Outcome Of Community-acquired Pneumonia Research Articles

HIV INFECTION AND COMMUNITYACQUIRED PNEUMONIA. CAUSES OF DEATH

The aim was to study the characteristics of community-acquired pneumonia in patients with HIV infection, depending on the outcome of the disease and to identify significant predictors of death. Materials and methods. The study included 80 patients with community-acquired pneumonia and HIV-infection. Two groups were formed in accordance with the outcome of community-acquired pneumonia. 1 group (study group) — 40 deceased patients, 2 group (comparison group) — 40 patients discharged from the hospital with improvement. Inclusion criteria: patients over 18 years of age, diagnosis of community-acquired pneumonia, diagnosis of HIV infection, informed consent of the patient. Patients with diagnosed pulmonary tuberculosis were excluded at the stage of examination and treatment. Results. Patients with HIV infection entered the hospital with community-acquired pneumonia of severe degree in 65% of cases, 71,25% of cases with respiratory insufficiency of II and III degrees, in 16,25% of cases with critically low oxygen saturation (less than 85%). The majority of patients had bilateral pneumonia (78,75%), in 28,75% of cases complicated by pleural effusion. Patients needed respiratory support at different levels-the chambers of the pulmonology ward in 3625% of cases, indications for noninvasive ventilation (NIV) in the intensive care unit (ICU) were noted in 80% of cases, ventilation in the ICU in 56,25% of cases. Deceased patients were significantly more likely to be injecting drug users, reported weight loss of more than 10% in six months, CD4+ cells did not exceed 50/μl, bilateral lung damage, pleural effusion, oxygen saturation less than 90%. The conclusion. Treatment and diagnosis of comorbid patients with community-acquired pneumonia and HIV infection is complex, in the stage of pronounced immunosuppression can lead to death. Early onset of NIV in the presence of severe respiratory failure may improve the survival prognosis.

Inflammatory biomarkers are associated with aetiology and predict outcomes in community-acquired pneumonia: results of a 5-year follow-up cohort study.

BackgroundBiomarkers may facilitate clinical decisions in order to guide antimicrobial treatment and prediction of prognosis in community-acquired pneumonia (CAP). We measured serum C-reactive protein, procalcitonin (PCT) and calprotectin levels, and plasma pentraxin 3 (PTX3) and presepsin levels, along with whole-blood white cell counts, at three time-points, and examined their association with microbial aetiology and adverse clinical outcomes in CAP.MethodsBlood samples were obtained at hospital admission, clinical stabilisation and 6-week follow-up from 267 hospitalised adults with CAP. Adverse short-term outcome was defined as intensive care unit admission and 30-day mortality. Long-term outcome was evaluated as 5-year all-cause mortality.ResultsPeak levels of all biomarkers were seen at hospital admission. Increased admission levels of C-reactive protein, PCT and calprotectin were associated with bacterial aetiology of CAP, while increased admission levels of PCT, PTX3 and presepsin were associated with adverse short-term outcome. In univariate and multivariate regression models, white blood cells and calprotectin at 6-week follow-up were predictors of 5-year all-cause mortality.ConclusionsCalprotectin emerges as both a potential early marker of bacterial aetiology and a predictor for 5-year all-cause mortality in CAP, whereas PCT, PTX3 and presepsin may predict short-term outcome.

Cosyntropin testing does not predict response to glucocorticoids in community-acquired pneumonia in a randomized controlled trial.

Glucocorticoids have been shown to improve outcome in community-acquired pneumonia (CAP). However, glucocorticoids have potential side-effects, and treatment response may vary. It is thus crucial to select patients with high likelihood to respond favourably. In critical illness, cosyntropin testing is recommended to identify patients in need for glucocorticoids. We investigated whether cosyntropin testing predicts treatment response to glucocorticoids in CAP. Predefined secondary analysis of a randomized controlled trial. Hospitalized patients with CAP. We performed 1µg cosyntropin tests in a randomized trial comparing prednisone 50mg for 7days to placebo. We investigated whether subgroups based on baseline and stimulated cortisol levels responded differently to glucocorticoids with regard to time to clinical stability (TTCS) and other outcomes by inclusion of interaction terms into statistical models. A total of 326 patients in the prednisone and 309 patients in the placebo group were evaluated. Neither basal cortisol nor a Δcortisol <250nmol/L after stimulation nor the combination of basal cortisol and Δcortisol predicted treatment response as measured by TTCS (all P for interaction >0.05). Similarly, we found no effect modification with respect to mortality, rehospitalization, antibiotic treatment duration or CAP-related complications (all P for interaction >0.05). However, glucocorticoids had a stronger effect on shortening length of hospital stay in patients with a baseline cortisol of ≥938nmol/L (P for interaction=0.015). Neither baseline nor stimulated cortisol after low-dose cosyntropin testing at a dose of 1µg predicted glucocorticoid responsiveness in mild to moderate CAP. A treatment decision for or against adjunct glucocorticoids in CAP should not be made depending on cortisol values or cosyntropin testing results.

