative predictive values of high fever at admission in predicting the positivity of the PCR test were 16.9%, 90.6%, 69.8%, and 45.8%, respectively. Sensitivity, specificity, positive, and negative predictive values of high fever during hospitalization to predict the positivity of PCR test were 36.1%, 85.9%, 76.7%, and 51.0%, respectively.

Conclusion

13.6% of our COVID-19 patients had objective high fever at admission. 26.5% had high fever during hospital stay. PCR-positive patients had less comorbidity. More PCR-positive patients had fever in the course of hospitalization and their length of hospital stay was longer and mortality was higher. Although we expected to find a high sensitivity, the sensitivity of high fever in our settings was lower than expected. Temperatures <38°C at admission and during hospitalization determine 90.6% and 85.9% of the PCR-negative patients, respectively. These high specificity values imply that if the PCR test is negative, the patient's temperature is more likely to be lower than 38°C.

How does chronic obstructive pulmonary disease affect the survival of patients with stage 4 lung cancer?

BACKGROUND

Lung cancer risk is increased in COPD. However, it is not clear how COPD affects the course of lung cancer.

AIM

To determine whether the overall survival of stage 4 lung cancer patients differ in various COPD stages.

STUDY DESIGN

A cross-sectional retrospective study.

METHODS

We screened lung cancer patients with ICD code: C34 and included stage 4 lung cancer patients with histological diagnosis and pulmonary function tests at admission in the study. Demographic data, stages, metastasis sites and number of metastases, performance status, pulmonary function tests, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, arterial blood gasses and treatment methods were recorded on a standardised database. We checked their dates of death from national database. Data were evaluated with SPSS programme version 18.

RESULTS

Out of 900 patients, 146 patients had stage 4 disease at the time of diagnosis and, 127 patients had COPD. There was a significant difference between survivals of stage 4 cancer patients with different COPD stages. As COPD stage increased, overall survival worsened (P = 0.037). Factors affecting survival were bone metastasis (P = 0.01, OR = 1.72), liver metastasis (P = 0.04, OR = 1.87), brain metastasis (P = 0.001, OR = 2.6), having N 2-3 disease (P = 0.01, OR = 1.79) and GOLD 4 COPD (P = 0.01, OR = 2.28).

CONCLUSION

As COPD becomes more severe, overall survival rates of stage 4 patients worsen. Bone metastasis, liver metastasis, brain metastasis, having N2-3 disease and GOLD 4 COPD worsen the overall survival.

Characteristics of Patients with Large-Cell Neuroendocrine Carcinoma of the Lung

OBJECTIVES

Neuroendocrine tumors of the lungs are a clearly different group of tumors with definite ultrastructural, immunohistochemical, and molecular features. We reported and analyzed the incidence, clinicopathological features, surgery rates, responses to first-line therapy, and survival outcomes of this rare condition according to our lung cancer patient database.

MATERIALS AND METHODS

We retrospectively collected the data of 62 patients who were histopathologically diagnosed with large cell neuroendocrine carcinoma of lung (LCNEC) between January 2010 and January 2016.

RESULTS

The patients were predominantly (95%) men (male:female=59:3) with their average age being 60.3±8.6 years. Diagnosis was made by the fine-needle aspiration biopsy (NAB) in 7 patients, bronchoscopic transbronchial biopsy in 13, and surgery in 42. Nearly 43.5% of the patients presented with the tumor in the right upper lobe. Additionally, tumors of 46.8% patients could be observed in peripheral locations. Sixteen patients presented with stage 1, 17 with stage 2, 15 with stage 3, and 14 with stage 4. Median progression-free survival (PFS) was 29 months (SE: 12.2) (95% CI, 5.2-52.8 months). Progression-free survival (PFS) was significantly better in patients with low N, M0, early stage, p63 positive, and TTF-1 positive across the entire cohort. Overall survival (OS) was significantly better in patients with comparatively lower N, M0, low stage, and peripheral location.

CONCLUSION

This study demonstrated a single-center experience with clinicopathologic factors and survival outcomes of LCNEC patients.

The relation between distant metastasis and genetic change type in stage IV lung adenocarcinoma patients at diagnosis

INTRODUCTION

Brain metastasis prevalence is higher in patients with positive epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) and C-ROS oncogene 1 (ROS-1) fusion change in lung adenocarcinoma.

OBJECTIVES

The purpose of our study is to investigate the relation between the genetic change type and the initial distant metastasis in stage IV lung adenocarcinoma patients with genetic changes.

METHODS

The study was conducted between January 2007 and December 2018 in a retrospective fashion with patients who had lung cancer diagnosed as stage IV adenocarcinoma. The relation between genetic mutation change (EGFR, ALK or ROS-1) and distant metastasis was analysed.

RESULTS

A total of 845 patients were included in the study. The median age was 62 (28-88). It was determined that lung and pleura metastases were more frequent at a significant level in patients with positive EGFR mutation (P = 0.032, P = 0.004, respectively). In patients with positive ALK fusion change, pleura metastasis was determined to be more frequent (P = 0.001). Multiple metastases were determined to be significantly more in patients with positive ALK fusion change than single metastasis (P = 0.02).

CONCLUSION

In patients with EGFR mutant lung adenocarcinoma, lung and pleura metastasis is more frequent and pleura metastasis is more frequent in ALK positive adenocarcinoma. Additionally, multiple organ metastases are higher in ALK positive lung adenocarcinoma.

Antibiotic resistance rates and penicillin MIC distribution in patients with streptococcal pneumonia between 2013-2019, and use of antibiotics in clinical practice

PURPOSE

The purpose of the present study is to investigate the antibiotic resistance rates and use of antibiotics in patients with streptococcal pneumonia in a reference tertiary care hospital for pulmonary diseases in Izmir, Turkey.

METHODS

A total of 1224 cases with streptococcal pneumonia between 2013 and 2019 were included in the study, retrospectively. Drug susceptibility testing for penicillin and other antibiotics were performed according to the recommendations of EUCAST criteria. Clinical data and general characteristics were collected and evaluated for each patient in accordance with the susceptibility testing report.

RESULTS

Totally, resistance rates for trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, tetracycline, clindamycin and levofloxacin resistance were 63.5%, 39.8%, 37.7%, 37.6%, 28.8%, and 4.8%, respectively. Antibiotic resistance was not detected against vancomycin,teicoplanin and linezolid. Multidrug resistance rate was found to be 27.1%. It was observed that there was a statistically significant decrease in trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, clindamycin and levofloxacin resistance rates by years (p: 0.000, 0.004, 0.000, 0.001, 0.010, respectively). The penicillin MIC distribution was higher at the range of 0.12-2 ​μg/mL and there was statistical difference among the ranges of MIC values for the representative years (p:0.033). Among the antibiotics investigated, the most commonly used antibiotic was moxifloxacin.

CONCLUSIONS

Trimethophrim-sulfamethoxazole resistance rate has been found higher than other antibiotics. As penicillin MIC values were at the range of 0.12-2 ​μg/mL frequently, high doses of penicillin treatment might be required in some patients. It is noteworthy that significant decrease in resistance rates in penicillin, erythromycin, clindamycin and tetracycline could be due to the vaccination programme carried out since 2008 in Turkey. As the empiric use of quinolones is high it would be more appropriate to use it according to the susceptibility testing. It is important to determine the regional antimicrobial susceptibility for Streptococcus pneumoniae to select appropriate empirical antimicrobials in the clinical practice.