Prevalence Of Pneumonia Research Articles

Clinical characteristics, resource use, and diagnostic accuracy of natriuretic peptides in cancer patients presenting with acute dyspnea to the Emergency Department

Abstract Background Previous studies suggest that dyspnea is a common presenting symptom in cancer patients and 6% of patients hospitalized for acute heart failure (AHF) have a history of cancer [1]. However, the clinical characteristics and diagnostic accuracy of natriuretic peptides in patients with active or past cancer presenting to the emergency department (ED) with acute dyspnea is largely unknown. Purpose We aimed to evaluate (1) the characteristics of patients presenting with acute dyspnea, (2) the prevalence of AHF, (3) the time to discharge and hospitalization rate, and (4) the diagnostic accuracy of natriuretic peptides (BNP and NT-proBNP) and the recommended algorithm to diagnose AHF in patients with and without cancer [2]. Methods Patients presenting with acute dyspnea to the ED were prospectively enrolled in a multicenter diagnostic study. Patient characteristics, including cancer status was prospectively assessed. Final diagnosis was centrally adjudicated by two independent cardiologists using all individual patient information including cardiac imaging, natriuretic peptides and follow-up data. Discrimination was assessed using the area under the curve (AUC). Results Among 2153 patients, 474 (22.0%) had cancer. Cancer patients were older, more frequently smokers, presented more often with productive cough and less often with paroxysmal nocturnal dyspnea, and had a higher prevalence of previous pulmonary embolism. Prevalence of AHF was 44.9% vs 51.0% in patients with and without cancer, respectively (P = 0.02), although it was the most frequent final adjudicated diagnosis for both groups. Cancer patients had a higher prevalence of pneumonia (18.1% vs 14.4%, P = 0.046) and lower prevalence of psychogenic hyperventilation (1.9% vs 5.2%, P = 0.002). Cancer-related dyspnea accounted for up to 30.4% of final diagnoses. Length of stay in the ED was similar in the two groups, although cancer patients had a higher hospitalization rate (85.0% vs 79.0%, P = 0.004) and the hospitalization was longer (median 9 vs 7 days, P<0.001). The diagnostic accuracy of NT-proBNP was high in cancer patients, but significantly lower compared to non-cancer patients (AUC 0.90 vs 0.93; P=0.02). The diagnostic accuracy of BNP was very high and comparable between groups (0.94 vs 0.95. P=0.40, Figure 1). In cancer patients, the AHF NT-proBNP algorithm maintained a very high safety for ruling out AHF but had lower efficacy with more patients remaining in the gray zone compared with patients without cancer (28.9% vs 18.9%, respectively; P<0.01, Figure 2). Conclusions Patients with cancer presenting with dyspnea have lower prevalence of AHF. Hospitalization rates are increased. The diagnostic performance of NT-proBNP, but not of BNP, is reduced. The efficacy of the NT-proBNP algorithm is reduced with more patients triaged to the grey zone and so is rule-in performance, possibly leading to overdiagnosis and mistreatment.Diagnostic accuracy of BNP and NT-proBNPNT-proBNP ESC algorithm

Development of a wastewater based infectious disease surveillance research system in South Korea.

Wastewater-based epidemiology has been used in pathogen surveillance for microorganisms at the community level. This study was conducted to determine the occurrence and trends of infectious pathogens in sewage from Yongin city and the relationships between these pathogens and the incidence of infectious diseases in the community. From December 2022 to November 2023, we collected inflow water from six wastewater treatment plants in Yongin city twice a month. The analyzed microorganisms included 15 respiratory viruses, 7 pneumonia-causing bacteria, 19 acute diarrhea-causing pathogens, SARS-CoV-2, Zika virus, hepatitis A virus, poliovirus, Mpox, and measles. They were detected through real-time PCR and conventional PCR. The concentrations of 9 pathogens among them were additionally analyzed using quantitative real time PCR. The correlation was confirmed through statistical analysis with the rate of detection for pathogens reported by the Korea Disease Control and Prevention Agency. Influenza A virus, human adenovirus, and human rhinovirus were moderately correlated (rho values of 0.45 to 0.58). Campylobacter spp. and sapovirus were strong correlated (rho values of 0.62, 0.63). Enteropathogenic E. coli, human coronavirus, and norovirus GII were very strong correlated (rho values of 0.86 to 0.92). We were able to identify the prevalence of respiratory viral infections, pneumonia, and acute diarrhea-causing pathogens in the community through wastewater-based epidemiology data. This study will be helpful in establishing a system for future surveillance of infectious diseases present in sewage.

Prevalence and etiology of ventilator-associated pneumonia during the COVID-19 pandemic in Denmark: Wave-dependent lessons learned from a mixed-ICU.

