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Sample records for hospitalized pneumonia patients

  1. Impact of Acute Kidney Injury in Patients Hospitalized With Pneumonia.

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    Chawla, Lakhmir S; Amdur, Richard L; Faselis, Charles; Li, Ping; Kimmel, Paul L; Palant, Carlos E

    2017-04-01

    Pneumonia is a common cause of hospitalization and can be complicated by the development of acute kidney injury. Acute kidney injury is associated with major adverse kidney events (death, dialysis, and durable loss of renal function [chronic kidney disease]). Because pneumonia and acute kidney injury are in part mediated by inflammation, we hypothesized that when acute kidney injury complicates pneumonia, major adverse kidney events outcomes would be exacerbated. We sought to assess the frequency of major adverse kidney events after a hospitalization for either pneumonia, acute kidney injury, or the combination of both. We conducted a retrospective database analysis of the national Veterans Affairs database for patients with a admission diagnosis of International Classification of Diseases-9 code 584.xx (acute kidney injury) or 486.xx (pneumonia) between October 1, 1999, and December 31, 2005. Three groups of patients were created, based on the diagnosis of the index admission and serum creatinine values: 1) acute kidney injury, 2) pneumonia, and 3) pneumonia with acute kidney injury. Patients with mean baseline estimated glomerular filtration rate less than 45 mL/min/1.73 m were excluded. The primary endpoint was major adverse kidney events defined as the composite of death, chronic dialysis, or a permanent loss of renal function after the primary discharge. The observations of 54,894 subjects were analyzed. Mean age was 68.7 ± 12.3 years. The percentage of female was 2.4, 73.3% were Caucasian, and 19.7% were African-American. Differences across the three diagnostic groups were significant for death, 25% decrease in estimated glomerular filtration rate from baseline, major adverse kidney events following admission, and major adverse kidney events during admission (all p pneumonia + acute kidney injury group (51% died and 62% reached major adverse kidney events). In both unadjusted and adjusted time to event analyses, patients with pneumonia + acute kidney injury

  2. Hospital Resource Utilisation by Patients with Community-Acquired Pneumonia

    LENUS (Irish Health Repository)

    McCarthy, S

    2017-09-01

    Little data is available on the resource utilisation of patients admitted with Community-Acquired Pneumonia (CAP) in Ireland. A retrospective review of 50 randomly-selected patients admitted to Beaumont Hospital with CAP was undertaken. The mean length of stay of patients with CAP was 12 days (+\\/- 16 days). All patients were emergency admissions, all had a chest x-ray, a C-reactive protein blood test, and occupied a public bed at some point during admission. Common antimicrobial therapies were intravenous (IV) amoxicillin\\/clavulanic acid and oral clarithromycin; 60% received physiotherapy. The estimated mean cost of CAP per patient was €14,802.17. Costs arising from admission to hospital with CAP are substantial, but efforts can be undertaken to ensure that resources are used efficiently to improve patient care such as discharge planning and fewer in-hospital ward transfers

  3. Detection of pneumonia associated pathogens using a prototype multiplexed pneumonia test in hospitalized patients with severe pneumonia.

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    Berit Schulte

    Full Text Available Severe pneumonia remains an important cause of morbidity and mortality. Polymerase chain reaction (PCR has been shown to be more sensitive than current standard microbiological methods--particularly in patients with prior antibiotic treatment--and therefore, may improve the accuracy of microbiological diagnosis for hospitalized patients with pneumonia. Conventional detection techniques and multiplex PCR for 14 typical bacterial pneumonia-associated pathogens were performed on respiratory samples collected from adult hospitalized patients enrolled in a prospective multi-center study. Patients were enrolled from March until September 2012. A total of 739 fresh, native samples were eligible for analysis, of which 75 were sputa, 421 aspirates, and 234 bronchial lavages. 276 pathogens were detected by microbiology for which a valid PCR result was generated (positive or negative detection result by Curetis prototype system. Among these, 120 were identified by the prototype assay, 50 pathogens were not detected. Overall performance of the prototype for pathogen identification was 70.6% sensitivity (95% confidence interval (CI lower bound: 63.3%, upper bound: 76.9% and 95.2% specificity (95% CI lower bound: 94.6%, upper bound: 95.7%. Based on the study results, device cut-off settings were adjusted for future series production. The overall performance with the settings of the CE series production devices was 78.7% sensitivity (95% CI lower bound: 72.1% and 96.6% specificity (95% CI lower bound: 96.1%. Time to result was 5.2 hours (median for the prototype test and 43.5 h for standard-of-care. The Pneumonia Application provides a rapid and moderately sensitive assay for the detection of pneumonia-causing pathogens with minimal hands-on time.Deutsches Register Klinischer Studien (DRKS DRKS00005684.

  4. [Validation of the Pneumonia Severity Index for hospitalizing patients with community-acquired pneumonia].

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    Querol-Ribelles, José M; Tenías, José M; Querol-Borrás, José M; González-Granda, Damiana; Hernández, Manuel; Ferreruela, Rosa; Martínez, Isidoro

    2004-04-10

    Our main objective was to assess the utility of the Pneumonia Severity Index (PSI) to decide the site of care home or hospital of patients with community-acquired pneumonia (CAP). All CAP patients who came to the emergency department from 1 January to 31 December, 2000, were prospectively assessed with a protocol based on the PSI and additional admission criteria applied to classes I, II and III. Mortality within 30 days and poor outcome were used as endpoints. We tested the diagnostic efficacy of the PSI scale in predicting mortality or unfavourable events by calculating the area below the ROC curve. Of the 243 CAP patients included, 124 (51%) belonged to classes I, II and III, and 119 (49%) belonged to classes IV and V. One hundred and fifty six (64%) patients were admitted. Fifteen (6.2%) patients died, all of them belonging to classes IV and V. Forty four (18%) patients showed a poor outcome. Only one patient who was initially sent home had a poor outcome. The prognostic value of the PSI scale to predict mortality (ROC = 0.92; CI 95%, 0.88-0.95) was high. Our results confirm that the PSI scale is a good prognostic index in clinical practice for predicting mortality due to CAP. In order to use the PSI to decide the site of care of patients with CAP, not only the score obtained but also additional factors should be taken into account.

  5. Age group analysis of psychological, physical and functional deterioration in patients hospitalized for pneumonia.

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    Martín-Salvador, Adelina; Torres-Sánchez, Irene; Sáez-Roca, Germán; López-Torres, Isabel; Rodríguez-Alzueta, Elisabeth; Valenza, Marie Carmen

    2015-10-01

    Hospital admissions due to pneumonia range from 1.1 to 4 per 1,000 patients and this figure increases with age. Hospitalization causes a decline in functional status. Physical impairment impedes recovery and constitutes a higher risk of disability and mortality in elderly people. The objective of this study is to assess the impact of hospital stay in patients with pneumonia related with age. A total of 116 patients with pneumonia were included in this study, and divided into two age groups:psychological and emotional profile were evaluated. Pneumonia severity, nutritional status, independence and comorbidities were also assessed. Statistical analyses revealed significant differences between both age groups in pneumonia severity and comorbidities. Significant improvements between admission and discharge were found in lung function in both groups (pgroup. Hospitalization leads to a significant physical impairment in patients admitted for pneumonia. This deterioration increases with age. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  6. Pre-hospital intubation factors and pneumonia in trauma patients.

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    Evans, Heather L; Warner, Keir; Bulger, Eileen M; Sharar, Sam R; Maier, Ronald V; Cuschieri, Joseph

    2011-10-01

    We reported similar rates of ventilator-associated pneumonia (VAP) previously in trauma patients intubated either in a pre-hospital (PH) venue or the emergency department. A subset of PH intubations with continuous quality assessment was re-examined to identify the intubation factors associated with VAP. The subgroup was derived from an existing data set of consecutive adult trauma patients intubated prior to Level I trauma center admission July 2007-July 2008. Intubation details recorded included bag-valve mask ventilation (BVM) and the presence of material in the airway. The diagnosis of VAP was made preferentially by quantitative bronchoalveolar lavage (BAL) cultures (≥ 10⁴ colony-forming units indicating infection). Baseline data, injury characteristics, and circumstances of intubation of patients with and without VAP were compared by univariable analysis. Detailed data were available for 197 patients; 32 (16.2%) developed VAP, on average 6.0±0.7 days after admission. Baseline characteristics were similar in the groups, but diabetes mellitus was more common in the VAP group (4 [12.5%] vs. 5 [3.0%]; p=0.02). There was a higher rate of blunt injury in the VAP patients (28 [87.5%] vs. 106 [64.2%]; p=0.01) and higher injury severity scores (33.1±2.8 vs. 23.0±1.0; p=0.0002) and chest Abbreviated Injury Scores (2.6±0.3 vs. 1.5±0.1; p=0.002). Lower Glasgow Coma Scale scores (7.9±0.9 vs. 9.9±0.4; p=0.04) and greater use of BVM (18 [56.3%] vs. 56 [34.0%]; p=0.02) were observed in patients who developed VAP. Among aspirations, 10 (31.3%) of patients with emesis developed VAP compared with only 4 (12.5%) with blood in the airway (p=0.003). Aspiration, along with depressed consciousness and greater injury severity, may predispose trauma patients to VAP. Prospective studies should focus on the quality and timing of aspiration relative to intubation to determine if novel interventions can prevent aspiration or decrease the risk of VAP after aspiration.

  7. Etiology of community-acquired pneumonia in hospitalized patients in Jordan

    International Nuclear Information System (INIS)

    Al-Ali, Musa K.; Batchoun, R. G.; Al-Nour, Tariq M.

    2006-01-01

    To ascertain the causative organisms of community acquired pneumonia (Cap) in Jordanian patients requiring hospital admission. A prospective study of both adults and children admitted to Princess Basma and Princess Rahma Teaching Hospitals in Irbid, Jordan with a diagnosis of CAP over a 6-month period from April to October 2002. A total of 35 adult patients were admitted with a mean age of 47 years, and 63 children with a mean age of 3 years. A pathogen was isolated from 25 (71%) adults, and from 17 (27%) children, and sputum cultures gave the best diagnostic yield. In adults Streptococcus pneumoniae was the most common isolate (26%), followed by Chlamydia pneumoniae (23%), Haemophilus influenzae (17%), Mycoplasma pneumoniae (9%), and Legionella pneumophila and Klebsiella pneumoniae (6%) each. Seven of the 9 gram negative isolates were from patients with some co morbid illness. While in children, Chlamydia pneumoniae was the most common (14%), followed by Mycoplasma pneumoniae (6%), and Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa (3%) each. Streptococcus pneumoniae and atypical microorganisms are the most common cause of CAP in previously healthy adults; while in those with associated co morbid illness, gram negative organisms are the likely cause. In children, the overall detection rate of causative organisms was low with atypical microorganisms being the most common. (author)

  8. Antibiotic Treatment of Hospitalized Patients with Pneumonia Complicated by Clostridium Difficile Infection.

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    Zycinska, K; Chmielewska, M; Lenartowicz, B; Hadzik-Blaszczyk, M; Cieplak, M; Kur, Z; Krupa, R; Wardyn, K A

    2016-01-01

    Clostridium difficile infection (CDI) is one of the most common gastrointestinal complication after antimicrobial treatment. It is estimated that CDI after pneumonia treatment is connected with a higher mortality than other causes of hospitalization. The aim of the study was to assess the relationship between the kind of antibiotic used for pneumonia treatment and mortality from post-pneumonia CDI. We addressed the issue by examining retrospectively the records of 217 patients who met the diagnostic criteria of CDI. Ninety four of those patients (43.3 %) came down with CDI infection after pneumonia treatment. Fifty of the 94 patients went through severe or severe and complicated CDI. The distribution of antecedent antibiotic treatment of pneumonia in these 50 patients was as follows: ceftriaxone in 14 (28 %) cases, amoxicillin with clavulanate in 9 (18 %), ciprofloxacin in 8 (16.0 %), clarithromycin in 7 (14 %), and cefuroxime and imipenem in 6 (12 %) each. The findings revealed a borderline enhancement in the proportion of deaths due to CDI in the ceftriaxone group compared with the ciprofloxacin, cefuroxime, and imipenem groups. The corollary is that ceftriaxone should be shunned in pneumonia treatment. The study demonstrates an association between the use of a specific antibiotic for pneumonia treatment and post-pneumonia mortality in patients who developed CDI.

  9. Comparison of clinical characteristics between healthcare-associated pneumonia and community-acquired pneumonia in patients admitted to secondary hospitals

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    Jong Hoo Lee

    Full Text Available BACKGROUND: Since healthcare-associated pneumonia (HCAP is heterogeneous, clinical characteristics and outcomes are different from region to region. There can also be differences between HCAP patients hospitalized in secondary or tertiary hospitals. This study aimed to evaluate the clinical characteristics of HCAP patients admitted into secondary community hospitals. METHODS: This was a retrospective study conducted in patients with HCAP or community-acquired pneumonia (CAP hospitalized in two secondary hospitals between March 2009 and January 2011. RESULTS: Of a total of 303 patients, 96 (31.7% had HCAP. 42 patients (43.7% resided in a nursing home or long-term care facility, 36 (37.5% were hospitalized in an acute care hospital for > 2 days within 90 days, ten received outpatient intravenous therapy, and eight attended a hospital clinic or dialysis center. HCAP patients were older. The rates of patients with CURB65 scores of 3 or more (22.9% vs. 9.1%; p = 0.001 and PSI class IV or more (82.2% vs. 34.7%; p < 0.001 were higher in the HCAP group. Drug-resistant pathogens were more frequently detected in the HCAP group (23.9% vs. 0.4%; p < 0.001. However, Streptococcus pneumoniae was the most common pathogen in both groups. The rates of antibiotic change, use of inappropriate antibiotics, and failure of initial antibiotic therapy in the HCAP group were significantly higher. Although the overall survival rate of the HCAP group was significantly lower (82.3% vs. 96.8%; p < 0.001, multivariate analyses failed to show that HCAP itself was a prognostic factor for mortality (p = 0.826. Only PSI class IV or more was associated with increased mortality (p = 0.005. CONCLUSIONS: HCAP should be distinguished from CAP because of the different clinical features. However, the current definition of HCAP does not appear to be a prognostic for death. In addition, the use of broad-spectrum antibiotics for HCAP should be reassessed because S. pneumoniae was most

  10. Comprehensive analysis of prognostic factors in hospitalized patients with pneumonia occurring outside hospital: Serum albumin is not less important than pneumonia severity assessment scale.

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    Miyazaki, Hiroyuki; Nagata, Nobuhiko; Akagi, Takanori; Takeda, Satoshi; Harada, Taishi; Ushijima, Shinichiro; Aoyama, Takashi; Yoshida, Yuji; Yatsugi, Hiroshi; Fujita, Masaki; Watanabe, Kentaro

    2018-08-01

    This study aimed to elucidate factors related to 30-day mortality of pneumonia occurring outside hospital by comprehensively analyzing data considered relevant to prognosis. Data considered relevant to prognosis were retrospectively examined from clinical charts and chest X-ray images of all patients with pneumonia occurring outside hospital admitted to our hospital from 2010 to 2016. The primary outcome was 30-day mortality. Data were collected from 534 patients (317 community-acquired pneumonia and 217 nursing- and healthcare associated pneumonia patients; 338 men (63.3%); mean age, 76.2 years-old). Eighty-three patients (9.9%) died from pneumonia within 30 days from the date of admission. The numbers of patients with pneumonia severity index (PSI) classes of I/II/III/IV/V and age, dehydration, respiratory failure, orientation disturbance, pressure (A-DROP) scores of 0/1/2/3/4/5 were 29/66/127/229/83, and 71/107/187/132/30/7, respectively. Mean (standard deviation) body mass index (BMI), serum albumin, blood procalcitonin, white blood cell and C-reactive protein were 20.00 (4.12) kg/m 2 , 3.16 (0.60) g/dL, 3.69 (13.15) ng/mL, 11559.4 (5656.9)/mm 3 , and 10.92 (8.75) mg/dL, respectively. Chest X-ray images from 152 patients exhibited a pneumonia shadow over a quarter of total lung field. Logistic regression analysis revealed that PSI class or A-DROP score, BMI, serum albumin, and extent of pneumonia shadow were related to 30-day mortality. Receiver operating characteristics curve analysis revealed that serum albumin was superior to PSI class or A-DROP score for predicting 30-day mortality. Serum albumin is not less important than PSI class or A-DROP score for predicting 30-day mortality in hospitalized patients with pneumonia occurring outside hospital. Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  11. Delirium symptoms during hospitalization predict long-term mortality in patients with severe pneumonia.

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    Aliberti, Stefano; Bellelli, Giuseppe; Belotti, Mauro; Morandi, Alessandro; Messinesi, Grazia; Annoni, Giorgio; Pesci, Alberto

    2015-08-01

    Delirium is common in critically ill patients and impact in-hospital mortality in patients with pneumonia. The aim of the study was to evaluate the prevalence of delirium symptoms during hospitalization in patients with severe pneumonia and their impact on one-year mortality. This was an observational, retrospective, cohort study of consecutive patients admitted to the respiratory high dependency unit of the San Gerardo University Hospital, Monza, Italy, between January 2009 and December 2012 with a diagnosis of severe pneumonia. A search through the charts looking for ten key words associated with delirium (confusion, disorientation, altered mental status, delirium, agitation, inappropriate behavior, mental status change, inattention, hallucination, lethargy) was performed by a multidisciplinary team. The primary endpoint was mortality at one-year follow-up. Secondary endpoint was in-hospital mortality. A total of 172 patients were enrolled (78 % males; median age 75 years). At least one delirium symptom was detected in 53 patients (31 %) during hospitalization. The prevalence of delirium symptoms was higher among those who died during hospitalization vs. those who survived (44 vs. 27 %, p = 0.049, respectively). Seventy-one patients (46 %) died during the one-year follow-up. The prevalence of at least one delirium symptom was higher among those who died than those who survived during the one-year follow-up (39 vs. 21 %, p = 0.014, respectively). At the multivariable logistic regression analysis, after adjustment for age, comorbidities and severe sepsis, the presence of at least one delirium symptom during hospitalization was an independent predictor of one-year mortality (OR 2.35; 95 % CI 1.13-4.90; p = 0.023). Delirium symptoms are independent predictors of one-year mortality in hospitalized patients with severe pneumonia. Further studies should confirm our results using prospective methods of collecting data.

  12. Low prevalence of Pneumocystis pneumonia in hospitalized patients with systemic lupus erythematosus: review of a clinical data warehouse.

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    Kapoor, T M; Mahadeshwar, P; Nguyen, S; Li, J; Kapoor, S; Bathon, J; Giles, J; Askanase, A

    2017-12-01

    Objective In the era of powerful immunosuppression, opportunistic infections are an increasing concern in systemic lupus erythematosus. One of the best-studied opportunistic infections is Pneumocystis pneumonia; however, the prevalence of Pneumocystis pneumonia in systemic lupus erythematosus is not clearly defined. This study evaluates the prevalence of Pneumocystis pneumonia in hospitalized systemic lupus erythematosus patients, with a focus on validating the Pneumocystis pneumonia and systemic lupus erythematosus diagnoses with clinical information. Methods This retrospective cohort study evaluates the prevalence of Pneumocystis pneumonia in all systemic lupus erythematosus patients treated at Columbia University Medical Center-New York Presbyterian Hospital between January 2000 and September 2014, using electronic medical record data. Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and patients with renal transplants (including both early and late post-transplant patients) represented immunocompromised control groups. Patients with systemic lupus erythematosus, Pneumocystis pneumonia, HIV/AIDS, or renal transplant were identified using diagnostic codes from the International Classification of Diseases, Ninth Revision (ICD-9). Results Out of 2013 hospitalized systemic lupus erythematosus patients, nine had presumed Pneumocystis pneumonia, yielding a low prevalence of Pneumocystis pneumonia in systemic lupus erythematosus of 0.45%. Three of the nine Pneumocystis pneumonia cases were patients with concomitant systemic lupus erythematosus and HIV/AIDS. Only one of these nine cases was histologically confirmed as Pneumocystis pneumonia, in a patient with concomitant systemic lupus erythematosus and HIV/AIDS and a CD4 count of 13 cells/mm 3 . The prevalence of Pneumocystis pneumonia in renal transplant patients and HIV/AIDS patients was 0.61% and 5.98%, respectively. Conclusion Given the reported high rate of adverse effects

  13. Quality of care for elderly patients hospitalized for pneumonia in the United States, 2006 to 2010.

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    Lee, Jonathan S; Nsa, Wato; Hausmann, Leslie R M; Trivedi, Amal N; Bratzler, Dale W; Auden, Dana; Mor, Maria K; Baus, Kristie; Larbi, Fiona M; Fine, Michael J

    2014-11-01

    Nearly every US acute care hospital reports publicly on adherence to recommended processes of care for patients hospitalized with pneumonia. However, it remains uncertain how much performance of these process measures has improved over time or whether performance is associated with superior patient outcomes. To describe trends in processes of care, mortality, and readmission for elderly patients hospitalized for pneumonia and to assess the independent associations between processes and outcomes of care. Retrospective cohort study conducted from January 1, 2006, to December 31, 2010, at 4740 US acute care hospitals. The cohort included 1 818 979 cases of pneumonia in elderly (≥65 years), Medicare fee-for-service patients who were eligible for at least 1 of 7 pneumonia inpatient processes of care tracked by the Centers for Medicare & Medicaid Services (CMS). Annual performance rates for 7 pneumonia processes of care and an all-or-none composite of these measures; and 30-day, all-cause mortality and hospital readmission, adjusted for patient and hospital characteristics. Adjusted annual performance rates for all 7 CMS processes of care (expressed in percentage points per year) increased significantly from 2006 to 2010, ranging from 1.02 for antibiotic initiation within 6 hours to 5.30 for influenza vaccination (P < .001). All 7 measures were performed in more than 92% of eligible cases in 2010. The all-or-none composite demonstrated the largest adjusted relative increase over time (6.87 percentage points per year; P < .001) and was achieved in 87.4% of cases in 2010. Adjusted annual mortality decreased by 0.09 percentage points per year (P < .001), driven primarily by decreasing mortality in the subgroup not treated in the intensive care unit (ICU) (-0.18 percentage points per year; P < .001). Adjusted annual readmission rates decreased significantly by 0.25 percentage points per year (P < .001). All 7 processes of care were independently

  14. Incidence and outcomes of patients hospitalized with COPD exacerbation with and without pneumonia

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    Søgaard M

    2016-03-01

    Full Text Available Mette Søgaard,1 Morten Madsen,1 Anders Løkke,2 Ole Hilberg,2 Henrik Toft Sørensen,1 Reimar W Thomsen1 1Department of Clinical Epidemiology, 2Department of Respiratory Medicine, Aarhus University Hospital, Aarhus C, Denmark Background: Pneumonia may be a major contributor to hospitalizations for chronic obstructive pulmonary disease (COPD exacerbation and influence their outcomes.Methods: We examined hospitalization rates, health resource utilization, 30-day mortality, and risk of subsequent hospitalizations for COPD exacerbations with and without pneumonia in Denmark during 2006–2012.Results: We identified 179,759 hospitalizations for COPD exacerbations, including 52,520 first-time hospitalizations (29.2%. Pneumonia was frequent in first-time exacerbations (36.1%, but declined in successive exacerbations to 25.6% by the seventh or greater exacerbation. Pneumonic COPD exacerbations increased 20% from 0.92 per 1,000 population in 2006 to 1.10 per 1,000 population in 2012. Nonpneumonic exacerbations decreased by 6% from 1.74 per 1,000 population to 1.63 per 1,000 population during the same period. A number of markers of health resource utilization were more prevalent in pneumonic exacerbations than in nonpneumonic exacerbations: length of stay (median 7 vs 4 days, intensive care unit admission (7.7% vs 12.5%, and several acute procedures. Thirty-day mortality was 12.1% in first-time pneumonic COPD exacerbations versus 8.3% in first-time nonpneumonic cases (adjusted HR [aHR] 1.20, 95% confidence interval [CI] 1.17–1.24. Pneumonia also predicted increased mortality associated with a second exacerbation (aHR 1.14, 95% CI 1.11–1.18, and up to a seventh or greater exacerbation (aHR 1.10, 95% CI 1.07–1.13. In contrast, the aHR of a subsequent exacerbation was 8%–13% lower for patients with pneumonic exacerbations.Conclusions: Pneumonia is frequent among patients hospitalized for COPD exacerbations and is associated with increased health care

  15. Antibiotic Conformity with Culture Results of Hospitalized Pneumonia Patients in Melati Ward at Dr. Hasan Sadikin General Hospital Bandung, Indonesia

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    Randhi Rinaldi

    2016-12-01

    Full Text Available Background: Pneumonia is an infection with the highest mortality rate in Indonesian hospitals. According to The American Thoracic Society and The Infectious Diseases Society of America (ATS/IDSA, empirical use of antibiotics is still effective for pneumonia treatment. Inappropriate use of antibiotics would cause negative effects such as prolonged hospitalization, a high cost of treatment, and increased antibiotic-resistant bacteria. The goal of this study was to clarify the empirical use of antibiotic conformity with a bacteria culture. Methods: This study was conducted from August to October 2013 using a descriptive retrospective method based on 116 medical records of pneumonia patients hospitalized in Melati Ward, Dr. Hasan Sadikin General Hospital Bandung during 2011–2012. The type of bacteria, conformity with antibiotics given to patients, and type of antibiotics were analyzed. The conformity of antibiotics was assessed based on the resistance test. If the results were sensitive, they would be put in the conforming group and in the non-conforming group if the results were resistant or intermediate. Data was derived with descriptive statistics, using percentage and frequency distribution, illustrated in tables and figures. Results: Based on culture results and sensitivity of antibiotic empirical therapy given, 55.17% cases were conformed. The most widely used antibiotic group was Third-generation Cephalosporin (60.34%. The most common bacterias were Klebsiella pneumonia (34.5% and Acinetobacter baumanni (13.8%. Conclusions: Most of the antibiotics given to pneumonia patients are still appropriate with results of the bacteria culture test and resistance test.

  16. Predictors of Pseudomonas and methicillin-resistant Staphylococcus aureus in hospitalized patients with healthcare-associated pneumonia.

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    Metersky, Mark L; Frei, Christopher R; Mortensen, Eric M

    2016-01-01

    Patients with healthcare-associated pneumonia (HCAP) are at high risk of infection with multidrug-resistant (MDR) pathogens. Factors discriminating infection with MDR Gram-negative (MDR-GN) organism from infection with methicillin-resistant Staphylococcus aureus (MRSA) are not well understood and patients are often treated for both organisms. This study was performed to determine risk factors predicting pneumonia due to Pseudomonas versus MRSA. Veterans age ≥65 hospitalized with HCAP between 2002 and 2012 were identified from the Veterans Affairs administrative databases. Patients were identified with Pseudomonas pneumonia, MRSA pneumonia or neither according to the International Classification of Diseases, 9th Revision, Clinical Modification codes. We assessed unadjusted and adjusted associations of patient characteristics and HCAP due to Pseudomonas or MRSA. Of the 61,651 patients with HCAP, 1156 (1.9%) were diagnosed with Pseudomonas pneumonia, 641 (1.0%) with MRSA pneumonia and 59,854 (97.1%) with neither. MRSA pneumonia was positively associated with male gender, age >74, diabetes, chronic obstructive pulmonary disease (COPD), recent nursing home or hospital stay, recent exposure to fluoroquinolone or antibiotics treating Gram-positive organisms, and severe pneumonia. MRSA pneumonia was negatively associated with complicated diabetes. Pseudomonas pneumonia was positively associated with recent hospital stay, immunocompromise, COPD, hemiplegia, recent exposure to inhaled corticosteroids, β-lactam/cephalosporin/carbapenem antibiotics, antibiotics against Gram-positive organisms, 'other antibiotics' and severe pneumonia. Pseudomonas pneumonia was negatively associated with age >84, higher socioeconomic status, drug abuse and diabetes. Patient characteristics may assist in identifying patients at risk for HCAP due to Pseudomonas or MRSA. © 2015 Asian Pacific Society of Respirology.

  17. Adherence to Therapeutic Guidelines for Patients with Community-Acquired Pneumonia in Australian Hospitals

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    N.R. Adler

    2014-01-01

    Full Text Available Community-acquired pneumonia (CAP is a significant cause of morbidity and mortality, particularly in elderly patients, and is associated with a considerable economic burden on the healthcare system. The combination of high incidence and substantial financial costs necessitate accurate diagnosis and appropriate management of patients admitted with CAP. This article will discuss the rates of adherence to clinical guidelines, the use of severity scoring tools and the appropriateness of antimicrobial prescribing for patients diagnosed with CAP. The authors maintain that awareness of national and hospital guidelines is imperative to complement the physicians’ clinical judgment with evidence-based recommendations. Increased use of pneumonia severity assessment tools and greater adherence to therapeutic guidelines will enhance concordant antimicrobial prescribing for patients with CAP. A robust and multifaceted educational intervention, in combination with antimicrobial stewardship programs, may enhance compliance of CAP guidelines in clinical practice in Australia.

  18. Independent radiographic prognostic factors in patients with hospital-treated community-acquired pneumonia

    International Nuclear Information System (INIS)

    Wilhelm, K.; Textor, J.; Schild, H.; Ewig, S.; Luederitz, B.; Krollmann, G.

    1999-01-01

    Purpose: To evaluate the independent prognostic impact of the chest radiograph for mortality from community-acquired pneumonia requiring hospitalization. Methods: Chest radiographs of 67 patients with hospital-treated community-acquired pneumonia were analyzed with regard to the prognostic implications of radiographic patterns, extent and density of infiltrates, and its evolution during treatment. Results: Non-survivors had a significantly higher extent of infiltrates (p=0.008), density of infiltrates (p=0.05), and radiographic spread during follow-up within 48-72 hours (p=0.0001). In multivariate analysis, persistent or progressive infiltrates were associated with a 47fold increase, and persistent or progressive density of infiltrates with an 18fold increase in risk of mortality. The presence of both parameters could correctly predict 96% of survivors and 90% of non-survivors. Conclusions: The chest radiograph is an independent predictor of the severity of pneumonia. Both persistent or progressive infiltrates and persistent or progressive density of infiltrates are independently associated with mortality from community-acquired pneumonia. (orig.) [de

  19. Bacteriological and clinical profile of Community acquired pneumonia in hospitalized patients

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    Shah Bashir

    2010-01-01

    Full Text Available The aim of our study was to obtain comprehensive insight into the bacteriological and clinical profile of community-acquired pneumonia requiring hospitalization. The patient population consisted of 100 patients admitted with the diagnosis of community-acquired pneumonia (CAP, as defined by British Thoracic society, from December 1998 to Dec 2000, at the Sher- i-Kashmir institute of Medical Sciences Soura, Srinagar, India. Gram negative organisms were the commonest cause (19/29, followed by gram positive (10/29. In 71 cases no etiological cause was obtained. Pseudomonas aeruginosa was the commonest pathogen (10/29, followed by Staphylococcus aureus (7/29, Escherichia coli (6/29, Klebsiella spp. (3/29, Streptococcus pyogenes (1/29, Streptococcus pneumoniae (1/29 and Acinetobacter spp. (1/29. Sputum was the most common etiological source of organism isolation (26 followed by blood (6, pleural fluid (3, and pus culture (1. Maximum number of patients presented with cough (99%, fever (95%, tachycardia (92%, pleuritic chest pain (75%, sputum production (65% and leucocytosis (43%. The commonest predisposing factors were smoking (65%, COPD (57%, structural lung disease (21%, diabetes mellitus (13%, and decreased level of consciousness following seizure (eight per cent and chronic alcoholism (one per cent. Fourteen patients, of whom, nine were males and five females, died. Staphylococcus aureus was the causative organism in four, Pseudomonas in two, Klebsiella in one, and no organism was isolated in seven cases. The factors predicting mortality at admission were - age over 62 years, history of COPD or smoking, hypotension, altered sensorium, respiratory failure, leucocytosis, and s0 taphylococcus pneumonia and undetermined etiology. The overall rate of identification of microbial etiology of community-acquired pneumonia was 29%, which is very low, and if serological tests for legionella, mycoplasma and viruses are performed the diagnostic yield would

  20. Epidemiology of human coronavirus NL63 infection among hospitalized patients with pneumonia in Taiwan.

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    Huang, Su-Hua; Su, Mei-Chi; Tien, Ni; Huang, Chien-Jhen; Lan, Yu-Ching; Lin, Chen-Sheng; Chen, Chao-Hsien; Lin, Cheng-Wen

    2017-12-01

    Human coronavirus (HCoV) NL63 is recognized in association with upper or lower respiratory tract illnesses in children. This study surveyed the prevalence of HCoV-NL63 and influenza viruses in patients with influenza-like illness in Taiwan during 2010-2011. Throat samples from 107 hospitalized patients with pneumonia and 175 outpatients with influenza-like illness were examined using real-time polymerase chain reaction assays with virus-specific primers, and then virus-positive specimens were confirmed by sequencing the polymerase chain reaction products. HCoV-NL63 infection was identified in 8.4% (9/107) of hospitalized patients with pneumonia, but not found in outpatients with influenza-like illness. Age distribution of HCoV-NL63 infection in hospitalized patients with pneumonia indicated that the group aged 16-25 years (20%) had the highest positive rate compared with the other groups, and exhibited a similar age-specific pattern to influenza A/H1N1 infection, but not influenza A/H3N2 and B infections in hospitalized patients. Seasonal prevalence of HCoV-NL63 infection was late winter, overlapping the highest peak of the influenza A/H1N1 epidemic during December 2010 to March 2011 in Taiwan. Co-infection of HCoV-NL63 and influenza A/H1N1 was detected in three hospitalized patients. Clinical manifestation analysis indicated that the main symptoms for HCoV-NL63 infection included fever (88.9%), cough (77.8%), and pneumonia (100%). Co-infection caused significantly higher rates of breathing difficulties, cough, and sore throat than those of single infection with HCoV-NL63 and influenza A/H1N1. Phylogenetic analysis indicated a low level of heterogeneity between Taiwan and global HCoV-NL63 strains. Understanding epidemiology of HCoV-NL63 in Taiwan provides an insight for worldwide surveillance of HCoV-NL63 infection. Copyright © 2015. Published by Elsevier B.V.

  1. Predictors for individual patient antibiotic treatment effect in hospitalized community-acquired pneumonia patients.

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    Simonetti, A F; van Werkhoven, C H; Schweitzer, V A; Viasus, D; Carratalà, J; Postma, D F; Oosterheert, J J; Bonten, M J M

    2017-10-01

    Our objective was to identify clinical predictors of antibiotic treatment effects in hospitalized patients with community-acquired pneumonia (CAP) who were not in the intensive care unit (ICU). Post-hoc analysis of three prospective cohorts (from the Netherlands and Spain) of adult patients with CAP admitted to a non-ICU ward having received either β-lactam monotherapy, β-lactam + macrolide, or a fluoroquinolone-based therapy as empirical antibiotic treatment. We evaluated candidate clinical predictors of treatment effects in multiple mixed-effects models by including interactions of the predictors with empirical antibiotic choice and using 30-day mortality, ICU admission and length of hospital stay as outcomes. Among 8562 patients, empirical treatment was β-lactam in 4399 (51.4%), fluoroquinolone in 3373 (39.4%), and β-lactam + macrolide in 790 (9.2%). Older age (interaction OR 1.67, 95% CI 1.23-2.29, p 0.034) and current smoking (interaction OR 2.36, 95% CI 1.34-4.17, p 0.046) were associated with lower effectiveness of fluoroquinolone on 30-day mortality. Older age was also associated with lower effectiveness of β-lactam + macrolide on length of hospital stay (interaction effect ratio 1.14, 95% CI 1.06-1.22, p 0.008). Older age and smoking could influence the response to specific antibiotic regimens. The effect modification of age and smoking should be considered hypothesis generating to be evaluated in future trials. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  2. Interleukin-6 and procalcitonin as biomarkers in mortality prediction of hospitalized patients with community acquired pneumonia

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    Ilija Andrijevic

    2014-01-01

    Full Text Available Introduction: Community acquired pneumonia (CAP may present as life-threatening infection with uncertain progression and outcome of treatment. Primary aim of the trial was determination of the cut-off value of serum interleukin-6 (IL-6 and procalcitonin (PCT above which, 30-day mortality in hospitalized patients with CAP, could be predicted with high sensitivity and specificity. We investigated correlation between serum levels of IL-6 and PCT at admission and available scoring systems of CAP (pneumonia severity index-PSI, modified early warning score-MEWS and (Confusion, Urea nitrogen, respiratory rate, Blood pressure, ≥65 years of age-CURB65. Methods: This was prospective, non-randomized trial which included 101 patients with diagnosed CAP. PSI, MEWS and CURB65 were assessed on first day of hospitalization. IL-6 and PCT were also sampled on the first day of hospitalization. Results: Based on ROC curve analysis (AUC ± SE = 0.934 ± 0.035; 95%CI(0.864-1.0; P = 0.000 hospitalized CAP patients with elevated IL-6 level have 93.4% higher risk level for lethal outcome. Cut-off value of 20.2 pg/ml IL-6 shows sensitivity of 84% and specificity of 87% in mortality prediction. ROC curve analysis confirmed significant role of procalcitonin as a mortality predictor in CAP patients (AUC ± SE = 0.667 ± 0.062; 95%CI(0.546-0.789; P = 0.012. Patients with elevated PCT level have 66.7% higher risk level for lethal outcome. As a predictor of mortality at the cut-off value of 2.56 ng/ml PCT shows sensitivity of 76% and specificity of 61.8%. Conclusions: Both IL-6 and PCI are significant for prediction of 30-day mortality in hospitalized patients with CAP. Serum levels of IL6 correlate with major CAP scoring systems.

  3. Mortality prediction to hospitalized patients with influenza pneumonia: PO2 /FiO2 combined lymphocyte count is the answer.

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    Shi, Shu Jing; Li, Hui; Liu, Meng; Liu, Ying Mei; Zhou, Fei; Liu, Bo; Qu, Jiu Xin; Cao, Bin

    2017-05-01

    Community-acquired pneumonia (CAP) severity scores perform well in predicting mortality of CAP patients, but their applicability in influenza pneumonia is powerless. The aim of our research was to test the efficiency of PO 2 /FiO 2 and CAP severity scores in predicting mortality and intensive care unit (ICU) admission with influenza pneumonia patients. We reviewed all patients with positive influenza virus RNA detection in Beijing Chao-Yang Hospital during the 2009-2014 influenza seasons. Outpatients, inpatients with no pneumonia and incomplete data were excluded. We used receiver operating characteristic curves (ROCs) to verify the accuracy of severity scores or indices as mortality predictors in the study patients. Among 170 hospitalized patients with influenza pneumonia, 30 (17.6%) died. Among those who were classified as low-risk (predicted mortality 0.1%-2.1%) by pneumonia severity index (PSI) or confusion, urea, respiratory rate, blood pressure, age ≥65 year (CURB-65), the actual mortality ranged from 5.9 to 22.1%. Multivariate logistic regression indicated that hypoxia (PO 2 /FiO 2  ≤ 250) and lymphopenia (peripheral blood lymphocyte count pneumonia confirmed a similar pattern and PO 2 /FiO 2 combined lymphocyte count was also the best predictor for predicting ICU admission. In conclusion, we found that PO 2 /FiO 2 combined lymphocyte count is simple and reliable predictor of hospitalized patients with influenza pneumonia in predicting mortality and ICU admission. When PO 2 /FiO 2  ≤ 250 or peripheral blood lymphocyte count pneumonia. © 2015 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.

  4. Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review

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    Leonor Pássaro

    2016-11-01

    Full Text Available Abstract Background Pneumonia is one of the leading hospital-acquired infections worldwide and has an important impact. Although preventive measures for ventilator-associated pneumonia (VAP are well known, less is known about appropriate measures for prevention of hospital-acquired pneumonia (HAP. Aim The purpose of this narrative review is to provide an overview of the current standards for preventing HAP in non-ventilated adult patients. Methods A search of the literature up to May 2015 was conducted using Medline for guidelines published by national professional societies or professional medical associations. In addition, a comprehensive search for the following preventive measures was performed: hand hygiene, oral care, bed position, mobilization, diagnosis and treatment of dysphagia, aspiration prevention, viral infections and stress bleeding prophylaxis. Findings Regarding international guidelines, several measures were recommended for VAP, whilst no specific recommendations for HAP prevention in non-ventilated patients are available. There is reasonable evidence available that oral care is associated with a reduction in HAP. Early mobilization interventions, swift diagnosis and treatment of dysphagia, and multimodal programmes for the prevention of nosocomial influenza cross-infection, have a positive impact on HAP reduction. The impact of bed position and stress bleeding prophylaxis remains uncertain. Systematic antibiotic prophylaxis for HAP prevention should be avoided. Conclusion Scant literature and little guidance is available for the prevention of HAP among non-ventilated adult patients. In addition, the criteria used for the diagnosis of HAP and the populations targeted in the studies selected are heterogeneous. Oral care was the most studied measure and was commonly associated with a decrease in HAP rate, although a broad range of interventions are proposed. No robust evidence is available for other measures. Further high

  5. Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review.

    Science.gov (United States)

    Pássaro, Leonor; Harbarth, Stephan; Landelle, Caroline

    2016-01-01

    Pneumonia is one of the leading hospital-acquired infections worldwide and has an important impact. Although preventive measures for ventilator-associated pneumonia (VAP) are well known, less is known about appropriate measures for prevention of hospital-acquired pneumonia (HAP). The purpose of this narrative review is to provide an overview of the current standards for preventing HAP in non-ventilated adult patients. A search of the literature up to May 2015 was conducted using Medline for guidelines published by national professional societies or professional medical associations. In addition, a comprehensive search for the following preventive measures was performed: hand hygiene, oral care, bed position, mobilization, diagnosis and treatment of dysphagia, aspiration prevention, viral infections and stress bleeding prophylaxis. Regarding international guidelines, several measures were recommended for VAP, whilst no specific recommendations for HAP prevention in non-ventilated patients are available. There is reasonable evidence available that oral care is associated with a reduction in HAP. Early mobilization interventions, swift diagnosis and treatment of dysphagia, and multimodal programmes for the prevention of nosocomial influenza cross-infection, have a positive impact on HAP reduction. The impact of bed position and stress bleeding prophylaxis remains uncertain. Systematic antibiotic prophylaxis for HAP prevention should be avoided. Scant literature and little guidance is available for the prevention of HAP among non-ventilated adult patients. In addition, the criteria used for the diagnosis of HAP and the populations targeted in the studies selected are heterogeneous. Oral care was the most studied measure and was commonly associated with a decrease in HAP rate, although a broad range of interventions are proposed. No robust evidence is available for other measures. Further high-quality studies are required to evaluate the impact of specific measures on

  6. Burden of methicillin-resistant Staphylococcus aureus pneumonia among hospitalized patients in Lebanon and Saudi Arabia

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    Althaqafi AO

    2017-02-01

    Full Text Available Abdulhakeem O Althaqafi,1 Madonna J Matar,2 Rima Moghnieh,3 Adel F Alothman,4 Thamer H Alenazi,5 Fayssal Farahat,1 Shelby Corman,6 Caitlyn T Solem,6 Nirvana Raghubir,7 Cynthia Macahilig,8 Seema Haider,9 Jennifer M Stephens6 1Department of Infection Prevention and Control, King Abdullah International Medical Research Center, King Saud bin AbdulAziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia; 2Department of Infectious Disease, Notre Dame de Secours University Hospital, Byblos, 3Makassed General Hospital, Beirut, Lebanese Republic; 4Department of Medicine, King Abdulaziz Medical City, Central Region, Ministry of National Guard Health Affairs, 5Infection Prevention & Control Department, King Abdulaziz Medical City-Riyadh (KAMC, Kingdom of Saudi Arabia; 6Real World Evidence: Data Analytics Center of Excellence, Pharmerit International, Bethesda, MD, 7Medical Affairs, Pfizer, New York, NY, 8Medical Data Analytics, Parsippany, NJ, 9Outcomes & Evidence, Global Health and Value, Pfizer, Groton, CT, USA Objectives: The objective of this study is to describe the real-world treatment patterns and burden of suspected or confirmed methicillin-resistant Staphylococcus aureus (MRSA pneumonia in Saudi Arabia and Lebanon. Methods: A retrospective chart review study evaluated 2011–2012 data from hospitals in Saudi Arabia and Lebanon. Patients were included if they had been discharged with a diagnosis of MRSA pneumonia, which was culture proven or suspected based on clinical criteria. Hospital data were abstracted for a random sample of patients to capture demographics (eg, age and comorbidities, treatment patterns (eg, timing and use of antimicrobials, hospital resource utilization (eg, length of stay, and clinical outcomes (eg, clinical status at discharge and mortality. Descriptive results were reported using frequencies or proportions for categorical variables and mean and standard deviation for continuous variables. Results: Chart

  7. Pneumonia and hospitalizations in the elderly

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    Francesco Cacciatore

    2017-05-01

    Full Text Available Pneumonia in the elderly is a common and severe problem. In this review we analyze the state of the art for pneumonia in the elderly. Several aspects are discussed: i how common is the disease; signs and symptoms in the elderly; ii the elderly must always be hospitalized and which is the best place - Intensive Care Unit or medical ward?; iii the role of comorbidities; iv etiology and pathogenesis; medical treatment - when and how to start; v antibiotic resistance; vi antibiotics in hospital acquired and ventilator related pneumonia; vii assisted non-invasive ventilation; viii the treatment in the terminally ill elderly patient.

  8. Cardiac complications associated with short-term mortality in schizophrenia patients hospitalized for pneumonia: a nationwide case-control study.

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    Ya-Tang Liao

    Full Text Available BACKGROUND: Pneumonia is one of most prevalent infectious diseases worldwide and is associated with considerable mortality. In comparison to general population, schizophrenia patients hospitalized for pneumonia have poorer outcomes. We explored the risk factors of short-term mortality in this population because the information is lacking in the literature. METHODS: In a nationwide schizophrenia cohort, derived from the National Health Insurance Research Database in Taiwan, that was hospitalized for pneumonia between 2000 and 2008 (n = 1,741, we identified 141 subjects who died during their hospitalizations or shortly after their discharges. Based on risk-set sampling in a 1∶4 ratio, 468 matched controls were selected from the study cohort (i.e., schizophrenia cohort with pneumonia. Physical illnesses were categorized as pre-existing and incident illnesses that developed after pneumonia respectively. Exposures to medications were categorized by type, duration, and defined daily dose. We used stepwise conditional logistic regression to explore the risk factors for short-term mortality. RESULTS: Pre-existing arrhythmia was associated with short-term mortality (adjusted risk ratio [RR] = 4.99, p<0.01. Several variables during hospitalization were associated with increased mortality risk, including incident arrhythmia (RR = 7.44, p<0.01, incident heart failure (RR = 5.49, p = 0.0183 and the use of hypoglycemic drugs (RR = 2.32, p<0.01. Furthermore, individual antipsychotic drugs (such as clozapine known to induce pneumonia were not significantly associated with the risk. CONCLUSIONS: Incident cardiac complications following pneumonia are associated with increased short-term mortality. These findings have broad implications for clinical intervention and future studies are needed to clarify the mechanisms of the risk factors.

  9. [Contribution of urinary pneumococcal antigen detection combined with the research of legionella antigen for diagnosis of pneumonia in hospitalized patients].

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    Honoré, S; Trillard, M; Ould-Hocine, Z; Lesprit, P; Deforges, L; Legrand, P

    2004-10-01

    Bacteriological confirmation of pneumonia (PNM) in hospitalized patients is often erratic or belated. Because of importance of prognosis, early adaptation of treatment requires an empirical antimicrobial therapy (generally aminopenicillin and macrolide combination). The starting therapeutic strategy should profit by a fast and reliable test asserting a pneumococcal etiology. The Binax Now S. pneumoniae (BNP) test allows an urinary pneumococcal antigen (UPA) detection using an immunochromatographic membrane assay within 15 minutes. We first evaluated the BNP test for 28 patients with pneumococcal PNM proved by culture, and 118 negative control patients without PNM. The BNP test was then evaluated by testing urine from 158 hospitalized patients with a clinical picture of PNM (community-acquired: 90, nosocomial: 68) for whom a research of urinary Legionella antigen (Binax Now) was prescribed and was positive for only two cases. 57 patients (36.1%) were hospitalized in ICU. The sensitivity was 71.4% (85.7% for the 21 bacteriemic PNM), and the specificity was 98.3%; that is consistent with previous published data. Among the 158 patients with PNM, UPA was detected in 17 cases (10.8%): 15 within the community-acquired PNM (16.7%) and 2 (2.9%) within the nosocomial cases. The pneumococcal etiology was confirmed by bacteriological samples in 7/17 patients (6 by blood cultures). The 10 others showed clinical and radiological features in agreement with a pneumococcal PNM. Among the 141 patients with negative AUP, S. pneumoniae was isolated from 6 of them (2 in blood cultures). The Binax Now S. pneumoniae test allowed a fast and reliable etiological diagnosis in 10.8% of hospitalized PNM (16.7% of the community-acquired cases) having a research of urinary Legionella antigen (conceiving with severity factors). So it could conduce to an improved adjustment of the starting antimicrobial therapy of hospitalized adult patients with PNM.

  10. Molecular detection of genes encoding AcrAB , Qep A efflux pumps in Klebsiella pneumoniae strains isolated from hospitalized patients in selected hospitals in Tehran

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    Mohsen Heidary

    2017-03-01

    Full Text Available Abstract Background and Objectives: Increasing emergence of fluoroquinolone resistance among clinical isolates of Klebsiella pneumoniae  (K. pneumoniae, has limited the treatment options for treatment of infections caused by these bacteria. The aim of this study was to investigate the dissemination of genes encoding AcrAB and QepA efflux pumps among K. pneumoniae strains. Methods: This study was carried out on 117 K. pneumoniae strains isolated from patients hospitalized in selected hospitals in Tehran city, 2015-2016, Iran. Antimicrobial susceptibility tests were performed using disk diffusion method (based on CLSI guidelines and identification of acr A, acr B and qep A genes using PCR assay. Results: In this study, colistin and tigecycline had the best effect against clinical isolates of K. pneumoniae. According to PCR results, 110 (94% isolates had acrA gene and 102 (87% isolates had acrB gene, respectively. The qepA gene was not found in any of the K. pneumoniae strains. Conclusion: According to the results of the present study, dissemination of the genes encoding AcrAB efflux pumps among K. pneumoniae strains, which cause resistance to fluoroquinolones, is a matter of concern. Therefore, infection control and prevention of the spread of drug-resistant bacteria requires careful management in drug prescription and identification of resistant isolates.

  11. US hospital care for patients with HIV infection and pneumonia: the role of public, private, and Veterans Affairs hospitals in the early highly active antiretroviral therapy era.

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    Uphold, Constance R; Deloria-Knoll, Maria; Palella, Frank J; Parada, Jorge P; Chmiel, Joan S; Phan, Laura; Bennett, Charles L

    2004-02-01

    We evaluated differences in processes and outcomes of HIV-related pneumonia care among patients in Veterans Affairs (VA), public, and for-profit and not-for-profit private hospitals in the United States. We compared the results of our current study (1995 to 1997) with those of our previous study that included a sample of patients receiving care during the years 1987 to 1990 to determine how HIV-related pneumonia care had evolved over the last decade. The sample consisted of 1,231 patients with HIV infection who received care for Pneumocystis carinii pneumonia (PCP) and 750 patients with HIV infection who received care for community-acquired pneumonia (CAP) during the years 1995 to 1997. We conducted a retrospective medical record review and evaluated patient and hospital characteristics, HIV-related processes of care (timely use of anti-PCP medications, adjunctive corticosteroids), non-HIV-related processes of care (timely use of CAP treatment medications, diagnostic testing, ICU utilization, rates of endotracheal ventilation, placement on respiratory isolation), length of inpatient hospital stay, and inpatient mortality. Rates of timely use of antibiotics and adjunctive corticosteroids for treating PCP were high and improved dramatically from the prior decade. However, compliance with consensus guidelines that recommend public, private not-for-profit hospitals, and for-profit hospitals. This study provides the first overview of HIV-related pneumonia care in the early highly active antiretroviral therapy era, and contrasts current findings with those of a similarly conducted study from a decade earlier. Quality of care for patients with PCP improved, but further efforts are needed to facilitate the appropriate management of CAP. In the third decade of the epidemic, it will be important to monitor whether variations in processes of care for various HIV-related clinical diagnoses among different types of hospitals persist.

  12. Non-invasive mechanical ventilation and mortality in elderly immunocompromised patients hospitalized with pneumonia: a retrospective cohort study.

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    Johnson, Christopher S; Frei, Christopher R; Metersky, Mark L; Anzueto, Antonio R; Mortensen, Eric M

    2014-01-27

    Mortality after pneumonia in immunocompromised patients is higher than for immunocompetent patients. The use of non-invasive mechanical ventilation for patients with severe pneumonia may provide beneficial outcomes while circumventing potential complications associated with invasive mechanical ventilation. The aim of our study was to determine if the use of non-invasive mechanical ventilation in elderly immunocompromised patients with pneumonia is associated with higher all-cause mortality. In this retrospective cohort study, data were obtained from the Department of Veterans Affairs administrative databases. We included veterans age ≥65 years who were immunocompromised and hospitalized due to pneumonia. Multilevel logistic regression analysis was used to determine the relationship between the use of invasive versus non-invasive mechanical ventilation and 30-day and 90-day mortality. Of 1,946 patients in our cohort, 717 received non-invasive mechanical ventilation and 1,229 received invasive mechanical ventilation. There was no significant association between all-cause 30-day mortality and non-invasive versus invasive mechanical ventilation in our adjusted model (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.66-1.10). However, those patients who received non-invasive mechanical ventilation had decreased 90-day mortality (OR 0.66, 95% CI 0.52-0.84). Additionally, receipt of guideline-concordant antibiotics in our immunocompromised cohort was significantly associated with decreased odds of 30-day mortality (OR 0.31, 95% CI 0.24-0.39) and 90-day mortality (OR 0.41, 95% CI 0.31-0.53). Our findings suggest that physicians should consider the use of non-invasive mechanical ventilation, when appropriate, for elderly immunocompromised patients hospitalized with pneumonia.

  13. [Estimation of economic costs for the care of patients with nosocomial pneumonia in a regional peruvian hospital, 2009-2011].

    Science.gov (United States)

    Dámaso-Mata, Bernardo; Chirinos-Cáceres, Jesús; Menacho-Villafuerte, Luz

    2016-06-01

    To estimate and compare the economic costs for the care of patients with and without nosocomial pneumonia at Hospital II Huánuco EsSalud during 2009-2011, in Peru. This was a partial economic evaluation of paired cases and controls. A collection sheet was used. nosocomial pneumonia. direct health costs, direct non-health costs, indirect costs, occupation, age, comorbidities, sex, origin, and education level. A bivariate analysis was performed. Forty pairs of cases and controls were identified. These patients were hospitalized for >2 weeks and prescribed more than two antibiotics. The associated direct health costs included those for hospitalization, antibiotics, auxiliary examinations, specialized assessments, and other medications. The direct non-health costs and associated indirect costs included those for transportation, food, housing, foregone payroll revenue, foregone professional fee revenue, extra-institutional expenses, and payment to caregivers during hospitalization and by telephone. The direct health costs for nosocomial pneumonia patients were more than three times and the indirect costs were more than two times higher than those for the controls. Variables with the greatest impact on costs were identified.

  14. Dental and microbiological risk factors for hospital-acquired pneumonia in non-ventilated older patients.

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    Victoria C Ewan

    Full Text Available We obtained a time series of tongue/throat swabs from 90 patients with lower limb fracture, aged 65-101 in a general hospital in the North East of England between April 2009-July 2010. We used novel real-time multiplex PCR assays to detect S. aureus, MRSA, E. coli, P. aeruginosa, S. pneumoniae, H. influenza and Acinetobacter spp. We collected data on dental/denture plaque (modified Quigley-Hein index and outcomes of clinician-diagnosed HAP.The crude incidence of HAP was 10% (n = 90, with mortality of 80% at 90 days post discharge. 50% of cases occurred within the first 25 days. HAP was not associated with being dentate, tooth number, or heavy dental/denture plaque. HAP was associated with prior oral carriage with E. coli/S. aureus/P.aeruginosa/MRSA (p = 0.002, OR 9.48 95% CI 2.28-38.78. The incidence of HAP in those with carriage was 35% (4% without, with relative risk 6.44 (95% CI 2.04-20.34, p = 0.002. HAP was associated with increased length of stay (Fishers exact test, p=0.01, with mean 30 excess days (range -11.5-115. Target organisms were first detected within 72 hours of admission in 90% participants, but HAP was significantly associated with S. aureus/MRSA/P. aeruginosa/E. coli being detected at days 5 (OR 4.39, 95%CI1.73-11.16 or 14 (OR 6.69, 95%CI 2.40-18.60.Patients with lower limb fracture who were colonised orally with E. coli/ S. aureus/MRSA/P. aeruginosa after 5 days in hospital were at significantly greater risk of HAP (p = 0.002.

  15. Diagnostic performance of initial serum albumin level for predicting in-hospital mortality among aspiration pneumonia patients.

    Science.gov (United States)

    Kim, Hyosun; Jo, Sion; Lee, Jae Baek; Jin, Youngho; Jeong, Taeoh; Yoon, Jaechol; Lee, Jeong Moon; Park, Boyoung

    2018-01-01

    The predictive value of serum albumin in adult aspiration pneumonia patients remains unknown. Using data collected during a 3-year retrospective cohort of hospitalized adult patients with aspiration pneumonia, we evaluated the predictive value of serum albumin level at ED presentation for in-hospital mortality. 248 Patients were enrolled; of these, 51 cases died (20.6%). The mean serum albumin level was 3.4±0.7g/dL and serum albumin levels were significantly lower in the non-survivor group than in the survivor group (3.0±0.6g/dL vs. 3.5±0.6g/dL). In the multivariable logistic regression model, albumin was associated with in-hospital mortality significantly (adjusted odds ratio 0.30, 95% confidential interval (CI) 0.16-0.57). The area under the receiver operating characteristics (AUROC) for in-hospital survival was 0.72 (95% CI 0.64-0.80). The Youden index was 3.2g/dL and corresponding sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were 68.6%, 66.5%, 34.7%, 89.1%, 2.05 and 0.47, respectively. High sensitivity (98.0%) was shown at albumin level of 4.0g/dL and high specificity (94.9%) was shown at level of 2.5g/dL. Initial serum albumin levels were independently associated with in-hospital mortality among adult patients hospitalized with aspiration pneumonia and demonstrated fair discriminative performance in the prediction of in-hospital mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis.

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    Zilberberg, Marya D; Nathanson, Brian H; Sulham, Kate; Fan, Weihong; Shorr, Andrew F

    2017-04-17

    Drug resistance among gram-negative pathogens is a risk factor for inappropriate empiric treatment (IET), which in turn increases the risk for mortality. We explored the impact of carbapenem-resistant Enterobacteriaceae (CRE) on the risk of IET and of IET on outcomes in patients with Enterobacteriaceae infections. We conducted a retrospective cohort study in Premier Perspective database (2009-2013) of 175 US hospitals. We included all adult patients with community-onset culture-positive urinary tract infection (UTI), pneumonia, or sepsis as a principal diagnosis, or as a secondary diagnosis in the setting of respiratory failure, treated with antibiotics within 2 days of admission. We employed regression modeling to compute adjusted association of presence of CRE with risk of receiving IET, and of IET on hospital mortality, length of stay (LOS) and costs. Among 40,137 patients presenting to the hospital with an Enterobacteriaceae UTI, pneumonia or sepsis, 1227 (3.1%) were CRE. In both groups, the majority of the cases were UTI (51.4% CRE and 54.3% non-CRE). Those with CRE were younger (66.6+/-15.3 vs. 69.1+/-15.9 years, p pneumonia or sepsis was comparable to other national estimates. Infection with CRE was associated with a four-fold increased risk of receiving IET, which in turn increased mortality, LOS and costs.

  17. The prognostic significance of respiratory rate in patients with pneumonia: a retrospective analysis of data from 705,928 hospitalized patients in Germany from 2010-2012.

    Science.gov (United States)

    Strauß, Richard; Ewig, Santiago; Richter, Klaus; König, Thomas; Heller, Günther; Bauer, Torsten T

    2014-07-21

    Measurement of the respiratory rate is an important instrument for assessing the severity of acute disease. The respiratory rate is often not measured in routine practice because its clinical utility is inadequately appreciated. In Germany, documentation of the respiratory rate is obligatory when a patient with pneumonia is hospitalized. This fact has enabled us to study the prognostic significance of the respiratory rate in reference to a large medical database. We retrospectively analyzed data from the external quality-assurance program for community-acquired pneumonia for the years 2010-2012. All patients aged 18 years or older who were not mechanically ventilated on admission were included in the analysis. Logistic regression was used to determine the significance of the respiratory rate as a risk factor for in-hospital mortality. 705,928 patients were admitted to the hospital with community-acquired pneumonia (incidence: 3.5 cases per 1000 adults per year). The in-hospital mortality of these patients was 13.1% (92 227 persons). The plot of mortality as a function of respiratory rate on admission was U-shaped and slanted to the right, with the lowest mortality at a respiratory rate of 20/min on admission. If patients with a respiratory rate of 12-20/min are used as a baseline for comparison, patients with a respiratory rate of 27-33/min had an odds ratio (OR) of 1.72 for in-hospital death, and those with a respiratory rate above 33/min had an OR of 2.55. Further independent risk factors for in-hospital death were age, admission from a nursing home, hospital, or rehabilitation facility, chronic bedridden state, disorientation, systolic blood pressure, and pulse pressure. Respiratory rate is an independent risk marker for in-hospital mortality in community-acquired pneumonia. It should be measured when patients are admitted to the hospital with pneumonia and other acute conditions.

  18. Adherence with national guidelines in hospitalized patients with community-acquired pneumonia: results from the CAPO study in Venezuela.

    Science.gov (United States)

    Levy, Gur; Perez, Mario; Rodríguez, Benito; Hernández Voth, Ana; Perez, Jorge; Gnoni, Martin; Kelley, Robert; Wiemken, Timothy; Ramirez, Julio

    2015-04-01

    The Community-Acquired Pneumonia Organization (CAPO) is an international observational study in 130 hospitals, with a total of 31 countries, to assess the current management of hospitalized patients with community-acquired pneumonia (CAP). 2 Using the centralized database of CAPO was decided to conduct this study with the aim of evaluate the level of adherence with national guidelines in Venezuela, to define in which areas an intervention may be necessary to improve the quality of care of hospitalized patients with CAP. In this observational retrospective study quality indicators were used to evaluate the management of hospitalized patients with CAP in 8 Venezuelan's centers. The care of the patients was evaluated in the areas of: hospitalization, oxygen therapy, empiric antibiotic therapy, switch therapy, etiological studies, blood cultures indication, and prevention. The compliance was rated as good (>90%), intermediate (60% to 90%), or low (Venezuela that are not performed according to the national guidelines of SOVETHORAX.1 In any quality improvement process the first step is to evaluate the difference between what is recommended and what is done in clinical practice. While this study meets this first step, the challenge for the future is to implement the processes necessary to improve the management of CAP in Venezuela. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  19. High Prevalence of Multiple Drug Resistance among ESBLs-Producing Klebsiella pneumoniae Isolated from Hospitalized Patients in Isfahan, Iran

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    Zahra Tahanasab

    2017-02-01

    Full Text Available Background:   This study was to evaluate the prevalence of CTX-Mand TEM type ESBLs-producing K. pneumoniae and determination of MDR, XDR, and PDR phenotypes of these isolates as well as find out the genetic relationship and molecular typing of these isolates using phenotypic and genotypic methods.Methods:   Non-repetitive 96 K. pneumonia isolates were isolated from hospitalized patients in Al-Zahra hospital of Isfahan, Iran. The antibiotic susceptibility test was assessed for 20 antibiotics using Kirby-Bauer disk diffusion method. The frequency of ESBL-producing isolates was determined by phenotypic confirmatory test. All ESBLs-producing isolates were assessed for blaTEM and blaCTX-M genes using PCR method. Molecular typing was performed by enterobacterial repetitive intergenic consensus sequence-based PCR (ERIC-PCR.Results:  Among 96 isolates, 58 isolates (60.4% were ESBL-producers. In this study, 85.7% and 30.3% of ESBL-producing isolates showed MDR and XDR phenotypes, respectively. No PDR isolate was found. PCR amplification on ESBL-producing isolates showed that 47 (81% isolates were carried blaTEM gene, while blaCTX-M was detected in all isolates (100%. ERIC-PCR typing was characterized the high genetic similarity among ESBL-producing K. pneumonia isolates and revealed 32 band pattern for the isolates. Conclusion:  This study showed high prevalence of important ESBL genes (blaCTX-M and blaTEM genes among the K. pneumoniae isolated from in-patients. Constant following of ESBLs, also identification of their types, in bacteria isolated from hospitalized patients has an important clinical impact. It can provide valuable information for the choice of appropriate antibacterial therapy and decrease of antibiotic resistance.

  20. Neumonia adquirida en la comunidad en dos poblaciones hospitalarias Community-acquired pneumonia in patients from two different hospitals

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    O. J. Caberlotto

    2003-01-01

    Full Text Available Se estudiaron en forma prospectiva pacientes con diagnóstico de neumonía adquirida en la comunidad que acudieron a la consulta en un hospital general y en un centro especializado en medicina respiratoria ubicados en la provincia de Buenos Aires, y que requirieron internación. Se evaluaron la distribución por sexo y edad, las comorbilidades asociadas, los agentes etiológicos, su incidencia y la mortalidad. Se incluyeron 52 pacientes (marzo 1998-febrero 1999 del Hospital General de Agudos Manuel Belgrano (HMB y 23 pacientes (junio 2000-mayo 2001 del Hospital del Tórax Dr. Antonio A. Cetrángolo (HCET. Se excluyeron pacientes con tuberculosis o micosis pulmonar, neoplasia de pulmón y diagnóstico serológico para HIV. Se completó una historia clínica y se realizaron estudios microbiológicos para gérmenes comunes, virus respiratorios y micobacterias. Para el estudio de los agentes productores de neumonías atípicas (Chlamydia spp, Coxiella burnetii, Mycoplasma pneumoniae y Legionella spp. y como complemento del estudio virológico, se utilizaron pruebas serológicas. No se observaron diferencias por sexo y edad en los dos grupos. En el HMB las comorbilidades más frecuentes fueron EPOC, diabetes e insuficiencia cardíaca, en tanto que en el HCET fueron EPOC, asma y fibrosis pulmonar. Se obtuvo un diagnóstico microbiológico en el 48% y 65.2% de los pacientes para ambos grupos. Los agentes hallados más frecuentemente fueron Mycoplasma pneumoniae, Streptococcus pneumoniae, influenza A y Legionella spp, este último germen con una incidencia del 12% en pacientes que evolucionaron favorablemente y que en su mayoría pertenecían al HMB. La mortalidad fue similar para ambos grupos (13.3%. En el HMB estuvo relacionada con la existencia de comorbilidades en 7 de 8 casos y en el HCET con el agravamiento de la insuficiencia respiratoria crónica.Patients hospitalized with community acquired pneumonia were studied prospectively in two hospitals

  1. Genome-based analysis of Carbapenemase-producing Klebsiella pneumoniae isolates from German hospital patients, 2008-2014.

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    Becker, Laura; Kaase, Martin; Pfeifer, Yvonne; Fuchs, Stephan; Reuss, Annicka; von Laer, Anja; Sin, Muna Abu; Korte-Berwanger, Miriam; Gatermann, Sören; Werner, Guido

    2018-01-01

    By using whole genome sequence data we aimed at describing a population snapshot of carbapenemase-producing K. pneumoniae isolated from hospitalized patients in Germany between 2008 and 2014. We selected a representative subset of 107 carbapenemase-producing K. pneumoniae clinical isolates possessing the four most prevalent carbapenemase types in Germany (KPC-2, KPC-3, OXA-48, NDM-1). Isolates were processed via illumina NGS. Data were analysed using different SNP-based mapping and de-novo assembly approaches. Relevant information was extracted from NGS data (antibiotic resistance determinants, wzi gene/ cps type, virulence genes). NGS data from the present study were also compared with 238 genome data from two previous international studies on K. pneumoniae. NGS-based analyses revealed a preferred prevalence of KPC-2-producing ST258 and KPC-3-producing ST512 isolates. OXA-48, being the most prevalent carbapenemase type in Germany, was associated with various K. pneumoniae strain types; most of them possessing IncL/M plasmid replicons suggesting a preferred dissemination of bla OXA-48 via this well-known plasmid type. Clusters ST15, ST147, ST258, and ST512 demonstrated an intermingled subset structure consisting of German and other European K. pneumoniae isolates. ST23 being the most frequent MLST type in Asia was found only once in Germany. This latter isolate contained an almost complete set of virulence genes and a K1 capsule suggesting occurrence of a hypervirulent ST23 strain producing OXA-48 in Germany. Our study results suggest prevalence of "classical" K. pneumonaie strain types associated with widely distributed carbapenemase genes such as ST258/KPC-2 or ST512/KPC-3 also in Germany. The finding of a supposed hypervirulent and OXA-48-producing ST23 K. pneumoniae isolates outside Asia is highly worrisome and requires intense molecular surveillance.

  2. Determination of antibiotic resistance profile in Klebsiella pneumonia strains isolated from urinary tract infections of patients hospitalized in Peyambaran hospital (Tehran-Iran

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    Marzieh Tavakol

    2017-04-01

    Full Text Available Background: Urinary tract infection (UTI is the second prevalent infection in human mostly caused by Escherichia coli and Klebsiella pneumonia. The aim of this study was to determine the antibiotic resistance profile and detect the prevalence of antibiotic resistance encoding genes in K .pneumoniae isolated from UTI. Materials and Methods: Fifty K. pneumonia strains isolated from 122 UTI samples of hospitalized patients in Payambaran Hospital (Tehran, Iran which were subjected to this study (2014 were confirmed by standard biochemical tests. Isolates were tested for susceptibility to 10 antimicrobial drugs by using disk diffusion method. Antibiotic resistance encoding genes frequently include the aadA1, aac(3-IV, sul1, blaSHV, Cat1, cmlA, tetA, tetB, dfrA1, CITM, qnr in isolates were determined by PCR. Results: The highest antibiotic resistance in K. pneumoniae isolates were for Tetracycline and the lowest resistance (2% for Gentamicin and Imipenem. To determine the frequency of antibiotic resistant genes, 64% and 4% of isolates had tetA and Gentamicin-(aac(3-IV resistant genes, respectively. Conclusion: Frequency of antibiotic resistance encoding genes may have important and basic role in the occurrence and transfer of antibiotic resistance which can be due to the indiscriminate use of antibiotics.

  3. Donepezil is associated with decreased in-hospital mortality as a result of pneumonia among older patients with dementia: A retrospective cohort study.

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    Abe, Yasuko; Shimokado, Kentaro; Fushimi, Kiyohide

    2018-02-01

    Pneumonia is one of the major causes of mortality in older adults. As the average lifespan has extended and new modalities to prevent or treat pneumonia are developed, the factors that affect the length of hospital stay (LHS) and in-hospital mortality of older patients with pneumonia have changed. The object of the present study was to determine the factors associated with LHS and mortality as a result of pneumonia among older patients with dementia. With a retrospective cohort study design, we used the data derived from the Japanese Administrative Database and diagnosis procedure combination/per diem payment system (DPC/PDPS) database. There were 39 336 admissions of older patients for pneumonia between August 2010 and March 2012. Patients with incomplete data were excluded, leaving 25 602 patients for analysis. Having dementia decreased mortality (OR 0.71, P LHS. Multiple logistic regression analysis identified donepezil as an independent factor that decreased mortality in patients with dementia (OR 0.36, P LHS and mortality were similar to those reported by others. Donepezil seems to decrease in-hospital mortality as a result of pneumonia among older patients with dementia. Geriatr Gerontol Int 2018; 18: 269-275. © 2017 Japan Geriatrics Society.

  4. Influence of socioeconomic status on community-acquired pneumonia outcomes in elderly patients requiring hospitalization: a multicenter observational study

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    Carratalà Jordi

    2010-07-01

    Full Text Available Abstract Background The associations between socioeconomic status and community-acquired pneumonia outcomes in adults have been studied although studies did not always document a relationship. The aim of this multicenter observational study was to determine the association between socioeconomic status and community-acquired pneumonia outcomes in the elderly, in the context of a public health system providing universal free care to the whole population. Methods A total of 651 patients aged ≥65 years hospitalized due to community-acquired pneumonia through the emergency departments of five Spanish public hospitals were recruited and followed up between May 2005 and January 2007. The primary outcomes studied were: length of stay, intensive care unit admission, overall mortality and readmission. Socioeconomic status was measured using both individual and community data: occupation [categorized in six social groups (I, II, III, IVa, IVb and V], educational level (≤ primary level or ≥ secondary level and disposable family income of the municipality or district of residence [>12,500 € (high municipality family income and ≤12,500 € (low municipality family income]. The six social groups were further categorized as upper/middle social class (groups I-IVb and lower class (group V. Bivariate and multivariate analyses were performed. OR and their 95% confidence intervals were calculated. All statistical tests were two tailed and statistical significance was established as p Results 17.7% of patients lived in a municipality or district with a high municipality family income and 63.6% were upper/middle social class (I-IVb. Only 15.7% of patients had a secondary education. The adjusted analysis showed no association between pneumonia outcomes and social class, educational level or municipality family income. However, length of stay increased significantly in patients in whom the factors, living alone and being a smoker or ex-smoker coincided (p

  5. Pneumonia

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    ... may have received extra vaccinations and disease-preventing antibiotics to help prevent pneumonia and other infections caused by bacteria. ... patients are hospitalized, treatment might include intravenous (IV) antibiotics ... Can I Help Myself Feel Better? If your doctor has prescribed ...

