Definition Of Pneumonia Research Articles

FACTORS RELATING TO VENTILATOR-ASSOCIATED EVENT (VAE)

Mechanical ventilation is an oxygen therapy that is effective in saving the lives of critical patients in the intensive care unit (ICU). Prolonged use results in an increased risk of infection, in this case ventilator-associated pneumonia (VAP). In 2013, the United States Centers for Disease Control and Prevention redefined monitoring of the quality of care for patients using ventilators by moving away from the definition of ventilator-associated pneumonia ( VAP) to the definition of a ventilator-associated event (VAE) as a sustained increase in ventilator support after a period of stable or decreased ventilator support. For this reason, it is necessary to search for data regarding factors that influence ventilator-associated events. The literature search method was carried out based on articles published between 2019-2024 in accordance with the inclusion and exclusion criteria that had been determined using 1 database, namely Scopus. This literature search used PRISMA guidelines in carrying out the screening process. From the search results, 60 articles were obtained. After going through the screening process, there were 3 articles that met the criteria and will be analyzed. The results of the study from 3 pieces of literature show that the factors associated with ventilator-associated events are ventilator-associated events, namely the application of SDD (selective digestive decontamination, VILI (ventilator induced lung injury), lung atelectasis, excess fluid, including pulmonary edema, use of medication chlorhexidine mouthwash for oral care, spontaneous breath trials, early mobility, tracheostomy, use of vasopressors, transfusion overload, delirium, type of sedation (continuous or intermittent), type of sedation drug (midazolam, propofol), and analgesia drugs (fentanyl, morphine, remifentanil ), conditions related to infection, gender, age, presence of comorbidities, body mass index, and disease severity index. Reason for intubation. Intubation can be carried out in the ICU or elsewhere.

Prevalence of and Risks for Bacterial Infections in Hospitalized Children With Bronchiolitis.

Viral bronchiolitis is a common pediatric illness. Treatment is supportive; however, some children have concurrent serious bacterial infections (cSBIs) requiring antibiotics. Identifying children with cSBI is challenging and may lead to unnecessary treatment. Improved understanding of the prevalence of and risk factors for cSBI are needed to guide treatment. We sought to determine the prevalence of cSBI and identify factors associated with cSBI in children hospitalized with bronchiolitis. We performed a retrospective cohort study of children <2 years old hospitalized with bronchiolitis at a free-standing children's hospital from 2012 to 2019 identified by International Classification of Diseases codes. cSBI was defined as bacteremia, urinary tract infection, meningitis, or pneumonia. Risk factors for cSBI were identified using logistic regression. We identified 7871 admissions for bronchiolitis. At least 1 cSBI occurred in 4.2% of these admissions; with 3.5% meeting our bacterial pneumonia definition, 0.4% bacteremia, 0.3% urinary tract infection, and 0.02% meningitis. cSBI were more likely to occur in children with invasive mechanical ventilation (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.78-3.63), a C-reactive protein ≥4 mg/dL (OR 2.20, 95% CI 1.47-3.32), a concurrent complex chronic condition (OR 1.67, 95% CI 1.22-2.25) or admission to the PICU (OR 1.46, 95% CI 1.02-2.07). cSBI is uncommon among children hospitalized with bronchiolitis, with pneumonia being the most common cSBI. Invasive mechanical ventilation, elevated C-reactive protein, presence of complex chronic conditions, and PICU admission were associated with an increased risk of cSBI.

Diagnostic accuracy of pocket-size lung ultrasound for etiological definition of pneumonia and surveillance of complications in children hospitalized: a prospective diagnostic cohort study

