Lower Respiratory Tract Infections Admissions Research Articles

Bronchiolitis and pneumonia requiring hospitalization in young first nations children in Northern Ontario, Canada.

High rates of lower respiratory tract infection (LRTI), including bronchiolitis and pneumonia, have been reported in Inuit infants living in arctic Canada. We examined rates of LRTI in First Nations Canadian infants living in the Sioux Lookout Zone, in Northern Ontario. A retrospective review of hospital admissions for LRTI during a 5-year period, in patients <1 year of age was carried out at the Sioux Lookout Meno Ya Win Health Centre, an acute-care hospital that provides secondary care to 31 mainly isolated communities and the town of Sioux Lookout. Admission rates were compared with those in the province of Ontario, as a whole. One-hundred and seventeen subjects were identified. The annualized rate of admission for nonbacterial LRTI was 44 per 1000 infants <1 year of age per year. This rate was significantly higher than for the whole province (P = 0.011). Admission rates also varied significantly between communities (P < 0.001).Thirteen percent of subjects required transfer to a tertiary care center. A virus was identified in 55% (36/65) of subjects tested for respiratory viruses, and respiratory syncytial virus and parainfluenza virus were identified most often. Of patients who had a blood culture performed, bacteria were found in 10% (6/59) of subjects. Many patients had radiographic evidence of consolidation, consistent with pneumonia. Rates of LRTI are significantly elevated in First Nations infants living in the Sioux Lookout Zone. Varying rates between communities suggest that environmental factors may be contributing to rates of LRTI in this population.

A multidisciplinary intervention to reduce antibiotic duration in lower respiratory tract infections

Prolonged antibiotic courses are common in patients with lower respiratory tract infections (LRTIs) and contribute to antibiotic resistance and side effects. This study describes a multidisciplinary intervention to reduce antibiotic duration in LRTI patients. This was a prospective before-and-after intervention study conducted from November 2011 to December 2012. Antibiotic duration was recorded for 6 months for all LRTI admissions (pneumonia, exacerbation of chronic obstructive pulmonary disease, exacerbation of asthma, and other LRTIs), followed by the introduction of an intervention intended to reduce the duration of antibiotic treatment. The intervention incorporated an antibiotic duration based on the CURB65 score, automatic stop dates and pharmacist feedback to prescribers. Two hundred and eighty-one patients were included in the pre-intervention group and 221 in the post-intervention group. The intervention resulted in a reduction in the duration of antibiotic treatment from 8.3 to 6.8 days (P < 0.001, 18.1% relative reduction). The rate of antibiotic-related adverse effects reduced from 31% to 19% (P = 0.03, 39.3% relative reduction). There was no increase in mortality or length of stay A simple intervention can significantly reduce antibiotic duration and antibiotic-related side effects.

G154 Estimation of the “True” Hospital Burden of Paediatric Respiratory Syncytial Virus on the NHS England

Background and AimRespiratory syncytial virus (RSV) is a major cause of acute lower respiratory tract infection (LRTI) in infants and young children and the leading cause of severe bronchiolitis between...

The cost of lower respiratory tract infections hospital admissions in the Canadian Arctic

BackgroundInuit infants who reside in the Nunavut (NU) regions of Arctic Canada have extremely high rates of lower respiratory tract infections (LRTIs) associated with significant health expenditures, but the costs in other regions of Arctic Canada have not been documented.ObjectiveThis prospective surveillance compares, across most of Arctic Canada, the rates and costs associated with LRTI admissions in infants less than 1 year of age, and the days of hospitalization and costs adjusted per live birth.DesignThis was a hospital-based surveillance of LRTI admissions of infants less than 1 year of age, residing in Northwest Territories (NT), the 3 regions of Nunavut (NU); [Kitikmeot (KT), Kivalliq (KQ) and Qikiqtani (QI)] and Nunavik (NK) from 1 January 2009 to 30 June 2010. Costs were obtained from the territorial or regional governments and hospitals, and included transportation, hospital stay, physician fees and accommodation costs. The rates of LRTI hospitalizations, days of hospitalization and associated costs were calculated per live birth in each of the 5 regions.ResultsThere were 513 LRTI admissions during the study period. For NT, KT, KQ, QI and NK, the rates of LRTI hospitalization per 1000 live births were 38, 389, 230, 202 and 445, respectively. The total days of LRTI admission per live birth were 0.25, 3.3, 2.6, 1.7 and 3 for the above regions. The average cost per live birth for LRTI admission for these regions was $1,412, $22,375, $14,608, $8,254 and $10,333. The total cost for LRTI was $1,498,232 in NT, $15,662,968 in NU and $3,874,881 in NK. Medical transportation contributed to a significant proportion of the costs.ConclusionLRTI admission rates in NU and Nunavik are much higher than that in NT and remain among the highest rates globally. The costs of these admissions are exceptionally high due to the combination of very high rates of admission, very expensive medical evacuations and prolonged hospitalizations. Decreasing the rates of LRTI in this population could result in substantial health savings.

