Risk Of Community-acquired Pneumonia Research Articles

Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children.

BackgroundThere are no reliable signs or symptoms that differentiate Mycoplasma pneumoniae (Mp) infection in community-acquired pneumonia (CAP) from other etiologies. Additionally, current diagnostic tests do not reliably distinguish between Mp infection and carriage. We previously determined that the measurement of Mp-specific immunoglobulin M antibody-secreting cells (ASCs) by enzyme-linked immunospot assay allowed for differentiation between infection and carriage. Using this new diagnostic test, we aimed to identify clinical and laboratory features associated with Mp infection.MethodsThis is a prospective cohort study of children, 3–18 years of age, with CAP from 2016 to 2017. Clinical features and biomarkers were compared between Mp-positive and -negative groups by Mann-Whitney U test or Fisher exact test, as appropriate. Area under the receiver operating characteristic curve (AUC) differences and optimal thresholds were determined by using the DeLong test and Youden J statistic, respectively.ResultsOf 63 CAP patients, 29 were Mp-positive (46%). Mp positivity was statistically associated with older age (median, 8.6 vs 4.7 years), no underlying disease, family with respiratory symptoms, prior antibiotic treatment, prolonged prodromal respiratory symptoms and fever, and extrapulmonary (skin) manifestations. Lower levels of C-reactive protein, white blood cell count, absolute neutrophil count, and procalcitonin (PCT), specifically PCT <0.25 μg/L, were statistically associated with Mp infection. A combination of age >5 years (AUC = 0.77), prodromal fever and respiratory symptoms >6 days (AUC = 0.79), and PCT <0.25 μg/L (AUC = 0.81) improved diagnostic performance (AUC = 0.90) (P = .05).ConclusionsA combination of clinical features and biomarkers may aid physicians in identifying patients at high risk for Mp CAP.

The association between vitamin D deficiency and community-acquired pneumonia

Emerging evidence has shown that vitamin D deficiency may be related with community-acquired pneumonia (CAP), but individually published studies showed inconclusive results. The aim of this study was to quantitatively summarize the association between vitamin D and the CAP.We conducted this meta-analysis though a systematic literature search of PubMed, Medline, and EMBASE up to 31 September 2018 with the following keywords 'vitamin D' or 'cholecalciferol' or '25-hydroxyvitamin D' or '25(OH)D' in combination with 'community-acquired pneumonia' or 'CAP' or 'pneumonia' with no limitations. This meta-analysis was performed following the guidelines of Meta-analysis of Observational Studies in Epidemiology. The association between vitamin D levels and CAP were measured as odds ratio (OR) and weighted mean difference (WMD). Results were combined using a random-effect or a fix-effect meta-analysis, and sensitivity analyses were conducted to explore potential factors.Eight observational studies involving 20,966 subjects were included. In this meta-analysis, CAP patients with vitamin D deficiency (serum 25(OH)D levels <20 ng/mL) experienced a significantly increased risk of CAP (odds ratio (OR) = 1.64, 95% confidence intervals (CI): 1.00, 2.67), and an obvious decrease of -5.63 ng/mL (95% CI: -9.11, -2.14) in serum vitamin D was demonstrated in CAP patients. Sensitivity analysis showed that exclusion of any single study did not materially alter the overall combined effect.The evidence from this meta-analysis indicates an association between vitamin D deficiency and an increased risk of CAP patients. However, well-designed trails are required to determine the explicit effect of vitamin D supplementation.

Retrospective Study: Association of Chronic Sphenoid Rhinosinusitis With Community Acquired Pneumonia.

