Pneumonia Patient Outcomes Research Articles

Main pulmonary artery diameter related to pneumonia severity.

The diameter (mPAD) of the main pulmonary artery (pulmonary artery trunk) is a crucial indicator for cardiovascular health and prognoses in various conditions. Its enlargement is associated with increased mortality and severity in COVID-19-related pneumonia. However, its relevance to non-COVID pneumonia remains uncertain. The aim of this study was to establish an association between mPAD and the severity of non-COVID pneumonia. Eligible participants with qualified Chest Computed Tomography scans from November 2019 to February 2023 were recruited to a cross-sectional retrospective study. They were stratified into pneumonia and non-pneumonia cohorts. Exclusion criteria included pulmonary hypertension, polytrauma, lung neoplasia, or a history of pulmonary stenosis repair. The mPAD was measured in both groups, and medical records were reviewed to identify comorbidities. Pulmonary CT data were classified by pattern and severity, and the mPAD was measured perpendicularly to the long axis of the artery at the point of bifurcation on an axial slice. Analysis of 380 CT scans (52.6% men, 47.4% women; mean age 52.88 ± 17.58) revealed a significant difference in mPAD between pneumonia and non-pneumonia cases (mean difference: 1.19 mm, 95% CI [0.46, 1.92], p = 0.001). Age correlated positively with mPAD (r = 0.231, 95% CI [0.028, 0.069], p < 0.0001), and this correlation persisted after adjusting for confounders (r = 0.220, 95% CI [0.019, 0.073], p = 0.001). Ordinal logistic regression indicated 1.28 times higher odds of severe pneumonia with a larger diameter. The study highlights associations between mPAD, pneumonia, and severity, suggesting clinical relevance. Furthermore, the mPAD should be carefully considered in defining severity criteria for adverse outcomes in pneumonia patients. Further research is needed to refine clinical criteria on the basis of these findings.

Relationship Between SpO2/FiO2 Ratio to Community Acquired Pneumonia Patient Outcomes at Kolonel Abunjani Bangko General Hospital

Background: Acute lower respiratory tract infection causes high morbidity and mortality, which can be found in the form of pneumonia. Community acquired pneumonia (CAP) severe pneumonia can lead to acute respiratory distress. To diagnose acute respiratory disorders, namely Acute Lung Injury (ALI) and Acute Respiratory Stress Syndrome (ARDS), the ratio PaO2/FiO2 is used. This requires invasive action by taking an arterial blood sample, which is expensive and not available in all health facilities. An alternative is pulse oximetry, which measures the SpO2/FiO2 ratio and is available in health facilities. It is inexpensive and non-invasive. This study aims to determine the relationship between SpO2 and FiO2 with the outcome of community pneumonia patients at Kolonel Abunjani Bangko Hospital. Method: The study design was a retrospective descriptive cross-sectional design. The research subjects were a total sampling of medical record data from inpatients with community acquired pneumonia for the period January-December 2022. The study variables included gender, age, SpO2/FiO2 ratio, and outcomes of pneumonia patients. Univariate and bivariate statistical tests were used to analyze the data. Results: In this study, there were 43 subjects who met the inclusion criteria. The distribution of inpatient community acquired pneumonia patients, especially in the gender was mostly male (67.4%), the highest age was 56–65 years and &gt;65 years (both 37.2%), the median SpO2 was 94% (36-99%), the median SpO2/FiO2 ratio was 447 (171-471%), the highest outcomes were alive patients (36 patients). The ratio of SpO2/FiO2 &gt;316 was the majority (33 patients). Based on the relationship between the SpO2/FiO2 ratio and the outcome of CAP with alive outcome was a SpO2/FiO2 ratio &gt;236 was more numerous than SpO2/FiO2 ratio &lt;236 with value of P=0.0005. Conclusion: There is a significant relationship between the SpO2/FiO2 ratio and the outcome of community acquired pneumonia patients at Kolonel Abundjani Hospital Bangko.

