Non-severe Community-acquired Pneumonia Research Articles

A Retrospective Study on Factors Associated with Severe Childhood Community-Acquired Pneumonia

Background and Aim: Globally, community-acquired pneumonia (CAP) is the most common source of mortality among children. Early diagnosis and effective management need the identification of risk factors. The purpose of this study was to characterize the clinical symptoms and investigation of various risk factors for severe CAP in children. Patients and Methods: A retrospective study was conducted on 186 children in the Pediatric Department of Niazi Welfare Teaching Hospital, Sargodha from March 2022 to November 2022. Children with pneumonia who had radiological confirmation were included. Community-acquired pneumonia cases were categorized into two groups: Group-I composed of severe CAP cases whereas Group-II non-severe CAP cases. Baseline characteristics such as age, nutritional status, and gender were collected. Vital signs, fever, duration of symptoms, and physical findings such as chest retraction, cyanosis, wheezing, and nasal faring were clinical data recorded. Laboratory findings such as serum electrolyte, full blood count, and inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were recorded. SPSS version 27 was used for data analysis. Results: Of the total 186 children, there were 74 (39.8%) females and 112 (60.2%) male. Age-wise distribution of patients were as follows: 146 (78.5%) in 0-5 years, 26 (14%) in 6-10 years, and 14 (7.5%) in 11-15 years. Out of 186 children, the incidence of severe and non-severe CAP was 58 (31.2%) and 130 (68.8%) respectively. The most common clinical signs in both categories are fever and cough, followed by reduced appetite, vomiting, and shortness of breath. A seizure is present in 14 (24.1%) severe CAP cases. Based on physical examination, Rhonchi is found in 94 (72.3%) non-severe and 46 (79.3%) severe CAP patients. Among patients with severe pneumonia, over half have chest retractions, but only 22% have non-severe pneumonia. Tachypnea was experienced by approximately 33% of severe pneumonia patients against 14% of individuals with non-severe pneumonia. As inflammatory indicators, ESR and CRP are high in all groups. Conclusion: The present study concluded that a fever persisting for >7 days and an elevation in RR are risk factors for severe pneumonia. Severe pneumonia is also prevented by a normal hematocrit level and BMI. There was a higher rate of severe pneumonia in CAP hospitalizations in children who had fevers lasting longer than seven days as well as tachypnea. According to these findings, RR should be utilized to determine both the severity of pneumonia and the identification of pneumonia. Keywords: Sever community-acquired pneumonia, Risk factors, Childhood pneumonia

Features of laser Doppler flowmetry in patients with bacterial and viral (covid-19) community-acquired pneumonia

Introduction. As a result of the coronavirus infection (COVID-19) pandemic, almost 74.9 thousand people died of pneumonia in Russia in 2021. Community-acquired pneumonia (CAP) is accompanied by a systemic re­sponse of the body to inflammation in the lung tissue and disorder of microhemocirculation. The method of laser Doppler flowmetry (LDF) allows assessing the general parameters of the microcirculatory bed and determining the state of various factors regulating the nutritive flow.Aim. To conduct a comparative analysis of LDF indices in patients with COVID-19- associated and bacterial CAP.Materials and methods. 140 patients were examined, 100 of them with non-severe CAP (main group), and 40 patients with extrapulmonary pathology (comparison group). The main group included 44 people with bacterial CAP and 56 people with COVID-19-associated CAP. Bacteriological studies of sputum were performed; detection of SARS-CoV-2 RNA in swabs from the oropharynx and nasopharynx by PCR, LDF to assess the state of pe­ripheral blood flow was carried out.Results. In patients with COVID-19-associated CAP, compared with patients with bacterial CAP, a decrease in the microcirculation index by 1.26 times (p<0.0005), an increase in the coefficient of variation by 1.11 times (p<0.0005) was found.Conclusion. In patients with COVID-19-associated CAP, compared with patients with bacterial CAP, more significant pathological changes in Dopplerograms were detected, which may indicate more pronounced disorders in the microcirculatory bed in COVID-19-associated CAP caused by exposure to the SARS-COV- 2 virus. Perhaps the established fact can lead to adverse outcomes of the course of the disease.

Doxycycline vs. macrolides in combination with a β-lactam antibiotic for the treatment of community-acquired pneumonia in inpatients.