Fibroblast growth factor 21 predicts outcome in community-acquired pneumonia: secondary analysis of two randomised controlled trials.

Acute systemic inflammatory conditions are accompanied by profound alterations of metabolism. However, the role of fibroblast growth factor 21 (FGF21), a recently identified central regulator of metabolism, is largely unknown in community-acquired pneumonia (CAP). This study aims to characterise the pattern of FGF21 in pneumonia and associations with disease severity and outcome.This is a secondary analysis of two independent multicentre randomised controlled trials in patients presenting to the emergency department with CAP. Primary and secondary efficacy parameters included 30-day mortality, length of hospital stay, time to clinical stability and duration of antibiotic treatment.A total of 509 patients were included in the analysis. FGF21 levels at admission strongly correlated with disease severity, as measured by the Pneumonia Severity Index. Increased levels of FGF21 were associated with prolonged time to clinical stability, antibiotic treatment and hospitalisation. FGF21 levels at admission were significantly higher in nonsurvivors than in survivors, yielding a 1.61-fold increased adjusted odds ratio of 30-day mortality (95% CI 1.21-2.14; p=0.001). Moreover, FGF21 was found to identify patients for 30-day mortality with superior discriminative power compared with routine diagnostic markers.Moderate-to-severe CAP patients with higher levels of FGF21 were at increased risk for clinical instability, prolonged hospitalisation and 30-day all-cause mortality.

Effect of adjunctive single high-dose vitamin D3 on outcome of community-acquired pneumonia in hospitalised adults: The VIDCAPS randomised controlled trial

Low vitamin D status is associated with increased risk of pneumonia, greater disease severity and poorer outcome. However, no trials have examined the effect of adjunctive vitamin D therapy on outcomes in adults with community-acquired pneumonia (CAP). We conducted a randomised, double-blind, placebo-controlled trial examining the effects of adjunctive vitamin D in adults hospitalised with CAP. Participants were randomised to either a single oral dose of 200,000 IU vitamin D3 or placebo. The primary outcome was the complete resolution of chest radiograph infiltrate at 6 weeks post-study treatment. Secondary outcomes included length of hospital stay, intensive care admission and return to normal activity. Only participants who completed the study or died within the 6 week period were included in the analysis (n = 60 vitamin D, n = 57 placebo). Adjunctive vitamin D did not have any effect on the primary outcome (OR 0.78, 95% CI 0.31 to 1.86, p = 0.548). However, there was evidence it increased the complete resolution of pneumonia in participants with baseline vitamin D levels <25 nmol/L (OR 17.0, 95% CI 1.40–549.45, P = 0.043), but this did not reach statistical significance using exact methods (OR 13.0, 95%CI 0.7–960.4, P = 0.083). There were no significant effects for any secondary outcome.

Angiotensin-converting enzyme polymorphism and pediatric pneumonia

ObjectivePneumonia is one of the leading causes of death for the Pediatric age group under five years worldwide. The role of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism in the risk and outcome of community-acquired pneumonia (CAP) has been studied in different ethnic populations and yielded inconsistent results. Therefore, the present study aimed to investigate whether this polymorphism is associated with the risk and outcome of CAP in the Egyptian pediatric population. MethodsThe prospective observational case-control study was performed on 77 children aged 2 months to 12yrs hospitalized with CAP and 73 matched healthy controls. Candidates were subjected to clinical and radiological evaluation in addition to complete blood count, c-reactive protein and genotyping for the ACE I/D polymorphism using PCR technique. Follow up of the outcome in the form of need for oxygen, ICU admission, need for mechanical ventilation, duration of hospital stay and death was done for all patients. ResultsNo statistically significant differences was observed between pneumonia patients and controls regarding the different genotypes of the ACE polymorphism II, ID and DD genotypes (p = 0.773). No association was detected between the different genotypes of the ACE polymorphism II, ID and DD genotypes and the need for oxygen, ICU admission, need for mechanical ventilation, duration of hospital stay and death (P = 0.143, 0.527, 0.716, 0.288, 0.544). ConclusionThe ACE I/D polymorphism is not associated with the risk nor the outcome of pneumonia in our pediatric population.