412. Comparison of Outcomes in Pneumonia Patients Hospitalized with COVID-19 and Influenza in Connecticut, 2015-2020

Abstract Background Since the start of the Coronavirus Disease 2019 (COVID-19) pandemic, comparisons between hospitalized COVID-19 and influenza patients diagnosed with pneumonia are scarce. The objective of this study was to compare characteristics and outcomes among the two. Methods Cases for this analysis came from FluSurv-NET and COVID-NET, population-based surveillance platforms of the Connecticut Emerging Infections program for laboratory-confirmed influenza and COVID-19 hospitalizations. FluSurv-NET pneumonia cases occurred during 4 seasons (2015-16 – 2018-19), COVID-NET cases occurred during March-December 2020. Chart reviews were completed for all FluSurv-NET cases and a sample of all COVID-NET cases. Pneumonia was defined as having radiographic key terms on chest x-ray/CT and a discharge diagnosis of pneumonia in the medical record. Outcomes used for comparison included length of stay, intensive care unit (ICU) admission, death, and the following 3 discharge diagnoses: acute respiratory distress syndrome (ARDS), respiratory failure and sepsis. Results A total of 1361 pneumonia cases were identified, 652 from COVID-NET (COVID-19 pneumonia[C-19-pna]) and 709 from FluSurv-NET (Influenza pneumonia [I-pna]). C-19-pna cases had a longer median length of stay compared to I-pna cases (9 days vs 5 days; p&amp;lt; .001) and were more likely to have a diagnosis of acute respiratory failure (64% vs 26.3%, p&amp;lt; .001) across all adult age groups (≥18 years). C-19-pna cases were also more likely to die and have an ARDS diagnosis compared to I-pna cases (25% vs 6.1%, p&amp;lt; .001; 10.8% vs 1.7%, p&amp;lt; .001 respectively); this was observed across age groups ≥ 50 years (p &amp;lt; .001). C-19-pna cases ≥65 years were more likely to be admitted to the ICU compared to I-pna cases ≥65 years (35.8% vs 22.2%, respectively p&amp;lt; .001). Conversely, a greater proportion of I-pna cases ≥65 years had a sepsis diagnosis compared to C-19-pna cases in the same age group (24% vs 16.9%, respectively p&amp;lt; .001). Conclusion C-19-pna cases were younger, more obese and had more chronic metabolic disease than I-pna cases. I-pna cases were more likely to have chronic lung disease and be immunocompromised than C-19-pna cases. C-19-pna resulted in a significantly longer median length of stay, greater in-hospital mortality, and greater morbidity. Disclosures All Authors: No reported disclosures

RATIONALITY EVALUATION OF ANTIBIOTIC USE IN PEDIATRIC PNEUMONIA AT HOSPITALS IN INDONESIA

Indonesia is a developing country that has high morbidity and mortality rates due to infectious diseases, one of which is pneumonia. This study aims to describe the use of antibiotics, to determine the rationality of antibiotic use using the Gyssens method, and to determine the relationship between the rationality of antibiotic use on the therapeutic outcomes of pediatric pneumonia patients in one of the public hospitals and private hospitals in Indonesia without PPRA at the same time. This study is a cross sectional study with retrospective data collection from the patient's medical record. The analysis was carried out descriptively and analytically with the Chi-square method to see the relationship between rational use of antibiotics and therapeutic outcomes. A single antibiotic which is generally used in one of the hospitals and private hospitals in Indonesia is Ampicillin. In addition, antibiotics that are often prescribed are Ceftriaxone and Cefotaxim). The use of antibiotics in Public Hospitals found 83 irrational use of antibiotics (81,4%) and 75 total uses of antibiotics (86,2%) in Private Hospitals. Irrational category III A (long duration) mostly occurs in two hospitals. The results of the research on the relationship between rationality and therapeutic outcome were analyzed by Chi-square. The results showed that the rationality of empirical antibiotic therapy significantly improved therapeutic outcomes (p=0.008) in one of the hospitals in Indonesia. The results of research conducted in one of the Indonesian private hospitals obtained p value = 0,153.

