Community-acquired Pneumonia Research Articles

The management of community-acquired pneumonia in adults at a rural regional hospital in KwaZulu Natal

BackgroundPneumonia stands as a significant global contributor to mortality, particularly in South Africa, where it ranks as the second leading cause of death. The country’s high prevalence of HIV infection compounds this issue, significantly increasing mortality rates associated with community-acquired pneumonia (CAP).ObjectiveThis study aimed to audit CAP patient management at a regional rural hospital in KwaZulu-Natal.MethodA retrospective review of patient files from September to December 2016 was undertaken. Data extraction from clinical files, conducted according to inclusion criteria, was transferred to a data collection sheet and analyzed using SPSS version 21.ResultsThe review encompassed 124 patient files over four months, revealing that 117 (94.4%) patients were not managed by the Standard Treatment Guidelines and Essential Medicines List for South Africa. Of the patients admitted with CAP, 54% were HIV positive, and 49 (39.5%) patients succumbed to the illness. Notably, none of the patients underwent assessment using a severity score.ConclusionThe findings underscore a need for more adherence to South African guidelines for managing CAP among staff at the rural regional hospital. This leads to severe consequences, exemplified by the high mortality rate. Urgent intervention is required to incorporate severity assessment scores into pneumonia evaluations, thus enabling appropriate clinical management.ContributionThis study sheds light on the significant impact of CAP within the South African hospital context, delineating critical gaps in clinical care and emphasizing the imperative to address clinical inertia.

External validation and comparative analysis of the HOSPITAL score and LACE index for predicting readmissions among patients hospitalised with community-acquired pneumonia in Australia.

ObjectiveCommunity-acquired pneumonia (CAP) is a leading cause of emergency hospitalisations globally and is associated with high readmission rates. Specific score systems developed for all medical conditions such as the HOSPITAL score and the LACE index can also usefully predict CAP readmissions. However, there is limited evidence regarding their performance in the Australian healthcare settings.MethodsThis multicentre retrospective study analysed adult CAP discharges from two metropolitan hospitals in South Australia between 1 January 2018 and 31 December 2023. Data for determining the HOSPITAL score and the LACE index were derived from electronic medical records. Demographic characteristics of patients readmitted within 30 days were compared with those who were not readmitted. The scores were evaluated for overall performance, discriminatory power and calibration, with discriminatory power assessed using the concordance statistic (C-statistic).ResultsOver 6years, 7245 CAP discharges were recorded, with 1329 (18.3%) readmissions within 30days. The mean (s.d.) age of the cohort was 74.4 (17.8) years. Readmitted patients were more likely to have multiple morbidities and frailty than those not readmitted (P<0.05). They also had a higher mean number of emergency department presentations and hospital admissions in the previous year and a longer initial hospital stay (P<0.05). Overall, the mean (s.d.) HOSPITAL score and LACE index were 3.4 (2.1) and 9.3 (3.6), respectively. Among readmissions, 28.4% occurred in patients with a HOSPITAL score >4 (intermediate and high-risk group), while 25.8% occurred in patients in the high-risk LACE category (LACE index>10). The C-statistic for the HOSPITAL score and LACE index was 0.62 (95% CI 0.61-0.64) and 0.63 (95% CI 0.61-0.65), respectively, with no significant difference in the area under the receiver operating characteristic curves (P>0.05).ConclusionsThe predictive abilities of the HOSPITAL score and the LACE index for CAP readmissions are modest and comparable in an Australian setting.

Surge in Mycoplasma Pneumoniae infection and Respiratory Viruses Co-infection in Children With Community-Acquired Pneumonia in the Post-Pandemic.