Ventilator-associated pneumonia (VAP) may be a particular concern in patients with severe coronavirus disease 2019 (COVID-19). We aimed to determine the prevalence and etiology of VAP in critically ill COVID-19 patients in a Danish intensive care unit (ICU) during the first three waves of the COVID-19 pandemic and to study associations between dexamethasone (DXM) use and development of VAP. In an observational single-center study patients were retrospectively screened for VAP including causative pathogens, use of DXM and commonly used antibiotics. Diagnosis of VAP required invasive mechanical ventilation (IMV) >48 h with presence of a new bacterial agent and clinical signs of infection. For analysis, common descriptive statistics were applied. Cox proportional hazards models were used to analyze the association between DXM use and VAP. VAP was detected in 53/119 (44.5%) mechanically ventilated patients across all three COVID-19 waves. Median length of IMV for VAP patients was 24 [15-41] days, and 3 out of 4 were males. VAP was most prevalent (47.0%) during the second wave. Common pathogens included Klebsiella pneumoniae (24.5%), Enterobacter aerogenes (17.0%) and Pseudomonas aeruginosa (13.2%), Staphylococcus aureus (13.2%), and Escherichia coli (13.2%). A change from Gram-negative bacteria only to a combination of Gram-positive and Gram-negative bacteria was observed in the second wave compared to first. Use of DXM was not associated with VAP (adjusted hazard ratio 1.63 95% CI: 0.84-3.17). The prevalence of VAP was high across all three COVID-19 waves and showed a different distribution of pathogens between the first and second wave. Use of DXM was not associated with VAP development. Further and larger studies are needed to understand the risk factors associated with VAP in patients with COVID-19.

Etiology and antimicrobial susceptibility patterns of bacteria causing pneumonia among adult patients with signs and symptoms of lower respiratory tract infections during the COVID-19 pandemic in Mwanza, Tanzania: a cross-sectional study

BackgroundBacterial pneumonia is among the leading causes of morbidity and mortality worldwide. The extensive misuse and overuse of antibiotics observed during the Corona Virus Disease 2019 (COVID-19) pandemic may have changed the patterns of pathogens causing bacterial pneumonia and their antibiotic susceptibility profiles. This study was designed to establish the prevalence of culture-confirmed bacterial pneumonia and describe their antimicrobial susceptibility profile in adult patients who presented with signs and symptoms of lower respiratory tract infections (LRTIs) during the COVID-19 pandemic.MethodologyThis hospital-based cross-sectional study was conducted from July 2021 to July 2022 at a zonal referral hospital and two district hospitals in Mwanza, Tanzania. Demographic and clinical data were collected using a standardized questionnaire. Sputum samples were processed by conventional culture followed by the identification of isolates and antibiotic susceptibility testing. Descriptive data analysis was performed using STATA version 15.0.ResultsA total of 286 patients with a median age of 40 (IQR 29–60) years were enrolled in the study. More than half of the patients enrolled were females (52.4%, n = 150). The overall prevalence of bacterial pneumonia was 34.3% (n = 98). The majority of the bacterial pathogens isolated were Gram-negative bacteria (GNB) (61.2%, 60/98), with a predominance of Klebsiella spp., 38.8% (38/98), followed by Streptococcus pyogenes (21.4%, 21/98). Multi drug resistant (MDR) bacteria were detected in 72/98 (73.5%) of the isolates. The proportions of GNB-resistant strains were 60.0% (36/60) for ciprofloxacin, 60% (36/60) for amoxicillin, 60% (36/60) for amoxicillin, 68.3% (41/60) for trimethoprim-sulfamethoxazole and 58.3% (35/60) for ceftriaxone.ConclusionOne-third of the patients with signs and symptoms of LRTIs had laboratory-confirmed bacterial pneumonia with a predominance of Gram negative MDR bacteria. This calls for continuous antimicrobial resistance (AMR) surveillance and antimicrobial stewardship programs in the study setting and other settings in developing countries as important strategies for tackling AMR.

Analysis of Pathogen Detection Data in 898 Pediatric Patients Hospitalized with Community-Acquired Pneumonia

Introduction: The prevalence of community-acquired pneumonia (CAP) in pediatric patients has seen significant changes following the lifting of COVID-19 restrictions. This study examines the epidemiology and pathogen detection in children hospitalized with CAP at Beijing New Century Children's Hospital throughout 2023. Objective: To analyze the pathogen detection rates and distribution characteristics among 898 pediatric CAP patients admitted during 2023, focusing on age-related and seasonal variations. Methods: This retrospective study included 898 pediatric patients diagnosed with CAP between January 1 and December 31, 2023. Respiratory pathogen detection was performed using a combination of antigen detection kits, nucleic acid testing, and bacterial culture. The data were analyzed for pathogen distribution across different age groups and seasons. Results: Of the 898 CAP cases, pathogens were detected in 703 cases (78.3%). Mycoplasma pneumoniae was the most frequently identified pathogen (44.1%), with detection rates increasing significantly with age, particularly in school-aged children. Viral pathogens were detected in 42.7% of cases, with Respiratory Syncytial Virus (32.4%) being the most prevalent. Bacterial pathogens were identified in 49.5% of cases, with Streptococcus pneumoniae (34.1%) and Haemophilus influenzae (33.0%) being the most common. Mixed infections were observed in 64.4% of cases, with a higher prevalence in older children and during the autumn and winter seasons. Conclusions: The study highlights significant age and seasonal variations in pathogen distribution among pediatric CAP patients. Mycoplasma pneumoniae was more common in older children and during autumn, while bacterial infections peaked in winter. The findings emphasize the need for age and season-specific strategies in managing pediatric CAP and suggest that comprehensive diagnostic approaches are crucial to accurately identify the causative pathogens.

