Παρασκευή, 13 Μαρτίου 2020

1.
 2020 Feb 25;10:19. doi: 10.3389/fcimb.2020.00019. eCollection 2020.

Effect of cAMP Receptor Protein Gene on Growth Characteristics and Stress Resistance of Haemophilus parasuis Serovar 5.

Jiang C1Cheng Y1Cao H1Zhang B1Li J1Zhu L1Li Z1Zeng W1Li C1He Q1,2.

Abstract

Haemophilus parasuis (HPS), a member of the family Pasteurellaceae, is a common bacteria in the upper respiratory tract of pigs but under certain circumstances can cause serious systemic disease (Glasser's disease) characterized by severe infection of the upper respiratory tract, fibrinous polyserositis, polyarthritis, and meningitis. cAMP receptor protein (CRP) is among the most important global regulators, playing a vital role in adapting to environmental changes during the process of bacterial infection. In order to investigate the function of the crp gene in the growth characteristics of H. parasuis serovar 5 (HPS5) and its ability to overcome adverse environmental stresses, a crp mutant strain (Δcrp) was constructed and verified. In this study, we found that the crp gene was involved in growth rate, biofilm formation, stress tolerance, serum resistance, and iron utilization. Compared with the wild type, both the growth rate of the crp mutant and its resistance to osmotic pressure decreased significantly. Similar phenomena were also found in biofilm formation and iron utilization. However, the resistance to heat shock and serum complement of the crp mutant were enhanced. This study aimed to reveal the function in growth characteristics and stress resistance of the crp gene in HPS5. Whether it relates to virulence requires additional in-depth research.

KEYWORDS:

Haemophilus parasuis; biofilm formation; cAMP receptor protein; crp gene; growth characteristics; stress resistance
PMID:
 
32158699
 
PMCID:
 
PMC7052058
 
DOI:
 
10.3389/fcimb.2020.00019
2.
 2020 Mar 10. doi: 10.1111/irv.12732. [Epub ahead of print]

Clinical implications of aminotransferase elevation in hospitalised infants aged 8-90 days with respiratory virus detection.

Abstract

BACKGROUND:

Fever and respiratory symptoms are the major causes of hospitalisation in infants aged 90 days or less. Respiratory viruses (RVs) are detected by multiplex reverse transcriptase-polymerase chain reaction (mRT-PCR) in up to 70% of infants tested in this population. Aminotransferase elevation is not uncommon in RV infections, and repeat laboratory investigations are frequent due to concerns regarding the occurrence of hepatic disease.

METHODS:

This retrospective observational cohort study included 271 infants aged 8-90 days, with positive RV mRT-PCR results. Data were obtained on demographics, laboratory results and final diagnoses of hepatobiliary disease.

RESULTS:

Fever (73.1%) and/or respiratory symptoms (75.6%) were the major presentations among the hospitalised infants. Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels were elevated in 62 (22.9%) of the 271 infants. Twenty-four of these 62 infants had their first follow-up, and 19 (79.2%) showed persistent elevation. All 10 (100%) infants who had their second follow-up showed persistently elevated aminotransferase levels. Eventually, none of the 10 infants were diagnosed with hepatic disease during the median follow-up of 10 days (range 3-232 days). Among the RVs of interest, parainfluenza virus type 1 was significantly associated with aminotransferase elevation (odds ratio: 2.95; 95% confidence interval [CI]: 1.11-7.83).

CONCLUSIONS:

RV-related non-specific hepatitis is occasionally observed in infants aged 8-90 days, and ALT elevation is the most common abnormality. However, a final diagnosis of primary hepatobiliary disease appears to be rare. Therefore, regular follow-ups and targeted testing may be recommended in this specific population.

KEYWORDS:

aminotransferase; hepatitis; respiratory tract infections
PMID:
 
32157800
 
DOI:
 
10.1111/irv.12732
3.
 2020 Mar 7. pii: S0009-8981(20)30112-1. doi: 10.1016/j.cca.2020.03.009. [Epub ahead of print]

Positive rate of RT-PCR detection of SARS-CoV-2 infection in 4880 cases from one hospital in Wuhan, China, from Jan to Feb 2020.

Liu R1Han H1Liu F2Lv Z1Wu K3Liu Y3Feng Y4Zhu C5.