Clinical and microbiological impact of syndromic pneumonia molecular testing in intensive care: A before and after study

• Molecular testing for respiratory pathogens provided quicker diagnosis in intensive care. • No effect was seen on length of stay. • A non significant reduction in all antibiotic use, with a significant decrease in macrolide usage was seen. Pneumonia is one of the most common diagnoses in ICU and carries high mortality rates, as well as significant healthcare costs. Microbiological diagnosis allows targeting of antimicrobial therapy, which is known to improve patient outcomes. Standard culture of sputum samples has limitations due to time required to obtain results. BioFire offers a syndromic panel of multiplex PCR to identify pathogens rapidly. This study evaluated patient outcomes relating to ICU admission, antimicrobial management and complications. The study analysed admission details of radiologically confirmed pneumonia patients admitted to ICUs in Hull Hospitals between 1st August and 31st December 2018 and 2019, before and after the introduction of BioFire testing. The review identified 139 and 120 patients in 2018 and 2019 periods respectively, who had radiologically confirmed pneumonia and sputum samples sent to the laboratory. No statistical difference was seen in the length of ITU admission or the duration of mechanical ventilation between the cohorts as a whole. However, sub-group analysis revealed a decrease in length of stay of 5.6 days in hospital and ventilator acquired pneumonias. We observed a reduction in time to change of antibiotics of 1.81 days (p < 0.001) after introduction of BioFire. Furthermore, we identified discrepancies when using BioFire, allowing for identification of additional pathogens in 23 patients not seen on standard culture. Rapid molecular diagnostics allow for a timelier antimicrobial therapy adjustment as well as ensuring appropriate infection control measures. Syndromic PCR-based testing shows potential for improving patient outcomes in pneumonia patients requiring ICU admission.

Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

BackgroundLittle is known in distinguishing clinical features and outcomes between coronavirus disease-19 (COVID-19) and influenza (FLU).Materials/methods Retrospective, single-centre study including patients with COVID-19 or FLU pneumonia admitted to the Intensive care Unit (ICU) of Policlinico Umberto I (Rome). Aims were: (1) to assess clinical features and differences of patients with COVID-19 and FLU, (2) to identify clinical and/or laboratory factors associated with FLU or COVID-19 and (3) to evaluate 30-day mortality, bacterial superinfections, thrombotic events and invasive pulmonary aspergillosis (IPA) in patients with FLU versus COVID-19.ResultsOverall, 74 patients were included (19, 25.7%, FLU and 55, 74.3%, COVID-19), median age 67 years (58–76). COVID-19 patients were more male (p = 0.013), with a lower percentage of COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) (p = 0.001 and p = 0.037, respectively) than FLU. SOFA score was higher (p = 0.020) and lymphocytes were significantly lower in FLU than in COVID-19 [395.5 vs 770.0 cells/mmc, p = 0.005]. At multivariable analysis, male sex (OR 6.1, p < 0.002), age > 65 years (OR 2.4, p = 0.024) and lymphocyte count > 725 cells/mmc at ICU admission (OR 5.1, p = 0.024) were significantly associated with COVID-19, whereas CKD and COPD were associated with FLU (OR 0.1 and OR 0.16, p = 0.020 and p < 0.001, respectively). No differences in mortality, bacterial superinfections and thrombotic events were observed, whereas IPA was mostly associated with FLU (31.5% vs 3.6%, p = 0.0029).ConclusionsIn critically ill patients, male sex, age > 65 years and lymphocytes > 725 cells/mmc are related to COVID-19. FLU is associated with a significantly higher risk of IPA than COVID-19.

Clinical Features and Risk Factors Associated With 30-Day Mortality in Patients With Pneumonia Caused by Hypervirulent Klebsiella pneumoniae (hvKP).