Background: Pneumonia, the leading infectious cause of death in children worldwide, often requires a chest radiograph (CXR) for diagnosis, involving radiation exposure. Point-of-Care Ultrasound (POCUS) offers a radiation-free alternative and, specifically the pocket-size variant, enhances convenience at the patient's bedside. While evidence supports ultrasound's accuracy in detecting community-acquired pneumonia (CAP) in children comparable to CXR, few studies have explored its ability to distinguish pneumonia etiology, especially utilizing pocket-size POCUS devices. Methods: In this prospective diagnostic cohort study conducted over a year in a tertiary pediatric referral center, we aim to assess the diagnostic accuracy of a pocket-size POCUS device compared to CXR for determining the etiology of CAP in pediatric patients (aged &gt;6 months and &lt;18 years). At least 76 participants diagnosed with CAP will undergo independent POCUS examinations at various intervals, complemented by CXRs when necessary, independently classified by a third investigator. The General Electrics Vscan AirTM®, featuring Bluetooth connectivity to smartphone/tablet, will be employed for POCUS. Data collection will include systematized POCUS and CXR descriptions, alongside sociodemographic, clinical, and therapeutic variables. Statistical analysis using SPSS® version 28 will evaluate the diagnostic accuracy of the POCUS device. Conclusions: This trial's outcomes hold significant promise in unveiling unknown data about the diagnostic accuracy of pocket-size POCUS for pediatric CAP etiological diagnosis. Utilizing a device meeting technical recommendations, featuring a dual-headed probe and Bluetooth connectivity, this study has the potential to bring innovation to clinical practice, improving patient care and creating scientific value. Trial Registration Number: NCT06296693.

Definition, Epidemiology, and Pathogenesis of Severe Community-Acquired Pneumonia.

The clinical presentation of community-acquired pneumonia (CAP) can vary widely among patients. While many individuals with mild symptoms can be managed as outpatients with excellent outcomes, there is a distinct subgroup of patients who present with severe CAP. In these cases, the mortality rate can reach approximately 25% within 30 days and even up to 50% within a year. It is crucial to focus attention on these patients who are at higher risk. Among the various definitions of severe CAP found in the literature, one commonly used criterion is the requirement for admission to intensive care unit. Notable epidemiological characteristics of these patients include the impact of acute cardiovascular diseases on clinical outcomes and the enduring, independent effect of pneumonia on long-term outcomes. Factors such as pathogen virulence, the presence of comorbidities, and the host response are important contributors to the pathogenesis of severe CAP. In these patients, the host response may be dysregulated and compartmentalized. Gaining a better understanding of the epidemiology and pathogenesis of severe CAP will provide a foundation for the development of new therapies for this condition. This manuscript aims to review the definition, epidemiology, and pathogenesis of severe CAP, shedding light on important aspects that can aid in the improvement of patient care and outcomes.

THE IMPACT OF HOSPITAL-ACQUIRED INFECTIONS ON PATIENT OUTCOMES

Hospital-acquired infections (HAIs), also known as healthcare-associated infections, are infections that patients acquire while they are in the hospital. They are typically not present or might be incubating at the time of admission. HAIs usually manifest 48 hours after admission to the hospital. The National Healthcare Safety Network (NHSN) of the Center for Disease Control and Prevention (CDC) closely monitors HAIs to prevent them and improve patient safety. HAIs include central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), and Hospital-acquired Pneumonia (HAP), Ventilator-associated Pneumonia (VAP), and Clostridium difficile infections (CDI). For the last few decades, hospitals have taken HAIs seriously. Several hospitals have established infection tracking and surveillance systems in place, along with robust prevention strategies to reduce the rate of HAIs. HAIs can have a significant impact on patients, both at an individual level and at the community level. They can lead to longer hospital stays, increased costs of care, and even death. HAIs can also be linked to the spread of multidrug-resistant infections. In recent years, the definitions of pneumonia have been changed to better identify patients at risk for multidrug-resistant (MDR) pathogens. This change was made to avoid the overuse of antibiotics. The term Healthcare-acquired Pneumonia (HCAP) has been made obsolete, and the term Hospital-acquired Pneumonia (HAP) has replaced it. HAP is defined as pneumonia that occurs 48 hours or more after admission to the hospital and did not appear to be incubating at the time of admission. Ventilator-associated pneumonia (VAP) is defined as pneumonia that develops more than 48 to 72 hours after endo-tracheal intubation. Both HAP and VAP are associated with poorer outcomes and significant morbidity and mortality worldwide.