  6. Pneumonia in the immunocompetent patient.

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    Reynolds, J H; McDonald, G; Alton, H; Gordon, S B

    2010-12-01

    Pneumonia is an acute inflammation of the lower respiratory tract. Lower respiratory tract infection is a major cause of mortality worldwide. Pneumonia is most common at the extremes of life. Predisposing factors in children include an under-developed immune system together with other factors, such as malnutrition and over-crowding. In adults, tobacco smoking is the single most important preventable risk factor. The commonest infecting organisms in children are respiratory viruses and Streptoccocus pneumoniae. In adults, pneumonia can be broadly classified, on the basis of chest radiographic appearance, into lobar pneumonia, bronchopneumonia and pneumonia producing an interstitial pattern. Lobar pneumonia is most commonly associated with community acquired pneumonia, bronchopneumonia with hospital acquired infection and an interstitial pattern with the so called atypical pneumonias, which can be caused by viruses or organisms such as Mycoplasma pneumoniae. Most cases of pneumonia can be managed with chest radiographs as the only form of imaging, but CT can detect pneumonia not visible on the chest radiograph and may be of value, particularly in the hospital setting. Complications of pneumonia include pleural effusion, empyema and lung abscess. The chest radiograph may initially indicate an effusion but ultrasound is more sensitive, allows characterisation in some cases and can guide catheter placement for drainage. CT can also be used to characterise and estimate the extent of pleural disease. Most lung abscesses respond to medical therapy, with surgery and image guided catheter drainage serving as options for those cases who do not respond.

  7. Decreasing incidence and mortality among hospitalized patients suffering a ventilator-associated pneumonia: Analysis of the Spanish national hospital discharge database from 2010 to 2014.

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    de Miguel-Díez, Javier; López-de-Andrés, Ana; Hernández-Barrera, Valentín; Jiménez-Trujillo, Isabel; Méndez-Bailón, Manuel; Miguel-Yanes, José M de; Del Rio-Lopez, Benito; Jiménez-García, Rodrigo

    2017-07-01

    The aim of this study was to describe trends in the incidence and outcomes of ventilator-associated pneumonia (VAP) among hospitalized patients in Spain (2010-2014).This is a retrospective study using the Spanish national hospital discharge database from year 2010 to 2014. We selected all hospital admissions that had an ICD-9-CM code: 997.31 for VAP in any diagnosis position. We analyzed incidence, sociodemographic and clinical characteristics, procedures, pathogen isolations, and hospital outcomes.We identified 9336 admissions with patients suffering a VAP. Incidence rates of VAP decreased significantly over time (from 41.7 cases/100,000 inhabitants in 2010 to 40.55 in 2014). The mean Charlson comorbidity index (CCI) was 1.08 ± 0.98 and it did not change significantly during the study period. The most frequent causative agent was Pseudomonas and there were not significant differences in the isolation of this microorganism over time. Time trend analyses showed a significant decrease in in-hospital mortality (IHM), from 35.74% in 2010 to 32.81% in 2014. Factor associated with higher IHM included male sex, older age, higher CCI, vein or artery occlusion, pulmonary disease, cancer, undergone surgery, emergency room admission, and readmission.This study shows that the incidence of VAP among hospitalized patients has decreased in Spain from 2010 to 2014. The IHM has also decreased over the study period. Further investigations are needed to improve the prevention and control of VAP.

  8. In-hospital mortality risk factors in community acquired pneumonia: evaluation of immunocompetent adult patients without comorbidities

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    Miguel Hernan Vicco

    2015-04-01

    Full Text Available Summary Objective: several scores were developed in order to improve the determination of community acquired pneumonia (CAP severity and its management, mainly CURB-65 and SACP score. However, none of them were evaluated for risk assessment of in-hospital mortality, particularly in individuals who were non-immunosuppressed and/or without any comorbidity. In this regard, the present study was carried out. Methods: we performed a cross-sectional study in 272 immunocompetent patients without comorbidities and with a diagnosis of CAP. Performance of CURB- 65 and SCAP scores in predicting in-hospital mortality was evaluated. Also, variables related to death were assessed. Furthermore, in order to design a model of in-hospital mortality prediction, sampled individuals were randomly divided in two groups. The association of the variables with mortality was weighed and, by multiple binary regression, a model was constructed in one of the subgroups. Then, it was validated in the other subgroup. Results: both scores yielded a fair strength of agreement, and CURB-65 showed a better performance in predicting in-hospital mortality. In our casuistry, age, white blood cell counts, serum urea and diastolic blood pressure were related to death. The model constructed with these variables showed a good performance in predicting in-hospital mortality; moreover, only one patient with fatal outcome was not correctly classified in the group where the model was constructed and in the group where it was validated. Conclusion: our findings suggest that a simple model that uses only 4 variables, which are easily accessible and interpretable, can identify seriously ill patients with CAP

  9. High Gastrointestinal Colonization Rate with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Emergence of Carbapenemase-Producing K. pneumoniae in Ethiopia

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    Desta, Kassu; Woldeamanuel, Yimtubezinash; Azazh, Aklilu; Mohammod, Halima; Desalegn, Dawit; Shimelis, Damte; Gulilat, Dereje; Lamisso, Biruk; Makonnen, Eyasu; Worku, Alemayehu; Mannerqvist, Kerstin; Struwe, Johan; Aspevall, Olov; Aklillu, Eleni

    2016-01-01

    We investigated the gastrointestinal colonization rate and antibiotic resistance patterns of Extended-Spectrum Beta-Lactamase (ESBL)- producing Escherichia coli and Klebsiella pneumoniae in hospitalized patients admitted at Ethiopia’s largest tertiary hospital. Fecal samples/swabs from 267 patients were cultured on chrome agar. ESBL. Bacterial species identification, verification of ESBL production and antibiotic susceptibility testing were done using Vitek 2 system (bioMérieux, France). Phenotype characterization of ESBL-E.coli and ESBL- K.pneumoniae was done using Neo-Sensitabs™. ESBL positivity rate was much higher in K. pneumoniae (76%) than E. coli (45%). The overall gastrointestinal colonization rate of ESBL producing Enterobacteriaceae (ESBL-E) in hospitalized patients was 52% (95%CI; 46%–58%) of which, ESBL-E. coli and K.pneumoniae accounted for 68% and 32% respectively. Fecal ESBL-E carriage rate in neonates, children and adults was 74%, 59% and 46% respectively. Gastrointestinal colonization rate of ESBL-E.coli in neonates, children and adults was 11%, 42% and 42% respectively. Of all E. coli strains isolated from adults, children and neonates, 44%, 49% and 22% were ESBL positive (p = 0.28). The prevalence of ESBL-K.pneumoniae carriage in neonates, children and adults was 68%, 22% and 7% respectively. All K. pneumoniae isolated from neonates (100%) and 88% of K. pneumoniae isolated from children were ESBL positive, but only 50% of K.pneumoniae isolated from adults were ESBL positive (p = 0.001). Thirteen patients (5%) were carriers of both ESBL-E.coli and ESBL-KP. The overall carrier rate of ESBL producing isolates resistant to carbapenem was 2% (5/267), all detected in children; three with E.coli HL cephalosporinase (AmpC), resistant to ertapenem and two with K. pneumoniae Carbapenemase (KPC) resistant to meropenem, ertapenem and impenem. We report a high gastrointestinal colonization rate with ESBL-E and the emergence of carbapenems-resistant K

  10. Mycoplasma Pneumoniae among Children Hospitalized with Community-acquired Pneumonia.

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    Kutty, Preeta K; Jain, Seema; Taylor, Thomas H; Bramley, Anna M; Diaz, Maureen H; Ampofo, Krow; Arnold, Sandra R; Williams, Derek J; Edwards, Kathryn M; McCullers, Jonathan A; Pavia, Andrew T; Winchell, Jonas M; Schrag, Stephanie J; Hicks, Lauri A

    2018-05-17

    The burden and epidemiology of Mycoplasma pneumoniae (Mp) among U.S. children (<18 years) hospitalized with community-acquired pneumonia (CAP) are poorly understood. In the Etiology of Pneumonia in the Community (EPIC) study, we prospectively enrolled 2254 children hospitalized with radiographically-confirmed pneumonia from January 2010-June 2012 and tested nasopharyngeal/oropharyngeal swabs for Mp using real-time polymerase chain reaction (PCR). Clinical and epidemiological features of Mp-PCR-positive and -negative children were compared using logistic regression. Macrolide susceptibility was assessed by genotyping isolates. In the EPIC study, 182(8%) children were Mp-PCR-positive (median age: 7 years); 12% required intensive care and 26% had pleural effusion. No in-hospital deaths occurred. Macrolide resistance was found in 6/169(4%) isolates. Of 178(98%) Mp-PCR-positive children tested for co-pathogens, 50(28%) had ≥1 co-pathogen detected. Variables significantly associated with higher odds of Mp detection included age {10-17 years [adjusted odds ratio (aOR): 7.9 (95% confidence interval (CI): 4.5-13.6)] and 5-9 years [aOR: 4.8 (CI: 2.9-7.8)] vs. 2-4 years}, outpatient antibiotics ≤5 days pre-admission [aOR: 2.3 (CI: 1.5-3.4)], and co-pathogen detection [aOR: 2.1 (CI: 1.3-3.1)]. Clinical characteristics often seen included hilar lymphadenopathy, rales, headache, sore throat, and decreased breath sounds. Usually considered as a mild respiratory infection, M. pneumoniae was the most commonly detected bacteria among children ≥5 years hospitalized with CAP; one-quarter of whom had co-detections. Although associated with clinically non-specific symptoms, there was a need for intensive care support in some cases. M. pneumoniae should be included in the differential diagnosis for school-aged children hospitalized with CAP.

  11. Frequency of nosocomial pneumonia in ICU Qazvin Razi hospital (2013

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    S. Makhlogi

    2016-12-01

    Full Text Available Background: Nosocomial pneumonia is the most prevalent cause of hospital-acquired infection in intensive care units (ICU. The aim of this research was to detect the frequency and predisposing factors of nosocomial Ventilator Associated Pneumonia, by cross sectional study on 188 patients that were hospitalized in ICU Qazvin Razi Hospital. Using questionnaire based on the national nosocomial infection surveillance system (NNIS data collected and analyzed. The average age of patients was 51±24 years old, 37 hospitalized patients (19/6% in the fourth day of admission were affected Ventilator Associated Pneumonia. The most common pathogenesis of causing nosocomial pneumonia were klebsiella in 13 patients (35/1%, staph in 8 patients (21/6%, sodomona in 8 patients (21/6%, ecoli in 3 patients (8/1%, cetrobacter in 2 patients (5/4%, antrococus and Proteus each of them in 1 patient (each 2/7%. Considering (19/6% frequency of nosocomial pneumonia in this study, it’s necessary to act standard protocols in nursing care and medication process.

  12. Causes of recurrent pneumonia in children in a general hospital.

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    Hoving, M F Paulien; Brand, Paul L P

    2013-03-01

    Because the few previous studies on underlying causes of recurrent pneumonia in children have come from tertiary care referral centres where selection bias may be important, the aim of this study was to examine underlying causes of recurrent pneumonia in children in a general hospital. We performed a retrospective chart review in a general hospital of 62 children with recurrent pneumonia over a 7.5 years period. In 19 patients (30.6%), no cause was identified, commonly because favourable natural history obviated the need for a full and invasive diagnostic work-up. Other underlying causes included recurrent aspiration in 16 patients (25.7%), lung disease (airway stenosis, bronchiectasis, middle lobe syndrome or tracheooesophageal fistula) in 10 patients (16.1%) and immune deficiency in 10 patients (16.1%). In contrast to previous studies, asthma was never diagnosed as an underlying cause, but diagnostic confusion between asthma (or recurrent upper respiratory tract infections) and recurrent pneumonia was common. The cause of recurrent pneumonia in children remains elusive in almost a third of patients, partly because the favourable natural history consistent with immune system maturation eliminates the need for further diagnostic procedures. Asthma is more likely a differential diagnostic consideration than an underlying cause of recurrent pneumonia in children. A standardised diagnostic guideline is needed to improve knowledge on causes of recurrent pneumonia in children. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  13. Impact of carbapenem resistance on the outcome of patients' hospital-acquired bacteraemia caused by Klebsiella pneumoniae.

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    Hussein, K; Raz-Pasteur, A; Finkelstein, R; Neuberger, A; Shachor-Meyouhas, Y; Oren, I; Kassis, I

    2013-04-01

    Carbapenem-resistant Enterobacteriaceae, especially Klebsiella spp., have become a major health problem recently worldwide. Since 2006 the incidence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections has increased substantially in Israel. Bloodstream infections (BSIs) caused by these strains have been associated with high rates of treatment failure and mortality. This study was designed to identify risk factors for carbapenem resistance among patients with healthcare-related (HCR) K. pneumoniae bacteraemia and predictors of mortality associated with HCR-CRKP bacteraemia compared with carbapenem-susceptible K. pneumoniae (CSKP). In this retrospective case-control study, all cases of K. pneumoniae bacteraemia during 2006-2008 were identified. Resistance patterns, underlying morbidities, risk factors for drug resistance and mortality rates were compared for patients with CRKP and CSKP bacteraemia. Two hundred and fourteen patients with CSKP bacteraemia were compared with 103 patients with CRKP bacteraemia. Severe, chronic comorbidities and prior antibiotic use were more frequent among patients with CRKP bacteraemia. On multivariate analysis prior use of macrolides and antibiotic exposure for ≥14 days remained the only independent factors associated with CRKP bacteraemia. Mortality rates of CRKP patients were significantly higher than those of CSKP patients. On multivariate analyses: bedridden status, chronic liver disease, Charlson comorbidity index ≥5, mechanical ventilation, and haemodialysis remained independently associated with mortality among patients with K. pneumoniae bacteraemia. Carbapenem resistance was not a risk factor for mortality. Previous antibiotic exposure is a risk factor for CRKP-BSI. Mortality among patients with K. pneumoniae bacteraemia is associated with serious comorbidities, but not with carbapenem resistance. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  14. Socioeconomic Factors Influencing Hospitalized Patients with Pneumonia Due to Influenza A(H1N1)pdm09 in Mexico

    Science.gov (United States)

    Manabe, Toshie; Higuera Iglesias, Anjarath Lorena; Vazquez Manriquez, Maria Eugenia; Martinez Valadez, Eduarda Leticia; Ramos, Leticia Alfaro; Izumi, Shinyu; Takasaki, Jin; Kudo, Koichiro

    2012-01-01

    Background In addition to clinical aspects and pathogen characteristics, people's health-related behavior and socioeconomic conditions can affect the occurrence and severity of diseases including influenza A(H1N1)pdm09. Methodology and Principal Findings A face-to-face interview survey was conducted in a hospital in Mexico City at the time of follow-up consultation for hospitalized patients with pneumonia due to influenza virus infection. In all, 302 subjects were enrolled and divided into two groups based on the period of hospitalization. Among them, 211 tested positive for influenza A(H1N1)pdm09 virus by real-time reverse-transcriptase-polymerase-chain-reaction during the pandemic period (Group-pdm) and 91 tested positive for influenza A virus in the post-pandemic period (Group-post). All subjects were treated with oseltamivir. Data on the demographic characteristics, socioeconomic status, living environment, and information relating to A(H1N1)pdm09, and related clinical data were compared between subjects in Group-pdm and those in Group-post. The ability of household income to pay for utilities, food, and health care services as well as housing quality in terms of construction materials and number of rooms revealed a significant difference: Group-post had lower socioeconomic status than Group-pdm. Group-post had lower availability of information regarding H1N1 influenza than Group-pdm. These results indicate that subjects in Group-post had difficulty receiving necessary information relating to influenza and were more likely to be impoverished than those in Group-pdm. Possible factors influencing time to seeking health care were number of household rooms, having received information on the necessity of quick access to health care, and house construction materials. Conclusions Health-care-seeking behavior, poverty level, and the distribution of information affect the occurrence and severity of pneumonia due to H1N1 virus from a socioeconomic point of view. These

  15. Socioeconomic factors influencing hospitalized patients with pneumonia due to influenza A(H1N1pdm09 in Mexico.

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    Toshie Manabe

    Full Text Available BACKGROUND: In addition to clinical aspects and pathogen characteristics, people's health-related behavior and socioeconomic conditions can affect the occurrence and severity of diseases including influenza A(H1N1pdm09. METHODOLOGY AND PRINCIPAL FINDINGS: A face-to-face interview survey was conducted in a hospital in Mexico City at the time of follow-up consultation for hospitalized patients with pneumonia due to influenza virus infection. In all, 302 subjects were enrolled and divided into two groups based on the period of hospitalization. Among them, 211 tested positive for influenza A(H1N1pdm09 virus by real-time reverse-transcriptase-polymerase-chain-reaction during the pandemic period (Group-pdm and 91 tested positive for influenza A virus in the post-pandemic period (Group-post. All subjects were treated with oseltamivir. Data on the demographic characteristics, socioeconomic status, living environment, and information relating to A(H1N1pdm09, and related clinical data were compared between subjects in Group-pdm and those in Group-post. The ability of household income to pay for utilities, food, and health care services as well as housing quality in terms of construction materials and number of rooms revealed a significant difference: Group-post had lower socioeconomic status than Group-pdm. Group-post had lower availability of information regarding H1N1 influenza than Group-pdm. These results indicate that subjects in Group-post had difficulty receiving necessary information relating to influenza and were more likely to be impoverished than those in Group-pdm. Possible factors influencing time to seeking health care were number of household rooms, having received information on the necessity of quick access to health care, and house construction materials. CONCLUSIONS: Health-care-seeking behavior, poverty level, and the distribution of information affect the occurrence and severity of pneumonia due to H1N1 virus from a socioeconomic

  16. Relationship between time to clinical response and outcomes among Pneumonia Outcomes Research Team (PORT) risk class III and IV hospitalized patients with community-acquired pneumonia who received ceftriaxone and azithromycin.

    Science.gov (United States)

    Zasowski, Evan; Butterfield, Jill M; McNutt, Louise-Ann; Cohen, Jason; Cosler, Leon; Pai, Manjunath P; Gottwald, Joseph; Chen, Wen Zhen; Lodise, Thomas P

    2014-07-01

    Recent Food and Drug Administration (FDA) guidance endorses the use of an early clinical response endpoint as the primary outcome for community-acquired bacterial pneumonia (CABP) trials. While antibiotics will now be approved for CABP, in practice they will primarily be used to treat patients with community-acquired pneumonia (CAP). More importantly, it is unclear how achievement of the new FDA CABP early response endpoint translates into clinically applicable real-world outcomes for patients with CAP. To address this, a retrospective cohort study was conducted among adult patients who received ceftriaxone and azithromycin for CAP of Pneumonia Outcomes Research Team (PORT) risk class III and IV at an academic medical center. The clinical response was defined as clinical stability for 24 h with improvement in at least one pneumonia symptom and with no symptom worsening. A classification and regression tree (CART) was used to determine the delay in response time, measured in days, associated with the greatest risk of a prolonged hospital length of stay (LOS) and adverse outcomes (in-hospital mortality or 30-day CAP-related readmission). A total of 250 patients were included. On average, patients were discharged 2 days following the achievement of a clinical response. In the CART analysis, adverse clinical outcomes were higher among day 5 nonresponders than those who responded by day 5 (22.4% versus 6.9%, P = 0.001). The findings from this study indicate that time to clinical response, as defined by the recent FDA guidance, is a reasonable prognostic indicator of real-world effectiveness outcomes among hospitalized PORT risk class III and IV patients with CAP who received ceftriaxone and azithromycin. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  17. Pneumonia caused by extensive drug-resistant Acinetobacter baumannii among hospitalized patients: genetic relationships, risk factors and mortality.

    Science.gov (United States)

    Li, Yu Jun; Pan, Chu Zhi; Fang, Chang Quan; Zhao, Zhu Xiang; Chen, Hui Ling; Guo, Peng Hao; Zhao, Zi Wen

    2017-05-30

    The clonal spread of multiple drug-resistant Acinetobacter baumannii is an emerging problem in China. We analysed the molecular epidemiology of Acinetobacter baumanni isolates at three teaching hospitals and investigated the risk factors, clinical features, and outcomes of hospital-acquired pneumonia caused by extensive drug-resistant Acinetobacter baumannii (XDRAB) infection in Guangzhou, China. Fifty-two A. baumannii isolates were collected. Multilocus sequence typing (MLST) was used to assess the genetic relationships among the isolates. The bla OXA-51-like gene was amplified using polymerase chain reaction (PCR) and sequencing. The resistance phenotypes were determined using the disc diffusion method. A retrospective case-control study was performed to determine factors associated with XDRAB pneumonia. Most of the 52 A. baumannii isolates (N = 37, 71.2%) were collected from intensive care units (ICUs). The respiratory system was the most common bodily site from which A. baumannii was recovered (N = 45, 86.5%). Disc diffusion classified the isolates into 17 multidrug-resistant (MDR) and 35 extensively drug-resistant (XDR) strains. MLST grouped the A. baumannii isolates into 5 existing sequence types (STs) and 7 new STs. ST195 and ST208 accounted for 69.2% (36/52) of the isolates. The clonal relationship analysis showed that ST195 and ST208 belonged to clonal complex (CC) 92. According to the sequence-based typing (SBT) of the bla OXA-51-like gene, 51 A. baumannii isolates carried OXA-66 and the rest carried OXA-199. There were no significant differences with respect to the resistance phenotype between the CC92 and non-CC92 strains (P = 0.767). The multivariate analysis showed that the APACHE II score, chronic obstructive pulmonary disease (COPD) and cardiac disease were independent risk factors for XDRAB pneumonia (P < 0.05). The mortality rate of XDRAB pneumonia was high (up to 42.8%), but pneumonia caused by XDRAB was not associated with in-hospital

  18. Pneumoniae in immunocompromised patients

    International Nuclear Information System (INIS)

    Jacobi, Volkmar; Lehnert, Thomas; Thalhammer, Axel

    2009-01-01

    Due to the large surface area, heat, high humidity and high oxygen supply in the lung makes an ideal environment for the propagation of germs. The purpose of the immune system is to establish and maintain the balance between saprophytes and immune defense so as to depress and ultimately kill germs as they infiltrate the body. This usually is achieved by the use of a highly complex immune system. It is a perfect combination of non-specific, cellular and humoral immune mechanisms with very specific immune cells and antibodies, which are specialized on particular pathogens. The specific defenses potentiate the effect of the nonspecific defense in a large extent so as to prevent re-infection and ultimately eliminate recognized pathogens. The causes of immune deficiency can be related to either the cellular or humoral level and affect both the specific and nonspecific defenses. There is a different excitation spectrum depending on the type of immune deficiency. Immune deficiency can prevalently cause complications in the course of infections, decelerate the healing and allow the occurrence of rare pathogens. In particular, the radiological characteristics of typical and atypical pneumonia in immunocompromised patients will be discussed. Particular emphasis is placed on the appearance of bacterial infections, mycobacterioses, PCP, CMV, and laid fungual pneumonia. Even it is not possible to identify certain pathogens radiologically, it is often possible to narrow the spectrum of germs causing pulmonary infections significantly by comparing with other pulmonary complications such as lymphoma or kaposisarcomas. (orig.)

  19. Penicillin as empirical therapy for patients hospitalised with community acquired pneumonia at a Danish hospital

    DEFF Research Database (Denmark)

    Kirk, O; Glenthøj, Jonathan Peter; Dragsted, Ulrik Bak

    2001-01-01

    and outcome parameters were collected. Three groups were established according to the initial choice of antibiotic(s): penicillin only (n = 160); non-allergic patients starting broader spectrum therapy (n = 54); and patients with suspected penicillin allergy (n = 29). RESULTS: The overall mortality within...... treated with penicillin monotherapy. No differences in clinical outcomes were documented between patients treated empirically with broad-spectrum therapy and penicillin monotherapy. Therefore, penicillin seems to be a reasonable first choice for initial therapy of HCAP in Denmark as in other regions...

  20. Hospital management of community-acquired pneumonia in Malta

    OpenAIRE

    Callus, Roberta; Micallef, Josef; Mamo, Jonathan; Montefort, Stephen

    2012-01-01

    Community-acquired pneumonia (CAP) remains a common diagnosis requiring hospital admission and a leading cause of death worldwide. No local guideline is currently available for the management of CAP. Our aim was to evaluate current practices in the management of CAP at Mater Dei Hospital, Malta. In this prospective study we looked at all adult patients admitted with CAP in winter and summer (105 consecutive days for both seasons). Data collected and analysed included: basic patient demographi...

  1. Time trends in primary-care morbidity, hospitalization and mortality due to pneumonia.

    NARCIS (Netherlands)

    Gageldonk-Lafeber, A.B. van; Bogaerts, M.A.H.; Verheij, R.; Sande, M.A.B. van der

    2009-01-01

    Most studies reporting pneumonia morbidity are restricted to hospitalized patients, although only a minority of pneumonia patients are admitted to hospital. To get a better understanding of the burden of disease in the general population, we conducted a population-based retrospective study to

  2. Prevalence of CTX-M and TEM β-lactamases in Klebsiella pneumoniae Isolates from Patients with Urinary Tract Infection, Al-Zahra Hospital, Isfahan, Iran

    Directory of Open Access Journals (Sweden)

    Nafiseh Maleki

    2018-01-01

    Full Text Available Background: Extended-spectrum β-lactamase (ESBL-producing is a significant resistant mechanism to β-lactams in Enterobacteriaceae, especially in Klebsiella pneumoniae. The main objectives of this study were to genetically characterize urinary clinical isolates of K. pneumoniae through the investigating of blaTEM, blaCTX-M and using molecular typing by Enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR method. We also determined the frequency of antibiotic resistance of K. pneumoniae strains to characterize the β-lactamases included. Materials and Methods: A cross-sectional study was carried out to evaluate 98 strains of K. pneumoniae isolated from urine culture of outpatients referred to Al-Zahra Hospital, Isfahan, Iran. Antibiotic susceptibility testing was performed using Kirby–Bauer's method. Screening of ESBLs was carried out using double-disk screening test. PCR technique was performed to detect TEM and CTX-M genes. The total DNA of each strain was tested by ERIC-PCR. Results: In 98 K. pneumoniae studied clinical isolates, 25.5% were ESBL producing and 44.9% multidrug-resistant (MDR. From 25 ESBL isolates, 23 (92% cases showed MDR phenotype. In ESBL producing isolates, 23 (92% were blaCTX-M and 19 (76% blaTEM positive. The antimicrobial drug susceptibilities of ESBL isolates indicated high resistant rates for cefotaxime and ceftazidime. All 25 ESBL producing isolates were resistant to cefotaxime. Complex patterns of fingerprints isolates showed that 36% of the isolates were belonged to the cluster no 5. Conclusion: This study revealed high antimicrobial resistance rates among ESBL isolates which can lead to various health difficulties. Epidemiological data collection from patients is recommended to develop the strategies to manage antibiotic resistance.

  3. Effects of aspiration pneumonia on the intensive care requirements and in-hospital mortality of hospitalised patients with acute cerebrovascular disease.

    Science.gov (United States)

    Güngen, Adil Can; Aydemir, Yusuf; Güngen, Belma Dogan; Yazar, Esra Ertan; Yağız, Orhan; Aras, Yeşim Güzey; Gümüş, Hatice; Erkorkmaz, Ünal

    2017-08-01

    In this study, we aimed to evaluate the effects of the development of aspiration pneumonia (AP) on the intensive care unit (ICU) requirements and in-hospital mortality of patients hospitalised in the neurology ward due to an acute cerebrovascular accident (CVA). Five hundred and three patients hospitalised in the neurology ward following an acute CVA were retrospectively analysed. The patients were divided into two groups: those with AP (group 1) and those without AP (group 2). Demographic characteristics and physical and radiological findings, including the localisation, lateralisation and aetiology of the infarction, in addition to ICU requirements and mortality, were evaluated. Aspiration pneumonia was detected in 80 (15.9%) patients during the in-hospital stay. Transfer to the ICU for any reason was required in 37.5% of the patients in group 1 and 4.7% of those in group 2 ( p < 0.001). In-hospital mortality occurred in 7.5% and 1.4% of the patients in group 1 and group 2, respectively ( p = 0.006). The incidence of AP was highest in patients with an infarction of the medial cerebral artery (MCA) ( p < 0.001). The AP was associated with older age ( p < 0.001), hypertension ( p = 0.007), echocardiography findings ( p = 0.032) and the modified Rankin Scale (mRS) score ( p < 0.001). Our findings suggest that the requirement rate for transfer to the ICU and the mortality rate appear to be significantly higher in patients with a diagnosis of AP. Precautions should be taken, starting from the first day of hospitalisation, to decrease the incidence of AP in patients with acute CVA, focusing especially on older patients and those with a severe mRS score.

  4. Molecular characterization of KPC-producing Klebsiella pneumoniae isolated from patients in a Public Hospital in Caracas, Venezuela.

    Science.gov (United States)

    Falco Restrepo, Aura Dayana; Velásquez Nieves, Mariel Alexandra; Takiff, Howard

    Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria are amongst the most important causative agents of nosocomial infections worldwide. Isolates of this bacterium have been identified in Venezuela but little is known about their local spread. The aim of this study was to perform the molecular characterization of KPC-producing strains isolated from 2012 to 2013 in a public hospital in Caracas, Venezuela. Twenty-two K. pneumoniae clinical isolates phenotypically classified as KPC producing were subjected to PCR screening for the presence of bla KPC genes and their location within transposon Tn4401. The bla KPC PCR product was sequenced to identify the KPC alleles. Genotypic analysis was performed by means of repetitive extragenic palindromic PCR (rep-PCR) and Multi Locus Sequence Typing (MLST). Finally, conjugation and electroporation assays were used to determine whether the bla KPC genes were found in plasmids. All isolates contained the bla KPC-2 variant, and 21 of the 22 were associated with the Tn4401b isoform. The strains were distributed in 8 sequence types (ST), three of which were new. Conjugation and electroporation assays indicated that 95.5% (n=21/22) of the isolates contained the bla KPC gene in plasmids. This study on circulating bacterial strains and the identification of KPC alleles may help to understand the routes of dissemination and control their spread within this hospital. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  5. Association of hypercapnia on admission with increased length of hospital stay and severity in patients admitted with community-acquired pneumonia: a prospective observational study from Pakistan.

    Science.gov (United States)

    Iqbal, Nousheen; Irfan, Muhammad; Zubairi, Ali Bin Sarwar; Awan, Safia; Khan, Javaid A

    2017-06-15

    To determine whether the presence of hypercapnia on admission in adult patients admitted to a university-based hospital in Karachi, Pakistan with community-acquired pneumonia (CAP) correlates with an increased length of hospital stay and severity compared with no hypercapnia on admission. A prospective observational study. Tertiary care hospital in Karachi, Pakistan. Patients who met the inclusion criteria were enrolled in the study. The severity of pneumonia was assessed by CURB-65 and PSI scores. An arterial blood gas analysis was obtained within 24 hours of admission. Based on arterial PaCO 2 levels, patients were divided into three groups: hypocapnic (PaCO 2 45 mm Hg) and normocapnic (PaCO 2 <35-45 mm Hg). The primary outcome was the association of hypercapnia on admission with mean length of hospital stay. Secondary outcomes were the need for mechanical ventilation, ICU admission and in-hospital mortality. A total of 295 patients of mean age 60.20±17.0 years (157 (53.22%) men) were enrolled over a 1-year period. Hypocapnia was found in 181 (61.35%) and hypercapnia in 57 (19.32%) patients. Hypercapnic patients had a longer hospital stay (mean 9.27±7.57 days), increased requirement for non-invasive mechanical ventilation (NIMV) on admission (n=45 (78.94%)) and longer mean time to clinical stability (4.39±2.0 days) compared with the other groups. Overall mortality was 41 (13.89%), but there was no statistically significant difference in mortality (p=0.35) and ICU admission (p=0.37) between the three groups. On multivariable analysis, increased length of hospital stay was associated with NIMV use, ICU admission, hypercapnia and normocapnia. Hypercapnia on admission is associated with severity of CAP, longer time to clinical stability, increased length of hospital stay and need for NIMV. It should be considered as an important criterion to label the severity of the illness and also a determinant of patients who will require a higher level of hospital

  6. Hospital-acquired Klebsiella pneumoniae infections in a paediatric ...

    African Journals Online (AJOL)

    is an important preventable cause of increased ... between July 2003 and December 2010, who developed a hospital-acquired Klebsiella pneumoniae infection, was undertaken to describe the trend in ..... Bacterial nosocomial pneumonia in.

  7. Mycoplasma pneumoniae pneumonia: CT features in 16 patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Inho; Kim, Tae Sung; Yoon, Hye-Kyung [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea)

    2006-03-15

    The objective of this study was to assess the computed tomography (CT) features of Mycoplasma pneumoniae pneumonia. We retrospectively reviewed CT findings of 16 patients (M:F=9:7, age range 1-74 years, median 9 years) with serologically proven Mycoplasma pneumoniae pneumonia and with chest CT scan available. Two distinctive patterns of CT features of M. pneumoniae pneumonia were noted between the paediatric (age <18 years) and the adult (age {>=}18 years) groups. The pediatric group (n=11) showed lobar or segmental consolidation (100%) with frequent pleural effusion (82%) and regional lymphadenopathy (82%) and mild volume decrease of the involved lobe (73%), while four of the five adult patients showed diffuse and/or multifocal, centrilobular or peribronchovascular areas of ground-glass attenuation (80%) with a lobular distribution, and frequent thickening of interlobular septa (60%) and the bronchial walls (40%) were also detected at high-resolution CT. The CT finding of a lobar or segmental consolidation with a parapneumonic effusion seen in our children with M. pneumoniae pneumonia was similar to that of bacterial lobar pneumonia. In contrast, the CT findings noted in our adult patients consisted of a mixture of a bacterial bronchopneumonia pattern and a viral interstitial pneumonia pattern. (orig.)

  8. Mycoplasma pneumoniae pneumonia: CT features in 16 patients

    International Nuclear Information System (INIS)

    Lee, Inho; Kim, Tae Sung; Yoon, Hye-Kyung

    2006-01-01

    The objective of this study was to assess the computed tomography (CT) features of Mycoplasma pneumoniae pneumonia. We retrospectively reviewed CT findings of 16 patients (M:F=9:7, age range 1-74 years, median 9 years) with serologically proven Mycoplasma pneumoniae pneumonia and with chest CT scan available. Two distinctive patterns of CT features of M. pneumoniae pneumonia were noted between the paediatric (age <18 years) and the adult (age ≥18 years) groups. The pediatric group (n=11) showed lobar or segmental consolidation (100%) with frequent pleural effusion (82%) and regional lymphadenopathy (82%) and mild volume decrease of the involved lobe (73%), while four of the five adult patients showed diffuse and/or multifocal, centrilobular or peribronchovascular areas of ground-glass attenuation (80%) with a lobular distribution, and frequent thickening of interlobular septa (60%) and the bronchial walls (40%) were also detected at high-resolution CT. The CT finding of a lobar or segmental consolidation with a parapneumonic effusion seen in our children with M. pneumoniae pneumonia was similar to that of bacterial lobar pneumonia. In contrast, the CT findings noted in our adult patients consisted of a mixture of a bacterial bronchopneumonia pattern and a viral interstitial pneumonia pattern. (orig.)

  9. The order of administration of macrolides and beta-lactams may impact the outcomes of hospitalized patients with community-acquired pneumonia: results from the community-acquired pneumonia organization.

    Science.gov (United States)

    Peyrani, Paula; Wiemken, Timothy L; Metersky, Mark L; Arnold, Forest W; Mattingly, William A; Feldman, Charles; Cavallazzi, Rodrigo; Fernandez-Botran, Rafael; Bordon, Jose; Ramirez, Julio A

    2018-01-01

    The beneficial effect of macrolides for the treatment of community-acquired pneumonia (CAP) in combination with beta-lactams may be due to their anti-inflammatory activity. In patients with pneumococcal meningitis, the use of steroids improves outcomes only if they are administered before beta-lactams. The objective of this study was to compare outcomes in hospitalized patients with CAP when macrolides were administered before, simultaneously with, or after beta-lactams. Secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study database. Study groups were defined based on the sequence of administration of macrolides and beta-lactams. The study outcomes were time to clinical stability (TCS), length of stay (LOS) and in-hospital mortality. Accelerated failure time models were used to evaluate the adjusted impact of sequential antibiotic administration and time-to-event outcomes, while a logistic regression model was used to evaluate their adjusted impact on mortality. A total of 99 patients were included in the macrolide before group and 305 in the macrolide after group. Administration of a macrolide before a beta-lactam compared to after a beta-lactam reduced TCS (3 vs. 4 days, p = .011), LOS (6 vs. 7 days, p = .002) and mortality (3 vs. 7.2%, p = .228). The administration of macrolides before beta-lactams was associated with a statistically significant decrease in TCS and LOS and a non-statistically significant decrease in mortality. The beneficial effect of macrolides in hospitalized patient with CAP may occur only if administered before beta-lactams.

  10. Evaluation of a Hospital-Based Pneumonia Nurse Navigator Program.

    Science.gov (United States)

    Seldon, Lisa E; McDonough, Kelly; Turner, Barbara; Simmons, Leigh Ann

    2016-12-01

    The aim of this study is to evaluate the effectiveness of a hospital-based pneumonia nurse navigator program. This study used a retrospective, formative evaluation. Data of patients admitted from January 2012 through December 2014 to a large community hospital with a primary or secondary diagnosis of pneumonia, excluding aspiration pneumonia, were used. Data included patient demographics, diagnoses, insurance coverage, core measures, average length of stay (ALOS), disposition, readmission rate, financial outcomes, and patient barriers to care were collected. Descriptive statistics and parametric testing were used to analyze data. Core measure performance was sustained at the 90th percentile 2 years after the implementation of the navigator program. The ALOS did not decrease to established benchmarks; however, the SD for ALOS decreased by nearly half after implementation of the navigator program, suggesting the program decreased the number and length of extended stays. Charges per case decreased by 21% from 2012 to 2014. Variable costs decreased by 4% over a 2-year period, which increased net profit per case by 5%. Average readmission payments increased by 8% from 2012 to 2014, and the net revenue per case increased by 8.3%. The pneumonia nurse navigator program may improve core measures, reduce ALOS, and increase net revenue. Future evaluations are necessary to substantiate these findings and optimize the cost and quality performance of navigator programs.

  11. Pneumonia

    OpenAIRE

    Coelho, Liana Sousa [UNESP; Tanni, Suzana Erico; Godoy, Irma de [UNESP

    2009-01-01

    Pneumonia is an infectious disease with great morbidity and mortality worldwide. According to the current guidelines recommendations the authors reviewed the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). In this paper will be presented data about etiology, clinics and diagnostic tools. © Copyright Moreira Jr. Editora.

  12. Neutrophil-to-lymphocyte ratio in predicting prognosis and course of community community-acquired pneumonia in hospitalized patients.

    Directory of Open Access Journals (Sweden)

    T. O. Pertseva

    2018-04-01

    Full Text Available Currently, a marker which could be used both to assess the severity of community acquired pneumonia (CAP and determine the risk of complications is being searched. According to some authors, Neutrophil-to-Lymphocyte Ratio (NLR could be such a marker. Therefore, the aim of our research was to determine the diagnostic significance of NLR in patients with CAP and to establish the relationship of NLR with other clinical and laboratory parameters. We conducted a retrospective analysis of 171 case histories of patients with CAP of 3 and 4 clinical groups, with the calculation of NLR (according to the common blood count. In the course of the work, it was found that NLR reflects a balance between the response of neutrophils and lymphocytes and this parameter is associated with the severity of systemic inflammation in patients with CAP. NLR has good diagnostic value in determining the mortality risk in patients with CAP, specially an increase in the level of NLR (more than 10 is associated with a high risk of life-threatening complications.

  13. Bronchiolitis obliterans organizing pneumonia: experience at three hospitals in Riyadh

    International Nuclear Information System (INIS)

    Alsaghir, Abdullah H.; Al-Mobeireek, Abdulla F.; Al-Jahdali, H.; Al-Etihan, A.; Al-Otair, H.; Al-Dayel, F.

    2007-01-01

    Because reports of bronchiolitis obliterans organizing pneumonia (BOOP) are lacking from the Middle East, we conducted a retrospective review of all histopathologically proven cases of BOOP over 10-year period at three tertiary care hospitals in Riyadh and describe the clinical features and outcome. Charts at the three hospitals were searched using a specific code for BOOP or cryptogenic organizing pneumonia (COP). Lung specimens have to show histological proof of BOOP with a compatible clinical picture. Chest radiographs and high resolution CT scans were reviewed. Twenty cases of biopsy-proven BOOP had well documented clinical and radiograph data. There were 11 males and 9 females (mean age 58 years; range 42-78). The clinical presentation f BOOP was acute or subacute pneumonia-like illness with cough (85%), fever (70%) dyspnea, (85%) and crackles (80%). The most frequent radiological pattern was a bilateral alveolar infiltrate. The most common abnormality on pulmonary function testing (n=14) was a restrictive pattern (11 patients). Most patients (70%) had no underlying cause (idiopathic BOOP). Other associations included thyroid cancer, rheumatoid arthritis, syphilis and Wegner's granulomatosis. Ten patients (50%) had a complete response to steroids, 6 (30%) had a partial response and 3 (15.8) with secondary BOOP had rapid progressive respiratory failure and died. The clinical presentation of BOOP in our patients is similar to other reported series. A favorable outcome occurs in the majority of cases. However, BOOP may occasionally be associated with a poor prognosis, particularly when associated with an underlying disease. (author)

  14. Effect of Prior Atorvastatin Treatment on the Frequency of Hospital Acquired Pneumonia and Evolution of Biomarkers in Patients with Acute Ischemic Stroke: A Multicenter Prospective Study

    Directory of Open Access Journals (Sweden)

    Yuetian Yu

    2017-01-01

    Full Text Available Objective. To investigate whether prior treatment of atorvastatin reduces the frequency of hospital acquired pneumonia (HAP. Methods. Totally, 492 patients with acute ischemic stroke and Glasgow Coma Scale ≤ 8 were enrolled in this study. Subjects were assigned to prior atorvastatin treatment group (n=268, PG and no prior treatment group (n=224, NG. All the patients were given 20 mg atorvastatin every night during their hospital stay. HAP frequency and 28-day mortality were measured. Levels of inflammatory biomarkers [white blood cell (WBC, procalcitonin (PCT, tumor necrosis factor-alpha (TNF-α, and interleukin-6 (IL-6] were tested. Results. There was no significant difference in the incidence of HAP between PG and NG (25.74% versus. 24.55%, p>0.05 and 28-day mortality (50.72% versus 58.18%, p>0.05. However, prior statin treatment did modify the mortality of ventilator associated pneumonia (VAP (36.54% versus 58.14%, p=0.041 and proved to be a protective factor (HR, 0.564; 95% CI, 0.310~0.825, p=0.038. Concentrations of TNF-α and IL-6 in PG VAP cases were lower than those in NG VAP cases (p<0.01. Conclusions. Prior atorvastatin treatment in patients with ischemic stroke was associated with a lower concentration of IL-6 and TNF-α and improved the outcome of VAP. This clinical study has been registered with ChiCTR-ROC-17010633 in Chinese Clinical Trial Registry.

  15. Community acquired pneumonia in the elderly: the Pneumonia in Italian Acute Care for Elderly units (PIACE study protocol by the Italian Society of Hospital and Community Geriatrics (SIGOT

    Directory of Open Access Journals (Sweden)

    Filippo Luca Fimognari

    2017-01-01

    Full Text Available Pneumonia is a frequent cause of hospital admission in elderly patients. Diagnosis of pneumonia in elderly persons with comorbidity may be challenging, due to atypical presentation and complex clinical scenarios. Community-acquired pneumonia (CAP arises out-of-hospital in subjects without previous contact with the healthcare system. Healthcare associated pneumonia (HCAP occurs in patients who have frequent contacts with the healthcare system and should be treated with empiric broad spectrum antibiotic therapy also covering multi-drug resistant (MDR pathogens. Recent findings, however, have questioned this approach, because the worse prognosis of HCAP compared to CAP may better reflect increased level of comorbidity and frailty (poor functional status, older age of HCAP patients, as well as poorer quality of hospital care provided to such patients, rather than pneumonia etiology by MDR pathogens. The Pneumonia in Italian Acute Care for Elderly units (PIACE Study, promoted by the Società Italiana di Geriatria Ospedale e Territorio (SIGOT, is an observational prospective cohort study of patients consecutively admitted because of pneumonia to hospital acute care units of Geriatrics throughout Italy. Detailed information regarding clinical presentation, diagnosis, etiology, comprehensive geriatric assessment, antibiotic therapy, possible complications and comorbidities was recorded to identify factors potentially predicting in-hospital mortality (primary endpoint, 3-month mortality, length of hospital stay, postdischarge rate of institutionalization and other secondary endpoints. This paper describes the rationale and method of PIACE Study and reviews the main evidence on pneumonia in the elderly.

  16. Predictors of viral pneumonia in patients with community-acquired pneumonia.

    Directory of Open Access Journals (Sweden)

    Ji Eun Kim

    Full Text Available BACKGROUND: Viruses are increasingly recognized as major causes of community-acquired pneumonia (CAP. Few studies have investigated the clinical predictors of viral pneumonia, and the results have been inconsistent. In this study, the clinical predictors of viral pneumonia were investigated in terms of their utility as indicators for viral pneumonia in patients with CAP. METHODS: Adult patients (≥ 18 years old with CAP, tested by polymerase chain reaction (PCR for respiratory virus, at two teaching hospitals between October 2010 and May 2013, were identified retrospectively. Demographic and clinical data were collected by reviewing the hospital electronic medical records. RESULTS: During the study period, 456 patients with CAP were identified who met the definition, and 327 (72% patients were tested using the respiratory virus PCR detection test. Viral pneumonia (n = 60 was associated with rhinorrhea, a higher lymphocyte fraction in the white blood cells, lower serum creatinine and ground-glass opacity (GGO in radiology results, compared to non-viral pneumonia (n = 250 (p < 0.05, each. In a multivariate analysis, rhinorrhea (Odd ratio (OR 3.52; 95% Confidence interval (CI, 1.58-7.87 and GGO (OR 4.68; 95% CI, 2.48-8.89 were revealed as independent risk factors for viral pneumonia in patients with CAP. The sensitivity, specificity, positive- and negative-predictive values (PPV and NPV of rhinorrhea were 22, 91, 36 and 83%: the sensitivity, specificity, PPV and NPV of GGO were and 43, 84, 40 and 86%, respectively. CONCLUSION: Symptom of rhinorrhea and GGO predicted viral pneumonia in patients with CAP. The high specificity of rhinorrhea and GGO suggested that these could be useful indicators for empirical antiviral therapy.

  17. A 12 year (1998-2009) antibiotic resistance surveillance of Klebsiella pneumoniae collected from intensive care and urology patients in 14 Dutch hospitals.

    NARCIS (Netherlands)

    Donk, C.F. van der; Beisser, P.S.; Hoogkamp-Korstanje, J.A.A.; Bruggeman, C.A.; Stobberingh, E.E.; Waar, K.; Vogels, W.H.; Bloembergen, P.; Beunders, A.J.; Rietra, P.; Hendrix, M.G.; Bijlmer, H.A.; Jongh, B.M. de; Hendriks, W.D.; Sturm, P.D.J.; Buiting, A.G.M.; Sabbe, L.J.; Trienekens, T.A.; Dessel, H. van

    2011-01-01

    OBJECTIVES: We evaluated the changes in antibiotic resistance from 1998 to 2009 of Klebsiella pneumoniae isolated from the intensive care units (ICUs) and urology services of 14 Dutch hospitals and the consequences for empirical therapy. METHODS: Quantitative antibiotic susceptibility testing of K.

  18. Prediction of pneumonia hospitalization in adults using health checkup data.

    Science.gov (United States)

    Uematsu, Hironori; Yamashita, Kazuto; Kunisawa, Susumu; Otsubo, Tetsuya; Imanaka, Yuichi

    2017-01-01

    Community-acquired pneumonia is a common cause of hospitalization, and pneumococcal vaccinations are recommended for high-risk individuals. Although risk factors for pneumonia have been identified, there are currently no pneumonia hospitalization prediction models based on the risk profiles of healthy subjects. This study aimed to develop a predictive model for pneumonia hospitalization in adults to accurately identify high-risk individuals to facilitate the efficient prevention of pneumonia. We conducted a retrospective database analysis using health checkup data and health insurance claims data for residents of Kyoto prefecture, Japan, between April 2010 and March 2015. We chose adults who had undergone health checkups in the first year of the study period, and tracked pneumonia hospitalizations over the next 5 years. Subjects were randomly divided into training and test sets. The outcome measure was pneumonia hospitalization, and candidate predictors were obtained from the health checkup data. The prediction model was developed and internally validated using a LASSO logistic regression analysis. Lastly, we compared the new model with comparative models. The study sample comprised 54,907 people who had undergone health checkups. Among these, 921 were hospitalized for pneumonia during the study period. The c-statistic for the prediction model in the test set was 0.71 (95% confidence interval: 0.69-0.73). In contrast, a comparative model with only age and comorbidities as predictors had a lower c-statistic of 0.55 (95% confidence interval: 0.54-0.56). Our predictive model for pneumonia hospitalization performed better than comparative models, and may be useful for supporting the development of pneumonia prevention measures.

  19. Survey of Legionella pneumophila among pneumonia patients at ...

    African Journals Online (AJOL)

    Objective: To determine the occurrence of L. pneumophila among pneumonia patients at Kenyatta National Hospital and any association with possible risk factors. Design: A cross- sectional descriptive study. Setting: The study was conducted from March to June 2007, at the medical ward of Kenyatta National Hospital.

  20. Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia.

    Science.gov (United States)

    Han, Xiudi; Zhou, Fei; Li, Hui; Xing, Xiqian; Chen, Liang; Wang, Yimin; Zhang, Chunxiao; Liu, Xuedong; Suo, Lijun; Wang, Jinxiang; Yu, Guohua; Wang, Guangqiang; Yao, Xuexin; Yu, Hongxia; Wang, Lei; Liu, Meng; Xue, Chunxue; Liu, Bo; Zhu, Xiaoli; Li, Yanli; Xiao, Ying; Cui, Xiaojing; Li, Lijuan; Purdy, Jay E; Cao, Bin

    2018-04-24

    Limited information exists on the clinical characteristics predictive of mortality in patients aged ≥65 years in many countries. The impact of adherence to current antimicrobial guidelines on the mortality of hospitalized elderly patients with community-acquired pneumonia (CAP) has never been assessed. A total of 3131 patients aged ≥65 years were enrolled from a multi-center, retrospective, observational study initiated by the CAP-China network. Risk factors for death were screened with multivariable logistic regression analysis, with emphasis on the evaluation of age, comorbidities and antimicrobial treatment regimen with regard to the current Chinese CAP guidelines. The mean age of the study population was 77.4 ± 7.4 years. Overall in-hospital and 60-day mortality were 5.7% and 7.6%, respectively; these rates were three-fold higher in those aged ≥85 years than in the 65-74 group (11.9% versus 3.2% for in-hospital mortality and 14.1% versus 4.7% for 60-day mortality, respectively). The mortality was significantly higher among patients with comorbidities compared with those who were otherwise healthy. According to the 2016 Chinese CAP guidelines, 62.1% of patients (1907/3073) received non-adherent treatment. For general-ward patients without risk factors for Pseudomonas aeruginosa (PA) infection (n = 2258), 52.3% (1094/2090) were over-treated, characterized by monotherapy with an anti-pseudomonal β-lactam or combination with fluoroquinolone + β-lactam; while 71.4% of intensive care unit (ICU) patients (120/168) were undertreated, without coverage of atypical bacteria. Among patients with risk factors for PA infection (n = 815), 22.9% (165/722) of those in the general ward and 74.2% of those in the ICU (69/93) were undertreated, using regimens without anti-pseudomonal activity. The independent predictors of 60-day mortality were age, long-term bedridden status, congestive heart failure, CURB-65, glucose, heart rate, arterial oxygen

  1. Determinants for hospitalization in " low-risk" community acquired pneumonia

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    Aliyu Muktar H

    2003-06-01

    Full Text Available Abstract Background A variable decision in managing community acquired pneumonia (CAP is the initial site of care; in-patient versus outpatient. These variations persist despite comprehensive practice guidelines. Patients with a Pneumonia Severity Index (PSI score lower than seventy have low risk for complications and outpatient antibiotic management is recommended in this group. These patients are generally below the age of fifty years, non-nursing home residents, HIV negative and have no major cardiac, hepatic, renal or malignant diseases. Methods A retrospective analysis of 296 low-risk CAP patients evaluated within a year one period at St. Agnes Hospital, Baltimore, Maryland was undertaken. All patients were assigned a PSI score. 208 (70% were evaluated and discharged from the emergency department (E.D. to complete outpatient antibiotic therapy, while 88 (30% were hospitalized. Patients were sub-stratified into classes I-V according to PSI. A comparison of demographic, clinical, social and financial parameters was made between the E.D. discharged and hospitalized groups. Results Statistically significant differences in favor of the hospitalized group were noted for female gender (CI: 1.46-5.89, p= 0.0018, African Americans (CI: 0.31-0.73, p= 0.004, insurance coverage (CI: 0.19-0.63, p= 0.0034, temperature (CI: 0.04-0.09, p= 0.0001 and pulse rate (CI: 0.03-0.14, p= 0.0001. No statistically significant differences were observed between the two groups for altered mental status, hypotension, tachypnea, laboratory/radiological parameters and social indicators (p>0.05. The average length of stay for in-patients was 3.5 days at about eight time's higher cost than outpatient management. There was no difference in mortality or treatment failures between the two groups. The documentation rate and justifications for hospitalizing low risk CAP patients by admitting physicians was less than optimal. Conclusions High fever, tachycardia, female gender

  2. Prevalência e prognóstico dos pacientes com pneumonia associada à ventilação mecânica em um hospital universitário Prevalence of ventilator-associated pneumonia in a university hospital and prognosis for the patients affected

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    Márcio Martins de Queiroz Guimarães

    2006-08-01

    Full Text Available OBJETIVO: Determinar prevalência de pneumonia associada à ventilação mecânica em unidade de terapia intensiva, fatores associados e evolução. MÉTODOS: Foram avaliados 278 pacientes sob ventilação mecânica por mais de 24 horas prospectivamente em hospital universitário. RESULTADOS: Desenvolveram a doença 38,1% dos pacientes, 35,7 casos/1.000 dias de ventilação mecânica: 45,3% por bacilos gram negativos, Pseudomonas aeruginosa (22% o mais comum e 43,4% por germes multi-resistentes. O grupo com pneumonia associada à ventilação mecânica teve maiores tempos de ventilação mecânica, desmame, permanência no hospital e na unidade de terapia intensiva (p 10 dias (7,7; 4,1 - 14,2, imunodepressão (4,3; 1,3 - 14,3, síndrome do desconforto respiratório agudo (3,5; 1,4 - 9,0, atelectasia (3,0; 1,2 - 7,3, parada cardiorrespiratória (0,18; 0,05 - 0,66 e hemorragia digestiva alta (0,07; 0,009 - 0,62]. Fatores associados ao óbito hospitalar: insuficiência renal crônica (26,1; 1,9 - 350,7, admissão prévia na unidade de terapia intensiva (15,6; 1,6 - 152,0, simplified acute physiologic score II > 50 pontos (11,9; 3,4 - 42,0 e idade > 55 anos (4,4; 1,6 - 12,3. CONCLUSÃO: A pneumonia associada à ventilação mecânica aumentou tempos de ventilação mecânica, permanência na unidade de terapia intensiva e no hospital, número de complicações, mas não a letalidade.OBJECTIVE: To determine the prevalence of ventilator-associated pneumonia in an intensive care unit, as well as to identify related factors and characterize patient evolution. METHODS: This study evaluated 278 patients on mechanical ventilation for more than 24 hours in a university hospital. RESULTS: Ventilator-associated pneumonia developed in 38.1% of the patients, translating to 35.7 cases/1000 ventilator-days: 45.3% were caused by gram-negative agents (Pseudomonas aeruginosa accounting for 22%; and multidrug resistant organisms were identified in 43.4%. In the

  3. Does marriage protect against hospitalization with pneumonia? A population-based case-control study

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    Mor A

    2013-10-01

    Full Text Available Anil Mor, Sinna P Ulrichsen, Elisabeth Svensson, Klara Berencsi, Reimar W Thomsen Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark Background: To reduce the increasing burden of pneumonia hospitalizations, we need to understand their determinants. Being married may decrease the risk of severe infections, due to better social support and healthier lifestyle. Patients and methods: In this population-based case-control study, we identified all adult patients with a first-time pneumonia-related hospitalization between 1994 and 2008 in Northern Denmark. For each case, ten sex- and age-matched population controls were selected from Denmark's Civil Registration System. We performed conditional logistic regression analysis to estimate the odds ratios (ORs for pneumonia hospitalization among persons who were divorced, widowed, or never married, as compared with married persons, adjusting for age, sex, 19 different comorbidities, alcoholism-related conditions, immunosuppressant use, urbanization, and living with small children. Results: The study included 67,162 patients with a pneumonia-related hospitalization and 671,620 matched population controls. Compared with controls, the pneumonia patients were more likely to be divorced (10% versus 7% or never married (13% versus 11%. Divorced and never-married patients were much more likely to have previous diagnoses of alcoholism-related conditions (18% and 11%, respectively compared with married (3% and widowed (6% patients. The adjusted OR for pneumonia-related hospitalization was increased, at 1.29 (95% confidence interval [CI]: 1.25-1.33 among divorced; 1.15 (95% CI: 1.12-1.17 among widowed; and 1.33 (95% CI: 1.29-1.37 among never-married individuals as compared with those who were married. Conclusion: Married individuals have a decreased risk of being hospitalized with pneumonia compared with never-married, divorced, and widowed patients

  4. Evaluating the Frequency of aac(6')-IIa, ant(2″)-I, intl1, and intl2 Genes in Aminoglycosides Resistant Klebsiella pneumoniae Isolates Obtained from Hospitalized Patients in Yazd, Iran.

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    Mokhtari, Hesam; Eslami, Gilda; Zandi, Hengameh; Dehghan-Banadkouki, Amin; Vakili, Mahmood

    2018-01-01

    Klebsiella pneumoniae (K. pneumoniae) is an opportunistic pathogen that could be resistant to many antimicrobial agents. Resistance genes can be carried among gram-negative bacteria by integrons. Enzymatic inactivation is the most important mechanism of resistance to aminoglycosides. In this study, the frequencies of two important resistance gene aac(6')-II a and ant(2″)-I, and genes coding integrase I and II, in K. pneumoniae isolates resistant to aminoglycosides were evaluated. In this cross-sectional study, an attempt was made to assess the antibiotic susceptibility of 130 K. pneumoniae isolates obtained from different samples of patients hospitalized in training hospitals of Yazd evaluated by disk diffusion method. The frequencies of aac(6')-II a, ant(2″)-I, intl1 , and intl2 genes were determined by PCR method. Data were analyzed by chi-square method using SPSS software (Ver. 16). our results showed that resistance to gentamicin, tobramycin, kanamycin, and amikacin were 34.6, 33.8, 43.8, and 14.6%, respectively. The frequencies of aac (6')-II a, ant(2″)-I, intl1 , and intl2 genes were 44.6, 27.7, 90, and 0%, respectively. This study showed there are high frequencies of genes coding aminoglycosides resistance in K. pneumoniae isolates. Hence, it is very important to monitor and inhibit the spread of antibiotic resistance genes.

  5. Radiological compromise and their relationship with the clinical course in the patients with pneumonia acquired in the community assisted in the Hospital San Juan de Dios de Bogota

    International Nuclear Information System (INIS)

    Marin, Jorge H; Saavedra, Carlos; Carrillo B, Jorge; Perez, Maria T

    1998-01-01

    In order to establish the relationship between the initial radiographic findings of patients with community - acquired pneumonia and their clinical course, a prospective study of 204 patients with this diagnosis was performed we found a statistically significant relationship between radiographic findings and the development of complications or death

  6. Aspiration pneumonia in patients with cleft palate

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    Lee, Seung Hun; Choi, Yo Won; Jeon, Seok Chol; Park, Choong Ki; Uhm, Ki Il [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2003-03-01

    To assess the incidence of aspiration pneumonia in infants with cleft palate and to compare the incidence between complete and incomplete types of cleft palate. A review of medical records revealed 100 infants who had undergone initial surgery to repair cleft palate in our hospital during a recent three-year period. Aspiration pneumonia was defined as the coexistence of pneumonia at chest radiography with a history of frequent choking during feeding. The anatomic distribution of aspiration pneumonia was analyzed, and the incidences of aspiration pneumonia in infants with complete and incomplete cleft palate were compared. Among 100 children, aspiration pneumonia was found in 35 (35%). Those with complete and incomplete cleft palate showed similar incidences of the condition (27 of 70 [39%] vs 8 of 30 [27%], p=0.36). Pneumonia was most commonly seen in the left lower lobe (11 of 35), followed by the right upper and lower lobes. Aspiration pneumonia is frequently associated with infants with cleft palate. There is no statistical difference in the incidence of aspiration pneumonia between the complete and the incomplete cleft palate group.

  7. Aspiration pneumonia in patients with cleft palate

    International Nuclear Information System (INIS)

    Lee, Seung Hun; Choi, Yo Won; Jeon, Seok Chol; Park, Choong Ki; Uhm, Ki Il

    2003-01-01

    To assess the incidence of aspiration pneumonia in infants with cleft palate and to compare the incidence between complete and incomplete types of cleft palate. A review of medical records revealed 100 infants who had undergone initial surgery to repair cleft palate in our hospital during a recent three-year period. Aspiration pneumonia was defined as the coexistence of pneumonia at chest radiography with a history of frequent choking during feeding. The anatomic distribution of aspiration pneumonia was analyzed, and the incidences of aspiration pneumonia in infants with complete and incomplete cleft palate were compared. Among 100 children, aspiration pneumonia was found in 35 (35%). Those with complete and incomplete cleft palate showed similar incidences of the condition (27 of 70 [39%] vs 8 of 30 [27%], p=0.36). Pneumonia was most commonly seen in the left lower lobe (11 of 35), followed by the right upper and lower lobes. Aspiration pneumonia is frequently associated with infants with cleft palate. There is no statistical difference in the incidence of aspiration pneumonia between the complete and the incomplete cleft palate group

  8. Should the patients colonized with extended-spectrum beta-lactamase-producing Gram-negative bacilli (E-GNB) coming to hospital from the community with pneumonia get anti-E-GNB active empirical treatment?

    Science.gov (United States)

    Peterlin, Lara; Žagar, Mateja; Lejko Zupanc, Tatjana; Paladin, Marija; Beović, Bojana

    2017-10-01

    Extended-spectrum beta-lactamases are responsible for resistance of Gram-negative bacilli to several beta-lactam antibiotics, including those prescribed for treatment pneumonia. To evaluate the importance of colonization with E-GNB for the choice of empirical treatment we performed a retrospective case-control study including 156 patients, hospitalized for treatment of pneumonia from 2009 through 2013. Empirical treatment success and in-hospital survival were significantly lower in patients colonized with E-GNB compared to non-colonized (p = 0.002, p = 0.035). When comparing subgroups of colonized patients, treatment success was significantly lower in patients who were colonized with E-GNB resistant to empirical antibiotic (p = 0.010), but not in those colonized by E-GNB susceptible to empirically given antibiotic (p = 0.104). Difference in in-hospital mortality was insignificant in both subgroups (p = 0.056, p = 0.331). The results of study suggest that an anti-E-GNB active antibiotic should be used for empirical treatment of pneumonia in E-GNB colonized patients.

  9. An Update on the Management Of Hospital-Acquired Pneumonia in the Elderly

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    Chao-Hsien Lee

    2008-12-01

    Full Text Available Pneumonia is the leading cause of infection-related death and represents the fifth cause of mortality in the elderly. There are several reported risk factors for acquiring pneumonia at an older age, such as alcoholism, lung and heart diseases, nursing home residence, and swallowing disorders. Hospital-acquired pneumonia (HAP is reviewed, with an emphasis on multidrug-resistant (MDR bacterial pathogens, such as Pseudomonas aeruginosa, Acinetobacter species, and methicillin-resistant Staphylococcus aureus. The clinical characteristics of pneumonia in the elderly differ substantially compared with younger patients, and the severity of the disease is strongly associated with increased age and age-related comorbid disorders. Streptococcus pneumoniae is the pathogen most frequently responsible for pneumonia in the elderly with early HAP without risk factors for MDR; enteric Gram-negative rods should be considered in nursing home-associated pneumonia, as well as anaerobes in patients with aspiration pneumonia. Special attention should be given to preventive measures such as vaccination, oral care, and nutrition. The management of HAP should be instituted early with: appropriate use of antibiotics in adequate doses; avoidance of excessive use of antibiotics by de-escalation of initial antibiotic therapy, based on microbiologic cultures and the clinical response of the patient; and reduction of the duration of treatment to the minimum effective period.

  10. Basic nursing care to prevent nonventilator hospital-acquired pneumonia.

    Science.gov (United States)

    Quinn, Barbara; Baker, Dian L; Cohen, Shannon; Stewart, Jennifer L; Lima, Christine A; Parise, Carol

    2014-01-01

    Nonventilator hospital-acquired pneumonia (NV-HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of our study was to (a) identify the incidence of NV-HAP in a convenience sample of U.S. hospitals and (b) determine the effectiveness of reliably delivered basic oral nursing care in reducing NV-HAP. A descriptive, quasi-experimental study using retrospective comparative outcomes to determine (a) the incidence of NV-HAP and (b) the effectiveness of enhanced basic oral nursing care versus usual care to prevent NV-HAP after introduction of a basic oral nursing care initiative. We used the International Statistical Classification of Diseases and Related Problems (ICD-9) codes for pneumonia not present on admission and verified NV-HAP diagnosis using the U.S. Centers for Disease Control and Prevention diagnostic criteria. We completed an evidence-based gap analysis and designed a site-specific oral care initiative designed to reduce NV-HAP. The intervention process was guided by the Influencer Model (see Figure) and participatory action research. We found a substantial amount of unreported NV-HAP. After we initiated our oral care protocols, the rate of NV-HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%). The overall number of cases of NV-HAP was reduced by 37% during the 12-month intervention period. The avoidance of NV-HAP cases resulted in an estimated 8 lives saved, $1.72 million cost avoided, and 500 extra hospital days averted. The extra cost for therapeutic oral care equipment was $117,600 during the 12-month intervention period. Cost savings resulting from avoided NV-HAP was $1.72 million. Return on investment for the organization was $1.6 million in avoided costs. NV-HAP should be elevated to the same level of concern, attention, and effort as prevention of ventilator-associated pneumonia in hospitals. Nursing needs to lead the way in the design and

  11. Statin Use and Hospital Length of Stay Among Adults Hospitalized With Community-acquired Pneumonia.

    Science.gov (United States)

    Havers, Fiona; Bramley, Anna M; Finelli, Lyn; Reed, Carrie; Self, Wesley H; Trabue, Christopher; Fakhran, Sherene; Balk, Robert; Courtney, D Mark; Girard, Timothy D; Anderson, Evan J; Grijalva, Carlos G; Edwards, Kathryn M; Wunderink, Richard G; Jain, Seema

    2016-06-15

    Prior retrospective studies suggest that statins may benefit patients with community-acquired pneumonia (CAP) due to antiinflammatory and immunomodulatory effects. However, prospective studies of the impact of statins on CAP outcomes are needed. We determined whether statin use was associated with improved outcomes in adults hospitalized with CAP. Adults aged ≥18 years hospitalized with CAP were prospectively enrolled at 3 hospitals in Chicago, Illinois, and 2 hospitals in Nashville, Tennessee, from January 2010-June 2012. Adults receiving statins before and throughout hospitalization (statin users) were compared with those who did not receive statins (nonusers). Proportional subdistribution hazards models were used to examine the association between statin use and hospital length of stay (LOS). In-hospital mortality was a secondary outcome. We also compared groups matched on propensity score. Of 2016 adults enrolled, 483 (24%) were statin users; 1533 (76%) were nonusers. Statin users were significantly older, had more comorbidities, had more years of education, and were more likely to have health insurance than nonusers. Multivariable regression demonstrated that statin users and nonusers had similar LOS (adjusted hazard ratio [HR], 0.99; 95% confidence interval [CI], .88-1.12), as did those in the propensity-matched groups (HR, 1.03; 95% CI, .88-1.21). No significant associations were found between statin use and LOS or in-hospital mortality, even when stratified by pneumonia severity. In a large prospective study of adults hospitalized with CAP, we found no evidence to suggest that statin use before and during hospitalization improved LOS or in-hospital mortality. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  12. Health related quality of life in patients with community-acquired pneumococcal pneumonia in France

    OpenAIRE

    Andrade, Luiz Flavio; Saba, Grèce; Ricard, Jean-Damien; Messika, Jonathan; Gaillat, Jacques; Bonnin, Pierre; Chidiac, Christian; Illes, Hajnal-Gabriela; Laurichesse, Henri; Detournay, Bruno; Petitpretz, Patrick; de Pouvourville, Gérard

    2018-01-01

    Background Community Acquired Pneumococcal Pneumonia is a lung infection that causes serious health problems and can lead to complications and death. The aim of this study was to observe and analyze health related quality of life after a hospital episode for patients with community acquired pneumococcal pneumonia in France. Methods A total of 524 individuals were enrolled prospectively in the study and were followed for 12 months after hospital discharge. Presence of streptococcus pneumoniae ...

  13. [Antibiotic therapy of hospital-acquired pneumonia and its pharmacoeconomics].

    Science.gov (United States)

    Kolář, Milan; Htoutou Sedláková, Miroslava; Urbánek, Karel; Uvízl, Radomír; Adamus, Milan; Imwensi, O P

    2016-03-01

    Important hospital-acquired infections include pneumonia, mainly because of the increasing resistance of bacterial pathogens to antimicrobials and the associated potential failure of antibiotic therapy. The present study aimed at determining the most frequent etiological agents of hospital-acquired pneumonia (HAP) and assessing the relationship between 30-day mortality and adequacy of antibiotic therapy. Based on the obtained information, optimal patterns of antibiotic therapy were to be defined, including a pharmacoeconomic perspective. In patients with clinically confirmed HAP, bacterial etiological agents were identified, their susceptibility to antimicrobials was determined and statistical methods were used to assess the relationship between adequacy of antibiotic therapy and 30-day mortality. The study comprised 68 patients with clinically confirmed HAP. The most common etiological agents were strains of Pseudomonas aeruginosa (30.8 %), Klebsiella pneumoniae (23.1 %) and Burkholderia cepacia complex (15.4 %). Gram-negative bacteria accounted for 86.5 % of all bacterial pathogens. The overall mortality reached 42.5 %. In the subgroup of patients with inadequate antibiotic therapy, 30-day mortality was significantly higher (83.3 %) than in the subgroup with adequate therapy (30.0 %; p = 0.002). The risk for 30-day mortality was 2.78 times higher in case of inadequate antibiotic therapy (95%CI: 1.52-5.07). The proportion of Pseudomonas aeruginosa strains was significantly higher in the subgroup of patients with inadequate antibiotic therapy than in those with adequate therapy (67 % vs. 27 %; p = 0.032). Results of the present study suggest a significant relationship between mortality of patients with HAP and ineffective antibiotic therapy due to resistance of the bacterial pathogen. Thus, it is clear that initial antibiotic therapy must be based on qualified assumption of sufficient activity against the most common bacterial pathogens and results of surveillance

  14. Diversity of genotypes in CTX-M-producing Klebsiella pneumoniae isolated in different hospitals in Brazil

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    Thiago Pavoni Gomes Chagas

    Full Text Available OBJECTIVE: The present study was undertaken to characterize CTX-M ESBL-producing Klebsiella pneumoniae collected from hospitals in different cities of Brazil. MATERIAL AND METHODS: Eighty-five K. pneumoniae strains isolated from hospitalized patients in six different hospitals of three cities of Brazil were analyzed. ESBL production was confirmed by the standard double-disk synergy test and the Etest®. The MIC50 and MIC90 for ESBL-producing isolates were determined by the Etest® method. The antimicrobial susceptibilities of bacterial isolates were determined using the agar diffusion method according to the CLSI. Screening for blaTEM, blaSHV, blaCTX-M genes and class 1 integron was performed by PCR amplification. To determine the genomic diversity of CTX-M-producers, isolates were analyzed by macrorestriction profile analysis following PFGE. RESULTS AND DISCUSSION: Seventy-one K. pneumoniae isolates were ESBL-producing. PCR and sequencing experiments detected 38 CTX-M-producing K. pneumoniae belonged to groups CTX-M 1, CTX-M 2, CTX-M 8 and CTX-M 9. The association of different types ESBL (CTX-M, SHV and TEM was frequent. All K. pneumoniae isolates carried class 1 integron. PFGE analysis revealed thirty-one clonal types among CTX-M-producing isolates. The data presented herein illustrate the diversity of genotypes of CTX-M producing K. pneumoniae among Brazilians hospitals.

  15. Risk factors and mortality from hospital acquired pneumonia in the Stroke Intensive Care Unit

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    Liudmila Carnesoltas Suarez

    2013-02-01

    Full Text Available Introduction. Stroke is the third leading cause of death. Hospital acquired pneumonia is an ongoing challenge due to the current microbiological spectrum, antimicrobial resistance, high mortality and associated costs. Objetive. To describe risk factors and their relationship to hospital stay and mortality of patients admitted to the Stroke ICU with hospital acquired pneumonia from 2007 to 2009. Methods. Prospective descriptive study. Variables: age, sex, risk factors, time of onset, stay and discharge status. We used chi square (X2 of homogeneity to determine the possible association between variables and the Fisher test probabilities. Results. 61 patients developed hospital acquired pneumonia (34.07%. We found a predominance of 60-80 year-old males. Among the risk factors we found major neurological damage in 21 (34.4%, smoking in 15 (24.5%, heart failure in 11 (18.0%, diabetes mellitus in 6 (9.8%, COPD in 4 (6.5%. Mechanical ventilation was used in 14 (38.4%, endotracheal intubation in 16 (29.2%, prolonged bedridden condition in 11 (18% and nasogastric tube placement in 7 (11.5%. The infection appeared between the third and sixth day in 57.4%; hospital stay was prolonged in 54% and 25 patients died (40.92%. Conclusions. Hospital acquired pneumonia was more common patients with mechanical ventilation, which prolonged stay and increased mortality. The microbiological environment was dominated by Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumanni.

