Pneumonia最新文献

{"title":"Effect of prophylactic administration of antipyretics on the immune response to pneumococcal conjugate vaccines in children: a systematic review.","authors":"Eleni Koufoglou,&nbsp;Georgia Kourlaba,&nbsp;Athanasios Michos","doi":"10.1186/s41479-021-00085-8","DOIUrl":"https://doi.org/10.1186/s41479-021-00085-8","url":null,"abstract":"<p><strong>Background: </strong>Prophylactic administration of antipyretics at the time of immunization seems to decrease some side effects, however reduced immune responses have been reported in some studies. This systematic review aimed to investigate the effect of prophylactic use of antipyretics on the immune response following administration of pneumococcal conjugate vaccines (PCVs).</p><p><strong>Methods: </strong>A systematic review of randomized controlled trials and observational studies concerning the immune response to PCVs after antipyretic administration was performed up to November 2020 in the electronic databases of Pubmed and Scopus.</p><p><strong>Results: </strong>Of the 3956 citations retrieved, a total of 5 randomized control trials including 2775 children were included in the review. Included studies were referred to PCV10 (3 studies), PCV7 and PCV13 (one study each). The prophylactic administration of paracetamol decreased the immune response to certain pneumococcal serotypes in all included studies. The effect was more evident following primary vaccination and with immediate administration of paracetamol. Despite the reductions in antibody geometric mean concentrations, a robust memory response was observed following the booster dose. Besides, antibody titers remained above protective levels in 88-100% of participants. The use of ibuprofen, that was evaluated in two studies, did not seem to affect the immunogenicity of PCVs .</p><p><strong>Conclusion: </strong>Although the reviewed studies had significant heterogeneity in design, paracetamol administration seems to affect the immune response for certain serotypes. The clinical significance of reduced immunogenicity especially before booster dose needs further investigation.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"13 1","pages":"7"},"PeriodicalIF":6.8,"publicationDate":"2021-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s41479-021-00085-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38825877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The expansive effects of polyamines on the metabolism and virulence of Streptococcus pneumoniae.","authors":"Bindu Nanduri,&nbsp;Edwin Swiatlo","doi":"10.1186/s41479-021-00082-x","DOIUrl":"https://doi.org/10.1186/s41479-021-00082-x","url":null,"abstract":"<p><p>Polyamines are common intracellular metabolites of nearly all cells, and their conservation across a vast diversity of cells suggests critical roles for these compounds in cellular physiology. Most intracellular polyamines are associated with RNA and, subsequently, polyamines have significant effects on transcription and translation. Putrescine and spermidine are the most common polyamines in bacteria. Intracellular polyamine pools in bacteria are tightly controlled by both de novo synthesis and transport. Polyamine homeostasis is emerging as a critical parameter of multiple pathways and physiology with substantial impact on bacterial pathogenesis, including the important human pathogen Streptococcus pneumoniae. Modulation of polyamine metabolism in pneumococci is an important regulator of central metabolism. It has broad effects on virulence factors such as capsule as well as stress responses that ultimately impact the survival of pneumococcus in a host. Polyamine transport protein as a single antigen or in combination with other pneumococcal proteins is shown to be an efficacious immunogen that protects against nasopharyngeal colonization, and invasive disease. A comprehensive description of polyamine metabolic pathways and their intersection with pneumococcal pathogenesis will undoubtedly point to novel approaches for treatment and prevention of pneumococcal disease.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"13 1","pages":"4"},"PeriodicalIF":6.8,"publicationDate":"2021-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s41479-021-00082-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25512625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malawian children with fast-breathing pneumonia with and without comorbidities.","authors":"Amy Sarah Ginsburg,&nbsp;Tisungane Mvalo,&nbsp;Jun Hwang,&nbsp;Melda Phiri,&nbsp;Eric D McCollum,&nbsp;Madalitso Maliwichi,&nbsp;Robert Schmicker,&nbsp;Ajib Phiri,&nbsp;Norman Lufesi,&nbsp;Susanne May","doi":"10.1186/s41479-021-00081-y","DOIUrl":"https://doi.org/10.1186/s41479-021-00081-y","url":null,"abstract":"<p><strong>Background: </strong>Due to high risk of mortality, children with comorbidities are typically excluded from trials evaluating pneumonia treatment. Understanding heterogeneity of outcomes among children with pneumonia and comorbidities is critical to ensuring appropriate treatment.