BackgroundReports on metastatic or invasive infections by hypervirulent Klebsiella pneumoniae (hvKP) have increased recently. However, the effects of its virulence on clinical course and outcomes in pneumonia patients have rarely been addressed. We assessed and compared the clinical features of hvKp and classic K. pneumoniae (cKP) strains isolated from patients with pneumonia caused by K. pneumoniae. We also investigated the effects of virulence factors and the K. pneumoniae capsular serotypes K1 and K2 on mortality.MethodsIn this retrospective study, we enrolled 91 patients diagnosed as having pneumonia caused by K. pneumoniae and obtained their demographic and clinical data from medical records. We evaluated genes for K1 and K2, antimicrobial susceptibility, and the virulence genes rmpA, iutA, entB, ybtS, kfu, mrkD, and allS. Strains that possessed rmpA and iutA were defined as hvKP (N=39), while the remaining were classified as cKP (N=52). Odds ratio (OR) for the risk factors associated with 30-day mortality was calculated using the binary logistic regression model.ResultsThe 30-day mortality in all patients was 23.1%; it was 17.9% (7/39) in the hvKP group and 26.9% (14/52) in the cKP group (P=0.315). Bacteremia (OR=38.1; 95% confidence interval [CI], 2.5–570.2), altered mental status (OR=8.8; 95% CI, 1.7–45.0), and respiratory rate >30 breaths/min (OR=4.8; 95% CI, 1.2–20.0) were independent risk factors for 30-day mortality in all patients.ConclusionsOur results suggest that hypervirulence determinants do not have a significant effect on 30-day mortality in patients with pneumonia caused by K. pneumoniae.

Systemic Inflammatory Response and Outcomes in Community-Acquired Pneumonia Patients Categorized According to the Smoking Habit or Presence of Chronic Obstructive Pulmonary Disease.

The systemic inflammatory response (SIR) may help to predict clinical progression, treatment failure, and prognosis in community-acquired pneumonia (CAP). Exposure to tobacco smoke may affect the SIR; the role of smoking in CAP has not been consolidated. We evaluated the SIR and outcomes of hospitalized CAP patients stratified by smoking habits and the presence of COPD. This retrospective analysis was conducted at the Hospital Clinic of Barcelona. Baseline, clinical, microbiological, and laboratory variables were collected at admission, using C-reactive protein (CRP) levels as a marker of SIR. The study outcomes were pleural complications, hospital stay, non-invasive and invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission. We also considered the in-hospital and 30-day mortality. Data were grouped by smoking habit (non-, former-, and current-smokers) and the presence of COPD. Current smokers were younger, had fewer comorbidities, and fewer previous pneumonia episodes. CRP levels were higher in current smokers than in other groups. Current smokers had a higher risk of pleural complications independent of CRP levels, the presence of pleuritic pain, and a higher platelet count. Current smokers more often required IMV and ICU admission. Current smokers have a greater inflammatory response and are at increased risk of pleural complications.

Review on the role of pidotimod in recurrent respiratory infections in children

Background: Physiological immaturity of the immune system is the most common cause of recurrent respiratory infections (RRIs) in children. Drugs acting on the immunological pathways such as immunostimulants can be a very useful approach in the management of RRIs in children. Pidotimod (PDT) is an immunostimulant that acts on both innate and adaptive immunity. The immunostimulant activity of PDT has been firmly established in the management of RRIs in children with or without asthma. Objectives: This review was performed to summarize the available literature on the correlation of immunity and RRIs and current evidence of PDT in RRIs and pneumonia in children. Methodology: The literature search was performed in PubMed and Google Scholar databases using search terms such as pidotimod, children, RRIs, and pneumonia. Results: A total of 18 clinical studies with 10,704 children were included in this review. This includes 13 randomized controlled trials, two meta-analysis, and two observational studies. This review of current clinical evidence demonstrates that when added to the standard of care, PDT significantly reduces the number of recurrences of RRIs, severity, and duration of acute episodes in children and is safe in its prevention and treatment. This ultimately results in reduced visits to pediatric clinics and lesser absenteeism from school. It is also effective in improving the clinical outcomes in pneumonia patients. Conclusion: Pidotimod is effective and safe in the prevention and treatment of RRIs in children.

The limited impact of psychiatric disease and psychotropic medication on the outcome of hospitalization for pneumonia.