  16. Pneumonia in the immunocompetent patient

    OpenAIRE

    Reynolds, J H; Mcdonald, G; Alton, H; Gordon, S B

    2010-01-01

    Pneumonia is an acute inflammation of the lower respiratory tract. Lower respiratory tract infection is a major cause of mortality worldwide. Pneumonia is most common at the extremes of life. Predisposing factors in children include an under-developed immune system together with other factors, such as malnutrition and over-crowding. In adults, tobacco smoking is the single most important preventable risk factor. The commonest infecting organisms in children are respiratory viruses and Strepto...

  17. Klebsiella pneumoniae bloodstream infections in neonates in a hospital in the Kingdom of Saudi Arabia.

    Science.gov (United States)

    Al-Rabea, A A; Burwen, D R; Eldeen, M A; Fontaine, R E; Tenover, F; Jarvis, W R

    1998-09-01

    To identify risk factors for Klebsiella pneumoniae bloodstream infections (BSI) in neonates in a hospital in the Kingdom of Saudi Arabia (KSA). Two case-control studies among hospitalized neonates during February 15-May 14, 1991, and a procedural and microbiological investigation. Hospital A, a maternity and children's hospital in KSA. Case patients had a blood culture positive for K pneumoniae after >2 days of hospitalization and had no evidence of a nonblood primary site of infection. When the 20 case patients were compared with controls, hospitalization in a critical-care unit (odds ratio [OR], 5.5; 95% confidence interval [CI95], 1.20-51.1; P=.03) was identified as a risk factor. When the case patients were compared with a second set of controls matched by critical-care status, receipt of a particular intravenous fluid (D10%/0.2NS; OR, 11.0; CI95, 1.42-85.2; P=.009) or a blood product (OR undefined; P=.04) were identified as risk factors. Infusates were administered via umbilical catheters for most case and control patients (19/20 vs 15/20, P>.05); catheters were manipulated more frequently in patients in critical-care units. Umbilical catheter tip, skin, or mucus membrane K pneumoniae colonization occurred in 47% and 53% of evaluated case and control patients, respectively. Available K pneumoniae isolates from blood cultures and colonization sites had identical antimicrobial susceptibility patterns. Emphasis on handwashing, careful preparation and administration of infusates, and aseptic technique for catheter insertion, maintenance, and manipulation was temporally associated with resolution of the epidemic. This outbreak was probably due to infusion therapy practices that led to BSI in nursery patients colonized with K pneumoniae. Both catheter-related infections and extrinsic contamination of infusates may have occurred. Hospital personnel should be aware of their potential to spread nosocomial pathogens from person to person and should implement Centers for

  18. Pneumonia: high-resolution CT findings in 114 patients

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    Reittner, Pia [Department of Radiology, Vancouver Hospital and Health Sciences Center, 855 W. 12th Ave., Vancouver, BC (Canada); Department of Radiology, Karl Franzens University and University Hospital Graz, Auenbruggerplatz 9, 8036 Graz (Austria); Ward, Suzanne; Heyneman, Laura; Mueller, Nestor L. [Department of Radiology, Vancouver Hospital and Health Sciences Center, 855 W. 12th Ave., Vancouver, BC (Canada); Johkoh, Takeshi [Department of Radiology, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka 565-0825 (Japan)

    2003-03-01

    The objective of the present study was to assess the high-resolution CT appearances of different types of pneumonia. The high-resolution CT scans obtained in 114 patients (58 immunocompetent, 59 immunocompromised) with bacterial, Mycoplasma pneumoniae, viral, fungal, and Pneumocystis carinii pneumonias were analyzed retrospectively by two independent observers for presence, pattern, and distribution of abnormalities. Areas of air-space consolidation were not detected in patients with viral pneumonia and were less frequently seen in patients with Pneumocystis carinii pneumonia (2 of 22 patients, 9%) than in bacterial (30 of 35, 85%), Mycoplasma pneumoniae (22 of 28, 79%), and fungal pneumonias (15 of 20, 75%; p<0.01). There was no significant difference in the prevalence or distribution of consolidation between bacterial, Mycoplasma pneumoniae, and fungal pneumonias. Extensive symmetric bilateral areas of ground-glass attenuation were present in 21 of 22 (95%) patients with Pneumocystis carinii pneumonia and were not seen in other pneumonias except in association with areas of consolidation and nodules. Centrilobular nodules were present less commonly in bacterial pneumonia (6 of 35 patients, 17%) than in Mycoplasma pneumoniae (24 of 28, 96%), viral (7 of 9, 78%), or fungal (12 of 20, 92%) pneumonia (p<0.01). Except for Pneumocystis carinii pneumonia and Mycoplasma pneumoniae pneumonia, which often have a characteristic appearance, high-resolution CT is of limited value in the differential diagnosis of the various types of infective pneumonia. (orig.)

  19. Pneumonia: high-resolution CT findings in 114 patients

    International Nuclear Information System (INIS)

    Reittner, Pia; Ward, Suzanne; Heyneman, Laura; Mueller, Nestor L.; Johkoh, Takeshi

    2003-01-01

    The objective of the present study was to assess the high-resolution CT appearances of different types of pneumonia. The high-resolution CT scans obtained in 114 patients (58 immunocompetent, 59 immunocompromised) with bacterial, Mycoplasma pneumoniae, viral, fungal, and Pneumocystis carinii pneumonias were analyzed retrospectively by two independent observers for presence, pattern, and distribution of abnormalities. Areas of air-space consolidation were not detected in patients with viral pneumonia and were less frequently seen in patients with Pneumocystis carinii pneumonia (2 of 22 patients, 9%) than in bacterial (30 of 35, 85%), Mycoplasma pneumoniae (22 of 28, 79%), and fungal pneumonias (15 of 20, 75%; p<0.01). There was no significant difference in the prevalence or distribution of consolidation between bacterial, Mycoplasma pneumoniae, and fungal pneumonias. Extensive symmetric bilateral areas of ground-glass attenuation were present in 21 of 22 (95%) patients with Pneumocystis carinii pneumonia and were not seen in other pneumonias except in association with areas of consolidation and nodules. Centrilobular nodules were present less commonly in bacterial pneumonia (6 of 35 patients, 17%) than in Mycoplasma pneumoniae (24 of 28, 96%), viral (7 of 9, 78%), or fungal (12 of 20, 92%) pneumonia (p<0.01). Except for Pneumocystis carinii pneumonia and Mycoplasma pneumoniae pneumonia, which often have a characteristic appearance, high-resolution CT is of limited value in the differential diagnosis of the various types of infective pneumonia. (orig.)

  20. Impact of pre-hospital antibiotic use on community-acquired pneumonia.

    Science.gov (United States)

    Simonetti, A F; Viasus, D; Garcia-Vidal, C; Grillo, S; Molero, L; Dorca, J; Carratalà, J

    2014-09-01

    Information on the influence of pre-hospital antibiotic treatment on the causative organisms, clinical features and outcomes of patients with community-acquired pneumonia (CAP) remains scarce. We performed an observational study of a prospective cohort of non-immunosuppressed adults hospitalized with CAP between 2003 and 2012. Patients were divided into two groups: those who had received pre-hospital antibiotic treatment for the same episode of CAP and those who had not. A propensity score was used to match patients. Of 2179 consecutive episodes of CAP, 376 (17.3%) occurred in patients who had received pre-hospital antibiotic treatment. After propensity score matching, Legionella pneumophila was more frequently identified in patients with pre-hospital antibiotic treatment, while Streptococcus pneumoniae was less common (p sensitivity and specificity of the pneumococcal urinary antigen test for diagnosing pneumococcal pneumonia were similar in the two groups. Patients with pre-hospital antibiotic treatment were less likely to present fever (p 0.02) or leucocytosis (p 0.001). Conversely, chest X-ray cavitation was more frequent in these patients (p 0.04). No significant differences were found in the frequency of patients classified into high-risk Pneumonia Severity Index classes, in intensive care unit admission, or in 30-day mortality between the groups. In conclusion, L. pneumophila occurrence was nearly three times higher in patients who received pre-hospital antibiotics. After a propensity-adjusted analysis, no significant differences were found in prognosis between study groups. Pre-hospital antibiotic use should be considered when choosing aetiological diagnostic tests and empirical antibiotic therapy in patients with CAP. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

  1. Risk Factors of Pneumonia Among Children Under 5 Years at a Pediatric Hospital in Sudan

    Directory of Open Access Journals (Sweden)

    Siham M.O. Gritly

    2018-04-01

    Full Text Available Introduction: Pneumonia is major cause of mortality among acute respiratory infections, killing up to 5 million of children below the age of 5 years annually in developing countries. Total 50% out-patients cases in Sudan are children while 30% of children admissions are due to pneumonia. Every year, the number of deaths in infant and children below the age of 5 years is reported to be 12 million. Objectives: The aim of this study is to find out the pneumonia risks in Sudan among children <5 years and to establish a baseline data and statistical information about pneumonia in the age group for future use. Study design and Setting: A hospital based descriptive study was conducted among children <5 years at Mohamed Al-Amin Hamid Pediatric Hospital in February 2017. Methods: Parents of 40 children <5 years admitted to the hospital during the study period completed the constructed questionnaire after obtaining informed consents from each of them. Data was then analyzed. Results: Children in this study consisted of 27 (57.50% males and 13 (42.5% females. Factors found to have association with pneumonia include low socio-economic status and low educational level of mothers. Conclusion and Recommendations: The study concluded that the pneumonia is more prevalent in children less than one year. Factors found to have association with pneumonia include low socioeconomic status and low educational level of mothers admitted to Mohamed Al-Amin pediatric hospital in Omdurman locality. It was recommended to have an early diagnosis and treatment of pneumonia. Community health education and completion of the immunization program are recommended to decrease the infection.

  2. Spatial variation of pneumonia hospitalization risk in Twin Cities metro area, Minnesota.

    Science.gov (United States)

    Iroh Tam, P Y; Krzyzanowski, B; Oakes, J M; Kne, L; Manson, S

    2017-11-01

    Fine resolution spatial variability in pneumonia hospitalization may identify correlates with socioeconomic, demographic and environmental factors. We performed a retrospective study within the Fairview Health System network of Minnesota. Patients 2 months of age and older hospitalized with pneumonia between 2011 and 2015 were geocoded to their census block group, and pneumonia hospitalization risk was analyzed in relation to socioeconomic, demographic and environmental factors. Spatial analyses were performed using Esri's ArcGIS software, and multivariate Poisson regression was used. Hospital encounters of 17 840 patients were included in the analysis. Multivariate Poisson regression identified several significant associations, including a 40% increased risk of pneumonia hospitalization among census block groups with large, compared with small, populations of ⩾65 years, a 56% increased risk among census block groups in the bottom (first) quartile of median household income compared to the top (fourth) quartile, a 44% higher risk in the fourth quartile of average nitrogen dioxide emissions compared with the first quartile, and a 47% higher risk in the fourth quartile of average annual solar insolation compared to the first quartile. After adjusting for income, moving from the first to the second quartile of the race/ethnic diversity index resulted in a 21% significantly increased risk of pneumonia hospitalization. In conclusion, the risk of pneumonia hospitalization at the census-block level is associated with age, income, race/ethnic diversity index, air quality, and solar insolation, and varies by region-specific factors. Identifying correlates using fine spatial analysis provides opportunities for targeted prevention and control.

  3. Application and comparison of scoring indices to predict outcomes in patients with healthcare-associated pneumonia

    OpenAIRE

    Fang, Wen-Feng; Yang, Kuang-Yao; Wu, Chieh-Liang; Yu, Chong-Jen; Chen, Chang-Wen; Tu, Chih-Yen; Lin, Meng-Chih

    2011-01-01

    Introduction Healthcare-associated pneumonia (HCAP) is a relatively new category of pneumonia. It refers to infections that occur prior to hospital admission in patients with specific risk factors following contact or exposure to a healthcare environment. There is currently no scoring index to predict the outcomes of HCAP patients. We applied and compared different community acquired pneumonia (CAP) scoring indices to predict 30-day mortality and 3-day and 14-day intensive care unit (ICU) adm...

  4. Lower Mortality Rate in Elderly Patients With Community?Onset Pneumonia on Treatment With Aspirin

    OpenAIRE

    Falcone, Marco; Russo, Alessandro; Cangemi, Roberto; Farcomeni, Alessio; Calvieri, Camilla; Barill?, Francesco; Scarpellini, Maria Gabriella; Bertazzoni, Giuliano; Palange, Paolo; Taliani, Gloria; Venditti, Mario; Violi, Francesco

    2015-01-01

    Background Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potential benefit of aspirin, which lowers platelet aggregation by inhibition of thromboxane A2 production, is still unclear. The aim of the study was to assess the impact of aspirin on mortality in patients with pneumonia. Methods and Results Consecutive patients admitted to the University?Hospital Policlinico Umberto I (Rome, Italy) with community?onset pneumonia were recruited and prospectiv...

  5. The Association Between Major Depressive Disorder and Outcomes in Older Veterans Hospitalized With Pneumonia.

    Science.gov (United States)

    DeWaters, Ami L; Chansard, Matthieu; Anzueto, Antonio; Pugh, Mary Jo; Mortensen, Eric M

    2018-01-01

    Major depressive disorder ("depression") has been identified as an independent risk factor for mortality for many comorbid conditions, including heart failure, cancer and stroke. Major depressive disorder has also been linked to immune suppression by generating a chronic inflammatory state. However, the association between major depression and pneumonia has not been examined. The aim of this study was to examine the association between depression and outcomes, including mortality and intensive care unit admission, in Veterans hospitalized with pneumonia. We conducted a retrospective national study using administrative data of patients hospitalized at any Veterans Administration acute care hospital. We included patients ≥65 years old hospitalized with pneumonia from 2002-2012. Depressed patients were further analyzed based on whether they were receiving medications to treat depression. We used generalized linear mixed effect models to examine the association of depression with the outcomes of interest after controlling for potential confounders. Patients with depression had a significantly higher 90-day mortality (odds ratio 1.12, 95% confidence interval 1.07-1.17) compared to patients without depression. Patients with untreated depression had a significantly higher 30-day (1.11, 1.04-1.20) and 90-day (1.20, 1.13-1.28) mortality, as well as significantly higher intensive care unit admission rates (1.12, 1.03-1.21), compared to patients with treated depression. For older veterans hospitalized with pneumonia, a concurrent diagnosis of major depressive disorder, and especially untreated depression, was associated with higher mortality. This highlights that untreated major depressive disorder is an independent risk factor for mortality for patients with pneumonia. Published by Elsevier Inc.

  6. Community-acquired Pneumonia in Hospitalized Urban Young ...

    African Journals Online (AJOL)

    As part of a comprehensive hospital-based study of acute lower respiratory infections (ALRI) in under-five urban Nigerian children, we sought to identify the possible clinical and investigative correlates of lobar versus bronchopneumonia, and the possible determinants of mortality in community-acquired pneumonia. Over a ...

  7. Bacteriology of aspiration pneumonia in patients with acute coma.

    Science.gov (United States)

    Lauterbach, Enise; Voss, Frederik; Gerigk, Roland; Lauterbach, Michael

    2014-12-01

    Loss of protective airway reflexes in patients with acute coma puts these patients at risk of aspiration pneumonia complicating the course of the primary disease. Available data vary considerably with regard to bacteriology, role of anaerobic bacteria, and antibiotic treatment. Our objective was to research the bacteriology of aspiration pneumonia in acute coma patients who were not pre-treated with antibiotics or hospitalized within 30 days prior to the event. We prospectively analyzed 127 patient records from adult patients admitted, intubated and ventilated to a tertiary medical intensive care unit with acute coma. Bacteriology and antibiotic resistance testing from tracheal aspirate sampled within 24 h after admission, blood cultures, ICU scores (APACHE II, SOFA), hematology, and clinical chemistry were assessed. Patients were followed up until death or hospital discharge. The majority of patients with acute coma suffered from acute cardiovascular disorders, predominantly myocardial infarction, followed by poisonings, and coma of unknown cause. In a majority of our patients, microaspiration resulted in overt infection. Most frequently S. aureus, H. influenzae, and S. pneumoniae were isolated. Anaerobic bacteria (Bacteroides spec., Fusobacteria, Prevotella spec.) were isolated from tracheal aspirate in a minority of patients, and predominantly as part of a mixed infection. Antibiotic monotherapy with a 2nd generation cephalosporin, or a 3rd generation gyrase inhibitor, was most effective in our patients regardless of the presence of anaerobic bacteria.

  8. Epidemiology and outcome of pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA in Canadian hospitals.

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    Manal Tadros

    Full Text Available BACKGROUND: MRSA remains a leading cause of hospital-acquired (HAP and healthcare-associated pneumonia (HCAP. We describe the epidemiology and outcome of MRSA pneumonia in Canadian hospitals, and identify factors contributing to mortality. METHODS: Prospective surveillance for MRSA pneumonia in adults was done for one year (2011 in 11 Canadian hospitals. Standard criteria for MRSA HAP, HCAP, ventilator-associated pneumonia (VAP, and community-acquired pneumonia (CAP were used to identify cases. MRSA isolates underwent antimicrobial susceptibility testing, and were characterized by pulsed-field gel electrophoresis (PFGE and Panton-Valentine leukocidin (PVL gene detection. The primary outcome was all-cause mortality at 30 days. A multivariable analysis was done to examine the association between various host and microbial factors and mortality. RESULTS: A total of 161 patients with MRSA pneumonia were identified: 90 (56% with HAP, 26 (16% HCAP, and 45 (28% CAP; 23 (14% patients had VAP. The mean (± SD incidence of MRSA HAP was 0.32 (± 0.26 per 10,000 patient-days, and of MRSA VAP was 0.30 (± 0.5 per 1,000 ventilator-days. The 30-day all-cause mortality was 28.0%. In multivariable analysis, variables associated with mortality were the presence of multiorgan failure (OR 8.1; 95% CI 2.5-26.0, and infection with an isolate with reduced susceptibility to vancomycin (OR 2.5, 95% CI 1.0-6.3. CONCLUSIONS: MRSA pneumonia is associated with significant mortality. Severity of disease at presentation, and infection caused by an isolate with elevated MIC to vancomcyin are associated with increased mortality. Additional studies are required to better understand the impact of host and microbial variables on outcome.

  9. Adesão a diretrizes e impacto nos desfechos em pacientes hospitalizados por pneumonia adquirida na comunidade em um hospital universitário Adherence to guidelines and its impact on outcomes in patients hospitalized with community-acquired pneumonia at a university hospital

    Directory of Open Access Journals (Sweden)

    Carla Discacciati Silveira

    2012-04-01

    evaluate the agreement between the criteria used for hospitalization of patients with community-acquired pneumonia (CAP and those of the Brazilian Thoracic Association guidelines, and to evaluate the association of that agreement with 30-day mortality. Secondarily, to evaluate the agreement between the treatment given and that recommended in the guidelines with length of hospital stay, microbiological profile, 12-month mortality, complications, ICU admission, mechanical ventilation, and 30-day mortality. METHODS: This was a retrospective study involving adult patients hospitalized between 2005 and 2007 at the Federal University of Minas Gerais Hospital das Clínicas, located in Belo Horizonte, Brazil. Medical charts and chest X-rays were reviewed. RESULTS: Among the 112 patients included in the study, admission and treatment criteria were in accordance with the guidelines in 82 (73.2% and 66 (58.9%, respectively. The 30-day and 12-month mortality rates were 12.3% and 19.4%, respectively. The 30-day mortality rate was lower for patients in whom the CRB-65 (mental Confusion, Respiratory rate, Blood pressure, and age > 65 years score was 1-2 and the antibiotic therapy was in accordance with the guidelines (p = 0.01. Cerebrovascular disease and appropriate antibiotic therapy showed independent associations with 30-day mortality. There was a trend toward an association between guideline-concordant antibiotic therapy and shorter hospital stay. CONCLUSIONS: In the population studied, admission and treatment criteria that were in accordance with the guidelines were associated with favorable outcomes in hospitalized patients with CAP. Cerebrovascular disease, as a risk factor, and guideline-concordant antibiotic therapy, as a protective factor, were associated with 30-day mortality.

  10. Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis

    OpenAIRE

    Komiya, Kosaku; Rubin, Bruce K.; Kadota, Jun-ichi; Mukae, Hiroshi; Akaba, Tomohiro; Moro, Hiroshi; Aoki, Nobumasa; Tsukada, Hiroki; Noguchi, Shingo; Shime, Nobuaki; Takahashi, Osamu; Kohno, Shigeru

    2016-01-01

    Aspiration pneumonia is thought to be associated with a poor outcome in patients with community acquired pneumonia (CAP). However, there has been no systematic review regarding the impact of aspiration pneumonia on the outcomes in patients with CAP. This review was conducted using the MOOSE guidelines: Patients: patients defined CAP. Exposure: aspiration pneumonia defined as pneumonia in patients who have aspiration risk. Comparison: confirmed pneumonia in patients who were not considered to ...

  11. Severe community-acquired pneumonia caused by Mycoplasma pneumoniae in young female patient

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    Milačić Nena

    2015-07-01

    Full Text Available Mycoplasma pneumonia is common agent causing community acquired pneumonia in younger population. However, the course of illness is usually benign and is rarely associated with pulmonary complications. We report a 27 years old female patient with unilateral pneumonia followed by pleural effusion and adhesions on the same side. This potential source of infection should be considered in young patients where resolution of symptoms from pneumonia is delayed.

  12. Coronary artery calcium before and after hospitalization with pneumonia: The MESA study.

    Science.gov (United States)

    Corrales-Medina, Vicente F; Dwivedi, Girish; Taljaard, Monica; Petrcich, William; Lima, Joao A; Yende, Sachin; Kronmal, Richard A; Chirinos, Julio A

    2018-01-01

    Epidemiological analyses demonstrate that pneumonia survivors have a higher risk of myocardial infarction than people with similar load of risk factors for atherosclerotic cardiovascular disease (ASCVD) but without pneumonia. This may be due to a higher baseline burden of ASCVD in patients with pneumonia that is not captured by the accounting of known ASCVD risk factors in epidemiological analyses or to unfavorable accelerating effects of pneumonia on atherosclerosis. We analyzed data from the Multi-Ethnic Study of Atherosclerosis. We identified 54 participants that were hospitalized for pneumonia during study follow-up and that also had assessment of coronary artery calcium (CAC, an objective marker of coronary atherosclerotic burden) before and after this hospitalization. We matched them to 54 participants who were not hospitalized for pneumonia but that had CAC assessments at the same study visits as the pneumonia cases. We compared baseline CAC scores and their progression between groups. Baseline CAC scores were similar in both groups (median [IQR]; 6.3 [0-356.8] in pneumonia participants vs. 10.8 [0-178.3] in controls; p = 0.25). After a median of 4.8 years, the direction and magnitude of CAC score change, and the slope of CAC score progression between groups was also similar (median change [IQR], 21.8 [0 to 287.29] in participants with pneumonia versus 15.8 [0 to 140.94] in controls, p = 0.28; difference in slope, 7.7, 95% CI -9.0 to 24.6, p = 0.18). However, among participants with high baseline ASCVD risk (i.e. ACC/AHA 10-year risk estimate ≥7.5%), participants with pneumonia showed a larger increase in CAC scores (median change [IQR]; 159.10 [38.55-407.34] versus 48.72 [0.97-246.99] in controls; p = 0.02) and a trend towards a steeper slope of CAC score progression (difference in slope, 19.7, 95% CI -6.6 to 45.6, p = 0.07). Pneumonia may accelerate the progression of atherosclerosis in people with high baseline ASCVD risk.

  13. Pneumocystis carinii pneumonia in AIDS patients

    DEFF Research Database (Denmark)

    Orholm, Marianne; Nielsen, T L; Holten-Andersen, W

    1992-01-01

    The aim of this study was to evaluate whether the amount of Pneumocystis carinii organisms found at fiberoptic bronchoscopy (FB) performed on HIV-positive patients correlated to the character of the P. carinii pneumonia (PCP). A consecutive series of 105 patients presented with 131 episodes of pu...

  14. Gram-negative bacilli are a major cause of secondary pneumonia in patients with pulmonary tuberculosis: evidence from a cross-sectional study in a tertiary hospital in Nigeria.

    Science.gov (United States)

    Iliyasu, Garba; Mohammad, Aminu B; Yakasai, Ahmad M; Dayyab, Farouq M; Oduh, Joan; Habib, Abdulrazaq G

    2018-05-19

    This study was aimed at describing the profile of bacterial aetiology of secondary pneumonia in pulmonary tuberculosis (PTB) patients. A 22-month analysis of patients with PTB and secondary bacterial pneumonia was conducted. Data on isolates recovered and the antimicrobial susceptibility profile were recorded. Of the 141 patients, there were 79 (56%) males and the mean age was 35.98±15.93. Gram-negative bacilli were isolated with equal frequency as Streptococcus pneumoniae (63 [44.7%]). Most of the isolates tested were sensitive to levofloxacin, ceftriaxone or chloramphenicol. Gram-negative bacilli are a major cause of pneumonia in patients with PTB on treatment.

  15. Clinical Predictors of Hospital-acquired Pneumonia Associated with Acute Ischemic

    Directory of Open Access Journals (Sweden)

    Alexis Suárez Quesada

    2015-06-01

    Full Text Available Background: hospital-acquired pneumonia is a constant challenge given the current microbiological spectrum, antimicrobial resistance together with its high mortality, morbidity and hospital costs. Objective: to identify the clinical predictors of pneumonia associated with acute ischemic stroke. Methods: a prospective cohort study was conducted in 201 patients diagnosed with acute ischemic stroke consecutively admitted to the stroke unit of the General Carlos Manuel de Céspedes Teaching Hospital during the first seven days after the onset, from January 2012 through December 2013. The independent predictors of hospital-acquired pneumonia were obtained using multivariable logistic regression. Results: fifty six point seven percent were male. The mean age was 64.17 ± 14.33 years. Cases of hospital-acquired pneumonia associated with stroke accounted for 19, 9 %. Subjects who developed pneumonia were older (68.55 ± 13.51 vs. 63.08 ± 14.36 years, had a lower score in the Glasgow Coma Scale (8.00 ± 2.60 vs. 14.00 ± 2.82, and an increased number of leukocytes at admission (10.888 ± 3.487 vs. 9.233 ± 2.539 × 109/L. The following independent factors were identified: Glasgow Coma Scale ≤ 11 (OR: 26.099; 95 % CI 7.164-85.075, history of chronic obstructive pulmonary disease (OR: 8.896; 95 % CI 1.203-65.779, dysphagia (OR: 7.652; 95 % CI 2.369- 24.720, history of heart failure (OR: 4.583; 95 % CI 1.240- 16.932 and dysarthria/severe motor aphasia (OR: 4.222; 95 % CI 1.374- 12.975. Conclusions: the resulting logistic regression model is valid for predicting post-stroke pneumonia based on data routinely acquired.

  16. Difference between Japanese Secondary and Tertiary Medical Facilities Regarding Changes in the Hospitalization of Children for Pneumonia after the Introduction of the Pneumococcal Conjugate Vaccine.

    Science.gov (United States)

    Haro, Kaoru; Ogawa, Masato; Hoshina, Takayuki; Kojiro, Masumi; Kusuhara, Koichi

    2017-05-24

    This study aimed to compare hospitalization of children for pneumonia between secondary and tertiary medical facilities, which hospitalize many children without and with underlying diseases, respectively, after the introduction of the pneumococcal conjugate vaccine (PCV). Our retrospective study included children admitted to the Department of Pediatrics at Kitakyushu General Hospital, a secondary medical facility, and the Hospital of the University of Occupational and Environment Health, Japan, a tertiary medical facility, from 2009 to 2013 for pneumonia. We compared the change in the rate of hospitalization for pneumonia after the introduction of the 7-valent PCV between the secondary and tertiary medical facilities. Hospitalization of patients with pneumonia declined by 28.8% in our secondary medical facility. In particular, hospitalization for pneumonia other than confirmed mycoplasmal or viral pneumonia was significantly reduced by 49.2%. In contrast, hospitalization of patients with pneumonia did not decline in our tertiary medical facility. After the introduction of PCV, hospitalization of children for pneumonia was not reduced at the tertiary medical facility. Various other pathogens besides pneumococcus may be associated with the development of pneumonia in children with underlying diseases.

  17. Molecular Identification of SHV,TEM, CTX-M β lactamases Genes and Antibiotics Resistance Pattern of k.pneumoniae Isolates Collected from ICU Patients of Namazi Hospital, Shiraz, Iran

    Directory of Open Access Journals (Sweden)

    T Archin

    2014-01-01

    Full Text Available Abstract Background and aim: β-lactamase enzymes producing bacteria ESBL have spread widely throughout the world. The production of enzymes induces bacterial resistance to a wide range of antibiotics which is leading to the limitation of infection control and correct treatment. The aim of the present study was to investigate patterns of antibiotic susceptibility to antibiotics and the presence of β-lactamase genes SHV, TEM, CTX-M, in Klebsiella pneumoniae isolates from clinical specimens of intensive care. Methods: Susceptibility of isolated bacteria against 10 antibiotics was determined by agar disk diffusion method according to the CLSI guidelines. The strains (DDST were examined for the presence of the spectrum β-lactamase enzymes. Using E-test, the minimum inhibitory concentration (MIC of the antibiotic was determined to cefotaxime. Moreover, SHV, TEM, CTX-M genes were identified by, Multiplex PCR method, and some of them were sequenced. Results: The antibiotic resistance against 10 antibiotics was determined. The highest percentage of isolates was resistant to ampicillin (100% and sensitivity to imipenem was 1.66%. In this study, the majority of strains produced ESBL (60%. TEM gene in 34.38% and all three genes (TEM and SHV and CTX at 33.13% of isolates were observed. Conclusion: The present study showed that the K. pneumoniae producing ESBL in patients in ICU are common. Therefore, the use of procedures and policies for infection control in hospitals and especially ICU is necessary. Key words: Klebsiella pneumoniae, ESBL, Multiplex PCR, antibiotic sensitivity

  18. Etiology and anti-microbial sensitivity of organisms causing community acquired pneumonia: A single hospital study

    Directory of Open Access Journals (Sweden)

    Resmi U Menon

    2013-01-01

    Full Text Available Objective: The objective of this study was to identify the common etiological pathogens causing community acquired pneumonia (CAP in our hospital and sensitivity patterns to the common antibiotics used. Materials and Methods: This study was undertaken in a 750 bedded multi-specialty referral hospital in Kerala catering to both urban and semi-urban populations. It is a prospective study of patients who attended the medical out-patient department and those admitted with a clinical diagnosis of CAP, during the year 2009. Data were collected based on detailed patient interview, clinical examination and laboratory investigations. The latter included sputum culture and sensitivity pattern. These were tabulated and percentage incidence of etiological pathogens calculated. The antimicrobial sensitivity pattern was also classified by percentage and expressed as bar diagram. Results: The study showed Streptococcus pneumoniae to be the most common etiological agent for CAP, in our hospital setting. The other organisms isolated in order of frequency were Klebsiella pneumoniae, Pseudomonas aeruginosa, Alpha hemolytic streptococci, Escherichia coli, Beta hemolytic streptococci and atypical coli. S. pneumoniae was most sensitive to linezolid, followed by amoxicillin-clavulanate (augmentin, cloxacillin and ceftriaxone. Overall, the common pathogens causing CAP showed highest sensitivity to amikacin, followed by ofloxacin, gentamycin, amoxicillin-clavulanate (augmentin, ceftriaxone and linezolid. The least sensitivity rates were shown to amoxicillin and cefoperazone. Conclusion: In a hospital setting, empirical management for cases of CAP is not advisable. The present study has shown S. pneumoniae as the most likely pathogen and either linezolid or amikacin as the most likely effective antimicrobial in cases of CAP, in our setting.

  19. The correlation of symptoms, pulmonary function tests and exercise testing with high-resolution computed tomography in patients with idiopathic interstitial pneumonia in a tertiary care hospital in South India.

    Science.gov (United States)

    Isaac, Barney Thomas Jesudason; Thangakunam, Balamugesh; Cherian, Rekha A; Christopher, Devasahayam Jesudas

    2015-01-01

    For the follow-up of patients with idiopathic interstitial pneumonias (IIP), it is unclear which parameters of pulmonary function tests (PFT) and exercise testing would correlate best with high-resolution computed tomography (HRCT).. To find out the correlation of symptom scores, PFTs and exercise testing with HRCT scoring in patients diagnosed as idiopathic interstitial pneumonia. Cross-sectional study done in pulmonary medicine outpatients department of a tertiary care hospital in South India. Consecutive patients who were diagnosed as IIP by a standard algorithm were included into the study. Cough and dyspnea were graded for severity and duration. Pulmonary function tests and exercise testing parameters were noted. HRCT was scored based on an alveolar score, an interstitial score and a total score. The HRCT was correlated with each of the clinical and physiologic parameters. Pearson's/Spearman's correlation coefficient was used for the correlation of symptoms and parameters of ABG, PFT and 6MWT with the HRCT scores. A total of 94 patients were included in the study. Cough and dyspnea severity (r = 0.336 and 0.299), FVC (r = -0.48), TLC (r = -0.439) and DLCO and distance saturation product (DSP) (r = -0.368) and lowest saturation (r = -0.324) had significant correlation with total HRCT score. Among these, DLCO, particularly DLCO corrected % of predicted, correlated best with HRCT score (r = -0.721).. Symptoms, PFT and exercise testing had good correlation with HRCT. DLCO corrected % of predicted correlated best with HRCT.

  20. The association of functional oral intake and pneumonia in patients with severe Traumatic Brain Injury

    DEFF Research Database (Denmark)

    Schow, Trine; Larsen, Klaus; Engberg, Aase Worså

    Abstract Objective(s): This study investigates the incidence and onset time of pneumonia for patients with severe Traumatic Brain Injury (TBI) in the early phase of rehabilitation, and identifies parameters associated with the risk of pneumonia. Design: Observational retrospective cohort study....... Setting: A subacute rehabilitation department, university hospital, Denmark. Participants: One-hundred and seventy-three patients aged 16-65 years with severe TBI admitted over a 5-year period. Patients are transferred to the Brain Injury Unit (BIU) as soon as they ventilate spontaneously. Intervention......: None Main Outcome Measure(s): Pneumonia. Results: Twenty-seven percent (27%) of the patients admitted to the BIU were in treatment for pneumonia and 12% developed pneumonia during rehabilitation, all but one within 19 days of admission. Of these patients, 81% received nothing by mouth. Three factors...

  1. Pneumonia in patients on the background of blood cancer

    Directory of Open Access Journals (Sweden)

    Pertseva T.A.

    2014-03-01

    Full Text Available Problematic issues of etiologic diagnosis and treatment of community-acquired and nosocomial pneumonia are being studied actively. At the same time specific features of pneumonia in patients with severe immune defects, against blood cancer including are studied insufficiently. By the result of microbiological examinations of 149 patients with pneumonia on the background of blood cancer, who have undergone treatment in hematological center of CE “Dnipropetrovsk local multi-field clinical hospital №4” in 2010-2012, bacterial causative agents were determined in 59,7% of accidents, among which gram-negative microorganisms made up 69,7%, gram-positive – 30,3%. In 63% of accidents the asso¬ciations of causative agents were determined: the combination of fungal flora made up 58, 4% bacterial associations – 25, 8%. Invasive methods of research have demonstrated a considerably bigger informativeness in determination of possible etiological diagnosis of pneumonia. In determination of causative agent in fluid of brochoalveolar lavage the part of positive results made up 77,4% against 30,3% in examination of sputum.

  2. Predictors of pneumonia in acute stroke in patients in an emergency unit

    Directory of Open Access Journals (Sweden)

    Sara R. M. Almeida

    2015-05-01

    Full Text Available Objective To evaluate the risk factors and comorbid conditions associated with the development of pneumonia in patients with acute stroke. To determine the independent predictors of pneumonia. Method Retrospective study from July to December 2011. We reviewed all medical charts with diagnosis of stroke. Results 159 patients (18-90 years were admitted. Prevalence of pneumonia was 32%. Pneumonia was more frequent in patients with hemorrhagic stroke (OR: 4.36; 95%CI: 1.9-10.01, p < 0.001, higher National Institute of Health Stroke Scale (NIHSS (p = 0.047 and, lower Glasgow Coma Score (GCS (p < 0.0001. Patients with pneumonia had longer hospitalization (p < 0.0001. Multivariable logistic regression analysis identified NIHSS as an independent predictor of pneumonia (95%CI: 1.049-1.246, p = 0.002. Conclusion Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficit as evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

  3. Community-acquired pneumonia in older patients: does age influence systemic cytokine levels in community-acquired pneumonia?

    LENUS (Irish Health Repository)

    Kelly, Emer

    2009-03-01

    Community-acquired pneumonia (CAP) is a major cause of death in the elderly. The age-related increase in comorbid illnesses plays a part but the effect of aging on the immune response may be equally important. We aimed to evaluate patients with CAP for evidence of a muted response to infection in elderly patients admitted to hospital compared with a younger patient group.

  4. Incidence, risk factors and outcome of nosocomial pneumonia in patients with central nervous system infections

    Directory of Open Access Journals (Sweden)

    Gajović Olgica

    2011-01-01

    Full Text Available Introduction. Pneumonia is the most frequent nosocomial infection in intensive care units. The reported frequency varies with definition, the type of hospital or intensive care units and the population of patients. The incidence ranges from 6.8-27%. Objective. The objective of this study was to determine the frequency, risk factors and mortality of nosocomial pneumonia in intensive care patients. Methods. We analyzed retrospectively and prospectively the collected data of 180 patients with central nervous system infections who needed to stay in the intensive care unit for more than 48 hours. This study was conducted from 2003 to 2009 at the Clinical Centre of Kragujevac. Results. During the study period, 54 (30% patients developed nosocomial pneumonia. The time to develop pneumonia was 10±6 days. We found that the following risk factors for the development of nosocomial pneumonia were statistically significant: age, Glasgow Coma Scale (GCS score <9, mechanical ventilation, duration of mechanical ventilation, tracheostomy, presence of nasogastric tube and enteral feeding. The most commonly isolated pathogens were Klebsiella-Enterobacter spp. (33.3%, Pseudomonas aeruginosa (24.1%, Acinetobacter spp. (16.6% and Staphylococcus aureus (25.9%. Conclusion. Nosocomial pneumonia is the major cause of morbidity and mortality of patients with central nervous system infections. Patients on mechanical ventilation are particularly at a high risk. The mortality rate of patients with nosocomial pneumonia was 54.4% and it was five times higher than in patients without pneumonia.

  5. Clinical characteristics of pneumonia in bedridden patients receiving home care: a 3-year prospective observational study.

    Science.gov (United States)

    Ishida, Tadashi; Tachibana, Hiromasa; Ito, Akihiro; Ikeda, Satoshi; Furuta, Kenjiro; Nishiyama, Akihiro; Noyama, Maki; Tokioka, Fumiaki; Yoshioka, Hiroshige; Arita, Machiko

    2015-08-01

    The aim of the study was to describe the epidemiology, clinical features, antimicrobial treatment, and outcomes of bedridden pneumonia patients receiving home healthcare. A 3-year prospective observational study of poor performance status (PS) 3-4 patients receiving long-term home healthcare and hospitalized at a single center with pneumonia between October 2010 and September 2013 was conducted, and their clinical characteristics were compared with non-bedridden community-acquired pneumonia (CAP) patients. A total of 131 CAP patients with PS 3-4, and 400 CAP patients with PS 0-2 were evaluated. The PS 3-4 patients were older, and exhibited a higher frequency of underlying diseases. Aspiration was thought to be associated with pneumonia in 77.1% of the PS 3-4 patients. Streptococcus pneumoniae was the leading pathogen in both groups, whereas the frequency of streptococci and polymicrobial infections was higher in the PS 3-4 group. The incidence of multidrug-resistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa was lower than in previous healthcare-associated pneumonia reports. The in-hospital mortality and recurrence rates were significantly higher in the PS 3-4 group than in the good PS group (17.6% vs. 6.0%, p < 0.001 and 15.3% vs. 7.5%, p = 0.008, respectively). The clinical characteristics of pneumonia in poor PS patients were similar to healthcare-associated pneumonia (HCAP), except for the frequency of drug-resistant pathogens. Hence, it might be beneficial to categorize pneumonia in home residents with poor PS separately from pneumonia in CAP patients who were previously healthy or experienced mild comorbidities. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  6. The effect of daily sedation interruption protocol on early incidence of ventilator-associated pneumonia among patients hospitalized in critical care units receiving mechanical ventilation

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    Mehdi Shahabi

    2016-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP is a common side effect in patients who receive intravenous sedation infusion. In routine care, after starting sedation infusion for patients who receive mechanical ventilation, interruption of sedation starts without protocol. This study aimed to evaluate the effect of daily sedation vacation protocol on the incidence of VAP in mechanically ventilated patients. Materials and Methods: In this clinical trial study, 80 patients with intravenous sedation infusion were selected and randomly allocated to intervention and control groups. In the intervention group, daily sedation vacation protocol and in the control group, routine sedation vacation was followed. Modified clinical pulmonary infection score questionnaire was completed before intervention and on the third, fourth, and fifth days after intervention. Data were analyzed by using repeated measures analysis of variance (ANOVA, Chi-square, and independent t-test. Results: The results of this study showed that the incidence rate of VAP in the intervention and control groups was 0% versus 15% on the third day of intervention, 12.5% versus 50% on the fourth day, and 27.5% versus 55.3% on the fifth day of intervention in the intervention and control groups, respectively. The incidence of VAP in the intervention group was significantly lower than in the control group (P < 0.05. Conclusions: The results of this study showed that in patients with intravenous sedation, infusion of a daily sedation vacation protocol may reduce the incidence of VAP. Therefore, in order to prevent VAP, nurses are recommended to use this daily sedation vacation protocol.

  7. Determining the Possible Etiology of Hospital-Acquired Pneumonia Using a Clone Library Analysis in Japan.

    Science.gov (United States)

    Yatera, Kazuhiro; Noguchi, Shingo; Yamasaki, Kei; Kawanami, Toshinori; Fukuda, Kazumasa; Naito, Keisuke; Akata, Kentaro; Kido, Takashi; Ishimoto, Hiroshi; Sakamoto, Noriho; Taniguchi, Hatsumi; Mukae, Hiroshi

    2017-05-01

    Obtaining precise etiological information regarding causative bacteria is important for the proper use of antimicrobials in hospital-acquired pneumonia (HAP), which is associated with a high rate of mortality. The aim of this study was to comparatively investigate the bacterial diversity in bronchoalveolar lavage fluid (BALF) in Japanese patients with HAP by the clone library method using the 16S rRNA gene. This study included Japanese patients with HAP who were treated at our hospital and referring hospitals. BALF specimens were obtained from pneumonia lesions identified on chest radiographs and/or computed tomography. Sputum specimens were also evaluated in patients with sputum production. Sixty-eight patients were ultimately enrolled. BALF cultivation revealed bacterial positivity in 53 of 68 (77.9%) patients, and Staphylococcus aureus (30.9%) was the most frequently isolated, followed by Pseudomonas aeruginosa (16.2%), and Escherichia coli (10.3%). In contrast, the clone library analysis identified the presence of some bacterial phenotype in 65 of 68 (95.6%) patients, and streptococci (16.2%), Corynebacterium species (11.8%), anaerobes (10.3%) were frequently detected as the predominant phylotypes. Both methods tended to detect S. aureus, Klebsiella pneumoniae, and E. coli in patients with late-onset pneumonia. In addition, the cases that phylotypes of S. aureus and P. aeruginosa were found to account for > 5% of the bacterial flora of each case were 42.9% and 72.7%, respectively. These results indicate that attention should be paid to the roles of gram-positive bacilli such as streptococci, Corynebacterium species and anaerobes, in addition to Gram-negative bacilli, in the pathogenesis of HAP.

  8. [Clinical evaluation of bedridden patients with pneumonia receiving home health care].

    Science.gov (United States)

    Fukuyama, Hajime; Ishida, Tadashi; Tachibana, Hiromasa; Iga, Chiya; Nakagawa, Hiroaki; Ito, Akihiro; Ubukata, Satoshi; Yoshioka, Hiroshige; Arita, Machiko; Hashimoto, Toru

    2010-12-01

    Pneumonia which develops in patients while living in their own home is categorized as community-acquired pneumonia (CAP), even if these patients are bedridden and receiving home health care. However, because of the differences in patient backgrounds, we speculated that the clinical outcomes and pathogens of bedridden patients with pneumonia who are receiving home health care would be different from those of CAP. We conducted a prospective study of patients with CAP who were hospitalized at our hospital from April 2007 through September 2009. We compared home health care bedridden pneumonia (performance status 4, PS4-CAP) with non-PS4-CAP in a total of 505 enrolled patients in this study. Among these, 66 had PS4-CAP, mostly associated with aspiration. Severity scores, mortality rate, recurrence rate and length of hospital stay of those with PS4-CAP were significantly higher than those with non-PS4-CAP. Drug resistant pathogens were more frequently isolated from patients with PS4-CAP than from those of non-PS4-CAP. The results of patients with PS4-CAP were in agreement with those of previous health care-associated pneumonia (HCAP) reports. The present study suggested home health care bedridden pneumonia should be categorized as HCAP, not CAP.

  9. Assessment of time to clinical response, a proxy for discharge readiness, among hospitalized patients with community-acquired pneumonia who received either ceftaroline fosamil or ceftriaxone in two phase III FOCUS trials.

    Science.gov (United States)

    Lodise, Thomas P; Anzueto, Antonio R; Weber, David J; Shorr, Andrew F; Yang, Min; Smith, Alexander; Zhao, Qi; Huang, Xingyue; File, Thomas M

    2015-02-01

    The primary driver of health care costs for patients with community-acquired pneumonia (CAP) is the hospital length of stay (LOS). Unfortunately, hospital LOS comparisons are difficult to make from phase III CAP trials because of their structured designs and prespecified treatment durations. However, an opportunity still exists to draw inferences about potential LOS differences between treatments through the use of surrogates for hospital discharge. The intent of this study was to quantify the time to a clinical response, a proxy for the time to discharge readiness, among hospitalized CAP patients who received either ceftaroline or ceftriaxone in two phase III CAP FOCUS clinical trials. On the basis of the Infectious Diseases Society of America and American Thoracic Society CAP management guidelines and recent FDA guidance documents for community-acquired bacterial pneumonia, a post hoc adjudication algorithm was constructed a priori to compare the time to a clinical response, a proxy for the time to discharge readiness, between patients who received ceftaroline or ceftriaxone. Overall, 1,116 patients (ceftaroline, n=562; ceftriaxone, n=554) from the pooled FOCUS trials met the selection criteria for this analysis. Kaplan-Meier analyses showed that ceftaroline was associated with a shorter time, measured in days, to meeting the clinical response criteria (P=0.03). Of the patients on ceftaroline, 61.0, 76.1, and 83.6% achieved a clinical response by days 3, 4, and 5, compared to 54.3, 69.8, and 79.3% of the ceftriaxone-treated patients. In the Cox regression, ceftaroline was associated with a shorter time to a clinical response (HR, 1.16, P=0.02). The methodology employed here provides a framework to draw comparative effectiveness inferences from phase III CAP efficacy trials. (The FOCUS trials whose data were analyzed in this study have been registered at ClinicalTrials.gov under registration no. NCT00621504 and NCT00509106.). Copyright © 2015, American Society

  10. Detection of plant DNA in the bronchoalveolar lavage of patients with ventilator-associated pneumonia.

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    Sabri Bousbia

    Full Text Available BACKGROUND: Hospital-acquired infections such as nosocomial pneumonia are a serious cause of mortality for hospitalized patients, especially for those admitted to intensive care units (ICUs. Despite the number of the studies reported to date, the causative agents of pneumonia are not completely known. Herein, we found by molecular technique that vegetable and tobacco DNA may be detected in the bronchoalveolar lavage from patients with ventilator-associated pneumonia (VAP. METHODOLOGY/PRINCIPAL FINDINGS: In the present study, we studied bronchoalveolar lavage (BAL from patients admitted to ICUs with ventilator-associated pneumonia. BAL fluids were assessed with molecular tests, culture and blood culture. We successfully identified plant DNA in six patients out of 106 (6% with ventilator-associated pneumonia. Inhalation was confirmed in four cases and suspected in the other two cases. Inhalation was significantly frequent in patients with plant DNA (four out of six patients than those without plant DNA (three out of 100 patients (P<0.001. Nicotiana tabacum chloroplast DNA was identified in three patients who were smokers (cases 2, 3 and 6. Cucurbita pepo, Morus bombycis and Triticum aestivum DNA were identified in cases 1, 4 and 5 respectively. Twenty-three different bacterial species, two viruses and five fungal species were identified from among these six patients by using molecular and culture techniques. Several of the pathogenic microorganisms identified are reported to be food-borne or tobacco plant-associated pathogens. CONCLUSIONS/SIGNIFICANCE: Our study shows that plants DNA may be identified in the BAL fluid of pneumonia patients, especially when exploring aspiration pneumonia, but the significance of the presence of plant DNA and its role in the pathogenesis of pneumonia is unknown and remains to be investigated. However, the identification of these plants may be a potential marker of aspiration in patients with pneumonia.

  11. Time to Guideline-Based Empiric Antibiotic Therapy in the Treatment of Pneumonia in a Community Hospital: A Retrospective Review.

    Science.gov (United States)

    Erwin, Beth L; Kyle, Jeffrey A; Allen, Leland N

    2016-08-01

    The 2005 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines for hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and health care-associated pneumonia (HCAP) stress the importance of initiating prompt appropriate empiric antibiotic therapy. This study's purpose was to determine the percentage of patients with HAP, VAP, and HCAP who received guideline-based empiric antibiotic therapy and to determine the average time to receipt of an appropriate empiric regimen. A retrospective chart review of adults with HAP, VAP, or HCAP was conducted at a community hospital in suburban Birmingham, Alabama. The hospital's electronic medical record system utilized International Classification of Diseases, Ninth Revision (ICD-9) codes to identify patients diagnosed with pneumonia. The percentage of patients who received guideline-based empiric antibiotic therapy was calculated. The mean time from suspected diagnosis of pneumonia to initial administration of the final antibiotic within the empiric regimen was calculated for patients who received guideline-based therapy. Ninety-three patients met the inclusion criteria. The overall guideline adherence rate for empiric antibiotic therapy was 31.2%. The mean time to guideline-based therapy in hours:minutes was 7:47 for HAP and 28:16 for HCAP. For HAP and HCAP combined, the mean time to appropriate therapy was 21:55. Guideline adherence rates were lower and time to appropriate empiric therapy was greater for patients with HCAP compared to patients with HAP. © The Author(s) 2015.

  12. Diagnostic value of chest radiographs in bedridden patients suspected of having pneumonia.

    Science.gov (United States)

    Esayag, Yaacov; Nikitin, Irina; Bar-Ziv, Jacob; Cytter, Ruth; Hadas-Halpern, Irith; Zalut, Todd; Yinnon, Amos M

    2010-01-01

    To assess the diagnostic value of the chest radiograph for the diagnosis of pneumonia in bedridden patients, using non-contrast-enhanced high-resolution chest computed tomography (CT) as the gold standard. We prospectively evaluated bedridden patients hospitalized with moderate to high clinical probability of pneumonia. Chest radiographs were interpreted in a blinded fashion by 3 observers and classified as definite, normal, or uncertain for pneumonia. Chest CT was obtained within 12 hours of chest radiograph. We applied Bayesian analysis to assess the accuracy of chest radiograph in the diagnosis of pneumonia. In a 5-month period, 58 patients were evaluated, 31 (53%) were female. Their chest radiographs were interpreted as negative, uncertain, or positive for pneumonia in 31 (53%), 15 (26%), and 12 (21%) patients, respectively, while CT confirmed pneumonia in 11 (35%), 10 (67%), and in 10 (83%). The sensitivity of the chest radiograph to diagnose pneumonia was 65%, the specificity was 93%, the positive and negative predictive values were, respectively, 83% and 65%, while the overall accuracy was 69% (95% confidence interval, 50%-79%). In bedridden patients with suspected pneumonia, a normal chest radiograph does not rule out the diagnosis, hence, a chest CT scan might provide valuable diagnostic information. Copyright 2010 Elsevier Inc. All rights reserved.

  13. The relationship between pneumonia and Glasgow coma scale assessment on acute stroke patients

    Science.gov (United States)

    Ritarwan, K.; Batubara, C. A.; Dhanu, R.

    2018-03-01

    Pneumonia is one of the most frequent medical complications of a stroke. Despite the well-documented association of a stroke associated infections with increased mortality and worse long-term outcome, on the other hand, the limited data available on independent predictors of pneumonia in acute stroke patients in an emergency unit. To determine the independentrelationship between pneumonia and Glasgow Coma Scale assessment on acute stroke patients. The cohort retrospective study observed 55 acute stroke patients who stayed in intensive care unit Adam Malik General Hospital from January until August 2017. Pneumonia was more frequent in patients with Ischemic stroke (OR 5.40; 95% CI: 1.28 – 6.40, p=0.003), higher National Institute of Health Stroke Scale (NIHSS) (p=0.014) and lower Glasgow Coma Scale (p=0.0001). Analysis multivariate logistic regression identified NIHSS as an independent of predictors of pneumonia (95% CI : 1.047 – 1.326, p=0.001). Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficits evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

  14. Long-Term Cognitive Impairment after Hospitalization for Community-Acquired Pneumonia: a Prospective Cohort Study.

    Science.gov (United States)

    Girard, Timothy D; Self, Wesley H; Edwards, Kathryn M; Grijalva, Carlos G; Zhu, Yuwei; Williams, Derek J; Jain, Seema; Jackson, James C

    2018-06-01

    Recent studies suggest older patients hospitalized for community-acquired pneumonia are at risk for new-onset cognitive impairment. The characteristics of long-term cognitive impairment after pneumonia, however, have not been elucidated. To characterize long-term cognitive impairment among adults of all ages hospitalized for community-acquired pneumonia. Prospective cohort study. Adults without severe preexisting cognitive impairment who were hospitalized with community-acquired pneumonia. At enrollment, we estimated baseline cognitive function with the Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). At 2- and 12-month follow-up, we assessed cognition using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and tests of executive function, diagnosing cognitive impairment when results were ≥ 1.5 standard deviations below published age-adjusted means for the general population. We also identified subtypes of mild cognitive impairment using standard definitions. We assessed 58 (73%) of 80 patients who survived to 2-month follow-up and 57 (77%) of 74 who survived to 12-month follow-up. The median [range] age of survivors tested was 57 [19-97] years. Only 8 (12%) had evidence of mild cognitive impairment at baseline according to the Short IQCODE, but 21 (38%) at 2 months and 17 (30%) at 12 months had mild cognitive impairment per the RBANS. Moderate-to-severe cognitive impairment was common among adults ≥ 65 years [4/13 (31%) and 5/13 (38%) at 2 and 12 months, respectively] but also affected many of those cognitive domains affected one-third of patients ≥ 65 years old and 20% of younger patients, and another third of survivors had mild cognitive impairment.

  15. A case of nosocomial Legionella pneumonia associated with a contaminated hospital cooling tower.

    Science.gov (United States)

    Osawa, Kayo; Shigemura, Katsumi; Abe, Yasuhisa; Jikimoto, Takumi; Yoshida, Hiroyuki; Fujisawa, Masato; Arakawa, Soichi

    2014-01-01

    We report the epidemiological investigation of a nosocomial pneumonia case due to Legionella pneumophila linked to a contaminated hospital cooling tower in an immune-compromised patient. A 73-year-old female patient was diagnosed with nosocomial Legionella pneumonia proven by a culture of L. pneumophila serogroup 1 from bronchoalveolar lavage fluid. Two strains isolated from the patient and two strains isolated from two cooling towers were found to be identical using repetitive-sequence-based-PCR with a 95% probability. This Legionella pneumonia case might be caused by aerosol from cooling towers on the roof of the hospital building which was contaminated by L. pneumophila. We increased up the temperature of hot water supply appropriately for prevention of Legionella breeding in an environment of patients' living. On the other hand, as the maintenance of cooling tower, we increased the frequency of Legionella culture tests from twice a year to three times a year. In addition, we introduced an automated disinfectants insertion machine and added one antiseptic reagent (BALSTER ST-40 N, Tohzai Chemical Industry Co., Ltd., Kawasaki, Japan) after this Legionella disease, and thereafter, we have no additional cases of Legionella disease or detection of Legionella spp. from the cooling tower or hot water supply. This case demonstrates the importance of detecting the infection source and carrying out environmental maintenance in cooperation with the infection control team. Copyright © 2013 Japanese Society of Chemotherapy and the Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  16. Patient positioning and ventilator-associated pneumonia.

    Science.gov (United States)

    Hess, Dean R

    2005-07-01

    Rotational beds, prone position, and semi-recumbent position have been proposed as procedures to prevent ventilator-associated pneumonia (VAP). Rotational therapy uses a special bed designed to turn continuously, or nearly continuously, the patient from side to side; specific designs include kinetic therapy and continuous lateral rotation therapy. A meta-analysis of studies evaluating the effect of rotational bed therapy shows a decrease in the risk of pneumonia but no effect on mortality. Two studies reported a lower risk of VAP in patients placed in a prone position, with no effect on mortality. Studies using radiolabeled enteral feeding solutions in mechanically ventilated patients have reported that aspiration of gastric contents occurs to a greater degree when patients are in the supine position, compared with the semirecumbent position. One study reported a lower rate of VAP in patients randomized to semi-recumbent compared to supine position. Although each of the techniques discussed in this paper has been shown to reduce the risk of VAP, none has been shown to affect mortality. The available evidence suggests that semi-recumbent position should be used routinely, rotational therapy should be considered in selected patients, and prone position should not be used as a technique to reduce the risk of VAP.

  17. Secular trends in Klebsiella pneumoniae isolated in a tertiary-care hospital: increasing prevalence and accelerated decline in antimicrobial susceptibility

    Directory of Open Access Journals (Sweden)

    Rodrigo de Carvalho Santana

    2016-04-01

    Full Text Available Abstract: INTRODUCTION Klebsiella pneumoniae has become an increasingly important etiologic agent of nosocomial infections in recent years. This is mainly due to the expression of virulence factors and development of resistance to several antimicrobial drugs. METHODS This retrospective study examines data obtained from the microbiology laboratory of a Brazilian tertiary-care hospital. To assess temporal trends in prevalence and antimicrobial susceptibility, K. pneumoniae isolates were analyzed from 2000 to 2013. The relative frequencies of K. pneumoniae isolation were calculated among all Gram-negative bacilli isolated in each period analyzed. Susceptibility tests were performed using automated systems. RESULTS: From 2000-2006, K. pneumonia isolates comprised 10.7% of isolated Gram-negative bacilli (455/4260. From 2007-2013, this percentage was 18.1% (965/5331. Strictly considering isolates from bloodstream infections, the relative annual prevalence of K. pneumoniae increased from 14-17% to 27-32% during the same periods. A progressive decrease in K. pneumoniae susceptibility to all antimicrobial agents assessed was detected. Partial resistance was also observed to antimicrobial drugs that have been used more recently, such as colistin and tigecycline. CONCLUSIONS Our study indicates that K. pneumoniae has become a major pathogen among hospitalized patients and confirms its recent trend of increasing antimicrobial resistance.

  18. Evaluation of the Yale New Haven Readmission Risk Score for Pneumonia in a General Hospital Population.

    Science.gov (United States)

    Schaefer, Gabrielle; El-Kareh, Robert; Quartarolo, Jennifer; Seymann, Gregory

    2017-09-01

    The Yale New Haven Readmission Risk Score (YNHRRS) for pneumonia is a clinical prediction tool developed to assess risk for 30-day readmission. This tool was validated in a cohort of Medicare patients; generalizability to a broader patient population has not been evaluated. In addition, it lacks indicators of functional status or social support, which have been shown in other studies to be predictors of readmission. The objective of this study was to evaluate the generalizability of the YNHRRS for pneumonia in a general population of hospitalized patients, and assess the impact of incorporating measures of functional status and social support on its predictive value. This retrospective chart review comprised all patients admitted to a 563-bed academic medical center with a primary diagnosis of pneumonia between March 2014 and March 2015. Abstraction of clinical variables allowed calculation of the YNHRRS and additional indicators of functional status and social support. The primary outcome was 30-day readmission rate. We created a logistic regression model to predict readmission using the YNHRRS, functional status, and social support as covariates. Among 270 discharges with pneumonia, the observed readmission rate was 23%. The YNHRRS was a significant predictor of readmission in our multivariate model, with an odds ratio of 2.20 (95% confidence interval, 1.29-3.73) for each 10% increase in calculated risk. Indicators of functional status and social support were not significant predictors of readmission. The YNHRRS can be applied to an unselected population as a tool to predict patients with pneumonia at risk for readmission. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Pneumonia risks in bedridden patients receiving oral care and their screening tool: Malnutrition and urinary tract infection-induced inflammation.

    Science.gov (United States)

    Matsusaka, Kaoru; Kawakami, Genichiro; Kamekawa, Hatsumi; Momma, Haruki; Nagatomi, Ryoichi; Itoh, Jun; Yamaya, Mutsuo

    2018-05-01

    Pneumonia develops in bedridden patients even when they are receiving oral care. However, the pneumonia risk in bedridden patients remains unclear, and no screening tool has been developed to assess this risk by using daily hospital data. We retrospectively examined pneumonia risk factors by analyzing the records of 102 bedridden patients receiving oral care. Body mass index, peripheral blood hemoglobin, and serum concentrations of total protein, albumin, total cholesterol and uric acid in the pneumonia group (n = 51; mean age 73.4 years) were lower than those in the non-pneumonia group (n = 51; mean age 68.1 years). In the univariate analysis, body mass index; leukocytosis; high C-reactive protein; low levels of hemoglobin, total protein and albumin (bedridden patient pneumonia risk (BPPR) score using these two risk factors to assess pneumonia risk. We applied scores of zero (0) or one (1) according to the absence or presence of the two risk factors and summed the scores in each patient. The proportion of pneumonia patients increased with increasing BPPR score when the patients were divided into three groups - low, moderate and high risk - according to the BPPR score (0, 1 or 2, respectively). Malnutrition, urinary tract infection-induced inflammation and anemia were associated with pneumonia in bedridden patients. BPPR scoring might be useful for assessing pneumonia risk and managing affected patients. Geriatr Gerontol Int 2018; 18: 714-722. © 2018 Japan Geriatrics Society.

  20. Pharmacoeconomic Analysis of Drugs Used in the Treatment of Pneumonia in Paediatric Population in a Tertiary Care Hospital in India-A Cost-of-Illness Study.

    Science.gov (United States)

    Saha, Lekha; Kaur, Sharonjeet; Khosla, Pratibha; Kumari, Sweta; Rani, Alka

    2017-12-11

    The cost of antibiotic therapy for the treatment of pneumonia in the inpatient paediatric population can have a major impact on the healthcare expenditure. We planned to assess the direct and indirect costs of diagnosis and medical treatment of paediatric patients with community acquired pneumonia who are hospitalized in a tertiary care hospital in India. 125 children with a diagnosis of pneumonia who were admitted to the inpatient department of a paediatric hospital receiving antibiotic treatment were observed. Data on clinical presentation and resources consumed were collected and the costs of pneumonia treatment were calculated. Descriptive statistics (mean ± standard deviation (SD)) were used to evaluate data regarding demographics, drugs prescribed and cost (direct and indirect cost). Multivariate regression analysis was used to find out predictors of direct and indirect cost. Among all pneumonia admissions, mild-to-moderate pneumonia constitutes 76.8%, and 23.2% children were admitted with severe pneumonia; 105 children out of 125 (84%) were suffering from associated disorders along with pneumonia. The majority of antibiotics prescribed belonged to beta lactams (52%) followed by aminoglycosides (19%), macrolides (13%) and peptides (11%). Parenteral routes of administration were used in a majority of patients as compared to oral. The average cost per patient in management of pneumonia was 12245 ± 593 INR ($187.34 ± 9.07).

  1. Pharmacoeconomic Analysis of Drugs Used in the Treatment of Pneumonia in Paediatric Population in a Tertiary Care Hospital in India—A Cost-of-Illness Study

    Directory of Open Access Journals (Sweden)

    Lekha Saha

    2017-12-01

    Full Text Available Aims and objectives: The cost of antibiotic therapy for the treatment of pneumonia in the inpatient paediatric population can have a major impact on the healthcare expenditure. We planned to assess the direct and indirect costs of diagnosis and medical treatment of paediatric patients with community acquired pneumonia who are hospitalized in a tertiary care hospital in India. Methods: 125 children with a diagnosis of pneumonia who were admitted to the inpatient department of a paediatric hospital receiving antibiotic treatment were observed. Data on clinical presentation and resources consumed were collected and the costs of pneumonia treatment were calculated. Descriptive statistics (mean ± standard deviation (SD were used to evaluate data regarding demographics, drugs prescribed and cost (direct and indirect cost. Multivariate regression analysis was used to find out predictors of direct and indirect cost. Results: Among all pneumonia admissions, mild-to-moderate pneumonia constitutes 76.8%, and 23.2% children were admitted with severe pneumonia; 105 children out of 125 (84% were suffering from associated disorders along with pneumonia. The majority of antibiotics prescribed belonged to beta lactams (52% followed by aminoglycosides (19%, macrolides (13% and peptides (11%. Parenteral routes of administration were used in a majority of patients as compared to oral. The average cost per patient in management of pneumonia was 12245 ± 593 INR ($187.34 ± 9.07.

  2. Pneumocystis carinii pneumonia in AIDS patients

    International Nuclear Information System (INIS)

    Wojtycha-Kwasnica, B.; Leszczynski, S.; Mian, M.; Mydlowska, A.

    1994-01-01

    On the basis of observed sixteen AIDS patients the authors discuss problems connected with early diagnosis, dynamics and differential diagnosis of chest radiographic findings during pneumocystis carinii pneumonia (pcp). 13 patients with P. carinii had the classic pulmonary appearance of this organism: a symmetrical diffuse perihilar interstitial infiltration and alveolar air-space consolidation. Pleural effusions and hilar adenopathy were characteristically absent. Three patients with pcp had unusual pulmonary features. In these cases the diagnosis was proven by laboratory tests and fiberooptic bronchoscopy. Early recognition of pulmonary findings improves the course of pcp. Contemporary existence of tuberculosis and Kaposi sarcoma makes worse the prognosis in AIDS patients with pcp. CT is an important part of the early diagnosis of pulmonary findings in pcp. (author)

  3. Pneumonia

    OpenAIRE

    Coelho, Liana Sousa [UNESP; Do Vale, Simone Alves [UNESP; Godoy, Irma de [UNESP; Tanni, Suzana Erico [UNESP

    2012-01-01

    Pneumonia is an infectious disease with great morbidity and mortality worldwide. According to the current guidelines recommendations the authors reviewed the treatment of community-acquired pneumonia (CAP) and health care-associated pneumonia (HCAP). In this paper will be also presented data about etiology, clinics and diagnostic tools. © Copyright Moreira Jr. Editora.

  4. Incidence of Hospitalized Pneumococcal Pneumonia among Adults in Guatemala, 2008-2012

    Science.gov (United States)

    Contreras, Carmen Lucía; Verani, Jennifer R.; Lopez, María Renee; Paredes, Antonio; Bernart, Chris; Moscoso, Fabiola; Roldan, Aleida; Arvelo, Wences; Lindblade, Kim A.; McCracken, John P.

    2015-01-01

    Background Streptococcus pneumoniae is a leading cause of pneumonia worldwide. However, the burden of pneumococcal pneumonia among adults in low- and middle-income countries is not well described. Methods Data from 2008–2012 was analyzed from two surveillance sites in Guatemala to describe the incidence of pneumococcal pneumonia in adults. A case of hospitalized pneumococcal pneumonia was defined as a positive pneumococcal urinary antigen test or blood culture in persons aged ≥ 18 years hospitalized with an acute respiratory infection (ARI). Results Among 1595 adults admitted with ARI, 1363 (82%) had either urine testing (n = 1286) or blood culture (n = 338) performed. Of these, 188 (14%) had pneumococcal pneumonia, including 173 detected by urine only, 8 by blood culture only, and 7 by both methods. Incidence rates increased with age, with the lowest rate among 18–24 year-olds (2.75/100,000) and the highest among ≥65 year-olds (31.3/100,000). The adjusted incidence of hospitalized pneumococcal pneumonia was 18.6/100,000 overall, with in-hospital mortality of 5%. Conclusions An important burden of hospitalized pneumococcal pneumonia in adults was described, particularly for the elderly. However, even adjusted rates likely underestimate the true burden of pneumococcal pneumonia in the community. These data provide a baseline against which to measure the indirect effects of the 2013 introduction of the pneumococcal conjugate vaccine in children in Guatemala. PMID:26488871

  5. Incidence of Hospitalized Pneumococcal Pneumonia among Adults in Guatemala, 2008-2012.

    Science.gov (United States)

    Contreras, Carmen Lucía; Verani, Jennifer R; Lopez, María Renee; Paredes, Antonio; Bernart, Chris; Moscoso, Fabiola; Roldan, Aleida; Arvelo, Wences; Lindblade, Kim A; McCracken, John P

    2015-01-01

    Streptococcus pneumoniae is a leading cause of pneumonia worldwide. However, the burden of pneumococcal pneumonia among adults in low- and middle-income countries is not well described. Data from 2008-2012 was analyzed from two surveillance sites in Guatemala to describe the incidence of pneumococcal pneumonia in adults. A case of hospitalized pneumococcal pneumonia was defined as a positive pneumococcal urinary antigen test or blood culture in persons aged ≥ 18 years hospitalized with an acute respiratory infection (ARI). Among 1595 adults admitted with ARI, 1363 (82%) had either urine testing (n = 1286) or blood culture (n = 338) performed. Of these, 188 (14%) had pneumococcal pneumonia, including 173 detected by urine only, 8 by blood culture only, and 7 by both methods. Incidence rates increased with age, with the lowest rate among 18-24 year-olds (2.75/100,000) and the highest among ≥65 year-olds (31.3/100,000). The adjusted incidence of hospitalized pneumococcal pneumonia was 18.6/100,000 overall, with in-hospital mortality of 5%. An important burden of hospitalized pneumococcal pneumonia in adults was described, particularly for the elderly. However, even adjusted rates likely underestimate the true burden of pneumococcal pneumonia in the community. These data provide a baseline against which to measure the indirect effects of the 2013 introduction of the pneumococcal conjugate vaccine in children in Guatemala.

  6. Hospital Outcomes of Adult Respiratory Tract Infections with Extended-Spectrum B-Lactamase (ESBL) Producing Klebsiella Pneumoniae

    OpenAIRE

    Loh, Li-Cher; Nor Izran Hanim bt Abdul Samad,; Rosdara Masayuni bt Mohd Sani,; Raman, Sree; Thayaparan, Tarmizi; Kumar, Shalini

    2007-01-01

    Klebsiella pneumoniae ranks high as a cause of adult pneumonia requiring hospitalization in Malaysia. To study whether extended-spectrum b-lactamase (ESBL) producing K. pneumoniae was linked to hospital outcomes, we retrospectively studied 441 cases of adult respiratory tract infections with microbial proven K. pneumoniae from an urban-based university teaching hospital between 2003 and 2004. 47 (10.6%) cases had ESBL. Requirement for ventilation and median length of hospital stay, were great...

  7. Postoperative pneumonia among patients with and without COPD in Spain from 2001 to 2015.

    Science.gov (United States)

    de Miguel-Díez, Javier; López-de-Andrés, Ana; Hernández-Barrera, Valentín; Jiménez-Trujillo, Isabel; Méndez-Bailón, Manuel; de Miguel-Yanes, José María; Jiménez-García, Rodrigo

    2018-02-13

    To describe and compare incidence, characteristics and outcomes of postoperative pneumonia among patients with or without COPD. We included hospitalized patients aged ≥40 years whose medical diagnosis included pneumonia and ventilator-associated pneumonia in the secondary's diagnosis field and who were discharged from Spanish hospitals from 2001 to 2015. Irrespectively of the position at the procedures coding list, we retrieved data about the type of surgical procedures using the enhanced ICD-9-CM codes. We grouped admissions by COPD status. The data were collected from the National Hospital Discharge Database. We included 117,665 hospitalizations of patients that developed postoperative pneumonia (18.06% of them had COPD). The incidence of postoperative pneumonia was significantly higher in COPD patients than in those without COPD (IRR 1.93, 95%CI 1.68-2.24). In hospital-mortality (IHM) was significantly lower in the first group of patients (29.79% vs 31.43%, p patients, were older age, more comorbidities, mechanical ventilation, pleural drainage tube, red blood cell transfusion, dialysis and emergency room admission. Time trend analysis showed a significant decrease in IHM from 2001 to 2015. COPD was associated with lower IHM (OR 0.91, 95%CI 0.88-0.95). The incidence of postoperative pneumonia was higher in COPD patients than in those without this disease. However, IHM was lower among COPD patients. IHM decreased over time, regardless of the existence or not of COPD. Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  8. Increased risk of pneumonia among ventilated patients with traumatic brain injury: every day counts!