Down Syndrome and Hospitalizations due to Respiratory Syncytial Virus: A Population-Based Study

To assess the risk estimates for respiratory syncytial virus (RSV) hospitalization in children with Down syndrome (DS) and the clinical features and severity of RSV lower respiratory tract infection (LRTI) in hospitalized children. Statewide hospitalization data for children with DS for 1995 through 2006 from the Colorado Health and Hospital Association database were combined with birth data from the Colorado Department of Public Health and Environment to obtain population-based estimates of RSV LRTI hospitalization for children with DS in the first 2years of life. RSV hospitalization data for children with DS at the Children's Hospital Colorado for 2000 through 2006 were used to compare the course and severity of hospitalization of DS LRTI admissions with those of matched control subjects. There were 85 RSV LRTI hospitalizations in 630 children born with DS in Colorado, with 50 having no concurrent underlying conditions identified. Children with DS had a significantly higher risk than did those without DS for being hospitalized with RSV LRTI (OR, 5.99; 95% CI, 6.68-5.38), even in the absence of other underlying conditions (OR 3.5; 95% CI, 3.10-4.12). In the case-control study, children with DS hospitalized for RSV presented more frequently with fever (P = .005), had consolidation reported more often on chest radiography (P = .003), and were given bronchodilator therapy more often during the hospital stay (P = .002). Children with DS have a higher risk of being hospitalized with RSV LRTI even in the absence of coexisting risk factors. They present more often with fever and more often have radiographic consolidation detected on chest radiography.

S65 Early supported discharge scheme (ESDS) for pneumonia & lower respiratory tract infection (LRTI): are there enough suitable patients?

BackgroundDespite the fact that ∼75% of community acquired pneumonia (CAP) is managed in the community, admissions for pneumonia, influenza & LRTI account for more than 2.3 million bed days/yr in...

Lower respiratory tract infections in chronic obstructive pulmonary disease outpatients with tracheostomy and persistent colonization by P. aeruginosa

Outpatients with tracheostomy can be managed with a low risk for severe airways infections despite colonization with pathogenic bacteria. No studies have been focused on chronic obstructive pulmonary disease (COPD), a condition known for recurrent exacerbations. The aim of our study was to verify whether at follow-up in tracheostomized COPD versus other disease outpatients, persistent P. aeruginosa colonization may influence the rate and treatment of lower respiratory tract infections (LRTI) or hospital admissions. Thirty-nine outpatients were considered: 24 were affected by COPD (age 66, 54–78 years, mean, range), 15 by restrictive lung disease (RLD) (57, 41–72 years). During an 18-month follow-up the number of LRTIs were recorded. Bacterial identifications were assessed at baseline and every month for 6 months in bronchial aspirates. The number of LRTI per patient was not significantly different between COPD [37, 1(0–6)] and RLD [18, 1(0–5)], [total, median (range)]. Persistent P. aeruginosa colonized 18 COPD (75%), 12 RLD patients (86%) and was not associated with an increased number of LRTI: 1(0–6) and 1(0–2), respectively. There were no differences in the number of hospital admissions: COPD 0(0–2), RLD 1(0–1), with a significant decrease versus before tracheostomy ( P<0.001). In conclusion, the rate of LRTI and hospital admissions in COPD outpatients with chronic tracheostomy was low, similar to non-COPD patients and independent of P. aeruginosa colonization.

The Influence of Case Mix, Site Selection, and Methods Biases on Costs of Hospitalization For Acute Exacerbations of Chronic Obstructive Airways Disease and Lower Respiratory Tract Infections

Objective To compare costs of hospitalization for lower respiratory tract infection (LRTI) in patients who received antibiotics before admission to those who did not, and in patients with and without underlying chronic obstructive airways disease (COAD) or diabetes mellitus. Methods All hospitalizations in a population of 366,849 residents in Tayside Scotland from 1993 to 1994 were analyzed. Three groups of patients were identified by primary discharge diagnosis in 1993/94 and previous admissions from 1980 to 1992: 1) acute exacerbation of COAD; 2) LRTI plus a secondary diagnosis of COAD or previous admission with COAD; 3) LRTI but no secondary COAD or previous admission with COAD. Setting specific costs were applied (e.g., general medicine, intensive care, geriatrics). Dispensed antibiotic prescribing in the 28 days before admission was identified from all community pharmacies. Nonparametric statistical tests were used. Results Patients with COAD were more likely to have received antibiotics before admission: COAD ( n = 893) 49%; COAD + LRTI ( n = 316) 43%; LRTI only ( n = 822) 33%. Patients who received antibiotics before admission had lower hospital costs than patients who did not. Mean total costs per admission: COAD £1604 versus £1625 ( p = .5); COAD + LRTI £2281 versus £2297 ( p = .5); LRTI only £2365 versus £3233; ( p = .009). Increasing age and diabetes mellitus were associated with higher hospital costs in all three groups. Conclusion Economic models of the value of preventing hospital admissions for COAD or LRTI will be subject to case mix bias unless they adjust for age, community antibiotic use, and comorbidity.