#Antipsychotic use and risk of hospitalisation or death due to #pneumonia in persons with and without Alzheimer’s disease

http://journal.publications.chestnet.org/mobile/article.aspx?articleid=2529123

Conclusions Regardless of applied study design, treatment duration, or the choice of drug, antipsychotic use was associated with higher risk of pneumonia. With observational data we cannot fully rule out a shared causality between pneumonia and antipsychotic use, but the risk-benefit balance should be considered when antipsychotics are prescribed.

Access to #Dental Care and Risk of #Pneumonia: the Importance of Healthy Teeth

https://idsa.confex.com/idsa/2016/webprogram/Paper58758.html

Pneumonia risk appears to be decreased in those who customarily attend routine dental check-ups. This is consistent with data that good oral health is an important component of overall health. Dental insurance was not associated with pneumonia in the final model; insurance alone may be insufficient to guarantee access to dental care.

Accuracy of lung #ultrasound in the diagnosis of #pneumonia in adults: systematic review and meta-analysis

http://journal.publications.chestnet.org/mobile/article.aspx?articleid=2583280

Lung ultrasound can help to accurately diagnose pneumonia, and it may be promising as an adjuvant resource to traditional approaches.

Risk of #pneumonia associated with incident #benzodiazepine use among community-dwelling adults with #Alzheimer disease

http://m.cmaj.ca/content/189/14/E519

When analyzed separately, benzodiazepine use was significantly associated with an increased risk of pneumonia (adjusted HR 1.28, 95% CI 1.07–1.54), whereas Z-drug use was not (adjusted HR 1.10, 95% CI 0.84–1.44). The risk of pneumonia was greatest within the first 30 days of benzodiazepine use (HR 2.09, 95% CI 1.26–3.48).
INTERPRETATION: Benzodiazepine use was associated with an increased risk of pneumonia among patients with Alzheimer disease. Risk of pneumonia should be considered when weighing the benefits and risks of benzodiazepines in this population.

Initial #Antibiotic Treatment Fails in Nearly One in Four #Pneumonia Patients, Study Finds https://pneumoniaresearchnews.com/2017/05/23/study-reports-initial-antibiotic-fails-in-one-of-four-pneumonia-patients/ The study was based on medical records of nearly 251,950 adults who received an initial regimen of beta-lactam, macrolide, tetracycline, or fluoroquinolone for their pneumonia between 2011 and 2015. Patients over the age of 65 were nearly twice as likely to be hospitalized compared to younger patients when our analysis was risk-adjusted and nearly three times more likely in unadjusted analysis. Elderly patients are more vulnerable and should be treated more carefully, potentially with more aggressive antibiotic therapy.”

The failure rates by class of antibiotic were 25.7 percent for beta-lactams, 22.9 percent for macrolides, 22.5 percent for tetracyclines, and 20.8 percent for fluoroquinolones.

Ultra-Short-Course #Antibiotics for Patients With Suspected #Ventilator-Associated #Pneumonia but Minimal and Stable Ventilator Settings
https://academic.oup.com/cid/article-abstract/64/7/870/2756965/Ultra-Short-Course-Antibiotics-for-Patients-With

Background.
Many patients started on antibiotics for possible ventilator-associated pneumonia (VAP) do not have pneumonia. Patients with minimal and stable ventilator settings may be suitable candidates for early antibiotic discontinuation. We compared outcomes among patients with suspected VAP but minimal and stable ventilator settings treated with 1–3 days vs >3 days of antibiotics.

Conclusions.
Very short antibiotic courses (1–3 days) were associated with outcomes similar to longer courses (>3 days) in patients with suspected VAP but minimal and stable ventilator settings. Assessing serial ventilator settings may help clinicians identify candidates for early antibiotic discontinuation.

Effectiveness of #β-Lactam Monotherapy vs Macrolide Combination Therapy for Children Hospitalized With #Pneumonia
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2659321

β-Lactam monotherapy and β-lactam plus macrolide combination therapy are both common empirical treatment strategies for children hospitalized with pneumonia, but few studies have evaluated the effectiveness of these 2 treatment

..1019 (71.9%) received β-lactam monotherapy and 399 (28.1%) received β-lactam plus macrolide combination therapy. In the unmatched cohort, there was no statistically significant difference in length of hospital stay between children receiving β-lactam monotherapy and combination therapy (median, 55 vs 59 hours; adjusted hazard ratio, 0.87; 95% CI, 0.74-1.01). The propensity-matched cohort (n = 560, 39.5%) showed similar results. There were also no significant differences between treatment groups for the secondary outcomes.

