Community-associated Pneumonia Research Articles

D-Dimer As A Parameter Of Disease And Death Of Covid-19 Patients In Islamic Hospital, Surabaya

Background: Previous studies of Community Associated Pneumonia (CAP) and Chronic Obstructive Pulmonary Disease (COPD), patients have shown that D-Dimer increases higher in severe cases and can be used as a prognostic biomarker and whilst D-Dimer> 1 mcg/ ml tends to be death for hospitalized adult patient with a diagnosis of Covid-19. However, D-Dimer's role in Covid-19 patients has not been fully studied. We aim to conduct research on D-Dimer as a parameter of Clinical Severity and Death of Covid-19 Patients in Islamic Hospital, in Surabaya. Methods: This type of research is an analytic observational study with a retrospective approach. The population in this study were all patient’s data retrieved from the Dahlia Room’s database from June to July 2020 which were taken through EMR (an Electrical Medical Records) from a total of 189 patients with the total sample of 82 patients. Data analysis in this study used chi-square (X2) with a significant value of p <0.05. Results: Age over 60 years is associated with a higher risk of severe Covid-19 infection (P<0.05). A history of hypertension significantly affects the severity of Covid-19 infection (P < 0.05). The proportion of recoveries (53.7%) was higher than the number of deaths (46.3%), although the majority of patients experienced severe clinical severity (39%). Laboratory parameters, such as D-dimer values, correlated significantly with patient age (P = 0.027, <0.05). Conclusion: The study highlights the importance of factors such as age and history of comorbid diseases in predicting the severity of Covid-19 infection. A better understanding of these risk factors can help in more effective management and management of Covid-19 patients.

Impact of antibiotic treatment duration on community-acquired pneumonia in children: a systematic review

The treatment of pediatric community-acquired pneumonia (CAP) with antibiotics is important due to its substantial global health impact. To support clinical practice and antibiotic stewardship, this narrative review investigates the effects of the length of antibiotic therapy on the outcomes of childhood CAP. A thorough search of PubMed, Scopus, and Google Scholar produced English articles published in the last ten years (2019–2024) and looked at the connection between the length of antibiotic therapy and the outcomes of community-associated pneumonia in children. There is increasing evidence to support the similarity of shorter and longer antibiotic regimens for treating juvenile community-acquired pneumonia. Research continuously shows that shorter periods of antibiotic therapy—usually five days—produce similar clinical results as lengthier regimens that last seven to 10 days. Furthermore, emphasis is placed on tailored treatment plans that take into account the child's age, the severity of the symptoms, and regional trends of antibiotic resistance. The included studies, albeit observational and retrospective, provide important insights into the safety, effectiveness, and consequences of various antibiotic regimens in the therapy of pediatric CAP. This review emphasizes the significance of evidence-based strategies to maximize antibiotic treatment for pediatric CAP, while also noting research limitations. More research is required to enhance treatment methods and results for kids with CAP. This includes carefully planned randomized controlled trials and integrated diagnostic tools.

