Outcome Of Pneumonia Research Articles

Incidence and Outcomes of Pneumocystis Pneumonia Following Chimeric Antigen Receptor T-Cell Therapy: A Real-World Analysis

Background: Pneumocystis Pneumonia (PCP) is a known opportunistic infection after chimeric antigen receptor (CAR) T-cell therapy. However, the incidence and outcomes of PCP are poorly understood, and there has been no clear consensus on the optimal duration for PCP prophylaxis post-CAR T-cell treatment. Methods: From a large real-world database, TriNetX Research Network, we identified patients who underwent commercial anti-CD19 and anti-BCMA CAR T-cell therapy between January 2019 and January 2023. The diagnosis of PCP was established using the ICD-10-CM code B59 (pneumocystosis) or through Logical Observation Identifiers Names and Codes (LOINC) documentation of positive microbiologic tests from respiratory samples. Results: Among the 1,107 and 280 patients who received anti-CD19 and anti-BCMA CAR T-cell therapies, 19 (1.7%) and 4 (1.4%) patients developed PCP, respectively. Altogether, a total of 23 (1.7%) patients developed PCP within a median of 139 days (range 19 to 732 days) post-infusion. (Figure) Demographics, the incidence and severity of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), and the initial choice for PCP prophylaxis, were similar for patients with and without PCP. Patients who developed PCP were more likely to have used dexamethasone (65 vs 43%, p=0.02) and have a shorter duration of trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis (median 9 [range 1 to 45] vs 19 [range 1 to 106] weeks, p=0.002). In the univariate analysis, patients who received TMP/SMX prophylaxis for less than 3 months showed a trend of a higher incidence of PCP compared to those who received it for more than 3 months (hazard ratio [HR] 3.54, 95% confidence interval [CI] 0.87 to 14.3, p=0.06). (Table) Regarding survival outcomes, patients with and without PCP had similar time-to-next-treatment or death (median 84 vs 68 days, HR 0.96, 95%CI 0.61 to 1.51) and overall survival (median 518 days vs not-reached, HR 1.61, 95%CI 0.91 to 2.88). Conclusions: In real-world conditions with routine prophylaxis, PCP is an infrequent opportunistic infection following anti-CD19 or anti-BCMA CAR T-cell therapy. Patients with and without PCP were associated with similar survival outcomes.

Community-Acquired Pneumonia in the Immunocompromised Host: Epidemiology and Outcomes.

The epidemiology and outcomes of community-acquired pneumonia (CAP) in immunocompromised hosts (ICHs) are not well defined. The objective of this study was to define the epidemiology and outcomes of CAP in ICHs as compared with non-ICHs. This ancillary study included a prospective cohort of hospitalized adult Louisville residents with CAP from 1 June 2014 to 31 May 2016. An ICH was defined per the criteria of the Centers for Disease Control and Prevention. Geospatial epidemiology explored associations between ICHs hospitalized with CAP and income level, race, and age. Mortality for ICHs and non-ICHs was evaluated during hospitalization and 30 days, 6 months, and 1 year after hospitalization. A total of 761 (10%) ICHs were identified among 7449 patients hospitalized with CAP. The most common immunocompromising medical conditions or treatments were advanced-stage cancer (53%), cancer chemotherapy (23%), and corticosteroid use (20%). Clusters of ICHs hospitalized with CAP were found in areas associated with low-income and Black or African American populations. Mortality by time point for ICHs vs non-ICHs was as follows: hospitalization, 9% vs 5%; 30 days, 24% vs 11%; 6 months, 44% vs 21%; and 1 year, 53% vs 27%, respectively. Approximately 1 in 10 hospitalized patients with CAP is immunocompromised, with advanced-stage cancer being the most frequent immunocompromising condition, as seen in half of all patients who are immunocompromised. Risk for hospitalization may be influenced by socioeconomic disparities and/or race. ICHs have a 2-fold increase in mortality as compared with non-ICHs.

