Community-Acquired Pneumonia Requiring Hospitalization Research Articles

Community-Acquired Pneumonia Requiring Hospitalization among French Guianese Children.

Community-acquired pneumonia remains a leading cause of hospitalizations among children worldwide. The diagnosis is based on the history, the physical examination results in children with fever plus respiratory signs and symptoms, and chest radiography. The microbiological etiology is confirmed by viral testing and hemocultures. The most likely etiology depends on the age of the child. The features of childhood pneumonia vary between countries and territories. The purpose of this study was to describe the epidemiological characteristics and current microbial ecology of community-acquired pneumonia in children in French Guiana. We performed a retrospective, descriptive, and monocentric study between January 1, 2015, and December 31, 2017, in the pediatric ward of the Cayenne Hospital in French Guiana. The studied population was aged from 0 to 15 years and 3 months and hospitalized for acute community-acquired pneumonia. A total of 415 patients (mean age 3.62 years) were included. A pathogen was identifiable in 22.4% of cases, including bacteria in 61.3%, viruses in 43%, and coinfections in 14%. The main pathogens were respiratory syncytial virus (31.2%), Streptococcus pneumoniae (20.4%), Haemophilus influenzae (11.8%), and Mycoplasma pneumoniae (10.8%). The burden of hospitalization for children with community-acquired pneumonia was highest among less than 2 years, in whom respiratory viruses were the most commonly detected causes of pneumonia. The share of vaccine-preventable diseases (S. pneumoniae, H. influenzae, and influenza) remains high. With the vaccination requirement imposed since 1 January 2018 against pneumococcus, Haemophilus influenzae, and whooping cough and the possibility of practicing multiplex PCR in our hospital, it will be interesting to study the impact of this law enforcement on new child generations and compare these new data to our study.

Incidence, Etiology, and Environmental Risk Factors of Community-Acquired Pneumonia Requiring Hospitalization in China: A 3-Year, Prospective, Age-Stratified, Multicenter Case-Control Study.

BackgroundCommunity-acquired pneumonia (CAP) is a leading infectious cause of hospitalization and death worldwide. Knowledge about the incidence and etiology of CAP in China is fragmented.MethodsA multicenter study performed at 4 hospitals in 4 regions in China and clinical samples from CAP patients were collected and used for pathogen identification from July 2016 to June 2019.ResultsA total of 1674 patients were enrolled and the average annual incidence of hospitalized CAP was 18.7 (95% confidence interval, 18.5–19.0) cases per 10000 people. The most common viral and bacterial agents found in patients were respiratory syncytial virus (19.2%) and Streptococcus pneumoniae (9.3%). The coinfections percentage was 13.8%. Pathogen distribution displayed variations within age groups as well as seasonal and regional differences. The severe acute respiratory syndrome coronavirus 2 was not detected. Respiratory virus detection was significantly positively correlated with air pollutants (including particulate matter ≤2.5 µm, particulate matter ≤10 µm, nitrogen dioxide, and sulfur dioxide) and significantly negatively correlated with ambient temperature and ozone content; bacteria detection was opposite.ConclusionsThe hospitalized CAP incidence in China was higher than previously known. CAP etiology showed that differences in age, seasons, regions, and respiratory viruses were detected at a higher rate than bacterial infection overall. Air pollutants and temperature have an influence on the detection of pathogens.

The Mortality Rate and Related Factors in Patients with Community-Acquired Pneumonia Requiring Hospitalization

The Mortality Rate and Related Factors in Patients with Community-Acquired Pneumonia Requiring Hospitalization

736. Incidence and Etiology of Community-Acquired Pneumonia Requiring Hospitalization Among American Indian/Alaskan Native Adults