Hospitalized patients with non-severe community-acquired pneumonia (CAP) are treated with a β-lactam plus either a macrolide or doxycycline. Limited data exist on the effectiveness of the latter combination. Therefore, we aimed to compare the combination of doxycycline vs. macrolide when either is combined with a β-lactam from effectiveness and safety perspectives. This was a retrospective cohort study in CAP inpatients between December 2013 and November 2020. Patients were divided into BL-D (β-lactam plus doxycycline) and BL-M (β-lactam plus a macrolide [azithromycin or clarithromycin]) groups. The primary endpoint was time to clinical stability. Secondary endpoints included length of stay (LOS) and in-hospital mortality. Of 197 patients included, 57 were in the BL-D arm and 140 were in the BL-M arm. Patients were similar at baseline, except for the presence of leukocytosis, risk factors for drug resistance, and duration of therapy (P < 0.05 for all comparisons). No difference in clinical cure rate was observed (94.7% vs. 91.4%; P = 0.43). Time to clinical stability and LOS were similar in both groups at 4 (P = 0.82) and 7days (P = 0.62), respectively. While only three patients died, only one (from the BL-M group) was due to sepsis. Liver enzymes elevation was more prominent in the BL-M group (21.4% vs. 5.3%; P = 0.01). A subgroup analysis showed shorter time to clinical stability with clarithromycin but higher cure rates with azithromycin. Data on doxycycline use with a β-lactam are scarce. Our study showed that such regimen was comparable in effectiveness to regimens involving macrolides with a better safety profile.

Short-Course vs Long-Course Antibiotic Therapy for Children With Nonsevere Community-Acquired Pneumonia

Short-course antibiotic therapy could enhance adherence and reduce adverse drug effects and costs. However, based on sparse evidence, most guidelines recommend a longer course of antibiotics for nonsevere childhood community-acquired pneumonia (CAP). To determine whether a shorter course of antibiotics was noninferior to a longer course for childhood nonsevere CAP. MEDLINE, Embase, Web of Science, the Cochrane Library, and 3 Chinese databases from inception to March 31, 2022, as well as clinical trial registries and Google.com. Randomized clinical trials comparing a shorter- vs longer-course therapy using the same oral antibiotic for children with nonsevere CAP were included. Random-effects models were used to pool the data, which were analyzed from April 15, 2022, to May 15, 2022. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence. Treatment failure, defined by persistence of pneumonia or the new appearance of any general danger signs of CAP (eg, lethargy, unconsciousness, seizures, or inability to drink), elevated temperature (>38 °C) after completion of treatment, change of antibiotic, hospitalization, death, missing more than 3 study drug doses, loss to follow-up, or withdrawal of informed consent. Nine randomized clinical trials including 11 143 participants were included in this meta-analysis. A total of 98% of the participants were aged 2 to 59 months, and 58% were male. Eight studies with 10 662 patients reported treatment failure. Treatment failure occurred in 12.8% vs 12.6% of participants randomized to a shorter vs a longer course of antibiotics. High-quality evidence showed that a shorter course of oral antibiotic was noninferior to a longer course with respect to treatment failure for children with nonsevere CAP (risk ratio, 1.01; 95% CI, 0.92-1.11; risk difference, 0.00; 95% CI, -0.01 to 0.01; I2 = 0%). A 3-day course of antibiotic treatment was noninferior to a 5-day course for the outcome of treatment failure (risk ratio, 1.01; 95% CI, 0.91-1.12; I2 = 0%), and a 5-day course was noninferior to a 10-day course (risk ratio, 0.87; 95% CI, 0.50-1.53; I2 = 0%). A shorter course of antibiotics was associated with fewer reports of gastroenteritis (risk ratio, 0.79; 95% CI, 0.66-0.95) and lower caregiver absenteeism (incident rate ratio, 0.74; 95% CI, 0.65-0.84). Results of this meta-analysis suggest that a shorter course of antibiotics was noninferior to a longer course in children aged 2 to 59 months with nonsevere CAP. Clinicians should consider prescribing a shorter course of antibiotics for the management of pediatric nonsevere CAP.

Risk Factors and Mental Health Status in Patients With Non-Tuberculous Mycobacterial Lung Disease: A Single Center Retrospective Study.

According to the existing data, the incidence and prevalence of non-tuberculous mycobacteria (NTM) are increasing worldwide. The risk factors and mental health status of patients with NTM lung disease are important and deserve our attention. A total of 180 patients with NTM lung disease hospitalized from January 2018 to December 2021 were selected as the NTM group, and 90 patients with non-severe community-acquired pneumonia (CAP) who were hospitalized during the same period were selected as the control group. The Symptom Checklist-90 (SCL-90) was used to assess the mental health status of the patients. The data were analyzed using descriptive statistics, logistic regression, and receiver operating characteristic (ROC) curves. There were no significant differences in age, sex, marital status, or smoking history between the two groups (p > 0.05), but there were significant differences in educational level, underlying diseases, occupation, living environment, and body mass index (BMI) (p < 0.01). According to the classification of basic diseases, bronchiectasis was found in 82 (45.6%) patients, followed by hypertension in 66 (36.7%) patients, and chronic obstructive pulmonary disease (COPD) in 39 (21.7%) patients. The NTM strains were identified M. intercelleulare caused 41 cases (22.8%), followed by Mycobacterium avium and Mycobacterium gordonae, each with 35 cases (19.4%), and Mycobacterium abscessus with 32 cases (17.8%). The SCL-90 found that 160 (88.9%) of 180 patients with NTM lung disease had developed mental health problems, among which the four highest-scoring factors were anxiety (ANX: 29.4%), depression (DEPR: 18.8%), sleep and diet (SD: 16.9%), and somatization (SOM: 11.3%). Through multivariate logistic regression analysis, it was found that educational level, underlying diseases, living environment, and BMI were independent risk factors for the occurrence of NTM lung disease (p < 0.01). The Hosmer–Lemeshow test was used to check the model's fitness. The ROC curve showed that the area under the curve (AUC) was 0.896, the sensitivity was 83.3%, and the specificity was 85.6%. Patients with NTM lung disease have many risk factors and prominent mental health problems that may require interventions during the process of clinical diagnosis and treatment.