    Science.gov (United States)

    Hui, Xuan; Haider, Adil H; Hashmi, Zain G; Rushing, Amy P; Dhiman, Nitasha; Scott, Valerie K; Selvarajah, Shalini; Haut, Elliott R; Efron, David T; Schneider, Eric B

    2013-09-01

    Patients with traumatic brain injury (TBI) frequently require mechanical ventilation (MV). The objective of this study was to examine the association between time spent on MV and the development of pneumonia among patients with TBI. Patients older than 18 y with head abbreviated injury scale (AIS) scores coded 1-6 requiring MV in the National Trauma Data Bank 2007-2010 data set were included. The study was limited to hospitals reporting pneumonia cases. AIS scores were calculated using ICDMAP-90 software. Patients with injuries in any other region with AIS score >3, significant burns, or a hospital length of stay >30 d were excluded. A generalized linear model was used to determine the approximate relative risk of developing all-cause pneumonia (aspiration pneumonia, ventilator-associated pneumonia [VAP], and infectious pneumonia identified by the International Classification of Disease, Ninth Revision, diagnosis code) for each day of MV, controlling for age, gender, Glasgow coma scale motor score, comorbidity (Charlson comorbidity index) score, insurance status, and injury type and severity. Among the 24,525 patients with TBI who required MV included in this study, 1593 (6.5%) developed all-cause pneumonia. After controlling for demographic and injury factors, each additional day on the ventilator was associated with a 7% increase in the risk of pneumonia (risk ratio 1.07, 95% confidence interval 1.07-1.08). Patients who have sustained TBIs and require MV are at higher risk for VAP than individuals extubated earlier; therefore, shortening MV exposure will likely reduce the risk of VAP. As patients with TBI frequently require MV because of neurologic impairment, it is key to develop aggressive strategies to expedite ventilator independence. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. The Prevalence of Oropharyngeal Dysphagia in Danish Patients Hospitalised with Community-Acquired Pneumonia

    DEFF Research Database (Denmark)

    Kristiansen, Dorte Melgaard; Baandrup, Ulrik; Bøgsted, Martin

    2017-01-01

    Community-acquired pneumonia (CAP) and oropharyngeal dysphagia (OD) are prevalent conditions in the elderly. The aim of this study was to explore the relationship between CAP, OD, and frailty in patients admitted to a department of respiratory medicine at a regional hospital. The outcome was mort......Community-acquired pneumonia (CAP) and oropharyngeal dysphagia (OD) are prevalent conditions in the elderly. The aim of this study was to explore the relationship between CAP, OD, and frailty in patients admitted to a department of respiratory medicine at a regional hospital. The outcome...

  10. The Mystery of Increased Hospitalizations of Elderly Patients

    Centers for Disease Control (CDC) Podcasts

    Pneumonia is a common illness that affects millions of people in the United States every year. In some people, particularly the elderly and those who are ill from pre-existing conditions, bacterial pneumonia may follow influenza or even a common cold. Dr. Martin Meltzer, discusses two articles in the May 2008 issue of Emerging Infectious Diseases journal about increased pneumonia-related hospitalizations of elderly patients in England.

  11. Elemental diets may reduce the risk of aspiration pneumonia in bedridden gastrostomy-fed patients.

    Science.gov (United States)

    Horiuchi, Akira; Nakayama, Yoshiko; Sakai, Ryosei; Suzuki, Manabu; Kajiyama, Masashi; Tanaka, Naoki

    2013-05-01

    Our clinical experience suggested that elemental diets were associated with a reduction in aspiration pneumonia among bedridden patients with percutaneous endoscopic gastrostomy (PEG). We compared the effects of elemental and standard liquid diets on the risk of clinical aspiration pneumonia and gastric emptying in bedridden patients receiving PEG feedings. Study 1: consecutive bedridden PEG patients received elemental diets or standard liquid diets in the same fashion. The frequency of defecation, diet aspirated from the trachea, and aspiration pneumonia during hospitalization were prospectively recorded. Study 2: a randomized, crossover trial using elemental or standard liquid diets containing (13)C sodium acetate as a tracer given to bedridden PEG patients who had experienced aspiration pneumonia. (13)C breath tests were performed to estimate gastric emptying. Study 1: 127 patients were enrolled, 60 with elemental and 67 with standard liquid diets. The diet was aspirated from the trachea in none (0%) with the elemental diet vs. 8 (11.9%) with standard liquid diets (P=0.0057); aspiration pneumonia developed none with the elemental diet vs. 5 (7.5%) with standard liquid diets (P=0.031) (number needed to treat 14, 95% confidence interval 7-85). Study 2: 19 patients were enrolled. The elemental diet was associated with a significant increase in the 10, 30 or 50% emptying (excretion) time (Pbedridden PEG patients. They may be preferred for bedridden PEG patients especially who have experienced aspiration pneumonia. Properly performed randomized-controlled trials are needed to prove this potential benefit.

  12. Prognostic value of vitamin D in patients with pneumonia: A ...

    African Journals Online (AJOL)

    Purpose: To investigate the prognostic role of vitamin D in pneumonia patients through meta-analysis. Methods: PubMed and Embase were systematically searched for relevant studies that assessed the impact of vitamin D on the risk of adverse outcomes among patients with pneumonia. Risk ratios (RR) with 95 ...

  13. Elderly patients with community-acquired pneumonia are not treated according to current guidelines

    DEFF Research Database (Denmark)

    Lindhardt Damsgaard, Tove; Klausen, Henrik Hedegaard; Christiansen, Christina

    2013-01-01

    Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in elderly patients, and the most important cause of death in the developed world. Optimised treatment and care will benefit patients as well as the health economy. This study investigated in-hospital compliance...

  14. The effect of marital status on the presentation and outcomes of elderly male veterans hospitalized for pneumonia.

    Science.gov (United States)

    Metersky, Mark L; Fine, Michael J; Mortensen, Eric M

    2012-10-01

    Although marital status has been shown to affect the outcomes of many conditions, there are limited data on the relationships between marital status and the presentation and outcomes of pneumonia. We used Veterans Affairs administrative databases to identify a retrospective cohort of male veterans age ≥ 65 years hospitalized for pneumonia between 2002 and 2007. We assessed unadjusted and adjusted associations between marital status and mortality, hospital length of stay, and readmission to the hospital using generalized linear mixed-effect models with admitting hospital as a random effect and adjusted for baseline patient characteristics. There were 48,635 patients (26,558 married and 22,077 unmarried) in the study. Married men had a slightly higher Charlson comorbidity score (3.0 vs 2.8, P Married patients had significantly lower crude and adjusted in-hospital mortality (9.4% vs 10.6%; adjusted OR, 0.87; 95% CI, 0.81-0.93) and mortality during the 90 days after hospital discharge (14.7% vs 16.0%; adjusted OR, 0.92; 95% CI, 0.88-0.98). Their adjusted incidence rate ratio length of stay was also lower (0.92; 95% CI, 0.91-0.92). Unmarried elderly men admitted to the hospital with pneumonia have a higher risk of in-hospital and postdischarge mortality, despite having a lower degree of comorbidity. Although marital status may be a surrogate marker for other predictors, it is an easily identifiable one. These results should be considered by those responsible for care-transition decisions for patients hospitalized with pneumonia.

  15. Appropriateness of clinical severity classification of new WHO childhood pneumonia guidance: a multi-hospital, retrospective, cohort study.

    Science.gov (United States)

    Agweyu, Ambrose; Lilford, Richard J; English, Mike

    2018-01-01

    Management of pneumonia in many low-income and middle-income countries is based on WHO guidelines that classify children according to clinical signs that define thresholds of risk. We aimed to establish whether some children categorised as eligible for outpatient treatment might have a risk of death warranting their treatment in hospital. We did a retrospective cohort study of children aged 2-59 months admitted to one of 14 hospitals in Kenya with pneumonia between March 1, 2014, and Feb 29, 2016, before revised WHO pneumonia guidelines were adopted in the country. We modelled associations with inpatient mortality using logistic regression and calculated absolute risks of mortality for presenting clinical features among children who would, as part of revised WHO pneumonia guidelines, be eligible for outpatient treatment (non-severe pneumonia). We assessed 16 162 children who were admitted to hospital in this period. 832 (5%) of 16 031 children died. Among groups defined according to new WHO guidelines, 321 (3%) of 11 788 patients with non-severe pneumonia died compared with 488 (14%) of 3434 patients with severe pneumonia. Three characteristics were strongly associated with death of children retrospectively classified as having non-severe pneumonia: severe pallor (adjusted risk ratio 5·9, 95% CI 5·1-6·8), mild to moderate pallor (3·4, 3·0-3·8), and weight-for-age Z score (WAZ) less than -3 SD (3·8, 3·4-4·3). Additional factors that were independently associated with death were: WAZ less than -2 to -3 SD, age younger than 12 months, lower chest wall indrawing, respiratory rate of 70 breaths per min or more, female sex, admission to hospital in a malaria endemic region, moderate dehydration, and an axillary temperature of 39°C or more. In settings of high mortality, WAZ less than -3 SD or any degree of pallor among children with non-severe pneumonia was associated with a clinically important risk of death. Our data suggest that admission to hospital

  16. Impact of an antimicrobial stewardship intervention on appropriateness of prescribing for community-acquired pneumonia in an Australian regional hospital.

    Science.gov (United States)

    Bond, Stuart E; Boutlis, Craig S; Yeo, Wilfred W; Miyakis, Spiros

    2017-05-01

    Community-acquired pneumonia (CAP) is the second commonest indication for antibiotic use in Australian hospitals and is therefore a frequent target for antimicrobial stewardship. A single-centre prospective study was conducted in a regional referral hospital comparing management of adult patients with CAP before and after an educational intervention. We demonstrated a reduction in duration of therapy and reduced inappropriate use of ceftriaxone-based regimens for non-severe CAP. © 2017 Royal Australasian College of Physicians.

  17. Mortality after hospitalization for pneumonia among individuals with HIV, 1995-2008: a Danish cohort study

    DEFF Research Database (Denmark)

    Soegaard, O.S.; Lohse, N.; Gerstoft, J.

    2009-01-01

    -based cohort of individuals with HIV, we included persons hospitalized with pneumonia from the Danish National Hospital Registry and obtained mortality data from the Danish Civil Registration System. Comparing individuals with and without pneumonia, we used Poisson regression to estimate relative mortality....... The following variables predicted mortality within 90 days following hospitalization for pneumonia (adjusted Odds Ratios): male sex (3.77, 95% CI: 1.37-10.4), Charlson Comorbidity Index score > or = 2 (3.86, 95% CI: 2.19-6.78); no current HAART (3.58, 95% CI: 1.83-6.99); history of AIDS (2.46, 95% CI: 1...

  18. The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study.

    Science.gov (United States)

    Marik, P E; Careau, P

    1999-01-01

    Aspiration of oropharyngeal material, with its high concentration of anaerobic bacteria, has been implicated in the pathogenesis of both ventilator-associated pneumonia (VAP) and aspiration pneumonitis (AP). Consequently, patients with these disorders are usually treated with antimicrobial agents with anaerobic activity. To determine the incidence of anaerobic bacteria in patients with VAP and AP. Prospective, nonrandomized, interventional study. University-affiliated community teaching hospital. We performed sequential blind protected specimen brush (PSB) sampling and mini-BAL in 143 patients with 185 episodes of suspected VAP and 25 patients with AP who required mechanical ventilation. Quantitative aerobic and anaerobic cultures were performed on all specimens. Pneumonia was considered to be present when either > 500 cfu/mL cultured from blind PSB sampling or > 5,000 cfu/mL cultured from mini-BAL were present. Using the predefined criteria, bacterial pneumonia was diagnosed in 63 of 185 suspected VAP episodes (34%) and 12 of 25 patients with AP (48%). At least one dose of an antibiotic was given in the 24 h prior to bacteriologic sampling in 106 suspected VAP episodes (57%) and in 12 patients with AP (48%). More than one pathogen was isolated from 11 VAP and four AP patients. Pseudomonas aeruginosa, Staphylococcus aureus, and enteric Gram-negative organisms were isolated most frequently from patients with VAP. In the patients with AP, enteric Gram-negative organisms were isolated in patients with GI disorders and Streptococcus pneumoniae and Haemophilus influenzae predominated in patients with "community-acquired" aspiration. Only one anaerobic organism was isolated from the entire group of patients; Veillonella paravula was isolated from a blind PSB specimen in a patient with suspected aspiration pneumonia. Despite painstaking effort, we were able to isolate only one anaerobic organism (nonpathogenic) from this group of patients. The spectrum of aerobes in

  19. Pneumonia caused by Bordetella bronchiseptica in two HIV-positive patients

    Directory of Open Access Journals (Sweden)

    Roberta Filipini Rampelotto

    Full Text Available ABSTRACT: CONTEXT AND OBJECTIVE: Bordetella bronchiseptica (BB is a Gram-negative coccobacillus responsible for respiratory diseases in dogs, cats and rabbits. Reports on its development in humans are rare. However, in immunosuppressed patients, especially in those with the immunodeficiency virus (HIV, BB can cause severe pulmonary infections. We report on two cases of pneumonia caused by BB in HIV-positive male patients in a university hospital. CASE REPORT: The first case comprised a 43-year-old patient who was admitted presenting chronic leg pain and coughing, with suspected pneumonia. BB was isolated from sputum culture and was successfully treated with trimethoprim/sulfamethoxazole in association with levofloxacin. The second case comprised a 49-year-old patient who was admitted presenting fever, nausea, sweating and a dry cough, also with suspected pneumonia. BB was isolated from sputum culture, tracheal secretions and bronchoalveolar lavage. The disease was treated with ciprofloxacin but the patient died. CONCLUSION: BB should be included in the etiology of pneumonia in immunodeficient HIV patients. As far as we know, these two were the first cases of pneumonia due to BB to occur in this university hospital.

  20. FEATURES OF PNEUMONIA IN HIV-INFECTED PATIENTS

    Directory of Open Access Journals (Sweden)

    M. T. Vatutin

    2016-01-01

    Full Text Available The article presents the clinical, diagnostic and treatment features of pneumocystis pneumonia in HIV-infected patients. The clinical case of diagnosis verification in a patient 58 years old with severe respiratory failure is described.

  1. Risks of pneumonia in patients with asthma taking inhaled corticosteroids

    DEFF Research Database (Denmark)

    O'Byrne, Paul M; Pedersen, Soren; Carlsson, Lars-Göran

    2011-01-01

    Rationale: Inhaled corticosteroids (ICS) are the mainstay of asthma treatment. Studies in chronic obstructive pulmonary disease reported increased rates of pneumonia with ICS. Concerns exist about an increased pneumonia risk in patients with asthma taking ICS. Objectives: To evaluate the risks...... of pneumonia in patients with asthma taking ICS. Methods: A retrospective analysis evaluated studies of the ICS budesonide in asthma. The primary data set were all double-blind, placebo-controlled trials lasting at least 3 months, involving budesonide (26 trials, n = 9,067 for budesonide; n = 5...... effect of ICS on pneumonia adverse events (AEs) or serious adverse events (SAEs). Measurements and Main Results: In the primary data set, the occurrence of pneumonia AEs was 0.5% (rate 10.0 events/1,000 patient-years [TPY]) for budesonide and 1.2% (19.3 per TPY) for placebo (hazard ratio, 0.52; 95...

  2. Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients.

    Science.gov (United States)

    Ugajin, Motoi; Yamaki, Kenichi; Hirasawa, Natsuko; Kobayashi, Takanori; Yagi, Takeo

    2014-01-01

    The credibility of prognostic indicators in nursing-home-acquired pneumonia (NHAP) is not clear. We previously reported a simple prognostic indicator in community-acquired pneumonia (CAP): blood urea nitrogen to serum albumin (B/A) ratio. This retrospective study investigated the prognostic value of severity indicators in NHAP versus CAP in elderly patients. Patients aged ≥65 years and hospitalized because of NHAP or CAP within the previous 3 years were enrolled. Demographics, coexisting illnesses, laboratory and microbiological findings, and severity scores (confusion, urea, respiratory rate, blood pressure, and age ≥65 [CURB-65] scale; age, dehydration, respiratory failure, orientation disturbance, and pressure [A-DROP] scale; and pneumonia severity index [PSI]) were retrieved from medical records. The primary outcome was mortality within 28 days of admission. In total, 138 NHAP and 307 CAP patients were enrolled. Mortality was higher in NHAP (18.1%) than in CAP (4.6%) (Pscale, 0.69 for the CURB-65 scale, 0.67 for the PSI class, and 0.65 for the B/A ratio. The area under the curve in CAP was 0.73 for the A-DROP scale, 0.76 for the CURB-65 scale, 0.81 for the PSI class, and 0.83 for the B/A ratio. Patient mortality was greater in NHAP than in CAP. Patient characteristics, coexisting illnesses, and detected pathogens differed greatly between NHAP and CAP. The existing severity indicators had less prognostic value for NHAP than for CAP.

  3. Prognostic value of vitamin D in patients with pneumonia: A ...

    African Journals Online (AJOL)

    1Management Office of Hospital Infection, 2Department of Tuberculosis Internal Medicine, The Chest Hospital of Linyi, Linyi. City, Shandong Province .... Retrospective cohort. Ethiopia. 521 children younger than 5 years with a diagnosis of pneumonia. None. Low level. Leow (2011) [25]. Prospective cohort. New Zealand.

  4. [Correlation between post-stroke pneumonia and outcome in patients with acute brain infarction].

    Science.gov (United States)

    Li, S J; Hu, H Q; Wang, X L; Cao, B Z

    2016-09-20

    Objective: To investigate the correlation between post-stroke pneumonia and outcome in patients with acute brain infarction. Methods: Consecutive acute cerebral infarction patients who were hospitalized in Department of Neurology, Jinan Military General Hospital were prospectively recruited from August 2010 to August 2014. The baseline data including age, sex, the National Institute of Health Stroke Scale (NIHSS) scores, type of Oxfordshire Community Stroke Project (OCSP: total anterior circulation infarct, partial anterior circulation infarct, posterior circulation infarct and lacunar infarct), fasting blood glucose etc. after admission were recorded. Post-stroke pneumonia was diagnosed by treating physician according to criteria for hospital-acquired pneumonia of the Centers for Disease Control and Prevention. Recovery was assessed by modified Rankin Scale (mRS) 180 days after stroke by telephone interview (mRS≤2 reflected good prognosis, and mRS>2 reflected unfavorable prognosis). Multinominal Logistic regression analysis, Kaplan-Meier curve and log rank test were used. Results: A total of 1 249 patients were enrolled, among them 173 patients were lost during follow-up. A total of 159 patients had post-stroke pneumonia, while 1 090 patients were without post-stroke. Compared with patients without post-stoke pneumonia, patients with post-stroke pneumonia were older (67±13 vs 63±12 years, P =0.000), more severe (NIHSS, 15(14) vs 4(4), P =0.000). Compared with patients without post-stoke pneumonia, more patients with post-stroke pneumonia suffered from heart failure (12.58% vs 3.40%, P =0.000), atrial fibrillation (26.42% vs 8.81%, P =0.000), myocardial infarction (10.06% vs 5.05%, P =0.016), recurrent brain infarction (30.19% vs 22.66%, P =0.045), total anterior circulation infarct type of OCSP (46.54% vs 19.63%, P =0.000), posterior circulation infarct of OCSP (39.62% vs 25.51%, P =0.001); more patients suffered from disorder of consciousness (60.38% vs 9

  5. iTRAQ-based Quantitative Proteomics Study in Patients with Refractory Mycoplasma pneumoniae Pneumonia.

    Science.gov (United States)

    Yu, Jia-Lu; Song, Qi-Fang; Xie, Zhi-Wei; Jiang, Wen-Hui; Chen, Jia-Hui; Fan, Hui-Feng; Xie, Ya-Ping; Lu, Gen

    2017-09-25

    Mycoplasma pneumoniae (MP) is a leading cause of community-acquired pneumonia in children and young adults. Although MP pneumonia is usually benign and self-limited, in some cases it can develop into life-threating refractory MP pneumonia (RMPP). However, the pathogenesis of RMPP is poorly understood. The identification and characterization of proteins related to RMPP could provide a proof of principle to facilitate appropriate diagnostic and therapeutic strategies for treating paients with MP. In this study, we used a quantitative proteomic technique (iTRAQ) to analyze MP-related proteins in serum samples from 5 patients with RMPP, 5 patients with non-refractory MP pneumonia (NRMPP), and 5 healthy children. Functional classification, sub-cellular localization, and protein interaction network analysis were carried out based on protein annotation through evolutionary relationship (PANTHER) and Cytoscape analysis. A total of 260 differentially expressed proteins were identified in the RMPP and NRMPP groups. Compared to the control group, the NRMPP and RMPP groups showed 134 (70 up-regulated and 64 down-regulated) and 126 (63 up-regulated and 63 down-regulated) differentially expressed proteins, respectively. The complex functional classification and protein interaction network of the identified proteins reflected the complex pathogenesis of RMPP. Our study provides the first comprehensive proteome map of RMPP-related proteins from MP pneumonia. These profiles may be useful as part of a diagnostic panel, and the identified proteins provide new insights into the pathological mechanisms underlying RMPP.

  6. Should International Classification of Diseases codes be used to survey hospital-acquired pneumonia?

    Science.gov (United States)

    Wolfensberger, A; Meier, A H; Kuster, S P; Mehra, T; Meier, M-T; Sax, H

    2018-05-01

    As surveillance of hospital-acquired pneumonia (HAP) is very resource intensive, alternatives for HAP surveillance are needed urgently. This study compared HAP rates according to routine discharge diagnostic codes of the International Classification of Diseases, 10 th Revision (ICD-10; ICD-HAP) with HAP rates according to the validated surveillance definitions of the Hospitals in Europe Link for Infection Control through Surveillance (HELICS/IPSE; HELICS-HAP) by manual retrospective re-evaluation of patient records. The positive predictive value of ICD-HAP for HELICS-HAP was 0.35, and sensitivity was 0.59. Therefore, the currently available ICD-10-based routine discharge data do not allow reliable identification of patients with HAP. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  7. Dysbiosis of upper respiratory tract microbiota in elderly pneumonia patients.

    Science.gov (United States)

    de Steenhuijsen Piters, Wouter A A; Huijskens, Elisabeth G W; Wyllie, Anne L; Biesbroek, Giske; van den Bergh, Menno R; Veenhoven, Reinier H; Wang, Xinhui; Trzciński, Krzysztof; Bonten, Marc J; Rossen, John W A; Sanders, Elisabeth A M; Bogaert, Debby

    2016-01-01

    Bacterial pneumonia is a major cause of morbidity and mortality in elderly. We hypothesize that dysbiosis between regular residents of the upper respiratory tract (URT) microbiome, that is balance between commensals and potential pathogens, is involved in pathogen overgrowth and consequently disease. We compared oropharyngeal microbiota of elderly pneumonia patients (n=100) with healthy elderly (n=91) by 16S-rRNA-based sequencing and verified our findings in young adult pneumonia patients (n=27) and young healthy adults (n=187). Microbiota profiles differed significantly between elderly pneumonia patients and healthy elderly (PERMANOVA, P<0.0005). Highly similar differences were observed between microbiota profiles of young adult pneumonia patients and their healthy controls. Clustering resulted in 11 (sub)clusters including 95% (386/405) of samples. We observed three microbiota profiles strongly associated with pneumonia (P<0.05) and either dominated by lactobacilli (n=11), Rothia (n=51) or Streptococcus (pseudo)pneumoniae (n=42). In contrast, three other microbiota clusters (in total n=183) were correlated with health (P<0.05) and were all characterized by more diverse profiles containing higher abundances of especially Prevotella melaninogenica, Veillonella and Leptotrichia. For the remaining clusters (n=99), the association with health or disease was less clear. A decision tree model based on the relative abundance of five bacterial community members in URT microbiota showed high specificity of 95% and sensitivity of 84% (89% and 73%, respectively, after cross-validation) for differentiating pneumonia patients from healthy individuals. These results suggest that pneumonia in elderly and young adults is associated with dysbiosis of the URT microbiome with bacterial overgrowth of single species and absence of distinct anaerobic bacteria. Whether the observed microbiome changes are a cause or a consequence of the development of pneumonia or merely coincide with

  8. The Multidisciplinary Swallowing Team Approach Decreases Pneumonia Onset in Acute Stroke Patients.

    Directory of Open Access Journals (Sweden)

    Shiro Aoki

    Full Text Available Dysphagia occurs in acute stroke patients at high rates, and many of them develop aspiration pneumonia. Team approaches with the cooperation of various professionals have the power to improve the quality of medical care, utilizing the specialized knowledge and skills of each professional. In our hospital, a multidisciplinary participatory swallowing team was organized. The aim of this study was to clarify the influence of a team approach on dysphagia by comparing the rates of pneumonia in acute stroke patients prior to and post team organization. All consecutive acute stroke patients who were admitted to our hospital between April 2009 and March 2014 were registered. We analyzed the difference in the rate of pneumonia onset between the periods before team organization (prior period and after team organization (post period. Univariate and multivariate analyses were performed using a Cox proportional hazards model to determine the predictors of pneumonia. We recruited 132 acute stroke patients from the prior period and 173 patients from the post period. Pneumonia onset was less frequent in the post period compared with the prior period (6.9% vs. 15.9%, respectively; p = 0.01. Based on a multivariate analysis using a Cox proportional hazards model, it was determined that a swallowing team approach was related to pneumonia onset independent from the National Institutes of Health Stroke Scale score on admission (adjusted hazard ratio 0.41, 95% confidence interval 0.19-0.84, p = 0.02. The multidisciplinary participatory swallowing team effectively decreased the pneumonia onset in acute stroke patients.

  9. Metabolic Profiling in Patients with Pneumonia on Intensive Care.

    Science.gov (United States)

    Antcliffe, David; Jiménez, Beatriz; Veselkov, Kirill; Holmes, Elaine; Gordon, Anthony C

    2017-04-01

    Clinical features and investigations lack predictive value when diagnosing pneumonia, especially when patients are ventilated and when patients develop ventilator associated pneumonia (VAP). New tools to aid diagnosis are important to improve outcomes. This pilot study examines the potential for metabolic profiling to aid the diagnosis in critical care. In this prospective observational study ventilated patients with brain injuries or pneumonia were recruited in the intensive care unit and serum samples were collected soon after the start of ventilation. Metabolic profiles were produced using 1D 1 H NMR spectra. Metabolic data were compared using multivariate statistical techniques including Principal Component Analysis (PCA) and Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA). We recruited 15 patients with pneumonia and 26 with brain injuries, seven of whom went on to develop VAP. Comparison of metabolic profiles using OPLS-DA differentiated those with pneumonia from those with brain injuries (R 2 Y=0.91, Q 2 Y=0.28, p=0.02) and those with VAP from those without (R 2 Y=0.94, Q 2 Y=0.27, p=0.05). Metabolites that differentiated patients with pneumonia included lipid species, amino acids and glycoproteins. Metabolic profiling shows promise to aid in the diagnosis of pneumonia in ventilated patients and may allow a more timely diagnosis and better use of antibiotics. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  10. Economic aspects of hospital treated pneumococcal pneumonia and the results of Pneumo 23 vaccine use in Serbia

    Directory of Open Access Journals (Sweden)

    Adžić Tatjana

    2008-01-01

    Full Text Available INTRODUCTION In Serbia, there is a significant number of persons suffering of pneumococcal pneumonia. Persons aged 65 years or older, immunocompromised patients, patients with co-morbidities, such as chronic obstructive lung disease and congestive heart failure, are at the highest risk for developing pneumococcal pneumonia. Most of the patients are treated empirically, although it is often overlooked that Streptococcus pneumoniae can be resistant to the used antibiotics. The treatment costs of such inpatients and outpatients are very high. In Serbia, immunization of persons at risk to develop the diseases caused by Streptococcus pneumoniae is carried out using pneumococcus polysaccharide vaccine according to clinical indications. The exact number of immunized persons and the total number of registered patients are still unknown, but it is certain of being unjustifiably low. OBJECTIVE The goal of the study was to investigate, during a one-year period, the number and basic characteristics of persons hospitably treated for pneumonia, the type of cause of the infection, applied antibiotic medications, duration and costs of hospital treatment at the Institute for Lung Diseases and Tuberculosis of the Clinical Centre of Serbia in Belgrade. METHOD We retrospectively analyzed the medical records of patients with pneumonia treated at the Institute for Lung Diseases and Tuberculosis of the Clinical Centre of Serbia in Belgrade during 2006. RESULTS During the observed one-year period, 290 patients underwent hospital treatment, of whom the cause of the infection was confirmed in 116 (40%. The average duration of hospitalization was 12 days, with treatment cost of 32,031.74 RSD (402.42 EUR per patient. The treatment cost per patient including general and intensive care was 18,290.01 RSD (229.78 EUR. The distribution cost of Pneumo 23 vaccine in Serbia, without purchase tax, was 746.90 RSD (9.38 EUR. CONCLUSION Pneumococcal pneumonia is a significant medical

  11. [Cross-cultural adaptation of the community-acquired pneumonia score questionnaire in patients with mild-to-moderate pneumonia in Colombia].

    Science.gov (United States)

    Bernal-Vargas, Mónica Alejandra; Cortés, Jorge Alberto; Sánchez, Ricardo

    2017-01-24

    One of the strategies for the rational use of antibiotics is the use of the score for community-acquired pneumonia (CAP Score). This instrument clinically evaluates patients with community-acquired pneumonia, thereby facilitating decision making regarding the early and safe withdrawal of antibiotics. To generate a translation and cross-cultural adaptation of the Community-Acquired Pneumonia (CAP) Score questionnaire in Spanish. Authorization for cross-cultural adaptation of the Community-Acquired Pneumonia (CAP) Score questionnaire was obtained; the recommendations of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the European Organisation for Research and Treatment of Cancer (EORTC) were carried out through the following stages: forward translation, reconciliation, backward translation, harmonization, obtaining a provisional questionnaire, and applying the questionnaire in a pilot test. The pilot test was conducted at a second-level public hospital in Bogotá after the study was approved by the ethics and research institutional boards. The changes suggested by the forward translators were applied. There were no discrepancies between the backward and forward translations, consequently, no revisions were necessary. Five items had modifications based on suggestions made by eleven patients hospitalized with a diagnosis of community-acquired pneumonia during the pilot test. A Spanish version of the Community-Acquired Pneumonia (CAP) Score was crossculturally adapted and is now available.

  12. Trajectories of Risk for Specific Readmission Diagnoses after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia.

    Science.gov (United States)

    Krumholz, Harlan M; Hsieh, Angela; Dreyer, Rachel P; Welsh, John; Desai, Nihar R; Dharmarajan, Kumar

    2016-01-01

    The risk of rehospitalization is elevated in the immediate post-discharge period and declines over time. It is not known if the extent and timing of risk vary across readmission diagnoses, suggesting that recovery and vulnerability after discharge differ by physiologic system. We compared risk trajectories for major readmission diagnoses in the year after discharge among all Medicare fee-for-service beneficiaries hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia from 2008-2010. We estimated the daily risk of rehospitalization for 12 major readmission diagnostic categories after accounting for the competing risk of death after discharge. For each diagnostic category, we identified (1) the time required for readmission risk to peak and then decline 50% from maximum values after discharge; (2) the time required for readmission risk to approach plateau periods of minimal day-to-day change; and (3) the extent to which hospitalization risks are higher among patients recently discharged from the hospital compared with the general elderly population. Among >3,000,000 hospitalizations, the yearly rate of rehospitalization was 67.0%, 49.5%, and 55.3% after hospitalization for HF, AMI, and pneumonia, respectively. The extent and timing of risk varied by readmission diagnosis and initial admitting condition. Risk of readmission for gastrointestinal bleeding/anemia peaked particularly late after hospital discharge, occurring 10, 6, and 7 days after hospitalization for HF, AMI, and pneumonia, respectively. Risk of readmission for trauma/injury declined particularly slowly, requiring 38, 20, and 38 days to decline by 50% after hospitalization for HF, AMI, and pneumonia, respectively. Patterns of vulnerability to different conditions that cause rehospitalization vary by time after hospital discharge. This finding suggests that recovery of various physiologic systems occurs at different rates and that post-discharge interventions to minimize

  13. Trajectories of Risk for Specific Readmission Diagnoses after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia.

    Directory of Open Access Journals (Sweden)

    Harlan M Krumholz

    Full Text Available The risk of rehospitalization is elevated in the immediate post-discharge period and declines over time. It is not known if the extent and timing of risk vary across readmission diagnoses, suggesting that recovery and vulnerability after discharge differ by physiologic system.We compared risk trajectories for major readmission diagnoses in the year after discharge among all Medicare fee-for-service beneficiaries hospitalized with heart failure (HF, acute myocardial infarction (AMI, or pneumonia from 2008-2010.We estimated the daily risk of rehospitalization for 12 major readmission diagnostic categories after accounting for the competing risk of death after discharge. For each diagnostic category, we identified (1 the time required for readmission risk to peak and then decline 50% from maximum values after discharge; (2 the time required for readmission risk to approach plateau periods of minimal day-to-day change; and (3 the extent to which hospitalization risks are higher among patients recently discharged from the hospital compared with the general elderly population.Among >3,000,000 hospitalizations, the yearly rate of rehospitalization was 67.0%, 49.5%, and 55.3% after hospitalization for HF, AMI, and pneumonia, respectively. The extent and timing of risk varied by readmission diagnosis and initial admitting condition. Risk of readmission for gastrointestinal bleeding/anemia peaked particularly late after hospital discharge, occurring 10, 6, and 7 days after hospitalization for HF, AMI, and pneumonia, respectively. Risk of readmission for trauma/injury declined particularly slowly, requiring 38, 20, and 38 days to decline by 50% after hospitalization for HF, AMI, and pneumonia, respectively.Patterns of vulnerability to different conditions that cause rehospitalization vary by time after hospital discharge. This finding suggests that recovery of various physiologic systems occurs at different rates and that post-discharge interventions to

  14. Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients

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    Ugajin M

    2014-02-01

    Full Text Available Motoi Ugajin, Kenichi Yamaki, Natsuko Hirasawa, Takanori Kobayashi, Takeo Yagi Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan Background: The credibility of prognostic indicators in nursing-home-acquired pneumonia (NHAP is not clear. We previously reported a simple prognostic indicator in community-acquired pneumonia (CAP: blood urea nitrogen to serum albumin (B/A ratio. This retrospective study investigated the prognostic value of severity indicators in NHAP versus CAP in elderly patients. Methods: Patients aged ≥65 years and hospitalized because of NHAP or CAP within the previous 3 years were enrolled. Demographics, coexisting illnesses, laboratory and microbiological findings, and severity scores (confusion, urea, respiratory rate, blood pressure, and age ≥65 [CURB-65] scale; age, dehydration, respiratory failure, orientation disturbance, and pressure [A-DROP] scale; and pneumonia severity index [PSI] were retrieved from medical records. The primary outcome was mortality within 28 days of admission. Results: In total, 138 NHAP and 307 CAP patients were enrolled. Mortality was higher in NHAP (18.1% than in CAP (4.6% (P<0.001. Patients with NHAP were older and had lower functional status and a higher rate of do-not-resuscitate orders, heart failure, and cerebrovascular diseases. The NHAP patients more frequently had typical bacterial pathogens. Using the receiver-operating characteristics curve for predicting mortality, the area under the curve in NHAP was 0.70 for the A-DROP scale, 0.69 for the CURB-65 scale, 0.67 for the PSI class, and 0.65 for the B/A ratio. The area under the curve in CAP was 0.73 for the A-DROP scale, 0.76 for the CURB-65 scale, 0.81 for the PSI class, and 0.83 for the B/A ratio. Conclusion: Patient mortality was greater in NHAP than in CAP. Patient characteristics, coexisting illnesses, and detected pathogens differed greatly between NHAP and CAP. The existing severity indicators

  15. Correlation between radiological and pathological findings in patients with Mycoplasma pneumoniae pneumonia

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    Hiroshi eTanaka

    2016-05-01

    Full Text Available Studies focused on the pathological-radiological correlation of human Mycoplasma (M pneumoniae pneumonia have rarely been reported. Therefore, we extensively reviewed the literature regarding pathological and radiological studies of Mycoplasma pneumonia, and compared findings between open lung biopsy specimen and computed tomography (CT. Major three correlations were summarized. 1 Peribronchial and perivascular cuffing characterized by mononuclear cells infiltration was correlated with bronchovascular bundles thickening on CT, which was the most common finding of this pneumonia. 2 Cellular bronchitis in the small airways accompanied with exudates or granulation tissue in the lumen revealed as centrilobular nodules on CT. 3 Neutrophils and exudates in the alveolar lumen radiologically demonstrated as air-apace consolidation or ground-glass opacities. In M.pulmonis-infected mice model, pathologic patterns are strikingly different according to host cell-mediated immunity (CMI levels; treatment with interleukin-2 lead to marked cellular bronchitis in the small airways and treatment with prednisolone or cyclosporin-A lead to neutrophils and exudates in the alveolar lumen. Patients with centrilobular nodules predominant radiologic pattern have a high level of CMI, measuring by tuberculin skin test. From these findings, up-regulation of host CMI could change radiological pattern to centrilobular nodules predominant, on the other hand down-regulation of host CMI would change radiological pattern to ground-glass opacity and consolidation. It was suggested the pathological features of M. pneumoniae pneumonia may be altered by the level of host CMI.

  16. Dying in Hospital with Dementia and Pneumonia: A Nationwide Study Using Death Certificate Data

    NARCIS (Netherlands)

    Houttekier, D.; Reyniers, T.; Deliens, L.; Den Noortgate, N.; Cohen, J.

    2014-01-01

    Background: For people with dementia dying from pneumonia, hospitalization at the end of life may be of little benefit and result in unfavourable outcomes such as hospital death. Objective: The aim of this study is to estimate the incidence of and factors associated with hospital death in people

  17. Bronchiolitis obliterans organising pneumonia in patients taking acebutolol or amiodarone.

    Science.gov (United States)

    Camus, P; Lombard, J N; Perrichon, M; Piard, F; Guérin, J C; Thivolet, F B; Jeannin, L

    1989-01-01

    Two patients, treated with acebutolol and amiodarone respectively, developed a disease clinically, radiologically, and pathologically indistinguishable from bronchiolitis obliterans organising pneumonia. In one case recovery followed discontinuation of acebutolol; in the other case cessation of amiodarone had no effect, and corticosteroids were required. In addition to these patients, several cases of bronchiolitis obliterans organising pneumonia have been reported during treatment with gold salts, amiodarone, and miscellaneous other drugs. Taken together, this information supports the view that bronchiolitis obliterans organising pneumonia may be a form of response by the lungs to insult by drugs. Images PMID:2588206

  18. Post-bronchoscopy pneumonia in patients suffering from lung cancer: Development and validation of a risk prediction score.

    Science.gov (United States)

    Takiguchi, Hiroto; Hayama, Naoki; Oguma, Tsuyoshi; Harada, Kazuki; Sato, Masako; Horio, Yukihiro; Tanaka, Jun; Tomomatsu, Hiromi; Tomomatsu, Katsuyoshi; Takihara, Takahisa; Niimi, Kyoko; Nakagawa, Tomoki; Masuda, Ryota; Aoki, Takuya; Urano, Tetsuya; Iwazaki, Masayuki; Asano, Koichiro

    2017-05-01

    The incidence, risk factors, and consequences of pneumonia after flexible bronchoscopy in patients with lung cancer have not been studied in detail. We retrospectively analyzed the data from 237 patients with lung cancer who underwent diagnostic bronchoscopy between April 2012 and July 2013 (derivation sample) and 241 patients diagnosed between August 2013 and July 2014 (validation sample) in a tertiary referral hospital in Japan. A score predictive of post-bronchoscopy pneumonia was developed in the derivation sample and tested in the validation sample. Pneumonia developed after bronchoscopy in 6.3% and 4.1% of patients in the derivation and validation samples, respectively. Patients who developed post-bronchoscopy pneumonia needed to change or cancel their planned cancer therapy more frequently than those without pneumonia (56% vs. 6%, ppneumonia, which we added to develop our predictive score. The incidence of pneumonia associated with scores=0, 1, and ≥2 was 0, 3.7, and 13.4% respectively in the derivation sample (p=0.003), and 0, 2.9, and 9.7% respectively in the validation sample (p=0.016). The incidence of post-bronchoscopy pneumonia in patients with lung cancer was not rare and associated with adverse effects on the clinical course. A simple 3-point predictive score identified patients with lung cancer at high risk of post-bronchoscopy pneumonia prior to the procedure. Copyright © 2017 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  19. Diagnoses of Early and Late Readmissions after Hospitalization for Pneumonia. A Systematic Review

    Science.gov (United States)

    Sjoding, Michael W.; Iwashyna, Theodore J.

    2014-01-01

    Rationale: Pneumonia is a frequent cause of hospitalization, yet drivers of post-pneumonia morbidity remain poorly characterized. Causes of hospital readmissions may elucidate important sources of morbidity and are of particular interest given the U.S. Hospital Readmission Reductions Program. Objectives: To review the primary diagnoses of early (≤30 d) and late (≥31 d) readmissions after pneumonia hospitalization. Methods: Systematic review of MEDLINE, Embase, and CINAHL databases. We identified original research studies of adults aged 18 years or older, hospitalized for pneumonia, and for whom cause-specific readmission rates were reported. Two authors abstracted study results and assessed study quality. Measurements and Main Results: Of the 1,243 citations identified, 12 met eligibility criteria. Included studies were conducted in the United States, Spain, Canada, Croatia, and Sweden. All-cause 30-day readmission rates ranged from 16.8 to 20.1% across administrative studies; the weighted average for the studies using chart review was 11.6% (15.6% in United States–based studies). Pneumonia, heart failure/cardiovascular causes, and chronic obstructive pulmonary disease/pulmonary causes are the most common reasons for early readmission after pneumonia hospitalization. Although it was the single most common cause for readmission, pneumonia accounted for only 17.9 to 29.4% of all 30-day readmissions in administrative studies and a weighted average of 23.0% in chart review studies. After accounting for study population, there was no clear difference in findings between claims-based versus chart-review studies. Few studies assessed readmissions beyond 30 days, although the limited available data suggest similar primary diagnoses for early and late readmissions. No studies assessed whether reasons for readmission were similar to patients’ reasons for healthcare use before hospitalization. Conclusions: Pneumonia, heart failure/cardiovascular disease, and chronic

  20. The comparison between proton pump inhibitors and sucralfate in incidence of ventilator associated pneumonia in critically ill patients.

    Science.gov (United States)

    Khorvash, Farzin; Abbasi, Saeed; Meidani, Mohsen; Dehdashti, Fatemeh; Ataei, Behrooz

    2014-01-01

    Ventilator associated pneumonia (VAP) are one of the most common nosocomial infections in intensive care unit (ICU). The ICU patients are at risk of stress ulcer and gastrointestinal bleeding for different reasons. In order to prevent this complication, anti acids are used for patients. This study compared pantoprazole with sucralfate in incidence of ventilator associated pneumonia. This randomized clinical trial was carried out on ICU patients with mechanical ventilation in Alzahra university hospital in Isfahan from 2010 to 2011. One hundred forty eight ventilated patients were randomly allocated in two groups. The first group was treated with sucralfate and the second group was treated with pantoprazole for stress ulcer prophylaxis and followed up during hospitalization in ICU for nosocomial pneumonia. Data analyzed by SPSS software. One hundred thirty seven patients were selected for study. During the study period, 34 cases (24.8%) acquired pneumonia, of which 10 were in the sucralfate group and 24 were in the pantoprazole group (14.1% vs. 36.4%). According to Chi-square test, rate of pneumonia was significantly lower in patients receiving sucralfate than the pantoprazole group (P < 0.001). On the basis of the results, there is a significant relationship between the kind of drug used for stress ulcer and ventilator associated pneumonia. According to this article, rate of pneumonia was significantly lower in patients receiving sucralfate than the pantoprazole group.

  1. The comparison between proton pump inhibitors and sucralfate in incidence of ventilator associated pneumonia in critically ill patients

    Directory of Open Access Journals (Sweden)

    Farzin Khorvash

    2014-01-01

    Full Text Available Background: Ventilator associated pneumonia (VAP are one of the most common nosocomial infections in intensive care unit (ICU. The ICU patients are at risk of stress ulcer and gastrointestinal bleeding for different reasons. In order to prevent this complication, anti acids are used for patients. This study compared pantoprazole with sucralfate in incidence of ventilator associated pneumonia. Materials and Methods: This randomized clinical trial was carried out on ICU patients with mechanical ventilation in Alzahra university hospital in Isfahan from 2010 to 2011. One hundred forty eight ventilated patients were randomly allocated in two groups. The first group was treated with sucralfate and the second group was treated with pantoprazole for stress ulcer prophylaxis and followed up during hospitalization in ICU for nosocomial pneumonia. Data analyzed by SPSS software. Results: One hundred thirty seven patients were selected for study. During the study period, 34 cases (24.8% acquired pneumonia, of which 10 were in the sucralfate group and 24 were in the pantoprazole group (14.1% vs. 36.4%. According to Chi-square test, rate of pneumonia was significantly lower in patients receiving sucralfate than the pantoprazole group ( P < 0.001. Conclusion: On the basis of the results, there is a significant relationship between the kind of drug used for stress ulcer and ventilator associated pneumonia. According to this article, rate of pneumonia was significantly lower in patients receiving sucralfate than the pantoprazole group.

  2. Nosocomial pneumonia in critically ill patients

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    Dandagi Girish

    2010-01-01

    Full Text Available The care of critically ill patients in the intensive care unit (ICU is a primary component of modern medicine. ICUs create potential for recovery in patients who otherwise may not have survived. However, they may suffer from problems associated with of nosocomial infections. Nosocomial infections are those which manifest in patients 48 hours after admission to hospital. Nosocomial infections are directly related to diagnostic, interventional or therapeutic procedures a patient undergoes in hospital, and are also influenced by the bacteriological flora prevailing within a particular unit or hospital. Urinary tract infections are the most frequent nosocomial infection, accounting for more than 40% of all nosocomial infections. Critical care units increasingly use high technology medicine for patient care, hemodynamic monitoring, ventilator support, hemodialysis, parenteral nutrition, and a large battery of powerful drugs, particularly antibiotics to counter infection. It is indeed a paradox that the use of high-tech medicine has brought in its wake the dangerous and all too frequent complication of nosocomial infections

  3. Appropriateness of laboratory tests: requests for atypical pneumonia serology in a teaching hospital.

    LENUS (Irish Health Repository)

    Jackson, L M

    2012-02-03

    The cost of providing medical care is ever-increasing but the resources available are at best static. Major savings can be made by reducing inappropriate investigations. Using serological testing for organisms causing atypical pneumonia as an example, we examined the appropriateness of requests and also physicians\\' understanding of the test. Of 119 patients tested, only 3 had titres indicative of acute infection. Most patients were tested within 2 days of hospital admission, before receipt of results excluding more likely diagnoses. Forty-five patients had no current or recent respiratory symptoms, in whom infection was highly unlikely. Titres were most often requested by the least experienced members of the clinical team. Of 70 patients with an acute illness in whom a definitive diagnosis, bacteriological or otherwise, was not made, in only 9 was a convalescent specimen sent for follow-up titres. Most requests for serology for organisms causing atypical pneumonia were inappropriate. Furthermore, in the majority of cases the test was incorrectly used.

  4. Incidence and risk factors of ventilator associated pneumonia in a tertiary care hospital.

    Science.gov (United States)

    Charles, Mv Pravin; Easow, Joshy M; Joseph, Noyal M; Ravishankar, M; Kumar, Shailesh; Umadevi, Sivaraman

    2013-01-01

    Ventilator associated pneumonia (VAP) is a type of nosocomial pneumonia associated with increased morbidity and mortality. Knowledge about the incidence and risk factors is necessary to implement preventive measures to reduce mortality in these patients. A prospective study was conducted at a tertiary care teaching hospital for a period of 20 months from November 2009 to July 2011. Patients who were on mechanical ventilation (MV) for more than 48 hours were monitored at frequent intervals for development of VAP using clinical and microbiological criteria until discharge or death. Of the 76 patients, 18 (23.7%) developed VAP during their ICU stay. The incidence of VAP was 53.25 per 1,000 ventilator days. About 94% of VAP cases occurred within the first week of MV. Early-onset and late-onset VAP was observed in 72.2% and 27.8%, respectively. Univariate analysis showed chronic lung failure, H2 blockers usage, and supine head position were significant risk factors for VAP. Logistic regression revealed supine head position as an independent risk factor for VAP. VAP occurred in a sizeable number of patients on MV. Chronic lung failure, H2 blockers usage, and supine head position were the risk factors associated with VAP. Awareness about these risk factors can be used to inform simple and effective preventive measures.

  5. Association of Unfinished Root Canal Treatments with the Risk of Pneumonia Hospitalization.

    Science.gov (United States)

    Lin, Po-Yen; Chiang, Yu-Chih; Chou, Yu-Ju; Chang, Hong-Ji; Chi, Lin-Yang

    2017-01-01

    The objective of root canal treatments (RCTs) is to control pulpal diseases and salvage infected teeth by eradicating microorganisms within the root canal system. However, an unfinished RCT can leave a space for bacterial accumulation, which can leak into the oral cavity and then aspirate into the lower respiratory tract and the lungs, causing infection. This study investigated the association of unfinished RCTs with the possible risk of pneumonia hospitalization using a nationwide population-based database. After a matching process, we recruited 116,490 subjects who received an initiated RCT and had no history of pneumonia before 2005 and observed until the end of 2011. An unfinished RCT was operationally defined as an endodontic session that was started on a tooth but had no subsequent completion records. Cox proportional hazards models and subgroup analyses were used to estimate the association of unfinished RCTs on the risk of pneumonia hospitalization. In total, 1285 subjects were hospitalized for pneumonia during 2005 to 2011 with an overall pneumonia hospitalization incidence rate of 0.22% per person year. After adjusting for confounding factors, the adjusted pneumonia hospitalization hazard ratio for subjects who had unfinished RCTs was 1.40 (95% confidence interval, 1.24-1.59) compared with subjects without unfinished RCTs (P endodontic treatments once started. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  6. Air assisted dispersive liquid-liquid microextraction with solidification of the floating organic droplets (AA-DLLME-SFO) and UHPLC-PDA method: Application to antibiotics analysis in human plasma of hospital acquired pneumonia patients.

    Science.gov (United States)

    Ferrone, Vincenzo; Cotellese, Roberto; Carlucci, Maura; Di Marco, Lorenzo; Carlucci, Giuseppe

    2018-03-20

    An ultra high-performance liquid chromatographic (UHPLC) method with PDA detection was developed and validated for the simultaneous quantification of metronidazole, meropenem, ciprofloxacin, linezolid and piperacillin in human plasma and applied to patients suffering from hospital acquired pneumonia (HAP). The method uses an air assisted dispersive liquid-liquid microextraction for sample preparation. All parameters in the extraction step, including selection of extractant, amount of extractant, ionic strength, pH, and extraction cycles, were investigated and optimized. Chromatography was carried out using a Poroshell 120 SB C 18 (50 × 2.1 mm I.D. 2.6 μm particle size) column and a gradient mobile phase consisting of ammonium acetate buffer (10 mM, pH 4.0) (eluent A); and a mixture of acetonitrile-methanol in a ratio (80/20)(eluent B). Ulifloxacin was used as internal standard. The method demonstrated good linearity with correlation coefficients, r 2  > 0.9995 for the drugs, as well as high precision (RSD% ≤ 9.87%), accuracy ranged from -8.14% to +8.98. The enrichment factor (EF) obtained ranged within 87 and 121. During the validation, the concentrations of the analytes were found to be stable after 3 freeze-thaw cycles and for at least 24 h after extraction. Subsequently, this method was used to quantify the drugs in patients with HAP in order to establish if the dosage regimen given was sufficient to eradicate the infection at the target site. Copyright © 2017. Published by Elsevier B.V.

  7. Hospital-acquired pneumonia after lung resection surgery is associated with characteristic cytokine gene expression.

    LENUS (Irish Health Repository)

    White, Mary

    2012-02-01

    BACKGROUND: Infection in humans has been linked with altered cytokine gene transcription. It is unclear whether this phenomenon is a consequence of an established disease process or precedes the infective process. The primary end point of this study was to determine whether hospital-acquired pneumonia (HAP) was associated with differential gene expression of interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, and IL-23p19. The secondary end point was to identify whether alteration in gene expression preceded the clinical onset of infection. METHODS: Sixty consecutive patients undergoing elective thoracic surgery were recruited. HAP was diagnosed as per National Nosocomial Infection Surveillance guidelines. Messenger RNA (mRNA) and protein levels were analyzed preoperatively and 24 h and 5 days postoperatively. RESULTS: Forty-one patients had an uncomplicated recovery. Nineteen patients developed HAP. IL-6, IL-10, IL-12p35, IL-23p19, IL-27p28, TNF-alpha, and IFN-gamma mRNA and protein levels of IL-6, IL-23, and IFN-gamma in peripheral blood leukocytes were analyzed before surgery and 24 h and 5 days postsurgery. IL-23p19 mRNA levels were reduced in the pneumonia group (median, 4.19; 10th-90th centile range, 3.90-4.71) compared with the nonpneumonia group (4.50; 3.85-5.32) day 1 postsurgery (P=02). IFN-gamma mRNA levels were reduced in the pneumonia group (2.48; 1.20-3.20) compared with nonpneumonia group (2.81; 2.10-3.26) (P=03) day 5 postsurgery. Results are expressed as log to base 10 copy numbers of cytokine mRNA per 10 million beta-actin mRNA copy numbers. All values are given as median and 10th to 90th centile range. CONCLUSIONS: Cytokine gene expression is altered immediately following surgery in patients with postoperative HAP.

  8. Community-Acquired Pneumonia: a Comparison between elderly and nonelderly patients

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    S. Jafari

    2006-08-01

    Full Text Available Background: Community-acquired pneumonia could be a life-threatening condition especially in elderly patients. The factors influencing the outcome in elderly patients are thought to be different from those in young adults. We compared the clinical and paraclinical profiles in elderly and nonelderly patients with community-acquired pneumonias. Methods: In this cross-sectional study, seventy nine patients who were hospitalized with community acquired pneumonia over a period of one year were included. Patients' medical records were reviewed; and data related to comorbid conditions, signs and symptoms, laboratory and radiographic findings were gathered using a checklist. Results: The clinical features, laboratory parameters and complications from pneumonia were almost similar in 41 elderly (group I, age ≥65years and 38 young (group II, age<65years subjects. Delirium was seen more in elderly group (p=0.05. The average body temperature and pulse rate were significantly higher in nonelderly group. Sixty one percent of elderly patients and 21% of young patients have Po2 less than 60 (p=0.02. Smoking (29.1%, neurological disturbances (19%, congestive heart failure (15.2%, chronic obstructive pulmonary disease and diabetes mellitus (13.9% were associated comorbidities in both groups. In non elderly group, immune compromise and IV drug use were more common as underlying comorbid conditions. Two of three mortalities were due to elder patients. Conclusion: Community acquired pneumonia could have more serious clinical and abnormal laboratory features in the elderly than younger patients. Mortality rate may be higher in older patients. Comorbid conditions are frequently seen in both elderly and nonelderly patients with community acquired pneumonia, but IV drug use and immune compromise are more frequent in nonelderly patients.

  9. Risk factors for pneumonia among patients with Parkinson's disease: a Taiwan nationwide population-based study

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    Chang YP

    2016-04-01

    Full Text Available Yang-Pei Chang,1 Chih-Jen Yang,2 Kai-Fang Hu,3 A-Ching Chao,4 Yu-Han Chang,5 Kun-Pin Hsieh,6 Jui-Hsiu Tsai,7 Pei-Shan Ho,8,9 Shen-Yang Lim101Department of Neurology, 2Department of Internal Medicine, 3Department of Dentistry, Kaohsiung Municipal Ta-Tung Hospital, 4Department of Neurology, College of Medicine, 5Department of Management, Kaohsiung Municipal Ta-Tung Hospital, 6School of Pharmacy, College of Pharmacy, 7Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, 8Faculty of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, 9Cancer Center, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan, Republic of China; 10Faculty of Medicine, University of Malaya, Kuala lumpur, MalaysiaObjective: Pneumonia is the leading cause of death in patients with Parkinson’s disease (PD. However, few studies have been performed to explore the risk factors for pneumonia development in patients with PD.Methods: We conducted a nationwide population-based cohort study of patients with PD to identify the risk factors for these patients developing pneumonia. Participants with newly diagnosed PD between 2000 and 2009 were enrolled from the 2000–2010 National Health Insurance Research Database in Taiwan. We compared patients with PD with an incidence of hospitalization with pneumonia vs those without, and Cox proportional hazard models were used to estimate the risk of pneumonia.Results: Of the 2,001 enrolled patients (mean follow-up duration 5.8 years, range: 2.7–14.7 years, 381 (19.0% had an incidence of hospitalization with pneumonia during the study period. Multivariate Cox proportional hazards analysis identified older age group (≥80 years of age, hazard ratio [HR] =3.15 [95% confidence interval 2.32–4.28], male sex (HR =1.59 [1.29–1.96], certain geographic regions (northern, HR =1.36 [1.04–1.78], southern and eastern, HR =1.40 [1.05–1.88], rural areas (HR =1.34 [1.05–1.72], chronic heart

  10. Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

    OpenAIRE

    Park, Hyun Oh; Kang, Dong Hoon; Moon, Seong Ho; Yang, Jun Ho; Kim, Sung Hwan; Byun, Joung Hun

    2017-01-01

    Background: Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and De...

  11. Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients

    OpenAIRE

    Foglia, Elizabeth; Meier, Mary Dawn; Elward, Alexis

    2007-01-01

    Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection among pediatric intensive care unit (ICU) patients. Empiric therapy for VAP accounts for approximately 50% of antibiotic use in pediatric ICUs. VAP is associated with an excess of 3 days of mechanical ventilation among pediatric cardiothoracic surgery patients. The attributable mortality and excess length of ICU stay for patients with VAP have not been defined in matched case control studies. VAP is as...

  12. Hospital acquired pneumonia is linked to right hemispheric peri-insular stroke.

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    André Kemmling

    Full Text Available Hospital acquired pneumonia (HAP is a major complication of stroke. We sought to determine associations between infarction of specific brain regions and HAP.215 consecutive acute stroke patients with HAP (2003-2009 were carefully matched with 215 non-pneumonia controls by gender, then NIHSS, then age. Admission imaging and binary masks of infarction were registered to MNI-152 space. Regional atlas and voxel-based log-odds were calculated to assess the relationship between infarct location and the likelihood of HAP. An independently validated penalized conditional logistic regression model was used to identify HAP associated imaging regions.The HAP and control patients were well matched by gender (100%, age (95% within 5-years, NIHSS (98% within 1-point, infarct size, dysphagia, and six other clinical variables. Right hemispheric infarcts were more frequent in patients with HAP versus controls (43.3% vs. 34.0%, p = 0.054, whereas left hemispheric infarcts were more frequent in controls (56.7% vs. 44.7%, p = 0.012; there was no significant difference between groups in the rate of brainstem strokes (p = 1.0. Of the 10 most infarcted regions, only right insular cortex volume was different in HAP versus controls (20 vs. 12 ml, p = 0.02. In univariate analyses, the highest log-odds regions for pneumonia were right hemisphere, cerebellum, and brainstem. The best performing multivariate model selected 7 brain regions of infarction and 2 infarct volume-based variables independently associated with HAP.HAP is associated with right hemispheric peri-insular stroke. These associations may be related to autonomic modulation of immune mechanisms, supporting recent hypotheses of stroke mediated immune suppression.

  13. Failure of CRP decline within three days of hospitalization is associated with poor prognosis of Community-acquired Pneumonia

    DEFF Research Database (Denmark)

    Andersen, Stine Bang; Baunbæk Egelund, Gertrud Louise; Jensen, Andreas Vestergaard

    2017-01-01

    BACKGROUND: C-reactive protein (CRP) is a well-known acute phase protein used to monitor the patient's response during treatment in infectious diseases. Mortality from Community-acquired Pneumonia (CAP) remains high, particularly in hospitalized patients. Better risk prediction during hospitaliza......BACKGROUND: C-reactive protein (CRP) is a well-known acute phase protein used to monitor the patient's response during treatment in infectious diseases. Mortality from Community-acquired Pneumonia (CAP) remains high, particularly in hospitalized patients. Better risk prediction during...... hospitalization could improve management and ultimately reduce mortality levels. The aim of this study was to evaluate CRP on the 3rd day (CRP3) of hospitalization as a predictor for 30 days mortality. METHODS: A retrospective multicentre cohort study of adult patients admitted with CAP at three Danish hospitals....... Predictive associations of CRP3 (absolute levels and relative decline) and 30 days mortality were analysed using receiver operating characteristics and logistic regression. RESULTS: Eight hundred and fourteen patients were included and 90 (11%) died within 30 days. The area under the curve for CRP3 level...

  14. Prevalence and prognostic influence of bacterial pyuria in elderly patients with pneumonia: A retrospective study.

    Science.gov (United States)

    Oka, Hiroaki; Komiya, Kosaku; Ohama, Minoru; Kawano, Yoshiyuki; Uchida, Masahiro; Miyajima, Hajime; Iwashita, Tomohiko; Okabe, Eiji; Kawamura, Tadao; Yasuda, Kazuhiro; Matsumoto, Taisuke; Kadota, Jun-Ichi

    2017-07-01

    The number of elderly patients with pneumonia is significantly increasing as the populations in many countries age. Although elderly patients with pneumonia are at risk of developing urinary tract infections, no studies have examined the prevalence or the prognostic impact of this complication. The aim of the present study was to investigate the prevalence of comorbid bacterial pyuria and the impact on the prognosis of elderly patients with pneumonia. We retrospectively evaluated 132 patients aged >65 years who were hospitalized for pneumonia and who underwent a urinary sediment test on admission. The background characteristics, laboratory results and treatment regimens were documented, and the risk factors for the complication of bacterial pyuria and its association with 90-day mortality in pneumonia patients were elucidated. A total of 37 (28%) of 132 patients were complicated by bacterial pyuria. The patients with bacterial pyuria were more often women, showed a poorer performance status, were more frequently fed by percutaneous endoscopic gastrostomy, and more frequently used diapers and/or a bladder catheter. Regarding first-line drugs, 82.6% of the patients received beta-lactamase inhibitors and extended-spectrum penicillins. The use of a bladder catheter and a poor performance status were associated with bacterial pyuria. A multivariate analysis showed that a poor performance status was the only factor associated with 90-day mortality. Bacterial pyuria did not affect the prognosis of patients who were treated with penicillin-based regimens. Thus, broad-spectrum antibiotics are not necessarily required for elderly patients with pneumonia complicated by urinary tract infection. Geriatr Gerontol Int 2017; 17: 1076-1080. © 2016 Japan Geriatrics Society.

  15. Health care and social care costs of pneumonia in Denmark: a register-based study of all citizens and patients with COPD in three municipalities

    Directory of Open Access Journals (Sweden)

    Brogaard SL

    2015-10-01

    Full Text Available Susanne Lausten Brogaard,1 Maj Britt Dahl Nielsen,1 Lars Ulrik Nielsen,2 Trine Mosegaard Albretsen,3 Morten Bundgaard,4 Niels Anker,1 Maja Appel,1 Kim Gustavsen,1 Rose-Marie Lindkvist,5 Anne Skjoldan,2 Grete Breinhild,3 Peter Bo Poulsen5 1COWI AS, Management - Health, Kongens Lyngby, 2Seniors and Health Department, Gladsaxe Municipality, Welfare Technology, Søborg, 3Elderly and Health Care Department, Lolland Municipality, Maribo, 4Department of Public Health, Holbaek Municipality, Holbaek, 5Pfizer Denmark ApS, Health & Value, Ballerup, Denmark Background: Pneumonia is a frequent lung infection and a serious illness, which is often diagnosed among patients hospitalized with acute exacerbations of COPD. The aim of this study was to estimate the attributable costs due to pneumonia among patients hospitalized with pneumonia compared to a matched general population control group without pneumonia hospitalization.Methods: This study includes citizens older than 18 years from three municipalities (n=142,344. Based on national registers and municipal data, the health and social care costs of pneumonia in the second half of 2013 are estimated and compared with propensity score-matched population controls.Results: The average health care costs of 383 patients hospitalized with pneumonia in the second half of 2013 were US$34,561 per patient. Among pneumonia patients with COPD, the costs were US$35,022. The attributable costs of patients with pneumonia compared to the population control group for the 6-month period were US$24,155 per case. Overall, the attributable costs for the 383 pneumonia cases amounted to US$9.25 million. Subgroup analyses showed that costs increased with age. The attributable costs due to pneumonia were highest among the 18–59-year-old and the 70–79-year-old patients. This difference is likely to reflect an increased risk of mortality among the pneumonia patients. Men have higher costs than women in the pneumonia group

  16. Coronavirus 229E-related pneumonia in immunocompromised patients.

    Science.gov (United States)

    Pene, Frédéric; Merlat, Annabelle; Vabret, Astrid; Rozenberg, Flore; Buzyn, Agnès; Dreyfus, François; Cariou, Alain; Freymuth, François; Lebon, Pierre

    2003-10-01

    Coronaviruses strains 229E and OC43 have been associated with various respiratory illnesses ranging from the self-resolving common cold to severe pneumonia. Although chronic underlying conditions are major determinants of severe respiratory virus infections, few data about coronavirus-related pneumonia in immunocompromised patients are available. Here we report 2 well-documented cases of pneumonia related to coronavirus 229E, each with a different clinical presentation. Diagnosis was made on the basis of viral culture and electron microscopy findings that exhibited typical crown-like particles and through amplification of the viral genome by reverse transcriptase-polymerase chain reaction. On the basis of this report, coronaviruses should be considered as potential causative microorganisms of pneumonia in immunocompromised patients.

  17. Relationship Between Laryngeal Sensory Deficits, Aspiration, and Pneumonia in Patients with Dysphagia.

    Science.gov (United States)

    Kaneoka, Asako; Pisegna, Jessica M; Inokuchi, Haruhi; Ueha, Rumi; Goto, Takao; Nito, Takaharu; Stepp, Cara E; LaValley, Michael P; Haga, Nobuhiko; Langmore, Susan E

    2018-04-01

    The laryngeal adductor reflex (LAR) is an airway protective reflex that manifests as a brief vocal fold closure in response to laryngeal stimulation. This study examined if the absence of the LAR in response to touch delivered by a laryngoscope is associated with penetration/aspiration or pneumonia in patients with dysphagia. Inpatients at a teaching hospital with clinical symptoms of dysphagia were recruited upon referral to the otolaryngology clinic for a swallowing evaluation. Otolaryngologists observed the status of secretions and touched each arytenoid with the tip of the laryngoscope. The patients were then asked to swallow 3-5 mL grape gelatin and 3-5 mL colored water. All procedures were video-recorded. Two independent raters noted absence/presence of the LAR and penetration/aspiration of pharyngeal secretions, gelatin, and water on the recorded videos. A diagnosis of pneumonia during the patient's entire hospital stay was determined by a review of the hospital's medical records. Statistical analyses were performed using Fisher's exact test. Sixty-one patients were included. Twenty-one patients (34.5%) did not exhibit the LAR. No association was found between the absent LAR and penetration or aspiration. There was, however, a significant association between an absence of the LAR and pneumonia development. Patients with an absent LAR had 6.8 times the odds of developing pneumonia as compared to those with a present LAR (OR 6.75; 95% CI 1.76-25.96; p < 0.01). Using the LAR as a marker of laryngeal sensory function appears to be valuable for identifying patients at high risk of pneumonia.

  18. Comparison of Serum Leptin Levels in Pulmonary Tuberculosis Patients with Acute Pneumonia Patients and Healthy Individuals

    Directory of Open Access Journals (Sweden)

    M. Naderi

    2017-10-01

    Full Text Available Aims: Leptin is one of the most important fat-derived hormones. Several studies have shown that serum leptin levels in systemic inflammatory diseases are reduced. The aim of this study was to evaluate the serum leptin levels in three groups: patients with active pulmonary tuberculosis (TB, patients with non-pulmonary infections (acute pneumonia and normal people. Materials & Methods: In this cross-sectional study, in 2010, 40 patients with active pulmonary TB (case group and 40 patients with non-pulmonary infections (positive control group admitted to Boo-Ali hospital in Zahedan and 40 healthy subjects (negative control group were selected using easy access and serum leptin levels were evaluated by ELISA. Data were analyzed by SPSS 18 software and one-way ANOVA. Findings: The mean of serum leptin levels in patients with non-pulmonary infections (p=0.030 and in patients with active pulmonary TB (p=0.004 were significantly lower than normal group, but the mean of serum leptin levels in patients with active pulmonary TB and patients with non-pulmonary infections were not significantly different (p=0.555. Conclusion: Serum leptin levels are lower in patients with active pulmonary tuberculosis and in patients with non-pulmonary infections than in normal people, but there is no difference between patients with active pulmonary tuberculosis and patients with non-pulmonary infections. Therefore, serum leptin levels are not an appropriate marker for the differentiation of active pulmonary tuberculosis from pulmonary infections (acute pneumonia.

  19. Safety of Induced Sputum Collection in Children Hospitalized With Severe or Very Severe Pneumonia.

    Science.gov (United States)

    DeLuca, Andrea N; Hammitt, Laura L; Kim, Julia; Higdon, Melissa M; Baggett, Henry C; Brooks, W Abdullah; Howie, Stephen R C; Deloria Knoll, Maria; Kotloff, Karen L; Levine, Orin S; Madhi, Shabir A; Murdoch, David R; Scott, J Anthony G; Thea, Donald M; Amornintapichet, Tussanee; Awori, Juliet O; Chuananon, Somchai; Driscoll, Amanda J; Ebruke, Bernard E; Hossain, Lokman; Jahan, Yasmin; Kagucia, E Wangeci; Kazungu, Sidi; Moore, David P; Mudau, Azwifarwi; Mwananyanda, Lawrence; Park, Daniel E; Prosperi, Christine; Seidenberg, Phil; Sylla, Mamadou; Tapia, Milagritos D; Zaman, Syed M A; O'Brien, Katherine L

    2017-06-15

    Induced sputum (IS) may provide diagnostic information about the etiology of pneumonia. The safety of this procedure across a heterogeneous population with severe pneumonia in low- and middle-income countries has not been described. IS specimens were obtained as part a 7-country study of the etiology of severe and very severe pneumonia in hospitalized children <5 years of age. Rigorous clinical monitoring was done before, during, and after the procedure to record oxygen requirement, oxygen saturation, respiratory rate, consciousness level, and other evidence of clinical deterioration. Criteria for IS contraindications were predefined and serious adverse events (SAEs) were reported to ethics committees and a central safety monitor. A total of 4653 IS procedures were done among 3802 children. Thirteen SAEs were reported in relation to collection of IS, or 0.34% of children with at least 1 IS specimen collected (95% confidence interval, 0.15%-0.53%). A drop in oxygen saturation that required supplemental oxygen was the most common SAE. One child died after feeding was reinitiated 2 hours after undergoing sputum induction; this death was categorized as "possibly related" to the procedure. The overall frequency of SAEs was very low, and the nature of most SAEs was manageable, demonstrating a low-risk safety profile for IS collection even among severely ill children in low-income-country settings. Healthcare providers should monitor oxygen saturation and requirements during and after IS collection, and assess patients prior to reinitiating feeding after the IS procedure, to ensure patient safety. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  20. A managed multidisciplinary programme on multi-resistant Klebsiella pneumoniae in a Danish university hospital

    DEFF Research Database (Denmark)

    Andersen, Stig Ejdrup; Knudsen, Inge Jenny Dahl

    2013-01-01

    BACKGROUND: Bacteria-producing extended spectrum β-lactamase (ESBL) enzymes are resistant to commonly used antimicrobials. In 2008, routine monitoring revealed a clonal hospital outbreak of ESBL-producing Klebsiella pneumoniae (ESBL-KP). METHODS: At a 510-bed Danish university hospital...... the application of a managed, multi-faceted intervention that does not require ongoing antibiotic stewardship....

  1. Radiological findings in seven patients of bronchiolitis obliterans with organized pneumonia

    International Nuclear Information System (INIS)

    Serrano Gotarredona, M.P.; Fernandez-Cruz, J.; Jimenez-Ruiz, M.

    1995-01-01

    We present seven patients, five women and two men, between 40 and 71 years old, who were diagnosed between 1983 and 1993 as having bronchiolitis obliterans with organized pneumonia (BOOP). Five of the patients were treated at Hospital Virgen del Rocio and two at Hospital Nuestra Se=A4ora de Valme. The histological, clinical and radiological features are described. All the patients responded favorable to corticosteroid therapy, and there have been no recurrences. We point out the predominance of patchy alveolar infiltrates which, in three cases proved to be migratory. We analyze the computerized tomography (CT) findings in three patients, comparing our observations with those reported in the literature. (Author)

  2. Pneumococcal and influenza vaccination status of hospitalized adults with community acquired pneumonia and the effects of vaccination on clinical presentation.

    Science.gov (United States)

    Demirdogen Cetinoglu, Ezgi; Uzaslan, Esra; Sayıner, Abdullah; Cilli, Aykut; Kılınc, Oguz; Sakar Coskun, Aysın; Hazar, Armağan; Kokturk, Nurdan; Filiz, Ayten; Polatli, Mehmet

    2017-09-02

    Previous reports have shown that vaccination rates of adult at-risk populations are low in Turkey. There are differing reports with regards to the effectiveness of the influenza and the pneumococcal polysaccharide vaccine (PPSV23) on the clinical outcomes of community acquired pneumonia (CAP). The purpose of this study was to analyze the influenza (FV) and pneumococcal vaccination (PV) status, the factors that influence the receipt of influenza/pneumococcal vaccine and the effects of prior vaccination on the clinical outcomes in adults hospitalized with CAP. Patients hospitalized with CAP between March 2009 and October 2013 and registered at the web-based Turkish Thoracic Society Pneumonia Database (TURCAP) were included in this multicentric, observational study. Of a total of 787 cases, data were analyzed for 466 patients for whom self-reported information on PV and FV was available. In this adult population with CAP, the vaccination rate with both the pneumococcal and influenza vaccines was found to be 6%. Prior FV was found to be the sole variable that was associated with the receipt of PV [OR 17.8, 95% CI (25-75:8.56-37.01), p pneumonia severity index (PSI) score ≥ 90, CURB-65 score ≥3 and multilobar involvement, but not the vaccination status, were identified as independent determinants of ICU admission. This study showed that, among patients hospitalized with CAP, the FV and/or PV rates are low. Prior vaccination does not appear to significantly affect the clinical outcomes.