The Acute Inflammatory Biomarkers - Are They Cost Effective and Real Time Early Predictors of Mortality in Acute Pneumonia? - A Prospective Observational Study

Introduction: The CT chest and investigations like IL6 and TNFɑ are the most accurate blood biomarkers of inflammatory changes and can be used to stage the severity and outcome of acute pneumonia. . Getting all the above mentioned investigations in a financially poor patients is not always possible. There are not much studies to look for the association between early raise in serum acute inflammatory bio markers and the prediction of mortality in acute pneumonia. So this study is under taken to know the association between significant raise in serum acute inflammatory biomarkers like hs CRP, LDH, ferritin, NLR, WBCs count in predicting the mortality of acute pneumonia in comparison with the serum IL6,q-SOFA score and CT chest severity score. Materials & Method: All patients underwent standardized workup, including complete blood count, blood biochemistry, ferritin, hs-CRP, LDH,IL6,CT scan of chest ,q-SOFA score assessment and electrocardiogram. All the biochemical investigations were done on day 1 and day 5 of admission to the hospital. The patients were followed-up for the whole in hospital stay duration. Results: All the measured serum acute inflammatory bio markers, IL6, NLR, WBCs count, q-SOFA score and chest CT severity score were significantly elevated in patients with death due to acute pneumonia than the survived ones. [p value-0.01] Conclusion: This study proves that, the early raise in serum acute inflammatory biomarkers have got real and cost effective predictive value and are non-inferior to total WBCs count, NLR,IL6, q- SOFA score and chest CT severity score in assessing the mortality of acute pneumonia. Keywords: Acute Pneumonia, Acute inflammatory bio markers, CT scan of Chest, IL6, NLR (Neutrophils to Lymphocytes ratio), q-SOFA score, WBCs count

Clinical characteristics and risk factors associated with secondary bacterial pneumonia among COVID-19 patients in ICU.

COVID-19 and secondary infections developing during COVID-19 follow-up are one of the most important causes of morbidity and mortality in intensive care units (ICU). In this study, we aimed to determine the frequency, microbiology, risk factors, and outcomes of secondary bacterial pneumonia in hospitalized patients due to COVID-19. We studied all patients with bacterial pneumonia developed in patients with severe COVID-19 infection in the COVID-19 intensive care unit in a single-center hospital between March 16, 2020 and June 17, 2020. Patients hospitalized and followed up in the ICU for respiratory failure were examined in terms of secondary infection affecting morbidity and mortality. Ninety-six (20%) of 471 patients had secondary bacterial pneumonia, respectively; of the leading pathogens were Acinetobacter baumannii (44.8%) and Klebsiella pneumoniae (39.6%), followed by Pseudomonas aeruginosa (4.2%), Escherichia coli (3.1%), methicillin-resistant Staphylococcus aureus (MRSA) (3.1%), Streptococcus pneumoniae (3.1%), and Methicillin-susceptible Staphylococcus aureus (MSSA) (1%). The mortality rate among infected (75% / 47.5%) was significantly higher than in uninfected patients. Associated with the development of secondary bacterial pneumonia in COVID-19 patients; corticosteroid therapy [odds ratio (OR) 6250, 95% confidence interval (CI) 1.383-28.571, p = 0.017), corticosteroid dose (OR 8.862 CI 2.299-70.258, p= 0.006), duration of mechanical ventilation (OR 1.199 CI) 1.088-1.322, p< 0.001). Secondary bacterial pneumonia was found to be associated with the severity and survival of the disease in patients admitted to ICU due to COVID-19. Duration of mechanical ventilation and use of corticosteroids and high-dose corticosteroids are risk factors for secondary bacterial pneumonia.

Serum KL-6 as a Candidate Predictor of Outcome in Patients with SARS-CoV-2 Pneumonia.

Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)-infection is associated with an extremely variable disease course. When interstitial pneumonia (IP) occurs, it can lead to acute respiratory distress syndrome and death. Serum Krebs von den Lungen-6 (KL-6) is an established marker of IP, but its role as a marker of SARS-CoV-2 pneumonia is debated. This bicentric study included 157 patients with SARS-CoV-2 pneumonia. The WHO Ordinal Scale for Clinical Improvement (0-10 points) was used to classify the clinical course. Serum samples were collected at admission, and on days 3 and 7 of hospitalization. KL-6 was measured by using automated chemiluminescence immunoassay. A total of 68 patients developed a severe SARS-CoV-2 pneumonia, 135 of them required oxygen, and 15 died during hospitalization. The patients requiring non-invasive ventilation, invasive ventilation, or extracorporeal membrane oxygenation had significantly higher serum KL-6 levels at admission. The serum KL-6 levels were tendentially higher in patients who died than in those who survived. Logistic regression identified serum KL-6 at a cut-off of 335 U/mL at admission as a significant predictor of severe SARS-CoV-2 pneumonia outcome. Serum KL-6 seems to be a candidate biomarker for the clinical routine to stratify patients with SARS-CoV-2 pneumonia for the risk of a severe disease outcome or death.

FRI043 The Double Pandemic Effect Of Obesity And COVID-19 Among United States Adult Hospitalizations: Outlining Hospitalization Outcomes Of A Synergistic Catastrophe

Abstract Disclosure: H. Shaka: None. A. Ilelaboye: None. E. Krishnaraju: None. M. Dasgupta: None. A. Shaka: None. P. Kanemo: None. Introduction: The COVID-19 pandemic exacerbated significant health disparities among adults in the US. Obesity has been on the rise in the US for decades and has been described as a pandemic. Morbid obesity (MO) is a known risk factor for worse outcomes for viral pneumonia including SARS-CoV-2. This study outlined the national impact of the COVID-19 pandemic on the ongoing obesity pandemic and assessed possible healthcare disparities in this population. Methods: The study obtained data from the US National Inpatient Sample from 2016 - 2020. This provides a nationally representative estimate of all US hospitalizations for each calendar year. We assessed rates of MO hospitalizations per 1000 adult hospitalizations yearly. We compared outcomes between 2019 and 2020 to evaluate the COVID-19 pandemic's effect on this population. Outcomes were also stratified by sex, race, and median household income. Results: From 2016 to 2020, hospitalizations involving adults with MO increased by 61%. While national hospitalizations dropped by about 9% in 2020, those involving adults with MO increased by 7.1% compared with 2019 adjusted for age, race, sex, and comorbidity index. In 2020, hospitalized adults with MO had a lower mean age and a higher proportion of men compared to 2019. There was no significant difference in the race, income and comorbidity index distribution of the patients in 2020 compared to 2019. Among adults with MO who died during hospitalization in 2020, about 1 in 5 had COVID-19 as the reason for admission. The mortality rate in all adults with MO increased from 1.5 to 2.7%. This represented an 84.5% higher odds of mortality compared to 2019. Stratification showed that there was an 80.0 vs 88.9% higher mortality in females vs males. Mortality in Hispanics increased by 169.7%, compared to 111.7% in Blacks and 66.8% in Whites. Patients in the lowest income quartile had an increase of 97.2 vs 61.7% in the highest income quartile. There were also significant regional variations in the increase in mortality among hospitalizations with MO. Year on year, total hospitalization charges in the studied population increased by $10 billion to over $156 billion, adjusted for inflation. The year 2020 also saw an overall increase in the length of hospitalizations for adults with MO. Discussion/conclusion: This study provides evidence that at the national level, patients with MO were significantly impacted by the COVID-19 pandemic. This contributed to significant healthcare costs. We recommend a national approach and response to the obesity pandemic as people with morbid obesity are projected to make up to 30% of the US population by 2030. We also highlighted significant racial and economic disparities in the outcomes of these patients. Although the reasons for such disparities are likely multifactorial, this adds to a growing body of evidence of disparities in healthcare across various health conditions. Presentation: Friday, June 16, 2023