Prevalence and predictors of radiographic pneumonia in children with wheeze: A systematic review and meta-analysis.

Diagnostic uncertainty exists surrounding the identification of radiographic pneumonia in children with wheeze. It is important to determine the prevalence and clinical predictors of pneumonia in this population to limit chest radiography (CXR) and promote judicious antibiotic use. The objectives were to (1) estimate the prevalence of radiographic pneumonia in children with wheeze and (2) systematically review the diagnostic accuracy of clinical findings for the identification of radiographic pneumonia. Data sources were MEDLINE, PubMed Central, Cochrane Library, CINAHL, and Web of Science (January 1995 to September 2023). For study selection, two reviewers identified high-quality studies reporting on clinical characteristics associated with radiographic pneumonia in wheezing children (age 0-21 years). Using Covidence software, data regarding study characteristics, methodologic quality, and results were extracted. Data were pooled using random-effects meta-analysis. A total of 8333 unique titles and abstracts were reviewed. Twelve studies, representing 7398 patients, were included. Fifteen percent of children with wheeze undergoing CXR had pneumonia. Findings associated with radiographic pneumonia included temperature ≥ 38.4°C (positive likelihood ratio [LR+] 2.1, 95% CI 1.2-3.6, specificity 85%), oxygen saturation < 92% (LR+ 3.6, 95% CI 1.4-8.9, specificity 89%), and grunting (LR+ 2.7, 95% CI 1.6-4.4, pooled specificity 91%). Factors associated with the absence of radiographic pneumonia included lack of fever (negative likelihood ratio [LR-] 0.67, 95% CI 0.52-0.85) and oxygen saturation ≥ 95% (LR- 0.64, 95% CI 0.42-0.98). Tachypnea and auscultatory findings were not associated with radiographic pneumonia. Heterogeneity across studies limits generalizability. Additionally, all included studies overestimate the rate of radiographic pneumonia given the fact that all subjects had a CXR performed due to clinical suspicion of pneumonia. Radiographic pneumonia occurs in 15% of wheezing children undergoing CXR for pneumonia. Auscultatory findings and tachypnea do not differentiate children with and without pneumonia, and the rate of radiographic pneumonia is very low in the absence of fever and hypoxemia.

Time to recovery from severe pneumonia and its predictors among pediatric patients admitted in South West Region governmental hospitals, South West Ethiopia: Prospective follow-up study

BackgroundThe Ethiopian Federal Ministry of Health has been working by introducing vaccines, and integrating the management of newborn and child illnesses to prevent pneumonia, pneumonia-related hospitalization, and mortality. Despite these attempts, the prevalence of pneumonia and the proportion of hospitalizations have increased. Little is known about recovery time from severe pneumonia and its predictors in pediatric patients in the study area. Therefore, this study aimed to determine the time to recovery from severe pneumonia and its predictors in pediatric patients admitted to government hospitals in the southwest Region. Methods and MaterialsA hospital-based prospective follow-up study was conducted among 791 pediatric patients admitted with severe pneumonia at a governmental hospital in the South West Region, of Ethiopia. A systematic sampling technique was used to recruit participants. Data were entered into Epi-data 4.4.2.1 and exported to STATA 14 for analysis. The assumptions of Cox proportional hazard models and goodness of fit were assessed using the Shoenfield residual and Cox-Snell, respectively. Bivariate and multivariable Cox regression models were used to identify the predictors of time to recovery. Variables with a p-value of <0.05 at a 95 % confidence level in multivariable Cox regression model analysis were declared statistically significant predictors of time to recovery. ResultsThis study revealed that 641 (81.04 %) participants recovered with an incidence rate of 12.48 per 100 person-day observations. The median time to recovery was 5 days. Rural residence [AHR=0.82; 95 % CI 0.69–0.97], hypoxemia [AHR=1.25; 95 % CI 1.01- 1.55], danger sign, [AHR=1.77; 95 % CI 1.28- 2.45], comorbidity [AHR=0.60; 95 % CI 0.50- 0.7] and history of previous respiratory infections [AHR=0.76; 95 % CI 0.64- 0.90] were found significant predictors of time to recovery from severe pneumonia. ConclusionIn this study, the recovery rate from severe pneumonia among pediatric patients was low and the time to recovery was slightly prolonged with a median time to recovery of five days. Rural residence, hypoxemia, danger signs, comorbidity, and history of previous respiratory infections were independent predictors of time to recovery among pediatric patients. Therefore, the Ethiopian Federal Ministry of Health, family, community leaders, healthcare providers, and other stakeholders should provide timely initiation of advanced diagnosis, appropriate therapeutic interventions, and proper follow-up for pediatric patients with severe pneumonia to reduce mortality.

