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Latest & greatest articles for pneumonia
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Efficacy of short-term prednisolone treatment in patients with chronic eosinophilic pneumonia In patients with chronic eosinophilic pneumonia (CEP), dramatic improvements are seen in response to corticosteroid therapy; however, relapse is common after treatment has ceased. The optimal duration of corticosteroid therapy remains unclear. In a randomised, open-label, parallel group study, eligible patients with CEP received oral prednisolone for either 3 months (3-month group) or 6 months (6-month
Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radiographically and with the use of current laboratory diagnostic tests are needed.We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among adults 18 years of age or older in five hospitals in Chicago and Nashville (...) . Patients with recent hospitalization or severe immunosuppression were excluded. Blood, urine, and respiratory specimens were systematically collected for culture, serologic testing, antigen detection, and molecular diagnostic testing. Study radiologists independently reviewed chest radiographs. We calculated population-based incidence rates of community-acquired pneumonia requiring hospitalization according to age and pathogen.From January 2010 through June 2012, we enrolled 2488 of 3634 eligible
Short-course versus long-course intravenous therapy with the same antibiotic for severe community-acquired pneumonia in children aged two months to 59 months. Pneumonia remains the single leading cause of childhood mortality, causing an estimated 1.3 million childhood deaths each year in children under the age of five years. The greater burden of disease occurs in low-income countries, where medical resources and hospital-based management are poor. The World Health Organization (WHO) current (...) evidence summaries recommend intravenous antibiotics for five days as first-line treatment for severe pneumonia. Although there is controversy around the specificity of clinical features in the diagnosis of pneumonia, the criteria for the diagnosis of severe pneumonia are better defined and widely used to triage children for referral and second-line therapy.Approximately 120 million new cases of pneumonia occur globally each year in children under five years of age, of which 14 million progress
Antibiotic treatment strategies for community-acquired pneumonia in adults. The choice of empirical antibiotic treatment for patients with clinically suspected community-acquired pneumonia (CAP) who are admitted to non-intensive care unit (ICU) hospital wards is complicated by the limited availability of evidence. We compared strategies of empirical treatment (allowing deviations for medical reasons) with beta-lactam monotherapy, beta-lactam-macrolide combination therapy, or fluoroquinolone
Community-acquired pneumonia as medical emergency: predictors of early deterioration Early organ dysfunction determines the prognosis of community-acquired pneumonia (CAP), and recognition of CAP as a medical emergency has been advocated.To characterise patients with 'emergency CAP' and evaluate predictors for very early organ failure or death.3427 prospectively enrolled patients of the CAPNETZ cohort were included. Emergency CAP was defined as requirement for mechanical ventilation
Anticholinergic Medications and Risk of Community-Acquired Pneumonia in Elderly Adults: A Population-Based Case-Control Study To determine whether use of anticholinergics is associated with risk of community-acquired pneumonia in older adults.Population-based case-control study.An integrated healthcare delivery system in Washington State.Data from a nested case-control study of community-dwelling immunocompetent adults aged 65 to 94 were analyzed. Pneumonia cases (n=1,039) were ascertained (...) according to International Classification of Diseases, Ninth Revision, codes from 2000 to 2003 and validated using chart review. Controls (n=2,022) were matched 2:1 to cases according to age, sex, and year.Anticholinergic medication exposure was ascertained using prescription data; acute use was defined as one or more prescription fills 90 days or less before the index date (date of pneumonia diagnosis), past use was defined as one or more prescription fills within the prior year but none within 90 days
