Cases Of Aspiration Pneumonia Research Articles

Incidence and characteristics of aspiration pneumonia in the Nagasaki Prefecture from 2005 to 2019

BackgroundAspiration pneumoniae remains a major health concern, particularly in the older population and has poor prognosis; however, the concept itself remains vague worldwide. This study aimed to determine the actual situation and characteristics of aspiration pneumonia from 2005 to 2019 in Nagasaki Prefecture, Japan.MethodsCases of aspiration pneumonia that occurred in the Nagasaki Prefecture between 2005 and 2019 were analyzed using emergency transportation records. The number of occurrences and incidence were analyzed according to age, sex, month, day of the week, and recognition time to clarify the actual situation of aspiration pneumonia.ResultsThe total number of new aspiration pneumonia cases was 8,321, and the mean age of the patients was 83.0 years. Annual incidence per 100,000 population increased from 12.4 in 2005 to 65.1 in 2019, with the most prominent increase in the ≥ 80-year-old stratum. Males (55.1%) were more commonly affected than females (44.9%), and 82.2% of the cases involved patients aged ≥ 70 years. No significant correlations were observed between the incidence of aspiration pneumonia and season, month, or day of the week. Aspiration pneumonia occurred frequently in houses (39.8%) and facilities for elderly individuals (40.8%). At 7 days after admission, 80.9% of patients were still hospitalized and 6.5% had died.ConclusionsThe incidence of aspiration pneumonia with risks of severity and mortality is increasing among elderly individuals. Valid preventive measures are urgently needed based on the findings that the disease occurs in both household and elderly care facility settings, regardless of the season.

A woman with schizophrenia who died due to Takotsubo cardiomyopathy occurring after electroconvulsive therapy

BackgroundElectroconvulsive therapy (ECT) is a safe treatment for treatment-resistant schizophrenia. However, it has some side effects, and Takotsubo cardiomyopathy is considered one of the minor complications. Several cases of patients developing Takotsubo cardiomyopathy during a course of ECT have been reported, but none have died. We present a case of post-ECT Takotsubo cardiomyopathy that became fatal.Case presentationWe experienced a case of a 67-year-old woman who had delusions and catatonic symptoms due to schizophrenia but was resistant to several medications. Her symptoms improved by conducting ECT, but she had difficulty maintaining her improvement, which caused her to receive multiple courses of ECT. 3 weeks after her 6th course of ECT, the patient was diagnosed with Takotsubo cardiomyopathy and had a fatal outcome.ConclusionOur patient had numerous cases of aspiration pneumonia and malnutrition before ECT was performed, which might have made this case fatal. In conclusion, appropriate supplementation of nutrition and reduction of physical stressors are important to avoid death from Takotsubo cardiomyopathy caused by ECT. Prescribing clozapine was a solution in the present case, but there are some difficulties, such as the restriction against prescribing this drug in Japan.

High throughput sequencing technology reveals alteration of lower respiratory tract microbiome in severe aspiration pneumonia and its association with inflammation

BackgroundAspiration pneumonia is a common and severe clinical condition. The microbiome present in the lower respiratory tract plays a crucial role in regulating human inflammatory response. However, the relationship between the altered lower respiratory tract microbiome and inflammation in aspiration pneumonia remains inadequately explored. PurposeTo investigate the alteration of the lower respiratory tract microbiome in severe aspiration pneumonia patients and explore the potential correlation between microbiome components and inflammatory response. MethodPatients in the severe aspiration pneumonia group and control group were enrolled from the intensive care unit of Jinshan Hospital, Fudan University between December 31, 2020 and August 19, 2021. Sputum specimens were collected from all participants and subsequently subjected to 16S rDNA high throughput sequencing technology. The concentration of inflammatory cytokines in serum was measured using enzyme-linked immunosorbent assay (ELISA) kits, and collected data including patients' demographic information, clinical data, and laboratory examination results were recorded for further analysis. ResultsAlteration in the lower respiratory tract microbiome was observed in severe aspiration pneumonia. Compared to the control group, a significant decrease in the relative abundance of Firmicutes was found at the phylum level (P < 0.01). At the family level, the relative abundance of Corynebacteriaceae, Enterobacteriaceae and Enterococcaceae increased significantly (P < 0.001, P < 0.05, P < 0.01). There were no significant differences in community diversity of the lower respiratory tract between the two groups. Patients in the severe aspiration pneumonia group exhibited significantly higher levels of inflammation compared to those in the control group. Correlation analysis showed that the relative abundance of Corynebacteriaceae was positively correlated with the expression level of IL-1β and IL-18 (P = 0.002, P = 0.02); the relative abundance of Enterobacteriaceae was negatively correlated with IL-4 (P = 0.011); no other significant correlations have been identified between microbiome and inflammatory indicators thus far (P > 0.05). ConclusionsAlteration of the lower respiratory tract microbiome is critically involved in inflammation and disease progression in severe cases of aspiration pneumonia. The potential inflammation regulation properties of the microbiome hold promising value for developing novel therapeutic approaches aimed at mitigating the severity of the disease.