Identifying the relationship between hospital rurality and antibiotic overuse

Background: Antibiotic overuse and the resulting patient outcomes span all hospitals. However, although antibiotic stewardship can improve antibiotic use, effective stewardship programs require expertise and an infrastructure that are not present in all hospitals. Rural hospitals have less access to resources, infectious disease expertise, and participation in academic research. Thus, we compared antibiotic overuse at discharge between rural and nonrural hospitals for patients diagnosed with community-associated pneumonia (CAP) or urinary tract infection (UTI)—the 2 most common hospital infections. Methods: To determine whether antibiotic overuse at discharge was higher among rural versus nonrural hospitals, we analyzed data from a 41-hospital prospective cohort of patients treated for CAP or UTI between July 1, 2017, and July 30, 2019, in Michigan. Antibiotic overuse was defined as treatment that was unnecessary (ie, patient did not have an infection), excessive (ie, duration >4 days for CAP), or included suboptimal fluoroquinolone use (ie, safer alternative available). Overuse was determined based on patient risk factors, symptoms, allergies, diagnostic results, and time to stability. Hospital rurality was defined using the Rural–Urban Continuum Codes (RUCC) score. We defined rural as a score ≥4 and very rural as a score of 7–9. We used t tests to compare the mean percentage of patients with antibiotic overuse at discharge between nonrural and rural (and very rural) hospitals. Results: Across 41 hospitals, we included 23,449 patients with CAP or UTI. There were 5 rural (and 3 very rural) hospitals with 2,039 (and 1,082) patients. Antibiotic overuse at discharge was present in 43.1% of patient cases in nonrural hospitals, 52.5% in rural hospitals (P = .04 vs nonrural) and 58.1% in very rural hospitals (P = .007 vs nonrural). Compared to nonrural hospitals, the mean percentage of cases with antibiotic overuse at discharge in rural hospitals was 9.4% higher (15.1% higher in very rural hospitals). Results were similar in a subgroup analysis of only patients with UTI (47.0% in rural vs 37.5% in nonrural, mean difference, 9.5%; P = .03) but were not statistically significant in patients with CAP (53.8% vs 48.0%, respectively; mean difference, 5.8%; P = 0.23). Conclusions: In this retrospective study, rural hospitals—especially very rural hospitals, had higher rates of antibiotic overuse at discharge than nonrural hospitals. Our findings suggest that antibiotic stewardship interventions tailored toward the unique differences in infrastructure, resources, and needs of rural hospitals are essential to community health.Disclosures: None

Value of D-dimer in predicting various clinical outcomes following community-acquired pneumonia: A network meta-analysis.

Whether high D-dimer level before treatment has any impact on poor outcomes in patients with community-associated pneumonia (CAP) remains unclear. Therefore, we conducted the first meta-analysis focusing specifically on prognostic value of high D-dimer level before treatment in CAP patients. Pubmed, Embase, the Cochrane Central Register of Controlled Trials and World Health Organization clinical trials registry center were searched up to the end of March 2021. Randomized clinical trials (RCT) and observational studies were included to demonstrate the association between the level of D-dimer and clinical outcomes. Data were extracted using an adaptation of the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS-PF). When feasible, meta-analysis using random-effects models was performed. Risk of bias and level of evidence were assessed with the Quality in Prognosis Studies tool and an adaptation of Grading of Recommendations Assessment, Development, and Evaluation. Data were analyzed using STATA 14.0 to complete meta and network analysis. Besides d-dimer levels in CAP patients with poor outcomes, we also analyzed proportion of patients with or without poor outcomes correctly classified by the d-dimer levels as being at high or low risk. The poor outcome includes severe CAP, death, pulmonary embolism (PE) and invasive mechanical ventilators. 32 studies with a total of 9,593 patients were eventually included. Pooled effect size (ES) suggested that d-dimer level was significantly higher in severe CAP patients than non-severe CAP patients with great heterogeneity (SMD = 1.21 95%CI 0.87-1.56, I2 = 86.8% p = 0.000). D-dimer level was significantly elevated in non-survivors compared to survivors with CAP (SMD = 1.22 95%CI 0.67-1.77, I2 = 85.1% p = 0.000). Prognostic value of d-dimer for pulmonary embolism (PE) was proved by hierarchical summary receiver operating characteristic curve (HSROC) with good summary sensitivity (0.74, 95%CI, 0.50-0.89) and summary specificity (0.82, 95%CI, 0.41-0.97). Network meta-analysis suggested that there was a significant elevation of d-dimer levels in CAP patients with poor outcome than general CAP patients but d-dimer levels weren't significantly different among poor outcomes. The prognostic ability of d-dimer among patients with CAP appeared to be good at correctly identifying high-risk populations of poor outcomes, suggesting potential for clinical utility in patients with CAP.