Protecting effects of smoking against COVID-19: a community-based retrospective cohort study in middle- and older-aged adults.

On December 7, 2022, China switched from dynamic zeroing strategy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to reopening. A nationwide SARS-CoV-2 epidemic emerged rapidly. The effect of smoking on SARS-CoV-2 infection remains unclear. We aimed to retrospectively investigate the relationship between smoking and coronavirus disease 2019 (COVID-19) using a community-based cohort of smokers and non-smokers. We included participants from a pre-pandemic cohort with a prolonged follow-up period. Data on smoking status, body mass index, and history of other diseases were collected from health examination and consultation clinic records. Cox regression analysis was used to identify the relationship between groups and SARS-CoV-2 infection over time. We analysed 218 male patients with varied smoking statuses (46.3% current or ex-smokers; average age 68.63 ± 9.81years). Two peaks in the epidemic were observed following the December 2022 outbreak. At the end of the second peak, non-smokers, current smokers, and ex-smokers had primary infection rates increase to 88.0%, 65.1%, and 81.0%, respectively, with a significant difference between the groups. Current smoking significantly protected against SARS-CoV-2 infection (HR 0.625, 95% CI 0.402-0.970, p = 0.036). Further analyses showed that the prevalence of pneumonia in the unvaccinated, older, diabetic, and non-smoking groups was significantly higher than that in the other groups (p < 0.05). Our study suggests a potential association between smoking and a reduced risk of SARS-CoV-2 infection and pneumonia. This indicates that nicotine and ACE2 play important roles in preventing COVID-19 and its progression. We suggest smokers use nicotine replacement therapy during hospitalization for COVID-19.

Early Detection of Pulmonary Embolism in a General Patient Population Immediately Upon Hospital Admission Using Machine Learning to Identify New, Unidentified Risk Factors: Model Development Study.

Under- or late identification of pulmonary embolism (PE)-a thrombosis of 1 or more pulmonary arteries that seriously threatens patients' lives-is a major challenge confronting modern medicine. We aimed to establish accurate and informative machine learning (ML) models to identify patients at high risk for PE as they are admitted to the hospital, before their initial clinical checkup, by using only the information in their medical records. We collected demographics, comorbidities, and medications data for 2568 patients with PE and 52,598 control patients. We focused on data available prior to emergency department admission, as these are the most universally accessible data. We trained an ML random forest algorithm to detect PE at the earliest possible time during a patient's hospitalization-at the time of his or her admission. We developed and applied 2 ML-based methods specifically to address the data imbalance between PE and non-PE patients, which causes misdiagnosis of PE. The resulting models predicted PE based on age, sex, BMI, past clinical PE events, chronic lung disease, past thrombotic events, and usage of anticoagulants, obtaining an 80% geometric mean value for the PE and non-PE classification accuracies. Although on hospital admission only 4% (1942/46,639) of the patients had a diagnosis of PE, we identified 2 clustering schemes comprising subgroups with more than 61% (705/1120 in clustering scheme 1; 427/701 and 340/549 in clustering scheme 2) positive patients for PE. One subgroup in the first clustering scheme included 36% (705/1942) of all patients with PE who were characterized by a definite past PE diagnosis, a 6-fold higher prevalence of deep vein thrombosis, and a 3-fold higher prevalence of pneumonia, compared with patients of the other subgroups in this scheme. In the second clustering scheme, 2 subgroups (1 of only men and 1 of only women) included patients who all had a past PE diagnosis and a relatively high prevalence of pneumonia, and a third subgroup included only those patients with a past diagnosis of pneumonia. This study established an ML tool for early diagnosis of PE almost immediately upon hospital admission. Despite the highly imbalanced scenario undermining accurate PE prediction and using information available only from the patient's medical history, our models were both accurate and informative, enabling the identification of patients already at high risk for PE upon hospital admission, even before the initial clinical checkup was performed. The fact that we did not restrict our patients to those at high risk for PE according to previously published scales (eg, Wells or revised Genova scores) enabled us to accurately assess the application of ML on raw medical data and identify new, previously unidentified risk factors for PE, such as previous pulmonary disease, in general populations.

Typical pneumonia among human immunodeficiency virus-infected patients in public hospitals in southern Ethiopia.