  3. The methodological quality of guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia: A systematic review.

    Science.gov (United States)

    Ambaras Khan, R; Aziz, Z

    2018-05-02

    Clinical practice guidelines serve as a framework for physicians to make decisions and to support best practice for optimizing patient care. However, if the guidelines do not address all the important components of optimal care sufficiently, the quality and validity of the guidelines can be reduced. The objectives of this study were to systematically review current guidelines for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), evaluate their methodological quality and highlight the similarities and differences in their recommendations for empirical antibiotic and antibiotic de-escalation strategies. This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Electronic databases including MEDLINE, CINAHL, PubMed and EMBASE were searched up to September 2017 for relevant guidelines. Other databases such as NICE, Scottish Intercollegiate Guidelines Network (SIGN) and the websites of professional societies were also searched for relevant guidelines. The quality and reporting of included guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) instrument. Six guidelines were eligible for inclusion in our review. Among 6 domains of AGREE-II, "clarity of presentation" scored the highest (80.6%), whereas "applicability" scored the lowest (11.8%). All the guidelines supported the antibiotic de-escalation strategy, whereas the majority of the guidelines (5 of 6) recommended that empirical antibiotic therapy should be implemented in accordance with local microbiological data. All the guidelines suggested that for early-onset HAP/VAP, therapy should start with a narrow spectrum empirical antibiotic such as penicillin or cephalosporins, whereas for late-onset HAP/VAP, the guidelines recommended the use of a broader spectrum empirical antibiotic such as the penicillin extended spectrum carbapenems and glycopeptides. Expert guidelines

  4. Placebo controlled trial of zinc supplementation on duration of hospital stay in children with pneumonia

    International Nuclear Information System (INIS)

    Singh, A.K.; Iqbal, M.J.; Akhtar, R.; Afzal, M.F.

    2012-01-01

    Background: Pneumonia is one of the leading causes of morbidity and mortality in children younger than 5 years of age. Zinc may have an important protective role in cases of childhood pneumonia. Objectives: To study the effect of zinc supplementation on duration of hospital stay in children (6 months to 5 years) with pneumonia. Methodology: This Randomized control trial was conducted in the Department of Paediatrics Unit - I, King Edward Medical University / Mayo Hospital, Lahore from January to December 2011. After consent, 150 children from 6 months to 5 years of age with pneumonia consistent with WHO ARI definition along with crepitations on auscultation were registered by non-probability purposive sampling and were randomized into treatment group (Group A) and placebo group (Group B). Seventy five children supplemented with zinc for 14 days while 75 children were supplemented with placebo. Outcome measure was duration of hospital stay. T-test was used to compare the groups. Results: Out of total study population of 150, majority (35%) of children were below 2 years. There was male predominance (64%). Mean duration of hospital stay was significantly reduced in treatment group (p value < 0.05). Conclusion: Zinc supplementation results in statistically significant reduction in the duration of hospital stay in children (6 months to 5 years) with pneumonia. (author)

  5. The association between number of doctors per bed and readmission of elderly patients with pneumonia in South Korea.

    Science.gov (United States)

    Lee, Joo Eun; Kim, Tae Hyun; Cho, Kyoung Hee; Han, Kyu-Tae; Park, Eun-Cheol

    2017-06-08

    There is an urgent need to reduce readmission of patients with pneumonia and improve quality of care. To assess the association between hospital resources and quality of care, we examined the effect of number of doctors per bed on 30-day readmission and investigated the combined effect of number of doctors per bed and number of beds. We used nationwide cohort sample data of health insurance claims by the National Health Insurance Service (NHIS) from 2002 to 2013. Pneumonia admissions to acute care hospitals among 7446 inpatients older than 65 were examined. We conducted a multivariate Cox proportional hazard model to analyze the association between the number of doctors per bed and 30-day readmission, as well as that of pneumonia-specific 30-day readmission with the combined effects of number of doctors per bed and number of beds. Overall, 1421 (19.1%) patients were readmitted within 30 days and 756 (11.2%) patients were readmitted for pneumonia within 30 days. Patients with pneumonia treated by very low or low number of doctors per bed showed higher readmission (pneumonia-specific readmission: hazard ratio [HR] = 1. 406, 95% confidence interval [CI] = 1.072-1.843 for low number of doctors per bed; all-cause readmissions: HR = 1.276, 95% CI = 1.026-1.587 for very low number of doctors per bed, and HR = 1.280, 95% CI = 1.064-1.540 for low number of doctors per bed). This empirical study showed that patients with pneumonia cared for in hospitals with more doctors were less likely to be readmitted. Pneumonia-specific 30-day readmission was also significantly associated with the combined effect of the number of doctors and the number of hospital beds.

  6. Community-acquired pneumonia requiring hospitalization: rational decision making and interpretation of guidelines.

    Science.gov (United States)

    Postma, Douwe F; van Werkhoven, Cornelis H; Oosterheert, Jan Jelrik

    2017-05-01

    This review focuses on the evidence base for guideline recommendations on the diagnosis, the optimal choice, timing and duration of empirical antibiotic therapy, and the use of microbiological tests for patients hospitalized with community-acquired pneumonia (CAP): issues for which guidelines are frequently used as a quick reference. Furthermore, we will discuss possibilities for future research in these topics. Many national and international guideline recommendations, even on critical elements of CAP management, are based on low-to-moderate quality evidence. The diagnosis and management of CAP has hardly changed for decades. The recommendation to cover atypical pathogens in all hospitalized CAP patients is based on observational studies only and is challenged by two recent trials. The following years, improved diagnostic testing, radiologically by low-dose Computed Tomography or ultrasound and/or microbiologically by point-of-care multiplex PCR, has the potential to largely influence the choice and start of antibiotic therapy in hospitalized CAP patients. Rapid microbiological testing will hopefully improve antibiotic de-escalation or early pathogen-directed therapy, both potent ways of reducing broad-spectrum antibiotic use. Current guideline recommendations on the timing and duration of antibiotic therapy are based on limited evidence, but will be hard to improve.

  7. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society

    Science.gov (United States)

    Kalil, Andre C.; Metersky, Mark L.; Klompas, Michael; Muscedere, John; Sweeney, Daniel A.; Palmer, Lucy B.; Napolitano, Lena M.; O'Grady, Naomi P.; Bartlett, John G.; Carratalà, Jordi; El Solh, Ali A.; Ewig, Santiago; Fey, Paul D.; File, Thomas M.; Restrepo, Marcos I.; Roberts, Jason A.; Waterer, Grant W.; Cruse, Peggy; Knight, Shandra L.; Brozek, Jan L.

    2016-01-01

    It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews. PMID:27418577

  8. C4. Pneumonia adquirida na comunidade (PAC: estudo retrospectivo num hospital central

    Directory of Open Access Journals (Sweden)

    A. Oliveira

    2003-11-01

    Full Text Available A PAC é uma importante causa de morbilidade e mortalidade nos doentes hospitalizados. O objectivo deste estudo foi analisar a etiologia, factores de risco, tratamento e mortalidade da PAC no internamento. Procedemos a um estudo retrospectivo de 246 doentes, admitidos no nosso Departamento com o diagnóstico de PAC num período de 24 meses. A média etária foi de 58,9 anos e 61% eram do sexo masculino. Em 48,6% existiam comorbilidades. Na radiografia torácica havia envolvimento multilobar em 17,1%, padrão alveolar em 66,7% e derrame pleural em 18,3%.Os agentes etiológicos foram pesquisados em 195 doentes (75,9% e foram positivos em 57 (29,2%: 11% das hemoculturas (19/173; 30% dos exames culturais de expectoração (48/160 e 10.4% das serologias e antigenúria para Legionella (7/67 foram positivos. Nos doentes com etiologia bacteriana o agente etiológico mais frequente foi S. pneumoniae (47%, seguindo-se os Gram-negativos (26% e H. Influenza (18%.A amoxicilina/clavulanato (82,9% e macrólidos (68,1% foram os antibióticos mais usados. Houve associação de antibióticos em 61,6% dos doentes. A duração média do tratamento foi de 12 dias. Em 93% dos doentes assistiu-se a evolução favorável. A mortalidade foi de 5,1%.Concluimos que o S. pneumoniae continua a ser o agente etiológico mais frequente de PAC. A escolha terapêutica esteve de acordo com as guidelines internacionais e o regime terapêutico mostrou-se adequado tendo a maioria das PAC evolução favorável com baixa mortalidade. : CAP is an important cause of morbidity and mortality in hospitalized patients. The aim of this study was to analyze etiology, risk factors, treatment and mortality of CAP. We conducted a retrospective analysis of clinical data from 246 patients admitted to our Department with CAP diagnosis throughout an 24 month period.The patients were in average age 58,9 years old and 61% were male. In 48,6% significant co-morbidities were found. On chest X-ray there

  9. CHLAMYDIA PNEUMONIAE – THE PREVALENCE OF ANTIBODIES IN HEALTHY POPULATION AND IN PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA

    Directory of Open Access Journals (Sweden)

    Darja Keše

    2001-06-01

    Full Text Available Background. To determinate the prevalence rates of Chlamydia pneumoniae infections in Slovenia and to evaluate the importance of C. pneumoniae infections at patients with community acquired pneumonia (CAP.Materials and methods. With the microimmunofluorescence test (micro-IF we evaluated the presence of C. pneumoniae specific antibodies in 1036 healthy subjects, in two periods of time, in 1991–93 and 1997–1998. We also tested the pair sera collected from 2118 patients with CAP between 1993–1999.Results. We demonstrated that C. pneumoniae infections are common in our population, as we detected IgG antibodies in 43.1% of healthy population. The prevalence rate of C. pneumoniae infections statistically significant increased in two periods of time. Acute C. pneumoniae infections were proved in 15.9% of all patients with CAP.Conclusions. C. pneumoniae is important respiratory pathogen also in our community. The infections are more common in older patients. Because C. pneumoniae like other Chlamydia species has tendency to cause chronic disease, it is reasonable to diagnose this bacterium in respiratory patients. It is also recommended to test convalescent sera at serologic laboratory diagnosis.

  10. Lung lobar volume in patients with chronic interstitial pneumonia

    International Nuclear Information System (INIS)

    Harada, Hisao; Koba, Hiroyuki; Saitoh, Tsukasa; Abe, Shosaku.

    1997-01-01

    We measured lung lobar volume by using helical computed tomography (HCT) in 23 patients with idiopathic interstitial pneumonia (IIP), 7 patients with chronic interstitial pneumonia associated with collagen vascular disease (CVD-IP), and 5 healthy volunteers HCT scanning was done at the maximal inspiratory level and the resting end-expiratory level. To measure lung lobar volume, we traced the lobar margin on HCT images with a digitizer and calculated the lobar volume with a personal computer. The lower lobar volume and several factors influencing it in chronic interstitial pneumonia were studied. At the maximal inspiratory level, the lower lobar volume as a percent of the whole lung volume was 46.8±4.13% (mean ± SD) in the volunteers, 39.5±6.19% in the patients with IIP, and 27.7±7. 86% in the patients with CVD-IP. The lower lobar volumes in the patients were significantly lower than in the volunteers. Patients with IIP in whom autoantibody tests were positive had lower lobar volumes that were very low and were similar to those of patients with CVD-IP. These data suggest that collagen vascular disease may develop in patients with interstitial pneumonia. The patients with IIP who had emphysematous changes on the CT scans had smaller decreases in total lung capacity and lower ratios of forced expiratory volume in one second to forced vital capacity than did those who had no emphysematous changes, those two groups did not differ in the ratio of lower lobar volume to whole lung volume. This suggests that emphysematous change is not factor influencing lower lobar volume in patients with chronic interstitial pneumonia. We conclude that chronic interstitial pneumonia together with very low values for lower lobar volume may be a pulmonary manifestation of collagen vascular disease. (author)

  11. Hiponatremia como factor de riesgo de muerte en pacientes internados por neumonía adquirida en la comunidad Hyponatremia as a risk factor of death in patients with community-acquired pneumonia requiring hospitalization

    Directory of Open Access Journals (Sweden)

    Ricardo E. Barcia

    2006-12-01

    Full Text Available Investigamos si la hiponatremia es un factor de riesgo de muerte en pacientes internados por neumonía adquirida en la comunidad (NAC y estimamos el peso relativo de otros factores de riesgo de muerte por NAC, en un estudio de cohorte, prospectivo, multicéntrico, en 5 Servicios de Clínica Médica del Area Metropolitana de Buenos Aires. Evaluamos adultos con NAC ingresados entre 21 de marzo de 2000 y 21 de diciembre del mismo año. Los factores de riesgo que mostraron asociación con evolución por análisis univariado, fueron sometidos a análisis de regresión logística, con un nivel de significación de a de 0.05. En 9 meses se internaron 238 pacientes con NAC: 150 (63% varones y 88 (36% mujeres, con edades medias 52.99 (±20.35 y 55.06 (±20.94 años, respectivamente. Fallecieron 25/238 (10.5%. En análisis multivariado, se asociaron significativamente con evolución: enfermedad vascular encefálica (EVE (B: 2.614, pWe investigated whether hyponatremia is a risk factor of death in patients hospitalized with community-acquired pneumonia (CAP and estimated the relative risk of death by CAP of other risk factors. The design was prospective multicentre cohort study. In 5 centers in Buenos Aires, Argentina, we studied adults hospitalized with CAP between March 21, 2000 and December 21, 2000. Using stepwise logistic regression, we analyzed risk factors that showed a univariate association with mortality; a significance level was 0.05. During a 9-month period, 238 patients were admitted with CAP: 150 (63% male and 88 (36% female, mean age 52.99 (±20.35 and 55.06 (±20.94, respectively. Mortality was 10.5% (25/238. By multivariate analysis, the following variables were statistically associated with evolution: cerebrovascular disease (CD (B: 2.614, p<0.001, RRE: 13.6, IC 95%: 3.7-49.6; hyponatremia at admission or during hospitalization (B: 1.994, p<0.001, RRE: 7.3, IC 95%: 2.5-20.8; and elevated blood urea (B: 0.016, p= 0.003, RRE: 1.016, IC 95

  12. Application of a Prognostic Scale to Estimate the Mortality of Children Hospitalized with Community-acquired Pneumonia.

    Science.gov (United States)

    Araya, Soraya; Lovera, Dolores; Zarate, Claudia; Apodaca, Silvio; Acuña, Julia; Sanabria, Gabriela; Arbo, Antonio

    2016-04-01

    Pneumonia is a major cause of mortality in children. The objective of this study was to construct a prognostic scale for estimation of mortality applicable to children with community-acquired pneumonia (CAP). This observational study included patients younger than 15 years with a diagnosis of CAP who were hospitalized between 2004 and 2013. A point-based scoring system based on the modification of the PIRO scale used in adults with pneumonia was applied to each child hospitalized with CAP. It included the following variables: predisposition (age pneumonia) and organ dysfunction (kidney failure, liver failure and acute respiratory distress syndrome). One point was given for each feature that was present (range, 0-10 points). The association between the modified PIRO score and mortality was assessed by stratifying patients into 4 levels of risk: low (0-2 points), moderate (3-4 points), high (5-6 points) and very high risk (7-10 points). Eight hundred sixty children hospitalized with CAP were eligible for study. The mean age was 2.8 ± 3.2 years. The observed mortality was 6.5% (56/860). Mortality ranged from 0% for a low PIRO score (0/708 pts), 18% (20/112 pts) for a moderate score, 83% (25/30 pts) for a high score and 100% (10/10 pts) for a very high modified PIRO score (P < 0.001). The present score accurately discriminated the probability of death in children hospitalized with CAP, and it could be a useful tool to select candidates for admission to intensive care unit and for adjunctive therapy in clinical trials.

  13. Patient life in hospital

    DEFF Research Database (Denmark)

    Ludvigsen, Mette Spliid

    Patient life in hospital.A qualitative study of informal relationships between hospitalised patients Introduction Within a patientology framework, this PhD dissertation is about an empirical study on patient life that provides insight into the nature of informal relationships between patients...... are created through stories about three roughly framed aspects of hospitalisation: A. Being together with fellow patients entails a constant dilemma, B. Relationships between patients are restricted and extended and C. Shifting perspectives in solidarity. Conclusion Patients' hospitalisation is strongly...

  14. Costs and health care resource utilization among chronic obstructive pulmonary disease patients with newly acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Lin J

    2014-07-01

    Full Text Available Junji Lin,1 Yunfeng Li,2 Haijun Tian,2 Michael J Goodman,1 Susan Gabriel,2 Tara Nazareth,2 Stuart J Turner,2,3 Stephen Arcona,2 Kristijan H Kahler21Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA; 2Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 3Ernest Mario School of Pharmacy, Rutgers University, New Brunswick, NJ, USA Background: Patients with chronic obstructive pulmonary disease (COPD are at increased risk for lung infections and other pathologies (eg, pneumonia; however, few studies have evaluated the impact of pneumonia on health care resource utilization and costs in this population. The purpose of this study was to estimate health care resource utilization and costs among COPD patients with newly acquired pneumonia compared to those without pneumonia. Methods: A retrospective claims analysis using Truven MarketScan® Commercial and Medicare databases was conducted. COPD patients with and without newly acquired pneumonia diagnosed between January 1, 2004 and September 30, 2011 were identified. Propensity score matching was used to create a 1:1 matched cohort. Patient demographics, comorbidities (measured by Charlson Comorbidity Index, and medication use were evaluated before and after matching. Health care resource utilization (ie, hospitalizations, emergency room [ER] and outpatient visits, and associated health care costs were assessed during the 12-month follow-up. Logistic regression was conducted to evaluate the risk of hospitalization and ER visits, and gamma regression models and two-part models compared health care costs between groups after matching. Results: In the baseline cohort (N=467,578, patients with newly acquired pneumonia were older (mean age: 70 versus [vs] 63 years and had higher Charlson Comorbidity Index scores (3.3 vs 2.6 than patients without pneumonia. After propensity score matching, the pneumonia cohort was nine times more likely

  15. Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting

    Directory of Open Access Journals (Sweden)

    Jaishika Seedat

    2016-02-01

    Full Text Available Oral care is a crucial routine for patients with dysphagia that, when completed routinely, can prevent the development of aspiration pneumonia. There is no standardised protocol for oral care within government hospitals in South Africa. This study aimed to investigate the outcome of an oral care protocol. Participants were patients with oropharyngeal dysphagia, with either stroke or traumatic brain injury as the underlying medical pathology, and nurses. All participants were recruited from one tertiary level government hospital in Gauteng, South Africa. 139 nurses participated in the study and received training on the oral care protocol. There were two groups of participants with oropharyngeal dysphagia. Group one (study group, n = 23 was recruited by consecutive sampling, received regular oral care and were not restricted from drinking water; however, all other liquids were restricted. Group two (comparison group, n = 23 was recruited via a retrospective record review, received inconsistent oral care and were placed on thickened liquids or liquid restricted diets. Results showed that a regimen of regular oral care and free water provision when combined with dysphagia intervention did prevent aspiration pneumonia in patients with oropharyngeal dysphagia. The article highlights two key findings: that regular and routine oral care is manageable within an acute government hospital context and a strict routine of oral care can reduce aspiration pneumonia in patients with oropharyngeal dysphagia. An implication from these findings is confirmation that teamwork in acute care settings in developing contexts must be prioritised to improve dysphagia management and patient prognosis.

  16. Klebsiella Pneumoniae Liver Abscess: A Case Series of Six Asian Patients.

    Science.gov (United States)

    Oikonomou, Katerina G; Aye, Myint

    2017-09-26

    BACKGROUND Liver abscesses represent a serious infection of hepatic parenchyma and are associated with significant morbidity and mortality. The emergence of a new hypervirulent variant of Klebsiella pneumoniae, which can cause serious infections in the Asian population, is under investigation. We report a case series of six Asian patients hospitalized at our institution from January 2013 to November 2015 for liver abscess due to Klebsiella pneumoniae. CASE REPORT Charts of six Asian patients were retrospectively reviewed. Four patients were male and two were female. The mean age was 53 years (range: 35-64 years). All patients had no known past medical history of immunodeficiency. Three patients had multiple liver abscesses at the time of initial presentation. In five patients, the source of entry of the pathogenic microorganism was unknown and in one patient the suspected source of entry was the gastrointestinal tract. In three patients there was also concomitant Klebsiella pneumoniae bacteremia. The mean duration of antibiotic treatment was seven weeks and the mean duration of hospital stay was 13.5 days. CONCLUSIONS Liver abscess should always be included in the differential diagnosis in cases of sepsis without obvious source and/or in the clinical scenarios of fever, abdominal pain, and liver lesions.

  17. Clinical signs of radiologic pneumonia in under-five hypokalemic diarrheal children admitted to an urban hospital in bangladesh.

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    Mohammod Jobayer Chisti

    Full Text Available BACKGROUND: Clinical signs of pneumonia are often veiled in under-five diarrheal children presenting with hypokalemia, making clinical diagnosis of pneumonia very difficult in such population. However, there is no published report that describes the influences of hypokalemia on the clinical signs of pneumonia in diarrheal children. Our objective was to assess the influences of hypokalemia, and their outcome in such children. METHODS: We prospectively enrolled all under-five diarrheal children (n = 180 admitted to the Special Care Ward of the Dhaka Hospital of icddr,b from September-December 2007 with radiological pneumonia who also had their serum potassium estimated. We compared the clinical features and outcome of the diarrheal children having pneumonia with (cases = 55 and without hypokalemia (controls = 125. RESULTS: The case-fatality among the cases was 2 times higher compared to the controls, but the difference was not statistically significant (p = 0.202. In logistic regression analysis, after adjusting for potential confounders such as age of the patient, clinical dehydration, severe wasting, abnormally sleepy, lower chest wall in-drawing, nasal flaring and inability to drink on admission, under-five diarrheal children with pneumonia who presented with nutritional edema had 3 times more risk to have hypokalemia compared to those without nutritional edema (OR = 2.76, 95% CI = 1.01-7.51 and these hypokalemic children were 64% less likely to present with fast breathing (OR = 0.36, 95% CI = 0.17-0.74. CONCLUSION AND SIGNIFICANCE: The results of our analysis are simple but may have great public health implications and underscore the importance of diligent assessment for pneumonia in under-five diarrheal children having risk of hypokalemia as in children with nutritional edema even in absence of fast breathing, a useful sign of pneumonia. This may help for early initiation of first dose of parental antibiotics

  18. Clinical Signs of Radiologic Pneumonia in Under-Five Hypokalemic Diarrheal Children Admitted to an Urban Hospital in Bangladesh

    Science.gov (United States)

    Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Ashraf, Hasan; Faruque, Abu S. G.; Bardhan, Pradip Kumar; Das, Sumon Kumar; Shahunja, K. M.; Shahid, Abu S. M. S. B.; Ahmed, Tahmeed

    2013-01-01

    Background Clinical signs of pneumonia are often veiled in under-five diarrheal children presenting with hypokalemia, making clinical diagnosis of pneumonia very difficult in such population. However, there is no published report that describes the influences of hypokalemia on the clinical signs of pneumonia in diarrheal children. Our objective was to assess the influences of hypokalemia, and their outcome in such children. Methods We prospectively enrolled all under-five diarrheal children (n = 180) admitted to the Special Care Ward of the Dhaka Hospital of icddr,b from September-December 2007 with radiological pneumonia who also had their serum potassium estimated. We compared the clinical features and outcome of the diarrheal children having pneumonia with (cases = 55) and without hypokalemia (controls = 125). Results The case-fatality among the cases was 2 times higher compared to the controls, but the difference was not statistically significant (p = 0.202). In logistic regression analysis, after adjusting for potential confounders such as age of the patient, clinical dehydration, severe wasting, abnormally sleepy, lower chest wall in-drawing, nasal flaring and inability to drink on admission, under-five diarrheal children with pneumonia who presented with nutritional edema had 3 times more risk to have hypokalemia compared to those without nutritional edema (OR = 2.76, 95% CI = 1.01–7.51) and these hypokalemic children were 64% less likely to present with fast breathing (OR = 0.36, 95% CI = 0.17–0.74). Conclusion and significance The results of our analysis are simple but may have great public health implications and underscore the importance of diligent assessment for pneumonia in under-five diarrheal children having risk of hypokalemia as in children with nutritional edema even in absence of fast breathing, a useful sign of pneumonia. This may help for early initiation of first dose of parental antibiotics along with

  19. Characterization of ST258 Colistin-Resistant, blaKPC-Producing Klebsiella pneumoniae in a Greek Hospital.

    Science.gov (United States)

    Mavroidi, Angeliki; Katsiari, Maria; Likousi, Sofia; Palla, Eleftheria; Roussou, Zoi; Nikolaou, Charikleia; Maguina, Asimina; Platsouka, Evangelia D

    2016-07-01

    The emergence of colistin resistance may further contribute to treatment failure of infection caused by multidrug-resistant (MDR) Klebsiella pneumoniae. The colistin resistance rates were determined and colistin-resistant carbapenemase-producing K. pneumoniae (COL-R CP-Kp) were characterized over an 18-month period in a Greek hospital. Out of 135 carbapenemase producers, 19 isolates (14%) were categorized as resistant to colistin. Phenotypic and molecular characterization of the COL-R CP-Kp isolates revealed that all were MDR blaKPC producers and, excluding one isolate of MLST ST383, belonged to the international clonal lineage ST258. Furthermore, PCR amplification and sequencing of the mgrB locus revealed nucleotide sequences of different sizes and insertions of IS1- and IS5-like mobile elements. The majority (63%) of the COL-R blaKPC producers was recovered from patients in the intensive care unit (ICU) and clinical data indicated that all patients should have acquired these isolates in the ICU. The findings of the present study underscore a concerning evolution of colistin resistance in a setting of high K. pneumoniae carbapenemase (KPC)-Kp endemicity, such as Greece. Thus, continuous surveillance, molecular characterization, prudent use of antibiotics, and implementation of infection control measures for K. pneumoniae are urgent.

  20. Lower mortality rate in elderly patients with community-onset pneumonia on treatment with aspirin.

    Science.gov (United States)

    Falcone, Marco; Russo, Alessandro; Cangemi, Roberto; Farcomeni, Alessio; Calvieri, Camilla; Barillà, Francesco; Scarpellini, Maria Gabriella; Bertazzoni, Giuliano; Palange, Paolo; Taliani, Gloria; Venditti, Mario; Violi, Francesco

    2015-01-06

    Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potential benefit of aspirin, which lowers platelet aggregation by inhibition of thromboxane A2 production, is still unclear. The aim of the study was to assess the impact of aspirin on mortality in patients with pneumonia. Consecutive patients admitted to the University-Hospital Policlinico Umberto I (Rome, Italy) with community-onset pneumonia were recruited and prospectively followed up until discharge or death. The primary end point was the occurrence of death up to 30 days after admission; the secondary end point was the intrahospital incidence of nonfatal myocardial infarction and ischemic stroke. One thousand and five patients (age, 74.7±15.1 years) were included in the study: 390 were receiving aspirin (100 mg/day) at the time of hospitalization, whereas 615 patients were aspirin free. During the follow-up, 16.2% of patients died; among these, 19 (4.9%) were aspirin users and 144 (23.4%; PFiO(2) ratio <300 negatively influenced survival, whereas aspirin therapy was associated with improved survival. Compared to patients receiving aspirin, the propensity score adjusted analysis confirmed that patients not taking aspirin had a hazard ratio of 2.07 (1.08 to 3.98; P=0.029) for total mortality. This study shows that chronic aspirin use is associated with lower mortality rate within 30 days after hospital admission in a large cohort of patients with pneumonia. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  1. Coinfection and Mortality in Pneumonia-Related Acute Respiratory Distress Syndrome Patients with Bronchoalveolar Lavage: A Prospective Observational Study.

    Science.gov (United States)

    Kao, Kuo-Chin; Chiu, Li-Chung; Hung, Chen-Yiu; Chang, Chih-Hao; Yang, Cheng-Ta; Huang, Chung-Chi; Hu, Han-Chung

    2017-05-01

    Pneumonia is the leading risk factor of acute respiratory distress syndrome (ARDS). It is increasing studies in patients with pneumonia to reveal that coinfection with viral and bacterial infection can lead to poorer outcomes than no coinfection. This study evaluated the role of coinfection identified through bronchoalveolar lavage (BAL) examination on the outcomes of pneumonia-related ARDS. We performed a prospective observational study at Chang Gung Memorial Hospital from October 2012 to May 2015. Adult patients were included if they met the Berlin definition of ARDS. The indications for BAL were clinically suspected pneumonia-related ARDS and no definite microbial sample identified from tracheal aspirate or sputum. The presence of microbial pathogens and clinical outcomes were analyzed. Of the 19,936 patients screened, 902 (4.5%) fulfilled the Berlin definition of ARDS. Of these patients, 255 (22.7%) had pneumonia-related ARDS and were included for analysis. A total of 142 (55.7%) patients were identified to have a microbial pathogen through BAL and were classified into three groups: a virus-only group (n = 41 [28.9%]), no virus group (n = 60 [42.2%]), and coinfection group (n = 41 [28.9%]). ARDS severity did not differ significantly between the groups (P = 0.43). The hospital mortality rates were 53.7% in virus-only identified group, 63.3% in no virus identified group, and 80.5% in coinfection identified group. The coinfection group had significantly higher mortality than virus-only group (80.5% vs. 53.7%; P = 0.01). In patients with pneumonia-related ARDS, the BAL pathogen-positive patients had a trend of higher mortality rate than pathogen-negative patients. Coinfection with a virus and another pathogen was associated with increased hospital mortality in pneumonia-related ARDS patients.

  2. Kytococcus schroeteri Pneumonia in Two Patients with a Hematological Malignancy

    NARCIS (Netherlands)

    Hodiamont, C. J.; Huisman, C.; Spanjaard, L.; van Ketel, R. J.

    2010-01-01

    Neutropenic patients are susceptible to infections with usually harmless microorganisms. We report two cases of severe pneumonia in hematological patients due to Kytococcus schroeteri, a saprophyte of the human skin. When blood cultures or respiratory specimens yield micrococcus-like colonies,

  3. Pattern of community acquired pneumonia in pregnant ladies in Ain Shams University hospitals

    Directory of Open Access Journals (Sweden)

    Aya M. Abdel Dayem

    2012-10-01

    Conclusion: Morbidity and mortality in pregnant patients with pneumonia continue to present a significant challenge. Early recognition of the diseases process and prompt treatment are required to ascertain an optimal outcome. The treatments in the gravid patients generally follow standard guide lines for the treatment of pneumonia in adults. Concern for fetal outcome should not delay treatment as improvement in maternal oxygenation and status is the best way to ensure fetal protection.

  4. An Update on Aerosolized Antibiotics for Treating Hospital-Acquired and Ventilator-Associated Pneumonia in Adults.

    Science.gov (United States)

    Wood, G Christopher; Swanson, Joseph M

    2017-12-01

    A significant percentage of patients with hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) have poor outcomes with intravenous antibiotics. It is not clear if adding aerosolized antibiotics improves treatment. This review is an update on using aerosolized antibiotics for treating HAP/VAP in adults. PubMed search using the terms "aerosolized antibiotics pneumonia," "nebulized antibiotics pneumonia," and "inhaled antibiotics pneumonia." Reference lists from identified articles were also searched. Clinical studies of aerosolized antibiotics for treating HAP/VAP in adults from July 2010 to March 2017. This article updates a previous review on this topic written in mid-2010. The size and quality of studies have improved dramatically in the recent time period compared to previous studies. However, there still are not large randomized controlled trials available. Colistin and aminoglycosides were the most commonly studied agents, and the most common pathogens were Pseudomonas and Acinetobacter. The clinical efficacy of adding aerosolized antibiotics was mixed. Approximately half of the studies showed better outcomes, and none showed worse outcomes. Aerosolized antibiotics appear to be relatively safe, though pulmonary adverse events can occur. Attention to proper administration technique in mechanically ventilated patients is required, including the use of vibrating plate nebulizers. Adding aerosolized antibiotics to intravenous antibiotics may improve the outcomes of adult patients with HAP/VAP in some settings. It seems reasonable to add aerosolized antibiotics in patients with multidrug-resistant organisms or who appear to be failing therapy. Clinicians should pay attention to potential adverse events and proper administration technique.

  5. Endogenous carboxyhemoglobin concentrations in the assessment of severity in patients with community-acquired pneumonia.

    Science.gov (United States)

    Corbacioglu, Seref Kerem; Kilicaslan, Isa; Bildik, Fikret; Guleryuz, Atacan; Bekgoz, Burak; Ozel, Ayca; Keles, Ayfer; Demircan, Ahmet

    2013-03-01

    Previous studies have shown that carbon monoxide, which is endogenously produced, is increased in community-acquired pneumonia (CAP). However, it has not been studied enough whether severity of pneumonia is correlated with increased carboxyhemoglobin (COHb) concentrations in CAP. The aim of this study was to determine whether endogenous carbon monoxide levels in patients with CAP were higher compared with the control group and, if so, to determine whether COHb concentrations could predict severity in CAP. Eighty-two patients with CAP were evaluated in this cross-sectional study during a 10-month period. Demographic data, pneumonia severity index and confusion, uremia, rate respiratory, pressure blood, age>65 (CURB-65) scores, hospital admission or discharge decisions, and 30-day hospital mortality rate were recorded. In addition, 83 control subjects were included to study. The COHb concentration was measured in arterial blood sample. The levels of COHb in patients with CAP were 1.70% (minimum-maximum, 0.8-3.2), whereas those in control subjects, 1.40% (minimum-maximum, 0.8-2.9). The higher COHb concentrations in patients with CAP were statistically significant (P < .05). Concentration of COHb correlated with pneumonia severity index (P = .04, r = 0.187); however, it did not correlate with CURB-65 (P = .218, r = 0.112). Although COHb concentrations show an increase in patients with pneumonia, it was concluded that this increase did not act as an indicator in diagnosis process or prediction of clinical severity for the physicians. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. The Mystery of Increased Hospitalizations of Elderly Patients

    Centers for Disease Control (CDC) Podcasts

    2008-04-15

    Pneumonia is a common illness that affects millions of people in the United States every year. In some people, particularly the elderly and those who are ill from pre-existing conditions, bacterial pneumonia may follow influenza or even a common cold. Dr. Martin Meltzer, discusses two articles in the May 2008 issue of Emerging Infectious Diseases journal about increased pneumonia-related hospitalizations of elderly patients in England.  Created: 4/15/2008 by Emerging Infectious Diseases.   Date Released: 4/30/2008.

  7. Costing of severe pneumonia in hospitalized infants and children aged 2-36 months, at a secondary and tertiary level hospital of a not-for-profit organization

    DEFF Research Database (Denmark)

    Madsen, Helle Ostergaard; Hanehøj, Malin; Das, Ashima Rani

    2009-01-01

    OBJECTIVES: To determine health care provider cost and household cost of the treatment of severe pneumonia in infants and young children admitted to secondary and tertiary level health care facilities. METHODS: The study was done in a private, not-for-profit medical college hospital, in Vellore...... comprised travel, accommodation and special food during the period of illness, and indirect costs of productivity loss for family members. Patient specific resource consumption and related charges were recorded from charts, nursing records, pharmacy lists and hospital bills, and the providers view point...

  8. Detection of Chlamydia pneumoniae in Ankylosing Spondylitis Patients

    Directory of Open Access Journals (Sweden)

    Dunya Fareed Salloom

    2018-03-01

    Full Text Available Ankylosing spondylitis is a complex debilitating disease because its pathogenesis is not clear. This study aims at detecting some pathogenesis factors that lead to induce the disease. Chlamydia pneumoniae is one of these pathogenesis factors which acts as a triggering factor for the disease. The study groups included forty Iraqi Ankylosing spondylitis patients and forty healthy persons as a control group. Immunological and molecular examinations were done to detect Chlamydia. pneumoniae in AS group. The immunological results were performed by Enzyme-Linked Immunosorbent Assay (ELISA to detect anti-IgG and anti-IgM antibodies of C. pneumoniae revealed that five of forty AS patients' samples (12.5% were positive for anti-IgG and IgM C. pneumoniae antibodies compared to controls which revealed seronegative. Molecular detection included 16srRNA and HSP-70 genes were to ensure the serological examination for detection of bacteria in the five blood samples which were positive; therefore, these results improved that C. pneumoniae played a role in the pathogenesis of the disease.

  9. The association of functional oral intake and pneumonia in patients with severe traumatic brain injury

    DEFF Research Database (Denmark)

    Hansen, T.S.; Larsen, K.; Engberg, Anders

    2008-01-01

    MEASURE: Pneumonia. RESULTS: Twenty-seven percent of the patients admitted to the brain injury unit were in treatment for pneumonia; pneumonia developed in 12% of the patients during rehabilitation; the condition occurred within 19 days of admission in all but 1 patient. Of these patients, 81% received...

  10. Rational strategy of pharmacotherapy of patients with community-acquired pneumonia at elderly and senil eage

    Directory of Open Access Journals (Sweden)

    L. F. Kuznetsova

    2014-04-01

    therapy to the national guidelines. Statistical data processing was carried out in the system of the SPT Statistica, version 8.0. Results and discussion. All hospitalized patients received systemic antibiotic therapy. Frequency assignments AMP patients at the outpatient stage was 21 %. Quick antibacterial therapy was in 15.1 % (n=10 cases, mainly in patients from 60 to 68 years, with no complications. Starting antibiotic therapy in most cases was chosen according to the national treatment guidelines. High efficiency of the combined antibacterial therapy compared with mono - antibacterial therapy was noted. Conclusions: The most effective antibacterial treatment was expected from the triple combination of antibacterial drugs: cephalosporins 3rd generation + fluoroquinolones + macrolides. The study has also noted the high relevance of the ongoing antibiotic therapy with existing national guidelines for management of patients with nonhospital pneumonia (89,9 %, which is comparable with the commitment to comply with the recommendations in the clinics of Europe and the USA.

  11. ROLE OF STREPTOCOCCUS PNEUMONIAE IN THE STRUCTURE OF BACTERIAL INFECTIONS IN THE CHILDREN HOSPITALIZED TO INPATIENT HOSPITALS IN MOSCOW IN 2011–2012

    Directory of Open Access Journals (Sweden)

    A. A. Baranov

    2013-01-01

    Full Text Available Data on the spread of Streptococcus pneumoniae serotypes in the RF are extremely limited. 3 pneumococcal conjugated vaccines are approved inRussia; however, neither has yet been employed in the framework of the national population immunization program. At the same time, it is the dataon the serotype range of pneumococcal infections that may be considered the prognostic efficacy criterion for the national vaccination programs.The objective of this research is identification of the circulating S. pneumoniae serotypes and spread of pneumococcal etiology infections in the structure of bacterial infections in the infants hospitalized to 5 inpatient hospital of Moscow in 2011–2012. The trial involved 864 patients in tote. Vast majority of patients (86% had acute purulent otitis media and sinusitis. Community-acquired pneumonia was diagnosed in 9% of patients, sepsis and bacteremia — in 3.6%; purulent meningitis — 1.2% of patients. It has been revealed that S. pneumoniae is the primary pathogen in the structure of nasopharyngeal carriage in the children under 5 years of age hospitalized with acute bacterial infections, and the primary bacterial causative agent of acute otitis media at this age. Nasopharyngeal pneumococcal carriage analysis revealed the prevalent serotypes — 19F, 14, 23F, 3, 6A and B; they were present in 3/4 of all cases; 19F was the most frequent (> 20%. Diversity of the S. pneumoniae serotypes detected in middle ear liquid was less significant — 17 serotypes (in comparison with 24 serotypes in nasopharynx. The 5 prevalent serotypes were 19F, 3, 14, 23F, 6B and 19A (> 75% in tote. Detection rate of serotypes 3 and 19A in middle ear liquid significantly exceeded the detection rate of these serotypes in case of nasopharyngeal carriage. The study of invasive infections revealed serotypes 14, 23F, 3 and 15C. These data may be used as a benchmark for future monitoring and evaluation of effect of PCV vaccines on epidemiology of

  12. Streptococcus pneumoniae – caused CAP in hospitalised patients: mortality predictors

    Directory of Open Access Journals (Sweden)

    Sandra Figueiredo

    2008-09-01

    Full Text Available Probably the most important decision in the management of Community-Acquired Pneumonia (CAP is patient site of care. Patients with Streptococcus pneumoniae-caused CAP admitted to our hospital between 1st January and 31st December 2006 were retrospectively analysed. Samples of blood, sputum, bronchial and bronchoalveolar lavage and urine were collected for microbiological testing using standard culture techniques and urine antigen detection. Pneumonia Severity Index (PSI and British Thoracic Society (BTS CURB-65 scoring tools were evaluated. The statistical treatment was performed using the SPSS 14.0 program. We included 104 patients, 67.3% male, median age 63 years old, mortality 13.4%. There was a significant association between the PSI and CURB-65 score and mortality. Despite advances, CAP is still an important health problem with a high atten - dant morbi-mortality. This study confirms the value of PSI and CURB-65 in the prediction of severe pneumonia. Resumo: A avaliação da gravidade perante qualquer caso de pneumonia adquirida na comunidade (PAC é de suma importância, pois dela decorrem decisões como a necessidade de internamento e o tratamento empírico inicial. Os autores apresentam um estudo retrospectivo, que incluiu doentes internados devido a pneumonia por Streptococcus pneumoniae durante o ano de 2006, no Hospital de São João. A confirmação etiológica de infecção foi feita por isolamentos no sangue, líquido pleural, secreções traqueobrônquicas, lavado brônquico, lavado broncoalveolar e pesquisa de antigenúria. Foram analisados os factores de risco e avaliados, com base nas normas PSI (Pneumonia Severity Index e da British Thoracic Society (BTS - CURB-65. A análise estatística foi efectuada utilizando teste T para amostras independentes e ANOVA, usando o programa de análise estatística SPSS 14.0.Foram incluídos 104 doentes com idade mediana de 63 anos, sendo 67

  13. Thin-section computed tomography findings in 104 immunocompetent patients with adenovirus pneumonia.

    Science.gov (United States)

    Park, Chan Kue; Kwon, Hoon; Park, Ji Young

    2017-08-01

    Background To date, there has been no computed tomography (CT) evaluation of adenovirus pneumonia in a large number of immunocompetent patients. Purpose To describe the thin-section CT findings of immunocompetent patients with adenovirus pneumonia. Material and Methods We prospectively enrolled 104 patients with adenovirus pneumonia from a military hospital. CT scans of each patient were retrospectively and independently assessed by two radiologists for the presence of abnormalities, laterality and zonal predominance of the parenchymal abnormalities, and dominant imaging patterns and their anatomic distributions. Results CT findings included consolidation (n = 92), ground-glass opacity (GGO; n = 82), septal thickening (n = 34), nodules (n = 46), bronchial wall thickening (n = 32), pleural effusion (n = 16), and lymphadenopathy (n = 3). Eighty-four patients (81%) exhibited unilateral parenchymal abnormalities and 57 (57%) exhibited lower lung zone abnormalities. The most frequently dominant CT pattern was consolidation with surrounding GGO (n = 50), with subpleural (70%) and peribronchovascular (94%) distributions. Consolidation-the second-most common pattern (n = 33)-also exhibited subpleural (79%) and peribronchovascular (97%) distributions. The dominant nodule pattern (n = 14) exhibited mixed (64%) and peribronchovascular (100%) distributions. A dominant GGO pattern was only observed in four patients; none had central distribution. Conclusion Although the manifestations of adenovirus pneumonia on CT are varied, we found the most frequent pattern was consolidation with or without surrounding GGO, with subpleural and peribronchovascular distributions. Parenchymal abnormalities were predominantly unilateral and located in the lower lung zone. If dominant consolidation findings are present in immunocompetent patients during the early stages, adenovirus pneumonia should be considered.

  14. Emerging trends of nosocomial pneumonia in intensive care unit of a tertiary care public teaching hospital in Western India.

    Science.gov (United States)

    Bhadade, Rakesh; Harde, Minal; deSouza, Rosemarie; More, Ashwini; Bharmal, Ramesh

    2017-01-01

    Nosocomial pneumonia poses great challenge to an intensivist. Detailed information about hospital-acquired pneumonia (HAP) and ventilator-acquired pneumonia (VAP) is crucial for prevention and optimal management, thus improving quality Intensive Care Unit (ICU) care. Hence, we aimed to study the current trend of nosocomial pneumonia in ICU. It was a prospective observational cohort study, conducted in the ICU of a tertiary care teaching public hospital over a period of 18 months. We studied clinical profile and outcome of 120 adult patients who developed VAP/HAP during the study period. We also analyzed the causative organisms, antibiotic sensitivity, and resistance pattern in these patients. Out of 120 patients, 29 patients were HAP and 91 patients were VAP. Mortality was 60% (72), and development of VAP and requirement of mechanical ventilation showed significant association with mortality (P antibiotiques et le modèle de résistance chez ces patients. Résultats: Sur 120 patients, 29 patients étaient HAP et 91 patients étaient VAP. La mortalité était de 60% (72), et le développement du VAP et l'exigence de ventilation mécanique ont montré une association significative avec la mortalité (P antibiotique maximale a été observée chez la pipéracilline + tazobactam (58,8%), suivie de l'imipénème (49,5%) et du méropénem (41,8%), alors que la résistance antibiotique maximale a été observée à cefépime (95,1%), suivie de ceftazidime et de l'amoxicilline (91,2%) . la pneumonie nosocomiale a montré une incidence élevée (17,44%) et la mortalité (60%). Les organismes communs identifiés étaient S. aureus et K. pneumoniae. La résistance était élevée pour les antibiotiques couramment utilisés et une forte sensibilité aux antibiotiques pour la pipéracilline + le tazobactam et le carbapénème.

  15. Racial variations in processes of care for patients with community-acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Whittle Jeff

    2004-08-01

    Full Text Available Abstract Background Patients hospitalized with community acquired pneumonia (CAP have a substantial risk of death, but there is evidence that adherence to certain processes of care, including antibiotic administration within 8 hours, can decrease this risk. Although national mortality data shows blacks have a substantially increased odds of death due to pneumonia as compared to whites previous studies of short-term mortality have found decreased mortality for blacks. Therefore we examined pneumonia-related processes of care and short-term mortality in a population of patients hospitalized with CAP. Methods We reviewed the records of all identified Medicare beneficiaries hospitalized for pneumonia between 10/1/1998 and 9/30/1999 at one of 101 Pennsylvania hospitals, and randomly selected 60 patients at each hospital for inclusion. We reviewed the medical records to gather process measures of quality, pneumonia severity and demographics. We used Medicare administrative data to identify 30-day mortality. Because only a small proportion of the study population was black, we included all 240 black patients and randomly selected 720 white patients matched on age and gender. We performed a resampling of the white patients 10 times. Results Males were 43% of the cohort, and the median age was 76 years. After controlling for potential confounders, blacks were less likely to receive antibiotics within 8 hours (odds ratio with 95% confidence interval 0.6, 0.4–0.97, but were as likely as whites to have blood cultures obtained prior to receiving antibiotics (0.7, 0.3–1.5, to have oxygenation assessed within 24 hours of presentation (1.6, 0.9–3.0, and to receive guideline concordant antibiotics (OR 0.9, 0.6–1.7. Black patients had a trend towards decreased 30-day mortality (0.4, 0.2 to 1.0. Conclusion Although blacks were less likely to receive optimal care, our findings are consistent with other studies that suggest better risk-adjusted survival

  16. Using decision trees to manage hospital readmission risk for acute myocardial infarction, heart failure, and pneumonia.

    Science.gov (United States)

    Hilbert, John P; Zasadil, Scott; Keyser, Donna J; Peele, Pamela B

    2014-12-01

    To improve healthcare quality and reduce costs, the Affordable Care Act places hospitals at financial risk for excessive readmissions associated with acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN). Although predictive analytics is increasingly looked to as a means for measuring, comparing, and managing this risk, many modeling tools require data inputs that are not readily available and/or additional resources to yield actionable information. This article demonstrates how hospitals and clinicians can use their own structured discharge data to create decision trees that produce highly transparent, clinically relevant decision rules for better managing readmission risk associated with AMI, HF, and PN. For illustrative purposes, basic decision trees are trained and tested using publically available data from the California State Inpatient Databases and an open-source statistical package. As expected, these simple models perform less well than other more sophisticated tools, with areas under the receiver operating characteristic (ROC) curve (or AUC) of 0.612, 0.583, and 0.650, respectively, but achieve a lift of at least 1.5 or greater for higher-risk patients with any of the three conditions. More importantly, they are shown to offer substantial advantages in terms of transparency and interpretability, comprehensiveness, and adaptability. By enabling hospitals and clinicians to identify important factors associated with readmissions, target subgroups of patients at both high and low risk, and design and implement interventions that are appropriate to the risk levels observed, decision trees serve as an ideal application for addressing the challenge of reducing hospital readmissions.

  17. Ventilator-associated pneumonia in critically ill African patients on ...

    African Journals Online (AJOL)

    Background: Stress ulcer prophylaxis is an integral part of the care of the critically ill. Agents that alter gastric pH may predispose these patients to gastric colonisation, with subsequent pneumonia and/or sepsis. Cytoprotective agents such as sucralfate preserve gastric acidity and may be protective. Objective: To determine ...

  18. Predicting mortality among older adults hospitalized for community-acquired pneumonia: an enhanced confusion, urea, respiratory rate and blood pressure score compared with pneumonia severity index.

    Science.gov (United States)

    Abisheganaden, John; Ding, Yew Yoong; Chong, Wai-Fung; Heng, Bee-Hoon; Lim, Tow Keang

    2012-08-01

    Pneumonia Severity Index (PSI) predicts mortality better than Confusion, Urea >7 mmol/L, Respiratory rate >30/min, low Blood pressure: diastolic blood pressure blood pressure 65 years (CURB-65) for community-acquired pneumonia (CAP) but is more cumbersome. The objective was to determine whether CURB enhanced with a small number of additional variables can predict mortality with at least the same accuracy as PSI. Retrospective review of medical records and administrative data of adults aged 55 years or older hospitalized for CAP over 1 year from three hospitals. For 1052 hospital admissions of unique patients, 30-day mortality was 17.2%. PSI class and CURB-65 predicted 30-day mortality with area under curve (AUC) of 0.77 (95% confidence interval (CI): 0.73-0.80) and 0.70 (95% CI: 0.66-0.74) respectively. When age and three co-morbid conditions (metastatic cancer, solid tumours without metastases and stroke) were added to CURB, the AUC improved to 0.80 (95% CI: 0.77-0.83). Bootstrap validation obtained an AUC estimate of 0.78, indicating negligible overfitting of the model. Based on this model, a clinical score (enhanced CURB score) was developed that had possible values from 5 to 25. Its AUC was 0.79 (95% CI: 0.76-0.83) and remained similar to that of PSI class. An enhanced CURB score predicted 30-day mortality with at least the same accuracy as PSI class did among older adults hospitalized for CAP. External validation of this score in other populations is the next step to determine whether it can be used more widely. © 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.

  19. Assisted autogenic drainage in infants and young children hospitalized with uncomplicated pneumonia, a pilot study.

    Science.gov (United States)

    Corten, Lieselotte; Jelsma, Jennifer; Human, Anri; Rahim, Sameer; Morrow, Brenda M

    2018-01-01

    Pneumonia is the most important respiratory problem in low-to-middle income countries. Airway clearance therapy continues to be used in children with pneumonia and secretion retention; however, there is lack of evidence to support or reject this treatment. This study aimed to investigate the feasibility of a randomized controlled trial (RCT) on the efficacy and safety of assisted autogenic drainage (AAD) compared to standard nursing care in children hospitalized with uncomplicated pneumonia. A single-blinded pilot RCT was conducted on 29 children (median age 3.5 months, IQR 1.5-9.4) hospitalized with uncomplicated pneumonia. The intervention group received standard nursing care with additional bi-daily AAD, for 10 to 30 min. The control group only received standard nursing care, unless otherwise deemed necessary by the physician or physiotherapist. The primary outcome measure was duration of hospitalization. The secondary outcome measures included days of fever and supplemental oxygen support; respiratory rate (RR) and heart rate adjusted for age; RR and oxygen saturation pre-, post-, and 1-hr post-treatment; oxygen saturation; adverse events; and mortality. No difference was found for duration of hospitalization (median 7.5 and 7.0 days for the control and intervention groups, respectively); however, Kaplan-Meier analysis revealed a strong tendency towards a shorter time to discharge in the intervention group (p = .06). No significant differences were found for the other outcome measures at time of discharge. No adverse events were reported. Within the intervention group, a significant reduction in RR adjusted for age was found. As no adverse events were reported, and AAD did not prolong hospitalization; AAD might be considered as safe and effective in young children with uncomplicated pneumonia. However, a larger multicentred RCT is warranted to determine the efficacy of AAD compared to standard nursing care. Copyright © 2017 John Wiley & Sons, Ltd.

  20. Prevalence of Multidrug-Resistant Pathogens and Their Antibiotic Susceptibility Pattern from Late-Onset Ventilator-Associated Pneumonia Patients from a Tertiary-Care Hospital in North India

    Directory of Open Access Journals (Sweden)

    Varsha Gupta

    2018-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP is seen as being most common in critically ill patients in intensive care units. Diagnostic protocol is challenging and the treatment is often difficult. Incorrectly selected antibiotic therapy further leads to the emergence of multidrug-resistant (MDR organisms. Materials and Methods: The present prospective study was conducted to study patients of VAP with the aim of determining the aerobic bacterial etiological agents, antimicrobial susceptibility patterns, and molecular detection of MBL (metallo beta lactamase genes. The antimicrobial susceptibility of the isolates by the disc diffusion method and the detection of various drug-resistance mechanisms was done. The minimum inhibitory concentration (MIC based on E-test was determined along with the molecular analysis by polymerase chain reaction for detection of MBL genes (IMP and VIM. Results: Out of a total of 372 patients admitted in intensive care unit during the time period (March 2010 to February 2013, 40 patients were finally diagnosed as having late-onset VAP. Among the study isolates (69, due to polymicrobial infection, the maximum isolates were Acinetobacter spp. (32 followed by Pseudomonas aeruginosa (18, Klebsiella pneumoniae (8, and others. MDR was high with 34% of Acinetobacter and 50% of Pseudomonas strains being MBL producers. Among Staphylococcus aureus, 50% strains were methicillin resistant. On molecular analysis, eight of the Acinetobacter and six of the Pseudomonas isolates came out to be positive for VIM 2 gene, whereas IMP was not detected in any of the isolates. Conclusion: The present study emphasizes the threat of MDR in VAP patients from ICU as the treatment options are limited. The knowledge of prevailing organisms, resistance mechanisms, and their antibiotic profile can go a long way in deciding appropriate empirical therapy.

  1. Possibilities of predicting of the non-severe community-acquired pneumonia outcomes in patients with type 2 diabetes mellitus or chronic heart failure

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    O. S. Makharynska

    2014-06-01

    Full Text Available Aim. Сommunity-acquired pneumonia is life-threatening disease with level of fatal events in hospitals within 12-36 %. In turn, presence of congestive heart failure or type 2 diabetes increases the risk of adverse outcomes in patients with community-acquired pneumonia. Methods and results. In the modern world’s literature there are many models predicting clinical outcomes of community-acquired pneumonia, but none of them includes questionnaires data for such patients. In our study, we used two questionnaires: "The scale of assessment community-acquired pneumonia" R. el Moussaoui and CapSym-12. C Сonclusion. Using logistic regression, we have found statistically significant indices sample questionnaires prognostic opportunities which were used in this study to assess the health and dynamics of symptoms of community-acquired pneumonia and that allows us to predict the outcome community-acquired pneumonia.

  2. Early Dysphagia Screening by Trained Nurses Reduces Pneumonia Rate in Stroke Patients: A Clinical Intervention Study.

    Science.gov (United States)

    Palli, Christoph; Fandler, Simon; Doppelhofer, Kathrin; Niederkorn, Kurt; Enzinger, Christian; Vetta, Christian; Trampusch, Esther; Schmidt, Reinhold; Fazekas, Franz; Gattringer, Thomas

    2017-09-01

    Dysphagia is a common stroke symptom and leads to serious complications such as aspiration and pneumonia. Early dysphagia screening can reduce these complications. In many hospitals, dysphagia screening is performed by speech-language therapists who are often not available on weekends/holidays, which results in delayed dysphagia assessment. We trained the nurses of our neurological department to perform formal dysphagia screening in every acute stroke patient by using the Gugging Swallowing Screen. The impact of a 24/7 dysphagia screening (intervention) over swallowing assessment by speech-language therapists during regular working hours only was compared in two 5-month periods with time to dysphagia screening, pneumonia rate, and length of hospitalization as outcome variables. Overall, 384 patients (mean age, 72.3±13.7 years; median National Institutes of Health Stroke Scale score of 3) were included in the study. Both groups (pre-intervention, n=198 versus post-intervention, n=186) were comparable regarding age, sex, and stroke severity. Time to dysphagia screening was significantly reduced in the intervention group (median, 7 hours; range, 1-69 hours) compared with the control group (median, 20 hours; range, 1-183; P =0.001). Patients in the intervention group had a lower rate of pneumonia (3.8% versus 11.6%; P =0.004) and also a reduced length of hospital stay (median, 8 days; range, 2-40 versus median, 9 days; range, 1-61 days; P =0.033). 24/7 dysphagia screening can be effectively performed by nurses and leads to reduced pneumonia rates. Therefore, empowering nurses to do a formal bedside screening for swallowing dysfunction in stroke patients timely after admission is warranted whenever speech-language therapists are not available. © 2017 American Heart Association, Inc.

  3. Internamento devido a PAC por Streptococcus pneumoniae - Avaliação de factores de mortalidade Streptococcus pneumoniae - caused CAP in hospitalised patients: mortality predictors

    Directory of Open Access Journals (Sweden)

    Sandra Figueiredo

    2008-10-01

    Full Text Available A avaliação da gravidade perante qualquer caso de pneumonia adquirida na comunidade (PAC é de suma importância, pois dela decorrem decisões como a necessidade de internamento e o tratamento empírico inicial. Os autores apresentam um estudo retrospectivo, que incluiu doentes internados devido a pneumonia por Streptococcus pneumoniae durante o ano de 2006, no Hospital de São João. A confirmação etiológica de infecção foi feita por isolamentos no sangue, líquido pleural, secreções traqueobrônquicas, lavado brônquico, lavado broncoalveolar e pesquisa de antigenúria. Foram analisados os factores de risco e avaliados, com base nas normas PSI (Pneumonia Severity Index e da British Thoracic Society (BTS - CURB-65. A análise estatística foi efectuada utilizando teste T para amostras independentes e ANOVA, usando o programa de análise estatística SPSS 14.0. Foram incluídos 104 doentes com idade mediana de 63 anos, sendo 67,3% do sexo masculino. O estudo revelou existir uma associação com significado estatístico entre os resultados de PSI e CURB-65 e a evolução para a mortalidade. Apesar da melhoria dos meios diagnósticos e profilácticos, e da terapêutica antibiótica, a pneumonia pneumocócica permanece uma entidade de grande morbilidade e mortalidade. O valor preditivo das normas PSI e CURB-65 foi confirmado nesta população de doentes, documentando uma correlação entre o número de factores de risco e a evolução da doença.Probably the most important decision in the management of Community-Acquired Pneumonia (CAP is patient site of care. Patients with Streptococcus pneumoniae-caused CAP admitted to our hospital between 1st January and 31st December 2006 were retrospectively analysed. Samples of blood, sputum, bronchial and bronchoalveolar lavage and urine were collected for microbiological testing using standard culture techniques and urine antigen detection. Pneumonia Severity Index (PSI and British Thoracic Society

  4. What is the effect of chest physiotherapy in hospitalized children with pneumonia?

    Science.gov (United States)

    Damiani, Felipe; Adasme, Rodrigo

    2015-10-19

    Chest physiotherapy is applied in clinical practice for the treatment of pneumonia. However, its use is still controversial. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified one systematic review including two relevant randomized controlled trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded it is unclear whether chest physiotherapy increases or decreases the length of hospitalization, severity, or the time to clinical improvement in children with pneumonia because the certainty of the evidence is very low.

  5. Pneumonia as comorbidity in chronic obstructive pulmonary disease (COPD). Differences between acute exacerbation of COPD and pneumonia in patients with COPD.

    Science.gov (United States)

    Boixeda, Ramon; Bacca, Sandra; Elias, Lorena; Capdevila, Josep Anton; Vilà, Xavier; Mauri, Montserrat; Almirall, Jordi

    2014-12-01

    Pneumonia is considered an independent entity in chronic obstructive pulmonary disease (COPD), to be distinguished from an infectious exacerbation of COPD. The aim of this study was to analyze the clinical characteristics and progress of the exacerbation of COPD (ECOPD) compared to pneumonia in COPD (PCOPD) patients requiring hospitalization. Prospective, longitudinal, observational cohort study including 124 COPD patients requiring hospital admission for lower respiratory tract infection. Patients were categorized according to presence of ECOPD (n=104) or PCOPD (n=20), depending on presence of consolidation on X-ray. Demographic, clinical, laboratory, microbiological and progress variables were collected. Patients with ECOPD showed more severe respiratory disease according to the degree of obstruction (P<.01) and need for oxygen therapy (P<.05). PCOPD patients showed increased presence of fever (P<.05), lower blood pressure (P<.001), more laboratory abnormalities (P<.05; leukocytosis, elevated CRP, low serum albumin) and increased presence of crepitus (P<.01). Microbiological diagnosis was achieved in 30.8% of cases of ECOPD and 35% of PCOPD; sputum culture yielded the highest percentage of positive results, predominantly Pseudomonas aeruginosa. Regarding the progress of the episode, no differences were found in hospital stay, need for ICU or mechanical ventilation. Our data confirm clinical and analytical differences between ECOPD and PCOPD in patients who require hospital admission, while there were no differences in subsequent progress. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  6. Respiratory virus surveillance in hospitalised pneumonia patients on the Thailand-Myanmar border.

    Science.gov (United States)

    Turner, Paul; Turner, Claudia; Watthanaworawit, Wanitda; Carrara, Verena; Cicelia, Naw; Deglise, Carole; Phares, Christina; Ortega, Luis; Nosten, Francois

    2013-09-16

    Pneumonia is a significant cause of morbidity and mortality in the developing world. Viruses contribute significantly to pneumonia burden, although data for low-income and tropical countries are scarce. The aim of this laboratory-enhanced, hospital-based surveillance was to characterise the epidemiology of respiratory virus infections among refugees living on the Thailand-Myanmar border. Maela camp provides shelter for ~45,000 refugees. Inside the camp, a humanitarian organisation provides free hospital care in a 158-bed inpatient department (IPD). Between 1st April 2009 and 30th September 2011, all patients admitted to the IPD with a clinical diagnosis of pneumonia were invited to participate. Clinical symptoms and signs were recorded and a nasopharyngeal aspirate (NPA) collected. NPAs were tested for adenoviruses, human metapneumovirus (hMPV), influenza A & B, and RSV by PCR. Seven hundred eight patient episodes (698 patients) diagnosed as pneumonia during the enhanced surveillance period were included in this analysis. The median patient age was 1 year (range: < 1-70), and 90.4% were aged < 5 years. At least one virus was detected in 53.7% (380/708) of episodes. Virus detection was more common in children aged < 5 years old (<1 year: OR 2.0, 95% CI 1.2-3.4, p = 0.01; 1-4 years: OR 1.4, 95% CI 0.8-2.3, p = 0.2). RSV was detected in 176/708 (24.9%); an adenovirus in 133/708 (18.8%); an influenza virus in 68/708 (9.6%); and hMPV in 33/708 (4.7%). Twenty-eight episodes of multiple viral infections were identified, most commonly adenovirus plus another virus. RSV was more likely to be detected in children <5 years (OR 12.3, 95% CI 3.0-50.8, p = 0.001) and influenza viruses in patients ≥5 years (OR 2.8, 95% CI 1.5-5.4, p = 0.002). IPD treatment was documented in 702/708 cases; all but one patient received antimicrobials, most commonly a beta-lactam (amoxicillin/ampicillin +/-gentamicin in 664/701, 94.7%). Viral nucleic acid was

  7. Childhood pneumonia at the University of Ilorin Teaching Hospital ...

    African Journals Online (AJOL)

    owner

    2013-01-09

    Jan 9, 2013 ... which was significantly higher ... University of Ilorin Teaching Hospital between 1st July ..... two organisms formed more than 40% of the isolates. ... Educational Services; 2007:425-. 41. 3. ... Brazilian children in a metropoli-.

  8. Fine particulate matter estimated by mathematical model and hospitalizations for pneumonia and asthma in children

    Directory of Open Access Journals (Sweden)

    Ana Cristina Gobbo César

    2016-03-01

    Full Text Available Abstract Objective: To estimate the association between exposure to fine particulate matter with an aerodynamic diameter <2.5 microns (PM2.5 and hospitalizations for pneumonia and asthma in children. Methods: An ecological study of time series was performed, with daily indicators of hospitalization for pneumonia and asthma in children up to 10 years of age, living in Taubaté (SP and estimated concentrations of PM2.5, between August 2011 and July 2012. A generalized additive model of Poisson regression was used to estimate the relative risk, with lag zero up to five days after exposure; the single pollutant model was adjusted by the apparent temperature, as defined from the temperature and relative air humidity, seasonality and weekday. Results: The values of the relative risks for hospitalization for pneumonia and asthma were significant for lag 0 (RR=1.051, 95%CI; 1.016 to 1.088; lag 2 (RR=1.066, 95%CI: 1.023 to 1.113; lag 3 (RR=1.053, 95%CI: 1.015 to 1.092; lag 4 (RR=1.043, 95%CI: 1.004 to 1.088 and lag 5 (RR=1.061, 95%CI: 1.018 to 1.106. The increase of 5mcg/m3 in PM2.5 contributes to increase the relative risk for hospitalization from 20.3 to 38.4 percentage points; however, the reduction of 5µg/m3 in PM2.5 concentration results in 38 fewer hospital admissions. Conclusions: Exposure to PM2.5 was associated with hospitalizations for pneumonia and asthma in children younger than 10 years of age, showing the role of fine particulate matter in child health and providing subsidies for the implementation of preventive measures to decrease these outcomes.

  9. Prognostic significance of platelet count changes during hospitalization for community-acquired pneumonia.

    Science.gov (United States)

    Gorelik, Oleg; Izhakian, Shimon; Barchel, Dana; Almoznino-Sarafian, Dorit; Tzur, Irma; Swarka, Muhareb; Beberashvili, Ilia; Feldman, Leonid; Cohen, Natan; Shteinshnaider, Miriam

    2017-06-01

    The prognostic significance of platelet count (PC) changes during hospitalization for community-acquired pneumonia (CAP) has not been investigated. For 976 adults, clinical data during hospitalization for CAP and all-cause mortality following discharge were compared according to ΔPC (PC on discharge minus PC on admission): groups A (declining PC, ΔPC 50 × 10 9 /l), and according to the presence of thrombocytopenia, normal PC, and thrombocytosis on admission/discharge. Groups A, B, and C comprised 7.9%, 46.5%, and 45.6% of patients, respectively. On hospital admission/discharge, thrombocytopenia, normal PC, and thrombocytosis were observed in 12.8%/6.4%, 84.1%/84.4%, and 3.1%/9.2% of patients, respectively. The respective 90-day, 3-year, and total (median follow-up of 54 months) mortality rates were significantly higher: in group A (40.3%, 63.6%, and 72.7%), compared to groups B (12.3%, 31.5%, and 39.0%) and C (4.9%, 17.3%, and 25.4%), p < 0.001; and in patients with thrombocytopenia at discharge (27.4%, 48.4%, and 51.6%), compared to those with normal PC (10.2%, 26.9%, and 35.4%) and thrombocytosis (8.9%, 17.8%, and 24.4%) at discharge (p < 0.001). Mortality rates were comparable among groups with thrombocytopenia, normal PC, and thrombocytosis at admission (p = 0.6). In the entire sample, each 100 × 10 9 /l increment of ΔPC strongly predicted lower mortality (p < 0.001, relative risk 0.73, 95% confidence interval 0.64-0.83). In conclusion, PC changes are common among CAP inpatients. Rising PC throughout hospitalization is a powerful predictor of better survival, while declining PC predicts poor outcome. Evaluation of PC changes during hospitalization for CAP may provide useful prognostic information.

  10. Randomized phase 2 trial to evaluate the clinical efficacy of two high-dosage tigecycline regimens versus imipenem-cilastatin for treatment of hospital-acquired pneumonia.

    Science.gov (United States)

    Ramirez, Julio; Dartois, Nathalie; Gandjini, Hassan; Yan, Jean Li; Korth-Bradley, Joan; McGovern, Paul C

    2013-04-01

    In a previous phase 3 study, the cure rates that occurred in patients with hospital-acquired pneumonia treated with tigecycline at the approved dose were lower than those seen with patients treated with imipenem and cilastatin (imipenem/cilastatin). We hypothesized that a higher dose of tigecycline is necessary in patients with hospital-acquired pneumonia. This phase 2 study compared the safety and efficacy of two higher doses of tigecycline with imipenem/cilastatin in subjects with hospital-acquired pneumonia. Subjects with hospital-acquired pneumonia were randomized to receive one of two doses of tigecycline (150 mg followed by 75 mg every 12 h or 200 mg followed by 100 mg every 12 h) or 1 g of imipenem/cilastatin every 8 h. Empirical adjunctive therapy was administered for initial coverage of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa infection, depending on the randomization regimen. Clinical response, defined as cure, failure of treatment, or indeterminate outcome, was assessed 10 to 21 days after the last day of therapy. In the clinically evaluable population, clinical cure with tigecycline 100 mg (17/20, 85.0%) was numerically higher than with tigecycline 75 mg (16/23, 69.6%) and imipenem/cilastatin (18/24, 75.0%). No new safety signals with the high-dose tigecycline were identified. A numerically higher clinical response was observed with the 100-mg dose of tigecycline. This supports our hypothesis that a higher area under the concentration-time curve over 24 h in the steady state divided by the MIC (AUC/MIC ratio) may be necessary to achieve clinical cure in patients with hospital-acquired pneumonia. Further studies are necessary. (The ClinicalTrials.gov identifier for this clinical trial is NCT00707239.).

  11. Penicillin treatment for patients with Community-Acquired Pneumonia in Denmark: a retrospective cohort study.

    Science.gov (United States)

    Egelund, Gertrud Baunbæk; Jensen, Andreas Vestergaard; Andersen, Stine Bang; Petersen, Pelle Trier; Lindhardt, Bjarne Ørskov; von Plessen, Christian; Rohde, Gernot; Ravn, Pernille

    2017-04-20

    Community-acquired pneumonia (CAP) is a severe infection, with high mortality. Antibiotic strategies for CAP differ across Europe. The objective of the study was to describe the epidemiology of CAP in Denmark and evaluate the prognosis of patients empirically treated with penicillin-G/V monotherapy. Retrospective cohort study including hospitalized patients with x-ray confirmed CAP. We calculated the population-based incidence, reviewed types of empiric antibiotics and duration of antibiotic treatment. We evaluated the association between mortality and treatment with empiric penicillin-G/V using logistic regression analysis. We included 1320 patients. The incidence of hospitalized CAP was 3.1/1000 inhabitants. Median age was 71 years (IQR; 58-81) and in-hospital mortality was 8%. Median duration of antibiotic treatment was 10 days (IQR; 8-12). In total 45% were treated with penicillin-G/V as empiric monotherapy and they did not have a higher mortality compared to patients treated with broader-spectrum antibiotics (OR 0.92, CI 95% 0.55-1.53). The duration of treatment exceeded recommendations in European guidelines. Empiric monotherapy with penicillin-G/V was commonly used and not associated with increased mortality in patients with mild to moderate pneumonia. Our results are in agreement with current conservative antibiotic strategy as outlined in the Danish guidelines.

  12. Evaluating quality indicators for patients with community-acquired pneumonia.

    Science.gov (United States)

    Rhew, D C; Goetz, M B; Shekelle, P G

    2001-11-01

    Several organizations have published evidence-based quality indicators for community-acquired pneumonia (CAP). However, there is variability in the types of indicators presented between organizations and the level of supporting evidence for each of the indicators. A systematic review of the literature and relevant Internet Web sites was performed to identify quality indicators for CAP that have been proposed or recommended by organizations, and each of the indicators was then critically appraised, using a well-defined set of criteria. The MEDLINE, EMBASE, Best Evidence, and Cochrane Systematic Review databases and Internet Web sites were searched for articles and guidelines published between January 1980 and May 2001 to identify quality indicators for CAP and relevant evidence. Experts in the area of health services research were contacted to identify additional sources. A well-defined set of criteria was applied to evaluate each of the quality indicators. The systematic review of the literature and Internet Web sites yielded 44 CAP-specific quality indicators. The critical appraisal of these indicators yielded 16 indicators that were supported by a study that identified an association between quality of care and the process of care or outcome measure, were applied to enough patients to be able to detect clinically meaningful differences, were clinically and/or economically relevant, were measurable in a clinical practice setting, and were precise in their specifications. Many organizations recommend indicators for CAP. Indicators may serve as measures of clinical performance for clinicians and hospitals, may help in benchmarking, and may ultimately facilitate improvements in quality of care and cost reductions. However, CAP indicators often vary in their meaningfulness, scientific soundness, and interpretability of results. A set of five critical appraisal questions may assist in the evaluation of which quality indicators are most valid.

  13. Prognostic value of vitamin D in patients with pneumonia: A ...

    African Journals Online (AJOL)

    Methods: PubMed and Embase were systematically searched for relevant studies that assessed the impact of ... (CAP) is the main type of pneumonia which can .... Pneumonia severity index. .... pneumonia related to intracellular pathogens.

