scholarly journals Clinical sign and biomarker-based algorithm to identify bacterial pneumonia among outpatients with lower respiratory tract infection in Tanzania

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Sarika K. L. Hogendoorn ◽  
Loïc Lhopitallier ◽  
Melissa Richard-Greenblatt ◽  
Estelle Tenisch ◽  
Zainab Mbarack ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Rate ◽  
Lower Respiratory Tract ◽  
Predictive Accuracy ◽  
Clinical Signs ◽  
Regression Tree ◽  
Community Acquired Pneumonia ◽  
Classification And Regression Tree ◽  
Respiratory Pathogens ◽  
Tract Infections

Abstract Background Inappropriate antibiotics use in lower respiratory tract infections (LRTI) is a major contributor to resistance. We aimed to design an algorithm based on clinical signs and host biomarkers to identify bacterial community-acquired pneumonia (CAP) among patients with LRTI. Methods Participants with LRTI were selected in a prospective cohort of febrile (≥ 38 °C) adults presenting to outpatient clinics in Dar es Salaam. Participants underwent chest X-ray, multiplex PCR for respiratory pathogens, and measurements of 13 biomarkers. We evaluated the predictive accuracy of clinical signs and biomarkers using logistic regression and classification and regression tree analysis. Results Of 110 patients with LRTI, 17 had bacterial CAP. Procalcitonin (PCT), interleukin-6 (IL-6) and soluble triggering receptor expressed by myeloid cells-1 (sTREM-1) showed an excellent predictive accuracy to identify bacterial CAP (AUROC 0.88, 95%CI 0.78–0.98; 0.84, 0.72–0.99; 0.83, 0.74–0.92, respectively). Combining respiratory rate with PCT or IL-6 significantly improved the model compared to respiratory rate alone (p = 0.006, p = 0.033, respectively). An algorithm with respiratory rate (≥ 32/min) and PCT (≥ 0.25 μg/L) had 94% sensitivity and 82% specificity. Conclusions PCT, IL-6 and sTREM-1 had an excellent predictive accuracy in differentiating bacterial CAP from other LRTIs. An algorithm combining respiratory rate and PCT displayed even better performance in this sub-Sahara African setting.

scholarly journals Clinical Sign and Biomarker-based Algorithm to Identify Bacterial Pneumonia Among Outpatients with Lower Respiratory Tract Infection in Tanzania

2021 ◽  
Author(s):  
Sarika K.L. Hogendoorn ◽  
Loïc Lhopitallier ◽  
Melissa Richard-Greenblatt ◽  
Estelle Tenisch ◽  
Zainab Mbarack ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Rate ◽  
Lower Respiratory Tract ◽  
Predictive Accuracy ◽  
Clinical Signs ◽  
Regression Tree ◽  
Community Acquired Pneumonia ◽  
Classification And Regression Tree ◽  
Respiratory Pathogens ◽  
Tract Infections

Abstract Background.Inappropriate antibiotics in lower respiratory tract infections (LRTI) is a major contributor to resistance. We aimed to design an algorithm based on clinical signs and host biomarkers to identify bacterial community-acquired pneumonia (CAP) among patients with LRTI.Methods. Participants with LRTI were selected in a prospective cohort of febrile (≥38°C) adults presenting to outpatient clinics in Dar es Salaam. Participants underwent chest X-ray, multiplex PCR for respiratory pathogens, and measurements of 13 biomarkers. We evaluated the predictive accuracy of clinical signs and biomarkers using logistic regression and classification and regression tree analysis.Results. Of 110 patients with LRTI, 17 had bacterial CAP. Procalcitonin (PCT), interleukin-6 (IL-6) and soluble triggering receptor expressed by myeloid cells-1 (sTREM-1) showed excellent predictive accuracy to identify bacterial CAP (AUROC 0.88, 95%CI 0.78-0.98; 0.84, 0.72-0.99; 0.83, 0.74-0.92, respectively). Combining respiratory rate with PCT or IL-6 significantly improved the model compared to respiratory rate alone (p=0.006, p=0.033, respectively). An algorithm with respiratory rate (≥32/minute) and PCT (≥0.25 μg/L) had 94% sensitivity and 82% specificity.Conclusions. PCT, IL-6 and sTREM-1 had excellent predictive accuracy in differentiating bacterial CAP from other LRTIs. An algorithm combining respiratory rate and PCT displayed even better performance in this sub-Sahara African setting.