ObjectivesOur objective in this study is to examine the association between chronic sphenoid rhinosinusitis and community acquired pneumonia (CAP).Study DesignRetrospective chart review.MethodsA list of chronic rhinosinusitis (CRS) patients who presented to a tertiary rhinology clinic from 2013 to 2015 was conducted. Patients were excluded if they were not seen for at least 2 years. Patients were categorized into CRS with sphenoid sinusitis (group A) and CRS without sphenoid sinusitis (group B). The former group was divided into 2 categories according to their computed tomography scan/endoscopy findings: mucosal thickening and opacification (partial, complete, purulent sphenoid drainage on endoscopy). Posterior ethmoid disease was analyzed in the same fashion. Charts were then reviewed on whether the patients developed CAP within 2 years of their visit to the rhinologist.ResultsSix hundred forty-five of 1061 patients were included in the analysis. There were 178 (27.60%) patients in group A and 467 (72.40%) patients in group B. There were 40 total cases of pneumonia with 27 (67.50%) cases having chronic sphenoid sinusitis. Patients with sphenoid sinusitis were 6.77 (95% confidence interval [CI], 3.36–13.66) times more likely to have pneumonia. Patients with partial/complete opacification of the sphenoid sinus were 19.76 (95% CI, 8.78–44.47) times more likely to have pneumonia. Patients with only mucosal thickening of the sphenoid sinus did not have significantly increased odds of having pneumonia. Posterior ethmoid disease did not have an association with CAP nor did it increase the risk of CAP in sphenoid sinusitis patients.ConclusionsThere is an association between chronic sphenoid rhinosinusitis and CAP. Partial/complete opacification of the sphenoid sinus had the highest association with pneumonia.

Effect of tobacco smoking on the risk of developing community acquired pneumonia: A systematic review and meta-analysis.

AimTo summarise and quantify the effect of tobacco smoking on the risk of developing community acquired pneumonia (CAP) in adults.MethodsWe systematically searched MEDLINE, Embase, CINAHL, PsychINFO and Web of Science, from inception to October 2017, to identify case-control and cohort studies and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. The review protocol was registered with the PROSPERO database (CRD42018093943). Study quality was assessed by the Newcastle-Ottawa Scale. Pooled odds ratios (ORs) or hazard ratios (HRs) were estimated using a random-effects model.ResultsOf 647 studies identified, 27 studies were included (n = 460,592 participants) in the systematic review. Most of the included studies were of moderate quality with a median score of six (IQR 6–7). Meta-analysis showed that current smokers (pooled OR 2.17, 95% CI 1.70–2.76, n = 13 studies; pooled HR 1.52, 95% CI 1.13–2.04, n = 7 studies) and ex-smokers (pooled OR 1.49, 95% CI 1.26–1.75, n = 8 studies; pooled HR 1.18, 95% CI 0.91–1.52, n = 6 studies) were more likely to develop CAP compared to never smokers. Although the association between passive smoking and risk of CAP in adults of all ages was not statistically significant (pooled OR 1.13, 95% CI 0.94–1.36, n = 5 studies), passive smoking in adults aged ≥65 years was associated with a 64% increased risk of CAP (pooled OR 1.64; 95% CI 1.17–2.30, n = 2 studies). Dose-response analyses of data from five studies revealed a significant trend; current smokers who smoked higher amount of tobacco had a higher risk of CAP.ConclusionTobacco smoke exposure is significantly associated with the development of CAP in current smokers and ex-smokers. Adults aged > 65 years who are passive smokers are also at higher risk of CAP. For current smokers, a significant dose-response relationship is evident.

Predictive value of protein C for long-term mortality of patients with community-acquired pneumonia

