The COVID-19 Pandemic and the Incidence of the Non-COVID-19 Pneumonia in Adults

Older Age ◽

Adult Patients ◽

Number Of Patients ◽

Influenza Activity ◽

Antibiotics Sensitivity ◽

Hospital Acquired ◽

The Impact

Introduction: The coronavirus disease 2019 (COVID-19) lockdown strategies were associated with a significant decrease in the common respiratory viral diseases and decreased the need for hospitalization among children in the COVID-19 outbreak. However, the trend of non-COVID-19 pneumonia in adult people remains uncertain. Our aim is to assess the impact of the COVID-19 pandemic on the incidence of the non-COVID-19 pneumonia in adult people and understand whether the substantial decrease in pneumonia cases is the same as the decline in the incidence of respiratory viral disease activity.Methods: We conducted a retrospective analysis of adult patients presenting with pneumonia from January 2019 to December 2020. Details on all the demographics of the patient of pneumonia, hospital course details, prior admission history within 3 months, respiratory culture, and antibiotics sensitivity test were also obtained.Results: The number of adult patients with community-acquired pneumonia in 2020 was lower than that in 2019, which decreased by 74 patients in 2020. The decreasing number of patients with community-acquired pneumonia between 2019 and 2020 was from −13.9% in January to March 2020 to −39.7% in October to December 2020. The decreasing number of patients with community-acquired pneumonia between 2019 and 2020 was from −14.8% in the youngest cohort to −28.7% in those aged ≥85 years. The number of reduced patients with community-acquired pneumonia is greater in late seasons and older age, respectively. The number of adult patients with hospital-acquired pneumonia in 2020 was lower than that in 2019, which decreased by 23 patients in 2020. The decreasing number of patients with hospital-acquired pneumonia between 2019 and 2020 was from −20.0% in January to March 2020 to −52.4% in October to December 2020. The decreasing number of patients with hospital-acquired pneumonia between 2019 and 2020 was from 0% in the youngest cohort to −45.6% in those aged ≥ 85 years. The number of reduced patients with hospital-acquired pneumonia is greater in late seasons and older age, respectively.Conclusion: Interventions applied to control the COVID-19 pandemic were effective not only in substantial changes in the seasonal influenza activity, but also in decreasing adult pneumonia cases.

Incidence and outcomes of hospitalization for community-acquired, ventilator-associated and non-ventilator hospital-acquired pneumonias in patients with type 2 diabetes mellitus in Spain

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001447 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001447

Author(s):

Ana Lopez-de-Andres ◽

Romana Albadalejo-Vicente ◽

Javier de Miguel-Diez ◽

Valentin Hernandez-Barrera ◽

Zichen Ji ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Incidence Rates ◽

Older Age ◽

Design And Methods ◽

IntroductionTo describe the incidence and compare in-hospital outcomes of community-acquired pneumonia (CAP), ventilator-associated pneumonia (VAP) and non-ventilator hospital-acquired pneumonia (NV-HAP) among patients with or without type 2 diabetes mellitus (T2DM) using propensity score matching.Research design and methodsThis was a retrospective observational epidemiological study using the 2016–2017 Spanish Hospital Discharge Records.ResultsOf 245 221 admissions, CAP was identified in 227 524 (27.67% with T2DM), VAP was identified in 2752 (18.31% with T2DM) and NV-HAP was identified in 14 945 (25.75% with T2DM). The incidence of pneumonia was higher among patients with T2DM (CAP: incidence rate ratio (IRR) 1.44, 95% CI 1.42 to 1.45; VAP: IRR 1.24, 95% CI 1.12 to 1.37 and NV-HAP: IRR 1.38, 95% CI 1.33 to 1.44). In-hospital mortality (IHM) for CAP was 12.74% in patients with T2DM and 14.16% in matched controls (p<0.001); in patients with VAP and NV-HAP, IHM was not significantly different between those with and without T2DM (43.65% vs 41.87%, p=0.567, and 29.02% vs 29.75%, p=0.484, respectively). Among patients with T2DM, older age and dialysis were factors associated with IHM for all types of pneumonia. In patients with VAP, the risk of IHM was higher in females (OR 1.95, 95% CI 1.28 to 2.96).ConclusionThe incidence rates of all types of pneumonia were higher in patients with T2DM. Higher mortality rates in patients with T2DM with any type of pneumonia were associated with older age, comorbidities and dialysis.

Community-Acquired Pneumonia and Hospital-Acquired Pneumonia in Adult Patients with Idiopathic Inflammatory Myopathy: Outcome and Antibiotic Therapy

Rheumatology and Therapy ◽

10.1007/s40744-020-00268-7 ◽

2020 ◽

Author(s):

Junyu Liang ◽

Chuanyin Sun ◽

Liqin Xu ◽

Guanhua Xu ◽

Heng Cao ◽

...