  14. Endoscopic gastrostomy, nasojejunal and oral feeding comparison in aspiration pneumonia patients

    Directory of Open Access Journals (Sweden)

    Ozge E Onur

    2013-01-01

    Full Text Available Background: Aspiration pneumonia is a potentially preventable illness requiring attention to small details of patient care. The type, management, and care of feeding should be carried out properly. Materials andMethods: This is a prospective clinical study of enteral feeding on patients admitted to hospital with aspiration pneumonia. The known enteral nutritional methods, advantages, and disadvantages were told to the patient or proxy. If they didn′t accept Percutaneous endoscopic gastrostomy (PEG, nasojejunal tube (NJT was advised. If they denied all of the procedures, oral feeding education was given. A total of 94 patients were enrolled to the study, 29 of them accepted PEG, 42 preferred NJT, and 23 preferred oral route. Results: A total of 94 patients with a mean age of 77.84, standard deviation 10.784; 95% confidence interval (CI 75.63-80.03 were enrolled to the study of which 27 (28.7% patients had a history of aspiration pneumonia. Oral feeding was prominently preferred for patients nursed by a relative (15; 65.2% of Oral feeding group and 16% of total or a caregiver (7; 30.4% of Oral feeding group and 7.4% of total while only 1 (4.3% of Oral feeding group and 1.1% of total with a health-care worker (P = 0.001. Overall re-aspiration rates at the 6 th month were 58%, 78%, 91% in EG, NJT, oral groups, respectively. Sixth months′ survival rates of the different feeding groups were not significantly divergent from each other. History of aspiration was also found to be a significant contributor of mortality. Conclusion: In aspiration pneumonia patients′ long-term survival rates of the different feeding groups were not significantly divergent from each other.

  15. Association of Admission to Veterans Affairs Hospitals vs Non-Veterans Affairs Hospitals With Mortality and Readmission Rates Among Older Men Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia.

    Science.gov (United States)

    Nuti, Sudhakar V; Qin, Li; Rumsfeld, John S; Ross, Joseph S; Masoudi, Frederick A; Normand, Sharon-Lise T; Murugiah, Karthik; Bernheim, Susannah M; Suter, Lisa G; Krumholz, Harlan M

    2016-02-09

    Little contemporary information is available about comparative performance between Veterans Affairs (VA) and non-VA hospitals, particularly related to mortality and readmission rates, 2 important outcomes of care. To assess and compare mortality and readmission rates among men in VA and non-VA hospitals. Cross-sectional analysis involving male Medicare fee-for-service beneficiaries aged 65 years or older hospitalized between 2010 and 2013 in VA and non-VA acute care hospitals for acute myocardial infarction (AMI), heart failure (HF), or pneumonia using the Medicare Standard Analytic Files and Enrollment Database together with VA administrative claims data. To avoid confounding geographic effects with health care system effects, we studied VA and non-VA hospitals within the same metropolitan statistical area (MSA). Hospitalization in a VA or non-VA hospital in MSAs that contained at least 1 VA and non-VA hospital. For each condition, 30-day risk-standardized mortality rates and risk-standardized readmission rates for VA and non-VA hospitals. Mean aggregated within-MSA differences in mortality and readmission rates were also assessed. We studied 104 VA and 1513 non-VA hospitals, with each condition-outcome analysis cohort for VA and non-VA hospitals containing at least 7900 patients (men; ≥65 years), in 92 MSAs. Mortality rates were lower in VA hospitals than non-VA hospitals for AMI (13.5% vs 13.7%, P = .02; -0.2 percentage-point difference) and HF (11.4% vs 11.9%, P = .008; -0.5 percentage-point difference), but higher for pneumonia (12.6% vs 12.2%, P = .045; 0.4 percentage-point difference). In contrast, readmission rates were higher in VA hospitals for all 3 conditions (AMI, 17.8% vs 17.2%, 0.6 percentage-point difference; HF, 24.7% vs 23.5%, 1.2 percentage-point difference; pneumonia, 19.4% vs 18.7%, 0.7 percentage-point difference, all P percentage-point difference, -0.22; 95% CI, -0.40 to -0.04) and HF (-0.63; 95% CI, -0.95 to -0.31), and

  16. Tuberculous pneumonia and bacteriaI pneumonia in diabetic patients: comparison of CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yoo Kyung; Shim, Sung Shine [College of Medicine, Chungnam Univ., Daejeon (Korea, Republic of); Kim, Jin Hwan [College of Medicine, Ewha Womans Univ., Seoul (Korea, Republic of)

    2004-07-01

    To compare the CT findings of tuberculous pneumonia (TBPN) with those of bacterial pneumonia (BAPN) in diabetic patients and to evaluate the usefulness of CT in the differential diagnosis of these two diseases. The chest CT scans of 23 diabetic patients with TBPN (M:F=21:2; mean age, 59 yrs.) and of 37 diabetic patients with BAPN (M:F=21:16; mean age, 63 yrs.) were evaluated by two radiologists with regard to low attenuation areas in regions of consolidation, cavities, air bronchogram, volume changes, ground-glass attenuation, findings of bronchogenic spread, and other associated findings. The involvement of each segment was recorded in all patients. The frequencies of multiple small low-attenuation areas in regions of consolidation (52%, 0%), multiple cavities (35%, 3%), loss of volume (70%, 30%) and findings of bronchogenic spread (96%, 30%) were significantly higher in TBPN than in BAPN (p< .05). Low-attenuation masses and bizarre-shaped cavities were noted only in TBPN. Large areas of ground-glass attenuation (4%, 38%) and bilateral pleural effusions (0%, 19%) were more common in BAPN, while air-bronchogram was common in both groups (96%, 86%). The involvement of the superior segment was significantly more common in TBPN (p< .05). In the diabetic patients with pulmonary consolidation, CT findings of multiple small low-attenuation areas, multiple cavities, bizarre-shaped cavities, low attenuation masses in cavities, volume loss, and findings of bronchogenic spread are more suggestive of TBPN, while large areas of ground-glass attenuation and bilateral pleural effusions are more suggestive of BAPN. CT may be useful in the differential diagnosis between TBPN and BAPN.

  17. Are quantitative cultures useful in the diagnosis of hospital-acquired pneumonia?

    Science.gov (United States)

    San Pedro, G

    2001-02-01

    Noninvasive and invasive tests have been developed and studied for their utility in diagnosing and guiding the treatment of hospital-acquired pneumonia, a condition with an inherently high mortality. Early empiric antibiotic treatment has been shown to reduce mortality, so delaying this treatment until test results are available is not justifiable. Furthermore, tailoring therapy based on results of either noninvasive or invasive tests has not been clearly shown to affect morbidity and mortality. This may be related to quantitative limitations of these tests or possibly to a high false-negative rate in patients who receive early antibiotic treatment and may therefore have suppressed bacterial counts. Results of these tests, however, do influence treatment. It is therefore hoped that they may ultimately provide a rational basis for making therapeutic decisions. In the future, outcomes research should be a part of large-scale clinical trials, and noninvasive and invasive tests should be incorporated into the design in an attempt to provide a better understanding of the value of such tests.

  18. Medicare Hospital Spending Per Patient - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...

  19. Discriminatory power of three typing techniques in determining relatedness of nosocomial Klebsiella pneumoniae isolates from a tertiary hospital in India.

    Science.gov (United States)

    Purighalla, Swathi; Esakimuthu, Sarita; Reddy, Mallika; Varghese, George K; Richard, Vijay S; Sambandamurthy, Vasan K

    2017-01-01

    The purpose of this study was to evaluate the discriminatory power of two DNA-based technique and a protein-based technique for the typing of nosocomial isolates of Klebsiella pneumoniae. A second objective was to determine the antimicrobial susceptibility pattern and characterise the presence of genes encoding extended-spectrum beta-lactamases (ESBLs) and carbapenemases. Forty-six K. pneumoniae isolates from patients with bloodstream infections at a tertiary care hospital in India between December 2014 and December 2015 were studied. All isolates were typed using enterobacterial repetitive intergenic consensus sequence-polymerase chain reaction (ERIC-PCR), randomly amplified polymorphic DNA (RAPD) analysis and matrix-assisted laser desorption ionisation time-of-flight (MALDI-TOF) mass spectrometry. Antimicrobial susceptibility profiles and ESBLs were detected using the BD Phoenix system. The types of ESBL and carbapenemase genes present were detected using PCR. Isolates were subtyped into 31, 30 and 33 distinct genotypes by ERIC-PCR, RAPD and MALDI-TOF, respectively. Several isolates displaying identical DNA fingerprints were binned into different branches based on their proteomic fingerprint. Antimicrobial susceptibility tests revealed that 33/46 strains were multidrug resistant (MDR); a majority of the strains (83%) were sensitive to colistin. PCR-based analysis demonstrated 19 strains to harbour two or more ESBL and carbapenemase genes. ERIC-PCR was the most reproducible method for typing K. pneumoniae isolates and could not be substituted by MALDI-TOF for clonality analysis. A high degree of genetic diversity and the presence of MDR genes highlight the challenges in treating K. pneumoniae-associated infections.

  20. Discriminatory power of three typing techniques in determining relatedness of nosocomial Klebsiella pneumoniae isolates from a tertiary hospital in India

    Directory of Open Access Journals (Sweden)

    Swathi Purighalla

    2017-01-01

    Full Text Available Purpose: The purpose of this study was to evaluate the discriminatory power of two DNA-based technique and a protein-based technique for the typing of nosocomial isolates of Klebsiella pneumoniae. A second objective was to determine the antimicrobial susceptibility pattern and characterise the presence of genes encoding extended-spectrum beta-lactamases (ESBLs and carbapenemases. Materials and Methods: Forty-six K. pneumoniae isolates from patients with bloodstream infections at a tertiary care hospital in India between December 2014 and December 2015 were studied. All isolates were typed using enterobacterial repetitive intergenic consensus sequence-polymerase chain reaction (ERIC-PCR, randomly amplified polymorphic DNA (RAPD analysis and matrix-assisted laser desorption ionisation time-of-flight (MALDI-TOF mass spectrometry. Antimicrobial susceptibility profiles and ESBLs were detected using the BD Phoenix system. The types of ESBL and carbapenemase genes present were detected using PCR. Results: Isolates were subtyped into 31, 30 and 33 distinct genotypes by ERIC-PCR, RAPD and MALDI-TOF, respectively. Several isolates displaying identical DNA fingerprints were binned into different branches based on their proteomic fingerprint. Antimicrobial susceptibility tests revealed that 33/46 strains were multidrug resistant (MDR; a majority of the strains (83% were sensitive to colistin. PCR-based analysis demonstrated 19 strains to harbour two or more ESBL and carbapenemase genes. Conclusion: ERIC-PCR was the most reproducible method for typing K. pneumoniae isolates and could not be substituted by MALDI-TOF for clonality analysis. A high degree of genetic diversity and the presence of MDR genes highlight the challenges in treating K. pneumoniae-associated infections.

  1. Compliance with the vaccination schedule in children hospitalized with pneumonia and associated factors

    Science.gov (United States)

    da Silva, Amanda Tabosa Pereira; Lima, Eduardo Jorge da Fonseca; Caminha, Maria de Fátima Costa; da Silva, Andresa Tabosa Pereira; Rodrigues, Edil de Albuquerque; dos Santos, Carmina Silva

    2018-01-01

    ABSTRACT OBJECTIVE: To verify the adequacy and factors associated with compliance with the immunization schedule (BCG, DTP-Hib, MMR, PCV-10) in children hospitalized with pneumonia at a pediatric referral hospital in Northeast Brazil. METHODS: This is a cross-sectional, descriptive study with an analytical component, with a sample of 452 children hospitalized with pneumonia at the Instituto de Medicina Integral Prof. Fernando Figueira, between 2010 and 2013. The inclusion criterion was children aged from one month to less than five years of age with proof in the immunization record. The exclusion criterion was the presence of hospital-acquired pneumonia or concomitant disease. We have evaluated the adequacy of the immunization schedule for the BCG, tetravalent, MMR, and 10-valent pneumococcal conjugate (PCV-10) vaccines. We used the chi-square test and Fisher's exact test followed by multivariate Poisson regression, estimating the crude and adjusted prevalence ratios and respective 95% confidence intervals. The variables with p < 0.20 in the univariate analysis were included in the multivariate analysis. RESULTS: There was good adequacy in the immunization schedule, except for PCV-10, which presented a percentage lower than 85%. We have observed an association between adequate compliance with the immunization schedule and education level of the mother (89.9% complete high school), sex of the child (87.2% female), age of the child (94.2% younger than six months), and breastfeeding (84.3% breastfed). CONCLUSIONS: Given the high rate of education level of the mother and the high percentage of breastfeeding, we can understand that there is a better understanding of the health of the child by the mothers studied in this study, showing the effectiveness of public policies for infant feeding. However, children did not have good adequacy of the immunization schedule of PCV-10, one of the main vaccines against pneumonia, which can be one of the main factors in the causes of

  2. Childhood pneumonia at the University of Ilorin Teaching Hospital ...

    African Journals Online (AJOL)

    Heart failure was associated complication present in 52 of the 60 children with one or more complications accounting for over 30% of all patients. Eleven out ... lower than the corresponding value of 10.2 ±12.3 days in those that died, p= 0.042.

  3. Outbreak of carbapenem-resistant Klebsiella pneumoniae: two-year epidemiologic follow-up in a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Graziella Hanna Pereira

    2013-02-01

    Full Text Available This study describes a carbapenem-resistant Klebsiella pneumoniae (CRKP outbreak that occurred from October 2008-December 2010. Polymerase chain reaction assays were performed to detect the blaKPC gene and molecular typing was performed using pulsed-field gel electrophoresis (PFGE. There were 33 CRKP infections; PFGE revealed five genotypes: genotype A in five (15%, B in 18 (55%, C in eight (24% and two unique profiles. Genotype B was disseminated in all hospital units and belonged to the same clone identified in 11 different hospitals in the state of São Paulo. Sixteen (48% patients died. Seven isolates (21% were resistant to polymyxin B and 45% were resistant to tigecycline and amikacin.

  4. Treatment of Chryseobacterium indologenes ventilator-associated pneumonia in a critically ill trauma patient.

    Science.gov (United States)

    Monteen, Megan R; Ponnapula, Supriya; Wood, G Christopher; Croce, Martin A; Swanson, Joseph M; Boucher, Bradley A; Fabian, Timothy C

    2013-12-01

    To report a case of Chryseobacterium indologenes ventilator-associated pneumonia (VAP) in a critically ill trauma patient. This report describes a 66-year-old critically ill trauma patient who developed VAP, which was caused by C indologenes. The patient was injured in a riding lawn mower accident that trapped him underwater in a pond. The patient required surgery for intra-abdominal injuries and was mechanically ventilated in the trauma intensive care unit. On hospital day 5, the patient developed signs and symptoms of VAP. A diagnosis of C indologenes VAP was confirmed based on a quantitative culture from a bronchoscopic bronchoalveolar lavage. The patient's infection was successfully treated with moxifloxacin for 2 days followed by cefepime for 7 days. Formally known as Flavobacterium indologenes, C indologenes is a Gram-negative bacillus normally found in plants, soil, foodstuffs, and fresh and marine water sources. Recently, worldwide reports of C indologenes infections in humans have been increasing, though reports from the United States are still rare. Bacteremia and pneumonia are the most commonly reported infections, and most patients are immunocompromised. The current case differs from most previous reports because this patient was in the United States and did not have any traditional immunocompromised states (eg, transplant, cancer, HIV/AIDS, or corticosteroid use). This case report demonstrates that C indologenes can cause VAP in a trauma ICU patient.

  5. Use of proton pump inhibitors is associated with increased mortality due to nosocomial pneumonia in bedridden patients receiving tube feeding.

    Science.gov (United States)

    Hamai, Kosuke; Iwamoto, Hiroshi; Ohshimo, Shinichiro; Wakabayashi, Yu; Ihara, Daisuke; Fujitaka, Kazunori; Hamada, Hironobu; Ono, Koichi; Hattori, Noboru

    2018-05-22

    To investigate the association between the use of proton pump inhibitors (PPI) and nosocomial pneumonia and gastrointestinal bleeding in bedridden patients receiving tube feeding. A total of 116 bedridden hospitalized patients receiving tube feeding, of which 80 were supported by percutaneous endoscopic gastrostomy and 36 by nasogastric tube, were included in the present study. The patients were divided into two groups: 62 patients treated with PPI (PPI group) and 54 patients without PPI (non-PPI group). Mortality due to nosocomial pneumonia was evaluated using the Kaplan-Meier approach and the log-rank test. A total of 36 patients (31%) died of nosocomial pneumonia during the observation period; the mortality rate due to nosocomial pneumonia was significantly higher in the PPI group than in the non-PPI group (P = 0.0395). Cox proportional hazard analysis showed that the use of PPI and lower levels of serum albumin were independent predictors of 2-year mortality due to nosocomial pneumonia. Gastrointestinal bleeding was observed in four patients in the non-PPI group (7.7%) and in one patient in the PPI group (1.6%); there was no significant difference between the two groups. The use of PPI in bedridden tube-fed patients was independently associated with mortality due to nosocomial pneumonia, and the PPI group had a non-significant lower incidence of gastrointestinal bleeding than the non-PPI group. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 The Authors Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.

  6. Molecular epidemiology of Klebsiella pneumoniae invasive infections over a decade at Kilifi County Hospital in Kenya.

    Science.gov (United States)

    Henson, Sonal P; Boinett, Christine J; Ellington, Matthew J; Kagia, Ngure; Mwarumba, Salim; Nyongesa, Sammy; Mturi, Neema; Kariuki, Samuel; Scott, J Anthony G; Thomson, Nicholas R; Morpeth, Susan C

    2017-10-01

    Multidrug resistant (MDR) Klebsiella pneumoniae is a common cause of nosocomial infections worldwide. Recent years have seen an explosion of resistance to extended-spectrum β-lactamases (ESBLs) and emergence of carbapenem resistance. Here, we examine 198 invasive K. pneumoniae isolates collected from over a decade in Kilifi County Hospital (KCH) in Kenya. We observe a significant increase in MDR K. pneumoniae isolates, particularly to third generation cephalosporins conferred by ESBLs. Using whole-genome sequences, we describe the population structure and the distribution of antimicrobial resistance genes within it. More than half of the isolates examined in this study were ESBL-positive, encoding CTX-M-15, SHV-2, SHV-12 and SHV-27, and 79% were MDR conferring resistance to at least three antimicrobial classes. Although no isolates in our dataset were found to be resistant to carbapenems we did find a plasmid with the genetic architecture of a known New Delhi metallo-β-lactamase-1 (NDM)-carrying plasmid in 25 isolates. In the absence of carbapenem use in KCH and because of the instability of the NDM-1 gene in the plasmid, the NDM-1 gene has been lost in these isolates. Our data suggests that isolates that encode NDM-1 could be present in the population; should carbapenems be introduced as treatment in public hospitals in Kenya, resistance is likely to ensue rapidly. Copyright © 2017 The Authors. Published by Elsevier GmbH.. All rights reserved.

  7. Penicillin treatment for patients with Community-Acquired Pneumonia in Denmark

    DEFF Research Database (Denmark)

    Egelund, Gertrud Baunbæk; Jensen, Andreas Vestergaard; Andersen, Stine Bang

    2017-01-01

    BACKGROUND: Community-acquired pneumonia (CAP) is a severe infection, with high mortality. Antibiotic strategies for CAP differ across Europe. The objective of the study was to describe the epidemiology of CAP in Denmark and evaluate the prognosis of patients empirically treated with penicillin...... penicillin-G/V using logistic regression analysis. RESULTS: We included 1320 patients. The incidence of hospitalized CAP was 3.1/1000 inhabitants. Median age was 71 years (IQR; 58-81) and in-hospital mortality was 8%. Median duration of antibiotic treatment was 10 days (IQR; 8-12). In total 45% were treated...... with penicillin-G/V as empiric monotherapy and they did not have a higher mortality compared to patients treated with broader-spectrum antibiotics (OR 0.92, CI 95% 0.55-1.53). CONCLUSION: The duration of treatment exceeded recommendations in European guidelines. Empiric monotherapy with penicillin...

  8. Clonal Dissemination of Extended-Spectrum β-Lactamase (ESBL)-Producing Klebsiella pneumoniae Isolates in a Korean Hospital

    Science.gov (United States)

    Ko, Kwan Soo; Yeom, Joon-Sup; Lee, Mi Young; Peck, Kyong Ran

    2008-01-01

    In this study, we investigated the molecular characteristics of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae isolates that were recovered from an outbreak in a Korean hospital. A new multilocus sequence typing (MLST) scheme for K. pneumoniae based on five housekeeping genes was developed and was evaluated for 43 ESBL-producing isolates from an outbreak as well as 38 surveillance isolates from Korea and also a reference strain. Overall, a total of 37 sequence types (STs) and six clonal complexes (CCs) were identified among the 82 K. pneumoniae isolates. The result of MLST analysis was concordant with that of pulsedfield gel electrophoresis. Most of the outbreak isolates belonged to a certain clone (ST2), and they produced SHV-1 and CTX-M14 enzymes, which was a different feature from that of the K. pneumoniae isolates from other Korean hospitals (ST20 and SHV-12). We also found a different distribution of CCs between ESBL-producing and -nonproducing K. pneumoniae isolates. The MLST method we developed in this study could provide unambiguous and well-resolved data for the epidemiologic study of K. pneumoniae. The outbreak isolates showed different molecular characteristics from the other K. pneumoniae isolates from other Korean hospitals. PMID:18303199

  9. Prevention of hospital-acquired pneumonia: European perspective.

    Science.gov (United States)

    Bonten, Marc J M

    2003-12-01

    Several preventive measures for VAP have been empirically tested. There is clear evidence that antibiotic-containing preventive strategies, such as SDD and oropharyngeal decontamination, are very effective in different patient populations. Selection of antibiotic resistance remains the major disadvantage of these strategies, however, limiting its applicability in settings with high levels of antibiotic resistance. This probably precludes the use of these strategies in many American settings, but may allow their use in European countries with much lower endemic levels of resistance. There is little evidence that systemic prophylaxis is effective for the prevention of VAP, and initial studies were associated with resistance problems. Of the non antibiotic-containing preventive strategies, subglottic aspiration was effective in several studies, whereas other strategies, such as immunonutrition with glutamine or the semirecumbent patient position, were effective in single studies. All these studies were executed in European ICUs. For these interventions, more data are needed on the generalizability, feasibility, and cost effectiveness. Few data support the use of sucralfate for stress ulcer prophylaxis and modulation of enteral nutrition practices as preventive measures for VAP.

  10. Problems and solutions on issues of medical care quality in community-acquired pneumonia in hospitals of Saratov region

    Directory of Open Access Journals (Sweden)

    Lotsmanov Yu.F.

    2011-06-01

    Full Text Available Qualitative assessment of diagnostics and treatment of patients with community-acquired pneumonia (CAP was carried out in ten therapeutic departments of urban and district hospitals of Saratov region, using quality indicators (Qls. Each case of CAP was assessed in expert health care quality (HCQ card according to the diagnostic and treatment quality federal standards and the basic Ql. The application of Ql in CAP patients allowed revealing the following: low CAP agent isolation rate; late hospitalization of CAP patients; low frequency of sputum bacteriological and bacterioscopic investigations prior to antibiotic therapy; insufficient frequency of step-by-step introduction of antibiotics. Recommendations on CAP patients dispenserization were not properly prescribed; recommendations on vaccination were absent. The basic measures of HCQ improvement are as follows: organizing for each CAP patient therapeutic and diagnostic quality control according to Ql; quick administrative decisions; using of HCQ expertise during the first 2-3 days of treatment to correct diagnosis and treatment; optimizing hospital diagnostic resources (laboratory and instrumental and rational pharmacotherapy

  11. [Antibiotic resistance analysis of Streptococcus pneumoniae isolates from the hospitalized children in Shanxi Children's Hospital from 2012 to 2014].

    Science.gov (United States)

    Ge, L L; Han, Z Y; Liu, A H; Zhu, L; Meng, J H

    2017-02-02

    Objective: To investigate the antibiotic resistance status of Streptococcus pneumoniae isolates from hospitalized children in Shanxi Children's Hospital. Method: E-test and Kirby-Bauer methods were applied to determine drug sensitivity of the isolates collected from the body fluid specimens of hospitalized children in Shanxi Children's Hospital from January 2012 to December 2014. The antimicrobial sensitivity and minimum inhibitory concentration (MIC) of Streptococcus pneumoniae to the conventional antibiotics were analyzed, in order to compare the annual trends of non-invasive isolates, while the differentiation of sensitivity from specimens. The comparison of rates was performed by Chi-squared test and Fisher's exact test. Result: A total of 671 isolates of streptococcus pneumoniae were obtained, which could be divided as non-invasive isolates(607), invasive isolates from non-cerebrospinal fluid(non-CSF)(40) and invasive isolates from cerebrospinal fluid(CSF)(24). The antimicrobial sensitivity(isolates(%)) of the 671 isolates were respectively vancomycin 671(100.0%), linezolid 671(100.0%), levofloxacin 665(99.1%), penicillin 595(88.7%), ceftriaxone 516(76.9%), cefotaxime 512(76.3%), sulfamethoxazole-trimethoprin(SMZ-TMP) 103(15.4%), clindamycin 28(4.2%), tetracycline 26(3.9%), erythromycin 12(1.8%). From 2012 to 2014, the susceptibility rates of non-invasive isolates to penicillin every year were 95.0%(96/101), 97.3%(110/113), 87.3%(343/393), respectively, and there was significant difference among the three years(χ(2)=13.266, P penicillin were 0.064, 2.000, 6.000 in 2012, which grew up to 1.000, 3.000, 16.000 in 2014. There was no significant difference in the susceptibility rate of non-invasive isolates to ceftriaxone and cefotaxime during these three years, (χ(2)=1.172, 1.198, both P >0.05). On the other hand, the values of MIC(50, )MIC(90) and the maximum value of MIC(mg/L) of ceftriaxone and cefotaxime both increased from 0.500, 2.000, 8.000 in 2012 to 0

  12. Spatial Analysis of Potentially Preventable Pneumonia and Asthma Hospitalizations for Children in the Texas Coastal Bend Area

    Science.gov (United States)

    Lin, Na

    Pneumonia and asthma, two common Ambulatory Care Sensitive Conditions (ACSCs), were two top reasons for the admission of children to the hospitals and emergency rooms in the United States in 2011. Pneumonia and asthma are potentially preventable if the child's environment is properly managed. Underlying vulnerabilities such as low socioeconomic status (SES) and proximity to air pollution play an important role in ACSCs hospitalization. Pneumonia and asthma are two common reasons for hospitalizations among children and missed school days in Texas Coastal Bend Area. This thesis examines the relationships between neighborhood socioeconomic characteristics, meteorological conditions and children ACSCs hospitalization, including pneumonia and asthma among children age 0-17 in this area. Hospital discharge data from 2007 to 2009 based on Zip Code Tabulation Area (ZCTA) were examined along with American Community Survey (ACS) data, air pollution data from Environmental Protection Agency (EPA) and temperature data from National Climatic Data Center (NCDC). Hotspot and Local Moran's I analyses were applied to identify the concentrations of the illnesses. Two regressions (OLS and GWR) were applied to identify factors that contribute the most to ACSCs hospitalization. Pearson's correlation was calculated to examine the relationship between meteorological condition and child hospitalization for asthma and pneumonia. A human subject survey was conducted to examine the relationships between neighborhood environment and children asthma cases. The main finding was that children from families with health insurance, children from single father families and children from poor families were more likely to visit hospital for ACSCs and pneumonia care. "Hispanic families" and especially "Hispanic families with father but no mother" also contributed most to child hospitalization for ACSCs and pneumonia, suggesting that family preventative health care education is needed for Hispanic

  13. Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

    Directory of Open Access Journals (Sweden)

    Hyun Oh Park

    2017-10-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU. This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. Results: Forty-six patients (45.5% had at least 1 episode of VAP, 10 (21.7% of whom died in the ICU. Of the 55 (54.5% patients who did not have pneumonia, 9 (16.4% died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029. Conclusion: Severe pulmonary contusion (pulmonary lung contusion score 6–12 is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

  14. Hospital Outcomes of Adult Respiratory Tract Infections with Extended-Spectrum B-Lactamase (ESBL) Producing Klebsiella Pneumoniae

    Science.gov (United States)

    Loh, Li-Cher; Nor Izran Hanim bt Abdul Samad; Rosdara Masayuni bt Mohd Sani; Raman, Sree; Thayaparan, Tarmizi; Kumar, Shalini

    2007-01-01

    Klebsiella pneumoniae ranks high as a cause of adult pneumonia requiring hospitalization in Malaysia. To study whether extended-spectrum b-lactamase (ESBL) producing K. pneumoniae was linked to hospital outcomes, we retrospectively studied 441 cases of adult respiratory tract infections with microbial proven K. pneumoniae from an urban-based university teaching hospital between 2003 and 2004. 47 (10.6%) cases had ESBL. Requirement for ventilation and median length of hospital stay, were greater in ‘ESBL’ than in ‘non-ESBL’ group [34% vs. 7.4%, p<0.001; 14 days vs. 5 days, p<0.001 respectively] but not crude hospital mortality rate [21.3% vs. 12.4%, p=0.092]. There was a four-fold increased risk of requiring ventilation [4.61 (2.72–7.85)] when ESBL was present. Our findings support the association of ESBL producing K. pneumoniae with adversed hospital outcomes and reiterate the need for vigilance on the part of treating clinicians. PMID:22993489

  15. Factors associated with pneumonia in Yanomami children hospitalized for Ambulatory Care sensitive conditions in the north of Brazil.

    Science.gov (United States)

    Caldart, Raquel Voges; Marrero, Lihsieh; Basta, Paulo Cesar; Orellana, Jesem Douglas Yamall

    2016-05-01

    In developing countries, pneumonia is the leading cause of sickness and mortality in childhood, especially among vulnerable groups. The scope of this study was to analyze the factors associated with pneumonia in Yanomami children hospitalized for Ambulatory Care Sensitive Conditions (ACSC). Hospital admissions were divided into two groups: i) pneumonia; and ii) other causes, according to the Brazilian ACSC list. Adjusted hospitalization rates were estimated and unconditional logistic regression was used to analyze factors associated with pneumonia. Over 90% of the registered cases were considered ACSC. The adjusted rate of ACSC was 18.6/1000. The odds ratio of hospitalization for pneumonia was 2.7 (CI: 1.3-5.4) times higher in children aged between 0.1 and 5.9 months; 1.9 (CI: 1.1-3.3) times higher in children who were hospitalized for 8-14 days; and three (CI: 1.2-7.5) times higher in children with a secondary diagnosis of malnutrition. The excess of avoidable hospitalizations is a clear indication of the low quality of care and limited accessibility to primary health care in indigenous territories, which is contrary to the assistance model proposed by the indigenous healthcare subsystem in Brazil, which should in theory focus on welfare technologies based on primary health care.

  16. The Prevalence of Oropharyngeal Dysphagia in Danish Patients Hospitalised with Community-Acquired Pneumonia.

    Science.gov (United States)

    Melgaard, Dorte; Baandrup, Ulrik; Bøgsted, Martin; Bendtsen, Mette Dahl; Hansen, Tina

    2017-06-01

    Community-acquired pneumonia (CAP) and oropharyngeal dysphagia (OD) are prevalent conditions in the elderly. The aim of this study was to explore the relationship between CAP, OD, and frailty in patients admitted to a department of respiratory medicine at a regional hospital. The outcome was mortality during hospitalization and within 30 days of discharge and rehospitalization within 30 days of discharge. A total of 154 consecutive patients (54.5% male, mean age 77.4 years (SD 11.51)) hospitalized because of CAP from September 1, 2013 to March 31, 2014 at North Denmark Regional Hospital were included in this study. The volume-viscosity swallow test was conducted for each patient. A total of 34.42% patients presented with OD. Patients with OD and CAP presented significant differences in age, CURB-65, and dementia compared with those of patients with CAP alone. The majority lived in nursing homes, had a lower body mass index, Barthel 20 score, and handgrip strength, and had poor oral health compared with patients with CAP only. Patients with OD presented an increased length of stay in hospital (P < 0.001), intra-hospital mortality (P < 0.001), and 30-day mortality rate (P < 0.001) compared with those of patients with CAP only. Their rate of rehospitalization 0-30 days after discharge was also increased (P < 0.001) compared with that of patients with CAP only. Thus, OD is related to frailty and poor outcome.

  17. Hospitalization Rate and Population-Based Incidence of Hospitalization for Community-Acquired Pneumonia Among Children in Suzhou, China.

    Science.gov (United States)

    Shan, Wei; Shi, Ting; Zhang, Xiyan; Xue, Jian; Wang, Yin; Yu, Jia; Huang, Yukai; Lin, Sheng; Zhao, Genming; Tian, Jianmei; Zhang, Tao

    2018-03-22

    Data on hospitalization burden of CAP in children is very limited in China. This study aimed to estimate the hospitalization rate and population-based incidence of hospitalization of CAP for children <15 years of age in Suzhou, China. This was a retrospective study of children hospitalized in Soochow University Affiliated Children's Hospital (SCH) from January 2010 to December 2014. Children who were residents of downtown Suzhou, 29 days to <15 years of age, with discharge diagnosis codes (ICD-10) including J09 to J18 and J20 to J22 were included. All-cause clinical community-acquired pneumonia (CCAP) and radiographically confirmed pneumonia (RCAP) were identified based on individual medical chart review. The hospitalization rate (HR) and population-based cumulative incidence of hospitalization (HI) were calculated. Among 184,734 children <15 years old admitted to SCH during the study period, 31,302 children were identified as having CCAP, and 24,218 (77.4%) children confirmed as having RCAP. CCAP hospitalization occurred year round and peaked during winter and early spring. The overall HRs for CCAP and RCAP were 189.0 (95%CI, 187.1-190.9) and 146.2 (95%CI, 144-148) per 1,000 hospitalizations respectively, and the HIs per 100,000 children annually were CCAP, 3,235.8 (95%CI, 3207.3-3264.2) and RCAP, 2,503.5 (95%CI, 2,478.3-2,528.6). For children <5 years old, the HR for CCAP was 248.4 (95%CI, 245.9-250.9) and RCAP 194.0 (95%CI, 191.4-196.3) per 1,000 hospitalizations; the HI for CCAP was 6,956.2 (95%CI: 6,892.8-7,019.6) and 5,431.9 (95%CI: 5,375.4-5,488.4) per 100,000 children for RCAP. The highest HR and HI were observed in children 29 days to <6 months old: HR for CCAP was 407.4 (95%CI: 400.9-413.9) per 1,000 hospitalizations and HI for CCAP was 11,203.7 (95%CI: 11,026.8-11,380.6) per 100,000 children annually. There is a considerable burden of CAP among children <15 years of age in Suzhou, particularly among children 29 days to <6 months of age and during winter

  18. Usefulness of Plasma YKL-40 in Management of Community-Acquired Pneumonia Severity in Patients

    Directory of Open Access Journals (Sweden)

    Hsiang-Ling Wang

    2013-11-01

    Full Text Available Plasma YKL-40 level has been reported as playing a significant role in community-acquired pneumonia (CAP. However, the correlation between plasma level of YKL-40 and the severity of CAP has not been reported. This study identifies the relationship between plasma level changes of the YKL-40 gene in adult patients hospitalized with CAP. The ELISA was used to measure the plasma YKL-40 level from 61 adult CAP patients before and after antibiotic treatment and from 60 healthy controls. The plasma YKL-40 levels were significantly increased in patients with CAP compared to normal controls. Moreover, the plasma concentration of YKL-40 correlated with the severity of CAP based on the pneumonia severity index (PSI score (r = 0.630, p < 0.001, the CURB-65 (confusion, uremia, respiratory rate, BP, age 65 years score (r = 0.640, p < 0.001, the Acute Physiology And Chronic Health Evaluation II (APACHE II score (r = 0.539, p < 0.001 and length of hospital stay (r = 0.321, p = 0.011, respectively. In conclusion, plasma YKL-40 may play a role in the diagnosis and clinical assessment of CAP severity, which could potentially guide the development of treatment strategies.

  19. Prognostic significance of postoperative pneumonia after curative resection for patients with gastric cancer.

    Science.gov (United States)

    Tu, Ru-Hong; Lin, Jian-Xian; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lu, Jun; Chen, Qi-Yue; Cao, Long-Long; Lin, Mi; Zheng, Chao-Hui; Huang, Chang-Ming

    2017-12-01

    Few studies have been designed to investigate the incidence of postoperative pneumonia after radical gastrectomy and its effect on prognosis of these patients. Incidences of postoperative pneumonia after radical gastrectomy in our department between January 1996 and December 2014 were summarized. Their effects on prognosis were retrospectively analyzed using survival curves and Cox regression. A total of 5237 patients were included in this study, 767 (14.4%) of them had complications, including 383 cases of postoperative pneumonia (7.2%). The 5-year overall and disease-specific survival of patients with postoperative pneumonia were both lower than those without this complication (P pneumonia were independent risk factors for disease-specific survival. Postoperative pneumonia after radical gastrectomy is an independent risk factor for prognosis of gastric cancer patients, especially in stage III. © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  20. Cumplimiento con las guías nacionales en pacientes hospitalizados con neumonía adquirida en la comunidad: Resultados del estudio capo en Argentina Adherence with National Guidelines in hospitalized patients with community-acquired pneumonia: Results of CAPO study in Argentina

    Directory of Open Access Journals (Sweden)

    Diana Christensen

    2007-12-01

    Full Text Available Un comité de seis sociedades científicas en Argentina desarrolló guías para la atención de pacientes con neumonía adquirida en la comunidad (NAC. El objetivo de este estudio fue evaluar el nivel de cumplimiento con el cuidado recomendado en las guías nacionales en pacientes hospitalizados con NAC en Argentina. Usando indicadores de calidad, la atención de 436 pacientes hospitalizados en 12 centros de Argentina fue evaluada en las áreas de hospitalización, oxigenoterapia, terapia antibiótica empírica, terapia switch, alta hospitalaria y prevención. El nivel de cumplimiento fue clasificado como óptimo (>90%, intermedio (60% a 90%, y bajo (A committee of six scientific organizations from Argentina developed guidelines for the management of patients with community-acquired pneumonia (CAP.The objective of this study was to evaluate the level of adherence with the recommended care suggested by the guidelines in patients hospitalized with CAP in Argentina. Using quality indicators the management of 436 patients who were hospitalized in 12 Argentinean institutions was evaluated. The care given among the following areas was reviewed: need for hospitalization, need for oxygen therapy, empiric antibiotic therapy, switch therapy, hospital discharge, and prevention. The level of adherence was classified as optimal (>90%, intermediate (60% to 90%, and low (<60%.The selection of the empiric antibiotic therapy and the administration of antibiotics between the first 8 hours after arrival had an adherence greater to 80%. A low level of adherence was found in the areas of switch therapy (53%, prevention of CAP with pneumococcal vaccine (51% and smoking cessation offered (29%. Using quality indicators it is possible to identify specific areas of management in patients with CAP to a low level of adherence with national guidelines. In Argentina interventions to improve switch therapy and prevention of CAP should be developed.

  1. Ventilator-associated pneumonia: Its incidence, the risk factor and drug resistance pattern in a tertiary care hospital

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    Sourabh Mitra

    2015-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP is an infection of the lung that develops 48 h or longer after mechanical ventilation. Objectives: The present study was aimed to find out the bacteriological profile of VAP along with the resistance pattern of bacteriological isolates. Materials and Methods: A prospective observational study was conducted from January 2013 to May 2014 among 791 patients admitted in critical care units of our tertiary care hospital. After selection by applying inclusion and exclusion criteria endotracheal aspirates were collected from ventilated patients. Samples were subjected to further processing by Gram-staining, culture, biochemical testing and antibiogram. Results : Out of 791 patients admitted in intensive care unit in this tertiary care hospital with VAP 540 (68.2% patients were culture positive. Pseudomonas aeruginosa was most commonly isolated pathogen of both early onset and late onset VAP. In early VAP Acinetobacter baumannii showed 62.5% metallo-beta-lactamase (MBL positivity. P. aeruginosa showed 27.5% MBL positivity, whereas in late onset VAP, 71.4% A. baumannii isolates and 75.8% P. aeruginosa isolates showed MBL positivity, respectively. Conclusion : Simple prevention of aspiration, sterilization of equipments, hand washing of personnel can reduce VAP in hospital care setting.

  2. Mannose-binding lectin and l-ficolin polymorphisms in patients with community-acquired pneumonia caused by intracellular pathogens.

    Science.gov (United States)

    van Kempen, Gijs; Meijvis, Sabine; Endeman, Henrik; Vlaminckx, Bart; Meek, Bob; de Jong, Ben; Rijkers, Ger; Bos, Willem Jan

    2017-05-01

    Community-acquired pneumonia (CAP) is the leading infectious disease requiring hospitalization in the western world. Genetic variability affecting the host response to infection may play a role in susceptibility and outcome in patients with CAP. Mannose-binding lectin (MBL) and l-ficolin (l-FCN) are two important activators of the complement system and they can enhance phagocytosis by opsonization. In a prospective cohort of 505 Dutch patients with CAP and 227 control participants we studied whether polymorphisms in the MBL (MBL2) and FCN (FCN2) genes influenced susceptibility and outcome. No difference in frequency of these genotypes was found between patients with CAP in general and controls. However, the +6424G>T single nucleotide polymorphism (SNP) in FCN2 was more common in patients with a Coxiella burnetii pneumonia (P = 0·014). Moreover, the haplotypes coding for the highest MBL serum levels (YA/YA and YA/XA) predisposed to atypical pneumonia (C. burnetii, Legionella or Chlamydia species or Mycoplasma pneumoniae) compared with controls (P = 0·016). Furthermore, patients with these haplotypes were more often bacteraemic (P = 0·019). It can therefore be concluded that MBL2 and FCN2 polymorphisms are not major risk factors for CAP in general, but that the +6424G>T SNP in the FCN2 gene predisposes to C. burnetii pneumonia. In addition, patients with genotypes corresponding with high serum MBL levels are at risk for atypical pneumonia, possibly caused by enhanced phagocytosis, thereby promoting cell entry of these intracellular bacteria. © 2016 The Authors. Immunology Published by John Wiley & Sons Ltd.

  3. Angiotensin-converting enzyme inhibitor use and protection against pneumonia in patients with diabetes

    NARCIS (Netherlands)

    van de Garde, Ewoudt M W; Souverein, Patrick C; Hak, Eelko; Deneer, Vera H M; van den Bosch, Jules M M; Leufkens, Hubert G M

    OBJECTIVES: Because of the high risk of pneumonia in patients with diabetes, we aimed to assess the effect of angiotensin-converting enzyme (ACE) inhibitor use on the occurrence of pneumonia in a general population of patients with diabetes. METHODS: The study population comprised all patients in

  4. [Investigation of antimicrobial resistance of Klebsiella pneumoniae and Pseudomonas aeruginosa isolates from rat-like animals around a hospital in Guangzhou].

    Science.gov (United States)

    Zhong, Xue-Shan; Ge, Jing; Chen, Shao-Wei; Xiong, Yi-Quan; Zheng, Xue-Yan; Qiu, Min; Huo, Shu-Ting; Chen, Qing

    2016-05-01

    To investigate antimicrobial resistance of Klebsiella pneumoniae and Pseudomonas aeruginosa isolates in fecal samples from rat-like animals. Rat-like animals were captured using cages around a hospital and the neighboring residential area between March and October, 2015. K. pneumoniae and P. aeruginosa were isolated from the fecal samples of the captured animals. Antimicrobial susceptibility test was performed according to the guidelines of Clinical and Laboratory Standards Institute (2014). A total of 329 rat-like animals were captured, including 205 Suncus murinus, 111 Rattus norvegicus, 5 Rattus flavipectus and 8 Mus musculus. The positivity rates of K. pneumoniae and P. aeruginosa were 78.4% and 34.7% in the fecal samples from the captured animals, respectively. K. pneumoniae isolates from Suncus murinus showed a high resistance to ampicillin, cephazolin, nitrofurantoin, piperacillin and cefotaxime (with resistance rates of 100%, 51.2%, 44.2%, 37.2%, and 23.3%, respectively), and K. pneumoniae isolates from Rattus spp. showed a similar drug-resistance profile. The prevalence rates of multidrug resistance and ESBLs were 40.9% and 10.7%, respectively. P. aeruginosa from both Suncus murinus and Rattus spp. exhibited the highest resistance rates to aztreonam (12.4% and 16.0%, respectively), followed by penicillins and fluoroquinolones. P. aeruginosa isolates were susceptible to cephems, aminoglycosides and carbapenems (with resistance rates below 5%). K. pneumoniae and P. aeruginosa isolated from rat-like animals showed drug-resistance profiles similar to those of the strains isolated from clinical patients, suggesting that the possible transmission of K. pneumoniae and P. aeruginosa between rat-like animals and human beings.

  5. First isolation and outbreak of OXA-48-producing Klebsiella pneumoniae in an Irish hospital, March to June 2011.

    LENUS (Irish Health Repository)

    O'Brien, D J

    2012-02-01

    Five OXA-48-producing Klebsiella pneumoniae were detected in a tertiary referral hospital in Ireland between March and June 2011. They were found in the clinical isolates of five cases that were inpatients on general surgical wards. None of the cases had received healthcare at a facility outside of Ireland in the previous 12 months. This is the first report of OXA-48-producing K. pneumoniae in Ireland.

  6. Perfil clínico, epidemiológico e etiológico de pacientes com pneumonia adquirida na comunidade internados em um hospital geral da microrregião de Sumaré, SP Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia at a general hospital in the Sumaré microregion of Brazil

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    Maria Rita Donalisio

    2011-04-01

    Full Text Available OBJETIVO: Analisar aspectos clínicos, etiológicos e epidemiológicos das pneumonias adquiridas na comunidade (PAC em indivíduos internados. MÉTODOS: Foram estudados prospectivamente 66 pacientes com PAC maiores de 14 anos no Hospital Estadual Sumaré, localizado na cidade de Sumaré (SP, entre outubro de 2005 e setembro de 2007. Coletamos dados sobre história clínica, exame clínico, escore pneumonia severity index (PSI e exames laboratoriais (hemocultura, bacterioscopia/cultura de escarro, sorologias para Chlamydophila pneumoniae, Mycoplasma pneumoniae e Legionella pneumophila, além de antígenos urinários de Legionella sp. e Streptococcus pneumoniae. RESULTADOS: A idade média dos pacientes foi de 53 anos, a maioria tinha baixa escolaridade, e 55,7% apresentavam pelo menos uma comorbidade no momento da internação. O percentual de idosos vacinados contra influenza entre os internados foi significativamente menor que os da comunidade dos municípios da microrregião de Sumaré (52,6% vs. > 70%. A febre foi menos frequente entre os idosos (p OBJECTIVE: To analyze the clinical, etiological, and epidemiological aspects of community-acquired pneumonia (CAP in hospitalized individuals. METHODS: We prospectively studied 66 patients (> 14 years of age with CAP admitted to the Hospital Estadual Sumaré, located in the Sumaré microregion of Brazil, between October of 2005 and September of 2007. We collected data related to clinical history, physical examination, pneumonia severity index (PSI scores, and laboratory tests (blood culture; sputum smear microscopy and culture; serology for Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila; and detection of Legionella sp. and Streptococcus pneumoniae antigens in urine. RESULTS: The mean age of patients was 53 years. Most had a low level of education, and 55.7% presented with at least one comorbidity at the time of hospitalization. The proportion of elderly people vaccinated

  7. Immune response to Mycoplasma pneumoniae P1 and P116 in patients with atypical pneumonia analyzed by ELISA

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    Birkelund Svend

    2004-02-01

    Full Text Available Abstract Background Serology is often used for the diagnosis of Mycoplasma pneumoniae. It is important to identify specific antigens that can distinguish between the presence or absence of antibodies against M. pneumoniae. The two proteins, P116 and P1, are found to be immunogenic. By using these in ELISA it is possible to identify an immune response against M. pneumoniae in serum samples. Results A recombinant protein derived from the P116 protein and one from the P1 protein were used in two ELISA tests, rP116-ELISA and rP1-ELISA. Human serum samples from patients with atypical pneumonia were tested and compared to the results of the complement fixation test. There was a good agreement between the two tests but the rP1-ELISA showed the best discrimination between positive and negative samples. Conclusion Two ELISA tests based on recombinant proteins have been analysed and compared to the complement fixation test results. The two ELISA tests were found suitable for use in serodiagnostics of M. pneumoniae infections. The use of specific antigens eliminates the risk of cross reaction to an immune response against other bacteria.

  8. Readmissions after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia among Young and Middle-Aged Adults: A Retrospective Observational Cohort Study

    Science.gov (United States)

    Ranasinghe, Isuru; Wang, Yongfei; Dharmarajan, Kumar; Hsieh, Angela F.; Bernheim, Susannah M.; Krumholz, Harlan M.

    2014-01-01

    Background Patients aged ≥65 years are vulnerable to readmissions due to a transient period of generalized risk after hospitalization. However, whether young and middle-aged adults share a similar risk pattern is uncertain. We compared the rate, timing, and readmission diagnoses following hospitalization for heart failure (HF), acute myocardial infarction (AMI), and pneumonia among patients aged 18–64 years with patients aged ≥65 years. Methods and Findings We used an all-payer administrative dataset from California consisting of all hospitalizations for HF (n = 206,141), AMI (n = 107,256), and pneumonia (n = 199,620) from 2007–2009. The primary outcomes were unplanned 30-day readmission rate, timing of readmission, and readmission diagnoses. Our findings show that the readmission rate among patients aged 18–64 years exceeded the readmission rate in patients aged ≥65 years in the HF cohort (23.4% vs. 22.0%, preadmission risk in patients aged 18–64 years was similar to patients ≥65 years in the HF (HR 0.99; 95%CI 0.97–1.02) and pneumonia (HR 0.97; 95%CI 0.94–1.01) cohorts and was marginally lower in the AMI cohort (HR 0.92; 95%CI 0.87–0.96). For all cohorts, the timing of readmission was similar; readmission risks were highest between days 2 and 5 and declined thereafter across all age groups. Diagnoses other than the index admission diagnosis accounted for a substantial proportion of readmissions among age groups readmissions in the HF cohort and 37–45% of readmissions in the AMI cohort, while a non-pulmonary diagnosis represented 61–64% of patients in the pneumonia cohort. Conclusion When adjusted for differences in patient characteristics, young and middle-aged adults have 30-day readmission rates that are similar to elderly patients for HF, AMI, and pneumonia. A generalized risk after hospitalization is present regardless of age. Please see later in the article for the Editors' Summary PMID:25268126

  9. Splenectomy is associated with higher infection and pneumonia rates among trauma laparotomy patients.

    Science.gov (United States)

    Fair, Kelly A; Connelly, Christopher R; Hart, Kyle D; Schreiber, Martin A; Watters, Jennifer M

    2017-05-01

    Splenectomy increases lifetime risk of thromboembolism (VTE) and is associated with long-term infectious complications, primarily, overwhelming post-splenectomy infection (OPSI). Our objective was to evaluate risk of VTE and infection at index hospitalization post-splenectomy. Retrospective review of all patients who received a laparotomy in the NTDB. Propensity score matching for splenectomy was performed, based on ISS, abdominal abbreviated injury score >3, GCS, sex and mechanism. Major complications, VTE, and infection rates were compared. Multiple logistic regression models were utilized to evaluate splenectomy-associated complications. 93,221 laparotomies were performed and 17% underwent splenectomy. Multiple logistic regression models did not demonstrate an association between splenectomy and major complications (OR 0.96, 95% CI 0.91-1.03, p = 0.25) or VTE (OR 1.05, 95% CI 0.96-1.14, p = 0.33). Splenectomy was independently associated with infection (OR 1.07, 95% CI 1.00-1.14, p = 0.045). Subgroup analysis of patients with infection demonstrated that splenectomy was most strongly associated with pneumonia (OR 1.41, 95% CI 1.26-1.57, p Splenectomy is not associated with higher overall complication or VTE rates during index hospitalization. However, splenectomy is associated with a higher rate of pneumonia. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. 4G/5G Polymorphism of Plasminogen Activator Inhibitor -1 Gene Is Associated with Mortality in Intensive Care Unit Patients with Severe Pneumonia

    Science.gov (United States)

    Sapru, Anil; Hansen, Helen; Ajayi, Temitayo; Brown, Ron; Garcia, Oscar; Zhuo, HanJing; Wiemels, Joseph; Matthay, Michael A.; Wiener-Kronish, Jeanine

    2011-01-01

    Background Higher plasma and pulmonary edema fluid levels of plasminogen activator inhibitor-1 (PAI-1) are associated with increased mortality in patients with pneumonia and acute lung injury. The 4G allele of the 4G/5G polymorphism of the PAI-1 gene is associated with higher PAI-1 levels and an increased incidence of hospitalizations for pneumonia. The authors hypothesized that the 4G allele would be associated with worse clinical outcomes (mortality and ventilator-free days) in patients with severe pneumonia. Methods The authors enrolled patients admitted with severe pneumonia in a prospective cohort. Patients were followed until hospital discharge. DNA was isolated from blood samples, and genotyping detection for the PAI-1 4G/5G polymorphism was carried out using Taqman-based allelic discrimination. Results A total of 111 patients were available for analysis. Distribution of genotypes was 4G/4G 26 of 111 (23%), 4G/5G 59 of 111 (53%), and 5G/5G 26 of 111 (23%). Of 111 patients, 32 (29%) died before hospital discharge and 105 patients (94%) received mechanical ventilation. Patients with the 4G/4G and the 4G/5G genotypes had higher mortality (35% vs. 8%, P = 0.007) and fewer ventilator-free days (median 4 vs. 13, P = 0.04) compared to patients with the 5G/5G genotype. Conclusions The 4G allele of the 4G/5G polymorphism in the PAI-1 gene is associated with fewer ventilator-free days and increased mortality in hospitalized patients with severe pneumonia. These findings suggest that PAI-1 may have a role in pathogenesis and that the 4G/5G polymorphism may be an important biomarker of risk in patients with severe pneumonia. PMID:19387177

  11. 4G/5G polymorphism of plasminogen activator inhibitor-1 gene is associated with mortality in intensive care unit patients with severe pneumonia.

    Science.gov (United States)

    Sapru, Anil; Hansen, Helen; Ajayi, Temitayo; Brown, Ron; Garcia, Oscar; Zhuo, HanJing; Wiemels, Joseph; Matthay, Michael A; Wiener-Kronish, Jeanine

    2009-05-01

    Higher plasma and pulmonary edema fluid levels of plasminogen activator inhibitor-1 (PAI-1) are associated with increased mortality in patients with pneumonia and acute lung injury. The 4G allele of the 4G/5G polymorphism of the PAI-1 gene is associated with higher PAI-1 levels and an increased incidence of hospitalizations for pneumonia. The authors hypothesized that the 4G allele would be associated with worse clinical outcomes (mortality and ventilator-free days) in patients with severe pneumonia. The authors enrolled patients admitted with severe pneumonia in a prospective cohort. Patients were followed until hospital discharge. DNA was isolated from blood samples, and genotyping detection for the PAI-1 4G/5G polymorphism was carried out using Taqman-based allelic discrimination. A total of 111 patients were available for analysis. Distribution of genotypes was 4G/4G 26 of 111 (23%), 4G/5G 59 of 111 (53%), and 5G/5G 26 of 111 (23%). Of 111 patients, 32 (29%) died before hospital discharge and 105 patients (94%) received mechanical ventilation. Patients with the 4G/4G and the 4G/5G genotypes had higher mortality (35% vs. 8%, P = 0.007) and fewer ventilator-free days (median 4 vs. 13, P = 0.04) compared to patients with the 5G/5G genotype. The 4G allele of the 4G/5G polymorphism in the PAI-1 gene is associated with fewer ventilator-free days and increased mortality in hospitalized patients with severe pneumonia. These findings suggest that PAI-1 may have a role in pathogenesis and that the 4G/5G polymorphism may be an important biomarker of risk in patients with severe pneumonia.

  12. A retrospective study of risk factors for carbapenem-resistant Klebsiella pneumoniae acquisition among ICU patients.

    Science.gov (United States)

    Hu, Yangmin; Ping, Yanting; Li, Leiqing; Xu, Huimin; Yan, Xiaofeng; Dai, Haibin

    2016-03-31

    Carbapenem-resistant Klebsiella pneumoniae (CRKP) is rapidly emerging as a life-threatening nosocomial infection. In this study, we aim to identify risk factors, especially antibiotic use, for CRKP infection among intensive care unit (ICU) patients. This was a matched case-control study of a 67-bed ICU in a tertiary care teaching hospital from 1 January 2011 through 30 June 2013. The control cases were selected among the patients with carbapenem-susceptible Klebsiella pneumoniae (CSKP) and were matched with CRKP cases for year of ICU admission and site of infection. The clinical outcomes and antibiotic treatments were analyzed. One hundred and thirty patients were included in the study (65 cases and 65 controls). Bivariable analysis showed that age of patients (p = 0.044), number of antibiotic groups (p = 0.001), and exposure to carbapenems (p carbapenems, previous carbapenem exposure (p carbapenems is an independent risk factor for CRKP infection. Patients with this clinical factor should be targeted for interventions to reduce the subsequent risk of infection.

  13. Factors Predicting Ventilator Dependence in Patients with Ventilator-Associated Pneumonia

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    Chia-Cheng Tseng

    2012-01-01

    Full Text Available Objectives. To determine risk factors associated with ventilator dependence in patients with ventilator-associated pneumonia (VAP. Study Design. A retrospective study was conducted at Chang Gung Memorial Hospital, Kaohsiung, from January 1, 2007 to January 31, 2008. Methods. This study evaluated 163 adult patients (aged ≥18 years. Eligibility was evaluated according to the criterion for VAP, Sequential Organ Failure Assessment (SOFA score, Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II score. Oxygenation index, underlying comorbidities, septic shock status, previous tracheostomy status, and factors related to pneumonia were collected for analysis. Results. Of the 163 VAP patients in the study, 90 patients survived, yielding a mortality rate of 44.8%. Among the 90 surviving patients, only 36 (40% had been weaned off ventilators at the time of discharge. Multivariate logistic regression analysis was used to identify underlying factors such as congestive cardiac failure (P=0.009, initial high oxygenation index value (P=0.04, increased SOFA scores (P=0.01, and increased APACHE II scores (P=0.02 as independent predictors of ventilator dependence. Results from the Kaplan-Meier method indicate that initial therapy with antibiotics could increase the ventilator weaning rate (log Rank test, P<0.001. Conclusions. Preexisting cardiopulmonary function, high APACHE II and SOFA scores, and high oxygenation index were the strongest predictors of ventilator dependence. Initial empiric antibiotic treatment can improve ventilator weaning rates at the time of discharge.

  14. Occurrence and analysis of irp2 virulence gene in isolates of Klebsiella pneumoniae and Enterobacter spp. from microbiota and hospital and community-acquired infections.

    Science.gov (United States)

    Souza Lopes, Ana Catarina; Rodrigues, Juliana Falcão; Cabral, Adriane Borges; da Silva, Maíra Espíndola; Leal, Nilma Cintra; da Silveira, Vera Magalhães; de Morais Júnior, Marcos Antônio

    2016-07-01

    Eighty-five isolates of Klebsiella pneumoniae and Enterobacter spp., originating from hospital- and community-acquired infections and from oropharyngeal and faecal microbiota from patients in Recife-PE, Brazil, were analyzed regarding the presence of irp2 gene. This is a Yersinia typical gene involved in the synthesis of siderophore yersiniabactin. DNA sequencing confirmed the identity of irp2 gene in five K. pneumoniae, five Enterobacter aerogenes and one Enterobacter amnigenus isolates. To our knowledge in the current literature, this is the first report of the irp2 gene in E. amnigenus, a species considered an unusual human pathogen, and in K. pneumoniae and E. aerogenes isolates from the normal microbiota and from community infections, respectively. Additionally, the analyses of nucleotide and amino acid sequences suggest the irp2 genes derived from isolates used in this study are more closely related to that of Yersinia pestis P.CE882 than to that of Yersinia enterocolitica 8081. These data demonstrated that K. pneumoniae and Enterobacter spp. from normal microbiota and from community- and hospital-acquired infections possess virulence factors important for the establishment of extra-intestinal infections. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Antiviral therapy and outcomes of patients with pneumonia caused by influenza A pandemic (H1N1 virus.

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    Shi-gui Yang

    Full Text Available BACKGROUND: There is limited data on the clinical outcome of patients with pandemic H1N1 (pH1N1 pneumonia who received oseltamivir treatment, especially when the treatment was administered more than 48 hours after symptom onset. METHODS: During the pandemic in 2009, a cohort of pH1N1 influenza pneumonia was built in China, and their clinical information was collected systematically, and analyzed with Cox models. RESULTS: 920 adults and 541 children with pneumonia who didn't receive corticosteroids were analyzed. In-hospital mortality was higher in adults who did not receive antiviral therapy (18.2% than those with who received oseltamivir ≤ 2 days (2.9%, between 2-5 days (4.6% and >5 days after illness onset (4.9%, p5 days, respectively. For males patients, aged ≥ 14 years and baseline PaO(2/FiO(23.8 mg/kg/d did not improve clinical outcome (mortality, higher dose 2.5% vs standard dose 2.8%, p>0.05. CONCLUSIONS: Antiviral therapy might reduce mortality of patients with pH1N1 pneumonia, even when initiated more than 48 hours after onset of illness. Greater protective effects might be in males, patients aged 14-60 years, and patients with PaO(2/FiO(2<200.

  16. Kinetic bed therapy to prevent nosocomial pneumonia in mechanically ventilated patients: a systematic review and meta-analysis.

    Science.gov (United States)

    Delaney, Anthony; Gray, Hilary; Laupland, Kevin B; Zuege, Danny J

    2006-01-01

    Nosocomial pneumonia is the most important infectious complication in patients admitted to intensive care units. Kinetic bed therapy may reduce the incidence of nosocomial pneumonia in mechanically ventilated patients. The objective of this study was to investigate whether kinetic bed therapy reduces the incidence of nosocomial pneumonia and improves outcomes in critically ill mechanically ventilated patients. We searched Medline, EMBASE, CINAHL, CENTRAL, and AMED for studies, as well as reviewed abstracts of conference proceedings, bibliographies of included studies and review articles and contacted the manufacturers of medical beds. Studies included were randomized or pseudo-randomized clinical trials of kinetic bed therapy compared to standard manual turning in critically ill mechanically ventilated adult patients. Two reviewers independently applied the study selection criteria and extracted data regarding study validity, type of bed used, intensity of kinetic therapy, and population under investigation. Outcomes assessed included the incidence of nosocomial pneumonia, mortality, duration of ventilation, and intensive care unit and hospital length of stay. Fifteen prospective clinical trials were identified, which included a total of 1,169 participants. No trial met all the validity criteria. There was a significant reduction in the incidence of nosocomial pneumonia (pooled odds ratio (OR) 0.38, 95% confidence interval (CI) 0.28 to 0.53), but no reduction in mortality (pooled OR 0.96, 95%CI 0.66 to 1.14), duration of mechanical ventilation (pooled standardized mean difference (SMD) -0.14 days, 95%CI, -0.29 to 0.02), duration of intensive care unit stay (pooled SMD -0.064 days, 95% CI, -0.21 to 0.086) or duration of hospital stay (pooled SMD 0.05 days, 95% CI -0.18 to 0.27). While kinetic bed therapy has been purported to reduce the incidence of nosocomial pneumonia in mechanically ventilated patients, the overall body of evidence is insufficient to support this

  17. Bacteremia with Streptococcus pneumoniae

    DEFF Research Database (Denmark)

    Christensen, J S; Jensen, T G; Kolmos, H J

    2012-01-01

    We conducted a hospital-based cohort study among adult patients with first-time Streptococcus pneumoniae bacteremia (SPB) from 2000 through 2008. Patients were identified in a population-based bacteremia database and followed up for mortality through the Danish Civil Registration System (CRS...

  18. Associations between nursing home performance and hospital 30-day readmissions for acute myocardial infarction, heart failure and pneumonia at the healthcare community level in the United States.

    Science.gov (United States)

    Pandolfi, Michelle M; Wang, Yun; Spenard, Ann; Johnson, Florence; Bonner, Alice; Ho, Shih-Yieh; Elwell, Timothy; Bakullari, Anila; Galusha, Deron; Leifheit-Limson, Erica; Lichtman, Judith H; Krumholz, Harlan M

    2017-12-01

    To evaluate community-specific nursing home performance with community-specific hospital 30-day readmissions for Medicare patients discharged with acute myocardial infarction, heart failure or pneumonia. Cross-sectional study using 2009-2012 hospital risk-standardised 30-day readmission data for Medicare fee-for-service patients hospitalised for all three conditions and nursing home performance data from the Centers for Medicare & Medicaid Services Five-Star Quality Rating System. Medicare-certified nursing homes and acute care hospitals. 12,542 nursing homes and 3,039 hospitals treating 30 or more Medicare fee-for-service patients for all three conditions across 2,032 hospital service areas in the United States. Community-specific hospital 30-day risk-standardised readmission rates. Community-specific nursing home performance measures: health inspection, staffing, Registered Nurses and quality performance; and an aggregated performance score. Mixed-effects models evaluated associations between nursing home performance and hospital 30-day risk-standardised readmission rates for all three conditions. The relationship between community-specific hospital risk-standardised readmission rates and community-specific overall nursing home performance was statistically significant for all three conditions. Increasing nursing home performance by one star resulted in decreases of 0.29% point (95% CI: 0.12-0.47), 0.78% point (95% CI: 0.60-0.95) and 0.46% point (95% CI: 0.33-0.59) of risk-standardised readmission rates for AMI, HF and pneumonia, respectively. Among the specific measures, higher performance in nursing home overall staffing and Registered Nurse staffing measures was statistically significantly associated with lower hospital readmission rates for all three conditions. Notable geographic variation in the community-specific nursing home performance was observed. Community-specific nursing home performance is associated with community-specific hospital 30-day

  19. Is elevated Red cell distribution width a prognostic predictor in adult patients with community acquired Pneumonia?

    Science.gov (United States)

    2014-01-01

    Background Community acquired pneumonia (CAP) is a major cause of morbidity and mortality. We recently demonstrated that among young patients (patient characteristic, 90-day mortality and complicated hospitalization. Results The cohort included 3815 patients. In univariate analysis, patients with co-morbid conditions tended to have a complicated course of CAP. In multivariate regression analysis, variables associated with an increased risk of 90-day mortality included age > 70 years, high Charlson comorbidity index (>2), Hb 30 mg/dl, systolic blood pressure 15%. Variables associated with complicated hospitalization included high Charlson comorbidity index, BUN > 30 mg/dl, hemoglobin 124 bpm, systolic blood pressure < 90 mmHg and elevated RDW. Mortality rate and complicated hospitalization were significantly higher among patients with increased RDW regardless of the white blood cell count or hemoglobin levels. Conclusions Elevated RDW levels on admission are associated with significant higher rates of mortality and severe morbidity in adult patients with CAP. RDW as a prognostic marker was unrelated with hemoglobin levels, WBC count, age or Charlson score. PMID:24597687

  20. Radiological and clinical course of pneumonia in patients with avian influenza H5N1

    International Nuclear Information System (INIS)

    Bay, Ali; Etlik, Omer; Oner, A. Faik; Unal, Ozkan; Arslan, Halil; Bora, Aydin; Davran, Ramazan; Yuca, Sevil Ari; Dogan, Murat

    2007-01-01

    Introduction: We evaluated chest X-ray and clinical findings of patients with lower respiratory tract infection due to influenza H5N1 and presented the radiological findings and clinical course of the infection. Materials and methods: Between December 2005 and February 2006, eight hospitalized patients (median age 10, 5-15 years) with avian-flu were evaluated in this study. All patients were evaluated with chest X-ray and four of them with CT scan. Post mortem pathological characterization were also available for three of the patients. Results: A rapidly progressive pneumonia with high mortality rate was observed especially for cases with late admission. The major radiologic abnormalities were extensive pneumonic infiltration with segmental and multifocal distribution, mostly located in lower zones of the lung. No pleural effusion and hilar lymphadenopathy was noted. Conclusion: Avian flu may be presented as rapidly progressive pneumonia. The chest radiography has an important role in diagnosis and should be obtained daily because of rapid change of the findings that may necessitate prompt action

  1. Radiological and clinical course of pneumonia in patients with avian influenza H5N1

    Energy Technology Data Exchange (ETDEWEB)

    Bay, Ali [Yuzuncu Yil University, Faculty of Medicine, Department of Pediatrics, Van (Turkey)]. E-mail: bayalibay@yahoo.com; Etlik, Omer [Yuzuncu Yil University, Faculty of Medicine, Department of Radiology, Van (Turkey); Oner, A. Faik [Yuzuncu Yil University, Faculty of Medicine, Department of Pediatrics, Van (Turkey); Unal, Ozkan [Yuzuncu Yil University, Faculty of Medicine, Department of Radiology, Van (Turkey); Arslan, Halil [Yuzuncu Yil University, Faculty of Medicine, Department of Radiology, Van (Turkey); Bora, Aydin [Yuzuncu Yil University, Faculty of Medicine, Department of Radiology, Van (Turkey); Davran, Ramazan [Yuzuncu Yil University, Faculty of Medicine, Department of Radiology, Van (Turkey); Yuca, Sevil Ari [Yuzuncu Yil University, Faculty of Medicine, Department of Pediatrics, Van (Turkey); Dogan, Murat [Yuzuncu Yil University, Faculty of Medicine, Department of Pediatrics, Van (Turkey)

    2007-02-15

    Introduction: We evaluated chest X-ray and clinical findings of patients with lower respiratory tract infection due to influenza H5N1 and presented the radiological findings and clinical course of the infection. Materials and methods: Between December 2005 and February 2006, eight hospitalized patients (median age 10, 5-15 years) with avian-flu were evaluated in this study. All patients were evaluated with chest X-ray and four of them with CT scan. Post mortem pathological characterization were also available for three of the patients. Results: A rapidly progressive pneumonia with high mortality rate was observed especially for cases with late admission. The major radiologic abnormalities were extensive pneumonic infiltration with segmental and multifocal distribution, mostly located in lower zones of the lung. No pleural effusion and hilar lymphadenopathy was noted. Conclusion: Avian flu may be presented as rapidly progressive pneumonia. The chest radiography has an important role in diagnosis and should be obtained daily because of rapid change of the findings that may necessitate prompt action.

  2. Pneumonia in immunosuppressed patients; Pneumonien bei immunsupprimierten Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Solyanik, O.; Gaass, T.; Hellbach, K. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer klinische Radiologie, Muenchen (Germany); Dinkel, J. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer klinische Radiologie, Muenchen (Germany); Comprehensive Pneumology Center Munich (CPC-M), Muenchen (Germany)

    2017-01-15

    Pulmonary infections are a common complication in immunosuppressed patients with a frequently fatal prognosis despite modern prophylactic therapy. An early and correct diagnosis is important for initiation of the appropriate therapy. Chest radiography is the preferred initial imaging examination but is not accurate enough for the detection of pulmonary infections in immunosuppressed patients. Pneumonia is caused by a broad spectrum of pathogens in immunocompromised patients. In addition to imaging, the clinical history and epidemiology also play an important role in the diagnostics. Using epidemiological and anamnestic information, computed tomography (CT) shows a significantly better sensitivity and specificity particularly for the diagnosis of atypical forms of pneumonia. Due to the exact imaging of the different infiltration patterns CT provides an increased sensitivity with respect to the etiological classification of pulmonary infections. This article reviews in particular the radiological findings of commonly occurring pulmonary infections in immunosuppressed patients. (orig.) [German] Pneumonien bei immunsupprimierten Patienten sind haeufige Komplikationen, die trotzt moderner Prophylaxe toedlich verlaufen koennen. Eine korrekte Diagnose ist daher von entscheidender Bedeutung, um die richtige Therapie einleiten zu koennen. Die Roentgenthoraxaufnahme ist selten spezifisch genug fuer die genaue Einordnung atypischer Pneumonien in Folge einer Immunsuppression. Pneumonien unter Immunsuppression werden durch ein sehr breites Erregerspektrum verursacht. Eine wichtige Rolle bei der Diagnosefindung spielen neben der Bildgebung auch die klinische Anamnese und Epidemiologie. Mithilfe der klinischen Anamnese und Epidemiologie bietet die Computertomographie (CT) bei immunsupprimierten Patienten zum einen eine erhoehte Sensitivitaet bei der Detektion insbesondere atypischer Pneumonien. Zum anderen weist die CT durch die exakte Abbildung unterschiedlicher Infiltratmuster

  3. Albumin and C-reactive protein have prognostic significance in patients with community-acquired pneumonia.

    Science.gov (United States)

    Lee, Jae Hyuk; Kim, Jooyeong; Kim, Kyuseok; Jo, You Hwan; Rhee, JoongEui; Kim, Tae Youn; Na, Sang Hoon; Hwang, Seung Sik

    2011-06-01

    This study aims to determine the association of commonly used biochemical markers, such as albumin and C-reactive protein (CRP), with mortality and the prognostic performance of these markers combined with the pneumonia severity index (PSI) for mortality and adverse outcomes in patients with community-acquired pneumonia (CAP). The data were gathered prospectively for patients hospitalized with CAP via the emergency department. Laboratory values, including CRP and albumin, clinical variables, and the PSI were measured. Primary outcomes were 28-day mortality and survival times. Secondary outcome was admission to the intensive care unit, vasopressor use, or the need for mechanical ventilation during the hospital stay. A total of 424 patients were included. The 28-day mortality was 13.7%. C-reactive protein and albumin were significantly different between survivors and nonsurvivors. In logistic regression analysis, CRP and albumin were independently associated with 28-day mortality (P scale. The Cox proportional hazards analysis showed that high serum albumin (≥3.3 mg/dL) had a hazard ratio of 0.5 (95% confidence interval, 0.3-0.9), and high CRP (≥14.3 mg/dL) had a hazard ratio of 2.0 (95% confidence interval, 1.1-3.4). For predicting secondary outcome, adding albumin to PSI increased areas under the curve significantly, but CRP did not. Albumin and CRP were associated with 28-day mortality in hospitalized patients with CAP, and these markers increased prognostic performance when combined with the PSI scale. Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.

  4. Significance of changes of serum NSE and CEA levels in patients with pneumonia and malignant tumors

    International Nuclear Information System (INIS)

    Liu Hengguo; Luo Nanping; Wang Ruishan; Bai Lu

    2005-01-01

    Objective: To investigate the significance of changes of serum NSE and CEA levels in patients with pneumonia and malignant tumors. Methods: Serum NSE (with RIA) and CEA (with ECLIA) levels in patients with pneumonia or various kinds of malignant tumors (altogether 140 patients) and 32 controls. Results: Serum NSE and CEA levels were significantly higher in patients with lung cancer, gastric cancer, renal cancer, brain tumor and pneumonia than those in the controls (P<0.05,P <0. 05 ,P <0. 01, P<0.01, P<0.01). Positive rate of serum NSE highest in patients with pneumonia, followed successively by renal cancer, brain tumor and lung cancer. NSE levels were positively correlated with CEA levels (r=0.29, P<0.05). Conclusion: As a tumor marker, NSE has important clinical significance in the diagnoses of malignant tumor and pneumonia. (authors)

  5. Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes.