Application of overlap anastomosis in digestive tract reconstruction during minimally invasive Ivor-Lewis esophagectomy.

This study aims to assess the feasibility of the Overlap anastomosis technique in minimally invasive Ivor-Lewis esophagectomy. An accompanying video presentation elucidates our surgical procedures. A retrospective review of 46 patients diagnosed with middle and lower esophageal cancer was conducted. These patients underwent minimally invasive Ivor-Lewis esophagectomy with Overlap anastomosis between January 2019 and December 2020. A consistent team of surgeons performed all procedures. The initial phase involved laparoscopic stomach mobilization, intra-abdominal lymphadenectomies, and preparation of the tubular stomach. Subsequently, with the patient in the left decubitus position, thoracoscopy was used to dissect the esophagus, excise the diseased segment, and conduct mediastinal lymph node dissection. The final stage encompassed the intrathoracic gastroesophageal anastomosis using the Overlap method. All surgeries were completed without converting to an open approach, achieving complete resection. There were no operative fatalities, with an average surgery duration of 259.4min. Average statistics included intraoperative blood loss of 92.3ml, 16.2 lymph nodes dissected, and a postoperative hospital stay of 10.3days. Postoperative complications comprised three instances of hoarseness due to recurrent laryngeal nerve palsy, two cases of aspiration pneumonia, one occurrence of chylothorax, and one gastric emptying disorder. Anastomotic technique-related complications were minimal, with only one patient experiencing an anastomotic leak that resolved spontaneously and two patients facing anastomotic stenosis, which was subsequently alleviated. Our findings posit that the Overlap anastomosis method is safe and efficient for minimally invasive Ivor-Lewis esophagectomy, marked by a notably low rate of anastomosis-related complications. Further evaluation of its long-term implications remains necessary.

Assessment of Clinical, Respiratory and Metabolic Parameters in Neonatal Calves in Different Courses of Aspiration Pneumonia

&#x0D; &#x0D; &#x0D; &#x0D; Iatrogenic aspiration pneumonia (AP), often caused by incorrect drenching and ‎feeding with inappropriate bottles, is a frequent condition that can lead to sudden death ‎depending on the amount of aspirated fluid. The evaluation of clinical scores‎ and blood ‎gas analytes may provide valuable insights into the complications that may arise due to AP in later ‎stages. In this study, the AP Group consisted of ‎23 Holstein breed calves aged 1-14 days, ‎which developed clinical signs such as cough, nasal and/or ocular discharge, and respiratory ‎distress after forced feeding with inappropriate bottles. The Control Group consisted of 11 healthy calves with similar characteristics. Clinical examinations, Calf ‎Health Score (CHS) evaluations, and venous blood gas analysis were performed. Based on anamnesis, calves with AP were classified as either Acute or Chronic AP. In clinical ‎examination, heart and respiratory rates were higher in the Acute AP Group compared to the ‎other groups (P&lt;0.001). Total CHS was higher in the AP Group than that in the Control ‎Group (P&lt;0.001). The pH, sO2, Cl and Hb levels of the AP Group were lower, and K and ‎lactate levels were higher compared to the Control Group (P&lt;0.031). Among all groups, ‎the pCO2 levels were highest in the Acute AP Group (P&lt;0.001). The Na level of the Chronic ‎AP Group was lower than that of the Control Group (P&lt;0.05). The hematocrit level was ‎lowest in the Chronic AP Group (P&lt;0.016). These findings suggest that venous blood samples can be effectively used to classify the course of AP ‎in neonatal calves; significant alterations in venous blood gas, electrolyte levels, and CHS can ‎be observed in affected animals; sO2 and pCO2 levels are particularly important in ‎distinguishing between acute and chronic cases of AP; and clinical and laboratory findings may ‎be similar to those observed in healthy animals in chronic cases depending on the body’s ability ‎to compensate or tolerate the disease.&#x0D; &#x0D; &#x0D; &#x0D;