European Network for ICU-Related Respiratory Infections (ENIRRIs): a multinational, prospective, cohort study of nosocomial LRTI

PurposeLower respiratory tract infections (LRTI) are the most frequent infectious complication in patients admitted to the intensive care unit (ICU). We aim to report the clinical characteristics of ICU-admitted patients due to nosocomial LRTI and to describe their microbiology and clinical outcomes.MethodsA prospective observational study was conducted in 13 countries over two continents from 9th May 2016 until 16th August 2019. Characteristics and outcomes of ventilator-associated pneumonia (VAP), ventilator-associated tracheobronchitis (VAT), ICU hospital-acquired pneumonia (ICU-HAP), HAP that required invasive ventilation (VHAP), and HAP in patients transferred to the ICU without invasive mechanical ventilation were collected. The clinical diagnosis and treatments were per clinical practice and not per protocol. Descriptive statistics were used to compare the study groups.Results1060 patients with LRTI (72.5% male sex, median age 64 [50–74] years) were included in the study; 160 (15.1%) developed VAT, 556 (52.5%) VAP, 98 (9.2%) ICU-HAP, 152 (14.3%) HAP, and 94 (8.9%) VHAP. Patients with VHAP had higher serum procalcitonin (PCT) and Sequential Organ Failure Assessment (SOFA) scores. Patients with VAP or VHAP developed acute kidney injury, acute respiratory distress syndrome, multiple organ failure, or septic shock more often. One thousand eight patients had microbiological samples, and 711 (70.5%) had etiological microbiology identified. The most common microorganisms were Pseudomonas aeruginosa (18.4%) and Klebsiella spp (14.4%). In 382 patients (36%), the causative pathogen shows some antimicrobial resistance pattern. ICU, hospital and 28-day mortality were 30.8%, 37.5% and 27.5%, respectively. Patients with VHAP had the highest ICU, in-hospital and 28-day mortality rates.ConclusionVHAP patients presented the highest mortality among those admitted to the ICU. Multidrug-resistant pathogens frequently cause nosocomial LRTI in this multinational cohort study.

Ventilation-Associated Pneumonia in Pediatric Intensive Care in Saudi Arabia: A Two-Year Retrospective Study of Incidence, Risk Factors, and Outcome

Abstract Objective This article assesses the incidence, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in pediatric intensive care unit (PICU) patients in western Saudi Arabia. Methods A retrospective cohort study enrolled 375 children admitted to the PICU of King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The study data involves clinical assessment of pediatric patients admitted to the PICU who received mechanical ventilation for ≥ 48 hours to monitor the primary outcome of developing VAP. Statistical analysis with univariate and multivariate analysis, a chi-square test, and a logistic regression model were used to analyze the risk factors associated with VAP. Results The VAP incidence among 375 enrolled patients was estimated to be 29.1% (95% class interval = 24.5–34.0%), accounting for 73.6 cases per 1,000 ventilator days. An approximately 1.4-fold increased mortality risk was observed in VAP cases with no statistical significance (p = 0.248). VAP incidence was independently associated with age groups 0 to 30 days (odds ratio [OR] = 6.88, p = 0.001), 1 to 12 months (OR = 4.55, p = 0.003), and &gt; 6 years (OR = 3.45, p = 0.038), in addition to the nasogastric tube (OR = 2.23, p = 0.019), bronchoscopy (OR = 6.28, p = 0.001), and longer ICU stay including 4 to 7 days (OR = 4.08, p = 0.002) and &gt; 7 days (OR = 4.96, p = 0.002). Conclusion Given the observed high incidence of VAP, it is imperative to urgently enhance our preventive strategies and rigorously scrutinize VAP risk factors within the institution. Extra precautions and specific risk identification may be warranted in high-risk age groups. Our findings underscore the necessity for a comprehensive assessment of risk factors and etiological agents, aligning them with incidence rates. This proactive approach would facilitate the early implementation of strategic interventions and practices, potentially reducing VAP development.

