Pub Date : 2020-05-01DOI: 10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2141
Shuhei Ideguchi, Kazuko Yamamoto, Masahiro Tahara, T. Takazono, Tomomi Saijo, Y. Imamura, Teiichiro Miyazaki, N. Sakamoto, K. Izumikawa, K. Yanagihara, K. Yatera, H. Mukae
{"title":"Pneumonia in Patients with Rheumatoid Arthritis: Impact of Microbial Airway Colonisation","authors":"Shuhei Ideguchi, Kazuko Yamamoto, Masahiro Tahara, T. Takazono, Tomomi Saijo, Y. Imamura, Teiichiro Miyazaki, N. Sakamoto, K. Izumikawa, K. Yanagihara, K. Yatera, H. Mukae","doi":"10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2141","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2141","url":null,"abstract":"","PeriodicalId":143194,"journal":{"name":"A59. CLINICAL DIAGNOSIS, PREDICTION AND OUTCOMES OF LUNG INFECTIONS","volume":"57 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141207915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-01DOI: 10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2159
R. M. ndez, I. A. Elori, P. González-Jiménez, L. Feced, Leyre Bouzas, S. Reyes, R. Amaro, V. Alcaraz, G. Scioscia, L. Fernández, A. Torres, R. Menéndez
{"title":"Acute and Sustained IL-17a Response in Bronchiectasis Exacerbations as Marker of Chronic Inflammation","authors":"R. M. ndez, I. A. Elori, P. González-Jiménez, L. Feced, Leyre Bouzas, S. Reyes, R. Amaro, V. Alcaraz, G. Scioscia, L. Fernández, A. Torres, R. Menéndez","doi":"10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2159","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2159","url":null,"abstract":"","PeriodicalId":143194,"journal":{"name":"A59. CLINICAL DIAGNOSIS, PREDICTION AND OUTCOMES OF LUNG INFECTIONS","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116295685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-01DOI: 10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2129
P. Ekren, Burcu Uysaler, Nur Toreyin, S. Aydemir, H. Pullukçu, A. Sayıner, F. Bacakoğlu
{"title":"Risk Factors for Ventilator-Associated Pneumonia Caused by MRSA in a Respiratory Intensive Care Unit","authors":"P. Ekren, Burcu Uysaler, Nur Toreyin, S. Aydemir, H. Pullukçu, A. Sayıner, F. Bacakoğlu","doi":"10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2129","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2129","url":null,"abstract":"","PeriodicalId":143194,"journal":{"name":"A59. CLINICAL DIAGNOSIS, PREDICTION AND OUTCOMES OF LUNG INFECTIONS","volume":"98 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141208674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-01DOI: 10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2130
M. Villalobos, R. Zotomayor, A. Gerodias, A. Reyes
RATIONALE Drug resistance in pneumonia (DRIP) score, among other prediction models, performed significantly better in detecting the risk of pneumonia due to drug-resistant pathogens (DRP). The use of this clinical prediction score may have the potential to decrease the use of unwarranted extended spectrum antibiotics in patients with low risk of pneumonia due to DRP. Furthermore, It can likewise select patients who will benefit from broad-spectrum antibiotics as initial therapy for patients with high risk of community acquired pneumonia due to DRP (CAPDRP). This study was initiated to validate its efficiency in the local setting. METHODS This is a single center cross-sectional study. Adult Filipino patients aged 18 years and above who were clinically diagnosed with CAP were included. DRIP score was performed within 48 hours of admission to patients admitted for CAP. A score of <4 was classified as low risk and a score of ≥ 4 was classified as high risk. Confirmation of the presence of DRP was done through review of microbiologic cultures. RESULTS A total of 195 patients were included. DRIP score identified patients at high or low risk of pneumonia due to DRP with a sensitivity of 62.1 (95% CI, 48.4 to 74.5), a specificity of 81% (95% CI, 73.4 to 87.2), a positive predictive value of 58.1% (95% CI, 44.8 to 70.5), and a negative predictive value of 83.5% (95% CI, 76, 89.4). The prevalence of pneumonia due to DRP was 29.7%. Pseudomonas aeruginosa was identified in 15 (7.14%) of patients and was the most common isolated DRP. Tube feeding (OR 5.24), prior infection with DRP (OR 4.47), and hospitalization within previous 60 days (OR 2.52) were identified to be the strongest risk factors associated with pneumonia due to DRP. A modified DRIP score (mDRIP) was derived by eliminating one of the major risk factors, which is residence in a long-term care facility. mDRIP has a sensitivity of 62.07%, specificity of 82.02%, positive likelihood ratio of 3.27 and negative likelihood ratio of 0.47. CONCLUSION This prospective study validated the performance of DRIP score in predicting pneumonia due to DRP. DRIP Score, as well as the modified DRIP score (mDRIP), are valuable prediction models that can be used in the local setting to possibly lessen unnecessary use and therefore preserve the utilization of broadspectrum antibiotics among low risk patients. Future studies are necessary to establish definitive benefit on patient outcome measures.