Abstract

BACKGROUND:

There's an outbreak of a novel coronavirus (SARS-CoV-2) infection since December 2019, first in China, and currently with more than 80 thousand confirmed infection globally in 29 countries till March 2, 2020. Identification, isolation and caring for patients early are essential to limit human-to-human transmission including reducing secondary infections among close contacts and health care workers, preventing transmission amplification events. The RT-PCR detection of viral nucleic acid test (NAT) was one of the most quickly established laboratory diagnosis method in a novel viral pandemic, just as in this COVID-19 outbreak.

METHODS:

4880 cases that had respiratory infection symptoms or close contact with COVID-19 patients in hospital in Wuhan, China, were tested for SARS-CoV-2 infection by use of quantitative RT-PCR (qRT-PCR) on samples from the respiratory tract. Positive rates were calculated in groups divided by genders or ages.

RESULTS:

The positive rate was about 38% for the total 4880 specimens. Male and older population had a significant higher positive rates. However, 57% was positive among the specimens from the Fever Clinics. Binary logistic regression analysis showed that age, not gender, was the risk factor for SARS-CoV-2 infection in fever clinics.

CONCLUSIONS:

Therefore, we concluded that viral NAT played an important role in identifying SARS-CoV-2 infection.
PMID:
 
32156607
 
DOI:
 
10.1016/j.cca.2020.03.009
4.
 2020 Mar 6;21(5). pii: E1831. doi: 10.3390/ijms21051831.

A Meta-Analysis of Multiple Whole Blood Gene Expression Data Unveils a Diagnostic Host-Response Transcript Signature for Respiratory Syncytial Virus.

Abstract

Respiratory syncytial virus (RSV) is one of the major causes of acute lower respiratory tract infection worldwide. The absence of a commercial vaccine and the limited success of current therapeutic strategies against RSV make further research necessary. We used a multi-cohort analysis approach to investigate host transcriptomic biomarkers and shed further light on the molecular mechanism underlying RSV-host interactions. We meta-analyzed seven transcriptome microarray studies from the public Gene Expression Omnibus (GEO) repository containing a total of 922 samples, including RSV, healthy controls, coronaviruses, enteroviruses, influenzas, rhinoviruses, and coinfections, from both adult and pediatric patients. We identified > 1500 genes differentially expressed when comparing the transcriptomes of RSV-infected patients against healthy controls. Functional enrichment analysis showed several pathways significantly altered, including immunologic response mediated by RSV infection, pattern recognition receptors, cell cycle, and olfactory signaling. In addition, we identified a minimal 17-transcript host signature specific for RSV infection by comparing transcriptomic profiles against other respiratory viruses. These multi-genic signatures might help to investigate future drug targets against RSV infection.

KEYWORDS:

RNA; RSV; array; meta-analysis; respiratory syncytial virus; transcriptomic
PMID:
 
32155831
 
DOI:
 
10.3390/ijms21051831
5.
 2020 Feb;70(2):102-108. doi: 10.1111/lam.13249. Epub 2019 Dec 13.

Evidence of Saffold virus circulation in Italy provided through environmental surveillance.

Abstract

Saffold virus (SAFV) is an emerging human cardiovirus associated with respiratory and gastrointestinal infection, and, more recently, to symptoms related to the endocrine, cardiovascular, and neurological systems. Information about SAFV circulation in Italy is scarce. In order to provide insights into the epidemiology of SAFV in Italy, 141 raw sewage samples collected throughout Italy were tested using broad-range nested RT-PCR primers targeting the 5'-NC region. Seven samples (5·0%) were confirmed as SAFV in samples collected in North, Centre and Southern Italy. Typing was attempted through amplification of the VP1 coding region, using both published and newly designed primers, and one sample was characterized as SAFV-2. SIGNIFICANCE AND IMPACT OF THE STUDY: Prevalence, genetic diversity and geographic distribution of SAFV in Italy is currently unknown. This study represents the first detection of SAFV in sewage samples in Italy, suggesting that it is circulating in the population despite lack of clinical reporting. Whether the virus is associated with asymptomatic cases or with undetected gastroenteritis or respiratory illness is unknown. Further studies are needed to investigate on the occurrence and persistence of SAFV in water environments and its waterborne transmission potential.