Typical pneumonia is a pressing issue in the treatment of human immunodeficiency virus (HIV) patients, especially in Sub-Saharan Africa, where it remains a significant menace. Addressing this problem is crucial in improving health outcomes and the reduction of the burden of diseases in this vulnerable category of patients. To determine the prevalence of community-acquired typical pneumonia among HIV patients in Public Hospitals in southern Ethiopia. A cross-sectional study was done among 386 HIV patients clinically suspected of typical pneumonia attending the anti-retroviral therapy (ART) clinics of two hospitals from March to September 2022. A pretested structured questionnaire was employed to collect the demographic, clinical, and behavioral data. Sputum samples were collected and inspected for bacteria following standard procedures, and antimicrobial susceptibility testing was performed employing the Kirby-Bauer disk diffusion method. Besides, extended-spectrum β-lactamase (ESβL) and carbapenemase-producing Gram-negative bacteria were inspected by the double disk synergy test and modified carbapenem inactivation method. Descriptive and inferential statistical analyses were also done. Overall, 39.1% (151/386) of sputum cultures (95% Confidence Interval: 32.4-44) were bacteriologically positive. A total of 151 bacteria were identified, comprising 72.8% (n = 110) of Gram-negative bacteria. The predominant isolate was Klebsiella pneumoniae (25.8%, n = 39), followed by Staphylococcus aureus (17.9%, n = 27); 59.6% (n = 90) of the entire isolates were multidrug-resistant (MDR). Forty percent (11/27) of S. aureus were methicillin-resistant S. aureus (MRSA), and 28.1% (n = 31) and 20.9% (n = 23) of Gram-negative bacteria were extended-spectrum beta-lactamases (ESBL) and carbapenemase producers, respectively. Occupational status, alcohol consumption, cluster of differentiation4 (CD4) Thymocyte cell count < 350, interruption of trimethoprim-sulfamethoxazole prophylaxis and antiretroviral treatment, and recent viral load ≥ 150 were found statistically significant. The higher rates of MDR, MRSA, ESBL, and carbapenem-resistant Enterobacterales (CRE) indicate that bacterial pneumonia is a vexing problem among HIV patients and therefore it is advisable to implement an antimicrobial stewardship program in the study area.

Chemical composition combined with network pharmacology and quality markers analysis for the quality evaluation of Qing-fei-da-yuan granules.

Qing-fei-da-yuan granules (QFDYGs) had been proved to be an effective TCM prescription for treating coronavirus disease 2019 (COVID-19), which are composed of a variety of TCMs, and characterized by multiple components, multiple targets and overall regulation. It is meaningful to further study the chemical composition and pharmacology of QFDYGs for quality evaluation. However, due to the complexity of the components of QFDYGs, there are no reliable and simple analytical methods for current quality evaluation. In this work, antipyretic activity assessment of QFDYGs in the LPS-induced New Zealand rabbit model was carried out to verify the efficacy firstly. It was proved that QFDYGs can be used to relieve fever to help preventing or controlling the prevalence of influenza and pneumonia. Subsequently, UHPLC-ESI-QTOF-MS/MS combined with network pharmacology, quality markers and fingerprint analysis were used to establish the quality control condition. The chemical compositions were analyzed by UHPLC-ESI-QTOF-MS/MS, and 79 of them were identified, such as arecoline, mangiferin, paeoniflorin, etc. Then, the network pharmacology strategy based on 45 candidate components (CCs) in conjunction with influenza and pneumonia diseases was employed to screen the potential active ingredients. According to the drug-CCs-genes-diseases (D-CCs-G-D) networks, baicalein, honokiol, baicalin, paeoniflorin, saikosaponin A, glycyrrhizic acid and hesperidin were selected as quality markers. And a method for content determination of the 7 quality markers was established by optimizing extraction methods, chromatographic conditions and methodological verification. Finally, the quality of 15 batches of QFDYGs was evaluated by using the 7 quality markers combined with fingerprints and principal component analysis (PCA). The analyzed results showed that baicalin, paeoniflorin, glycyrrhizic acid and hesperidin were the high content and stable quality markers. QFDYGs were characterized by overall consistency and individual ingredient differences among the 15 batches. Our quality evaluation study will provide reference for the further development and research of QFDYGs.

Prevalence, Clinical Severity, and Serotype Distribution of Pneumococcal Pneumonia Among Adults Hospitalized With Community-Acquired Pneumonia in Tennessee and Georgia, 2018-2022.