Meningococcal infection in children: factors influencing outcome

Generalized forms of meningococcal infection are characterized by high risk of complication and fatal outcomes. In Russian Federation, 2016, meningococcal infection was the second most common cause of pediatric deaths (25%) due to infectious diseases after community associated-pneumonia. Mandatory vaccination against meninococcal infection is not regulated, and immunization coverage according to epidemic indications is insufficient. During first 6–8 hours of illness clinical signs of this infection may be non-specific, because of that it is difficult to make correct diagnosis at outpatient department. Aim of the study was to analyze mistakes of diagnostics of meningococcal infection and to assess factors influencing the disease outcome. Material and methods. Retrospective cohort study was performed including 113 pediatric cases of generalized meningococcal infection occurred in Arkhangelsk region (46 cases with fatal outcome and 67 patients, who recovered). Factors influencing the outcome were recognized using Cox regression. Results. Median age of patients was 11 months. Clinical forms were meningitis (13,3%), meningococcemia (40,7%), mixed form (46%). The diagnosis of meningococcal infection was made at outpatient department in 36,9% of cases. The main causes of diagnostic mistakes were the lack of experience among primary care physicians and non-specificic symptoms during the first hours of the disease. Age younger 2 years, septic shock and time between onset of the diseases and admission to the hospital were associated with fatal outcome. Conclusion. To manage meningococcal disease we need to have good compliance with clinical guidelines for outpatient departments and hospitals; to optimize medical students education for prevention of diagnostic mistakes. Vaccination is the most effective method of prevention of deaths associated with meningococcal infection.

Perfil epidemiológico de infecciones respiratorias agudas en adultos hospitalizados.

Introducción: Las enfermedades respiratorias agudas constituyen una de las patologías de alta prevalencia en los pacientes hospitalizados en las áreas clínicas y conlleva un alto gasto público y social.
 Objetivo: Describir los aspectos epidemiológicos de las enfermedades respiratorias agudas en pacientes mayores de 18 años ingresados en el área clínica del Hospital General Ambato.
 Material y métodos: Estudio de tipo descriptivo, retorspectivo, basado en la revisión de historias clínicas de pacientes ingresados al Hospital General Ambato durante el periodo de enero 2017 a junio del 2017.
 Resultados: Las enfermedades respiratorias agudas representan el 16% de las hospitalizaciones, la Enfermedad Pulmonar Obstructiva Crónica exacerbada / sobreinfectada se presentó en el 43% de los pacientes seguida por la Neumonia asociada a la comunidad 23%, el género masculino represento el 54,3 %, la edad promedio fue de 73,3 años, el 27,2 % de los pacientes tubieron hábito tabáquico, el 87,5 % de los casos presentó algun tipo de comorbilidad asociada al diagnóstico de ingreso, la mortalidad alcanzo el 9%.
 Conclusiones: Las enfermedades respiratorias agudas representan el 16% de causas de hospitalización en las áreas clínicas, la EPOC exacerbada /sobreinfectada junto con la Neumonia comunitaria son las patologias más prevalentes en este grupo de pacientes

Improving the Diagnosis of Legionella Pneumonia within a Healthcare System through a Systematic Consultation and Testing Program.

Legionella testing is not recommended for all patients with pneumonia, but rather for particular patient subgroups. As a result, the overall incidence of Legionella pneumonia may be underestimated. To determine the incidence of Legionella pneumonia in a veteran population in an endemic area after introduction of a systematic infectious diseases consultation and testing program. In response to a 2011-2012 outbreak, the VA Pittsburgh Healthcare System mandated infectious diseases consultations and testing for Legionella by urine antigen and sputum culture in all patients with pneumonia. Between January 2013 and December 2015, 1,579 cases of pneumonia were identified. The incidence of pneumonia was 788/100,000 veterans per year, including 352/100,000 veterans per year and 436/100,000 veterans per year with community-associated pneumonia (CAP) and health care-associated pneumonia, respectively. Ninety-eight percent of patients with suspected pneumonia were tested for Legionella by at least one method. Legionella accounted for 1% of pneumonia cases (n = 16), including 1.7% (12/706) and 0.6% (4/873) of CAP and health care-associated pneumonia, respectively. The yearly incidences of Legionella pneumonia and Legionella CAP were 7.99 and 5.99/100,000 veterans, respectively. The sensitivities of urine antigen and sputum culture were 81% and 60%, respectively; the specificity of urine antigen was >99.97%. Urine antigen testing and Legionella cultures increased by 65% and 330%, respectively, after introduction of our program. Systematic testing of veterans in an endemic area revealed a higher incidence of Legionella pneumonia and CAP than previously reported. Widespread urine antigen testing was not limited by false positivity.