Laparoscopic-assisted robotic distal gastrectomy for gastric cancer by Billroth II reconstruction.

There are several reconstructions in distal gastrectomy for gastric cancer, and there is no clear definition regarding the method selection. The optimal reconstruction is likely to vary according to the surgical setting, and the optimal reconstruction for robotic distal gastrectomy is urgently needed. In addition, as robotic gastrectomy is getting popular, cost and operative time are pressing issues of robotic gastrectomy. Gastrojejunostomy was planned with Billroth II reconstruction using a linear stapler arranged specifically for a robotic approach. After firing the stapler, the common insertion orifice of the stapler was closed using a 30 cm long non-absorbable barbed suture, and continuously, the afferent loop of the jejunum was lifted to the stomach with the same barbed suture. In addition, we introduced laparoscopic-assisted robotic gastrectomy, using extracorporeally inserted laparoscopic devices from the assistant port. Scissors, clips, and linear staplers were all laparoscopic tools inserted extracorporeally. Twenty-one gastric cancer patients underwent laparoscopic-assisted robotic distal gastrectomy by Billroth II reconstruction with our modifications. There were no anastomosis-related complications such as leakage, stenosis, or bleeding. There were 2 cases of aspiration pneumonia (Clavien-Dindo grade 2), 1 case of pancreatic juice leakage (grade 3a), and 1 case of delayed gastric emptying (grade 1). We successfully arranged Billroth II reconstruction for robotic distal gastrectomy with fewer operative and postoperative complications. Laparoscopic-assisted robotic gastrectomy using extracorporeally inserted devices, and continuous suturing using a barbed suture will reduce the time and cost of robotic gastrectomy.

Development and validation of prediction models for the discharge destination of elderly patients with aspiration pneumonia.

Discharge planning enhances the safe and timely transfer of inpatients between facilities. Predicting the discharge destination of inpatients with aspiration pneumonia is important for discharge planning. We aimed to develop and validate prediction models for the discharge destination of elderly patients with aspiration pneumonia. Using a nationwide inpatient database, we identified aspiration pneumonia cases for patients aged ≥65 years who had been admitted to hospital from their home or from a nursing home between April 2020 and March 2021. We divided the cases into derivation and validation cohorts according to the location of the admitting hospital. We developed two prediction models by dividing the cases based on the patient's place of residence prior to admission, one model to predict the home discharge of cases admitted from home and the other to predict the home or to a nursing home discharge of cases admitted from a nursing home. The models were internally validated with bootstrapping and internal-externally validated using a validation cohort. Nomograms that could be used easily in clinical practice were also created. The derivation cohort included 19,746 cases admitted from home and 14,359 cases admitted from a nursing home. Of the former, 10,760 (54.5%) cases were discharged home; from the latter, 7,071 (49.2%) were discharged to either home or a nursing home. The validation cohort included 6,262 cases admitted from home and 6,352 cases admitted from a nursing home. In the internal-external validation, the C-statistics of the final model for the cases admitted from home and the cases admitted from a nursing home were 0.71 and 0.67, respectively. We developed and validated new prediction models for the discharge of elderly patients with aspiration pneumonia either to home or to a nursing home. Our models and nomograms could facilitate the early implementation of discharge planning.

The Role of the Respiratory Microbiome in the Pathogenesis of Aspiration Pneumonia: Implications for Diagnosis and Potential Therapeutic Choices.

