The University of Louisville journal of respiratory infections最新文献

{"title":"Effectiveness of the Influenza Vaccine in Preventing Hospitalizations of Patients\u0000 with Influenza Community-Acquired Pneumonia","authors":"T. Chandler, S. Furmanek, Connor English, Connor Glick, Wesley Trail, Lara Daniels, U. Owolabi, R. Carrico, J. Ramirez, T. Wiemken","doi":"10.18297/JRI/VOL2/ISS1/6","DOIUrl":"https://doi.org/10.18297/JRI/VOL2/ISS1/6","url":null,"abstract":"Introduction: Influenza vaccination is the primary strategy for prevention of influenza infection. Influenza infection can vary from mild or even asymptomatic illness to severe community-acquired pneumonia (CAP). Although many national and international investigators and organizations report annual estimates of influenza vaccine effectiveness for prevention of influenza infection in the community, few studies report estimates for the prevention of hospitalizations due to influenza CAP, the most severe form of the infection. The objective of this study is to determine the effectiveness of the influenza vaccine for prevention of hospitalization in patients with influenza-associated CAP. Methods: This was a test-negative study using data from the first two years of the University of Louisville Pneumonia Study, a prospective, observational study of all hospitalized patients with pneumonia in Louisville, Kentucky from 6/1/2014 – 5/31/2016. Univariate and multivariate logistic models were used to evaluate the association between vaccine status and influenza-associated/noninfluenza-associated CAP hospitalization. Unadjusted and adjusted vaccine effectiveness estimates were calculated. Results: A total of 1951 hospitalized patients with CAP were included in the analysis, and 831 (43%) reported having received the influenza vaccination for the influenza season by the time they were hospitalized. A total of 152 (8%) cases of influenza-CAP were confirmed in the study population, with 63 (8%) cases confirmed in vaccinated individuals. The unadjusted vaccine effectiveness was not significant, with a point estimate of 5% (95% CI: -33%, 32%). After adjusting for potential cofounders, vaccine effectiveness was also found to not be significant with a point estimate of 8% (95% CI: -30%, 35%). Conclusions: In conclusion, we found that, over the 2014/2015 and 2015/2016 influenza seasons, influenza vaccine was not effective for prevention of hospitalization with CAP due to influenza. More effective vaccines are necessary to prevent the most serious forms of influenza. DOI: 10.18297/jri/vol2/iss1/6 Received Date: February 12, 2018 Accepted Date: February 27, 2018 Website: https://ir.library.louisville.edu/jri Affiliations: 1University of Louisville Division of Infectious Diseases, Louisville, KY 40202 2University of Louisville School of Public Health and Information Sciences Department of Epidemiology and Population Health, Louisville, KY 40202 ©2018, The Author(s). *Correspondence To: Thomas R Chandler Work: Address: Division of Infectious Diseases, University of Louisville Work Email: thomas.chandler@louisville.edu 26 ULJRI Vol 2, (1) 2018 ORIGINAL RESEARCH The objective of this study is to determine the effectiveness of the influenza vaccine for prevention of hospitalization in patients with influenza-CAP and to determine how well the estimated effectiveness in the general population estimates the effectiveness in hospitalized patients with CAP.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88704937","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}

{"title":"Real-Time PCR Detection of Mycoplasma pneumoniae, Chlamydia pneumoniae and\u0000 Legionella pneumophila in Respiratory Specimens Using the ARIES® System","authors":"Subathra Marimuthu, L. Wolf, J. Summersgill","doi":"10.18297/jri/vol2/iss1/3/","DOIUrl":"https://doi.org/10.18297/jri/vol2/iss1/3/","url":null,"abstract":"Background: Mycoplasma pneumoniae (Mpn), Chlamydia pneumoniae (Cpn), and Legionella pneumophila (Lpn) can cause both epidemic and endemic occurrences of acute respiratory disease and are responsible for up to 22% of cases of community acquired pneumonia. Due to the limited availability of FDA-approved molecular diagnostic assays, we developed and evaluated a multiplexed Real-time PCR assay for the detection of these agents in two respiratory specimen types on the Luminex ARIES ® instrument. The instrument provides for