</p><p><strong>Methods: </strong>We explored whether the percentage of children with fast-breathing pneumonia cured at Day 14 was lower among those with selected comorbidities enrolled in a prospective observational study than among those enrolled in a concurrent randomized controlled trial evaluating treatment with amoxicillin in Lilongwe, Malawi.</p><p><strong>Results: </strong>Among 79 children with fast-breathing pneumonia in the prospective observational cohort, 57 (72.2%) had HIV infection/exposure, 20 (25.3%) had malaria, 2 (2.5%) had severe acute malnutrition, and 17 (21.5%) had anemia. Treatment failure rate was slightly (not significantly) lower in children with comorbidities (4.1%, 3/73) compared to those without comorbidities (4.5%, 25/552) similarly treated. There was no significant difference in clinical cure rates by Day 14 (95.8% with vs 96.7% without comorbidity).</p><p><strong>Conclusions: </strong>Children with fast-breathing pneumonia excluded from a concurrent clinical trial due to comorbidities did not fare worse. Children at higher risk whose caregivers seek care early and who receive appropriate risk assessment (e.g., pulse oximetry, hemoglobin, HIV/malaria testing) and treatment, can achieve clinical cure by Day 14.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT02960919 ; registered November 8, 2016.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"13 1","pages":"3"},"PeriodicalIF":6.8,"publicationDate":"2021-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s41479-021-00081-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25401681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HSV-pneumonitis in a patient with lung cancer receiving check point inhibitors - a case report.","authors":"Johannes Sumer,&nbsp;Frederike Waldeck,&nbsp;Nadja Fischer,&nbsp;Christina Appenzeller,&nbsp;Markus Koster,&nbsp;Martin Früh,&nbsp;Werner C Albrich","doi":"10.1186/s41479-020-00079-y","DOIUrl":"https://doi.org/10.1186/s41479-020-00079-y","url":null,"abstract":"<p><strong>Background: </strong>Herpes simplex virus (HSV) is commonly associated with oro-facial and genital manifestations. It rarely causes encephalitis and even less commonly, in heavily immunosuppressed patients, visceral disease or bronchopneumonitis. We present a case of cytologically-proven, PCR-positive HSV-1 tracheobronchitis and pneumonitis in a patient with less severe immunocompromise.</p><p><strong>Case presentation: </strong>A 64 year old white man with steroid-induced diabetes mellitus and progressive small-cell bronchial carcinoma despite chemo- and immunotherapy with two checkpoint inhibitors presented with symptoms of lower respiratory tract infection. Community-acquired pneumonia was suspected and empirical broad-spectrum antibacterial treatment was initiated. Chest CT-scan revealed ground-glass opacities and tree-in bud lesions. Cytology of BAL showed extensive cytopathic effects typically caused by infection with herpes virus and PCR confirmation of HSV-1. Acute phase HSV serology was positive for IgG and borderline for IgM. The patient deteriorated clinically due to tumor progress and infection despite high-dose acyclovir therapy and died 2 weeks after admission.</p><p><strong>Conclusions: </strong>We report an unusual case of fatal HSV-1 pneumonitis due to reactivation in a patient with lung cancer, steroid-induced diabetes and treatment with two checkpoint inhibitors. In immunosuppressed patients with non-improving pneumonia invasive diagnostic procedures are warranted including cytology and molecular diagnostics.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"13 1","pages":"1"},"PeriodicalIF":6.8,"publicationDate":"2021-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s41479-020-00079-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38852514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost effectiveness analysis of implementing tuberculosis screening among applicants for non-immigrant U.S. work visas.","authors":"Bisma Ali Sayed,&nbsp;Drew L Posey,&nbsp;Brian Maskery,&nbsp;La'Marcus T Wingate,&nbsp;Martin S Cetron","doi":"10.1186/s41479-020-00078-z","DOIUrl":"https://doi.org/10.1186/s41479-020-00078-z","url":null,"abstract":"<p><strong>Background: </strong>While persons who receive immigrant and refugee visas are screened for active tuberculosis before admission into the United States, nonimmigrant visa applicants (NIVs) are not routinely screened and may enter the United States with infectious tuberculosis.</p><p><strong>Objectives: </strong>We evaluated the costs and benefits of expanding pre-departure tuberculosis screening requirements to a subset of NIVs who arrive from a moderate (Mexico) or high (India) incidence tuberculosis country with temporary work visas.</p><p><strong>Methods: </strong>We developed a decision tree model to evaluate the program costs and estimate the numbers of active tuberculosis cases that may be diagnosed in the United States in two scenarios: 1) \"Screening\": screening and treatment for tuberculosis among NIVs in their home country with recommended U.S. follow-up for NIVs at elevated risk of active tuberculosis; and, 2) \"No Screening\" in their home country so that cases would be diagnosed passively and treatment occurs after entry into the United States. Costs were assessed from multiple perspectives, including multinational and U.S.