Although the lungs were considered to be sterile until recently, the advent of molecular biology techniques, such as polymerase chain reaction, 16 S rRNA sequencing and metagenomics has led to our expanding knowledge of the lung microbiome. These methods may be particularly useful for the identification of the causative agent(s) in cases of aspiration pneumonia, in which there is usually prior administration of antibiotics. The most common empirical treatment of aspiration pneumonia is the administration of broad-spectrum antibiotics; however, this may result in negative cultures from specimens taken from the respiratory tract. Therefore, in such cases, polymerase chain reaction or metagenomic next-generation sequencing may be life-saving. Moreover, these modern molecular methods may assist with antimicrobial stewardship. Based upon factors such as age, altered mental consciousness and recent hospitalization, there is a shift towards the predominance of aerobes, especially Gram-negative bacteria, over anaerobes in aspiration pneumonia. Thus, the therapeutic choices should be expanded to cover multi-drug resistant Gram-negative bacteria in selected cases of aspiration pneumonia.

Effects of Fasting versus Non-Fasting on Emetic Complications in Radiological Examinations Using Intravascular Non-Ionic Iodinated Contrast Media: A Systematic Review and Meta-Analysis.

To compare the incidence of aspiration pneumonia, nausea, and vomiting after intravascular administration of non-ionic iodinated contrast media (ICM) between patients who fasted before contrast injection and those who did not. Ovid-MEDLINE and Embase databases were searched from their inception dates until September 2022 to identify original articles that met the following criteria: 1) randomized controlled trials or observational studies, 2) separate reports of the incidence of aspiration pneumonia, nausea, and vomiting after intravascular injection of non-ionic ICM, and 3) inclusion of patients undergoing radiological examinations without fasting. A bivariate beta-binomial model was used to compare the risk difference in adverse events between fasting and non-fasting groups. The I² statistic was used to assess heterogeneity across the studies. Ten studies, encompassing 308013 patients (non-fasting, 158442), were included in this meta-analysis. No cases of aspiration pneumonia were reported. The pooled incidence of nausea was 4.6% (95% confidence interval [CI]: 1.4%, 7.8%) in the fasting group and 4.6% (95% CI: 1.1%, 8.1%) in the non-fasting group. The pooled incidence of vomiting was 2.1% (95% CI: 0.0%, 4.2%) in the fasting group and 2.5% (95% CI: 0.7%, 4.2%) in the non-fasting group. The risk difference (incidence in the non-fasting group-incidence in the fasting group) in the incidence of nausea and vomiting was 0.0% (95% CI: -4.7%, 4.7%) and 0.4% (95% CI: -2.3%, 3.1%), respectively. Heterogeneity between the studies was low (I² = 0%-13.5%). Lack of fasting before intravascular administration of non-ionic ICM for radiological examinations did not increase the risk of emetic complications significantly. This finding suggests that hospitals can relax fasting policies without compromising patient safety.

Screening of dysphagia and bedside rehabilitation nursing in patients with cerebral hemorrhage

Objective: To explore the early screening and rehabilitation nursing measures of dysphagia in patients with cerebral hemorrhage. Methods: A total of 443 patients with cerebral hemorrhage who were hospitalized in our hospital from October 2019 to October 2021 were selected as the research objects, and 381 patients with cerebral hemorrhage who were hospitalized in our hospital from September 2017 to September 2019 were selected as the control group. The swallowing function of the patients was evaluated by water swallow test and indirect assessment, and the patients were treated with routine rehabilitation nursing and pharyngeal cold stimulation. The incidence of aspiration pneumonia and clinical effects were compared between the two groups. Results: The incidence of aspiration pneumonia in the two groups: there were 15 cases of aspiration pneumonia in the treatment group (incidence rate 15/443, 3.55%), and 32 cases in the control group (incidence rate 32/381, 9.1%), there were statistical differences between the two groups(P&lt;0.01).The curative effect observation between the treatment group and the control group: after 1 week rehabilitation treatment, the observation group showed marked effect in 34 cases, improved in 215 cases, and ineffective in 194 cases, the effective rate was 56.2%; in the control group, 25 cases were markedly effective, improved in 119 cases, ineffective in 237 cases, and the effective rate was 37.8%., the difference between the two groups was statistically significant (p&lt;0.01).Conclusion Patients with cerebral hemorrhage have a higher incidence of dysphagia, and earlier rehabilitation assessment and nursing intervention can significantly reduce the incidence of complications and improve clinical efficacy. Conclusion: Patients with cerebral hemorrhage have a higher incidence of dysphagia, and earlier rehabilitation assessment and nursing intervention can significantly reduce the incidence of complications and improve clinical efficacy.