nucleic acid extraction plus PCR amplification and target detection in the same cassette. The ARIES ® instrument generates a cycle threshold value and a confirmatory melt curve value for each reaction, including results for an internal sample processing control. The limit of detection for Mpn, Cpn and Lpn, was 100 CFU/ mL, 1000 CFU/mL and 100 CFU/mL, respectively. In addition, accuracy, precision, specificity and stability studies were conducted to validate the assay for diagnostic use. Between November 2016 and June 2017, a total of 836 patient specimens were processed in our reference laboratory, with six positive Mpn and two positive Lpn. No specimens were positive for Cpn during this time period. The availability of a robust multiplex PCR assay greatly enhances the ability to rapidly diagnose infections caused by these three agents causing atypical pneumonia.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87250736","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}

{"title":"Communication between Clinicians and the Hospital-based Microbiology Laboratory:\u0000 Strategies for 2018 and Beyond","authors":"Hans H. Liu","doi":"10.18297/JRI/VOL2/ISS1/2","DOIUrl":"https://doi.org/10.18297/JRI/VOL2/ISS1/2","url":null,"abstract":"Treatment of infections in the hospital poses some unique issues in comparison with treatment of other equally sick inpatients without infections. The diversity of potential pathogens for a given infected site (e.g., pneumonia) and the changing spectrum of antimicrobial susceptibilities are variables generally not encountered with other diseases. Infectious diseases may also have distinctly geographical and/ or travel-related aspects as shown by inhaled fungal infections such as coccidioidosmycosis from the southwestern United States or Ebola virus disease in West Africa. Communicable diseases due to specific infectious agents (e.g., influenza virus, methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum beta-lactamase-producing gram-negative rod bacteria (ESBL-GNR’s), and many other examples) also pose challenges in timely diagnosis, infection control, and patient-familycolleague education. In the case of Ebola virus, the presence of only a few infected individuals in the United States in 2014 caused nationwide concern among healthcare workers and the public. Clinicians, infection control staff and the hospitalbased microbiology laboratory all received many inquiries about potential routes of transmission, diagnostic testing, and personal protective strategies.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84782846","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}

{"title":"Non-resolving Community Acquired Pneumonia (CAP) due to Blastomyces dermatitidis\u0000 (Pulmonary Blastomycosis): Case Report and Review of Literature","authors":"J. Britto","doi":"10.18297/JRI/VOL2/ISS1/9","DOIUrl":"https://doi.org/10.18297/JRI/VOL2/ISS1/9","url":null,"abstract":"In this case report, we describe a case of progressive acute pulmonary blastomycosis in a healthy adult living in Kentucky, initially presenting with flu like illness with a left sided consolidation, who did not respond to antibiotic therapy. Patient’s clinical condition deteriorated with development of necrotizing bronchopneumonia, mediastinal lymphadenopathy, tree-in-bud reticulonodularity and pleural effusion. A diagnosis of progressive pulmonary blastomycosis was established by radiological findings as well as transbronchial needle aspiration cytology and bronchoalveolar lavage culture demonstrating Blastomyces dermatitidis. Patient showed significant clinical improvement with resolution of pulmonary lesions on antifungal treatment. Since symptoms of blastomycosis are often similar to the symptoms of flu or other lung infections, our case highlights the importance of maintaining a high index of suspicion and appropriate microbiologic and histologic evaluation especially in patients who live in or have traveled to areas endemic for blastomycosis and are not responding to antibiotic therapy. Early diagnosis coupled with prompt initiation of antifungal treatment may lead to favorable outcomes. DOI: 10.18297/jri/vol2/iss1/9 Received Date: February 12, 2018 Accepted Date: March 26, 2018 Website: https://ir.library.louisville.edu/jri Affiliations: 1St. Elizabeth Physicians, Infectious Disease, Crestview Hills, KY, USA ©2018, The Author(s). 