Hospital Admissions For Pneumonia Research Articles

Extreme temperatures increase the risk of pediatric pneumonia: a systematic review and meta-analysis.

The impact of climate change on ambient temperatures threatens to worsen pediatric pneumonia-related outcomes considerably. This study examined the associations of temperature variation and extreme temperature with pediatric pneumonia-related events using a meta-analysis. We systematically searched PubMed, Medline, Embase, and Web of Science databases for relevant literature, and the quality of evidence was assessed. Fixed and random-effects meta-analyses were performed to calculate the pooled relative risks (RRs) of the associations with pneumonia-related events. We observed that a 1°C temperature variation increased the RR of pneumonia events by 1.06-fold (95% confidence interval (CI): 1.03-1.10). A 1°C temperature variation increased the RR by 1.10-fold of the pediatric pneumonia hospital admissions (95% CI: 1.00-1.21) and 1.06-fold of the pediatric pneumonia emergency department visits (95% CI: 1.01-1.10). Extreme cold increased the RR by 1.25-fold of the pediatric pneumonia events (95% CI: 1.07-1.45). A 1°C temperature variation increased the RR of pneumonia events in children by 1.19-fold (95% CI: 1.08-1.32), girls by 1.03-fold (95% CI: 1.02-1.05), and in temperate climate zones by 1.07-fold (95% CI: 1.03-1.11). Moreover, an increase in extreme cold increased the RR of pneumonia events in children by 2.43-fold (95% CI: 1.72-3.43), girls by 1.96-fold (95% CI: 1.29-2.98) and in temperate climate zones by 2.76-fold (95% CI: 1.71-4.47). Our study demonstrated that pediatric pneumonia events are more prevalent among children, particularly girls, and individuals residing in temperate climate zones. Climate change represents an emergent public health threat, affecting pediatric pneumonia treatment and prevention.. PROSPERO (CRD42022378610).

Incidence of community-acquired pneumonia hospitalisation in persons with bronchiectasis during the COVID-19 lockdown in Denmark: a retrospective cohort study

BackgroundPersons with bronchiectasis have a high risk of community-acquired pneumonia. Social distancing measures, implemented to prevent the spreading of SARS-CoV-2, could potentially reduce the incidence of other infectious diseases.Research questionWas...

Readmission following hospital admission for community-acquired pneumonia in England

IntroductionReadmission rates following hospital admission with community-acquired pneumonia (CAP) have increased in the UK over the past decade. The aim of this work was to describe the cohort of patients...

Impact of National Tobacco Control Policy on Rates of Hospital Admission for Pneumonia: When Compliance Matters.

A number of studies claim that tobacco control (TC) regulations are associated with reductions in smoking-related hospitalisation rates, but very few have estimated the impact of TC laws (TCL) at both countrywide and regional levels, and none of them have studied the impact of TCL in relation to compliance with TC regulations. This study evaluates the effects of Russian TCL on hospital admission (HA) rates for pneumonia countrywide and in 10 Russian regions and the extent of these effects in connection with the compliance with TCL. Methods: HA rates for pneumonia from 2005-2019 were analysed to compare the periods before and after the adoption of TCL in 2013. An interrupted time series design and a Poisson regression model were used to estimate the immediate and long-term effects of TCL on pneumonia annual hospitalisation rates after the TCL adoption, compared with the pre-law period. The 10 Russian regions were compared using the TCL implementation scale (TCIS) developed on the basis of the results of the Russian TC policy evaluation survey; Spearman's rank correlation and linear regression models were employed. Results showed a 14.3% reduction in HA rates for pneumonia (RR 0.88; p = 0.01) after the adoption of TCL in Russia with significant long-term effect after 2013 (RR 0.86; p = 0.006). Regions with better enforcement of TCL exhibited greater reductions in pneumonia HA rates (rsp = -0.55; p = 0.04); (β = -4.21; p = 0.02). Conclusions: TCL resulted in a sustained reduction in pneumonia hospitalisation rates, but these effects, varying by region, may depend on the scale of the TCL enforcement.

Risk stratification of hospital admissions for COVID-19 pneumonia by chest radiographic scoring in a Johannesburg tertiary hospital.