Conclusions and Relevance Empirical macrolide combination therapy conferred no benefit over β-lactam monotherapy for children hospitalized with community-acquired pneumonia. The results of this study elicit questions about the routine empirical use of macrolide combination therapy in this population

#Predictors of #pneumonia in lower respiratory tract infections: 3C prospective cough complication cohort study
http://erj.ersjournals.com/content/50/5/1700434

The predictive value of patient characteristics, presenting symptoms and clinical findings for the diagnosis of pneumonia in the first 7 days was established.

Of the 720 out of 28 883 (2.5.%) radiographed within 1 week of the index consultation, 115 (16.0%; 0.40% of 28 883) were assigned a definite or probable pneumonia diagnosis. The significant independent predictors of radiograph-confirmed pneumonia were temperature >37.8°C (RR 2.6; 95% CI 1.5–4.8), crackles on auscultation (RR 1.8; 1.1–3.0), oxygen saturation <95% (RR 1.7; 1.0–3.1) and pulse >100·min–1 (RR 1.9; 1.1–3.2). Most patients with pneumonia (99/115, 86.1%) exhibited at least one of these four clinical signs; the positive predictive value of having at least one of these signs was 20.2% (95% CI 17.3–23.1).

In routine practice, radiograph-confirmed pneumonia as a short-term complication of LRTI is very uncommon (one in 270). Pulse oximetry may aid the diagnosis of pneumonia in this setting

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Negative Chest #Radiography and Risk of #Pneumonia

http://pediatrics.aappublications.org/content/early/2018/08/24/peds.2018-0236

There were 683 children enrolled during the 2-year study period, with a median age of 3.1 years (interquartile range 1.4–5.9 years). There were 457 children (72.8%) with negative CXRs; 44 of these children (8.9%) were clinically diagnosed with pneumonia, and 42 (9.3%) were given antibiotics for other bacterial syndromes. Of the 411 children with negative CXRs who were managed without antibiotics, 5 were subsequently diagnosed with pneumonia within 2 weeks (negative predictive value of CXR 98.8%; 95% confidence interval 97.0%–99.6%).

CONCLUSIONS: A negative CXR excludes pneumonia in the majority of children. Children with negative CXRs and low clinical suspicion for pneumonia can be safely observed without antibiotic therapy

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#Triple therapy in the management of chronic obstructive pulmonary disease: systematic review and meta-analysis

https://www.bmj.com/content/363/bmj.k4388

21 trials (19 publications) were included. Triple therapy consisted of a long acting muscarinic antagonist (LAMA), long acting β agonist (LABA), and inhaled corticosteroid (ICS). Triple therapy was associated with a significantly reduced rate of moderate or severe exacerbations compared with LAMA monotherapy (rate ratio 0.71, 95% confidence interval 0.60 to 0.85), LAMA and LABA (0.78, 0.70 to 0.88), and ICS and LABA (0.77, 0.66 to 0.91). Trough forced expiratory volume in 1 second (FEV1) and quality of life were favourable with triple therapy.

The overall safety profile of triple therapy is reassuring, but #pneumonia was significantly higher with triple therapy than with dual therapy of LAMA and LABA (relative risk 1.53, 95% confidence interval 1.25 to 1.87).

Conclusions Use of triple therapy resulted in a lower rate of moderate or severe exacerbations of #COPD, better lung function, and better health related quality of life than dual therapy or monotherapy in patients with advanced COPD.

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#Benzodiazepines or related drugs and risk of #pneumonia: A systematic review and meta‐analysis

https://onlinelibrary.wiley.com/doi/full/10.1002/gps.5048

Benzodiazepines and benzodiazepine‐related drugs (BZRDs) are used to treat various psychiatric diseases. However, there are concerns that BZRDs increase the risk of pneumonia.

After pooling the estimates, the odds for developing pneumonia were 1.25‐fold higher (odd ratio, OR = 1.25; 95% confidence interval (CI), 1.09‐1.44) in BZRD users compared with individuals who had not taken BZRD. On the basis of exposure window, we found an increased risk of pneumonia among current (OR = 1.4; 95%CI, 1.22‐1.6) and recent (OR = 1.38; 95%CI, 1.06‐1.8) users, but not with the past users (OR = 1.11; 95%CI, 0.96‐1.27).