Neumonía adquirida en la comunidad: epidemiología, diagnóstico, escalas pronósticas de gravedad y nuevas opciones terapéuticas

This narrative review article explores the current scientific knowledge on the definition, epidemiology, diagnostic criteria, microbiology, treatment, and prevention of severe community-acquired pneumonia (SCAP) in immunocompetent adults. At present, despite major scientific advances in diagnostic evaluation, clinical management, antimicrobial therapy, and prevention, severe community-acquired pneumonia remains a major cause of morbidity and mortality, as well as having a major economic impact in terms of increased healthcare expenditure worldwide. This pathology is considered one of the leading causes of sepsis/septic shock, with an extremely high overall mortality rate, which justifies all the effort in early diagnosis, proper management, and prompt initiation of antimicrobial therapy. Including biomarkers (isolated or in combination) associated with applying diagnostic criteria and prognostic severity scales in clinical practice helps identify patients with severe community-acquired pneumonia, defines immediate admission to the intensive care unit, and, thus, minimizes the adverse outcomes of this serious pathology.

Impact of childhood 13-valent pneumococcal conjugate vaccine introduction on adult pneumonia hospitalisations in Mongolia: a time series analysis

IntroductionFew studies have assessed the potential indirect effects of childhood pneumococcal conjugate vaccine (PCV) programs on the adult pneumonia burden in resource-limited settings. We evaluated the impact of childhood PCV13 immunisation on adult all-cause pneumonia following a phased program introduction from 2016. MethodsWe conducted a time-series analysis to assess changes in pneumonia hospitalisation incidence at four district hospitals in Mongolia. Adults (≥18 years) that met the clinical case definition for all-cause pneumonia were enrolled. A negative binomial mixed-effects model was used to assess the impact of PCV13 introduction on monthly counts of pneumonia admissions from January 2015—February 2022. We also performed a restricted analysis excluding the COVID-19 pandemic period. All models were stratified by age and assessed separately. Additional analyses assessed the robustness of our findings. FindingsThe average annual incidence of all-cause pneumonia hospitalisation was highest in adults 65+ years (62·81 per 10,000 population) and declined with decreasing age. After adjusting for the COVID-19 pandemic period, we found that rates of pneumonia hospitalisation remained largely unchanged over time. We did not observe a reduction in pneumonia hospitalisations in any age group. Results from restricted and sensitivity analyses were comparable to the primary results, finding limited evidence of a reduced pneumonia burden. InterpretationWe did not find evidence of indirect protection against all-cause pneumonia in adults following childhood PCV13 introduction. Direct pneumococcal vaccination and other interventions should be considered to reduce burden of pneumonia among older adults. FundingPfizer clinical research collaboration agreement (contract number: WI236621).

Abstract 327: Implementation of Bronchoalveolar Lavages as a Quality Improvement Initiative in Out-of-Hospital Cardiac Arrest Patients

Patients who suffer OHCA are at risk for early onset pneumonia due to loss of airway protection, emergency airway access and intubation, CPR, mechanical ventilation, among other complications. It is difficult to accurately diagnose early onset pneumonia post OHCA due to multi-organ dysfunction post arrest and radiography findings confounded by non-infectious inflammation from CPR and aspiration. As a result, a substantial number of patients receive empiric antibiotics. A bronchoalveolar lavage (BAL) can screen for the presence of bacteria in the lungs and aid in identifying the incidence of early onset pneumonia after OHCA. We implemented a quality improvement (QI) initiative to collect a BAL on initial patient presentation to our hospital in May 2018. We conducted an observational, retrospective study to assess the impact of BAL implementation on empiric antibiotic prescribing. We used a rigorous study definition of pneumonia requiring at least two of the following positive within the same 24-hour period: BAL, chest radiography, and/or a fever &gt;38°C. We compared rates of antibiotic prescription in the first 7 days of hospitalization for patients receiving a BAL to those without, as well as rates of antibiotic prescriptions before and after implementation of the BAL QI initiative. Implementation of initial BAL collection was successful and resulted in a 66% increase of BALs (from 44 to 73 BALs) collected compared to an average from the prior 2 years. We hypothesized rates of antibiotic prescription would decrease post-implementation of BAL collection; however, there was no statistically significant change in rate of antibiotic prescription (Figure 1) over the initial 7-day hospitalization period X 2 ( Df = 1, N = 3247) = 0.68, p = 0.54. Over 80% of patients with pneumonia received antibiotics, roughly 60% of OHCA patients received antibiotics despite no pneumonia diagnosis by any definition. Further study is needed to alter these practices and reduce antibiotic overuse.