Chest radiographic scoring systems for COVID-19 pneumonia have been developed. However, little is published on the utilityof these scoring systems in low- and middle-income countries. To perform risk stratification of COVID-19 pneumonia in Johannesburg, South Africa (SA), by comparing the Brixia score withclinical parameters, disease course and clinical outcomes. To assess inter-rater reliability and developing predictive models of the clinicaloutcome using the Brixia score and clinical parameters. Retrospective investigation was conducted of adult participants with established COVID-19 pneumonia admitted at a tertiaryinstitution from 1 May to 30 June 2020. Two radiologists, blinded to clinical data, assigned Brixia scores. Brixia scores were compared withclinical parameters, length of stay and clinical outcomes (discharge/death). Inter-rater agreement was determined. Multivariable logisticregression extracted variables predictive of in-hospital demise. The cohort consisted of 263 patients, 51% male, with a median age of 47 years (interquartile range (IQR) = 20; 95% confidenceinterval (CI) 46.5 - 49.9). Hypertension (38.4%), diabetes (25.1%), obesity (19.4%) and HIV (15.6%) were the most common comorbidities.The median length of stay for 258 patients was 7.5 days (IQR = 7; 95% CI 8.2 - 9.7) and 6.5 days (IQR = 8; 95% CI 6.5 - 12.5) for intensivecare unit stay. Fifty (19%) patients died, with a median age of 55 years (IQR = 23; 95% CI 50.5 - 58.7) compared with survivors, of medianage 46 years (IQR = 20; 95% CI 45 - 48.6) (p=0.01). The presence of one or more comorbidities resulted in a higher death rate (23% v. 9.2%;p=0.01) than without comorbidities. The median Brixia score for the deceased was higher (14.5) than for the discharged patients (9.0)(p<0.001). Inter-rater agreement for Brixia scores was good (intraclass correlation coefficient 0.77; 95% CI 0.6 - 0.85; p<0.001). A modelcombining Brixia score, age, male gender and obesity (sensitivity 84%; specificity 63%) as well as a model with Brixia score and C-reactiveprotein (CRP) count (sensitivity 81%; specificity 63%) conferred the highest risk for in-hospital mortality. We have demonstrated the utility of the Brixia scoring system in a middle-income country setting and developed the first SArisk stratification models incorporating comorbidities and a serological marker. When used in conjunction with age, male gender, obesityand CRP, the Brixia scoring system is a promising and reliable risk stratification tool. This may help inform the clinical decision pathway inresource-limited settings like ours during future waves of COVID-19.

Comparative Incidence of Diabetes Following Hospital Admission for COVID-19 and Pneumonia: A Cohort Study.

The incidence of diabetes may be elevated following coronavirus disease 2019 (COVID-19), but it is unclear whether this is specific to severe acute respiratory syndrome coronavirus 2 infection, associated with shared risk factors for severe COVID-19 and diabetes, and/or a generic risk following illness. People admitted to the hospital for COVID-19 and/or pneumonia between 1 April 2020 and 31 August 2020 in England were linked with the National Diabetes Audit to identify incident diabetes after discharge up to 31 March 2021. Comparator cohorts admitted with pneumonia over the same dates in 2017, 2018, and 2019 were followed until 31 March 2018, 31 March 2019, and 31 March 2020, respectively. Poisson regression models were used to calculate adjusted diabetes incidence rates. Using the cohort of people discharged from the hospital following a diagnosis of COVID-19 without pneumonia in 2020 as the standard population (incidence rate 16.4 [95% CI 12.8-20.7] per 1,000 person-years), adjusting for age, sex, ethnicity, and deprivation, gave incidence rates of 19.0 (95% CI 13.8-25.6) and 16.6 (95% CI 13.3-20.4) per 1,000 person-years for those admitted for COVID-19 with pneumonia and pneumonia without COVID-19, respectively, in 2020. These rates are not significantly different from those found after hospital admission for pneumonia in 2019, 2018, and 2017, at 13.7 (95% CI 10.8-17.3), 13.8 (95% CI 10.9-17.4), and 14.2 (95% CI 10.9-18.3) per 1,000 person-years, respectively. Our data do not support a clear impact of COVID-19 on the incidence of diabetes compared with risks in several comparator groups, including contemporaneously assessed risks in people hospitalized with pneumonia.