Genetic variants of interferon regulatory factor 5 associated with the risk of community-acquired pneumonia

Interferon regulatory factor 5 (IRF5) is a key transcription factor involved in the control of the expression of pro-inflammatory cytokines and immune responses to infection, and multiple polymorphisms of the IFR5 gene have been shown to be associated with autoimmune and infectious diseases. Several studies have investigated single nucleotide polymorphisms (SNPs) in a number of genes associated with the susceptibility to or severity and outcome of community-acquired pneumonia (CAP), but no research has yet been conducted on the role of IRF5 gene polymorphisms in CAP. In this study, we investigated the effects of four IFR5 variants, rs77571059, rs2004640, rs10954213, and rs3807306 on the susceptibility to CAP by genotyping 228 CAP patients and 177 healthy donors. Our results indicated that IFR5 variants rs77571059 and rs2004640 and haplotype GTAA were associated with the susceptibility to CAP and rs77571059 was related to the severity of the disease, suggesting that IFR5 variants may contribute to the pathogenesis of CAP and may serve as prognostic markers of CAP susceptibility and outcome.

Antibiotic treatment outcomes in community-acquired pneumonia

The optimal empiric antibiotic regimen for patients with community-acquired pneumonia (CAP) remains unclear. This study aimed to evaluate the clinical cure rate, mortality, and length of stay among patients hospitalized with community- acquired pneumonia in nonintensive care unit (ICU) wards and treated with a β-lactam, β-lactam and macrolide combination, or a fluoroquinolone. This prospective cohort study was performed using standardized web-based database sheets from January 2009 to September 2013 in nine tertiary care hospitals in Turkey. Six hundred and twenty-one consecutive patients were enrolled. A pathogen was identified in 78 (12.6%) patients. The most frequently isolated bacteria were S. pneumoniae (21.8%) and P. aeruginosa (19.2%). The clinical cure rate and length of stay were not different among patients treated with β-lactam, β-lactam and macrolide combination, and fluoroquinolone. Forty-seven patients (9.2%) died during the hospitalization period. There was no difference in survival among the three treatment groups. In patients admitted to non-ICU hospital wards for CAP, there was no difference in clinical outcomes between β-lactam, β-lactam and macrolide combination, and fluoroquinolone regimens.

Fibroblast growth factor-21 predicts adverse outcome in community-acquired pneumonia

Fibroblast growth factor-21 predicts adverse outcome in community-acquired pneumonia

Chronic comorbidity of internal organs as a risk factor of complications and fatal outcome of community-acquired pneumonia.

With the purpose to estimate influence of comorbidity at the risk of complications and death due to community-acquired pneumonia (CAP) the retrospective analysis of 1587 case histories of inpatients with CAP (mean age – 48.5±18.4, males – 815 (51.4%), women – 772 (48,6%)) was performed. Comorbidity was observed in 1114 (70.2%). More frequently complications of CAP were developed in patients with chronic diseases than without them (p=0.013). Increased risk of pleural effusion was associated with chronic diseases of digestive system (OR=1.85 (95%CI 1.30-2.26)) and diabetes mellitus (OR=2.35 (95%CI 1.40-3.96)). Risk of sepsis development is higher in patients with nervous system diseases (OR=3.62 (95%CI 1.37-9.56) and drug or alcohol addiction (OR=19.08 (95%CI 7.30-49.82). Risk of pulmonary edema rose in patients with drug or alcohol addiction (OR=24.16; 95%CI 8.07-72.34), malignancy (OR=8.97; 95%CI 1.94-41.49), diabetes mellitus (OR=4.04; 95%CI 1.48-11.01), diseases of nervous (OR=4.04; 95%CI 1.17-13.94), urinary (OR=3.39; 95%CI 1.33-8.64) and cardiovascular (OR=2.29, 95%CI 0.98-5.34) systems. Higher risk of death in patients with CAP was associated with the presence of cardiovascular diseases (OR=2.17; 95%CI 1.11-4.25), diabetes mellitus (OR=2.95; 95%CI 1.20-7.21), drug or alcohol addiction (OR=38.40; 95%CI 15.05-97.98).