Efficacy of Doxycycline for Mild-to-Moderate Community-Acquired Pneumonia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Doxycycline has been recommended as a treatment option for non-severe community-acquired pneumonia (CAP) in adults. We sought to review the evidence for the efficacy of doxycycline in adult patients with mild-to-moderate CAP. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) of doxycycline versus comparator to assess the clinical efficacy. The primary outcome was the clinical cure rate. Random effects model meta-analyses were used to generate pooled odds ratio (OR) and evaluate heterogeneity (I2). Risk of bias (RoB) and quality of evidence (QoE) were evaluated using the Cochrane Risk of Bias 2.0 tool and GRADE methods, respectively. We included 6 RCTs with 834 clinically evaluable patients. The trials were performed between 1984 and 2004. Comparators were 3 macrolides (roxithromycin, spiramycin, and erythromycin) and 3 fluoroquinolones (ofloxacin, fleroxacin, and levofloxacin). Four trials had an overall high RoB. The clinical cure rate was similar between the doxycycline and comparator groups (87.2% [381/437] vs 82.6% [328/397]; OR 1.29 [95% confidence interval {CI}: .73-2.28]; I2 = 30%; low QoE). Subgroup analysis of two studies with a low RoB showed significantly higher clinical cure rates in the doxycyline group (87.1% [196/225] vs 77.8% [165/212]; OR 1.92 [95% CI: 1.15-3.21]; P = .01; I2 = 0%). Adverse event rates were comparable between the doxycycline and comparator groups. The efficacy of doxycycline was comparable to macrolides or fluoroquinolones in mild-to-moderate CAP and thus represents a viable treatment option. Considering the lack of recent trials, it warrants large-scale clinical trials.

Respiratory virus testing and clinical outcomes among children hospitalized with pneumonia.

Despite the increased availability of diagnostic tests for respiratory viruses, their clinical utility for children with community-acquired pneumonia (CAP) remains uncertain. To identify patterns of respiratory virus testing across children's hospitals prior to the COVID-19 pandemic and to determine whether hospital-level rates of viral testing were associated with clinical outcomes. Multicenter retrospective cohort study of children hospitalized for CAP at 19 children's hospitals in the United States from 2010-2019. Using a novel method to identify the performance of viral testing, we assessed time trends in the use of viral tests, both overall and stratified by testing method. Adjusted proportions of encounters with viral testing were compared across hospitals and were correlated with length of stay, antibiotic and oseltamivir use, and performance of ancillary laboratory testing. There were 46,038 hospitalizations for non-severe CAP among children without complex chronic conditions. The proportion with viral testing increased from 38.8% to 44.2% during the study period (p < .001). Molecular testing increased (27.2% to 40.0%, p < .001) and antigen testing decreased (33.2% to 7.8%, p < .001). Hospital-specific adjusted proportions of testing ranged from 10.0% to 83.5% and were not associated with length of stay, antibiotic use, or antiviral use. Hospitals that performed more viral testing did not have lower rates of ancillary laboratory testing. Viral testing practices varied widely across children's hospitals and were not associated with clinically important process or outcome measures. Viral testing may not influence clinical management for many children hospitalized with CAP.

Do we need blood culture stewardship programs? A quality control study and survey to assess the appropriateness of blood culture collection and the knowledge and attitudes among physicians in Swiss hospitals

BackgroundGuidance for blood culture (BC) collection is limited. Inappropriate BC collection may be associated with potentially harmful consequences for the patient such as unnecessary laboratory testing, treatment and additional costs. The aim of the study was to assess the appropriateness of BC collection and related knowledge and attitude of precribers. MaterialsWe conducted a single-center quality control study to assess the appropriateness of BC collection according to the local guidelines in a Swiss university hospital in 2020 by combining three different approaches: point prevalence, patient-individual longitudinal and diseases-related analysis. Second, we conducted a survey regarding BC collection practices and knowledge among physicians in two non-university and one university hospital using an 18-item electronic questionnaire. ResultsWe analyzed 1114 BC collected in 344 patients. Approximately 40% of the BCs were collected inappropriately, in particular in diseases with low pretest probability of bacteremia such as non-severe community acquired pneumonia (CAP). Follow-up blood culture (FUBC) collection was inappropriate in 60%. Growth of a relevant pathogen was more frequently observed in appropriately than in inappropriately collected BCs (18% vs. 3%, p < 0.001). In the survey, uncertainty concerning the need of index BC collection was high in non-severe CAP and uncomplicated cellulitis. ConclusionsAlmost half of the BCs was not collected according to the guidelines, especially in non-severe CAP and in case of FUBCs. Substantial uncertainty among physicians regarding BC ordering practices was identified. The implementation of diagnostic stewardship programs may improve BC collection practices, increase adherence to local guidelines, and may help reducing unnecessary diagnostics and treatment.