Clinical features and risk factors analysis for poor outcomes of severe community-acquired pneumonia in children: a nomogram prediction model.

Pneumonia remains the leading cause of death among children aged 1-59 months. The early prediction of poor outcomes (PO) is of critical concern. This study aimed to explore the risk factors relating to PO in severe community-acquired pneumonia (SCAP) and build a PO-predictive nomogram model for children with SCAP. We retrospectively identified 300 Chinese pediatric patients diagnosed with SCAP who were hospitalized in the Affiliated Hospital of Southwest Medical University from August 1, 2018, to October 31, 2021. Children were divided into the PO and the non-PO groups. The occurrence of PO was designated as the dependent variable. Univariate and multivariate logistic regression analyses were used to identify the risk factors of PO. A nomogram model was constructed from the multivariate logistic regression analysis and internally validated for model discrimination and calibration. The performance of the nomogram was estimated using the concordance index (C-index). According to the efficacy evaluation criteria, 56 of 300 children demonstrated PO. The multivariate logistic regression analysis resulted in the following independent risk factors for PO: co-morbidity (OR: 8.032, 95% CI: 3.556-18.140, P < 0.0001), requiring invasive mechanical ventilation (IMV) (OR: 7.081, 95% CI: 2.250-22.282, P = 0.001), and ALB < 35 g/L (OR: 3.203, 95% CI: 1.151-8.912, P = 0.026). Results of the internal validation confirmed that the model provided good discrimination (concordance index [C-index], 0.876 [95% CI: 0.828-0.925]). The calibration plots in the nomogram model were of high quality. The nomogram facilitated accurate prediction of PO in children diagnosed with SCAP and could be helpful for clinical decision-making.

Frequency, clinical characteristics, and outcomes of pneumonia in patients with out-of-hospital cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation

AimThis study aimed to describe the frequency, clinical characteristics, and outcomes of pneumonia in OHCA patients treated with ECPR in a multicenter setting. MethodsThis is a secondary analysis of the SAVE-J II study, which was a multicenter, retrospective cohort of OHCA patients treated with ECPR. Age, sex, comorbidities, presence of witnessed CA, presence of bystander CPR, initial rhythm, cause of CA, low-flow time, initiation of targeted temperature management, details of sputum culture, pneumonia, and prophylactic antibiotic use were recorded. Pneumonia was diagnosed when the patients met all the clinical, radiologic, and microbiologic criteria acquired after hospitalization. ResultsIn total, 1,986 patients were included in the analysis, and 947 (48%) died during the first 2 days of admission. A prophylactic antibiotic was used in 712 (35.9%) patients. Overall, the hazard of death was high on days 1 and 2 of admission, exceeding 20% on both days; 251 (12.6%) patients developed pneumonia during hospitalization, and the hazard of pneumonia development remained high (>2%) in the first 7 days of admission.Staphylococcus aureus and Klebsiella species were commonly identified in the sputum culture. Among patients who survived the first 7 days, the odds ratio (OR) of those with pneumonia and unfavorable neurological outcomes defined by cerebral performance category 3–5 was approximately 1. In those who survived the first 10 days, the OR was greater than 1 with a wide confidence interval. ConclusionsThis is the first study describing details of pneumonia in OHCA patients treated with ECPR using a large dataset.

Bibliometric Analysis of Global Research Output on Antimicrobial Resistance among Pneumonia Pathogens (2013-2023).