Fístula oronasal congénita secundaria en un neonato felino de Maine Coon: Terapia clínica y soporte nutricional asistido

Congenital malformations are related to hereditary factors or promoted by environmental agents, to mention: toxic, infectious, nutritional, chemical and physical. In felines, the casuistry of neonates with malformation is between 1% and 2%. Among the most observed pathologies, we highlight the cleft palate (more frequent), hydrocephalus and agenesis of the digestive tract. In secondary cleft palate the closure of the palate is incomplete, the patient has milk flow through the nostrils, coughing, choking and / or sneezing in the food and respiratory tract infections, the diagnosis being confirmed by inspection of the oral cavity. The article deals with clinical management and assisted nutrition, without surgical correction. A newborn, male, Maine Coon cat was admitted to a clinic complaining of a parent's rejection. On physical examination, the presence of a secondary congenital cleft palate was observed. The tutor and veterinary doctor opted for clinical management, considering the scarcity of literature regarding surgical treatment in neonates with this pathology. The patient was fed by an orogastric tube until his complete adaptation to the large format dry food at five months of age. During this process of adaptation to his congenital condition, the feline developed two cases of aspiration pneumonia by Klebsiella pneumoniae and the ingestion of a foreign body (part of the orogastric tube), assessed by radiography and removed by endoscopy in the descending portion of the duodenum. In the follow-up of the patient until the age of one year and nine months, the feline did not present recurrences regarding aspiration pneumonia. The animal was healthy until the date of submission of this work. This report aims to discuss the clinical management of the patient in this condition and the diets offered for vital maintenance, as well as their growth.

Detection of associated bacteria in aspiration pneumonia and lung abscesses using partial 16S rRNA gene amplicon sequencing

ObjectivesLower respiratory tract infections (LRTIs) are often caused by the patient’s own oral commensal bacteria. Causative bacteria must be identified to select the appropriate antimicrobial agents; however, the pathogens are identified via routine culture methods in only approximately half of LRTI cases. MethodsTo investigate LRTI-associated bacteria, we conducted culture testing under aerobic and anaerobic conditions using culture-independent partial 16S rRNA gene amplicon sequencing analysis using a high-throughput sequencer in cases of aspiration pneumonia and lung abscesses. ResultsCulture testing of 17 aspiration pneumonia cases revealed Streptococcus spp. (n = 13), Prevotella spp. (n = 9), and Veillonella spp. (n = 8); 16S rRNA analysis of these cases yielded Streptococcus spp. (n = 16), Veillonella spp. (n = 12), Haemophilus spp. (n = 12), Prevotella spp. (n = 11), and Rothia spp. (n = 11). Culture testing of 8 lung abscess cases revealed Streptococcus spp. (n = 7) and Fusobacterium spp. (n = 4); 16S rRNA analysis of these cases yielded Fusobacterium spp. (n = 8), Prevotella spp. (n = 7), Streptococcus spp. (n = 6), and Porphyromonas spp. (n = 5). All taxa with abundance ratios of ≥50% on the 16S rRNA analysis were also detected in the cultures. However, several taxa were either undetected in the cultures despite relatively high abundance ratios on the 16S rRNA analysis or negative on the 16S rRNA analysis and isolated only by culturing. ConclusionOur data provide a comprehensive list of bacterial taxa that may be associated with aspiration pneumonia and lung abscesses. In empirically treating LRTIs, this information will help determine the best treatment against the targeted anaerobes.