During the COVID-19 pandemic, multifaceted non-pharmaceutical interventions have not only reduced the transmission of SARS-CoV2 but also affected the prevalence of other respiratory pathogens. With the lifting of many restrictions, a surge in cases of pneumonia in children has been reported in many hospitals in China. The study assessed the changes in pathogen and symptoms of children with community-acquired pneumonia (CAP) before and after the adjustments of prevention and control measures of epidemic and provided recommendations for CAP in children. Children diagnosed with CAP were enrolled in the study from 2022 to 2023. A cross-sectional retrospective study was conducted in a general hospital. We analyzed the data about demographic data, clinical symptoms, pathogens, and medical treatments. The Chi-square and Mann-Whitney U-test were used to assess the statistical significance of groups. We studied 1103 children, 339 in 2022 and 764 in 2023. Compared with children in 2022, more children were diagnosed with CAP in 2023 and these children had a higher body temperature and levels of CRP and PCT, which indicated these children got severe inflammation. The positive rate of the pathogen was also higher in 2023, especially the detective rate of Mycoplasma pneumoniae. The number of children infected with more than two pathogens was higher in 2023, especially those co-infected with the virus and M. Pneumoniae. Concerning the medicine therapy, the usage of β-lactam antibiotics, Macrolide antibiotics, and antiviral drugs kept rapid growth. After the adjustment of epidemic prevention and control policies in 2023, more children got CAP with severe clinical symptoms, and more antibiotics and antiviral drugs were used. Further study is needed to explore the reasons for the increase in children with CAP and to explore the rationality of treatment.

Hypermucoviscous Klebsiella Pneumoniae Caused Community-Acquired Pneumonia in Gondar, Northwest Ethiopia.

The incidence of hypermucoviscous Klebsiella pneumoniae (hmvKp), which complicates community-acquired pneumonia, has been increasing recently. This study aimed to detect hypermucoviscous K. pneumoniae and determine its antimicrobial susceptibility pattern in adult patients with community-acquired pneumonia in Northwest Ethiopia. This cross-sectional study included 39 K. pneumoniae isolates identified by using Gram stain, culture, and biochemical tests from 312 adult patients with community-acquired pneumonia at the University of Gondar Comprehensive Specialized Referral Hospital from April to June 2021. The hypermucoviscous strains were identified by using the string test. Antimicrobial susceptibility testing was performed by using the Kirby-Bauer disk dif-fusion method. Data were entered by using EPI data version 4.6 and were analyzed by using SPSS version 20. A p-value ≤ 0.05 at a 95% confidence interval was considered statistically significant. Overall, 35.9% (n = 14) of the 39 K. pneumoniae isolates were hypermucoviscous phenotype. The mean age of the hmvKp group was lower than of the cKp group (36.93 ± 12.573 vs. 53.52 ± 19.556 years, p = 0.007). All hmvKp isolates were resistant to amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. Azithromycin resistance in the hmvKp strains was significantly higher than in the cKp group (p = 0.012). This study demonstrates that the hmvKp phenotype causes community-acquired pneumonia and a full resistance to amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. Antimicrobial resistance was higher in the hmvKp strain than in the classic strains. Further detection of resistance genes, capsular serotypes, hypermucoviscosity-related genes, and virulence genes is necessary.

Comparative prospective cohort study of efficacy and safety according to dosage and administration of ceftriaxone for community-acquired pneumonia

IntroductionLimited prospective evidence has been accumulated regarding the efficacy and safety of ceftriaxone (CTRX) based on differences in dosage and administration of the drug as empiric therapy for community-acquired pneumonia (CAP). This study aimed to compare initial treatment failure, 30-day mortality, and side effects between two groups of hospitalized adult CAP patients: one receiving intravenous CTRX at 1g twice daily (1gq12hr) and the other receiving 2g once daily (2gq24hr). MethodsWe prospectively included patients with CAP admitted to our hospital between October 2010 and December 2018. We analyzed patients initially treated solely with CTRX as either 1gq12hr or 2gq24hr. The primary outcome was initial treatment failure, while secondary outcomes were 30-day mortality and side effects. Inverse probability of treatment weighting (IPTW) analysis was used to minimize biases. ResultsAmong the 457 CAP patients, 186 patients were in the 1gq12hr group and 271 patients were in the 2gq24hr group. After IPTW analysis, no significant differences in initial treatment failure rate (2.43 % vs 4.46 %, p = 0.27) or 30-day mortality rate (2.95 % vs 6.43 %, p = 0.13) were seen between groups. A small but noteworthy tendency was noted in the frequency of side effects between the two groups (1.04 % vs 4.20 %, p = 0.08) following IPTW analysis, even though the difference was not significant. ConclusionsThis study did not find any significant difference between ceftriaxone 1gq12hr and 2gq24hr regarding efficacy or safety in adult patients with CAP. However, CTRX 1gq12hr may represent a safer option in terms of side effects.