Prevalence of Human metapneumovirus infection among patients with influenza-like illness: Report from a Tertiary Care Centre, Southern India

Background:Human metapneumovirus (HMPV), discovered in the 21st century, has emerged as an important cause of influenza-like illness in children and adults causing mild upper respiratory tract infection to severe bronchiolitis and community-associated pneumonia. The aim of this study was to determine the prevalence of HMPV in the Union Territory of Puducherry, India, as part of National Influenza Surveillance Programme. Materials and Methods: From November 2011 to December 2013, a total of 447 nasopharyngeal samples were collected from patients with acute respiratory infections and tested for HMPV RNA by real-time polymerase chain reaction. Results: HMPV was identified in 23/447 (5%) samples with 11/23 in the age group of 14–30 years. Most of the HMPV infections were mild with no fatalities. Two patients were co-infected with the respiratory syncytial virus and one with influenza B virus. The seasonal distribution showed increasing HMPV infection cases in rainy months except for a peak in summer of 2012. Phylogenetic analysis based on the sequences of the nucleoprotein gene of one HMPV strain showed a high degree of sequence identity with Indian strains obtained during 2006 and 2011. Conclusion: This study shows that HMPV infection is more common in adults than in children. Sequence homology suggests the circulation of closely related HMPV strains within the country.

Obesity as a Determinant of Staphylococcus Aureus Colonization Among Maximum Security Prisoners in New York State

While obesity is a risk factor for non-communicable diseases, its influence on susceptibility to infections is not well understood. Epidemiologic data suggest associations between obesity and community-associated pneumonia, wound infections, bacteremia, and sepsis. Nasal colonization with Staphylococcus aureus (SA) is an established risk for these conditions. Given the burden of SA disease and obesity in certain high-risk communities, such as the incarcerated, the study objective was to assess the association between obesity and SA colonization.

Genetics and Medicine of Critical Conditions: from Theory to Practice

The authors consider the role of genetic studies in modern medicine. The high death rates due to critical conditions (sepsis, multiple organ dysfunction, acute respiratory distress syndrome, nosocomial infections) initiate a search for prognostic models. The paper presents the results of the investigations made at the V.A. Negovsky Research Institute of General Reanimatology jointly with the V. N. Vavilov Institute of General Genetics. The panel of genetic markers, which is associated with the increased risk of both community-associated and nosocomial pneumonia (combinations of polymorphic variants in the xenobiotic detoxification gene (CYP1A1), cytokines (IL-6), and renin-angiotensin-converting enzyme (ACE), has been revealed. Genetic factors are essential in determining a response to drugs; 20—95% of the individual variability in the efficiency of their metabolism has been ascertained to result from genetic variability. An associative study has revealed differences in the efficiency of antibacterial therapy in terms of the GSTP1 and ABCB1 genes. Thus, it can be said that the possibilities of molecular genetic methods open prospects for developing the new area in reanimatology — critical care genetics. Identification of groups at increased risk for life-threatening conditions is particularly important in preventing their development and detecting their early markers for the timely determination of the required volume of specialized medical care. Key words: multifactorial diseases, gene polymorphism, xenobiotic detoxification genes, community-associated pneumonia, nosocomial pneumonia.

Aspiration pneumonia: management in Germany

In Germany, 65.54% of all patients with community-acquired pneumonia treated as inpatients are older than 70 years. For every case of community-acquired pneumonia treated in a hospital, the hospital has to report details and outcomes to the federal institute for quality management. The in-hospital mortality of patients with community-acquired pneumonia is compared to other hospitals every year. Dysphagia is assessed systematically in patients with acute stroke and in other diseases when clinically feasible. The German Guideline for Nutrition of patients with acute stroke recommends follow up assessment of the dysphagia at least every week and before discharge. It depends on the local structure of the hospital where a patient with aspiration pneumonia is admitted. Options are a Department for General Internal Medicine, a Department for Pneumology or a Geriatric Department. The mean length of stay for patients with community-associated pneumonia was 11.8 days in the year 2005.The mortality increases with age. Patients admitted from nursing homes have a higher mortality than patients living in the community. In 6.9% of patients with community-acquired pneumonia, the antibiotic therapy was not initiated or was stopped in consent with the patient or with the caregiver because of severe comorbidity. In Germany, the follow up of the patient after discharge is normally done by primary care physicians. Patients living in a nursing home are also cared by a primary care physician, usually a general practitioner. Only very few primary care physicians have a formal training in Geriatrics.