-only perspectives.</p><p><strong>Results: </strong>Under \"Screening\" versus \"No Screening\", an estimated 179 active tuberculosis cases and 119 hospitalizations would be averted in the United States annually via predeparture treatment. From the U.S.-only perspective, this program would result in annual net cost savings of about $3.75 million. However, rom the multinational perspective, the screening program would cost $151,388 per U.S. case averted for Indian NIVs and $221,088 per U.S. case averted for Mexican NIVs.</p><p><strong>Conclusion: </strong>From the U.S.-only perspective, the screening program would result in substantial cost savings in the form of reduced treatment and hospitalization costs. NIVs would incur increased pre-departure screening and treatment costs.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"12 1","pages":"15"},"PeriodicalIF":6.8,"publicationDate":"2020-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s41479-020-00078-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38746265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An observational study of the reactogenicity and immunogenicity of 13-valent pneumococcal conjugate vaccine in women of childbearing age in Papua New Guinea.","authors":"Sarah Javati,&nbsp;Geraldine Masiria,&nbsp;Arthur Elizah,&nbsp;John-Paul Matlam,&nbsp;Rebecca Ford,&nbsp;Peter C Richmond,&nbsp;Deborah Lehmann,&nbsp;William S Pomat,&nbsp;Anita H J van den Biggelaar","doi":"10.1186/s41479-020-00076-1","DOIUrl":"https://doi.org/10.1186/s41479-020-00076-1","url":null,"abstract":"<p><strong>Background: </strong>Maternal immunization with pneumococcal conjugate vaccine (PCV) may protect young infants in high-risk settings against the high risk of pneumococcal infections in early life. The aim of this study was to determine the safety and immunogenicity of 13-valent PCV (PCV13) in healthy women of childbearing age in PNG.</p><p><strong>Methods: </strong>As part of this observational study, 50 non-pregnant women of childbearing age (18-45 yrs. old) living in the highlands of PNG were vaccinated with a single dose of PCV13. Local and systemic reactogenicity were assessed 24-48 h after vaccination. Venous blood samples were collected before and 1 month after vaccination to measure PCV13 serotype-specific IgG antibody concentrations.</p><p><strong>Results: </strong>No severe adverse effects were reported during the 1-month follow-up period. IgG antibody concentrations significantly increased after vaccination for all PCV13 serotypes. One month after vaccination IgG antibody levels ≥2.5 μg/mL were reached in at least 75% of women for all PCV13 serotypes, except serotype 3, and ≥ 5 μg/mL in at least 75% of women for 7 serotypes (serotypes 6B, 9 V, 14, 18C, 19A, 19F and 23F).</p><p><strong>Conclusion: </strong>PCV13 is safe and immunogenic in women of childbearing age living in a high-risk setting in PNG. This supports the implementation of studies to investigate the safety and immunogenicity of maternal PCV vaccination in high-risk settings as a strategy to protect infants in these settings against the high risk of pneumococcal infections in early life.</p><p><strong>Trial registration: </strong>NCT04183322 . Registered 3 December 2019 - Retrospectively registered.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"12 1","pages":"13"},"PeriodicalIF":6.8,"publicationDate":"2020-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s41479-020-00076-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38350381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"E-cigarette, or vaping, product use-associated lung injury: a review.","authors":"Samuel H Belok,&nbsp;Raj Parikh,&nbsp;John Bernardo,&nbsp;Hasmeena Kathuria","doi":"10.1186/s41479-020-00075-2","DOIUrl":"https://doi.org/10.1186/s41479-020-00075-2","url":null,"abstract":"<p><strong>Background: </strong>E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) is a disease entity related to the use of battery-operated or superheating devices that create an aerosolized form of nicotine and tetrahydrocannabinol (THC) and/or other substances for inhalation.</p><p><strong>Methods: </strong>We performed a literature review to document epidemiology, pathogenesis and risk factors, diagnosis, clinical presentation, evaluation and management of EVALI.</p><p><strong>Results: </strong>In the summer of 2019, an outbreak of EVALI cases brought this disease entity into the national spotlight. Since being recognized as a serious pulmonary disease with public health implications, more than 2600 cases have been reported to CDC with 68 deaths as of February 2020. The pathophysiology of EVALI remains unknown. Substances such as Vitamin E acetate have been implicated as a possible causes of lung injury. The CDC has established case definitions of \"confirmed EVALI\" cases to help guide identification of the disease and assist in surveillance. While clinical judgement by healthcare providers is imperative in the identification of EVALI cases, the heterogeneous presentations of EVALI make this difficult as well. Ultimately most investigative studies should be aimed at ruling out other disease processes that can present similarly. Treatment is centered around removing the offending substance and providing supportive care.