39 ULJRI Vol 2, (1) 2018 REVIEW ARTICLE *Correspondence To: Johnson Britto, MD, MPH Work Address: St. Elizabeth Physicians, Infectious Disease, Crestview Hills, KY, USA Work Email: johnsypb@gmail.com Due to a lack of clinical improvement after three days of antimicrobial treatment, chest computed tomographic (CT) scan was obtained that showed a dense consolidation involving the majority of the left lower lobe, and a trace left pleural effusion (Figure 2). Bronchoscopy was performed. Bronchoscopy did not show any endobronchial lesions, Gram’s stain of bronchoalveolar lavage (BAL) of left lower lobe showed many white blood cells and rare Gram-positive bacilli, culture grew 10,000-100,000 CFU/mL of normal respiratory flora, KOH Prep was negative for fungal elements, acid-fast bacilli was negative, as was legionella PCR. BAL sample was not sent for cytological analysis. She was hospitalized for five days during which there was no significant change in her clinical status and she remained without clinical improvement or deterioration. She completed a five day course of oral oseltamivir. Intravenous antimicrobials were switched to oral levofloxacin to complete a course of seven days and she was discharged home with outpatient follow up. Figure 1. Initial Chest X-ray (CXR) showing ovoid superior segment left lower lobe consolidation. Figure 2. Chest computed tomographic (CT) scan showing dense consolidation involving the majority of the left lower lobe and trace left pleural effusion. After discharge from hospital, she ","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82792381","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}

{"title":"Characteristics and Clinical Outcomes of Hospitalized Patients with\u0000 Community-Acquired Pneumonia who are Active Intravenous Drug Users","authors":"V. Salunkhe, P. Peyrani, Leslie A Beavin, S. Furmanek, J. Ramirez","doi":"10.18297/JRI/VOL2/ISS2/3/","DOIUrl":"https://doi.org/10.18297/JRI/VOL2/ISS2/3/","url":null,"abstract":"Background: Intravenous drug users (IVDU) have a 10-fold increased risk of community-acquired pneumonia (CAP) compared to the general population. There is scarce data available evaluating the clinical outcomes of IVDU hospitalized patients with CAP and that data mostly focuses on mortality. The objective of this study was to evaluate the clinical characteristics, incidence and outcomes of hospitalized patients with CAP in active intravenous drug users in Louisville, Kentucky. Methods: This was a secondary data analysis of the University of Louisville Pneumonia study. IVDU patients were propensity score matched to a non-IVDU group. Study outcomes were time to clinical stability (TCS), length of stay (LOS), mortality at discharge, and mortality at 1 year. Stratified Cox proportional hazard regression was performed to evaluate TCS and LOS. Conditional logistic regression was performed to evaluate mortality. Statistical significance was defined as p ≤ 0.05. Results: From a total of 8,284 hospitalized patients with CAP reviewed, 113 patients were matched per group. Median (IQR) age for the IVDU was 33 (28-43) versus 36 (28-48) for the matched nonIVDU group (p<0.001). Analysis showed no association with TCS (stratified hazard ratio (sHR): 0.81; 95% CI: 0.58-1.14; p=0.227), LOS (sHR: 0.71; 95% CI: 0.50-1.01; p=0.053), mortality at discharge (conditional odds ratio (cOR): 1.67; 95% CI: 0.40-6.97; p=0.484) and mortality at 1 year (cOR: 1.125; 95% CI: 0.43-2.92; p=0.808). Conclusions: This study shows that active IVDU hospitalized patients with CAP do not have worse outcomes when compared with non-IVDU hospitalized patients with CAP. Patients in the IVDU group were significantly younger. Since severity scores commonly used are heavily influenced by age, these will not likely be useful tools to assist the physicians with the site for care and management. DOI: 10.18297/jri/vol2/iss2/3 Received Date: February 22, 2018 Accepted Date: July 24, 2018 Website: https://ir.library.louisville.edu/jri Copyright: ©2018 the author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Affiliations: 1University of Louisville Division of Infectious Diseases, Louisville, KY 40202 2Pfizer, Inc., Collegeville, PA *Correspondence To: Vidyulata Salunkhe Work Address: University of Louisville, Division of Infectious Diseases 501 E. Broadway, Louisville, KY 40202 Work Email: vidyulata.salunkhe@louisville.edu 7 ULJRI Vol 2, (2) 2018 ORIGINAL RESEARCH population-based cohort study of all hospitalized adults with CAP who were residents in the city of Louisville, Kentucky, from June 1st, 2014 to May 31st, 2016 [13]. Inclusion Criteria Diagnosis of CAP required the presence of criterion A, B, and C: A. New pulmonary infiltrate on imaging (CT scan or chest x-ray) at the tim","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86943928","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}