Patients with moderate to severe COVID-19 outcomes on remdesivir according to baseline 4C mortality score

BackgroundRemdesivir was the first antiviral to show clinical benefit in patients with moderate-to-severe COVID-19. Previous trials demonstrated a faster time to recovery in hospitalized patients treated with remdesivir vs placebo. Current guidelines recommend treatment with remdesivir based on hospitalization status, oxygen requirements, and time from symptom onset. However, other factors may be evaluated to determine disease severity and risk for progression. The 4C mortality score is a validated, eight variable score that may be used to categorize patients by mortality risk at the time of hospital admission for COVID pneumonia. The objective of this study was to determine if the 4C mortality score may be used to predict which patients with moderate to severe COVID-19 would benefit the most from remdesivir at the time of hospital admission. MethodsThis was a single-center retrospective cohort study comparing time to recovery among hospitalized patients with moderate-to-severe COVID-19 who were treated with remdesivir compared to those who were treated with standard of care (SOC). The primary outcome was time to recovery, defined as discharge from the hospital or no longer requiring supplemental oxygen, stratified by the 4C mortality score risk group. Secondary outcomes included in-hospital mortality, hospital length of stay, and time to recovery in patients who were started on remdesivir within 7 days from symptom onset vs after 7 days from symptom onset. A survival analysis was used to analyze time to recovery outcomes. ResultsData was collected and analyzed for a total of 300 patients, of which 200 received remdesivir and 100 received SOC. Patients in the remdesivir group had a longer time to recovery compared to patients in the SOC group (6 days vs 4 days). This finding was driven by patients who were categorized to the intermediate risk and high risk mortality groups. Additionally, patients who received remdesivir had a longer length of hospital stay compared to those who received SOC (12 days vs 9 days). Remdesivir was not associated with an increased rate of adverse events. ConclusionsThis study of patients admitted with moderate-to-severe COVID-19 found that patients who were treated with remdesivir had a longer time to recovery and a longer length of stay compared to those who received SOC. These findings add to the body of evidence questioning the benefit of remdesivir therapy among patients hospitalized with COVID-19.

Ambient temperature variability and hospital admissions for pneumonia: A nationwide study

Few investigations have assessed the impact of short-term ambient temperature change on pneumonia risk. We aimed to study the relation of temperature variability (TV) with daily hospitalizations for pneumonia in China. We conducted a time-series study in 184 major cities by extracting daily hospital data between 2014 and 2017 from a medical insurance claims database of 0.28 billion beneficiaries. TV was calculated as standard deviation of daily minimum and maximum temperatures over exposure days. We estimated associations of pneumonia admissions with TV for each city using over-dispersed generalized linear models controlling for weather conditions and ambient air pollution, and pooled city-specific estimates using random effects meta-analyses. We also investigated exposure-response relationship curve and potential effect modifiers. We identified 4.2 million pneumonia hospitalizations during the study period. TV was positively related to daily pneumonia admissions. At the national-average level, each 1-°C increase in TV at 0–6 days' exposure corresponded to a 0.65 % (95 % CI: 0.34 %–0.96 %) increase in pneumonia admissions. An approximately linear exposure-response curve for the relation of TV with pneumonia admission was noted. The relations were more evident in cities with larger average age (P = 0.038). As the first study in China to assess the impact of temperature change on pneumonia on a national scale, our results indicated that acute TV exposure was related to higher admissions for pneumonia. Our findings should provide new insight into the health impacts associated with climate change.

SEALANT GLUE TO MANAGE BLEEDING POSTNAVIGATION BRONCHOSCOPY-GUIDED LUNG BIOPSY

SEALANT GLUE TO MANAGE BLEEDING POSTNAVIGATION BRONCHOSCOPY-GUIDED LUNG BIOPSY

Short-term effects of heat on respiratory mortality and morbidity in Germany – small-area analysis in the framework of the EXHAUSTION project