Markers of neutrophil extracellular traps predict adverse outcome in community-acquired pneumonia: secondary analysis of a randomised controlled trial.

Neutrophil extracellular traps (NETs) are a hallmark of the immune response in inflammatory diseases. However, the role of NETs in community-acquired pneumonia (CAP) is unknown. This study aims to characterise the impact of NETs on clinical outcomes in pneumonia.This is a secondary analysis of a randomised controlled, multicentre trial. Patients with CAP were randomly assigned to either 50 mg prednisone or placebo for 7 days. The primary end-point was time to clinical stability; main secondary end-points were length of hospital stay and mortality.In total, 310 patients were included in the analysis. Levels of cell-free nucleosomes as surrogate markers of NETosis were significantly increased at admission and declined over 7 days. NETs were significantly associated with reduced hazards of clinical stability and hospital discharge in multivariate adjusted analyses. Moreover, NETs were associated with a 3.8-fold increased adjusted odds ratio of 30-day mortality. Prednisone treatment modified circulatory NET levels and was associated with beneficial outcome.CAP is accompanied by pronounced NET formation. Patients with elevated serum NET markers were at higher risk for clinical instability, prolonged length of hospital stay and 30-day all-cause mortality. NETs represent a novel marker for outcome and a possible target for adjunct treatments of pneumonia.

The IMPROVE-GAP Trial aiming to improve evidence-based management of community-acquired pneumonia: study protocol for a stepped-wedge randomised controlled trial

BackgroundCommunity-acquired pneumonia is a leading worldwide cause of hospital admissions and healthcare resource consumption. The largest proportion of hospitalisations now occurs in older patients, with high rates of multimorbidity and complex care needs. In Australia, this population is usually managed by hospital inpatient general internal medicine units. Adherence to consensus best-practice guidelines is poor. Ensuring evidence-based care and reducing length of stay may improve patient outcomes and reduce organisational costs. This study aims to evaluate an alternative model of care designed to improve adherence to four Level 1 or 2 evidence-supported interventions (routine corticosteroids, early switch to oral antibiotics, early mobilisation and routine malnutrition screening).Methods/DesignThe IMPROVing Evidence-based treatment Gaps and outcomes in community-Acquired Pneumonia (IMPROVE-GAP) trial is a pragmatic, investigator-initiated, stepped-wedge randomised trial. Patients hospitalised under a general internal medicine unit who meet a standard case definition for community-acquired pneumonia will be included. Eight general internal medicine units at two Australian hospitals in a single health service will be randomised using concealed allocation to: (i) usual medical, nursing and allied health care delivered according to existing organisational practice or (ii) care supported by a dedicated “community-acquired pneumonia service”: a multidisciplinary team deploying algorithm-based implementation of a bundle of the four evidence-based interventions. The primary outcome measure will be length of hospital stay. Secondary outcome measures include inpatient mortality, 30 and 90 day readmission rates and mortality and health-service utilisation costs. Protocol adherence will be measured and reported, and serious adverse events (rates of hyperglycaemia requiring new insulin; falls during mobilisation) will be collected and reported.DiscussionIMPROVE-GAP represents an important and unique precedent for testing a new service-delivery model for improving compliance with a number of evidence-based interventions. Its stepped-wedge randomised controlled trial design provides a means to address some significant ethical, organisational and other methodological challenges to evaluating the effectiveness of health-service interventions in complex hospital populations. The new service-delivery model will effectively be fully implemented by trial completion, facilitating rapid, seamless translation into practice should care outcomes be superior. This trial is currently recruiting.Trial registrationClinicalTrials.gov, NCT02835040. Prospectively registered on 22 May 2016.

Incidence, Etiology, and Outcomes of Community-Acquired Pneumonia: A Population-Based Study.