{"title":"Validation Study of the Drug Resistance in Pneumonia (DRIP) Score in Predicting the Risk of Drug-Resistant Pathogens Among Patients with Pneumonia: A Single Center Cross-Sectional Study","authors":"M. Villalobos, R. Zotomayor, A. Gerodias, A. Reyes","doi":"10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2130","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2130","url":null,"abstract":"RATIONALE Drug resistance in pneumonia (DRIP) score, among other prediction models, performed significantly better in detecting the risk of pneumonia due to drug-resistant pathogens (DRP). The use of this clinical prediction score may have the potential to decrease the use of unwarranted extended spectrum antibiotics in patients with low risk of pneumonia due to DRP. Furthermore, It can likewise select patients who will benefit from broad-spectrum antibiotics as initial therapy for patients with high risk of community acquired pneumonia due to DRP (CAPDRP). This study was initiated to validate its efficiency in the local setting. METHODS This is a single center cross-sectional study. Adult Filipino patients aged 18 years and above who were clinically diagnosed with CAP were included. DRIP score was performed within 48 hours of admission to patients admitted for CAP. A score of <4 was classified as low risk and a score of ≥ 4 was classified as high risk. Confirmation of the presence of DRP was done through review of microbiologic cultures. RESULTS A total of 195 patients were included. DRIP score identified patients at high or low risk of pneumonia due to DRP with a sensitivity of 62.1 (95% CI, 48.4 to 74.5), a specificity of 81% (95% CI, 73.4 to 87.2), a positive predictive value of 58.1% (95% CI, 44.8 to 70.5), and a negative predictive value of 83.5% (95% CI, 76, 89.4). The prevalence of pneumonia due to DRP was 29.7%. Pseudomonas aeruginosa was identified in 15 (7.14%) of patients and was the most common isolated DRP. Tube feeding (OR 5.24), prior infection with DRP (OR 4.47), and hospitalization within previous 60 days (OR 2.52) were identified to be the strongest risk factors associated with pneumonia due to DRP. A modified DRIP score (mDRIP) was derived by eliminating one of the major risk factors, which is residence in a long-term care facility. mDRIP has a sensitivity of 62.07%, specificity of 82.02%, positive likelihood ratio of 3.27 and negative likelihood ratio of 0.47. CONCLUSION This prospective study validated the performance of DRIP score in predicting pneumonia due to DRP. DRIP Score, as well as the modified DRIP score (mDRIP), are valuable prediction models that can be used in the local setting to possibly lessen unnecessary use and therefore preserve the utilization of broadspectrum antibiotics among low risk patients. Future studies are necessary to establish definitive benefit on patient outcome measures.","PeriodicalId":143194,"journal":{"name":"A59. CLINICAL DIAGNOSIS, PREDICTION AND OUTCOMES OF LUNG INFECTIONS","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131223659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-09DOI: 10.21203/rs.3.rs-16306/v1
Jianhua Liu, Jinrong Liu, Bei Wang, Yajing Liu, Chen Zhao, F. Zhao, Jianzhong Zhang, Shunying Zhao
Background Unresolved atelectasis occurs in some children with refractory mycoplasma pneumoniae pneumonia (RMPP). The aim was to analyze factors predicting unresolved atelectasis in RMPP and the impact of corticosteroids and bronchoscopy lavage therapy (BLT) on developing atelectasis.Methods We retrospectively analyzed data for 230 pediatric RMPP from January 2013 to June 2017 in Beijing Children’s Hospital. In this study, we diagnosed RMPP when patients' clinical and radiological findings deteriorated after 7 days of macrolide therapy, peripheral blood C-reactive protein (CRP) was higher than 40mg/L, and chest imaging showed consolidation with high density > 1/2 pulmonary lobe. We divided patients into two groups according to the presence/absence of atelectasis on chest imaging after a 6-month follow-up. We calculated the predictive value of fever duration, levels of CRP and lactate dehydrogenase (LDH), and the size of lobe consolidation, regarding atelectasis. Additionally, we compared