Comparison of pneumonia severity scoring methods in identification of severe community acquired pneumonia

AbstractWhether macrolide combination therapy reduces the mortality of patients with severe community-acquired pneumonia (CAP) hospitalized in the non-intensive care unit (ICU) remains unclear. Therefore, we investigated the efficacy of adding azithromycin to β-lactam antibiotics for such patients. This prospective cohort study enrolled consecutive patients with CAP hospitalized in the non-ICU between October 2010 and November 2016. The 30-day mortality between β-lactam and azithromycin combination therapy and β-lactam monotherapy was compared in patients classified as mild to moderate and severe according to the CURB-65, Pneumonia Severity Index (PSI), and Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) criteria. Inverse probability of treatment weighting (IPTW) analysis was used to reduce biases. Based on the CURB-65 and PSI, combination therapy did not significantly reduce the 30-day mortality in either group (179 patients in the combination group, 952 in the monotherapy group). However, based on the IDSA/ATS criteria, combination therapy significantly reduced the 30-day mortality in patients with severe (odds ratio [OR] 0.12, 95% confidence interval [CI] 0.007–0.57), but not non-severe pneumonia (OR 1.85, 95% CI 0.51–5.40); these results were similar after IPTW analysis. Azithromycin combination therapy significantly reduced the mortality of patients with severe CAP who met the IDSA/ATS criteria.

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Impact of Blood Cultures on the Changes of Treatment in Hospitalized Patients with Community-Acquired Pneumonia

The Open Respiratory Medicine Journal ◽

10.2174/1874306401307010060 ◽

2013 ◽

Vol 7 (1) ◽

pp. 60-66 ◽

Cited By ~ 3

Author(s):

Genta Ishikawa ◽

Naoki Nishimura ◽

Atsushi Kitamura ◽

Yasuhiko Yamano ◽

Yutaka Tomishima ◽

...

Keyword(s):

Antimicrobial Agents ◽

Pneumonia Severity Index ◽

Severity Index ◽

Community Acquired Pneumonia ◽

Blood Cultures ◽

Contributing Factors ◽

Pneumonia Severity ◽

Alternative Diagnosis ◽

Severe Community Acquired Pneumonia ◽

Initial Blood

Background: Initial blood cultures (BCs) with severe community-acquired pneumonia (CAP) are warranted. However, other than severity, the specific contributing factors that affect the decision to change antimicrobial agents have not been evaluated previously. Methods: Consecutive adults with CAP hospitalized between January 2008 and December 2010 were assessed retrospectively. We enrolled those who were over 18 years old with typical symptoms of pneumonia and with an infiltrate consistent with pneumonia, from which 2 sets of BCs were obtained. Those who had been immunocompromised, hospitalized, or prescribed antibiotics in the past 30 days were excluded. We retrospectively assessed the factors contributing to the change in antimicrobial agents as well as the frequency of these changes in the enrolled patients based on the initial BC results. Results: In total, 793 patients with initial diagnosis of CAP were admitted; 399 met the inclusion criteria. Among them, 386 were made definitive diagnosis of CAP after admission (the remaining 13 were made alternative diagnosis [non-pneumonia illnesses]). BC results were positive in 17 (4.4%) out of 386 CAP patients, among whom antimicrobial therapy was changed based on the BC results in 8 (2.1%) (Pneumonia Severity Index [PSI] grade IV; 2, PSI grade V; 6). Alternative diagnosis after admission was contributing factors for changing antimicrobial agents based on the positive blood culture results. Conclusions: The use of BCs should be limited to patients with very severe cases. It would be helpful to find alternative diagnosis and modify treatment.

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Evaluation of severity scoring systems in patients with severe community acquired pneumonia

Romanian Journal of Internal Medicine ◽

10.2478/rjim-2021-0025 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Katerina Spasovska ◽

Krsto Grozdanovski ◽

Zvonko Milenkovic ◽

Mile Bosilkovski ◽

Marija Cvetanovska ◽

...

Keyword(s):

Statistical Significance ◽

Scoring Systems ◽

Simplified Acute Physiology Score ◽

Community Acquired Pneumonia ◽

Mortality Prediction ◽

Outcome Variable ◽

Severity Scoring ◽

Increased Risk ◽

Severity Scores ◽

Severe Community Acquired Pneumonia

Abstract Background: The aim of this study was to evaluate the ability of severity scoring systems to predict 30-day mortality in patients with severe community-acquired pneumonia. Methods: The study included 98 patients aged ≥18 years with community acquired pneumonia hospitalized at the Intensive Care Unit of the University Clinic for Infectious Diseases in Skopje, Republic of North Macedonia, during a 3-year period. We recorded demographic, clinical and common biochemical parameters. Five severity scores were calculated at admission: CURB 65 (Confusion, Urea, Respiratory Rate, Blood pressure, Age ≥65 years), SCAP (Severe Community Acquired Pneumonia score), SAPS II (Simplified Acute Physiology Score), SOFA (Sequential Organ Failure Assessment Score) and MPM (Mortality Prediction Model). Primary outcome variable was 30-day in-hospital mortality. Results: The mean age of the patients was 59.08 ± 15.76 years, predominantly males (68%). The overall 30-day mortality was 52%. Charlson Comorbidity index was increased in non-survivors (3.72 ± 2.33) and was associated with the outcome. All severity indexes had higher values in patients who died, that showed statistical significance between the analysed groups. The areas under curve (AUC) values of the five scores for 30-day mortality were 0.670, 0.732, 0,726, 0.785 and 0.777, respectively. Conclusion. Widely used severity scores accurately detected patients with pneumonia that had increased risk for poor outcome, but none of them individually demonstrated any advantage over the others.

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