scholarly journals Intra-hospital mortality for community-acquired pneumonia in mainland Portugal between 2000 and 2009

Pulmonology ◽  
2019 ◽  
Vol 25 (2) ◽  
pp. 66-70 ◽  
Author(s):  
F. Teixeira-Lopes ◽  
A. Cysneiros ◽  
A. Dias ◽  
V. Durão ◽  
C. Costa ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Community Acquired Pneumonia ◽  
Mainland Portugal

scholarly journals Quantitative assessment of erector spinae muscles and prognosis in elderly patients with pneumonia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hiroki Yoshikawa ◽  
Kosaku Komiya ◽  
Takashi Yamamoto ◽  
Naoko Fujita ◽  
Hiroaki Oka ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Regression Models ◽  
Proportional Hazards ◽  
Community Acquired Pneumonia ◽  
Cox Proportional Hazards ◽  
Erector Spinae ◽  
Cross Sectional ◽  
Proportional Hazards Regression ◽  
Survivor Group

AbstractErector spinae muscle (ESM) size has been reported as a predictor of prognosis in patients with some respiratory diseases. This study aimed to assess the association of ESM size on all-cause in-hospital mortality among elderly patients with pneumonia. We retrospectively included patients (age: ≥ 65 years) admitted to hospital from January 2015 to December 2017 for community-acquired pneumonia who underwent chest computed tomography (CT) on admission. The cross-sectional area of the ESM (ESMcsa) was measured on a single-slice CT image at the end of the 12th thoracic vertebra and adjusted by body surface area (BSA). Cox proportional hazards regression models were used to assess the influence of ESMcsa/BSA on in-hospital mortality. Among 736 patients who were admitted for pneumonia, 702 patients (95%) underwent chest CT. Of those, 689 patients (98%) for whom height and weight were measured to calculate BSA were included in this study. Patients in the non-survivor group were significantly older, had a greater frequency of respiratory failure, loss of consciousness, lower body mass index, hemoglobin, albumin, and ESMcsa/BSA. Multivariate analysis showed that a lower ESMcsa/BSA independently predicted in-hospital mortality after adjusting for these variables. In elderly patients with pneumonia, quantification of ESMcsa/BSA may be associated with in-hospital mortality.

scholarly journals 1476. Impact of an Educational Campaign on Rates of Sputum Culture Acquisition as an Opportunity for Antibiotic De-escalation

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S739-S739
Author(s):  
Jessica Snawerdt ◽  
Derek N Bremmer ◽  
Dustin R Carr ◽  
Thomas L Walsh ◽  
Tamara Trienski ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Community Acquired Pneumonia ◽  
Sputum Culture ◽  
Post Intervention ◽  
Significant Difference ◽  
Educational Campaign ◽  
The Difference ◽  
Hospital Acquired ◽  
Culture Acquisition

Abstract Background The 2019 community-acquired pneumonia (CAP) guidelines recommend obtaining a sputum culture in patients who are empirically treated for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa to assist clinicians in optimizing antimicrobial therapy. A previous study at our institution found respiratory cultures were rarely obtained in patients with CAP. As a result of these findings, an educational campaign was implemented to promote the use of an induced sputum protocol. Methods This was a multicenter, retrospective cohort study that included patients who were ≥18 years of age, had a diagnosis of CAP, and received ≥48 hours of anti-pseudomonal antibiotics. Patients were excluded if mechanically ventilated within 48 hours of admission or diagnosed with hospital-acquired or ventilator-associated pneumonia. Patients were grouped into pre- and post-intervention time periods. The intervention involved education on obtaining respiratory cultures including technique on induced sputums and updates to CAP order sets. The primary outcome was the rate of sputum culture acquisition. Secondary outcomes included duration of anti-pseudomonal and anti-MRSA therapy, in-hospital mortality, and length of stay. Results A total of 143 patients met inclusion criteria, 72 in the pre-implementation group and 71 in the post-implementation group. Baseline characteristics were similar between the two groups. More patients in the post-implementation group had a sputum culture obtained but the difference was not statistically significant (38.9% vs 53.5%; p=0.08). Anti-pseudomonal therapy was continued for an average of 5.6 days pre-implementation and 5.2 days post-implementation (p=0.499). There was also not a significant difference in anti-MRSA duration between the two groups (3.4 days vs 3.2 days; p=0.606). In-hospital mortality and length of stay were similar between the two groups. Conclusion An educational campaign focusing on the acquisition of induced sputums led to an increase in rates of sputum cultures collected. However, this did not correlate with a decrease in duration of anti-MRSA or anti-pseudomonal therapy. Further interventions should be made to optimize de-escalation of broad spectrum antibiotics based on sputum culture results. Disclosures All Authors: No reported disclosures

scholarly journals Implementation of a specialist pneumonia intervention nurse service significantly lowers mortality for community acquired pneumonia