Болезнь легионеров с неврологическими проявлениями: клинический случай

INTRODUCTION. Legionnaires' disease may be manifested by neurological symptoms along with lung damage. Cerebellar ataxia and dysarthria are rare extrapulmonary manifestations of legionellosis. These symptoms significantly reduce the quality of life of patients. AIM. To analyze the literature data on neurological manifestations of legionellosis and to present a clinical case of Legionnaires' disease manifestation with neurological symptoms. MATERIAL AND METHODS. We performed an analysis of the available literature. Twenty-four Russian and international literature sources (PubMed databases) were evaluated, describing the characteristics and prevalence of neurological manifestations in Legionnaires' disease. We also described the main theories of the pathogenesis of these clinical manifestations. Our clinical case is presented. RESULTS AND DISCUSSION. As of today, few cases of Legionnaires' disease with cerebellar symptoms have been described. Dysarthria and ataxia are the most frequent manifestations of cerebellar dysfunction in legionellosis. Cases where neurologic symptoms persisted after the resolution of pneumonia have been described previously. There are also reports of manifestation of Legionnaires' disease with cerebellar ataxia. The pathophysiology of cerebellar involvement is unknown. There are hypotheses of toxin-mediated and immune-mediated mechanisms. Recent studies have shown that L. pneumophila can activate receptors responsible for enacting the inflammasome pathway. This mechanism promotes cell death that occurs to remove the intracellular pathogen, which may be responsible for central nervous system dysfunction. CASE PRESENTATION. A 48-year-old woman was hospitalized with a suspected stroke. She works in diamond production and is in contact with aerosolized liquids. Four days before hospitalization she complained of a headache, and in the evening before she lost consciousness. Slurred speech, unsteadiness, and inability to walk were noted. At hospitalization, no instrumental evidence of stroke was obtained. Inflammatory markers were elevated. Chest computer tomography showed infiltrative changes. The rapid test for antigenuria (L. pneumophila) was positive, and community-acquired legionellosis was confirmed. Levofloxacin was administrated. After discharge, dysarthria, dysphagia, and instability in the Romberg pose persisted. CONCLUSION. The example of this clinical observation demonstrates that in rare cases Legionnaires' disease can manifest as other diseases, which requires a certain vigilance of doctors of different specialities in order to timely diagnose the disease. KEYWORDS: Legionnaires' disease, legionellosis, community-acquired pneumonia, central nervous system, infectious disease

The Association between Dyslipidemia and Pulmonary Diseases.

Dyslipidemia is one of the most common diseases worldwide. As a component of metabolic syndrome, the prevalence and mechanism by which dyslipidemia promotes cardiovascular diseases has been well studied, although the relationship between pulmonary diseases is not well understood. Because the lung is a respiratory organ with a large surface area and is exposed to the environment outside the body, it continuously inhales various substances. As a result, pulmonary diseases have a vast diversity, including chronic inflammatory diseases, allergic diseases, cancers, and infectious diseases. Recently, growing evidence has suggested that dyslipidemia plays a role in the pathogenesis and prognosis of various pulmonary diseases. We herein review the current understanding of the relationship between dyslipidemia and pulmonary diseases, including chronic obstructive pulmonary diseases, asthma, and lung cancer, and infectious pulmonary diseases, including community-acquired pneumonia, tuberculosis, nontuberculous mycobacterial pulmonary disease, and COVID-19. In addition, we focus on recent evidence of the utility of statins, specifically 3-hydroxy-3-methylglutaryl-coA reductase inhibitors, in the prevention and treatment of the various pulmonary diseases described above.

Clinical Manifestations, Macrolide Resistance, and Treatment Utilization Trends of Mycoplasma pneumoniae Pneumonia in Children and Adolescents in South Korea.