Antimicrobial resistance (AMR) is a pressing global concern, posing significant challenges to the effective treatment of infections, including pneumonia. This bibliometric analysis aims to investigate the research output on AMR among pneumonia pathogens from 2013 to 2023. Data were extracted from the Web of Science Core Collection (WOS-CC) using an inclusive search strategy. The analysis included 152 relevant studies published in 99 different sources, involving 988 authors and yielding an average of 16.33 citations per document over the past decade. The findings reveal a notable increase in research on AMR among pneumonia pathogens, indicating a growing awareness of this critical issue. Collaborative studies were prevalent, with the majority of authors engaging in joint research efforts. Bradford's Law identified twelve core journals that were instrumental in disseminating research in this field, with "Medicine" emerging as the most prolific journal. The USA and China emerged as the leading contributors, while Germany displayed a strong inclination towards collaborative research. Intermountain Medical Center, Saitama Medical University, and Udice-French Research Universities were the most productive institutions, and Yayan J. and Rasche K. were the top authors. Furthermore, the analysis identified commonly encountered microorganisms such as Acinetobacter baumanii and Klebsiella pneumoniae in the context of AMR. Time-based analysis of keywords highlighted the significance of terms like "community-acquired pneumonia" and "ventilator-associated pneumonia". Overall, this comprehensive study sheds light on the global research landscape of AMR among pneumonia pathogens. The insights gained from this analysis are essential for guiding future research priorities and collaborative efforts to combat AMR effectively and improve treatment outcomes for pneumonia and related infections. As the frequency of reports concerning resistance among pneumonia pathogens, notably A. baumannii and K. pneumoniae, continues to rise, there is an immediate requirement for pharmaceutical manufacturers and healthcare providers to respond proactively and ready themselves for the forthcoming implications of this matter. It also underscores the importance of knowledge dissemination and evidence-based interventions to address this growing public health challenge. However, the study acknowledges the limitations associated with using a single publication database and encourages the inclusion of data from other sources in future research.

CD4+ T cells related to disease severity in elderly and frailty community-acquired pneumonia patients: A retrospective cohort study.

Elderly and frailty individuals show a more senescent immune system, which may relate to worse outcome in community-acquired pneumonia (CAP). This study aimed to explore prognostic factors related to immune. Sixty of elderly (≥65 years) and frailty (clinical frailty scale ≥5 scores) nonsevere CAP patients and 60 severe CAP (SCAP) patients were recruited at our center. Clinical and laboratory data, and several assessment scores were collected. Compared with nonsevere CAP group, the elderly and frailty SCAP patients showed higher level of BMI, PaCO2 and lactate in arterial blood-gas, CURB-65 score, ICU admission, mechanical ventilation, shock accidence, and longer hospital stay using two-tailed t test. The SCAP group also showed increased CRP, IL-6, and PCT, and decreased CD3+ T cells, CD4+ T cells, and CD8+ T cells. Logistic regression analysis showed that CD4+ T cells, IL-6 and PCT were independent prognostic factors for SCAP. The area under the receiver operating characteristic (ROC) curve for CD4+ T cells combined with PCT was 0.771 (95% CI 0.683-0.859), and the sensitivity and specificity were both 76.7%. Paired t test analysis showed that low CD4+ T cells in SCAP patients increased after treatment. CD4+ T cells decreased in elderly and frailty SCAP patients, and CD4+ T cells combined with PCT were relatively accurate in the prediction of elderly and frailty SCAP.

P-480 Outcome of pneumocystis jirovecii pneumonia in patients with multiple myeloma

P-480 Outcome of pneumocystis jirovecii pneumonia in patients with multiple myeloma

446. VOCAL FOLD AUGMENTATION REDUCES PNEUMONIA INCIDENCE IN PATIENTS WITH IATROGENIC RECURRENT LARYNGEAL NERVE PALSY AFTER ESOPHAGECTOMY