Objective To investigate the predictive value of protein C(PC) for long-term mortality of patients with community-acquired pneumonia(CAP). Methods A total of 657 patients with CAP were enrolled in Taian Central Hospital from January 2011 to December 2011.The patients were divided into short-term group(≤30 days), medium-term group(>30~90 days) and long-term group(>90 days). PC, high sensitivity C-reactive protein(hs-CRP), procalcitonin(PCT), pneumonia severity index(PSI) score and CURB-65 score were measured at the time of admission.The ROC curve was used to evaluate the independent risk factors.The Kaplan-Meier survival function curve was used to analyze the difference of mortality between the short-term group and long-term group.Independent risk factors for CAP risk were analyzed by COX regression. Results A total of 597 cases were followed up, there were 49 cases(8.09%) in the short-term group, 11 cases(1.84%) in the medium-term group, and 537 cases(89.93%) in the long-term group.The PC levels in the short-term group, medium-term group and long-term group were (32.2±10.6)%, (43.1±9.9)%, (69.6±23.0)%, respectively.The level of PC was significantly increased in the short-term group compared with the medium-term group and long-term group (short-term group vs.medium-term group, q=6.18, P<0.05, short-term group vs.long-term group, q=9.87, P<0.05). The hs-CRP levels in the short-term group, medium-term group and long-term group were (108.1±22.4)mg/L, (68.2±12.9)mg/L, (25.1±17.1)mg/L, respectively.The level of hs-CRP was significantly increased in the short-term group compared with the medium-term group and long-term group (short-term group vs.medium-term group, q=5.23, P<0.05, short-term group vs.long-term group, q=12.95, P<0.05). Meanwhile, PC showed higher accuracy(AUC, 0.889) than CURB-65(AUC, 0.828) and hs-CRP(AUC, 0.711) in the long-term group.The Kaplan-Meier survival function curve showed that the mortality rate was significantly higher in the high-value group compared with the low-value group(F=17.10, P<0.01). PC was an independent factor for long-term mortality and was associated with poorer survival by the COX regression analysis. Conclusion PC has a high predictive value for long-term mortality in CAP patients. Key words: Pneumonia; Community-acquired infections; Protein C; Mortality; Forecasting; Risk factors

Withdrawal of inhaled corticosteroids in COPD patients: rationale and algorithms.

Observational studies indicate that overutilization of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD). Overprescription and the high risk of serious ICS-related adverse events make withdrawal of this treatment necessary in patients for whom the treatment-related risks outweigh the expected benefits. Elaboration of an optimal, universal, user-friendly algorithm for withdrawal of ICS therapy has been identified as an important clinical need. This article reviews the available evidence on the efficacy, risks, and indications of ICS in COPD, as well as the benefits of ICS treatment withdrawal in patients for whom its use is not recommended by current guidelines. After discussing proposed approaches to ICS withdrawal published by professional associations and individual authors, we present a new algorithm developed by consensus of an international group of experts in the field of COPD. This relatively simple algorithm is based on consideration and integrated assessment of the most relevant factors (markers) influencing decision-making, such a history of exacerbations, peripheral blood eosinophil count, presence of infection, and risk of community-acquired pneumonia.

Knowledge of asthmatic disease as a pneumonia protective factor

ObjectiveTo assess whether knowledge of asthmatic disease may be a protective factor against the risk of community-acquired pneumonia (CAP) in people with asthma over the age of 18 who receive inhaled treatment. MethodObservational study of cases and controls in a population with asthma. One hundred and twenty-three people with asthma diagnosed with pneumonia were recruited according to clinical and radiological criteria (cases), and 246 people with asthma not diagnosed with pneumonia during the past year (controls), matched by age. The main study factor was the assessment of knowledge about asthmatic disease through an ad hoc questionnaire, with seven questions and two possible answers (known, unknown). ResultsThe bivariate analysis shows that knowledge of asthmatic disease has a statistically significant association as a protective factor of CAP. In the multivariate analysis, it shows an association of knowledge of asthmatic disease as a protective factor of CAP (OR=.24), regardless of age, level of studies, functionality, and severity of asthma. ConclusionsA good knowledge of asthmatic disease reduces the risk of CAP in asthmatic patients using inhaled treatment.