BackgroundThe microbial etiology of community-acquired pneumonia (CAP) is often unclear in clinical practice, and previous studies have produced variable results. Population-based studies examining etiology and incidence are lacking. This study examined the incidence and etiology of CAP requiring hospitalization in a population-based cohort as well as risk factors and outcomes for specific etiologies.MethodsConsecutive admissions due to CAP in Reykjavik, Iceland were studied. Etiologic testing was performed with cultures, urine-antigen detection, and polymerase chain reaction analysis of airway samples. Outcomes were length of stay, intensive care unit admission, assisted ventilation, and mortality.ResultsThe inclusion rate was 95%. The incidence of CAP requiring hospitalization was 20.6 cases per 10000 adults/year. A potential pathogen was detected in 52% (164 of 310) of admissions and in 74% (43 of 58) with complete sample sets. Streptococcuspneumoniae was the most common pathogen (61 of 310, 20%; incidence: 4.1/10000). Viruses were identified in 15% (47 of 310; incidence: 3.1/10000), Mycoplasmapneumoniae were identified in 12% (36 of 310; incidence: 2.4/10000), and multiple pathogens were identified in 10% (30 of 310; incidence: 2.0/10000). Recent antimicrobial therapy was associated with increased detection of M pneumoniae (P < .001), whereas a lack of recent antimicrobial therapy was associated with increased detection of S pneumoniae (P = .02). Symptoms and outcomes were similar irrespective of microbial etiology.ConclusionsPneumococci, M pneumoniae, and viruses are the most common pathogens associated with CAP requiring hospital admission, and they all have a similar incidence that increases with age. Symptoms do not correlate with specific agents, and outcomes are similar irrespective of pathogens identified.

Low Levels of Immunoglobulins and Mannose-Binding Lectin Are Not Associated With Etiology, Severity, or Outcome in Community-Acquired Pneumonia.

BackgroundDisease severity and outcome in community-acquired pneumonia (CAP) depend on the host and on the challenge of the causal microorganism(s). We measured levels of immunoglobulins (Igs) and complement in 257 hospitalized adults with CAP and examined the association of low levels of Igs or complement to microbial etiology, disease severity, and short-term and long-term outcome.MethodsSerum Igs were analyzed in blood samples obtained at admission and at 6 weeks postdischarge if admission levels were low. Serum complement deficiencies were screened with a total complement activity enzyme-linked immunosorbent assay (ELISA), with further analyzes performed if justified. Disease severity was assessed by the CURB-65 severity score. Short-term outcome was defined as a composite end point of intensive care unit (ICU) admission and 30-day mortality, and long-term outcome as 5-year all-cause mortality.ResultsAt admission, 87 (34%) patients had low levels of at least 1 Ig, with low IgG2 as the most prevalent finding (55/21%). IgG levels were lower in bacterial than viral CAP (8.48 vs 9.97 g/L, P = .023), but low Igs were not associated with microbial etiology. Fifty-five (21%) patients had low lectin pathway activity, of which 33 (13%) were mannose-binding lectin (MBL) deficient. Low admission levels of any Ig or MBL were not associated with disease severity, short-term outcome, or long-term outcome. Excluding patients defined as immunocompromised from analysis did not substantially affect these results.ConclusionIn hospitalized adults with CAP, low admission levels of Igs or complement were in general not associated with microbial etiology, disease severity, short-term outcome, or long-term outcome.

Cytokine responses, microbial aetiology and short-term outcome in community-acquired pneumonia.

BackgroundThe inflammatory response to community‐acquired pneumonia (CAP) is orchestrated through activation of cytokine networks and the complement system. We examined the association of multiple cytokines and the terminal complement complex (TCC) with microbial aetiology, disease severity and short‐term outcome.Materials and methodsPlasma levels of 27 cytokines and TCC were analysed in blood samples obtained at hospital admission, clinical stabilization and 6‐week follow‐up from 247 hospitalized adults with CAP. Fourteen mediators were included in final analyses. Adverse short‐term outcome was defined as intensive care unit (ICU) admission and 30‐day mortality.ResultsCytokine and TCC levels were dynamic in the clinical course of CAP, with highest levels seen at admission for most mediators. Admission levels of cytokines and TCC did not differ between groups of microbial aetiology. High admission levels of IL‐6 (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.18‐1.84, P = .001), IL‐8 (OR 1.79, 95% CI 1.26‐2.55, P = .001) and MIP‐1β (OR 2.28, 95% CI 1.36‐3.81, P = .002) were associated with a CURB‐65 severity score of ≥3, while IL‐6 (OR 1.37, 95% CI 1.07‐1.74, P = .011) and MIP‐1β (OR 1.86, 95% CI 1.03‐3.36, P = .040) were associated with a high risk of an adverse short‐term outcome.ConclusionsIn this CAP cohort, admission levels of IL‐6, IL‐8 and MIP‐1β were associated with disease severity and/or adverse short‐term outcome. Still, for most mediators, only nonsignificant variations in inflammatory responses were observed for groups of microbial aetiology, disease severity and short‐term outcome.

