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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.
#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
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.
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
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
BioMed Central
Prediction model for pneumonia in primary care patients with an acute respiratory tract infection: role of symptoms, signs, and…
Background 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. We determined predictive signs, symptoms and biomarkers for…
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
..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
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
Wiley Online Library
Abnormal Coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia
Background
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.
Ob...
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.
Ob...
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 …
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 …
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 …
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) …
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) …