A resurgence of Mycoplasma pneumoniae (MP)-the leading cause of community-acquired bacterial pneumonia, particularly in children-occurred following the COVID-19 pandemic. We aimed to investigate the clinical manifestations, macrolide resistance patterns, and therapeutic approaches related to the MP pneumonia epidemic. Children and adolescents diagnosed with MP pneumonia in September-December 2023 were screened. Clinical data were retrospectively collected from 13 major hospitals using concordant microbiological criteria, including either a positive PCR result or four-fold increase in serological markers. Demographic characteristics, treatment modalities, and clinical outcomes were analyzed. Of the 474 screened patients, 374 (median age: 7.7 [IQR, 5.4-9.6] years; hospitalization rate: 88.6%) met the microbiological confirmation criteria. Most patients experienced fever (98.9%), and lobular/lobar consolidation (59.1%) was the dominant radiological finding. The macrolide resistance rate remained high at 87.0%; corticosteroids were widely used (55.6%) alongside macrolides, despite resistance. Patients with consolidation had prolonged fever (median 8 vs. 7 days, p = 0.020) and higher hospitalization rates (92.3% vs. 83.0%, p = 0.008). Macrolide resistance did not significantly influence radiological outcomes. This study highlights the ongoing challenge of macrolide resistance in MP pneumonia and need for tailored therapeutic approaches. Despite high resistance, macrolides remain commonly prescribed, often concurrently with corticosteroids.

Analysis of Pathogen Detection Data in 898 Pediatric Patients Hospitalized with Community-Acquired Pneumonia

Introduction: The prevalence of community-acquired pneumonia (CAP) in pediatric patients has seen significant changes following the lifting of COVID-19 restrictions. This study examines the epidemiology and pathogen detection in children hospitalized with CAP at Beijing New Century Children's Hospital throughout 2023. Objective: To analyze the pathogen detection rates and distribution characteristics among 898 pediatric CAP patients admitted during 2023, focusing on age-related and seasonal variations. Methods: This retrospective study included 898 pediatric patients diagnosed with CAP between January 1 and December 31, 2023. Respiratory pathogen detection was performed using a combination of antigen detection kits, nucleic acid testing, and bacterial culture. The data were analyzed for pathogen distribution across different age groups and seasons. Results: Of the 898 CAP cases, pathogens were detected in 703 cases (78.3%). Mycoplasma pneumoniae was the most frequently identified pathogen (44.1%), with detection rates increasing significantly with age, particularly in school-aged children. Viral pathogens were detected in 42.7% of cases, with Respiratory Syncytial Virus (32.4%) being the most prevalent. Bacterial pathogens were identified in 49.5% of cases, with Streptococcus pneumoniae (34.1%) and Haemophilus influenzae (33.0%) being the most common. Mixed infections were observed in 64.4% of cases, with a higher prevalence in older children and during the autumn and winter seasons. Conclusions: The study highlights significant age and seasonal variations in pathogen distribution among pediatric CAP patients. Mycoplasma pneumoniae was more common in older children and during autumn, while bacterial infections peaked in winter. The findings emphasize the need for age and season-specific strategies in managing pediatric CAP and suggest that comprehensive diagnostic approaches are crucial to accurately identify the causative pathogens.

The efficacy of nebulized budesonide and ambroxol hydrochloride in treating pediatric community-acquired pneumonia and their impact on clinical characteristics and inflammatory markers

PurposeTo evaluate the therapeutic efficacy of intravenous amoxicillin clavulanate potassium combined with nebulized budesonide and ambroxol hydrochloride in pediatric community-acquired pneumonia (CAP) and its impact across various microbial strains and clinical symptoms. The primary objective of this study is to evaluate the efficacy of intravenous amoxicillin-clavulanate combined with nebulized budesonide and ambroxol hydrochloride in the treatment of pediatric community-acquired pneumonia (CAP), and to analyze their impact on different microbial strains and clinical symptoms. Secondary objectives include assessing the treatment's effect on the improvement of clinical symptoms, hospital stay duration, and the levels of inflammatory markers.DesignProspective, single-center study.MethodsFifty-six children with CAP, aged under 6 years, from Affiliated Maternity and Child Health Care Hospital of Nantong University were included. Patients were treated with conventional therapy and the study medication. Clinical characteristics, microbiological data, symptom improvement, and hospitalization times were analyzed.FindingsYoung children, particularly under 1 year, exhibited a higher incidence of multiple microbial infections and severe clinical manifestations. Treatment with budesonide and ambroxol hydrochloride led to significant clinical improvement across all age groups, with notable efficacy against various pathogens.ConclusionsNebulized budesonide and ambroxol hydrochloride are effective in treating pediatric CAP, offering a promising therapeutic option, particularly for young children with severe presentations.