Keyword(s):

Antibiotic Therapy ◽

Inflammatory Myopathy ◽

Idiopathic Inflammatory Myopathy ◽

Adult Patients ◽

Use of a Structured Panel Process to Define Quality Metrics for Antimicrobial Stewardship Programs

Infection Control and Hospital Epidemiology ◽

10.1086/665324 ◽

2012 ◽

Vol 33 (5) ◽

pp. 500-506 ◽

Cited By ~ 62

Author(s):

Andrew M. Morris ◽

Stacey Brener ◽

Linda Dresser ◽

Nick Daneman ◽

Timothy H. Dellit ◽

...

Keyword(s):

Quality Improvement ◽

Antimicrobial Stewardship ◽

Bloodstream Infections ◽

The United States ◽

Public Reporting ◽

Modified Delphi ◽

Number Of Patients ◽

Days Of Therapy ◽

The Impact

Introduction.Antimicrobial stewardship programs are being implemented in health care to reduce inappropriate antimicrobial use, adverse events, Clostridium difficile infection, and antimicrobial resistance. There is no standardized approach to evaluate the impact of these programs.Objective.To use a structured panel process to define quality improvement metrics for evaluating antimicrobial stewardship programs in hospital settings that also have the potential to be used as part of public reporting efforts.Design.A multiphase modified Delphi technique.Setting.Paper-based survey supplemented with a 1-day consensus meeting.Participants.A 10-member expert panel from Canada and the United States was assembled to evaluate indicators for relevance, effectiveness, and the potential to aid quality improvement efforts.Results.There were a total of 5 final metrics selected by the panel: (1) days of therapy per 1000 patient-days; (2) number of patients with specific organisms that are drug resistant; (3) mortality related to antimicrobial-resistant organisms; (4) conservable days of therapy among patients with community-acquired pneumonia (CAP), skin and soft-tissue infections (SSTI), or sepsis and bloodstream infections (BSI); and (5) unplanned hospital readmission within 30 days after discharge from the hospital in which the most responsible diagnosis was one of CAP, SSTI, sepsis or BSI. The first and second indicators were also identified as useful for accountability purposes, such as public reporting.Conclusion.We have successfully identified 2 measures for public reporting purposes and 5 measures that can be used internally in healthcare settings as quality indicators. These indicators can be implemented across diverse healthcare systems to enable ongoing evaluation of antimicrobial stewardship programs and complement efforts for improved patient safety.

Management of Health-Care Associated Pneumonia (HCAP)

Italian Journal of Medicine ◽

10.4081/itjm.2012.87 ◽

2013 ◽

pp. 87-90

Author(s):

Alessia Rosato ◽

Claudio Santini

Keyword(s):

Health Care ◽

Treatment Approach ◽

Multidrug Resistant ◽

Outpatient Setting ◽

Traditional Classification ◽

Health Care Associated Pneumonia ◽

Introduction The traditional classification of Pneumonia as either community acquired (CAP) or hospital acquired (HAP) reflects deep differences in the etiology, pathogenesis, approach and prognosis between the two entities. Health-Care Associated Pneumonia (HCAP) develops in a heterogeneous group of patients receiving invasive medical care or surgical procedures in an outpatient setting. For epidemiology and outcomes, HCAP closely resembles HAP and possibly requires an analogous therapeutic regimen effective against multidrug-resistant pathogens. Materials and methods We reviewed the pertinent literature and the guidelines for the diagnosis and management of HCAP to analyze the evidence for the recommended approach. Results Growing evidence seems to confirm the differences in epidemiology and outcome between HCAP and CAP but fails to confirm any real advantage in pursuing an aggressive treatment for all HCAP and CAP patients. Discussion Further investigations are needed to establish the optimal treatment approach according to the different categories of patients and the different illness severities. Keywords Health Care Associated Pneumonia (HCAP); Community Acquired Pneumonia (CAP); Hospital Acquired Pneumonia (HAP); Multidrug-resistant (MDR) Pathogens

Pulmonary Infections

Chest Imaging ◽

10.1093/med/9780199858064.003.0033 ◽

2019 ◽

pp. 187-189

Author(s):

Santiago Martínez-Jiménez

Keyword(s):

Antibiotic Therapy ◽

Treatment Failure ◽

Clinical Response ◽

Chest Radiography ◽

Clinical Perspective ◽

Immunosuppressed Patients ◽

Healthcare Associated ◽

Pneumonia can be classified as: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), healthcare-associated pneumonia (HCAP), and pneumonia in immunosuppressed patients. Although the above are similar pathologically, they are very different from a clinical perspective. Chest radiography is often performed to support the diagnosis and to determine the extent of involvement prior to the onset of therapy. Radiography should not be performed in the short term in patients who are improving clinically as it can lead to the misdiagnosis of treatment failure. Chest radiography in patients treated for pneumonia should only be obtained before 4-6 weeks after the onset of therapy if there is a failure of clinical response or if complications of pneumonia are clinically suspected. The majority of pneumonias will resolve after 6 weeks of appropriate antibiotic therapy.