    Science.gov (United States)

    Al-Khaled, Mohamed; Matthis, Christine; Binder, Andreas; Mudter, Jonas; Schattschneider, Joern; Pulkowski, Ulrich; Strohmaier, Tim; Niehoff, Torsten; Zybur, Roland; Eggers, Juergen; Valdueza, Jose M; Royl, Georg

    2016-01-01

    Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to 72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability. © 2016 S. Karger AG, Basel.

  6. Clinical characteristics of children with Mycoplasma pneumoniae infection hospitalized during the Danish 2010-2012 epidemic

    DEFF Research Database (Denmark)

    Sørensen, Cristel M; Schønning, Kristian; Rosenfeldt, Vibeke

    2013-01-01

    Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. Pneumonia may be the most severe manifestation of respiratory M. pneumoniae infection. The most typical symptoms in children are cough and wheezing, which are often accompanied by upper respiratory tract manifestations...

  7. Prevalence of Mycoplasma Pneumoniae Infection in Patients with COPD Exacerbation; a Letter to the Editor

    Directory of Open Access Journals (Sweden)

    Ali Reza Amiri

    2018-03-01

    Full Text Available Dear editor;Currently, control and prevention of respiratory illnesses is considered a health priority in most developed countries and managing the risk factors is necessary for improving the population’s health. Chronic obstructive pulmonary disease (COPD is the 5th cause of death around the world and estimations have indicated that due to an increase in environmental pollution, this disease will become the 3rd cause of death in the future.In previous studies, pulmonary infection with mycoplasma pneumoniae has been introduced as one of the causes for COPD exacerbation. Mycoplasma pneumoniae affects the upper and lower respiratory tract and its clinical manifestation is trachea-bronchitis accompanied by restlessness and dry coughs. The pathogenesis spectrum of this bacterium ranges from mild pharyngitis and trachea-bronchitis to acute pneumonia. Epidemiologic studies have shown that this bacterium is responsible for more than 20% of community acquired pneumonias.In a cross-sectional study by the authors of the present letter, 66 patients over the age of 18 years who had presented to the emergency department of Imam Reza Hospital, Mashhad, Iran, with diagnosis of COPD exacerbation were evaluated. Sputum sample of the patients was obtained and sent to the laboratory for performing polymerase chain reaction (PCR. Mean age of the patients participating in this study was 67.28 ± 13.68 years (60.6% male. The result of PCR was positive in 6 patients out of the total of 66 patients (9.1%. The results of the present study showed that there was no correlation between age (p=0.18, sex (p=0.25, duration of being affected with COPD (p=0.20, consumption of antibiotics (p=0.35, smoking (p=0.62, opioid abuse (p=0.44, corticosteroid use (p=0.57, underlying illness (p=0.94 and health care—associated pneumonia (HCAP (p=0.46 with mycoplasma infection. However, prevalence of leukocytosis (p=0.01 and myalgia (p=0.02 was significantly higher in the mycoplasma

  8. Clinical outcome in measles patients hospitalized with complications

    International Nuclear Information System (INIS)

    Rehman, A.U.; Saeed, T.

    2008-01-01

    Measles is a highly communicable viral illness and is common cause of childhood mortality and morbidity. Keeping in view the high prevalence of measles in the developing world, we carried out this study to look into the complicated measles cases and clinical outcome in patients admitted in children ward of Ayub Teaching Hospital. Detailed history and physical examination of all the hospitalized patients with complication of measles were recorded in a proforma. Immunization and nutritional status of each admitted patient was assessed and the clinical outcome of measles was compared with demographic profile. one hundred thirty six hospitalized patients with complications of measles were studied. There was 60.3% male and 57.3% of patients were vaccinated against measles. Malnourished patients were 71.35% and had longer hospital stay (>5 days). Pneumonia (39.7%) and diarrhoea (38.2%) were the commonest complications. Seven children died and encephalitis (57.1%) was the commonest cause of death. The most common complications of measles are pneumonia and diarrhoea with dehydration requiring admission. Malnutrition results in more complications and longer hospital stay. Mortality is significantly associated with encephalitis. (author)

  9. Outbreak of OXA-48-Producing Klebsiella pneumoniae Involving a Sequence Type 101 Clone in Batna University Hospital, Algeria.

    Science.gov (United States)

    Loucif, Lotfi; Kassah-Laouar, Ahmed; Saidi, Mahdia; Messala, Amina; Chelaghma, Widad; Rolain, Jean-Marc

    2016-12-01

    Seven nonredundant ertapenem-resistant Klebsiella pneumoniae isolates were collected between May 2014 and 19 January 2015 in the nephrology and hematology units of Batna University Hospital in Algeria. All strains coproduced the bla OXA-48 , bla CTX-M-15 , bla SHV-1 , and bla TEM-1D genes. Six of these isolates belonged to the pandemic clone sequence type 101 (ST101). The bla OXA-48 gene was located on a conjugative IncL/M-type plasmid. This is the first known outbreak of OXA-48-producing K. pneumoniae isolates involving an ST101 clone in Batna University Hospital. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  10. Top 9 Ways to Reduce the Risk of Pneumonia If You or a Loved One Is Hospitalized

    Science.gov (United States)

    ... You website Home > Consumers > Monthly alerts for consumers Top 9 ways to reduce the risk of pneumonia ... is used on the patient, whether or not gloves are worn. In fact, healthcare providers should clean ...

  11. The correlation between albumin levels with 30 days mortality in community acquired pneumonia patients

    Science.gov (United States)

    Damayanti, N.; Abidin, A.; Keliat, E. N.

    2018-03-01

    The assessment of level severity ofCommunity-Acquired Pneumonia (CAP) patient at the early admission to the hospital is critical because it will determine the severity of the disease and the subsequent management of the plan. Albumin can be used as a biomarker to assess the severity of CAP. To identify the correlation between albumin level at early admission in hospital with 30-day mortality in patients with CAP. It was a cohort study. We had examined of 50 CAP subject with theCURB-65 score (Confusion, Urea, Respiratory rate, Blood pressure, Age >65years), albumin, sputum culture at the early admission at Emergency Room (ER). Then, albumin levels associated with 30-day mortality was assessed using Chi-Square test. Analysis with chi-square test found a significant correlation between albumin level with 30-day mortality (p=0.001) and Relative Risk was 2.376 (95% CI 1.515-3.723). It means that patients with CAP who has severe hypoalbuminemia have a higher risk ofdying in 30 days with 2,376 times more significant than patients with mild to moderate hypoalbuminemia. In conclusion, albumin levels at early admission in the hospital correlate with 30-day mortality in CAP patients.

  12. Community-acquired lobar pneumonia in children in the era of universal 7-valent pneumococcal vaccination: a review of clinical presentations and antimicrobial treatment from a Canadian pediatric hospital

    Directory of Open Access Journals (Sweden)

    Rowan-Legg Anne

    2012-08-01

    Full Text Available Abstract Background Community-acquired pneumonia (CAP is a common cause of pediatric admission to hospital. The objectives of this study were twofold: 1 to describe the clinical characteristics of CAP in children admitted to a tertiary care pediatric hospital in the pneumococcal vaccination era and, 2 to examine the antimicrobial selection in hospital and on discharge. Methods A retrospective review of healthy immunocompetent children admitted to a tertiary pediatric hospital from January 2007 to December 2008 with clinical features consistent with pneumonia and a radiographically-confirmed consolidation was performed. Clinical, microbiological and antimicrobial data were collected. Results One hundred and thirty-five hospitalized children with pneumonia were evaluated. Mean age at admission was 4.8 years (range 0–17 years. Two thirds of patients had been seen by a physician in the 24 hours prior to presentation; 56 (41.5% were on antimicrobials at admission. 52 (38.5% of patients developed an effusion, and 22/52 (42.3% had pleural fluid sampled. Of 117 children who had specimens (blood/pleural fluid cultured, 9 (7.7% had pathogens identified (7 Streptococcus pneumoniae, 1 Group A Streptococcus, and 1 Rhodococcus. 55% of patients received 2 or more antimicrobials in hospital. Cephalosporins were given to 130 patients (96.1% in hospital. Only 21/126 patients (16.7% were discharged on amoxicillin. The median length of stay was 3 days (IQR 2–4 for those without effusion and 9 (IQR 5–13 for those with effusion. No deaths were related to pneumonia. Conclusions This study provides comprehensive data on the clinical characteristics of hospitalized children with CAP in the pneumococcal 7-valent vaccine era. Empiric antimicrobial choice at our institution is variable, highlighting a need for heightened antimicrobial stewardship.

  13. Mycoplasma pneumoniae-Induced-Stevens Johnson Syndrome: Rare Occurrence in an Adult Patient

    Directory of Open Access Journals (Sweden)

    Samad Rasul

    2012-01-01

    Full Text Available Stevens-Johnson syndrome (SJS is an uncommon occurrence in Mycoplasma pneumoniae (M. pneumoniae infection (1–5% and has been mainly reported in children and young adults. We present a case of SJS in a 32-year-old male induced by M. pneumoniae infection. This patient presented with fever, cough, and massive occupation of mucus membranes with swelling, erythema, and necrosis accompanied by a generalized cutaneous rash. He clinically responded after treatment with antibiotics and IVIG. SJS is usually a drug-induced condition; however, M. pneumoniae is the commonest infectious cause and should be considered in the differential diagnosis.

  14. Brief hospitalizations of elderly patients

    DEFF Research Database (Denmark)

    Strømgaard, Sofie; Rasmussen, Søren Wistisen; Schmidt, Thomas Andersen

    2014-01-01

    BACKGROUND: Crowded departments are a common problem in Danish hospitals, especially in departments of internal medicine, where a large proportion of the patients are elderly. We therefore chose to investigate the number and character of hospitalizations of elderly patients with a duration of less...

  15. Patients' perceptions of interactions with hospital staff are associated with hospital readmissions: a national survey of 4535 hospitals.

    Science.gov (United States)

    Yang, Lianping; Liu, Chaojie; Huang, Cunrui; Mukamel, Dana B

    2018-01-29

    Reducing 30-day hospital readmissions has become a focus of the current national payment policies. Medicare requires that hospitals collect and report patients' experience with their care as a condition of payment. However, the extent to which patients' experience with hospital care is related to hospital readmission is unknown. We established multivariate regression models in which 30-day risk-adjusted readmission rates were the dependent variables and patients' perceptions of the responsiveness of the hospital staff and communication (as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores) were the independent variables of interest. We selected six different clinical conditions for analyses, including acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure, hip/knee surgery, pneumonia, and stroke. Data included all acute care hospitals reporting in Hospital Compare in 2014. The number of hospitals with reported readmissions ranged from 2234 hospitals for AMI to 3758 hospitals for pneumonia. The average 30-day readmission rates ranged from 5.19% for knee/hip surgery to 22.7% for COPD. Patient experience of hospital-staff responsiveness as "top-box" ranged from 64% to 67% across the six clinical conditions, communication with nurses ranged from 77% to 79% and communication with doctors ranged from 80% to 81% (higher numbers are better). Our finding suggests that hospitals with better staff responsiveness were significantly more likely to have lower 30-day readmissions for all conditions. The effect size depended on the baseline readmission rates, with the largest effect on hospitals in the upper 75th quartile. A ten-percentage-point increase in staff responsiveness led to a 0.03-0.18 percentage point decrease in readmission rates. We found that neither communication with physicians nor communication with nurses was significantly associated with hospital readmissions. Our findings

  16. Factors Associated With Pneumonia Among Overweight and Obese Under-Five Children in an Urban Hospital of a Developing Country

    Directory of Open Access Journals (Sweden)

    K. M. Shahunja MBBS

    2016-10-01

    Full Text Available To our knowledge, there are no data on the role of overweight and obesity in childhood pneumonia. We sought to determine that impact of overweight and obesity in such children. In this retrospective chart analysis, we enrolled hospitalized children aged 6 to 59 months in the Dhaka Hospital of the icddr,b, Bangladesh (International Centre for Diarrhoeal Disease Research, Bangladesh, from January 2010 to June 2014. Children with pneumonia having overweight and obesity (body mass index Z score [BMIZ] >2.00 constituted cases (n = 25, and those who had pneumonia without overweight and obesity (BMIZ −2.00 to 2.00 constituted controls (n = 75. Controls were 3-fold of the cases and were randomly selected. Demographic, clinical, and laboratory data of the cases and the controls were compared. The cases more often had diarrhea and dehydration (36% vs 12%, P = .013, hypoxemia (SpO2 < 90% in room air; 28% vs 7%, P = .009 on admission, and required to change antibiotics (32% vs 11%, P = .023 during hospitalization compared to the controls. However, in logistic regression analysis the cases were independently associated with diarrhea (P < .001 and hypoxemia (P = .024 on admission. Our data suggest that overweight and obesity in children with pneumonia is prone to be associated with hypoxemia on admission, which may guide clinicians in promptly managing pneumonia in order to evade its ramification in such children. However, future research with larger samples is imperative to consolidate or refute our observation.

  17. Hospitalization costs of severe bacterial pneumonia in children: comparative analysis considering different costing methods.

    Science.gov (United States)

    Nunes, Sheila Elke Araujo; Minamisava, Ruth; Vieira, Maria Aparecida da Silva; Itria, Alexander; Pessoa, Vicente Porfirio; Andrade, Ana Lúcia Sampaio Sgambatti de; Toscano, Cristiana Maria

    2017-01-01

    To determine and compare hospitalization costs of bacterial community-acquired pneumonia cases via different costing methods under the Brazilian Public Unified Health System perspective. Cost-of-illness study based on primary data collected from a sample of 59 children aged between 28 days and 35 months and hospitalized due to bacterial pneumonia. Direct medical and non-medical costs were considered and three costing methods employed: micro-costing based on medical record review, micro-costing based on therapeutic guidelines and gross-costing based on the Brazilian Public Unified Health System reimbursement rates. Costs estimates obtained via different methods were compared using the Friedman test. Cost estimates of inpatient cases of severe pneumonia amounted to R$ 780,70/$Int. 858.7 (medical record review), R$ 641,90/$Int. 706.90 (therapeutic guidelines) and R$ 594,80/$Int. 654.28 (Brazilian Public Unified Health System reimbursement rates). Costs estimated via micro-costing (medical record review or therapeutic guidelines) did not differ significantly (p=0.405), while estimates based on reimbursement rates were significantly lower compared to estimates based on therapeutic guidelines (pmetodologias de custeio, na perspectiva do Sistema Único de Saúde. Estudo de custo, com coleta de dados primários de uma amostra de 59 crianças com 28 dias a 35 meses de idade hospitalizadas por pneumonia bacteriana. Foram considerados custos diretos médicos e não médicos. Três metodologias de custeio foram utilizadas: microcusteio por revisão de prontuários, microcusteio considerando diretriz terapêutica e macrocusteio por ressarcimento do Sistema Único de Saúde. Os custos estimados pelas diferentes metodologias foram comparados utilizando o teste de Friedman. Os custos hospitalares de crianças com pneumonia grave foram R$ 780,70 ($Int. 858.7) por revisão de prontuários, R$ 641,90 ($Int. 706.90) por diretriz terapêutica e R$ 594,80 ($Int. 654.28) por

  18. T cell responses in senior patients with community-acquired pneumonia related to disease severity.

    Science.gov (United States)

    Bian, Lu-Qin; Bi, Ying; Zhou, Shao-Wei; Chen, Zi-Dan; Wen, Jun; Shi, Jin; Mao, Ling; Wang, Ling

    2017-12-01

    Senior individuals older than 65 years of age are at a disproportionally higher risk of developing pneumonia. Impaired capacity to defend against airway infections may be one of the reasons. It is generally believed that weaker regulatory T cell responses may be beneficial to host defense against pathogens. In senior patients with community-acquired bacterial pneumonia, we investigated the frequencies and functions of regulatory T cells. Interestingly, we found that compared to age- and sex-matched healthy controls, senior pneumonia patients presented lower frequencies of Foxp3-expressing and Helios-expressing CD4 + T cells. The quantity of Foxp3 and Helios being expressed, measured by their mRNA transcription levels, was also lower in CD4 + T cells from pneumonia patients. Furthermore, following TCR and TGF-β stimulation, pneumonia patients presented impaired capacity to upregulate Foxp3 and Helios. Functional analyses revealed that CD4 + T cells from pneumonia patients secreted lower amounts of IL-10 and TGF-β, two cytokines critical to regulatory T cell-mediated suppression. Also, the expression of granzyme B and perforin, which were cytolytic molecules potentially utilized by regulatory T cells to mediate the elimination of antigen-presenting cells and effector T cells, were reduced in CD4 + CD25 + T cells from senior pneumonia patients. In addition, the CD4 + CD25 + T cells from senior pneumonia patients presented reduced capacity to suppress effector CD4 + and CD8 + T cell proliferation. Moreover, the value of pneumonia severity index was inversely correlated with several parameters of regulatory T cell function. Together, our results demonstrated that senior pneumonia patients presented a counterintuitive impairment in regulatory T cell responses that was associated with worse prognosis. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Community-Acquired Pneumonia Hospitalization among Children with Neurologic Disorders.

    Science.gov (United States)

    Millman, Alexander J; Finelli, Lyn; Bramley, Anna M; Peacock, Georgina; Williams, Derek J; Arnold, Sandra R; Grijalva, Carlos G; Anderson, Evan J; McCullers, Jonathan A; Ampofo, Krow; Pavia, Andrew T; Edwards, Kathryn M; Jain, Seema

    2016-06-01

    To describe and compare the clinical characteristics, outcomes, and etiology of pneumonia among children hospitalized with community-acquired pneumonia (CAP) with neurologic disorders, non-neurologic underlying conditions, and no underlying conditions. Children children's hospitals. Neurologic disorders included cerebral palsy, developmental delay, Down syndrome, epilepsy, non-Down syndrome chromosomal abnormalities, and spinal cord abnormalities. We compared the epidemiology, etiology, and clinical outcomes of CAP in children with neurologic disorders with those with non-neurologic underlying conditions, and those with no underlying conditions using bivariate, age-stratified, and multivariate logistic regression analyses. From January 2010-June 2012, 2358 children with radiographically confirmed CAP were enrolled; 280 (11.9%) had a neurologic disorder (52.1% of these individuals also had non-neurologic underlying conditions), 934 (39.6%) had non-neurologic underlying conditions only, and 1144 (48.5%) had no underlying conditions. Children with neurologic disorders were older and more likely to require intensive care unit (ICU) admission than children with non-neurologic underlying conditions and children with no underlying conditions; similar proportions were mechanically ventilated. In age-stratified analysis, children with neurologic disorders were less likely to have a pathogen detected than children with non-neurologic underlying conditions. In multivariate analysis, having a neurologic disorder was associated with ICU admission for children ≥2 years of age. Children with neurologic disorders hospitalized with CAP were less likely to have a pathogen detected and more likely to be admitted to the ICU than children without neurologic disorders. Published by Elsevier Inc.

  20. RAPID DETECTION OF PNEUMOCOCCAL ANTIGEN IN PLEURAL FLUID OF PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA

    NARCIS (Netherlands)

    BOERSMA, WG; LOWENBERG, A; HOLLOWAY, Y; KUTTSCHRUTTER, H; SNIJDER, JAM; KOETER, GH

    Background Detection of pneumococcal antigen may help to increase the rate of diagnosis of pneumococcal pneumonia. This study was designed to determine the value of rapid detection of pneumococcal antigen in pleural fluid from patients with community acquired pneumonia. Methods Thoracentesis was

  1. Impact of Pneumococcal Conjugate Vaccines on Pneumonia Hospitalizations in High- and Low-Income Subpopulations in Brazil

    DEFF Research Database (Denmark)

    Warren, Joshua L.; Shioda, Kayoko; Kürüm, Esra

    2017-01-01

    Background Pneumococcal conjugate vaccines (PCVs) are being used worldwide. A key question is whether the impact of PCVs on pneumonia is similar in low- and high-income populations. However, most low-income countries, where the burden of disease is greatest, lack reliable data that can be used...... to evaluate the impact. Data from middle-income countries that have both low- and high-income subpopulations can provide a proxy measure for the impact of the vaccine in low-income countries. Methods We evaluated the impact of PCV10 on hospitalizations for all-cause pneumonia in Brazil, a middle......-income country with localities that span a broad range of human development index (HDI) levels. We used complementary time series and spatiotemporal methods (synthetic controls and hierarchical Bayesian spatial regression) to test whether the decline in pneumonia hospitalizations associated with vaccine...

  2. [Aspects of the antimicrobial resistence profile in infections with Escherichia coli and Klebsiella pneumoniae in diabetic patients].

    Science.gov (United States)

    Petrovici, Cristina G; Dorobăţ, Carmen; Matei, Mioara; Teodor, Andra; Luca, V; Miftode, Egidia

    2011-01-01

    Infections in diabetic patient remains an important cause of morbidity and mortality, triggering and maintaining a prolonged metabolic imbalance. Emergence of extented spectrum beta-lactmase (ESBL) in Escherichia coli and Klebsiella pneumoniae is a major concern, because of the atypical manner infection acts in this group of imunodepressed patients and also for the limited therapeutic solutions. For this reason we have evaluated the profile of antimicrobial resistance of these pathogens in both diabetic and non diabetic patients. The aim of this study was to evaluate, in a retrospective case control study, the antibiotic susceptibility pattern in isolates of E. coli and Klebsiella spp. from different biological products in 49 diabetics and 150 non-diabetics admitted in The Clinical Hospital of Infectious Diseases Iaşi over a period of two years. Most of strains of E. coli and Klebsiella spp. ESBL positive were found in uroculture. Significant differences in E. coli resistance rate between diabetics and nondiabetics were noted for amoxicillin-clavulanic acid and ciprofloxacin (31,4% vs.13,98%, p=0,04, respectively 52,9% vs. 24,46%, p=0,004). More isolates of ESBL positive K. pneumoniae were found in diabetic patients (50% vs. 24%). Ciprofloxacin resistance of K. pneumoniae was significantly higher in diabetics (75% vs 39%; p=0,05). There was no resistance in E. coli and K. pneumoniae isolates to imipenem in the diabetic group. The high resistance rate to quinolones and 3rd generation cefalosporins limits their use for the treatment of Escherichia coli and K. pneumoniae infections. Other alternatives for empiric therapy in community and nosocomial-acquired infections in diabetic patient remains carbapenems, aminoglycosides and colimycin.

  3. Empiric antibiotics pending bronchoalveolar lavage data in patients without pneumonia significantly alters the flora, but not the resistance profile, if a subsequent pneumonia develops.

    Science.gov (United States)

    Thakkar, Rajan K; Monaghan, Sean F; Adams, Charles A; Stephen, Andrew; Connolly, Michael D; Gregg, Shea; Cioffi, William G; Heffernan, Daithi S

    2013-05-01

    Ventilator-associated pneumonia (VAP) occurs in up to 25% of mechanically ventilated patients, with an associated mortality up to 50%. Early diagnosis and appropriate empiric antibiotic coverage of VAP are crucial. Given the multitude of noninfectious clinical and radiographic anomalies within trauma patients, microbiology from bronchioalveolar lavage (BAL) is often needed. Empiric antibiotics are administered while awaiting BAL culture data. Little is known about the effects of these empiric antibiotics on patients with negative BAL microbiology if a subsequent VAP occurs during the same hospital course. This is a retrospective chart review of intubated trauma patients undergoing BAL for suspected pneumonia over a 3-y period at a Level 1 trauma center. All patients with suspected VAP undergoing a BAL receive empiric antibiotics. If microbiology data are negative at 72 h, all antibiotics are stopped; however, if the BAL returns with ≥10(5) colony-forming units per milliliter, the diagnosis of VAP is confirmed. We divided patients into three groups. Group 1 consisted of patients in whom the initial BAL was positive for VAP. Group 2 consisted of patients with an initial negative BAL, who subsequently developed VAP at a later point in the hospital course. Group 3 consisted of patients with negative BAL who did not develop a subsequent VAP. We obtained 499 BAL specimens in 185 patients over the 3-y period. A total of 14 patients with 23 BAL specimens initially negative for VAP subsequently developed VAP later during the same hospital stay. These patients did not have an increase in the hospital length of stay, intensive care unit days, ventilator days, or mortality compared with those who had a positive culture on the first suspicion of VAP. There was a significant increase in the percentage of Enterobacter (21% versus 8%) and Morganella (8% versus 0%) as the causative organism in these 14 patients when the VAP occurred. Furthermore, the profile of the top two

  4. The Seropositivity Rate of Atypical Agents in Patients with Community-Acquired Pneumonia

    Directory of Open Access Journals (Sweden)

    Ruhan Karakoc Gunes

    2007-08-01

    Full Text Available The aim of this study was to investigate the IgM antibody positivities of atypical pneumonia agents in patients with community-acquired pneumonia (CAP, and to compare the results with controls. The serum samples which were collected from 87 adult patients and 21 healthy controls have been investigated by a commercial ELISA (Pneumobact ELISA IgM, Vircell, Spain in which four different atypical pneumonia agents were fixed onto a slide. In the patients group, IgM positivity rates for the agents were as follows, respectively; 2.3% for Legionella pneumophila, 56.3% Chlamydia pneumoniae, 33.3% for Mycoplasma pneumoniae, 9.2% for Coxiella burnetii. The rates of IgM positivities in the control group varied 7% for all of the agents except M. Pneumoniae and C. Pneumoniae and 2 of these controls were positive for L. Pneumophila IgM, one was positive for C. Burnetii IgM. According to the statistical evaluation, there were significant differences for IgM seropositivities to Mycoplasma pneumoniae and Chlamydia Pneumoniae,between the patient and the control groups (p0.05. We showed that the seropositivity rate of atypical agents in patients with CAP was significantly higher when compared to healthy control group. This result suggests us, atypical agents might be responsible in CAP patients in a great amount. Furthermore, our study also suggests that clinical and radiological findings are not useful for discriminating atypical from typical pneumonia. [TAF Prev Med Bull 2007; 6(4.000: 279-284

  5. Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

    Directory of Open Access Journals (Sweden)

    Shafazand Masoud

    2012-03-01

    Full Text Available Abstract Background Chronic heart failure (CHF is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method Patients (n = 2,648 seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.

  6. Salmonella Typhimurium pneumonia in a patient with multiple myeloma.

    Science.gov (United States)

    Khan, Sadia; Kumar, V Anil; Sidharthan, Neeraj; Mehta, Asmita; Backer, Binita; Dinesh, Kavitha R

    2015-04-01

    Pneumonia due to non-typhoidal Salmonella is a rarely reported entity. A fatal case of Salmonella pneumonia is reported here where Salmonella Typhimurium was isolated from the endotracheal aspirate and blood culture. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  7. Prevention of colonization and infection by Klebsiella pneumoniae carbapenemase-producing enterobacteriaceae in long-term acute-care hospitals.

    Science.gov (United States)

    Hayden, Mary K; Lin, Michael Y; Lolans, Karen; Weiner, Shayna; Blom, Donald; Moore, Nicholas M; Fogg, Louis; Henry, David; Lyles, Rosie; Thurlow, Caroline; Sikka, Monica; Hines, David; Weinstein, Robert A

    2015-04-15

    Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (hereafter "KPC") are an increasing threat to healthcare institutions. Long-term acute-care hospitals (LTACHs) have especially high prevalence of KPC. Using a stepped-wedge design, we tested whether a bundled intervention (screening patients for KPC rectal colonization upon admission and every other week; contact isolation and geographic separation of KPC-positive patients in ward cohorts or single rooms; bathing all patients daily with chlorhexidine gluconate; and healthcare-worker education and adherence monitoring) would reduce colonization and infection due to KPC in 4 LTACHs with high endemic KPC prevalence. The study was conducted between 1 February 2010 and 30 June 2013; 3894 patients were enrolled during the preintervention period (lasting from 16 to 29 months), and 2951 patients were enrolled during the intervention period (lasting from 12 to 19 months). KPC colonization prevalence was stable during preintervention (average, 45.8%; 95% confidence interval [CI], 42.1%-49.5%), declined early during intervention, then reached a plateau (34.3%; 95% CI, 32.4%-36.2%; Pinfection, all-cause bacteremia, and blood culture contamination in a high-risk LTACH population. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  8. Transmission of Pneumocystis carinii from patients to hospital staff

    DEFF Research Database (Denmark)

    Lundgren, Bettina; Elvin, K; Rothman, L P

    1997-01-01

    rooms in departments of infectious diseases managing patients with P carinii pneumonia (PCP), suggesting the airborne route of transmission. Exposure of staff to P carinii may occur in hospital departments treating patients with PCP. METHODS: Exposure to P carinii was detected by serological responses...... to human P carinii by ELISA, Western blotting, and indirect immunofluorescence in 64 hospital staff with and 79 staff without exposure to patients with PCP from Denmark and Sweden. DNA amplification of oropharyngeal washings was performed on 20 Danish staff with and 20 staff without exposure to patients...... with PCP. RESULTS: There was no significant difference in the frequency or level of antibodies to P carinii between staff exposed and those unexposed to patients with PCP. None of the hospital staff had detectable P carinii DNA in oropharyngeal washings. CONCLUSIONS: There is no difference in antibodies...

  9. Impact of infant pneumococcal conjugate vaccination on community acquired pneumonia hospitalization in all ages in the Netherlands

    NARCIS (Netherlands)

    van Deursen, A. M.M.; Schurink-van't Klooster, Tessa M; Man, W. H.; van de Kassteele, J.; van Gageldonk-Lafeber, Arianne B; Bruijning-Verhagen, P. C.J.L.; de Melker, Hester E.; Sanders, E. A.M.; Knol, Mirjam J.

    2017-01-01

    Background The long-term impact of pneumococcal conjugate vaccines on pneumonia hospitalizations in all age-groups varies between countries. In the Netherlands, the 7-valent pneumococcal conjugate vaccine (PCV7) was implemented for newborns in 2006 and replaced by PCV10 in 2011. We assessed the

  10. Influence of HIV infection on the clinical presentation and outcome of adults with acute community-acquired pneumonia in Yaounde, Cameroon: a retrospective hospital-based study

    Directory of Open Access Journals (Sweden)

    Yone Eric Walter

    2012-08-01

    Full Text Available Abstract Background The impact of HIV infection on the evolution of acute community-acquired pneumonia (CAP is still controversial. The aim of this study was to investigate possible differences in the clinical presentation and in-hospital outcomes of patients with CAP with and without HIV infection in a specialised service in Yaounde. Methods Medical files of 106 patients (51 men aged 15 years and above, admitted to the Pneumology service of the Yaounde Jamot Hospital between January 2008 and May 2012, were retrospectively studied. Results Sixty-two (58.5% patients were HIV infected. The median age of all patients was 40 years (interquartile range: 31.75-53 and there was no difference in the clinical and radiological profile of patients with and without HIV infection. The median leukocyte count (interquartile range was 14,600/mm3 (10,900-20,600 and 10,450/mm3 (6,400-16,850 respectively in HIV negative and HIV positive patients (p = 0.002. Median haemoglobin level (interquartile range was 10.8 g/dl (8.9-12 in HIV negative and 9.7 g/dl (8–11.6 in HIV positive patients (p = 0.025. In-hospital treatment failure on third day (39.5% vs. 25.5.1%, p = 0.137 and mortality rates (9% vs. 14.5%, p = 0.401 were similar between HIV negative and HIV positive patients. Conclusion Clinical and radiological features as well as response to treatment and in hospital fatal outcomes are similar in adult patients hospitalised with acute community-acquired pneumonia in Yaounde. In contrast, HIV infected patients tend to be more anaemic and have lower white cell counts than HIV negative patients. Larger prospective studies are needed to consolidate these findings.

  11. Relapsing bronchiolitis obliterans organising pneumonia and chronic sarcoidosis in an atopic asthmatic patient.

    Science.gov (United States)

    Carbonelli, C; Roggeri, A; Cavazza, A; Zompatori, M; Zucchi, L

    2008-03-01

    Asthma is thought to be a Th2 disease while sarcoidosis is considered a Th1 granulomatous disorder. Organising pneumonia is a histologic pattern of lung injury. When it has no recognisable cause it is defined as cryptogenic organising pneumonia. We herein report the case of a patient with recurrent and steroid sensitive organising pneumonia associated with chronic sarcoidosis in an atopic, moderate persistent asthmatic patient. Each disease has been documented with transbronchial biopsies and recurrence of organising pneumonia was suggested by clinical features and by follow up HRCT which shows distinctive signs even in associated disease. Steroids are the mainstay of therapy for these disorders and especially for the consolidated processes typical of organising pneumonia but prognostic indices for relapse and progression are lacking.

  12. Antibiotic prescribing on admission to patients with pneumonia and prior outpatient antibiotic treatment: a cohort study on clinical outcome

    NARCIS (Netherlands)

    van de Garde, Ewoudt M. W.; Natsch, Stephanie; Prins, Jan M.; van der Linden, Paul D.

    2015-01-01

    Objective: Most pneumonia treatment guidelines recommend that prior outpatient antibiotic treatment should be considered when planning inpatient antibiotic regimen. Our purpose was to study in patients admitted for community-acquired pneumonia the mode of continuing antibiotic treatment at the

  13. Antibiotic prescribing on admission to patients with pneumonia and prior outpatient antibiotic treatment : A cohort study on clinical outcome

    NARCIS (Netherlands)

    Van De Garde, Ewoudt M W; Natsch, Stephanie; Prins, Jan M.; Van Der Linden, Paul D.

    2015-01-01

    Objective: Most pneumonia treatment guidelines recommend that prior outpatient antibiotic treatment should be considered when planning inpatient antibiotic regimen. Our purpose was to study in patients admitted for community-acquired pneumonia the mode of continuing antibiotic treatment at the

  14. Age specific fast breathing in under-five diarrheal children in an urban hospital: Acidosis or pneumonia?

    Science.gov (United States)

    Nuzhat, Sharika; Ahmed, Tahmeed; Kawser, Chowdhury Ali; Khan, Azharul Islam; Islam, S M Rafiqul; Shahrin, Lubaba; Shahunja, K M; Shahid, Abu S M S B; Al Imran, Abdullah; Chisti, Mohammod Jobayer

    2017-01-01

    Children with diarrhea often present with fast breathing due to metabolic acidosis from dehydration. On the other hand, age specific fast breathing is the cornerstone for the diagnosis of pneumonia following classification of pneumonia recommended by the World Health Organization (WHO). Correction of metabolic acidosis by rehydrating the diarrheal children requires time, which delays early initiation of appropriate antimicrobials for pneumonia and thereby increases the risk of deaths. We need to further investigate the simple clinical features other than fast breathing which might help us in earliest diagnosis of pneumonia in children with diarrhea Thus, the objective of our study was to identify other contributing clinical features that may independently help for early diagnosis of pneumonia in diarrheal children who present with age specific fast breathing. This was an unmatched case-control study. Diarrheal children aged 0-59 months, admitted to Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) during January 2014 to December 2014 having age specific fast breathing (11-59 months ≥40 breaths/min) were studied. The study children with clinical and radiological pneumonia constituted the cases (n = 276) and those without pneumonia constituted the controls (n = 446). Comparison of clinical features and outcomes between the cases and the controls was made. The distribution of acidosis among the cases and the controls was comparable (35% vs. 41%, p = 0.12). The cases had proportionately higher deaths compared to the controls, however, the difference was not statistically significant (3% vs. 1%; p = 0.23). In logistic regression analysis after adjusting for potential confounders, the cases were independently associated with cough (OR = 62.19, 95% CI = 27.79-139.19; ppneumonia. The results underscore the importance of early identification of these simple clinical features that may help to minimize potential delay due to

  15. Clinical predictors and outcome of metabolic acidosis in under-five children admitted to an urban hospital in Bangladesh with diarrhea and pneumonia.

    Science.gov (United States)

    Chisti, Mohammod J; Ahmed, Tahmeed; Ashraf, Hasan; Faruque, A S G; Bardhan, Pradip K; Dey, Sanjoy Kumer; Huq, Sayeeda; Das, Sumon Kumar; Salam, Mohammed A

    2012-01-01

    Clinical features of metabolic acidosis and pneumonia frequently overlap in young diarrheal children, resulting in differentiation from each other very difficult. However, there is no published data on the predictors of metabolic acidosis in diarrheal children also having pneumonia. Our objective was to evaluate clinical predictors of metabolic acidosis in under-five diarrheal children with radiological pneumonia, and their outcome. We prospectively enrolled all under-five children (n = 164) admitted to the Special Care Ward (SCW) of the Dhaka Hospital of icddr, b between September and December 2007 with diarrhea and radiological pneumonia who also had their total serum carbon-dioxide estimated. We compared the clinical features and outcome of children with radiological pneumonia and diarrhea with (n = 98) and without metabolic acidosis (n = 66). Children with metabolic acidosis more often had higher case-fatality (16% vs. 5%, p = 0.039) compared to those without metabolic acidosis on admission. In logistic regression analysis, after adjusting for potential confounders such as age of the patient, fever on admission, and severe wasting, the independent predictors of metabolic acidosis in under-five diarrheal children having pneumonia were clinical dehydration (OR 3.57, 95% CI 1.62-7.89, p = 0.002), and low systolic blood pressure even after full rehydration (OR 1.02, 95% CI 1.01-1.04, p = 0.005). Proportions of children with cough, respiratory rate/minute, lower chest wall indrawing, nasal flaring, head nodding, grunting respiration, and cyanosis were comparable (p>0.05) among the groups. Under-five diarrheal children with radiological pneumonia having metabolic acidosis had frequent fatal outcome than those without acidosis. Clinical dehydration and persistent systolic hypotension even after adequate rehydration were independent clinical predictors of metabolic acidosis among the children. However, metabolic acidosis in young diarrheal children had no impact on the

  16. Clinical predictors and outcome of metabolic acidosis in under-five children admitted to an urban hospital in Bangladesh with diarrhea and pneumonia.

    Directory of Open Access Journals (Sweden)

    Mohammod J Chisti

    Full Text Available BACKGROUND: Clinical features of metabolic acidosis and pneumonia frequently overlap in young diarrheal children, resulting in differentiation from each other very difficult. However, there is no published data on the predictors of metabolic acidosis in diarrheal children also having pneumonia. Our objective was to evaluate clinical predictors of metabolic acidosis in under-five diarrheal children with radiological pneumonia, and their outcome. METHODS: We prospectively enrolled all under-five children (n = 164 admitted to the Special Care Ward (SCW of the Dhaka Hospital of icddr, b between September and December 2007 with diarrhea and radiological pneumonia who also had their total serum carbon-dioxide estimated. We compared the clinical features and outcome of children with radiological pneumonia and diarrhea with (n = 98 and without metabolic acidosis (n = 66. RESULTS: Children with metabolic acidosis more often had higher case-fatality (16% vs. 5%, p = 0.039 compared to those without metabolic acidosis on admission. In logistic regression analysis, after adjusting for potential confounders such as age of the patient, fever on admission, and severe wasting, the independent predictors of metabolic acidosis in under-five diarrheal children having pneumonia were clinical dehydration (OR 3.57, 95% CI 1.62-7.89, p = 0.002, and low systolic blood pressure even after full rehydration (OR 1.02, 95% CI 1.01-1.04, p = 0.005. Proportions of children with cough, respiratory rate/minute, lower chest wall indrawing, nasal flaring, head nodding, grunting respiration, and cyanosis were comparable (p>0.05 among the groups. CONCLUSION AND SIGNIFICANCE: Under-five diarrheal children with radiological pneumonia having metabolic acidosis had frequent fatal outcome than those without acidosis. Clinical dehydration and persistent systolic hypotension even after adequate rehydration were independent clinical predictors of metabolic acidosis among the children

  17. Evaluation of an algorithm for switching from IV to PO therapy in clinical practice in patients with community-acquired pneumonia

    NARCIS (Netherlands)

    van der Eerden, Menno M.; de Graaff, Casper S.; Vlaspolder, Fer; Bronsveld, Willem; Jansen, Henk M.; Boersma, Wim G.

    2004-01-01

    Background: in patients with community-acquired pneumonia (CAP), switching from IV to PO antibiotics offers advantages over IV therapy alone, including improved cost-effectiveness through reductions in the length of hospital stay and treatment costs. Objective: The aim of this study was to determine

  18. Pneumococcal pneumonia: clinical features, diagnosis and management in HIV-infected and HIV noninfected patients.

    Science.gov (United States)

    Madeddu, Giordano; Fois, Alessandro Giuseppe; Pirina, Pietro; Mura, Maria Stella

    2009-05-01

    In this review, we focus on the clinical features, diagnosis and management of pneumococcal pneumonia in HIV-infected and noninfected patients, with particular attention to the most recent advances in this area. Classical clinical features are found in young adults, whereas atypical forms occur in immunocompromised patients including HIV-infected individuals. Bacteremic pneumococcal pneumonia is more frequently observed in HIV-infected and also in low-risk patients, according to the Pneumonia Severity Index (PSI). Pneumococcal pneumonia diagnostic process includes physical examination, radiologic findings and microbiologic diagnosis. However, etiologic diagnosis using traditional culture methods is difficult to obtain. In this setting, urinary antigen test, which recognizes Streptococcus pneumoniae cell wall C-polysaccharide, increases the probability of etiologic diagnosis. A correct management approach is crucial in reducing pneumococcal pneumonia mortality. The use of the PSI helps clinicians in deciding between inpatient and outpatient management in immunocompetent individuals, according to Infectious Diseases Society of America (IDSA)-American Thoracic Society (ATS) guidelines. Recent findings support PSI utility also in HIV-infected patients. Recently, efficacy of pneumococcal vaccine in reducing pneumococcal disease incidence has been evidenced in both HIV-infected and noninfected individuals. Rapid diagnosis and correct management together with implementation of preventive measures are crucial in order to reduce pneumococcal pneumonia related incidence and mortality in HIV-infected and noninfected patients.

  19. Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease.

    Science.gov (United States)

    Molinos, L; Clemente, M G; Miranda, B; Alvarez, C; del Busto, B; Cocina, B R; Alvarez, F; Gorostidi, J; Orejas, C

    2009-06-01

    The purpose of this study was to analyse the possible differences, especially those regarding mortality, between patients hospitalized for community-acquired pneumonia (CAP) with and without chronic obstructive pulmonary disease (COPD), and the risk factors related to mortality in the COPD group. 710 patients with CAP were included in a prospective multicenter observational study. 244 of the patients had COPD confirmed by spirometry. COPD was associated with mortality in patients with CAP (OR=2.62 CI: 1.08-6.39). Patients with COPD and CAP had a significantly higher 30-day mortality rate as compared to patients without COPD. Multivariate analysis showed that PaO(2) or =45 mmHg (OR=4.6; CI: 2.3-15.1); respiratory rate > or =30/min (OR=12.25; CI: 3.45-35.57), pleural effusion (OR=8.6; 95% CI: 2.01-24.7), septic shock (OR=12.6; 95% CI: 3.4-45.66) and renal failure (OR=13.4; 95% CI: 3.2-37.8) were significantly related to mortality. Purulent sputum and fever were considered as protective factors. COPD was an independent risk factor for mortality in patients with CAP. Hypoxemia and hypercapnia are associated with mortality in patients with CAP with and without COPD. Chronic obstructive pulmonary disease and PaCO(2) value could be useful prognostic factors and should be incorporated in risk stratification in patients with CAP.

  20. Study of prone positioning to reduce ventilator-associated pneumonia in hypoxaemic patients.

    Science.gov (United States)

    Mounier, R; Adrie, C; Français, A; Garrouste-Orgeas, M; Cheval, C; Allaouchiche, B; Jamali, S; Dinh-Xuan, A T; Goldgran-Toledano, D; Cohen, Y; Azoulay, E; Timsit, J-F; Ricard, J-D

    2010-04-01

    The aim of the present study was to examine whether prone positioning (PP) affects ventilator associated-pneumonia (VAP) and mortality in patients with acute lung injury/adult respiratory distress syndrome. 2,409 prospectively included patients were admitted over 9 yrs (2000-2008) to 12 French intensive care units (ICUs) (OUTCOMEREA). The patients required invasive mechanical ventilation (MV) and had arterial oxygen tension/inspiratory oxygen fraction ratios patients on the PP propensity score (+/-10%), MV duration longer than that in PP patients before the first turn prone, and centre. VAP incidence was similar in the PP and control groups (24 versus 13 episodes.1,000 patient-days MV(-1) respectively, p = 0.14). After adjustment, PP did not decrease VAP occurrence (HR 1.64 (95% CI 0.70-3.84); p = 0.25) but significantly delayed hospital mortality (HR 0.56 (95% CI 0.39-0.79); p = 0.001), without decreasing 28-day mortality (37% in both groups). Post hoc analyses indicated that PP did not protect against VAP but, when used for >1 day, might decrease mortality and benefit the sickest patients (Simplified Acute Physiology Score >50). In ICU patients with hypoxaemic acute respiratory failure, PP had no effect on the risk of VAP. PP delayed mortality without decreasing 28-day mortality. PP >1 day might decrease mortality, particularly in the sickest patients.

  1. Internal and External Validation of a multivariable Model to Define Hospital-Acquired Pneumonia After Esophagectomy

    NARCIS (Netherlands)

    Weijs, Teus J; Seesing, Maarten F J; van Rossum, Peter S N; Koëter, Marijn; van der Sluis, Pieter C; Luyer, Misha D P; Ruurda, Jelle P; Nieuwenhuijzen, Grard A P; van Hillegersberg, Richard

    BACKGROUND: Pneumonia is an important complication following esophagectomy; however, a wide range of pneumonia incidence is reported. The lack of one generally accepted definition prevents valid inter-study comparisons. We aimed to simplify and validate an existing scoring model to define pneumonia

  2. An empirical assessment of boarding and quality of care: delays in care among chest pain, pneumonia, and cellulitis patients.

    Science.gov (United States)

    Liu, Shan W; Chang, Yuchiao; Weissman, Joel S; Griffey, Richard T; Thomas, James; Nergui, Suvd; Hamedani, Azita G; Camargo, Carlos A; Singer, Sara

    2011-12-01

    As hospital crowding has increased, more patients have ended up boarding in the emergency department (ED) awaiting their inpatient beds. To the best of our knowledge, no study has compared the quality of care of boarded and nonboarded patients. This study sought to examine whether being a boarded patient and boarding longer were associated with more delays, medication errors, and adverse events among ED patients admitted with chest pain, pneumonia, or cellulitis. This study was a retrospective cohort design in which data collection was accomplished via medical record review from two urban teaching hospitals. Patients admitted with chest pain, pneumonia, or cellulitis between August 2004 and January 2005 were eligible for inclusion. Our outcomes measures were: 1) delays in administration of home medications, cardiac enzyme tests, partial thromboplastin time (PTT), and antibiotics; 2) medication errors; and 3) adverse events or near misses. Primary independent variables were boarded status, boarding time, and boarded time interval. Multiple logistic regression models controlling for patient, ED, and hospital characteristics were used. A total of 1,431 patient charts were included: 811 with chest pain, 387 with pneumonia, and 233 with cellulitis. Boarding time was associated with an increased odds of home medication delays (adjusted odds ratio [AOR] = 1.07, 95% confidence interval [CI] = 1.05 to 1.10), as were boarded time intervals of 12, 18, and 24 hours. Boarding time also was associated with lower odds of having a late cardiac enzyme test (AOR = 0.93, 95% CI = 0.88 to 0.97). Boarding was associated with home medication delays, but fewer cardiac enzyme test delays. Boarding was not associated with delayed PTT checks, antibiotic administration, medication errors, or adverse events/near misses. These findings likely reflect the inherent resources of the ED and the inpatient units. © 2011 by the Society for Academic Emergency Medicine.

  3. Haemophilus influenzae pneumonia in human immunodeficiency virus-infected patients. The Grupo Andaluz para el Estudio de las Enfermedades Infecciosas.

    Science.gov (United States)

    Cordero, E; Pachón, J; Rivero, A; Girón, J A; Gómez-Mateos, J; Merino, M D; Torres-Tortosa, M; González-Serrano, M; Aliaga, L; Collado, A; Hernández-Quero, J; Barrera, A; Nuño, E

    2000-03-01

    Although Haemophilus influenzae is a common etiologic agent of pneumonia in patients infected with human immunodeficiency virus (HIV), the characteristics of this pneumonia have not been adequately assessed. We have prospectively studied features of H. influenzae pneumonia in 26 consecutive HIV-infected inpatients. Most of these patients were severely immunosuppressed; 73.1% had a CD4+ cell count caused by H. influenzae affects mainly patients with advanced HIV disease, and since its clinical and radiological features may be diverse, this etiology should be considered when pneumonia occurs in patients with advanced HIV infection. The mortality rate associated with H. influenzae pneumonia is not higher than that occurring in the general population.

  4. What factors on admission influence ICU mortality in adult patients admitted to the intensive care unit with severe pneumonia?

    International Nuclear Information System (INIS)

    Mansoor, F.; Akhtar, A.; Qadeer, A.; Ali, Z.; Kaleem, B.; Sikandar, I.

    2016-01-01

    Objective: To identity the risk factors on intensive care unit (ICU) admission that are linked with ICU mortality in patients with severe pneumonia. Study Design: A retrospective observational study. Place and Duration of Study: Patients admitted to the medical ICU in Shifa International Hospital, Islamabad, between October 2013 and March 2014. Material and Methods: Adult patients admitted to the ICU with the suspected diagnosis of severe pneumonia were studied. In addition to the co-morbidities, presence or absence of septic shock and acute kidney injury, PaO/sub 2//FiO/sub 2/ ratio and type of mechanical ventilation were recorded on ICU admission. This data was initially recorded on paper forms and latter entered in the SPSS. Bivariate analysis was performed to study the relationship between these risk factors and their effect on the ICU mortality. Results: We evaluated a total number of 82 patients with severe pneumonia. ICU mortality was 14.8 percent (12 patients). Statistical analysis showed that patients with severe acute respiratory distress syndrome (ARDS), septic shock, history of chronic liver disease and human immunodeficiency virus (HIV) neutropenic sepsis and those who received invasive mechanical ventilation were at higher risk of mortality. We did not find any direct correlation between age, presence of acute kidney injury, history of diabetes mellitus and risk of death in the ICU. Conclusion: In adult patients, septic shock, severe ARDS, history of chronic liver disease, neutropenic sepsis and presence of HIV, and invasive mechanical ventilation are associated with a higher risk of ICU mortality in patients admitted with severe pneumonia. (author)

  5. Latex allergies - for hospital patients

    Science.gov (United States)

    ... ency/patientinstructions/000499.htm Latex allergies - for hospital patients To use the sharing features on this page, ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  6. First Identification of a Patient Colonized With Klebsiella pneumoniae Carrying blaNDM-1 in Taiwan

    Directory of Open Access Journals (Sweden)

    Hua-Shin Wu

    2010-11-01

    Full Text Available New Delhi metallo-β-lactamase 1 (NDM-1 is a novel type of metallo-β-lactamase (MBL. Enterobacteriaceae carrying this NDM-1 encoding gene, blaNDM-1, have been identified worldwide. Bacteria carrying blaNDM-1 are not only resistant to carbapenem, but also highly resistant to many classes of antibiotics, which indicate the importance of prompt identification of these bacteria and implementation of strict infection control measures to prevent their transmission. Here, we report the first identification and management of a patient colonized with Klebsiella pneumoniae carrying blaNDM-1 in Taiwan, who returned from New Delhi where he had been hospitalized for a gun-shot injury.

  7. Traditional Chinese medicine therapy decreases the pneumonia risk in patients with dementia

    Science.gov (United States)

    Lin, Shun-Ku; Tsai, Yueh-Ting; Lo, Pei-Chia; Lai, Jung-Nien

    2016-01-01

    Abstract Pneumonia is a frequent complication in dementia patients and is associated with high mortality rates. The aim of this retrospective cohort study was to determine whether traditional Chinese medicine (TCM) therapy can decrease pneumonia risk in dementia patients. The cohort dataset was obtained from the Longitudinal Health Insurance Database 2005, a sublibrary of the National Health Insurance Research Database, containing all medical data of 1 million beneficiaries, randomly selected from the all Insurers in year 2005. Newly diagnosed dementia patients (n = 9712) without pneumonia were analyzed from January 1997 to December 2003. After matching by sex, age, urban level, Charlson comorbidity index, insured amount, and comorbidities, 1376 pairs (1:1) of TCM and non-TCM users were acquired. Every dementia patient was individually recorded from 1997 to 2012 to identify pneumonia incidence (onset after 3 months of dementia diagnosis). Demographic characteristics, Charlson comorbidity index, comorbidities, behavioral and psychological symptoms of dementia, and psychotropic drugs were also investigated. Cox proportional regression was used to compute hazard ratios and 95% confidence intervals (CIs) after adjustment for the above-mentioned variables. There were 419 (30.5%) and 762 (55.4%) pneumonia cases in the TCM and non-TCM cohorts during a mean follow-up period of 7.6 years. The adjusted hazard ratios (95% CI) for pneumonia admission was 0.62 (0.55–0.70) for the TCM group. Patients who received TCM therapy at higher cumulative doses or for longer periods experienced increased protection from pneumonia admission. Ma-Xing-Gan-Shi-Tang, Yin-Qiao-San, and Xiao-Qing-Long-Tang might represent possible formulae reducing the incidence of pneumonia. TCM might be associated with a lower risk of pneumonia in dementia patients. PMID:27631269

  8. Doripenem in hospital infections: a focus on nosocomial pneumonia, complicated intra-abdominal infections, and complicated urinary tract infections

    Directory of Open Access Journals (Sweden)

    Tze Shien Lo

    2009-06-01

    . Judicious use should be considered when using doripenem as a first-line agent or drug of choice for serious infections. Doripenem is a well-tolerated drug with common adverse effects including headache, nausea and diarrhea. Caution should be used in patients with hypersensitivity to carbapenems and adverse reactions to β-lactam agents. Dosage adjustment is needed for patients with renal impairment. Doripenem has demonstrated economic and clinical benefits. It has been shown to reduce hospital length of stay and duration of mechanical ventilation for intensive care unit (ICU patients. Therefore, doripenem is a welcome addition to our limited armamentarium of antibiotics available to treat serious bacterial infections in hospitalized patients.Keywords: doripenem, nosocomial pneumonia, intra-abdominal infections, urinary tract infections

  9. Mycoplasma pneumonia-associated Acute Hepatitis in an Adult Patient without Lung Infection

    Directory of Open Access Journals (Sweden)

    Shou-Wu Lee

    2009-04-01

    Full Text Available Mycoplasma pneumonia is a major cause of respiratory infections in school-aged children. Most M. pneumonia infections in adults involve the respiratory tract. Extrapulmonary manifestations of M. pneumonia infection may be found in the skin, cardiovascular, neurologic and hematologic systems. Concomitant liver disease is rare in adults. Here, we report an unusual case of a patient who presented with fever and abdominal pain, but without pulmonary manifestations. The laboratory work-up demonstrated a hepatocellular pattern of acute hepatitis caused by M. pneumonia infection. Symptoms subsided and laboratory parameters improved with antibiotics treatment. Thus, this case can help raise clinicians' awareness of the possibility of M. pneumonia infection, with or without lung involvement, as a part of the evaluation of undetermined hepatitis.

  10. Ekstrapulmonale komplikationer ved mycoplasma pneumoniae-infektioner

    DEFF Research Database (Denmark)

    Bjørn, Anne-Mette Bay; Lebech, Anne-Mette K

    2002-01-01

    Mycoplasma pneumoniae is a common cause of atypical pneumonia in children and young adults. The infection is generally mild and only a very few patients are admitted to hospital. However, extrapulmonary complications are well recognised--mostly as manifestations from the central nervous system (CNS)....

  11. Pneumonia Caused by Moraxella Catarrhalis in Haematopoietic ...

    African Journals Online (AJOL)

    Two patients with haematopoietic stem cell transplant who developed pneumonia caused by M. catarrhalis at King Faisal Specialist Hospital and Research Centre in Riyadh are reported and the literature is reviewed. To our knowledge, these are the first case reports of M. catarrhalis pneumonia in haematopoietic stem cell ...

  12. Detection and quantification of Streptococcus pneumoniae from ...

    African Journals Online (AJOL)

    The aim of this study was to develop a real time polymerase chain reaction (PCR) for quantitative detection of Streptococcus pneumoniae from clinical respiratory specimens. Initially, 184 respiratory specimens from patients with community acquired pneumonia (CAP) (n = 129) and 55 cases with hospital associated ...

  13. Fatal Klebsiella pneumoniae meningitis and concomitant disseminated intravascular coagulation in a patient with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Ho Min-Po

    2009-01-01

    Full Text Available Bacterial meningitis remains a major cause of death and long-term neurologic sequelae worldwide. We present a case of fatal Klebsiella pneumoniae meningitis and concomitant disseminated intravascular coagulation (DIC in a 72-year-old woman with diabetes mellitus (DM. Both blood and cerebrospinal fluid cultures grew Klebsiella pneumoniae . Due to advanced age, newly recognized DM, K. pneumoniae bacteremia, and DIC, the prognosis of our patient was poor. Eight hours after arrival to the emergency department, cardiopulmonary resuscitation was necessary in this patient, but she died despite an early diagnosis and appropriate antibiotic therapy.

  14. Exhaled Breath Metabolomics for the Diagnosis of Pneumonia in Intubated and Mechanically-Ventilated Intensive Care Unit (ICU-Patients

    Directory of Open Access Journals (Sweden)

    Pouline M. P. van Oort

    2017-02-01

    Full Text Available The diagnosis of hospital-acquired pneumonia remains challenging. We hypothesized that analysis of volatile organic compounds (VOCs in exhaled breath could be used to diagnose pneumonia or the presence of pathogens in the respiratory tract in intubated and mechanically-ventilated intensive care unit patients. In this prospective, single-centre, cross-sectional cohort study breath from mechanically ventilated patients was analysed using gas chromatography-mass spectrometry. Potentially relevant VOCs were selected with a p-value < 0.05 and an area under the receiver operating characteristics curve (AUROC above 0.7. These VOCs were used for principal component analysis and partial least square discriminant analysis (PLS-DA. AUROC was used as a measure of accuracy. Ninety-three patients were included in the study. Twelve of 145 identified VOCs were significantly altered in patients with pneumonia compared to controls. In colonized patients, 52 VOCs were significantly different. Partial least square discriminant analysis classified patients with modest accuracy (AUROC: 0.73 (95% confidence interval (CI: 0.57–0.88 after leave-one-out cross-validation. For determining the colonization status of patients, the model had an AUROC of 0.69 (95% CI: 0.57–0.82 after leave-one-out cross-validation. To conclude, exhaled breath analysis can be used to discriminate pneumonia from controls with a modest to good accuracy. Furthermore breath profiling could be used to predict the presence and absence of pathogens in the respiratory tract. These findings need to be validated externally.

  15. [Nutritional assessment for hospitalized patients].

    Science.gov (United States)

    Henríquez Martínez, T; Armero Fuster, M

    1991-01-01

    A review of the following points was performed: Factors favouring the development and presence of malnutrition among hospitalized patients. Useful parameters in nutritional evaluation. Types of malnutrition. The Chang nutritional evaluation protocol is used in our Hospital, which is simple, inexpensive, reliable, specific and easily reproduced. This is based on five variables (three anthropometric and two biochemical), randomized and based on reference tables and values. A study was made on data corresponding to 70 patients, in whom a prevalence of malnutrition was observed in critical patients. The patients were classified based on three different definitive possibilities (Marasmo, Kwashiorkor and combined), and three grades of malnutrition (slight, moderate and severe).

  16. pneumocytis carinii pneumonia in hiv/aids patients at an urban

    African Journals Online (AJOL)

    hi-tech

    2003-01-01

    Jan 1, 2003 ... common non-opportunistic pathogens before severe degrees of immunosuppression ... Methods: Patients presenting with a sub-acute onset of cough and dyspnoea ..... of community acquired Pneumocytis carinii Pneumonia:.

  17. Meropenem susceptibility of Neisseria meningitidis and Streptococcus pneumoniae from meningitis patients in The Netherlands

    NARCIS (Netherlands)

    van de Beek, D.; Hensen, E. F.; Spanjaard, L.; de Gans, J.; Enting, R. H.; Dankert, J.

    1997-01-01

    In-vitro susceptibility of 299 Neisseria meningitidis and 157 Streptococcus pneumoniae strains from meningitis patients in The Netherlands in 1993 and 1994 to meropenem was determined using the Etest. Susceptibility to penicillin, ceftriaxone, and chloramphenicol was also determined. Rifampicin

  18. ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients

    DEFF Research Database (Denmark)

    Maschmeyer, Georg; Helweg-Larsen, Jannik; Pagano, Livio

    2016-01-01

    The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological and occasionally laboratory findings in patients at risk of this infection. Diagnostic proof by bronchoalveolar lavage should not delay th...

  19. Early identification of pneumonia patients at increased risk of Middle East respiratory syndrome coronavirus infection in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Anwar E. Ahmed

    2018-05-01

    Full Text Available Background: The rapid and accurate identification of individuals who are at high risk of Middle East respiratory syndrome coronavirus (MERS-CoV infection remains a major challenge for the medical and scientific communities. The aim of this study was to develop and validate a risk prediction model for the screening of suspected cases of MERS-CoV infection in patients who have developed pneumonia. Methods: A two-center, retrospective case–control study was performed. A total of 360 patients with confirmed pneumonia who were evaluated for MERS-CoV infection by real-time reverse transcription polymerase chain reaction (rRT-PCR between September 1, 2012 and June 1, 2016 at King Abdulaziz Medical City in Riyadh and King Fahad General Hospital in Jeddah, were included. According to the rRT-PCR results, 135 patients were positive for MERS-CoV and 225 were negative. Demographic characteristics, clinical presentations, and radiological and laboratory findings were collected for each subject. Results: A risk prediction model to identify pneumonia patients at increased risk of MERS-CoV was developed. The model included male sex, contact with a sick patient or camel, diabetes, severe illness, low white blood cell (WBC count, low alanine aminotransferase (ALT, and high aspartate aminotransferase (AST. The model performed well in predicting MERS-CoV infection (area under the receiver operating characteristics curves (AUC 0.8162, on internal validation (AUC 0.8037, and on a goodness-of-fit test (p = 0.592. The risk prediction model, which produced an optimal probability cut-off of 0.33, had a sensitivity of 0.716 and specificity of 0.783. Conclusions: This study provides a simple, practical, and valid algorithm to identify pneumonia patients at increased risk of MERS-CoV infection. This risk prediction model could be useful for the early identification of patients at the highest risk of MERS-CoV infection. Further validation of the prediction model on a

  20. The Effect of Adjuvant Zinc Therapy on Recovery from Pneumonia in Hospitalized Children: A Double-Blind Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Mohammad Javad Qasemzadeh

    2014-01-01

    Full Text Available Objectives. Pneumonia is one of the common mortality causes in young children. Some studies have shown beneficial effect of zinc supplements on treatment of pneumonia. The present study aimed to investigate the effects of short courses of zinc administration on recovery from this disease in hospitalized children. Methods. In a parallel Double-Blind Randomized Controlled Trial at Ayatollah Golpaygani Hospital in Qom, 120 children aged 3–60 months with pneumonia were randomly assigned 1 : 1 to receive zinc or placebo (5 mL every 12 hours along with the common antibiotic treatments until discharge. Primary outcome was recovery from pneumonia which included the incidence and resolving clinical symptoms and duration of hospitalization. Results. The difference between two groups in all clinical symptoms at admittance and the variables affecting the disease such as age and sex were not statistically significant (P<0.05 at baseline. Compared to the placebo group, the treatment group showed a statistically significant decrease in duration of clinical symptoms (P=0.044 and hospitalization (P=0.004. Conclusions. Supplemental administration of zinc can expedite the healing process and results in faster resolution of clinical symptoms in children with pneumonia. In general, zinc administration, along with common antibiotic treatments, is recommended in this group of children. It can also reduce the drug resistance caused by multiple antibiotic therapies. This trial is approved by Medical Ethic Committee of Islamic Azad University in Iran (ID Number: 8579622-Q. This study is also registered in AEARCTR (The American Economic Association's Registry for Randomized Controlled Trials. This trial is registered with RCT ID: AEARCTR-0000187.

  1. Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre-antibiotic era!

    Directory of Open Access Journals (Sweden)

    S Qureshi

    2015-01-01

    Full Text Available The rise in super bugs causing Ventilator-Associated Pneumonia (VAP is a major cause of mortality and morbidity despite recent advances in management owing to the looming ′antibiotic apocalypse′. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV for ≥48 hrs. Endotracheal aspirates (ETA from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP, while Nonfermenting Gram negative bacilli (NFGNB were significantly associated with late onset VAP (LOVAP. Most of the isolates were multi drug resistant (MDR super bugs. With limited treatment options left for this crisis situation like the pre-antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs.

  2. Usefulness of a semi-quantitative procalcitonin test and the A-DROP Japanese prognostic scale for predicting mortality among adults hospitalized with community-acquired pneumonia.

    Science.gov (United States)

    Kasamatsu, Yu; Yamaguchi, Toshimasa; Kawaguchi, Takashi; Tanaka, Nagaaki; Oka, Hiroko; Nakamura, Tomoyuki; Yamagami, Keiko; Yoshioka, Katsunobu; Imanishi, Masahito

    2012-02-01

    The solid-phase immunoassay, semi-quantitative procalcitonin (PCT) test (B R A H M S PCT-Q) can be used to rapidly categorize PCT levels into four grades. However, the usefulness of this kit for determining the prognosis of adult patients with community-acquired pneumonia (CAP) is unclear. A prospective study was conducted in two Japanese hospitals to evaluate the usefulness of this PCT test in determining the prognosis of adult patients with CAP. The accuracy of the age, dehydration, respiratory failure, orientation disturbance, pressure (A-DROP) scale proposed by the Japanese Respiratory Society for prediction of mortality due to CAP was also investigated. Hospitalized CAP patients (n = 226) were enrolled in the study. Comprehensive examinations were performed to determine PCT and CRP concentrations, disease severity based on the A-DROP, pneumonia severity index (PSI) and confusion, urea, respiratory rate, blood pressure, age ≥65 (CURB-65) scales and the causative pathogens. The usefulness of the biomarkers and prognostic scales for predicting each outcome were then examined. Twenty of the 170 eligible patients died. PCT levels were strongly positively correlated with PSI (ρ = 0.56, P scale were found to be useful for predicting mortality in adult patients with CAP. © 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology.

  3. Fatal Klebsiella pneumoniae meningitis in a patient with diabetes mellitus and Hansen′s disease

    OpenAIRE

    Vani Gopal; T Mangaiyarkarasi; R Gopal

    2014-01-01

    Klebsiella is a Gram-negative bacterium that causes different types of health care-associated infections including pneumonia, bloodstream infections, surgical site infections and meningitis. We report here a case of Klebsiella pneumoniae meningitis in a patient with diabetes mellitus and Hansen′s disease. A middle-aged man with a known case of diabetes mellitus and Hansen′s disease presented with the complaints of blurred vision in the left eye and the patient was found to have cataract. Pati...

  4. Fatal pneumonia and empyema thoracis caused by imipenem-resistant Nocardia abscessus in a cancer patient.

    Science.gov (United States)

    Lai, Chih-Cheng; Tsai, Hsih-Yeh; Ruan, Sheng-Yuan; Liao, Chun-Hsing; Hsueh, Po-Ren

    2015-12-01

    We describe a case of pneumonia and empyema thoracis caused by trimethoprim-sulfamethoxazole-susceptible, but imipenem-resistant Nocardia abscessus in a cancer patient. The isolate was confirmed to the species level by 16S rRNA sequencing analysis. The patient did not respond to antibiotic therapy, including ceftriaxone and imipenem, and died of progressing pneumonia and multiple organ failure. Copyright © 2013. Published by Elsevier B.V.

  5. Penicillin treatment for patients with Community-Acquired Pneumonia in Denmark

    DEFF Research Database (Denmark)

    Egelund, Gertrud Baunbæk; Jensen, Andreas Vestergaard; Andersen, Stine Bang

    2017-01-01

    BACKGROUND: Community-acquired pneumonia (CAP) is a severe infection, with high mortality. Antibiotic strategies for CAP differ across Europe. The objective of the study was to describe the epidemiology of CAP in Denmark and evaluate the prognosis of patients empirically treated with penicillin......-G/V was commonly used and not associated with increased mortality in patients with mild to moderate pneumonia. Our results are in agreement with current conservative antibiotic strategy as outlined in the Danish guidelines....

  6. SUSCEPTIBILITY OF RESPIRATORY ISOLATES OF STREPTOCOCCUS PNEUMONIAE ISOLATED FROM CHILDREN HOSPITALIZED IN THE CLINICAL CENTER NIS.

    Science.gov (United States)

    Dinić, Marina M; Mladenović Antić, Snezana; Kocić, Branislava; Stanković Dordević, Dobrila; Vrbić, Miodrag; Bogdanović, Milena

    2016-01-01

    Streptococcus pneumoniae is one of the most common causes of respiratory infections. The aim was to study the susceptibility to antimicrobial agents of respiratory isolates ofStreptococcus pneumoniae obtained from hospitalized children. A total of 190 respiratory pneumococcal isolates obtained from children aged from 0 to 14 years were isolated and identified by using standard microbiological methods. Susceptibility to oxacillin, erythromycin, clindamycin, tetracycline, cotrimoxazole, ofloxacin and rifampicin was tested by disc diffusion method. Minimal inhibitory concentrations for amoxicillin and ceftriaxone were determined by means of E test. The macrolide-resistant phenotype was detected by double disc diffusion test. All tested isolates were susceptible to amoxicillin and ceftriaxone. The minimal amoxicillin concentration inhibiting the growth of 50% of isolates and of 90% of isolates was 0.50 microg/ml and 1.0 microg/ml, respectively and the minimal ceftriaxone concentration inhibiting the growth of 50% of isolates and of 90% of isolates was 0.25 microg/ml and 0.50 microg/ml, respectively. Susceptibility to erythromycin and clindamycin was observed in 21.6% and 29.47% of isolates, respectively. The resistence to macrolides-M phenotype was detected in 10.07% of isolates and constitutive macrolide-lincosamide-streptogramin phenotype (constitutive MLS phenotype) was found in 89.93% of isolates. All tested isolates were susceptible to ofloxacin and rifampicin. Amoxicillin could be the therapy of choice in pediatric practice. The macrolides should not be recommended for the empirical therapy of pneumococcal respiratory tract infection in our local area.

  7. Predicting 30-Day Pneumonia Readmissions Using Electronic Health Record Data.

    Science.gov (United States)

    Makam, Anil N; Nguyen, Oanh Kieu; Clark, Christopher; Zhang, Song; Xie, Bin; Weinreich, Mark; Mortensen, Eric M; Halm, Ethan A

    2017-04-01

    Readmissions after hospitalization for pneumonia are common, but the few risk-prediction models have poor to modest predictive ability. Data routinely collected in the electronic health record (EHR) may improve prediction. To develop pneumonia-specific readmission risk-prediction models using EHR data from the first day and from the entire hospital stay ("full stay"). Observational cohort study using stepwise-backward selection and cross-validation. Consecutive pneumonia hospitalizations from 6 diverse hospitals in north Texas from 2009-2010. All-cause nonelective 30-day readmissions, ascertained from 75 regional hospitals. Of 1463 patients, 13.6% were readmitted. The first-day pneumonia-specific model included sociodemographic factors, prior hospitalizations, thrombocytosis, and a modified pneumonia severity index; the full-stay model included disposition status, vital sign instabilities on discharge, and an updated pneumonia severity index calculated using values from the day of discharge as additional predictors. The full-stay pneumonia-specific model outperformed the first-day model (C statistic 0.731 vs 0.695; P = 0.02; net reclassification index = 0.08). Compared to a validated multi-condition readmission model, the Centers for Medicare and Medicaid Services pneumonia model, and 2 commonly used pneumonia severity of illness scores, the full-stay pneumonia-specific model had better discrimination (C statistic range 0.604-0.681; P pneumonia. This approach outperforms a first-day pneumonia-specific model, the Centers for Medicare and Medicaid Services pneumonia model, and 2 commonly used pneumonia severity of illness scores. Journal of Hospital Medicine 2017;12:209-216. © 2017 Society of Hospital Medicine

  8. Streptococcus pneumoniae Drugs Resistance in Acute Rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Chong Jie Hao

    2016-03-01

    Full Text Available Background: Acute rhinosinusitis that usually caused by Streptococcus pneumoniae becomes the reason why patients seek for medical care. Drugs resistance in Streptococcus pneumoniae is increasing worldwide. This study was conducted to determine drugs resistance of Streptococcus pneumonia from acute rhinosinusitis in Dr. Hasan Sadikin General Hospital. Methods: A descriptive laboratory study was conducted in June–October 2014 at the Laboratory of Microbiology Faculty of Medicine Universitas Padjadjaran. The sample was taken using nasopharyngeal swabbing from 100 acute rhinosinusitis patients in Dr. Hasan Sadikin General Hospital and planted on tryptic soy agar containing 5% sheep blood and 5 μg/ml of gentamicin sulphate and then incubated in 5% CO2 incubator at 37°C for 24 hours. The identification of Streptococcus pneumonia was performed by optochin test. The susceptibility test against Streptococcus pneumoniae was done using disk diffusion method.The antibiotic disks were trimethoprim-sulfamethoxazole, oxacillin, levofloxacin, azithromycin, and doxycycline. Results: Out of 100 samples, 8 of them were tested positive for Streptococcus pneumoniae. Three of Streptococcus pneumoniae isolates died with unknown reason after it were stored at -80 .The drugs resistance test showed the resistance of Streptococcus pneumonia to oxacillin, azithromycin and trimethoprim were 6, whereas levofloxacin and doxycycline are 4. Conclusions: Streptococcus pneumonia drugs resistance in acute rhinosinusitis shows the resistance of Streptococcus pneumoniae to oxacillin, azithromycin and trimethoprim are 6, whereas the resistance to levofloxacin and doxycycline are 4.