Psychotropic medicine has been suggested to be a risk factor for the onset of pneumonia, especially aspiration pneumonia. However, the impact of coexisting psychiatric disease and psychotropic medication on the outcomes of pneumonia patients in the respiratory care unit setting is less well-known. We conducted a single-centre retrospective study of 209 consecutive patients who were hospitalized due to pneumonia. Using the patients' records, coexisting psychiatric diseases and the use of psychotropic medicines were reviewed to examine their association with the clinical course of inpatients with pneumonia. Psychotropic medicines, including agents for insomnia, were used in 73 (34.9%) patients, and there were 35 (16.9%) patients who had psychiatric disease. Among the 12 (5.7%) fatal cases, 4 patients were treated with psychotropic medicines, all of which were agents for insomnia. However, the rate of psychotropic medicine usage in the fatal cases (33.3%) was equivalent to that of the survivors (35%, p=0.905), and the coexistence of psychiatric disease did not affect survival. The median duration of hospitalization was 15 days. The duration of hospitalization of the patients who received psychotropic medicines (median: 17 [range: 7-89] days) was also equivalent to that of the other patients (14 [2-55] days, p=0.081). While the present study was a single-centre study and had a small population, coexisting psychiatric disease and psychotropic medicine use did not have a strong impact on the outcomes of pneumonia patients who were hospitalized in the respiratory unit of a university hospital. Further prospective studies targeting a larger cohort are needed.

419: JCAHO-CMS PN-5b: Does Compliance With the 4-Hour Antibiotic Rule Affect Outcomes in Pneumonia Patients?

419: JCAHO-CMS PN-5b: Does Compliance With the 4-Hour Antibiotic Rule Affect Outcomes in Pneumonia Patients?

The effect of community-acquired pneumonia on plasma esterases in older people.

Pneumonia is a major cause of morbidity and mortality in older people. The poor outcome of older pneumonia patients despite treatment is still not understood. The aim of this study was to examine the effect of community-acquired pneumonia on enzymes of drug metabolism in older people. Fifteen patients (median age 67 years) with a clinical and radiological diagnosis of community-acquired pneumonia and 14 healthy volunteers matched for age and gender (median age 75 years) were recruited. Plasma activities of benzoylcholinesterase, butyrylcholinesterase, acetylcholinesterase and aspirin esterase were determined spectrophotometrically at three time points in pneumonia patients--within 24 h of admission to hospital, 2 days later and 10 days later. Monocyte aryl hydrocarbon hydroxylase (AHH) activity was determined spectrofluorimetrically at the same time points. Enzyme activities were measured at one time point in healthy controls. Mean plasma benzoylcholinesterase activity was significantly lower in pneumonia patients on admission to hospital (mean +/- SEM 848 +/- 100) and after 10 days of treatment (mean +/- SEM 925 +/- 114) than in healthy controls (mean +/- SEM 1333 +/- 84, P < 0.05). Similarly, plasma acetylcholinesterase activity was significantly lower in pneumonia patients on admission (P = 0.007) and after 10 days of treatment (P = 0.01) than in controls. Butyrylcholinesterase activity was lower in pneumonia patients on admission (P = 0.029) than in healthy controls, but improved slightly after treatment so there was no longer a significant difference at 10 days compared with controls (P = 0.077). In contrast there were no significant differences in plasma aspirin esterase activity or induced monocyte AHH activity between pneumonia patients and healthy controls. The activities of benzoylcholinesterase (r = -0.536, P = 0.04), butyrylcholinesterase (r = -0.638, P = 0.01), acetylcholinesterase (r = -0.583, P = 0.022) and aspirin esterase (r = -0.624, P = 0.013) correlated inversely with the British Thoracic Society pneumonia poor prognostic index. The activities of several esterases are reduced in older pneumonia patients. Other enzymes including aspirin esterase and induced monocyte AHH activity are unaltered in pneumonia. There was a significant inverse relationship between the activities of all esterases studied and the British Thoracic Society pneumonia poor prognostic index.