The prognostic role of ultrasonographic air bronchogram in the management of community acquired pneumoniae in children

Chest ultrasound is a non-invasive method for evaluating children with suspected community-acquired pneumonia (CAP), allowing close follow-up and reduction of ionizing radiation. We studied the prognostic role of the change of ultrasonographic (US) air bronchogram in the management of CAP in terms of rate of complicated CAP, change in empiric antibiotic therapy, relationship to defervescence time, and length of hospitalization. Patients with diagnosis of CAP and radiographic evidence of lung consolidation were prospectively enrolled. The first chest US examination was performed within 12 h from admission and after 48 h. A new grading system (USINCHILD score) based on the presence and features of air bronchogram was adopted. Thirty six patients (mean age of 5 years) were stratified into two groups according to the presence of an increase in at least 1 grade of US score (Δ US grade), expression of an improvement of lung consolidation. The US grade after 48 h < 1 was associated with an increased risk of complicated CAP (OR: 160.88, p-value: 0.0109) and a longer defervescence time (70 h, p-value: 0.0047). Moreover, Δ US grade ≥ 1 was predictive of a short hospitalization (7 days, p-value: 0.0061). USINCHILD score could be an innovative biotechnology tool for the management of pediatric CAP.

Signs and Symptoms That Rule out Community-Acquired Pneumonia in Outpatient Adults: A Systematic Review and Meta-Analysis.

A systematic review of clinical decision rules to identify patients at low risk for community-acquired pneumonia (CAP) has not been previously presented in the literature. A systematic review of MEDLINE for prospective studies that used at least 2 signs, symptoms, or point-of-care tests to determine the likelihood of CAP. We included studies that enrolled adults and adolescents in the outpatient setting where all or a random sample of patients received a chest radiograph as the reference standard. We excluded retrospective studies and studies that recruited primarily patients with hospital-acquired CAP. Our search identified 974 articles, 12 of which were included in the final analysis. The simple heuristic of normal vital signs (temperature, respiratory rate, and heart rate) to identify patients at low risk for CAP was reported by 4 studies and had a summary estimate of the negative likelihood ratio (LR-) of 0.24 (95% CI, 0.17 to 0.34) and a sensitivity of 0.89 (95% CI, 0.79 to 0.94). The simple heuristic of normal vital signs combined with a normal pulmonary examination to identify patients at low risk for CAP was reported by 3 studies, and had a summary estimate of LR- of 0.10 (95% CI, 0.07 to 0.13) with an area under the receiver operating characteristic curve of 0.92. Adults with an acute respiratory infection who have normal vital signs and a normal pulmonary examination are very unlikely to have CAP. Given a baseline CAP risk of 4%, these patients have only a 0.4% likelihood of CAP.

Risk of community-acquired pneumonia in older adults with sarcopenia of a hospital from Callao, Peru 2010–2015

IntroductionSarcopenia is a geriatric syndrome characterized by loss of muscle mass and strength. The prevalence in people between 60–70 years is about 5–13% and in adults over 80 years, between 11–50% in the USA. Sarcopenia increases the risk of mortality and nosocomial infections.Community-acquired pneumonia is the first infectious-related cause of death in elderly people. However, there is lack of evidence about the association between sarcopenia and pneumonia. The aim of our study was to determine the incidence and risk factors of community-acquired pneumonia in older adults with sarcopenia in a Peruvian hospital. MethodsA retrospective cohort study was conducted in the geriatrics service of Centro Medico Naval “Cirujano Mayor Santiago Tavara”. Sarcopenia was defined by “European Consensus of Sarcopenia” criteria. MultivariatePoisson regression model was conducted to estimate the effect of the independent association between sarcopenia and pneumonia. ResultsA total of 1598 subjects were enrolled, 59.0% were male; with a mean age of 78.3 ± 8.6 years. The prevalence of sarcopenia was 15.1% (95% CI: 13.3–16.8) and the incidence of community-acquired pneumonia was 15.14% (95%CI 13.4–16.9). In the multivariate model, we found a higher incidence of pneumonia in sarcopenic compared to non-sarcopenic, RR(a) 3.88 (95% CI: 2.82–5.33). DiscussionOur study showed a higher incidence of community-acquired pneumonia in sarcopenic subject. Results provide information on the importance of detecting this syndrome because it gives us scientific evidence of the interest of a correct comprehensive geriatric assessment in older patients with a high risk of pneumonia.