  9. Outbreak by Hypermucoviscous Klebsiella pneumoniae ST11 Isolates with Carbapenem Resistance in a Tertiary Hospital in China

    Directory of Open Access Journals (Sweden)

    Lingling Zhan

    2017-05-01

    Full Text Available Hypervirulent and multidrug resistant Klebsiella pneumoniae strains pose a significant threat to the public health. In the present study, 21 carbapenem-resistant K. pneumoniae isolates (CRKP were determined by the string test as hypermucoviscous K. pneumoniae (HMKP, with the prevalence of 15.0% (21/140 among CRKP, and 1.1% (21/1838 among all K. pneumoniae isolates. Among them, 7 (33.3%, and 1 (4.76% isolate belonged to capsular serotype K20 and K2 respectively, while 13 (61.9%, 13/21 weren't successfully typed by capsular serotyping. All the 21 isolates were carbapenemase-producers and were positive for blaKPC-2. In addition to blaKPC-2, all the 21 isolates except one harbor blaSHV-11, and 15 carry extended-spectrum β-lactamase gene blaCTX-M-65. The virulence-associated genes with more than 90% of positive rates among 21 isolates included ureA (100%, 21/21, wabG (100%, 21/21, fimH (95.2%, 20/21, entB (95.2%, 20/21, ycf (95.2%, 20/21, ybtS (95.2%, 20/21, and iutA (90.5%, 19/21. rmpA and aerobactin were found in 57.1% (12/21 isolates. Five sequence types (STs were identified by multilocus sequence typing (MLST, including ST11 (11 K-non capsule typable and 5 K20 isolates, ST268 (1 K20 isolate and 1 K-non capsule typable isolate, ST65 (1 K2 isolate, ST692 (1 K-non capsule typable isolate, and ST595, a novel sequence type (1 K-non capsule typable isolate. Pulsed-field gel electrophoresis (PFGE results showed two major PFGE clusters, of which cluster A accounts for 6 ST11 isolates (28.6% and cluster B includes 8 ST11 isolates (38.1%, 8/21. Ten and six ST11 isolates were isolated from 2014 and 2015, respectively, while 8 were isolated from the same month of December in 2014. Ten isolates were collected from the intensive care unit (ICU, and all except one belonged to ST11. Additional 4 ST11 isolates were collected from patients in non-ICU wards, who had more than 10 days of ICU stay history in 2014 prior to transfer to their current wards where the

  10. High minimum inhibitory concentration of imipenem as a predictor of fatal outcome in patients with carbapenem non-susceptible Klebsiella pneumoniae.

    Science.gov (United States)

    Wu, Ping-Feng; Chuang, Chien; Su, Chin-Fang; Lin, Yi-Tsung; Chan, Yu-Jiun; Wang, Fu-Der; Chuang, Yin-Ching; Siu, L Kristopher; Fung, Chang-Phone

    2016-09-02

    Carbapenem resistance in Klebsiella pneumoniae is important because of its increasing prevalence and limited therapeutic options. To investigate the clinical and microbiological characteristics of patients infected or colonized with carbapenem non-susceptible K. pneumoniae (CnsKP) in Taiwan, we conducted a retrospective study at Taipei Veterans General Hospital from January 2012 to November 2013. Carbapenem non-susceptibility was defined as a minimum inhibitory concentration (MIC) of ≥2 mg/L for imipenem or meropenem. A total of 105 cases with CnsKP were identified: 49 patients with infection and 56 patients with colonization. Thirty-one isolates had genes that encoded carbapenemases (29.5%), including K. pneumoniae carbapenemase (KPC)-2 (n = 27), KPC-3 (n = 1), VIM-1 (n = 1) and IMP-8 (n = 2). The in-hospital mortality among patients with CnsKP was 43.8%. A MIC for imipenem ≥16 μg/mL, nasogastric intubation and Acute Physiology and Chronic Health Evaluation II score were independent risk factors for in-hospital mortality for all patients with CnsKP. A MIC for imipenem ≥16 μg/mL was also an independent risk factor for 14-day mortality in patients with CnsKP. In conclusion, a positive culture for CnsKP was associated with high in-hospital mortality. A high imipenem MIC of CnsKP can predispose a patient to a poor prognosis.

  11. [Ability of procalcitonin to predict bacteremia in patients with community acquired pneumonia].

    Science.gov (United States)

    Julián-Jiménez, Agustín; Timón Zapata, Jesús; Laserna Mendieta, Emilio José; Parejo Miguez, Raquel; Flores Chacartegui, Manuel; Gallardo Schall, Pablo

    2014-04-07

    To analyze the usefulness and ability of procalcitonin (PCT) to predict the presence of bacteremia in patients with community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae (S. pneumoniae) or other bacteria. This is an observational, prospective and descriptive study involving patients who were diagnosed with CAP in our Emergency Department. Data collected included socio-demographic and comorbidity variables, Charlson index, stage in the Pneumonia Severity Index and criteria of severe NAC, microbiologic studies and biomarker determinations (PCT and C reactive protein). The follow-up was carried out during 30 days to calculate the predictive power and the diagnostic performance for bacteremia caused or not by S. pneumoniae. Four hundred and seventy-four patients were finally included in the study. Blood cultures were positive in 85 individuals (17.9%) and S. pneumoniae was identified as the responsible pathogen in 75 of them (88.4%) (in 5 cases together with another agent). The area under the Receiver Operating Characteristic curve for PCT to predict bacteremia (caused by S. pneumoniae or not) was 0.988 (95% confidence interval 0.908-0.995; P98% and>10, respectively. The most frequently isolated serotypes of S. pneumoniae were 19A, 7F, 1 and 3. The highest mean levels of PCT were found in serotypes 7F, 19A, 3 and 1, which showed statistically significant differences with regard to the others serotypes considered (P=.008). Serotypes associated with the highest percentage of severe sepsis-septic shock, 30-days mortality and multi-lobe or bilateral affection were 3, 1 and 19A; 1, 3 and 19A; and 3, 19A and 6A, respectively. PCT had a remarkable diagnostic ability to discard or suspect bacteremia and to guide the etiology of CAP caused by S. pneumoniae. Serotypes 1, 3, 19A and 7F showed greater frequency, systemic inflammatory response and clinical severity. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  12. Validity of bacterial pneumonia score for predicting bacteremia in children with pneumonia

    Directory of Open Access Journals (Sweden)

    Rosalia Theodosia Daten Beyeng

    2011-12-01

    Full Text Available Background Bacteremia in children with pneumonia reflects a severe condition, with longer duration of hospital care and potentially lethal complications. Early detection of bacteremia in patients with pneumonia may reduce serious complications. Few bacteremia screening tools have been widely used in chidren with pneumonia. One of those tools is the bacterial pneumonia score (BPS. Objective To assess the validity of the bacterial pneumonia score for predicting bacteremia in pediatric patients with pneumonia. Methods A diagnostic test was conducted on children aged 1 to 60 months hospitalized with pneumonia from December 2009 to August 2010. Subjects were collected consecutively. Pneumonia was diagnosed using the World Healt Organization (WHO criteria. Subjects underwent complete blood counts and blood culture examinations at admission. Statistical analyses included sensitivity, specificity, positive and negative predictive value (PPV/NPV, positive and negative likelihood ratio (PLR/NLR, and post-test probability. Results Our study included 229 children. Based on BPS with a cut-off score of ≥ 4, the sensitivity was 83.3%, specificity 49.7%, PPV 8.4%, NPV 98.2%, PLR 1.66, NLR 0.31, and post-test probability 8.4% for detecting bacteremia in pediatric pneumonia patients. Conclusion BPS can not be used for predicting bacteremia in pediatric patients with pneumonia.

  13. Exposure to fine particulate matter and hospital admissions due to pneumonia: Effects on the number of hospital admissions and its costs.

    Science.gov (United States)

    Patto, Nicole Vargas; Nascimento, Luiz Fernando Costa; Mantovani, Katia Cristina C; Vieira, Luciana C P F S; Moreira, Demerval S

    2016-07-01

    Given that respiratory diseases are a major cause of hospitalization in children, the objectives of this study are to estimate the role of exposure to fine particulate matter in hospitalizations due to pneumonia and a possible reduction in the number of these hospitalizations and costs. An ecological time-series study was developed with data on hospitalization for pneumonia among children under 10 years of age living in São José do Rio Preto, state of São Paulo, using PM2.5 concentrations estimated using a mathematical model. We used Poisson regression with a dependent variable (hospitalization) associated with PM2.5 concentrations and adjusted for effective temperature, seasonality and day of the week, with estimates of reductions in the number of hospitalizations and costs. 1,161 children were admitted to hospital between October 1st, 2011, and September 30th, 2013; the average concentration of PM2.5 was 18.7 µg/m3 (≈32 µg/m3 of PM10) and exposure to this pollutant was associated with hospitalization four and five days after exposure. A 10 µg/m3 decrease in concentration would imply 256 less hospital admissions and savings of approximately R$ 220,000 in a medium-sized city.

  14. Costs and risk factors for ventilator-associated pneumonia in a Turkish University Hospital's Intensive Care Unit: A case-control study

    Directory of Open Access Journals (Sweden)

    Serin Simay

    2004-04-01

    Full Text Available Abstract Background Ventilator-associated pneumonia (VAP which is an important part of all nosocomial infections in intensive care unit (ICU is a serious illness with substantial morbidity and mortality, and increases costs of hospital care. We aimed to evaluate costs and risk factors for VAP in adult ICU. Methods This is a-three year retrospective case-control study. The data were collected between 01 January 2000 and 31 December 2002. During the study period, 132 patients were diagnosed as nosocomial pneumonia of 731 adult medical-surgical ICU patients. Of these only 37 VAP patients were assessed, and multiple nosocomially infected patients were excluded from the study. Sixty non-infected ICU patients were chosen as control patients. Results Median length of stay in ICU in patients with VAP and without were 8.0 (IQR: 6.5 and 2.5 (IQR: 2.0 days respectively (P Conclusion Respiratory failure, coma, depressed consciousness, enteral feeding and length of stay are independent risk factors for developing VAP. The cost of VAP is approximately five-fold higher than non-infected patients.

  15. Streptococcus pneumoniae bacteraemia due to parotitis in a patient with systemic sclerosis and secondary Sjögren's syndrome.

    Science.gov (United States)

    Yii, Irene Yuen Lin; Tan, Jamie Bee Xian; Fong, Warren Weng Seng

    2016-10-01

    Invasive pneumococcal disease is an uncommon and notifiable disease in Singapore. It is often associated with significant morbidity and mortality. We report a rare case of invasive pneumococcal bacteraemia due to parotitis in a patient with systemic sclerosis and secondary Sjögren's syndrome. We also present a retrospective review of Streptococcus pneumoniae bacteraemia cases in Singapore General Hospital from January 2011 to April 2016. A 59-year-old Malay lady with a history of systemic sclerosis with secondary Sjögren's syndrome presented with fever and left parotid gland swelling. Clinical examination revealed poor salivary pooling and left parotid swelling without fluctuance. Ultrasound of the left parotid gland confirmed acute parotitis without evidence of abscess or sialolithiasis. Blood cultures were positive for S. pneumoniae . She was diagnosed to have invasive pneumococcal bacteraemia secondary to acute parotitis, and treated with intravenous benzylpenicillin with clearance of bacteraemia after 3 days. Upon discharge, her antibiotics were changed to intravenous ceftriaxone to facilitate outpatient parenteral antibiotic therapy for another 2 weeks. She responded favourably to antibiotics at follow-up, with no complications from the bacteraemia. A review of the microbiological records of the Singapore General Hospital revealed 116 cases of pneumococcal bacteraemia, most (80.3 %) of which were due to pneumonia. None were due to parotitis. S. pneumoniae parotitis and subsequent bacteraemia is rare. Prompt recognition of the disease and appropriate use of antibiotics are important. This case highlights that close communication between healthcare workers (microbiologist, rheumatologist and infectious disease specialist) is essential in ensuring good clinical outcomes in patients with a potentially fatal disease.

  16. Incidence and outcome of ventilator-associated pneumonia in Inkosi ...

    African Journals Online (AJOL)

    pneumonia in Inkosi Albert Luthuli and King Edward VIII. Hospital surgical ... Ventilator-associated pneumonia (VAP) is one of the most common causes of hospital morbidity and mortality, but has ... microbial flora.[5] ... or confirmed community-acquired or .... Patients' baseline function, comorbidities, injury severity score and.

  17. Viral Pneumonia in Patients with Hematologic Malignancy or Hematopoietic Stem Cell Transplantation.

    Science.gov (United States)

    Vakil, Erik; Evans, Scott E

    2017-03-01

    Viral pneumonias in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation cause significant morbidity and mortality. Advances in diagnostic techniques have enabled rapid identification of respiratory viral pathogens from upper and lower respiratory tract samples. Lymphopenia, myeloablative and T-cell depleting chemotherapy, graft-versus-host disease, and other factors increase the risk of developing life-threatening viral pneumonia. Chest imaging is often nonspecific but may aid in diagnoses. Bronchoscopy with bronchoalveolar lavage is recommended in those at high risk for viral pneumonia who have new infiltrates on chest imaging. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. [Screening for malnutrition among hospitalized patients in a Colombian University Hospital].

    Science.gov (United States)

    Cruz, Viviana; Bernal, Laura; Buitrago, Giancarlo; Ruiz, Álvaro J

    2017-04-01

    On admission, 30 to 50% of hospitalized patients have some degree of malnutrition, which is associated with longer length of stay, higher rates of complications, mortality and greater costs. To determine the frequency of screening for risk of malnutrition in medical records and assess the usefulness of the Malnutrition Screening Tool (MST). In a cross-sectional study, we searched for malnutrition screening in medical records, and we applied the MST tool to hospitalized patients at the Internal Medicine Wards of San Ignacio University Hospital. Of 295 patients included, none had been screened for malnutrition since hospital admission. Sixty one percent were at nutritional risk, with a higher prevalence among patients with HIV (85.7%), cancer (77.5%) and pneumonia. A positive MST result was associated with a 3.2 days increase in length of hospital stay (p = 0.024). The prevalence of malnutrition risk in hospitalized patients is high, but its screening is inadequate and it is underdiagnosed. The MST tool is simple, fast, low-cost, and has a good diagnostic performance.

  19. [Risk factors associated with the isolation of extended spectrum betalactamases producing Escherichia coli or Klebsiella pneumoniae in a tertiary care hospital in Colombia].

    Science.gov (United States)

    Jiménez, Adriana; Alvarado, Alejandra; Gómez, Felipe; Carrero, Germán; Fajardo, Claudia

    2014-04-01

    Extended-spectrum beta-lactamases (ESBL) are an emerging resistance phenomenon with particular incidence in Latin America. In Colombia there is very little information regarding the risk factors associated with its acquisition. To determine the risk factors that are associated with infection or colonization by Escherichia coli or Klebsiella pneumoniae producing ESBL in patients older than 18 years. A case-control study, ratio 1:1, in patients with an isolate from any sample of E. coli or K. pneumoniae producing ESBL in the period from January 2009 to November 2011 at San José University Hospital in Bogotá (Colombia). We studied 110 cases and 110 controls, 62.7% were E. coli and 37.3% K. pneumoniae . In the multivariate analysis the independent risk factors found were: chronic renal failure (odds ratio [OR] 2.99, confidence interval 95% [95% CI] 1.10-8.11, p=0.031), urologic surgery (OR 4.78 95% CI 1.35 to 16.87, p=0.015), history of antibiotic use in the previous three months (OR 2.24, 95% CI 1.09 – 4.60, p=0.028), nosocomial origin of infection (OR=2.92 95% CI 1.39 – 6.13, p=0.004) and previous hospitalization (OR 1,59, 95% CI=1.03 – 2.46, p=0,036). Anticipating the resistance pattern of the organism infecting a patient based on risk factors may allow the choice of appropriate empirical antibiotic therapy, which will have an impact on reducing patients' morbidity and mortality.

  20. An outbreak of ESBL-producing Klebsiella pneumoniae in an Iranian referral hospital: epidemiology and molecular typing.

    Science.gov (United States)

    Mahmoudi, Shima; Pourakbari, Babak; Rahbarimanesh, Aliakbar; Abdolsalehi, Mohammad Reza; Ghadiri, Keyghobad; Mamishi, Setareh

    2018-05-07

    Klebsiella pneumoniae is a common cause of nosocomial infections; however, there is limited information in Iran regarding nosocomial outbreaks due to extended-spectrum β-lactamase (ESBL) producing K pneumoniae strains, particularly using molecular methods. The present study focused on the molecular mechanism of ESBL resistance and genetic relatedness in K. pneumoniae isolates causing nosocomial infections in an Iranian referral hospital. This study was evaluated the antimicrobial resistance and molecular epidemiology of K. pneumoniae causing nosocomial infections between October 2013 and March 2014. The ESBL detection was carried out for all the isolates by the CLSI method and PCR was carried out for the detection of the blaSHV, blaTEM, and blaCTX-M genes among ESBL-producing K. pneumonia. Molecular typing of the K. pneumoniae was performed using random amplification of polymorphic DNA-polymerase chain reaction (RAPD-PCR). A total of 30 isolates of K. pneumoniae were used for epidemiological analysis. High rates of resistance to cefotaxime (n=29, 97%), cefazolin (n=29, 97%), cefepime (n=25, 83%) and gentamicin (n=23, 77%) were observed. A total of 29 strains (97%) produced ESBLs. The frequency of blaSHV, blaCTX-M and blaTEM genes among these isolates were 83% (n=25), 70% (n=21) and 57% (n=17), respectively. Surprisingly 11 isolated (37%) carried blaSHV, blaCTX-M and blaTEM genes simultaneously. Moreover, the concurrent presence of "blaSHV and blaCTX-M" and "blaSHV and blaTEM" was seen in 8 (27%) and 4 (13%) isolates, respectively. RAPD-PCR analyses revealed that K. pneumoniae isolates belonged to 2 RAPD-PCR types among which one cluster counted for 28 isolates. To our knowledge this is the first published report of nosocomial outbreak of ESBL-producing K. pneumoniae in children in Iran. Although the epidemiology of nosocomial infections with ESBL-producing organisms has not yet been explored in depth in Iran, our findings suggest that ESBL-producing organisms are

  1. Higiene bucal: prática relevante na prevenção de pneumonia hospitalar em pacientes em estado crítico Higiene bucal: práctica relevante en la prevención de neumonía hospitalaria en pacientes en estado crítico Oral hygiene: a relevant practice to prevent hospital pneumonia in critically ill patients

    Directory of Open Access Journals (Sweden)

    Isa Rodrigues da Silveira

    2010-10-01

    Full Text Available Este artigo objetivou atualizar o conhecimento a respeito dos aspectos microbiológicos da cavidade oral e sua relação com a higiene bucal na prevenção da pneumonia associada à ventilação mecânica. Estudos analisados têm sido favoráveis ao uso de antissépticos para descontaminação da orofaringe, embora ainda não exista uma padronização de condutas a respeito da técnica e produtos.Este artículo tuvo por objetivo actualizar el conocimiento sobre aspectos microbiológicos de la cavidad oral y verificar la relación de la higiene bucal con la prevención de la neumonía asociada a la ventilación mecánica. Los estudios analizados se han mostrado favorables al uso de antisépticos para descontaminar la cavidad oral y la faringe, a pesar de que todavía no existe una estandarización de conductas sobre la técnica y de los productos utilizados en ese proceso.The objective of this article was to update knowledge on the microbiological aspects of the oral cavity and, verify the relation of oral hygiene with the prevention of pneumonia associated with mechanical ventilation. The studies analyzed were in favor of the use of antiseptics for decontaminating the oral cavity and pharynx, although there is still no standardization of procedures on the technique and products used in this process.

  2. Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke

    DEFF Research Database (Denmark)

    Sørensen, Rikke Terp; Rasmussen, Rune Skovgaard; Overgaard, Karsten

    2013-01-01

    Dysphagia occurs in approximately 51%-78% of patients with acute stroke. The incidence of pneumonia caused by aspiration in dysphagic patients increases both mortality and the need for hospitalization. The aim of this study was to investigate whether the incidence of aspiration pneumonia could...... be reduced in such patients by an early screening for dysphagia and intensified oral hygiene....

  3. A Patient with Non-Hodgkin Lymphoma and Nonspecific Interstitial Pneumonia during Ibrutinib Therapy

    OpenAIRE

    Jungmann, Sven; Ludwig, Wolf-Dieter; Schönfeld, Nicolas; Blum, Torsten-Gerriet; Großwendt, Claudia; Boch, Christian; Rehbock, Beate; Griff, Sergej; Schmittel, Alexander; Bauer, Torsten T.

    2017-01-01

    We present a 74-year-old male with nonspecific interstitial pneumonia (NSIP) during treatment with ibrutinib for mantle cell lymphoma. Previously, the patient had received six cycles of bendamustine and rituximab and six cycles of R-CHOP, followed by rituximab maintenance therapy. Respiratory tract complications of ibrutinib other than infectious pneumonia have not been mentioned in larger trials, but individual case reports hinted to a possible association with the development of pneumonitis...

  4. Indication for fiberoptic bronchoscopy in HIV-infected patients suspected for Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Orholm, M; Lundgren, Jens Dilling; Nielsen, T L

    1990-01-01

    During a six-month period, 40 consecutive fiberoptic bronchoscopic procedures including bronchoalveolar lavage, bronchial brushing and forceps biopsy were performed in local anaesthesia on 34 HIV-infected males presenting symptoms compatible with Pneumocystis carinii pneumonia. In 23 examinations...... did not differ with regard to history, clinical examination, immunology, serology or chest radiograph. We conclude that fiberoptic bronchoscopy should be performed on wide indications in HIV-infected patients with symptoms compatible with P. carinii pneumonia. The procedure is easily performed...

  5. Pneumocystis carinii pneumonia in a patient on etanercept for psoriatic arthritis.

    LENUS (Irish Health Repository)

    Lahiff, C

    2007-12-01

    Pneumocystis carinii pneumonia (PCP) is a rare form of pneumonia associated with immune-suppression. It is common in patients with AIDS and with a CD4 count of less than 200 cells\\/mm(3). We report a case of PCP secondary to immune-suppression in a 41-year-old man with psoriatic arthritis being treated with the immune-modulatory agent etanercept.

  6. BILATERAL ENDOGENOUS BACTERIAL ENDOPHTHALMITIS SECONDARY TO PNEUMONIA IN AN AIDS PATIENT : A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Rajendra Ku.

    2015-08-01

    Full Text Available INTRODUCTI ON: Endogenous or metastatic endophthalmitis is a very rare sever form of ocular disease which is uncommon now - a - days. Prevalence of endogenous bacterial endophthalmitis is 2 - 8% of all cases of endophthalmitis 1 . Mostly it is associated with chronic disease like diabetes mellitus, renal failure, liver abscesses, prolong placement of catheter, IV line or central venous line, drug abusers and immunocompromise d patients. Gram +bacteria are the most common causative organism of the endogenous bacterial endophthalmitis . 1 A few cases of endogenous bacterial endophthalmitis due to klebsiella pneumonias, a gram - ve organism have been documented and majority of them were in Taiwan . 2, 3,4,5,6, 7 K. pneumonia endophthalmitis is associated with diabetes mellitus and hepatic abscesses can be bilateral and resulted into poor visual outcome . 2,3,4,5,6, 7 K. pneumonia pneumonia has been reported most frequently from patients with alcoholic liver diseases and one of the common cause of acute osteomyelitis and septic arthritis . 8,9 In this scenario we report the case of a Malawian in African Continent who developed bilateral endogenous bacterial endophthalmitis after suffering from pneumonia in immunocompromise state. PURPOSE : to report a case bilateral endogenous endophthalmitis secondary to pneumonia in an AIDS patient . DESIGN : Observational case report . METHODS : A patient with bilateral pain full red eye with diminution of vision was seen in c onsultation by ophthalmology. RESULT : with clinical characteristic and laboratory diagnosis of sputum and blood conf i rmed the causative agent for pneumonia and endophthalmitis is K.pneumonia. CONCLUSION : it is unusual disease, required early detection and prompt treatment.

  7. Kinetic therapy reduces complications and shortens hospital stay in patients with cardiogenic shock - a retrospective analysis.

    Science.gov (United States)

    Simonis, Gregor; Flemming, Kerstin; Ziegs, Enrico; Haacke, Katrin; Rauwolf, Thomas; Strasser, Ruth H

    2007-03-01

    Kinetic therapy (KT) has been shown to reduce complications and to shorten hospital stay in trauma patients. Data in non-surgical patients are inconclusive, and kinetic therapy has not been tested in patients with cardiogenic shock. The present analysis compares KT with standard care in patients with cardiogenic shock. A retrospective analysis of 133 patients with cardiogenic shock admitted to 1 academic heart center was performed. Patients with standard care (SC, turning every 2 h by the staff) were compared with kinetic therapy (KT, using oscillating air-flotation beds). 68 patients with KT were compared with 65 patients with SC. Length of ventilator therapy was 11 days in KT and 18 days in SC (p=0.048). The mortality was comparable in both groups. Pneumonia occurred in 14 patients in KT and 39 patients in SC (ppatients treated with kinetic therapy. The use of KT shortens hospital stay and reduces rates of pneumonia and pressure ulcers as compared to SC.

  8. Process of care and prescription in pneumonia acquired in the community in university hospitals in Colombia

    International Nuclear Information System (INIS)

    Martinez, Carlos Eli; Jaimes, Fabian A; Montufar, Franco E; Hincapie, Gustavo A; Morales, Alvaro; Acero, Rafael; Muneton, David; Gomez, Sujey; Cuenca, Diana Maria; Salinas, Juan Carlos; Zabaleta Joel E

    2003-01-01

    The objective is to describe the process of care and prescription practices for CAP patients in four university hospitals in Colombia. Patients older than 15 years with a diagnosis of CAP during the two years study period. Collection of demographic and clinical status data and management during the first day of consult, classification in severity groups according to fine's prediction rule. Evaluation of the frequency of use of ancillary diagnostic tests antimicrobials prescription and agreement with ATS guidelines according to severity group and hospital. 734 patients were included, mean age 56 years old, 50.5% males, mean length of stay 8.6 days, 39% fine's classes IV to V. Frequency of sputum sampling (overall cohort between hospitals rank) was 46% (10 - 67%), chest x-ray 95% (57-100%), blood cultures 34% (0 -63%) and arterial blood gas analysis 71% (10-88%). the use of ancillary diagnostic test had wide variation between hospitals and severity classes, specially for sputum and blood gases. At least 45 different antimicrobial protocols were used in the cohort. Overall agreement between actual prescription and guidelines recommendations was variable (mean 44%, range 22 to 72%) between groups and hospitals, but without significant impact on mortality. There are many differences between actual clinical practice and guidelines for the management of CAP and wide variations between hospitals, but the precise effect of the lack of guideline-adherence on mortality is unclear

  9. Fatal Klebsiella pneumoniae meningitis in a patient with diabetes mellitus and Hansen's disease.

    Science.gov (United States)

    Gopal, Vani; Mangaiyarkarasi, T; Gopal, R

    2014-01-01

    Klebsiella is a Gram-negative bacterium that causes different types of health care-associated infections including pneumonia, bloodstream infections, surgical site infections and meningitis. We report here a case of Klebsiella pneumoniae meningitis in a patient with diabetes mellitus and Hansen's disease. A middle-aged man with a known case of diabetes mellitus and Hansen's disease presented with the complaints of blurred vision in the left eye and the patient was found to have cataract. Patient was operated for cataract and Intraocular lens implanted. Patient developed headache and vomiting on the 4th post-operative day. Lumbar puncture was carried out and gram stain of cerebrospinal fluid showed Gram-negative bacilli in the direct smear and culture yielded a heavy growth of K. pneumoniae. The patient was treated with antimicrobials according to the susceptibility pattern. He initially showed improvement but later on developed altered sensorium and hypotension. Patient succumbed to infection in spite of all medical attention.

  10. Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study.

    Science.gov (United States)

    Ho, Sai-Wai; Teng, Ying-Hock; Yang, Shun-Fa; Yeh, Han-Wei; Wang, Yu-Hsun; Chou, Ming-Chih; Yeh, Chao-Bin

    2017-01-13

    Isolated minor rib fractures (IMRFs) after blunt chest traumas are commonly observed in emergency departments. However, the relationship between IMRFs and subsequent pneumonia remains controversial. This nationwide cohort study investigated the association between IMRFs and the risk of pneumonia in patients with blunt chest traumas. Nationwide population-based cohort study. Patients with IMRFs were identified between 2010 and 2011 from the Taiwan National Health Insurance Research Database. Non-traumatic patients were matched through 1:8 propensity-score matching according to age, sex, and comorbidities (namely diabetes, hypertension, cardiovascular disease, asthma and chronic obstructive pulmonary disease (COPD)) with the comparison cohort. We estimated the adjusted HRs (aHRs) by using the Cox proportional hazard model. A total of 709 patients with IMRFs and 5672 non-traumatic patients were included. The primary end point was the occurrence of pneumonia within 30 days. The incidence of pneumonia following IMRFs was 1.6% (11/709). The aHR for the risk of pneumonia after IMRFs was 8.94 (95% CI=3.79 to 21.09, ppneumonia following IMRFs. In the IMRF group, presence of single or two isolated rib fractures was associated with an increased risk of pneumonia with aHRs of 3.97 (95% CI 1.09 to 14.44, ppneumonia following IMRFs is low, patients with two isolated rib fractures were particularly susceptible to pneumonia. Physicians should focus on this complication, particularly in elderly patients and those with COPD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. Severe Hyponatremia due to Levofloxacin Treatment for Pseudomonas aeruginosa Community-Acquired Pneumonia in a Patient with Oropharyngeal Cancer

    Directory of Open Access Journals (Sweden)

    Mihaela Mocan

    2016-01-01

    Full Text Available Hyponatremia (serum Na levels of <135 mEq/L is the most common electrolyte imbalance encountered in clinical practice, affecting up to 15–28% of hospitalized patients. This case report refers to a middle-aged man with severe hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion related to four possible etiological factors: glossopharyngeal squamous cell carcinoma, cisplatin treatment, right basal pneumonia with Pseudomonas aeruginosa, and the treatment with Levofloxacin. This case report discusses a rare complication of common conditions and of a common treatment. To our knowledge this is the first case of hyponatremia related to Levofloxacin and the second related to fluoroquinolones.

  12. [Bacteremic pneumococcal pneumonia].

    Science.gov (United States)

    Pineda Solas, V; Pérez Benito, A; Domingo Puiggros, M; Larramona Carrera, H; Segura Porta, F; Fontanals Aymerich, D

    2002-11-01

    Streptococcus pneumonia is the most common bacterial cause of community-acquired pneumonia in children. The reference standard for etiological diagnosis is isolation of S. pneumoniae from blood Since the advent of conjugate vaccines, disease caused by this organism can now be prevented. Many studies have been performed of the global incidence of invasive pneumococcal infections and of pneumococcal meningitis but few studies investigated bacteremic pneumococcal pneumonia and its complications in children. To determine the incidence, patient characteristics, clinical signs, laboratory data, percentage and days of hospitalization, response to antibiotic treatment, antibiotic resistance, complications and causal serogroups of bacteremic pneumococcal pneumonia in our environment in order to estimate requirements for systematic vaccination programs. From January 1990 to May 2001, data on all pediatric cases of invasive pneumococcal infections diagnosed in our hospital were collected. Several characteristics of patients with bacteremic pneumococcal pneumonia were analyzed. Bacteremic pneumococcal pneumonia was diagnosed in patients with positive blood or pleural fluid cultures for S. pneumoniae and radiographically evident pulmonary infiltrate. The incidence of both types of pneumonia were determined according to population census data. All S. pneumonia strains were sent to the Pneumococci Reference Laboratory of the Instituto Carlos III in Madrid for serotyping. We estimated the serotype coverage of the pneumococcal 7-valent conjugate vaccine according to the serotypes included in this vaccine and their distribution. Forty cases of bacteremic pneumococcal pneumonia were diagnosed, yielding an incidence of 17,10 and 5 cases per 10(5) children aged less than 2, 4 and 15 years old respectively. The mean age was 50 months and 43% were aged less than 4 years. Peaks occurred in January, March, April and May. A total of 77.5% of the patients were admitted to hospital and the

  13. Fuzzy model to estimate the number of hospitalizations for asthma and pneumonia under the effects of air pollution.

    Science.gov (United States)

    Chaves, Luciano Eustáquio; Nascimento, Luiz Fernando Costa; Rizol, Paloma Maria Silva Rocha

    2017-06-22

    Predict the number of hospitalizations for asthma and pneumonia associated with exposure to air pollutants in the city of São José dos Campos, São Paulo State. This is a computational model using fuzzy logic based on Mamdani's inference method. For the fuzzification of the input variables of particulate matter, ozone, sulfur dioxide and apparent temperature, we considered two relevancy functions for each variable with the linguistic approach: good and bad. For the output variable number of hospitalizations for asthma and pneumonia, we considered five relevancy functions: very low, low, medium, high and very high. DATASUS was our source for the number of hospitalizations in the year 2007 and the result provided by the model was correlated with the actual data of hospitalization with lag from zero to two days. The accuracy of the model was estimated by the ROC curve for each pollutant and in those lags. In the year of 2007, 1,710 hospitalizations by pneumonia and asthma were recorded in São José dos Campos, State of São Paulo, with a daily average of 4.9 hospitalizations (SD = 2.9). The model output data showed positive and significant correlation (r = 0.38) with the actual data; the accuracies evaluated for the model were higher for sulfur dioxide in lag 0 and 2 and for particulate matter in lag 1. Fuzzy modeling proved accurate for the pollutant exposure effects and hospitalization for pneumonia and asthma approach. Prever o número de internações por asma e pneumonia associadas à exposição a poluentes do ar no município em São José dos Campos, estado de São Paulo. Trata-se de um modelo computacional que utiliza a lógica fuzzy baseado na técnica de inferência de Mamdani. Para a fuzzificação das variáveis de entrada material particulado, ozônio, dióxido de enxofre e temperatura aparente foram consideradas duas funções de pertinência para cada variável com abordagem linguísticas: bom e ruim. Para a variável de saída número interna

  14. Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients.

    Science.gov (United States)

    Foglia, Elizabeth; Meier, Mary Dawn; Elward, Alexis

    2007-07-01

    Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection among pediatric intensive care unit (ICU) patients. Empiric therapy for VAP accounts for approximately 50% of antibiotic use in pediatric ICUs. VAP is associated with an excess of 3 days of mechanical ventilation among pediatric cardiothoracic surgery patients. The attributable mortality and excess length of ICU stay for patients with VAP have not been defined in matched case control studies. VAP is associated with an estimated $30,000 in attributable cost. Surveillance for VAP is complex and usually performed using clinical definitions established by the CDC. Invasive testing via bronchoalveolar lavage increases the sensitivity and specificity of the diagnosis. The pathogenesis in children is poorly understood, but several prospective cohort studies suggest that aspiration and immunodeficiency are risk factors. Educational interventions and efforts to improve adherence to hand hygiene for children have been associated with decreased VAP rates. Studies of antibiotic cycling in pediatric patients have not consistently shown this measure to prevent colonization with multidrug-resistant gram-negative rods. More consistent and precise approaches to the diagnosis of pediatric VAP are needed to better define the attributable morbidity and mortality, pathophysiology, and appropriate interventions to prevent this disease.

  15. Dysbiosis of upper respiratory tract microbiota in elderly pneumonia patients

    NARCIS (Netherlands)

    Piters, Wouter A. A. de Steenhuijsen; Huijskens, Elisabeth G. W.; Wyllie, Anne L.; Biesbroek, Giske; van den Bergh, Menno R.; Veenhoven, Reinier H.; Wang, Xinhui; Trzcinski, Krzysztof; Bonten, Marc J.; Rossen, John W. A.; Sanders, Elisabeth A. M.; Bogaert, Debby

    Bacterial pneumonia is a major cause of morbidity and mortality in elderly. We hypothesize that dysbiosis between regular residents of the upper respiratory tract (URT) microbiome, that is balance between commensals and potential pathogens, is involved in pathogen overgrowth and consequently

  16. Bilateral pulmonary nodules in an adult patient with bronchiolitis obliterans-organising pneumonia.

    Science.gov (United States)

    Kopanakis, Antonios; Golias, Christos; Pantentalakis, George; Patentalakis, Michalis; Mermigkis, Charalampos; Mermigkis, Christos; Charalabopoulos, Alexandros; Peschos, Dimitrios; Batistatou, Anna; Charalabopoulos, Konstantinos

    2009-01-01

    A 58-year-old male ex-smoker was admitted to hospital because of nodular infiltrates on chest x rays. He was complaining of fatigue, dyspnoea with exertion, low grade fever and weight loss. Physical examination was unremarkable. Bronchoscopy was inconclusive but revealed endobronchial lesions of chronic active inflammation. The diagnosis of cryptogenic organising pneumonitis bronchiolitis obliterans-organising pneumonia (COP-BOOP) was established by open lung biopsy. Proliferative bronchiolitis with regions of organising pneumonia is the characteristic feature of COP. The radiological picture of bilateral pulmonary nodules is an infrequent manifestation of COP. Lung biopsy, open or with video assistance thoracic surgery, is recommended to confirm the diagnosis.

  17. The outcome of Pneumocystis carinii pneumonia in Danish patients with AIDS

    DEFF Research Database (Denmark)

    Pedersen, C; Lundgren, Jens Dilling; Nielsen, T

    1989-01-01

    A total of 100 consecutive patients with AIDS were evaluated for efficacy and safety of treatment and secondary prophylaxis directed against Pneumocystis carinii pneumonia (PCP). 89 episodes of PCP were recorded in 75 patients. 63 of the 75 patients (84%) with a first episode of PCP were discharged...

  18. Association of Proton Pump Inhibitors Usage with Risk of Pneumonia in Dementia Patients.

    Science.gov (United States)

    Ho, Sai-Wai; Teng, Ying-Hock; Yang, Shun-Fa; Yeh, Han-Wei; Wang, Yu-Hsun; Chou, Ming-Chih; Yeh, Chao-Bin

    2017-07-01

    To determine the association between usages of proton pump inhibitors (PPIs) and subsequent risk of pneumonia in dementia patients. Retrospective cohort study. Taiwanese National Health Insurance Research Database. The study cohort consisted of 786 dementia patients with new PPI usage and 786 matched dementia patients without PPI usage. The study endpoint was defined as the occurrence of pneumonia. The Cox proportional hazard model was used to estimate the pneumonia risk. Defined daily dose methodology was applied to evaluate the cumulative and dose-response relationships of PPI. Incidence of pneumonia was higher among patients with PPI usage (adjusted hazard ratio (HR) = 1.89; 95% CI = 1.51-2.37). Cox model analysis also demonstrated that age (adjusted HR = 1.05; 95% CI = 1.03-1.06), male gender (adjusted HR = 1.57; 95% CI = 1.25-1.98), underlying cerebrovascular disease (adjusted HR = 1.30; 95% CI = 1.04-1.62), chronic pulmonary disease (adjusted HR = 1.39; 95% CI = 1.09-1.76), congestive heart failure (adjusted HR = 1.54; 95% CI = 1.11-2.13), diabetes mellitus (adjusted HR = 1.54; 95% CI = 1.22-1.95), and usage of antipsychotics (adjusted HR = 1.29; 95% CI = 1.03-1.61) were independent risk factors for pneumonia. However, usage of cholinesterase inhibitors and histamine receptor-2 antagonists were shown to decrease pneumonia risk. PPI usage in dementia patients is associated with an 89% increased risk of pneumonia. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  19. Post-inhaled corticosteroid pulmonary tuberculosis and pneumonia increases lung cancer in patients with COPD.

    Science.gov (United States)

    Wu, Ming-Fang; Jian, Zhi-Hong; Huang, Jing-Yang; Jan, Cheng-Feng; Nfor, Oswald Ndi; Jhang, Kai-Ming; Ku, Wen-Yuan; Ho, Chien-Chang; Lung, Chia-Chi; Pan, Hui-Hsien; Wu, Min-Chen; Liaw, Yung-Po

    2016-10-10

    Inhaled corticosteroids (ICS) have been associated with decreased lung cancer risk. However, they have been associated with pulmonary infections (tuberculosis [TB] and pneumonia) in patients with chronic obstructive pulmonary disease (COPD). TB and pneumonia have increased lung cancer risk. The association between post-ICS pulmonary infections and lung cancer remains unclear. We conducted a retrospective cohort study from 2003 to 2010 using the Taiwan National Health Insurance Research Database. Among the 1,089,955 patients with COPD, we identified 8813 new users of ICS prescribed for a period of 3 months or more and 35,252 non-ICS users who were randomly matched for sex, age and date of ICS use from 2003 to 2005. Cox proportional hazard regression was used to estimate the hazard ratio (HR) of pulmonary infections in patients with/without ICS use. The HRs for lung cancer in ICS users with sequential lung infections were as follows; 2.42 (95 % confidence interval [CI], 1.28-4.58) for individuals with TB, 2.37 (95 % CI, 1.01-5.54) for TB and pneumonia, and 1.17(95 % CI, 0.69-1.98) for those with pneumonia. For non-ICS users with pulmonary infections, the HRs were 1.68 (95 % CI, 0.78-3.65) for individual with TB and pneumonia, 1.42 (95 % CI, 0.89-2.26) for TB, and 0.95 (95 % CI, 0.62-1.46) for individuals with pneumonia. COPD patients with TB /or pneumonia who used ICS had increased risk of lung cancer. Because the overall prognosis of lung cancer remains poor, screening tests are recommended for patients with these conditions.

  20. Hospitalized Patients and Fungal Infections

    Science.gov (United States)

    ... are mild skin rashes, but others can be deadly, like fungal pneumonia. Because of this, it’s important ... the environment. Fungi live outdoors in soil, on plants, trees, and other vegetation. They are also on ...

  1. Pneumocystis carinii pneumonia, pulmonary tuberculosis and visceral leishmaniasis in an adult HIV negative patient

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Toledo Jr.

    Full Text Available This is a case report of a 29 year old male with pneumocystis pneumonia and tuberculosis, and who was initially suspected of having HIV infection, based on risk factor analyses, but was subsequently shown to be HIV negative. The patient arrived at the hospital with fever, cough, weight loss, loss of appetite, pallor, and arthralgia. In addition, he was jaundiced and had cervical lymphadenopathy and mild heptosplenomegaly. He had interstitial infiltrates of the lung, sputum smears positive for Mycobacterium tuberculosis and Pneumocystis carinii, and stool tests were positive for Strongyloides stercoralis and Schistosoma mansoni. He was diagnosed as having AIDS, and was treated for tuberculosis, pneumocystosis, and strongyloidiasis with a good response. The patient did not receive anti-retroviral therapy, pending outcome of the HIV tests. A month later, he was re-examined and found to have worsening hepatosplenomegaly, pancytopenia, fever, and continued weight loss. At this time, it was determined that his HIV ELISA antibody tests were negative. A bone marrow aspirate was done and revealed amastigotes of leishmania, and a bone marrow culture was positive for Leishmania species. He was treated with pentavalent antimony, 20 mg daily for 20 days, with complete remission of symptoms and weight gain. This case demonstrates that immunosuppression from leishmaniasis and tuberculosis may lead to pneumocystosis, and be misdiagnosed as HIV infection. The occurrence of opportunistic infections in severely ill patients without HIV must always be considered and alternate causes of immunosuppression sought.

  2. CT analysis of 40 patients with chronic type of idiopathic interstitial pneumonia from an air-polluted area

    International Nuclear Information System (INIS)

    Katagiri, Shiro; Ohshima, Kazunori; Fukushima, Kazuo; Kawabata, Yoshinori.

    1995-01-01

    We analyzed CT scans of 40 patients with chronic type of idiopathic interstitial pneumonia (IIP) who had admitted to our hospital in Kawasaki. All patients were diagnosed because of the presence of honeycombing. The characteristic findings were centrilobular emphysema and bulla. In addition to such common features of IIP multiple centrilobular nodular shadows were seen in about 60% of the patients. Considering that all patients had lived for more than 30 years in Kawasaki when air-pollution had been badly high in this area and that the majority of the patients (36 of 50) had been smokers we suspected that multiple nodules on CT might be due to long-term exposure to particular dusts including asbestos and that centrilobular emphysema might be due to smoking. (author)

  3. The impact of airborne particulate matter on pediatric hospital admissions for pneumonia among children in Jinan, China: A case-crossover study.

    Science.gov (United States)

    Lv, Chenguang; Wang, Xianfeng; Pang, Na; Wang, Lanzhong; Wang, Yuping; Xu, Tengfei; Zhang, Yu; Zhou, Tianran; Li, Wei

    2017-06-01

    This study aims to examine the effect of short-term changes in the concentration of particulate matter of diameter ≤2.5 µm (PM 2.5 ) and ≤10 µm (PM 10 ) on pediatric hospital admissions for pneumonia in Jinan, China. It explores confoundings factors of weather, season, and chemical pollutants. Information on pediatric hospital admissions for pneumonia in 2014 was extracted from the database of Jinan Qilu Hospital. The relative risk of pediatric hospital admissions for pneumonia was assessed using a case-crossover approach, controlling weather variables, day of the week, and seasonality. The single-pollutant model demonstrated that increased risk of pediatric hospital admissions for pneumonia was significantly associated with elevated PM 2.5 concentrations the day before hospital admission and elevated PM 10 concentrations 2 days before hospital admission. An increment of 10 μg/m 3 in PM 2.5 and PM 10 was correlated with a 6% (95% CI 1.02--1.10) and 4% (95% CI 1.00-1.08) rise in number of admissions for pneumonia, respectively. In two pollutant models, PM 2.5 and PM 10 remained significant after inclusion of sulfur dioxide or nitrogen dioxide but not carbon monoxide. This study demonstrated that short-term exposure to atmospheric particulate matter (PM 2.5 /PM 10 ) may be an important determinant of pediatric hospital admissions for pneumonia in Jinan, China. This study demonstrated that short-term exposure to atmospheric particulate matter (PM 2.5 /PM 10 ) may be an important determinant of pediatric hospital admissions for pneumonia in Jinan, China, and suggested the relevance of pollutant exposure levels and their effects. As a specific group, children are sensitive to airborne particulate matter. This study estimated the short-term effects attribute to other air pollutants to provide references for relevant studies.

  4. Radiological findings in three acquired immunodeficiency syndrome patients with Rhodococcus equi pneumonia

    International Nuclear Information System (INIS)

    Liu Jinxin; Tang Xiaoping; Zhang Lieguang

    2011-01-01

    Objective: To study the imaging appearances of Rhodococcus equi pneumonia in three patients with acquired immunodeficiency syndrome ( AIDS). Methods: Thoracic imaging appearances of' Rhodococcus equi pneumonia in three patients with AIDS were retrospectively analyzed. Results: The chest radiograph showed patchy consolidations and small nodules (n=3), large consolidations with multiple cavitations (n=2). CT showed large lobar or segmental consolidations with multiple cavitations (n=2), patchy consolidations (n=2), bronchiectasis (n=1), multiple small centrilobular nodules (n=2) and tree-in-bud patterns (n=2). Conclusion: The most common radiological findings in AIDS patients with Rhodococcus equi pulmonary infection are large consolidations with multiple cavitations and multiple centrilobular nodules. (authors)

  5. Clinical response and hospital costs associated with the empirical use of vancomycin and linezolid for hospital-acquired pneumonia in a Chinese tertiary care hospital: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Song Y

    2014-10-01

    Full Text Available Yuanlin Song,1,* Yicheng Yang,2,* Wendong Chen,3,4 Wei Liu,2 Kai Wang,2 Xuehai Li,5 Ke Wang,2 Manny Papadimitropoulos,3,6 William Montgomery7 1Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 2Lilly Suzhou Pharmaceutical Co, Ltd, Shanghai Branch, Shanghai, People's Republic of China; 3Division of Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, 4Normin Health, Toronto, ON, Canada; 5VitalStrategic Research Institute, Shanghai, People's Republic of China; 6Global Health Outcomes Research, Eli Lilly, Indianapolis, IN, USA; 7Eli Lilly Australia Pty Ltd, West Ryde, NSW, Australia *These authors contributed equally to this work Aims: To evaluate clinical outcomes and allocation of hospital costs associated with empirical use of vancomycin or linezolid for hospital-acquired pneumonia (HAP in the People's Republic of China. Methods: Hospital episodes including HAP treated by vancomycin or linezolid between 2008 and 2012 in a Chinese tertiary care hospital were retrospectively identified from hospital administrative databases. Propensity score methods created best-matched pairs for the antibiotics. The matched pairs were used for adjusted comparisons on clinical response and allocation of hospital costs. Multiple regression analyses adjusting residual imbalance after matching were performed to confirm adjusted comparisons. Results: Sixty matched pairs were created. Adjusted comparisons between vancomycin and linezolid showed similar clinical response rates (clinical cure: 30.0% versus 31.7%, respectively; P=0.847; treatment failure: 55.0% versus 45.0%, respectively; P=0.289 but a significantly lower in-hospital mortality rate for vancomycin (3.3% versus 18.3%, respectively; P=0.013. After further adjusting for the imbalanced variables between matched treatment groups, the risks of treatment failure associated with the two antibiotics were comparable (odds ratio: 1.139; P=0.308 and there was

  6. Effectiveness differences of ranitidine and omeprazole in prevention of stress ulcer and its effect on pneumonia occurrence and outcome of acute stroke patients

    Science.gov (United States)

    Batubara, C. A.; Ritarwan, K.; Rambe, A. S.

    2018-03-01

    Stress ulcer is one ofacute stroke complications. Giving ranitidine or omeprazole may prevent stress ulcer, but may increase the occurrence of pneumonia. Thus, it will affect the outcome of acute stroke. The method was experimental with a randomized control-group pretest - posttest design. This study divided the subjects into two groups, ranitidine 300mg and omeprazole 20mg group.We observed the patients whether stress ulcer or pneumonia occurred during hospitalization. Then, we measured the outcome by the National Institutes of Health Stroke Scaleand modified Rankin Scale. There were 32 subjects in this study. Only 1 (3.1%) subject suffered stress ulcer, and 3 (3.1%) suffered pneumonia in ranitidine group. Moreover, 2 (6.2%) subjects suffered pneumonia in omeprazole group. The differences were not significant between the two groups (p = 0.31 and p = 0.54). There was no significant effect and difference effect on the administration of both medications to the outcome at day 14. These results indicate that ranitidine and omeprazole have anequal effectiveness in the prevention of stress ulcer and also have equal effect on the occurrence of pneumonia, and both have no effect on the outcome of acute stroke patients.

  7. Risk and prognostic factors for pneumonia and choking amongst Parkinson's disease patients with dysphagia.

    Science.gov (United States)

    Goh, Kwang-Hwee; Acharyya, Sanchalika; Ng, Samuel Yong-Ern; Boo, Jasmine Pei-Ling; Kooi, Amanda Hui-Juan; Ng, Hwee-Lan; Li, Wei; Tay, Kay-Yaw; Au, Wing-Lok; Tan, Louis Chew-Seng

    2016-08-01

    To evaluate the time to hospitalisation and baseline factors associated with pneumonia/choking in Parkinson's Disease (PD) patients. Although dysphagia and pneumonia are common problems in PD, scarce research has been performed. A total of 194 PD patients who underwent a VFS evaluation were retrospectively selected. The mode of feeding and admissions for pneumonia/choking were analyzed. Baseline clinical and demographic variables were compared between feeding groups. Kaplan-Meier survival analysis was performed to estimate time to pneumonia/choking. Clinical variables significantly associated with pneumonia/choking free survival were identified using Cox regression. Hospitalisation for pneumonia/choking occurred in 89 out of 194 patients, with the highest admission rate in rejected enteral feeding group (66.7%), followed by enteral feeding (61.8%) and oral feeding (38.8%) groups. The estimates of median time to event were 11, 14, and 47 months for rejected enteral feeding, enteral and oral feeding groups respectively (log-rank test p < 0.001). The rejected enteral feeding group had the highest risk of pneumonia/choking (HR 4.61, 95%CI:2.33-9.08, p < 0.001), followed by enteral feeding group (HR 2.29, 95%CI:1.25-4.19, p = 0.007), when compared to oral feeding group after adjusting for possible confounders. A stepwise Cox regression showed that the rejected enteral feeding (HR 4.89, 95%CI:2.19-10.88, p < 0.001), enteral mode of feeding (HR 2.43, 95%CI:1.11-5.32, p = 0.026), and Charlson weighted index of co-morbidity (HR 1.27, 95%CI:1.03-1.58, p = 0.028) were independently associated with higher hazard of pneumonia/choking. Compliance to feeding recommendations is important to reduce the risk of hospitalisation for pneumonia/choking. The recommended mode of feeding and comorbidity index was significantly associated with pneumonia/choking risk. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Appropriateness of hospitalization for CAP-affected pediatric patients: report from a Southern Italy General Hospital

    Directory of Open Access Journals (Sweden)

    Antonelli Fabio

    2009-09-01

    Full Text Available Abstract Background Community-acquired pneumonia (CAP is a common disease, responsible for significant healthcare expenditures, mostly because of hospitalization. Many practice guidelines on CAP have been developed, including admission criteria, but a few on appropriate hospitalization in children. The aim of this study was to evaluate appropriate hospital admission for CAP in a pediatric population. Methods We evaluated appropriate admission to a Pediatric Unit performing a retrospective analysis on CAP admitted pediatric patients from a Southern Italy area. Diagnosis was made based on clinical and radiological signs. Appropriate hospital admission was evaluated following clinical and non-clinical international criteria. Family ability to care children was assessed by evaluating social deprivation status. Results In 2 winter seasons 120 pediatric patients aged 1-129 months were admitted because of CAP. Median age was 28.7 months. Raised body temperature was scored in 68.3% of patients, cough was present in 100% of cases, and abdominal pain was rarely evidenced. Inflammatory indices (ESR and CRP were found elevated in 33.3% of cases. Anti-Mycoplasma pneumoniae antibodies were found positive in 20.4%. Trans-cutaneous (TC SaO2 was found lower than 92% in 14.6%. Dyspnoea was present in 43.3%. Dehydration requiring i.v. fluid supplementation was scored in 13.3%. Evaluation of familial ability to care their children revealed that 76% of families (derived from socially depressed areas were "at social risk", thus not able to appropriately care their children. Furthermore, analysis of CAP patients revealed that "at social risk" people accessed E.D. and were hospitalized more frequently than "not at risk" patients (odds ratio = 3.59, 95% CI: 1,15 to 11,12; p = 0.01, and that admitted "at social risk" people presented without clinical signs of severity (namely dyspnoea, and/or SaO2 ≤ 92%, and/or dehydration more frequently than "not at risk" population

  9. A Nationwide Assessment of the Association of Smoking Bans and Cigarette Taxes With Hospitalizations for Acute Myocardial Infarction, Heart Failure, and Pneumonia.

    Science.gov (United States)

    Ho, Vivian; Ross, Joseph S; Steiner, Claudia A; Mandawat, Aditya; Short, Marah; Ku-Goto, Meei-Hsiang; Krumholz, Harlan M

    2017-12-01

    Multiple studies claim that public place smoking bans are associated with reductions in smoking-related hospitalization rates. No national study using complete hospitalization counts by area that accounts for contemporaneous controls including state cigarette taxes has been conducted. We examine the association between county-level smoking-related hospitalization rates and comprehensive smoking bans in 28 states from 2001 to 2008. Differences-in-differences analysis measures changes in hospitalization rates before versus after introducing bans in bars, restaurants, and workplaces, controlling for cigarette taxes, adjusting for local health and provider characteristics. Smoking bans were not associated with acute myocardial infarction or heart failure hospitalizations, but lowered pneumonia hospitalization rates for persons ages 60 to 74 years. Higher cigarette taxes were associated with lower heart failure hospitalizations for all ages and fewer pneumonia hospitalizations for adults aged 60 to 74. Previous studies may have overestimated the relation between smoking bans and hospitalizations and underestimated the effects of cigarette taxes.

  10. [Evolution of susceptibility to antibiotics of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumanii, in a University Hospital Center of Beirut between 2005 and 2009].

    Science.gov (United States)

    Hamouche, E; Sarkis, D K

    2012-06-01

    Until recently, multiresistant bacteria were only limited to hospitals. However, they are now responsible for community acquired infections, affecting people who have had no contact with the hospital environment. Several mechanisms are associated with these resistances. The production of betalactamases is however the predominant mechanism and especially the production of extended spectrum beta-lactamases or ESBL by strains of Escherichia coli and Klebsiella pneumoniae, which mediate resistance to third generation cephalosporins and aztreonam (AZT). The association of multiple mechanisms of resistance (efflux pumps, impermeability and enzymatic inactivation) generates multi resistant bacteria such as Pseudomonas aeruginosa MDR and Klebsiella pneumoniae MDR. The aim of the study was to analyze retrospectively the susceptibility to antibiotics of strains of E. coli, K. pneumoniae, P. aeruginosa and A. baumanii isolated from hospitalized and outpatients in a university hospital center of Beirut over a period of five years from 2005 to 2009. Bacterial strains were classified according to their origin (inpatients versus outpatients), their ability to produce or not ESBLs for E. coli and K. pneumonia and if they were MDR for P. aeruginosa and A. baumanii. Antibiotics susceptibilities were retrieved from the informatics database of the hospital. Comparison of susceptibility percentages was done using a unilateral z-test on a computer program. In 2009, 2541 strains of E. coli were isolated, 773 of which or 30.4 % were ESBL producers while 2031 strains were isolated in 2005, of which 361 or 17.8 % were ESBL producers (pproducing strains between 2007 and 2009: 33.4 % versus 30.4 % (p=0.03). Among 560 strains of K. pneumoniae isolated in 2009, 178 strains or 31.8 % were ESBL producers in comparison to 23.7 % of the strains isolated in 2005 (p=0.03). We also noticed a decrease in hospital strains susceptibility to piperacilline-tazobactam (TZP), cefotaxime (CTX

  11. Pneumocystis Pneumonia

    Science.gov (United States)

    ... among 16 patients after kidney transplantation. Journal of clinical microbiology 2008;46:966-71. Pifer LL, Hughes WT, ... diagnosis of Pneumocystis jirovecii pneumonia: a meta-analysis. Clinical microbiology and infection 2013;19:39-49. CDC. Pneumocystis ...

  12. Pneumocystis jirovecii pneumonia in patients with end-stage renal disease

    DEFF Research Database (Denmark)

    Leth, Steffen; Jensen-Fangel, Søren; Østergaard, Lars Jørgen

    2014-01-01

    Background: Data on occurrence and risk factors for pneumocystis pneumonia (PCP) in patients with end-stage renal disease (ESRD) are sparse. Methods: This was a nationwide population-based study assessing occurrence and risk factors for PCP among patients with ESRD and population controls over a 21...

  13. Nosocomial Pneumonia in Mechanically Ventilated Patients Receiving Ranitidine or Sucralfate as Stress Ulcer Prophylaxis

    Directory of Open Access Journals (Sweden)

    Smita Prakash

    2008-01-01

    We concluded that stress ulcer prophylaxis with ranitidine increases the risk for late- onset pneumonia in mechanically ventilated critically ill patients by favoring gastric colonization by gram- negative bacilli compared with sucralfate. In patients receiving mechanical ventilation, the use of sucralfate may be preferable to H 2 blockers.

  14. The Dysphagia in Stroke Protocol Reduces Aspiration Pneumonia in Patients with Dysphagia Following Acute Stroke: a Clinical Audit.

    Science.gov (United States)

    Perry, Sarah E; Miles, Anna; Fink, John N; Huckabee, Maggie-Lee

    2018-03-30

    Cough reflex testing has been evaluated as a component of the clinical swallowing assessment as a means of identifying patients at risk of aspiration during swallowing. A previous study by our research group found good sensitivity and specificity of the cough reflex test for identifying patients at risk of aspiration post-stroke, yet its use did not decrease pneumonia rates, contrary to previous reports. The aim of this study was to expand on our earlier work by implementing a clinical management protocol incorporating cough reflex testing within the same healthcare setting and compare patient outcomes to those from the original study and to evaluate clinical outcomes in patients with acute stroke who were managed using the Dysphagia in Stroke Protocol (DiSP). Secondarily, to compare those outcomes to historical data prior to implementation of the DiSP. This clinical audit measured outcomes from 284 patients with acute stroke managed per the DiSP, which guides use of videofluoroscopic swallowing study and patient management based on clinical exam with cough reflex testing. Data from our previous trial were included for comparison of pre- and post-DiSP patient outcomes. Data collection took place between November 2012 and April 2016 at four urban hospitals within New Zealand. Following implementation of the DiSP, the rate of aspiration pneumonia (10%) was substantially lower than the pre-DiSP rate (28%), with no pneumonia readmissions within 3 months. Pneumonia-related mortality was unchanged. By 3 months, 81% of the patients were on a normal diet and 67% had returned home, compared to pre-DiSP outcomes of 55% and 55% respectively. Previous work has suggested that simply implementing cough reflex testing in dysphagia management may not be sufficient to improve patient outcomes. The present study adds to this picture by suggesting that the true variable of influence may be the way in which the results of the test are applied to patient care. There is a strong case

  15. Factors predicting the outcomes of elderly hospitalized myasthenia gravis patients: a national database study

    Directory of Open Access Journals (Sweden)

    Tiamkao S

    2017-04-01

    Full Text Available Somsak Tiamkao,1,2 Sineenard Pranboon,3 Kaewjai Thepsuthammarat,4 Kittisak Sawanyawisuth1,5,6 1Department of Medicine, Faculty of Medicine, 2The Neuroscience Research and Development Group, 3Nursing Division, Srinagarind Hospital, 4Clinical Epidemiology Unit, Faculty of Medicine, 5Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH, 6Ambulatory Medicine Research Group, Khon Kaen University, Khon Kaen, Thailand Background: Myasthenia gravis (MG in elderly populations is increasing. This study aimed to evaluate predictors for treatment outcomes in elderly hospitalized MG patients using the national database. Methods: We collected data of elderly hospitalized MG patients from the National Health Security Office from October 2009 to September 2010. Predictors for treatment outcomes were examined. Results: During the study period, 1,948 identified MG patients were admitted to hospitals throughout Thailand. Of those, 441 patients (22.64% were aged ≥ 60 years. There were 66 patients (14.97% who had poor outcomes. There were only three significant factors in the final model. Presence of pneumonia, use of mechanical ventilators, and septicemia had adjusted odds ratios (95% confidence interval of 2.83 (1.03, 7.75, 5.33 (2.24, 12.72, and 4.47 (1.86, 10.75, respectively. Conclusion: Pneumonia, being on a mechanical ventilator, and septicemia were independent factors associated with poor treatment outcomes in elderly hospitalized MG patients according to national data. Keywords: pneumonia, ventilator, mortality, predictor 

  16. Differential microRNAs expression in serum of patients with lung cancer, pulmonary tuberculosis, and pneumonia.

    Science.gov (United States)

    Abd-El-Fattah, Amal A; Sadik, Nermin Abdel Hamid; Shaker, Olfat Gamil; Aboulftouh, Mariam Lotfy

    2013-01-01

    MicroRNAs (miRNAs) play critical regulatory roles in the physiological and pathological processes. The high stability of miRNAs in human serum represents attractive novel diagnostic biomarkers of clinical conditions. Several studies have shown that aberrant expression of miRNAs in human cancer including lung cancer, but little is known about their effects on some infectious lung diseases such as pulmonary tuberculosis (TB) and pneumonia. In this study, we investigated miRNA expression pattern in serum of Egyptian patients with lung cancer, TB, and pneumonia compared with matched healthy controls. Using microarray-based expression profiling followed by real-time quantitative polymerase chain reaction validation, we compared the levels of a series of circulating miRNAs (miR-21, miR-155, miR-182, and miR-197) in serum from patients with lung cancer (n = 65), pulmonary tuberculosis (n = 29), pneumonia (n = 29), and transudate (n = 16) compared with matched healthy controls (n = 37). MiRNA SNORD68 was the housekeeping endogenous control. We found that the serum levels of miR-21, miR-155, and miR-197 were significantly elevated in the patients with lung cancer and pneumonia whereas miR-182 and miR-197 levels were increased only in patients with lung cancer and TB, respectively, compared with controls. Receiver operating characteristic analysis revealed that miR-182, miR-155, and miR-197 have superior diagnostic potential in discriminating patients with lung cancer, pneumonia, and TB, respectively, from controls. Our results conclude that the differential expression of the four studied miRNAs can be potential non-invasive biomarkers for patients with lung cancer, TB and pneumonia.

  17. The Functional Dysphagia Scale Is a Useful Tool for Predicting Aspiration Pneumonia in Patients With Parkinson Disease.

    Science.gov (United States)

    Lee, Jong Hwa; Lee, Kyeong Woo; Kim, Sang Beom; Lee, Sook Joung; Chun, Sang Myung; Jung, Sung Moon

    2016-06-01

    To describe the correlation between the functional dysphagia scale and aspiration pneumonia and which characteristics influence the occurrence of aspiration pneumonia in patients with idiopathic Parkinson disease. Fifty-three patients with idiopathic Parkinson disease were prospectively evaluated in this study. Disease severity and functional status were measured by modified Hoehn and Yahr (H&Y) staging, Schwab and England activities of daily living (S-E ADL) scale and Korean version of Mini-Mental State Examination (K-MMSE). Swallowing function was evaluated by the functional dysphagia scale (FDS) and the penetration-aspiration scale (PAS) based on a videofluoroscopic swallowing study. The patients were followed up for 3 months and divided into two groups according to the occurrence of aspiration pneumonia. The correlation between the variables and aspiration pneumonia was analyzed. Eight patients of the 53 patients were allocated to the aspiration pneumonia group and 45 patients to the non-aspiration pneumonia group. The patients in the aspiration pneumonia group had significantly higher H&Y staging, and scored lower on S-E ADL scale and K-MMSE. The patients in the aspiration pneumonia group had significantly higher scores on FDS and PAS. A multiple logistic regression analysis showed that the S-E ADL scale and the FDS were associated with the occurrence of aspiration pneumonia in the patients with Parkinson disease. Given that the FDS can quantitatively assess the functional problems associated with dysphagia, it can be clinically effective in predicting the occurrence of aspiration pneumonia, and the FDS and the S-E ADL scale could be predictive variables for aspiration pneumonia in patients with Parkinson disease.

  18. Candida glabrata-pneumonia in a non-immuno-suppressed patient: Imaging by digital radiology and CT

    International Nuclear Information System (INIS)

    Bankier, A.; Fleischmann, D.; Wiesmayr, M.; Laczika, K.; Huebsch, P.

    1994-01-01

    Pneumonias caused by Candida glabrata are extremely rare and occur almost exclusively in immunocompromised patients. We report an atypical case of Candida glabrata pneumonia in a non-immunocompromised patient and describe the imaging findings on digital radiography and computed tomography. (orig.) [de

  19. Risk of pneumonia in patients with gastroesophageal reflux disease: A population-based cohort study.

    Directory of Open Access Journals (Sweden)

    Wan-Tseng Hsu

    Full Text Available The prevalence of gastroesophagel reflux disease (GERD has steadily increased. However, the association between GERD itself and the risk of pneumonia remains unclear. This study aimed to investigate the association between GERD and long-term risk of pneumonia and to identify the major risk factors for pneumonia in GERD patients.Using the Taiwan National Health Insurance Research Database, we identified patients who were newly diagnosed with GERD and treated with proton pump inhibitors (PPIs from January 1, 2004 through December 31, 2010. Two groups comprising 15,715 GERD cases and 15,715 non-GERD matched controls were generated using propensity score matching, thereby making the differences in basic demographics, concomitant medication use, and comorbidities between the two groups inconsiderable.Cumulative incidence of pneumonia was significantly higher in the patients with GERD than that in the non-GERD matched controls, with an adjusted HR of 1.48 (95% confidence interval [CI] = 1.31-1.67; P < 0.001 within 6-year follow-ups. Multivariate stratified analyses revealed similar results in many subgroups, with a highest risk in individuals younger than 40 years of age (HR = 2.17, 95% CI = 1.48-3.19. Crucially, patients with GERD using PPIs longer than 4 months were at a significantly increased risk of pneumonia than those who did not use PPIs or took PPIs less than 4 months.GERD was significantly associated with long-term risk of pneumonia, especially in GERD with PPI use longer than 4 months or in the young population. Further prospective longitudinal studies should be conducted for validation and implementing clinical practice guidelines.

  20. Mycoplasmal pneumonia in children

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, H.; Lengerke, H.J. v.

    1987-10-01

    Roentgenographic findings of bilateral interstitial pneumonia without segmental consolidation and with regional lymphadenitis, which occurs after infancy, are always suggestive of pneumonia from Mycoplasma pneumoniae, as this is one of the most frequent types of pneumonia in children. M. pneumonia can be presumed by the discrepancy between the extensive roentgenographic findings and the generally good condition of the patient. Before therapy is decided upon it is important to know what the etiology is.

  1. [Satisfaction of hospitalized patients in a hospital in Apurimac, Peru].

    Science.gov (United States)

    Sihuin-Tapia, Elsa Yudy; Gómez-Quispe, Oscar Elisban; Ibáñez-Quispe, Vladimiro

    2015-01-01

    In order to determine the satisfaction of hospitalized patients in the Sub-regional Hospital of Andahuaylas, 175 patients were surveyed using the Servqual multidimensional model. The estimate of variables associated with the satisfaction of the hospitalized patients was performed by using bivariate and multivariate logistic regression analysis. We found 25.0% satisfaction. Lower levels of satisfaction were associated with having a secondary level education (aOR: 0.05; 95% CI: 0.01 to 0.64) and with having been hospitalized in the surgery department (aOR 0.14, CI: 95%: 0.04 to 0.53). It was concluded that there was a low level of satisfaction with the quality of care received by hospitalized patients and this was associated with the level of education and type of hospital department.

  2. Autopsy-proven causes of death in lungs of patients immunocompromised by secondary interstitial pneumonia Causas de óbito por pneumonia intersticial secundária em autópsias pulmonares de pacientes imunocomprometidos

    Directory of Open Access Journals (Sweden)

    Alberto Antonio Terrabuio Junior

    2007-02-01

    Full Text Available PURPOSE: To present the more frequent associations found in autopsies of immunocompromised patients who developed secondary interstitial pneumonia as well as the risk of death (odds ratio in having specific secondary interstitial pneumonia according to the cause of immunocompromise. METHOD: From January 1994 to March 2004, 17,000 autopsies were performed at Hospital das Clínicas, São Paulo University Medical School. After examining the pathology report review, we selected 558 of these autopsies (3.28% from patients aged 15 years or more with primary underlying diseases who developed radiologically diffuse infiltrates of the lung during their hospital course and died after secondary interstitial pneumonia (bronchopneumonia, lobar pneumonia, interstitial pneumonia, diffuse alveolar damage, pulmonary recurrence of underlying disease, drug-induced lung disease, cardiogenic pulmonary edema, or pulmonary embolism. Histology slides were reviewed by experienced pathologists to confirm or not the presence of secondary interstitial pneumonia. Statistical analysis included the Fisher exact test to verify any association between histopathology and the cause of immunocompromise; a logistic regression was used to predict the risk of death for specific histological findings for each of the independent variables in the model. RESULTS: Secondary interstitial pneumonia was histologically represented by diffuse interstitial pneumonitis ranging from mild nonspecific findings (n = 213 to a pattern of diffuse alveolar damage (n = 273. The principal causes of immunocompromise in patients with diffuse alveolar damage were sepsis (136 cases, neoplasia (113 cases, diabetes mellitus (37 cases, and transplantation (48 cases. A high risk of death by pulmonary edema was found for patients with carcinoma of colon. Similarly, in patients with lung cancer or cachexia, A high risk of death by bronchopneumonia (OR = 3.6; OR = 2.6, respectively was found. Pulmonary

  3. Predictors of mortality in patients with extensively drug-resistant Acinetobacter baumannii pneumonia receiving colistin therapy.

    Science.gov (United States)

    Choi, Ik Sung; Lee, Yu Ji; Wi, Yu Mi; Kwan, Byung Soo; Jung, Kae Hwa; Hong, Woong Pyo; Kim, June Myong

    2016-08-01

    The ratio of the area under the free (unbound) concentration-time curve to minimum inhibitory concentration (fAUC/MIC) was proposed to be the pharmacokinetic/pharmacodynamic index most strongly linked to the antibacterial effect of colistin against Acinetobacter baumannii. A retrospective study of patients who received colistin to treat pneumonia caused by extensively drug-resistant (XDR) A. baumannii over a 4-year period was performed to assess the impact of the colistin MIC on mortality. A total of 227 patients were included in the analysis. The 7-day and 14-day mortality rates of patients with XDR A. baumannii pneumonia receiving colistin therapy were 15.0% and 23.8%, respectively. In the multivariate analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, days from index culture to first dose of colistin, underlying tumour and septic shock at presentation were independent predictors of mortality in patients with XDR A. baumannii pneumonia receiving colistin therapy. In the univariate analysis, the colistin dose based on ideal body weight (IBW) correlated with patient outcome. Therefore, the use of IBW appeared to be more appropriate to calculate the colistin dosage. In addition, these results highlight the clinical significance of colistin MIC in patients with XDR A. baumannii pneumonia receiving colistin therapy. Although MICs were in the 'susceptible' range, patients infected with isolates with high colistin MICs showed a poorer clinical response rate than patients infected with isolates with low colistin MICs. Further clinical studies are needed to evaluate the roles of colistin MIC for predicting mortality in XDR A. baumannii pneumonia with a high colistin MIC. Copyright © 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  4. Pneumonia risk in asthma patients using inhaled corticosteroids: a quasi-cohort study.

    Science.gov (United States)

    Qian, Christina J; Coulombe, Janie; Suissa, Samy; Ernst, Pierre

    2017-09-01

    Studies have linked the use of inhaled corticosteroids (ICSs) to excess pneumonia risk in chronic obstructive pulmonary disease patients. The risk in