Background and Aim: Short-term associations between heat and respiratory mortality and morbidity have been well recognized. However, most studies were conducted in major cities, whereas evidence for more rural areas is limited. In this study, we assessed the short-term associations between air temperature and cause-specific respiratory mortality and hospital admissions in the warm season (May-September) in Germany at a small-area level. Methods: Daily counts of mortality and hospital admissions for respiratory diseases, chronic obstructive pulmonary disease, asthma, lower respiratory tract infections, and pneumonia from 2000 to 2016 were obtained for Germany at the small-area level. Small areas were defined as districts for mortality data and municipalities for hospital admission data. Daily mean air temperatures estimated by a spatio-temporal model were assigned to each small area. We first applied small area-specific Poisson regression allowing for overdispersion, using Distributed Lag Non-linear Models to assess the heat effects at lag 0-1 days (average of same- and previous-day temperatures). Random-effects meta-analysis was then used to pool the small area-specific estimates. Besides, we conducted subgroup analyses to investigate effect modification by age and sex. Results: We observed increased risks for all investigated cause-specific respiratory mortality and hospital admissions associated with heat. The strongest heat effect was found for pneumonia. For an increment from the 75th to the 99th percentile of the temperature distribution, the pooled risk ratio was 1.49 (95% CI: 1.42, 1.57) for pneumonia mortality and 1.20 (95% CI: 1.19, 1.22) for pneumonia hospital admissions. The heat effects were stronger among the elderly (75+ years) and females. Conclusions: Using data from both urban and rural areas, our study suggests the adverse heat effects on respiratory mortality and morbidity in the warm season in Germany. These heat effects were more pronounced among the elderly and females. Keywords: Air temperature, heat, respiratory, mortality, hospital admissions

The short-term effects of air pollutants on pneumonia hospital admissions in Lanzhou, China, 2014–2019: evidence of ecological time-series study

The short-term effects of air pollutants on pneumonia hospital admissions in Lanzhou, China, 2014–2019: evidence of ecological time-series study

Relationship between meteorological variables and pneumonia in children in the Metropolitan Region of Porto Alegre, Brazil

This work aims to analyze the relationship between meteorological conditions and the occurrence of hospital admissions for pneumonia in children under 5years of age in the Metropolitan Region of Porto Alegre, Brazil, from 1998 to 2017. To this end, data from hospital admissions obtained from the Unified Health System database (DATASUS) were used and classified into two groups: acute respiratory infections (ARI) and asthma, according to the international classification of diseases, tenth edition (ICD-10). Data regarding meteorological variables were also used: temperature, relative humidity, atmospheric pressure and wind speed, at 12Z and 18Z, as well as the Thermal Comfort Index (TCI), Effective Temperature as a function of the wind (ETw) and Windchill (W). From the data obtained, a descriptive analysis of the diseases and a statistical analysis with the analysis of correlation and main components were performed. Results showed that pneumonia (catalogued in the ICD-10 as J12 to J18) was the main cause of hospitalizations in children. The annual, monthly and daily hospitalization frequency distributions showed higher rates of admissions occurring in the months of May to September. The peaks of admissions and high admissions (HA) occurred mainly in the winter months (June, July and August), and in 1998. Meanwhile, the correlation and principal component analysis showed an increase in hospital admissions due to pneumonia related to a decrease in temperature and ETw and W indices (negative anomalies) and an increase in atmospheric pressure and relative humidity (positive anomalies).

Incidence of Hospitalisation and Emergency Department Visits for Pneumococcal Disease in Children, Adolescents, and Adults in Liguria, Italy: A Retrospective Analysis from 2012-2018.

Streptococcus pneumoniae infection is responsible for significant morbidity and mortality, particularly in young children and older adults. The aim of this study was to investigate the incidence of hospitalisation and emergency department (ED) visits in relation to episodes of pneumococcal disease (PD) following the introduction of pneumococcal conjugate vaccines (PCVs) into the Liguria region of Italy. Between 2012 and 2018, episodes of all-cause pneumonia (80,152), pneumococcal-specific pneumonia (1254), unspecified pneumonia (66,293), acute otitis media (AOM; 17,040), and invasive PD (IPD; 1788) were identified from in-patient claims, ED and hospital discharge records, and the Liguria Chronic Condition Data Warehouse. In children < 15 years of age, pneumococcal pneumonia-related hospitalisations decreased from 35 to 13 per 100,000 person-years during the study period (p < 0.001); this decrease is potentially related to PCV use in children. All-cause pneumonia hospitalisations remained stable, whereas IPD hospitalisations increased and AOM hospitalisations decreased. In adults, hospitalisations for all-cause pneumonia increased from 5.00 to 7.50 per 1000 person-years (+50%; p < 0.001). Pneumococcal and unspecified pneumonia hospital admissions increased significantly during the study period, considerably affecting those ≥ 65 years of age. IPD hospitalisations varied across all age groups, but a significant change was not observed. Despite pneumococcal vaccination, substantial burden remains for PD in children and adults in Liguria, Italy.

