Prevalence and prognostic influence of bacterial pyuria in elderly patients with pneumonia: A retrospective study.

AIM: The number of elderly patients with pneumonia is significantly increasing as the populations in many countries age. Although elderly patients with pneumonia are at risk of developing urinary tract infections, no studies have examined the prevalence or the prognostic impact of this complication. The aim of the present study was to investigate the prevalence of comorbid bacterial pyuria and the impact on the prognosis of elderly patients with pneumonia. METHODS: We retrospectively evaluated 132 patients aged >65 years who were hospitalized for pneumonia and who underwent a urinary sediment test on admission. The background characteristics, laboratory results and treatment regimens were documented, and the risk factors for the complication of bacterial pyuria and its association with 90-day mortality in pneumonia patients were elucidated. RESULTS: A total of 37 (28%) of 132 patients were complicated by bacterial pyuria. The patients with bacterial pyuria were more often women, showed a poorer performance status, were more frequently fed by percutaneous endoscopic gastrostomy, and more frequently used diapers and/or a bladder catheter. Regarding first-line drugs, 82.6% of the patients received beta-lactamase inhibitors and extended-spectrum penicillins. The use of a bladder catheter and a poor performance status were associated with bacterial pyuria. A multivariate analysis showed that a poor performance status was the only factor associated with 90-day mortality. CONCLUSIONS: Bacterial pyuria did not affect the prognosis of patients who were treated with penicillin-based regimens. Thus, broad-spectrum antibiotics are not necessarily required for elderly patients with pneumonia complicated by urinary tract infection. Geriatr Gerontol Int 2017; 17: 1076-1080.

Evaluation of prognostic differences in elderly patients with pneumonia treated by between pulmonologists and non-pulmonologists: a propensity score analysis.

INTRODUCTION: The incidence of pneumonia among elderly people is increasing in aged countries, and both pulmonologists and non-pulmonologists treat such patients. OBJECTIVES: The aim of this study was to assess prognostic differences between elderly patients treated by pulmonologists and those treated by non-pulmonologists. METHODS: This study was a retrospective cohort using a propensity score analysis. Patients 65 years of age or over with pneumonia were consecutively included. The propensity score was estimated based on the patient's background and severity of pneumonia. The difference in 30-day and 90-day mortality depending on the attending physician's specialty was analyzed after adjusting for other variables, including the propensity score. RESULTS: We assessed 68 and 182 patients treated by pulmonologists and non-pulmonologists, respectively. The pulmonologists tended to be in charge of patients with hypoxemia, chronic obstructive pulmonary disease or dementia without aspiration pneumonia or renal dysfunction (area under receiver operating characteristic curve to predict treatment by a pulmonologist according to the propensity score = 0.737, P < 0.001). In the multivariate analysis, white blood count cell (adjusted hazard ratio, 1.000, P = 0.030) and the serum albumin level (0.382, P = 0.001) were associated with 30-day mortality, and a bedridden status (3.000, P = 0.013) and the serum albumin level (0.382, P < 0.001) were associated with 90-day mortality; however, the attending physician's specialty was not associated with these prognoses. CONCLUSIONS: The overall prognosis of pneumonia in elderly patients may not necessarily improve, irrespective of treatment by pulmonologists, and host factors seemed to be associated with mortality.

Risk factors for unexpected death from suffocation in elderly patients hospitalized for pneumonia.

AIM: Unexpected death from suffocation as a result of ortholaryngeal mucinous secretions or vomitus during recovery from pneumonia is devastating for patients, their families and medical professionals. This study aimed to determine the risk factors for unexpected death from suffocation in elderly patients hospitalized for pneumonia. METHODS: This study was carried out with patients aged 65 years and older that were hospitalized for pneumonia and died of any cause. Unexpected death from suffocation was defined as: (i) being in the recovery stage of pneumonia; (ii) presenting stable vital signs a week before death; (iii) dying within 24 h after suffocation; and (iv) aspiration confirmed by transtracheal suction. The clinical features and courses, and methods of feeding were retrospectively analyzed. RESULTS: A total of 11 patients that had an unexpected death from suffocation and 62 patients who died of other causes were enrolled. There were significantly more patients that received tube feeding after admission (continuation and introduction) among the patients who had died of suffocation (63.6%) than in those who had died of other causes (12.9%; P < 0.001). A multiple logistic regression analysis showed that tube feeding after admission was strongly associated with unexpected death from suffocation (adjusted odds ratio 9.536, P = 0.047) after adjusting for sex, age, level of serum albumin, PaO2 /FIO2 ratio, the pneumonia severity score and performance status. CONCLUSION: A continuation of tube feeding after admission is thus considered to be a significant predictor of unexpected death from suffocation in elderly patients with pneumonia.

Sai-rei-to-induced lung injury: a case report and brief review of the literature.

An 81-year-old man was admitted to our hospital due to persistent fever and dyspnea with pulmonary infiltrates. He was treated successfully by discontinuing his current medications, including Sai-rei-to, and administering glucocorticoids. Drug lymphocyte stimulation tests showed a positive result for Sai-rei-to alone, and the resumption of other regular drugs did not re-induce the lung injury. Therefore, we diagnosed the patient with Sai-rei-to-induced lung injury. Sai-rei-to is a combination drug that consists of Sho-saiko-to and Gorei-san. This paper briefly reviews drug-induced lung injury caused by Sai-rei-to or its components with a case report.