Ceftaroline: a comprehensive update

Ceftaroline is a novel broad-spectrum cephalosporin antibiotic currently under US Food and Drug Administration (FDA) review for a new drug application (NDA), filed by Cerexa, Inc. (a wholly owned subsidiary of Forest Laboratories), for the treatment of complicated skin and skin-structure infections (cSSSIs) and community-associated pneumonia (CAP). The antibiotic acts by binding to penicillin-binding proteins in bacteria, consistent with other β-lactams. The antimicrobial spectrum of ceftaroline ranges from aerobic and anaerobic Gram-positive bacteria, including drug-resistant isolates of staphylococci, i.e. heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA), vancomycin-intermediate S. aureus (VISA) and vancomycin-resistant S. aureus (VRSA), to anaerobic Gram-negative pathogens such as Moraxella catarrhalis and Haemophilus influenzae (including β-lactamase-positive strains), as well as bacteria with multiple resistance phenotypes. Ceftaroline fosamil is the prodrug that is rapidly dephosphorylated by in vivo plasma phosphatases to the active drug ceftaroline, which follows a two-compartmental pharmacokinetic model and is eliminated primarily by renal excretion, with a plasma half-life of ca. 2.5h. Ceftaroline is well tolerated, which is consistent with its good safety profile similar to other cephalosporins in clinical trials. Thus, it would be a promising drug to fight multidrug-resistant superbugs such as S. aureus and Streptococcus pneumoniae for the treatment of cSSSIs and CAP.

Evaluation of the in vivo efficacy of intramuscularly administered ceftaroline fosamil, a novel cephalosporin, against a methicillin-resistant Staphylococcus aureus strain in a rabbit endocarditis model