Understanding the pneumococcal serotypes causing community-acquired pneumonia (CAP) is essential for evaluating the impact of pneumococcal vaccines. We conducted a prospective surveillance study of adults aged ≥18 years hospitalized with CAP at 3 hospitals in Tennessee and Georgia between 1 September 2018 and 31 October 2022. We assessed for pneumococcal etiology with cultures, the BinaxNOW urinary antigen detection test, and serotype-specific urinary antigen detection assays that detect 30 pneumococcal serotypes contained in the investigational pneumococcal conjugate vaccine V116, as well as licensed vaccines PCV15 and PCV20 (except serotype 15B). The distribution of pneumococcal serotypes was calculated based on serotype-specific urinary antigen detection results. Among 2917 hospitalized adults enrolled with CAP, 352 (12.1%) patients had Streptococcus pneumoniae detected, including 51 (1.7%) patients with invasive pneumococcal pneumonia. The 8 most commonly detected serotypes were: 3, 22F, 19A, 35B, 9N, 19F, 23A, and 11A. Among 2917 adults with CAP, 272 (9.3%) had a serotype detected that is contained in V116, compared to 196 (6.7%) patients with a serotype contained in PCV20 (P < .001), and 168 (5.8%) patients with a serotype contained in PCV15 (P < .001). A serotype contained in V116 but not PCV15 or PCV20 was detected in 120 (4.1%) patients, representing 38.0% of serotype detections. Approximately 12% of adults hospitalized with CAP had S. pneumoniae detected, and approximately one-third of the detected pneumococcal serotypes were not contained in PCV15 or PCV20. Development of new pneumococcal vaccines with expanded serotype coverage has the potential to prevent a substantial burden of disease.

Uji Aktivitas Antibakteri Ekstrak Buah Tin (Ficus carica L.) Terhadap Bakteri Streptococcus pneumoniae

Streptococcus pneumoniae (pneumococcus) is a normal flora in the respiratory tract that can mutate into pathogenic bacteria that cause Invasive Pneumococcal Disease (IPD) such as pneumonia. The high prevalence of pneumonia causes antibiotics to be the appropriate therapy to treat cases of infection by bacteria. However, the use of antibiotics that are not indicated can lead to other health problems, namely antibiotic resistance. One of the efforts that can be made to reduce the rate of antibiotic resistance is the utilization of natural-based antibiotics. One of the plants that has potential as a natural antibiotic is Tin fruit (Ficus carica L.) which is thought to be due to the presence of antibacterial compounds in it, namely tannins, phenols, and flavonoids. The specialty of Tin fruit is also mentioned in the Qur'an surah At-Tiin verse 1 which means "By (the fruit) Tin and (the fruit) Olive". To determine the antibacterial activity of Tin fruit (Ficus carica L.) against Streptococcus pneumoniae bacteria. The research conducted was a true experimental post test study using the disc diffusion method (Kirby Bauer method) to see the effectiveness of Tin fruit extract (Ficus carica L.) in inhibiting the growth of Streptococcus pneumoniae bacteria. Tin fruit extract (Ficus carica L.) with a concentration of 50% is resistant to Streptococcus pneumoniae bacteria with an inhibition diameter of 4.35 mm. While the 100% concentration is sensitive in inhibiting the growth of Streptococcus pneumoniae bacteria with an inhibition diameter of 19.45 mm. Tin fruit extract (Ficus carica L.) has antibacterial activity in inhibiting the growth of Streptococcus pneumoniae bacteria.

Bundle care approach to reduce device associated infections in post-living-donor-liver transplantation in a tertiary care hospital, Egypt

BackgroundDevice-associated infections (DAIs) are a significant cause of morbidity following living donor liver transplantation (LDLT). We aimed to assess the impact of bundled care on reducing rates of device-associated infections.MethodsWe performed a before-and-after comparative study at a liver transplantation facility over a three-year period, spanning from January 2016 to December 2018. The study included a total of 57 patients who underwent LDLT. We investigated the implementation of a care bundle, which consists of multiple evidence-based procedures that are consistently performed as a unified unit. We divided our study into three phases and implemented a bundled care approach in the second phase. Rates of pneumonia related to ventilators [VAP], bloodstream infections associated with central line [CLABSI], and urinary tract infections associated with catheters [CAUTI] were assessed throughout the study period. Bacterial identification and antibiotic susceptibility testing were performed using the automated Vitek-2 system. The comparison between different phases was assessed using the chi-square test or the Fisher exact test for qualitative values and the Kruskal-Wallis H test for quantitative values with non-normal distribution.ResultsIn the baseline phase, the VAP rates were 73.5, the CAUTI rates were 47.2, and the CLABSI rates were 7.4 per one thousand device days (PDD). During the bundle care phase, the rates decreased to 33.3, 18.18, and 4.78. In the follow-up phase, the rates further decreased to 35.7%, 16.8%, and 2.7% PDD. The prevalence of Klebsiella pneumonia (37.5%) and Methicillin resistance Staph aureus (37.5%) in VAP were noted. The primary causative agent of CAUTI was Candida albicans, accounting for 33.3% of cases, whereas Coagulase-negative Staph was the predominant organism responsible for CLABSI, with a prevalence of 40%.ConclusionThis study demonstrates the effectiveness of utilizing the care bundle approach to reduce DAI in LDLT, especially in low socioeconomic countries with limited resources. By implementing a comprehensive set of evidence-based interventions, healthcare systems can effectively reduce the burden of DAI, enhance infection prevention strategies and improve patient outcomes in resource-constrained settings.