Impact of 3,4-dideoxyglucosone-3-ene (3,4-DGE) on cytotoxicity of acidic heat-sterilized peritoneal dialysis fluid.

Of the glucose degradation products (GDPs) in glucose-rich peritoneal dialysate, we investigated the influence of 3,4-dideoxyglucosone-3-ene (3,4-DGE) on the cytotoxicity of acidic heat-sterilized peritoneal dialysis fluid (L-H PDF) using human peritoneal mesothelial cells (HPMC). We prepared acidified filtration-sterilized PDF (glucose concentration 3.86%) containing eight types of added GDP [3,4-DGE, glyoxal (GO), methylglyoxal (MGO), 3-deoxyglucosone (3-DG), formaldehyde (FA), acetaldehyde (AA), 5-hydroxymethyl-2-furaldehyde (5-HMF), and furfural (FF)] or seven types of GDP (GO, MGO, 3-DG, FA, AA, 5-HMF, and FF). HPMC were exposed to these two types of solution and acidic heat-sterilized PDF (glucose concentration 3.86%, L-H 3.86) for 4 h. Cell viability was determined by 3,(4,5-dimethythiazol-2-yl)2,5-diphenyl-terazolium bromide (MTT) assay. MTT viability was decreased significantly compared with the control when treated with L-H 3.86 or acidified neutral filtration-sterilized PDF (glucose concentration 3.86%) containing eight GDPs. However, no significant decrease in MTT viability was observed when HPMC were treated with acidified neutral filtration-sterilized PDF (glucose concentration 3.86%) containing seven GDPs. Thus, 3,4-DGE strongly affects the cytotoxicity of L-H PDF. It is suggested that the cytotoxicity of L-H PDF is based on the presence of 3,4-DGE.

The effect of peritoneal rest in combination therapy of peritoneal dialysis and hemodialysis: using the cultured human peritoneal mesothelial cell model.

The effects of peritoneal rest for 24 h during peritoneal dialysis and hemodialysis combination therapy were investigated using cultured human peritoneal mesothelial cell (HPMC) models. Cell activity was investigated by 3-[4,5-dimethylthiazol-2-yl]-2, 5-diphenylterazolium bromide (MTT) assay after exposing HPMCs to peritoneal dialysis fluids (PDFs) with different pH levels. The following PDFs (50 microl/well) were used for exposure durations of 30 or 240 min: acidic heat-sterilized PDFs (L-H PDF, pH 5.5) and neutral heat-sterilized PDFs (N-H PDF, pH 6.7). Control wells were exposed to M-199 Hanks medium containing 20% fetal bovine serum (FBS) for 30 or 240 min. Supernatants were then aspirated from each well and M-199 culture medium containing 20% FBS (50 microl) was added to each well to rest HPMCs for 24 h before investigation of MTT activity. The activity of HPMCs exposed to L-H PDF for 240 min decreased to approximately 20% and 15% when compared with controls (glucose concentrations of 1.36% and 3.86%, respectively; P < 0.01 versus control, Tukey-Kramer test), and to approximately 60% and 40% after exposure to N-H PDF for 240 min (glucose: 1.36% and 3.86%; P < 0.01). The activity of HPMCs exposed to L-H PDF for 240 min followed by rest was approximately 20% and 4% when compared with controls (glucose: 1.36% and 3.86%; P < 0.01) and was 93% and 96% when compared with controls after exposure to N-H PDF for 240 min followed by rest (glucose: 1.36% and 3.86%). These findings suggest that rest for 24 h after exposure to N-H PDF improves the activity of HPMCs.

Synergistic cytotoxicity of acidity and 3,4-Dideoxyglucosone-3-ene under the existence of lactate in peritoneal dialysis fluid.

Of the non-physiological compounds in glucose-rich peritoneal dialysis fluid, we investigated the synergistic cytotoxicity of acidity and 3,4-Dideoxyglucosone-3-ene(3,4-DGE) under the existence of lactate using human peritoneal mesothelial cells (HPMC). The effect of pH on cell viability at various levels of pH (5.5, 6.7, 7.15), with or without lactate was examined by adding 1N-HCl to phosphate buffer solution. We also examined the cytotoxic effects of 3,4-DGE and pH (5.5, 6.7 or 7.15). Additionally, we compared the cytotoxic effects of 3,4-DGE and pH (5.5, 6.7 or 7.15) under existence of lactate (40 meq/L) or absence of lactate. The cells were exposed to these solutions for 2 or 4 h. Cell viability was determined by MTT (3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenylterazolium bromide) assay. 3,4-DGE or acidic solution alone had no significant effects on MTT viability under the absence of lactate. However, acidic solutions containing 3,4-DGE significantly decreased MTT viability under the existence of lactate. The MTT viability of HPMC was not decreased by 3,4-DGE or acidity alone under the absence of lactate. However, the combination of acidity and 3,4-DGE markedly decreased MTT viability under the existence of lactate, strongly suggesting the synergistic cytotoxicity of 3,4-DGE and acidity under the existence of lactate.