Oral Care in Critically Ill Infants and the Potential Effect on Infant Health: An Integrative Review.

Critically ill infants admitted to the neonatal intensive care unit are at risk for ventilator-associated pneumonia and abnormal oral colonization. Adherence to evidence-based guidelines for oral care in critically ill adults is associated with improved short- and long-term health outcomes. However, oral care guidelines for critically ill infants admitted to the neonatal intensive care unit have not been established, possibly increasing their risk of ventilator-associated pneumonia and other health complications. To describe and summarize the evidence regarding oral care for critically ill infants admitted to the neonatal intensive care unit and to identify gaps needing further investigation. The MEDLINE (through PubMed) and CINAHL databases were searched for observational studies and randomized controlled trials investigating the effect of oral care on oral colonization, ventilator-associated pneumonia, and health outcomes of infants in the neonatal intensive care unit. This review of 5 studies yielded evidence that oral care may promote a more commensal oral and endotracheal tube aspirate microbiome. It may also reduce the risk of ventilator-associated pneumonia and length of stay in the neonatal intensive care unit. However, the paucity of research regarding oral care in this population and differences in oral care procedures, elements used, and timing greatly limit any possible conclusions. Oral care in critically ill infants may be especially important because of their suppressed immunity and physiological immaturity. Further appropriately powered studies that control for potential covariates, monitor for adverse events, and use recommended definitions of ventilator-associated pneumonia are needed to make clinical recommendations.

Antimicrobial Solutions for Endotracheal Tubes in Prevention of Ventilator-Associated Pneumonia.

Ventilator-associated pneumonia is one of the most frequently encountered hospital infections and is an essential issue in the healthcare field. It is usually linked to a high mortality rate and prolonged hospitalization time. There is a lack of treatment, so alternative solutions must be continuously sought. The endotracheal tube is an indwelling device that is a significant culprit for ventilator-associated pneumonia because its surface can be colonized by different types of pathogens, which generate a multispecies biofilm. In the paper, we discuss the definition of ventilator-associated pneumonia, the economic burdens, and its outcomes. Then, we present the latest technological solutions for endotracheal tube surfaces, such as active antimicrobial coatings, passive coatings, and combinatorial methods, with examples from the literature. We end our analysis by identifying the gaps existing in the present research and investigating future possibilities that can decrease ventilator-associated pneumonia cases and improve patient comfort during treatment.

Pneumococcal colonization and severity of pneumonia in hospitalized Cambodian children following introduction of the 13-valent pneumococcal conjugate vaccine

This study sought to characterize pneumococcal colonization and clinical/radiological features in Cambodian children admitted to hospital with an illness compatible with pneumonia following national introduction of the 13-valent pneumococcal conjugate vaccine (PCV13). Children aged 0-59 months admitted to Angkor Hospital for Children who met the World Health Organization (WHO) case definition for clinical pneumonia were enrolled over a 3-year period. Clinical, radiological and vaccination data were collected at enrolment. A nasopharyngeal swab was collected for detection of pneumococcal colonization using the WHO standard culture method. Between 1 September 2015 and 31August 2018, 2209 analysable illness episodes were enrolled. Pneumococci were detected in 943/2209 (42.7%) children. PCV13 serotypes were detected less frequently in children who had been vaccinated appropriately for their age compared with undervaccinated children: 309/567 (53.6%) vs 216/342 (63.2%) (P=0.006). Age-appropriate PCV13 vaccination was negatively associated with hypoxic presentation [adjusted odds ratio (aOR) 0.72, 95% confidence interval (CI) 0.60-0.87; P=0.0006] and primary endpoint pneumonia on chest x ray (aOR 0.69, 95% CI 0.54-0.90; P=0.006). The introduction of PCV13 in Cambodia was associated with a decline in vaccine serotype nasopharyngeal colonization, and clinical and radiological severity in children hospitalized with clinical pneumonia.

