Central Nervous System Depressants and Risk of Hospitalization due to Community-Acquired Pneumonia in very Old Patients

2020 ◽  
Vol 15 (2) ◽  
pp. 131-136
Author(s):  
Jeronimo Espinosa ◽  
Paulino A. Alvarez ◽  
Veronica Castro ◽  
Maria F. Caceres ◽  
Maria C. Soler-Riera ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Drug Interactions ◽  
Community Acquired Pneumonia ◽  
Old Patients ◽  
Very Old ◽  
Old Adults ◽  
Increased Risk ◽  
Wide Range ◽  
Very Old Patients

Background: Central Nervous System (CNS) depressants like antipsychotics, opioids, benzodiazepines and zolpidem are frequently used by patients of a wide range of ages. Uncertainty remains about their effect in very old adults (>80 years old) and their potential for pharmacodynamic and pharmacokinetic drug-drug interactions in this population. Objective: To assess if the use of CNS depressants is associated with a higher risk of hospitalization due to community-acquired pneumonia (CAP) in very old patients. Methods: In this prospective study, 362 patients over 80 years of age who had been consequently admitted to the general ward of a teaching hospital were examined. Each patient was assessed, by our pharmacovigilance team within 24 hours of admission, to identify outpatient medication use and potential drug-drug interactions. Results: The overall use of CNS depressants as a group was not associated with a higher risk of admission due to CAP in very old patients (55% vs. 49%; OR=1.28 [0.76-2.16], p=0.34). However, the use of antipsychotics was associated with a higher rate of admissions due to CAP in this population (OR=1.98 [1.10-3.57], p=0.02). No association was seen between opioids (p=0.27), zolpidem (p=0.83), or benzodiazepines (p=0.15) and the rate of admissions due to CAP in these patients. Moreover, pharmacodynamic or pharmacokinetic interactions leading to CNS depression were equally found in patients admitted for CAP and those admitted for other reasons. Conclusion: The use of antipsychotics in very old adults was associated with an increased risk of hospital admission due to CAP. This suggests that the use of these medications in this population should be done with caution. No association was observed with opioids, benzodiazepines and zolpidem with the latter outcome.

scholarly journals Community-acquired pneumonia in critically ill very old patients: a growing problem

2020 ◽  
Vol 29 (155) ◽  
pp. 190126
Author(s):  
Catia Cillóniz ◽  
Cristina Dominedò ◽  
Juan M. Pericàs ◽  
Diana Rodriguez-Hurtado ◽  
Antoni Torres
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Multidrug Resistant ◽  
Community Acquired Pneumonia ◽  
Old Patients ◽  
Very Old ◽  
Uncommon Presentation ◽  
Increased Risk ◽  
Short And Long Term ◽  
Very Old Patients

Very old (aged ≥80 years) adults constitute an increasing proportion of the global population. Currently, this subgroup of patients represents an important percentage of patients admitted to the intensive care unit. Community-acquired pneumonia (CAP) frequently affects very old adults. However, there are no specific recommendations for the management of critically ill very old CAP patients. Multiple morbidities, polypharmacy, immunosenescence and frailty contribute to an increased risk of pneumonia in this population. CAP in critically ill very old patients is associated with higher short- and long-term mortality; however, because of its uncommon presentation, diagnosis can be very difficult. Management of critically ill very old CAP patients should be guided by their baseline characteristics, clinical presentation and risk factors for multidrug-resistant pathogens. Hospitalisation in intermediate care may be a good option for critical ill very old CAP patients who do not require invasive procedures and for whom intensive care is questionable in terms of benefit.

scholarly journals Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia

2019 ◽  
Vol 8 (7) ◽  
pp. 961 ◽  
Author(s):  
Cillóniz ◽  
Dominedò ◽  
Ielpo ◽  
Ferrer ◽  
Gabarrús ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Antibiotic Therapy ◽  
Lower Risk ◽  
Chronic Renal Disease ◽  
Community Acquired Pneumonia ◽  
Old Patients ◽  
Very Old ◽  
Independent Risk Factors ◽  
Very Old Patients

Background: Little is known about risk and prognostic factors in very old patients developing sepsis secondary to community-acquired pneumonia (CAP). Methods: We conducted a retrospective observational study of data prospectively collected at the Hospital Clinic of Barcelona over a 13-year period. Consecutive patients hospitalized with CAP were included if they were very old (≥80 years) and divided into those with and without sepsis for comparison. Sepsis was diagnosed based on the Sepsis-3 criteria. The main clinical outcome was 30-day mortality. Results: Among the 4219 patients hospitalized with CAP during the study period, 1238 (29%) were very old. The prevalence of sepsis in this age group was 71%. Male sex, chronic renal disease, and diabetes mellitus were independent risk factors for sepsis, while antibiotic therapy before admission was independently associated with a lower risk of sepsis. Thirty-day and intensive care unit (ICU) mortality did not differ between patients with and without sepsis. In CAP-sepsis group, chronic renal disease and neurological disease were independent risk factors for 30-day mortality. Conclusion: In very old patients hospitalized with CAP, in-hospital and 1-year mortality rates were increased if they developed sepsis. Antibiotic therapy before hospital admission was associated with a lower risk of sepsis.