Factors associated with presbyphagia in patients with community-acquired pneumonia: A cross-sectional study

BackgroundPresbyphagia, an age-related decline in swallowing function, is considered a precursor stage of dysphagia and a risk state that can lead to aspiration pneumonia and malnutrition. We examined factors associated with presbyphagia in patients with community-acquired pneumonia (CAP). MethodsA cross-sectional study was conducted with 80 patients with CAP aged ≥65 years admitted to an acute care hospital between June 2021 and April 2024. Presbyphagia was assessed using the 10-item Eating Assessment Tool. The survey items included grip strength, body mass index, the Mini-Cog©, repetitive saliva swallowing test, tongue pressure, and evaluations for sarcopenia and frailty. Logistic regression analysis was performed to examine the factors associated with presbyphagia after adjusting for age and sex. ResultsOf 80 patients, 44 (55%) had presbyphagia. The presbyphagia group was older, had lower Barthel Index scores, and had a higher proportion of history of cerebrovascular accident, sarcopenia and frailty than the non-presbyphagia group. Logistic regression analysis revealed frailty (adjusted odds ratio: 3.106, 95% confidence interval: 1.161–8.313, p = 0.024) was significantly associated with presbyphagia. ConclusionsOur results revealed a significant association between presbyphagia and frailty in patients with CAP. The relationship between presbyphagia and frailty suggests that these conditions are not caused by a single functional decline or structural change but by a combination of factors. Therefore, it is crucial to comprehensively evaluate presbyphagia in patients with CAP to provide appropriate interventions.

Associations Between Severe Influenza-Complicated Thromboembolism Events, Intensive Care Unit Stays and Mortality, and Associated Risk Factors: A Retrospective Cohort Study.

A retrospective cohort study was conducted, recruiting consecutive patients with TE events admitted to the ICU between December 2015 through December 2018 at our institution in Taiwan. The study included a group of 108 patients with severe influenza and a control group of 192 patients with severe community-acquired pneumonia. Associations between complicated TE, length of ICU stay, and 90-day mortality were evaluated using logistic regression analysis, and risk factors were identified using univariate and multivariate generalized linear regression analyses. TE event prevalence was significantly higher in ICU patients with severe influenza than in ICU patients with severe CAP (21.3% vs. 5.7%, respectively; p < 0.05). Patients with severe influenza who developed TE experienced a significant increase in the ratio of mechanical ventilation use, length of mechanical ventilation use, ICU stay, and 90-day mortality when compared to patients without TE (all p < 0.05). The comparison of severe CAP patients with and without TE revealed no significant differences (p > 0.05). The development of thromboembolic events in patients with severe influenza or severe noninfluenza CAP is linked to influenza infection and hypertension (p < 0.05). Furthermore, complicated TE and the severity of the APACHE II score are risk factors for 90-day mortality in ICU patients with severe influenza (p < 0.05). Patients with severe influenza and complicated TE are more likely to have an extended ICU stay and 90-day mortality than patients with severe CAP. The risk is significantly higher for patients with a higher APACHE II score. The results of this study may aid in defining better strategies for early recognition and prevention of severe influenza-complicated TE.

Outcome of Community-Acquired Pneumonia in Children Admitted to PICU at Minia Children University Hospital.

Outcome of Community-Acquired Pneumonia in Children Admitted to PICU at Minia Children University Hospital.