Modern view on the etiology and immunological aspects of pneumonia

Pneumonia is the most common and deadly nosology among all respiratory diseases associated with microorganisms. Despite advances in antibacterial and antiviral therapy, mortality due to pneumonia is not decreasing. It should be noted that the problem of infectious pathology has always been discussed only in narrow circles of specialists, which led to its underestimation, including during the pandemic of a new coronavirus infection. At present, scientific possibilities have not reached their perfection in the etiological diagnosis of pneumonia. Of no small concern is the lack of sections on immunology in the training program for general practitioners and pulmonologists and, as a result, the lack of knowledge by most medical specialists of the basics of the immune response in various infectious diseases, in particular, the differences in the immune response of a macroorganism in viral and bacterial infections, the stages of the immune response, differences between innate and adaptive immune responses, possibilities of immunocorrective therapy. Being followers of the scientific school of pulmonology of academician N.S. Molchanov, in this review, we evaluated the features of etiological factors and immune characteristics of the body on the course and out-comes of pneumonia, taking into account modern scientific knowledge. The current definition of pneumonia is formulated, the issues of the etiology of pneumonia from the perspective of the lung microbiome, the features of the immune response of the macroorganism in viral and bacterial pneumonia, the inconsistency of immune protection and the impact of comorbidity on this are covered in detail. Understanding the processes that lead to the disruption of the respiratory microbiome, the multiplication of pathobionts, the attachment of multiresistant microorganisms and the reactivity of the macroorganism will contribute to the development of new therapeutic approaches in the treatment of pneumonia.

Examining the Definition of Ventilator-Associated Pneumonia in the Trauma Setting: A Single-Center Analysis.

Background: Ventilator associated pneumonia (VAP) is defined by the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) using laboratory findings, pathophysiologic signs/symptoms, and imaging criteria. However, many critically ill trauma patients meet the non-specific laboratory and sign/symptom thresholds for VAP, so the TQIP designation of VAP depends heavily upon imaging evidence. We hypothesized that physician opinions widely vary regarding chest radiograph findings significant for VAP. Patients and Methods: The TQIP Spring 2021 Benchmark Report (BR) was used to identify 14 patients with VAP at an academic Level 1 Trauma Center. Critically ill trauma patients (n = 7) who spent at least four days intubated and met TQIP's laboratory and sign/symptom thresholds for VAP but did not appear as VAPs on the BR comprised the control group. For each deidentified patient, four successive chest radiographic images were compiled and arranged chronologically. Cases and controls were randomly arranged in digital format. Blinded physicians (n = 27) were asked to identify patients with VAP based solely on imaging evidence. Results: Radiographic evidence of VAP was highly subjective (Krippendorff α = 0.134). Among physicians of the same job description, inter-rater reliability remained low (α = 0.137 for trauma attending physicians; α = 0.141 for trauma fellows; α = 0.271 for radiologists). When majority judgment was compared to the TQIP BR, there was disagreement between the two tests (Cohen κ = -0.071; sensitivity, 64.3%; specificity, 28.6%). Conclusions: Current definitions of VAP rely on subjective imaging interpretation and ignore the reality that there are numerous explanations for opacities on CXR. The inconsistency of physicians' imaging interpretation and protean physiologic findings for VAP in trauma patients should preclude the current definition of VAP from being used as a quality improvement metric in TQIP.