Respiratory tract damage with bocavirus infection in children

2020 ◽  
Vol 19 (2) ◽  
pp. 14-18
Author(s):  
E. V. Sharipova ◽  
I. V. Babachenko ◽  
M. A. Shcherbatyh
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Clinical Manifestations ◽  
Respiratory Viruses ◽  
Community Acquired Pneumonia ◽  
Human Bocavirus ◽  
Long Time ◽  
Clinically Significant ◽  
Tract Infections ◽  
Tract Damage

Long time the main pathogens associated with the development of community-acquired pneumonia were bacteria. However, in recent years in the Russian Federation, like all over the world, the view of the damage of lower respiratory tract changed, including a unique approach to community-acquired pneumonia as a bacterial infection, and respiratory viruses have become seen as a direct cause of lower respiratory tract damage, or as part of a viral-bacterial co-infection. These studies became possible since the widespread introduction of PCR techniques in the clinical setting, identification of respiratory viruses has increased and new microorganisms such, one as human bocavirus have been discovered. Objective: to study the features of respiratory tract damage in acute bocavirus infection in children of different ages. Materials and methods: A retrospective analysis of 97 medical hospital documentation of children with acute bocavirus infection, detected confirmed by PCR in nasopharyngeal aspirate. Results: In this work, it was shown that human bocavirus spread throughout the year with an increase in the incidence of clinically significant forms in the autumnwinter period, including during the period of an increase in the incidence of influenza. HBoV infection requiring hospitals is most significant in the first three years of life. In 74.2% of hospitalized children, bocavirus infection occurs with lower respiratory tract infections in the form of bronchitis — 77.8%, pneumonia — 28.9% and rarely bronchiolitis and is complicated by the development of respiratory failure in 28.9% of cases. Changes in the blood test are non-specific, and the level of C-reactive protein in children with various clinical manifestations of HBoV infection generally does not exceed 50 mg / l. An x-ray of the chest organs does not objectively reflect the existing volume and nature of the inflammatory process in the lungs.

scholarly journals Vaccine Effectiveness Against Influenza-Associated Lower Respiratory Tract Infections in Hospitalized Adults, Louisville, Kentucky, 2010–2013

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Eric J Chow ◽  
Melissa A Rolfes ◽  
Ruth L Carrico ◽  
Stephen Furmanek ◽  
Julio A Ramirez ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Community Acquired Pneumonia ◽  
Vaccine Effectiveness ◽  
Self Report ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Radiographic Findings ◽  
History Of ◽  
Tract Infections

Abstract Background Preventing severe complications of influenza such as hospitalization is a public health priority; however, estimates of influenza vaccine effectiveness (VE) against influenza-associated acute lower respiratory tract infection (LRTI) hospitalizations are limited. We examined influenza VE against influenza-associated LRTIs in hospitalized adult patients. Methods We retrospectively analyzed data from a randomized trial of oseltamivir treatment in adults hospitalized with LRTI in Louisville, Kentucky, from 2010 to 2013. Patients were systematically tested for influenza at the time of enrollment. We estimated VE as 1 – the adjusted odds ratio (aOR) of antecedent vaccination in influenza-positives vs negatives × 100%. Vaccination status was obtained by patient self-report. Using logistic regression adjusting for age, sex, season, timing of illness, history of chronic lung disease, and activities of daily living, we estimated VE against hospitalized influenza-associated LRTIs and community-acquired pneumonia (CAP) with radiographic findings of infiltrate. Results Of 810 patients with LRTI (median age, 62 years), 184 (23%) were influenza-positive and 57% had radiographically confirmed CAP. Among influenza-positives and -negatives, respectively, 61% and 69% were vaccinated. Overall, 29% were hospitalized in the prior 90 days and >80% had comorbidities. Influenza-negatives were more likely to have a history of chronic obstructive pulmonary disease than influenza-positives (59% vs 48%; P = .01), but baseline medical conditions were otherwise similar. Overall, VE was 35% (95% CI, 4% to 56%) against influenza-associated LRTI and 51% (95% CI, 13% to 72%) against influenza-associated radiographically confirmed CAP. Conclusions Vaccination reduced the risk of hospitalization for influenza-associated LRTI and radiographically confirmed CAP. Clinicians should maintain high rates of influenza vaccination to prevent severe influenza-associated complications.

scholarly journals Predictors of pneumonia in lower respiratory tract infections: 3C prospective cough complication cohort study

2017 ◽  
Vol 50 (5) ◽  
pp. 1700434 ◽  
Author(s):  
Michael Moore ◽  
Beth Stuart ◽  
Paul Little ◽  
Sue Smith ◽  
Matthew J. Thompson ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Predictive Value ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Clinical Signs ◽  
Routine Practice ◽  
Lower Respiratory Tract Infections ◽  
Acute Cough ◽  
Presenting Symptoms ◽  
Tract Infections

The aim was to aid diagnosis of pneumonia in those presenting with lower respiratory tract symptoms in routine primary care.A cohort of 28 883 adult patients with acute cough attributed to lower respiratory tract infections (LRTIs) was recruited from 5222 UK practices in 2009–13. Symptoms, signs and treatment were recorded at presentation and subsequent events followed-up for 30 days by chart review. 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.

scholarly journals Modelling hospital admissions for lower respiratory tract infections in the elderly in England