The importance of Haemophilus influenzae in community-acquired pneumonia: an emerging pathogen in the elderly regardless of comorbidities compared to Streptococcus pneumoniae

BackgroundHaemophilus influenzae community-acquired pneumonia (CAP) is common, and it is equally common to Streptococcus pneumoniae in some settings. The purpose of this study was to provide additional data on patients affected by H. influenzae CAP and their outcomes.MethodsStreptococcus pneumoniae-caused CAP (111 cases) was compared to CAP with H. influenzae (53 cases). Patients were adults (≥ 18 years) from the prospective study “Etiology of community acquired pneumonia in Sweden” (ECAPS), which was established during the years 2016–2018.ResultsCases with H. influenzae CAP were significantly older compared to S. pneumoniae CAP (median 77 vs 70 years, p = 0.037) albeit similar comorbidities. Haemophilus influenzae was generally absent in the bloodstream compared to S. pneumoniae (18% vs 2%, p = 0.01) but clinical presentations were comparable. Only a minority of patients, 34% with H. influenzae and 41% with S. pneumoniae CAP had underlying lung disease.ConclusionIn the light of childhood immunization campaigns against S. pneumoniae and the increasing numbers of pneumococcal vaccinations among the elderly, coupled with an aging population, the incidence of CAP caused by H. influenzae may increase. Further research is needed to understand the impact of H. influenzae CAP and to a development of a vaccine against this emerging microbe.

Clinical manifestations of scarlet fever in children in the megalopolis at the present stage.

BACKGROUND: according to the literature, an increase in severe forms of scarlet fever among children was noted in a number of foreign countries in 2022-2023. AIMS: to identify the current clinical features of scarlet fever in children in a large metropolis of Russia. MATERIALS AND METHODS: an observational descriptive retrospective continuous study of the clinical features of the course of scarlet fever in children was conducted according to 295 case histories of patients diagnosed with Scarlet fever from 2020 to 2022 on the basis of the GBUZ "DGKB named after Z.A. Bashlyaeva DZM", GBUZ "DGKB No. 9 named after G.N. Speransky DZM" in Moscow. The statistical processing of the material uses traditional methods for calculating extensive and intensive indicators (p1 and p2), errors of extensive indicators (m1 and m2) and standard deviations (rmax↔rmip), taking into account the confidence interval (t) and confidence probability (P=95%), a method for comparing indicators using a well-known formula, where at t ≥ 2.0 P ≥ 95% p ≤ 0.05, the definition of standard deviations, taking into account the confidence interval (t) and the confidence probability P = 95%. The comparison of percentages in the analysis of four-field conjugacy tables was performed using the exact Fisher criterion. The differences were considered statistically significant at p 0.05. RESULTS: as a result of the study, it was revealed that the abolition of strict anti-epidemic restrictions on COVID-19 in 2022 led not only to an increase in the incidence of scarlet fever among children from 0 to 18 years of age by 3.6 times in 2022 compared with 2021, but, as a result, to an increase in hospitalization of children in hospitals in Moscow. Thus, the number of hospitalized children with scarlet fever in 2022 increased by 18.0 times compared to 2020. The majority of those hospitalized (83.4%) were children from organized groups, including those aged 3 to 7 years (52.9%) and from 7 to 14 years (39.3%), with an average severity of the disease (93.6%). It was noted that that among the examined children, 53 children (18%) had a history of COVID-19, and among this group of children, one in five children had severe scarlet fever, while among children who did not have a history of COVID-19, these were significantly (p 0.001) 8.4 times less (respectively, 20.7% versus 2.5%). It was revealed that every 8-9 patients (12.2%) had various complications, mainly of a septic nature and those that arose in the first week of the disease, including otitis media, sinusitis, community-acquired pneumonia, parathonsillar and lateral pharyngeal abscesses and toxic shock syndrome. In the second week and later, complications of an infectious and allergic nature were reported, including tubulointerstitial nephritis, acute renal injury, post-infectious cardiomyopathy, acute post-streptococcal glomerulonephritis, toxic allergic vasculitis, post-streptococcal arthritis. Beta-lactam antibiotics remain the etiotropic drugs of choice. Antibiotics of the cephalosporin 53.6% and penicillin 46.4% series were used to treat scarlet fever. CONCLUSIONS: in modern conditions of the megalopolis, scarlet fever occurs with a typical clinical picture. The majority of those hospitalized were children of preschool and school age, only 12.2% of children were diagnosed with various complications of scarlet fever and the vast majority of children (93.6%) had a moderate severity of scarlet fever. It was noted that against the background of an increase in the number of hospitalized patients, the number of patients with severe scarlet fever decreases, while the incidence of complications in patients does not change (12.3% - 12.8%). It was shown that among patients who had suffered from COVID-19, scarlet fever was 8.3 times more likely to occur in severe form compared with children who had no history of COVID-19 disease (respectively, 20.7% vs. 2.5, p 0.0001).