MODERN VIEW FROM UKRAINE ON ETIOLOGY, PATHOGENESIS AND CLINICAL-DIAGNOSTIC ASPECTS OF COMMUNITY-ACQUIRED PNEUMONIA IN CHILDREN

Pneumonia is a disease characterized by lung tissue inflammation and the development of respiratory failure. Pneumonia is the most common infectious cause of childhood mortality, occurring every 43 seconds worldwide. Despite advancements in medicine and the use of cutting-edge diagnostic, treatment, and preventive technologies, the incidence of pneumonia remains relatively high, especially in resource-poor countries, adversely affecting the socio-economic life of society. Objective: To summarize contemporary scientific perspectives on the classification, etiology, pathogenesis, and clinical-diagnostic aspects of community-acquired pneumonia in children. Materials and Methods: The literature search was conducted using PubMed, Scopus, Web of Science, WHO, UNICEF databases, international protocols, as well as domestic scientific manuals and professional publications, and medical care standards. Search terms included "community-acquired pneumonia," "pneumonia in childhood," and "pneumonia in children." The analysis utilized methods such as a systemic approach, epidemiological analysis, bibliosemantic analysis, and graphical representation. Results: It was conducted the search and analysis of modern scientific medical literature on community-acquired pneumonia in childhood. Pneumonia is a leading infectious cause of illness and hospitalization in children worldwide. Bacteria, viruses, and mixed infections are identified among the main etiological agents, with cases of non-specific pathogens also observed. The variation in pathogens is presented based on age groups. It is discussed major risk factors for community-acquired pneumonia and pathways of pathogen penetration. Modern insights into the disease's pathogenesis are analyzed, involving a complex process with stages characterized by the development of infectious toxemia, respiratory failure, and disturbances in water-electrolyte balance. The main clinical symptoms are described according to the child's age, along with contemporary methods of laboratory and instrumental diagnostics of community-acquired pneumonia. Conclusions: Information from scientific literature is provided on the contemporary definition, classification, epidemiology, etiology, pathogenesis, clinical presentation, and diagnostics of community-acquired pneumonia in childhood. Currently, severe and non-severe forms of pneumonia are distinguished based on respiratory rate and additional threatening symptoms. The increasing incidence of viral-bacterial pneumonia is noted, with bacteria remaining the primary etiological factor. Pneumococcus and Haemophilus influenzae type B predominate among bacteria. It is also observed an increase in cases of viral pneumonia, attributed to respiratory syncytial and coronavirus infections. The disease's pathogenesis involves multiple phases with the involvement of other organ systems. Clinical features of community-acquired pneumonia include fever, respiratory failure, and cough. Laboratory diagnostic methods include a complete blood count, determination of C-reactive protein levels, and procalcitonin. Among diagnostic methods, chest X-ray, computed tomography, and ultrasound diagnostics of the chest organs are considered the most conclusive.

2177. Institutional Prevalence of Drug-Resistant Pathogens in Community-Acquired Pneumonia

Abstract Background Community-acquired pneumonia (CAP) is a leading cause of hospitalizations and plays a major role in mortality. The previous Infectious Diseases Society of America (IDSA) definition of healthcare-associated pneumonia (HCAP) was found to be neither sensitive nor specific for identifying drug-resistant pathogens including methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PsA) as a cause of CAP, and use is no longer supported by current guidelines. The 2019 IDSA guidelines for CAP management emphasizes the need for clinician understanding of local epidemiology data to guide selection of appropriate treatment. The primary objective of this study was to determine the prevalence of MRSA and PsA CAP at our institution. Methods This was a retrospective observational study of patients admitted to our 870-bed public hospital with a CAP or HCAP diagnosis within 48 hours of admission between March 2016 and March 2021. The primary outcome of prevalence of CAP caused by MRSA or PsA was determined by comparing the number of blood and adequate sputum cultures with MRSA or PsA to total reviewed cases. Secondary outcomes included the percentage of initial antibiotic regimens involving a broad-spectrum agent, percentage of initial broad-spectrum regimens de-escalated within 72 hours if indicated, and duration of CAP antibiotic treatment. Results A total of 220 patients were included. MRSA or PsA was isolated in 1.36% of adequate sputum cultures collected (n=3/35) and in no collected blood cultures (n=0/208). The local prevalence of CAP caused by MRSA or PsA among the analyzed sample was 1.36% (n=3/220) (Table 1). MRSA nares screening tests were completed in 10% of cases, 4.5% of which were positive (n=1/22). Secondary end point results are presented in Table 2.Table 1.Prevalence of MRSA and PsA in CAP Based on Culture DataTable 2.Secondary Outcome Data Conclusion The overall prevalence of CAP caused by MRSA or PsA among admitted patients is low at Parkland Hospital. Further research is needed to identify local risk factors associated with CAP caused by drug-resistant pathogens. Disclosures All Authors: No reported disclosures.