Recent symptomatic Omicron infection reduced COVID-19 pneumonia risk during reinfection: A computed tomography–based cohort study

ObjectivesSARS-CoV-2 infection could cause persistent lung injury or indicate potential genetic susceptibilities. Although infection-elicited hybrid immunity could protect against severe COVID-19, it remains unknown whether recent infection could reduce pneumonia risk during reinfection due to insufficient viral and chest computed tomography (CT) screening. MethodsA total of 15,598 patients, 96% fully vaccinated and 52% boosted, from Xiangyang, China, who had symptomatic COVID-19 and chest CT scans during the first Omicron BF.7 wave in December 2022 to January 2023, were followed through the second Omicron XBB.1.5 wave between May and August 2023. A total of 17,968 second-wave patients with COVID-19 with chest CT scans but without previous symptomatic COVID-19 were enrolled as first-time infection controls. ResultsA total of 19.6% (3,061 of 15,598) first-wave patients were diagnosed with pneumonia. Among second-wave reinfected patients, only 0.2% (four of 2202) developed pneumonia, which was lower than the 1.7% (311 of 17,968) pneumonia prevalence among the second-wave first-time patients, with an adjusted relative risk of 0.11 (95% confidence interval: 0.04-0.29). A total of 1.3% (40 of 3,039) first-wave pneumonia survivors showed residual abnormal patterns in follow-up CT scans within 8 months after pneumonia diagnosis. ConclusionsIn a highly vaccinated population, previous symptomatic Omicron infection within 8 months reduced pneumonia risk during reinfection. Uninfected individuals might need up-to-date vaccination to reduce pneumonia risk.

The Prevalence, Predisposing Factors, and Outcomes of Pneumocystis jirovecii Pneumonia among Pediatric Inpatients, Northeastern Iran

Abstract Objective Pneumocystis jirovecii pneumonia (PJP), caused by Pneumocystis jirovecii, is one of the opportunistic fungal infections that can cause life-threatening pneumonia in children with underlying diseases. Due to the similarity of the symptoms of PJP with other lung infections, such as tuberculosis, differential and accurate diagnosis is necessary. The current study investigated the molecular diagnosis of P. jirovecii, predisposing factors and the outcomes, among pediatric inpatients in Northeastern Iran. Methods In this study, 180 bronchoalveolar lavage specimens were obtained from hospitalized children with respiratory disorders. The specimens were examined using Giemsa stain, and the genomic DNA was extracted according to the protocol of the AmpliSens kit. A real-time polymerase chain reaction (PCR) technique was used to detect P. jirovecii by the AmpliSens Pneumocystis jirovecii (carinii)-FRT PCR kit. Results Among the patients studied, 34 (18.9%) were positive and 8 (4.4%) were suspicious of the presence of P. jirovecii. Among the 34 positive cases, 12 (35%) were diagnosed before, and 22 (65%) during the coronavirus 2019 (COVID-19) pandemic. Only two cases (5.88%) among the positive ones detected by the real-time PCR method were observed using Giemsa staining. Also, no correlation was observed between positive cases of infection and the sex, the outcomes, and underlying diseases. Conclusion The results showed that PJP has a relatively high prevalence among pediatric inpatients with respiratory disorders. Neutropenia is a significant predisposing factor in these patients. However, there is no correlation between PJP cases and outcomes and underlying diseases. Most of the patients with PJP were affected during the COVID-19 pandemic, probably due to treatment with corticosteroids.

Diagnostic Performance of Plasma SP-D, KL-6, and CC16 in Acutely Hospitalised Patients Suspected of Having Community-Acquired Pneumonia-A Diagnostic Accuracy Study.

Community-acquired pneumonia is a common cause of acute hospitalisation. Identifying patients with community-acquired pneumonia among patients suspected of having the disease can be a challenge, which causes unnecessary antibiotic treatment. We investigated whether the circulatory pulmonary injury markers surfactant protein D (SP-D), Krebs von den Lungen-6 (KL-6), and Club cell protein 16 (CC16) could help identify patients with community-acquired pneumonia upon acute admission. In this multi-centre diagnostic accuracy study, SP-D, KL-6, and CC16 were quantified in plasma samples from acutely hospitalised patients with provisional diagnoses of community-acquired pneumonia. The area under the receiver operator characteristics curve (AUC) was calculated for each marker against the following outcomes: patients' final diagnoses regarding community-acquired pneumonia assigned by an expert panel, and pneumonic findings on chest CTs. Plasma samples from 339 patients were analysed. The prevalence of community-acquired pneumonia was 63%. AUCs for each marker against both final diagnoses and chest CT diagnoses ranged between 0.50 and 0.56. Thus, SP-D, KL-6, and CC16 demonstrated poor diagnostic performance for community-acquired pneumonia in acutely hospitalised patients. Our findings indicate that the markers cannot readily assist physicians in confirming or ruling out community-acquired pneumonia.