Conclusion
Current or recent exposure to BZRD is associated with an increased pneumonia risk. Clinicians need to weight the benefit‐risk balance of BZRD use, especially those with other risk factors for pneumonia.

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Rapid Testing in Suspected #MRSA #Pneumonia

https://journal.chestnet.org/article/S0012-3692(19)30156-4/fulltext?mobileUi=0

Guidelines recommend empirical vancomycin or linezolid for patients with suspected pneumonia at risk for methicillin-resistant Staphylococcus aureus (MRSA). Unneeded vancomycin or linezolid use may unnecessarily alter host flora and expose patients to toxicity

Sensitivity of RPCR was 95.7%, with a negative likelihood ratio of 0.04 for MRSA. The clinical trial randomized 45 patients: 22 to antibiotic management made on the basis of RDT and 23 to usual care. Duration of vancomycin or linezolid administration was significantly reduced in the intervention group (32 h [interquartile range, 22-48] vs 72 h [interquartile range, 50-113], P < .001). Proportions with complications and length of stay trended lower in the intervention group. Hospital mortality was 13.6% in the intervention group and 39.1% for usual care (95% CI of difference, –3.3 to 50.3, P = .06). Standardized mortality ratio was 0.48 for the intervention group and 1.18 for usual care.

Conclusions
A highly sensitive BAL RDT for MRSA significantly reduced use of vancomycin and linezolid in ventilated patients with suspected pneumonia. Management made on the basis of RDT had no adverse effects, with a trend to lower hospital mortality

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Excess #Antibiotic Treatment Duration and Adverse Events in Patients Hospitalized With #Pneumonia: A Multihospital Cohort Study

https://annals.org/aim/article-abstract/2737823/excess-antibiotic-treatment-duration-adverse-events-patients-hospitalized-pneumonia-multihospital

..Excess days were calculated by subtracting each patient's shortest effective (expected) treatment duration (based on time to clinical stability, pathogen, and pneumonia classification community-acquired vs. health care–associated) from the actual duration.

..Excess treatment was not associated with lower rates of any adverse outcomes, including death, readmission, emergency department visit, or Clostridioides difficile infection. Each excess day of treatment was associated with a 5% increase in the odds of antibiotic-associated adverse events reported by patients after discharge.

Conclusion:
Patients hospitalized with pneumonia often receive excess antibiotic therapy. Excess antibiotic treatment was associated with patient-reported adverse events. Future interventions should focus on whether reducing excess treatment and improving documentation at discharge improves outcomes.

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Prediction model for #pneumonia in primary care patients with an acute respiratory tract infection: role of symptoms, signs, and biomarkers

Diagnosing pneumonia can be challenging in general practice but is essential to distinguish from other respiratory tract infections because of treatment choice and outcome prediction..

..Two hundred forty-nine patients were included of whom 30 (12%) displayed a consolidation on chest X ray. Absence of runny nose and whether or not a patient felt ill were independent predictors for pneumonia. CRP predicts pneumonia better than the other biomarkers but adding CRP to the clinical model did not improve classification (− 4%); however, CRP helped guidance of the decision which patients should be given antibiotics.

Conclusions
Adding CRP measurements to a clinical model in selected patients with an acute respiratory infection does not improve prediction of pneumonia, but does help in giving guidance on which patients to treat with antibiotics. Our findings put the use of biomarkers and chest X ray in diagnosing pneumonia and for treatment decisions into some perspective for general practitioners

https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-4611-1

Empirical Anti-#MRSA vs Standard Antibiotic Therapy and Risk of 30-Day Mortality in Patients Hospitalized for #Pneumonia

..Compared with standard therapy alone, in weighted propensity score analysis, empirical anti-MRSA therapy plus standard therapy was significantly associated with an increased adjusted risk of death (adjusted risk ratio [aRR], 1.4 [95% CI, 1.3-1.5]), kidney injury (aRR, 1.4 [95% CI, 1.3-1.5]), and secondary C difficile infections (aRR, 1.6 [95% CI, 1.3-1.9]), vancomycin-resistant Enterococcus spp infections (aRR, 1.6 [95% CI, 1.0-2.3]), and secondary gram-negative rod infections (aRR, 1.5 [95% CI, 1.2-1.8]).