Development and evaluation of an interoperable natural language processing system for identifying pneumonia across clinical settings of care and institutions.

To evaluate the feasibility, accuracy, and interoperability of a natural language processing (NLP) system that extracts diagnostic assertions of pneumonia in different clinical notes and institutions. A rule-based NLP system was designed to identify assertions of pneumonia in 3 types of clinical notes from electronic health records (EHRs): emergency department notes, radiology reports, and discharge summaries. The lexicon and classification logic were tailored for each note type. The system was first developed and evaluated using annotated notes from the Department of Veterans Affairs (VA). Interoperability was assessed using data from the University of Utah (UU). The NLP system was comprised of 782 rules and achieved moderate-to-high performance in all 3 note types in VA (precision/recall/f1: emergency = 88.1/86.0/87.1; radiology = 71.4/96.2/82.0; discharge = 88.3/93.0/90.1). When applied to UU data, performance was maintained in emergency and radiology but decreased in discharge summaries (emergency = 84.7/94.3/89.3; radiology = 79.7/100.0/87.9; discharge = 65.5/92.7/76.8). Customization with 34 additional rules increased performance for all note types (emergency = 89.3/94.3/91.7; radiology = 87.0/100.0/93.1; discharge = 75.0/95.1/83.4). NLP can be used to accurately identify the diagnosis of pneumonia across different clinical settings and institutions. A limited amount of customization to account for differences in lexicon, clinical definition of pneumonia, and EHR structure can achieve high accuracy without substantial modification.

Epidemiology of pneumonia in hospitalized adults ≥18 years old in four districts of Ulaanbaatar, Mongolia, 2015–2019

Community-acquired pneumonia is a leading cause of morbidity and mortality among children and adults worldwide. Adult pneumonia surveillance remains limited in many low- and middle-income settings, resulting in the disease burden being largely unknown. A retrospective cohort study was conducted by reviewing medical charts for respiratory admissions at four district hospitals in Ulaanbaatar during January 2015-February 2019. Characteristics of community-acquired pneumonia cases were summarized by disease severity and age. To explore factors associated with severe pneumonia, we ran univariable and age-adjusted logistic regression models. Incidence rates were calculated using population denominators. In total, 4290 respiratory admissions met the case definition for clinical pneumonia, including 430 admissions of severe pneumonia. The highest proportion of severe pneumonia admissions occurred in adults >65 years (37.4%). After adjusting for age, there were increased odds of severe pneumonia in males (adjusted odds ratio [aOR]: 1.63; 95% confidence interval [CI]: 1.33-2.00) and those with ≥1 underlying medical condition (aOR: 1.46; 95% CI: 1.14-1.87). The incidence of hospitalized pneumonia in adults ≥18 years increased from 13.49 (95% CI: 12.58-14.44) in 2015 to 17.65 (95% CI: 16.63-18.71) in 2018 per 10,000 population. The incidence of severe pneumonia was highest in adults >65 years, ranging from 9.29 (95% CI: 6.17-13.43) in 2015 to 12.69 (95% CI: 9.22-17.04) in 2018 per 10,000 population. Vaccination and other strategies to reduce the risk of pneumonia, particularly among older adults and those with underlying medical conditions, should be prioritized. Pfizer clinical research collaboration agreement (contract number: WI236621).

Aetiology of childhood pneumonia in low- and middle-income countries in the era of vaccination: a systematic review.