Association of Prescribed Opioids With Increased Risk of Community-Acquired Pneumonia Among Patients With and Without HIV

Some opioids are known immunosuppressants; however, the association of prescribed opioids with clinically relevant immune-related outcomes is understudied, especially among people living with HIV. To assess the association of prescribed opioids with community-acquired pneumonia (CAP) by opioid properties and HIV status. This nested case-control study used data from patients in the Veterans Aging Cohort Study (VACS) from January 1, 2000, through December 31, 2012. Participants in VACS included patients living with and without HIV who received care in Veterans Health Administration (VA) medical centers across the United States. Patients with CAP requiring hospitalization (n = 4246) were matched 1:5 with control individuals without CAP (n = 21 146) by age, sex, race/ethnicity, length of observation, and HIV status. Data were analyzed from March 15, 2017, through August 8, 2018. Prescribed opioid exposure during the 12 months before the index date was characterized by a composite variable based on timing (none, past, or current); low (<20 mg), medium (20-50 mg), or high (>50 mg) median morphine equivalent daily dose; and opioid immunosuppressive properties (yes vs unknown or no). CAP requiring hospitalization based on VA and Centers for Medicare & Medicaid data. Among the 25 392 VACS participants (98.9% male; mean [SD] age, 55 [10] years), current medium doses of opioids with unknown or no immunosuppressive properties (adjusted odds ratio [AOR], 1.35; 95% CI, 1.13-1.62) and immunosuppressive properties (AOR, 2.07; 95% CI, 1.50-2.86) and current high doses of opioids with unknown or no immunosuppressive properties (AOR, 2.07; 95% CI, 1.50-2.86) and immunosuppressive properties (AOR, 3.18; 95% CI, 2.44-4.14) were associated with the greatest CAP risk compared with no prescribed opioids or any past prescribed opioid with no immunosuppressive (AOR, 1.24; 95% CI, 1.09-1.40) and immunosuppressive properties (AOR, 1.42; 95% CI, 1.21-1.67), especially with current receipt of immunosuppressive opioids. In stratified analyses, CAP risk was consistently greater among people living with HIV with current prescribed opioids, especially when prescribed immunosuppressive opioids (eg, AORs for current immunosuppressive opioids with medium dose, 1.76 [95% CI, 1.20-2.57] vs 2.33 [95% CI, 1.60-3.40]). Prescribed opioids, especially higher-dose and immunosuppressive opioids, are associated with increased CAP risk among persons with and without HIV.

Patient-Reported Consequences of Community-Acquired Pneumonia in Patients with Chronic Obstructive Pulmonary Disease.

Community acquired pneumonia (CAP) carries high morbidity, mortality, and economic burden, which is even higher in adults diagnosed with chronic obstructive pulmonary disease (COPD). While several studies have assessed the clinical burden and mortality risk of CAP and COPD, very few studies focus on CAP burden from a COPD patient perspective. Individuals recently diagnosed with CAP and with pre-existing COPD were recruited through the COPD Foundation. The CAP Burden of Illness Questionnaire (CAP-BIQ), a content validated questionnaire assessing CAP symptomatology, duration of symptoms and CAP impact on work, activities and family, was administered at baseline and at 30-days follow-up. Of the 490 participants recruited, 481 had data sufficient for analysis. The prevalence of respiratory-related symptoms was very high (>90%) at the time of diagnosis with other generalized symptoms such as fatigue, trouble sleeping, headaches and confusion present in more than 60% of participants. Mean duration of symptoms varied from approximately 2 weeks for headaches and fever to more than a month for fatigue, wheezing, dyspnea, and cough. Employed participants missed an average of 21 days of work and those not employed missed 36 days of usual activities. Over 84% required help from family, friends or care givers. CAP is a serious and burdensome condition for people with COPD, a condition that can impair activities for weeks, frequently requires care from family or friends, and includes lingering symptoms. The patient-reported impact of CAP reported in this study underscores the need for prevention strategies in this population.

Knowledge of asthmatic disease as a pneumonia protective factor.