Similar associations between anti-MRSA therapy use and 30-day mortality were found by instrumental variable analysis (aRR, 1.6 [95% CI, 1.4-1.9]) and among patients admitted to the intensive care unit (aRR, 1.3 [95% CI, 1.2-1.5]), those with a high risk for MRSA (aRR, 1.2 [95% CI, 1.1-1.4]), and those with MRSA detected on surveillance testing (aRR, 1.6 [95% CI, 1.3-1.9]). No significant favorable association was found between empirical anti-MRSA therapy and death among patients with MRSA detected on culture (aRR, 1.1 [95% CI, 0.8-1.4]).

Conclusions and Relevance  This study suggests that empirical anti-MRSA therapy was not associated with reduced mortality for any group of patients hospitalized for pneumonia. These results contribute to a growing body of evidence that questions the value of empirical use of anti-MRSA therapy using existing risk approaches

https://bit.ly/2P4MKKQ

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Abnormal Coagulation parameters are associated with poor prognosis in patients with novel #coronavirus #pneumonia

In the recent outbreak of novel coronavirus infection in Wuhan, China, significantly abnormal coagulation parameters in severe novel coronavirus pneumonia (NCP) cases were a concern..

Conventional coagulation results and outcomes of consecutive 183 patients with confirmed NCP in Tongji hospital were retrospectively analysed.

Results
The overall mortality was 11.5%, the non‐survivors revealed significantly higher D‐dimer and fibrin degradation product (FDP) levels, longer prothrombin time and activated partial thromboplastin time compared to survivors on admission (P<0.05). 71.4% of non‐survivors and 0.6% survivors met the criteria of disseminated intravascular coagulation during their hospital stay.

Conclusions
The present study shows that abnormal coagulation results, especially markedly elevated D‐dimer and FDP are common in deaths with NCP.

https://bit.ly/3c9PKzH

Antibiotic Use and Outcomes in Children in the Emergency Department With Suspected #Pneumonia
https://2medical.news/2020/03/23/antibiotic-use-and-outcomes-in-children-in-the-emergency-department-with-suspected-pneumonia/

Antibiotic therapy is often prescribed for suspected community-acquired pneumonia (CAP) in children despite a lack of knowledge of causative pathogen. Our objective in this study was to investigate the association between antibiotic prescription and treatment failure in children with suspected CAP who are discharged from the hospital emergency department (ED).. ..Of 337 eligible children, 294 were matched on the basis of propensity score. There was …

Predictive Value of Initial #CT scan for Various Adverse Outcomes in Patients with #COVID-19 #Pneumonia
https://2medical.news/2020/10/16/predictive-value-of-initial-ct-scan-for-various-adverse-outcomes-in-patients-with-covid-19-pneumonia/

..This study investigates the predictive value of CT severity score (CSS) for length-of-stay (LOS) in hospital, initial disease severity, ICU admission, intubation, and mortality ..Total of 121 patients (60±16 years), including 54 women and 67 men, with positive RT-PCR tests were enrolled. We found a significant but weak correlation between CSS and qSOFA, as a measure of disease severity (r: 0.261, p= 0.003). No significant …

Short-Course #Antimicrobial Therapy for Pediatric Community-Acquired #Pneumonia The SAFER Randomized Clinical Trial
https://2medical.news/2021/03/09/short-course-antimicrobial-therapy-for-pediatric-community-acquired-pneumonia-the-safer-randomized-clinical-trial/

Community-acquired pneumonia (CAP) is a common occurrence in childhood; consequently, evidence-based recommendations for its treatment are required. Objective To determine whether 5 days of high-dose amoxicillin for CAP was associated with noninferior rates of clinical cure compared with 10 days of high-dose amoxicillin. Design, Setting, and Participants The SAFER (Short-Course Antimicrobial Therapy for Pediatric Respiratory Infections) study was a 2-center, parallel-group, noninferiority randomized clinical trial …

Empiric #antibiotics for community-acquired #pneumonia in adult patients: a systematic review and a network meta-analysis
https://2medical.news/2021/03/21/empiric-antibiotics-for-community-acquired-pneumonia-in-adult-patients-a-systematic-review-and-a-network-meta-analysis/

The main aim of this network meta-analysis is to identify the empiric antibiotic (Em-ATB) with the highest probability of being the best (HPBB) in terms of (1) cure rate and (2) mortality rate in hospitalised patients with community acquired pneumonia (CAP) . Method Inclusion criteria: (1) adult patients (>16 years old) diagnosed with CAP that required hospitalisation; (2) randomised to at least two different Em-ATBs, (3) …