Pneumococcal urinary antigen testing for antimicrobial guidance in community-acquired pneumonia–A register-based cohort study

ObjectivesTo evaluate the effect of pneumococcal urinary antigen test (UAT) usage on broad-spectrum antibiotic treatment in community-acquired pneumonia (CAP). MethodsPatients admitted to 32 Swedish hospitals between 2011 and 2014 were retrospectively included from the Swedish National Quality Register of CAP. Using propensity score matched data, stratified by CRB-65 score, we studied the effect of performing UAT and of positive test results on treatment with broad-spectrum β-lactam monotherapy (BSBM) and antibiotics with coverage for atypical bacteria compared to narrow-spectrum β-lactam monotherapy (NSBM). ResultsUAT was performed for 4,995/14,590 (34.2%) patients, 603/4,995 (12.1%) of whom had positive test results. At day three, performing UAT was not associated with decreased use of BSBM (OR 1.07, 95% CI 0.94–1.23) but was associated with increased atypical coverage among patients with CRB-65 score 2 (OR 1.47, 95% CI 1.06–2.02). A positive UAT was associated with decreased BSBM use (OR 0.39, 95% CI 0.25–0.60) and decreased atypical coverage (OR 0.25, 95% CI 0.16–0.37), predominantly in non-severe CAP. At day one, performing UAT was associated with atypical coverage among patients with CRB-65 scores 2 (OR 2.60, 95% CI 1.69–3.98) and 3–4 (OR 3.69, 95% CI 1.55–8.79), and a positive test reduced the odds of BSBM treatment among CRB-65 score 3–4 patients (OR 3.49, 95% CI 1.02–12.0). ConclusionsPerforming UAT had no overall effect on decreasing the use of BSBM treatment by day three of hospitalization, yet non-severely ill patients with positive UAT results were less likely to be treated with BSBM and antibiotics with atypical coverage.

Is a shorter course of antibiotics better for children with CAP?

Results of the SCOUT-CAP randomized clinical trial published in the January 2022 issue of JAMA Pediatrics found that a short 5-day antibiotic treatment course is superior to a standard 10-day regimen for children with non-severe community-acquired pneumonia (CAP) in an outpatient setting. A short 5-day strategy reduced both antibiotic exposure and resistance while presenting a similar clinical response and antibiotic-related adverse effect profile as a standard 10-day course. According to the study, CAP is one of the most common serious infections in pediatric populations, with reports of about 1.5 million ambulatory visits by U.S. children yearly. “It’s critical that we minimize the use of unnecessary antibiotics, both to eliminate the risk of antibiotic adverse effects and slow the progression of antimicrobial resistance, a global public health threat,” said Derek Williams, MD, MPH, lead investigator of the study. Although antibiotics are not always needed, when required it is important to choose the right antibiotic, at the right dose, and only for as long as necessary to effectively treat the infection, said Williams, who is an associate professor of pediatrics at Vanderbilt University School of Medicine. The randomized, double-blind, placebo-controlled clinical trial included 380 healthy children between the ages of 6 months and roughly 6 years with non-severe CAP in 8 U.S. cities between December 2016 and December 2019. They were seen in outpatient clinics, urgent care settings, and emergency departments. Children were only included in the study if they had not experienced the following at time of enrollment based on caregiver reporting: subjective fever or temperature 38.3°C or higher in the previous 24 hours; tachypnea (50 and 40 breaths per minute for children younger than 2 years, and 2 years and older, respectively); and severe cough. Study participants were randomized 1:1 to either receive a 5-day course of matching placebo or an additional 5-day course of the originally prescribed β-lactam antibiotic—including amoxicillin, amoxicillin and clavulanate, or cefdinir—on day 6 of therapy. Dosing for amoxicillin or amoxicillin and clavulanate was 80 to 100 mg/kg a day (maximum 2,000 mg a day) based on the amoxicillin component divided twice daily, and cefdinir dosing was 12 to 16 mg/kg a day (maximum 600 mg a day) divided twice daily. The taste and appearance of the matching placebo was consistent and dosed at the same interval as the original 5-day course therapy. Study participants underwent two in-person outcome assessment visits on study days 6 to 10 and days 19 to 25, respectively. The primary composite endpoint—a ranking of each child’s clinical response, symptom resolution, and antibiotic-associated adverse effects—made up the end-of-treatment response adjusted for duration of antibiotic risk (RADAR) in an ordinal desirability of outcome ranking (DOOR). Participants were then ranked by the number of antibiotic days within each DOOR, with the hypothesis that shorter antibiotic durations were more desirable. RADAR was used to determine the more desirable outcome probability estimate for short- versus standard-course strategy. During the antibiotic resistance analysis, throat swab samples were taken from the oropharyngeal flora of 171 children between days 19 and 25 to assess antibiotic resistance. The research findings showed that a majority of children had an adequate clinical response to both strategies, with fewer than 10% of children experiencing a poor response. The research team found that the short-course strategy had a 69% probability of a more desirable RADAR outcome compared with the standard-course strategy. The antibiotic resistance analysis showed that the range of antibiotic resistance genes per prokaryotic cell (RGPC) was significantly lower in the short-course strategy compared with the standard-course strategy for total RGPC and β-lactamase RGPC, according to the study. “SCOUT-CAP is the first clinical trial to use this innovative trial design, taking into account both the response to and potential side effects of antibiotic therapy,” said C. Buddy Creech, MD, MPH, a professor of pediatrics at Vanderbilt University Medical Center, who was also part of the study. “These data are immediately applicable to frontline clinicians, and we hope it helps to shift the paradigm for childhood pneumonia toward more judicious treatment approaches, resulting in safer and more effective care,” said Williams. Future trials using this approach may allow us to optimize therapy for other infectious diseases in children and adults, said Creech.