the starting time and dosage of corticosteroids and the starting time of BLT between the two groups.Results Ninety-five patients developed atelectasis (atelectasis group/group A), and 135 patients did not (non-atelectasis group/group NA). Chest imaging showed > 2/3 pulmonary lobe consolidation in 93.7% of patients in group A and 54.1% of patients in group NA. Multiple logistic regression analysis showed that fever duration, CRP and LDH levels, and lobe consolidation were related to developing atelectasis. Areas under the curve revealed that CRP ≥ 137 mg/L had 82.11% sensitivity and 80.07% specificity, and LDH ≥ 471 IU/L had 62.65% sensitivity and 60.31% specificity to predict atelectasis. Fewer patients receiving corticosteroids and BLT within 10 days after illness onset developed atelectasis.Conclusions Fever duration>10 days, CRP and LDH levels, and lobe consolidation are risk factors for developing atelectasis in RMPP. CRP ≥ 137 mg/L, LDH ≥ 471 IU/L, and >2/3 pulmonary lobe consolidation were significant predictors of atelectasis, which can aid in early recognition. Corticosteroid administration and subsequent BLT within 10 days of the disease onset, and increased corticosteroid dosage may help reduce the incidence of atelectasis in these RMPP patients.
{"title":"Unresolved Atelectasis in Refractory Mycoplasma Pneumoniae Pneumonia: Predictive Factors and the Influence of Corticosteroids and Bronchoscopy Lavage Therapy","authors":"Jianhua Liu, Jinrong Liu, Bei Wang, Yajing Liu, Chen Zhao, F. Zhao, Jianzhong Zhang, Shunying Zhao","doi":"10.21203/rs.3.rs-16306/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-16306/v1","url":null,"abstract":"\u0000 Background Unresolved atelectasis occurs in some children with refractory mycoplasma pneumoniae pneumonia (RMPP). The aim was to analyze factors predicting unresolved atelectasis in RMPP and the impact of corticosteroids and bronchoscopy lavage therapy (BLT) on developing atelectasis.Methods We retrospectively analyzed data for 230 pediatric RMPP from January 2013 to June 2017 in Beijing Children’s Hospital. In this study, we diagnosed RMPP when patients' clinical and radiological findings deteriorated after 7 days of macrolide therapy, peripheral blood C-reactive protein (CRP) was higher than 40mg/L, and chest imaging showed consolidation with high density > 1/2 pulmonary lobe. We divided patients into two groups according to the presence/absence of atelectasis on chest imaging after a 6-month follow-up. We calculated the predictive value of fever duration, levels of CRP and lactate dehydrogenase (LDH), and the size of lobe consolidation, regarding atelectasis. Additionally, we compared the starting time and dosage of corticosteroids and the starting time of BLT between the two groups.Results Ninety-five patients developed atelectasis (atelectasis group/group A), and 135 patients did not (non-atelectasis group/group NA). Chest imaging showed > 2/3 pulmonary lobe consolidation in 93.7% of patients in group A and 54.1% of patients in group NA. Multiple logistic regression analysis showed that fever duration, CRP and LDH levels, and lobe consolidation were related to developing atelectasis. Areas under the curve revealed that CRP ≥ 137 mg/L had 82.11% sensitivity and 80.07% specificity, and LDH ≥ 471 IU/L had 62.65% sensitivity and 60.31% specificity to predict atelectasis. Fewer patients receiving corticosteroids and BLT within 10 days after illness onset developed atelectasis.Conclusions Fever duration>10 days, CRP and LDH levels, and lobe consolidation are risk factors for developing atelectasis in RMPP. CRP ≥ 137 mg/L, LDH ≥ 471 IU/L, and >2/3 pulmonary lobe consolidation were significant predictors of atelectasis, which can aid in early recognition. Corticosteroid administration and subsequent BLT within 10 days of the disease onset, and increased corticosteroid dosage may help reduce the incidence of atelectasis in these RMPP patients.","PeriodicalId":143194,"journal":{"name":"A59. CLINICAL DIAGNOSIS, PREDICTION AND OUTCOMES OF LUNG INFECTIONS","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117215224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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