Optimizing Gastroesophageal Reflux Disease treatment: A call to shift from omeprazole.

Gastroesophageal reflux disease (GERD) is a disorder of the upper respiratory tract, which develops due to the regurgitation of acid from the stomach into the oesophagus. If left untreated, GERD may cause serious complications such as Barrett's oesophagus, oesophageal strictures, and oesophageal adenocarcinoma. According to a study published by Nirwan JS et al in 2020, individuals suffering from Gastroesophageal reflux disease globally is 1.03 billion.[1] Proton pump inhibitors (PPIs) are frequently used drugs for the treatment of GERD. Omeprazole belongs to PPIs class of drugs and it has been a drug of choice for GERD because it is affordable, easily available, and it can be taken along with other medicines. However, Proton pump inhibitors are not completely risk-free, chronic use of Proton Pump inhibitors has been associated with decreased calcium and magnesium absorption increasing the risk of osteoporosis and electrolyte disturbances respectively. It also increases the risk of community-acquired pneumonia [2] However, Esomeprazole the s-isomer of omeprazole yields much better results than omeprazole. It is more effective and safe in the treatment of GERD, not only does it decrease the symptoms of the disease rapidly ie. heartburn [4] but also it reduces the relapse of the symptoms twice that of omeprazole. Maintenance of intragastric pH &gt; 4 is an effective measure for the management of gastroesophageal reflux disease, esomeprazole has demonstrated improved acid inhibition over omeprazole with a high mean percentage of 24-hour intragastric pH &gt; 4. The healing rate for reflux esophagitis and relapse was also higher for esomeprazole than that of omeprazole.[3] According to a study, the number of individuals with GERD in the South Asia region is around 8000 per 100000 [4]. Knowing the extent of Gastroesophageal patients present in Pakistan and how rapidly this number can escalate due to poor lifestyle modifications. Omeprazole which is the most frequent drug prescribed for the treatment of GERD [5] should be discouraged and Esomeprazole being more beneficial in terms of healing time and relapse of symptoms should be promoted to prevent chronic use adverse effects of Proton pump inhibitors. Overall, such a measure will improve the quality of life of a person suffering from gastroesophageal reflux disease which otherwise may lead to more severe implications.

Reassessing Halm's clinical stability criteria in community-acquired pneumonia management.

Halm's clinical stability criteria have long guided antibiotic treatment and hospital discharge decisions for patients hospitalised with community-acquired pneumonia (CAP). Originally introduced in 1998, these criteria were established based on a relatively small and select patient population. Consequently, our study aims to reassess their applicability in management of CAP in a contemporary real-world setting. This cohort study included 2918 immunocompetent patients hospitalised with CAP from three hospitals in Denmark between 2017-2020. The primary outcome was time to achieve clinical stability as defined by Halm's criteria. Additionally, we examined recurrence of clinical instability and severe complications. Cumulative incidence function or Kaplan-Meier survival curves were used to analyse these outcomes, considering competing risks. The study population primarily comprised elderly individuals (median age: 75 years) with significant comorbidities. The median time to clinical stability according to Halm's criteria was 4 days, with one-fifth experiencing recurrence of instability after early clinical response (stability within 3 days). Severe complications within 30 days mainly comprised mortality, with rates of 5.1% (64/1257) overall in those with early clinical response, 1.7% (18/1045) in the subgroup without do-not-resuscitate orders, and 17.3% (276/1595) among the rest. Halm's clinical stability criteria effectively classify CAP patients with different disease courses, yet achieving stability required more time in this aging population with substantial comorbidities and more severe disease. Early clinical response indicates reduced risk of complications, especially in those without do-not-resuscitate orders.

High Rates of Nonsusceptibility to Common Oral Antibiotics in Streptococcus pneumoniae Clinical Isolates From the United States (2019-2021).

