Risk Of Pneumonia In Adults Research Articles

Epidemiological features of Streptococcus pneumoniae in patients with acute respiratory tract infection in Beijing, China during 2009–2020

BackgroundStreptococcus pneumoniae (S. pneumoniae) is one of the common pathogens causing acute respiratory tract infection (ARTI). The study aimed to investigate the prevalence of S. pneumoniae in patients with ARTI in Beijing, and to provide reference evidence for prevention and control of S. pneumoniae. MethodThe patients from the surveillance data of ARTI in Beijing from 2009 to 2020 were recruited in the study. All patients were tested for S. pneumoniae and other viral and bacterial pathogens. Logistic regression model was used to explore the epidemiological features of S. pneumoniae. ResultsTotally, 4.63% (253/5468) of the ARTI patients were positive for S. pneumoniae. The age, case type and antibiotic therapy in one week before sampling affected the positive rate of S. pneumoniae in patients. No significant difference on the positive rate of S. pneumoniae between the mild and severe pneumonia. Patients infected with S. pneumoniae had a higher risk of pneumonia in adults and the elderly, but a lower risk in children. The leading bacterial and viral pathogens in patients positive for S. pneumoniae were Haemophilus influenzae (36.36%) and human rhinovirus (35.59%), respectively. ConclusionThis study showed that the prevalence of S. pneumoniae in the patients with ARTI was at a low level in Beijing from 2009 to 2020, which was higher in elderly patients, outpatients and patients without antibiotic therapy. It is necessary to further explore the serotype of S. pneumoniae and PCVs vaccine coverage, and rationally develop vaccine manufacture and vaccination programs to reduce the burden of pneumococcal diseases.

Factor XI Deficiency Is Not Associated with Increased Risk of Pneumonia in Adults

Background: Factor XI (FXI) deficiency is a rare bleeding disorder, common in Ashkenazi Jews. Recently, target FXI as antithrombotic therapy became real issue as FXI antisense oligonucleotide appeared safe and efficient for preventing post- operative deep vein thrombosis following knee replacement (Buller et al. NEJM2015). The fact that in two models of Klebsiella pneumonia and Streptococcus pneumonia of FXI knock out (KO) mice there was an increased lethality as a result of enhanced bacterial overgrowth and dissemination along with augmented inflammatory response (Stroo et al. JTH 2017), incited us to explore whether patients with FXI deficiency harbor increased risk of pneumonia or increased pneumonia fatality in comparison to individuals with normal factor XI activityMethods: This historical cohort study was performed by using the electronic database of the largest health care provider in Israel. All adults tested for FXI activity between 2002 and 2014 were included in the study. FXI activity was classified into three categories; normal (activity >50%), mild-moderate deficiency (activity: 20-50%), and severe deficiency (activity <20%). The cohort was followed until December 31, 2015 for incident overall pneumonia and severe pneumonia defined as pneumonia requiring hospitalization. The association was assessed using Cox proportional regression models with adjustment for age, gender, smoking status , diabetes, chronic obstructive disease ,ischemic heart disease, cirrhosis, previous stroke, malignancy, previous pneumonia, influenza vaccine, as well as pneumococcal vaccineResults: Of the 10,193 included patients; 8,958 (87.9%) had normal FXI activity, 804 (7.9%) had mild-moderate deficiency and 431 (4.2%) had severe deficiency. A total of 579 individuals had pneumonia and 221 individuals had severe pneumonia during follow up. Compared to individuals with normal FXI activity the adjusted HR for overall pneumonia was 0.81 (95% CI, 0.60-1.10) in those with mild-moderate deficiency, and 0.97 (0.68-1.37) in those with severe factor XI deficiency. The adjusted HR for severe pneumonia was 0.86 (95% CI, 0.56-1.30) in those with mild-moderate deficiency, and 0.86 (0.51-1.40) in those with severe FXI deficiency.Of the 579 patients with pneumonia; 33 (5.7%) and 47 (8.1%) patients died within 30 days and 90 days, respectively. Compared to individuals with normal FXI activity the adjusted HRs for 30 days and 90 days mortality were 0.50 (0.15-1.7) and 0.47 (0.17-1.30), respectivelyin those with mild-moderate deficiency, and 0.81 (0.23-2.9) and 0.47 (0.14-1.60), respectively in those with severe FXI deficiencyConclusions: FXI deficiency is not associated with increased incidence of pneumonia or with increased mortality among patients with pneumonia and as such it is suggested that FXI target therapy can be applied in adult patients without the fear of exposing them to increased risk of pneumonia DisclosuresNo relevant conflicts of interest to declare.