Clinical characteristics of patients with pneumonia caused by Klebsiella pneumoniae in Taiwan and prevalence of antimicrobial-resistant and hypervirulent strains: a retrospective study

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0660-x ◽

2020 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Chih-Han Juan ◽

Shih-Yu Fang ◽

Chia-Hsin Chou ◽

Tsung-Ying Tsai ◽

Yi-Tsung Lin

Keyword(s):

Retrospective Study ◽

Klebsiella Pneumoniae ◽

Clinical Characteristics ◽

Drug Resistant ◽

Resistant Strains ◽

Healthcare Associated ◽

Drug Resistant Strains ◽

Abstract Background We aimed to compare the clinical characteristics of patients with community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), and hospital-acquired pneumonia (HAP) caused by Klebsiella pneumoniae and analyze the antimicrobial resistance and proportion of hypervirluent strains of the microbial isolates. Methods We conducted a retrospective study on patients with pneumonia caused by K. pneumoniae at the Taipei Veterans General Hospital in Taiwan between January 2014 and December 2016. To analyze the clinical characteristics of these patients, data was extracted from their medical records. K. pneumoniae strains were subjected to antimicrobial susceptibility testing, capsular genotyping and detection of the rmpA and rmpA2 genes to identify hypervirulent strains. Results We identified 276 patients with pneumonia caused by K. pneumoniae, of which 68 (24.6%), 74 (26.8%), and 134 (48.6%) presented with CAP, HCAP, and HAP, respectively. The 28-day mortality was highest in the HAP group (39.6%), followed by the HCAP (29.7%) and CAP (27.9%) groups. The HAP group also featured the highest proportion of multi-drug resistant strains (49.3%), followed by the HCAP (36.5%) and CAP groups (10.3%), while the CAP group had the highest proportion of hypervirulent strains (79.4%), followed by the HCAP (55.4%) and HAP groups (41.0%). Conclusion Pneumonia caused by K. pneumoniae was associated with a high mortality. Importantly, multi-drug resistant strains were also detected in patients with CAP. Hypervirulent strains were prevalent in all 3 groups of pneumonia patients, even in those with HAP.

Pneumonia

10.1093/med/9780199568741.003.0129 ◽

2018 ◽

Author(s):

Pippa Newton

Keyword(s):

Nosocomial Pneumonia ◽

Acute Infection ◽

Healthcare Setting ◽

Pulmonary Parenchyma ◽

Post Intubation ◽

Hospital Acquired ◽

Symptoms And Signs

Pneumonia is defined as acute infection of the pulmonary parenchyma, presenting with consistent symptoms and signs and associated with new radiographic shadowing. It may be acute or chronic in onset and involve either one area of a lung (e.g. lobar pneumonia) or be multifocal in nature. It may be community acquired or hospital acquired. Community- acquired pneumonia is defined as pneumonia occurring in an individual with no recent contact with a healthcare setting, or in a patient admitted to hospital with development of symptoms and/or signs of pneumonia within 48 hours of admission. Hospital-acquired pneumonia or nosocomial pneumonia occurs when a patient develops symptoms or signs of pneumonia after 48 hours of admission to a healthcare setting or in the context of a long-term nursing home resident. A subtype of nosocomial pneumonia is ventilator-associated pneumonia, defined as pneumonia occurring at least 48–72 hours post intubation.

Antimicrobial prescribing for hospital-acquired pneumonia

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.0325 ◽

2020 ◽

Vol 81 (1) ◽

pp. 1-3

Author(s):

Tim Felton ◽

Dan Wootton

Keyword(s):

Decision Making ◽

Antibiotic Prescribing ◽

High Quality ◽

Antimicrobial Prescribing ◽

High Quality Evidence ◽

Hospital Acquired ◽

The Impact ◽

Inform Decision Making ◽

Quality Evidence

The impact of hospital-acquired pneumonia and the pressure to reduce unnecessary antibiotic prescribing has lead to the publication of prescribing guidelines from the National Institute for Health and Care Excellence. This editorial gives an overview of the guidelines and emphasises the need for more high-quality evidence to inform decision making in this group of patients.