KEYWORDS:

PCR; detection; environmental; viruses; wastewater
PMID:
 
31742735
 
DOI:
 
10.1111/lam.13249
[Indexed for MEDLINE]
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6.
 2020 Feb;70(2):995-1006. doi: 10.1099/ijsem.0.003861.

Tsukamurella asaccharolytica sp. nov., Tsukamurella conjunctivitidis sp. nov. and Tsukamurella sputi sp. nov., isolated from patients with bacteraemia, conjunctivitis and respiratory infection in Hong Kong.

Teng JLL1,2,3Fong JYH3Fok KMN3Lee HH3Chiu TH3Tang Y3Ngan AHY3Wong SSY1,3,2Que TL4Lau SKP3,2,1,5Woo PCY3,2,1,5.

Abstract

Three bacterial strains, HKU70T, HKU71T and HKU72T, were isolated from the conjunctival swab, blood and sputum samples of three patients with conjunctivitis, bacteraemia and respiratory infection, respectively, in Hong Kong. The three strains were aerobic, Gram-stain positive, catalase-positive, non-sporulating and non-motile bacilli and exhibited unique biochemical profiles distinguishable from currently recognized Tsukamurella species. 16S rRNA, secArpoB and groEL gene sequence analyses revealed that the three strains shared 99.6-99.9, 94.5-96.8, 95.7-97.8 and 97.7-98.9 % nucleotide identities with their corresponding closest Tsukamurella species respectively. DNA-DNA hybridization confirmed that they were distinct from other known species of the genus Tsukamurella (26.2±2.4 to 36.8±1.2 % DNA-DNA relatedness), in line with results of in silico genome-to-genome comparison (32.2-40.9 % Genome-to-Genome Distance Calculator and 86.3-88.9 % average nucleotide identity values]. Fatty acids, mycolic acids, cell-wall sugars and peptidoglycan analyses showed that they were typical of members of Tsukamurella. The G+C content determined based on the genome sequence of strains HKU70T, HKU71T and HKU72T were 69.9, 70.2 and 70.5 mol%, respectively. Taken together, our results supported the proposition and description of three new species, i.e. Tsukamurella sputi HKU70T (=JCM 33387T=DSM 109106T) sp. nov., Tsukamurella asaccharolytica HKU71T (=JCM 33388T=DSM 109107T) sp. nov. and Tsukamurella conjunctivitidis HKU72T (=JCM 33389T=DSM 109108T) sp. nov.

KEYWORDS:

Novel; Tsukamurella; average nucleotide identity; bacteraemia; conjunctivitis; respiratory infection
PMID:
 
31738158
 
DOI:
 
10.1099/ijsem.0.003861
[Indexed for MEDLINE]
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7.
 2019 Sep 27;14(9):e0218062. doi: 10.1371/journal.pone.0218062. eCollection 2019.

Confounding by indication of the safety of de-escalation in community-acquired pneumonia: A simulation study embedded in a prospective cohort.

Abstract

Observational studies have demonstrated that de-escalation of antimicrobial therapy is independently associated with lower mortality. This most probably results from confounding by indication. Reaching clinical stability is associated with the decision to de-escalate and with survival. However, studies rarely adjust for this confounder. We quantified the potential confounding effect of clinical stability on the estimated impact of de-escalation on mortality in patients with community-acquired pneumonia. Data were used from the Community-Acquired Pneumonia immunization Trial in Adults (CAPiTA). The primary outcome was 30-day mortality. We performed Cox proportional-hazards regression with de-escalation as time-dependent variable and adjusted for baseline characteristics using propensity scores. The potential impact of unmeasured confounding was quantified through simulating a variable representing clinical stability on day three, using data on prevalence and associations with mortality from the literature. Of 1,536 included patients, 257 (16.7%) were de-escalated, 123 (8.0%) were escalated and in 1156 (75.3%) the antibiotic spectrum remained unchanged. Crude 30-day mortality was 3.5% (9/257) and 10.9% (107/986) in the de-escalation and continuation groups, respectively. The adjusted hazard ratio of de-escalation for 30-day mortality (compared to patients with unchanged coverage), without adjustment for clinical stability, was 0.39 (95%CI: 0.19-0.79). If 90% to 100% of de-escalated patients were clinically stable on day three, the fully adjusted hazard ratio would be 0.56 (95%CI: 0.27-1.12) to 1.04 (95%CI: 0.49-2.23), respectively. The simulated confounder was substantially stronger than any of the baseline confounders in our dataset. Quantification of effects of de-escalation on patient outcomes without proper adjustment for clinical stability results in strong negative bias. This study suggests the effect of de-escalation on mortality needs further well-designed prospective research to determine effect size more accurately.
PMID:
 
31560686
 
PMCID:
 
PMC6764693
 
DOI:
 
10.1371/journal.pone.0218062
[Indexed for MEDLINE] 
Free PMC Article
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8.
 2019 Oct;16(10):1-24. Epub 2019 Oct 2.