Chemotherapy and radiation therapy in locally advanced oropharyngeal cancer

Background. About 650,000 new cases of head and neck cancer are diagnosed worldwide each year. About 66 % of these patients already have a common stage of the disease. Mortality up to one year is 38.8-44.4 %. The male/female ratio is 3.4:1. Smoking, alcohol consumption, human papillomavirus (HPV) infection, and herpes viruses are the main risk factors for the developing oropharyngeal cancer (OPC).&#x0D; Objective. To identify the features and to describe the treatment of OPC.&#x0D; Materials and methods. Analysis of literature data on this issue.&#x0D; Results and discussion. HPV-associated OPC is characterized by the favorable survival rates. 60-80 % of patients with such OPC are non-smokers and do not abuse alcohol, the average age is 45-55 years. The main principles of diagnosis and treatment of locally advanced forms of OPC include the use of modern imaging methods, staging depending on HPV status, definitive chemoradiation therapy, dose escalation (66-72 Gray), the use of integrated boosts on the tumor and affected lymph nodes, radiation therapy (RT) without a break, the use of the adaptive RT method. It has been shown that RT split courses reduce local tumor control by 13 %, while increasing the risk of late radiation complications by 18-40 %. RT with modulated dose intensity is accompanied by the reduction in the risk of all-cause mortality by 21 %, as well as the risk of cancer-specific mortality, and by the reduction of the number of aspiration pneumonia cases. Adaptive RT is a modern RT technology that involves adjusting the radiation plan during the course of treatment due to the changes in the anatomy of the tumor and surrounding tissues. The main stages of adaptive RT are obtaining the current data from the megavolt computed tomography, recalculation of the dose distribution, comparison with the plan before treatment, and adaptation of the plan. The results of chemotherapy should be evaluated no earlier than 12 weeks after its completion. Rehabilitation after chemoradiation therapy (prevention of trismus) involves massage and training of the jaw muscles, maintaining proper posture, oral hygiene.&#x0D; Conclusions. 1. HPV status is an important parameter in predicting the course of OPC. 2. HPV-associated OPC is characterized by the favorable survival rates. 3. The planned RT must be held without an interruption. 4. RT with modulated dose intensity is accompanied by the reduction in all-cause mortality by 21 %, as well as the risk of cancer-specific mortality. 5. The main area of research in HPV-associated OPC is the de-escalation of treatment regimens.

A Descriptive and Quantitative Immunohistochemical Study Demonstrating a Spectrum of Platelet Recruitment Patterns Across Pulmonary Infections Including COVID-19.

ObjectivesPulmonary platelet deposition and microangiopathy are increasingly recognized components of coronavirus disease 2019 (COVID-19) infection. Thrombosis is a known component of sepsis and disseminated intravascular coagulation. We sought to compare the level of platelet deposition in the pulmonary vasculature in cases of confirmed COVID-19 infection to other lung injuries and infections.MethodsImmunohistochemistry was performed on 27 autopsy cases and 2 surgical pathology cases targeting CD61. Multiple cases of normal lung, diffuse alveolar damage, COVID-19, influenza, and bacterial and fungal infections, as well as one case of pulmonary emboli, were included. The levels of CD61 staining were compared quantitatively in the autopsy cases, and patterns of staining were described.ResultsNearly all specimens exhibited an increase in CD61 staining relative to control lung tissue. The area of CD61 staining in COVID-19 infection was higher than influenza but still comparable to many other infectious diseases. Cases of aspiration pneumonia, Staphylococcus aureus infection, and blastomycosis exhibited the highest levels of CD61 staining.ConclusionsPlatelet deposition is a phenomenon common to many pulmonary insults. A spectrum of staining patterns was observed, suggestive of pathogen-specific mechanisms of platelet deposition. Further study into the mechanisms driving platelet deposition in pulmonary injuries and infections is warranted.

Careful history taking detects initially unknown underlying causes of aspiration pneumonia.

The majority of pneumonia in the elderly is attributed to aspiration. Identifying the cause of aspiration is essential for efficient treatment and prevention. However, the methodology on how to investigate the causes is not established. Therefore, we studied cases that were initially admitted for pneumonia and were newly diagnosed with an underlying cause of aspiration. This is the first study to analyze such cases collectively. This was a retrospective study. Patients aged 65 years or older admitted for pneumonia from October 2012 to November 2018 and were newly diagnosed with a cause of aspiration after admission was included. Patients were excluded if they had hospital-acquired pneumonia, interstitial lung disease, or obstructive pneumonia or were immunocompromised. In total, 4043 patients were admitted for pneumonia and 125 cases who were newly diagnosed with causes of aspiration after admission were included in the study. This constituted 30.7% of suspected aspiration pneumonia cases in which there was no known cause of aspiration on admission. The most common conditions newly identified were neurologic disorders, upper gastrointestinal disorders, drug-induced conditions, and head and neck disease. Some were lethal. The diagnosis enabled treatment of the underlying condition and prevention of aspiration in most cases. The most common sign that lead to the diagnosis was symptoms seen from admission, followed by chronic symptoms. In 30.7% of those with suspected aspiration pneumonia with an unknown cause, a cause of aspiration was newly diagnosed. Careful history taking concerning neurological, gastrointestinal and drug-induced disorders is essential in elderly patients with pneumonia. Geriatr Gerontol Int 2020; 20: 785-790.