Abstract Background Recurrent laryngeal nerve (RLN) palsy is a significant complication associated with esophagectomy, resulting in a high incidence of pneumonia and a poor quality of life. Vocal fold augmentation (VFA) can help alleviate the associated symptoms of dysphonia. We aimed to investigate the impact of VFA on pneumonia incidence in patients suffering from RLN palsy after esophagectomy. Methods This is a retrospective cohort study. Patients who underwent esophagectomy at our center from 2003 to 2022, and experienced right, left or bilateral RLN palsy postoperatively were selected from a prospectively managed database. VFA consisted of medialisation thyroplasty, injection laryngoplasty, arytenoid adduction or a combination of these procedures. Pneumonia was defined as lung changes on chest x-ray, along with clinical evidence of infection within six months after esophagectomy. Pearson’s chi-squared test was used to assess the difference in pneumonia rates. Univariate and multivariate logistic regression analyses were used to identify associations between variables and the outcome of pneumonia. Results A total of 107 esophagectomy patients with RLN palsy were included. The overall palsy rate was 14.5%. 41 patients (38.3%) underwent VFA. Of the patients who underwent VFA, 13 (31.7%) underwent medialization thyroplasty, 26 (63.4%) underwent injection laryngoplasty, 1 (2.4%) underwent injection laryngoplasty and medialization thyroplasty, and 1 (2.4%) underwent injection laryngoplasty and arytenoid adduction. Pneumonia rate (14.6%) for patients who underwent VFA was significantly lower than that of patients without VFA (47.0%, P &amp;lt; 0.001). On univariate and multivariate analyses, patients who underwent VFA were less likely to suffer from pneumonia compared to those without VFA (OR = 0.194, P = 0.001). Conclusion Vocal fold augmentation reduces pneumonia incidence in patients with recurrent laryngeal nerve palsy after esophagectomy.

Outcomes of pediatric community-acquired pneumonia before and after national pneumococcal immunization in Taiwan.

In Taiwan, the incidence of invasive pneumococcal disease (IPD) in children declined after the catch-up primary vaccination programs and the full national immunization program (NIP) with PCV13. The objective of the study was to investigate the clinical outcomes of pediatric community-acquired pneumonia (CAP) before and after the NIP. The study included patients aged 3 months to 17 years who were diagnosed with CAP and treated at the National Taiwan University Hospital between 2007 and 2019. Patients were assigned to three birth cohorts according to their birth years and vaccination eligibility: non-NIP, catch-up, and full NIP. We compared the rates of severe outcomes, including case fatality and pathogens. A total of 6557 patients who met the CAP criteria were enrolled during the study period. The case-fatality rate decreased from 3.2% (94/2984) in the non-NIP cohort to 0.3% (7/2176) in the catch-up cohort and 0.8% (11/1397) in the full NIP cohort (p < 0.001). Furthermore, there was a significant decrease in invasive ventilation from the non-NIP (17.9%) to both catch-up (6.8%) and full NIP cohorts (9.1%). The rate of IPD declined from the non-NIP cohort to the catch-up cohort (1.8% vs. 0.6%, p < 0.001) and from the catch-up to the full NIP cohort (0.6% vs. 0.07%, p = 0.014). In contrast, the rates of infections with other pathogens increased after NIP. The introduction of PCV13 showed significant reduction in case-fatality and IPD rates. The increasing rates of other pathogens warrant further surveillance for their clinical significance.

The relationship between neurogenic dysphagia, stroke-associated pneumonia and functional outcome in a cohort of ischemic stroke patients treated with mechanical thrombectomy

IntroductionMechanical thrombectomy (MT) is an established treatment approach in acute ischemic stroke patients with large vessel occlusion (LVO). Recent studies suggest that the prevalence of dysphagia and pneumonia risk is increased in this patient population. The aim of this study was to systematically evaluate the prevalence, predictors, and influence of neurogenic dysphagia for 3-month outcome in a large population of patients receiving MT and to elucidate the relationship between dysphagia, stroke-associated pneumonia (SAP) and medium-term functional outcome.Materials and methodsData of a prospective collected registry of patients with LVO and MT between 2016 and 2019 were analyzed retrospectively. Binary logistic regression was carried out to determine predictors for dysphagia and 3-month outcome as measured by the modified Rankin Scale, respectively. A mediation analysis was performed to investigate the mediating influence of intercurrent SAP.ResultsA total of 567 patients were included in the study. Mean age was 73.4 years, 47.8% of the patients were female, and median NIHSS was 15.0. The prevalence of dysphagia was 75.1% and 23.3% of all patients developed SAP. In the regression analysis, dysphagia was one of the main independent predictors for poor functional outcome at 3 months. The mediator analysis revealed that the effect of dysphagia on the functional outcome at 3 months was not mediated by the occurrence of SAP.DiscussionThe prevalence of dysphagia is high and exerts both negative short- and medium-term effects on patients with large vessel occlusion who undergo MT.