Acute bronchiolitis: assessment and management in the emergency department.

Abstract

Acute bronchiolitis is the most common lower respiratory tract infection in young children that leads to emergency department visits and hospitalizations. Bronchiolitis is a clinical diagnosis, and diagnostic laboratory and radiographic tests play a limited role in most cases. While studies have demonstrated a lack of efficacy for bronchodilators and corticosteroids, more recent studies suggest a potential role for combination therapies and high-flow nasal cannula therapy. Frequent evaluation of patient clinical status including respiratory rate, work of breathing, oxygen saturation, and the ability to take oral fluids are important in determining safe disposition. This issue reviews the literature to provide evidence-based recommendations for effective evaluation and treatment of pediatric patients with acute bronchiolitis.
PMID:
 
31557431
[Indexed for MEDLINE]
Icon for EB Medicine
9.
 2019 Sep 13;12(1):576. doi: 10.1186/s13104-019-4579-3.

The pulsed ultrasound strategy effectively decreases the S. aureus population of chronic rhinosinusitis patients.

Abstract

OBJECTIVE:

Staphylococcus aureus with the ability of biofilm formation and the drug resistance acquisition is one of the most frequently isolated pathogens from chronic rhinosinusitis patients. Ultrasound as an alternative therapy is effectively able to kill the bacteria by cavitation in or on the bacterial cells and peroxide generation and hence improving antibiotic treatment efficacy.

RESULTS:

Staphylococcus aureus was detected in 4 and 6 out of 14 patients by phenotypic and qPCR assays, respectively. Four patients were completely resolved after pulsed ultrasound treatment. However, presence of the S. aureus was confirmed in three healthy controls by bacterial cultivation. Pulsed ultrasound have been quantitatively decreased the S. aureus population in chronic rhinosinusitis patients (p < 0.05). Further studies need to be investigated the effectiveness of pulsed ultrasound as an alternative course of CRS patient's treatment.

KEYWORDS:

Chronic rhinosinusitis; Pulsed ultrasound; Real-time PCR; Staphylococcus aureus; Treatment
PMID:
 
31519221
 
PMCID:
 
PMC6743179
 
DOI:
 
10.1186/s13104-019-4579-3
[Indexed for MEDLINE] 
Free PMC Article
Icon for BioMed CentralIcon for PubMed Central
10.
 2019 Jun;31(2):159-160. doi: 10.4314/mmj.v31i2.10.

An adolescent with multi-organ involvement from typhoid fever.

Kumwenda M1Tam PI1,2,3.

Abstract

Typhoid fever is usually a mild clinical disease, but it can have potentially serious complications. Here, we describe a case of an adolescent male who presented with severe illness and multi-organ involvement from typhoid fever. He required follow-up after discharge but eventually recovered. Clinicians should be aware of the spectrum of clinical manifestations as early recognition will improve monitoring and management of typhoid disease.

KEYWORDS:

adolescent; anemia; cardiovascular; enteric fever; gastrointestinal; haematological; musculoskeletal; neurological; typhoid fever
PMID:
 
31452851
 
PMCID:
 
PMC6698619
 
DOI:
 
10.4314/mmj.v31i2.10
[Indexed for MEDLINE] 
Free PMC Article
Icon for PubMed Central
11.
 2019 Jun;31(2):126-132. doi: 10.4314/mmj.v31i2.4.

The examination of nurses' adherence to the 'five rights' of antibiotic administration and factors influencing their practices: a mixed methods case study at a tertiary hospital, Malawi.