2019 ◽  
Author(s):  
Robert C. Free ◽  
Matthew Richardson ◽  
Camilla Pillay ◽  
Julie Skeemer ◽  
Kayleigh Hawkes ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Antibiotic Treatment ◽  
Clinical Education ◽  
Guideline Adherence ◽  
Low Cost ◽  
Community Acquired Pneumonia ◽  
Bottom Line ◽  
Specialist Nurse ◽  
Guidelines Adherence

AbstractObjectivesEvaluate clinical outcomes associated with implementing a specialist pneumonia intervention nursing (SPIN) service, to improve adherence with BTS guidelines for hospitalised community acquired pneumonia (CAP).DesignRetrospective cohort study, comparing periods before (2011-13) and after (2014-16) SPIN service implementation.SettingSingle NHS trust across two hospital sites in Leicester City, EnglandParticipants13,496 adult (aged ≥16) admissions to hospital with a primary diagnosis of CAPInterventionsThe SPIN service was set up in 2013/2014 to provide clinical review of new CAP admissions; assurance of guidelines adherence; delivery of CAP clinical education and clinical follow up after discharge.Main outcome measuresThe primary outcomes were proportions of CAP cases receiving antibiotic treatment within 4 hours of admission and change in crude in-hospital mortality rate. Secondary outcomes were adjusted mortality rate and length of stay (LOS).ResultsThe SPIN service reviewed 38% of CAP admissions in 2014-16. 82% of these admissions received antibiotic treatment in <4 hours (68.5% in the national audit). Compared with the pre-SPIN period, there was a significant reduction in both 30-day (OR=0.77 [0.70-0.85], p<0.0001) and in-hospital mortality (OR=0.66 [0.60-0.73], p<0.0001) after service implementation, with a review by the service having the largest independent 30-day mortality benefit (HR=0.60 [0.53-0.67], p<0.0001). There was no change in LOS (median 6 days).ConclusionsImplementation of a SPIN service improves adherence with BTS guidelines and achieves significant reductions in CAP associated mortality. This enhanced model of care is low cost, highly effective and readily adoptable in secondary care.Key MessagesWhat is the key question?Does a specialist nurse-led intervention affect BTS guideline adherence and mortality for patients admitted to hospital with community acquired pneumonia (CAP)?What is the bottom line?Implementing specialist nurse teams for CAP delivers improved guideline adherence and survival for patients admitted with the condition.Why read on?This study shows a low-cost specialist nursing service focussed on CAP is associated with a significant improvement in BTS guidelines adherence and patient survival.

Factors predicting in‐hospital mortality among patients admitted with community acquired pneumonia at a tertiary care hospital Karachi, Pakistan

2020 ◽  
Vol 14 (4) ◽  
pp. 328-334
Author(s):  
Nousheen Iqbal ◽  
Muhammad Irfan ◽  
Faraz Siddique ◽  
Verda Arshad ◽  
Ali Bin Sarwar Zubairi
Keyword(s):  
Hospital Mortality ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Community Acquired Pneumonia ◽  
Care Hospital

scholarly journals Health Care-Associated Pneumonia and Community-Acquired Pneumonia: a Single-Center Experience

2007 ◽  
Vol 51 (10) ◽  
pp. 3568-3573 ◽  
Author(s):  
Scott T. Micek ◽  
Katherine E. Kollef ◽  
Richard M. Reichley ◽  
Nareg Roubinian ◽  
Marin H. Kollef
Keyword(s):  
Health Care ◽  
Staphylococcus Aureus ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Health Care Providers ◽  
Community Acquired Pneumonia ◽  
Antimicrobial Treatment ◽  
Care Providers ◽  
Health Care Associated Pneumonia ◽  
Culture Positive

ABSTRACT Pneumonia occurring outside of the hospital setting has traditionally been categorized as community-acquired pneumonia (CAP). However, when pneumonia is associated with health care risk factors (prior hospitalization, dialysis, residing in a nursing home, immunocompromised state), it is now more appropriately classified as a health care-associated pneumonia (HCAP). The relative incidences of CAP and HCAP among patients requiring hospital admission is not well described. The objective of this retrospective cohort study, involving 639 patients with culture-positive CAP and HCAP admitted between 1 January 2003 and 31 December 2005, was to characterize the incidences, microbiology, and treatment patterns for CAP and HCAP among patients requiring hospital admission. HCAP was more common than CAP (67.4% versus 32.6%). The most common pathogens identified overall included methicillin-resistant Staphylococcus aureus (24.6%), Streptococcus pneumoniae (20.3%), Pseudomonas aeruginosa (18.8%), methicillin-sensitive Staphylococcus aureus (13.8%), and Haemophilus influenzae (8.5%). The hospital mortality rate was statistically greater among patients with HCAP than among those with CAP (24.6% versus 9.1%; P < 0.001). Administration of inappropriate initial antimicrobial treatment was statistically more common among HCAP patients (28.3% versus 13.0%; P < 0.001) and was identified as an independent risk factor for hospital mortality. Our study found that the incidence of HCAP was greater than that of CAP among patients with culture-positive pneumonia requiring hospitalization at Barnes-Jewish Hospital. Patients with HCAP were more likely to initially receive inappropriate antimicrobial treatment and had a greater risk of hospital mortality. Health care providers should differentiate patients with HCAP from those with CAP in order to provide more appropriate initial antimicrobial therapy.