BackgroundA leading infectious cause of hospitalization among adults in the United States is community-acquired pneumonia (CAP). The etiology and incidence of CAP in American Indians/Alaskan Natives (AI/AN) has not been described.MethodsWe conducted a retrospective study by reviewing the medical records of all AI/AN patients 18 years or older admitted to W.W. Hastings Hospital in Tahlequah, Oklahoma with a diagnosis of a respiratory infection from January 1, 2016 to December 31, 2016. Only patients with a radiographically confirmed CAP were included and those with a recent hospitalization or immunosuppressed were excluded. Patient demographics, comorbidities and results of molecular tests, antigen detection, high quality sputum culture and blood culture were reviewed. Population-based incidence rates of CAP requiring hospitalization were calculated according to age.ResultsFrom January 2016 through December 2016, 763 patients were admitted with a diagnosis of a respiratory infection, of which 193 (25%) met the inclusion criteria. Of this group, 103 (53%) had at least one pathogen detected: one or more viruses were detected in 47 (24%), one or more bacteria were detected in 63 (33%). The most common pathogens were Streptococcus pneumoniae (12% of patients), rhinovirus/enterovirus (11% of patients), respiratory syncytial virus (5% of patients), legionella pneumophila (4% of patients), and human metapneumovirus (4% of patients). The annual incidence of CAP was 13.6 cases (95% confidence interval, 11.9, 15.7) per 10,000 adults, with the highest incidence among adults ages 65–79 (43 cases per 10,000 adults) and those 80 years of age or older (102 cases per 10,000 adults). Seventy-five percent of patients had an underlying medical condition, 47% had diabetes mellitus (DM), followed by chronic obstructive lung disease (38%) and chronic heart disease (32%).ConclusionIn this AI/AN population, a respiratory pathogen was identified in 53% of the cases despite the use of cutting edge diagnostic tests in most patients. Bacteria were detected more often than viruses. Compared with recent publications of CAP affecting non-Hispanic whites, non-Hispanic blacks and Hispanics, the population described in this study was older and had higher prevalence of DM.Disclosures All authors: No reported disclosures.

Duration of Antibiotic Use Among Adults With Uncomplicated Community-Acquired Pneumonia Requiring Hospitalization in the United States.

Previous studies suggest that duration of antibiotic therapy for community-acquired pneumonia (CAP) often exceeds national recommendations and might represent an important opportunity to improve antibiotic stewardship nationally. Our objective was to determine the average length of antibiotic therapy (LOT) for patients treated for uncomplicated CAP in US hospitals and the proportion of patients with excessive durations. Records of retrospective cohorts of patients aged 18-64 years with private insurance and aged ≥65 years with Medicare hospitalized for CAP in 2012-2013 were used. Inpatient LOT was estimated as a function of length of stay. Outpatient LOT was based on prescriptions filled post discharge based on data from outpatient pharmacy files. Excessive duration was defined as outpatient LOT >3 days. Inclusion criteria were met for 22128 patients aged 18-64 years across 2100 hospitals and 130746 patients aged ≥65 years across 3227 hospitals. Median total LOT was 9.5 days. LOT exceeded recommended duration for 74% of patients aged 18-64 years and 71% of patients aged ≥65 years. Patients aged 18-64 years had a median (quartile 1-quartile 3) 6 (3-7) days outpatient LOT and those aged ≥65 years had 5 (3-7) days. In this nationwide sample of patients hospitalized for CAP, median total LOT was just under 10 days, with more than 70% of patients having likely excessive treatment duration. Better adherence to recommended CAP therapy duration by improving prescribing at hospital discharge may be an important target for antibiotic stewardship programs.

Overuse of Antibiotics in Treatment of Community-Acquired Pneumonia Requiring Hospitalization

Overuse of Antibiotics in Treatment of Community-Acquired Pneumonia Requiring Hospitalization

Diagnosis and Management of Pediatric Community Acquired Pneumonia Requiring Hospitalization: How Well Are We Following National Guidelines?

Diagnosis and Management of Pediatric Community Acquired Pneumonia Requiring Hospitalization: How Well Are We Following National Guidelines?

Overall Duration of Antibiotic Use Among Adults With Community-Acquired Pneumonia Requiring Hospitalization

Overall Duration of Antibiotic Use Among Adults With Community-Acquired Pneumonia Requiring Hospitalization

Community-Acquired Pneumonia Requiring Hospitalization.

Community-Acquired Pneumonia Requiring Hospitalization.

Community-Acquired Pneumonia Requiring Hospitalization.

Community-Acquired Pneumonia Requiring Hospitalization.

Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults

BackgroundCommunity-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radiographically and with the use of current laboratory diagnostic tests are needed.MethodsWe conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among adults 18 years of age or older in five hospitals in Chicago and Nashville. Patients with recent hospitalization or severe immunosuppression were excluded. Blood, urine, and respiratory specimens were systematically collected for culture, serologic testing, antigen detection, and molecular diagnostic testing. Study radiologists independently reviewed chest radiographs. We calculated population-based incidence rates of community-acquired pneumonia requiring hospitalization according to age and pathogen.ResultsFrom January 2010 through June 2012, we enrolled 2488 of 3634 eligible adults (68%). Among 2320 adults with radiographic evidence of pneumonia (93%), the median age of the patients was 57 years (interquartile range, 46 to 71); 498 patients (21%) required intensive care, and 52 (2%) died. Among 2259 patients who had radiographic evidence of pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 853 (38%): one or more viruses in 530 (23%), bacteria in 247 (11%), bacterial and viral pathogens in 59 (3%), and a fungal or mycobacterial pathogen in 17 (1%). The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%). The annual incidence of pneumonia was 24.8 cases (95% confidence interval, 23.5 to 26.1) per 10,000 adults, with the highest rates among adults 65 to 79 years of age (63.0 cases per 10,000 adults) and those 80 years of age or older (164.3 cases per 10,000 adults). For each pathogen, the incidence increased with age.ConclusionsThe incidence of community-acquired pneumonia requiring hospitalization was highest among the oldest adults. Despite current diagnostic tests, no pathogen was detected in the majority of patients. Respiratory viruses were detected more frequently than bacteria. (Funded by the Influenza Division of the National Center for Immunizations and Respiratory Diseases.)

Community-Acquired Pneumonia Requiring Hospitalization among U.S. Children

BackgroundIncidence estimates of hospitalizations for community-acquired pneumonia among children in the United States that are based on prospective data collection are limited. Updated estimates of pneumonia that has been confirmed radiographically and with the use of current laboratory diagnostic tests are needed.MethodsWe conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among children younger than 18 years of age in three hospitals in Memphis, Nashville, and Salt Lake City. We excluded children with recent hospitalization or severe immunosuppression. Blood and respiratory specimens were systematically collected for pathogen detection with the use of multiple methods. Chest radiographs were reviewed independently by study radiologists.ResultsFrom January 2010 through June 2012, we enrolled 2638 of 3803 eligible children (69%), 2358 of whom (89%) had radiographic evidence of pneumonia. The median age of the children was 2 years (interquartile range, 1 to 6); 497 of 2358 children (21%) required intensive care, and 3 (<1%) died. Among 2222 children with radiographic evidence of pneumonia and with specimens available for bacterial and viral testing, a viral or bacterial pathogen was detected in 1802 (81%), one or more viruses in 1472 (66%), bacteria in 175 (8%), and both bacterial and viral pathogens in 155 (7%). The annual incidence of pneumonia was 15.7 cases per 10,000 children (95% confidence interval [CI], 14.9 to 16.5), with the highest rate among children younger than 2 years of age (62.2 cases per 10,000 children; 95% CI, 57.6 to 67.1). Respiratory syncytial virus was more common among children younger than 5 years of age than among older children (37% vs. 8%), as were adenovirus (15% vs. 3%) and human metapneumovirus (15% vs. 8%). Mycoplasma pneumoniae was more common among children 5 years of age or older than among younger children (19% vs. 3%).ConclusionsThe burden of hospitalization for children with community-acquired pneumonia was highest among the very young, with respiratory viruses the most commonly detected causes of pneumonia. (Funded by the Influenza Division of the National Center for Immunization and Respiratory Diseases.)

Etiology of Community-Acquired Pneumonia Requiring Hospitalization in Children

To determine the incidence and etiologies of pediatric community-acquired pneumonia requiring hospitalization since the introduction of vaccines for

PRS15 Cost-Effectiveness of Azithromycin and Clarithromycin Treatments for Community Acquired Pneumonia Requiring Hospitalization for Immunocompetent Individuals of Age 65 and Older, from Public Perspective in Brazil