{"title":"Pulmonary Aspergillosis: A Review on Diagnosis and Management","authors":"B. Jalil, J. Galvis, K. Kersh, M. Saad, M. Fraig, J. Guardiola","doi":"10.18297/jri/vol2/iss2/6/","DOIUrl":"https://doi.org/10.18297/jri/vol2/iss2/6/","url":null,"abstract":"Aspergillosis is acquired by inhalation of spores of Aspergillus, a ubiquitous species in the environment. In normal hosts, spore inhalation rarely causes lung disease. Pulmonary aspergillosis covers a wide spectrum of clinical syndromes depending on the interaction between Aspergillus and the host (immune-status, prior bronchopulmonary disease). It runs the gamut from invasive aspergillosis to Aspergillus bronchitis and colonization. Invasive aspergillosis occurs in severely immunocompromised patients, typically with neutropenia. Chronic pulmonary aspergillosis affects patients with chronic structural lung disease such as chronic obstructive pulmonary disease, mycobacterial lung disease, but without significant immunocompromise. Aspergillus bronchitis affects patients with bronchial disease such as bronchiectasis. Allergic bronchopulmonary aspergillosis affects patients with bronchial asthma or cystic fibrosis, and is due to an allergic response to Aspergillus. In this review of literature, we discuss the pulmonary manifestations of Aspergillus infection, its diagnosis and treatments. DOI: 10.18297/jri/vol2/iss2/6 Received Date: March 8, 2018 Accepted Date: June 28, 2018 Website: https://ir.library.louisville.edu/jri Copyright: ©2018 the author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Affiliations: 1Division of Pulmonary, Critical Care, and Sleep Disorders Medicine Department of Medicine, University of Louisville 2Department of Pathology and Laboratory Medicine, University of Louisville *Correspondence To: Bilal A Jalil Work Address: Pulmonary and Critical Care Fellow University of Louisville 550 S Jackson St, A3R40 Louisville, KY 40241, USA Work Email: bilal.jalil@louisville.edu 27 ULJRI Vol 2, (2) 2018 REVIEW ARTICLE","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82975129","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}

{"title":"Pulmonary Histoplasmosis in a patient with Cough, Dyspnea, Pulmonary Nodule and\u0000 Rheumatologic Manifestations: Case Report and Review","authors":"J. Britto","doi":"10.18297/JRI/VOL2/ISS2/8/","DOIUrl":"https://doi.org/10.18297/JRI/VOL2/ISS2/8/","url":null,"abstract":"In this case report we describe a case of pulmonary histoplasmosis in a healthy adult female living in Kentucky. The patient presented with two months history of poly-arthralgia and myalgia, intermittent dry cough, chest tightness, exertional dyspnea, malaise, fatigue and one week history of skin rash. She did not respond to broad-spectrum antibiotic therapy and she also had extensive endocrine and rheumatologic work up that was negative. A diagnosis of histoplasmosis was established based on radiological findings as well as endobronchial ultrasound-guided transbronchial needle aspiration cytology (EBUS-TBNA) of mediastinal lymph nodes demonstrating necrotizing granuloma with fungal stains positive for Histoplasma. Patient showed significant clinical improvement on antifungal treatment. Since symptoms of histoplasmosis are often similar to the symptoms of community acquired pneumonia, other lung infections or malignancy, our case highlights the importance of maintaining a high index of suspicion and appropriate radiological, microbiology, and histologic evaluation especially in patients who live in or have traveled to areas endemic for histoplasmosis and are not responding to antibiotic therapy. Early diagnosis coupled with prompt initiation of antifungal treatment may lead to favorable outcomes. DOI: 10.18297/jri/vol2/iss2/8 Received Date: July 2, 2018 Accepted Date: August 1, 2018 Website: https://ir.library.louisville.edu/jri Copyright: ©2018 the author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Affiliations: 