Impact of anti-tobacco legislation on hospitalization of patients with respiratory diseases in three regions of the Russian Federation

AIM: Tо assess the impact of anti-tobacco measures under federal anti-tobacco law on the hospital admissions for pneumonia of various diagnoses, and other acute respiratory infections of the lower respiratory tract, bronchial asthma, and asthmatic status in the Samara, Arkhangelsk regions, and the Chuvash Republic.&#x0D; MATERIAL AND METHODS: A retrospective analysis of monthly hospital admissions for pneumonia (ICD-10 J12J18), and other acute respiratory infections of the lower respiratory airways (ICD-10 J20J22), asthma (ICD-10 J45), and status asthmaticus (ICD-10 J46) was carried out in the three selected regions of the Russian Federation from the 1st of January, 2012, till the 31st of December, 2017, and in subgroups (014, 1559, 60 years, and older). The analytical approach used was the interrupted time series method, which was performed using the STATA 15.0 software package.&#x0D; RESULTS: From this study, it was revealed that there was a decrease in the hospital incidence of respiratory airways infections after each stage of enacting the anti-tobacco policy in all the three selected regions of the Russian Federation. In the Arkhangelsk region, this decrease amounted to 19% in 2013, and 22% in 2014. In the Samara region, 20% and 23% respectively, and the Chuvash Republic, 31% and 39% respectively. A significant decrease in hospital admissions for asthma and status asthmaticus was observed only in the Chuvash Republic (the decrease occurred by 11% in 2013, and by 12% in 2014). In other regions, the observed decrease was not significant.&#x0D; CONCLUSION: From this study, the results obtained have shown that the anti-tobacco measures introduced in Russia in 2013 and 2014 were responsible for the decrease in the number of hospitalizations for lower respiratory airways infections within the same period.

Covid-19, Clinical Manifestations in Pregnant Women, Aftermaths on Timing and Mode of Delivery at Hail, Saudi Arabia

Objectives: The study was performed to identify the clinical manifestation of Covid-19 infection during pregnancy its impact on the pregnancy outcomes, and its presentation in completely/incompletely vaccinated women. Material and Methods: We conducted this cross-sectional study at Ha`il, a northern city in Saudi Arabia, starting from 15th Dec. 2021 till 15th Jan. 2022. The mean differences of background variables were computed by using the Independent-Sample t-test. A Chi-square test was applied to assess the presentation of the disease in pregnant/non–pregnant and vaccinated/ non-vaccinated women. P-value &lt;0.05 was taken as statistically significant. Results: Fatigue followed by fever and cough (65, 42, and 38% respectively) were the most common presentations of infection during pregnancy. Hospitalization (15.4%) and ICU (9.4%) admissions were more in pregnant than in non-pregnant women. Clinical manifestations were the same in the completely and incompletely vaccinated women. The incompletely vaccinated women were at increased risk of hospitalization (p-value 0.01), and pneumonia (p-value 0.05). The covid-19 infection has no significant association with age of the participants, body mass index, and parity. Covid-positive women during pregnancy underwent fewer cesarean- sections than Covid negative (20% vs. 80%, p &lt;0.05). The mean gestational age at delivery, preterm birth, and neonatal weight at birth were the same in both groups. The rate of transmission of the infection to the neonates remained extremely low. Conclusion: Covid disease during pregnancy doesn’t increase the risk of preterm birth, cesarean delivery, or low birth weight of the babies. Complete vaccination against tcovid-19 declines the risk of hospital admission for severe disease and pneumonia in women.