BackgroundThis systematic review aimed to describe common aetiologies of severe and non-severe community acquired pneumonia among children aged 1 month to 9 years in low- and middle-income countries.MethodsWe searched the MEDLINE, EMBASE, and PubMed online databases for studies published from January 2010 to August 30, 2020. We included studies on acute community-acquired pneumonia or acute lower respiratory tract infection with ≥1 year of continuous data collection; clear consistent case definition for pneumonia; >1 specimen type (except empyema studies where only pleural fluid was required); testing for >1 pathogen including both viruses and bacteria. Two researchers reviewed the studies independently. Results were presented as a narrative summary. Quality of evidence was assessed with the Quality Assessment Tool for Quantitative Studies. The study was registered on PROSPERO [CRD42020206830].ResultsWe screened 5184 records; 1305 duplicates were removed. The remaining 3879 titles and abstracts were screened. Of these, 557 articles were identified for full-text review, and 55 met the inclusion criteria – 10 case-control studies, three post-mortem studies, 11 surveillance studies, eight cohort studies, five cross-sectional studies, 12 studies with another design and six studies that included patients with pleural effusions or empyema. Studies which described disease by severity showed higher bacterial detection (Streptococcus pneumoniae, Staphylococcus aureus) in severe vs non-severe cases. The most common virus causing severe disease was respiratory syncytial virus (RSV). Pathogens varied by age, with RSV and adenovirus more common in younger children. Influenza and atypical bacteria were more common in children 5-14 years than younger children. Malnourished and HIV-infected children had higher rates of pneumonia due to bacteria or tuberculosis.ConclusionsSeveral viral and bacterial pathogens were identified as important targets for prevention and treatment. Bacterial pathogens remain an important cause of moderate to severe disease, particularly in children with comorbidities despite widespread PCV and Hib vaccination.

Risk Factors for the Development of Pneumonia Below 2 Years of Age

Acute respiratory tract illness is the leading cause of death in the developing countries. This case control study was endeavored with an aim to assess the factors that can increase the risk of pneumonia in children. Methodology: This Case-Control study was carried out at the Paediatrics Department of Jalalabad Ragib Rabeya Medical College Hospital (JRRMCH) in Sylhet from January 2018 to July 2018.This study involved 200 children of 6 to 24 months age, among them 100 children who was hospitalized in JRRMCH for pneumonia during the study period as case. The control group included 100 children who was selected purposively came for immunization at JRRMCH EPI centre and at OPD for other problem but free from pneumonia. Sample were selected according to the inclusion &amp; exclusion criteria. A case definition for pneumonia as outlined by the WHO(2014) was used as the criteria for case inclusion. Children with history of low birth weight, congenital cardiovascular or respiratory malformation, chromosomal abnormalities, recurrent wheeze, were excluded from the study. Data were collected by interviews of the parents using a structured questionnaire. Pneumonia (a child with cough or difficult breathing and fast breathing and or chest in-drawing with recently developed radiological pulmonary shadowing)1 affected 100 children included in case group and 100 children free of pneumonia included in control group. SPSS version 22 were used to analyze the data. Independent sample‘t’ test and Chi (x2 ) square test were done. Results: Residential area, socio-economic status, maternal education, H/A score, formula feeding, types of complimentary feeding, passive smoking, birth order &gt;2, family member, crowding index and birth spacing are significantly associated with development of pneumonia. Conclusion: Children belonged to rural area, poor maternal education, low socio-economic status, stunting height for age, formula feeding, types of complimentary feeding, exposure to passive smoking, birth order&gt;2, birth spacing, family member and crowding index were significantly (p&lt;0.05) associated with pneumonia.

The great fall of chloroquine- lessons learned from the pandemic

Drugs like chloroquine (CQ)/ Hydroxy chloroquine (HCQ) had been widely used as treatment options at the start of pandemic with little supporting evidence. American Thoracic Society (ATS) led International Task Force had come up with some important `suggestions’ regarding CQ/ HCQ usage initially. They have suggested to use these drugs in covid 19 patients with severe pneumonia on a case by case basis. However, the role of HCQ prophylaxis, the effect of combination with macrolides, benefit versus risk assessment, age group profile and the exact definition of severe pneumonia remain unanswered among others. Now, it had become quite obvious that our perceptions based on some observational studies were completely wrong.