According to Brazilian public databases (DATASUS), community acquired pneumonia (CAP) requiring hospitalization for individuals of age 65+ have a mortality relative risk increase of 4.05 when compared to the average rate of younger ages. This study has the objective of evaluating the cost-effectiveness of azithromycin 500mg/day QD and clarithromycin 1g/day BID for the treatment of CAP for immunocompetent individuals age 65 and older from the public healthcare perspective in Brazil. A decision-tree model, built based on the following health states: death, cure and discontinuing due to adverse events (phlebitis, diarrhea, infusion reaction which would lead to switching the antibiotics). Risks and length of treatment were obtained from the published literature and acquisition costs were retrieved from Brazilian public databases (Banco de Preços em Saúde and SIGTAP - Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e OPM do SUS). Resource utilization (exams, procedures and materials) were gathered based on the latest clinical guidelines for CAP defined by the Brazilian Society of Pneumology. The time horizon was defined as one year. Effectiveness was expressed as life years gained (LYG). Values were expressed in 2011 USD. First order probabilistic sensitivity analysis was carried by Monte Carlo simulation of 10,000 iterations considering the range of values for the lengths of treatment in a normal distribution. Simulation considering 10,000 iterations showed the following values for azithromycin and clarithromycin respectively: Total LYG [9,640vs.8,840]; average costs per treatment [USD614.11vs.USD618.15]; average cost-effectiveness ratio [USD637.07/LYGvs.USD699.23/LYG], representing a cost saving per patient of USD62.17/LYG for azithromycin. Considering 180,851 cases of pneumonia hospitalizations for adults age 65+ registered at public hospitals in Brazil(2010), the overall estimated savings for the incorporation of azithromycin would be approximately USD730,561.15. In this analysis, azithromycin presented the greatest effectiveness diminishing costs, by reducing mortality and treatment discontinuation due to adverse events.

PRS14 Cost-Effectiveness of Azithromycin and Clarithromycin Treatments for Community Acquired Pneumonia Requiring Hospitalization for Immunocompetent Individuals of Age 65 and Older, from Private Perspective in Brazil

PRS14 Cost-Effectiveness of Azithromycin and Clarithromycin Treatments for Community Acquired Pneumonia Requiring Hospitalization for Immunocompetent Individuals of Age 65 and Older, from Private Perspective in Brazil

Efficacy of Corticosteroids in the Treatment of Community-Acquired Pneumonia Requiring Hospitalization

Recent studies suggested that administration of corticosteroids may improve clinical outcomes in patients with severe pneumonia. The aim of this study was to assess the effectiveness of corticosteroids as an adjunctive therapy in community-acquired pneumonia (CAP) requiring hospitalization. An open label, prospective, randomized control study was conducted from September 2003 to February 2004 in a community general hospital in Japan. Thirty-one adult CAP patients who required hospitalization were enrolled. Fifteen patients received 40 mg of prednisolone intravenously for 3 days (steroid group). Sixteen patients did not receive prednisolone (control group). Both groups were also evaluated for their adrenal function. The primary endpoint was length of hospital stay. Secondary endpoints were duration of intravenous (IV) antibiotics and time required to stabilize vital signs. Both groups demonstrated similar baseline characteristics and length of hospital stay, and yet a shorter duration of IV antibiotics was observed in the steroid group (p < 0.05). In addition, vital signs were stabilized earlier in the steroid group (p < 0.05). These differences were more prominent in the moderate-severe subgroup but not as significant in the mild-moderate subgroup. The prevalence of relative adrenal insufficiency (RAI) in both groups was high (43%), yet there was no difference in baseline characteristics between patients, with or without RAI. In multiple regression models, RAI seemed to have no influence on clinical courses. In moderate-severe CAP, administration of corticosteroids promotes resolution of clinical symptoms and reduces the duration of intravenous antibiotic therapy.

Molecular detection of Mycoplasma pneumoniae in adults with community-acquired pneumonia requiring hospitalization.

Mycoplasma pneumoniae infection was diagnosed in 18 (12.5%) of 144 adults hospitalized with community-acquired pneumonia. The infection was demonstrated by PCR in 15 patients and by serology, using two methods, in 10 patients. The mean age of the 8 patients with positive M. pneumoniae PCR and negative serology was significantly higher than that of the 10 patients with positive serology.