2006 ◽  
Vol 134 (6) ◽  
pp. 1150-1157 ◽  
Author(s):  
B. MÜLLER-PEBODY ◽  
N. S. CROWCROFT ◽  
M. C. ZAMBON ◽  
W. J. EDMUNDS
Keyword(s):  
Respiratory Tract ◽  
Elderly Patients ◽  
Lower Respiratory Tract ◽  
Hospital Admissions ◽  
Vaccine Development ◽  
Whooping Cough ◽  
Linear Regression Analysis ◽  
Respiratory Pathogens ◽  
Syncytial Virus ◽  
Tract Infections

Despite the importance of lower respiratory-tract infection (LRI) in causing hospitalizations in elderly patients ([ges ]65 years of age) and recent advances in vaccine development, a complete picture of the causative organisms is not available. All hospital discharge diagnoses (ICD-10 code) for LRI in elderly patients in England during 1995–1998 were reviewed. Using known seasonality in potential causative agents of LRI, the contribution of different respiratory pathogens to hospitalizations coded as ‘unspecified LRI’ was estimated by multiple linear regression analysis. Ninety-seven per cent of 551633 LRI-associated diagnoses had no specific organism recorded. From the statistical model the estimated proportions of admissions attributable to different pathogens were applied to calculate estimated hospitalization rates: 93·9 hospitalizations/10000 population aged [ges ]65 years due to S. pneumoniae, 22·9 to influenza virus, 22·3 to H. influenzae, 17·0 to whooping cough, and 12·8 to respiratory syncytial virus. There is enormous potential to improve health using existing vaccines and those under development.

scholarly journals Current Antibiotic Treatment and Outcome for Lower Respiratory Tract Infections

1998 ◽  
Vol 9 (suppl e) ◽  
pp. 30E-34E
Author(s):  
Alasdair P MacGowan ◽  
Tracey Halladay ◽  
Andrew M Lovering
Keyword(s):  
Respiratory Tract ◽  
Hospital Stay ◽  
Lower Respiratory Tract ◽  
Community Acquired Pneumonia ◽  
Economic Evaluations ◽  
Chronic Obstructive ◽  
National Guidelines ◽  
Obstructive Pulmonary Disease ◽  
Duration Of Hospital Stay ◽  
Tract Infections

A number of national guidelines have been published to aid the antimicrobial management of community-acquired pneumonia. However, data on prescriptions for lower respiratory tract infection (LRTI) indicate considerable variation in the choice of first-line and subsequent therapy at national and local levels. Outcomes research in LRTI, whether based on clinical, economic or patient-focused criteria, is still evolving. Clinical outcomes are best studied for both pneumonia and exacerbation of chronic obstructive pulmonary disease. Economic evaluations often do not encompass all of the costs, for example, time off from work or the economic impact of antibacterial resistance. Duration of hospital stay is a good marker of costs for hospital providers and may be affected by age. marital status and comorbidities. Antibiotic choice may have an impact on the duration of hospital stay by increasing side effects, predisposing patients to hospitalacquired infection or reduced clinical efficacy. Patient expectation is largely unstudied in pulmonary infection.

scholarly journals Sputum Quality Assessment Regarding Sputum Culture for Diagnosing Lower Respiratory Tract Infections in Children

2019 ◽  
Vol 7 (12) ◽  
pp. 1926-1930
Author(s):  
Gorica Popova ◽  
Katerina Boskovska ◽  
Ivana Arnaudova-Danevska ◽  
Olga Smilevska-Spasova ◽  
Tatjana Jakovska
Keyword(s):  
Respiratory Tract ◽  
Quality Assessment ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Diagnostic Value ◽  
Sputum Culture ◽  
Grading System ◽  
Respiratory Pathogens ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

BACKGROUND: The clinical relevance of specimens from the lower airways is often debatable. However, they are most commonly examined for diagnosing lower respiratory tract infections (LRTIs).AIM: This study aimed to determine the diagnostic value of sputum quality assessment about sputum culture for diagnosing LRTIs in children.METHODS: In six months, a total of 1485 sputum samples were quality assessed by using Bartlett’s grading system. All samples, regardless of their quality, were cultured, identified, and antimicrobial susceptibility testing was performed by Kirby-Bauer disc-diffusion method.RESULTS: Among the acceptable category, defined by Bartlett’s grading system, 132 (63.2%) samples showed culture positivity of which Streptococcus pneumoniae 48 (36.4%) was most commonly isolated, followed by Moraxella catarrhalis 22 (16.7%) and Haemophilus influenza 21 (15.9%). Among the non-acceptable category, 185 (14.5%) samples were culture positive of which most commonly isolated were Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa with 64 (34.6%), 54 (29.2%) and 28 (15.1%), respectively.CONCLUSION: Sputum quality assessment is a useful tool for distinguishing the true respiratory pathogens from possible colonising flora for which antibiotic treatment should not be highly considered.  

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