</p><p><strong>Conclusions: </strong>EVALI is a serious pulmonary disease with public health implications. Diagnosis requires a high degree of suspicion to diagnose and exclusion of other possible causes of lung disease. It may be beneficial to involve a pulmonary specialist early in the management of this disease which is generally supportive care.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":" ","pages":"12"},"PeriodicalIF":6.8,"publicationDate":"2020-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s41479-020-00075-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38629806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Etiology of community-acquired pneumonia in adults: a systematic review.","authors":"Saeed Shoar,&nbsp;Daniel M Musher","doi":"10.1186/s41479-020-00074-3","DOIUrl":"https://doi.org/10.1186/s41479-020-00074-3","url":null,"abstract":"<p><strong>Background: </strong>The etiology of community-acquired pneumonia (CAP) has evolved since the beginning of the antibiotic era. Recent guidelines encourage immediate empiric antibiotic treatment once a diagnosis of CAP is made. Concerns about treatment recommendations, on the one hand, and antibiotic stewardship, on the other, motivated this review of the medical literature on the etiology of CAP.</p><p><strong>Methods: </strong>We conducted a systematic review of English-language literature on the etiology of CAP using methods defined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed using a combination of the keywords 'pneumonia', 'CAP', 'etiology', 'microbiology', 'bacteriology', and 'pathogen'. We examined articles on antibiotics that were develop to treat pneumonia. We reviewed all 'related articles' as well as studies referenced by those that came up in the search. After we excluded articles that did not give sufficient microbiological data or failed to meet other predetermined criteria, 146 studies remained. Data were stratified into diagnostic categories according to the microbiologic studies that were done; results are presented as the percentage in each category of all cases in which an etiology was established.</p><p><strong>Results: </strong><i>Streptococcus pneumoniae</i> remains the most common cause of CAP although declining in incidence; this decline has been greater in the US than elsewhere. <i>Haemophilus influenzae</i> is the second most common cause of CAP, followed by <i>Staphylococcus aureus</i> and Gram negative bacilli. The incidence of all bacteria as causes of CAP has declined because, with routine use of PCR for viruses, the denominator, cases with an established etiology, has increased. Viruses were reported on average in about 10% of cases, but recent PCR-based studies identified a respiratory virus in about 30% of cases of CAP, with substantial rates of viral/bacterial coinfection.</p><p><strong>Conclusion: </strong>The results of this study justify current guidelines for initial empiric treatment of CAP. With pneumococcus and <i>Haemophilus</i> continuing to predominate, efforts at antibiotic stewardship might be enhanced by greater attention to the routine use of sputum Gram stain and culture. Because viral/bacterial coinfection is relatively common, the identification of a virus by PCR does not, by itself, allow for discontinuation of the antibiotic therapy.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":" ","pages":"11"},"PeriodicalIF":6.8,"publicationDate":"2020-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s41479-020-00074-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38462507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in clinical outcomes and process of care measures in community acquired pneumonia: a systematic review.","authors":"H Lawrence,&nbsp;W S Lim,&nbsp;T M McKeever","doi":"10.1186/s41479-020-00073-4","DOIUrl":"https://doi.org/10.1186/s41479-020-00073-4","url":null,"abstract":"<p><strong>Background: </strong>Variation in outcomes of patients with community acquired pneumonia (CAP) has been reported in some, but not all, studies. Although some variation is expected, unwarranted variation in healthcare impacts patient outcomes and equity of care. The aim of this systematic review was to: i) summarise current evidence on regional and inter-hospital variation in the clinical outcomes and process of care measures of patients hospitalised with CAP and ii) assess the strength of this evidence.</p><p><strong>Methods: </strong>Databases were systematically searched from inception to February 2018 for relevant studies and data independently extracted by two investigators in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Included studies enrolled adults hospitalised with CAP and reported a measure of variation between two or more units in healthcare outcomes or process of care measures. Outcomes of interest were mortality, length of hospital stay (LOS) and re-admission rates. A structured synthesis of the studies was performed.