Increased risk of bullous pemphigoid in male and very old patients: A population-based study on incidence

1999 ◽  
Vol 41 (2) ◽  
pp. 266-268 ◽  
Author(s):  
Martin Junga ◽  
Werner Kippesb ◽  
Gerald Messer ◽  
Detlef Zillikens ◽  
Berthold Rzany
Keyword(s):  
Bullous Pemphigoid ◽  
Population Based ◽  
Population Based Study ◽  
Old Patients ◽  
Very Old ◽  
Increased Risk ◽  
Very Old Patients

scholarly journals O2A.3 Increased risk of central nervous system tumors with carbamate insecticide use in the prospective cohort agrican

2019 ◽  
Vol 76 (Suppl 1) ◽  
pp. A13.2-A14
Author(s):  
Clément Piel ◽  
Camille Pouchieu ◽  
Lucile Migault ◽  
Beatrix Béziat ◽  
Mathilde Boulanger ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Experimental Studies ◽  
Cns Tumors ◽  
Active Ingredients ◽  
Carbamate Insecticides ◽  
Increased Risk ◽  
Pesticide Exposures ◽  
Wide Range ◽  
Incident Cases

BackgroundPesticide exposures are suspected to be implicated in the excess of Central Nervous System (CNS) tumors observed in farmers, but evidence concerning individual pesticides remains limited. Carbamate insecticides, used on a wide range of crops, have shown evidence of carcinogenicity in some experimental studies. In the cohort AGRICAN (AGRIculture and CANcer), we assessed the associations between potential exposures to carbamate insecticides and the incidence of CNS tumors, overall and by histological subtype.MethodsAGRICAN enrolled 181 842 participants involved in agriculture. Incident CNS tumors were identified by linkage with cancer registries from enrolment (2005–2007) until 2013. Carbamate exposure was assessed by combining information on lifetime periods of pesticide use on crop or livestock and the French crop-exposure matrix PESTIMAT, individually for each of the 19 carbamate insecticides registered in France since 1950. Associations were estimated using proportional hazards models with age as the underlying timescale, adjusting for gender, educational level and smoking.ResultsDuring a 6.9 year average follow-up, 381 incident cases of CNS tumors occurred, including 164 gliomas and 134 meningiomas. Analyses showed increased risks of CNS tumors with overall exposure to carbamate insecticides and linear trends with duration of use of each carbamate. Considering tumor subtypes, hazard ratios for gliomas ranged from 1.18 for thiofanox to 4.60 for formetanate and for meningiomas from 1.51 for carbaryl to 3.67 for thiofanox.ConclusionsFindings reinforce carcinogenicity evidence for already suspected active ingredients and draw attention to additional active ingredients, notably used on fruit trees, vineyards, potatoes and beets.

scholarly journals Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired pneumonia

2019 ◽  
Author(s):  
Catia Cilloniz ◽  
Cristina Dominedò ◽  
Antonella Ielpo ◽  
Miquel Ferrer ◽  
Albert Gabarrus ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Antibiotic Therapy ◽  
Lower Risk ◽  
Chronic Renal Disease ◽  
Community Acquired Pneumonia ◽  
Old Patients ◽  
Very Old ◽  
Independent Risk Factors ◽  
Very Old Patients

Background: Little is known about risk and prognostic factors in very old patients developing sepsis secondary to community-acquired pneumonia (CAP). Methods: We conducted a retrospective observational study of data prospectively collected at the Hospital Clinic of Barcelona over a 13-year period. Consecutive patients hospitalized with CAP were included if they were very old (≥80 years) and divided into those with and without sepsis for comparison. Sepsis was diagnosed based on the Sepsis-3 criteria. The main clinical outcome was 30-day mortality. Results: Among the 4,219 patients hospitalized with CAP during the study period, 1,238 (29%) were very old. The prevalence of sepsis in this aged group was 71%. Male sex, chronic renal disease, and diabetes mellitus were independent risk factors for sepsis, while antibiotic therapy before admission was independently associated with a lower risk of sepsis. Thirty-day and intensive care unit (ICU) mortality did not differ between patients with and without sepsis. In CAP-sepsis group, chronic renal disease and neurological disease were independent risk factors for 30-day mortality. Conclusion: In very old patients hospitalized with CAP, in-hospital and 1-year mortality rates were increased if they developed sepsis. Antibiotic therapy before hospital admission was associated with a lower risk of sepsis.

Sign in / Sign up

Export Citation Format

Share Document