Spatiotemporal clustering of in-hospital Clostridioides difficile infection.

To determine whether Clostridioides difficile infection (CDI) exhibits spatiotemporal interaction and clustering. Retrospective observational study. The University of Iowa Hospitals and Clinics. This study included 1,963 CDI cases, January 2005 through December 2011. We extracted location and time information for each case and ran the Knox, Mantel, and mean and maximum component size tests for time thresholds (T = 7, 14, and 21 days) and distance thresholds (D = 2, 3, 4, and 5 units; 1 unit = 5-6 m). All tests were implemented using Monte Carlo simulations, and random CDI cases were constructed by randomly permuting times of CDI cases 20,000 times. As a counterfactual, we repeated all tests on 790 aspiration pneumonia cases because aspiration pneumonia is a complication without environmental factors. Results from the Knox test and mean component size test rejected the null hypothesis of no spatiotemporal interaction (P < .0001), for all values of T and D. Results from the Mantel test also rejected the hypothesis of no spatiotemporal interaction (P < .0003). The same tests showed no such effects for aspiration pneumonia. Our results from the maximum component size tests showed similar trends, but they were not consistently significant, possibly because CDI outbreaks attributable to the environment were relatively small. Our results clearly show spatiotemporal interaction and clustering among CDI cases and none whatsoever for aspiration pneumonia cases. These results strongly suggest that environmental factors play a role in the onset of some CDI cases. However, our results are not inconsistent with the possibility that many genetically unrelated CDI cases occurred during the study period.

Effects of Semi-Solid Enteral Formula on Aspiration Pneumonia and Diarrhea

Objective: The effects of semi-solid enteral formula were investigated in tube feeding patients with aspiration pneumonia and/or diarrhea caused by liquid enteral formula. Methods: In 25 cases of aspiration pneumonia and 10 cases of diarrhea (5 cases had both aspiration pneumonia and diarrhea) caused by liquid enteral formula, the rate of improvement by changing the liquid enteral formula to semi-solid enteral formula was studied. The semi-solid enteral formula (PG Soft® EJ) was infused via the nasogastric tube (16Fr) or percutaneous endoscopic gastrostomy (PEG) tube (20Fr). Results: The semi-solid enteral formula was effective in 72% of aspiration pneumonia cases and in 80% of diarrhea cases. Constipation was observed in one case but was controlled with magnesium oxide. Conclusion: In cases of aspiration pneumonia and/or diarrhea, changing liquid enteral formula to semi-solid enteral formula frequently shows improvement.

Proportion of Aspiration Pneumonia Cases Among Patients With Community-Acquired Pneumonia: A Single-Center Study in Korea.

ObjectiveTo investigate the proportion of aspiration pneumonia cases among patients with community-acquired pneumonia in Korea.MethodsThis retrospective study included patients with community-acquired pneumonia who had been admitted to the emergency department of a university-affiliated tertiary hospital in Gyeonggi Province, Korea between January 1, 2016 and December 31, 2016. Among these patients, those with aspiration pneumonia were identified using ICD-10 codes (J69.*). Patients with recurrent pneumonia were excluded, as were those who were immunocompromised. The proportion of cases of aspiration pneumonia was calculated, and the characteristics and clinical outcomes of patients with aspiration pneumonia and non-aspiration pneumonia were compared.ResultsThe proportion of aspiration pneumonia cases among patients with community-acquired pneumonia was 14.2%. Patients with aspiration pneumonia were significantly more likely to be older (p<0.001) and male (p<0.001), and to have a higher confusion, uremia, respiratory rate, blood pressure, and age ≥65 years (CURB-65) score (p<0.001) as compared to patients with non-aspiration pneumonia. They were also more likely to require admission to the intensive care unit (p<0.001) and a longer hospital stay (p<0.001).ConclusionAspiration pneumonia accounts for 14.2% of all cases of community-acquired pneumonia in Korea. These data may contribute to the establishment of healthcare strategies for managing aspiration pneumonia among Korean adults.