Abstract

BACKGROUND:

Adherence to 'Five Rights' of medication administration guidelines namely the right drug, the right patient, the right dose, the right time and the right route is the basic nursing standard and a crucial component in medication safety. Specifically for antibiotics, this helps to minimize resistance and reduce hospital costs. There is a dearth in literature on how nurses apply this standard when administering antibiotics to inpatients. This study explored nurses' adherence to the 'Five Rights' of antibiotic administration and factors influencing their practices.

METHODS:

This was a cross sectional case study using prospective observation of 23 nurses and 49 patients with pneumonia and follow up interviews with 13 nurses. Participants were selected between November 2015 and February 2016. The study setting was two medical wards of a tertiary hospital. Observations were guided using a checklist to collect quantitative data. This was followed by semi-structured in-depth interviews with nurses.

RESULTS:

From the quantitative data, untimely administration of antibiotics was common, with only 10.1% of patients given antibiotics at the right time. Nurses gave the right (prescribed) antibiotics in 67.3% of the patients and 59.2% of the patients received the required doses. 69.4% of the patients received the antibiotics using the right route. The right documentation of dose initiation and continuation occurred in 38.5% and 24.5% respectively. From follow up interview data, two main themes were identified: Competency gap with subthemes namely inconsistent undestanding of three/four times a day dosing schedules and knowledge translation gap; Conflict between medication administration times and ward routines.

CONCLUSIONS:

We found poor compliance with the 'Five Rights' of antibiotic administration. This has been attributed to both a competency gap and challenges within the hospital system.

KEYWORDS:

Adherence; Antibiotics; Antimicrobial resistance; Five Rights; Nurses; antibiotic stewardship
PMID:
 
31452845
 
PMCID:
 
PMC6698626
 
DOI:
 
10.4314/mmj.v31i2.4
[Indexed for MEDLINE] 
Free PMC Article
Icon for PubMed Central
12.
 2019 Nov;24(4):212-221. doi: 10.1016/j.idh.2019.07.002. Epub 2019 Aug 8.

Factors associated with influenza vaccination in Japanese elderly outpatients.

Abstract

BACKGROUND:

Elderly patients benefit from influenza vaccination, but the number of Japanese elderly patients who are vaccinated is insufficient. Several factors are associated with influenza vaccination acceptance, but little is known about Japanese elderly outpatients. The purpose of this study was to examine factors associated with influenza vaccination in elderly outpatients in Japan.

METHODS:

During the 2017-2018 influenza season, outpatients from one hospital and one clinic in Kitaibaraki City, Ibaraki, Japan, participated in this study. Patients answered a self-report questionnaire exploring factors such as their vaccination status during the 2017-2018 season, past influenza vaccination, perceived susceptibility to influenza and adverse events of the vaccine, perceived vaccine efficacy, physician recommendations. Multivariable logistic regression analyses were conducted to identify factors associated with vaccination.

RESULTS:

Of 377 patients, 316 (83.8%) responded, and the vaccination rate was 57%. Eighty-three patients (27.0%) reported that their physician recommended the influenza vaccine. In multivariate analysis, influenza vaccination was associated with higher age (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.03-1.14), physician recommendations (OR 2.49, 95% CI 1.18-5.25), low perceived susceptibility to vaccine-related adverse events (OR 0.33, 95% CI 0.15-0.74), and belief in vaccine efficacy (OR 4.73, 95% CI 2.08-10.8).

CONCLUSIONS:

Influenza vaccination was associated with belief in vaccine efficacy, perceived susceptibility to vaccine-related adverse events, physician recommendations, and older age. Increasing the frequency of physician recommendations may lead to increased vaccination coverage.

KEYWORDS:

Elderly; Influenza; Physician recommendations; Vaccination
PMID:
 
31402297
 
DOI:
 
10.1016/j.idh.2019.07.002
[Indexed for MEDLINE]
Icon for Elsevier Science
13.
 2019 Oct;13(10):605-613. doi: 10.1111/crj.13062. Epub 2019 Aug 16.

Plasma cytokine profile on admission related to aetiology in community-acquired pneumonia.

Abstract

BACKGROUND:

Potentially unnecessary antibiotic use for community-acquired pneumonia (CAP) contributes to selection of antibiotic-resistant pathogens. Cytokine expression at the time that treatment is started may assist in identifying patients not requiring antibiotics. We determined plasma cytokine patterns in patients retrospectively categorized as strict viral, pneumococcal or combined viral-bacterial CAP.