Respiratory MUC5B disproportion is involved in severe community-acquired pneumonia

BackgroundMucus production is a process involved in the pathogenesis of Community-acquired pneumonia (CAP). The study is to determine Mucin 5B (MUC5B) protein concentration and its proportion in the bronchoalveolar lavage fluid (BALF) of CAP patients and evaluate its value to help assess disease severity.MethodsA total of 118 patients were enrolled in this cross-sectional study, including 45 with severe CAP (SCAP) and 73 with non-severe CAP (NSCAP). MUC5B concentration in BALF were determined by immunoblotting analysis. Total protein concentration of BALF was detected by Pierce BCA kit. Cytokines IL6, IL10, IFNγ, IL13, and IL17 in BALF were measured using commercial enzyme-linked immunosorbent assay (ELISA). Spearman’s correlation analysis was applied to evaluate the relationships between MUC5B concentration or MUC5B/total protein ratio and the CURB-65 score, as well as cytokines. Logistic regression analysis was used to identify the independent factors associated with severe CAP. Receiver operating characteristic (ROC) curve was used to evaluate the assessment value of MUC5B/total protein ratio and other indexes for CAP severity.ResultsMUC5B concentration in the BALF of NSCAP group was higher than that in SCAP group [NSCAP 13.56 µg/ml (IQR 5.92–25.79) vs. SCAP 8.20 µg/ml (IQR 4.97–14.03), p = 0.011]. The total protein concentration in the BALF of NSCAP group was lower than that in SCAP group [NSCAP 0.38 mg/ml (IQR 0.15–1.10) vs. SCAP 0.68 mg/ml (IQR 0.46–1.69), p = 0.002]. The MUC5B/total protein ratio was remarkably higher in NSCAP group than that in SCAP groups [NSCAP 3.66% (IQR 1.50–5.56%) vs. SCAP 1.38% (IQR 0.73–1.76%), p < 0.001]. MUC5B/total protein ratio was negatively correlated with total protein concentration (rs = − 0.576, p < 0.001), IL6 (rs = − 0.312, p = 0.001), IL10 (rs = − 0.228, p = 0.013), IL13 (rs = − 0.183, p = 0.048), IL17 (rs = − 0.282, p = 0.002) and CURB-65 score (rs = − 0.239, p = 0.009). Logistic regression identified that MUC5B/total protein ratio, IL6 level and CURB-65 score as independent variables related to CAP severity. ROC curve demonstrated best assessment value of MUC5B/total protein ratio for SCAP (AUC 0.803, p < 0.001), with a sensitivity of 88.9% and a specificity of 64.4%.ConclusionsRespiratory MUC5B disproportion is related to CAP severity. MUC5B/total protein ratio may serve as an assessment marker and a potential therapeutic target for severe CAP.

Prognostic Value of Histidine-Rich Glycoprotein for Community-Acquired Pneumonia.

Purpose Histidine-rich glycoprotein (HRG) is abundant in serum and has been implicated in several processes including blood coagulation and immune response. This prospective study is aimed at exploring HRG as a biomarker in patients hospitalized for community-acquired pneumonia (CAP). Methods A total of 160 patients (73 severe CAP, 57 nonsevere CAP), and 30 healthy controls were enrolled in 2019. Demographic and clinical data were recorded for all patients. Serum HRG concentration was measured upon admission using ELISA. Results HRG levels were significantly lower in severe CAP patients compared with other groups, regardless of etiology, and were negatively correlated with serum interleukin-6 and disease severity index scores. Combination of CURB-65, PSI, and APACHE II scores with HRG values significantly improved the accuracy of predicting 30-day mortality in these patients. Cox regression analysis showed that HRG could serve as an independent risk factor for 30-day mortality. Notably, patients with HRG ≤ 16.92 μg/mL had significantly lower cumulative survival than those with HRG > 16.92 μg/mL. Conclusion Serum HRG levels are lower in patients with severe CAP and are negatively correlated with disease severity scores. Measurement of HRG upon admission can provide valuable prognostic information for patients with CAP.