scholarly journals The effect of comorbidities for the prognosis of community-acquired pneumonia: an epidemiologic study using a hospital surveillance in Japan

2019 ◽  
Author(s):  
Mai Thi Ngoc Nguyen ◽  
Nobuyuki Saito ◽  
Yukiko Wagatsuma
Keyword(s):  
Hospital Mortality ◽  
Charlson Comorbidity Index ◽  
Epidemiologic Study ◽  
Severe Pneumonia ◽  
Community Acquired Pneumonia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Chronic Pulmonary Diseases ◽  
History Of ◽  
Comorbidity Index

Abstract Objective Pneumonia is a common but serious illness that continues to present significant morbidity and mortality. Although the effect of severity at admission on outcome has been well reported, the role of comorbidity is still not widely understood. The Charlson Comorbidity Index measures comorbidity with a well-established history of predicting long-term outcome but its utility in pneumonia prognosis is still limited. Here, we use the Charlson Comorbidity Index and hospital surveillance data to investigate associations between comorbidities and in-hospital mortality due to community-acquired pneumonia.Results Among the 535 eligible adult patients (69.0% male, median [IQR] age, 79 [70-84] years), 100 (18.7%) acquired severe to extremely severe pneumonia. The median [IQR] CCI was 1[1-3]. Malignancy (129 of 535, 24.1%), chronic pulmonary diseases (113 of 535, 21.1%) and congestive heart failure (103 of 535, 19.3%) were frequent. Higher Charlson Comorbidity Index scores were associated with higher risk of in-hospital mortality (OR 1.28; 95% CI 1.07-1.53). These results support the inclusion of comorbid burden in predicting community-acquired pneumonia outcome.

scholarly journals In-hospital mortality associated with community-acquired pneumonia due to methicillin-resistant Staphylococcus aureus: a matched-pair cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yukiyo Sakamoto ◽  
Yasuhiro Yamauchi ◽  
Taisuke Jo ◽  
Nobuaki Michihata ◽  
Wakae Hasegawa ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Healthcare Costs ◽  
Community Acquired Pneumonia ◽  
Matched Pair ◽  
Multivariable Logistic Regression Analysis ◽  
Methicillin Resistant ◽  
Mrsa Infection

Abstract Background It remains unclear whether methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is associated with higher mortality compared with non-MRSA pneumonia. This study’s objective was to compare outcomes including in-hospital mortality and healthcare costs during hospitalisation between patients with MRSA pneumonia and those with non-MRSA pneumonia. Methods Using a national inpatient database in Japan, we conducted a 1:4 matched-pair cohort study of inpatients with community-acquired pneumonia from 1 April 2012 to 31 March 2014. In-hospital outcomes (mortality, length of stay and healthcare costs during hospitalisation) were compared between patients with and without MRSA infection. We performed multiple imputation using chained equations followed by multivariable regression analyses fitted with generalised estimating equations to account for clustering within matched pairs. All-cause in-hospital mortality and healthcare costs during hospitalisation were compared for pneumonia patients with and without MRSA infection. Results Of 450,317 inpatients with community-acquired pneumonia, 3102 patients with MRSA pneumonia were matched with 12,320 patients with non-MRSA pneumonia. The MRSA pneumonia patients had higher mortality, longer hospital stays and higher costs. Multivariable logistic regression analysis revealed that MRSA pneumonia was significantly associated with higher in-hospital mortality compared with non-MRSA pneumonia (adjusted odds ratio = 1.94; 95% confidence interval: 1.72–2.18; p < 0.001). Healthcare costs during hospitalisation were significantly higher for patients with MRSA pneumonia than for those with non-MRSA pneumonia (difference = USD 8502; 95% confidence interval: USD 7959–9045; p < 0.001). Conclusions MRSA infection was associated with higher in-hospital mortality and higher healthcare costs during hospitalisation, suggesting that preventing MRSA pneumonia is essential.

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