To assess whether knowledge of asthmatic disease may be a protective factor against the risk of community-acquired pneumonia (CAP) in people with asthma over the age of 18 who receive inhaled treatment. observational study of cases and controls in a population with asthma. One hundred and twenty-three people with asthma diagnosed with pneumonia were recruited according to clinical and radiological criteria (cases), and 246 people with asthma not diagnosed with pneumonia during the past year (controls), matched by age. The main study factor was the assessment of knowledge about asthmatic disease through an ad hoc questionnaire, with seven questions and two possible answers (known, unknown). the bivariate analysis shows that knowledge of asthmatic disease has a statistically significant association as a protective factor of CAP. In the multivariate analysis, it shows an association of knowledge of asthmatic disease as a protective factor of CAP (OR=.24), regardless of age, level of studies, functionality, and severity of asthma. A good knowledge of asthmatic disease reduces the risk of CAP in asthmatic patients using inhaled treatment.

Association of High Mobility Group Box Protein B1 Gene Polymorphisms with Pneumonia Susceptibility and Severity.

To investigate the relationship between the high mobility group box protein B1 (HMGB1) single nucleotide polymorphisms (SNPs) rs1412125, rs2249825, and rs1045411 with pneumonia in terms of susceptibility, severity, and inflammatory response. The genotypes of HMGB1 rs1412125 (-1615T > C), rs2249825 (3814C > G), and rs1045411 (2262C > T) loci in 328 patients with community-acquired pneumonia (CAP) and 317 healthy subjects were analyzed by Sanger sequencing. The expression and secretion of the inflammatory cytokines HMGB1, interleukin (IL)-10, tumor necrosis factor-alpha (TNF-α), and IL-6 were determined after lipopolysaccharide (LPS) stimulation of peripheral whole blood cells. The risk of CAP was higher in carriers of the mutant HMGB1 rs1412125 and rs2249825 alleles than those that had the wild type alleles (adjusted odds ratio [OR] = 1.241; 95% confidence interval [CI] = 1.061-1.448; p = 0.007; adjusted OR = 1.225; 95% CI = 1.038-1.427; p = 0.016, respectively). Moreover, the mutation-carrying patients with CAP were more likely to develop severe community-acquired pneumonia (SCAP). There was no correlation between the HMGB1 rs1045411 SNP alleles and CAP or SCAP (p > 0.05). The expression and secretion of the inflammatory cytokines HMGB1, IL-10, TNF-α, and IL-6 was significantly higher in LPS-stimulated peripheral blood among patients with mutations at the rs1412125 and rs2249825 loci compared with those with wild type alleles (p < 0.05). The 30-day mortality rates for CAP patients with mutations at the rs1412125 and rs2249825 loci of HMGB1 were significantly higher than those that had wild type alleles. The mortality rate difference between rs1045411 wild-type CAP patients and mutant was not significant (p = 0.789). SNPs at the rs1412125 and rs2249825 loci of HMGB1 are associated with pneumonia in terms of susceptibility, severity, and inflammatory response.

1470. Neurocognitively-Acting Potentially Inappropriate Medications, Alcohol, and Community-Acquired Pneumonia Among Patients with and Without HIV