Nuclear countdown

Case: A 50-year-old woman presented with a 10-year history of progressive symptoms, beginning with right facial numbness. She developed dysgeusia, and dysphagia before the onset of dysarthria. She had progressive gait instability with frequent backwards falls. A gastrostomy was inserted for persistent weight loss. She required hospital admission for aspiration pneumonia and type 2 respiratory failure. On examina- tion she had a head drop and staring expression with reduced blink frequency and hypophonia. There was bilateral facial weakness with temporalis and tongue wasting. She had a supranuclear gaze palsy and her saccadic eye movements were almost absent in all directions. Limbs were hypotonic with distal weakness and reduced reflexes.InvestigationsNCS/EMG showed chronic widespread partial denervation in the facial, trigeminal (motor) and hypoglossal-innervated muscles. Blink reflexes were absent bilaterally. There were chronic denerva- tion changes in the cervical and lumbar spinal segments. MRI brain showed global atrophy particularly implicating the temporal lobes and brainstem.DiagnosisA diagnosis of Facial-Onset Sensory and Motor Neuronopathy (FOSMN) was made. Given the additional clinical features of supranuclear gaze palsy we believe this is the first case of FOSMN-PSP overlap syndrome.ConclusionWe report a unique FOSMN case with some overlap features of PSP, not previously described. daniel.rice-wilson@nhs.net23

Legionnaires' Disease: Update on Diagnosis and Treatment.

Legionellosis is the infection caused by bacteria of the genus Legionella, including a non-pneumonic influenza-like syndrome, and Legionnaires’ disease is a more serious illness characterized by pneumonia. Legionellosis is becoming increasingly important as a public health problem throughout the world; although it is an underreported disease, studies have consistently documented a high incidence. In addition, health costs associated with the disease are high. Diagnosis of Legionnaires’ disease is based mainly on the detection of Legionella pneumophila serogroup 1 antigen in urine. However, there have been advances in detection tests for patients with legionellosis. New methodologies show greater sensitivity and specificity, detect more species and serogroups of Legionella spp., and have the potential for use in epidemiological studies. Testing for Legionella spp. is recommended at hospital admission for severe community-acquired pneumonia, and antibiotics directed against Legionella spp. should be included early as empirical therapy. Inadequate or delayed antibiotic treatment in Legionella pneumonia has been associated with a worse prognosis. Either a fluoroquinolone (levofloxacin or moxifloxacin) or a macrolide (azithromycin preferred) is the recommended first-line therapy for Legionnaires’ disease; however, little information is available regarding adverse events or complications, or about the duration of antibiotic therapy and its association with clinical outcomes. Most published studies evaluating antibiotic treatment for Legionnaires’ disease are observational and consequently susceptible to bias and confounding. Well-designed studies are needed to assess the usefulness of diagnostic tests regarding clinical outcomes, as well as randomized trials comparing fluoroquinolones and macrolides or combination therapy that evaluate outcomes and adverse events.

Sex-differences in incidence of hospitalizations and in hospital mortality of community-acquired pneumonia among children in Spain: a population-based study

The aim of this study is to examine trends from 2016 to 2019 in the incidence of hospitalizations and in-hospital mortality (IHM) of subjects < 18 years with community-acquired pneumonia (CAP), assessing possible sex differences. We used Spanish national hospital discharge data to select all patients < 18 years with CAP. We identified 43,511 children (53% boys) hospitalized with CAP. The incidence of CAP was significantly higher in boys than in girls, with an age-adjusted incidence rate ratio of 1.05 (95%CI 1.03–1.07) for boys compared to girls, and rose from 126 per 100,000 children in 2016 to 131 in 2019 (p < 0.0001). There were no sex differences in isolated pathogens, comorbidities, length of hospital stay, or IHM. Variables independently associated with IHM were age 10 to 17 years, congenital heart disease, neurological diseases, and use of invasive mechanical ventilation. Asthma was a protective factor for IHM among girls.Conclusion: The incidence of hospital admissions for CAP was higher among boys than among girls and rose significantly from 2016 to 2019. There were no sex differences in hospital outcomes. Age 10 to 17 years, congenital heart disease, neurological diseases, and use of mechanical ventilation were risk factors for IHM in both sexes, while asthma was a protective factor among girls. No differences were found in IHM over time.What is Known:• Community-acquired pneumonia is one of the most common reasons for hospitalizations among children.• There are few studies that allow to know the evolution of community-acquired pneumonia in children.What is New:• Incidence of hospital admissions for community-acquired pneumonia was higher in boys than girls and it rose significantly from 2016 to 2019.• Age 10 to 17 years, congenital heart disease, neurological diseases and use of mechanical ventilation were risk factors for in-hospital mortality in both sexes.