Analysis of antibiotic prescriptions in patients with community-acquired pneumonia in clinical practice

Objective. To analyze new strategies for the treatment of community-acquired pneumonia (CAP) by age and assess treatment efficacy by age category based on real world data. Materials and Methods. A total of 612 patients (medical charts) with CAP treated in 3 hospitals during the 2017–2019 were included in the retrospective pharmacoepidemiological study. A retrospective analysis of antimicrobial therapy (AMT) administration in the treatment of CAP was performed. Results. Duration of hospital stay in CAP patients of young age was 10% shorter than in patients of any other age category. The least frequency (19.6%) of antibiotic combination administration as initial empiric therapy was found in patients of young age. There were no significant differences in frequency of initial AMT administration between age groups. Ceftriaxone, cefepime and cefoperazone were the most common antimicrobials used as monotherapy in all age groups. Ceftriaxone with azithromycin combination was the most common (42%) initial combination therapy in all age groups. The highest number (27) of various antibiotic combinations was administered to old patients, and the lowest number (16) – to young patients. Efficacy of initial AMT was similar between elderly and old patients. Overall efficacy of initial AMT in patients with non-severe CAP and severe CAP was 54% and 50%, respectively. Analysis of antimicrobial treatment of CAP in real practice and its compliance with the current clinical guidelines showed cephalosporin plus macrolide to be a predominant antibiotic combination (83%). Conclusions. Antibiotic combination administration was found to be common in patients with non-severe CAP, whereas initial monotherapy was administered to severe CAP patients. Antibiotic prescription pattern in patient of young age was different from that in any other age groups. CAP had a less severe course in young patients as evidenced by shorter duration of hospital stay, more frequent monotherapy administration and higher efficacy of initial AMT compared to other age categories. There were no prescriptions of the recommended fifth generation cephalosporin (ceftaroline fosamil).

No difference between length of antibiotic course for treatment of pneumonia in children, meta-analysis finds

A shorter course of antibiotics is as effective as a longer course in children with non-severe community-acquired pneumonia (CAP), an analysis of nine randomised controlled trials (RCTs) has concluded. The systematic review and meta-analysis, published in JAMA Pediatrics on 14 November 2022, comprised nine RCTs comparing a shorter course (e.g. three days vs. five to […]

Сравнительная фармакоэпидемиологическая характеристика назначений антибактериальных препаратов, применяемых у больных с инфекцией нижних дыхательных путей в условиях типичной практики г. Курска и г. Кишинева

Objective: to study the structure of medical prescriptions for antibacterial drugs used in patients with various types of infection of the bronchopulmonary system in the conditions of typical practice in Kursk (Russian Federation) and Chisinau (Republic of Moldova). Materials and methods. In order to assess the structure of prescribing various classes of antibacterial agents used to treat patients with infections of the respiratory system, a survey of doctors from medical organizations in Kursk and Chisinau was conducted in the period from October 2019. to January 2020 as a one-time descriptive study. As model diseases are taken: acute bronchitis with purulent sputum, exacerbation of chronic obstructive pulmonary disease with purulent sputum, non-severe community-acquired pneumonia. Results. The leaders in prescription for acute bronchitis with purulent sputum were cephalosporins: in Kursk, their share was 24% (cefixime was most often prescribed), and in Chisinau, 26.8% (leaders were cefixime and ceftriaxone). In patients with exacerbation of chronic obstructive pulmonary disease and purulent sputum, doctors from both cohorts also more often recommended cephalosporins: 29.4% and 36.1% for Kursk and Chisinau, respectively; among them, cefixime, ceftriaxone and cefotaxime were leaders in Kursk, while ceftriaxone, cefotaxime and cefuroxime axetil were the priorities in Chisinau. For non-severe community-acquired pneumonia, doctors in Kursk preferred macrolides (more often - azithromycin and clarithromycin), inhibitor-protected penicillins (more often - amoxicillin/clavulanate) and cephalosporins (mainly of the 3rd generation), in Chisinau, cephalosporins (mainly of the 3rd generation) and penicillins (including inhibitor-protected) were more often prescribed, the proportion of macrolides was significantly less. Conclusion. Doctors from Chisinau and Kursk implement pharmacotherapy for this group of patients in accordance with modern clinical guidelines; at the same time, cases of irrational use of certain medicines are recorded.