Inhaled Glucocorticoids and Pneumonia in Preterm Infants: Post Hoc Results from the NEuroSIS Trial

Background: Inhaled glucocorticoids may increase the risk of pneumonia in adults. Thus, respiratory infections may be a potential explanation for the non-significantly increased mortality seen in the glucocorticoid group in the largest randomized trial on inhaled glucocorticoids for preventing bronchopulmonary dysplasia in preterm infants published to date (NEuroSIS). Objective: To evaluate the effect of inhaled budesonide on the risk of death due to respiratory infections in the NEuroSIS trial. Methods: We performed post hoc analyses of prospectively collected data from 856 preterm infants on presumed but not culture-proven sepsis and antimicrobial drug use. Additionally, pulmonary complications reported on adverse event forms, death certificates and autopsy reports were compared between study groups. Results: Treatment groups did not differ in the number of episodes with suspected sepsis (184/437 [42.1%] in the budesonide vs. 171/419 [40.8%] in the placebo group). Neither the number of patients receiving antimicrobial drugs nor the length of antimicrobial treatment differed between groups. Our analyses for pulmonary adverse events as well as for pulmonary complications reported on death certificates and autopsy reports did not suggest a negative impact of inhaled budesonide on these outcomes. Conclusion: The current analysis does not support the assumption that respiratory tract infections explain the increased mortality seen in the glucocorticoid group in the NEuroSIS trial.

Effect of Not Monitoring Residual Gastric Volume on Risk of Ventilator-Associated Pneumonia in Adults Receiving Mechanical Ventilation and Early Enteral Feeding

Effect of Not Monitoring Residual Gastric Volume on Risk of Ventilator-Associated Pneumonia in Adults Receiving Mechanical Ventilation and Early Enteral Feeding

Risk of Pneumonia in Adults With Closed Versus Unclosed Atrial Septal Defect (from a Nationwide Cohort Study)

Atrial septal defect (ASD) is associated with pulmonary hyperperfusion and inflammation and has been linked with increased risk of pneumonia. We investigated the risk of pneumonia in patients with ASD and the impact of ASD closure in a nationwide cohort study. All adults in Denmark (n= 1,168) diagnosed with ASD from 1977 to 2009 were identified through Danish public registries. We compared the risk of hospitalization for pneumonia, use of antibiotics, and mortality with age- and gender-matched general population controls. The median follow-up from time of diagnosis was 9.6years (range 1 to 33). Cox regression analysis showed that both patients with closed (n= 863) and unclosed (n= 305) ASD had a higher risk of hospitalization for pneumonia (adjusted hazard ratios [HRs] 2.8, 95% confidence interval [CI] 2.3 to 3.5 and 3.1, 95% CI 2.4 to 4.0, respectively) than controls. Patients with ASD also used more antibiotics (adjusted HR for closure 1.4, 95% CI 1.3 to 1.5 and adjusted HR for no closure 1.4, 95% CI 1.2 to 1.6) than the controls. Antibiotic use normalized (adjusted HR 1.1, 95% CI 1.0 to 1.3) and the risk of pneumonia decreased (adjusted HR 1.8, 95% CI 1.1 to 3.0) within 5years after closure. The proportion of patients with ASD with pneumonia-related death (8.4%) was comparable with that of the general population (9.5%). In conclusion, patients with ASD had a substantially higher risk of hospitalization for pneumonia and used more antibiotics than the general population. The pneumonia risk diminished, but did not completely normalize, 5years after closure.

The role of vitamin D supplementation in the risk of developing pneumonia: three independent case–control studies

BackgroundVitamin D plays a role in host defence against infection. Vitamin D deficiency has been associated with an increased risk of respiratory tract infections in children and adults. This study...

Exposition à la fumée du tabac et risque infectieux bactérien

Tobacco smoke is a proven risk factor for bacterial infection. In adults without COPD, smoking is associated with a significant increase in the relative risk (RR) of pneumonia (RR=2.97; 95% CI 1.52-5.81), S pneumoniae pneumonia (RR=2.50; 95% IC 1.50-5.10), Legionella infection (RR=3.75; 95% CI 2.17-6.17). Smoking has clearly been shown to be associated with an increased risk of tuberculosis (RR=2.60; 95% CI 2,20-3,20), and also with increased incidence of post-operative infections. In young children whose parents smoke, passive exposure to tobacco smoke is associated with an increased relative risk of seasonal infections (RR=1.7; CI 95% 1.55-1.91) and recurrent otitis media (RR=1.48; 95% CI 1.08-2.04). Passive smoking also increases risk of pneumonia in adults (RR=2.5; CI 95% 1.2-5.1). Plausible explanations of the increased risk of infection in active or passive smokers include increased bacterial adherence, decrease of lung and nasal clearance, and changes in the immune response. Exposure to tobacco smoke approximately doubles the risk of infection. This increased burden of infection has significant healthcare cost implications. Each infectious episode in an individual should prompt an attempt at smoking cessation.