Time to antibiotics administration and outcome in community-acquired pneumonia: Secondary analysis of a randomized controlled trial

BackgroundThe association between early antibiotic administration and outcomes remains controversial in patients hospitalized for community-acquired pneumonia. MethodsWe performed a secondary analysis of a randomized controlled trial comparing two antibiotic treatment strategies for patients hospitalized for moderately severe CAP. The univariate and multivariate associations between time to antibiotic administration (TTA) and time to clinical stability were assessed using a Cox proportional hazard model. Secondary outcomes were death, intensive care unit admission and hospital readmission up to 90days. Results371 patients (mean age 76years, CURB-65 score≥2 in 52%) were included. Mean TTA was 4.35h (SD 3.48), with 58.5% of patients receiving the first antibiotic dose within 4h.In multivariate analysis, number of symptoms and signs (HR 0.876, 95% CI 0.784–0.979, p=0.020), age (HR 0.986, 95% CI 0.975–0.996, p=0.007), initial heart rate (HR 0.992, 95% CI 0.986–0.999, p=0.023), and platelets count (HR 0.998, 95% CI 0.996–0.999, p=0.004) were associated with a reduced probability of reaching clinical stability. The association between TTA and time to clinical stability was not significant (HR 1.009, 95% CI 0.977–1.042, p=0.574). We found no association between TTA and the risk of intensive care unit admission, death or readmission up to 90days after the initial admission. ConclusionIn patients hospitalized for moderately severe CAP, a shorter time to antibiotic administration was not associated with a favorable outcome. These findings support the current recommendations that do not assign a specific time frame for antibiotics administration.

Impact of COPD on outcomes in hospitalized patients with community-acquired pneumonia: Analysis of the Spanish national hospital discharge database (2004–2013)

AimTo examine trends in incidence and outcomes of community-acquired pneumonia (CAP) hospitalizations among patients with or without COPD in Spain (2004–2013). MethodsWe used national hospital discharge data to select all hospital admissions for CAP. Incidence was calculated overall and according to the presence or absence of COPD. ResultsWe identified 901,136 hospital admissions for CAP (32.25% with COPD). Incidence of hospitalizations of CAP increased significantly over time among patients with and without COPD, but it was higher among people with COPD for all years analyzed. S. pneumoniae decreased over time for both groups. Time trend analyses showed significant decreases in mortality during admission for CAP for patients with and without COPD. Factor independently associated with higher mortality in both groups included: male sex, older age, higher comorbidity, isolation of S. aureus or P. aeruginosa, use of mechanical ventilation, and readmission. The presence of COPD was associated with a lower in-hospital mortality (IHM) (OR: 0.58, 95%CI 0.57–0.59). ConclusionsThe incidence of hospitalizations for CAP increased over time in patients with and without COPD, being higher in the COPD population for all years analyzed. IHM decreased over time in both groups. There were no differences in mortality between COPD and non-COPD patients.

Decrease in the incidence and in hospital mortality of community-acquired pneumonia among children in Spain (2001–2014)