1St. Elizabeth Physicians, Infectious Disease, Crestview Hills, KY, USA *Correspondence To: Johnson Britto, MD, MPH Work Address: St. Elizabeth Physicians, Infectious Disease, Crestview Hills, KY, USA Work Email: johnsypb@gmail.com 45 ULJRI Vol 2, (2) 2018 REVIEW ARTICLE and oxygen saturation 98% on room air. On physical exam, she had a skin rash with description as noted above, otherwise she had no respiratory distress, no lymphadenopathy, no joint swelling or tenderness. Examination of the respiratory system, cardiovascular system, abdomen, central nervous system was noted to be unremarkable. Initial diagnostic laboratory work up showed leucocyte count of 9,100 cells/mm3 (no eosinophilia), hemoglobin 14.3 g/dl, hematocrit 44.3% and platelet count 295,000/mm3. Serum electrolytes, renal function, liver function tests, and lipid screen were normal. Urinalysis was negative for protein or blood. Rapid Streptococcus group A antigen test and Influenza test for A & B antigens were negative. Chest X-ray (CXR) showed new linear opacity best seen on the lateral view in the region of the lingula with differential of fluid or fat within the major fissure versus small infiltrate in the lingula (Figure 2). High resolution chest ","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87536361","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}

{"title":"The Association of qSOFA, SOFA, and SIRS with Mortality in Emergency Department\u0000 Pneumonia","authors":"I. Mecham, N. Dean, E. Wilson, A. Jephson, M. Lanspa","doi":"10.18297/JRI/VOL2/ISS2/4/","DOIUrl":"https://doi.org/10.18297/JRI/VOL2/ISS2/4/","url":null,"abstract":"Rationale: Sepsis scores are widely used and influence management decisions. Objective: To determine the association between 30-day mortality with Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA) in emergency department patients with pneumonia. Secondary outcomes included the association of sepsis scores with hospital admission and direct ICU admission. Methods: This is a secondary analysis of a pneumonia population conducted in the emergency department of 3 tertiary care medical centers and 4 community hospitals. Adult immunocompetent patients diagnosed with pneumonia were included from 3 twelve-month periods spanning December 2009 to October 2015. We generated area under the receiver operating characteristic curve (AUC) values for each sepsis score for 30 day mortality and secondarily for hospital admission and direct ICU admission. We also created logistic regression models to assess associations of individual score components to the outcomes. Results: We studied 6931 patients with mean (SD) age 58 (20) years, and 30 day all-cause mortality rate 7%. Hospital and ICU admission rate was 63% and 16% respectively. Sepsis by SIRS was present in 70% of patients. Only respiratory rate and white blood count of the SIRS criteria were associated with 30-day mortality (OR=2.42 [1.94, 3.03] and 2.06 [1.68, 2.54] respectively, both p<0.001). Sepsis by qSOFA was present in 20%; all three components were associated with 30-day mortality (systolic blood pressure OR=1.36 [1.10, 1.68], respiratory rate OR=2.14 [1.72, 2.67], and altered mentation OR=6.53 [5.25, 8.09]; all p≤0.005). All six SOFA components were associated with 30-day mortality (all p≤0.001). qSOFA outperformed SIRS for 30-day mortality, (AUC=0.70 vs 0.61, p<0.001), hospital admission (AUC=0.70 vs 0.67, p<0.001), and intensive care unit admission (AUC=0.72 vs 0.64, p<0.001). SOFA significantly outperformed qSOFA for all outcomes except intensive care unit admission (AUC=0.74 vs 0.72, p=0.08). When compared to traditional pneumonia severity scores, the sepsis scores underperformed in prediction of mortality and ICU admission. Conclusions: In emergency department patients with pneumonia, qSOFA outperformed SIRS in relation to 30-day mortality, as well as hospital and ICU admission. SOFA performed better than qSOFA and SIRS for all outcomes except ICU admission. DOI: 10.18297/jri/vol2/iss2/4 Received Date: May 7, 2018 Accepted Date: July 10, 2018 Website: https://ir.library.louisville.edu/jri Copyright: ©2018 the author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Affiliations: 1Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Medicine, University of Utah, Salt Lake City, U","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74741134","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}