</p><p><strong>Results: </strong>Twenty-two studies were included in the analysis. The median number of units compared across studies was five (IQR 4-15). Evidence for variation in mortality between units was inconsistent; of eleven studies that performed statistical significance testing, five found significant variation. For LOS, of nine relevant studies, all found statistically significant variation. Four studies reported site of admission accounted for 1-24% of the total observed variation in LOS. A shorter LOS was not associated with increased mortality or readmission rates. For readmission, evidence was mixed; of seven studies, 4 found statistically significant variation. There was consistent evidence for variation in the use of intensive care, obtaining blood cultures on admission, receiving antibiotics within 8 h of admission and duration of intravenous antibiotics. Across all outcome measures, only one study accounted for natural variation between units in their analysis.</p><p><strong>Conclusion: </strong>There is consistent evidence of moderate quality for significant variation in length of stay and process of care measures but not for in-patient mortality or hospital re-admission. Evidence linking variation in outcomes with variation in process of care measures was limited; where present no difference in mortality was detected despite POC variation. Adjustment for natural variation within studies was lacking; the proportion of observed variation due to chance is not quantified by existing evidence.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":" ","pages":"10"},"PeriodicalIF":6.8,"publicationDate":"2020-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s41479-020-00073-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38441062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation for using electronic health records to identify community acquired pneumonia hospitalization among people with and without HIV.","authors":"Maria C Rodriguez-Barradas,&nbsp;Kathleen A McGinnis,&nbsp;Kathleen Akgün,&nbsp;Janet P Tate,&nbsp;Sheldon T Brown,&nbsp;Adeel A Butt,&nbsp;Michael Fine,&nbsp;Matthew Bidwell Goetz,&nbsp;Christopher J Graber,&nbsp;Laurence Huang,&nbsp;David Rimland,&nbsp;Amy Justice,&nbsp;Kristina Crothers","doi":"10.1186/s41479-020-00068-1","DOIUrl":"https://doi.org/10.1186/s41479-020-00068-1","url":null,"abstract":"<p><strong>Background: </strong>Cohort studies identifying the incidence, complications and co-morbidities associated with community acquired pneumonia (CAP) are largely based on administrative datasets and rely on International Classification of Diseases (ICD) codes; however, the reliability of ICD codes for hospital admissions for CAP in people with HIV (PWH) has not been systematically assessed.</p><p><strong>Methods: </strong>We used data from the Veterans Aging Cohort Study survey sample (<i>N</i> = 6824; 3410 PWH and 3414 uninfected) to validate the use of electronic health records (EHR) data to identify CAP hospitalizations when compared to chart review and to compare the performance in PWH vs. uninfected patients. We used different EHR algorithms that included a broad set of CAP ICD-9 codes, a set restricted to bacterial and viral CAP codes, and algorithms that included pharmacy data and/or other ICD-9 diagnoses frequently associated with CAP. We also compared microbiologic workup and etiologic diagnosis by HIV status among those with CAP.</p><p><strong>Results: </strong>Five hundred forty-nine patients were identified as having an ICD-9 code compatible with a CAP diagnosis (13% of PWH and 4% of the uninfected, <i>p</i> < 0.01). The EHR algorithm with the best overall positive predictive value (82%) was obtained by using the restricted set of ICD-9 codes (480-487) in primary position or secondary only to selected codes as primary (HIV disease, respiratory failure, sepsis or bacteremia) with the addition of EHR pharmacy data; this algorithm yielded PPVs of 83% in PWH and 73% in uninfected (<i>P</i> = 0.1) groups. Adding aspiration pneumonia (ICD-9 code 507) to any of the ICD-9 code/pharmacy combinations increased the number of cases but decreased the overall PPV. Allowing COPD exacerbation in the primary position improved the PPV among the uninfected group only (to 76%). More PWH than uninfected patients underwent microbiologic evaluation or had respiratory samples submitted.</p><p><strong>Conclusions: </strong>ICD-9 code-based algorithms perform similarly to identify CAP in PLWH and uninfected individuals. Adding antimicrobial use data and allowing as primary diagnoses ICD-9 codes frequently used in patients with CAP improved the performance of the algorithms in both groups of patients. The algorithms consistently performed better among PWH.</p>","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":" ","pages":"6"},"PeriodicalIF":6.8,"publicationDate":"2020-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s41479-020-00068-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38212388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}