BackgroundAlcohol interactions with neurocognitively-acting potentially inappropriate medications (NC-PIMs) may be more common, more harmful, and associated with lower levels of alcohol use among people living with HIV.MethodsWe conducted a nested case–control study using data from the Veterans Aging Cohort Study (2007–2015). Cases with community-acquired pneumonia (CAP) requiring hospitalization (n = 6,716) were 1:5 matched to controls without CAP (n = 33,253) at the time of event by age, sex, race, HIV status, baseline year, and duration of observation time. Index date was defined as CAP date for cases and match date for controls. Based on pharmacy data in the year prior to index date, NC-PIMs included receipt of at least one prescription of any duration for anticonvulsants, sedatives (including benzodiazepines), prescription opioids, antidepressants, antipsychotics, and muscle relaxants. Among HIV+, NC-PIMs exposure also included ritonavir (RTV), cobicistat (COBI), and efavirenz (EFV). Conditional logistic regression models were used to obtain adjusted odds ratios (OR) and 95% confidence intervals (CI) for NC-PIMs (any and count overall, and by class), alcohol use disorder (AUD) diagnoses in the year prior to index date, and their interaction adjusted for smoking status, VACS Index, steroids, vaccination status (influenza and pneumonia), hepatitis C, previous CAP, and various comorbidities.ResultsAmong 39,989 patients, 17,161 (43%) were HIV+, 98% were male, and median age was 58 years. An increase in number of classes of NC-PIMs was associated with a 17% increase in the odds of CAP among HIV+ and uninfected, and this effect was augmented by contemporaneous AUD. Among HIV+, all classes of NC-PIMs apart from EFV were positively associated with CAP, most notably antipsychotics (OR 1.66, 95% CI 1.43–1.93). Among uninfected, the highest risk of CAP was associated with antipsychotics (OR 1.81, 95% CI 1.61–2.03) and anticonvulsants (OR 1.64, 95% CI 1.49–1.80). AUD positively interacted with sedatives, opioids, antidepressants, and muscle relaxants in both groups, and with RTV/COBI in HIV+ patients.ConclusionNC-PIMs, especially with concurrent AUD, are associated with increased CAP risk among those living with and without HIV. Disclosures All authors: No reported disclosures.

Associations between Community-Acquired Pneumonia and Proton Pump Inhibitors in the Laryngeal/Voice-Disordered Population.

To examine the relationship between community-acquired pneumonia (CAP) and proton pump inhibitor (PPI) treatment among patients with laryngeal/voice disorders. Retrospective cohort analysis. Large national administrative US claims database. Patients were included if they were ≥18 years old; had outpatient treatment for a laryngeal/voice disorder from January 1, 2010, to December 31, 2014 (per International Classification of Diseases, Ninth Revision, Clinical Modification codes); had 12 months of continuous enrollment prior to the index date (ie, first diagnosis of laryngeal/voice disorder); had no preindex diagnosis of CAP; and had prescription claims captured from 1 year preindex to end of follow-up. Patient demographics, comorbid conditions, index laryngeal diagnosis, number of unique preindex patient encounters, and CAP diagnoses during the postindex 3 years were collected. Two models-a time-dependent Cox regression model and a propensity score-based approach with a marginal structural model-were separately performed for patients with and without pre-index date PPI prescriptions. A total of 392,355 unique patients met inclusion criteria; 188,128 (47.9%) had a PPI prescription. The 3-year absolute risk for CAP was 4.0% and 5.3% among patients without and with preindex PPI use, respectively. For patients without and with pre-index date PPI use, the CAP occurrence for a person who had already received a PPI is 30% to 50% higher, respectively, than for a person who had not yet had a PPI but may receive one later. Patients without and with pre-index date PPI use experienced a roughly 30% to 50% increased likelihood of CAP, respectively, as compared with patients who had not had PPI prescriptions.

Association between passive smoking and community-acquired pneumonia among the adult population

Introduction Exposure to passive smoking emerges as a significant risk for developing respiratory infections especially community-acquired pneumonia (CAP). This study was designed to assess the effect of passive smoking exposure on developing CAP. Patients and methods A case–control study including 40 patients presented with CAP were divided into two groups according to being exposed or not exposed to passive smoking in their home environment. They were assessed clinically and their length of hospital stay and duration of possible ICU admission were estimated. Mechanical ventilation and mortality risk were also secondary endpoints in this study. Results Age and sex among both groups did not show significant differences. Length of hospital stay and duration of ICU admission were significantly higher in passive smoker patients. Patients aged 60 years old or higher were at more increased risk of developing CAP. In addition, patients exposed to two or more smokers in their homes had a higher risk of having CAP. Conclusion Passive smoking exposure increases risk of developing CAP. The risk is increased significantly in patients of 60 years old or over as well as in patients exposed to two or more smokers in their home environment.