{"title":"Comparison of Mortality and Therapy in Community Acquired Pneumonia","authors":"Gina Maki, D. Moreno, A. Harris, S. Lawrence, A. Masica, L. Lamerato, M. Zervos","doi":"10.18297/JRI/VOL2/ISS2/5/","DOIUrl":"https://doi.org/10.18297/JRI/VOL2/ISS2/5/","url":null,"abstract":"Background: Community associated pneumonia (CAP) is one the most common causes of hospital admissions, exceeding more than one million per year in the United States, contributing to 3.4% of inpatient mortality. Our objective was to compare 30-day mortality using therapies recommended for treatment of CAP. Methods: A multicenter retrospective analysis from four different hospitals was assessed from 2008 to 2013. The data was obtained from electronic medical records which included more than 70,000 patients. CAP patients were identified using discharge diagnostic codes during the years 2008-2013, as well as receiving therapy with ceftriaxone and azithromycin or a respiratory fluoroquinolone. Demographic data, antibiotic therapy, and Charlson comorbidity score was obtained to compare the study groups. Results: A total of 21,800 patients met the inclusion criteria for CAP. 1,740 patients were excluded as they received both beta-lactams and fluoroquinolones. The study included 20,600 patients. 11,201 patients (55.84%) received ceftriaxone with azithromycin, and 8,859 (44.16%) received fluoroquinolone therapy. The mortality rate for patients who received fluoroquinolone therapy was lower compared to the patients who received ceftriaxone plus azithromycin (3.56% vs 6.71%, p-value <0.001). Conclusions: Our study showed statistically significant lower 30-day mortality using fluoroquinolone therapy compared to ceftriaxone plus azithromycin for treatment of CAP. Prospective blinded randomized control trials would be needed to support this evidence. DOI: 10.18297/jri/vol2/iss2/5 Received Date: July 20, 2018 Accepted Date: August 9, 2018 Website: https://ir.library.louisville.edu/jri Copyright: ©2018 the author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Affiliations: 1Department of Medicine, Division of Infectious Diseases, Henry Ford Hospital, Detroit MI 2Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 3Washington University, St. Louis, MO 4Baylor Scott & White Health, Dallas, TX 5Wayne State University School of Medicine, Detroit, MI *Correspondence To: Gina Maki, DO Work Address: Department of Internal Medicine Henry Ford Hospital 2799 West Grand Boulevard Detroit, Michigan, USA. Work Email: gmaki1@hfhs.org Work Phone: 313-916-3623 19 ULJRI Vol 2, (2) 2018 ORIGINAL RESEARCH hospital length of stay, readmission status, and mortality within 30 days was collected from each of the four hospitals’ electronic medical records (EMR). Information was obtained from each participating centers’ EMR which was then entered into a single database. This database included approximately 70,000 patients. Data was de-identified and coded using explicit data specifications and uploaded into one large ","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80217650","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}

{"title":"A Continuum of Disease from Community-Acquired Pneumonia to Multiple Organ\u0000 Dysfunction Syndrome","authors":"J. Ramirez","doi":"10.18297/JRI/VOL2/ISS2/1/","DOIUrl":"https://doi.org/10.18297/JRI/VOL2/ISS2/1/","url":null,"abstract":"Community-acquired pneumonia (CAP) is one of the primary causes of sepsis, septic shock, acute respiratory distress syndrome (ARDS), and multiple organ dysfunction syndrome (MODS) [1-3]. The chain of immune responses in patients with pneumonia can be considered as a continuum of disease from an initial appropriate response in patients with CAP, to a deleterious response that encompasses Severe CAP, Sepsis, Septic Shock, ARDS and MODS. As the lung infection overwhelms the natural defenses that are produced by physiologic pulmonary and systemic inflammation, a deeper line of defense is necessary. At this point, the immune system may develop an inflammatory response that may be damaging to vital organs, culminating with organ failure. In this opinion piece I will review the pathophysiology of CAP and construct a continuum of disease from CAP to MODS.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73264479","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}