Lactate on emergency department arrival as a predictor of mortality and site-of-care in pneumonia patients: a cohort study To investigate the predictive performance of lactate, CURB-65, and a combination of lactate and CURB-65 (LAC-CURB-65) for mortality, hospitalisation and intensive care unit (ICU) admission in pneumonia patients in the emergency department (ED).Consecutive adult patients with pneumonia presenting from January 2012 to May 2014 were divided into low-, moderate- and high-risk (...) risk had the highest mortality (52%), hospitalisation (70%) and ICU admission rates (27%).Lactate is superior to CURB-65 in predicting mortality, hospitalisation and ICU admission in pneumonia patients in the ED. LAC-CURB-65 significantly improved the predictive value of CURB-65.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. Pneumococcal polysaccharide conjugate vaccines prevent pneumococcal disease in infants, but their efficacy against pneumococcal community-acquired pneumonia in adults 65 years of age or older is unknown.In a randomized, double-blind, placebo-controlled trial involving 84,496 adults 65 years of age or older, we evaluated the efficacy of 13-valent polysaccharide conjugate vaccine (PCV13) in preventing first episodes (...) of vaccine-type strains of pneumococcal community-acquired pneumonia, nonbacteremic and noninvasive pneumococcal community-acquired pneumonia, and invasive pneumococcal disease. Standard laboratory methods and a serotype-specific urinary antigen detection assay were used to identify community-acquired pneumonia and invasive pneumococcal disease.In the per-protocol analysis of first episodes of infections due to vaccine-type strains, community-acquired pneumonia occurred in 49 persons in the PCV13 group
Regulation of neutrophilic inflammation in lung injury induced by community-acquired pneumonia. Community-acquired pneumonia is commonly caused by Streptococcus pneumoniae, which is associated with excessive neutrophilic inflammation. The high-affinity thrombin receptor, proteinase-activated receptor 1 (PAR1), has been implicated in mediating the interplay between coagulation and inflammation. However, its role during S pneumoniae-induced neutrophilic inflammation, and the mechanisms (...) for neutrophil recruitment in this context are poorly understood. We aimed to investigate the role of neutrophilic inflammation and PAR1 in S pneumoniae-induced pneumonia.We used the most clinically advanced PAR-1 antagonist, SCH530348, and performed neutrophil depletion and chemokine neutralisation studies in two murine models. We also did translational studies to examine CXC and CC chemokine receptor expression by flow cytometry on neutrophils in blood and bronchoalveolar lavage fluid (BALF) from
Community-acquired pneumonia requiring hospitalization among U.S. children. Incidence estimates of hospitalizations for community-acquired pneumonia among children in the United States that are based on prospective data collection are limited. Updated estimates of pneumonia that has been confirmed radiographically and with the use of current laboratory diagnostic tests are needed.We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among (...) of pneumonia. The median age of the children was 2 years (interquartile range, 1 to 6); 497 of 2358 children (21%) required intensive care, and 3 (<1%) died. Among 2222 children with radiographic evidence of pneumonia and with specimens available for bacterial and viral testing, a viral or bacterial pathogen was detected in 1802 (81%), one or more viruses in 1472 (66%), bacteria in 175 (8%), and both bacterial and viral pathogens in 155 (7%). The annual incidence of pneumonia was 15.7 cases per 10,000
Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. In patients with severe community-acquired pneumonia, treatment failure is associated with excessive inflammatory response and worse outcomes. Corticosteroids may modulate cytokine release in these patients, but the benefit of this adjunctive therapy remains controversial.To assess the effect of corticosteroids (...) in patients with severe community-acquired pneumonia and high associated inflammatory response.Multicenter, randomized, double-blind, placebo-controlled trial conducted in 3 Spanish teaching hospitals involving patients with both severe community-acquired pneumonia and a high inflammatory response, which was defined as a level of C-reactive protein greater than 150 mg/L at admission. Patients were recruited and followed up from June 2004 through February 2012.Patients were randomized to receive either
Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia: retrospective cohort study. To characterize the absolute risks for older patients of readmission to hospital and death in the year after hospitalization for heart failure, acute myocardial infarction, or pneumonia.Retrospective cohort study.4767 hospitals caring for Medicare fee for service beneficiaries in the United States, 2008-10.More than 3 million Medicare fee for service beneficiaries (...) in risk from maximum daily declines after discharge; and the extent to which risks are higher among patients recently discharged from hospital compared with the general elderly population.Within one year of hospital discharge, readmission to hospital and death, respectively, occurred following 67.4% and 35.8% of hospitalizations for heart failure, 49.9% and 25.1% for acute myocardial infarction, and 55.6% and 31.1% for pneumonia. Risk of first readmission had declined 50% by day 38 after
Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. The risk of cardiovascular disease (CVD) after infection is poorly understood.To determine whether hospitalization for pneumonia is associated with an increased short-term and long-term risk of CVD.We examined 2 community-based cohorts: the Cardiovascular Health Study (CHS, n = 5888; enrollment age, ≥65 years; enrollment period, 1989-1994) and the Atherosclerosis Risk in Communities study (ARIC, n (...) = 15,792; enrollment age, 45-64 years; enrollment period, 1987-1989). Participants were followed up through December 31, 2010. We matched each participant hospitalized with pneumonia to 2 controls. Pneumonia cases and controls were followed for occurrence of CVD over 10 years after matching. We estimated hazard ratios (HRs) for CVD at different time intervals, adjusting for demographics, CVD risk factors, subclinical CVD, comorbidities, and functional status.Hospitalization for pneumonia.Incident CVD
Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial. Clinical trials yielded conflicting data about the benefit of adding systemic corticosteroids for treatment of community-acquired pneumonia. We assessed whether short-term corticosteroid treatment reduces time to clinical stability in patients admitted to hospital for community-acquired pneumonia.In this double-blind, multicentre, randomised, placebo (...) -controlled trial, we recruited patients aged 18 years or older with community-acquired pneumonia from seven tertiary care hospitals in Switzerland within 24 h of presentation. Patients were randomly assigned (1:1 ratio) to receive either prednisone 50 mg daily for 7 days or placebo. The computer-generated randomisation was done with variable block sizes of four to six and stratified by study centre. The primary endpoint was time to clinical stability defined as time (days) until stable vital signs
2015LancetControlled trial quality: predicted high
The TaperGuard Evac oral tracheal tube for mechanically ventilated intensive care patients at risk of ventilator-associated pneumonia Shile Shiley Endotr y Endotracheal T acheal T ube with T ube with T aperGuard Cuff aperGuard Cuff for intensiv for intensive care patients at risk of e care patients at risk of v ventilator-associated pneumonia entilator-associated pneumonia Medtech innovation briefing Published: 2 March 2015 nice.org.uk/guidance/mib22 pathways Summary Summary The T aperGuard (...) Evac oral tracheal tube is intended for airway management in critically ill patients needing mechanical ventilation. Two randomised controlled trials comparing the use of T aperGuard Evac with conventional tubes found no statistically significant differences between the groups in the incidence of ventilator-associated pneumonia, time to onset of ventilator-associated pneumonia, or length of intensive care unit stay. Using T aperGuard Evac costs £111.07 (for a box of 10 single-use tubes), plus
Pharmacokinetic/pharmacodynamic measures for guiding antibiotic treatment for hospital acquired pneumonia Pharmacokinetic/pharmacodynamic measures for guiding antibiotic treatment for hospital acquired pneumonia Pharmacokinetic/pharmacodynamic measures for guiding antibiotic treatment for hospital acquired pneumonia Lux LJ, Posey RE, Daniels LS, Henke DC, Durham C, Jonas DE, Lohr KN Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA (...) . No evaluation of the quality of this assessment has been made for the HTA database. Citation Lux LJ, Posey RE, Daniels LS, Henke DC, Durham C, Jonas DE, Lohr KN. Pharmacokinetic/pharmacodynamic measures for guiding antibiotic treatment for hospital acquired pneumonia. Rockville: Agency for Healthcare Research and Quality (AHRQ). Comparative Effectiveness Review No. 136. 2014 Authors' objectives To conduct a systematic review of the use of pharmacokinetic/pharmacodynamic (PK/PD) measures or strategies
Approach to the Hospitalized Patient with Community-Acquired Pneumonia: Should Procalcitonin Be Part of the Initial Evaluation? Approach to the Hospitalized Patient with Community-Acquired Pneumonia: Should Procalcitonin Be Part of the Initial Evaluation? – Clinical Correlations Search Approach to the Hospitalized Patient with Community-Acquired Pneumonia: Should Procalcitonin Be Part of the Initial Evaluation? November 21, 2014 7 min read By Matthew Light, MD Peer Reviewed A 79 year-old female (...) chest x-ray shows a lingular consolidation with air bronchograms. The Pneumonia Severity Index . The patient is given ceftriaxone and azithromycin and admitted to the medicine service. The question arises, is there a role for checking a procalcitonin (PCT) level in this patient as part of the initial work-up or tracking PCT levels during hospitalization? Rates of hospitalization for pneumonia (PNA) in the United States, though trending down, . In addition . With such substantial morbidity