Clustering of Communicable Diseases in Indonesia and the Factors that Affect Them: 2018 Basic Health Research Data Statistical Review

The prevalence of communicable diseases in Indonesia is still high and causes morbidity and mortality in several Indonesian provinces. This cross-sectional study classified provinces based on the prevalence of seven communicable diseases: acute respiratory infections (ARI), pneumonia, diarrhea, filariasis, malaria, hepatitis, and tuberculosis (TB). The study analyzed the 2018 Indonesian Basic Health Research data. It is essential to categorize these diseases to identify regions with low, moderate, and high prevalence and the factors that affect them to facilitate the treatment of these diseases. Grouping provinces and influenced factors were analyzed using K-means, ANOVA, and stepwise regression. The results revealed that Group 1 shows a high prevalence, except for hepatitis and diarrhea. Group 2 demonstrates a moderate prevalence, excluding hepatitis and diarrhea, while Group 3 has a low prevalence. Improved access to primary healthcare services reduced the prevalence of pneumonia and TB, while using insecticide-treated mosquito nets for less than three years increased the prevalence of ARI and pneumonia. Adequate bedroom lighting reduced the prevalence of ARI, whereas being underweight in individuals over 18 increased it. In individuals aged 16–18 with short stature, there was an increase in the prevalence of hepatitis and malaria. Regularly draining the bathtub once a week and ensuring proper bedroom ventilation reduced the incidence of diarrhea. Using improved long-lasting insecticidal nets (LLINs) for mosquitos led to a decrease in filariasis cases. Specific factors influence each communicable disease and necessitate a multisectoral approach for effective treatment.

COVID-19 pneumonia in lung transplant recipients: understanding risk factors and treatment outcomes in Japan

Lung transplant (LTx) recipients face a significant risk from coronavirus disease 2019 (COVID-19), with elevated hospitalization mortality rates even post-vaccination. While severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) typically induces pneumonia in even healthy individuals, it can also infect the transplanted lungs of LTx recipients, potentially leading to graft dysfunction. Despite the prevalence of COVID-19 pneumonia in LTx recipients, data on its characteristics and associated risk factors remain limited. This retrospective study analyzed data from LTx recipients at Tohoku University Hospital between January 2001 and November 2023. COVID-19 cases were identified, and patient records, including thoracic computed tomography (CT) evaluations, were reviewed. Patient characteristics, vaccination history, immunosuppressant use, and comorbidities were assessed. Descriptive analysis was utilized for data presentation. Among 172 LTx recipients, 39 (22.7%) contracted COVID-19, with 9 (23%) developing COVID-19 pneumonia. COVID-19 incidence in LTx recipients aligned with national rates, but pneumonia risk was elevated. Delayed antiviral therapy initiation was noted in pneumonia cases. Remdesivir was uniformly administered and remained the primary treatment choice. LTx recipients are susceptible to COVID-19 pneumonia, warranting vigilance and tailored management strategies. Pre-transplant vaccination and prompt COVID-19 diagnosis and treatment are imperative for optimizing outcomes in this population.

Regional Differences in the Spread of Pneumonia in Russia: A Comparative Spatiotemporal Analysis of the Situation in 2017–2021

Introduction: Pneumonia remains a respiratory disease of concern that keeps influencing morbidity and mortality throughout the world in the 21st century. Increased incidence rates of pneumonia have been registered in Russia for a long time. In this regard, regional surveillance seems relevant across the country for a better understanding of recent spatial differences in the disease spread and their fluctuations. Objective: To carry out a spatiotemporal analysis of regional differences in pneumonia prevalence in the adult population of Russia in 2017–2021 with a focus on pre- and COVID-19 pandemic periods, given the Russian long-term dynamics for 2010–2022. Materials and methods: The study covers the years 2017–2021 with sufficient data on pneumonia prevalence collected. Static and dynamic parameters were calculated for the compared pre- and pandemic periods. A series of cartograms developed using GIS tools made it possible to visualize the information obtained and assess the spatiotemporal situation of the process under study. Results: The long-term dynamics of pneumonia prevalence rates in the adult population in Russia was examined with the regional trends in 2017–2021 assessed. In 2017–2019, they rose in most regions of Russia but the growth rate did not exceed 30 %. In 2019–2021, in the context of the COVID-19 pandemic, the pneumonia situation changed dramatically and the disease rates increased in most regions. A significant deterioration of the situation was observed in most of the European part of Russia with the growth rates ranging from 70 % to 90 %. The number of regions with a null increase in the pneumonia prevalence dropped from 25 to five. Conclusions: Changes in the regional differences in the disease prevalence in the adult population of Russia for 2017–2021 were assessed. The uneven interregional spread of pneumonia complicated during the pandemic compared with the pre-pandemic period. Increased growth rates of the disease prevalence of varying intensity were observed in 80 Russian regions.