33. Evaluating the Safety and Effectiveness of a Non-Severe Community-Acquired Pneumonia Pharmacist Pathway

BackgroundOne of the main roles of the SSM Health WI Regional Antimicrobial Stewardship Program is to create infection treatment pathways based on the Infectious Diseases Society of America (IDSA) practice guidelines. Treatment pathways are used to guide provider prescribing of antimicrobials for disease states such as community-acquired pneumonia (CAP). The objective of this study was to evaluate the safety and effectiveness of a non-severe CAP pharmacist pathway based on the updated IDSA and American Thoracic Society 2019 CAP practice guideline.MethodsA retrospective chart review was performed on all patients placed on the non-severe CAP pharmacist pathway at SSM Health St. Mary’s Hospital in Madison, WI from September 2020 through April 2021. Patients who initially started on the pathway were removed if they met prespecified criteria (Table 1). The primary outcome in this study was 30-day respiratory-related readmission rate. Secondary outcomes included average total length of antibiotic therapy, pharmacist interventions [intravenous (IV) to oral (PO) conversion, antibiotic de-escalation (including discontinuation of azithromycin with negative legionella urinary antigen), duration of therapy], and 30-day all-cause readmission rate. Table 1. Criteria for Removal from the Pathway Figure 1. Pharmacist Interventions ResultsA total of 119 patients were initiated on the non-severe CAP pharmacist pathway, of which 47 patients (40%) completed the pathway and 72 patients (60%) were removed from the pathway. Of the 47 patients who completed the pathway, there were no respiratory-related readmissions with a 30-day all-cause readmission rate of 6.4% (N=3/47). The average total duration of beta-lactam therapy was 6.8 days and the average total duration of macrolide therapy was 1 day due to de-escalation with a negative legionella urinary antigen result. A total of 61 pharmacist-driven interventions were completed [IV to PO conversion (N=15), de-escalation (N=27), and duration of therapy (N=19)]. Table 2. Summary of Results ConclusionThe findings of this study suggest that implementation of a non-severe CAP pharmacist pathway is safe and effective. No readmissions were related to non-severe CAP management and pharmacists completed guideline-driven interventions related to antimicrobial de-escalation, IV to PO conversion, and duration of therapy. Disclosures All Authors: No reported disclosures

Incidence and Risk Factors of Acute Kidney Injury in Patients Hospitalized with Pneumonia: A Prospective Observational Study.

Background: Acute kidney injury (AKI) is frequent in hospitalized patients with critical illness and presents in up to one-quarter of patients with non-severe community-acquired pneumonia (CAP), resulting in increased short and long-term mortality. There is a paucity of literature from resource-limited settings regarding the incidence and risk factors for AKI in patients with CAP. In this study, we looked at the incidence and risk factors for AKI in patients hospitalized with CAP in a resource-limited setting Methods: This prospective observational study conducted over 1 year period included patients ≥ 18 years of age diagnosed with CAP admitted to a tertiary care center. The differences in baseline characteristics between hospitalized CAP patients with and without AKI; and risk factors for AKI and the need for renal replacement therapy (RRT) were analyzed using Chi-square test, t-test, Mann-Whitney U test, and logistic regression with p-value <0.05 considered statistically significant. Results: We observed 27.6 % (58/210) of patients had AKI in our study. Patients with AKI had significantly higher baseline comorbidities of chronic kidney disease (p=0.005) and coronary artery disease (p=0.032), and significantly higher uric acid (p=0.002), lower albumin (p=0.005), lower total protein (p=0.015), higher bilirubin (p=0.001), higher LDH (p=0.041), and higher CURB-65 score (p<0.001) in addition to elevated creatinine, BUN (p<0.001) compared to the no-AKI group. The patient group requiring RRT had significantly more males (p=0.019), with significantly higher phosphorus (p=0.038), lower ALT (p=0.022), and expectedly higher creatinine (p<0.001) and blood urea nitrogen (p=0.016). The adjusted logistic regression analysis revealed that patients with higher CURB-65 scores were at increased odds of undergoing RRT (OR 8.74, 95% CI 5.27 to 12.21, p=0.039). Conclusion: There is a high incidence of AKI in patients hospitalized for CAP in developing countries. Clinicians should be alert for the prevention and early detection of AKI in CAP patients.

Biomarker Value in the Diagnosis of Community-Acquired Pneumonia with Concomitant Chronic Heart Failure.

The diagnosis of community-acquired pneumonia (CAP) with chronic heart failure (CHF) is associated with objective difficulties. Our case–control study aims to establish whether established serum inflammatory biomarkers are relevant to the diagnosis of CAP in patients with CHF. Seventy inpatients with previously diagnosed CHF and suspected non-severe CAP were recruited and then stratified into two subgroups with confirmed and rejected diagnosis of CAP. C-reactive protein (CRP), procalcitonin (PCT), tumor necrosis factor α (TNFα), interleukin-6 (IL-6) and brain natriuretic peptide (BNP) were measured. The value of biomarkers was determined using logistic regression, and their discriminatory efficacy was assessed by analyzing receiver operating characteristic (ROC) curves. Significantly higher levels of CRP 50.0 (35.5–98.5) mg/L, PCT 0.10 (0.05–0.54) ng/mL and IL-6 46.1(21.4–150.3) pg/mL in cases were identified as compared to the control group—15.0 (9.5–25.0) mg/L, 0.05 (0.05–0.05) ng/mL and 13.6 (9.5; 25.0) pg/mL, respectively. The Area Under the ROC Curve (95% CI) was the highest for CRP—0.91 (0.83–0.98), followed by PCT—0.81 (0.72–0.90) and IL-6—0.81 (0.71–0.91). A CRP value of >28.5 mg/L had an optimal sensitivity and specificity ratio (85.7/91.4%). In conclusion, the measurement of serum CRP, PCT and IL-6 levels can be useful for the diagnosis of CAP in patients with CHF. CRP showed optimal diagnostic utility in this population.