Short-term exposure to ambient air pollution and pneumonia hospital admission among patients with COPD: a time-stratified case-crossover study

BackgroundPneumonia is a major contributor to hospital admission for patients with chronic obstructive pulmonary disease (COPD). However, evidence for acute effects of ambient air pollution exposure on pneumonia hospital admission among patients with COPD is scarce. We aimed to examine the association between short-term exposure to ambient air pollution and pneumonia hospital admission among patients with COPD.MethodsWe enrolled COPD cases aged ≥ 60 years old and further filtered those who were admitted into hospitals from pneumonia during 2016–2019 in Guangdong province, China for main analysis. A time-stratified case-crossover design was applied to investigate the association and conditional logistic regression model was used for data analysis. We performed inverse distance weighting method to estimate daily individual-level exposure on particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM2.5), particulate matter with an aerodynamic diameter ≤ 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) based on personal residential addresses.ResultsWe included 6473 pneumonia hospital admissions during the study period. Each interquartile range (IQR) increase in PM2.5 (lag 2; IQR, 22.1 μg/m3), SO2 (lag 03; IQR, 4.2 μg/m3), NO2 (lag 03; IQR, 21.4 μg/m3), and O3 (lag 04; IQR, 57.9 μg/m3) was associated with an odds ratio in pneumonia hospital admission of 1.043 (95% CI: 1.004–1.083), 1.081 (95% CI: 1.026–1.140), 1.045 (95% CI: 1.005–1.088), and 1.080 (95% CI: 1.018–1.147), respectively. Non-linear trends for PM2.5, PM10, and SO2 were observed in the study. Sex, age at hospital admission, and season at hospital admission did not modify the associations.ConclusionsWe found significantly positive associations of short-term exposure to PM2.5, SO2, NO2, and O3 with pneumonia hospital admission among COPD patients. It provides new insight for comprehensive pneumonia prevention and treatment among COPD patients.

Efficacy and safety of antimicrobial stewardship prospective audit and feedback in patients hospitalized with COVID-19: A protocol for a pragmatic clinical trial

The use of broad-spectrum antibiotics is widespread in patients with COVID-19 despite a low prevalence of bacterial co-infection, raising concerns for the accelerated development of antimicrobial resistance. Antimicrobial stewardship (AMS) is vital but there are limited randomized clinical trial data supporting AMS interventions such as prospective audit and feedback (PAF). High quality data to demonstrate safety and efficacy of AMS PAF in hospitalized COVID-19 patients are needed. This is a prospective, multi-center, non-inferiority, pragmatic randomized clinical trial evaluating AMS PAF intervention plus standard of care (SOC) versus SOC alone. We include patients with microbiologically confirmed SARS-CoV-2 infection requiring hospital admission for severe COVID-19 pneumonia. Eligible ward beds and critical care unit beds will be randomized prior to study commencement at each participating site by computer-generated allocation sequence stratified by intensive care unit versus conventional ward in a 1:1 fashion. PAF intervention consists of real time review of antibacterial prescriptions and immediate written and verbal feedback to attending teams, performed by site-based AMS teams comprised of an AMS pharmacist and physician. The primary outcome is clinical status at post-admission day 15 measured using a 7-point ordinal scale. Patients will be followed for secondary outcomes out to 30 days. A total of 530 patients are needed to show a statistically significant non-inferiority, with 80% power and 2.5% one-sided alpha assuming standard deviation of 2 and the non-inferiority margin of 0.5. This study protocol presents a pragmatic clinical trial design with small unit cluster randomization for AMS intervention in hospitalized COVID-19 that will provide high-level evidence and may be adopted in other clinical situations. This study is being performed at the University of Alberta and is registered at ClinicalTrials.gov (NCT04896866) on May 17, 2021.