Sir, Ceftaroline fosamil is the prodrug form of a novel, parenteral, broad-spectrum cephalosporin, ceftaroline, exhibiting bactericidal activity against Gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA), as well as common Gram-negative pathogens. To date, Phase III trials using intravenous (iv) administration of ceftaroline fosamil (herein after referred to as ceftaroline) have been completed for complicated skin and skin structure infections and for community-associated pneumonia. Pathogens such as MRSA are becoming more virulent and are no longer confined to acute-care settings. Ceftaroline may be administered by both iv and intramuscular (im) routes, facilitating outpatient antibiotic therapy for MRSA. Recently, Ge et al. assessed the pharmacokinetic profile for iv and im ceftaroline treatment in different animal species, and demonstrated favourable pharmacokinetic profiles following im administration. Teicoplanin, a glycopeptide antibiotic, may be administered either intravenously or intramuscularly and was used as a positive control. The aim of the present study was to assess the in vivo activity of three different doses of ceftaroline against MRSA compared with teicoplanin after im administration in a rabbit model of endocarditis. In the present study, we used an MRSA strain (P9) isolated from blood cultures exhibiting heterogeneous high-level methicillin resistance (methicillin MIC1⁄4128 mg/L). MICs of ceftaroline, teicoplanin and vancomycin were 1, 0.5 and 1 mg/L, respectively. In vivo studies were performed with New Zealand white female rabbits weighing 2.5–3.0 kg. Animals were treated in accordance with institutional policies and the guidelines stipulated by the animal welfare committee. The Committee of Animal Ethics of the University of Nantes approved all animal experimentation in this study. Using a well-established rabbit endocarditis model, experimental endocarditis was induced with an inoculum of 10 cfu of the MRSA isolate. Treatment was started 24 h after inoculation and antibiotics (ceftaroline and teicoplanin) were administered twice daily using the im route for 4 days. Animals (10 per group) were randomly assigned to no treatment (controls), 40 mg/kg ceftaroline im twice daily, 20 mg/kg ceftaroline im twice daily, 5 mg/kg ceftaroline im twice daily or 20 mg/kg teicoplanin im twice daily. Animals were euthanized at the beginning of the treatment period (controls) or at the end of the im treatment (12 h after the last injection). Aortic valve vegetations were excised, weighed and homogenized in 0.5 mL of saline buffer and used for quantitative cultures on agar. Bacterial counts were determined after 24 h of incubation at 378C. The lower detection limit was 1 cfu per 50 mL of undiluted vegetation homogenate. Statistical analyses were performed with GraphPad Prism software (version 4.0; GraphPad Software, San Diego, CA, USA). Analysis of variance was used to compare the antibacterial effects (bacterial counts) between the different groups, followed by a Bonferroni’s test to compare groups two by two. A P value of ≤0.05 was considered significant. After im administration of 5, 20 and 40 mg/kg doses of ceftaroline, the Cmax increased approximately in proportion to the dose (5.18, 15.75 and 37.85 mg/L, respectively) and the plasma half-life increased from 0.74 to 1.14 h. The in vivo outcome after a 4 day treatment regimen and the rate of sterilization of the vegetations produced by the MRSA strain are shown in Table 1. A dose-dependent response was observed with sterilization rates for ceftaroline of 100%, 80% and 33% for the 40, 20 and 5 mg/kg ceftaroline doses, respectively. The difference between the 20 and 40 mg/kg doses was not statistically significant (P.0.05). In vivo bactericidal activity was consistent across all animals tested at the 40 mg/kg dose and for most animals (8/10) at the 20 mg/kg dose of ceftaroline. As a positive control, 20 mg/kg teicoplanin im demonstrated bactericidal activity, with a sterilization rate of 60%. Using murine thigh and lung infection models, Andes and Craig determined that the T.MIC was the pharmacokinetic– pharmacodynamic parameter that best correlated with efficacy of ceftaroline. In our study, the mean %T.MICs for a 1 mg/L target with 20 mg/kg ceftaroline given by im injection were 46% and 31% over 8 and 12 h, respectively. Using an infective endocarditis rabbit model, the %T.MICs attained with im administration were associated with bactericidal activity against MRSA after a 4 day treatment. The efficacy of im ceftaroline in the present study was similar to that

Lavado broncoalveolar para el diagnóstico de neumonía en enfermos en ventilación mecánica

To evaluate the diagnostic role of bronchoalveolar lavage (BAL) in mechanically ventilated patients with suspected pneumonia and to describe the clinical outcome in the different kinds of pneumonia in critically ill patients.Descriptive study.A 17-bed medical and surgical intensive care unit.Mechanically ventilated patients admitted to the ICU from November 2003 to March 2006 with suspected pneumonia who underwent bronchoscopy with BAL.BAL was performed by fiberoptic bronchoscopy with three aliquots of 50 ml sterile normal saline. Recovered BAL fluid was pro-cessed for microbiologic analysis.Age, APACHE II score within the first 24 hours of admission, time on mechanical ventilation, ICU length of stay, mortality, and isolated bacteria were analyzed.A total of 96 cases of suspected pneumonia with BAL were recruited, including 4 groups: community associated pneumonia (CAP), 12 cases, early-onset ventilator-associated pneumonia (VAP), 26 cases, late-onset ventilator-associated pneumonia, 43 cases, and immunocompromised patients, 15 cases. BAL was positive (> 10000 ufc/ml) in 40 (41.7%) patients (2, 16, 17 and 5 patients with CAP, early-onset VAP, late-onset VAP and immunocompromised, respectively). Mortality was 33.3%, 26.9%, 25.6% and 73.3% in CAP, early-onset VAP, late-onset VAP and immunocompromised patients respectively.The low incidence of positive BAL in the CAP group supports using BAL only for particularly severe, selected cases. Mortality was very high in the immunocompromised patients. In the light of our personal experience, BAL is most useful in the diagnosis of pneumonia in the group of patients with VAP.