Analysis of the selection of antimicrobial drugs for community-acquired pneumonia by final year medical students

Currently bacterial community-acquired pneumonia (CAP) remains one of the important problems of providing medical care on an outpatient basis. Despite the high detection rate and modern methods of treatment this disease holds the first place among the causes of death in the category of infectious diseases. Knowledge about rational use of drugs is obtained in higher medical school and subsequently serves as a basis for further work of a practicing physician. Purpose of the study: to analyze the knowledge of final year medical students in the field of rational choice of antimicrobial agent (AMA) in the treatment of non-severe CAP in outpatient setting in patient without concomitant diseases and risk factors. Total 240 final year students of A.I. Yevdokimov Moscow State University of Medicine and Dentistry were offered in February-April, 2019 to indicate their preferred AMA for a young previously healthy patient with mild CAP. The study involved 178 women (74.17 %) and 62 men (25.83 %). The average age of the respondents was 24.8+3.3 years. There were 271 options for the appointment of AMA with 152 (56.1 %) given by the international nonproprietary name and 119 (43.9 %) by trade name. Remarkably, the AMAs which are recommended for the treatment of mild CAP on an outpatient basis, accounted only for 46.2 % in this study. Of particular concern is the fact that only about 40—50 % of AMA prescribing for CAP by medical graduates is in line with current clinical guidelines. The inappropriate choice of a drug in this particular situation not just increases the drug load, the cost of pharmacotherapy and the risk of side effects, but also directly affects the results of treatment. This situation emphasizes the need for a purposeful formation of a personal formulary of medicines for a graduate of a medical university, taking into account the basic principles of rational pharmacotherapy and the provisions of clinical guidelines relevant to the Russian Federation.

Clinical and epidemiological features of community-acquired pneumonia during an epidemic of respiratory viral infection

Community-acquired pneumonia (CAP) is one of the most common lower respiratory tract diseases. An increase in the CAP incidence has been reported to be associated with epidemics of acute respiratory viral infections (ARVI).Aim. Аssess clinical and epidemiological features of CAP in patients admitted to hospital during an ARVI epidemic.Methods. A cross-sectional study included 208 patient records. Medical history, physical examination, laboratory and imaging data were analyzed. CAP severity was assessed by CRB-65 scale and the systemic inflammatory response syndrome (SIRS) criteria.Results. Most CAP patients (75%) were of active working age; all presented signs of ARVI upon admission. Nasal mucosa diagnostic smears have revealed type A influenza viruses: H1N1 – 5 (83.3%) and H3N2 – 1 (16.7%) cases. 195 (93.8%) patients were not vaccinated against influenza. X-rays showed that unilateral (81.7%) and lobular pneumonia (55.8%) were the most common CAP types. 93.2% patients had nonsevere CAP, according to CRB-65. But 88 (42.3%) subjects qualified for SIRS upon admission. Concomitant conditions as risk factors of an adverse course of CAP were present in 89 patients (42.8%). Sputum analysis, if available, most frequently identified Streptococcus pneumoniae (23 cases or 38.9%) as a causative agent. Antibacterial drugs (ABD) used to treat CAP were ceftriaxone 206 (99%), macrolides 188 (90.4%), and fluoroquinolones 94 (45.2%). The initial antibacterial treatment regimens were: 186 (89.4%) prescriptions of ceftriaxone + macrolides, 16 (7.7%) prescriptions of ceftriaxone alone, and 6 (2.9%) prescriptions of levofloxacin. A switch between ABDs was reported in 78 (37.5%) cases, including 61 switches to fluoroquinolones. The median ABD administration duration was 10 (8 – 13) days.Conclusion. Most of the hospitalized CAP patients were of working age and not vaccinated against influenza. Streptococcus pneumoniae was the most common causative agent. PCR (polymerase chain reaction) smear analysis was performed only in 6 patients with ARVI, which does not allow us to assess the role of viruses and viral-bacterial associations in the etiology of CAP. In spite of non-severe CAP, all hospitalizations were justified, due to multiple risk factors of unfavorable prognosis of CAP and epidemiological factors. Most patients received a combination of generation 3 cephalosporins and macrolides as the initial therapy for CAP.