Dysphagia and risk of aspiration pneumonia: A nonrandomized, pair-matched cohort study

Background/purposeDysphagia was associated with increased prevalence of aspiration pneumonia (AP) in studies that were criticized for either their small sample size or lack of prospective design. Using a considerably larger nationwide, population-based database and a long-term prospective cohort design, our study aimed to explore the relationship between dysphagia and the subsequent development of AP. Materials and methodsFrom 2000 to 2009, we gathered a study cohort consisting of 6979 newly diagnosed cases of dysphagia from Taiwan's National Health Insurance Research Database. For the control group, another 20,937 individuals without dysphagia were matched for age, sex, and comorbidity. The two cohorts were followed-up to observe the occurrence of AP and correlated mortality. ResultsDuring an average of 3.88 ± 2.73 years of follow-up, we observed 315 cases of new AP [non-dysphagia (193, 0.92%) vs. dysphagia (122, 1.75%), p < 0.0001], and the incidence of AP was significant in the dysphagia group. After adjusting for age, sex, and comorbidity, dysphagia-related AP [hazard ratio (HR) 2.499; 95% confidence interval (CI), 2.089–2.99; p < 0.0001], dysphagia related mortality [HR 3.229; 95% CI, 3.052–3.417; p < 0.0001], and many other systemic diseases were independently associated with a diagnosis of AP. ConclusionDysphagia was highly associated with an increased risk of AP according to data derived from a large nationwide cohort database. Nonetheless, larger prospective studies or meta-analyses are recommended to confirm our findings.

Retrospective Observational Study of Organophosphate Poisoning in an Urban Malaysian Hospital

Objectives: The objective of this study is to determine treatment interventions that provided the best outcome for patients. Initial treatment interventions performed in the emergency department such as decontamination, antidote administration and intubation will be analysed. Subsequent management in the intensive care unit with complications related to invasive ventilation will be analysed. The risks of aspiration pneumonia for patients who underwent gastric lavage with or without administration of activated charcoal will also be analysed.Methods: A retrospective observational study was conducted. Study population included all patients presenting to the emergency department of Hospital Tengku Ampuan Rahimah with history of having consumed an organophosphate from the 1st April 2013 to 31st March 2016. The inclusion criteria was all patients with history of ingesting an insecticide containing a suspected organophosphate. The exclusion criteria was patients confirmed not to have ingested an organophosphate from clinical inference and confirmation of actual poison.Results: A total of 84 patients were sampled with 75 patients fulfilling criteria for study inclusion. A total of 22 cases developed complications during their hospital stay with 13 cases of nosocomial infection, 8 cases of aspiration pneumonia, 2 cases with in hospital cardiac arrest and 1 case of atropine toxicity.Malathion and chlorpyrifos were the only two identified organophosphates with the remaining 38 having consumed an unidentified organophosphate. Using chi-square test, there appears to be a significant difference between chlorpyrifos and malathion in terms of need for intubation with a p value of 0.017.Conclusion: Resuscitation of airway, breathing and circulation with close observation for early signs of proximal muscle weakness or paralysis countered with judicious atropine administration is sufficient to ensure good outcome for cases of malathion and chlorpyrifos poisoning which present early to the emergency department.The risk of aspiration pneumonia is high in patients with organophosphate poisoning outweighing the benefits of performing a gastric lavage. Aspiration of stomach contents with a ryle's tube after endotracheal intubation is an acceptable method of gastrointestinal decontamination for patients who have consumed a large quantity of organophosphate.Pralidoxime may be beneficial in reducing the period of respiratory paralysis or weakness for chlorpyrifos poisoning but shows no clear benefit for malathion poisoning. The prolonged muscle paralysis seen in malathion poisoning weighs heavily on intensive care resources. Banning the sale of malathion may help reduce morbidity from prolonged ventilation as well as reduce the burden on intensive care resources.