A study of clinical profile and outcome of pneumonia associated with traditional child rearing practices in infants

Background: Customs and traditions are strictly followed in many Indian families, both rural and urban. Certain established child rearing practices are being advocated by elders and are being followed traditionally even today. Many of these practices play a significant role in causing pneumonia in children. This study was undertaken to compare and assess the clinical features and outcome of pneumonia occurring in children with traditional rearing practices and in infants without traditional child rearing practices and various factors influencing them. Methods: The present study is a prospective case control study, done in the department of paediatrics, Al-Ameen Medical College and Hospital Vijayapura, in which a total of 220 infants with clinical and/or radiological signs of pneumonia were enrolled during the period of March 2022 to February 2023. Results: 73 out of 220 infants (33%) with pneumonia had history of traditional child rearing practices. Demographic factors like combined families, young and illiterate mothers, lower socioeconomic status, domiciliary deliveries were found to be statistically significant. Increased clinical severity and prolonged outcome (60.4%) and complications (42.5%) were found to be more in pneumonia in infants associated with traditional child rearing practices. Conclusions: This study showed increased clinical severity and prolonged outcome and more complications of pneumonia in infants associated with traditional child rearing practices. High mortality (7.5%) was also seen. Most common traditional child rearing practices influencing outcome in infants are oil bath and blowing into the nose. Thus there is an urgent need to systematically study the utility, futility and possible dangers of a large number of traditional child rearing practices followed in infants.

Predicting of Poor Outcomes for Patients HIV-associated Community-Acquired Pneumonia: Who are at risk and how reduce mortality in such patients?

Predicting of Poor Outcomes for Patients HIV-associated Community-Acquired Pneumonia: Who are at risk and how reduce mortality in such patients?

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

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

Comparison of ROX Index and Surfactant Protein-D with HFNC Outcome in COVID-19 Patients

Background: In COVID-19, severe clinical deterioration can lead to respiratory distress. High Flow Nasal Cannula (HFNC) is an oxygenation treatment recommended in severe COVID-19 patients, with various studies showing decreased recovery time and intensive care needed. However, instruments to predict HNFC outcomes, specifically in COVID-19, are not yet widely studied. ROX index is a practical instrument proven effective in predicting HFNC outcome in pneumonia while showing high variabilities of optimum time of assessments and cut-off values in COVID-19. Surfactant Protein-D (SP-D) is an alveolar protein showing potential as a biomarker in acute lung injury and respiratory distress. In this study, we analyzed ROX index and SP-D potential as HFNC outcome predictors in COVID-19 patients. Methods: This prospective study recruited severe and critical COVID-19 patients treated with HFNC. Patient characteristics, laboratory values including initial serum SP-D values, and ROX index were recorded. Significant differences were analyzed using Chi-Square and Mann-Whitney tests. Receiver operating characteristic (ROC) analysis was used to determine HFNC outcome predictive abilities of ROX index and serum SP-D. Result: 31 subjects with successful HFNC outcomes in 19 subjects and failed HFNC outcomes in 12 subjects were included in this study. ROX index and SP-D value were significantly higher in subjects with successful HFNC compared to failed HFNC (p &lt; 0.05). ROX index at 6, 12, and 24 hours showed good HFNC outcome predictive ability (AUC &gt; 0.7, p &lt; 0.05). Conclusion: Successful HFNC outcome in COVID-19 was significantly related to higher ROX index and serum SP-D values. ROX index also showed good potential as an HFNC outcome predictor in COVID-19 patients.