ObjectivesTo describe trends in the incidence and outcomes of community-acquired pneumonia (CAP) hospitalizations among Spanish children from 2001 to 2014 and to assess the effect of the pneumococcal vaccination (PCV) coverage in this period. MethodsThis study was conducted using the Spanish National Hospital Database from 2001 to 2014 including subjects <18years. We selected discharges with a primary diagnosis of CAP.Study variable included age, sex, comorbid conditions, procedures, isolated pathogens and hospital outcome variables.In order to estimate the effect of coverage of pneumococcal vaccination in hospitalizations for CAP, we used the number of commercialized doses of PCV (PCV7 PCV10, and PCV13) for each year.Incidence rates of admissions for CAP were calculated by dividing the number of admissions per year, sex, and age group by the corresponding number of people in that population group according to the census data. ResultsWe identified 194,419 admissions for CAP. Incidence rate was highest among children younger than 2years and decreased significantly by 3.67% per year over the study period in this age group. Among children aged 2–4years incidence of CAP seem to decrease after year 2009. S. pneumoniae isolations decreased significantly over time but virus isolations increased. In children aged <2years and 2–4years increase in PVC was associated to a decrease in the incidence of CAP hospitalizations.Overall crude in hospital mortality following CAP fell significantly from 4.1‰ in 2001–2003 to 2.8‰ in 2012–2014. ConclusionsCAP incidence rates decreased significantly among children <2years of age from 2001 to 2014. S. pneumoniae isolations decreased significantly over time but virus isolations increased. In hospital mortality paralleling CAP fell significantly in children and adolescents from 2001 to 2014. Improvement in vaccination coverage seems to have a mitigating effect on hospitalizations and outcomes for CAP in children.

Time-dependent association of glucocorticoids with adverse outcome in community-acquired pneumonia: a 6-year prospective cohort study

BackgroundThe hypothalamic-pituitary-adrenal stress axis plays a crucial role in community-acquired pneumonia (CAP), with high cortisol being associated with disease severity and corticosteroid treatment resulting in earlier time to recovery. Our aim in the present study was to compare different glucocorticoid hormones, including cortisol, 11-deoxycortisol, cortisone, and corticosterone, regarding their association with short- and long-term adverse outcomes in a well-defined CAP cohort.MethodsWe prospectively followed 285 patients with CAP from a previous Swiss multicenter trial for a median of 6.1 years and measured different admission glucocorticoid serum levels by liquid chromatography coupled with tandem mass spectrometry. We used adjusted Cox regression models to investigate associations between admission hormone levels and all-cause mortality at different time points.ResultsMortality was 5.3% after 30 days and increased to 47.3% after 6 years. High admission cortisol was associated with adverse outcome after 30 days (adjusted OR 3.85, 95% CI 1.10–13.49, p = 0.035). In the long term (i.e.,), however, high admission cortisol was associated with better survival (adjusted HR after 3 years 0.53, 95% CI 0.32–0.89, p = 0.017; adjusted HR after 6 years 0.57, 95% CI 0.36–0.90, p = 0.015). Compared with 11-deoxycortisol, cortisone, and corticosterone, cortisol showed the highest association with mortality.ConclusionsAmong different glucocorticoid hormones, cortisol showed the highest association with mortality in CAP. Whereas a more pronounced glucocorticoid stress response on hospital admission was associated with higher short-term adverse outcome, long-term outcome was favorable in these patients. These data should support the correct interpretation of glucocorticoid blood data.

The role of transthoracic ultrasonography in predicting the outcome of community-acquired pneumonia in hospitalized children.

Transthoracic ultrasound (TUS) has recently become a valuable tool in the diagnosis of community-acquired pneumonia (CAP). This study assessed the association between TUS findings and clinical outcome in children with CAP. The medical records of pediatric patients hospitalized with CAP who underwent transthoracic ultrasonography within 48 hours of admission were retrospectively reviewed. Associations between the TUS findings and patient outcome were analyzed, including intensive care unit (ICU) admission, length of hospital stay, and tube thoracotomy. The study enrolled 142 patients (median age, 60 months): 28 (19.7%) required ICU admission, 14 (9.89%) underwent tube thoracotomy, and 26 (18.3%) had a hospital stay > 9 days. Multifocal involvement seen by TUS were independently associated with ICU admission, a prolonged hospital stay, and tube thoracotomy (p = 0.0027, p = 0.02, and p = 0.0262, respectively). A pleural effusion and fluid bronchogram were independent predictors of a longer hospital stay (p = 0.003 and p = 0.006, respectively). In addition, a fluid bronchogram was an independent predictor of tube thoracotomy (p = 0.0262).ConclusionTUS findings of fluid bronchogram, multifocal involvement, and pleural effusion were associated with adverse outcomes, including longer hospital stay, ICU admission, and tube thoracotomy in hospitalized CAP children. Therefore, TUS is a novel tool for prognostic stratifications of CAP in hospitalized children.