Streptococcus pneumoniae isolates from the United States (n = 1038; 2019-2021) were susceptible to omadacycline (99.8%), levofloxacin (99.7%), and ceftriaxone (98.1%), whereas doxycycline (80.2%), oral penicillin (63.5%), cefpodoxime (76.8%), and azithromycin (54.4%) activity was limited. Tet(M) did not affect omadacycline activity but altered activity of older tetracyclines including doxycycline, suggesting omadacycline is an important option for treatment of community-acquired bacterial pneumonia.

Stress hyperglycemia ratio and its influence on mortality in elderly patients with severe community-acquired pneumonia: a retrospective study

BackgroundCommunity-acquired pneumonia (CAP) is a significant health issue among the elderly, with severe cases (SCAP) having high mortality rates. This study assesses the predictive significance of the stress hyperglycemia ratio (SHR) in elderly SCAP patients and its impact on outcomes in both diabetic and non-diabetic patients.Methods and materialsThis retrospective study included 406 SCAP patients aged 65 or older from the Second People’s Hospital of Lianyungang (January 2020 to December 2023). Data collected included demographics, medical history, vital signs, and lab results. SHR was calculated from initial blood glucose and estimated average glucose (HbA1c). Statistical analyses, including Cox regression and Kaplan-Meier analysis, evaluated SHR’s impact on mortality. Mediation models explored the effects of neutrophil-lymphocyte ratio (NLR) and SHR.ResultsThe 28-day mortality rate was 21.67%. Deceased patients had higher age, Charlson Comorbidity Index, procalcitonin, NLR, glucose, and SHR levels compared to survivors (P < 0.05). Both SHR and NLR significantly increased mortality risk, particularly in non-diabetic patients. Combining NLR and SHR improved ROC AUC to 0.898, with 89.80% sensitivity and 81.10% specificity. Kaplan-Meier analysis showed higher cumulative survival for SHR < 1.14, regardless of diabetes status (P < 0.05). NLR mediated 13.02% of the SHR-survival relationship, while SHR mediated 14.06% of the NLR-survival relationship.ConclusionElevated SHR is a significant mortality risk factor in elderly SCAP patients, independent of diabetes status. Stringent glucose control and careful monitoring of SHR may improve outcomes in elderly patients with acute respiratory conditions.

Lipidomic and metabolomic changes in community-acquired and COVID-19 pneumonia

This prospective observational study compared the 1H NMR blood lipidomes and metabolomes of 71 patients with community-acquired pneumonia (CAP), 75 patients with COVID-19 pneumonia, and 75 healthy controls (matched by age and sex) to identify potential biomarkers and pathways associated with respiratory infections. Both pneumonia groups had comparable severity indices, including mortality, invasive mechanical ventilation, and intensive care unit admission rates. Patients with COVID-19 pneumonia exhibited more pronounced hypolipidemia, with significantly lower levels of total cholesterol and LDL-c compared to patients with CAP. Atherogenic lipoprotein subclasses (VLDL-cholesterol, IDL-cholesterol, IDL-triglyceride, and LDL-triglyceride/LDL-cholesterol) were significantly increased in severe cases of both pneumonia types, while lower HDL-c and small, dense HDL particles were associated with more severe illness. Both infected groups showed decreased esterified cholesterol and increased triglycerides, along with reduced phosphatidylcholine, lysophosphatidylcholine, PUFA, omega-3 fatty acids, and DHA. Additionally, infected patients had elevated levels of glucose, lactate, 3-hydroxybutyrate, and acetone, which are linked to inflammation, hypoxemia, and sepsis. Increased levels of branched-chain amino acids, alanine, glycine, and creatine, which are involved in energy metabolism and protein catabolism, were also observed. Neurotransmitter synthesis metabolites like histidine and glutamate were higher in infected patients, especially those with COVID-19. Notably, severe infections showed a significant decrease in glutamine, essential for lymphocyte and macrophage energy. The severity of COVID-19 pneumonia was also associated with elevated glycoprotein levels (glycoprotein A, glycoprotein B, and glycoprotein F), indicating an inflammatory state. These findings suggest that metabolomic and lipidomic changes in pneumonia are connected to bioenergetic pathways regulating the immune response.