Pneumonia最新文献

Background: The diagnostic performance of the BioFire® FilmArray® Pneumonia Panel Plus (FAPP) compared to standard microbial culture (SMC) during bronchiectasis (BE) exacerbations is unknown.

Objective: To compare the microbiological diagnostic performance between FAPP and SMC during BE exacerbations.

Study design and methods: A prospective observational study was conducted in adults with a BE exacerbation at the Hospital Clinic of Barcelona (Spain) June 2020 to April 2022. All sputum samples underwent processing using both the FAPP and SMC (n = 109) but we focused in good quality samples (n = 73).

Results: The FAPP detected pathogens in a higher percentage (n = 64, 88%) compared to SMC (n = 41, 56%). This increase was higher in samples from patients receiving empiric antibiotic treatment (n = 24, 89% and n = 10, 37%, for FAPP and SMC, respectively). The FAPP identified in 29 sputum (40%) more than one microorganism, while by SMC were all monomicrobial (n = 73, 100%). In 93 out of 109 BE exacerbations (85%), clinicians used the FAPP results for treatment decisions. According to the pathogen found by FAPP, immediate change of empiric treatment occurred in 15 out of 38 patients (40%) receiving empiric antimicrobial at time of exacerbation. Early treatment adequacy likely contributed to the low rate of treatment modifications observed by day 5 of exacerbation when the overall rate of treatment changes was low (8%) and treatment failure was noted in only 2% of the total population.

Conclusion: The FAPP demonstrated significantly higher microbiological diagnostic performance compared to SMC, regardless of prior antibiotic exposure. Improved pathogen detection using FAPP enabled more accurate initial antimicrobial therapy, which was associated with low rates of treatment failure.

Background: The 2019 American Thoracic Society and Infectious Diseases Society of America community acquired pneumonia guidelines recommend empiric coverage of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa based on previous respiratory isolation, recent IV antibiotic use, and locally validated risk factors. This study aims to describe how local risk factors may be determined efficiently using data retrieved electronically.

Methods: This retrospective cohort study focused on the time period May 13, 2020, through June 30, 2024. Consecutive adults admitted to one of five acute care facilities with confirmed community-acquired pneumonia were included. Community-acquired pneumonia was defined as the presence of one or more pneumonia diagnosis codes and an order for a respiratory culture or an antimicrobial with the indication of pneumonia or sepsis, 24 h before or within 48 h after the date and time of admission. Patients were excluded if they had a diagnosis code for hospital-acquired or ventilator-associated pneumonia, any subsequent admission in the study period, or if they had a previous respiratory culture positive for methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa within a year of admission. The causative pathogen and the presence or absence of evaluated risk factors were electronically abstracted from billing data and health records. Serial quality assessments of electronic data were performed to improve accuracy until a well validated population was determined.

Results: There were 4,558 unique patients included. Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa rates were 0.6% and 0.7%, respectively. Only age was inversely associated with risk of methicillin-resistant Staphylococcus aureus (OR = 0.86, 95% CI: 0.76-0.98). No significant risk factors for Pseudomonas aeruginosa were found.

Conclusions: In rural or otherwise resource limited healthcare settings, risk factors for methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa community-acquired pneumonia may be determined using only electronic data capture and the methodology described in this article.

Introduction: COVID-19 severely impacted global health, especially older adults and those with comorbidities. Immunosuppressed patients are at high risk for severe outcomes, yet studies yield conflicting mortality rates for this group. This study examines the clinical characteristics and outcomes of immunosuppressed (IS) versus non-immunosuppressed (nIS) patients with COVID-19 in ICUs.

Methods: A multicenter, observational case-control study included 5,824 ICU patients with COVID-19 from the CIBERESUCICOVID study. Patients were categorized as IS or nIS based on history of transplantation, HIV, active neoplasia, and use of immunosuppressive drugs or corticosteroids. The primary outcome was 90-day mortality; secondary outcomes included in-hospital, 15-day, 30-day and 1-year mortality, ICU-free days, ventilator-free days, and hospital length of stay. Subgroup analyses examined vaccination status and tocilizumab treatment. Propensity score (PS) matching was used to obtain balance among the baseline variables in the two groups.

Results: IS patients (n = 689, 11.8%) were older, had more comorbidities, and higher APACHE-II scores. After PS matching, IS patients had higher 90-day mortality (39 vs. 33%; HR 1.30, 95% CI 1.04 to 1.62), as well as higher in-hospital (37 vs. 29%; sHR 1.35, 95% CI 1.08 to 1.69), 30-day (28 vs 23%; HR 1.31, 95% CI 1.01 to 1.69) and 1-year mortality (45 vs. 38%; HR 1.26, 95% CI 1.02 to 1.57). Among IS patients, transplant recipients had significantly higher 90-day mortality after matching (HR 4.45, 95% CI 1.46 to 13.58). Vaccinated IS patients showed higher mortality than vaccinated nIS patients, though differences were not significant after PS matching. Tocilizumab treatment in IS patients was associated with reduced mortality; multivariable analysis confirmed a significant decrease in in-hospital mortality (sHR 0.56, 95% CI 0.42 to 0.76).

Conclusion: Critical immunosuppressed patients with COVID-19 have higher mortality, particularly transplant recipients. Tocilizumab shows potential benefits for IS patients. These findings highlight the need for tailored therapeutic strategies for immunosuppressed individuals with severe COVID-19. Further research is needed to confirm these results in the current clinical context.

Background: Streptococcus pneumoniae is an important cause of pneumonia in older adults, however, serotyping and indirect impact information from low and middle-income countries is lacking. Mongolia has a childhood 13-valent pneumococcal conjugate vaccine (PCV13) program, but no adult pneumococcal vaccination program. We describe pneumococcal carriage rates, disease and serotype distribution among adults hospitalised with pneumonia, and explore changes over the COVID-19 pandemic period.

Methods: Adults (≥ 18 years) hospitalised with clinical pneumonia were enrolled over 3 years (March 2019-February 2022) into a prospective pneumonia surveillance program. Nasopharyngeal swabs were tested to detect pneumococci using lytA qPCR and molecular serotyping by DNA microarray and metagenomics. Pneumococcal pneumonia was identified using serotype-specific urinary antigen detection and BinaxNOW^® assays. Pneumococcal carriage and pneumonia prevalence were assessed over the COVID-19 period with log-binomial regression used to estimate prevalence and adjusted prevalence ratios (pre- versus early- and late-COVID-19 periods).

Results: Of 3,178 pneumonia cases, S. pneumoniae was identified in 12.1% (333/2,759) of swabs and 8.6% (253/2,925) of urine samples. PCV13 serotype carriage prevalence was 3.1% (82/2,663) and non-PCV13 serotype carriage prevalence 5.7% (152/2,663). In the late-COVID-19 period, pneumococcal carriage prevalence was reduced by 66% (aPR 0.34, 95%CI 0.25-0.46) and pneumococcal pneumonia by 82% (aPR 0.18, 95%CI 0.12-0.27) compared with the pre-COVID-19 transmission period.

Conclusion: Despite paediatric vaccination with high coverage, we identified some residual PCV13 serotypes with predominance of non-PCV13 serotypes carried and causing disease in adults. Direct adult vaccination which targets these serotypes will potentially reduce disease in adults in Mongolia.