OBJECTIVE:

To investigate whether cytokine-based prediction models can be used to differentiate strict viral CAP from other aetiologies at admission.

METHODS:

From 344 hospitalized CAP patients, 104 patients were categorized as viral CAP (n = 17), pneumococcal CAP (n = 48) and combined bacterial-viral CAP (n = 39). IL-6, IL-10, IL-27, IFN-γ and C-reactive protein (CRP) were determined on admission in plasma. Prediction of strict viral aetiology was explored with two multivariate regression models and ROC curves.

RESULTS:

Viral pneumonia was predicted by logistic regression using multiple cytokine levels (IL-6, IL-27 and CRP) with an AUC of 0.911 (95% CI: 0.852-0.971, P < .001). For the same patients the AUC of CRP was 0.813 (95% CI: 0.728-0.898, P < .001).

CONCLUSIONS:

This study demonstrated differences in cytokine expression in selected CAP patients between viral and bacterial aetiology. Prospective validation studies are warranted.

KEYWORDS:

cytokines; immunology; pneumonia; viral infection
PMID:
 
31310442
 
DOI:
 
10.1111/crj.13062
[Indexed for MEDLINE]
Icon for Wiley
14.
 2019 Nov;24(4):229-239. doi: 10.1016/j.idh.2019.06.002. Epub 2019 Jul 4.

Strategies to reduce non-ventilator-associated hospital-acquired pneumonia: A systematic review.

Abstract

BACKGROUND:

Point prevalence studies identify that pneumonia is the most common healthcare associated infection. However, non-ventilator associated healthcare associated pneumonia (NV-HAP) is both underreported and understudied. Most research conducted to date, focuses on ventilator associated pneumonia. We conducted a systematic review, to provide the latest evidence for strategies to reduce NV-HAP and describe the methodological approaches used.

METHODS:

We performed a systematic search to identify research exploring and evaluating NV-HAP preventive measures in hospitals and aged-care facilities. The electronic database Medline was searched, for peer-reviewed articles published between 1st January 1998 and 31st August 2018. An assessment of the study quality and risk of bias of included articles was conducted using the Newcastle-Ottawa Scale.

RESULTS:

The literature search yielded 1551 articles, with 15 articles meeting the inclusion criteria. The majority of strategies for NV-HAP prevention focussed on oral care (n = 9). Three studies evaluated a form of physical activity, such as passive movements, two studies used dysphagia screening and management; and another study evaluated prophylactic antibiotics. Most studies (n = 12) were conducted in a hospital setting. Six of the fifteen studies were randomised controlled trials.

CONCLUSION:

There was considerable heterogeneity in the included studies, including the type of intervention, study design, methods and definitions used to diagnose the NV-HAP. To date, interventions to reduce NV-HAP appear to be based broadly on the themes of improving oral care, increased mobility or movement and dysphagia management.

KEYWORDS:

Healthcare-associated pneumonia; Infection control; Nursing care; Systematic review
PMID:
 
31279704
 
DOI:
 
10.1016/j.idh.2019.06.002
[Indexed for MEDLINE] 
Free full text
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15.
 2019 Mar;41(3):466-476. doi: 10.1016/j.clinthera.2019.01.007. Epub 2019 Feb 8.

Outpatient Antimicrobial Stewardship: Targets for Community-acquired Pneumonia.

Abstract

PURPOSE:

Community-acquired pneumonia (CAP) is one of the leading causes of death in the United States. The primary objective of this study was to determine the prevalence of appropriate diagnosis and treatment of outpatients treated for CAP. Knowledge of problems with CAP treatment can be helpful in developing stewardship initiatives to improve care of outpatients with CAP.

METHODS:

Included in this study were patients 18 years and older who received antibiotic therapy for the treatment of CAP in the outpatient setting. Outpatients were identified by International Classification of Diseases, Ninth Revision (ICD-9) and International Classification of Diseases, Tenth Revision (ICD-10) codes for CAP in the Veterans Affairs Western New York Healthcare System between January 2008 and January 2018. Appropriate treatment was evaluated using CAP guidelines. Factors associated with an inappropriate regimen were determined via multivariable analyses.