Angiotensin-converting enzyme polymorphism and pediatric pneumonia

ObjectivePneumonia is one of the leading causes of death for the Pediatric age group under five years worldwide. The role of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism in the risk and outcome of community-acquired pneumonia (CAP) has been studied in different ethnic populations and yielded inconsistent results. Therefore, the present study aimed to investigate whether this polymorphism is associated with the risk and outcome of CAP in the Egyptian pediatric population. MethodsThe prospective observational case-control study was performed on 77 children aged 2 months to 12yrs hospitalized with CAP and 73 matched healthy controls. Candidates were subjected to clinical and radiological evaluation in addition to complete blood count, c-reactive protein and genotyping for the ACE I/D polymorphism using PCR technique. Follow up of the outcome in the form of need for oxygen, ICU admission, need for mechanical ventilation, duration of hospital stay and death was done for all patients. ResultsNo statistically significant differences was observed between pneumonia patients and controls regarding the different genotypes of the ACE polymorphism II, ID and DD genotypes (p = 0.773). No association was detected between the different genotypes of the ACE polymorphism II, ID and DD genotypes and the need for oxygen, ICU admission, need for mechanical ventilation, duration of hospital stay and death (P = 0.143, 0.527, 0.716, 0.288, 0.544). ConclusionThe ACE I/D polymorphism is not associated with the risk nor the outcome of pneumonia in our pediatric population.

Proton Pump Inhibitors and Infant Pneumonia/Other Lower Respiratory Tract Infections: National Nested Case-control Study.

The possible association between the use of proton pump inhibitors (PPIs) and community-acquired pneumonia (CAP) or another lower respiratory tract infection (LRTI) remains uncertain. We conducted a nested case-control study using routinely collected national health and drug dispensing data in New Zealand to examine the risk of CAP or another LRTI resulting in hospitalization or death in infants dispensed a PPI. The cohort included 21,991 patients without a history of CAP or another LRTI who were born between 1 January 2005 and 31 December 2012 and were dispensed omeprazole, lansoprazole, or pantoprazole (the PPIs available in New Zealand during the study period) on at least one occasion during the first year of life. Cases had a first diagnosis after cohort entry (first PPI dispensing) of CAP (n = 65) validated by hospital discharge letter or death record, and chest radiography; or LRTI (including CAP) (n = 566) validated by hospital discharge letter or death record, with or without chest radiography. Up to 10 controls, matched by sex and date of birth, were randomly selected for each case. We conducted complete case analyses for the fully adjusted models. In the adjusted analysis based on CAP cases and their controls, the matched odds ratio for current versus past use of PPIs was 0.88 (95% confidence interval 0.36-2.16). For all LRTI cases and their controls, the matched odds ratio was 1.13 (0.87-1.48). In otherwise healthy community-dwelling infants, current use of a PPI does not appear to increase the risk of CAP or other LRTIs.

Genetic variants of interferon regulatory factor 5 associated with the risk of community-acquired pneumonia

Interferon regulatory factor 5 (IRF5) is a key transcription factor involved in the control of the expression of pro-inflammatory cytokines and immune responses to infection, and multiple polymorphisms of the IFR5 gene have been shown to be associated with autoimmune and infectious diseases. Several studies have investigated single nucleotide polymorphisms (SNPs) in a number of genes associated with the susceptibility to or severity and outcome of community-acquired pneumonia (CAP), but no research has yet been conducted on the role of IRF5 gene polymorphisms in CAP. In this study, we investigated the effects of four IFR5 variants, rs77571059, rs2004640, rs10954213, and rs3807306 on the susceptibility to CAP by genotyping 228 CAP patients and 177 healthy donors. Our results indicated that IFR5 variants rs77571059 and rs2004640 and haplotype GTAA were associated with the susceptibility to CAP and rs77571059 was related to the severity of the disease, suggesting that IFR5 variants may contribute to the pathogenesis of CAP and may serve as prognostic markers of CAP susceptibility and outcome.