Incidence of Community-Acquired Pneumonia Requiring Hospitalization

Pneumonia is the leading cause of death due to infectious diseases in the United States; however, the incidence of most infections causing community-acquired pneumonia in adults is not well defined.We evaluated all adults, residing in 2 counties in Ohio, who were hospitalized in 1991 because of community-acquired pneumonia. Information about risk factors, symptoms, and outcome was collected through interview and medical chart review. Serum samples were collected from consenting individuals during the acute and convalescent phases, and specific etiologic diagnoses were assigned based on results of bacteriologic and immunologic tests.The incidence of community-acquired pneumonia requiring hospitalization in the study counties in 1991 was 266.8 per 100,000 population; the overall case-fatality rate was 8.8%. Pneumonia incidence was higher among blacks than whites (337.7/100,000 vs 253.9/ 100,000; P < .001), was higher among males than females (291.4 vs 244.8; P < .001), and increased with age (91.6/100,000 for persons aged < 45 years, 277.2/ 100,000 for persons aged 45-64 years, and 1012.3/ 100,000 for persons aged > or = 65 years; P < .001). Extrapolation from study incidence data showed the projected annual number of cases of community-acquired pneumonia requiring hospitalization in the United States to be 485,000. These data provide previously unavailable estimates of the annual number of cases that are due to Legionella species (8000-18,000), Mycoplasma pneumoniae (18,700-108,000), and Chlamydia pneumoniae (5890-49,700).These data provide information about the importance of community-acquired pneumonia and the relative and overall impact of specific causes of pneumonia. The study provides a basis for choosing optimal empiric pneumonia therapy, and allows interventions for prevention of pneumonia to be targeted at groups at greatest risk for serious illness and death.

The Value of Open Lung Biopsy in Immunocompetent Patients With Community-acquired Pneumonia Requiring Hospitalization

To determine the role of open lung biopsy in immunocompetent patients with community-acquired pneumonia who require hospitalization. A group of 1,118 patients with severe community-acquired pneumonia that required hospitalization were enrolled in the study. Of the patients, 26 underwent open lung biopsy. Another 18 of these patients were immunocompromised and were excluded from this segment of the study. Tertiary care 800-bed hospital from November 1981 to May 1989. Progressive diffuse pulmonary infiltrates and negative conventional cultures were the indications for biopsy in most of these patients. Eighteen (69 percent) were immunocompromised. The eight immunocompetent patients underwent a retrospective review of their course in hospital. Three patients died. The diagnostic yield from open lung biopsy was 25 percent. A specific histologic diagnosis was made in one patient--lipoid pneumonia. The pulmonary histologic finding were nonspecific in the remaining patients, but in four, in combination with the clinical data, gave useful information and resulted in therapy change. Culture of a pulmonary tissue yielded cytomegalovirus in one other patient. Serologic testing had a low yield in this group with three patients having a positive result. Open lung biopsy is rarely necessary in immunocompetent patients with community-acquired pneumonia. In a small group of patients where it is necessary, however, both positive and negative results are important in directing therapy.

Parenteral Followed by Oral Ofloxacin for Nosocomial Pneumonia and Community-acquired Pneumonia Requiring Hospitalization

We report a multicentric, open trial of intravenous followed by oral ofloxacin, 400 mg every 12 h, as therapy for 100 cases of nosocomial pneumonia and community-acquired pneumonia requiring hospitalization. The typical subject was 57 yr old, and underlying diseases, such as chronic obstructive pulmonary diseases (COPD), diabetes mellitus, and congestive heart failure, were common. For 10 subjects previous therapy had failed. There were 118 pathogens isolated in blood or sputum; S. pneumoniae was the most common (42), followed by H. influenzae (13), Klebsiella spp. (11), and S. aureus (10). Ofloxacin was administered for an average of 5.7 days intravenously followed by 6.9 days orally. Response to therapy was judged to be cure in 71 subjects, improvement in 24, and failure in 5. Among the more seriously ill subjects, ofloxacin therapy was successful for four of five immunocompromised subjects, for 12 of 12 subjects with nosocomial pneumonia, three of whom were on the ventilator, and for nine of 10 subjects with community-acquired pneumonia and bacteremia, including seven of eight cases due to S. pneumoniae. Univariate risk factor analysis revealed underlying COPD and/or tachypnea upon admission to be associated with failure of ofloxacin therapy, with bacteremia suggestive of failure. Conversely, ofloxacin was equally effective in cases in whom previous therapy failed and in cases of nosocomial pneumonia, multilobar pneumonia, and/or pneumonia due to S. pneumoniae. Results for P. aeruginosa were inconclusive. Intravenous followed by oral ofloxacin was highly effective in many difficult cases of pneumonia.