FINDINGS:

This study included 518 outpatients, of whom 66% were appropriately diagnosed with CAP. Of the 341 appropriately diagnosed patients, only 31% received an antibiotic regimen consistent with guidelines. Regarding inappropriate regimens, 76.7% contained an incorrect drug based on patient comorbidities, and 39.4% consisted of an inappropriate duration, which was most often attributable to prolonged length of therapy >7 days. The odds of being prescribed an inappropriate regimen if a patient was considered to be at risk for drug-resistant Streptococcus pneumoniae (DRSP) was 4.2 (95% CI, 2.4-7.4). The population at risk for DRSP was more likely to present to the health care system again within 30 days compared with low-risk patients (19.4% vs 8.7%, P = 0.005).

IMPLICATIONS:

Improvement in prescribing is needed for CAP. An outpatient stewardship program that targets patients with risk factors for DRSP would improve adherence to guidelines.

KEYWORDS:

antibiotic; antimicrobial stewardship; community-acquired pneumonia; outpatient; pneumonia
PMID:
 
30739721
 
DOI:
 
10.1016/j.clinthera.2019.01.007
[Indexed for MEDLINE]
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17.
 2019 Jan 18;152(2):59-61. doi: 10.1016/j.medcli.2018.10.024. Epub 2018 Nov 24.

Influenza vaccination in health-care workers: Auctoritas and potestas.

[Article in English, Spanish]
PMID:
 
30482394
 
DOI:
 
10.1016/j.medcli.2018.10.024
[Indexed for MEDLINE]
Icon for Ediciones Doyma, S.L.
19.
 2019 Jul;74(1):60-68. doi: 10.1016/j.annemergmed.2018.06.017. Epub 2018 Aug 2.

Performance of the CURB-65 Score in Predicting Critical Care Interventions in Patients Admitted With Community-Acquired Pneumonia.

Abstract

STUDY OBJECTIVE:

Confusion, uremia, elevated respiratory rate, hypotension, and aged 65 years or older (CURB-65) is a clinical prediction rule intended to stratify patients with pneumonia by expected mortality. We assess the predictive performance of CURB-65 for the proximal endpoint of receipt of critical care intervention in emergency department (ED) patients admitted with community-acquired pneumonia.

METHODS:

We performed a retrospective analysis of electronic health records from a single tertiary center for ED patients admitted as inpatients with a primary diagnosis of pneumonia from 2010 to 2014. Patients with a history of malignancy, tuberculosis, bronchiectasis, HIV, or readmission within 14 days were excluded. We assessed the predictive accuracy of CURB-65 for receipt of critical care interventions (ie, vasopressors, large-volume intravenous fluids, invasive catheters, assisted ventilation, insulin infusions, or renal replacement therapy) and inhospital mortality. Logistic regression was performed to assess the increase in odds of critical care intervention or inhospital mortality by increasing CURB-65 score.

RESULTS:

There were 2,322 patients admitted with community-acquired pneumonia in the study cohort; 630 (27.1%) were admitted to the ICU within 48 hours of ED triage and 343 (14.8%) received a critical care intervention. Of patients with a CURB-65 score of 0 to 1, 181 (15.6%) were admitted to the ICU, 74 (6.4%) received a critical care intervention, and 7 (0.6%) died. Of patients with a CURB-65 score of 2, 223 (27.0%) were admitted to the ICU, 127 (15.4%) received a critical care intervention, and 47 (5.7%) died. Among patients with CURB-65 score greater than or equal to 3, 226 (67.0%) were admitted to the ICU, 142 (42.1%) received a critical care intervention, and 43 (12.8%) died. The areas under the receiver operating characteristic for CURB-65 as a predictor of critical care intervention and mortality were 0.73 and 0.77, whereas sensitivity of CURB-65 score greater than or equal to 2 in predicting critical care intervention was 78.4%; for mortality, 92.8%.

CONCLUSION:

Patients with CURB-65 score less than or equal to 2 were often admitted to the ICU and received critical care interventions. Given this finding and the relatively low sensitivity of CURB-65 for critical care intervention, clinicians should exercise caution when using CURB-65 to guide disposition. Future ED-based clinical prediction rules may benefit from calibration to proximal endpoints.
PMID:
 
30078659
 
PMCID:
 
PMC6359992
 [Available on 2020-07-01]
 
DOI:
 
10.1016/j.annemergmed.2018.06.017
[Indexed for MEDLINE]
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20.
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